Sleep Health and Cognitive Function among Middle-aged Adults: the SleepCog Study

PROJECT SUMMARY/ABSTRACT Dr. Minjee Kim is a practicing neurologist with expertise in sleep research and clinical assessment of cognitive impairment (CI). Her long-term goal is to become an independent investigator studying: (1) the role of sleep as a potentially modifiable determinant of CI, Alzheimer’s disease and related dementias (ADRD); (2) the design of

health system interventions for the early detection and treatment of sleep disturbance (SD) to mitigate CI/ADRD risk. The career development plan proposes to fill critical gaps in her skills through formal and informal training in aging research, data science, and health system interventions. This award will ensure she has the knowledge,

skills, and experience to conduct in-depth investigations, lead pragmatic clinical trials, and translate research findings into routine clinical care. Dr. Kim has convened an outstanding mentoring team with complementary expertise in sleep, cognitive aging, health system interventions, pragmatic trials, data science, biostatistics, and

primary care. Northwestern University offers Dr. Kim an exceptional environment, with dedicated resources from the Department of Neurology, Center for Circadian and Sleep Medicine, Center for Applied Health Research on Aging, Claude D. Pepper Older Americans Independence Center, and Clinical and Translational Sciences

Institute to support her research, career development, and transition to independent clinical investigation. SD refers to manifestations of poor sleep health, including inadequate duration, inappropriate timing, irregular pattern, low efficiency, unsatisfactory quality, and daytime sleepiness. Many forms of SD can be effectively

addressed in primary care, yet SD remains largely undetected in clinical settings. SD is common in later life and has been linked to CI/ADRD risk. Yet less is known about SD in middle age (MA). As clinically meaningful cognitive decline is believed to present during MA, more research is needed that examines midlife determinants

of cognitive decline that could be targets of interventions. If identified early, SD in midlife may be modifiable with immediate benefits on physical and mental health, and might possibly reduce later life risk of CI/ADRD. To address this, Dr. Kim has added new sleep measures (actigraphy, sleep diary, questionnaires) to a new

NIA cohort study investigating cognitive function among middle-aged adults (‘MidCog’; PI: Wolf) explicitly for this proposal. Leveraging the MidCog study and linked electronic health records (EHR) data, Dr. Kim will investigate associations between SD, cognitive function, self-care capacity, and health status (Aim 1), and then

apply machine learning to develop SD prediction models from EHR data (Aim 2). In Aim 3, Dr. Kim will adapt and pilot test an EHR-embedded primary care strategy for routine detection of SD, guided by the SD prediction model. Fidelity and preliminary efficacy outcomes will be captured via the EHR, providing preliminary data for a

next-step implementation and evaluation of a scalable, primary care strategy for the timely detection and management of SD. This K23 award will be the foundation for Dr. Kim’s future investigations focused on multi- site pragmatic trials testing health system interventions targeting SD to mitigate later life CI/ADRD risk.