Music-based Intervention for Insomnia in Persons Living with Dementia and their Caregivers

项目摘要 阿尔茨海默病患者的失眠症状(即入睡困难、睡眠维持困难) 疾病和相关痴呆症使人虚弱，并有助于增加制度化、减少 认知功能和加速疾病进展。此外，失眠障碍与贫穷有关。 照顾者的健康后果，如生活质量差和负担加重。考虑到潜在的有害因素 药物治疗的副作用，非药物治疗方法，如音乐，可能提供更安全的 改善失眠症状的替代方案。音乐干预特别有希望，因为长期的 阿尔茨海默病和相关痴呆症患者对音乐的记忆相对保留--即使在 本病处于中度阶段。先前关于音乐干预改善老年人睡眠的研究是 在主要是高加索老年人中对没有阿尔茨海默病和相关痴呆的人进行了调查 成年人。因此，有证据表明，在代表性不足的社区中，有针对性的音乐干预可以改善睡眠- 居住的痴呆症患者及其照顾者匮乏。在一项试验性研究中(由 NIA，F32AG060630)申请人已经审查了拟议的基于音乐的 对PLWD及其照顾者的干预并确定了改善接生的机会 干预。K23指导患者导向研究职业发展奖的目的是 为她提供必要的专业知识，以启动成功和独立的研究计划- 使用基于音乐的音乐改善PLWD及其照顾者睡眠和行为症状的最终目标 接近了。这项提议的具体目标是：i)构建并迭代地改进移动设备的原型 申请书，题为“为改善痴呆症患者的睡眠而个性化的镇静音乐” (作曲家)供PLWD及其照顾者使用；ii)在试点RCT中检查其可接受性；以及III) 功效。干预措施的发展将以利益攸关方的意见为指导，其中包括可持续发展计划 和他们的照顾者。72名二元组将随机接受为期4周的作曲家干预或 睡眠教育组。音乐选择将为PLWD量身定做，并考虑到已知的睡眠诱导 属性。可接受性将使用调查和定性数据进行检查。干预措施的影响 PLWD和照顾者的结果将使用客观(活动记录)和主观(代理报告)来确定 措施。在指导团队的指导下，申请者精心构建了研究性培训 获取四个核心领域的知识和专业知识的活动：i)以用户为中心的移动应用程序设计 技术，二)行为干预发展，三)基于社区的参与性研究，以及四) 行为研究方法，包括临床试验研究的测量、分析和传播。 拟议的研究项目的结果不仅将为更大规模的疗效试验提供信息，还将提供 申请人有机会获得必要的技能，开始她作为独立调查员的职业生涯。

Project Summary Insomnia symptoms (i.e., difficulty initiating sleep, maintaining sleep) in persons living with Alzheimer’s Disease and related Dementias are debilitating and contribute to increased institutionalization, reduced cognitive function and accelerated disease progression. Furthermore, insomnia disruption is linked to poor health outcomes in caregivers, such as poor quality of life and increased burden. Given the potential harmful side effects of pharmacologic treatment, non-pharmacologic approaches, such as music, may provide a safer alternative to improving insomnia symptoms. Music interventions are particularly promising because long-term memory for music remains relatively preserved in Alzheimer’s Disease and related Dementias - even in the moderate stage of the disease. Prior studies of music interventions to improve sleep in older adults were conducted with persons without Alzheimer’s Disease and related Dementias in primarily Caucasian older adults. Thus, the evidence for tailored music interventions to improve sleep in underrepresented community- dwelling persons living with dementia (PLWD) and their caregivers is lacking. In a pilot study (funded by the NIA, F32AG060630) the applicant has examined the feasibility of one component of the proposed music-based intervention in PLWD and their caregivers and identified opportunities to improve the delivery of the intervention. The purpose of this K23 Mentored Patient-Oriented Research Career Development Award is to provide her with the expertise necessary to initiate a successful and independent program of research – with the ultimate goal to improve sleep and behavioral symptoms in PLWD and their caregivers using music-based approaches. The specific aims of this proposal are to: i) build and iteratively refine the prototype of the mobile application, entitled, “Calming Music Personalized for Sleep Enhancement in PeRsons living with Dementia” (CoMPoSER) for use among PLWD and their caregivers; ii) in a pilot RCT examine its acceptability; and iii) efficacy. The development of the intervention will be guided by the input from stakeholders, including PLWD and their caregivers. Seventy-two dyads will be randomized to either the 4-week CoMPoSER intervention or sleep education group. Music selections will be tailored to PLWD and account for known sleep-inducing properties. Acceptability will be examined using survey and qualitative data. The effects of the intervention on PLWD and caregiver outcomes will be determined using objective (actigraphy) and subjective (proxy reported) measures. Under the guidance of the mentoring team, the applicant has carefully constructed research training activities to gain knowledge and expertise in four core areas: i) user-centered design of mobile application technology, ii) behavioral intervention development, iii) Community-based Participatory Research, and iv) behavioral research methods, including measurement, analysis and dissemination of clinical trial research. Results from the proposed research project will not only inform a larger efficacy trial, but also provide an opportunity for the applicant to gain the necessary skills to launch her career as an independent investigator.