2/2 MINDFULNESS-BASED STRESS REDUCTION AND COGNITIVE FUNCTION IN STRESS AND AGING

描述（由申请人提供）：本申请响应由国家补充和替代医学中心（NCCAM）和国家精神卫生研究所（NIMH）共同发起的协作R34机制。我们将评估适应和测试正念减压（MBSR）的可行性，这是一种有希望的CAM治疗方法，用于改善患有焦虑症或重度抑郁症（MDD）以及认知障碍的老年人的临床结果和神经认知功能。这个项目很重要，因为这些疾病非常常见，并在老年人中引起认知障碍；总之，这些临床和神经认知障碍是高度致残的，现有的治疗方法也没有充分的帮助。我们的治疗发展建议是基于众所周知的下丘脑-垂体-肾上腺（HPA）轴过度活跃的应激反应与认知障碍之间的衰老联系。我们已经证明，下丘脑轴过度活跃依赖于担忧的严重程度，并且通过治疗是可逆的，可以改善记忆和临床症状。这些发现表明，抑制老年精神障碍中HPA轴过度活跃的新疗法将修复认知障碍。我们还表明，以正念为基础的干预是可以接受的，可行的，并减少老年人的焦虑和抑郁。正念减压疗法通过增加正念、减少忧虑和沉思来抵消焦虑和抑郁；它还可以抑制HPA轴的过度活跃，由此产生了一种假设，即正念减压疗法可以通过增加正念来改善患有焦虑症和重度抑郁症的老年人的临床症状和认知障碍，从而减少担忧/反刍，减少HPA轴的应激反应。因此，我们建议对患有抑郁或焦虑和情绪相关认知障碍的老年人调整和测试正念减压疗法。第一阶段将对患有记忆障碍或执行功能障碍的抑郁或焦虑的老年人试行正念减压疗法，根据需要修改干预措施，开发依从性和能力测量方法，并测试控制条件。第二阶段（试验性随机对照试验）将随机抽取100名老年人参加MBSR方案或对照条件，并将检验可行性。焦虑和抑郁症状以及记忆和执行功能是结果；正念、忧虑/沉思和皮质醇的变化是中介。正念减压疗法是一种治疗老年焦虑症和重度抑郁症的新方法。我们建议在开发治疗方法的同时，探索治疗效果背后可能的心理和生物学机制（正念和神经内分泌变化），使本研究具有临床和科学意义。

DESCRIPTION (provided by applicant): This application responds to the collaborative R34 mechanism co-sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Mental Health (NIMH). We will evaluate the feasibility of adapting and testing Mindfulness-Based Stress Reduction (MBSR), a promising CAM treatment, for improving clinical outcomes and neurocognitive function in older adults with anxiety disorders or major depressive disorder (MDD) along with cognitive impairment. This project is important because these disorders are very common and cause cognitive impairment in older adults; together, these clinical and neurocognitive impairments are highly disabling and inadequately helped by existing treatments. Our treatment development proposal is based on well-known links in aging between a hyperactive hypothalamic-pituitary-adrenal (HPA) axis stress response and cognitive impairment. We have demonstrated that HPA axis hyperactivity is dependent on worry severity and is reversible with treatment, improving memory as well as clinical symptoms. These findings suggest that novel treatments that inhibit HPA axis hyperactivity in late-life mental disorders will remediate cognitive impairment. We have also shown that mindfulness-based interventions are acceptable, feasible, and reduce anxiety and depression in older adults. MBSR counteracts anxiety and depression by increasing mindfulness and decreasing worry and rumination; it also inhibits HPA axis hyperactivity, generating the hypothesis that MBSR can improve clinical symptoms and cognitive impairment in older adults with anxiety disorders and MDD via increased mindfulness, resulting in reduced worry/rumination and reducing the HPA axis stress response. We therefore propose to adapt and test MBSR for older adults with depression or anxiety and mood-related cognitive impairment. Phase 1 will pilot an MBSR protocol for depressed or anxious older adults with memory impairment or executive dysfunction, modify the intervention as needed, develop adherence and competency measurement, and test a control condition. Phase 2 (pilot RCT) will randomize 100 older adults to the MBSR protocol or a control condition and will examine feasibility. Anxiety and depressive symptoms and memory and executive function are outcomes; changes in mindfulness, worry/rumination, and cortisol are mediators. MBSR is a promising, novel treatment strategy for late-life anxiety disorders and MDD. We propose to develop the treatment while exploring putative psychological and biological mechanisms (mindfulness and neuroendocrine changes) underlying the treatment effect, giving this study clinical and scientific significance.