# Assessing Urban-Rural Environmental Stress Inequities in ADRD through Ecological Momentary Assessment

> **NIH NIH R01** · TRUSTEES OF INDIANA UNIVERSITY · 2024 · $817,345

## Abstract

This study aims to identify and understand the role of environmental stressors in the development of Alzheimer’s
Disease-Related Dementias (ADRD) and related health inequities across urban and rural populations. We will
recruit 600 participants (300 urban dwelling and 300 rural dwelling) from the U.S. State of Indiana at high risk for
developing ADRD. High risk individuals will be identified by analyzing passive digital markers (PDM) in electronic
health record (EHR) data using a validated algorithm developed and tested by our research team in a currently
funded NIA R01. Participants will complete a cognitive assessment based on the Uniform Data Set (UDS) 3.0
from the NIA Alzheimer’s Disease Center program to determine eligibility at baseline. Only individuals with mild
cognitive impairment (MCI) will be enrolled in the study. Following a process utilized in our currently funded R21
data collection, each enrolled participant will then report their stressors for a two-week period using our novel
Stress Reports in Variable Environments (STRIVE) mobile ecological momentary assessment (EMA) app while
wearing a smartwatch to track their activity level, heart rate, and sleep. Our custom built STRIVE app passively
collects GPS coordinates of participants every 60 seconds and participant initiated self-reports of stressors,
including description, subjective severity, coping response, and photo of stressful environment. We will conduct
qualitative thematic analysis of text- and image-based stressor data. These measurements will be used as
indicators of each participant’s ‘usual environment’ as well as experience of and exposure to environmental
stressors. We will continue to monitor PDMs in participant EHR data and administer cognitive assessments 12
months, and 24 months to determine if subjects convert from MCI to ADRD. Through this research, we will
address 2 aims: 1) To determine where, when, and what environmental stressors are experienced by urban and
rural dwelling individuals at high risk for ADRD, and 2) to determine inequities in the relationship between
environmental stressors, lived environment, and conversion to ADRD between urban and rural dwellers.
Completing these aims will advance knowledge of 1) How environmental stress plays a role in ADRD health
inequities; 2) New environmental stress-related therapeutic targets for treatment of ADRD; and 3) New
interventional strategies based on validated stress factors to mitigate ADRD health disparity between urban and
rural environments.

## Key facts

- **NIH application ID:** 10977884
- **Project number:** 1R01NS139192-01
- **Recipient organization:** TRUSTEES OF INDIANA UNIVERSITY
- **Principal Investigator:** Evan Jordan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $817,345
- **Award type:** 1
- **Project period:** 2024-07-10 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10977884

## Citation

> US National Institutes of Health, RePORTER application 10977884, Assessing Urban-Rural Environmental Stress Inequities in ADRD through Ecological Momentary Assessment (1R01NS139192-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10977884. Licensed CC0.

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