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

项目总结 在这个K23中，我(瑞安·梅斯博士)将接受以正念为基础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，在认知基础方面有很强的研究背景 心理健康和衰老的问题。我的长期目标是成为一名独立的调查者和领先的开发者 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 随着年龄的增长，人们的生活方式更加健康。通过这个K23项目，以及MGH丰富的多学科培训环境，我 将实现以下培训目标：1)使用定性方法确定实施障碍 利益相关者；2)针对特定老龄化人群优化基于生活方式和正念的干预；3)进行严格的 技术增强的临床试验；以及4)收集和分析有关生活方式行为变化的移动健康数据。要实现 为了实现这些目标，我组建了一个模范导师团队，由我的主要导师安娜-玛丽亚·弗伦萨努博士领导，她是一名 临床健康心理学家和现场视频心身干预开发的领导者；共同导师克里斯汀博士 里奇是一位老年病学家和姑息治疗内科医生，他几十年来一直在研究如何改善脑血管疾病的检测和治疗 ADRD；顾问斯蒂芬·巴特尔斯博士，老年精神病学家和实施科学方面的国家专家； 朱德森·布鲁尔，精神病学家和神经学家，因基于APP的正念程序而享誉国际 行为改变；顾问，奥利维亚·奥克雷克博士，老年精神病学家，专门研究可改变的生活方式风险因素 和顾问，Bettina Hoeppner博士，一位在统计学和纵向方面有专长的实验心理学家 移动健康数据的建模。从逻辑上讲，这个建议是建立在我之前共同开发我的健康大脑(MHB)的工作基础上的 -第一个基于正念的生活方式计划，修改具有主观认知的老年人ADRD风险因素 下降(SCD)。SCD是预防ADRD的关键窗口，而认知症状尚处于最早阶段 先前针对多种生活方式因素的试验表明，依从性有限，时间密集，且未能产生效果 行为改变。相比之下，MHB 1)教授正念技能以改善生活方式；2)使用移动健康技术 (Actgraph Watches，智能手机应用程序)，用于评估和强化行为；3)通过视频直播。对于目标1，我 将使用Proctor实施中的元素与医疗利益相关者(N=20)进行现场视频焦点小组 框架以实现 解决高效推荐的障碍，制定参与者参与策略，并优化学习 程序。对于目标2，我将通过现场视频试点在有SCD和ADRD风险的老年人(≥60岁)中建立随机对照试验 因素--MHB与教育对照(N=50)的可行性、可接受性、适当性和忠诚度 遵循预定的基准。这些发现将为疗效试验(R01)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的资金优先事项，即开发可行的和 促进遵守保护ADRD的生活方式的个性化战略。在此期间获得的经验 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.