Mindfulness Meditation and Insomnia in Alzheimer Disease Caregivers: Inflammatory and Biological Aging Mechanisms

阿尔茨海默病护理人员的正念冥想和失眠：炎症和生物衰老机制

• 批准号: 10200615
• 负责人: Michael R Irwin
• 金额: $ 68.98万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200615
• 关键词: Aging; Alzheimer' s Disease; Alzheimer' s disease caregiver; American; Attenuated; Awareness; Behavior; Behavior Therapy; Behavioral; Biological; Biological Aging; C-reactive protein; CDKN2A gene; Cardiovascular Diseases; Caregiver Burden; Caregivers; Cell Aging; Chronic; Chronic Disease; Clinical; Cognitive Therapy; Communities; Cytokine Activation; DNA Damage; Data; Dimensions; Disease Marker; Disease remission; Education; Educational Curriculum; Elderly; Equipment and supply inventories; Family health status; Fatigue; Fibrinogen; Functional disorder; Gene Expression; Geroscience; Goals; Health; Healthcare; Incidence; Individual; Inflammation; Inflammatory; Intervention; Intervention Trial; Left; Malignant Neoplasms; Medical; Meta-Analysis; Mindfulness Training; Mitochondria; Modeling; Molecular; Morbidity - disease rate; Nuclear; Outcome; Pharmaceutical Preparations; Phenotype; Population; Prevalence; Primary Health Care; Production; Public Health; Randomized Controlled Trials; Reporting; Research; Risk; Risk Factors; Self Care; Self Management; Signal Transduction; Sleep; Sleep disturbances; Sleeplessness; Societies; Spouse Caregiver; Stress; TLR4 gene; Telomerase; Telomere Shortening; United States National Institutes of Health; actigraphy; base; behavioral health; burden of illness; caregiving; cost; cytokine; depressive symptoms; diaries; disorder risk; experience; follow-up; genomic biomarker; healthspan; improved; indexing; inflammatory marker; innovation; mindfulness; mindfulness intervention; mindfulness meditation; modifiable risk; monocyte; mortality; mortality risk; perceived stress; primary outcome; response; screening; secondary outcome; senescence; sleep quality; targeted treatment; telomere; transcriptome

Project Summary/Abstract This randomized controlled trial aims to evaluate the ability of validated, curriculum based, mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I) vs. Sleep Seminar (SS), an active education control, to treat insomnia in older adult Alzheimer Disease (AD) spousal caregivers with insomnia (N=150) over one-year follow-up. This study also aims to identify whether treatment of insomnia reverses the adverse trajectories of mechanisms of disease risk indicators, namely inflammation and cellular aging. Over 5 million Americans provide informal AD caregiving, which negatively impacts health and is associated with a 63% greater risk of mortality as compared to non-caregiving controls. Insomnia occurs in over 60% of AD caregivers and has independent negative influences on caregiver health and mechanisms of disease risk. Finally, insomnia is a modifiable risk factor, yet no prior study has targeted insomnia in AD caregivers. We have found that MAP-I improves sleep complaints in older adults. Further, we have shown that mindfulness based treatment of insomnia reduces cellular and genomic markers of inflammation and slows cellular aging as indexed by telomere erosion over a one year period. Inflammation and cellular aging in late life predict morbidity and mortality, making these biological mechanisms valuable markers of disease risk in AD caregivers. The specific aims of the study are to 1) determine the effects of MAP-I vs. SS on subjective and objective dimensions of insomnia; 2) evaluate the effects of MAP-I vs. SS on cellular and genomic markers of inflammation; 3) evaluate the effects of MAP-I vs. SS on markers of cellular aging. We will explore moderating effects of caregiver stress on insomnia outcomes, and also the effects of MAP-I vs. SS on outcomes of caregiver stress, health functioning, chronic medical morbidity and related medication use at follow-up. If successful, this research will identify whether treatment of a modifiable risk factor, insomnia, influences sleep and two mechanisms of disease risk, namely, inflammation and cellular aging, which has implications for improving overall health-span of AD caregivers as well as older adults.

项目摘要/摘要 这项随机对照试验旨在评估经过验证的，基于课程的，基于正念的干预措施，被称为失眠症（MAP-I）与睡眠研讨会（SS），一种积极的教育控制，一种对治疗老年人阿尔茨海默疾病（AD）配偶的体育护理中的失眠症的能力（SS），对Insomnia（Insomnia）（Insomnia）（n Insomnia）（n Insomnia）（n = 150）。这项研究还旨在确定失眠症治疗是否会逆转疾病风险指标机制的不利轨迹，即炎症和细胞衰老。超过500万美国人提供非正式的广告照顾，这对健康产生了负面影响，与非关注控制相比，死亡风险高63％。失眠发生在60％以上的AD护理人员中，对护理人员的健康和疾病风险机制产生了独立的负面影响。最后，失眠是一种可修改的危险因素，但先前的研究没有针对AD护理人员的失眠症。我们发现MAP-I改善了老年人的睡眠投诉。此外，我们已经表明，基于正念的失眠症的治疗可降低炎症的细胞和基因组标志物，并减慢一年内端粒侵蚀所索引的细胞衰老。晚期的炎症和细胞衰老预测了发病率和死亡率，使这些生物学机制在AD护理人员中具有宝贵的疾病风险标志物。研究的具体目的是1）确定MAP-I与SS对失眠的主观和客观维度的影响； 2）评估MAP-I与SS对炎症的细胞和基因组标记的影响； 3）评估MAP-I与SS对细胞衰老标记的影响。我们将探讨护理人员应力对失眠症结果的调节作用，以及MAP-I与SS对护理人员压力，健康功能，慢性医疗发病率和随访时使用相关药物使用的影响。如果成功的话，这项研究将确定对可修改的危险因素，失眠，影响睡眠和疾病风险的两种机制的治疗，即炎症和细胞衰老，这对改善了AD护理人员以及老年人的整体健康状况具有影响。