Recovery among Older Adults Following Head Injury

老年人头部受伤后的康复

• 批准号: 10413601
• 负责人: Jennifer S. Albrecht
• 金额: $ 68.91万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10413601
• 关键词: Adult; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Characteristics; Cognition; Cognitive; Craniocerebral Trauma; Data; Development; Early identification; Elderly; Emergency department visit; Frontotemporal Dementia; Future; Health; Heterogeneity; Hospitalization; Impaired cognition; Impairment; Individual; Injury; Intervention; Knowledge; Literature; Lower Extremity; Measures; Modeling; Outcome; Participant; Patients; Pattern; Physical Function; Pilot Projects; Population; Prospective cohort study; Public Health; Recovery; Rehabilitation therapy; Research; Risk; Shock; Signal Transduction; Traumatic Brain Injury; Vulnerable Populations; Work; acute care; adverse outcome; aged; base; cognitive function; cognitive recovery; cognitive rehabilitation; comorbidity; dementia risk; experience; fall injury; falls; follow-up; high risk; human old age (65+); mild traumatic brain injury; psychologic; psychological distress; rehabilitative care; sleep quality; targeted treatment; trauma centers; young adult

Development of Alzheimer's disease and related dementias (ADRD) is multifactorial, and some causal factors can be influenced or modified. Recently, the Lancet Commission included traumatic brain injury (TBI) in its list of 12 key potentially modifiable ADRD risk factors. TBI is a very common injury among older adults, resulting in over 123,000 hospitalizations and 485,000 emergency department visits annually. Importantly, rates of TBI are rapidly increasing in this population. TBI results in cognitive impairment and increases risk for both Alzheimer's disease and fronto-temporal dementia. Furthermore, TBI can result in worsened health outcomes (e.g., poor physical functioning, psychological distress, worsened sleep quality), which in turn increase risk for ADRD. Yet, despite the large public health impact of TBI among older adults, little is known about changes in cognition and related domains following discharge from acute care in this population. Although such information is urgently needed to guide rehabilitation, care planning, and promotion of optimal long-term recovery in this vulnerable population, these data are severely lacking in the literature. One major reason for this lack of knowledge is that most prior research on TBI has focused on younger adults. Unfortunately, many findings from younger adults do not generalize to older adults due to their higher comorbidity burden and poorer cognitive and physical functioning at discharge from acute care. The objective of the proposed research is to gain an in-depth understanding of recovery of cognition, psychological and physical functioning, and sleep quality following TBI among older adults. To achieve this objective, we propose to conduct a prospective cohort study of 250 patients aged 65 years and older treated for mild TBI at the R Adams Cowley Shock Trauma Center with follow-up at 3, 6, and 12 months to complete three Specific Aims: 1) Assess recovery of cognitive functioning and identify predictors of poor recovery; 2) Assess recovery of physical and psychological functioning and sleep quality and identify predictors of poor recovery; 3) Identify interactions between recovery trajectories. The significance of this research is that it will identify unique recovery patterns across important domains of functioning (including cognitive function) and factors that impact the course of recovery following mild TBI among older adults. Identification of individuals at risk for poor cognitive recovery following TBI will highlight a population at high risk of ADRD and would permit targeting those individuals with cognitive rehabilitation interventions, potentially reducing ADRD risk. The rationale for the proposed study is that early identification of patients with poorer recovery trajectories will permit development and targeting of appropriately timed interventions to mitigate ADRD risk and other adverse outcomes. The potential impact of this work is that it will generate new knowledge that will guide targeted treatment efforts and inform development of a geriatric-TBI focused rehabilitation intervention that will be the focus of a future R01 application.

阿尔茨海默病和相关痴呆症 (ADRD) 的发生是多因素的，并且一些致病因素可能会受到影响或改变。最近，《柳叶刀》委员会将创伤性脑损伤 (TBI) 纳入其 12 个潜在可改变的 ADRD 关键危险因素清单中。 TBI 是老年人中非常常见的伤害，每年导致超过 123,000 人次住院治疗和 485,000 人次急诊就诊。重要的是，该人群的 TBI 发生率正在迅速增加。 TBI 会导致认知障碍，并增加患阿尔茨海默病和额颞叶痴呆的风险。此外，TBI 可能导致健康状况恶化（例如身体机能不佳、心理困扰、睡眠质量恶化），进而增加 ADRD 的风险。然而，尽管 TBI 对老年人的公共健康产生了巨大影响，但对该人群出院后认知和相关领域的变化知之甚少。尽管迫切需要此类信息来指导这一弱势群体的康复、护理计划和促进最佳长期康复，但文献中严重缺乏这些数据。造成这种认识不足的一个主要原因是，大多数先前关于 TBI 的研究都集中在年轻人身上。不幸的是，来自年轻人的许多研究结果并不能推广到老年人，因为他们的合并症负担较高，并且在急性护理出院时认知和身体功能较差。本研究的目的是深入了解老年人 TBI 后的认知恢复、心理和身体功能以及睡眠质量。为了实现这一目标，我们建议对 250 名 65 岁及以上在 R Adams Cowley 休克创伤中心接受轻度 TBI 治疗的患者进行一项前瞻性队列研究，并在 3、6 和 12 个月进行随访，以完成三个具体目标：1）评估认知功能的恢复情况并确定恢复不良的预测因素； 2）评估身体和心理功能以及睡眠质量的恢复情况，并确定恢复不良的预测因素； 3) 确定恢复轨迹之间的相互作用。这项研究的意义在于，它将确定重要功能领域（包括认知功能）的独特恢复模式以及影响老年人轻度创伤性脑损伤后恢复过程的因素。识别 TBI 后认知恢复不良风险的个体将突出显示 ADRD 高风险人群，并允许针对这些个体进行认知康复干预，从而有可能降低 ADRD 风险。拟议研究的理由是，早期识别恢复轨迹较差的患者将有助于制定和瞄准适当时机的干预措施，以减轻 ADRD 风险和其他不良后果。这项工作的潜在影响在于，它将产生新的知识，指导有针对性的治疗工作，并为以老年 TBI 为重点的康复干预措施的开发提供信息，这将是未来 R01 应用的重点。