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

我的健康大脑：基于正念的生活方式干预，可降低老年人患痴呆症的早期风险

• 批准号: 10350813
• 负责人: Ryan Andrew Mace
• 金额: $ 19.28万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10350813
• 关键词: Address; Adherence; Age; Aging; Alcohols; Alzheimer disease prevention; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Attention; Award; Awareness; Behavior; Behavior Therapy; Benchmarking; Brain; Cardiovascular Diseases; Cellular Phone; Chronic stress; Clinic; Clinical; Clinical Trials; Cognition; Cognitive; Complement; Dementia; Detection; Education; Elderly; Elements; Enhancement Technology; Environment; Exercise; Feedback; Focus Groups; Funding; General Hospitals; Goals; Grant; Habits; Health; Health Technology; Health behavior; Hyperphagia; Impaired cognition; Incidence; Individual; International; Intervention; Interview; Life Expectancy; Life Style; Link; Massachusetts; Medical; Medical Staff; Mental Health; Mentors; Mentorship; Methodological Studies; Methodology; Mind-Body Intervention; Modeling; Monitor; Myristica fragrans; Neurobehavioral Manifestations; Outcome; Palliative Care; Patient Care; Patient Self-Report; Patients; Peer Review; Peripheral; Persons; Physicians; Population; Population Intervention; Prevalence; Prevention; Procedures; Proctor framework; Provider; Psyche structure; Psychiatrist; Psychologist; Publications; Publishing; Qualitative Methods; Research; Research Personnel; Risk; Risk Factors; Scientist; Services; Sleep Deprivation; Smoking; Telephone Interviews; Testing; Time; Training; Unhealthy Diet; Work; acceptability and feasibility; actigraphy; base; behavior change; behavioral adherence; biological adaptation to stress; cardiovascular risk factor; cognitive control; cognitive function; cognitive interview; dementia risk; efficacy testing; efficacy trial; experience; global health; health data; healthy aging; healthy lifestyle; human old age (65+); implementation barriers; implementation framework; implementation science; improved; interest; lifestyle factors; lifestyle intervention; mHealth; medical schools; mind control; mindfulness; mindfulness intervention; modifiable lifestyle factors; multidisciplinary; new technology; novel; patient engagement; personalized strategies; pilot test; prevent; primary outcome; programs; recruit; reinforced behavior; skills; smartphone Application; social; statistics; therapy development; virtual

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.

项目概要 在这个 K23 中，我（Ryan Mace 博士）将接受基于正念的生活方式干预开发的培训，以帮助 预防阿尔茨海默病和相关痴呆症（ADRD）。我是马萨诸塞州的临床健康心理学家 综合医院 (MGH) 和哈佛医学院，在认知基础方面拥有强大的研究背景 心理健康和老龄化。我的长期目标是成为一名独立调查员和领先的开发人员 技术增强的行为干预措施，从试点测试到实施，以大规模推广 随着年龄的增长，生活方式更加健康。通过这个 K23 项目以及麻省总医院丰富的多学科培训环境，我 将实现以下培训目标：1）使用医学定性方法确定实施障碍 利益相关者； 2）针对特定老龄化人群优化生活方式和基于正念的干预措施； 3）行为严谨 技术增强的临床试验； 4) 收集和分析有关生活方式行为变化的移动健康数据。达到 为了实现这些目标，我组建了一支模范导师团队，由我的主要导师 Ana-Maria Vranceanu 博士领导。 临床健康心理学家和实时视频身心干预开发领域的领导者；共同导师克里斯汀博士 Ritchie 是一位老年病学家和姑息治疗医生，在改善老年痴呆症的检测和治疗方面进行了数十年的研究 ADRD；顾问斯蒂芬·巴特尔斯 (Stephen Bartels) 博士，一位老年精神病学家和国家实施科学专家；顾问，博士 Judson Brewer，一位精神病学家和神经科学家，因基于应用程序的正念项目而享誉国际 行为改变；顾问，Olivia Okereke 博士，一位老年精神病学家，专门研究可改变生活方式的危险因素 ADRD；兼顾问贝蒂娜·霍普纳 (Bettina Hoeppner) 博士是一位实验心理学家，拥有统计学和纵向研究方面的专业知识 移动健康数据建模。该提案在逻辑上建立在我之前共同开发“我的健康大脑”(MHB) 的工作基础上 – 第一个基于正念的生活方式计划，旨在改变具有主观认知的老年人 ADRD 风险因素 下降（SCD）。 SCD是预防ADRD的关键窗口期，而认知症状则处于最早阶段，但 先前针对多种生活方式因素的试验显示，依从性有限、耗时且未能产生效果 行为改变。相比之下，MHB 1) 教授正念技能以改善生活方式； 2）使用移动医疗技术 （ActiGraph 手表、智能手机应用程序）评估和强化行为； 3) 通过实时视频传送。对于目标 1，我 将使用 Proctor 实施中的元素与医疗利益相关者 (N = 20) 进行实时视频焦点小组讨论 框架 解决高效转诊的障碍，制定参与者参与策略并优化研究 程序。对于目标 2，我将通过实时视频试点 RCT，针对患有 SCD 和 ADRD 风险的老年人（年龄 ≥ 60 岁）建立 因素 — MHB 与教育控制的可行性、可接受性、适当性和保真度 (N=50) 遵循预定的基准。研究结果将为功效试验 (R01) 提供信息，该试验也将测试 生活方式和认知的改善。该 K23 与 NIA 的资助优先事项相一致，即开发可行且 促进遵守预防 ADRD 的生活方式的个性化策略。期间获得的经验 该奖项将促进我作为一名专注于健康老龄化和 ADRD 预防的领先临床科学家的独立性。