A Multi-Modal Combination Intervention to Promote Cognitive Function in Older Intensive Care Unit Survivors

促进老年重症监护病房幸存者认知功能的多模式组合干预

• 批准号: 10662893
• 负责人: Maya Elias
• 金额: $ 14.95万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662893
• 关键词: Adult; Affect; Age; Alzheimer' s disease related dementia; Behavior Therapy; Behavioral; Biological; Body Temperature; COVID-19; Chronotherapy; Circadian Rhythms; Clinical; Clinical Trials; Clinical Trials Design; Cognition; Cognitive; Cohort Studies; Critical Care; Critical Illness; Data; Delirium; Development; Distress; Dose; Earplug; Educational Intervention; Elderly; Enrollment; Ensure; Equation; Eye; Foundations; Funding; Future; Goals; Grant; Heart failure; Hip Fractures; Hospitalization; Hospitals; Impaired cognition; Individual; Intensive Care; Intensive Care Units; Intervention; Intervention Trial; K-Series Research Career Programs; Knowledge; Malignant Neoplasms; Masks; Mediating; Mentored Patient-Oriented Research Career Development Award; Methodology; Modeling; Obstructive Sleep Apnea; Outcome; Outcome Study; Participant; Patients; Pharmaceutical Preparations; Polysomnography; Postdoctoral Fellow; Principal Investigator; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Research; Risk Reduction; Sample Size; Science; Series; Severities; Severity of illness; Sleep; Sleep Deprivation; Sleep disturbances; Statistical Data Interpretation; Sum; Survivors; Symptoms; Syndrome; Testing; Training; Training Activity; Treatment Efficacy; United States National Institutes of Health; actigraphy; active control; circadian; cognitive function; cognitive training; computerized; design; executive function; experience; high risk; improved; improved outcome; intervention effect; multimodality; post-doctoral training; prevent; programs; psychological outcomes; risk mitigation; sex; symptom management; symptom science; symptomatic improvement; wearable sensor technology

The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare the candidate, Dr. Maya Elias, for an independent program of geriatric critical care research. More than 60% of intensive care unit (ICU) patients are adults ages 60 and older. Following hospital discharge, about 25% of ICU survivors experience cognitive impairment comparable in severity to mild Alzheimer’s disease and related dementias. Moreover, ICU survivors often experience sleep disturbances and inactivity, and almost 80% of ICU patients experience disturbances in circadian rhythm, which may affect cognitive function. The scientific premises of the proposed study are: 1) a combined sleep promotion and cognitive training intervention will have synergistic effects to mitigate the risk of cognitive impairment and development of Alzheimer’s disease and related dementias in older ICU survivors; and 2) chronotherapeutic timing of interventions (i.e., adjusting timing of interventions according to circadian rhythm profiles) may improve intervention efficacy. The proposed research and training build upon prior NIH-funded postdoctoral research conducted by Dr. Elias (F32NR018585). Training Aim 1 will develop expertise in designing and refining behavioral sleep and cognitive interventions through training in clinical trial methodologies and statistical analyses. Training Aim 2 will expand knowledge of circadian science and chronotherapy to examine circadian rhythm as a mechanistic factor underlying delirium and cognitive decline related to Alzheimer’s disease and related dementias in older ICU survivors. This Career Development Award will also support Dr. Elias to lead a clinical trial, which will evaluate feasibility of existing behavioral sleep and cognitive interventions to inform the design of a larger randomized controlled trial. Using a 2 x 2 factorial design, 100 English- or Spanish-speaking older ICU survivors will be enrolled after discharge out of the ICU and randomized to one of 4 combinations of two interventions: SLEEP [nighttime use of earplugs and eye masks] and COG [daily computerized cognitive training sessions]. Specific Aim 1 will test the separate and combined effects of SLEEP and COG, versus AC [active control], in improving cognitive function for older ICU survivors. Specific Aim 2 will examine circadian rhythm parameters of continuous body temperature to determine the optimal window for timing of the COG intervention. Specific Aim 3 will examine if the effects of each intervention [SLEEP + COG, SLEEP, COG] on cognitive function are mediated by sleep and activity, and will examine if selected biological and clinical factors moderate the intervention effects. Exploratory Aim 4 will explore the effect of each intervention on cognitive function at 1 month and incident Alzheimer’s disease and related dementias at 6 months and 12 months after hospital discharge. Results will yield crucial preliminary data for future clinical trials and will guide Dr. Elias to establish a program of research testing interventions that will improve outcomes for older ICU survivors throughout recovery from critical illness.

这项受过指导的以患者为导向的研究职业发展奖的目的是为候选人Maya Elias博士准备一项独立的老年重症监护研究计划。 60％以上的重症监护病房（ICU）患者是60岁及60岁以上的成年人。住院后，约有25％的ICU生存经历的认知障碍与轻度阿尔茨海默氏病和相关痴呆症相当。此外，ICU的存活率经常患睡眠障碍和不活跃，几乎80％的ICU患者患有昼夜节律的疾病，这可能会影响认知功能。拟议的研究的科学信念是：1）促进睡眠和认知训练干预措施将具有协同作用，以减轻老年症患者的认知障碍和发展的认知障碍和发展的风险； 2）干预措施的时间治疗时间（即根据昼夜节律概况调整干预措施的时间）可能会提高干预效率。拟议的研究和培训是基于Elias博士（F32NR018585）进行的先前由NIH资助的博士后研究。培训目标1将通过临床试验方法和统计分析中的培训来开发设计和完善行为睡眠和认知干预措施方面的专业知识。训练目标2将扩大对昼夜节律和年代疗法的了解，以研究昼夜节律，这是与阿尔茨海默氏病和相关痴呆症相关的旧ICU存活中的机械因素和认知下降的机械因素。该职业发展奖还将支持Elias博士领导临床试验，该试验将评估现有行为睡眠和认知干预措施的可行性，以告知大型随机对照试验的设计。使用2 x 2阶乘设计，从ICU排出后将招募100个英语或西班牙语的较旧的ICU冲浪者，并随机分配到两种干预措施的4种组合之一：睡眠[夜间使用耳塞和眼罩]和COG [每日计算机化认知训练课程]。特定的目标1将测试睡眠和COG的单独和组合效应，而不是AC [主动控制]，以改善较旧的ICU存活的认知功能。特定的目标2将检查连续体温的昼夜节律参数，以确定COG干预时间的最佳窗口。具体目标3将检查每种干预措施[睡眠 + COG，睡眠，COG]对认知功能的影响是否是由睡眠和活动介导的，并将检查选定的生物学和临床因素是否适应干预效果。探索目的4将探索每种干预对1个月认知功能的影响，并在出院后6个月零12个月时阿尔茨海默氏病和相关痴呆症发生。结果将为未来的临床试验产生至关重要的初步数据，并将指导Elias博士建立研究测试干预措施的计划，该计划将改善整个重症疾病中恢复整个ICU生存的结果。

项目成果

Inactivity May Identify Older Intensive Care Unit Survivors at Risk for Post-Intensive Care Syndrome.

不活动可能会导致重症监护病房的老年幸存者面临重症监护后综合症的风险。

• DOI: 10.4037/ajcc2024785
• 发表时间: 2024
• 期刊: American journal of critical care : an official publication, American Association of Critical-Care Nurses
• 作者: Elias,MayaN;Ahrens,EmilyA;Tsai,Chi-Shan;Liang,Zhan;Munro,CindyL
• 通讯作者: Munro,CindyL