Aging with a Traumatic Brain Injury: Implications for Balance Deficits and Fall Risk

脑外伤导致的衰老：对平衡缺陷和跌倒风险的影响

• 批准号: 10702005
• 负责人: David J Clark
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10702005
• 关键词: Acceleration; Acute; Adult; Age; Aging; Area; Bone Density; Brain; Brain Injuries; Chronic; Cognition; Cognitive; Complex; Control Groups; Craniocerebral Trauma; Data Set; Eligibility Determination; Enrollment; Equilibrium; Exhibits; Future; Goals; Gulf War; Health; Impaired cognition; Individual; Injury; Intervention; Investigation; Knowledge; Learning; Life Style Modification; Literature; Longevity; Measures; Motor; Neurosecretory Systems; Participant; Pathway interactions; Patient Self-Report; Performance; Persons; Physical Function; Population; Predisposition; Process; Recording of previous events; Regression Analysis; Rehabilitation therapy; Reporting; Research; Risk; Risk Factors; Severities; Societies; Testing; Traumatic Brain Injury; Traumatic Brain Injury recovery; Uncertainty; Veterans; Visuospatial; age effect; age group; age related neurodegeneration; balance testing; brain health; cognitive function; cognitive performance; cognitive testing; cohort; comorbidity; cost; design; disability; equilibration disorder; experience; fall risk; falls; healthy aging; human old age (65+); improved; lifestyle intervention; motor deficit; motor impairment; neuroinflammation; neuroregulation; oculomotor; peer; preservation; pressure; secondary outcome; visual tracking

Accumulating research indicates that a TBI sustained in early or middle adulthood has the potential to influence the trajectory of the aging process, both in the context of brain function and whole-body health. People who consider themselves to be fully recovered and asymptomatic many years following a brain injury might actually exhibit poorer function than peers who did not experience a head injury. The TBI literature reveals compelling evidence that TBI can elicit long-term abnormal cascades of neuroendocrine and neuroinflammatory processes that alter the structural and functional integrity of brain networks. However, there is little direct evidence to establish whether “normal” age-related neurodegeneration and decline of physical and cognitive function are made worse by a TBI that occurred many years earlier. By understanding the chronic effects of “aging with a TBI” we can better identify potential interventions to reduce negative repercussions across the lifespan. This is an important area of investigation, considering there is a substantial window of opportunity for Veterans who have experienced a TBI to engage in rehabilitative interventions and lifestyle modifications that may preserve function as they transition to older age. The overarching hypothesis of this new line of research is that participants who experienced a moderate TBI in early or middle adulthood (at least 15 years prior to study enrollment) will have poorer performance on balance and cognitive tests, despite self-reporting no persistent motor or cognitive impairment from the TBI. We also seek to evaluate the potential for practice-based learning and improvement of complex balance tasks in this population, in order to gain experience for conducting future rehabilitation studies. Veterans with prior TBI (TBI+ group) will be compared to a control group who report no history of TBI (TBI- group). We propose to enroll Veterans who are transitioning into older age (i.e., age between 50-65 years). This study will focus on balance function because of its close association with fall risk. Falls and resultant injuries are a major cause of disability in older Veterans and civilians, which poses a substantial rehabilitation demand and cost to individuals and society. The significance of balance deficits and falls will only grow in the coming years, as more than 50% of all Veterans will be 65 years or older by 2050. Further, loss of balance is very common in the acute stage of recovery from TBI, suggesting damage to neural control pathways/networks that might be susceptible to chronic effects. As secondary outcomes, we will conduct assessments that are related to balance function (including cognitive and oculomotor function) and that increase the risk of injuries due to a fall (bone mineral density). The TBI literature suggests that these secondary outcomes are also susceptible to the chronic effects of a TBI. The first aim of the study is to determine if TBI+ participants have impaired balance, cognition, and oculomotor performance compared to TBI- participants. The second aim of the study is to evaluate the potential for practice-based learning of balance tasks requiring visuospatial cognitive engagement. In addition to the proposed group analyses, we will also conduct exploratory regression analysis within the TBI+ participants to examine potential relationships between the severity of injury and continuous measures of motor and cognitive performance. The knowledge and experience gained from this study will prepare us to conduct larger studies to better understand the chronic effects of aging with a TBI, as well as prepare us to test rehabilitation interventions to promote healthy aging in this population.

累积研究表明，在成年初期或中期维持的TBI有可能 在大脑功能和全身健康的背景下，影响衰老过程的轨迹。 脑损伤后多年以来，人们认为自己已经完全康复和无症状的人 实际上，与没有头部受伤的同龄人相比，功能实际上可能较差。 TBI文学 揭示了令人信服的证据，表明TBI可以引起神经内分泌和 改变大脑网络的结构和功能完整性的神经炎症过程。但是，那里 几乎没有直接的证据来确定“正常”与年龄相关的神经变性和身体下降是否 多年前发生的TBI使认知功能变得更糟。通过理解 “与TBI老化”的慢性影响我们可以更好地识别潜在的干预措施以减少负面 整个生命周期的影响。考虑到存在很大的投资领域 经历了TBI进行康复干预措施的退伍军人的机会之窗 生活方式的修改可能会在过渡到老年时可以保留功能。总体假设 这项新的研究是，在成年初期或中期经历了现代TBI的参与者（在 学习入学率至少15年）的平衡和认知测试的表现较差，绝望 自我报告没有TBI的持续发动机或认知障碍。我们还试图评估潜力 为了基于实践的学习和改进该人群的复杂平衡任务，以获取 进行未来康复研究的经验。将比较具有先验TBI（TBI+组）的退伍军人 对于没有报告TBI史的对照组（TBI-GROUP）。我们建议注册的退伍军人 过渡到老年（即50-65岁之间的年龄）。这项研究将重点放在平衡功能上，因为 与跌倒风险的密切关联。跌倒和导致的伤害是老年退伍军人残疾的主要原因 和平民，对个人和社会构成了实质性的康复需求和成本。 平衡的意义定义和跌倒只会在未来几年中增长，因为所有退伍军人中有50％以上 到2050年将达到65岁或以上。此外，在从 TBI提示可能损害神经控制途径/网络，可能容易受到慢性影响。作为 次要结果，我们将进行与平衡功能相关的评估（包括认知和 动眼功能）并增加了由于跌落（骨矿物质密度）而导致的损伤风险。 TBI文学 表明这些次要结果也容易受到TBI的慢性影响。第一个目的 该研究是为了确定TBI+参与者的平衡，认知和动眼表现是否受损 与TBI相比。该研究的第二个目的是评估基于实践的潜力 学习需要视觉认知参与的平衡任务。除了提议的组 分析，我们还将在TBI+参与者中进行探索性回归分析，以检查潜力 受伤的严重程度与运动和认知表现的连续测量之间的关系。 从这项研究中获得的知识和经验将使我们为进行更大的研究做好准备，以更好地了解 TBI衰老的慢性影响，并为我们做好准备测试康复干预措施以促进 在这个人群中的健康衰老。