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

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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.