Anxiety psychopathology is highly prevalent in people living with mild cognitive impairment (MCI),
Alzheimer's disease and related dementias (ADRD) and their care partners. Recent meta-
analyses suggest clinically significant anxiety symptoms in approximately 40% of those with
ADRD and approximately 25% in their care partners, as well as increased rates of anxiety in
clinical samples of patients with MCI. Moreover, a recent review suggests that elevated anxiety
is a marker for and potentially contributes to earlier onset of ADRD symptoms among those with
MCI. Despite this, there are no well-established interventions for anxiety in MCI/ADRD or their
care partners. Moreover, prior treatment protocols for anxiety are lengthy, excessively rely on
intact memory and cognitive abilities, and result in high dropout rates. Brief, mechanism focused
interventions offer an efficient, alternative approach to dealing with anxiety in people with
MCI/ADRD and their care partners. Anxiety sensitivity (AS) is an extremely well-researched risk
mechanism relevant to the genesis and maintenance of anxiety and other forms of
psychopathology. AS acts as a broad stress amplification factor as it exacerbates the experience
of somatic and emotional sensations, leading to increased distress. As such, individuals with
elevated AS are more likely to experience exaggerated responses to a wide array of stressors
including cognitive symptoms (e.g., concentration and memory problems). Fortunately, focused
interventions have been developed showing that AS can be quickly and effectively reduced.
These interventions include psychoeducation but focus heavily on interoceptive exposure (IE)
exercises designed to reduce conditioned fear to anxiety-provoking internal stimuli. Across clinical
trials, evidence shows such interventions can markedly reduce AS and that these reductions
mediate reductions in anxiety symptoms. While AS interventions have been successfully used in
a variety of samples, they have not been tested for people with MCI/ADRD. We propose to
conduct a fully powered randomized clinical trial (RCT) to test a brief, CBT-based intervention,
called cognitive anxiety sensitivity treatment (CAST) for people with MCI/mild AD. We
believe the IE component of CAST will be particularly relevant to MCI/mild ADRD where learning
may be compromised due to cognitive decline. Moreover, our preliminary data suggest that CAST
yields medium to high effect size reductions in AS and anxiety in older adults with MCI. Dyads
consisting of MCI/mild AD and their care partners will be randomized to CAST to a Health
Education Control (HEC) condition (N = 197) and followed for six months to evaluate change in
anxiety and distress, cognitive functioning and quality of life.
