Saturday, May 17, 2025
5/17/2025
Development of an online mindfulness training program for adults with subjective cognitive decline - PROJECT SUMMARY In the United States alone, in thirty years, prevalence rates of Alzheimer’s disease (AD) are projected to be at 13.8 million, with familial and societal costs estimated at $800 billion US dollars annually. With limited treatment options, there has been a renewed focus on targeting neurodegenerative, pathophysiological processes through behavioral and lifestyle-based interventions in the prodromal phase of AD. Presence of subjective cognitive decline (SCD)—referring to perceived persistent declines in cognitive functioning compared with previously normal cognitive status—has been identified as a potential preclinical stage of AD. Individuals with SCD show steeper declines in cognitive functioning later in life and have a higher rate of conversion to dementia. Moreover, SCD is also associated with the classical neural signatures of AD. Additionally, as individuals with SCD, by definition, show no objective indication of cognitive decline but are known to seek medical advice at memory disorders clinics, they make ideal candidates for prevention research. In the proposed application, our overall objective is to develop and test the feasibility of an entirely online, asynchronous mindfulness training program, and an active control group—internet-based Lifestyle Education (iLifeEd)—for targeting mind-wandering and plasma-based biomarkers of amyloid beta (Aβ) and tau pathology in adults with subjective cognitive decline. Mindfulness meditation involving the cultivation of purposeful and nonjudgmental attention to specific phenomena as they arise holds significant promise as an attention training platform. There is increasing support for engagement in mindfulness practices to reduce mind-wandering and enhance the executive control of attention, partially via mindfulness-induced alterations in connectivity of the default mode network with other large-scale networks. More recently, mindfulness has also been linked with higher volumes of the hippocampus, lower levels of amyloid burden and tauopathy in mid-life and older adults, suggesting a potential link between mindfulness training and AD biomarkers. However, clinical trials of mindfulness meditation are predominantly in-person, group-based MSBR programs that limit accessibility, and where online programs have been examined, studies show poor adherence and high attrition The proposed project is divided into two main objectives, wherein Aim 1 will iteratively develop and refine the iMBSR and iLifeEd protocols with a team of stakeholders, including psychologists, contemplative scholars, instructional design specialist, computer programmers, and focus group participants. Aim 2 is a Stage I pilot study, examining the feasibility of iMBSR and iLifeEd protocols, in an independent sample of 60 adults with subjective cognitive decline. Our main hypothesis is that iMBSR, carefully curated to include active components of the MBSR program, and designed to be entirely self-paced and online, will be feasible and acceptable to adults at higher risk for developing AD and other related dementias.
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