George

W.

Rebok

,

PhD

In terms of my research background, I have a life-course developmental orientation, a background in gerontology and cognitive aging, developmental psychology, prevention science, and public mental health, and postdoctoral training in cognitive neuropsychology, epidemiology, and biostatistics. My research skills include extensive knowledge of aging and developmental theory and research, clinical experimental trial design, quantitative analyses of longitudinal data, and an ability to work collaboratively with multidisciplinary teams and research centers. Since joining the Hopkins faculty in 1989, I have pursued research in two interrelated areas: 1) the design and implementation of preventive trials targeted at childhood antecedents of adolescent and adult psychopathology, including depression, early achievement problems, and poor concentration, and 2) the neurocognitive predictors of functional abilities and decline in demented and nondemented older adults and their modifiability through interactive cognitive interventions. These two research streams converge around a common focus on attentional and cognitive parameters of maladaptive behavior, plasticity of functioning, perceived competence or self-efficacy as a variable linking physiological, psychological, and social function, and short- and long-term outcomes of preventive intervention and treatment.
My research objectives include continuation and expansion of my research on: 1) pre-preventive identification of early risk antecedents and protective influences on later life cognitive health and functional decline; 2) the prevention of age-associated cognitive and functional losses, Alzheimer's disease and related dementias, depression, and disability; and 3) the study of long-term outcomes of cognitive intervention trials with both well and minimally-to-severely impaired elderly. With regard to Area 1, my previous research on normal aging and dementia has highlighted the central importance of memory problems, poor attention, and slowed information processing speed as early risk factors for later life functional problems and decline. This work has included the study of functional activities related to cognitively based activities of daily living such as driving, medication usage, financial management, and meal preparation. I plan to continue this line of research trying to more precisely delineate the nature, evolving course, and potential identification and modifiability of selected neuro-cognitive risk factors for poor cognitive health and functional decline, with a particular focus on loss of driving skills and mobility.
With regard to Area 2, preventive interventions, I plan to continue the psychoeducational interventions on memory, cognition, and cognitively based daily functioning that I have been using in the ACTIVE clinical trial and other training studies with at-risk elderly and expand them to include other intervention formats either alone or in combination with psychoeducational interventions. Specifically, these would include multimodal interventions involving physical activity and exercise (both aerobic, nonaerobic, and combined aerobic/nonaerobic activity), pharmacologic agents (potentially including vitamin supplements, NSAIDS), and community-based interventions involving cross-generational tutoring and mentoring using the Experience Corps model. Along these same lines, I plan to explore the use of using various formats for intervention and service delivery including multimedia interactive technology for cognitive training and internet, web-based technology for promotion of cognitive health care information and preventive health practice for the elderly.
Finally, with regard to Area 3, long-term outcomes, there is very little in the gerontological and geriatric literature on the long term maintenance of intervention effects for preventing subsequent psychopathology and decline in the aged. The effects of most of the intervention studies have been short-lived and highly target-specific with little generalization to non-trained tasks. In the ACTIVE study, I will examine 10-year follow-up data on maintenance effects of training on proximal cognitive targets and on everyday functional skills. Along with the other site PIs, I also have a unique opportunity with additional funding to follow this cohort (N = 2,832) for an additional 10 years to characterize developmental course, cohort-related effects, and subgroup variation on outcomes, including outcomes related to quality of life, disability, institutionalization, hospitalization, morbidity, and mortality. As part of this effort, I will examine dosage effects of the various interventions and the effects of additional booster or refresher training on intervention effect maintenance. Modeling these longer term outcomes should also help us better understand individual, genetic, and environmental factors that predict responsiveness or nonresponsiveness to cognitive intervention in the elderly.