The Predictors and Long-Term Trajectory of Poststroke Cognitive Decline

中风后认知衰退的预测因子和长期轨迹

• 批准号: 8300428
• 负责人: Deborah Levine
• 金额: $ 15.93万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8300428
• 关键词: Adult; Age; Aged, 80 and over; Antihypertensive Agents; Area; Attenuated; Behavior; Behavioral; Black race; Blood Pressure; Blood Vessels; Caring; Cholesterol; Chronic Disease; Clinical; Clinical Services; Clinical Trials; Cognitive; Cohort Studies; Communities; Data; Data Collection; Dementia; Demographic Factors; Development; Development Plans; Diabetes Mellitus; Disease; Elderly; Ensure; Environment; Epidemiologic Studies; Equilibrium; Female; Funding; Future; Gender; Geographic Factor; Geography; Geriatrics; Goals; Grant; Health; Health Care Costs; Health behavior; Healthcare; Hypertension; Impaired cognition; Individual; Intervention; Intervention Studies; Junior Physician; K-Series Research Career Programs; Knowledge; Lead; Location; Long-Term Effects; Measurement; Measures; Medical; Mentors; Methods; Mexican Americans; Michigan; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Participant; Pathway interactions; Patients; Physicians; Population; Population Decreases; Prevalence; Quality of life; Race; Recording of previous events; Rehabilitation therapy; Research; Resource Allocation; Resources; Risk; Risk Factors; Rural; Sampling; Scientist; Series; Stroke; Stroke prevention; Survival Rate; Survivors; Testing; Time; United States National Institutes of Health; Universities; acute stroke; age related; aging population; blood pressure regulation; career development; cigarette smoking; cognitive change; cognitive function; cohort; demographics; design; disability; effective therapy; epidemiology study; experience; geographic difference; high risk; improved; medication compliance; middle age; mortality; multidisciplinary; population based; post stroke; prevent; programs; prospective; racial difference; residence; skills; success; treatment adherence

DESCRIPTION (provided by applicant): With population aging and improved stroke survival, the rates of post stroke cognitive decline (PSCD) are increasing. PSCD is associated with adverse health outcomes, increased health costs, and poorer quality of life. There is significant variability in which stroke patients develop PSCD. Many factors likely drive this variability, including age at stroke, time from stroke onset, stroke features, socio-demographics, geography, health conditions, behaviors and medical care factors. Yet, PSCD remains poorly understood. The long-term goal of this career development award is to promote the candidate's development into a leader and independently funded physician-scientist in PSCD among older adults. The aims of this project are: 1) To determine the impact of stroke on cognitive function, both in the short-term and the long-term; 2) To determine the socio-demographic, geographic, medical, and behavioral predictors of PSCD; 3) To assess whether blood pressure or anti-hypertensive medication adherence are associated with cognitive function in stroke survivors using primary and secondary data. This project will combine data from 2 leading prospective stroke cohort studies in the US: 1) a large, geographically dispersed, race- and gender-balanced cohort of middle-aged and older adults being followed for stroke and cognitive decline and with premorbid and post stroke cognitive assessments, and 2) a population-based stroke surveillance project in a bi-ethnic community with immediate post stroke cognitive assessments. Both cohort studies have cognitive measures sensitive to PSCD and data on stroke features. This research will generate knowledge by better identifying potential mechanisms of PSCD and will assist in planning interventions to improve the care and prevention of stroke and PSCD. This research ultimately will lead to greater understanding of PSCD, better treatments, and better outcomes in older people. The candidate, Dr. Deborah Levine, who will focus her research on the growing population of stroke survivors, will pursue a mentored research plan designed to enhance her skills in the methods needed to study PSCD. A detailed career development plan will promote the candidate's development of expertise in four areas: 1) the analysis and conduct of longitudinal epidemiologic studies of older adults; 2) the measurement of cognitive outcomes; 3) patient treatment adherence and chronic illness interventions; and 4) geriatrics and stroke care. The career development plan consists of a multidisciplinary team of experienced mentors and advisors who will oversee a range of formal coursework and practical experiences in these areas to ensure the candidate's future success. Exceptional resources of a top university and a mentoring team with proven success in developing junior physician-scientists in these topic areas makes the University of Michigan an ideal environment for this project. PUBLIC HEALTH RELEVANCE: One in three individuals will experience dementia, a stroke, or both during their lifetime. A key question for this new century is: In this era of population aging and improved stroke survival, how can cognitive disability from stroke be reduced or delayed? To begin to confront this problem, we will establish a research program to study the epidemiology of post stroke cognitive decline and to identify risk factors that may be targets for future intervention studies. Reducing post stroke cognitive decline will be important to decrease the risk and population burden of stroke and dementia. Information from this study will better identify potential mechanisms of post stroke cognitive decline and may assist in planning interventions to reduce or prevent post stroke cognitive decline in older adults.

描述（由申请人提供）：随着人口衰老和中风生存的改善，中风后认知下降（PSCD）的速度正在增加。 PSCD与不良健康结果，健康成本增加和生活质量差有关。中风患者患PSCD存在明显的差异。许多因素可能会推动这种变异性，包括中风时的年龄，中风发作的时间，中风特征，社会人口统计学，地理，健康状况，行为和医疗因素。然而，PSCD仍然很了解。该职业发展奖的长期目标是将候选人的发展促进老年人中PSCD的领导者和独立资助的医师科学家。该项目的目的是：1）确定中风对短期和长期的认知功能的影响； 2）确定PSCD的社会人口统计学，地理，医学和行为预测指标； 3）评估血压或抗高血压药物的依从性是否与使用主要和次要数据的中风幸存者中的认知功能有关。该项目将结合美国2项领先的中风队列研究的数据：1）在中期和认知下降的中年和老年人中，一项大型，地理，种族和性别均衡的中年和老年人的群体以及中风后的认知认知评估以及2）基于人口的STROKE STROKE STROKE STRIEST STRICK intrake STROKE coje tock in trouke strook coptions cognights stroke评估。两项队列研究都对PSCD敏感和中风特征的数据敏感。这项研究将通过更好地识别PSCD的潜在机制来产生知识，并将有助于计划干预措施，以改善中风和PSCD的护理和预防。这项研究最终将导致对PSCD，更好的治疗方法以及老年人的更好结果。 候选人Deborah Levine博士将把研究重点放在中风幸存者不断增长的人群上，他将遵循一项旨在提高她在研究PSCD所需方法的技能的指导研究计划。详细的职业发展计划将促进候选人在四个领域的专业知识的发展：1）对老年人的纵向流行病学研究的分析和进行； 2）认知结果的测量； 3）患者治疗依从性和慢性疾病干预措施； 4）老年医学和中风护理。职业发展计划由一个由经验丰富的导师和顾问组成的跨学科团队组成，他们将在这些领域监督一系列正式的课程和实践经验，以确保候选人未来的成功。顶尖大学的卓越资源和在这些主题领域发展初级医师科学家方面取得成功取得成功的指导团队使密歇根大学成为该项目的理想环境。 公共卫生相关性：三分之一的人会在一生中经历痴呆症，中风或两者兼而有之。这个新世纪的一个关键问题是：在这个人口衰老的时代 并改善了中风的存活情况，如何减少或延迟中风的认知障碍？为了开始面对这个问题，我们将建立一个研究计划，以研究中风后认知下降的流行病学，并确定可能是未来干预研究目标的危险因素。减少中风后认知下降对于减轻中风和痴呆症的风险和人口负担至关重要。这项研究的信息将更好地确定中风后认知下降的潜在机制，并可能有助于计划干预措施，以减少或预防老年人中风后认知下降。