mGlide-Care: A mHealth Partnership with Care Givers to Improve HTN Management in Patients with Cognitive Impairment

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Project Summary The principal investigator Dr. Lakshmi’s goal is to develop evidence-based technology interventions that support chronic disease care in older persons including those with mild cognitive impairment (MCI) and early stage Alzheimer’s disease and Alzheimer’s Disease Related Dementia (AD/ADRD). This K24 application will provide her with protected time to: 1) build skills in implementation science, aging research and the conduct of research with persons with cognitive impairment and their family caregivers; 2) accelerate mentoring of early career clinical faculty in the Department of Neurology particularly on K-awards and transition to the 1st R01; 3) obtain pilot feasibility and effect size data for a larger clinical trial of a mobile health technology (mHealth) intervention to improve hypertension (HTN) care in persons with MCI and early stage AD/ADRD. Dr. Lakshmi is a tenured faculty in the Division of Epidemiology and Community Health, School of Public Health (SPH) at the University of Minnesota and in the Department of Neurology. Her rich institutional environment includes partnerships with the Divisions of Biostatistics and Health Policy and Management, Medical School departments and community health systems. Dr. Lakshmi is a member of the Center for Health Aging and Innovation, a collaboration that aims to advance interdisciplinary aging research. The research focus of this K24 is improving the management of uncontrolled HTN in persons with MCI and early stage AD/ADRD. HTN is the most significant stroke, cardiovascular disease and dementia risk factor and is substantially under-treated especially in older persons. Dr. Lakshmi has worked on mHealth interventions since 2011, with a successful record of multiple funded grants. Her clinical trial, mGlide RCT, is implementing a mHealth-based care model for HTN care in community health systems serving diverse, low-income patients. In this K24, Dr. Lakshmi will develop mGlide-Care – an adaptation of mGlide – to address uncontrolled HTN in people with MCI and early AD/ADRD. Aim 1 will engage stakeholders to study the acceptability of mHealth mediated HTN care and will use their input to develop mGlide-Care. Stakeholders are persons with early stage AD/ADRD and MCI, unpaid family caregivers, primary care providers, geriatricians and clinical pharmacists. Aim 2 is a feasibility pilot to test mGlide-Care vs. usual care in 75 participants with uncontrolled HTN and early stage AD/ADRD or MCI. Caregivers will assist participants. Outcomes will include HTN control and participant and caregiver reported measures. Dr. Lakshmi is the site-PI for two NIH research networks, StrokeNet and DISCOVERY (Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on RecoverY). She also has access to rich cohort data including Atherosclerosis Risk in Communities-Neurocognitive study (ARIC-NCS) and others. Dr. Lakshmi will leverage the substantial resources from her health technology grants, StrokeNet, DISCOVERY, and cohorts including ARIC-NCS to mentor junior investigators in NIA priority areas. Her goal is to prepare her mentees for their own major scientific advances and independent research careers.