Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss:
A Pilot Randomized Controlled Trial
Abstract
Background
Older adults with subjective cognitive decline (SCD) are at increased risk not only for Alzheimer’s disease, but for poor mental health, impaired sleep, and diminished quality of life (QOL), which in turn, contribute to further cognitive decline, highlighting the need for early intervention.
Objective
In this randomized controlled trial, we assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML), on perceived stress, sleep, mood, and health-related QOL in older adults with SCD.
Methods
Sixty community-dwelling older adults with SCD were randomized to a KK or ML program and asked to practice 12 minutes daily for 12 weeks, then at their discretion for the following 3 months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological well-being, sleep quality, and health-related QOL were measured using well-validated instruments.
Results
Fifty-three participants (88%) completed the 6-month study. Participants in both groups showed significant improvement at 12 weeks in psychological well-being and in multiple domains of mood and sleep quality (p’s ≤ 0.05). Relative to ML, those assigned to KK showed greater gains in perceived stress, mood, psychological well-being, and QOL-Mental Health (p’s ≤ 0.09). Observed gains were sustained or improved at 6 months, with both groups showing marked and significant improvement in all outcomes. Changes were unrelated to treatment expectancies.
Conclusions
Findings suggest that practice of a simple meditation or ML program may improve stress, mood, well-being, sleep, and QOL in adults with SCD, with benefits sustained at 6 months and gains that were particularly pronounced in the KK group.
Keywords: Alzheimer’s disease, memory complaints, mind-body therapy, mood, quality of life, sleep, stress, subjective cognitive impairment
INTRODUCTION
Alzheimer’s disease (AD) is a devastating neurodegenerative condition affecting an estimated 44 million adults worldwide, with prevalence projected to reach over 75 million by 2030 and 135.5 million by 2050 [1]. Onset is usually slow and insidious, typically preceded years earlier by subjective deterioration in memory. There is growing evidence that subjective cognitive decline (SCD), characterized by the subjective perception that one’s memory is noticeably worse than a few years before, may represent a preclinical stage of AD, particularly when the decline is a cause for concern [2, 3]. SCD in older adults is a significant predictor of subsequent, accelerated cognitive decline and of incident mild cognitive impairment (MCI) and AD [3–7]; this association is particularly strong in those with SCD who express worry regarding their memory problems, and is not explained by depression, demographics, APOE4 status, or other AD risk factors [8]. SCD is also accompanied by neuropathological changes linked to AD pathogenesis, including elevated amyloid-β deposition [9–12], increased white matter lesions [13, 14], and reductions in hippocampal and grey matter volume [15–17].
SCD is associated with elevated risk not only for cognitive decline and incident dementia, but also for other burdensome health outcomes, including increased neuropsychiatric impairment [18, 19] and diminished quality of life (QOL) [20, 21]. SCD has been strongly linked to chronic psychological distress [22–24]; adults with SCD are also significantly more likely to report symptoms of sleep disturbance [18, 25], depression [19, 21, 25–27], and anxiety [21, 25, 27]. Chronic stress, along with mood and sleep disturbances, can lead, in turn, to accelerated cognitive decline, neurodegenerative changes, and deterioration of both physical and mental health [28–37]. Like subjective memory complaints [3, 4, 6, 27, 38], these psychosocial factors are significant, independent predictors of subsequent cognitive decline and progression to AD [4, 5, 34, 35, 39–51], with reported risk estimates similar to or greater than those for hypertension, diabetes, obesity, and other established risk factors [42, 52, 53], highlighting the importance of timely and effective intervention.
After decades of disappointing trials, there are still no effective treatments for preventing, delaying, or reversing cognitive decline. While emphasis is increasingly shifting to early intervention [2, 54], approved treatments for those with early memory loss, including those with SCD [18, 55, 56], are lacking. Moreover, although memory complaints have been consistently associated with adverse psychosocial outcomes and poor perceived health, those with SCD rarely seek care for their symptoms [24]. Yet this prodromal or preclinical period may comprise a critical therapeutic window for altering the vicious cycle of increasing psychological distress, sleep deficits, poor quality of life, and associated cognitive decline and neuropathogenic change. As indicated above, neuropsychological impairment is common in those with early cognitive decline, and can lead to profound negative changes in both physical health and neurocognitive function [28–32, 34–36, 57]. Thus, interventions that address these psychosocial risk factors may hold promise for not only enhancing health and well-being, but for slowing and possibly preventing cognitive decline in those at risk for AD. Of particular interest in this regard are mind-body therapies, including music listening and meditation. There is growing evidence that both meditation and simple, passive music therapy can reduce stress and depression, enhance well-being, and improve sleep in a range of populations, including those with and at risk for cognitive impairment [36, 58–67]. However, despite the promise of these simple practices, rigorous controlled studies remain few, and none has yet investigated the potential efficacy of these relaxation practices for improving psychological and related outcomes in those with preclinical memory loss. In this parallel arm randomized controlled trial (RCT), we assessed the effects of two simple 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML) on perceived stress, sleep, mood, and health-related QOL in older adults with SCD.
