Complicated Grief in Older Adults: Physiological Substrates of Emotion Regulation

描述(由申请人提供)：老年人的复杂悲痛：情绪调节的生理基础本申请老龄化职业发展奖描述了一项综合的培训计划和研究项目，以使候选人成为老年人情绪调节的生理基础方面的专家。丧偶之痛在老年人中非常普遍，美国每年有超过90万人丧偶。尽管大多数人逐渐适应寡妇生活，但也有一些人经历了一个复杂的过程。复杂的悲痛尽管接受了抗抑郁治疗，但仍持续存在，已被发现是老年人认知能力下降、健康状况不佳、抑郁和自杀的独立预测因素，使其成为一个主要的公共卫生问题。认知因素，如无法将注意力从对死者的侵扰性想法上转移出来，被假设为损害了对寡妇生活的适应(呃)。此外，生理机制，如低级别的炎症过程，可能有助于在这一人群中发现情绪失调。这项拟议的研究将评估老年人的神经激活、免疫标记物以及注意力和情绪调节的神经心理学测试。我们将招募135名老年人(45名有复杂悲伤，45名有简单悲伤，45名没有失去亲人，这是根据新的共识标准进行的结构化面试确定的)。具体目的是：目的1)检查e-Stroop测量的复杂悲伤老年人的注意缺陷，并与对照组(简单悲伤和非丧亲者)进行比较；目的2)检查这三组中36名使用功能磁共振成像的老年人注意缺陷的神经基础；目的3)评估复杂悲伤老年人与对照组(简单悲伤和非丧失亲属者)比较的循环炎症标志物(如sTNF-RII、IL-6、SLL-6R和IL-1Ra)。该项目的长期目标是探索神经活动是否在循环炎症标记物和注意力缺陷之间的关系中起中介作用。加州大学洛杉矶分校考辛斯精神神经免疫学中心拥有出色的资源(例如3T成像扫描仪)和优秀的导师(包括Michael Irwin医学博士)，这些都是丧亲之痛、免疫学和神经成像研究方面的高级培训所必需的，这些培训将促进候选人Mary-France O‘Connor博士发展成为一名独立的研究员，并使她能够制定R01提案，以评估复杂悲伤的治疗，基于生理和心理机制。

DESCRIPTION (provided by applicant): Complicated Grief in Older Adults: Physiological Substrates of Emotion Regulation This application for a Career Development Award in Aging describes an integrated training plan and research project to allow the candidate to become an expert in the physiological underpinnings of emotion regulation in older adults. Conjugal bereavement is highly prevalent in older adults, with more than 900,000 people widowed each year in the U.S. Although most adjust gradually to widow(er)hood, others experience a complicated course. Complicated grief, which persists despite anti-depressant treatment, has been found to be an independent predictor of cognitive decline, poor health, depression and suicidality in older adults, making it a major public health concern. Cognitive factors, such as the inability to shift attention away from intrusive thoughts of the deceased are hypothesized to impair adjusting to a life as a widow(er). Furthermore, physiological mechanisms, such as low-grade inflammatory processes, may contribute to emotional dysregulation found in this population. The proposed research will assess neural activation, immune markers, and neuropsychological tests of attention and emotion regulation in older adults. We will recruit 135 older adults (45 with complicated grief, 45 with uncomplicated grief and 45 non-bereaved, determined by a structured interview with new consensus criteria). The specific aims are: Aim 1) To examine attentional deficits in older adults with complicated grief as measured by the e-Stroop as compared to controls (uncomplicated grief and non-bereaved); Aim 2) To examine the neural substrates of attentional deficits in a subsample of 36 older adults with fMRI in these three groups; Aim 3) To evaluate circulating markers of inflammation (e.g., sTNF-RII, IL-6, slL-6R and IL-1Ra) in older adults with complicated grief as compared to controls (uncomplicated grief and non-bereaved). The long-term goal of the project is to explore whether neural activity mediates the relationship between circulating markers of inflammation and attentional deficits. The Cousins Center for Psychoneuroimmunology at UCLA has both excellent resources (e.g. 3T imaging scanner) and excellent mentors (including Dr. Michael Irwin, MD) necessary for advanced training in bereavement, immunology, and neuroimaging research that will facilitate development of the candidate, Dr. Mary-Frances O'Connor, into an independent investigator and allow her to develop an R01 proposal to evaluate treatment for complicated grief, based on both physiological and psychological mechanisms.