Mindfulness Meditation and Insomnia in Alzheimer Disease Caregivers: Inflammatory and Biological Aging Mechanisms

项目总结/摘要 这项随机对照试验旨在评估经验证的，基于课程的，基于正念的干预措施的能力，称为失眠的正念意识实践（MAP-I）与睡眠研讨会（SS），一种积极的教育对照，治疗老年阿尔茨海默病（AD）配偶照顾者失眠（N=150）超过一年的随访。这项研究还旨在确定失眠的治疗是否逆转了疾病风险指标机制的不良轨迹，即炎症和细胞衰老。超过500万美国人提供非正式的广告，这对健康产生了负面影响，与非广告对照相比，死亡风险增加了63%。超过60%的AD照顾者发生抑郁症，对照顾者的健康和疾病风险机制有独立的负面影响。最后，失眠是一个可改变的风险因素，但没有先前的研究针对AD照顾者的失眠。我们发现MAP-I改善了老年人的睡眠投诉。此外，我们已经证明，基于正念的失眠治疗减少了炎症的细胞和基因组标记，并减缓了细胞衰老，如端粒侵蚀在一年内所指示的。晚年的炎症和细胞老化可预测发病率和死亡率，使这些生物学机制成为AD护理人员疾病风险的重要标志物。该研究的具体目的是1）确定MAP-I与SS对失眠的主观和客观维度的影响; 2）评价MAP-I与SS对炎症的细胞和基因组标志物的影响; 3）评价MAP-I与SS对细胞衰老标志物的影响。我们将探讨护理人员压力对失眠结局的调节作用，以及MAP-I与SS对护理人员压力结局、健康功能、慢性疾病发病率和随访时相关药物使用的影响。如果成功，这项研究将确定治疗可改变的风险因素失眠是否会影响睡眠和疾病风险的两种机制，即炎症和细胞衰老，这对改善AD护理人员和老年人的整体健康状况具有重要意义。

Project Summary/Abstract This randomized controlled trial aims to evaluate the ability of validated, curriculum based, mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I) vs. Sleep Seminar (SS), an active education control, to treat insomnia in older adult Alzheimer Disease (AD) spousal caregivers with insomnia (N=150) over one-year follow-up. This study also aims to identify whether treatment of insomnia reverses the adverse trajectories of mechanisms of disease risk indicators, namely inflammation and cellular aging. Over 5 million Americans provide informal AD caregiving, which negatively impacts health and is associated with a 63% greater risk of mortality as compared to non-caregiving controls. Insomnia occurs in over 60% of AD caregivers and has independent negative influences on caregiver health and mechanisms of disease risk. Finally, insomnia is a modifiable risk factor, yet no prior study has targeted insomnia in AD caregivers. We have found that MAP-I improves sleep complaints in older adults. Further, we have shown that mindfulness based treatment of insomnia reduces cellular and genomic markers of inflammation and slows cellular aging as indexed by telomere erosion over a one year period. Inflammation and cellular aging in late life predict morbidity and mortality, making these biological mechanisms valuable markers of disease risk in AD caregivers. The specific aims of the study are to 1) determine the effects of MAP-I vs. SS on subjective and objective dimensions of insomnia; 2) evaluate the effects of MAP-I vs. SS on cellular and genomic markers of inflammation; 3) evaluate the effects of MAP-I vs. SS on markers of cellular aging. We will explore moderating effects of caregiver stress on insomnia outcomes, and also the effects of MAP-I vs. SS on outcomes of caregiver stress, health functioning, chronic medical morbidity and related medication use at follow-up. If successful, this research will identify whether treatment of a modifiable risk factor, insomnia, influences sleep and two mechanisms of disease risk, namely, inflammation and cellular aging, which has implications for improving overall health-span of AD caregivers as well as older adults.