CAPRA - Year 3 Pilot Awardees

HwaJung Choi, PhD
Michigan Medicine, University of Michigan 

Factors influencing trends in midlife cognitive functioning in the US vs. other high-income countries​

The health of working-age adults in the US has been poorer in recent years and further behind other high-income countries, which has profound implications for the labor market, wellbeing, and healthcare costs to individuals, families, and society. Dementia is among the most expensive diseases affecting many people’s lives -- financially and non-financially. The rate of dementia has declined among older adults (e.g., over 70) in the US, but this may not hold for working-age adults. Evidence suggests midlife cognitive functioning is a significant predictor of developing dementia in old age, but there is little evidence on population trends in cognitive functioning of working-age adults. A better understanding of midlife dementia risks is critically important to inform interventions to reduce the dementia rate in the future. We will assess the cognitive functioning of middle-aged adults in the US over time and identify potential factors that explain the trend.

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Jun Li, PhD, MSPH
Maxwell School of Citizenship & Public Afairs,
Syracuse University

Specialization in Post-Acute Dementia Care: Do High-Volume Home Health Agencies and Skilled Nursing Facilities Result in Better Patient Outcomes?​

​Forty percent of older adults discharged from a hospital received post-acute care from a home health agency or skilled nursing facility in 2019. Alzheimer’s Disease and Related Dementias (ADRD) is a common condition among users of these services. Appropriate, high-quality care is critical for minimizing hospital and emergency department visits, antianxiety medications, and physical or chemical restraints. However, there are few resources for ADRD patients to find post-acute care that is tailored to their specific needs. Using national Medicare data and an instrumental variables design, this study aims to determine whether people with ADRD have better outcomes if they are treated by home health agencies and skilled nursing facilities that specialize in ADRD patients. The study's findings will determine whether provider specialization can be used as a reliable quality indicator in programs such as Care Compare to assist ADRD patients in locating high-quality post-acute care.

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Ana Montoya, MD, MPH, CMD
Michigan Medicine, University of Michigan

Functional Decline among Nursing Home Residents with ADRD during COVID
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In nursing homes, long-stay residents with Alzheimer’s disease and related dementias (ADRD) receive care and assistance with activities of daily living (ADLs). However, during the COVID-19 pandemic, infection control measures and staff and personal protective equipment (PPE) shortages may have disrupted nursing home resident care and daily routines and, consequently, affected residents’ ADL performance. It is unknown whether facility-level characteristics may be associated with greater functional decline in ADLs among residents with ADRD.  This study will use Minimum Data Set (MDS) data to examine functional decline in ADLs among long-stay nursing home residents with and without a diagnosis of ADRD during the COVID-19 pandemic and to determine facility-level factors that are associated with greater functional decline in ADLs. This study will lead to a larger scale national study to evaluate functional decline in ADLs and inform potential interventions that may be implemented for residents with ADRD in nursing homes.

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Leah Richmond-Rakerd, PhD
​Department of Psychiatry, Unviersity of Michigan 
​Terrie Moffitt, PhD
​Department of Pyschology, Duke University
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Do infections lead to the onset of Alzheimer’s disease and related dementias in the population?
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It has been hypothesized that infectious agents, which can lead to neuroinflammation, may be a contributory cause to neurodegeneration. We propose to investigate infections as a potential risk factor for Alzheimer’s disease and related dementias (ADRD). Using New Zealand nationwide health registers, we will test whether infections forecast the development of ADRD in the subsequent 30 years. We will test whether associations hold across sex, age, different types of infections, and different types of dementia; within sibling pairs matched on family-level risk factors; and after controlling for socioeconomic deprivation and psychiatric and physical comorbidities. Results will provide evidence for whether the prevention and control of infections might reduce the societal burden of neurodegenerative conditions. Through this project we will also create exportable tools for use by other ADRD researchers employing linked administrative data in their work, including a linked-sibling data resource. 

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Mellanie Springer, MD, MS
Michigan Medicine, University of Michigan 

Education and racial disparities in post-stroke cognitive decline
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Low educational attainment and Black race are risk factors for post-stroke cognitive impairment and dementia. In the general older adult population, the effect of education on the number of years lived with dementia has been shown to vary by race. What is not known is how education moderates race differences in cognitive decline and dementia after stroke. This pilot project will leverage data from pooled longitudinal cohorts to evaluate whether education partially accounts for race differences in cognitive trajectories after stroke and whether the effect of education on post-stroke cognitive trajectories differs by race.