Multicomponent Behavioral Sleep Intervention for Insomnia in Older Adults with Mild Cognitive Impairment

项目摘要 据估计，7%至20%的老年人患有轻度认知障碍（MCI），60%的MCI患者患有 一些睡眠障碍失眠是老年人最常见的睡眠障碍， 启动或维持睡眠，过早醒来，以及第二天的后果，如难以集中注意力。的 拟议的项目旨在解决文献和临床实践中的一个主要差距，缺乏有效的非药物治疗， 治疗患有轻度认知障碍的老年人失眠。我们建议进行一项随机试验性研究 测试一个简短的（4周），基于平板电脑的，个性化的，多成分的失眠行为干预（MBSI-I） 这将针对已知的病因风险因素和患有轻度认知障碍的老年人失眠的永久因素， 与睡眠教育对照组相比，干预措施的关键组成部分包括促进有意义的 白天活动，晚上促进放松疗法。我们将确定初步立即（一个月） 与睡眠教育相比，MBSI-I对睡眠相关结局和健康相关结局的持续有效性（3个月） 生活质量此外，我们将探讨MBSI-I影响睡眠和健康相关生活质量的机制 使用标准化问卷和炎症生物标记物。实时监控干预依从性，使用 移动终端技术与真实的时间数据传输，代表了失眠治疗的根本性变革 范例，并将是最有益的，因为这组有记忆障碍。完成后，该提案将 为大规模干预试验提供基础知识，并解决当前失眠治疗的局限性 轻度认知障碍的患者。这项研究与国家研究所的战略使命密切相关 因为它提出了个性化护理的策略，并使用真实的时间健康信息来改善 轻度认知障碍的老年人失眠症状，并为成功的症状建立证据 在这个弱势群体中。此外，为此制定的跨学科培训计划和目标 该提案将填补我目前技能的关键空白，并为我提供必要的专业知识，以启动一个成功的， 独立研究项目，旨在改善高危老年人的睡眠和健康相关生活质量。通过 扩展我的知识1）移动终端技术，2）认知健康相关结果的测量，3） 行为干预和转化研究的临床试验，4）生物标志物评估，和5）科学写作， 口头报告，手稿开发和同行评审，我将能够进行更有效的研究评估 老年人睡眠问题的非药物治疗。为了我事业的成功 发展目标，我将遵循强化培训计划，包括课程，实验室培训，指导 研讨会、讲习班和其他结构化活动;参与研究、数据分析和手稿 准备;专业发展活动;和密切指导。总体而言，这方面的研究和培训活动 这份提案将为我作为独立调查员的职业生涯奠定坚实的基础。

PROJECT SUMMARY It is estimated that 7% to 20% of older adults have mild cognitive impairment (MCI) and 60% of people with MCI have some sleep disturbances. Insomnia is the most common sleep disturbance in older adults and is characterized by difficulty initiating or maintaining sleep, awakening too early, and next day consequences such as difficulty concentrating. The proposed project seeks to address a major gap in the literature and clinical practice, lack of effective nonpharmacological treatments for insomnia in older adults with mild cognitive impairment. We propose conducting a randomized pilot study testing a brief (4 week), tablet-based, personalized, multicomponent behavioral sleep intervention for insomnia (MBSI-I) that will target known etiological risk factors and perpetuators of insomnia among older adults with mild cognitive impairment, compared to a sleep education control. Key components of the intervention include stimulating meaningful activity during the day and promoting relaxation therapy at night. We will determine preliminary immediate (one month) and sustained efficacy (3 months) of MBSI-I compared to sleep education on sleep related outcomes and health related quality of life. Additionally, we will explore mechanisms by which MBSI-I affects sleep and health related quality of life using standardized questionnaires and inflammatory biomarkers. Real-time monitoring of intervention adherence, using mobile device technology with real time data transmission, represents a fundamental change in the insomnia treatment paradigm and will be most beneficial given that this group has memory impairments. Upon completion, this proposal will provide foundational knowledge for large scale intervention trials and address limitations in current insomnia treatments in patients with mild cognitive impairment. This research closely aligns with the strategic mission of the National Institute of Nursing Research because it proposes strategies to personalize care and use real time health information to improve symptoms of insomnia in older adults with mild cognitive impairment and to build evidence toward successful symptom management in this vulnerable population. Furthermore, the interdisciplinary training plan and goals developed for this proposal will fill a critical void in my current skillset and provide me the expertise necessary to initiate a successful and independent program of research related to improve sleep and health-related quality of life in at-risk older adults. By expanding my knowledge of 1) mobile device technology, 2) measurement of cognitive health related outcomes, 3) clinical trials of behavioral interventions and translational research, 4) biomarker assessment, and 5) scientific writing, oral presentations, manuscript development and peer review, I will be able to conduct research to evaluate more effective nonpharmacological treatments for sleep problems in older adults. To facilitate the achievement of my career development goals, I will follow an intensive training plan that incorporates coursework, laboratory training, mentoring and seminars, workshops, and other structured activities; participation in research studies, data analysis, and manuscript preparation; professional development activities; and close mentorship. Overall, the research and training activities in this proposal will build a strong foundation for my career as an independent investigator.