Emory research goes deep on mild cognitive impairment
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By Nancy Badertscher
For the AJC

Every 65 seconds, someone in America develops Alzheimer’s, now considered the most expensive disease in America.

Affecting nearly six million Americans, with a projected 14 million affected by 2050, Alzheimer’s has no known cure. 

The costs, the prevalence and the family heartbreak associated with Alzheimer’s have researchers around the world — including at Atlanta’s own Emory University — scrambling for answers. They’re searching for a cure, ways to prevent the development of the disease and ways to slow its progression.

This series provides a glimpse into the research taking place at Emory.


Today’s installment looks at mild cognitive impairment, a condition that researchers say affects up to 20% of people 65 and older.

The issue: Mild Cognitive Impairment

Mild cognitive impairment (MCI) is the stage between normal age-related cognitive decline and dementia. Mild forgetfulness is part of normal aging. MCI causes cognitive changes that are serious enough to be noticed by the individual and people around them and that make complex everyday activities, such as managing schedules and finances and driving, more challenging. With our rapidly aging society, it is estimated that by 2060 more than 98 million individuals will be age 65 or older and at risk of developing MCI.

A diagnosis of MCI can signal an increased risk of developing Alzheimer’s disease and other types of dementia. Recent studies show that within five years of an MCI diagnosis, 32% of individuals with MCI will progress to Alzheimer’s disease and 38% will progress to other types of dementia. Unfortunately, there is no cure for MCI.

While MCI may present a window of opportunity for care that may delay progression to Alzheimer’s disease and other dementia, current management of MCI is limited to identifying medical risk factors, recommending behavior and lifestyle modifications and periodic testing. There is little evidence of the effectiveness of these efforts, however.

Researchers believe this represents a significant gap in both clinical care and research into mild cognitive impairment.

The research

The MCI Empowerment Program (MCIEP), a strategic partnership between Emory and Georgia Tech, is funded by $23.7 million in grants from the James M. Cox Foundation and Cox Enterprises, which owns The Atlanta Journal-Constitution.

It is a comprehensive intervention focused on education, physical, cognitive and social enrichment.

The program, which is currently under development, will provide much needed support for those diagnosed with MCI, their care partners and family members.

Once enrolled in MCIEP, participants will complete a series of tests and work with researchers to set personalized goals to be carried out in a day program, at home, and in the community, using innovative therapy, physical settings and technologies.

Individualized interventions will promote behavior and lifestyle modifications through education and well-being programs, physical activity, cognitive stimulation, social engagement and training on functional tasks. This comprehensive approach will allow researchers to test whether these modifications have a positive impact on individuals with MCI and their care partners.

The day program will be carried out in an innovative space designed by Nelson Architects and based on research conducted at Georgia Tech.

The specially designed space will promote safety, comfort and engagement.

The space will allow researchers to study how the surroundings — such as lighting and sound — affect and, potentially, alter the subjects’ cognitive impairment.

Technology used in the day program and in participants’ homes will track diet, exercise and sleep, while motivating the participants to reach their behavior and lifestyle modification goals.

Technology will provide monitoring for safety, such as detecting if a stove top is left on. It will be available to provide flexible reminders of everyday activities and opportunities for strengthening social interactions with family and friends.

Participants will be able to work with researchers and industry professionals to develop products and solutions to problems they encounter in everyday life.

Testing different components will give researchers a better understanding of how to improve assessment, therapy and support for individuals with MCI, their care partners and family members.

Periodic testing also will help researchers determine how a comprehensive, personalized, and integrated intervention increases empowerment and the quality of life of individuals with MCI and their care partners.

The outlook The MCI Empowerment Program is scheduled to open its doors in October 2019. Researchers at Emory Brain Health Center and Georgia Tech, along with partners Pacific Northwest National Laboratory and Oregon Center for Aging and Technology, will use Emory’s MCIEP for rapid development and evaluation of new evidence-based programs and technologies.

The future As the MCI Empowerment Program progresses, leaders will work with local, regional and national networks to support the implementation of programs in other communities.

This will be critical for bridging the clinical and research gaps that limit treatment recommendations for individuals and families living with MCI.



ABOUT THE RESEARCHERS



Allan Levey, MD, Ph.D., the study’s principal investigator, is a professor, chair of the Department of Neurology at Emory and director of the Goizueta Alzheimer’s Disease Research Center. 



Amy Rodriguez, Ph.D., is an assistant professor in the Department of Neurology, Emory University School of Medicine. As a speech-language pathologist and rehabilitation scientist, her research focuses on interventions to improve cognitive and language function in aging and neurologic disease. She leads the Therapeutic Programs Core of the MCI Empowerment Program.



Elizabeth Mynatt, Ph.D., a distinguished professor in the College of Computing and executive director of Georgia Tech’s Institute for People and Technology (IPaT), is co-leading the Technology Core of the MCI Empowerment Program. She investigates the design and evaluation of health information technologies, including personalized mobile technology that supports breast cancer patients in their cancer journey.



Gari Clifford, DPhil, is coleading the Technology Core of the MCI Empowerment Program. His research focuses on machine learning and signal processing applied to medical diagnosis and assessment.

He joined the faculty of Emory and Georgia Tech in 2014 and is the chair of the Department of Biomedical Informatics. Previously, he was on the faculty at the University of Oxford where he helped found the Sleep & Circadian Neuroscience Institute.

Craig Zimring, Ph.D., is leading the Built Environment Core of the MCI Empowerment Program. Zimring is the director of Georgia Tech’s SimTigrate Design Lab, a professor in Tech’s School of Architecture and a founder and developer of the field of evidence-based design of health care environments.

Jennifer DuBose is leading the Innovation Accelerator Core of the MCI Empowerment Program.

She is the associate director of Georgia Tech’s SimTigrate Design Lab and a principal research associate in Tech’s College of Design. Her research focuses on evidence-based design for health care facilities.