Multicomponent Behavioral Sleep Intervention for Insomnia in Older Adults with Mild Cognitive Impairment

多成分行为睡眠干预治疗轻度认知障碍老年人失眠

• 批准号: 9923768
• 负责人: Miranda Varrasse McPhillips
• 金额: $ 15.38万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9923768
• 关键词: Achievement; Address; Adherence; Aerobic; Affect; Alzheimer' s Disease; Anxiety; Assisted Living Facilities; Attention; Beds; Behavior Therapy; Behavioral; Biological Markers; Clinical Trials; Cognition; Cognitive; Cognitive Therapy; Collection; Communities; Consult; Control Groups; Coupled; Data; Data Analyses; Degenerative Disorder; Development; Discipline of Nursing; Disease susceptibility; Education; Educational workshop; Elderly; Emotional; Enrollment; Etiology; Exercise; Feedback; Foundations; Future; Goals; Health; Health Personnel; Hygiene; Impaired cognition; Impairment; Inflammatory; Intervention; Intervention Studies; Intervention Trial; Knowledge; Link; Literature; Manuscripts; Measurement; Measures; Memory impairment; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Mission; Modeling; Monitor; National Institute of Nursing Research; Nursing Homes; Oral; Outcome; Participant; Patients; Peer Review; Persons; Pharmacologic Substance; Pharmacology; Pilot Projects; Populations at Risk; Preparation; Prevalence; Protocols documentation; Public Health; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Relaxation; Relaxation Therapy; Reporting; Research; Research Activity; Research Personnel; Risk; Risk Factors; SF-36; Scientist; Sleep; Sleep Disorders; Sleep disturbances; Sleeplessness; Standardization; Stress; Structure; Symptoms; Tablets; Technology; Telephone; Testing; Time; Training; Training Activity; Translational Research; United States National Institutes of Health; Vulnerable Populations; Writing; actigraphy; active control; awake; base; behavioral clinical trial; brief intervention; career; career development; classical conditioning; clinical practice; data exchange; diaries; efficacy testing; epidemiology study; follow-up; handheld mobile device; health related quality of life; improved; innovation; laboratory experience; medical complication; mild cognitive impairment; mobile computing; novel; personalized care; post intervention; programs; psychologic; real time monitoring; research study; sleep health; sleep onset; sleep quality; social; symptom management; symptomatic improvement

PROJECT SUMMARY It is estimated that 7% to 20% of older adults have mild cognitive impairment (MCI) and 60% of people with MCI have some sleep disturbances. Insomnia is the most common sleep disturbance in older adults and is characterized by difficulty initiating or maintaining sleep, awakening too early, and next day consequences such as difficulty concentrating. The proposed project seeks to address a major gap in the literature and clinical practice, lack of effective nonpharmacological treatments for insomnia in older adults with mild cognitive impairment. We propose conducting a randomized pilot study testing a brief (4 week), tablet-based, personalized, multicomponent behavioral sleep intervention for insomnia (MBSI-I) that will target known etiological risk factors and perpetuators of insomnia among older adults with mild cognitive impairment, compared to a sleep education control. Key components of the intervention include stimulating meaningful activity during the day and promoting relaxation therapy at night. We will determine preliminary immediate (one month) and sustained efficacy (3 months) of MBSI-I compared to sleep education on sleep related outcomes and health related quality of life. Additionally, we will explore mechanisms by which MBSI-I affects sleep and health related quality of life using standardized questionnaires and inflammatory biomarkers. Real-time monitoring of intervention adherence, using mobile device technology with real time data transmission, represents a fundamental change in the insomnia treatment paradigm and will be most beneficial given that this group has memory impairments. Upon completion, this proposal will provide foundational knowledge for large scale intervention trials and address limitations in current insomnia treatments in patients with mild cognitive impairment. This research closely aligns with the strategic mission of the National Institute of Nursing Research because it proposes strategies to personalize care and use real time health information to improve symptoms of insomnia in older adults with mild cognitive impairment and to build evidence toward successful symptom management in this vulnerable population. Furthermore, the interdisciplinary training plan and goals developed for this proposal will fill a critical void in my current skillset and provide me the expertise necessary to initiate a successful and independent program of research related to improve sleep and health-related quality of life in at-risk older adults. By expanding my knowledge of 1) mobile device technology, 2) measurement of cognitive health related outcomes, 3) clinical trials of behavioral interventions and translational research, 4) biomarker assessment, and 5) scientific writing, oral presentations, manuscript development and peer review, I will be able to conduct research to evaluate more effective nonpharmacological treatments for sleep problems in older adults. To facilitate the achievement of my career development goals, I will follow an intensive training plan that incorporates coursework, laboratory training, mentoring and seminars, workshops, and other structured activities; participation in research studies, data analysis, and manuscript preparation; professional development activities; and close mentorship. Overall, the research and training activities in this proposal will build a strong foundation for my career as an independent investigator.

项目摘要 据估计，有7％至20％的老年人患有轻度认知障碍（MCI），而有MCI的人中有60％ 一些睡眠障碍。失眠是老年人最常见的睡眠障碍，其特征是困难 发起或保持睡眠，过早唤醒以及第二天的后果，例如困难。这 拟议的项目旨在解决文献和临床实践中的主要差距，缺乏有效的非药理学 患有轻度认知障碍的老年人失眠的治疗方法。我们建议进行一项随机试验研究 测试简短的（4周），基于平板电脑的，个性化的，多组分的行为睡眠干预措施（MBSI-I） 这将针对患有轻度认知的老年人中已知的病因危险因素和失眠的永久性因素 与睡眠教育控制相比，损害。干预的关键组成部分包括刺激有意义的 白天的活动并促进晚上放松疗法。我们将立即确定初步（一个月） 与睡眠教育有关睡眠与睡眠相关和与健康相关的睡眠教育相比，MBSI-I的持续疗效（3个月） 生活质量。此外，我们将探索MBSI-I影响睡眠和与健康相关的生活质量的机制 使用标准化问卷和炎症生物标志物。实时监控干预依从性，使用 带有实时数据传输的移动设备技术代表失眠治疗的根本变化 范式范式将是最有益的，因为该组有记忆障碍。完成后，该建议将 提供大规模干预试验的基本知识，并解决当前失眠治疗中的局限性 在轻度认知障碍的患者中。这项研究与国家研究所的战略使命密切相符 护理研究是因为它提出了个性化护理和使用实时健康信息来改进的策略 老年人患有轻度认知障碍的老年人失眠的症状，并为成功症状建立证据 在这个脆弱人群中的管理。此外，为此而制定的跨学科培训计划和目标 提案将填补我当前技能的关键空隙，并为我提供了启动成功和的必要专业知识 独立的研究计划与高危老年人改善睡眠和与健康相关的生活质量有关。经过 扩展我对1）移动设备技术的了解，2）测量与认知健康相关结果的测量，3） 行为干预和翻译研究的临床试验，4）生物标志物评估，以及5）科学写作， 口头演示，手稿开发和同行评审，我将能够进行研究以评估更有效 老年人睡眠问题的非药物治疗。促进我职业生涯的成就 发展目标，我将遵循一项密集的培训计划，该计划包括课程工作，实验室培训，指导 以及研讨会，讲习班和其他结构化活动；参与研究，数据分析和手稿 准备;专业发展活动；和密切的指导。总体而言，其中的研究和培训活动 提案将为我作为独立调查员的职业奠定坚实的基础。