Assessing Urban-Rural Environmental Stress Inequities in ADRD through Ecological Momentary Assessment

This study aims to identify and understand the role of environmental stressors in the development of Alzheimer’s Disease-Related Dementias (ADRD) and related health disparities across urban and rural populations. We will recruit 600 participants (300 urban dwelling and 300 rural dwelling) from the U.S. State of Indiana at high risk for developing ADRD. High risk individuals will be identified by analyzing passive digital markers (PDM) in electronic health record (EHR) data using a validated algorithm developed and tested by our research team in a currently funded NIA R01. Participants will complete a cognitive assessment based on the Uniform Data Set (UDS) 3.0 from the NIA Alzheimer’s Disease Center program to determine eligibility at baseline. Only individuals with mild cognitive impairment (MCI) will be enrolled in the study. Following a process utilized in our currently funded R21 data collection, each enrolled participant will then report their stressors for a two-week period using our novel Stress Reports in Variable Environments (STRIVE) mobile ecological momentary assessment (EMA) app while wearing a smartwatch to track their activity level, heart rate, and sleep. Our custom built STRIVE app passively collects GPS coordinates of participants every 60 seconds and participant initiated self-reports of stressors, including description, subjective severity, coping response, and photo of stressful environment. We will conduct qualitative thematic analysis of text- and image-based stressor data. These measurements will be used as indicators of each participant’s ‘usual environment’ as well as experience of and exposure to environmental stressors. We will continue to monitor PDMs in participant EHR data and administer cognitive assessments 12 months, and 24 months to determine if subjects convert from MCI to ADRD. Through this research, we will address 2 aims: 1) To determine where, when, and what environmental stressors are experienced by urban and rural dwelling individuals at high risk for ADRD, and 2) to determine disparities in the relationship between environmental stressors, lived environment, and conversion to ADRD between urban and rural dwellers. Completing these aims will advance knowledge of 1) How environmental stress plays a role in ADRD health disparities; 2) New environmental stress-related therapeutic targets for treatment of ADRD; and 3) New interventional strategies based on validated stress factors to mitigate ADRD health disparity between urban and rural environments.