Cognitive Aging Trajectories in Survivors of Trauma

创伤幸存者的认知老化轨迹

• 批准号: 10662957
• 负责人: KAREN Ann LAWRENCE
• 金额: $ 12.38万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662957
• 关键词: Accidents; Address; Adult; Affect; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anxiety; COVID-19; COVID-19 pandemic; Clinical; Clinical Sciences; Cognition; Cognitive; Cognitive aging; Cross-Sectional Studies; DSM-V; Data; Data Collection; Dementia; Diagnosis; Diagnostic; Diagnostic and Statistical Manual of Mental Disorders; Disasters; Elderly; Epidemiology; Episodic memory; Event; Funding; Goals; Health; Impaired cognition; Incidence; Intervention; Investigation; Kentucky; Link; Longitudinal Studies; Medical; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Modeling; Modification; National Center for Advancing Translational Sciences; Neuropsychology; Participant; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Prevalence; Prevention; Psychologist; Public Health; Recording of previous events; Research; Research Design; Research Personnel; Risk; Risk Factors; Severities; Sex Differences; Short-Term Memory; Survivors; Symptoms; Testing; Training; Translational Research; Trauma; Traumatic Brain Injury; United States; Universities; War; Woman; aged; apolipoprotein E-4; biopsychosocial factor; carrier status; clinical center; cognitive function; cohort; comorbidity; dementia risk; disability; executive function; first responder; functional decline; human old age (65+); meetings; men; mild cognitive impairment; military veteran; multilevel analysis; pandemic disease; post-pandemic; pre-clinical; pre-pandemic; processing speed; prospective; recruit; sex; sexual assault; statistics; traumatic stress; young adult

Dementia and the prodromal stages of cognitive decline, together, affect approximately 25-30% of older adults across the United States (U.S.). Posttraumatic Stress Disorder (PTSD) has been linked to a 111% increased risk of developing dementia of any type, even after controlling for potential confounders such as traumatic brain injury (TBI). Therefore, PTSD may be an important target for early prevention of cognitive decline and potential progression to dementia. Most studies on PTSD and cognition have used a cross-sectional study design and have not examined important potential effect modifiers (e.g., sex and APOE4 carrier status), leaving a gap in our fundamental understanding of the effect of PTSD on longitudinal trajectories of cognitive functioning. Further, although PTSD is more prevalent in women, most research on PTSD and cognition has been conducted in men. This proposal is of timely public health importance, as the pre-pandemic lifetime prevalence of PTSD in the U.S. was 6%, but post-pandemic epidemiological findings have indicated a rise to approximately 32% among young adults. COVID-19 events have also resulted in PTSD symptoms without meeting Diagnostics and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Criterion A. Therefore, critical research gaps in our understanding of the effect of PTSD on cognitive aging include: 1) prospective investigation wherein temporal sequencing and rate of cognitive decline can be evaluated in the context of PTSD, 2) testing the potential modifying effects of sex and APOE4 carrier status on the relationship between PTSD status and cognitive decline and, 3) understanding whether Criterion A is necessary when determining the relationship between PTSD and cognitive decline. Aims 1 and 2 will leverage existing data from the National Alzheimer's Coordinating Center (NACC). In adults aged 55+ years, multilevel modeling and interaction analyses will determine the impact of PTSD status on trajectories, rate, and temporal sequence of domain-specific cognitive decline and will test sex and APOE4 carrier status as potential effect modifiers. For Aim 3, men and women participants, aged 65+, with and without Criterion A trauma, will be recruited and multiple regression will be used to unambiguously clarify if PTSD severity (Criteria B through E) is associated with cognitive functioning without meeting Criterion A. This K01 award will provide training and mentorship in aging health, cognitive aging, sex-specific health effects of PTSD, neuropsychology of PTSD, longitudinal study design, and advanced statistics and propel the PI to become an independent investigator with expertise in the effects of traumatic stress and biopsychosocial factors on cognitive aging, with a sex-specific focus and in alignment with Goals B-3, B-4, and F-4 of NIA’s Strategic Directions 2020-2025.

痴呆症和认知能力下降的前驱阶段共同影响了大约 25-30% 的老年人 在美国 (U.S.)，创伤后应激障碍 (PTSD) 的发病率增加了 111%。 即使在控制了潜在的混杂因素（例如脑外伤）后，仍存在患任何类型痴呆症的风险 因此，PTSD可能是早期预防认知衰退和潜在的重要目标。 大多数关于 PTSD 和认知的研究都采用横断面研究设计和 没有重要检查潜在的影响修饰因素（例如性别和 APOE4 携带者状态），在 我们对 PTSD 对认知功能纵向轨迹影响的基本理解。 此外，虽然 PTSD 在女性中更为普遍，但大多数关于 PTSD 和认知的研究都是 这项提议对于公共卫生具有重要意义，因为大流行前的终生患病率很高。 在美国，创伤后应激障碍 (PTSD) 的发生率为 6%，但大流行后的流行病学调查结果表明，这一比例有所上升 大约 32% 的年轻人也出现了 PTSD 症状，但并未出现这种症状。 符合《精神疾病诊断和统计手册》第五版 (DSM-5) 标准 A。因此， 我们在理解 PTSD 对认知衰老的影响方面的关键研究差距包括：1）前瞻性 调查、时间顺序和认知能力下降的速度可以在以下背景下进行评估： PTSD，2) 测试性别和 APOE4 携带者状态对两者之间关系的潜在改变作用 PTSD 状态和认知能力下降，3) 了解在确定时是否需要标准 A PTSD 和认知能力下降之间的关系将利用现有数据。 国家阿尔茨海默病协调中心 (NACC) 对 55 岁以上的成年人进行多层次建模和 交互分析将确定 PTSD 状态对轨迹、速率和时间序列的影响 特定领域的认知能力下降，并将测试性别和 APOE4 携带者状态作为潜在的效果调节剂。 目标 3，将招募 65 岁以上的男性和女性参与者，无论有无标准 A 创伤， 多元回归将用于明确阐明 PTSD 严重程度（标准 B 至 E）是否相关 具有认知功能但未满足标准 A。该 K01 奖项将提供以下方面的培训和指导： 老龄化健康、认知衰老、创伤后应激障碍 (PTSD) 的性别特异性健康影响、创伤后应激障碍 (PTSD) 的神经心理学、纵向 研究设计和高级统计数据，推动 PI 成为具有专业知识的独立研究者 创伤应激和生物心理社会因素对认知衰老的影响，以性别为重点， 与 NIA 2020-2025 年战略方向的目标 B-3、B-4 和 F-4 保持一致。