R01AG072582

Using Informatics to Evaluate and Predict Cataract Surgery Impact on Alzheimer's Disease and Related Dementias and Mild Cognitive Impairment Outcomes - Project Summary/Abstract

Background

Visual impairment has been strongly associated with Alzheimer's Disease and Related Dementias (ADRD) in numerous cross-sectional and longitudinal studies, and we have found that worse baseline vision is tied to increasingly higher risk of subsequent dementia. Neurosensory deprivation from visual impairment may place greater demands on cognitive resources, accelerating cognitive decline and increasing the incidence of cognitive impairment. Conversely, improving vision could improve cognitive outcomes by increasing neurosensory input and reducing cognitive demand for processing visual information. Cataracts are the most common cause of visual impairment—fortunately reversible with surgery. However, we have found that ADRD patients are only half as likely to undergo cataract surgery as those without ADRD. This may reflect concerns regarding less potential benefit and greater perceived risks.

Objectives

Our long-term goal is to evaluate cataract surgery as a potential intervention to "bend the curve" for risk of ADRD onset and progression, including optimizing patient selection and timing for surgery. The objective of this proposal is to investigate how cataract surgery may affect the incidence and progression of Mild Cognitive Impairment (MCI) and ADRD, develop models to predict individual patients' ADRD/MCI outcomes following cataract surgery, and identify key confounders, mediators, and effect modifiers. We hypothesize that cataract surgery is associated with (1) reduction in incidence of new MCI and ADRD and (2) reduced cognitive decline and impairment progression among patients with baseline MCI or ADRD, and that (3) we will be able to predict individual patient outcomes. We propose to use methods our group has developed to archive and analyze electronic health record (EHR) data, to develop a curated data set and achieve three aims: (1) determine impact of cataract surgery on ADRD and MCI incidence; (2) determine impact of cataract surgery on cognitive decline and impairment among patients with baseline ADRD or MCI, and (3) develop patient-level predictive models for ADRD and MCI outcomes after cataract surgery.

Impact

EHR-based machine learning analysis has not been applied to ADRD research to date, and the influence of cataract surgery on cognitive outcomes is not yet known. Finding that a widely-available cataract surgery intervention improves cognitive outcomes would be transformative. We estimate a potential unmet need for cataract surgery affecting almost 350,000 patients annually—just among the subset of patients with existing Alzheimer's Disease. Results from this work will directly inform discussion of cataract surgery risks and benefits and will also facilitate future research, including pragmatic clinical trial design. By developing and disseminating open-source EHR-based algorithms to identify and classify cognitive and visual impairment, this proposal will enable investigation of other ADRD risk factors and interventions, eye disease research, and a more precise approach to managing individual patients.

The Leland Stanford Junior University

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Palo Alto, California 943033225 United States

Single Zip Code

Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional) (PAR-19-070)

Amendment Since initial award the total obligations have increased 283% from $793,778 to $3,042,048.