POINTER-zzz: Sleep Ancillary to U.S. Study to Protect Brain Health through Lifestyle Intervention to Reduce Risk of Alzheimer's Disease

项目总结 目前还没有发现可以预防或治疗阿尔茨海默病的药物治疗方法。到目前为止，没有 通过生活方式干预针对可改变风险的药理学方法提供了最大的 疾病延迟的有希望的证据。高度流行的慢性心脏代谢性疾病对 老年美国人把一个重要的聚光灯放在发展之前的漫长的前驱时期上。 阿尔茨海默氏症和其他痴呆症--用于预防。美国研究通过生活方式保护大脑健康 干预以降低风险(美国指标)使用已证明的多域干预方法 在心血管疾病和糖尿病预防以及认知功能方面取得成功，在芬兰的一群 上了年纪的人。美国指针将于2018年秋季推出，以调查是否随机分配给两个 结构、强度和责任感不同的生活方式干预影响认知轨迹超过2 2000年认知正常的老年人(60-79岁)，他们认知能力下降的风险增加， 阿尔茨海默病和其他痴呆症。这项名为POINTER-ZZZ的辅助研究将增加居家客观睡眠 对700名家长试验参与者进行评估，以检查生活方式改变和心血管疾病的影响 对睡眠障碍的风险管理，这些障碍与认知能力下降和阿尔茨海默病有关。在……里面 老年人，以睡眠呼吸紊乱和睡眠碎片为标志的慢性睡眠障碍 与海马体功能受损、脑内β-淀粉样蛋白负荷增加和高血压风险增加有关 阿尔茨海默氏症。这些睡眠异常和其他睡眠异常也与心血管疾病减少有关 和脑血管健康。尽管有一些证据表明，节食、锻炼和 减少心脏代谢风险可以改善睡眠，改善睡眠有利于老年人的认知功能 成人，这些作用尚未在大规模严格的临床试验中得到证实， 客观测量睡眠。POINTER-ZZZ提供了一个前所未有的机会来充分利用 由一项多点随机对照预防试验提供的资源，该试验的特点是 认知正常但易患阿尔茨海默病的成年人测试为期两年的强化生活方式干预的效果 使用血氧仪对睡眠障碍呼吸和使用活动记录仪对睡眠碎片进行研究。指示器-zzz将会 还要研究睡眠变化是否预示着全局和领域特定认知功能的变化，以及 其他家长试验结果。指针-zzz结果可以确定改善睡眠的有效策略，该策略 可能对预防阿尔茨海默病和相关痴呆症产生重要影响。

PROJECT SUMMARY No pharmacologic treatments have been identified to prevent or treat Alzheimer’s disease. To date, non- pharmacological approaches that target modifiable risks through lifestyle interventions provide the most promising evidence for disease delay. The impact of highly prevalent and chronic cardiometabolic conditions in older Americans places an important spotlight on the long prodromal period that precedes the development of Alzheimer’s and other dementias – for prevention. The U.S. study to PrOtect brain health through lifestyle INTErvention to Reduce risk (U.S. POINTER) uses a multi-domain intervention approach that has proven successful for cardiovascular disease and diabetes prevention, and for cognitive function in a Finnish cohort of older adults. U.S. POINTER launches in Fall 2018 to investigate whether random assignment to one of two lifestyle interventions that differ in structure, intensity, and accountability influences cognitive trajectory over 2 years in 2000 cognitively normal older adults (age 60-79 yrs) who are at increased risk for cognitive decline, Alzheimer’s disease and other dementias. The ancillary study, POINTER-zzz, will add in-home objective sleep assessments for 700 parent trial participants to examine the effects of lifestyle modification and cardiovascular risk management on sleep disturbances that have been linked to cognitive decline and Alzheimer’s disease. In older adults, chronic sleep disturbances marked by sleep-disordered breathing and sleep fragmentation are associated with impaired hippocampal functioning, greater brain beta-amyloid burden, and increased risk for Alzheimer’s disease. These and other sleep abnormalities are also associated with reduced cardiovascular and cerebrovascular health. Although there is some evidence to suggest that diet, exercise, and cardiometabolic risk reduction can improve sleep and that improved sleep benefits cognitive function in older adults, these effects have not been confirmed in a large-scale rigorous clinical trial with comprehensive and objective measures of sleep. POINTER-zzz provides an unprecedented opportunity to leverage extensive resources provided by a multi-site randomized controlled prevention trial in a well-characterized cohort of cognitively normal but Alzheimer-vulnerable adults to test the effects of a 2-year intensive lifestyle intervention on sleep-disordered breathing using oximetry and on sleep fragmentation using actigraphy. POINTER-zzz will also examine whether changes in sleep predict changes in global and domain-specific cognitive function and other parent trial outcomes. POINTER-zzz results may identify an effective strategy for improving sleep that could have important consequences for the prevention of Alzheimer’s disease and related dementias.