Successful aging involves not only the maintenance of cognitive function, but sustained normal physical function. One measure of abnormal physical function is abnormal gait and balance (impaired mobility), an important outcome in geriatric epidemiology. Impaired mobility is associated with falls, institutionalization, incident stroke, and mortality. Some conventional vascular disease risk factors (such as physical inactivity, dyslipidemia) have been associated with impaired mobility, though less has been demonstrated regarding emerging vascular risk factors, such as inflammatory biomarkers. Serial measures of vascular disease risk factors, such as decline in physical activity, have not been used in studies examining risk of impaired mobility. Few studies on impaired mobility have included Hispanics. Subclinical neurovascular disease, defined as white matter hyperintensities and silent brain infarcts seen on magnetic resonance imaging (MRI), is associated with vascular disease risk factors and has been linked to impaired mobility. There have been few studies examining the pathway by which all three (vascular risk factors, subclinical neurovascular disease and impaired mobility) may be linked. This K23 proposal will take advantage of the existing infrastructure in the Northern Manhattan Study (NOMAS), a well respected epidemiological study with a high proportion of Hispanics aimed at elucidating risk factors for vascular outcomes (stroke, myocardial infarction, vascular death). Mobility examinations will be performed on participants in the MRI sub-study who have been returning for a 5 year neuro-psychological evaluation.
Our aim i s to characterize the association between vascular disease risk factors (physical inactivity, dyslipidemia, inflammatory biomarkers) with measures of mobility (gait speed and Tinetti gait and balance scale as the primary outcomes). We will analyze whether these associations remain after including global and regional (frontal lobe versus peri-ventricular for example) measures of white matter hyperintensities and silent brain infarction is acting as mediators. In order to achieve these scientific goals I will need training in three areas: selected topics in geriatric medicine, gait and balance measures in the geriatric population, and advanced statistical and epidemiological methods. Achieving these scientific and training goals will allow me to transition into being an independently funded academic neurologist with a focus on the contributions of subclinical stroke to unsuccessful aging, as well as broaden my expertise on stroke in the geriatric population.

Public Health Relevance

Successful aging involves not only the maintenance of cognitive function, but also sustained normal physical function, of which mobility is a critical component. Multiple silent strokes to the brain may impair mobility in the elderly. The goal of this project is to better understand the role of vascular disease on impaired mobility so as to derive treatment interventions.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Mentored Patient-Oriented Research Career Development Award (K23)
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NST-2 Subcommittee (NST)
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Moy, Claudia S
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Columbia University (N.Y.)
Schools of Medicine
New York
United States
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Willey, Joshua Z; Gardener, Hannah; Moon, Yeseon P et al. (2014) Lipid profile components and subclinical cerebrovascular disease in the northern Manhattan study. Cerebrovasc Dis 37:423-30
Willey, Joshua Z; Park Moon, Yeseon; Ruder, Rachel et al. (2014) Physical activity and cognition in the northern Manhattan study. Neuroepidemiology 42:100-6
Willey, Joshua Z; Demmer, Ryan T; Takayama, Hiroo et al. (2014) Cerebrovascular disease in the era of left ventricular assist devices with continuous flow: risk factors, diagnosis, and treatment. J Heart Lung Transplant 33:878-87
Willey, Joshua Z; Moon, Yeseon Park; Kahn, Emily et al. (2014) Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the northern Manhattan study. J Am Heart Assoc 3:e001106
Banks, Garrett P; Weiss, Shennan A; Pisapia, David et al. (2013) A case of late-onset leukoencephalopathy, calcifications, and cysts presenting with intracerebral hemorrhage resembling a neoplasm. Cerebrovasc Dis 35:396-7
Willey, Joshua; Gonzalez-Castellon, Marco (2013) Cholesterol level and stroke: a complex relationship. JAMA Intern Med 173:1765-6
Willey, Joshua Z; Khatri, Pooja; Khoury, Jane C et al. (2013) Variability in the use of intravenous thrombolysis for mild stroke: experience across the SPOTRIAS network. J Stroke Cerebrovasc Dis 22:318-22
Willey, Joshua Z (2012) Of people admitted within 2 h of mild/improving stroke, 31% do not receive rtPA, although many of these people have poor outcomes. Evid Based Med 17:162-3
Willey, Joshua Z; Rodriguez, Carlos J; Moon, Yeseon Park et al. (2012) Coronary death and myocardial infarction among Hispanics in the Northern Manhattan Study: exploring the Hispanic paradox. Ann Epidemiol 22:303-9