RESERVE for Delirium Superimposed on Dementia (DSD)

RESERVE 治疗谵妄叠加痴呆 (DSD)

• 批准号: 8514734
• 负责人: DONNA Marie FICK
• 金额: $ 39.18万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-09 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8514734
• 关键词: Acute; Address; Affect; Alleles; Antipsychotic Agents; Apolipoprotein E; Attention; Benzodiazepines; Caring; Clinical; Cognitive; Complex; Confusion; Data; Delirium; Dementia; Diabetes Mellitus; Effectiveness; Elderly; Etiology; Event; Evidence based treatment; Exclusion Criteria; Exhibits; Family; Funding; Future; Goals; Health; Home environment; Hospitalization; Hospitals; Impaired cognition; Individual; Infection; Institutionalization; Intervention; Literature; Memory; Metabolic; Methods; Morbidity - disease rate; Nursing Homes; Operative Surgical Procedures; Outcome; Outcome Study; Patients; Persons; Pharmaceutical Preparations; Phase; Physical Function; Population; Process; Psyche structure; Public Health; Quality of life; Randomized; Rehabilitation therapy; Reporting; Research; Research Personnel; Resolution; Risk; Risk Factors; Sampling; Severities; Staging; Stratification; Syndrome; Testing; Thinking; Treatment Efficacy; Work; abstracting; base; clinical practice; cognitive function; cognitive reserve; cost; cost effective; cost effectiveness; effectiveness trial; efficacy testing; executive function; experience; high risk; improved; inclusion criteria; indexing; innovation; interest; mortality; multi-site trial; premature; prevent; public health relevance; theories; treatment as usual

DESCRIPTION (provided by applicant): Delirium is a common syndrome in older adults, characterized by a sudden and fluctuating decline in cognitive functioning. Most cases of delirium occur in older adults with dementia during an acute illness. Delirium superimposed on dementia (DSD) carries a high rate of morbidity and mortality and a national cost rivaling that of diabetes. DSD persists much longer in the post-hospital period than formerly recognized and accelerates the trajectory of cognitive decline. These older adults experience more complications, realize less rehabilitation potential and are at risk for premature institutionalization. Currently there are few evidence-based treatments for DSD. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior work. Both delirium and dementia are conditions of reduced cognitive reserve and share common risk factors: a lifetime of low engagement in complex mental activities and presence of the ApoE *E4 allele. Several lines of evidence also indicate that delirium and dementia share many clinical, metabolic, and cellular manifestations that indicate reduced cognitive reserve. It is plausible, then, that interventions that improve cognitive reserve in one condition may also be effective in the other. Cognitively stimulating activities improve cognitive functioning by inducing neuroplastic events that support cognitive reserve. Our clinical observations and preliminary work indicate that use of these activities may also help resolve DSD: individually tailored cognitive activities can facilitate processing in the cognitive domains affected by delirium: attention, orientation, memory, abstract thinking, and executive functioning. Cognitive processing helps restore cognitive functioning. In delirium, improved cognitive function is accompanied by improvement in physical function and resolution of delirium. Our primary aim in this RCT is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD). We will randomize 256 subjects, newly admitted to post acute care, to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD. This project builds on over a decade of funded research and clinical practice conducted by the investigators, and brings their unique and collaborative efforts together in an innovative manner to address the problem of DSD in post-acute care.

描述（由申请人提供）：del妄是老年人的常见综合征，其特征是认知功能突然下降。大多数del妄的病例发生在急性疾病期间患有痴呆症的老年人。在痴呆症（DSD）上叠加的del妄具有很高的发病率和死亡率，并且具有糖尿病的国家成本。在院后时期，DSD的持续时间比以前被认可的时间更长，并加速了认知能力下降的轨迹。这些老年人经历了更多的并发症，具有较小的康复潜力，并有可能过早制度化的风险。目前，对DSD的循证治疗很少。我们已经开发了一种基于理论的DSD干预措施，该干预源自有关认知储备的文献，并根据我们的先前工作。 del妄和痴呆症都是认知储备降低并共享常见风险因素的条件：在复杂的心理活动中参与度和apoe *e4等位基因的存在。几条证据还表明，妄想和痴呆症具有许多临床，代谢和细胞表现，表明认知储备降低。因此，可以在一种情况下改善认知储备的干预措施在另一种情况下也可能有效。认知刺激活动通过诱导支持认知储备的神经塑性事件来改善认知功能。我们的临床观察结果和初步工作表明，使用这些活动也可能有助于解决DSD：单独量身定制的认知活动可以促进受ir妄影响的认知领域的处理：注意，方向，记忆，记忆，抽象思维和执行功能。认知处理有助于恢复认知功能。在del妄中，改善的认知功能伴随着del妄的身体功能和解决方案的改善。我们在此RCT中的主要目的是测试娱乐刺激对长者作为解决DSD（储备-DSD）的工具的功效。我们将将256个受试者随机分配，新允许在急诊室后进行干预（储备-DSD）或控制（通常的护理）。干预受试者将在长达30天内接受30分钟的认知刺激娱乐活动。我们假设接受储备-DSD的受试者将有：ir妄的严重程度和持续时间；更大的关注，定向，记忆，抽象思维和执行功能；与接受常规护理的DSD受试者相比，身体机能的收益更大。我们还将评估干预功效的潜在主持人（复杂的心理活动和APOE状态的寿命）。我们的次要目的是描述与Reserve-DSD相关的成本。该项目以研究人员进行的十多年的资助研究和临床实践为基础，并以创新的方式将其独特和协作的努力一起解决，以解决急性后护理中DSD的问题。