The long-term goal of the work in this laboratory is to keep older adults functioning independently at home with high quality of life, while also reducing caregiver burden and cost of care to society.
We have been working with cognitively healthy older adults as well as individuals with cognitive deficits, including Mild Cognitive Impairment (MCI), Parkinson’s disease and Alzheimer’s disease (AD). Given the limited effectiveness of drug therapies to date, we believe that the development of cognitive interventions that will delay functional disability and increase patient well-being are critically important. While memory and executive functioning impairment have been identified as the most important cognitive determinants of everyday functional limitations in persons with MCI, studies have primarily focused on memory for the content of previously learned information and on laboratory-based executive functioning test. In the everyday environment, multiple memory processes are needed to support autonomy in daily life activities. In addition, standardized executive functioning tasks fail to capture everyday situations were successful multi-tasking is required to accomplish multiple goals or multi-layered goals. Our work has demonstrated that deficits in prospective memory, temporal order memory and source memory are better predictors of everyday functional status in individuals with MCI than deficits in retrospective memory. By observing individuals completing complex tasks of daily living in our on-campus smart home environment, we have identified the role that specific memory and executive functioning deficits play in the poorer performances of healthy older adults and individuals with MCI relative to younger adults on complex real-world everyday tasks. We are currently completing a series of studies that involve observing participants completing everyday tasks of daily living as they natural do in their own home and community environments. We are especially interested in learning more about how compensatory strategy use and the role of the environment can support or hinder a person’s ability to remain functionally independent. We expect this work to assist in creating more ecological valid laboratory-based assessment measures and questionnaires and we are currently evaluating such measures. In addition, the above research is expected to enhance our intervention work designed to keep individuals functioning independently. Below are examples of some of our active clinical studies:
Smart Home Assessment and Intervention: We also have several large grants from the National Institute of Health (NIH), the National Science Foundation (NSF) and the Department of Defense (DOD) to support collaborative work with computer scientists and engineers. This work involves developing smart environments and portable technologies for health monitoring and assistance. We are conducting a 5-year longitudinal study of older adults performing daily activities in their own smart homes. By tracking residents’ daily behavior over a long period, we are working to develop intelligent software that can perform automated functional assessment and identify trends that are indicators of acute health changes (e.g., infection, injury) and slower progressive decline (e.g., dementia). We are also working to improve overall health and well-being of residents by delivering prompt-based interventions that support functional independence and promote healthy lifestyle behaviors (e.g., social contact, exercise, regular sleep). In addition, we are working to improve our paper-and pencil notebook by creating a digital memory notebook (DMN) and allowing for real-time intervention by developing a smart home / DMN partnership. Such a partnership would facilitate continued use of a DMN to support functional independence through activity recognition and context-aware prompting, and would offer improved interfaces over the pen-and-paper versions. Most recently, with support from NSF, we will be adding a robotics component to our smart home and intervention work. In addition, we will be experimenting with a clinician in the loop to better understand how to capture acute health care changes with our smart home technology.
Preventative Intervention Work: Accumulating evidence suggests that engaging in healthy lifestyle behaviors may slow cognitive and physical decline and promote brain neuroplasticity. We are currently piloting a scalable 7-week holistic brain health intervention being administered in a group format. Middle-aged and older adult participants are being presented with information about healthy lifestyle factors that can influence cognitive aging (e.g., exercise, nutrition, sleep hygiene, social engagement). We are also using wearable technologies to track factors such as activity level and sleep and collecting blood biomarker and genomic data to explore as possible moderator variables. This work builds on a group problem-solving model that we have successfully used in prior work to help teach individuals with MCI and their care-partners to integrate new memory strategies into their everyday lives. In addition we are investigating the relationship between personality characteristics and health-related behaviors. In other prevention work, we are working to better understand the types of compensatory strategies (e.g., external aids, routine, assistive technologies) that individuals utilize in their homes to maintain their independence. We are testing individuals in their own homes and observing their completion of everyday task of daily living. We are comparing this data with laboratory-based neuropsychological data as well as with sensor-based technology. We expect that this work will lead to the development of more ecologically valid neuropsychological tasks that will better predict real-world functioning. We also expect this work will inform interventions for assisting older adults and individuals with cognitive impairment to maintain their independence.