My research focuses on brain-body connections involved in human health and performance. My goal is to understand differences in resiliency, growth and rehabilitation by investigating the pathways and mechanistic drivers that shape physiological, cognitive, and clinical presentations. In this way, I use patient data and computational strategies to dissect complex physical and mental health problems, to discover critical insights for risk classification and personalized care. As a postdoctoral fellow, I have taken this approach to study genetic, cardiovascular and proteomic influences on the cognitive performance of older adult Veterans, and collaborated on multi-modal exercise and cognitive training trails to promote their fitness and memory. This research aligns with my clinical training as a rehabilitation psychologist, with the goal of maximizing the functional outcomes of my patients.
Jerome Yesavage, Postdoctoral Faculty Sponsor
Brain and Learning Sciences
Cognitive Improvement Following Physical Exercise and Cognitive Training Intervention for Older Adults with MCI.
The journals of gerontology. Series A, Biological sciences and medical sciences
BACKGROUND: The diagnosis of mild cognitive impairment (MCI) presents a critical period for intervention. Although exercise and cognitive training (CT) interventions have reported independent success for improving cognition, some meta-analyses have suggested combined interventions provide maximal benefits. Much previous research has studied land-based as opposed to water-based exercise, which places potential barriers on older adults. The purpose of the current study was to examine the impact of combined exercise (water- or land-based) and CT treatment on cognition for older adults with MCI.METHODS: Participants were 67 adults ages 54 to 86 years classified with MCI who engaged in six months of land or in aquatic with subsequent CT over four weeks. Primary outcome variables were performance measures of several cognitive domains across three time points (baseline, following exercise intervention, and following CT intervention). Linear mixed effects modeling examined exercise group differences across time periods in an intention-to-treat analysis.RESULTS: Both aquatic- and land-based exercise with CT interventions resulted significant in improvement in learning and memory outcomes, though improvement in executive functioning, processing speed, language, and visuospatial abilities was limited to water-based and CT treatment group. Differences in linear growth patterns between groups were non-significant.CONCLUSIONS: Results suggest that for older adults with MCI to obtain global cognitive benefits (i.e., Learning and Memory, Executive Functioning, Processing Speed, Language, and Visuospatial abilities) using combined exercise and CT interventions, they must be able to fully engage in exercise, and aquatic-based activities should be further considered.
View details for DOI 10.1093/gerona/glac189
View details for PubMedID 36099058
BDNF Val66Met Moderates the Effects of Hypertension on Executive Functioning in Older Adults Diagnosed With aMCI.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVE: To investigate whether the BDNF Val66Met polymorphism influences the associations of hypertension, executive functioning and processing speed in older adults diagnosed with amnestic Mild Cognitive Impairment (aMCI).DESIGN: Secondary data analysis using moderation modeling.SETTING: Veterans Affairs Hospital, Palo Alto, CA.PARTICIPANTS: Sample included 108 community-dwelling volunteers (mean age 71.3 ± 9.2 years) diagnosed with aMCI.MEASUREMENTS: Cognitive performance was evaluated from multiple baseline assessments (Trail Making Test; Stroop Color-Word Test; Symbol Digit Modality Test) and grouped into standardized composite scores representing executive function and processing speed domains. BDNF genotypes were determined from whole blood samples. Hypertension was assessed from resting blood pressures or by self-report.RESULTS: Controlling for age, BDNF Val66Met moderated the effects of hypertension on executive functioning, but added no significant variance to processing speed scores. Specifically, hypertensive carriers of the BDNF Met allele performed significantly below the sample mean on tasks of executive functioning, and evidenced significantly lower scores when compared to Val-Val homozygotes and normotensive participants.CONCLUSIONS: Results posit that the executive functioning of non-demented older adults may be susceptible to interactions between BDNF genotype and hypertension, and Val-Val homozygotes and normotensive older adults may be more resilient to these effects of cognitive change. Further research is needed to understand the underlying processes and to implement strategies that target modifiable risk factors and promote cognitive resilience.
View details for DOI 10.1016/j.jagp.2022.05.012
View details for PubMedID 35779988
Physical Activity "I Can Only Go About a Block Before Running Out of Breath"
PRACTICAL STRATEGIES IN GERIATRIC MENTAL HEALTH: CASES AND APPROACHES
View details for Web of Science ID 000555001100019
Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With Vasopressor- Dependent Shock: A Propensity Score- Matched Analysis From 130 US Hospitals
CLINICAL INFECTIOUS DISEASES
2017; 64 (7): 877-885
Shock frequently complicates necrotizing fasciitis (NF) caused by group A Streptococcus (GAS) or Staphylococcus aureus. Intravenous immunoglobulin (IVIG) is sometimes administered for presumptive toxic shock syndrome (TSS), but its frequency of use and efficacy are unclear.Adult patients with NF and vasopressor-dependent shock undergoing surgical debridement from 2010 to 2014 were identified at 130 US hospitals. IVIG cases were propensity-matched and risk-adjusted. The primary outcome was in-hospital mortality and the secondary outcome was median length of stay (LOS).Of 4127 cases of debrided NF with shock at 121 centers, only 164 patients (4%) at 61 centers received IVIG. IVIG subjects were younger with lower comorbidity indices, but higher illness severity. Clindamycin and vasopressor intensity were higher among IVIG cases, as was coding for TSS and GAS. In-hospital mortality did not differ between matched IVIG and non-IVIG groups (crude mortality, 27.3% vs 23.6%; adjusted odds ratio, 1.00 [95% confidence interval, .55-1.83]; P = .99). Early IVIG (≤2 days) did not alter this effect (P = .99). Among patients coded for TSS, GAS, and/or S. aureus, IVIG use was still unusual (59/868 [6.8%]) and lacked benefit (P = .63). Median LOS was similar between IVIG and non-IVIG groups (26 [13-49] vs 26 [11-43]; P = .84). Positive predictive values for identifying true NF and debridement among IVIG cases using our algorithms were 97% and 89%, respectively, based on records review at 4 hospitals.Adjunctive IVIG was administered infrequently in NF with shock and had no apparent impact on mortality or hospital LOS beyond that achieved with debridement and antibiotics.
View details for DOI 10.1093/cid/ciw871
View details for Web of Science ID 000397439600012
View details for PubMedID 28034881
View details for PubMedCentralID PMC5850528