Research

     
      


The Boston University Alzheimer’s Disease Center

The Boston University Alzheimer’s Disease Center aims to reduce the human and economic costs of Alzheimer’s disease through the advancement of knowledge. The Boston University Alzheimer’s Disease Center was established in 1996 as one of 29 centers in the US funded by the National Institutes of Health to advance research on Alzheimer’s disease and related conditions. The Center is jointly based at the Boston University Medical Campus and Bedford VA Medical Center. In 2008, the Center began researching Chronic Traumatic Encephalopathy (CTE). We foster and support high-impact, innovative research on Chronic Traumatic Encephalopathy and other long-term consequences of repetitive brain trauma in athletes and military personnel.
https://www.bu.edu/alzresearch/
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The Center for Translational Cognitive Neuroscience
The research in our lab focuses on examining memory across the age range in healthy younger and older adults and patients with Alzheimer’s disease. We study how the brain stores and retrieves memory. We focus on examining ways to help patients with Alzheimer’s disease improve their memory in side effect free, non-invasive ways.
http://sites.bu.edu/ctcnlab/
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The New England Centenarian Study
The New England Centenarian Study is an international survey of exceptional human longevity that has recruited almost 4,000 centenarians, as well as some of their siblings and offspring since 1994. Participants are carefully phenotyped at enrollment and are followed annually to track their health, and their changes in physical and cognitive functions. We examine potential genes they may have in common and other lifestyle and environmental factors that could influence the ability to live to very old age in good health. Our key findings include:

  • Exceptional longevity runs strongly in families
  • Among centenarians, disability is typically compressed towards at least their early- to mid-nineties
  • With even older ages of survival, e.g., age 105+ years, morbidity is also compressed towards the end of these exceptionally long lives
  • The genetic influence upon survival increases with older and older ages of survival beyond the nonagenarian years
  • This genetic influence probably involves many genetic variants with individually modest effects, but as a group, they have a strong effectBut for some rare exceptions, centenarians have just as many disease-associated genetic variants as the average population. Thus, their genetic advantage is likely due to variants that slow aging and decrease risk for aging-related diseases such as heart disease, stroke, cancer, diabetes and Alzheimer’s disease.

http://www.bumc.bu.edu/centenarian/
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Long Life Family Study
The Long Life Family Study is a longitudinal, observational study that has followed 5000 individuals from 550 families that demonstrate clustering for exceptional longevity since 2006. Out goal is to discover factors that help individuals remain healthy as they age by tracking participants’ morbidity, disability, cognitive decline, and eventually mortality. Analyses of genetic and non-genetic data hope to discover how people age, and why some people age more healthily than others. The Long Life Family Study is funded by and collaborates closely with The National Institute on Aging.
http://longlifefamilystudy.wustl.edu/LLFS/Home.html
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RACE: rAndomized controlled trial of Autologous microbiome reconstitution to prevent Colonization by antibiotic rEsistant bacteria
The Section of Geriatrics has partnered with OpenBiome, a non-profit organization devoted to researching the use of fecal microbiota to prevent disease, in this CDC-funded clinical trial. The study aims to determine whether transplantation of a person’s own fecal microbiota after treatment with antibiotics is safe and prevents the occurrence of antibiotic resistant infections in nursing home residents. By mitigating the potential risks of allogenic FMT from universal donors, autologous prophylactic FMT may lead to transformative possibilities in addressing the threat presented by ARB. We envision a future where autologous FMT emerges to enable microbiome reconstitution following antibiotics, reducing the patient, public health, and economic burdens of nosocomial infections, and mitigating the risk of antibiotic resistance.
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Safety and Immunogenicity of Adjuvanted versus High-Dose Inactivated Influenza Vaccines in Older Adults (Centers for Disease Control & Prevention Clinical Immunization Safety Assessment (CISA)

This CDC-funded, randomized, blinded clinical trial works to assess the safety and immunogenicity of adjuvanted inactivated influenza vaccine (aIIV3) versus High-Dose inactivated influenza vaccine (IIV3-HD) in subjects aged ≥65 years. Duke University and BMC are the two study sites.
Older adults are at high risk for influenza-related morbidity and mortality due to immunosenescence (decreased immune responses with age), multi-morbidity, specific age-related diseases (e.g. congestive heart failure, chronic lung disease) and age-related changes in compensatory physiologic responses to inflammatory states. Although the incidence of influenza is usually higher in younger adults and children than older adults, 90% of influenza-related deaths occur in older adults.
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Preventing hospitalizations in older hemodialysis (HD) patients: the role of primary care access
This research aims to provide preliminary evidence on the need for increased primary care access for hemodialysis patients. The average HD patient is hospitalized nearly twice a year; which is almost double the hospitalization rate compared to other Medicare beneficiaries. In older non-HD populations, access to primary care is associated with deceased hospitalizations rates for certain conditions such as diabetes, asthma, or chronic obstructive pulmonary disease. Such conditions are considered “ambulatory sensitive” and are likely preventable with increased visits to primary care. Increased access to primary care may be a potential intervention to reduce the overall number of hospitalizations in older HD patients.
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An Initiative to Improve Early Mobilization using Medical Student Education on a Geriatrics Inpatient Service
This new medical student quality improvement project aims to improve ambulation of hospitalized older adults. Hospitalized geriatric patients are at risk for physical deconditioning and functional decline due to prolonged bed rest. Hospitalized older adults can benefit both physically and psychologically from early mobilization.
Fourth year medical students on their 4-week required geriatrics rotation are trained in safe patient ambulation and assigned to educate and walk a patient. This educational program has been well received and showed student confidence in ambulating hospitalized older adults. Next steps include changes in student scheduling to increase student participation rates and number of patient walks and tracking impact on relevant geriatric patient outcomes such as length of stay and rate of discharge to skilled nursing facilities.

This project was selected for presentation during the Presidential Poster Session at the 2018 Annual Scientific Meeting of the American Geriatrics Society.
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Prescribing and Monitoring Controlled Substances in Home Care
The geriatric patient population is not well represented in studies regarding opioid use and misuse; none of the interventions that have been validated in the ambulatory setting have been implemented in the home-based primary care setting. This makes it difficult to prescribe controlled substances safely in older adults. This qualitative study includes a need-assessment survey among home care geriatrics providers in regards to prescribing and monitoring controlled substances in home care. The initial results of the study highlighted current attitudes and practices of geriatrics home-based primary care providers at out hospital. The study results will serve as a stepping stone in developing efficient and effective plans for prescribing and monitoring controlled substances in the geriatrics home care setting.

This project was selected for presentation during the Presidential Poster Session at the 2018 Annual Scientific Meeting of the American Geriatrics Society.
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Digital Markers of Cognition Across the Spectrum of Preclinical Cognitive Impairment to Dementia
The identification of early markers of cognitive impairment are needed to allow for timely diagnosis and greater opportunity for intervention. The goal of this project is to investigate the association of digitally captured neuropsychological test performance (via digital voice recorders and digital pens) with traditional test measures, dementia status, and neuroimaging markers in a healthy aging cohort. This has the potential to establish digital metrics as a sensitive measure of cognitive change in individuals with and without dementia leading to earlier detection and therefore earlier treatment of underlying brain pathology.
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Mobility in Older Hemodialysis Patients
Mobility, the ability to move reliably and safely, signifies independence and is integral to self-worth. Almost 70% of hemodialysis patients have difficulty walking. Hemodialysis patients with poor mobility are twice more likely to die or be hospitalized than non-hemodialysis patients. Most importantly, poor mobility is cited by patients as a major cause of poor quality of life. While risk factors for poor mobility have been studied in other populations, such insights may not be applicable to older hemodialysis patients. Older hemodialysis patients have unique challenges, like frequent travel for hemodialysis treatment and post-hemodialysis fatigue that make usual mobility treatments, such as supervised exercise, extremely difficult. The knowledge gap about potentially modifiable risk factors for poor mobility in older hemodialysis patients is impeding our efforts to improve mobility and quality of life for this highly vulnerable population.

Using a mixed methods approach, this NIH-funded study is investigating the relationships of the home environment, caregivers, cognition, and depression with mobility in older hemodialysis patients. The data gathered will inform the design of a future multifactorial intervention to improve mobility in this population.