Addressing the chronic pain-early cognitive decline comorbidity among older adults; The Active Brains study

项目总结 慢性疼痛和早期认知功能衰退在老年人中越来越普遍，而且是双向相关的 阿尔茨海默病和相关痴呆(ADRD)的个体危险因素。慢性疼痛与认知 衰退会相互加剧，使个人陷入“残疾螺旋”，或使身体、情绪和精神状况恶化 认知功能与ADRD的增量风险。目前，还没有成功的循证治疗方法 解决老年人慢性疼痛-早期认知能力下降的共病问题。由NCCIH和 NIA我们使用混合方法迭代地开发了一种多模式的、基于理论的、基于群体的心身活动 该计划专为患有慢性疼痛和早期认知衰退的老年人量身定做。该计划有帮助 老年人管理疼痛，增加认知储备，增加对他们有意义的活动的参与度 使用配额式起搏，并配以数字监测设备。该方案具有良好的可行性和可操作性。 对虚拟交付和远程数据收集的可接受性。参与计划与以下方面的改进相关 多通道身体功能(自我报告、6分钟步行试验和Actigraph测量步数)、情感功能 (抑郁和焦虑)，认知功能(自我报告和目标)，疼痛强度和理论知情的中介。 在我们充满希望的研究的基础上，我们现在提议对我们的身心活动计划进行一次全面的随机对照试验 (活跃的大脑-数字)与教育控制(健康促进计划)两者实际上都是在 N=260名患有肌肉骨骼慢性疼痛和早期认知功能减退的老年人。我们将建立积极的疗效 大脑--数字化，6个月以上改进的可持续性，以及通过相关中介和 版主。试验将在马萨诸塞州综合医院进行，使用我们既定的方法和 基础设施。活跃的大脑-数字有可能成为第一个针对老年人的循证计划 慢性疼痛和早期认知功能下降，对预防这种高风险的AD/ADRD具有重要意义 人口。该项目直接与NIA的战略目标C、目标1和目标3保持一致。

PROJECT SUMMARY Chronic pain and early cognitive decline are increasingly prevalent among older adults, bidirectionally related, and individual risk factors for Alzheimer’s Disease and Related Dementias (ADRD). Chronic pain and cognitive decline exacerbate each other, placing individuals on a “disability spiral” or worsened physical, emotional, and cognitive functioning with incremental risk of ADRD. Currently there are no evidence-based treatments that successfully address the chronic pain-early cognitive decline comorbidity among older adults. With funding from NCCIH and NIA we used mixed methods to iteratively develop a multimodal, theory grounded, group-based mind-body activity program tailored to the unique needs of older adults with chronic pain and early cognitive decline. The program helps older adults manage pain, increase cognitive reserves, and increase engagement in activities that are meaningful to them using quota-based pacing reinforced by a digital monitoring device. The program shows excellent feasibility and acceptability for virtual delivery and remote data collection. Program participation is associated with improvement in multimodal physical function (self-report, 6-minute walk test and Actigraph measured stepcount), emotional function (depression and anxiety), cognitive function (self-report and objective), pain intensity and theory informed mediators. Building on our promising study we now propose to conduct a fully powered RCT of our mind-body activity program (Active Brains-Digital) versus an educational control (Health Enhancement Program) both delivered virtually among N=260 older adults with musculoskeletal chronic pain and early cognitive decline. We will establish efficacy of Active Brains-Digital, sustainability of improvement over 6 months, and mechanisms of change through relevant mediators and moderators. The trial will take place at the Massachusetts General Hospital using our established methodology and infrastructure. Active Brains-Digital has the potential to be the first evidence-based program for older adults with chronic pain and early cognitive decline, with important implications for prevention of AD/ADRD in this high risk population. This project directly aligns with NIA strategic Goal C, objectives 1 and 3.