The purpose of this individual National Research Service Award (NRSA) is to provide postdoctoral researchtraining for a neuroscience nurse to become an independent investigator focusing on the behavioral andbiological mechanisms that contribute to neuropsychiatric syndromes such as apathy in patients withneurodegenerative disease (ND). In addition to coursework and the acquisition of new research skills, Ipropose to focus this NRSA on impairments of goal-directed behavior (GDB) that are very common butunderstudied in ND. The syndrome of apathy, defined as a reduction in self-generated or voluntary behavior,1has profound consequences for morbidity and mortality in the patient and for family caregiver burden.Treatments for apathy are hindered because of our poor understanding of the mechanisms underlying thisbehavior. In my cross-sectional dissertation data (funded by NINR F31NR013306), I identified three subtypesof apathy in patients with behavioral variant Frontotemporal Degeneration (bvFTD): difficulty with initiation,planning or motivation. Each subtype is related to disease in distinct frontal regions.Based on preliminary longitudinal data, I will collect additional data to test the hypothesis that subtypes ofapathy will worsen over time, and that decline will be restricted to the subtype of initial impairment. I will alsoextend my research program to investigate how biologic and environmental factors contribute to worsening inapathy. I have had more than 8 years of experience as an Advanced Practice Nurse and Research NurseCoordinator in a nationally ranked laboratory that studies the neural basis for behavior in ND. I have directaccess to research participants as well as a large database of genetic and neuroimaging data that I willincorporate into my analyses. My research training will be guided by two internationally known scientists, Dr.Ann Kolanowski, a well-known gerontological nurse expert and leader, and Dr. Murray Grossman, a highlyacclaimed cognitive neurologist and experienced scientist.The interdisciplinary training during the performance of this work will serve as an essential component inattaining my career goal to become an independent neuroscience nurse researcher. The long-term impact ofthis research training will be profound for patients with ND, their caregivers, and families. Knowledge of thenatural history of apathy is essential in the development of interventions for subtypes of apathy. Consistentwith the National Institute of Nursing Research (NINR) priorities, this innovative work will lead to a betterunderstanding of these brain behavior relationships and with this new knowledge, tailored interventions willbe designed to reduce apathy and the poor health outcomes that are associated with this devastating condition.

Public Health Relevance

I plan to focus my postdoctoral training on becoming an independent nurse research investigator; the research component of my postdoctoral fellowship focuses on the longitudinal study of behavioral and biological mechanisms underlying apathy. The proposed work will dissect apathy quantitatively; following the progression in a natural history study while examining factors that modulate apathy; providing greater insight into the basis for this condition. My training and research are foundational to the development of effective interventions aimed at treating the specific dysfunctions contributing to apathy.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Postdoctoral Individual National Research Service Award (F32)
Project #
Application #
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Banks, David
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Pennsylvania State University
Other Health Professions
Schools of Nursing
University Park
United States
Zip Code
Massimo, Lauren; Munoz, Elizabeth; Hill, Nikki et al. (2016) Genetic and environmental factors associated with delirium severity in older adults with dementia. Int J Geriatr Psychiatry :
Massimo, Lauren; Zee, Jarcy; Xie, Sharon X et al. (2015) Occupational attainment influences survival in autopsy-confirmed frontotemporal degeneration. Neurology 84:2070-5
Massimo, Lauren; Powers, John P; Evans, Lois K et al. (2015) Apathy in Frontotemporal Degeneration: Neuroanatomical Evidence of Impaired Goal-directed Behavior. Front Hum Neurosci 9:611
Fitts, Whitney; Weintraub, Daniel; Massimo, Lauren et al. (2015) Caregiver report of apathy predicts dementia in Parkinson's disease. Parkinsonism Relat Disord 21:992-5
Massimo, Lauren; Evans, Lois K (2014) Differentiating subtypes of apathy to improve person-centered care in frontotemporal degeneration. J Gerontol Nurs 40:58-65