Please visit Prof. Edward’s profile page for additional information and a list of publications.
Effects of Stroke and Alzheimer’s Disease on Function, Community Participation and Quality of Life
- How does cognitive impairment affect the performance of complex life activities?
- How do subtle changes and losses of executive function abilities affect community participation and quality of life for persons with stroke and Alzheimer’s disease?
- What are the long-term effects of very mild stroke on community participation and quality of life?
- Are there age related differences in stroke recovery and stroke outcome?
- How are disparities in stroke care associated with poorer stroke outcomes in African Americans ?
- Do performance based measures of executive function provide more ecologically valid and accurate estimates of functional capacity than traditional neuropsychological tests?
Dr. Edwards and her colleagues are using neurological, neuropsychological, occupational performance and outcomes research methods to explore the effects of cognitive impairment and racial disparities in adults with stroke and Alzheimer’s disease. Through collaborations with UW-Madison faculty in Neurology and Geriatric Medicine as well as investigators at Washington University in St. Louis, Georgetown University and Johns Hopkins School of Public Health several active studies are underway.
ALZHEIMER’S DISEASE IN MINORITY AND MEDICALLY UNDERSERVED ELDERS
Dr. Dorothy Edwards: PI, R01: Enhancing Participation of Underrepresented Groups in Biomarker Research. NIH: National Center for Minority Health and Health Disparities (NCMHD)-part of the UW Health Disparities Center of Excellence Program. Alexandra Adams MD and C. Sorknesss Pharm D. Center Principal Investigators. (2009-2014).
Dr. Dorothy Edwards: Core Leader, Minority Recruitment Satellite Program (Core F). University of Wisconsin Madison Alzheimer’s Disease Research Center. Sanjay Asthana M.D. Principal Investigator, National Institute on Aging (2009-2014).
Dr. Dorothy Edwards is the PI of the Minority Recruitment Satellite Program for the newly funded University of Wisconsin Alzheimer’s Disease Research Center. UW has received 5 year of funding for this research program. UW is now one of 29 NIH funded Alzheimer’s Disease Centers. The UW Alzheimer’s Disease Research Center Application was funded by the National Institute on Aging (NIA) as of April 1. Funding is from 2009-2014. Sanjay Asthana MD is the Principal Investigator, National Institute on Aging. Total funding for Dr. Edwards part is $1,250,000.00 for the 5 year term of the project.
Dr. Edwards’ research funded by the National Institute on Aging (National Institute on Aging, 5-P0AG05681) focused on exploring the needs and characteristics of cognitively impaired minority and medically underserved urban elders. These studies also examined strategies for recruitment and retention of minority elders and their families for longitudinal studies of AD and other dementias. A related study funded by the Retirement Research Foundation assessed cognitive and psychiatric impairments in urban elders with suspected of self neglect syndrome. A common thread in these studies is multidisciplinary assessment of the elders in context (in their own homes) in order to better understand the factors which support (or fail to support) community living in cognitively impaired elders. These studies also examined the use of formal and informal services by family caregivers of these elders. A similar research and service program in being developed in Milwaukee through collaboration with Dr. Mark Sager of the Wisconsin Alzheimer’s Institute and Dr. Sanjay Asthana of the UW GRECC and Division of Geriatric Medicine.
STROKE TREATMENTS AND STROKE OUTCOME
Stroke is the major cause of disability in adults in the United States. Disability due to stroke is a major public health problem that costs an estimated 13 billion dollars per year. Although most people who survive stroke recover to some degree, this recovery is often incomplete, leaving the individual with significant occupational performance deficits. We know very little about the factors influencing the full recovery of life roles and participation in prior activities. These deficits often produce long term need for assistance from caregivers and society. One goal of these studies is to identify reliable, valid and clinically viable measures to guide occupational therapists treating persons with stroke. The second goal is to examine the outcomes of stroke rehabilitation in order to provide data to support the creation of new rehabilitation models designed to decrease secondary disability and increase quality of life for both individuals and families coping with the aftermath of stroke.
The majority of stroke outcome research has focused on motor recovery and assessment of basic activities of daily living. Despite the fact that stroke rehabilitation requires new learning, much less attention has been paid to cognitive impairment after stroke and the use of cognitive strategies to facilitate stroke recovery. My stroke research, conducted in collaboration with Dr. Alexander Dromerick and Neurologist at the National Rehabilitation Hospital and Georgetown University, and the Cognitive Rehabilitation Research Group led by Dr. Carolyn Baum at Washington University at St. Louis has led to a series of studies of stroke recovery. The overall goal of these descriptive and intervention studies is to improve the occupational performance and community participation of persons with stroke. This research includes two randomized controlled studies of constraint induced movement therapy in the acute stages of stroke recovery (National Institute of Neurologic Disease and Stroke, 1R01-NS41261-01A1), examination of the accuracy of acute assessment of persons with stroke, assessment of executive function abilities after stroke, and examination of the impact of mild stroke on community participation and quality of life (James S. McDonnell Foundation, 9832CRHQUA11). My current Longitudinal Study of the Impact of Mild Stroke on Community Re-Integration and Quality of Life is still underway at Washington University in St. Louis.
DISPARITIES IN STROKE RECOVERY
Despite significant advances in prevention and acute treatment of cerebrovascular disease in the last few decades, stroke remains the third leading cause of death and the leading cause of adult disability in the United States. Health care costs related to stroke total over $50 billion per year in the US alone. A disproportionate amount of morbidity and mortality from stroke falls on underserved populations. The overall incidence of stroke, as well as mortality from stroke, is significantly higher in blacks compared to whites. The Stroke Disparities Project recently approved by the National Institute of Neurologic Disease and Stroke on is designed to examine disparities in stroke recovery including issues of access to care, barriers to adherence to stroke prevention strategies, how genetic and environmental factors and their interactions contribute to the incidence of stroke risk factors and subtype-specific strokes and whether racial differences occur in the recovery trajectory and in optimal recovery after stroke; and determine whether disparities exist in other long-term sequelae of stroke and what factors influence these outcomes. This project is led by Dr. Chelsea Kidwell of Georgetown University and includes investigators from Howard University, Johns Hopkins University and the University of Michigan. Dr. Dorothy Edwards is the PI of the Patient Recruitment, Retention, Behavioral Intervention and Outcome Core of this 5 year study.
Kinesiology Associate Professor Dorothy Edwards has just received funding from the National Institute of Neurological Disease and Stroke (NINDS) to study disparities in stroke recovery in African Americans. This five-year grant, the Stroke Disparities Program Project, was awarded to a team of investigators lead by Dr. Chelsea Kidwell of the Department of Neurology at Georgetown University. In addition to Edwards, other investigators representing Johns Hopkins University, Howard University and the University of Michigan have come together to address the problems of greater stroke-related mortality and poorer outcomes in African Americans with stroke. The Stroke Disparities project will test community education programs designed to decrease the time from symptom onset to treatment, study the effects of microhemorrahges on stroke outcome, and conduct a randomized controlled trial of the effects on community health workers trained as health care navigators on secondary prevention practices in persons after first ischemic stroke. Professor Edwards is the Principal Investigator of the Patient Recruitment, Retention, Behavioral Intervention and Outcomes Core. Through this project she will extend her studies of the effects of stroke on occupational performance and quality of life. She hopes to integrate UW MS OT students and students from the OT program at Howard University into her research.