This application for an NIA Mentored Patient-Oriented Research Career Development (K23) award seeks support to develop a program of research related to understanding the mechanisms of health disparities in Parkinsonism. As part of the education plan, the PI proposes to: 1) Increase her understanding of health behavior theory, geriatrics and health disparities;2) Gain additional epidemiological skills in study design and health measurement;and 3) Acquire the analytic skills associated with psychometric and longitudinal data analysis. Along with these educational goals, there is an associated research project. The principal research objective of this project is to understand the patient-level factors related to healthcare disparities in the diagnosis and treatment of Parkinsonian signs. Specifically, this study proposes to evaluate how older adults'aging beliefs affect the recognition of Parkinsonian signs, and how race, culture and socioeconomic status impact this relationship. To achieve these goals, there are three specific aims: 1) To validate a screening instrument for Parkinsonian signs by comparing it with neurological examination;2) To examine older adults'beliefs regarding movement changes and their association with Parkinsonian signs and relevant patient-level characteristics;and 3) To determine the association between beliefs about aging, subsequent comorbidities, including falls and fractures, and the detection and treatment of Parkinson's and Alzheimer's disease. After validation of a screening instrument for Parkinsonian signs, this measure will be incorporated into a cross-sectional and prospective evaluation of the relationship between aging beliefs and Parkinsonian signs, particularly as it is modified by socioeconomic factors. Subjects will be recruited and surveyed in primary care clinics and outcomes will be determined through the electronic health record. Successful completion of this project will lead to the development of educational interventions targeting improved understanding of aging related functional decline among older adults. This application will provide critical support for the PI to become an independent researcher and a leader in health services research in aging and neurodegenerative diseases.

Public Health Relevance

Aging-related movement problems are common in older adults and lead to increased disability and death. Underserved minorities may be particularly vulnerable to under-recognition and treatment of these movement problems.
This research aims to understand why patients may not get appropriate and timely therapy in order to develop public health strategies to improve care for older adults.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG034236-03
Application #
8241058
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Chen, Wen G
Project Start
2010-04-15
Project End
2015-03-31
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
3
Fiscal Year
2012
Total Cost
$158,652
Indirect Cost
$11,752
Name
University of Pennsylvania
Department
Neurology
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Fleisher, Jori E; Shah, Krunal; Fitts, Whitney et al. (2016) Associations and implications of low health literacy in Parkinson's Disease. Mov Disord Clin Pract 3:250-256
Brennan, Laura; Siderowf, Andrew; Rubright, Jonathan D et al. (2016) Development and initial testing of the Penn Parkinson's Daily Activities Questionnaire. Mov Disord 31:126-34
Fleisher, Jori E; Dahodwala, Nabila A; Xie, Sharon X et al. (2016) Development and Validation of the Parkinson's Disease Medication Beliefs Scale (PD-Rx). J Parkinsons Dis 6:383-92
Dahodwala, Nabila; Pei, Qinglin; Schmidt, Peter (2016) Sex Differences in the Clinical Progression of Parkinson's Disease. J Obstet Gynecol Neonatal Nurs 45:749-56
Brennan, Laura; Siderowf, Andrew; Rubright, Jonathan D et al. (2016) The Penn Parkinson's Daily Activities Questionnaire-15: Psychometric properties of a brief assessment of cognitive instrumental activities of daily living in Parkinson's disease. Parkinsonism Relat Disord 25:21-6
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Fitts, Whitney; Massimo, Lauren; Lim, Nicholas et al. (2016) Computerized assessment of goal-directed behavior in Parkinson's disease. J Clin Exp Neuropsychol 38:1015-25
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
Pigott, Kara; Rick, Jacqueline; Xie, Sharon X et al. (2015) Longitudinal study of normal cognition in Parkinson disease. Neurology 85:1276-82
Writing Group for the NINDS Exploratory Trials in Parkinson Disease (NET-PD) Investigators; Kieburtz, Karl; Tilley, Barbara C et al. (2015) Effect of creatine monohydrate on clinical progression in patients with Parkinson disease: a randomized clinical trial. JAMA 313:584-93

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