Cognition and Alzheimer's Disease and Related Dementia (ADRD) examines the precursors of cognitive decline and the effects of cognitive decline, including ADRD, on patients, caregivers, and health care systems, both domestically and around the globe. This research theme integrates previously disjointed Penn research on one of the most vexing challenges in preparing for an aging society: preventing ADRDs, and coping with their consequences at the individual and societal level. ADRD currently affects more than 5.5 million Americans, and close to 50 million people worldwide. The number living with ADRD is predicted to double every 20 years, with the majority of growth occurring within LMICs. The economic impact of dementia already represents over one percent of global GDP when including direct medical, social and informal care costs. Penn already has prominent researchers working on the basic science of ADRD causes and treatments, including the Institute on Aging, the Penn Memory Center, Penn’s Alzheimer’s Disease Center, and the Center for Neurodegenerative Disease Research. PARC’s ADRD core aims at complementing this ADRD basic science research at Penn with innovative research on understanding the life-course and contextual determinants of ADRD and the socioeconomic consequences of ADRD for individuals, families, and societies, domestically and abroad. This theme will also create a new PARC research network, cultivate new data sources, bring new investigators to ADRD research, and bring researchers together across fields and disciplines to identify new opportunities to further ADRD research. Moreover, PARC's new ADRD theme has the promise to enhance the existing knowledge and evidence base for ADRD in populations that are currently underrepresented in ADRD research, and which will, in combination with other Penn or NIA-funded ADRD data, contribute to an identity of PARC's ADRD theme that is distinctive in terms of a focus on diverse domestic and global populations, an integration of social-science and biomedical research approaches, and the creation of innovative research networks and opportunities.

This new cross-cutting theme brings together many academic disciplines including sociology, nursing, economics, medicine, psychology, anthropology, and public health. There is an increasing need to better understand the precursors and the effects of cognitive decline, including Alzheimer’s Disease and Related Dementias (ADRD), on patients, caregivers, and health care systems, domestically and around the globe. For example, Coe has studied the cost of ADRD and Hodgson has examined interventions and care practices for persons living with dementia and their families and caregivers. McHugh has shown that surgical patients with Alzheimer’s Disease and related dementias are particularly at risk for poor outcomes, including mortality, when cared for in hospitals with a relatively low proportion of nurses with BSN degrees. Coe, Hoffman, Halpern, and Werner have received a new NIA R01 to study end-of-life care for individuals with ADRD. Karlawish’s work focuses on many aspects of life with Alzheimer’s disease, including quality of life. Kable has extended his research on neural bases of individual differences in decision making to examine differences as a function of healthy aging, and the extent to which these differences can be accounted for by preclinical Alzheimer’s Disease pathology. With a pilot grant from Penn’s Institute on Aging, Boen and Elo are investigating how exposures to psychosocial stress and biological functioning influence cognitive change across the life course using multiple longitudinal U.S. data sets. Internationally, I Kohler has examined predictors of cognition and mental health among older adults in Sub-Saharan Africa, a low-income, high HIV-prevalent context, and she has established the MLSFH Mature Adults Cohort as one of very few LIC longitudinal studies with HCAP-comparable data on cognition. Elo and Behrman, with Karlawish as a co-investigator, received supplemental funding to PARC’s P30 grant to field the HCAP in the Chilean Social Protection Survey (EPS). Schofield is working to understand the role of sleep and nutrition on cognition in India. Hubbard’s methodological work has been applied to studies of aging and dementia. Trojanowski, as the director of the Penn Institute on Aging, and Halpern, as the director of the Palliative and Advanced Illness Research Center, bring collaboration opportunities between medicine, neuroscientists, economists and demographers.