Wearable Multi-modality Cuffless Blood Pressure Monitoring

阿尔茨海默病(AD)通常通过大脑中淀粉样β蛋白(ABeta)沉积的标志物来诊断， 脑脊液和/或血液。到目前为止，这些特征被证明不足以解释 阿尔茨海默病的发展，并识别高危个体。越来越多的证据表明，ABeta是清白的 通过在睡眠中特别活跃的淋巴系统，现在也被认为是淋巴系统 功能是由血管搏动驱动的。考虑到两个血管的可靠发现，这是耐人寻味的 AD患者的功能障碍和睡眠障碍，这些观察结果共同提示了潜在的原因 脑血管状况、睡眠障碍和AD进展之间的联系。事实上，脑血管减少 脉动性和血压脉搏波的变化已经被证明与AD的严重程度有关。 目前，没有适用于长持续时间(例如24小时)的节拍到节拍的表征的技术 阿尔茨海默病的血管和臀部动力学。如果这样的监测是可能的，这可以帮助研究人员 研究关于AD潜在机制的几个现有假说，最终可能有助于 改进AD的检测和治疗策略。 我们在马萨诸塞州综合医院的团队已经开发出一种可穿戴的多模式脑血管 监控平台，称为NINcan，能够长达24小时使用。这项技术正在得到增强 我们的Active R01项目(EB027122)，使用我们的新的颞浅动脉眼压测量(STAT)方法 在头部水平进行连续、无袖带的血压监测。本补编提出了两个具体目标。在……里面 目标1我们将进一步开发用于多模式脑血管和液体监测的NINScan，以及 优化其在AD动态监测中的使用。这将通过改进发色团和 深度敏感度以及患者可用性。对于目标2，我们将在老年人和AD患者中进行可行性测试 患者在实验室和24小时录音期间(包括日常活动和睡眠)。这些数据将使我们能够 在健康组和患者组之间进行(I)BP、(Ii)BP搏动性、(Iii) 脑血和水(淋巴)容量，以及(Iv)血和水体积的搏动性。数据还将 将被添加到作为EB027122一部分开发的Physionet数据库。 这一补充将导致最全面的大脑监测系统能够24小时使用， 包括静态和动态血压和脑液测量，这似乎是AD的关键。我们预计这一次 增强能力将有助于更好地了解AD，并有望刺激新的 诊断或治疗，以及提供远远超出AD的有用能力。

Alzheimer’s disease (AD) is typically diagnosed by markers of amyloid-beta (ABeta) deposits in the brain, cerebrospinal fluid, and/or blood. So far, such hallmarks have proven insufficient for explaining the development of AD, and identifying at-risk individuals. A growing body of evidence suggests that ABeta is cleared via the glymphatic system, which is especially active during sleep, and it is now also thought that glymphatic function is driven by vascular pulsations. This is intriguing given the reliable findings of both vascular dysfunction and disordered sleep in AD patients, and together these observations suggest potential causal links between cerebrovascular status, sleep disruption, and AD progression. Indeed, reduced cerebrovascular pulsatility and changes in the blood pressure (BP) pulse wave have already shown to be related to AD severity. Currently, there is no technology suitable for long-duration (e.g. 24-hr) beat-to-beat characterization of these vascular and glymphatic dynamics in AD. If such monitoring was possible, this could help researchers investigate several extant hypotheses regarding the underlying mechanisms of AD, that ultimately could help to improve AD detection and treatment strategies. Our team at Massachusetts General Hospital has developed a wearable, multimodal cerebrovascular monitoring platform, called NINscan, which is capable of up to 24-hr use. This technology is being enhanced in our active R01 project (EB027122), using our novel superficial temporal artery tonometry (STAT) method for continuous, cuffless BP monitoring at the level of the head. This supplement proposes two specific aims. In Aim 1 we will further develop NINscan for multimodal cerebral vascular and fluid monitoring, as well as optimizing its use for ambulatory monitoring in AD. This will be accomplished by improving chromophore and depth sensitivity as well as patient usability. For Aim 2, we will conduct feasibility testing in older adults and AD patients, both in the lab and during 24-hr recordings (including daily activities and sleep). This data will allow us to conduct preliminary comparisons between healthy and patient groups on (i) BP, (ii) BP pulsatility, (iii) cerebral blood and water (glymphatic) volumes, and (iv) blood and water volume pulsatility. The data will also be added to the Physionet database being developed as part of EB027122. This supplement will lead to the most comprehensive cerebral monitoring system capable of 24-hr use, including static and dynamic BP and cerebral fluid measurements that appear key to AD. We expect that this enhanced capability will facilitate a better understanding of AD and hopefully stimulate the development of new diagnostics or therapies, as well as providing capabilities that are useful well beyond AD.