Targeting cognitive function and interoceptive awareness to improve self-management in patients with co-morbid heart failure and cognitive impairment.

针对认知功能和内感受意识，改善合并心力衰竭和认知障碍患者的自我管理。

• 批准号: 10410772
• 负责人: Elena Salmoirago-Blotcher
• 金额: $ 75.43万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-05 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10410772
• 关键词: Address; Affect; Aging; Attention; Awareness; Behavioral; Biological Markers; Cardiac; Cellular Phone; Cerebrovascular Disorders; Chronic; Clinical; Cognition; Diagnosis; Education; Elderly; Electronics; Ensure; Event; Health Care Costs; Heart failure; Hospitals; Impaired cognition; Individual; Interoception; Intervention; Intervention Studies; Investigation; Knowledge; Life Style; Link; Mediating; Mindfulness Training; Monitor; National Institute on Aging; Outcome; Outpatients; Participant; Pathway interactions; Patient Education; Patients; Pharmacology; Phase; Physiological; Population; Prognosis; Randomized; Recommendation; Rehabilitation therapy; Relaxation; Role; Self Care; Self Management; Signal Transduction; Symptoms; Telephone; Testing; Time; United States; Vulnerable Populations; Work; age group; aging population; cerebral hypoperfusion; cognitive function; cognitive performance; comorbidity; design; digital; follow-up; hospital readmission; improved; innovation; interest; medical attention; mild cognitive impairment; mortality; multiple chronic conditions; pandemic disease; prevent; programs; response; skills; treatment as usual

PROJECT SUMMARY/ABSTRACT Due to population ageing, heart failure (HF) is reaching pandemic proportions and is now the most common hospital discharge diagnosis among older adults in the United States. HF carries an unfavorable prognosis, with both 6-month hospital readmissions and 5-year mortality rates reaching 50%. To improve clinical outcomes, it is critical that patients implement adequate self-care, i.e., they adhere to pharmacological and lifestyle recommendations and monitor their symptoms to ensure they receive medical attention in a timely fashion. Mild cognitive impairment (MCI) affects up to two-thirds of patients with HF and is a key barrier to their ability to effectively implement self-care. Despite its negative impact on self-care and on clinical outcomes, only a small number of self-care intervention studies specifically address MCI and interventions targeting this important comorbidity are sorely needed. There is preliminary evidence that mindfulness training (MT) can improve cognitive function in individuals with MCI. MT has also been shown to improve interoceptive awareness, a skill which could increase the patient’s ability to recognize worsening of HF symptoms in a timely fashion, receive treatment sooner, and potentially prevent re-admissions. Finally, by eliciting the relaxation response, MT enhances vagal control, which has been associated with better cognitive function. This application, designed in response to PAR-20-180 “Identifying innovative mechanisms or interventions that target multimorbidity and its consequences” and in line with NIA interests, will leverage our expertise with remote MT for patients with chronic conditions to conduct a phase II mechanistic RCT with the following objectives: a) To study the effects of MT on cognitive function and interoceptive awareness in patients with co- morbid MCI and HF, b) To assess whether improvements in these proximal factors could positively impact self- care and c) To study the underlying physiological mechanisms by which MT could improve cognition in this population. Stable outpatients (n=176) with HF and MCI will be randomly assigned to phone-delivered MT (a weekly, 30-minute session for 8 weeks integrated with a 20-min guided daily individual practice via digital recordings) plus enhanced usual care (EUC) or to EUC alone. Consistent with current recommendations, usual care will be enhanced in both groups with self-care education materials. At baseline, 3 months (end of treatment), and 9 months since baseline participants will undergo comprehensive assessments of cognitive function, interoceptive awareness, HF self-care and other psycho-behavioral factors, cardiac vagal control, and HF biomarkers. This is the first rigorous investigation of the effects of MT on cognitive function, interoceptive awareness, and self-care in patients with co-morbid MCI and HF. Demonstrating that, by improving cognitive performance and interoceptive awareness, MT promotes self-care in patients with co-morbid HF and MCI will pave the way to the integration of MT into rehabilitation programs and self-care interventions to improve clinical outcomes in this vulnerable population.

项目摘要/摘要 由于人口衰老，心力衰竭（HF）达到了大流行比例，现在是最常见的 美国老年人的医院出院诊断。 HF带有不利的预后， 6个月的医院再入院率和5年死亡率达到50％。改善临床 结果，至关重要的是，患者实施足够的自我保健，即他们遵守药物和 生活方式建议并监测其症状，以确保他们及时接受医疗护理 时尚。轻度认知障碍（MCI）最多影响三分之二的HF患者，并且是其其关键障碍 有效实施自我保健的能力。尽管对自我保健和临床结果的负面影响，但仅 少数自我保健干预研究专门针对MCI和针对此目的的干预措施 重要的合并症非常需要。有初步证据表明正念培训（MT）可以 改善MCI个体的认知功能。 MT还显示出可提高感受性的 意识，这项技能可以提高患者及时识别HF症状后悔的能力 时尚，尽快接受治疗，并有可能防止重新入场。最后，通过引起放松 响应，MT增强了迷走神经控制，这与更好的认知功能有关。这 应用于响应于20年至180年的“确定创新机制或干预措施”的应用程序。 目标多发生及其后果”，并符合NIA的利益，将利用我们的专业知识 具有慢性病患者进行II期机械RCT的远程MT 目标：a）研究MT对共同患者认知功能和感受性意识的影响 病态MCI和HF，b）评估这些近端因素的改善是否可以对自我产生积极影响 护理和c）研究MT可以改善认知的潜在物理机制 人口。 HF和MCI的稳定门诊病人（n = 176）将随机分配到电话交付的MT（a） 每周，通过数字数字进行了20分钟指导的每日练习，为期30分钟，共8周 录音）加上加强的常规护理（EUC）或单独使用EUC。与当前的建议一致 两组具有自我保健教育材料的小组都将得到注意。基线，3个月（结束 治疗），自基准参与者将经过认知的全面评估以来9个月 功能，感官意识，HF自我保健和其他心理行为因素，心脏迷走神经控制和 HF生物标志物。这是MT对认知功能的影响的第一笔严格投资 合并MCI和HF患者的意识和自我保健。证明这一点，通过提高认知 表现和感受性的意识，MT促进了HF和MCI的患者的自我保健 铺平了将MT整合到康复计划和自我保健干预措施中的道路，以改善临床 这个脆弱人群的结果。