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Principal Investigator: KATHLEEN C INSEL
Organization: UNIVERSITY OF ARIZONA
Fiscal Year: 2024
Award: $844,799
Funding agency: National Institute of Nursing Research
Abstract
Mild cognitive impairment (MCI) is characterized by mild impairment in one or more cognitive functions and is
associated with an increased risk for failure to take prescribed medications. Hypertension is prevalent among
persons with MCI (PwMCI) and nonadherence to medications increases the risk of accelerated cognitive
decline through cerebrovascular disease. Adherence is often only 46% or lower among PwMCI. Further, the
COVID-19 pandemic has resulted in the isolation of these individuals from care partners (friends, family, and
healthcare workers) who assist with medication management, uncovering the urgent need for developing self-
management tools. We have previously developed a theory-based mobile health (mHealth) system called
Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) to support adherence in
cognitively normal older adults, which can be adapted for PwMCI. No existing studies have evaluated the
benefits of mHealth self-management tools to support hypertension medication adherence for PwMCI. In order
for such digital interventions to be beneficial, they have to be carefully designed/adapted to meet the unique
capabilities and limitations of PwMCI. User-centered technology has been shown to promote independence
and autonomy by compensating for lost cognitive skills. In this proposal, we are poised to address the unique
needs for digital technology use in this at-risk population of PwMCI based on user-centered design to guide the
development of Medication Education, Decision Support, Reminding, and Monitoring-Memory (MEDSReM-M)
system, conduct iterative usability testing to optimize the system for PwMCI, and examine the efficacy to
support hypertension medication adherence. In Aim 1, facilitators and barriers for use of MEDSReM will be
identified by interviewing PwMCI and their care partners, after they are shown the self-management system to
guide the development of MEDSReM-M. Then using heuristic evaluations and cognitive walkthroughs, and
through iterative usability testing with PwMCI, we will test, redesign, and optimize the system for PwMCI. In
Aim 2 we will conduct a randomized controlled trial involving 100 PwMCI to test the effects of MEDSReM-M
relative to an standardized educational control group on outcomes including adherence to hypertension
medications, blood pressure, self-determination (competence and autonomy), and technology acceptance. We
will then test predictors of the rate of change in medication adherence over 3 months to inform future large-
scale deployment. Taking a human factors approach to identify needs and requirements for technological
support to take medications as intended, and iterative testing for the usability of MEDSReM-M among PwMCI
with a consequent RCT, will result in a digital health intervention system that has the potential to reduce
cognitive decline associated with cardiovascular risks, save healthcare dollars, and promote autonomy and
quality of life in this vulnerable population.
Terms: <21+ years old><Acceleration><Activities of Daily Living><Activities of everyday life><Address><Adherence><Adoption><Adult><Adult Human><Age><Amentia><Analgesic Management><Android><Anti-Hypertensive Agents><Anti-Hypertensive Drugs><Anti-Hypertensives><Apoplexy><Attention><Blood Pressure><Brain Vascular Accident><Brain Vascular Disorders><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cardiac infarction><Caring><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Disease><Cerebrovascular Disorders><Cerebrovascular Stroke><Chronic><Cognition><Cognitive><Cognitive Disturbance><Cognitive Impairment><Cognitive decline><Cognitive function abnormal><Collaborations><Communities><Compensation><Competence><Control Groups><Dementia><Deterioration><Development><Disturbance in cognition><Dose><Drug Prescribing><Drug Prescriptions><Drugs><Education><Education for Intervention><Educational Intervention><Educational aspects><Ensure><Evaluation><Failure><Family><Friends><Future><Groups at risk><Health><Health Care Professional><Health Care Providers><Health Personnel><Health Professional><Health system><Healthcare><Healthcare Providers><Healthcare professional><Healthcare worker><Heart failure><Human><Hypertension><Hypotensive Agent><Hypotensive Drugs><Impaired cognition><Impairment><Individual><Instruction Intervention><Intervention><Intervention Strategies><Interview><Intracranial Vascular Diseases><Intracranial Vascular Disorders><Learning Skill><Medication><Medication Management><Memory><Modern Man><Monitor><Myocardial Infarct><Myocardial Infarction><Older Population><Outcome><People at risk><Persons><Persons at risk><Pharmaceutical Preparations><Pharmacologic Management><Population><Populations at Risk><QOL><Quality of life><Randomized, Controlled Trials><Reminder Systems><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Self Determination><Self Management><Self Medication><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Social Support System><Standardization><Stroke><Structure><Support System><System><Technology><Testing><Time><Training Intervention><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Vulnerable Populations><adulthood><ages><anti-hypertension><brain attack><brain vascular disease><brain vascular dysfunction><cardiac failure><cardiac infarct><cardiovascular risk><cardiovascular risk factor><cerebral vascular accident><cerebral vascular disease><cerebral vascular dysfunction><cerebrovascular accident><cerebrovascular dysfunction><co-morbid><co-morbidity><cognitive ability><cognitive dysfunction><cognitive function><cognitive loss><cognitive skill><comorbidity><coronary attack><coronary infarct><coronary infarction><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 pandemic consequence><coronavirus disease 2019 pandemic impact><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><daily living function><daily living functionality><dementia risk><design><designing><determine efficacy><developmental><digital><digital health><digital intervention><digital technology><digital therapeutics><digital therapy><digital treatment><drug adherence><drug compliance><drug/agent><effects following the COVID-19 pandemic><efficacy analysis><efficacy assessment><efficacy determination><efficacy evaluation><efficacy examination><efficacy study><evaluate efficacy><examine efficacy><experience><functional ability><functional capacity><group intervention><health care><health care personnel><health care worker><health provider><health workforce><healthcare personnel><heart attack><heart infarct><heart infarction><heuristics><high blood pressure><high risk><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disorder><impact of the SARS-CoV-2 pandemic><improved><instructional intervention><internet portal><interventional strategy><intracranial vascular dysfunction><isolated individuals><isolated people><lonely individuals><lonely people><m-Health><mHealth><mHealth self-management><medical personnel><medication adherence><medication compliance><medication non-adherence><medication nonadherence><medication prescription><medication therapy management><member><mild cognitive disorder><mild cognitive impairment><mobile health><mobile health self-management><older adult><older adulthood><older groups><older individuals><older person><on-line portal><online portal><prescribed medication><preservation><procedural memory><prospective memory><randomized control trial><randomized, clinical trials><rate of change><remote monitoring><risk factor for dementia><risk for dementia><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><stroked><strokes><support tools><theories><tool><treatment provider><usability><user centered design><vulnerable group><vulnerable individual><vulnerable people><web portal><web-based portal>