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2021 Alzheimer's Association Clinician Scientist Fellowship (AACSF)

Autonomic Biomarkers of Mild Behavioral Impairment in ADRD

Could mild behavioral impairment be used as a biomarker to predict individuals at risk of developing dementia?

James Bateman, M.D., M.P..H.
Wake Forest University Health Sciences
Winston-Salem, NC - United States


Mild Behavioral Impairment (MBI) may be associated with neuropsychiatric symptoms including agitation, depression, apathy, delusions, hallucinations, and sleep difficulties. Studies show that MBI may precede brain changes and potential progression to Mild Cognitive Impairment (or MCI, a condition with subtle memory loss that may precede dementia, including Alzheimer’s dementia).  Researchers believe that the identification of biomarkers associated with MBI could help improve prediction of which individuals are more likely to progress to dementia. 

Dr. James Bateman and colleagues believe that measures of certain biological processes that occur automatically and without conscious effort, including blood pressure, breathing, and heart rate may serve as biomarkers of MBI.

Research Plan

Dr. Bateman and his team will leverage clinical, cognitive, brain scan and biomarker datasets from an existing study, Clinical Core cohort of Wake Forest Alzheimer’s Disease Research Center (ADRC), with 600 participants. From this ongoing study, the researchers will recruit 100 participants with MCI and 100 participants who are cognitively unimpaired. Dr. Bateman and his colleagues will further divide the groups into those with and without MBI. 

The researchers will study how participants experience emotions throughout the day and compare this to reports of mood and behavioral changes from caregivers. Next, the researchers will invite participants to the clinic and fit them with wearables such as electrocardiogram sensors to understand changes in heart rate when participants complete tests of memory and thinking (involving a common stressful experience).

Finally, the researchers will study whether changes in heart rate may be associated with brain changes associated with Alzheimer’s such as the levels of beta-amyloid and tau using brain scans and biomarker datasets. Both beta-amyloid and tau proteins accumulate to form plaques and tangles, the two main hallmark brain changes observed in Alzheimer’s. 


If successful, the results of this study, may help identify emotional dysregulation in individuals with MBI as a potential biomarker of MCI and Alzheimer’s.

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