In 2018, an estimated 5.7 million Americans live with Alzheimer's disease (AD), with as many as 98% experiencing behavioral and psychological symptoms of dementia (BPSD). BPSD negatively impacts AD patients' and their caregivers' quality of life, results in earlier institutionalization and increases costs of care. Most approaches to assessment of BPSD rely on survey-based clinical scales completed by the caregiver during a clinic visit, such as the neuropsychiatric inventory questionnaire (NPI-Q). Recall bias and reporting of symptoms outside of the home, where symptoms occur, negatively impacts the accuracy of these scales. Accurate appraisal of BPSD is needed to apply the right treatment at the right time. This proposal outlines a career development plan to assist Dr. Bateman in becoming a patient-oriented AD researcher with specialization in innovative, technology-based measurement and intervention design. This career award will provide him with the needed research skills, knowledge and experience to become an independent investigator with expertise in BPSD and strengths in leveraging mobile health technologies to improve the lives of persons with AD. This will be accomplished through participation and completion of course work, mentorship interactions, practical research training activities, and an original research project to improve BPSD and caregiver distress measurement. This project utilizes smartphone-based ecological momentary assessment (EMA) delivery of the NPI-Q to AD caregivers (NPIQ-EMA). EMA is a group of methods that incorporate repeated sampling of participants by the asking questions of subjects in a real-time and real- environment. The proposed project is a randomized phase 2 clinical trial where AD patient-caregiver dyads receiving care from the Healthy Aging Brain Center (HABC) program at Eskenazi Health will be recruited and randomized to either an intervention group receiving the 6 month long NPIQ-EMA intervention and usual care in the HABC program or a control group receiving usual care (HABC program) alone with primary outcomes of feasibility and usability. Recruitment will take place at Eskenazi Health, one of the nation's largest safety net hospitals. Dr. Bateman's project will profit from the Indiana University Center of Aging Research (IUCAR) expertise in AD intervention trials, mobile health research, and analysis. Dr. Bateman and his mentorship team designed a career development to ensure his successful transition into an independent, investigator in AD research. This plan incorporates 1) participation in a master in clinical research program that emphasizes biostatistics, ethical research conduct, research methods, and effective grant writing; 2) mentorship; 3) practical research training; 4) extramural training; and 5) leveraging of a nationally recognized research environment at Indiana University. Completion of this training plan and research project will help Dr. Bateman develop into an independently funded investigator.
Behavioral and psychological symptoms of dementia (BPSD) leads to worse Alzheimer's disease (AD) patient and caregiver quality of life, greater psychotropic medication use and early institutionalization. Survey-based clinical scales including those used for BPSD have known limitations. Clinicians need more reliable, valid and longitudinal assessment of BPSD for effective management; thus, the goal of the current study is to develop a more accurate and clinically relevant approach to BPSD measurement through delivery of the NPI-Q via a mobile ecological momentary assessment (EMA) format.