The UW Medicine Garvey Institute for Brain Health Solutions announced the award of $1 million in Innovation Grant awards to eleven UW faculty-led teams. These teams are composed of individuals representing four schools (Medicine, Nursing, Public Health, Social Work), 13 departments and numerous centers and locations including the VA Puget Sound Healthcare System, Harborview Medical Center, UW Medical Center, the Memory and Brain Wellness Center (MBWC) and the Alzheimer’s Disease Research Center (ADRC).
The awardees are:
Hesamoddin Jahanian, PhD (Department of Radiology, School of Medicine; Department of Bioengineering)
Tom Grabowski, MD (Departments of Radiology and Neurology, School of Medicine; UW Medicine Memory and Brain Wellness Center)
Positron emission tomography (PET) is an imaging technique that uses radioactive substances to visualize and assess the brain function. Apart from its heavy use in clinical oncology, PET is widely used in a variety of other conditions such as various neurological, psychiatric, neuropsychological, and cognitive disorders and is the gold standard for assessing neurodegeneration. In particular, PET is clinically used to distinguish Alzheimer’s disease from other dementias and assess the disease progression. Despite its clinical importance, PET imaging encounters barriers because of limited availability, expense and radiation exposure.
This project seeks to address this barrier to brain health using artificial intelligence to predict PET brain images from magnetic resonance imaging (MRI) data. Such a method would be extremely beneficial in clinical settings because unlike PET, MRI is widely available, non-invasive and relatively inexpensive. The approach essentially turns an MRI scanner into a PET scanner, opening up this technology to sites and applications in which PET is either unavailable or infeasible. Doing so would give millions of people access to initial screens for Alzheimer’s disease, assessment of disease progression and an easy way to monitor treatment.
Kathleen Pagulayan, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine; VA Puget Sound Healthcare System)
Jeanne Hoffman, PhD, ABPP-RP (Department of Rehabilitation Medicine, School of Medicine)
Orli Shulein, MS, CCC-SLP (Department of Rehabilitation Medicine, School of Medicine)
Rhonda Williams, PhD, ABPP-RP (Department of Rehabilitation Medicine, School of Medicine; VA Puget Sound Healthcare System)
More than a million people in the United States sustain a mild traumatic brain injury (mTBI) every year. Although many individuals recover fully, there are also a high number of people who report difficulties with attention, memory and other thinking abilities months and even years following their injury. These cognitive difficulties can affect multiple aspects of day to day functioning such as work, school and relationships. As such, effective and accessible clinical interventions are critically needed.
A promising treatment option is cognitive rehabilitation which has been shown to improve both objective and subjective cognitive functioning in people with mild traumatic brain injury. However, most cognitive rehabilitation research has focused on full-length (20 hours), in-person interventions, which is not feasible for many individuals due to time and financial constraints. This is further complicated by the current risks of in-person care associated with COVID-19.
This study will evaluate a brief (6 hours), virtual cognitive rehabilitation intervention developed specifically for individuals with persisting cognitive difficulties after mTBI. We will evaluate several outcomes related to improving patient care including treatment satisfaction, feasibility of this intervention when using telehealth and preliminary treatment effectiveness. The proposed treatment aims to provide the same clinical impact of traditional cognitive rehabilitation while reducing treatment burden and increasing access to a broader population.
Debby Tsuang, MD, MSc (Departments of Psychiatry and Behavioral Sciences and Medicine-Medical Genetics, School of Medicine; Department of Epidemiology, School of Public Health; VA Puget Sound Healthcare System)
Ge Li, MD, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine; VA Puget Sound Healthcare System)
Murray Raskind, MD (Department of Psychiatry and Behavioral Sciences, School of Medicine; VA Puget Sound Healthcare System)
Edmund Seto, PhD (Department of Environmental and Occupational Health Sciences, School of Public Health)
Alzheimer’s disease and related dementias (ADRD) affect more than 10% of adults who are age 65 and older, but the toll of ADRD is most devastating among older African Americans. African Americans are about two times more likely to develop ADRD than European Americans and are more likely to encounter racial disparities in ADRD diagnosis and care. COVID-19 has widened these disparities; in addition to being more susceptible to COVID-19 infection and fatalities, older African Americans are also more likely to experience digital and technical inequities. This has led older African Americans to feel socially isolated from support systems (e.g., community centers and churches) and bereft of mental-health support which puts them at risk for the development/worsening of depression, anxiety, cognitive impairment and sleep disturbances. Many of these risks are likely exacerbated for older African Americans with cognitive impairment or ADRD.
It is essential that we consider ways to bridge the digital divide and to confront racial disparities in ADRD diagnosis and care in the context of COVID-19-related social distancing. This project will evaluate several traditional and mobile health tools for remotely monitoring the effects of social isolation on cognition and mental health in older African Americans with baseline cognitive complaints. By testing three different strategies, we will identify the most effective, feasible and subject-preferred approach to collecting cognitive and mental health data which will help address these alarming brain health disparities.
Oleg Zaslavsky, PhD, RN (Department of Biobehavioral Nursing and Health Informatics, School of Nursing)
Annie Chen, PhD (Department of Biomedical Informatics and Medical Education, School of Medicine)
Kimiko Domoto-Reilly, MD, MS (Department of Neurology, School of Medicine)
Lewy body dementias (LBD), a term referring to both dementia with Lewy bodies and Parkinson’s disease dementia, are the second most common type of degenerative dementia in older adults. These are complex disorders in which patients may exhibit disruptive behaviors that make caregiving challenging. Compared to other types of dementias, caregivers of people with LBD report higher stress and more severe depressive symptoms. The ongoing COVID-19 pandemic has multiplied the challenges that caregivers of persons with dementia face in providing care for their loved ones. As such, support interventions for caregivers of persons with LBD are urgently needed.
In this study, we will adapt our online intervention for older adults with frailty to target the unique needs of caregivers of people with LBD. We will conduct participatory design sessions with potential users to determine their needs and priorities specific to LBD and deploy the re-designed intervention in a pilot study focused on usability and efficacy. Through this newly tailored support system, we aim to bolster the health of caregivers as well as their ability to assist care partners living with LBD.
This intervention could potentially be used in conjunction with usual care and/or as a stand-alone module in emergent circumstances, such as the current pandemic, when routine professional interventions may not be readily available. By fostering the development of a community-driven online support system, this project will begin to lay the groundwork for promoting resilience within families affected by the behavioral challenges of dementia.
Robert Bonow, MD (Department of Neurological Surgery, School of Medicine)
Randall Chesnut, MD (Departments of Neurological Surgery, Orthopaedics and Sports Medicine, School of Medicine; Department of Global Health, School of Public Health)
Nancy Temkin, PhD (Department of Neurological Surgery, School of Medicine; Department of Biostatistics, School of Public Health)
Anne Moore (Department of Radiology, School of Medicine)
Following severe cases of traumatic brain injury (TBI), the brain can swell, leading to elevations in intracranial pressure (ICP). Patients who develop high ICP following severe TBI are more likely to have poor neurologic recovery from their injury, and control of ICP likely contributes to improved outcomes. ICP detection and management is typically guided by invasive monitors placed through the skull and into the injured brain. These devices are highly accurate and reliable, but they are also expensive and expose the patient to rare but potentially serious risks. This is problematic because as few as one-third of patients are found to have elevated ICP, even when the best available evidence is used to guide their placement.
Using ultrasound to measure optic nerve sheath diameter (ONSD) could be an inexpensive, noninvasive and reliable means of monitoring ICP. Located behind the eye, the optic nerve sheath surrounds the nerve carrying visual signals to the brain. Increases in intracranial pressure are transmitted into this conduit, causing it to dilate. Ultrasound-measured ONSD has been shown to correlate with ICP in many neurologic conditions, including TBI, but it has not been systematically evaluated as a screening or a monitoring tool.
This study will routinely measure ONSD in patients undergoing invasive ICP monitoring for severe traumatic brain injury at Harborview Medical Center. The goal is to determine whether ONSD measurement with ultrasound can be combined with readily available clinical data to improve the prediction of elevated ICP, and to assess whether it can be used to monitor ICP during a patient’s hospital stay. If successful, ONSD measurement could have a significant impact on TBI care in both high and low resource settings.
Amy Starosta, PhD (Department of Rehabilitation Medicine, School of Medicine)
Jeanne Hoffman, PhD (Department of Rehabilitation Medicine, School of Medicine)
Kari Stephens, PhD (Departments of Family Medicine and Biomedical Informatics and Medical Education, School of Medicine)
Traumatic brain injury (TBI) is common in the United States with 2.87 million emergency department visits related to TBI per year. Chronic pain is a frequent complaint following TBI, with more than half of patients reporting pain. Individuals with TBI are often prescribed opioids for pain following their injury, but unfortunately may be especially vulnerable to post-injury alcohol and drug use problems.
Despite increased opioid prescriptions and risk factors for this population, there are no clinical practice guidelines for opioid prescription following TBI and limited published research. The project seeks to address this knowledge gap by using routinely collected clinical data from several different data sources to examine when and how opioids are prescribed following TBI in a community-based population.
This complete picture of opioid prescription following TBI may reveal trends of higher opioid prescription for specific subpopulations or areas of healthcare. Through understanding the trajectory of opioid prescription following TBI, we will be able to identify the scope of the problem and the most appropriate time points for intervention. Ultimately this project will provide the foundation for new approaches to reduce opioid prescription in the clinical management of in TBI.
Michele Bedard-Gilligan, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Kristen Lindgren, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Most adults in the United States experience a traumatic event at some point in their lives. Trauma exposure is linked to numerous negative outcomes including development of mental health disorders, increased suicidality, work and relationship impairment and increased physical health conditions. Effective treatments that help trauma survivors cope and decrease negative consequences exist, but many people don’t receive these treatments because of a lack of providers who are trained in evidence-based, trauma-focused treatment, especially those in rural or underserved areas on the frontlines in community clinics.
This project aims to build, implement and test an ECHO (Extension for Community Healthcare Outcomes) model for disseminating evidence-based, trauma-focused care, both psychotherapy and pharmacotherapy approaches, to providers working with underserved communities in Washington state. The ECHO approach links academic experts and community providers using virtual technology and relies on collaborative learning and bidirectional sharing of knowledge to improve patient outcomes in real-world settings. This project aims to increase local capacity for and expertise in providing evidence-based care by building curriculum and training 25-35 providers in Washington who work with underserved communities. By capturing outcomes on provider attitudes and knowledge, clinic-level service provision and patient outcomes, the team will evaluate the impact and reach of the training model, with the goal of expanding the ECHO approach to improve trauma-informed mental health care throughout Washington.
Mark Duncan, MD (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Kevin Hallgren, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Matt Iles-Shih, MD (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Andrew Saxon, MD (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Deaths related to the opioid overdose epidemic remain at an all-time high across the country, including in Washington, despite significant efforts to reduce them. There is a pressing need to support medication treatment for opioid use disorder (OUD) to help people stay in treatment and reduce the risk of overdose death and other serious health consequences of untreated addiction. Smartphone-based apps can facilitate the delivery of an evidence-based approach called contingency management that incentivizes use of medications for OUD, reduces use of non-prescribed opioids and improves retention in OUD treatment.
This study will leverage a commercially available smartphone app that can bring this much-needed behavioral support to patients receiving OUD treatment in a primary care clinic and in a specialty OUD treatment clinic. The approach offers a potentially non-labor intensive, cost-effective and highly scalable means of delivering OUD care. In addition to these advantages, it is also uniquely suited to ensuring ongoing contingency management therapy regardless of COVID-19 precautions and/or other potential disruptions to usual care. If successful, this project could inform policy decisions related to making contingency management more accessible across a spectrum of OUD treatment settings.
Richard Ries, MD (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Alan Gojdics, MEd (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Adam Livengood, MA (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Diane Powers, MBA, MA (Department of Psychiatry and Behavioral Sciences, School of Medicine)
Although suicide is one of the leading causes of death for people with substance use disorders (SUDs), no widespread suicide prevention intervention exists for delivery in community addiction treatment settings. The effectiveness and feasibility of delivering Preventing Addiction Related Suicide (PARS), a group-based psychoeducational program that provides evidence-based suicide prevention and safety strategies to SUD patients, was recently demonstrated in a NIH-funded trial led by the UW Center for Suicide Prevention and Recovery (CSPAR).
To enhance widespread implementation and dissemination of PARS (and to adapt this crucial intervention for addiction treatment amid COVID-19 disruptions to health care access and delivery), this project will develop online training and implementation tools including a state-of-the-art website and Zoom-based training video with testing and certification capacity. The project, called PARS-Web, is a collaboration between UW CSPAR, the Advancing Integrated Mental Health Solutions (AIMS) Center and the University’s CoMotion Center. Currently, Washington and 37 other states mandate suicide training for behavioral health clinicians. PARS-Web will be created in collaboration with key state agencies and suicide prevention professionals to meet the new training requirements for Washington State Chemical Dependency Professionals. The goal is to design a platform for delivering an easily adopted, feasible and evidence-based suicide prevention intervention (PARS) and to integrate the program as a part of standard care in addiction treatment agencies statewide and, eventually, nationwide.
Jeff Iliff, PhD (Department of Psychiatry and Behavioral Sciences and Neurology, School of Medicine; VA Puget Sound Healthcare System)
Deidre Jansson, MSc, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine; VA Puget Sound Healthcare System)
This project will determine the accuracy and specificity of arterial spin labeling (ASL) — a non‐invasive perfusion technique used in MRI to track cerebral blood flow — in measuring vascular and glial‐dependent water transfer to establish whether it is a valuable clinical tool in Alzheimer’s disease. This simple and safe technique, already approved for use in a clinical setting, has potential to circumvent current invasive approaches in human subjects at risk for Alzheimer’s disease‐related dementias.
Rebecca Hendrickson, MD, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine; VA Puget Sound Healthcare System)
Kathleen Pagulayan, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine; VA Puget Sound Healthcare System)
Abigail Schindler, PhD (Department of Psychiatry and Behavioral Sciences, School of Medicine; VA Puget Sound Healthcare System)
This project will conduct a preliminary investigation into the potential association between microbiota abundance, hormone levels, and peripheral inflammation and current symptoms (psychiatric and cognitive) in Veterans with and without a history of mild Traumatic Brain Injury (mTBI). This work has the potential to form a new line of research that could ultimately provide new treatment options for individuals who have treatment-resistant emotional and cognitive difficulties post-mTBI.