Complicated Grief in Older Adults: Physiological Substrates of Emotion Regulation

描述（由申请人提供）：老年人的复杂悲伤：情绪调节的生理基质这份老龄化职业发展奖的申请描述了一个综合培训计划和研究项目，使候选人成为老年人情绪调节生理基础方面的专家。配偶丧亲在老年人中非常普遍，美国每年有90多万人丧偶。虽然大多数人逐渐适应丧偶，但其他人经历了一个复杂的过程。复杂的悲伤，尽管抗抑郁治疗仍然存在，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入性想法中转移出来，被假设为损害对寡妇生活的适应。此外，生理机制，如低度炎症过程，可能有助于在这一人群中发现的情绪失调。这项拟议中的研究将评估老年人的神经激活、免疫标记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名患有复杂性悲伤，45名患有单纯性悲伤，45名没有丧失亲人，通过新的共识标准进行结构化访谈确定）。具体目标是：目的1）检查与对照组（单纯性悲伤和非丧亲）相比，通过e-Stroop测量的患有复杂性悲伤的老年人的注意力缺陷;目的2）检查这三组中36名老年人的fMRI子样本中注意力缺陷的神经基质;目的3）评估炎症的循环标志物（例如，sTNF-RII、IL-6、sIL-6 R和IL-1 Ra）与对照组（单纯性悲伤和非丧亲者）的比较。该项目的长期目标是探索神经活动是否介导炎症循环标记物和注意力缺陷之间的关系。加州大学洛杉矶分校的心理神经免疫学研究中心拥有这两种优秀的资源（如3 T成像扫描仪）和优秀导师（包括博士迈克尔欧文，医学博士）必要的先进培训丧亲之痛，免疫学和神经影像学研究，这将有利于发展的候选人，博士玛丽弗朗西斯奥康纳，成为一个独立的调查员，并允许她开发一个R 01的建议，以评估治疗复杂的悲伤，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.