CAREER: Frailty Assessment for Older Adults with Walking Disabilities using Dynamical Modeling of Cardiac, Brain, and Motor Systems in Response to Provocative Testing

职业：使用心脏、大脑和运动系统的动态模型来响应激发测试，对患有步行障碍的老年人进行虚弱评估

• 批准号: 2402238
• 负责人: Nima Toosizadeh
• 金额: $ 58.02万
• 依托单位: RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
• 依托单位国家: 美国
• 项目类别: Continuing Grant
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=2402238&HistoricalAwards=false
• 关键词: CAREER; Frailty; Assessment; Older; Adults

Frailty syndrome in older adults results from deterioration of many physiological systems. To diagnose frailty, clinicians consider weight loss, muscle weakness/strength, cognitive ability, walking speed, and endurance as well as level of physical activity using separate assessments that can be difficult for patients. To make frailty diagnoses more accurate and testing easier for patients and clinicians, the project will develop a new strategy that tests and measures the combined interactions of the multiple systems that are impacted by frailty, including the musculoskeletal, heart, and brain systems. This new model will give researchers a better picture of the impairments due to frailty in all aging patients, with a focus on walking disabilities and heart disease. This Faculty Early Career Development Program (CAREER) project will integrate hands-on education activities within the research and provide opportunities for students to work within hospital and research environments. These efforts will support underrepresented students in the development of a Science, Technology, Engineering, and Math plus Medicine (STEM+M) identity.The overarching research goal of this CAREER project is to better understand and model aging-related physiological deficits due to frailty in response to adverse events using a new platform that tests upper-extremity function in older adults with walking disabilities. The model will be tested among older adult patients with advanced heart disease. The underlying mechanisms leading to frailty are factors related to inflammation and hormonal dysregulation that shift homeostasis from an anabolic to a catabolic state. The dominant symptom of frailty progression is muscle loss and weakness, which in combination with cognitive impairments and deficits in cardiac autonomic control can compromise the response to stress in frail individuals. This research will implement a method based on nonlinear state space reconstruction to characterize dynamic interactions between physiological systems in response to provocative testing of upper-extremity function. Motor performance, cardiac automimic control, and brain function during the provocative test will be assessed using motion, electrocardiogram, and functional near-infrared spectroscopy sensors, all of which are wearable and feasible to implement broadly. Research outcomes are expected to address two critical questions: 1) can a dynamic stress-response model of physiological systems using a sub-maximal stress test replicate the results of real-life stress?; and 2) to what extent considering the interactions between multiple physiological systems explain frailty characteristics in the stress-response model? To test these hypotheses, the research objectives are to: 1) develop a multimodal frailty score using the stress-response model in comparison with available frailty tools and biomarkers leveraging feature engineering for machine learning; and 2) determine the association between the frailty score with adverse outcomes after therapy for advanced heart disease patients. In the education plan of this project, students will participate in research to design and develop the frailty model and toolkit. Beyond student training, the project will provide the opportunity to educate heart disease patients with walking disabilities and their caregivers about the benefits of localized sub-maximal exercises to enhance physical and mental health.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

老年人的脆弱综合征是由于许多生理系统恶化而导致的。为了诊断脆弱的人，临床医生考虑体重减轻，肌肉无力/力量，认知能力，步行速度和耐力以及使用单独的评估，这对患者来说很难。为了使患者和临床医生更加准确地诊断和测试，该项目将制定一种新策略，以测试和测量受脆弱影响的多个系统的联合相互作用，包括肌肉骨骼，心脏和脑系统。这种新模型将使研究人员可以更好地了解所有老龄化患者脆弱的障碍，重点是步行障碍和心脏病。这个教师早期职业发展计划（职业）项目将在研究中整合动手教育活动，并为学生提供在医院和研究环境中工作的机会。这些努力将支持代表性不足的学生在发展科学，技术，工程和数学加上医学（STEM+M）身份的发展。该职业项目的总体研究目标是，由于不良平台，使用新的平台测试了在步行不良的成年人中，由于不良平台而响应不良平台而导致的脆弱事件，因此可以更好地理解和模拟与老化相关的生理缺陷。该模型将在患有晚期心脏病的老年人患者中进行测试。导致脆弱的基本机制是与炎症和激素失调有关的因素，将稳态从合成代谢转移到分解代谢状态。脆弱进展的主要症状是肌肉丧失和无力，与认知障碍和心脏自主控制中的缺陷相结合，可能会损害对体弱个体压力的反应。这项研究将实施一种基于非线性状态空间重建的方法，以表征生理系统之间的动态相互作用，以响应上流功能的挑衅性测试。在挑衅性测试期间，运动性能，心脏自动控制和大脑功能将使用运动，心电图和功能性近红外光谱传感器进行评估，所有这些光谱传感器都是可穿戴的，并且可以广泛实现。期望研究结果将解决两个关键问题：1）生理系统的动态应力反应模型是否可以使用亚最大压力测试复制现实生活压力的结果？ 2）考虑到多个生理系统之间的相互作用在多大程度上解释了应力响应模型中的脆弱特征？为了检验这些假设，研究目标是：1）与可用的脆弱工具和生物标志物相比，使用应力反应模型开发多模式脆弱得分，并利用功能工程来用于机器学习； 2）确定治疗后心脏病患者治疗后脆弱的评分与不良结果之间的关联。在该项目的教育计划中，学生将参与研究和开发脆弱模型和工具包的研究。除了学生培训外，该项目还将为心脏病患者及其护理人员提供教育的机会，以了解局部亚Xima的锻炼的好处，以增强身心健康。该奖项反映了NSF的法定任务，并被认为是值得通过基金会的知识分子优点和更广泛的影响审查标准来通过评估来通过评估来提供支持的。