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R34合作机制。我们将评估适应和测试基于正念的压力减轻(MBSR)的可行性，这种基于正念的压力减轻(MBSR)是一种有前景的CAM治疗方法，用于改善患有焦虑症或严重抑郁障碍(MDD)并伴有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，因为这些障碍非常常见，会导致老年人的认知障碍；加在一起，这些临床和神经认知障碍是高度残疾的，现有的治疗方法对它们没有足够的帮助。我们的治疗开发建议是基于众所周知的衰老在下丘脑-垂体-肾上腺(HPA)轴应激反应和认知损害之间的联系。我们已经证明，HPA轴多动依赖于担忧的严重程度，并且通过治疗、改善记忆和临床症状是可逆的。这些发现表明，抑制晚期精神障碍患者HPA轴过度活动的新疗法将补救认知障碍。我们还表明，基于正念的干预是可接受的、可行的，可以减少老年人的焦虑和抑郁。MBSR通过增加正念、减少担忧和沉思来抵消焦虑和抑郁；它还抑制HPA轴多动，从而产生这样的假设，即MBSR可以通过增加正念来改善患有焦虑症和MDD的老年人的临床症状和认知障碍，从而减少担忧/沉思，并降低HPA轴的应激反应。因此，我们建议调整和测试MBSR，以适应和测试患有抑郁或焦虑和情绪相关认知障碍的老年人。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的老年人试行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100名老年人随机分配到MBSR方案或控制条件下，并将检查可行性。焦虑和抑郁症状以及记忆和执行功能是结果；正念、担忧/沉思和皮质醇的变化是中介。MBSR是一种很有前途的治疗晚期焦虑症和MDD的新策略。我们建议开发治疗，同时探索潜在的心理和生物机制(正念和神经内分泌变化)的治疗效果，赋予这项研究的临床和科学意义。

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.