Biological and neural mechanisms of falls

跌倒的生物学和神经机制

基本信息

批准号：
9293219
负责人：
JOE VERGHESE
金额：
$ 49.86万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-01 至 2018-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9293219
关键词：
Address Age Aged, 80 and over Aging Atherosclerosis Attention Bilateral Biological Biological Markers Biology Blood Vessels Clinical Clinical assessments Cognition Cognition Disorders Cognitive Communities Data Effectiveness Effectiveness of Interventions Elderly Enrollment Equilibrium Fall prevention Gait Gait abnormality Health Care Costs High Prevalence Human Image Impairment Incidence Individual Inflammation Inflammatory Inflammatory Response Institutionalization Intervention Isoprostanes Knowledge Lacunar Infarctions Lead Lesion Leukoaraiosis Link Malondialdehyde Measures Mediating Microvascular Dysfunction Modeling Motor Near-Infrared Spectroscopy Oxidative Stress Participant Pathway interactions Peripheral Nerves Pharmaceutical Preparations Physical Function Physical activity Play Prefrontal Cortex Premature Mortality Prevention strategy Preventive Intervention Protocols documentation Reporting Research Risk Risk Factors Role Severities Site Stroke Syndrome Techniques Testing Time Translations United States Vascular Diseases Walking Work base cerebrovascular clinical predictors clinical risk cognitive function cost design disability economic cost equilibration disorder fall risk falls improved innovation macrovascular disease microvascular pathology multidisciplinary neuroimaging neuromechanism new technology public health relevance relating to nervous system success

项目摘要

DESCRIPTION (provided by applicant): One in three community dwelling people over age 65 and one in two over age 80 fall each year. The consequences of falls among older adults are often devastating, resulting in loss of independence, institutionalization and premature mortality. Falls also are responsible for greater than 20 billion dollars a year in healthcare costs in the United States. Although many fall prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest. Current falls research in aging is mostly focused on clinical predictors of falls and there is a knowledge gap regarding underlying biological and neural mechanisms of falls. Emerging evidence from our and other studies implicates biological derangements in inflammation, oxidative stress, and vascular pathways in the occurrence of disorders of gait, balance, and cognition, which are major risk factors for falls in older adults. We hypothesize that abnormal biological pathways initiate atherosclerosis leading to cerebral vascular damage that increases risk of falls in older adults. We draw together a multidisciplinary team to conduct high-quality research to establish biological and neural mechanisms of falls building on our extensive cognitive and mobility research. We will cross-enroll 530 participants, age 65 and older, from the ongoing Central Control of Mobility in Aging study offering a cost and time efficient strategy to study biological and neural mechanisms of falls. This proposal will employ rigorous clinical assessments, many developed and validated in our other aging studies, to assess fall risk. We propose the following three synergistic aims focusing on our common theme of biological and neural contributions to falls in aging. 1). Determine biological mechanisms (inflammation, oxidative stress, and vascular pathways) contributing to falls. 2). Establish contributions of central microvascular pathology to fall risk using state of the art neuroimaging techniques. 3). Establish the contribution of the prefrontal cortex to falls using an innovative functional near infrared spectroscopy (fNIRS), that enables imaging during walking. While biological risk factors for falls are potentially modifiable, the paucity of data is a critical barrier for translation to clinical interventions. While many fal prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest in research settings and even less so in the real world. A deeper understanding of underlying biological mechanisms and neural substrates for falls may lead to more efficient risk identification and improve the effectiveness of current interventions for fallsin older adults.

描述（由申请人提供）：三分之一的社区居住在65岁以上的人和每年80岁以上的人中有一个。老年人跌倒的后果通常是毁灭性的，导致独立，制度化和过早死亡率丧失。在美国，瀑布还负责每年的医疗保健费用超过200亿美元。尽管已经测试了针对临床危险因素的许多秋季预防策略，但它们在减少跌倒方面的成功仍然很小。当前对衰老的研究主要集中在跌倒的临床预测因素上，并且关于跌倒的潜在生物学和神经机制存在知识差距。来自我们和其他研究的新兴证据暗示了步态，平衡和认知疾病发生的炎症，氧化应激和血管途径的生物学扰动，这是老年人跌倒的主要危险因素。我们假设异常的生物途径引发了动脉粥样硬化，导致脑血管损伤，从而增加了老年人跌倒的风险。我们汇集了一个多学科团队，以进行高质量的研究，以建立我们广泛的认知和流动性研究的瀑布的生物学和神经机制。我们将跨越530名参与者，年龄在65岁及以上的参与者，这是从衰老研究中的流动性中心控制，从而提供成本和时间效率的策略来研究跌倒的生物学和神经机制。该提案将采用严格的临床评估，其中许多在我们的其他老化研究中得到了验证，以评估跌倒风险。我们提出以下三个协同目标，重点是我们对衰老跌倒的生物学和神经贡献的共同主题。 1）。确定导致跌倒的生物学机制（炎症，氧化应激和血管途径）。 2）。使用艺术神经影像技术的状态为中央微血管病理的贡献，以使风险降低。 3）。使用创新的功能近红外光谱（FNIRS），建立前额叶皮层对跌落的贡献，该功能可以在步行过程中进行成像。虽然跌倒的生物危险因素可能是可改变的，但数据的匮乏是转化为临床干预措施的关键障碍。尽管已经测试了针对临床风险因素的许多FAL预防策略，但在减少跌倒方面的成功在研究环境中是适度的，在现实世界中的成功率甚至更少。对跌倒的潜在生物学机制和神经底物的更深入了解可能会导致更有效的风险识别，并提高瀑布老年人当前干预措施的有效性。