Investigating cognitive-motor variability to predict driving performance in stroke survivors with MCI

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PROJECT SUMMARY/ABSTRACT Dr. Neha Lodha is an Assistant Professor in the Department of Health and Exercise Science at Colorado State University (CSU). Dr. Lodha's long-term career goal is to become an independent investigator advancing the science of functional mobility to improve the quality of life in aging and age-related neurological disorders and dementias. Up to this point, Dr. Lodha has acquired strong scientific background in neurophysiology and motor control. To accomplish her career goal, a key additional element required is the training in cognitive sciences. Understanding how cognitive and motor systems interact to enable independent mobility is important for identifying the precise mechanisms and developing interventions to promote functional mobility. The short-term training goals of the current K01 application are to train in 1) conducting cognitive assessments with specific emphasis on the intra-individual variability (IIV) approach, 2) clinical trials design and analysis, 3) multivariate statistics, 4) driving technology, and 5) transition to independence. To achieve these goals, Dr. Lodha has assembled a mentoring team that consists of 1) an eminent gerontologist, Dr. Manfred Diehl (primary mentor) with expertise in aging, IIV and cognitive development across the lifespan, 2) an experimental psychologist, Dr. Karlene Ball (co-mentor) who is internationally renowned for her work in cognitive correlates of driving mobility in aging and dementia, 3) a vascular neurologist, Dr. Sharon Poisson (advisor) with extensive experience in clinical trials in stroke survivors, and 4) a renowned biostatistician, Dr. Haonan Wang (co-advisor) with experience in statistical inference and modeling for clinical data. The proposed research plan focuses on identifying the motor and cognitive impairments underlying driving deficits in older stroke survivors with mild cognitive impairment as they are most likely to resume on-road driving after stroke. Conventionally, driving impairments are shown to be independently influenced by mean-level performance in specific motor and cognitive domains. However, this mean-level approach neglects the well-established fact that performance becomes highly variable and unstable in older adults with neurological disorders, such as those at preclinical stages of Alzheimer's disease and mild cognitive imapirment. The proposed research will apply the novel intra- individual variability (IIV) approach to investigate driving mobility in older stroke survivors. The goal of the research plan is to identify the impact of stroke on IIV in motor and cognitive performance (Aim 1); determine the contribution of IIV measures to predict driving performance (Aim 2); and use IIV measures to predict change in driving performance over a two-year period (Aim 3). The training plan will accelerate Dr. Lodha's career to pursue a unique and independent line of research that combines cognitive and motor processes to promote the functional mobility of older adults and is directly aligned with NIA's AD/ADRD goal to identify sensitive behavioral measures for earliest manifestations of functional impairments in older adults.