Feasibility of Internet-Based Mind-Body Training for Adults With Subjective Cognitive Decline: Protocol for a Randomized Controlled Trial

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Abstract
Background: In the United States, the prevalence of Alzheimer disease (AD) is projected to double over the next 30 years, with associated familial and societal costs estimated at US $1 trillion annually if current trends continue. Although pharmacological treatments of AD are showing promise, the adoption of healthy lifestyle behaviors, particularly during the preclinical phase of AD, may reduce dementia rates by up to 45%. Subjective cognitive decline (SCD), defined as persistent self-perceived declines in cognitive functioning compared with previously normal cognitive abilities, has been identified as a potential preclinical stage of AD. Objective: This randomized controlled trial aims to evaluate the feasibility and acceptability of an internet-based, asynchronous mindfulness-based stress reduction program compared with an active control group (an internet-based lifestyle education program). Secondary objectives include examining preliminary effects of each intervention on SCD, plasma-based biomarkers of amyloid and tau pathology, and everyday mind-wandering. Methods: Sixty adults aged 50 years and older will be screened for SCD in the absence of objective cognitive impairment, based on the Uniform Data Set Neuropsychological Battery (version 3.0) from the National Alzheimer’s Coordinating Center. Eligible and consenting participants will complete behavioral and imaging-based tasks of sustained attention and mind-wandering, as well as blood draws at baseline and after the 8-week intervention. After baseline assessments, participants will be randomized to either an internet-based, asynchronous mindfulness-based stress reduction program or the internet-based lifestyle education program. Both programs have been adapted from our manualized in-person programs and refined through focus group interviews with the target population. Results: The study was funded in April 2024. Phase 1 focused on iterative development of the 2 programs based on focus group feedback. Recruitment for the randomized controlled trial (internet-based mind-body training trial) began in June 2025 and is ongoing. Recruitment is expected to conclude in September 2026, with data collection ending in December 2026. Conclusions: Behavioral, lifestyle-based interventions that emphasize experiential practices show promise as preventative strategies to prevent decline in cognitive and brain health. Yet, there remain significant barriers to engaging with in-person programs, including limited accessibility, time and schedule constraints, and travel logistics. The internet-based mind-body training trial will evaluate the feasibility and acceptability of 2 fully online, mind-body training programs for adults at risk for AD. Future Stage II and Stage III studies will be necessary to establish the efficacy of these programs for improving AD biomarkers and cognitive outcomes and their broader dissemination to adults noticing subtle changes in cognitive functioning.

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