Optimizing a closed-loop digital meditation intervention for remediating cognitive decline and reducing stress in older adults

优化闭环数字冥想干预，以修复老年人的认知衰退和减轻压力

• 批准号: 10627999
• 负责人: ADAM H GAZZALEY
• 金额: $ 141.67万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10627999
• 关键词: Adolescent; Advanced Development; Age Years; Aging; Alzheimer' s Disease; Atrophic; Attention; Behavior; Clinical; Cognition; Cognitive; Cognitive deficits; Cognitive remediation; Country; Data; Dementia; Dose; Elderly; Ethnic Origin; Exhibits; Experimental Designs; Explosion; General Population; Genetic; Goals; Human Characteristics; Impaired cognition; Individual; Intervention; Intervention Trial; Knowledge; Lead; Meditation; Memory impairment; Mental Health; Methodology; Modeling; Moods; Neurodegenerative Disorders; Participant; Patients; Performance; Personal Satisfaction; Physiological; Population; Populations at Risk; Preventive therapy; Psychiatry; Public Health; Quality of life; Race; Randomized, Controlled Trials; Reaction Time; Regulation; Research; Risk; Sample Size; Sampling; Societies; Source; Stress; Subgroup; Symptoms; age related; aging population; attentional control; cardiovascular risk factor; cognitive ability; cognitive control; cognitive enhancement; cohort; design; digital; digital intervention; distraction; experience; follow up assessment; follow-up; functional decline; functional outcomes; handheld mobile device; hazard; improved; indexing; individual variation; mild cognitive impairment; neural; neuropathology; novel; pharmacologic; pre-clinical; precision medicine; prevent; primary outcome; recruit; response; social; stress reactivity; stress reduction; success; sustained attention; telomere; treatment effect; treatment program; treatment response; vigilance; white matter; young adult

Abstract Deficits in cognitive control are at the core of much cognitive decline experienced by many older adults, often leading to functional decline and eventually dementia. The rapidly growing segment of the population facing such cognitive decline has the potential to negatively impact society broadly and it has been estimated that maintaining or improving cognition in older adults (OA) could potentially prevent or delay the onset of an estimated 10 million new cases of Alzheimer’s disease and other dementias. Given the lack of success in discovering effective pharmacological or preventative therapies to prevent dementias, developing targeted interventions to remediate cognitive deficits is vital. To this end, we developed a novel closed-loop, digital meditation intervention (MediTrain) that was designed to improve regulation of focused attention in healthy OA. In a mechanistic RCT, we recently showed that MediTrain lead to broad improvements in cognitive control, with the greatest gains seen in a subgroup of OA with cognitive deficits (i.e., MCI-like). In addition, this intervention led to reduced stress reactivity and improvements in cellular markers of aging. A goal of this proposal will be to extend the scope of our intervention by conducting a mobile RCT (mRCT) in a large sample, recruited nationally, who will complete the study entirely on mobile devices, providing the statistical power to perform planned moderator and subgroup analyses to understand the sources of variability in treatment response. Another important question that emerged from our initial RCT of MediTrain in OA was: what is the minimal and/or optimal dose of the intervention required to achieve the benefits we observed? Thus, this proposed research will tackle two specific aims: First, we will conduct in a large, mRCT of MediTrain in OA at varying doses of treatment to determine the minimum effective dose required for cognitive improvement and stress reduction. Second, we will examine the moderating effect of cognitive decline on treatment effects. We will also include an exploratory aim to examine the impact of potential genetic (Alzheimer’s polygenic hazard scores), physiological (cardiovascular risk), and social (race/ethnicity) moderators on the treatment effects. To accomplish these aims, we will conduct a large-scale mRCT of MediTrain deployed on mobile devices in a diverse, nation-wide sample of OA (N = 3240), who will complete the study entirely on mobile devices. This large, national cohort will provide the sample size necessary to examine individual and subgroup differences in treatment response across a diverse swath of the general population. All participants will complete baseline, immediate follow-up, and 6-month follow-up assessments of cognitive and functional outcomes. We anticipate that this unique methodological approach and experimental design will significantly advance the development of treatment programs directed at the broad range of cognitive abilities and clinical populations that suffer from deficient regulation of attentional control.

抽象的 认知控制缺陷是许多老年人认知能力下降的核心，通常 导致功能衰退并最终导致痴呆。快速增长的人口群体面临着 这种认知能力下降有可能对社会产生广泛的负面影响，据估计 维持或改善老年人 (OA) 的认知能力可能会预防或延缓认知障碍的发生 估计有 1000 万新发阿尔茨海默病和其他痴呆症病例。鉴于在这方面缺乏成功 发现有效的药物或预防疗法来预防痴呆症，开发有针对性的治疗方法 纠正认知缺陷的干预措施至关重要。为此，我们开发了一种新颖的闭环数字化 冥想干预 (MediTrain) 旨在改善健康 OA 的注意力集中调节。 在一项机械随机对照试验中，我们最近表明 MediTrain 可以广泛改善认知控制， 在具有认知缺陷（即 MCI 样）的 OA 亚组中观察到的最大收益。此外，本次干预 导致应激反应减少和衰老细胞标志物改善。该提案的目标是 通过在全国招募的大样本中进行移动随机对照试验（mRCT）来扩大我们的干预范围， 谁将完全在移动设备上完成研究，为执行计划提供统计能力 主持人和亚组分析，以了解治疗反应变异性的来源。其他 我们最初对 OA 中的 MediTrain 随机对照试验得出的重要问题是：什么是最小和/或最佳 实现我们观察到的益处所需的干预剂量是多少？因此，这项拟议的研究将解决 有两个具体目标：首先，我们将在 OA 中进行不同剂量治疗的 MediTrain 大型 mRCT 确定改善认知和减轻压力所需的最小有效剂量。其次，我们将 检查认知能力下降对治疗效果的调节作用。我们还将包括一个探索性目标 检查潜在遗传（阿尔茨海默氏症多基因危险评分）、生理（心血管疾病）的影响 风险）和社会（种族/民族）调节因素对治疗效果的影响。为了实现这些目标，我们将进行 MediTrain 的大规模 mRCT 部署在移动设备上，在多样化的全国 OA 样本中 (N = 3240)， 谁将完全在移动设备上完成研究。这个庞大的全国性队列将提供样本量 有必要检查不同领域的个体和亚组治疗反应差异 一般人群。所有参与者将完成基线、立即随访和 6 个月随访 认知和功能结果的评估。我们预计这种独特的方法论和 实验设计将显着促进针对广泛疾病的治疗方案的开发 认知能力范围和患有注意力控制调节不足的临床人群。