Novel Multimodal Assessment of Practical Judgment Across the Alzheimer's Continuum: Toward a Better Understanding of how to Predict Risk in the Elderly

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ABSTRACT By the year 2050, as many as 16 million individuals in the U.S. will express symptoms of Alzheimer’s disease (AD). A recent White House Conference on Aging emphasized the need to improve detection of diminished capacity as a means to improve personal safety and prevent financial exploitation and abuse. Realizing this directive requires well-validated methods for assessing judgment in everyday life. Judgment is an important cognitive ability critical to real-world adaptive functioning across age ranges, but particularly for older adults. Further work must address how to identify individuals who are at risk for exploitation, when and how judgment first becomes compromised, and how to use objective cognitive tests to measure practical judgment that predicts real-world outcomes. Despite the substantial need for reliable and valid assessment of judgment in older adults, empirical studies have not addressed these questions in a wholistic manner. Additionally, no formal studies have assessed judgment in direct relation to underlying structural and functional brain networks or to apolipoprotein E (APOE) allele status, an important genetic risk factor for AD. Given these critical gaps in the literature, we will build upon our previous work by recruiting 96 older adults who include the cognitively unimpaired and those with subjective cognitive decline, mild cognitive impairment, and Alzheimer’s clinical syndrome. Our goals include determination of optimal assessment methods that elucidate judgment ability during the critical, early period of cognitive decline when functional status may become compromised in a possibly hazardous way and employment of resting state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging to measure the relationship between practical judgment and structural and functional brain networks. We will evaluate how changes in neural networks along the AD continuum track with differences in judgment, while also assessing the synergistic interactions of APOE allele status. Our team is well-positioned to tackle these goals, with a strong history of research in the fields of neurocognitive aging and the assessment of judgment, excellent institutional support, and access to state-of-the-art neuroimaging. From a public health perspective, early identification of risk of exploitation due to poor judgment is imperative. Elucidation of the changes associated with judgment ability, utilizing multimodal techniques, will directly enhance clinical diagnosis, patient care, and prediction of at-risk populations. Importantly, this R15 project provides excellent opportunities for underrepresented undergraduate students to contribute meaningfully to our innovative program of cognitive aging research. It will also enhance our research and educational infrastructure by affording access to data derived from clinical populations and state-of-the-art neuroimaging methods unavailable at Brooklyn College.