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March 16, 2015
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Aging, Alzheimer’s disease and dementia have all been prominent research topics of late, as the human population just keeps getting older. Virginia Wadley Bradley, PhD, Associate Professor of Medicine in the UAB Department of Medicine, recently received an R01 award of nearly $2.3 million from the National Institute on Aging to test a computer-based training program on people with Mild Cognitive Impairment (MCI). 

Mild cognitive impairment, or MCI, is a stage of cognitive decline between the expected decline associated with normal aging, and the more serious decline of dementia. The clinical trial will focus on processing speed, and will compare participants to a control group partaking in mentally stimulating activities.

“Prior research has shown that people who have memory loss consistent with MCI weren’t able to benefit from certain types of memory training, but were able to benefit from processing speed training,” Bradley says. “It has been associated with maintenance of medication management and driving in people with regular abilities.” The processing speed training has not been done in people diagnosed with MCI, she says. 

“We are trying to maintain everyday brain function, which is thought to be mediated or improved through processing speed abilities,” Bradley says. The research will also look at genetic predictors and brain structure, taking participants’ saliva samples and MRI sequences as biomarkers for  disease risk. 

The funding came in August 2014 after Wadley submitted her grant a second time—with assistance from the Center for Clinical and Translational Science, she says. Wadley participated in a CCTS PDQ, or Panels Done Quickly, at the suggestion of Dr. Richard Allman, former director of the Comprehensive Center for Healthy Aging at UAB.

The grant was due November 2013, and the PDQ took place in late October 2013, Bradley recalls. She says the PDQ—a meeting of experts from disciplines across fields at UAB—forced her to complete her work in advance and allow time for revisions. 

wadley partyFunding party to celebrate the R01 grant award to Dr. Wadley“It forced me to get the grant done,” she says. “I was actually kind of wary of sharing the grant with all these people, and getting prepared to present it.” 

But the experience was positive, she says. “It was very helpful—it was a good discussion with people from different disciplines offering their perspectives and suggestions. “ For example, she received statistical help finding power to achieve sufficient results, and making simulations for power analyses. Another critique Bradley recalls was accounting for how to know the participants are doing the training at home after they reach that phase of the program. 

“I had read about another study using camera features built into laptops and iPads to track compliance, but we didn’t want to do that—it’s too invasive. But I did add a compliance check during home visits to make sure the person is familiar with the program—participants also are keeping logs and get phone calls to check on any barriers to compliance. We specifically designed it not to require Internet connections—it will run offline.” 

Other advice came in the form of budget considerations. 

“Dr. Robert Kimberly [CCTS director] suggested I talk to the program officer about whether they would really give this size budget to a non-pharmacologic intervention, and should I scale back? It was a good point.”

In the end, Bradley maintained her budget request, and got it. Now she and her research team will be able to provide each participant with an iPad to conduct the computer-based protocols. These are broken into categories by the type or amount of attention they require for completion: divided attention, selective attention, simple attention, and increasingly brief displays—trying to improve the amount of information processed in a single glance. Ten sessions are done at UAB before participants transition to home training on the iPads. The home training will continue for two years, once a week for an hour. The trial aims to include 140 participants diagnosed with MCI. Participants will be reassessed six weeks and twice annually after joining the study on cognitive function and everyday driving skills. 

The UAB Memory Disorders Clinic will refer participants to the trial based on clinical symptoms of MCI.  The study will conduct additional evaluations in memory and cognitive testing, plus everyday abilities using lab-based testing. 

“For example, we’ll use the driving assessment clinic run out of the Department of Ophthalmology for on-road evaluations, and also get an MRI at the outset, to look at predictors of who can benefit from this type of training,” Bradley says. Individuals who are interested in participating can contact Dr. Bradley at (205) 975-2294 or Program Manager Marianne McLaughlin at (2050) 934-0233.
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