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

摘要 到2050年，美国将有多达1600万人出现阿尔茨海默氏症的症状 疾病(AD)。最近的一次白宫老龄问题会议强调，有必要改进对老年疾病的检测 作为改善人身安全和防止金融剥削和滥用的手段的能力减弱。 实现这一指令需要经过充分验证的方法来评估日常生活中的判断。判断是 一种重要的认知能力，对不同年龄段的现实世界适应能力至关重要，尤其是对 上了年纪的人。进一步的工作必须解决如何识别面临剥削风险的个人，以及何时和何时 判断最初是如何妥协的，以及如何使用客观的认知测试来衡量实用性 预测现实世界结果的判断。尽管需要可靠和有效的评估 对于老年人的判断，实证研究并没有以整体的方式解决这些问题。 此外，还没有正式的研究评估与潜在结构和功能直接相关的判断。 脑网络或载脂蛋白E(APOE)等位基因状态是AD的重要遗传危险因素。考虑到这些 ，我们将在以前工作的基础上招募96名老年人，其中包括 认知正常和有主观认知下降、轻度认知障碍和阿尔茨海默氏症的人 临床综合征。我们的目标包括确定最佳的评估方法，以阐明判断 在认知功能下降的关键早期阶段的能力，此时功能状态可能会受损 静息状态功能磁共振成像的一种可能危险的方法和应用 和扩散张量成像，以衡量实际判断和结构和 功能强大的大脑网络。我们将评估AD连续轨道上的神经网络如何变化 判断的差异，同时也评估APOE等位基因状态的协同交互作用。我们的团队是 能够很好地实现这些目标，在神经认知老化和 对判断力的评估，出色的机构支持，以及获得最先进的神经成像。从… 从公共卫生的角度来看，及早识别由于判断失误而造成的剥削风险是当务之急。 利用多通道技术阐明与判断能力相关的变化将直接 加强对高危人群的临床诊断、患者护理和预测。重要的是，这个R15项目 为未被充分代表的本科生提供极好的机会，为我们的 认知老化研究的创新方案。它还将加强我们的研究和教育基础设施 通过提供从临床人群和最先进的神经成像方法获得的数据 在布鲁克林学院是没有的。

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.