Wearable Multi-modality Cuffless Blood Pressure Monitoring

随着人口的老龄化，阿尔茨海默病（AD）正成为越来越大的医疗负担 系统目前的评估和监测方法需要到诊所或医院进行认知检查。 测试和测量脑中、脑脊液中淀粉样蛋白β（Ab）或tau沉积物的标志物，和/或 是血这些测试是繁重的，唐突的，昂贵的，事实上，构成了一个不合理的护理模式 早期发现和监测AD。理想情况下，大脑健康和AD状态可以在家里评估， 类似于家庭心电图（ECG）或血压（BP）检查心血管疾病。一 以家庭为基础的评估不仅对有残疾的老年人特别有帮助， 流动性，视力和/或认知状况，而且还有五分之一的美国老年人生活在农村地区， 无法获得足够的常规医疗护理。然而，要想可行，这种方法必须充分 低成本和易于使用，这对于大脑监测或AD评估都还没有实现。 越来越多的证据表明，神经血管功能障碍对脑卒中的发生和/或 AD的发展，特别是动态神经血管振荡可能参与了AD的清除。 毒素如淀粉样蛋白β和tau蛋白通过胶质淋巴系统。我们在马萨诸塞州总医院的团队 开发了一种可穿戴的多模式脑血管监测平台，称为NINscan。这项技术 通过将我们的新型表面活性剂与我们的活性R01项目（EB027122） 颞动脉张力计（STAT）方法，用于在头部水平进行连续、无袖带血压监测。一 EB027122的资助补充正在研究将这种相同的NINscan系统用于长期的可行性， 持续时间、神经血管和胶质相关变量的动态监测。 本补充建议调查我们是否可以调整NINscan方法，以使自我或 基于脑和AD状态的评估，以最终部署在家中。目标1将涉及 简化NINscan硬件并提供自我指导指令，以方便在家收集 老年人和早期AD患者的神经血管和认知数据。目标2将有老年人和早期 AD患者在实验室中自我收集多模态大脑和认知数据。我们将进行初步调查 测试这些数据是否可以用于可靠地识别AD。目标3将设法把收集到的 神经血管和认知数据集，沿着临床表征数据，进入公共Physionet 作为父R01（EB 027122）的一部分正在开发的数据库。 这种补充剂有可能提供独特的在家大脑和认知评估能力， 包括静态和动态BP、神经血管和胶质淋巴功能。数据将提供关键 深入了解自我部署大脑评估的挑战，以及自我收集的AD数据的实用性 评估，以及提供一种新的能力，是有用的，在许多条件下超越AD。

As the population ages, Alzheimer’s disease (AD) is becoming a growing burden on the health care system. Current assessment and monitoring approaches require visits to the clinic or hospital for cognitive testing and to measure markers of amyloid-beta (Ab) or tau deposits in the brain, in cerebrospinal fluid, and/or in blood. These tests are burdensome, obtrusive, expensive and, in fact, constitute an unstainable care model for early detection and monitoring of AD. Ideally, brain health and AD status could be assessed at home, similar to home-based electrocardiography (ECG) or blood pressure (BP) checks for cardiovascular disease. A home-based assessment would be particularly helpful not only to older adults who have limitations with mobility, vision and/or cognitive status, but also to the 1 in 5 older Americans who live in rural areas, and those with inadequate access to routine medical care. To be viable, however, such an approach must be sufficiently low-cost and easy-to-use, which has not yet been achieved for either brain monitoring or AD assessment. A growing body of evidence suggests that neurovascular dysfunction is important to the onset and/or development of AD, and, in particular, dynamic neurovascular oscillations may be involved in the clearance of toxins such as amyloid beta and tau by the glymphatic system. Our team at Massachusetts General Hospital has developed a wearable, multimodal cerebrovascular monitoring platform, called NINscan. This technology is being enhanced and tested in our active R01 project (EB027122) by incorporating our novel superficial temporal artery tonometry (STAT) method for continuous, cuffless BP monitoring at the level of the head. A funded supplement to EB027122 is investigating the feasibility of adapting this same NINscan system for long- duration, ambulatory monitoring of both neurovascular and glymphatics-relevant variables. This supplement proposes to investigate whether we can adapt the NINscan approach to enable self- or caregiver-based assessment of brain and AD status for eventual deployment at home. Aim 1 will involve simplifying the NINscan hardware and providing self-guided instructions to facilitate at-home collection of neurovascular and cognitive data by older adults and early AD patients. Aim 2 will have older adults and early AD patients self-collect multimodal cerebral and cognitive data in the laboratory. We will conduct a preliminary test of whether such data can be used to reliably identify AD. Aim 3 will seek to incorporate the collected neurovascular and cognitive dataset, along with clinical characterization data, into the public Physionet database being developed as part of the parent R01 (EB027122). This supplement has the potential to provide a unique capability of at-home brain and cognitive assessment, including static and dynamic BP, neurovascular, and glymphatic functioning. The resulting data will provide key insights into the challenges of self-deployed brain assessments, and the utility of self-collected data for AD assessment, as well as providing a novel capability that is useful in numerous conditions beyond AD.