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？

基本信息

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
项目类别：
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&apos s Disease Alzheimer&apos 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

项目摘要

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.

项目概要该项目调查前庭功能丧失是否可以预测阿尔茨海默病 (AD) 患者的跌倒。拟议的研究是一项对 150 名 AD 患者进行的观察性研究，旨在评估两者之间的关联我们还将探讨前庭功能与 2 年跌倒发生率之间的关系。功能与平衡和步态功能以及空间认知功能相关，作为潜在的具体而言，目标 1 是确定前庭功能导致跌倒风险的机制。前庭丧失是否预示轻中度 AD 患者跌倒。基线前庭功能预测 2 年跌倒发生率较高。与前庭损失相关的跌倒风险足够大（>~10%）进一步研究前庭疗法作为跌倒风险的临床显着调节剂，目的 2 是评估。 AD 中的前庭丧失是否预示着静态和动态平衡受损（使用 Berg 测量）平衡量表 (BBS) 和计时启动 (TUG) 测试我们努力大幅减少。 2 年随访期间的前庭功能预测 BBS 和 TUG 表现会出现更大的下降。目标 3 是评估 AD 中的前庭丧失是否预示着空间认知能力受损。进行空间认知的认知测试（包括金钱路线图测试、卡片旋转测试）测试、视觉形式辨别测试和时钟绘图测试），我们还将询问参与者以及看护者关于驾驶困难、丢失物品、迷路和徘徊行为的问题 AD 患者空间认知受损的功能表现。两年随访期间前庭功能的下降预示着空间认知能力的进一步下降测试分数以及功能性空间认知障碍的发生率较高。平衡能力受损（来自目标 2）和空间认知技能受损都是独立的为了实现这些目标，我们将研究前庭功能丧失和跌倒事件之间关联的中介因素。利用约翰·霍普金斯大学完善的资源，包括约翰·霍普金斯大学阿尔茨海默氏病研究中心和记忆与阿尔茨海默病治疗中心是瀑布的主要来源。如果我们的观察性研究表明 AD 的发病率和当前的干预措施并不均有效。证明前庭功能丧失与较差的平衡感和空间认知以及跌倒事件有关，这些结果将为预防 AD 患者跌倒的干预试验的设计提供信息。