Longitudinal Impact of Health and Lifestyle Behaviors on Cognition in Individuals with Multiple Sclerosis

Project Summary/Abstract
This CDA proposal seeks to investigate the long-term impact of modifiable health-related behaviors (e.g.,
smoking, exercise) on cognitive decline over time among persons with multiple sclerosis (MS; Specific
Aim 1). This is important given the detrimental impact of cognitive impairment in MS, affecting
symptom management, instrumental activities of daily living, and independence. Since there are no
proven treatments for cognitive impairment, it is imperative to identify modifiable risk factors –
specifically health-related behaviors – that can serve as potential treatment targets. Moreover, in order to
modify these behaviors, this proposal will explore disease (MS)-related, person-specific, and
environmental facilitators and barriers to engaging in health-related behaviors (Specific Aim 2). Such
aims are consistent with the mission of the National Center for Medical Rehabilitation Research
(NCMRR) to “determine the impact of modifiable lifestyle and health-related behaviors on
prevention of secondary conditions, psychosocial functioning, and community participation,” as
outlined in the 2016 NIH Research Plan on Rehabilitation.
The Specific Aims will be accomplished via two longitudinal, observational studies among persons with
MS. Cognitive trajectories will be established by standardized neuropsychological assessments. Health-
related behaviors will be evaluated using self-report inventories. Facilitators/barriers to engaging in
health-related behaviors will be determined by quantitative inventories and qualitative semi-structured
interviews. Data from this investigation will serve as pilot data for a R01 grant in which a
multicomponent lifestyle intervention to improve cognition among persons with MS will be proposed.
Such intervention has been recently conducted in older adults at-risk of developing dementia, with
ongoing replications around the world. Information from this project will help adapt this type of
intervention to individuals with MS by accounting for MS-specific facilitators and barriers to engaging in
health behaviors.
I have assembled a multidisciplinary mentoring team, with expertise in clinical neuropsychology,
cognitive rehabilitation, epidemiology, advanced biostatistics, clinical trial design, and digital health
technology. By completing the proposed training and research plans, I will be able to achieve my training
goals, including: (1) applying population-based survey research design to lifestyle behaviors; (2) learning
qualitative research design and advanced statistical techniques; (3) learning how to conduct clinical trials
and applications of digital health technology; and (4) honing professional skills, such as manuscript
writing, grantsmanship, laboratory management, and mentorship. Achieving these goals will help me
transition into an independent clinical investigator, with a long career of grant-funded research.

Grant Number: 3K23HD104855-04S1
NIH Institute/Center: NIH
Principal Investigator: Michelle Chen