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Principal Investigator: Jane Chung
Organization: VIRGINIA COMMONWEALTH UNIVERSITY
Fiscal Year: 2024
Award: $627,333
Funding agency: National Institute on Aging
PROJECT SUMMARY/ABSTRACT
Markers of functional decline begin years before clinical symptoms of Alzheimer’s disease and related
dementias (ADRD). It is essential to capture these functional changes as early as possible to intervene before
symptoms arise to prevent further deterioration and loss of independence. Resources to assess cognitive
changes and detect the progression to mild cognitive impairment (MCI) and ADRD are limited among older
adults with health disparities. The digital technology-based assessment of cognitively complex activities, such
as life-space mobility (LSM), has the potential to identify those at risk for cognitive decline. The proposed
longitudinal, case-control study aims to develop sensitive, practical, and ecologically acceptable LSM digital
markers that could be clinically relevant markers of subsequent cognitive decline among older adults, including
those with health disparities. Additionally, we will examine the moderating role of social health factors (e.g.,
social isolation, loneliness) in the relationship between sensor-based LSM features and cognitive function. We
will create a Real-Life Activity and Life-Space Mobility Monitoring Solution (RAMS), consisting of a GPS data
logger and wrist-worn actigraphy to assess real-life mobility performance objectively. The RAMS measures will
include spatial and temporal mobility measures (e.g., movement size, outdoor time) and physical activity
measures (e.g., sedentary time, activity fragmentation). We propose to recruit individuals aged ≥ 65 from a
racially and socioeconomically diverse group. Participants will be classified as cognitively normal (CN; n=157)
or MCI (n=157) based on a neuropsychological battery at baseline and will be prospectively followed up for 3
years to collect 7-day RAMS data and neuropsychological evaluations every 6 months. The specific aims are
to (1) Compare baseline and longitudinal trajectories of RAMS measures between CN and MCI groups and
determine the impact of social health factors on RAMS indicators and cognitive function; (2) Determine RAMS
indicators that classify CN and MCI groups at baseline and evaluate the ability of RAMS indicators to predict
the subsequent onset of MCI and dementia over a 3-year period; and (3) Evaluate older adults’ attitudes
towards and willingness to use digital health technology for monitoring risks of cognitive decline using a mixed-
methods approach. The public health impact of this study will provide unique insights into clinically meaningful
digital measures and modifiable risk factors to support the need for early treatment and prevention of
progression into MCI and dementia in older adults, including low-income ethnic minority older adults.
Understanding digital health monitoring acceptance will inform the translation of RAMS markers as a clinically
relevant tool for early detection of cognitive decline. Results will support our long-term goal to implement
RAMS as a platform for real-time monitoring to reduce functional and cognitive decline and maintain
independent functional living in an aging population.
Terms: <65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><AD related dementia><ADRD><Active Follow-up><Affect><Aged 65 and Over><Alzheimer's and related dementias><Alzheimer's diagnosis><Alzheimer's disease and related dementia><Alzheimer's disease and related disorders><Alzheimer's disease diagnosis><Alzheimer's disease or a related dementia><Alzheimer's disease or a related disorder><Alzheimer's disease or related dementia><Alzheimer's disease related dementia><Amentia><Area><Attitude><Behavioral><Biological Markers><Case-Base Studies><Case-Comparison Studies><Case-Compeer Studies><Case-Referent Studies><Case-Referrent Studies><Case/Control Studies><Characteristics><Classification><Clinical><Cognitive><Cognitive Disturbance><Cognitive Impairment><Cognitive decline><Cognitive function abnormal><Communities><Complex><Computers><Consumption><Data><Dementia><Detection><Deterioration><Diagnosis><Digital biomarker><Disturbance in cognition><Early Diagnosis><Early identification><Early treatment><Evaluation><Exhibits><Frequencies><Global Positioning System><Goals><Health><Health Care Technology><Health Status><Health Technology><Healthcare Technology><Impaired cognition><Individual><Intention><Interview><Level of Health><Life><Loneliness><Longitudinal Studies><Low income><Measurement><Measures><Medicare claim><Methods><Monitor><Movement><Neuropsychologies><Neuropsychology><Participant><Performance><Physical activity><Population><Prevention><Privacy><Public Health><Race><Races><Research Resources><Resources><Risk><Risk Factors><Role><Social isolation><Specific qualifier value><Specified><Speed><Survey Instrument><Surveys><Symptoms><Systematics><Technology><Time><Translations><Travel><Visit><Work><Wrist><above age 65><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><actigraph><actigraphy><active followup><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged group><aged groups><aged individual><aged individuals><aged people><aged person><aged persons><aged population><aged populations><aged ≥65><aging population><barriers to implementation><bio-markers><biologic marker><biomarker><biomarker identification><body movement><burden of chronic disease><burden of chronic illness><case-controlled studies><clinical relevance><clinically relevant><cognitive change><cognitive dysfunction><cognitive function><cognitive loss><community based design><community based research><data visualization><decline in function><decline in functional status><dementia burden><dementia risk><digital><digital health><digital marker><digital measure><digital technology><digital tool><disparity in health><early biomarkers><early detection><early detection biomarkers><early detection markers><early therapy><effective intervention><ethnic minority><ethnic minority group><ethnic minority individual><ethnic minority people><ethnic minority population><follow up><follow-up><followed up><followup><functional decline><functional status><functional status decline><health care access><health care availability><health care service access><health care service availability><health disparity><health level><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><human old age (65+)><identification of biomarkers><identification of new biomarkers><implementation barriers><implementation challenges><improved><insight><interest><lonely><long-term study><longitudinal outcome studies><longterm study><low SES><low socio-economic position><low socio-economic status><low socioeconomic position><low socioeconomic status><malleable risk><marker identification><medically under served><medically underserved><mild cognitive disorder><mild cognitive impairment><modifiable risk><neuroimaging biomarker><neuroimaging marker><neuropsychologic><old age><older adult><older adulthood><over 65 years><population aging><portability><preference><prevent><preventing><programs><prospective><racial><racial background><racial minority><racial minority group><racial minority individual><racial minority people><racial minority population><racial origin><real time monitoring><realtime monitoring><recruit><risk factor for dementia><risk for dementia><sedentary><sensor><social><social influence><social role><socio-economic><socio-economically><socioeconomically><socioeconomics><tool><translation><trend><wearable><wearable device><wearable electronics><wearable system><wearable technology><wearable tool><wearables><willingness><≥65 years>