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）共同发起的合作R34机制。我们将评估调整和测试正念减压（MBSR）的可行性，MBSR是一种有前途的CAM治疗方法，用于改善患有焦虑症或重度抑郁症（MDD）的老年人的临床结局和神经认知功能，沿着认知障碍。这个项目很重要，因为这些疾病非常常见，并导致老年人的认知障碍;这些临床和神经认知障碍是高度致残的，现有的治疗方法无法充分帮助。我们的治疗开发建议是基于众所周知的联系，在老化之间的过度活跃的下丘脑-垂体-肾上腺（HPA）轴的应激反应和认知功能障碍。我们已经证明，HPA轴多动是依赖于担心的严重程度，是可逆的治疗，改善记忆以及临床症状。这些发现表明，抑制老年精神障碍患者HPA轴过度活跃的新疗法将修复认知障碍。我们还表明，基于正念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、减少忧虑和沉思来对抗焦虑和抑郁;它还抑制下丘脑-垂体-肾上腺轴过度活跃，产生了这样一种假设，即正念减压疗法可以通过增加正念来改善患有焦虑症和抑郁症的老年人的临床症状和认知障碍，从而减少忧虑/沉思，减少下丘脑-垂体-肾上腺轴的应激反应。因此，我们建议调整和测试MBSR的老年人抑郁症或焦虑症和情绪相关的认知障碍。第一阶段将为患有记忆障碍或执行功能障碍的抑郁或焦虑老年人试行MBSR方案，根据需要修改干预措施，制定依从性和能力测量，并测试控制条件。第二阶段（试验性随机对照试验）将随机选择100名老年人接受正念减压治疗或对照治疗，并将研究其可行性。焦虑和抑郁症状以及记忆和执行功能是结果;正念、担忧/反刍和皮质醇的变化是中介。正念减压疗法是治疗老年焦虑症和抑郁症的一种很有前途的新的治疗策略。我们建议开发治疗方法，同时探索治疗效果背后的假定心理和生物机制（正念和神经内分泌变化），使这项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.