I wish to pursue an academic career as a clinician and researcher in geriatric psychiatry studying and teaching about the interface between depression (Depr.), cognition and dementia (Dem.) in the elderly. My experiences as a clinician, teacher, and researcher have increased my interest in pursuing these relationships in older adults. As a clinician on an inpatient mood and geropsychiatry unit, I have struggled with differential diagnosis in cognitively impaired elderly patients. As a research physician on a large epidemiologic study of dementia, I initiated a study of Depr. in demented and non-demented subjects, obtaining preliminary data confirming the hypothesis of an increase in subsequent Dem. among subjects with late-onset Depr (LOD). However, I felt that more definitive studies with accurate assessment of both Depr. and cognition would be needed. my participation in Duke's Clinical Research Center for depression in late life affords me a unique opportunity to more fully research my observations linking Depr. with Dem. in the elderly. To do so, I will need further training and experience in (1) the classification and differential diagnosis of LOD, (2) MRI analysis, (3) classification and measurement of APOE, (4) neuropsychological assessment, (5) research methods, and (6) longitudinal data collection, management and analysis. Methods: Training Experiences. I will receive close supervision and tutoring by local experts in each of these areas, as well as advice and input by recognized educators and investigators from outside institutions. So that I can attain the skills necessary to be an educator and mentor of others, I will continue to teach medical students, residents and fellows. I will get specific training in the examination of neuroimaging studies and in neuropsychological assessment. Finally, i will be taking classes in research methods and psychometrics that will help refine my skills in study design and data analysis. Research Project. Geriatric Depression: Apolipoprotein E and dementia risk. The major aims of this project will examine cognitive functioning. APOE genotype and MRI hippocampal size in depressed elderly subjects. The project is designed to test these aims and to establish a large data base which will form the basis for more longitudinal studies of depression, neuropsychological function, MRI changes and APOE genotype. Results: The training experiences will develop my skills as a clinical researcher and as a teacher in geriatric psychiatry. The research project will produce a data base to help achieve my training goals, yield data to answer some important questions about Depr. and APOE genotype, MRI changes, and cognitive status, give me experience in running longitudinal studies, and position me to continue research in this area as a PI. Thus, this award will help establish me as an independent investigator, giving me the experience necessary to become a resource for those interested in depressive and cognitive disorders of the elderly.
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