Trajectory of Recovery in the Elderly

老年人康复轨迹

• 批准号: 9267110
• 负责人: Mark G Baxter
• 金额: $ 49.73万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9267110
• 关键词: Acceleration; Adult; Affect; Age; Aging; Alzheimer' s Disease; Amnesia; Anesthesia procedures; Anesthetics; Area; Biochemistry; Brain; Caring; Cerebrovascular Circulation; Clinical; Clinical Research; Clinical assessments; Cognition; Cognitive; Comprehension; Data; Day Surgery; Development; Diagnosis; Diffusion Magnetic Resonance Imaging; Disease; Elderly; Etiology; Eye; Failure; Functional Magnetic Resonance Imaging; Functional disorder; General Anesthesia; Geriatrics; Healthcare; Home environment; Hospitals; Hypnosis; Imaging Techniques; Impaired cognition; Impairment; Individual; Inflammatory; Inpatients; Instruction; Life; Link; Literature; Longitudinal Studies; Magnetic Resonance Imaging; Measures; Modernization; Neuraxis; Neuropsychological Tests; Operative Surgical Procedures; Outcome; Participant; Patients; Perioperative; Pharmaceutical Preparations; Physiological; Play; Population; Populations at Risk; Postoperative Period; Principal Investigator; Process; Recovery; Research; Resources; Rest; Risk; Role; Self Care; Signal Transduction; Specific qualifier value; Spin Labels; Stress; Surgeon; Syndrome; Testing; Theoretical model; Time; United States National Institutes of Health; Work; animal data; clinical practice; cognitive capacity; cognitive process; cognitive recovery; cognitive reserve; cohort; cost; expectation; experience; follow-up; healthy volunteer; human data; improved; neuroinflammation; neurotoxic; older patient; patient population; post-operative cognitive dysfunction; postoperative delirium; prevent; public health relevance; volunteer; willingness

DESCRIPTION (provided by applicant): Elderly patients undergoing anesthesia and surgery frequently suffer from postoperative cognitive dysfunction (POCD) and postoperative delirium (PD). The cause of these entities is unknown; specifically it is unclear what part the anesthetics play in the development of POCD and PD. We hypothesize that elderly patient's cognitive capacities recover more slowly after receiving general anesthesia, perhaps because they have more limited cognitive reserve. A more prolonged recovery would confound diagnoses of POCD and PD and potentially puts patients who are discharged on the day of surgery at risk of not understanding postoperative instructions. The trajectory of postoperative cognitive recovery has never been explored and elderly participants have been explicitly not included in any type of emergence research. To explore this vital area we propose to study young and elderly volunteers with a combination of two state of the art neuropsychological tests (postoperative quality of recovery scale and the NIH Toolbox) and magnetic resonance imaging. Starting from baseline, we will determine multiple cognitive domains and resting state networks, treat the volunteers with general anesthesia, and then explore the recovery of the cognitive domains and alterations in functional networks. The data acquired in this project will have both clinical and theoretical relevance. Apart from distinguishing immediate drug effects from POCD and PD, characterization of the trajectory of cognitive recovery in the elderly could affect changes in clinical practice vis a vis the criteria we employ to determine, for example, hospital discharge in this population. Currently many elderly patients are (perhaps inappropriately) sent home on the day of surgery. Furthermore, characterization of the trajectory of recovery in this population would enable us to better educate our patients and those who help care for them as to the proper expectations and time course for their recovery from anesthesia. Most fundamentally, the trajectory at which various patients recover from anesthesia is the most unappreciated confounding factor in this debate on the direct and indirect effects of anesthetic drugs. The effects of the anesthesia itself are theoretically (and as we propose here, practically) separable from those due to surgery, by studying the former in the absence of the latter we can delineate the trajectory of cognitive recovery from anesthesia itself, developing an understanding that is currently lacking and yet necessary to understand POCD and PD in general.

描述（申请人提供）：接受麻醉和手术的老年患者经常出现术后认知功能障碍（POCD）和术后谵妄（PD）。这些实体的原因尚不清楚；具体而言，尚不清楚麻醉剂在 POCD 和 PD 的发展中发挥什么作用。 我们假设老年患者接受全身麻醉后认知能力恢复较慢，可能是因为他们的认知储备更有限。 恢复时间较长可能会混淆 POCD 和 PD 的诊断，并可能使手术当天出院的患者面临不理解术后说明的风险。 术后认知恢复的轨迹从未被探索过，老年参与者也被明确排除在任何类型的突发研究中。 为了探索这一重要领域，我们建议结合两种最先进的神经心理学测试（术后恢复质量量表和 NIH 工具箱）和磁共振成像来研究年轻和老年志愿者。 从基线开始，我们将确定多个认知域和静息状态网络，对志愿者进行全身麻醉，然后探索认知域的恢复和功能网络的改变。 该项目获得的数据将具有临床和 理论相关性。 除了区分 POCD 和 PD 的直接药物效应外，老年人认知恢复轨迹的特征可能会影响临床实践相对于我们用来确定标准的变化，例如，老年人的出院情况。 这个人口。 目前，许多老年患者在手术当天就被送回家（也许是不恰当的）。此外，描述该人群的康复轨迹将使我们能够更好地教育我们的患者和帮助照顾他们的人，了解他们从麻醉中恢复的适当期望和时间进程。 最根本的是，在关于麻醉药物的直接和间接影响的争论中，不同患者从麻醉中恢复的轨迹是最不被重视的混杂因素。 麻醉本身的效果在理论上（正如我们在这里提出的，实际上）是可分离的 与手术引起的认知障碍相比，通过在没有后者的情况下研究前者，我们可以描绘麻醉本身认知恢复的轨迹，形成目前缺乏但对于总体理解 POCD 和 PD 所必需的理解。