Vision and hallucinations in older adults

老年人的视力和幻觉

基本信息

批准号：
10351593
负责人：
Ali G Hamedani
金额：
$ 23.43万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-01 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10351593
关键词：
Address Adverse effects Affect Age Age related macular degeneration Aging Alzheimer&apos s Disease Alzheimer&apos s disease patient Biometry Black race Blindness Brain Brain Diseases Caregivers Caring Cataract Cataract Extraction Cessation of life Chronic Clinical Cognitive Cognitive aging Data Data Analyses Data Collection Development Diagnosis Disease Distress Dose Elderly Epidemiologist Epidemiology Eye Eye diseases Funding Future Goals Hallucinations Health Health Services Research Health Surveys Health and Retirement Study Healthcare Hip Fractures Image Impaired cognition Incidence Individual Injury Inner Plexiform Layer Intervention K-Series Research Career Programs Knowledge Link Masks Measurement Measures Medicare Medicare claim Mentors Mentorship Modeling Nerve Degeneration Neurocognitive Neurodegenerative Disorders Neurology Nursing Homes Ophthalmologist Ophthalmology Optical Coherence Tomography Outcome Outcomes Research Parkinson Disease Pathogenesis Patients Pennsylvania Peripheral Persons Pharmaceutical Preparations Play Population Positioning Attribute Prevention Preventive Primary Open Angle Glaucoma Prognosis Progressive Disease Prospective Studies Prospective cohort Public Health Quality of life Reproducibility Request for Proposals Research Research Personnel Research Training Retinal Ganglion Cells Risk Risk Factors Role Sampling Severities Source Structural Models Structure Survival Analysis Testing Thick Time Training Treatment outcome Universities Vision Visual Visual Acuity Visual Cortex Visual Fields Visual Hallucination Visual Pathways Visual impairment Visual system structure age related atypical antipsychotic base clinical investigation clinical practice cohort comorbidity constriction data management epidemiology study evidence base experience fall risk ganglion cell glaucoma surgery high dimensionality high risk improved macula mortality neuropsychiatry premature prevent programs prospective recruit response retinal imaging screening guidelines stroke risk treatment guidelines treatment response trend

Address Adverse effects Affect Age Age related macular degeneration Aging Alzheimer&apos s Disease Alzheimer&apos s disease patient Biometry Black race Blindness Brain Brain Diseases Caregivers Caring Cataract Cataract Extraction Cessation of life Chronic Clinical Cognitive Cognitive aging Data Data Analyses Data Collection Development Diagnosis Disease Distress Dose Elderly Epidemiologist Epidemiology Eye Eye diseases Funding Future Goals Hallucinations Health Health Services Research Health Surveys Health and Retirement Study Healthcare Hip Fractures Image Impaired cognition Incidence Individual Injury Inner Plexiform Layer Intervention K-Series Research Career Programs Knowledge Link Masks Measurement Measures Medicare Medicare claim Mentors Mentorship Modeling Nerve Degeneration Neurocognitive Neurodegenerative Disorders Neurology Nursing Homes Ophthalmologist Ophthalmology Optical Coherence Tomography Outcome Outcomes Research Parkinson Disease Pathogenesis Patients Pennsylvania Peripheral Persons Pharmaceutical Preparations Play Population Positioning Attribute Prevention Preventive Primary Open Angle Glaucoma Prognosis Progressive Disease Prospective Studies Prospective cohort Public Health Quality of life Reproducibility Request for Proposals Research Research Personnel Research Training Retinal Ganglion Cells Risk Risk Factors Role Sampling Severities Source Structural Models Structure Survival Analysis Testing Thick Time Training Treatment outcome Universities Vision Visual Visual Acuity Visual Cortex Visual Fields Visual Hallucination Visual Pathways Visual impairment Visual system structure age related atypical antipsychotic base clinical investigation clinical practice cohort comorbidity constriction data management epidemiology study evidence base experience fall risk ganglion cell glaucoma surgery high dimensionality high risk improved macula mortality neuropsychiatry premature prevent programs prospective recruit response retinal imaging screening guidelines stroke risk treatment guidelines treatment response trend

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项目摘要

PROJECT SUMMARY Visual hallucinations affect approximately 20% of Alzheimer disease and 50% of all Parkinson disease patients. Hallucinations are a leading source of patient and caregiver distress and are an independent risk factor for injury, nursing home placement, and mortality. Because treatment options for hallucinations are limited and have significant adverse effect risks, the prevention of hallucinations would have a transformative public health impact for older adults with neurodegenerative disease. Visual impairment is a risk factor for hallucinations, and since up to half of all vision loss in the U.S. is preventable or treatable, the prevention and treatment of ophthalmic disease could prevent or reduce the severity of hallucinations in older adults. However, studies of specific age-related eye diseases and hallucination outcomes are lacking, limiting these improvements in healthcare. This proposal requests support for a mentored career development award for Dr. Ali Hamedani, a neurology-trained neuro-ophthalmologist and epidemiologist at the University of Pennsylvania. The overarching goal of this project is to understand how visual pathway structure, function, diseases, and treatments contribute to hallucinations in older adults. In Aim 1, Dr. Hamedani will analyze longitudinal data from two Medicare-linked national health surveys (the National Health and Aging Trends Study and Health and Retirement Study) to determine whether age-related macular degeneration, primary open-angle glaucoma, and cataract surgery are associated with the incidence of hallucinations in a nationally representative sample of 5,200 high-risk older adults using advanced survival analysis with marginal structural models to account for time-dependent confounding. In Aim 2, Dr. Hamedani will recruit a prospective cohort of Parkinson disease patients who are beginning a medication for hallucinations to determine whether low-contrast acuity and retinal ganglion cell thickness are associated with hallucination severity and treatment response. In executing these aims, Dr. Hamedani will be obtain additional training in ophthalmic epidemiology, retinal imaging, and biostatistics under the mentorship of experts in optical coherence tomography and ophthalmic clinical investigation (Joel Schuman, MD) and neurodegenerative disease epidemiology and health services research (Allison Willis, MD MSCI). The results of this project will provide fundamental knowledge about the visual system’s role in causing hallucinations and pave the way for future studies to test visual impairment and ophthalmic disease as a prevention target for hallucinations and other neurocognitive outcomes in older adults. Through the research training and mentorship experience gained during this career development award, Dr. Hamedani will establish himself as an independent investigator in the applied epidemiology and outcomes research of ophthalmology in aging and neurodegenerative disease.

项目摘要视觉幻觉影响约20％的阿尔茨海默氏病和所有帕金森氏病的50％患者。幻觉是患者和护理人员困扰的主要来源，是独立的风险受伤的因素，护理家庭安置和死亡率。因为幻觉的治疗选择是有限且具有明显的不利影响风险，预防幻觉将具有变革性公共卫生对神经退行性疾病的老年人的影响。视觉障碍是一个危险因素幻觉，并且由于美国所有视力损失的最多一半是可以预防的或可以治疗的，因此预防和眼科疾病的治疗可以预防或减少老年人幻觉的严重程度。然而，缺乏针对特定年龄相关的眼部疾病和幻觉结果的研究，限制了这些改善医疗保健。该提案要求支持博士的指导职业发展奖。宾夕法尼亚大学的受神经学训练的神经疾病学家和流行病学家阿里·哈米达尼（Ali Hamedani）。该项目的总体目标是了解视觉途径结构，功能，疾病和治疗导致老年人的幻觉。在AIM 1中，Hamedani博士将分析纵向数据从两项与医疗保险联系的国家卫生调查（国家卫生和衰老趋势研究与健康以及退休研究）确定与年龄相关的黄斑变性，原发性开角青光眼和白内障手术与全国代表性样本中的幻觉有关 5,200名使用高级生存分析的高风险老年人与边缘结构模型有关时间依赖的混杂。在AIM 2中，Hamedani博士将招募前瞻性帕金森氏病开始使用幻觉的药物来确定低对比度的敏锐度并保持神经节细胞厚度与幻觉严重性和治疗反应有关。在执行这些 AIMS，Hamedani博士将接受眼科流行病学，视网膜成像和光学相干断层扫描和眼科临床专家心态下的生物统计学调查（医学博士Joel Schuman）和神经退行性疾病流行病学和卫生服务研究（Allison Willis，MD MSCI）。该项目的结果将提供有关视觉的基本知识系统在引起幻觉和为将来的研究铺平道路上的作用，以测试视觉障碍和眼科疾病是老年人幻觉和其他神经认知结果的预防靶标。通过在此职业发展奖中获得的研究培训和心态经验，博士 Hamedani将成为应用流行病学和结果的独立研究者衰老和神经退行性疾病中眼科研究。