Wearable Multi-modality Cuffless Blood Pressure Monitoring

Massachusetts General Hospital, Boston MA

Investigators

Abstract

As the population ages, Alzheimer’s disease (AD) is becoming a growing burden on the health care system. Current assessment and monitoring approaches require visits to the clinic or hospital for cognitive testing and to measure markers of amyloid-beta (Ab) or tau deposits in the brain, in cerebrospinal fluid, and/or in blood. These tests are burdensome, obtrusive, expensive and, in fact, constitute an unstainable care model for early detection and monitoring of AD. Ideally, brain health and AD status could be assessed at home, similar to home-based electrocardiography (ECG) or blood pressure (BP) checks for cardiovascular disease. A home-based assessment would be particularly helpful not only to older adults who have limitations with mobility, vision and/or cognitive status, but also to the 1 in 5 older Americans who live in rural areas, and those with inadequate access to routine medical care. To be viable, however, such an approach must be sufficiently low-cost and easy-to-use, which has not yet been achieved for either brain monitoring or AD assessment. A growing body of evidence suggests that neurovascular dysfunction is important to the onset and/or development of AD, and, in particular, dynamic neurovascular oscillations may be involved in the clearance of toxins such as amyloid beta and tau by the glymphatic system. Our team at Massachusetts General Hospital has developed a wearable, multimodal cerebrovascular monitoring platform, called NINscan. This technology is being enhanced and tested in our active R01 project (EB027122) by incorporating our novel superficial temporal artery tonometry (STAT) method for continuous, cuffless BP monitoring at the level of the head. A funded supplement to EB027122 is investigating the feasibility of adapting this same NINscan system for long- duration, ambulatory monitoring of both neurovascular and glymphatics-relevant variables. This supplement proposes to investigate whether we can adapt the NINscan approach to enable self- or caregiver-based assessment of brain and AD status for eventual deployment at home. Aim 1 will involve simplifying the NINscan hardware and providing self-guided instructions to facilitate at-home collection of neurovascular and cognitive data by older adults and early AD patients. Aim 2 will have older adults and early AD patients self-collect multimodal cerebral and cognitive data in the laboratory. We will conduct a preliminary test of whether such data can be used to reliably identify AD. Aim 3 will seek to incorporate the collected neurovascular and cognitive dataset, along with clinical characterization data, into the public Physionet database being developed as part of the parent R01 (EB027122). This supplement has the potential to provide a unique capability of at-home brain and cognitive assessment, including static and dynamic BP, neurovascular, and glymphatic functioning. The resulting data will provide key insights into the challenges of self-deployed brain assessments, and the utility of self-collected data for AD assessment, as well as providing a novel capability that is useful in numerous conditions beyond AD.