Nora Mattek

Nora Mattek
Oregon Health and Science University | OHSU · Department of Neurology

MPH

About

203
Publications
9,512
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
3,382
Citations

Publications

Publications (203)
Article
Objective The Survey for Memory, Attention, and Reaction Time (SMART) was recently introduced as a brief (<5 min), self-administered, web-based measure of cognitive performance in older adults. The purpose of this study was threefold: (1) to develop preliminary norms on the SMART; (2) to examine the relationship between demographic variables (i.e....
Article
Full-text available
Introduction: Impairment in financial capacity places older adults at risk of fraud or abuse and can be a harbinger of loss of independence. Online automated monitoring of financial transactions offers an objective, unobtrusive, and continuous data collection strategy to minimize risk and to detect early changes in an important complex activity of...
Article
Full-text available
Seasonal variation in rest-activity patterns has been observed in healthy adult populations. This study examined seasonal variation in total time spent overnight in the bedroom by cognitively intact older adults and older adults with mild cognitive impairment (MCI). We hypothesize that seasonal variation in rest-activity patterns is observed in the...
Article
Full-text available
Background: α-klotho might play a role in neurodegenerative diseases. Objective: To determine levels of α-klotho and apoE in serum and cerebrospinal fluid (CSF) samples and their relationship with the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). Methods: All subjects were between age 39 to 83+ (n = 94). CDR and MMSE...
Article
Full-text available
Introduction: Reproducibility and replicability of results are rarely achieved for digital biomarkers analyses. We reproduced and replicated previously reported sample size estimates based on digital biomarker and neuropsychological test outcomes in a hypothetical 4-year early-phase Alzheimer's disease trial. Methods: Original data and newly col...
Article
Full-text available
The COVID-19 pandemic has greatly impacted the economic security of millions of older adults. Job loss and reductions in personal income were significant in 2020 stemming from pandemic-induced shutdowns that temporarily closed large swaths of the U.S. economy. Yet, the specific financial impacts of the pandemic on older adults, including family car...
Conference Paper
Full-text available
Results from a June 2020 survey on comfort with two forms of artificial companion (AC) robots in normal compared with pandemic times will be presented. 1,082 adults age 21-92 (mean 64) completed the online survey for a response rate of 45%. Significantly greater comfort is reported with small AC robots relative to larger human-shaped robots in both...
Article
Full-text available
Online cognitive tests offer a cost-effective, accessible means of cognitive screening and may prove especially important for individuals with memory complaints, a risk factor for cognitive impairment (Kaup et al., 2015). Although older adults’ perceptions of everyday technologies impact their uptake and adoption, there is limited understanding abo...
Article
Full-text available
Background In a progressively technology-infused world, older adults are becoming accustomed to the digitization of research participation. During the COVID-19 pandemic, it became necessary to conduct remote study visits typically carried out over the telephone or using video calling programs (e.g. Zoom). Methods The National Alzheimer’s Coordinat...
Article
Background/objectives: The COVID-19 global outbreak allowed a natural experiment to observe how older adults changed social patterns and how it affected their emotional well-being. We studied the frequency and modes of social contact and their effects on older adults' mood before and during the COVID-19 pandemic. Design: Phone-based surveys were...
Article
Background: Social isolation is a risk factor for dementia, but the underlying mechanism is not well understood. It is possible that lack of social contacts negatively affects emotional well-being, which leads to cognitive decline. To shed light on this potential mediation mechanism, we examined changes in type and frequency of social contacts and...
Article
The Oregon Center for Aging & Technology (ORCATECH) has developed, refined, and deployed to hundreds of diverse older adults a home‐based research platform for providing assessment of cognition and multiple domains of function. The pandemic has brought to the forefront the necessity of this type of remotely conducted research. Even absent a pandemi...
Article
Given the COVID‐19 pandemic and necessary restrictions on older adults’ in‐person clinical and research exposure, there is an urgent need for validated cognitive measures that can be self‐administered remotely in the home to expand the reach of cognitive assessment. The current presentation describes the implementation, validity, and usability of t...
Article
Full-text available
Background: Older adults spend a considerable amount of time inside their residences; however, most research investigates out-of-home mobility and its health correlates. We measured indoor mobility using room-to-room transitions, tested their psychometric properties, and correlated indoor mobility with cognitive and functional status. Materials and...
Article
Background: The ability to capture people's movement throughout their home is a powerful approach to inform spatiotemporal patterns of routines associated with cognitive impairment. The study estimated indoor room activities over 24 hours and investigated relationships between diurnal activity patterns and mild cognitive impairment (MCI). Methods...
Article
Background and Objectives The COVID-19 pandemic has limited older adults’ access to in-person medical care, including screenings for cognitive and functional decline. Remote, technology-based tools have shown recent promise in assessing changes in older adults’ daily activities and mood, which may serve as indicators of underlying health-related ch...
Article
Background: As researchers incorporate in-home technologies to identify and track changes in older adults' cognitive and daily functioning that could lead to early interventions, the attitudes of older adults across the continuum from normal cognitive aging to mild cognitive impairment (MCI) must be assessed to ensure technology adoption and adher...
Article
In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsy...
Article
Objectives: The aim of the study was to examine the unique contributions of age to objectively measure driving frequency and dangerous driving behaviors in healthy older adults after adjusting for executive function (EF). Method: A total of 28 community-dwelling older adults (mean age = 82.0 years, standard deviation [SD] = 7.5) without dementia...
Article
Introduction: Brief, Web-based, and self-administered cognitive assessments hold promise for early detection of cognitive decline in individuals at risk for dementia. The current study describes the design, implementation, and convergent validity of a fWeb-based cognitive assessment tool, the Survey for Memory, Attention, and Reaction Time (SMART)...
Article
Background: Computer use is a cognitively complex instrumental activity of daily living (IADL) that has been linked to cognitive functioning in older adulthood, yet little work has explored its capacity to detect incident mild cognitive impairment (MCI). Objective: To examine whether routine home computer use (general computer use as well as use...
Article
Introduction: Medication-taking is a routine instrumental activity of daily living affected by mild cognitive impairment (MCI) but difficult to measure with clinical tools. This prospective longitudinal study examined in-home medication-taking and transition from normative aging to MCI. Methods: Daily, weekly, and monthly medication-taking metri...
Article
Full-text available
Key activities and life events that impact quality of life and health may be gleaned from cross-sectional annual surveys or for medical data, derived intermittently from electronic health records. These methods cannot reflect the day-to-day and week-to-week changes that typically occur in domestic life. To assess the frequency and types of major li...
Article
Full-text available
Many older adults have sleep apnea. It often goes undiagnosed. Sleep apnea is associated with decreased oxygen to the brain, fragmented sleep, shorter sleep duration, impaired cognition, increased risk for dementia, and less clearance of amyloid and tau. Little longitudinal data are available identifying objective measures of sleep apnea over time...
Article
Full-text available
Background: The COVID-19 pandemic has changed the health security of older adults. Few have examined how older US veterans have reacted and coped with the COVID-19 pandemic. We aimed to identify changes in physical health and their differential impact by rurality of older veterans. Method: Participants were veterans (aged ≥ 62 years) and their coha...
Article
Full-text available
I-CONECT is a randomized controlled clinical trial to examine the impact of social interaction delivered via video-chat on cognitive function (clinicaltrials.gov number: NCT02871921, project website: www.I-CONECT.org ). We aimed to enroll 320 community-dwelling socially isolated older adults (age >=75 years). The recruitment of participants has sta...
Article
Full-text available
Older Veterans are at especially high risk of depression and social isolation due to COVID-19 stay-at-home orders and necessary safety precautions. We aimed to objectively measure differences in mood reports before and after COVID-19 stay-at-home orders in rural older Veterans. Participants age > 62 were enrolled in the Collaborative Aging Research...
Article
Full-text available
Financial capacity describes the ability to make and carry out sound financial decisions sufficient to meet an individual’s needs for health and well-being. Impairments in financial capacity have been shown to be one of the earliest functional changes in patients with mild cognitive impairment (MCI), the precursor to Alzheimer’s disease and related...
Article
An active lifestyle is associated with better cognitive health in older individuals. This relationship is understudied in U.S. Veterans, a population at risk of cognitive impairment due to the high prevalence of associated risk factors and comorbidities. Passive monitoring of daily activities provides objective measures of activity that may serve a...
Article
Changes in mood, loneliness, pain, and need for assistance may be potential early markers of cognitive decline in older adults. These changes can be subtle, and fluctuating, and thus easily missed during intermittent clinic visits. Continuous long‐term monitoring of these self‐reported internal states and needs, and their relationship to developing...
Article
Weight loss has been associated with earlier onset of dementia and accelerated cognitive decline. Current methods of assessing nutritional health, including body mass and dietary habits, occur in clinic settings semiannually to annually. A home‐based non‐invasive system allows for continuous data collection that could generate clinically meaningful...
Article
Surveys assessing rates of technology adaptation among older adults are cross‐sectional in nature, but few studies assess usage among a single older adult cohort. This study analyzes rates of computer device utilization among community‐dwelling older adults age 62 and older who are enrolled in longitudinal technology studies at the Oregon Center fo...
Article
High‐frequency biomarkers (HFB) are measurements collected weekly, on a daily basis or even more frequently. They are designed to detect early progression from one cognitive state to a later stage. Examples include home‐based measurements, e.g., computer usage and sleep patterns. In randomized controlled trials (RCT), we aim to detect the differenc...
Article
Sleep duration is associated with cognitive health in older individuals and is increasingly recognized as an important modifiable factor related to dementia risk. Sleep and its relationship with cognitive function is understudied in rural U.S. Veterans, who are under‐represented in clinical research aging studies. Participants (age > 57) were enrol...
Article
Full-text available
Introduction: Future digital health research hinges on methodologies to conduct remote clinical assessments and in-home monitoring. The Collaborative Aging Research Using Technology (CART) initiative was introduced to establish a digital technology research platform that could widely assess activity in the homes of diverse cohorts of older adults a...
Preprint
Full-text available
The primary outcome of Randomized clinical Trials (RCTs) are typically dichotomous, continuous, multivariate continuous, or time-to-event. However, what if this outcome is unstructured, e.g., a list of variables of mixed types, longitudinal sequences, images, audio recordings, etc. When the outcome is unstructured it is unclear how to assess RCT su...
Article
Full-text available
Introduction: Federally funded Alzheimer's Disease Centers in the United States have been using a standardized neuropsychological test battery as part of the National Alzheimer's Coordinating Center Uniform Data Set (UDS) since 2005. Version 3 (V3) of the UDS replaced the previous version (V2) in 2015. We compared V2 and V3 neuropsychological test...
Article
Dementia affects one in ten adults over age 65. Paradoxically, dementia (e.g., Alzheimer’s disease and related dementias) is underdiagnosed, with approximately 50% of those with dementia lacking a formal diagnosis. This limits options for care, support and research engagement. To address this gap, we developed and implemented a telehealth-based ECH...
Preprint
BACKGROUND Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multi-domain nature of this technology may also serve to inform caregivers of...
Article
Full-text available
Background Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of...
Article
Full-text available
Background: Research participation burden, despite being an integral concept in research ethics, is not well-conceptualized in the context of the use of technology in research. This knowledge gap is especially critical for the older adult population as new technology solutions are increasingly embedded in clinical trials for this demographic. Our...
Preprint
BACKGROUND Current clinical trial assessment methodology relies on a combination of self-report measures, cognitive and physical function tests, and biomarkers. This methodology is limited by recall bias and recency effects in self-report and by assessments that are brief, episodic, and clinic-based. Continuous monitoring of ecologically valid meas...
Article
Full-text available
Background: The current clinical trial assessment methodology relies on a combination of self-report measures, cognitive and physical function tests, and biomarkers. This methodology is limited by recall bias and recency effects in self-reporting and by assessments that are brief, episodic, and clinic based. Continuous monitoring of ecologically v...
Article
Full-text available
Early studies of technology adoption and computer use identified a “digital divide” between older adults and the general population. As that gap has narrowed, other demographic variables have been identified as continuing to foster disparities in access to and use of computers and related technologies. For example, gender, socioeconomic status, edu...
Article
Full-text available
Approximately 60% of those with dementia do not carry a diagnosis, undermining patient participation in clinical trials and family access to support. Under-diagnosis is driven by lack of knowledge about dementia, stigma, clinician inexperience and therapeutic nihilism. To address clinician-based contributors to under-diagnosis, we developed and imp...
Conference Paper
Full-text available
Physical activity and sleep are behaviors that contribute to overall health, and are notoriously challenging to improve. For individuals co-residing as a couple, there is growing recognition of the importance of the interdependence between individuals’ behaviors (e.g. the physical activity and sleep habits of one’s partner has an influence on one’s...
Article
Full-text available
Caring for a person with Alzheimer’s disease and related dementias (ADRD) can be stressful. Support programs are available for caregivers, but distance and cost present barriers to participation. Our mixed-methods study explored consumer acceptability and preliminary efficacy of a telehealth-based caregiver intervention, Tele-STAR. Caregivers in Te...
Article
Full-text available
In our previous NIH-funded randomized controlled behavioral clinical trial, we developed a conversation-based social interaction cognitive stimulation protocol delivered by trained interviewers through webcams and a user-friendly interactive Internet interface. Daily 30 minute face-to-face video-chats were conducted for 6 weeks. Despite a short dur...
Preprint
BACKGROUND Aging veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer’s dementia (AD), which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signal...
Article
Full-text available
Background: Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest si...
Article
Background: Although there are known clinical measures that may be associated with risk of future falls in older adults, we are still unable to predict when the fall will happen. Our objective was to determine whether unobtrusive in-home assessment of walking speed can detect a future fall. Method: In both ISAAC and ORCATECH Living Laboratory st...
Article
Background An in-depth examination of prospectively collected falls details may facilitate more effective falls prevention. Who was involved? What happened? Where did the fall take place? When did it happen? Why did it occur? This study aims to provide previously unavailable details about the circumstances surrounding fall events and their conseque...
Article
Full-text available
Background:Postoperative cognitive dysfunction (POCD) is a common postoperative complication experienced by patients aged 65 years and older, and these older adults comprise more than one third of the surgical patients in the USA. Because not everyone with a history of exposure to surgery and anesthesia develops POCD, there are likely major biologi...
Preprint
BACKGROUND Among the areas that has challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers provide an interesting approach as they allow objective, ecologically valid, and long term follow-up with continuous assessment. There is a multitude of sensors and devices that can be applied but...
Article
Background: Among areas that have challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured by means of digital devices, such as embedded environmental sensors or wearables. Digital b...
Article
Full-text available
Educational programs help families cope with the emotional demands of dementia caregiving. Internet-based videoconferencing programs are available to increase access to these interventions; however, many have not been tested for fidelity to the land-based intervention, threatening internal validity. We pilot-tested fidelity assessments of a telehea...
Article
Full-text available
Assessment of subjective and objective effects of caregiving most commonly occurs using questionnaires or diaries, which can be subject to inaccuracies in self-reporting. Given the inherent difficulty of accurately reporting activities related to caregiving, tools that objectively measure aspects of caregiving are needed. Here we report findings fr...
Article
Pre-death grief (PDG) is a salient concept for family caregivers for those with Alzheimer’s disease and related dementias (ADRD). The prolonged experience of grieving in response to dementia-related decremental losses increases caregiver burden and contributes to complicated grief after the death of the person with ADRD. Therapeutic interventions c...
Article
Full-text available
The determinants of increased care needs of older adults within retirement communities have received limited research attention. Yet a delay in detection of increased dependence may result in potentially dangerous or costly outcomes. Continuous, in-home monitoring technology has been shown to provide rich and sensitive data, capturing subtle behavi...
Article
An end-to-end suite of technologies has been established for the unobtrusive and continuous monitoring of health and activity changes occurring in the daily life of older adults over extended periods of time. The technology is aggregated into a system that incorporates the principles of being minimally obtrusive, while generating secure, privacy pr...
Article
Background: Understanding contributions of different brain pathologies to domain-specific cognitive trajectories in the oldest old is crucial to guide future intervention studies. Methods: Two-hundred-twenty Oregon Alzheimer's Disease Center research participants who were cognitively intact at entry were followed on average for 7.3 years with an...