Comprehensive Investigation of the Clinical Course of Traumatic Brain Injury

脑外伤临床过程的综合调查

• 批准号: 8633829
• 负责人: Kristen Dams-O'Connor
• 金额: $ 10.73万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-12-11 至 2018-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8633829
• 关键词: Accounting; Address; Adult; Age; Aging; Alleles; Autopsy; Award; Biological Markers; Brain; Caring; Cerebrum; Clinical; Clinical Data; Clinical Research; Clinical Trials; Cognitive; Cohort Studies; Common Data Element; Comorbidity; Consent; Data; Data Set; Dementia; Development; Development Plans; Discipline; Elderly; Evaluation; Event; Exhibits; Face; Family; Frequencies; Funding; Future; Genetic; Genotype; Glasgow Outcome Scale; Goals; Health; Heterogeneity; Hospitals; Impaired cognition; Individual; Injury; Intervention; Knowledge; Lead; Lewy Bodies; Life; Linear Regressions; Longevity; Measurement; Measures; Mediating; Medical; Mental Depression; Mentored Research Scientist Development Award; Methods; Modeling; Neurofibrillary Tangles; Observational Study; Outcome; Outcome Measure; Participant; Pathology; Patients; Pattern; Peripheral; Physical activity; Prevalence; Procedures; Property; Psychometrics; Public Health; Quality of life; Recording of previous events; Recovery; Recovery of Function; Research; Research Training; Resources; Role; Sample Size; Secure; Senile Plaques; Serum; Severities; Statistical Methods; Statistical Models; Survivors; Techniques; Testing; Time; Traumatic Brain Injury; United States National Institutes of Health; Work; care systems; career; career development; experience; follow-up; frailty; improved; instrument; meetings; neuroimaging; neuropathology; novel; population based; prospective; public health relevance; research and development; screening; sex; tau aggregation; tool

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is a major public health concern in the US, and the current prevalence of TBI in the US is unprecedented. Individuals with TBI experience diverse patterns of early recovery and long- term clinical outcomes, and some TBI survivors experience accelerated cognitive and health decline as they age. Little is known about factors that predict different trajectories of outcome. The extent to which factors associated with cognitive and health decline in older adults in general (e.g., physical inactivity, medical comorbidity) applies to older adults with a history of TBI is not known. Many existing studies face methodological challenges that limit their usefulness in evaluating cognitive and health outcomes over time, such as small sample sizes, limited follow-up, use of imprecise functional measures, and application of traditional regression approaches whose assumptions are typically not met in longitudinal clinical studies. Our current knowledge of TBI outcomes is confined by these limitations. Recent methodological developments in psychometrics and statistical modeling can be applied to existing data sets, as proposed here, to significantly advance understanding of TBI outcomes and the factors that influence these outcomes over time. The proposed research and career development plan will first evaluate and account for measurement imprecision in commonly used TBI outcome measures, and then evaluate trajectories of temporal change in cognitive and health outcomes for individuals with TBI using advanced statistical methods ideally suited to this purpose. The research and career development plan outlined in this application consists of four complementary objectives that will be implemented during the award period. Objective 1 aims to develop proficiency in the application of advanced psychometric methods to evaluate and adjust for measurement error and bias in commonly used TBI assessment tools. Objective 2 is to acquire mastery in applying sophisticated statistical methods that are capable of evaluating longitudinal relationships among factors that influence TBI outcomes over time, and relate individual clinical trajectories to postmortem neuropathological features of TBI. Objective 3 involves establishing broad fluency in related disciplines of neuropathology, neuroimaging, and genetics that are necessary for interdisciplinary TBI research. Objective 4 is to secure independent research funding. Results from the research related to this K01 award will advance knowledge regarding potentially modifiable factors that are associated with heterogeneity in clinical outcomes over time after TBI, paving the way for appropriately timed and individually tailored interventions throughout the lifespan for TBI survivors. The knowledge gained can direct efforts to improve health and life quality for TBI survivors, and to help patients, families, and care systems plan for the future.

描述（由申请人提供）：创伤性脑损伤（TBI）是美国的主要公共卫生问题，美国当前的TBI患病率是前所未有的。具有TBI的人会经历早期康复和长期临床结果的各种模式，一些TBI幸存者随着年龄的增长而经历了加速认知和健康的下降。关于预测结果轨迹不同的因素知之甚少。通常，老年人的认知和健康下降相关的因素（例如，身体上的不活动，） 医疗合并症）适用于具有TBI史的老年人。许多现有研究面临的方法论挑战限制了它们在评估随着时间的评估认知和健康结果时的实用性，例如小样本量，有限的随访，不精确的功能措施的使用以及在纵向临床研究中通常无法达到假设的传统回归方法的应用。我们目前对TBI结果的了解受这些局限性的限制。如这里提出的那样，可以将心理计量学和统计模型的最新方法论发展应用于现有数据集，以显着提高对TBI结果的理解以及随着时间的推移影响这些结果的因素。拟议的研究和职业发展计划将首先评估并说明常用TBI结果指标的测量不精确，然后使用适合此目的的先进统计方法来评估TBI患者的认知和健康结果的时间变化轨迹。 本申请中概述的研究和职业发展计划由四个互补目标组成，这些目标将在奖励期间实施。目标1旨在提高应用高级心理测量方法的熟练程度，以评估和调整常用TBI评估工具中的测量错误和偏见。目标2是要精通应用复杂的统计方法，该方法能够评估影响TBI结果随着时间的影响的因素之间的纵向关系，并将单个临床轨迹与TBI的后神经病理学特征联系起来。目标3涉及在跨学科TBI研究所必需的神经病理学，神经影像学和遗传学的相关学科中建立广泛的流利性。目标4是为了获得独立的研究资金。 与该K01奖有关的研究的结果将促进有关TBI之后随着时间的推移临床结果的潜在可修改因素的知识，为TBI幸存者的整个寿命铺平了适当定时且个人定制的干预措施。获得的知识可以指导改善TBI幸存者的健康和生活质量，并帮助患者，家庭和护理系统为未来提供计划。