Functional Decline in Three Dementia Types

三种痴呆症类型的功能下降

• 批准号: 8322002
• 负责人: Walter Anthony Kukull
• 金额: $ 6.3万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8322002
• 关键词: Accounting; Activities of Daily Living; Adopted; African American; Age; Alzheimer' s Disease; Attention; Boxing; Caregivers; Caring; Case Series; Clinical; Clinical Trials; Cognitive; Comorbidity; Confounding Factors (Epidemiology); Data; Data Collection; Data Set; Data Sources; Databases; Dementia; Diagnosis; Diagnostic; Education; Elderly; Enrollment; Family Caregiver; Family health status; Gender; Generations; Goals; Health Personnel; Healthcare Systems; Hobbies; Hospitalization; Impaired cognition; Impairment; Individual; Institutionalization; Investigation; Knowledge; Lead; Lewy Body Disease; Life; Marital Status; Measures; Modeling; Outcome; Outcome Measure; Participant; Patients; Pattern; Performance; Persons; Placebos; Play; Population; Publishing; Quality of life; Questionnaires; Race; Relative (related person); Research; Risk; Sampling; Sum; Symptoms; Task Performances; Testing; Time; Vascular Dementia; Visit; Visuospatial; Work; base; clinical Diagnosis; clinical care; cognitive function; executive function; follow-up; functional decline; functional disability; functional status; longitudinal database; male; meetings; mortality; sex; skills; treatment as usual

DESCRIPTION (provided by applicant): Decline in ability to carry out normal activities of daily living is a highly salient end-point to examine the course of dementia. This project seeks to inform research and clinical care as to expected rates of functional decline in Alzheimer's disease (AD), vascular dementia (VaD) and dementia with Lewy bodies (DLB), and differences among these dementia types. The specific aims are: 1) Determine the extent to which the rate of functional decline differs among persons with AD, VaD, and DLB; 2) Evaluate whether the relationship of dementia type and functional decline varies by age or sex; and 3) Determine the extent to which certain dementia types are at increased risk for decline in specific activities. The data source will be the Uniform Data Set (UDS), developed and maintained by the National Alzheimer's Coordinating Center since 2005, and consisting of data collected from 29 Alzheimer's Disease Centers (ADCs). In this longitudinal, nation-wide database, each participant has an initial visit and is re-evaluated annually. Published diagnostic criteria were adopted as part of the UDS and data are collected using standard forms. The analytic sample will be drawn from all UDS enrollees who: 1) made at least 2 visits where diagnostic criteria were met at visit 1 (clinical diagnosis of dementia and primary diagnosis of probable AD, probable VaD, or DLB); 2) age 60+ years (visit 1); 3) Clinical Dementia Rating-Sum of Boxes (CDR-SOB) score <16 (visit 1); and 4) time between successive visits restricted to 0.5-1.5 years. Currently, there are 2846 participants meeting these criteria (2610 AD, 174 DLB, 62 VaD). All participants have 2+ visits, 1339 have 3+ visits, 442 have 4+ visits and 10 have 5 visits. These numbers will increase as the UDS continues to enroll new participants and follow existing ones. For aim 1, two continuous outcomes, measured at each visit, will be examined: a total score from the Functional Activities Questionnaire (FAQ) and the CDR-SOB score from the CDR scale. Linear mixed effects models will be used to examine the effect of dementia type on rate of functional decline while accounting for within-subject and within-center correlations in outcomes and potential confounding variables (age, sex, race, marital status, education, co-morbidities, time since symptom onset, baseline cognitive impairment). To evaluate the degree to which age and sex alter the effect of dementia type on functional decline (aim 2), interaction terms will be tested for inclusion in models. In aim 3, we will examine four specific activities from the FAQ (and two corresponding items from the CDR), selected a priori based on hypotheses that these activities involve cognitive domains known to be more impaired in DLB and VaD, relative to AD. For each activity, binary outcomes of decline/no decline (over the past year) will be derived and generalized linear mixed models will be used to examine the association between odds of decline and dementia type. The results of this study may assist clinicians and family caregivers to anticipate and plan for a demented individual's need for help with activities of daily living.

描述（由申请人提供）：日常生活正常活动的能力下降是检查痴呆症过程的高度终点。该项目旨在为研究和临床护理提供有关阿尔茨海默氏病（AD），血管痴呆（VAD）和痴呆症的预期功能下降率（DLB）（DLB）的预期率，以及这些痴呆症类型的差异。具体目的是：1）确定AD，VAD和DLB患者的功能下降率在多大程度上； 2）评估痴呆症类型和功能下降的关系是否随着年龄或性别而变化； 3）确定某些痴呆症类型的特定活动风险增加的程度。数据源将是自2005年以来由国家阿尔茨海默氏症协调中心开发和维护的统一数据集（UDS），由29个阿尔茨海默氏病中心（ADC）收集的数据组成。在这个全国范围内的纵向数据库中，每个参与者都有初次访问，并且每年都进行重新评估。采用已发布的诊断标准作为UDS的一部分，并使用标准表格收集数据。分析样本将从所有UDS参与者中得出：1）至少进行了2次访问，在访问1时达到了诊断标准（痴呆症的临床诊断和可能的AD的主要诊断，可能的VAD或DLB）； 2）年龄60岁以上（访问1）； 3）盒子的临床痴呆评分（CDR-SOB）得分<16（访问1）； 4）连续访问之间的时间仅限于0.5 - 1。5年。目前，有2846名参与者符合这些标准（2610年，174 dlb，62 VAD）。所有参与者都有2次以上的访问，1339人有3次以上的访问，442个访问次数超过4个，有10次访问。随着UDS继续招募新参与者并关注现有的参与者，这些数字将会增加。对于AIM 1，将检查每次访问时测量的两个连续结果：功能活动调查表（FAQ）的总分数和CDR量表的CDR-SOB分数。线性混合效应模型将用于检查痴呆类型对功能下降速率的影响，同时考虑结果内和中心内相关性以及潜在的混杂变量（年龄，性别，性别，种族，婚姻状况，教育，共同培养业，自症状自症状发作以来，基线认知障碍以来）。为了评估年龄和性别的程度改变痴呆症类型对功能下降的影响（AIM 2），将测试相互作用项以纳入模型。在AIM 3中，我们将检查来自FAQ的四个特定活动（以及CDR中的两个相应的项目），根据假设这些活动涉及的认知领域涉及DLB和VAD中的认知域，相对于AD，选择了一个先验性。对于每种活动，将得出下降/无下降的二元结果（在过去的一年中），并将使用广义的线性混合模型来检查下降和痴呆类型的几率之间的关联。这项研究的结果可能会帮助临床医生和家庭护理人员预测和计划，以使个人在日常生活中需要帮助。