Longitudinal Characterization of Nutritional Behavior Using Unobtrusive Digital Technology in Aging, Alzheimer's and Related Disorders

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PROJECT SUMMARY Changes in dietary behavior and weight loss have been linked to malnutrition and to the onset of dementia; however, current assessment tools are not designed to detect subtle prodromal changes in behavior that can occur up to six years prior to symptom onset. With an estimated global burden of 107 million dementia cases by 2050, there is a critical need for objective assessment tools to identify changes in food-related behavior and associated function that could be predictive of Alzheimer’s disease and related disorders (ADRD). The overall goal of this project is to address this critical need through the proposed research and mentored training of the applicant. The Life Laboratory Assessment Platform (Life Lab) is a paradigm shift towards studying the behav- iors and patterns of change among individuals using in-home, unobtrusive, objective, and ecologically-valid measurements in real time (pervasive computing, sensors, and other technologies). The platform is part of the Oregon Center for Aging and Technology under the direction of Dr. Kaye (proposed primary mentor) who is currently deploying the platform in homes of older adults, a portion of whom have mild cognitive impairment (MCI) and early-stage dementia. The proposed research takes the Life Lab into a novel research space by col- lecting objective measures of dietary behavior. The scientific goals of this proposal are to identify feasible digi- tal measures of longitudinal dietary behavior, compare automated, home-based system outcome measures to current conventional outcome measures, and detect composite objective functional outcome metrics and ob- jective behavioral-functional signatures of malnourished patients. Intensive longitudinal data (daily, weekly and quarterly assessments for up to 18 months) from 80 participants (mild cognitive impairment, early AD, and age- matched peers) currently enrolled in Life Lab projects will be used to characterize longitudinal body mass fluc- tuations, and identify viable digital measures of food seeking behavior and sustained dietary supplement intake providing a baseline of activities and behaviors to contrast for future trials. The applicant will gain a new set of skills in order to conduct the proposed study and prepare for an independent research career by training in (1) clinical geriatrics, gerontology and aging biology, (2) design and statistical analysis of data-rich research ap- proaches using digital technology, and (3) acquiring nutrition data from older adults using technology. The pro- posed team of mentors each provide expertise in one or more of these areas and are committed to collabora- tively facilitating the applicant’s training. The detailed training plan contains multi-modal learning (e.g. formal coursework, seminars, and workshops; application-based training; and national and international scientific meetings). The applicant will apply these new skills to the proposed research project and obtain R01/R61 sup- port to conduct longitudinal studies using digital biomarkers to identify prodromal changes in dietary behavior and to develop effective single and multi-domain lifestyle and non-pharmaceutical interventions for maintaining functional independence and improving cognition in older adults with or at risk for ADRD.