This trial is evaluating whether Stepped-care protocol adapted from the SPRINT intensive-treatment algorithm will improve 1 primary outcome, 5 secondary outcomes, and 3 other outcomes in patients with Cognitive Decline. Measurement will happen over the course of Baseline to an average of 42 months.
This trial requires 920 total participants across 2 different treatment groups
This trial involves 2 different treatments. Stepped-care Protocol Adapted From The SPRINT Intensive-treatment Algorithm is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are in Phase 3 and have had some early promising results.
The cause of brain damage in cognitive aging remains unknown. Future studies are required to clarify the role of the immune system in mediating some age-related cognitive decline.
Cognitive decline (increased risk of conversion to dementia) is a high prevalence condition that affects 2 in 5 Americans at some point in time. In those with and without cognitive impairment, symptoms may be more severe and debilitating than in those who are not impaired. Clinicians must be aware of this high prevalence condition to detect early in the illness process so that early interventions for optimal outcomes can be implemented. Clinicians have a special need for information about cognitive decline, preferably early on in the illness in order to help optimize outcomes in affected patients.
We found evidence that treatments with acetylcholinesterase inhibitors were most effective for patients with cognitive decline but with the caveat that they also adversely affected functional ability.
Signs of cognitive decline include forgetfulness, poor recall of new information, distractibility and trouble thinking. In a sample of healthy older adults, poor verbal fluency was the most prominent sign of cognitive decline. In a sample of older adults with cognition problems, poor performance on tests of verbal fluency was the most prominent sign of cognitive impairment.
We found that approximately 1.9% of people are diagnosed with major psychoses, such as schizophrenia or mood disorders like major depressive disorder (M/D) a year in the US. The occurrence of M/D is strongly associated with higher frequency of cognitive declines and cognitive decline is inversely related to age.
This first meta-analysis suggests that cognitive decline can be partially (37%) and entirely (65%) ameliorated and that cognitive benefit will not be seen following acute treatment. The potential clinical significance of these findings is discussed.
The association between cognitive function and family history of dementia was stronger in this cross-sectional rather than cross-generational sample. Future studies should replicate this effect in longitudinal sample designs and, if significant, explore potential mechanisms of interaction between cognitive ageing and genetic risk for dementia.
The treatment with the stepped-care SITAP protocol is a feasible intervention (for example, outpatient, ambulatory, or telecare treatment). It seems to be effective on depression and sleep disorders, and to be associated with an improvement of cognitive functions. A larger, long-term follow-up treatment is needed to evaluate permanent effects of the intervention on depressive symptoms and cognitive functions.
Individuals are not getting the most effective treatment, which means that they are not benefiting from the therapy. The fact that the stepped-care algorithm is being used in all patients could also be perceived as a disadvantage.
We conclude that the step IFT protocol is promising and may be a viable treatment strategy in patients with MCI; however, future studies addressing the step IFT protocol as a preventive treatment strategy for patients at risk for dementia are needed.
In contrast to the current literature, data from the current study supports the assumption that a diagnosis of Alzheimer's disease does not necessarily lead to a more cognitive decline in overall performance of the test battery. The implication of this finding is that it is not right to focus on only diagnostically sensitive cognitive tests when evaluating and diagnosing people with cognitive decline. It also implies that clinicians need to evaluate the cognitive tests that are sensitive to dementia as part of their assessments. Findings from a recent study of the present study point toward a relatively non-specific decline in cognition which is more related to age and intelligence than to any disease. The study also shows that the test battery that is recommended by the FSCI does not give a complete picture of dementia in aging adults.
[There is still the lack of a clear treatment target for cognitive decline. (https://www.imagingrealignment.org/2017-04/when-cognitive-change-does-not-lead-to-a-significant-change-in-a-functional-network).] It is estimated that the worldwide market sales of pharmaceutical therapies alone are $600 billion per year. However, current drug therapies are thought to work for only about half of patients. The cost-effectiveness of an intervention for cognitive decline remains a [big unresolved issue] (https://imajetrpr.com/content/4-1-4/full_text_article1.cfm).