Application of the Modified Story Memory Technique (mSMT)© to Aging

Application of the Modified Story Memory Technique (mSMT)© to Aging

This study is a double-blind placebo-controlled randomized clinical trial (RCT) to provide Class I evidence in support of or in refute of the efficacy of the modified Story Memory Technique (mSMT) in healthy aging (HA)and in persons with mild cognitive impairment (MCI). Outcomes will be measured through three mechanisms: (1) a traditional neuropsychological evaluation (NPE) (2) an assessment of global functioning (AGF) examining the impact of the treatment on daily activities, and (3) an optional functional magnetic resonance imaging (fMRI) scan.

Studies conducted at Kessler Foundation (KF) have demonstrated the modified Story Memory Technique (mSMT) to be effective for improving new learning in individuals with MS and TBI. Efficacy of the individualized mSMT has been clearly demonstrated across three realms of functioning, objective behavior, brain functioning and everyday life in multiple RCTs with both MS and TBI samples. This convincing data provides Class I evidence supporting the efficacy of the individual mSMT for improving new learning and memory in MS with documentation of long-lasting treatment effects on both standardized learning tests and neuroimaging. Current work with the mSMT is focusing on a group administration format, with a RCT funded by the Department of Defense.

Ongoing work in healthy aging (HA), led by George Rebok, PhD at the Johns Hopkins School of Public Health, has applied cognitive retraining to older healthy adults. Multiple, strong rationale for pursuing such applications of cognitive rehabilitation include the fact that the 65 and older population is growing (an estimated 20% of population (72 million) will be 65 and older by 2030), cognitive decline is most feared aspect of growing older, drug trial results addressing this challenge have been disappointing and, most importantly, cognitive impairments heavily affect the aging population. Specifically, 1 in 4 adults 70 years or older have a cognitive impairment without dementia and roughly 5.3 million people in the U.S. have Alzheimer's disease. Rebok and colleagues have applied Speed of Processing Training to a large cohort of healthy older adults (age 65+) and found a 33-48% risk reduction of dementia onset 10 years post treatment. These encouraging results suggest that providing cognitively enhancing treatments prior to the onset of dementia may in fact stave off the dementia process and provide older individuals with more years free of cognitive deficit.

Given the substantial success of the mSMT in improving new learning and memory functioning in persons with TBI and MS, we seek to apply the mSMT to an aging population with multiple aims.

Aim 1. Examine the efficacy of the mSMT to increase learning and memory abilities in older adults with mild cognitive impairment (MCI) and older adults with no signs of cognitive impairment (healthy aging group: HA).

Aim 2. Examine the long term impact of the mSMT on new learning and memory abilities one and two years post-intervention for both the MCI group and the HA group.

Aim 3. Examine the impact of early cognitive enhancement with the mSMT on measures of daily life functioning and overall quality of life immediately posttreatment and at each follow-up assessment.

Aim 4. Examine the neural correlates during encoding and retrieval associated with early cognitive enhancement from the mSMT immediately post-treatment and at each follow-up assessment

To achieve these goals, we will recruit 40 individuals over the age of 65 to participate in the study. Each participant will undergo baseline cognitive assessment. Based on the assessment results, he / she will be allocated to the HA block or the MCI block. Within each block, participants will be randomized to a treatment group or a placebo control group. The treatment group will undergo 10 sessions of the mSMT, while the placebo control group will undergo 10 sessions of memory exercises. We have used this placebo condition in multiple randomized clinical trials in the past, with success. Repeat assessments will then occur within one week of completing treatment, 6 months after completing treatment, one year after completing treatment, 2 years after completing treatment and 6 years after treatment. Each assessment will evaluate new learning and memory abilities as well as multiple other aspects of cognitive functioning through a neuropsychological assessment (NP). Participants will also complete an assessment of global functioning (AGF) which evaluates cognitive functioning in daily life. In addition, we will collect neuroimaging data on a subsample of participants willing and able to complete imaging procedures

Inclusion Criteria:

• older than 65
• primary language is English.

Exclusion Criteria:

• diagnosis of any neurological condition (Alzheimer's disease, dementia, stroke, multiple sclerosis, Brain Injury, Parkinson's disease, etc.).
• diagnosis of a psychiatric disorder such as post-traumatic stress disorder, schizophrenia or bipolar disorder.
• abuse of illicit drug within the past 6 months.

For optional MRI

• pacemaker or other implanted electrical device, brain stimulator, aneurysm clip (metal clips on the wall of a large artery), metallic prostheses (including metal pins and rods, heart valves, and internal hearing aids [cochlear implants]), permanent eyeliner, implanted delivery pumps, or shrapnel fragments.
• dental implants
• left handed.