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 (Aß) 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.