Addressing Hearing Loss as a Common Unmet Contributor to Neuropsychiatric Symptoms

解决听力损失作为神经精神症状的常见未得到解决的原因

• 批准号: 10641903
• 负责人: CARRIE L NIEMAN
• 金额: $ 80.69万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641903
• 关键词: Address; Admission activity; Adult; Adverse event; Age; Agitation; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Ambulatory Care; Attenuated; Behavior Therapy; Caring; Characteristics; Clinic; Clinical; Communication; Communication impairment; Consultations; Control Groups; Dementia; Devices; Disease; Disease Progression; Distress; Elderly; Elements; Ensure; Environmental Risk Factor; Equation; Equipment and supply inventories; Ethnic Origin; Etiology; Exposure to; Goals; Health; Hearing; Hearing Aids; Hearing Tests; Heterogeneity; High Prevalence; Home; Impaired cognition; Individual; Institution; Intervention; Interview; Knowledge; Link; Maintenance; Manuals; Measures; Mental Depression; Methodology; Methods; Modeling; Nature; Nursing Homes; Outcome; Outcome Measure; Outpatients; Patients; Perception; Personal Satisfaction; Pharmaceutical Preparations; Pilot Projects; Presbycusis; Prevalence; Process; Protocols documentation; Public Health; Quality of life; Questionnaires; Race; Randomized, Controlled Trials; Recommendation; Research; Role; Safety; Series; Severities; Sleep disturbances; Specific qualifier value; Structure; Surveys; Symptoms; Target Populations; Technology; Testing; Therapeutic; Time; Translating; Waiting Lists; Work; cohort; comorbidity; cost; dementia care; efficacy trial; experience; functional decline; hearing impairment; holistic approach; human old age (65+); implementation barriers; improved; innovation; insight; intervention refinement; mild cognitive impairment; neuropsychiatric symptom; neuropsychiatry; post intervention; primary outcome; recruit; reduce symptoms; responders and non-responders; response; socioeconomics; symptom management; tertiary prevention; theories; therapy design

PROJECT SUMMARY As the number of adults age 65 and older continue to increase, the prevalence of Alzheimer’s disease and other related dementias (ADRD) is also expected to increase in the U.S. Neuropsychiatric symptoms (NPS) such as agitation, apathy, depression, and sleep disturbance are highly prevalent in patients with ADRD, with up to 97% of the individuals suffering at least one NPS over the disease course. NPS requires considerable management and time by care partners, and are associated with rapid cognitive and functional decline, worse quality of life, greater care partner burden, and earlier nursing home admissions. Although nonpharmacological intervention for NPS is recommended, psychotropic medications continue to be widely prescribed, resulting in adverse events. Similar to ADRD, the prevalence of hearing loss increases with age. However, hearing care as tertiary prevention for older adults who have already developed cognitive impairment has largely been ignored. MPIs and the Co-Is of the current proposal have been working together for many years, demonstrating that i) there is a high prevalence of hearing loss among indiviudals with mild cognitive impairment (MCI) and ADRD, ii) increasing severity of hearing loss is associated with greater number of NPS and NPS severity, and that iii) a user-centered hearing care intervention that utilizes emerging over-the-counter (OTC) hearing technology may ameliorate NPS. The current proposal is based upon a prior NIA Stage 1b trial that involved an initial pilot study of a hearing care intervention that utilized OTC hearing devices and was delivered in an outpatient setting. The proposed study returns to Stage 1a and 1b to refine and test the preliminary efficacy of a revised hearing care intervention strategy that targets NPS and examines the underlying mechanism(s) of action. Aim 1 seeks to refine the hearing care intervention through a Stage 1a study that involves consultation with experts and end-users to develop a revised intervention protocol that integrates the latest evidence-informed approaches to NPS along with alignment with theoretical frameworks, consideration of implementation challenges encountered in the initial pilot study, and the ability to deliver the intervention in various settings, including the home. Aim 2 will then assess the preliminary efficacy of the revised hearing care intervention through a larger Stage 1b randomized controlled trial, which will allow for greater rigor in assessing the intervention than prior work. Aim 3 will employ a mixed methods approach to characterize response heterogeneity and underlying mechanism(s) of action. The proposed study embraces the iterative and multidirectional nature of the NIA Stage Model with the goal of developing impactful behavioral interventions that reach the maximum level of potency and potentially implementable to the maximum number of older adults. This proposal builds critical foundational knowledge regarding the role of hearing care as an integral component of managing NPS. These findings will directly translate to a larger Stage 2/3 efficacy trial.

项目摘要 随着65岁及65岁以上的成年人的数量继续增加，阿尔茨海默氏病的流行和 预计其他相关痴呆症（ADRD）也有望在美国神经精神症状（NPS）中增加 例如，躁动，冷漠，抑郁和睡眠障碍在ADRD患者中非常普遍 在疾病病程中，至少有一个NP的患者中，多达97％的人。 NP需要考虑 护理伙伴的管理和时间与快速认知和功能下降有关，更糟 虽然非药理 建议对NP进行干预，精神药物继续被广泛规定，从而导致 不利事件。与ADRD相似，听力损失的患病率随着年龄的增长而增加。但是，听到护理为 针对已经患有认知障碍的老年人的三级预防被忽略了。 MPI和当前建议的共同努力已经共同努力了很多年，证明了我） 轻度认知障碍（MCI）和ADRD的个体中听力丧失的患病率很高， ii）听力损失的严重程度增加与更多的NP和NPS严重程度有关，并且III）a 以用户为中心的听力护理干预措施利用新兴的非处方（OTC）听力技术可能 改善NP。当前的建议基于先前的NIA阶段1B试验，该试验涉及初始飞行员 研究使用OTC听力设备的听力护理干预措施，并以门诊的身份交付 环境。拟议的研究返回到第1A和1B期，以完善和测试修订后的初步效率 针对NP的听力护理干预策略并检查了动作的基本机制。目的 1试图通过一项涉及与专家协商的1A阶段研究来完善听力护理干预措施 和最终用户开发经过修订的干预协议，以整合最新的证据信息 NP的方法以及与理论框架保持一致，考虑实施 最初的试点研究遇到的挑战，以及在各种环境中提供干预的能力， 包括房屋。 AIM 2然后将评估修订后的听力干预的初步效率 通过较大的1B随机对照试验，这将使评估更严格 干预比先前的工作。 AIM 3将采用混合方法来表征响应 作用的异质性和基本机制。拟议的研究涵盖了迭代和 NIA阶段模型的多向性质，目的是制定有影响力的行为干预措施 达到最大效力水平，并且可以在较旧的最大数量中实现 成年人。该建议建立了有关听力作为不可或缺的作用的重要基础知识 管理NP的组成部分。这些发现将直接转化为较大的2/3阶段有效试验。

项目成果

ACR Appropriateness Criteria® Tinnitus: 2023 Update.

• DOI: 10.1016/j.jacr.2023.08.017
• 发表时间: 2023-11
• 期刊: Journal of the American College of Radiology : JACR
• 作者: Vikas Jain;B. Policeni;A. Juliano;O. Adunka;Mohit Agarwal;Prachi Dubey;Elliott R Friedman;M. Gule-Monroe;Mari Hagiwara;Christopher H Hunt;Bruce M Lo;Esther S Oh;Tanya J Rath;J. K. Roberts;David Schultz;M. R. Taheri;D. Zander;Judah Burns