Addressing the chronic pain-early cognitive decline comorbidity among older adults; The Active Brains study

项目摘要 慢性疼痛和早期认知能力下降在老年人中越来越普遍，双向相关， 阿尔茨海默病和相关痴呆症（ADRD）的个体风险因素。慢性疼痛与认知功能 衰退相互加剧，使个人陷入“残疾螺旋”或身体、情感和精神状况恶化， 认知功能与ADRD风险增加。目前还没有基于证据的治疗方法， 解决老年人中慢性疼痛-早期认知能力下降的并发症。在NCCIH的资助下， NIA我们使用混合方法迭代开发多模态，理论基础，基于群体的身心活动 该计划专为患有慢性疼痛和早期认知能力下降的老年人的独特需求而量身定制。该计划有助于 老年人管理疼痛，增加认知储备，并增加对他们有意义的活动的参与 使用基于配额的起搏，并由数字监控设备加强。该方案具有良好的可行性， 虚拟交付和远程数据收集的可接受性。计划参与与以下方面的改善有关： 多模式身体功能（自我报告，6分钟步行测试和Actigraph测量步数），情绪功能 （抑郁和焦虑），认知功能（自我报告和客观），疼痛强度和理论知情的调解人。 在我们有希望的研究的基础上，我们现在建议对我们的身心活动计划进行一项全面的RCT （活跃的大脑-数字）与教育控制（健康增强计划），两者都是在 N=260名患有慢性肌肉骨骼疼痛和早期认知功能下降的老年人。我们将建立有效的活性 大脑-数字化，6个月以上的持续改进，以及通过相关中介和 版主。试验将在马萨诸塞州综合医院进行，采用我们已建立的方法， 基础设施演进Active Brains-Digital有可能成为第一个针对老年人的循证计划， 慢性疼痛和早期认知功能下降，对预防AD/ADRD的重要意义，在这个高风险 人口该项目直接与国家执行局战略目标C，具体目标1和3相一致。

PROJECT SUMMARY Chronic pain and early cognitive decline are increasingly prevalent among older adults, bidirectionally related, and individual risk factors for Alzheimer’s Disease and Related Dementias (ADRD). Chronic pain and cognitive decline exacerbate each other, placing individuals on a “disability spiral” or worsened physical, emotional, and cognitive functioning with incremental risk of ADRD. Currently there are no evidence-based treatments that successfully address the chronic pain-early cognitive decline comorbidity among older adults. With funding from NCCIH and NIA we used mixed methods to iteratively develop a multimodal, theory grounded, group-based mind-body activity program tailored to the unique needs of older adults with chronic pain and early cognitive decline. The program helps older adults manage pain, increase cognitive reserves, and increase engagement in activities that are meaningful to them using quota-based pacing reinforced by a digital monitoring device. The program shows excellent feasibility and acceptability for virtual delivery and remote data collection. Program participation is associated with improvement in multimodal physical function (self-report, 6-minute walk test and Actigraph measured stepcount), emotional function (depression and anxiety), cognitive function (self-report and objective), pain intensity and theory informed mediators. Building on our promising study we now propose to conduct a fully powered RCT of our mind-body activity program (Active Brains-Digital) versus an educational control (Health Enhancement Program) both delivered virtually among N=260 older adults with musculoskeletal chronic pain and early cognitive decline. We will establish efficacy of Active Brains-Digital, sustainability of improvement over 6 months, and mechanisms of change through relevant mediators and moderators. The trial will take place at the Massachusetts General Hospital using our established methodology and infrastructure. Active Brains-Digital has the potential to be the first evidence-based program for older adults with chronic pain and early cognitive decline, with important implications for prevention of AD/ADRD in this high risk population. This project directly aligns with NIA strategic Goal C, objectives 1 and 3.