Does vestibular loss predict falls in patients with Alzheimer's Disease?

前庭丧失是否预示着阿尔茨海默病患者会跌倒？

• 批准号: 9915832
• 负责人: Yuri Agrawal
• 金额: $ 40.34万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9915832
• 关键词: Age; Alzheimer' s Disease; Alzheimer' s disease patient; Automobile Driving; Behavior; Calendar; Caregivers; Clinical Trials; Cognition; Cognitive; Data; Discrimination; Elderly; Enrollment; Equilibrium; Event; Evoked Potentials; Executive Dysfunction; Exercise; Fall prevention; Gait; Impaired cognition; Impairment; Incidence; Infrastructure; Intervention; Intervention Trial; Investigation; Labyrinth; Maps; Measures; Mediator of activation protein; Memory; Mental Depression; Morbidity - disease rate; Nursing Homes; Observational Study; Participant; Patients; Performance; Pharmaceutical Preparations; Physical therapy; Physiology; Prevalence; Process; Public Health; Research; Resources; Risk Factors; Rotation; Source; System; Testing; Text Messaging; Vestibular loss; Visit; Visual; Work; adjudication; base; caregiver strain; clinically significant; cognitive function; cognitive skill; cognitive testing; equilibration disorder; executive function; experience; fall risk; falls; follow-up; mortality; novel; primary outcome; recruit; spatial memory; therapy design; treatment center; way finding

Project summary This project investigates whether vestibular loss predicts falls in patients with Alzheimer’s disease (AD). The proposed research is an observational study of 150 patients with AD to evaluate the association between baseline vestibular function and 2-year incidence of falls. We will also explore whether vestibular function is associated with balance and gait function, as well as spatial cognitive function, as potential mechanisms by which vestibular function contributes to fall risk. Specifically, Aim 1 is to determine whether vestibular loss predicts falls in patients with mild-moderate AD. We hypothesize that poorer vestibular function at baseline predicts a higher 2-year incidence of falls. Additionally, we hypothesize that the attributable risk of falls associated with vestibular loss will be substantial enough (>~10%) to warrant further investigation of vestibular therapy as a clinically significant modifier of fall risk. Aim 2 is to evaluate whether vestibular loss in AD predicts impaired static and dynamic balance, measured using the Berg Balance Scale (BBS) and the Timed-Up-and-Go (TUG) test. We hypothesize that greater reduction in vestibular function over the 2-year follow-up period predicts greater decline in BBS and TUG performance. Aim 3 is to evaluate whether vestibular loss in AD predicts impaired spatial cognitive skills. We will administer cognitive tests of spatial cognition (including the Money Road Map test, the Card Rotations test, the Visual Form Discrimination test and the Clock Drawing test), and we will also query participants and caregivers about difficulty with driving, losing objects, getting lost and wandering behaviors as functional manifestations of impaired spatial cognition in AD patients. We hypothesize that greater reduction in vestibular function over the 2-year follow-up period predicts greater decline in spatial cognitive test scores, and a higher incidence of functional spatial cognitive impairment. Moreover, we hypothesize that impaired balance measures (from Aim 2) and impaired spatial cognitive skills will both be independent mediators of the association between vestibular loss and incident falls. To accomplish these aims, we will leverage well-established resources at Johns Hopkins including the Johns Hopkins Alzheimer’s Disease Research Center and the Memory and Alzheimer’s Treatment Center. Falls are a major source of morbidity in AD and current interventions are not uniformly effective. If our observational studies demonstrate that vestibular loss is associated with poorer balance and spatial cognition and incident falls, these results will inform the design of interventional trials to prevent falls in AD patients.

项目摘要 该项目调查了阿尔茨海默氏病（AD）患者的前庭损失预测是否落下。 拟议的研究是对150名AD患者的观察性研究，以评估该关联 在基线前庭功能和跌倒两年事件之间。我们还将探索前庭是否 功能与平衡和步态功能以及空间认知功能相关联 前庭功能有助于下降风险的机制。具体来说，目标1是确定 中度适度AD患者的前庭损失预测是否落下。我们假设贫穷 基线预测的前庭功能较高的2年跌倒事件。此外，我们假设 与前庭损失相关的跌倒风险将足够大（> 〜10％） 进一步研究前庭治疗是临床上重要的跌倒风险修饰符。目标2是评估 使用Berg测量的静态平衡和动态平衡是否会损害AD预测中的前庭丢失。 平衡量表（BBS）和定时和GO（TUG）测试。我们假设减少了 在两年的随访期间，前庭功能的预测在BBS和TUG性能的下降较大。 AIM 3是评估AD预测中的前庭损失是否损害了空间认知技能。我们将 管理空间认知的认知测试（包括货币路线图测试，卡旋转 测试，视觉形式歧视测试和时钟绘图测试），我们还将查询参与者 照顾者对驾驶困难，失去物体，迷路和流浪行为的困难 AD患者空间认知受损的功能表现。我们假设更大 在2年的随访期间，前庭功能的降低预测较大的空间认知下降更大 测试分数以及功能空间认知障碍的较高事件。而且，我们假设 平衡测量受损（来自目标2）和空间认知技能受损将是独立的 前庭损失与事件之间关联的调解人。为了实现这些目标，我们将 利用约翰·霍普金斯（Johns Hopkins）包括约翰·霍普金斯（John Hopkins）阿尔茨海默氏病的良好资源 研究中心与记忆和阿尔茨海默氏症治疗中心。瀑布是主要来源 AD和当前干预措施的发病率并非均匀有效。如果我们的观察性研究 证明前庭损失与较差的平衡和空间认知和事件相关， 这些结果将为介入试验的设计提供信息，以防止AD患者下降。