Technology-Enabled Therapy for Elders with Mild Cognitive Impairment and Co-morbid Insomnia

Abstract Mild cognitive impairmentMCIis often viewed as a transitional stage between normal aging and early stage of Alzheimer s disease and related dementiaMCI affects up toof the population of older adultsand sleep disturbances have been identified as one of the core neuropsychiatric problems in MCISleep disturbances are associated with a range of negative outcomes for persons with MCIincluding worsening cognitive functionphysical functiondepressionand fatiguewhich can all lead to functional impairments that greatly reduce quality of lifeOne of the most common sleep disturbances in persons with MCI is insomniawith a prevalence ofWhile non pharmacological treatmentsespecially in person cognitive behavioral therapy for insomniaCBTIhave demonstrated clinical efficacy in improving sleep and preserving cognitive function in the general population of older adultsthere have been few studies focused on adapting CBTI for older adults with MCIThe goal of this SBIR Phase I is to develop and test a provider supportedtechnology enabled system to adapt and deliver evidence based CBTI to persons with MCI and co morbid insomniawith the support of health providersThe proposed intervention combines internet mobile based delivery and smart messaging prompts as reminders to compensate for cognitive processes that can be impaired in MCISpecific aims for this Phase I includeDevelop a technology enabled system to deliver CBTI for older adults with MCIConduct formative evaluations with persons with MCI to refine smart messaging prompts and test usability of the patient software platformand cognitive interviews with providers to assess feasibility of implementing the intervention in the clinical settingandConduct a six week pilot randomized controlled trial to assess preliminary effectiveness and feasibility of the CBTI interventionWe hypothesize that participants in the CBTI intervention group will demonstrate a significant improvement in quality of sleepboth subjective and objectiveand an improvement in cognitive and physical functioningcompared to those in the control groupData collected in Phase I will be used to determine the sample size necessary for an adequately powered Phase II randomized trialIf successfulthis product will contribute to the adoption and dissemination of a low costmulti technology enabled CBTI intervention to reduce sleep disturbancesand improve cognitive and physical function among persons with MCIA successful Phase II study will result in a technology enabled program that can benefit multiple types of provider organizationsmental health clinicsprimary care clinicsand geriatric clinicsserving large numbers of older adults with MCIthus having significant commercial potential Narrative More thanmillion people in the United States suffer from mild cognitive impairmentMCIwith overof them experiencing insomniaGiven the negative outcomes associated with MCI and co morbid insomniathere is strong interest in developing non pharmacological treatments for improving sleep in this population of older adultsThe proposed project provides a technology enabled system that is designed to adapt cognitive behavioral therapy for insomniaCBTIfor older adults with MCICombining emerging innovative technologies with evidence based practicethe proposed CBTI intervention system has the potential to be deployed by multiple provider organizationsincluding mental health clinicsprimary care clinicsgeriatric clinicsand home care agenciespotentially benefiting millions of older adults in the U Swho have MCI and co morbid sleep problems