ADEPT-ICU: Attenuating Depression with Internet Cognitive Behavioral Therapy (CBT) to Slow Cognitive Decline in Older Intensive Care Unit (ICU) Survivors

PROJECT SUMMARY/ABSTRACT Alzheimer’s disease and related dementias (ADRD) affect 47 million people worldwide with an annual global cost of $818 billion. The risk of developing ADRD is disproportionately borne by older adults with multiple chronic conditions from underrepresented racial and ethnic groups (URGs). One such high risk group is older survivors of critical illness who were admitted to the intensive care units (ICUs). Nearly half of ICU survivors experience subjective cognitive decline (SCD), i.e., perceived decline in memory and thinking even with normal objective cognitive data. With over 5 million adult ICU admissions in the US each year, an intervention reducing SCD in older ICU survivors could significantly prevent or lower the incidence of ADRD. Thus, there is an urgent need for an inclusive randomized controlled trial (RCT) to rigorously test whether a novel, accessible, and scalable intervention can reduce SCD in a diverse cohort of older ICU survivors. One potential target for such interventions is depression in ICU survivors. To date, there are no large scale RCTs which have rigorously tested whether depression focused psychotherapies, such as cognitive behavioral therapy (CBT), reduce SCD in a diverse cohort of older ICU survivors with depression. To address this knowledge gap, we have created a multi-PI team based at the Indiana University Center for Aging Research and the Indiana Alzheimer’s Disease Research Center, with complementary expertise in geriatric psychiatry, ICU survivorship, and psychology. Our multi-PI team proposes a two-arm RCT called “Attenuating DEPression with Internet CBT to Slow Cognitive Decline in Older ICU Survivors” (ADEPT-ICU). ADEPT-ICU will test the efficacy of an existing internet CBT intervention Good Days Ahead (GDA) compared to an active control, for slowing cognitive decline among older ICU survivors with depression after ICU hospitalization. GDA is an evidence-based, therapist-assisted CBT that uses a scalable internet-based platform. Leveraging our well-established ICU recruitment infrastructure, we will enroll a cohort of 300 older ICU survivors with moderate to severe depression (≥10 total score on Patient Health Questionnaire-9 [PHQ-9]), with ≥50% identifying as Black or Hispanic/Latino or completing ≤12 years of education. Our central hypothesis is that successful treatment of depression with the GDA intervention will reduce SCD, slow objective cognitive decline, and improve quality of life in a diverse cohort of ICU survivors with depression. To test this hypothesis, we propose the following aims: Aim 1. Determine the effect of internet CBT-D on SCD in older ICU survivors with depression. Aim 2. Determine the effect of internet CBT- D on objective cognitive function in older ICU survivors with depression. Aim 3. Determine the effect of internet CBT-D on quality of life in older ICU survivors with depression.