Although the majority of Americans with Alzheimer?s disease and related dementias (ADRD) live independently, the neighborhood contexts in which they develop and navigate cognitive impairment are largely ignored. Environmental factors may significantly increase the risk of or buffer against ADRD, yet strategies to address cognitive decline to date largely overlook the role of neighborhoods. Residence in advantaged neighborhoods may promote cognitive functioning and/or buffer against dementia in part through greater density of physical and social resources (e.g., recreation centers, parks, libraries, coffee shops) that benefit cognitive reserve and maintain mental function through physical activity, mental stimulation, and social engagement. This project proposes to develop the new niche of clinical geography by translating geographic knowledge into a preliminary tool designed to facilitate place-based interventions that maintain and improve cognition among aging residents. First, the project aims to identify built and social environmental factors linked to changes in cognitive function over time and the onset of cognitive impairment based on secondary data analysis of a national, racially diverse, population-based sample. The dataset includes multiple measures of cognitive function and residential geographic coordinates for 30,000+ aging Americans tracked annually since 2003. Interpretations of longitudinal generalized linear mixed models will focus on identifying environmental factors relevant to trajectories of cognitive decline and onset of cognitive impairment. Second, the project aims to translate this knowledge into a preliminary diagnostic tool: Environmental Neighborhood Health Assessment to Nurture Cognitive Enhancement (ENHANCE). A community advisory board (CAB) will be formed to develop ENHANCE through diverse input from gerontologists, ADRD experts, dementia community advocates, urban planners, and older adults. The CAB will discuss how environmental factors can impact cognitive decline, develop the tool, and refine ENHANCE based upon preliminary feasibility and pilot testing. The F32 fellowship will facilitate Dr. Finlay?s career development and future as a successful independent health researcher. It complements and extends her expertise in health geography and environmental gerontology through mentored training in five new areas: 1) advanced quantitative analysis; 2) cognitive function and ADRD; 3) clinical observation of cognitive impairment; 4) tailored design of environmental audits; and 5) NIH grant skills. The interdisciplinary and supportive training environment at the University of Michigan provides a foundation for Dr. Finlay to pursue translational research throughout her career. Her long-term research objective is to develop a new concept of ?cognability? (a measure of how supportive an area is to cognitive functioning and how it buffers against cognitive impairment) with a reliable and efficient instrument to evaluate relevant macro and micro environmental conditions. Resulting tailored, place-specific interventions are intended to help aging individuals reduce risk for cognitive impairment and ADRD, live independently longer, and lessen need for long-term care.

F32AG064815

2020-02-01

2022-01-31