( Abstract: Diseases of blood vessels in the brain culminate in vascular dementia (VaD) and ultimately rob one of independence in activities of daily living in elder years. They often commence an insidious progression in early to midlife with a concomitant diminution in work proficiency. Vascular dementia is treatable, however. Successful containment of the progression requires rigorous management of associated health risks, such as control of blood sugars; weight loss, reduction of blood pressure levels and of alcohol consumption; smoking cessation; improved diet; and increased exercise. Management of these health risks is highly effective in halting cognitive decline and preserving ADL independence. However, consistent health management is nearly impossible to achieve in most patients with vascular mild cognitive impairment, the early stage of vascular dementia, who are still living independently. In this proposal, we aim to enhance SymTrend, a currently marketed electronic diary system, to help this vast under treated aging population. We propose to tailor SymTrend to VaD risk factors add links to inexpensive Bluetooth and open source data enabled devices (e.g., BP monitors) and apps and to optimize real time tracking, feedback, and guidance for managing these health risks. Objectives: We will add four components to SymTrend: 1) links to Apple Health and Bluetooth devices, 2) expansion of the internally programmed statistical software to improve its graphics and messaging to support patient feedback and symptom management, 3) create reports that will depict progress in symptom management that are analytically useful for clinicians and can serve as the basis for patient feedback: its frequency, content, and modality (text, voice, web/mobile display); and 4) extend the system?s analysis capabilities to detect and address vulnerabilities that arise from stressors such as family issues that impair work and activities of daily living. We will supplement these technical features with enhanced educational material on the SymTrend website. Design and Methods: Neurologists from Massachusetts General Hospital will refer 10 adults with vascular mild cognitive impairment for participation in this project. The patients will be given Bluetooth devices appropriate for their condition and will be trained to use SymTrend and Apple Health software. They will use the software and devices for three months; will receive messages throughout from the system and/or a research coordinator about their progress, with encouragement and strategies to fully manage their symptoms; and their neurologist will be in communication with them about the progress charts and will adjust their care on the basis of this real-time data. Significance: Successful completion of the technical implementation and research project will enable a care reinvention for neurologists to use with their out-patients in this large population.
Individuals with uncontrolled vascular disease are at risk for an insidious progression of brain injury starting in early to midlife and ultimately culminating in a vascular dementia, robbing them of activities of daily living independence. Successful containment of this progression requires rigorous vascular risk factor management ? the control of blood pressure, blood sugars, weight, and alcohol consumption; the cessation of smoking, and an increase in aerobic activity. SymTrend?s mobile and web system for managing vascular risk factors will help improve adherence to health and lifestyle strategies, will stem cognitive decline, and will preserve independence in the community for older adults.
