A tai chi/qigong intervention for older adults living with HIV: a study protocol of an exploratory clinical trial.

BACKGROUND: Almost half of people living with HIV (PLWH) in the USA are over 50 years of age; this is expected to increase to 70% by 2020. Yet, few interventions exist for older PLWH that address psychological and physical symptoms combined, both prevalent in this population. There is a need to find innovative and accessible interventions that can help older PLWH to manage their symptoms. Mind-body interventions, like tai chi/qigong (TCQ), improve both physical and psychological health. TCQ is a series of slow, low-impact meditative movements that integrates breathwork, meditation, and stances. METHODS: The present study is an exploratory clinical trial that will evaluate the acceptability and feasibility of a 12-week, small group TCQ intervention (n = 24), a sham qigong control condition (n = 24), and a standard of care control condition (n = 24) for older people living with HIV/AIDS. It will also explore any preliminary associations between the TCQ intervention and symptom alleviation. Participants will be recruited from community-based health and social services organizations in Miami, FL, and randomized to one of the 3 conditions. DISCUSSION: We will assess feasibility and acceptability through questionnaires and adherence to TCQ. We will assess preliminary associations with symptoms such as depression, anxiety, social support, chronic HIV-related fatigue, and clinical outcomes. These will be described through proportions, means, and changes over time through graphing techniques. Outcomes will be assessed at baseline, at post-intervention, and at 3 months follow-up. These preliminary analyses also will provide information necessary to estimate effect size and power needed for a larger clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT03840525 . Registered on 16 July 2018.

Emerging Complementary and Integrative Therapies for Geriatric Mental Health.

PURPOSE: The use of complementary and integrative medicine (CIM) is on the rise among diverse populations of older adults in the USA. CIM is commonly perceived as safer, less expensive, and more culturally acceptable. There is a growing body of evidence to support the use of CIM, especially mind-body therapies, diet and nutritional supplements used for mental disorders of aging. RECENT FINDINGS: We summarize the results of the recent clinical trials and meta-analyses that provide the evidence for the role of CIM in treating older adults with mood or cognitive disorders that includes the use of diet and supplements, and mind-body therapies. SUMMARY: Dietary and mind-body therapies have become increasingly popular and show the strongest evidence of efficacy for mood and cognitive disorders. Although the use of vitamins and supplements is the most popular CIM practice, only mixed evidence supports their use with additional concerns for herb (supplement)-drug interactions. Despite increasing use of CIM by the general population, information to guide clinicians providing care for older adults remains limited with variable scientific rigor of the available RCTs for a large number of commonly used CIM interventions for the mental health of older adults.

Advances in Mind/Body Therapies: Concept, Data and Delivery

Mind/body therapies, such as yoga, mindfulness, and guided imagery, are often touted in media reports as ways to slow cognitive decline, improve brain health, and ameliorate negative psychological symptoms such as stress and depression. However, the clinical and neurobiological evidence base for these uses in older adults is limited. Moreover, many older adults, particularly during the COVID-19 pandemic, have difficulty accessing these therapies due to the in-person, group formats in which they are often delivered. A major difficulty in understanding the objective benefits of mind/body therapies for subjective cognitive and psychological symptoms is infrequent measurement during clinical trials using retrospective questionnaires. Thus, increased clinical efficacy research, neurobiological research, and methodological research to identify new ways to deliver and measure the effects of mind/body therapies is urgently needed. In this general session, three presenters will discuss recent advances in mind/body therapies, including new evidence from large-scale trials, and methodological innovations enabling remote therapy delivery and the assessment of behavioral outcomes. First, Dr. Felipe Jain will discuss smartphone delivery of mind/body therapies and new technologies that use passive smartphone sensors to enable continuous measurement of behavior. The development of digital phenotypes of psychological symptoms from these fine-grained behavioral assessments will be discussed. Dr. Jain's presentation will describe a smartphone application which delivers mind/body tools, mentalizing imagery therapy (MIT), and caregiver skills, to older adult family caregivers of persons living with dementia. His talk will elucidate simultaneous capture of usage data and passive smartphone sensor data in a subset of participants in a clinical trial using the application. Statistical methods to derive individual behavioral phenotypes for symptom tracking of psychological stress and sleep will be presented. Second, Dr. Eric Lenze will share clinical and neuroimaging results of a large trial of mindfulness-based stress reduction (MBSR) with and without exercise aimed at improving cognitive function and brain health in older adults. His talk will include clinical effects of intervention on episodic memory and executive function, and structural brain markers including hippocampal volume and dorsolateral prefrontal cortex thickness and surface area. Finally, he will focus on sensitive analyses of functional brain connectivity from before to after treatment. Finally, Dr. Helen Lavretsky will discuss the recent trends in the methodology of conducting mind-body efficacy and effectiveness trials. She will also discuss the results of a recently completed trial of Kundalini yoga for prevention of cognitive decline in women with subjective memory complaints and at risk for AD. This will also cover clinical outcomes and the role of neural and peripheral biomarkers of response. The panel discussion will outline future research directions in mind-body therapies for treatment and prevention in older adults, with a focus on diversity and inclusion of underrepresented populations.

Neurological pathophysiology of SARS-CoV-2 and pandemic potential RNA viruses: a comparative analysis.

SARS-CoV-2 has infected hundreds of millions of people with over four million dead, resulting in one of the worst global pandemics in recent history. Neurological symptoms associated with COVID-19 include anosmia, ageusia, headaches, confusion, delirium, and strokes. These may manifest due to viral entry into the central nervous system (CNS) through the blood-brain barrier (BBB) by means of ill-defined mechanisms. Here, we summarize the abilities of SARS-CoV-2 and other neurotropic RNA viruses, including Zika virus and Nipah virus, to cross the BBB into the CNS, highlighting the role of magnetic resonance imaging (MRI) in assessing presence and severity of brain structural changes in COVID-19 patients. We present new insight into key mutations in SARS-CoV-2 variants B.1.1.7 (P681H) and B.1.617.2 (P681R), which may impact on neuropilin 1 (NRP1) binding and CNS invasion. We postulate that SARS-CoV-2 may infect both peripheral cells capable of crossing the BBB and brain endothelial cells to traverse the BBB and spread into the brain. COVID-19 patients can be followed up with MRI modalities to better understand the long-term effects of COVID-19 on the brain.

Experiences of American Older Adults with Pre-existing Depression During the Beginnings of the COVID-19 Pandemic: A Multicity, Mixed-Methods Study.

OBJECTIVE: To determine the effect of the COVID-19 pandemic on the mental health of older adults with pre-existing major depressive disorder (MDD). PARTICIPANTS: Participants were 73 community-living older adults with pre-existing MDD (mean age 69 [SD 6]) in Los Angeles, New York, Pittsburgh, and St Louis. DESIGN AND MEASUREMENTS: During the first 2 months of the pandemic, the authors interviewed participants with a semistructured qualitative interview evaluating access to care, mental health, quality of life, and coping. The authors also assessed depression, anxiety, and suicidality with validated scales and compared scores before and during the pandemic. RESULTS: Five themes from the interviews highlight the experience of older adults with MDD: 1) They are more concerned about the risk of contracting the virus than the risks of isolation. 2) They exhibit resilience to the stress and isolation of physical distancing. 3) Most are not isolated socially, with virtual contact with friends and family. 4) Their quality of life is lower, and they worry their mental health will suffer with continued physical distancing. 5) They are outraged by an inadequate governmental response to the pandemic. Depression, anxiety, and suicidal ideation symptom scores did not differ from scores before the pandemic. CONCLUSION: Most older adults with pre-existing MDD show resilience in the first 2 months of the COVID-19 pandemic but have concerns about the future. Policies and interventions to provide access to medical services and opportunities for social interaction are needed to help to maintain mental health and quality of life as the pandemic continues.