Transdisciplinary and Integrative Approaches to Brain & Behavioral Changes with Age

1. Transdisciplinary and Integrative Approaches to Brain & Behavioral Changes with Age Molly V. Wagster, PhD Thinking, Moving, and Feeling Conference September 5, 2007

2. Why the dearth of integrative approaches? • Long history, perhaps fostered by academia and the Federal grants process, of studying one domain/discipline at a time • Difficulty of mastering multiple disciplines • Lack of insight into the complex interplay of cognitive, emotional and motor function • Tools to study these multiple disciplines Is the research environment changing?

3. Integrative Approaches to Cognitive and Motor Function Resource Allocation • Older adults prioritize walking over memorizing (Li et al., Psychol Sci, 12, 2004) • Low cognitive demand and high cognitive demand adversely affect postural control (Huxhold et al., Brain Res Bull, 69, 2006)

4. Integrative Approaches to Cognitive and Motor Function • Executive function decline in older adults associated with decline in D2 receptor availability in caudate (Volkow et al., Am J Psychiatry, 155, 1998) • Dopamine depletion of frontal cortex, caudate in rodents results in deficits similar to frontal lobe dysfunction (Kaasinen & Rinne, Neurosci & Biobeh Rev, 26, 2002)

5. Integrative Approaches to Cognition and Motor Function • Rate of progression of parkinsonian-like signs related to risk of Alzheimer’s disease (Wilson et al., Arch Neurol, 60, 2003) • Slowing in walking speed is predictive of cognitive impairment (Marquis et al., Arch Neurol, 59, 2002 • Gait abnormalities predict non-Alzheimer’s dementia (Verghese et al., NEJM, 347, 2002

6. Integrative Approaches to Cognitive and Emotional Function • Older adults recruit cognitive control processes to strengthen positive emotional information in memory (Mather & Knight, Psych & Aging, 20, 2005) • Emotional content improves performance on working memory tasks (Mikels et al., Psych & Aging, 20, 2005) • Memory of older adults benefits from emotional salience (Kensinger et al., Exp Aging Res, 32, 2006) • Hippocampal function plays a role in depression (Sahay & Hen, Nat Neurosci, 10, 2007)

7. Ultimate Objective Scientifically ascertain effective & practical measures that can be utilized by the public & health care providers to promote cognitive & emotional health Cognitive & Emotional Health Project: The Healthy Brain NIA NIMH NINDS Molly Wagster, PhD Jovier Evans, PhD Emmeline Edwards, PhD

15. Cognitive & Emotional Health: The Healthy Brain WorkshopJuly 2001 NIA, NIMH, NINDS Recommendations • Review of existing data • Complete bibliography for the Measures documents • Complete the catalogue of NIH supported studies and explore feasibility of adding information about non-NIH supported and international studies. • Create a panel to conduct a critical analysis of existing studies, with a goal of identifying opportunities for secondary analysis, add-on studies and identifying weaknesses and gaps in existing data and proposing additional focused multi-site analysis. • Encourage formation of a consortium of studies for collaborative analysis and reanalysis of existing data.

16. Critical Evaluation Study Committee

18. Conclusions from CEHP Critical Evaluation Study • Cognitive and emotional health must be studied simultaneously • Large amount of published data • Even larger amount of potential unpublished data • Encourage secondary data analytic studies • Encourage ancillary studies/prevention trials • Develop standard questionnaire to measure cognitive and emotional health

19. NIH Toolbox for Assessment of Neurological and Behavioral Function • Develop assessment tool for multiple indicators (sensory, motor, emotional and cognitive) of neural and behavioral health functioning for use in large cohort studies and clinical trials • Use as a form of “common currency” across diverse study designs and populations • Maximize yield from large, expensive studies with minimal increment in subject burden and cost

21. The NIH Roadmap • Established to provide an innovative approach to accelerate fundamental discovery and translation of that knowledge into effective prevention strategies and new treatments • Addresses the opportunities and gaps that no single Institute at NIH could tackle alone • Funded from a pool of money to which all NIH Institutes contribute and benefit

23. Clinical and Translational Science Awards (CTSA) • Scale and complexity of today’s biomedical research problems demand shift from individual disciplines and exploration of new organizational models for team science • CTS Awards will help catalyze the development of intellectual academic homes for clinical and translational science • 12 Centers and 52 planning grants for centers to be awarded. Full implementation in 2012 with about 60 institutions linked to energize disciplines of clinical and translational science

24. CTSAs in the US Columbia University Health Sciences(New York, NYDuke University(Durham NC)Mayo Clinic College of Medicine(Rochester, MN)Oregon Health & Science University(Portland, OR)Rockefeller University(New York, NY)University of California, Davis(Davis, CA)University of California, San Francisco(San Francisco, CA)University of Pennsylvania(Philadelphia, PA)University of Pittsburgh(Pittsburgh, PA)University of Rochester(Rochester, NY)University of Texas Health Science Center at Houston(Houston, TX)Yale University(New Haven, CT)

25. Ending on a hopeful note! • Expanding and maturing knowledge base on the interplay among cognitive, emotional and motor functions • Opportunities at the Federal level for shifting from studying individual disciplines to integrative, transdisciplinary science approaches • Tools and resources are being created to foster transdisciplinary and integrative research