Technology-Enabled Therapy for Elders with Mild Cognitive Impairment and Co-morbid Insomnia - Abstract
Mild cognitive impairment (MCI) is often viewed as a transitional stage between normal aging and early stage
of Alzheimer’s disease and related dementia. MCI affects up to 20% of the population of older adults, and
sleep disturbances have been identified as one of the core neuropsychiatric problems in MCI. Sleep
disturbances are associated with a range of negative outcomes for persons with MCI, including worsening
cognitive function, physical function, depression, and fatigue, which can all lead to functional impairments that
greatly reduce quality of life. One of the most common sleep disturbances in persons with MCI is insomnia,
with a prevalence of 44%. While non-pharmacological treatments, especially in-person cognitive behavioral
therapy for insomnia (CBTI), have demonstrated clinical efficacy in improving sleep and preserving cognitive
function in the general population of older adults, there have been few studies focused on adapting CBTI for
older adults with MCI.
The goal of this SBIR Phase I is to develop and test a provider-supported, technology-enabled system
to adapt and deliver evidence-based CBTI to persons with MCI and co-morbid insomnia, with the support of
health providers. The proposed intervention combines internet/mobile-based delivery and smart messaging
prompts as reminders to compensate for cognitive processes that can be impaired in MCI. Specific aims for
this Phase I include: (1) Develop a technology-enabled system to deliver CBTI for older adults with MCI; (2)
Conduct formative evaluations with persons with MCI to refine smart messaging prompts and test usability of
the patient software platform, and cognitive interviews with providers to assess feasibility of implementing the
intervention in the clinical setting; and (3) Conduct a six-week pilot randomized controlled trial to assess
preliminary effectiveness and feasibility of the CBTI intervention. We hypothesize that participants in the CBTI
intervention group will demonstrate a significant improvement in quality of sleep (both subjective and
objective), and an improvement in cognitive and physical functioning, compared to those in the control group.
Data collected in Phase I will be used to determine the sample size necessary for an adequately
powered Phase II randomized trial. If successful, this product will contribute to the adoption and dissemination
of a low-cost, multi-technology enabled CBTI intervention to reduce sleep disturbances, and improve cognitive
and physical function among persons with MCI. A successful Phase II study will result in a technology-enabled
program that can benefit multiple types of provider organizations (mental health clinics, primary care clinics,
and geriatric clinics) serving large numbers of older adults with MCI, thus having significant commercial
potential.
