Active Aging

Sunday, October 24, 2021 | Special Advertising Section 1 R 12 ACTIVE AGING By Paula Span The New York Times Learning your odds of eventually developing de- mentia — a pressing con- cern for many, especially those with a family history of it — requires medical testing and counseling. But what if everyday behavior, like overlooking a couple of credit card payments or habitually braking while driving, could foretell your risk? A spate of experiments is underway to explore that possibility, reflecting the growing awareness that the pathologies underlying dementia can begin years or even decades before symptoms emerge. “Early detection is key for intervention, at the stage when that would be most effective,” said Sayeh Bayat, the lead author of a driving study funded by the National Institutes of Health and conducted at Washington University in St. Louis. Such efforts could help identify potential volunteers for clinical trials, researchers say, and help protect older people against financial abuse and other dangers. In recent years, many once-promising demen- tia drugs, particularly for Alzheimer’s disease, have failed in trials. One pos- sible reason, researchers say, is that the drugs are administered too late to be helpful. Identifying risks earlier, when the brain has sustained less dam- age, could create a pool of potential participants with “preclinical” Alzheimer’s Spotting signals of developing dementia in everyday behaviors disease, who could then test preventive measures or treatments. It could also bring improvements in daily life. “We could support people’s ability to drive longer, and have safer streets for everyone,” Bayat offered as an example. For now, the search for older people who are likely to develop Alzheimer’s or other dementias takes place mostly in research settings, where patients learn their risk status through some combina- tion of genetic testing, spinal taps or PET scans to detect amyloid in the brain, as well as through questions about family history. “It’s all about finding people soon enough to intervene and prevent or delay the onset of the dis- ease,” said Emily Largent, a medical ethicist and health policy researcher at the Penn Memory Center in Philadelphia, which undertakes many such studies. Other kinds of pre- dictive tests are on the horizon, including over- the-counter blood tests for tau, another Alzheimer’s biomarker, but are several years away, Largent said. That leaves methods that are invasive, like spinal taps, or expensive, like PET scans. These approaches can’t be used to screen large groups of people. “They’re not avail- able everywhere,” Bayat said. “They’re not very accessible or scalable.” But a GPS device in someone’s car could monitor driving behav- ior almost continuously at low cost, providing so-called digital biomark- ers. “Studies have shown that driving changes in people with symptomatic Alzheimer’s,” Bayat said. “But some changes occur even earlier.” Driving performance The Washington University study enrolled 64 older adults with preclinical Alzheimer’s, as determined by spinal taps (the results were not shared with participants), and 75 who were deemed cognitively normal. For a year, researchers measured both groups’ driving performance — how often they accelerated or braked aggressively, exceeded or fell well below the speed limit, made abrupt moves — and their “driving space” (number of trips, average distance, unique destinations, trips at night). “Only now, because we have these technologies, can we do this kind of research,” Bayat said. The study found that driving behavior and age could predict preclini- cal Alzheimer’s 88% of the time. Those findings could spur recruitment for clinical trials and allow interventions — like an alert when a car drifts — to help keep drivers on the road. In areas with inadequate public trans- portation (which is most areas), that could enhance seniors’ independence. Dr. Jason Karlawish, a geriatrician and co-direc- tor of the Penn Memory Center, called the study “provocative” and well designed. “The results suggest that monitoring a real-world, cognitively in- tense behavior can detect the earliest, subtle signs of emerging cognitive impairment,” he said in an email. SALLY DENG FOR THE NEW YORK TIMES Continued on next page