My Healthy Brain: a mindfulness-based lifestyle intervention to modify early risk of dementia in older adults

项目摘要 在这个K23中，我（Ryan Mace博士）将获得基于正念的生活方式干预发展的培训， 预防阿尔茨海默病和相关痴呆症（ADRD）。我是马萨诸塞州的临床健康心理学家 综合医院（MGH）和哈佛医学院，在认知基础方面具有强大的研究背景 心理健康和衰老的关系我的长期目标是成为一名独立的调查员和领先的开发人员， 技术强化的行为干预措施，从试点测试到实施，以大规模推广 更健康的生活方式。通过这个K23项目和MGH丰富的多学科培训环境，我 将实现以下培训目标：1）使用定性方法识别实施障碍， 利益相关者; 2）优化特定老龄化人群的生活方式和基于正念的干预措施; 3）进行严格的 技术增强的临床试验;以及4）收集和分析关于生活方式行为改变的移动的健康数据。实现 为了实现这些目标，我组建了一个由我的主要导师Ana-Maria Vranceanu博士领导的模范导师团队， 临床健康心理学家和现场视频身心干预发展的领导者;共同导师，克莉丝汀博士 里奇是一位老年病学家和姑息治疗医生，他在改善老年痴呆症的发现和治疗方面有着数十年的研究。 顾问，斯蒂芬巴特尔博士，老年精神病学家和国家专家在实施科学;顾问，博士。 Judson Brewer是一位精神病学家和神经科学家，以基于应用程序的正念项目而闻名， 行为改变;顾问，Olivia Okereke博士，一位老年精神病学家，专门研究可改变的生活方式风险因素， ADRD;和顾问，博士贝蒂娜Hoeppner，实验心理学家与统计学和纵向专业知识 移动的健康数据建模。这个建议逻辑上建立在我以前的工作共同开发我的健康大脑（MHB） - 第一个基于正念的生活方式计划，以修改老年人的ADRD风险因素， 下降（SCD）。SCD是ADRD预防的关键窗口，而认知症状处于最早阶段，但 先前针对多种生活方式因素的试验显示，依从性有限，时间密集，并且未能产生 行为改变相比之下，MHB 1）教授正念技能以改善生活方式; 2）使用移动的健康技术 （ActiGraph手表，智能手机应用程序），以评估和加强行为;和3）通过现场视频提供。对于目标1， 将使用普罗克特实施过程中的元素，与医疗利益相关者（N = 20）进行现场视频焦点小组讨论 框架 解决有效转诊的障碍，制定参与者参与策略，并优化研究 程序.对于目标2，我将通过一项在有SCD和ADRD风险的老年人（年龄≥ 60岁）中进行的现场视频试点RCT， 因素-MHB与教育对照的可行性、可接受性、适当性和保真度（N=50） 根据预先设定的基准。这些发现将为一项疗效试验（R 01）提供信息，该试验还将测试 改善生活方式和认知能力。该K23符合NIA的资助优先事项，即开发可行的， 个性化的策略，以促进坚持保护ADRD的生活方式。积累的经验 该奖项将促进我作为一名专注于健康老龄化和ADRD预防的领先临床科学家的独立性。

PROJECT SUMMARY In this K23, I (Dr. Ryan Mace) will acquire training in mindfulness-based lifestyle intervention development for the prevention of Alzheimer’s Disease and Related Dementias (ADRD). I am a clinical health psychologist at Massachusetts General Hospital (MGH) and Harvard Medical School, with a strong research background in the cognitive underpinnings of mental health and aging. My long-term goal is to become an independent investigator and leading developer of technology-enhanced behavioral interventions, from pilot testing to implementation, for the large-scale promotion of healthier lifestyles with aging. Through this K23 project, and the rich multidisciplinary training environment at MGH, I will achieve the following Training Goals: 1) identify implementation barriers using qualitative methods with medical stakeholders; 2) optimize lifestyle and mindfulness-based interventions for specific aging populations; 3) conduct rigorous technology-enhanced clinical trials; and 4) collect and analyze mobile health data on lifestyle behavior change. To achieve these goals, I have assembled an exemplary mentorship team led by my primary mentor, Dr. Ana-Maria Vranceanu, a clinical health psychologist and a leader in live video mind-body intervention development; co-mentor, Dr. Christine Ritchie, a geriatrician and palliative care physician with decades of research on improving the detection and treatment of ADRD; advisor, Dr. Stephen Bartels, a geriatric psychiatrist and national expert in implementation science; advisor, Dr. Judson Brewer, a psychiatrist and neuroscientist internationally renowned for app-based mindfulness programs for behavior change; advisor, Dr. Olivia Okereke, a geriatric psychiatrist specializing in modifiable lifestyle risk factors of ADRD; and advisor, Dr. Bettina Hoeppner, an experimental psychologist with expertise in statistics and longitudinal modeling of mobile health data. This proposal logically builds on my prior work co-developing My Healthy Brain (MHB) – the first mindfulness-based lifestyle program to modify ADRD risk factors in older adults with subjective cognitive decline (SCD). SCD is a critical window for ADRD prevention, while cognitive symptoms are at the earliest stage, yet prior trials targeting multiple lifestyle factors have shown limited adherence, are time-intensive, and failed to produce behavior change. In contrast, MHB 1) teaches mindfulness skills to improve lifestyles; 2) uses mobile health technologies (ActiGraph watches, smartphone app) to assess and reinforce behaviors; and 3) is delivered via live video. For Aim 1, I will conduct live video focus groups with medical stakeholders (N = 20) using elements from Proctor’s implementation framework to address barriers to efficient referrals, develop participant engagement strategies, and optimize study procedures. For Aim 2, I will establish — via a live video pilot RCT in older adults (age ≥ 60) with SCD and ADRD risk factors — the feasibility, acceptability, appropriateness, and fidelity of the MHB versus an education control (N=50) following predetermined benchmarks. The findings will inform an efficacy trial (R01) that will also test mechanisms of improvements in lifestyle and cognition. This K23 aligns with the NIA funding priority of developing feasible and personalized strategies for promoting adherence to lifestyles that are protective of ADRD. The experiences gained during the award will facilitate my independence as a leading clinician scientist focused on healthy aging and ADRD prevention.