Improving Brain Health in Older Veterans: A Mindfulness Training Pilot Study

Va Northern California Health Care Sys, Mather CA

Investigators

Abstract

Extensive efforts have been pointed towards determining approaches by which brain health can be enhanced in older adults given the rapid increase in the U.S. aging population, including Veterans, and rising incidence of Alzheimer?s disease and other forms of cognitive impairment. Additional attention is now also focusing on concerns of accelerated aging processes in Veterans due to common morbidities such as history of traumatic brain injury and posttraumatic stress disorder (PTSD). Thus, finding interventions that can improve brain health in older adult Veterans is critical. Mindfulness-based training has proven effective in improving brain health in younger and middle-aged adults, though there is a paucity of studies that have addressed the potential efficacy of mindfulness training in older adults. Interestingly, areas of cognition that experience the greatest extent of enhancement from mindfulness training are also some of the same primary areas most susceptible to the effects of aging, such as attention, processing speed and cognitive control. In addition, mindfulness training holds the potential to simultaneously address other dimensions of brain health such as stress and anxiety reduction, and associated beneficial decreases in blood pressure and cortisol (a primary effector arm of the stress response). The proposed mixed methods pilot study builds on current on-going work by the Principal Investigator and Co-Investigator in which Mindfulness-Based Stress Reduction (MBSR) is being used to improve cognition and reduce stress in Veterans with stroke and with chronic mild traumatic brain injury/PTSD. We propose a randomized, controlled trial of MBSR versus a Psychological Education (PEd) group in order to determine the acceptability, feasibility, and potential efficacy of MBSR in improving brain health in older Veterans. Fifty-eight subjects will be randomly assigned to MBSR or PEd groups. Specific Aim 1 evaluates the acceptability and feasibility of older adults participating in Mindfulness-Based Stress Reduction (MBSR). Specific Aim 2 evaluates the potential efficacy of MBSR in older Veterans to enhance attention abilities. Specific Aim 3 evaluates the potential efficacy of MBSR in older Veterans to reduce anxiety and biomarkers of stress (i.e., blood pressure and cortisol). Assessments will be conducted immediately prior to and after intervention, as well as three months following intervention. Based on pilot work by our group with Veterans, and outcome studies of mindfulness-based interventions in other populations, it is predicted that MBSR will be both acceptable and feasible in healthy older Veterans (Specific Aim 1), will enhance attentional abilities (Specific Aim 2), and will decrease both subjectively reported anxiety and physiological measures of stress (Specific Aim 3). Mindfulness-based intervention offers a compelling and novel, side-effect free intervention to improve brain health in our aging Veterans, ultimately presenting the possibility of significantly increased quality of life, delayed age-related declines, and decreased health-care utilization, with associated medical care cost savings. MBSR lends itself well to VA rollout given its straightforward structure and application, allowing for ease of dissemination should it prove acceptable, feasible and efficacious for older Veterans.