The purpose of this individual National Research Service Award (NRSA) is to provide research training for a neuroscience nurse to become an independent investigator focusing on the biological mechanisms that contribute to neurobehavioral changes such as apathy in patients with neurodegenerative disease (ND). In addition to scholarly coursework and the acquisition of research skills, I propose to focus this NRSA on impairments of goal-directed behavior that are very common but understudied in ND. The syndrome of apathy, defined as a reduction in self-generated or voluntary behavior,1 has profound consequences for morbidity and mortality in the patient and for family caregiver burden. Apathy is one of the primary neuropsychiatric syndromes associated with the disruption of the frontal-striatal system, but the behavioral and biological mechanisms underlying apathy are not well understood. Apathy is especially prevalent in behavioral variant Frontotemporal Degeneration (bvFTD), where it is reported in up to 90.5% of mild stage patients.2 I hypothesize three subtypes of apathy that compromise distinct components of goal-directed behavior, and that each of these subtypes of apathy are associated with a specific neuroanatomic substrate. I will investigate these empirically using a novel computerized reaction time test and neuroimaging. I have had more than 5 years experience as an Advanced Practice Nurse and Research Nurse Coordinator in a nationally ranked laboratory that studies the neural basis for behavior in ND and have direct access to a large database of neuropsychological and neuroimaging data. My research training will be guided by two internationally known scientists, Dr. Lois Evans, a well-known gerontological nurse expert and leader, and Dr. Murray Grossman, a highly acclaimed cognitive neurologist and experienced scientist. The long-term impact of this research training will be profound for patients with ND, their caregivers, and families. Current treatment of apathy has been hindered because of our poor understanding of the mechanisms underlying this condition. The precise characterization of apathy will allow us to implement the most appropriate therapy for a patient. Consistent with the National Institute of Nursing Research (NINR) priorities, this work will lead to a better understanding of why these behaviors occur and with this knowledge, tailored interventions can be implemented by professional and lay caregivers.

Public Health Relevance

I plan to focus my pre-doctoral training on becoming an independent nurse research investigator, and the research component of my pre-doctoral fellowship focuses on the interruption of goal-direct behavior in patients with neurodegenerative disease, leading to a profound form of apathy that is associated with increased morbidity and mortality. Although this significant problem is commonly observed in patients and has a pervasive impact on caregivers, the mechanisms underlying apathy have not been well studied. The proposed work will dissect apathy quantitatively, providing both behavioral and neuroanatomical insight into the basis for this condition, and this will lead to effective interventions aimed at treating the specific dysfunctions contributing to apathy.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Banks, David
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University of Pennsylvania
Schools of Nursing
United States
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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
Powers, John P; Massimo, Lauren; McMillan, Corey T et al. (2014) White matter disease contributes to apathy and disinhibition in behavioral variant frontotemporal dementia. Cogn Behav Neurol 27:206-14
Massimo, Lauren; Evans, Lois K (2014) Differentiating subtypes of apathy to improve person-centered care in frontotemporal degeneration. J Gerontol Nurs 40:58-65
Avants, Brian B; Libon, David J; Rascovsky, Katya et al. (2014) Sparse canonical correlation analysis relates network-level atrophy to multivariate cognitive measures in a neurodegenerative population. Neuroimage 84:698-711
Massimo, Lauren; Libon, David J; Chandrasekaran, Keerthi et al. (2013) Self-appraisal in behavioural variant frontotemporal degeneration. J Neurol Neurosurg Psychiatry 84:148-53
Massimo, Lauren; Evans, Lois K; Benner, Patricia (2013) Caring for loved ones with frontotemporal degeneration: the lived experiences of spouses. Geriatr Nurs 34:302-6