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

解决老年人慢性疼痛-早期认知能力下降的合并症；

• 批准号: 10370093
• 负责人: Christine S Ritchie
• 金额: $ 59.47万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10370093
• 关键词: Address; Adherence; Alzheimer disease prevention; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Anxiety; Awareness; Behavior; Benchmarking; Brain; Breathing; Bypass; Cellular Phone; Clinical Trials; Cognition; Cognitive; Consent; Coping Skills; Data; Data Collection; Education; Elderly; Emotional; Enrollment; Evidence based program; Evidence based treatment; Exercise; Funding; General Hospitals; Geriatrics; Goals; Health; Hip region structure; Impaired cognition; Individual; Infrastructure; Intervention; Interview; Investigation; Life; Link; Massachusetts; Measures; Mediating; Mediator of activation protein; Mental Depression; Methodology; Methods; National Center for Complementary and Integrative Health; Neurobehavioral Manifestations; Outcome; Pain; Pain intensity; Pain management; Participant; Patient Self-Report; Patients; Performance; Persistent pain; Pharmaceutical Preparations; Physical Function; Population; Psychology; Randomized; Reaction; Reporting; Respiratory Diaphragm; Scanning; Single-Blind Study; Strategic Planning; Stress; Technology Assessment; Testing; Time; Walking; Wrist; acceptability and feasibility; actigraphy; active control; adverse event risk; barrier to care; base; blind; body-mind; chronic musculoskeletal pain; chronic pain; clinical predictors; clinically relevant; cognitive benefits; cognitive function; cognitive performance; cognitive reserve; comorbidity; depressive symptoms; digital; disability; effective intervention; efficacy testing; emotional functioning; ethnic minority; experience; falls; feasibility trial; fitbit; follow-up; high risk population; improved; intervention delivery; mindfulness; monitoring device; multidisciplinary; multimodality; normal aging; novel; pain catastrophizing; pain symptom; pre-clinical; primary outcome; programs; racial and ethnic; racial minority; recruit; reinforcer; response; secondary outcome; side effect; skills; slow potential; theories; uptake; virtual; virtual delivery

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.

项目概要 慢性疼痛和早期认知能力下降在老年人中越来越普遍，并且是双向相关的 阿尔茨海默病和相关痴呆症 (ADRD) 的个体危险因素。 衰退使彼此恶化，使个人陷入“残疾螺旋”或身体、情感和精神状况恶化。 ADRD 风险增加的认知功能目前尚无成功的循证治疗方法。 在 NCCIH 和 NIA 我们使用混合方法迭代开发多模式、基于理论、基于群体的身心活动 该计划针对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。 老年人控制疼痛，增加认知储备，并更多地参与对他们有意义的活动 使用由数字监控设备加强的基于配额的节奏该计划显示出良好的可行性和有效性。 虚拟交付和远程数据收集的可接受性与改进有关。 多模式身体功能（自我报告、6 分钟步行测试和 Actigraph 测量的步数）、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中介。 基于我们有希望的研究，我们现在建议对我们的身心活动计划进行全面的随机对照试验 （活跃大脑-数字）与教育控制（健康增强计划）均以虚拟方式在 N=260 名患有肌肉骨骼慢性疼痛和早期认知能力下降的老年人 我们将确定 Active 的功效。 Brains-Digital、6 个月内改进的可持续性以及通过相关中介和机制进行的变革机制 试验将使用我们既定的方法在马萨诸塞州总医院进行。 Active Brains-Digital 有潜力成为第一个针对老年人的循证计划。 慢性疼痛和早期认知能力下降，对于预防这种高风险人群的 AD/ADRD 具有重要意义 该项目与 NIA 战略目标 C、目标 1 和 3 直接一致。