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Beattie Z, Miller LM, Almirola C, Au-Yeung WTM, Bernard H, Cosgrove KE, Dodge HH, Gamboa CJ, Golonka O, Gothard S, Harbison S, Irish S, Kornfeld J, Lee J, Marcoe J, Mattek NC, Quinn C, Reynolds C, Riley T, Rodrigues N, Sharma N, Siqueland MA, Thomas NW, Truty T, Wall R, Wild K, Wu CY, Karlawish J, Silverberg NB, Barnes LL, Czaja S, Silbert LC, Kaye J. The Collaborative Aging Research Using Technology Initiative: An Open, Sharable, Technology-Agnostic Platform for the Research Community. Digit Biomark 2020; 4:100-118. [PMID: 33442584 DOI: 10.1159/000512208] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Future digital health research hinges on methodologies to conduct remote clinical assessments and in-home monitoring. The Collaborative Aging Research Using Technology (CART) initiative was introduced to establish a digital technology research platform that could widely assess activity in the homes of diverse cohorts of older adults and detect meaningful change longitudinally. This paper reports on the built end-to-end design of the CART platform, its functionality, and the resulting research capabilities. Methods CART platform development followed a principled design process aiming for scalability, use case flexibility, longevity, and data privacy protection while allowing sharability. The platform, comprising ambient technology, wearables, and other sensors, was deployed in participants' homes to provide continuous, long-term (months to years), and ecologically valid data. Data gathered from CART homes were sent securely to a research server for analysis and future data sharing. Results The CART system was created, iteratively tested, and deployed to 232 homes representing four diverse cohorts (African American, Latinx, low-income, and predominantly rural-residing veterans) of older adults (n = 301) across the USA. Multiple measurements of wellness such as cognition (e.g., mean daily computer use time = 160-169 min), physical mobility (e.g., mean daily transitions between rooms = 96-155), sleep (e.g., mean nightly sleep duration = 6.3-7.4 h), and level of social engagement (e.g., reports of overnight visitors = 15-45%) were collected across cohorts. Conclusion The CART initiative resulted in a minimally obtrusive digital health-enabled system that met the design principles while allowing for data capture over extended periods and can be widely used by the research community. The ability to monitor and manage health digitally within the homes of older adults is an important alternative to in-person assessments in many research contexts. Further advances will come with wider, shared use of the CART system in additional settings, within different disease contexts, and by diverse research teams.
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Affiliation(s)
- Zachary Beattie
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lyndsey M Miller
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Carlos Almirola
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wan-Tai M Au-Yeung
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hannah Bernard
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kevin E Cosgrove
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hiroko H Dodge
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charlene J Gamboa
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Ona Golonka
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sarah Gothard
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sam Harbison
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephanie Irish
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Judith Kornfeld
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan Lee
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Marcoe
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nora C Mattek
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charlie Quinn
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Christina Reynolds
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas Riley
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathaniel Rodrigues
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicole Sharma
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mary Alice Siqueland
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Neil W Thomas
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Timothy Truty
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Rachel Wall
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Katherine Wild
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nina B Silverberg
- Division of Neuroscience, National Institute on Aging, National Institute of Health, Bethesda, Maryland, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Sara Czaja
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weil Cornell Medicine, New York, New York, USA
| | - Lisa C Silbert
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Jeffrey Kaye
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Schenning KJ, Murchison CF, Mattek NC, Kaye JA, Quinn JF. Sex and genetic differences in postoperative cognitive dysfunction: a longitudinal cohort analysis. Biol Sex Differ 2019; 10:14. [PMID: 30922389 PMCID: PMC6440164 DOI: 10.1186/s13293-019-0228-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/14/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common postoperative complication experienced by patients aged 65 years and older, and these older adults comprise more than one third of the surgical patients in the USA. Because not everyone with a history of exposure to surgery and anesthesia develops POCD, there are likely major biological risk factors involved. There are important gaps in our knowledge regarding whether genetic makeup, biological sex, or other Alzheimer's disease risk factors predispose older adults to developing POCD. We set out to determine whether biological sex and Apolipoprotein E-ε4 (APOE4) carrier status increase the risk of developing POCD in older adults. METHODS We performed a cohort analysis of 1033 participants of prospective longitudinal aging studies. Participants underwent regular cognitive test batteries and we compared the annual rate of change over time in various cognitive measures in the women exposed to surgery and general anesthesia compared to the men exposed to surgery and general anesthesia. Mixed-effects statistical models were used to assess the relationship between biological sex, APOE4 carrier status, surgery and anesthesia exposure, and the rate of change in cognitive test scores. RESULTS When comparing all men (n = 89) and women (n = 164) who had surgery, there were no significant sex differences in postoperative cognitive outcomes. However, men with an APOE4 allele performed significantly worse on cognitive testing following surgery and anesthesia than women APOE4 carriers, even after adjusting for age, education level, and comorbidities. CONCLUSIONS Older men with APOE4 allele may be more vulnerable to postoperative cognitive dysfunction than older women with APOE4 allele.
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Affiliation(s)
- Katie J Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Mail Code L459, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Charles F Murchison
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, 97239, USA
| | - Nora C Mattek
- Department of Neurology, Oregon Health & Science University, Portland, OR, 97239, USA.,Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR, 97239, USA.,Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jeffrey A Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, 97239, USA.,Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR, 97239, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, 97239, USA.,Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Joseph F Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, 97239, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, 97239, USA.,Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, 97239, USA
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