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

项目摘要 不稳定症状（即，难以启动睡眠，维持睡眠）的人与阿尔茨海默氏症 疾病和相关的痴呆症使人衰弱，并有助于增加机构化，减少 认知功能和加速疾病进展。此外，失眠中断与穷人有关。 照顾者的健康结果，如生活质量差和负担增加。考虑到潜在的有害 药物治疗的副作用，非药物方法，如音乐，可以提供一个更安全的 改善失眠症状的替代方法。音乐干预特别有希望，因为长期 音乐记忆在阿尔茨海默氏症和相关痴呆症中仍然相对保留-即使在老年痴呆症中， 疾病的中度阶段。先前关于音乐干预改善老年人睡眠的研究是 在没有阿尔茨海默病和相关痴呆的人中进行，主要是白人老年人， 成年人了因此，在代表性不足的社区中，有针对性的音乐干预改善睡眠的证据- 老年痴呆症患者（PLWD）及其护理人员缺乏。在一项试点研究（由 NIA，F32 AG 060630），申请人已经检查了所提出的基于音乐的组合物的一个组成部分的可行性。 对艾滋病患者及其照顾者进行干预，并确定了改善艾滋病方案提供的机会。 干预这个K23指导的以患者为导向的研究职业发展奖的目的是 为她提供必要的专业知识，以启动一个成功的和独立的研究计划-与 最终目标是改善PLWD及其护理人员的睡眠和行为症状， 方法。该提案的具体目标是：i）构建和迭代地改进移动的的原型， 应用程序，题为“平静的音乐个性化的睡眠增强与老年痴呆症的皮尔逊” （CoMPoSER）供PLWD及其护理人员使用; ii）在试点RCT中检查其可接受性;以及iii） 功效干预措施的制定将以包括艾滋病患者在内的利益攸关方的投入为指导 和他们的照顾者。将72对二人组随机分配至4周CoMPoSER干预组或 睡眠教育组。音乐选择将根据PLWD量身定制，并考虑已知的睡眠诱导 特性.可接受性将使用调查和定性数据进行审查。干预措施对 将使用客观（体动记录）和主观（代理报告）确定PLWD和护理人员结局 措施在导师团队的指导下，申请人精心构建了研究训练 开展活动，以获得以下四个核心领域的知识和专门知识：㈠以用户为中心的移动的应用程序设计 技术，ii）行为干预发展，iii）以社区为基础的预防性研究，以及iv） 行为研究方法，包括临床试验研究的测量、分析和传播。 拟议研究项目的结果不仅将为更大规模的疗效试验提供信息， 申请人有机会获得必要的技能，以开始她作为独立调查员的职业生涯。

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.