Predictors of Cognitive Impairment in Survivors of Critical Illness

危重疾病幸存者认知障碍的预测因素

• 批准号: 8127802
• 负责人: Timothy D Girard
• 金额: $ 14.35万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8127802
• 关键词: Accounting; Acute; Admission activity; Adult; Age; Aging; Award; Blood Coagulation Disorders; Brain; C-reactive protein; Caring; Categories; Central Nervous System Diseases; Clinical; Clinical Investigator; Clinical Trials; Coma; Complication; Critical Care; Critical Illness; Data; Delirium; Dementia; Development; Diagnosis; Elderly; Ensure; Epidemiology; Etiology; Face; Fibrin fragment D; Functional disorder; Funding; Future; Geriatrics; Goals; Health; Hypoxia; Impaired cognition; Incidence; Inflammation; Intensive Care; Interleukin-6; Investigation; K-Series Research Career Programs; Link; Measures; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Metabolic; Molecular; Molecular Epidemiology; Monitor; Neuraxis; Neuropsychology; Organ failure; Outcome; Outcomes Research; Pathogenesis; Patients; Play; Population; Prevention; Preventive Intervention; Protein C; Public Health; Quality of life; Recovery; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sepsis; Severities; Survivors; Therapeutic Intervention; Training; Training Programs; United States; Vulnerable Populations; Work; career; career development; clinical epidemiology; cognitive function; cohort; cost; design; experience; high risk; human old age (65+); improved; investigator training; older patient; prevent; programs; promoter; prospective; septic

DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award (K23) will provide Dr. Timothy D. Girard the opportunity to develop his career as a clinical investigator in the field of geriatric critical care and to establish an independent program of aging research focused on the clinical and molecular epidemiology of critical-illness associated cognitive impairment. Through an integrated program of didactic activities and course work in geriatrics, clinical and molecular epidemiology, and neuropsychology; intensive mentorship by local experts; and hands-on experience in the design, implementation, and analysis of a prospective clinical investigation, Dr. Girard will use this award to become a highly trained investigator in aging research. The primary scientific goal of this proposal is to identify and study the clinical and molecular predictors of long-term cognitive impairment (LTCI) after critical illness. Older patients account for the majority of ICU admissions, and cognitive impairment is a major impediment to meaningful recovery in this vulnerable population; survivors of critical illness have a 25%-75% risk of developing LTCI, a manifestation of persistent brain dysfunction associated with reduced quality of life and significant societal costs. Utilizing a prospective cohort investigation, Dr. Girard will identify those ICU patients at highest risk for LTCI and quantify the contribution of important risk factors to LTCI after critical illness. Specifically, the candidate will identify clinical risk factors for an increased incidence and severity of long-term cognitive impairment after critical illness (Aim 1). Furthermore, he will determine whether inflammation and coagulopathy are risk factors for an increased incidence and severity of LTCI after critical illness (Aim 2). Finally, Dr. Girard will determine which categories of delirium defined by clinical risk factors in critically ill patients are associated with an increased incidence and severity of LTCI after critical illness (Aim 3). This work will pave the way for the study of preventive and therapeutic interventions by ensuring that such efforts will be focused on patients at highest risk. Dr. Girard's long-term research goal is to improve the outcomes of older critically ill patients through the prevention and treatment of critical illness-associated cognitive impairment. RELEVANCE: Advances in intensive care medicine have improved the likelihood of survival for patients with critical illness, but studies have shown that many survivors develop persistent cognitive impairment, which reduces quality of life. This study seeks to identify risk factors for cognitive impairment after critical illness in order to guide the development of strategies to prevent and treat this potentially devastating complication of critical illness.

描述（由申请人提供）：这项受过指导的以患者为导向的研究职业发展奖（K23）将为Timothy D. Girard博士提供机会发展他在老年重症监护领域的临床研究者的职业，并建立了一个独立的老龄化研究计划，并建立了一项针对临床和分子表育障碍的临床和分子流行病学相关认知的临床和分子流行病学。通过老年医学，临床和分子流行病学以及神经心理学的教学活动和课程工作的综合计划；当地专家的密集指导；以及对预期临床调查的设计，实施和分析方面的实践经验，吉拉德博士将使用该奖项成为培训的老龄化研究研究员。该提案的主要科学目标是识别和研究重症患者后长期认知障碍（LTCI）的临床和分子预测指标。老年患者占大部分ICU入院，认知障碍是该脆弱人群中有意义恢复的主要障碍。重症疾病的幸存者患LTCI的风险为25％-75％，这是与生活质量降低和大量社会成本相关的持续性脑功能障碍的表现。利用前瞻性队列调查，Girard博士将确定那些LTCI风险最高的ICU患者，并量化重要危险危险因素对LTCI的贡献。具体而言，候选人将确定临床风险因素，以增加危重疾病后长期认知障碍的发病率和严重程度（AIM 1）。此外，他将确定炎症和凝血病是否是危重疾病后LTCI发病率和严重程度增加的危险因素（AIM 2）。最后，吉拉德（Girard）博士将确定危重患者临床风险因素定义的del妄类别与危重疾病后LTCI的发病率和严重程度增加有关（AIM 3）。这项工作将通过确保将这种努力集中在风险最高的患者上，为预防和治疗干预措施的研究铺平道路。吉拉德（Girard）博士的长期研究目标是通过预防和治疗与重症疾病相关的认知障碍来改善较老的重症患者的结果。 相关性：重症监护医学的进步改善了重症患者生存的可能性，但研究表明，许多幸存者会发展出持续的认知障碍，从而降低了生活质量。这项研究旨在确定严重疾病后认知障碍的危险因素，以指导制定预防和治疗这种危害疾病并发症的策略。