Impact and Implications of concurrent hearing and vision impairment on risk for Alzheimer's disease and related dementias and social isolation in older adults

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The goal of the proposed fellowship is to prepare the applicant, Alison Huang, for an independent research career focused on informing approaches to reduce risk of Alzheimer’s disease and related dementias (ADRD) through the understanding of modifiable sensory and social risk factors. The proposed fellowship consists of two complementary components: (1) a research project that aims to assess the impact of dual sensory impairment (DSI, concurrent hearing and vision impairment) on risk for ADRD, social isolation, and cognitive training intervention efficacy; and (2) a training plan composed of mentored research, didactic and informal training, and professional development. The applicant will be supported by a strong mentorship team with expertise in cognitive aging, sensory impairment, social isolation, and statistical and epidemiologic methods. The research-training plan will help Ms. Huang a) learn and apply rigorous methods for analysis of longitudinal data; b) strengthen content expertise in sensory, social, and cognitive ADRD risk factors; and c) effectively disseminate her findings and strengthen skills in teaching and leadership. In the absence of effective treatments, interventions to reduce ADRD risk are critical. Identification and understanding of how interactions between modifiable risk factors impact magnitude of ADRD risk is needed to inform ADRD interventions. There is scientific premise to suggest DSI is a strong risk factor for ADRD, yet there is gap in the research in this area. Sensory impairment also amplifies and may interact with other ADRD risk factors, such as social isolation, to increase risk. In addition to conferring ADRD risk, sensory impairment can impact efficacy of current ADRD interventions that rely on auditory/visual tasks yet DSI is rarely considered in intervention design and implementation. To fill these gaps, this project proposes to use longitudinal data from the National Health and Aging Trends Study (NHATS) and the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial to investigate: (1) the associations between DSI and 9-year cognitive change and incident dementia; (2) DSI as a risk factor for social isolation over time and as a moderator of the social isolation – cognitive change and incident dementia associations; and (3) DSI as a moderator of cognitive training intervention effects on 10-year cognitive change and incident dementia. The proposed research directly addresses high priority areas for NIA. The 2020-2025 NIA Strategic Directions for Research on Aging calls for more research on how “multiple factors, such as…social engagement…sensory dysfunction interact to … contribute to cognitive decline” (Goal D-6) and for research to support “interventions for treating, preventing, or mitigating the impact of age-related diseases and conditions” (Goal C-3). Findings from the proposed study may support inclusion of sensory impairment in multi-domain ADRD interventions and accommodations for sensory impairment in interventions that promote health in older adults.