My Healthy Brain: a mindfulness-based lifestyle intervention to modify early risk of dementia in older adults

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PROJECT SUMMARY In this K23, I (Dr. Ryan Mace) will acquire training in mindfulness-based lifestyle intervention development for the prevention of Alzheimer’s Disease and Related Dementias (ADRD). I am a clinical health psychologist at Massachusetts General Hospital (MGH) and Harvard Medical School, with a strong research background in the cognitive underpinnings of mental health and aging. My long-term goal is to become an independent investigator and leading developer of technology-enhanced behavioral interventions, from pilot testing to implementation, for the large-scale promotion of healthier lifestyles with aging. Through this K23 project, and the rich multidisciplinary training environment at MGH, I will achieve the following Training Goals: 1) identify implementation barriers using qualitative methods with medical stakeholders; 2) optimize lifestyle and mindfulness-based interventions for specific aging populations; 3) conduct rigorous technology-enhanced clinical trials; and 4) collect and analyze mobile health data on lifestyle behavior change. To achieve these goals, I have assembled an exemplary mentorship team led by my primary mentor, Dr. Ana-Maria Vranceanu, a clinical health psychologist and a leader in live video mind-body intervention development; co-mentor, Dr. Christine Ritchie, a geriatrician and palliative care physician with decades of research on improving the detection and treatment of ADRD; advisor, Dr. Stephen Bartels, a geriatric psychiatrist and national expert in implementation science; advisor, Dr. Judson Brewer, a psychiatrist and neuroscientist internationally renowned for app-based mindfulness programs for behavior change; advisor, Dr. Olivia Okereke, a geriatric psychiatrist specializing in modifiable lifestyle risk factors of ADRD; and advisor, Dr. Bettina Hoeppner, an experimental psychologist with expertise in statistics and longitudinal modeling of mobile health data. This proposal logically builds on my prior work co-developing My Healthy Brain (MHB) – the first mindfulness-based lifestyle program to modify ADRD risk factors in older adults with subjective cognitive decline (SCD). SCD is a critical window for ADRD prevention, while cognitive symptoms are at the earliest stage, yet prior trials targeting multiple lifestyle factors have shown limited adherence, are time-intensive, and failed to produce behavior change. In contrast, MHB 1) teaches mindfulness skills to improve lifestyles; 2) uses mobile health technologies (ActiGraph watches, smartphone app) to assess and reinforce behaviors; and 3) is delivered via live video. For Aim 1, I will conduct live video focus groups with medical stakeholders (N = 20) using elements from Proctor’s implementation framework to address barriers to efficient referrals, develop participant engagement strategies, and optimize study procedures. For Aim 2, I will establish — via a live video pilot RCT in older adults (age ≥ 60) with SCD and ADRD risk factors — the feasibility, acceptability, appropriateness, and fidelity of the MHB versus an education control (N=50) following predetermined benchmarks. The findings will inform an efficacy trial (R01) that will also test mechanisms of improvements in lifestyle and cognition. This K23 aligns with the NIA funding priority of developing feasible and personalized strategies for promoting adherence to lifestyles that are protective of ADRD. The experiences gained during the award will facilitate my independence as a leading clinician scientist focused on healthy aging and ADRD prevention.