Measurement & Prediction of Everyday Function Dementia

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DESCRIPTION (provided by applicant): This five-year career development plan is designed to further refine the candidate's research skills, enabling her to become an independent and productive researcher focused on the assessment of everyday functional impairments in older adults. The training plan emphasizes three content areas: 1) test development of ecologically valid measures for use with older adults; 2) the integration of structural imaging techniques into neuropsychological research; and 3) research design and statistical analysis. Learning objectives will be met utilizing several training modalities: a) regularly scheduled structured meetings with Sponsors, Mentors, and Consultants; b) formal coursework; c) attendance at regular on-site research colloquia and annual scientific conferences; and d) direct research experience. The aim of this project is to develop a method of conceptualizing and measuring everyday function that is: 1) grounded in neuroanatomy and neuropsychology, 2) sensitive to a wide spectrum of functional change and; 3) useful in understanding how a multitude of factors can contribute to, and/or mediate everyday function. Study participants will include individuals diagnosed with mild cognitive impairment or dementia, and a sample of cognitively normal older adults. The proposed model of the functional changes associated with dementia has been adapted from the classification system set forth by the World Health Organization (WHO), [96] which describe the consequence of disease at three levels: impairment, disability, and handicap. These levels can be hierarchically arranged wherein 'impairments' (observable, externalized neurological manifestations of disease) are precursors to 'disability' (declines in the ability to carry out activities essential to normal life), which in turn is a precursor to 'handicap' (the social consequence of disease). In this project, all three levels of functional change will be assessed, with a particularly emphasis on assessing functional change at the level of impairment in order to increase the sensitivity to early functional changes associated with the preclinical and early stages of dementia. A new scale will be developed to assess functional impairments, which organizes these impairments into neuropsychologically and neuroanatomically-relevant domains. Measures of disability and preliminary assessment of handicap will also be included to examine the relationship between the different levels functional change set forth in the model.