CAPRA - Year 5 Pilot Awardees

Andrew F Brouwer, PhD, MS, MA
School of Public Health,  University of Michigan ​

A microsimulation approach to modeling individual trajectories of Alzheimer's disease risk factors and progression

Understanding the progression of Alzheimer’s disease and related dementias is important for making clinical care decisions, developing personalized medicine approaches, and making large-scale predictions for future healthcare burdens. Models are an important tool both for estimating risk and protective factors of transitions in disease states in large, longitudinal data sets and for projecting individual and population-level trajectories. In this project, we combine multistate transition models analyzing transition patterns in cognitive status and important dementia risk factors in the University of Michigan Memory and Aging Project with microsimulation models that project those patterns forward, estimating and quantifying uncertainty around future trajectories. We will investigate the potential impact of interventions on modifiable dementia risk factors, such as hypertension and diabetes.

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Janette Dill, PhD
School of Public Health, University of Minnesota

Co-I:  Jerry Jacobs, PhD
Penn Arts & Sciences, University of Pennsylvania

The use of technology among home care agencies in the care of adults with dementia

People with dementia make up a large proportion of all elderly people who receive hands-on care provided by home care aides in home and community-based care (HCBC). The adoption of emerging technologies in the home may help older adults navigate physical, social, and cognitive challenges, including adults with dementia. In addition, technological advances have the potential to substantially alter workforce needs and mitigate a portion of the rising workforce demand. However, how home care agencies are employing technologies is not well understood, and there is a general lack of published evidence of efficacy. The goals of this study are to identify how technology is used in HCBC, how it impacts the home care workforce, and how it impacts perceived health outcomes for adults with dementia is an important step in understanding how adults with dementia can continue to age in place. ​

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Dianne McWilliam, PhD Candidate
Department of Economics, University of Michigan

Co-I:  Edward C. Norton, PhD
School of Public Health, University of Michigan

How do macroeconomic conditions affect elder abuse for those with ADRD? National evidence from state Adult Protective Services reports

​Older adults with Alzheimer’s Disease and Related Dementias (ADRD) are particularly vulnerable to elder abuse, facing a higher risk and potentially worse consequences from abuse. As more informal caregivers balance employment and family responsibilities, caregivers are more likely to be affected by changes in the economy. Changes in economic conditions may affect both the amount of eldercare provided, and financial stress experienced by the caregiver – two factors that may affect rates of elder abuse. Despite this, little is known about how macroeconomic conditions affect elder abuse, especially among older adults with ADRD. This study will assess trends in domestic elder abuse in the U.S. and examine the causal effect of macroeconomic conditions on elder abuse, both overall and among victims with ADRD. We will exploit within-state variation in unemployment rates and leverage new administrative data capturing information on all elder abuse reports to state Adult Protective Services programs, from 2016.

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Brian Stamm, MD
Michigan Medicine, University of Michigan

Determining the vascular contributions to sex differences in cognitive decline and dementia

Women have a greater burden of Alzheimer’s disease (AD) and faster cognitive decline than men. However, the drivers of sex differences in dementia and cognitive decline—and how these change throughout the lifespan— have not been fully elucidated. We will study a series of questions that will advance our understanding of the sex differences in dementia and cognitive decline and the role of vascular risk factors, namely high blood pressure (BP) levels and BP variability, as well as stroke. Our main scientific hypothesis is that higher BP levels, BP variability, and incident stroke in women, particularly in later life, contribute to sex differences in dementia incidence and cognitive decline. We will use the BP COG dataset, a pooled cohort of six US longitudinal cohort studies. This research ultimately seeks to reduce the burden of AD in women to achieve health equity in aging and brain health. 

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Wen Ye, PhD
School of Public Health, University of Michigan

Development of a Microsimulation Model for Cognitive Impairment and Dementia in Type 2 Diabetes Patients

Cognitive impairment and dementia (CID) are increasingly recognized as important complications of type 2 diabetes (T2D) that significantly impact affected individuals (including their diabetes management), their families, and healthcare systems. However, few recommendations are available to guide clinicians about how to prevent or treat CID in people with T2D. It is critical to understand the role of risk factors (e.g., comorbidities and frailty) for T2D-related dementia, and to identify and test traditional and new classes of drugs (e.g., sodium-glucose co-transporters) that reduce T2D-related dementia risk in clinical settings. The objectives of this pilot study are to develop and internally validate a preliminary microsimulation model for CID in patients with T2D. This will provide a framework for develop a full model to aid clinical trial design, project the long-term efficacy and cost-effectiveness of interventions, and inform health policy and resource allocation for dementia in the T2D population.