Music-based Intervention for Insomnia in Persons Living with Dementia and their Caregivers

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Project Summary Insomnia symptoms (i.e., difficulty initiating sleep, maintaining sleep) in persons living with Alzheimer’s Disease and related Dementias are debilitating and contribute to increased institutionalization, reduced cognitive function and accelerated disease progression. Furthermore, insomnia disruption is linked to poor health outcomes in caregivers, such as poor quality of life and increased burden. Given the potential harmful side effects of pharmacologic treatment, non-pharmacologic approaches, such as music, may provide a safer alternative to improving insomnia symptoms. Music interventions are particularly promising because long-term memory for music remains relatively preserved in Alzheimer’s Disease and related Dementias - even in the moderate stage of the disease. Prior studies of music interventions to improve sleep in older adults were conducted with persons without Alzheimer’s Disease and related Dementias in primarily Caucasian older adults. Thus, the evidence for tailored music interventions to improve sleep in underrepresented community- dwelling persons living with dementia (PLWD) and their caregivers is lacking. In a pilot study (funded by the NIA, F32AG060630) the applicant has examined the feasibility of one component of the proposed music-based intervention in PLWD and their caregivers and identified opportunities to improve the delivery of the intervention. The purpose of this K23 Mentored Patient-Oriented Research Career Development Award is to provide her with the expertise necessary to initiate a successful and independent program of research – with the ultimate goal to improve sleep and behavioral symptoms in PLWD and their caregivers using music-based approaches. The specific aims of this proposal are to: i) build and iteratively refine the prototype of the mobile application, entitled, “Calming Music Personalized for Sleep Enhancement in PeRsons living with Dementia” (CoMPoSER) for use among PLWD and their caregivers; ii) in a pilot RCT examine its acceptability; and iii) efficacy. The development of the intervention will be guided by the input from stakeholders, including PLWD and their caregivers. Seventy-two dyads will be randomized to either the 4-week CoMPoSER intervention or sleep education group. Music selections will be tailored to PLWD and account for known sleep-inducing properties. Acceptability will be examined using survey and qualitative data. The effects of the intervention on PLWD and caregiver outcomes will be determined using objective (actigraphy) and subjective (proxy reported) measures. Under the guidance of the mentoring team, the applicant has carefully constructed research training activities to gain knowledge and expertise in four core areas: i) user-centered design of mobile application technology, ii) behavioral intervention development, iii) Community-based Participatory Research, and iv) behavioral research methods, including measurement, analysis and dissemination of clinical trial research. Results from the proposed research project will not only inform a larger efficacy trial, but also provide an opportunity for the applicant to gain the necessary skills to launch her career as an independent investigator.