Life-Space and Activity Digital Markers for Detection of Cognitive Decline in Community-Dwelling Older Adults: The RAMS Study

项目摘要/摘要 功能衰退的标记物在阿尔茨海默病和相关的临床症状出现前几年就开始了 痴呆(ADRD)。必须尽早捕获这些功能变化，以便在此之前进行干预 出现症状是为了防止进一步恶化和丧失独立性。评估认知能力的资源 改变和检测进展为轻度认知障碍(MCI)和ADRD在老年人中是有限的 有健康差距的成年人。基于数字技术的认知复杂活动的评估，如 作为生活空间移动性(LSM)，有可能识别那些认知能力下降的风险。建议数 纵向病例对照研究旨在开发敏感、实用和生态可接受的LSM数字 可能是老年人随后认知能力下降的临床相关标志，包括 那些有健康差距的人。此外，我们将研究社会健康因素的调节作用(例如， 社交隔离、孤独)在基于传感器的LSM特征与认知功能之间的关系中。我们 将创建一个由GPS数据组成的真实生活活动和生活空间移动性监控解决方案(RAMS) 记录仪和手腕佩戴的动作记录仪，以客观地评估现实生活中的移动性能。公羊措施将 包括空间和时间流动性度量(例如，运动大小、户外时间)和体力活动 衡量标准(例如，久坐时间、活动零碎)。我们建议招聘年龄在≥65岁的个人从 种族和社会经济多元化的群体。参与者将被归类为认知正常(CN；n=157) 或MCI(n=157)，基于基线的神经心理学组合，并将前瞻性随访3 每6个月收集一次7天公羊数据和神经心理评估。具体目标是 为了(1)比较CN组和MCI组之间RAMS测量的基线和纵向轨迹以及 确定社会健康因素对RAMS指标和认知功能的影响；(2)确定RAMS 在基线对CN和MCI组进行分类的指标，并评估RAMS指标的预测能力 随后3年内发生的MCI和痴呆症；以及(3)评估老年人的态度 支持和愿意使用数字健康技术来监测认知下降的风险，使用混合- 方法：研究方法。这项研究对公共健康的影响将为临床研究提供独特的见解 数字化措施和可修改的风险因素，以支持早期治疗和预防的需要 老年人，包括低收入少数民族老年人，进展为MCI和痴呆症。 了解数字健康监测的接受性将有助于将RAMS标志物翻译为临床 早期发现认知功能减退的相关工具。结果将支持我们实施的长期目标 将RAMS作为实时监测的平台，以减少功能和认知衰退并保持 在老龄化的人口中独立的功能生活。

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.