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.

越来越多的研究表明，在成年早期或中期持续的创伤性脑损伤有可能导致 影响衰老过程的轨迹，无论是在大脑功能还是全身健康方面。 自认为脑损伤多年后已完全康复且无症状的人 事实上，与没有经历过头部损伤的同龄人相比，他们的功能可能更差。 揭示了令人信服的证据，表明 TBI 可以引起神经内分泌和神经系统的长期异常级联反应。 然而，神经炎症过程改变了大脑网络的结构和功能完整性。 几乎没有直接证据可以证明是否“正常”与年龄相关的神经退行性变和身体机能下降 多年前发生的创伤性脑损伤会使认知功能变得更差。 “TBI 带来的衰老”的慢性影响，我们可以更好地确定潜在的干预措施，以减少负面影响 考虑到存在重大影响，这是一个重要的研究领域。 经历过 TBI 的退伍军人参与康复干预的机会之窗 生活方式的改变可能会在他们进入老年时保留功能。 这项新的研究路线是，在成年早期或中期经历过中度 TBI 的参与者（在 入学前至少 15 年）在平衡和认知测试中的表现将较差，尽管 自我报告没有 TBI 造成的持续性运动或认知障碍。我们还寻求评估潜在的可能性。 用于基于实践的学习和改善该人群的复杂平衡任务，以获得 将比较以前患有 TBI 的退伍军人（TBI+ 组）进行未来康复研究的经验。 没有报告 TBI 病史的对照组（TBI 组）。我们建议招募有过 TBI 病史的退伍军人。 过渡到老年（即 50-65 岁之间的年龄），因为本研究将重点关注平衡功能。 跌倒和由此造成的伤害是老年退伍军人残疾的主要原因。 和平民，这给个人和社会带来了巨大的康复需求和成本。 平衡赤字和跌倒的重要性在未来几年只会增加，因为超过 50% 的退伍军人 到 2050 年，患者将年满 65 岁。此外，在身体恢复的急性阶段，失去平衡是很常见的。 TBI，表明神经控制通路/网络受到损害，可能容易受到慢性影响。 次要结果，我们将进行与平衡功能相关的评估（包括认知和功能） 动眼功能）并增加跌倒受伤的风险（骨矿物质密度）。 表明这些次要结果也容易受到 TBI 的慢性影响。 该研究旨在确定 TBI+ 参与者的平衡能力、认知能力和动眼能力是否受损 与 TBI 参与者相比，该研究的第二个目的是评估基于实践的潜力。 除了建议的小组之外，还需要学习需要视觉空间认知参与的平衡任务。 分析中，我们还将在 TBI+ 参与者中进行探索性回归分析，以检查潜在的 损伤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做好准备进行更大规模的研究，以更好地理解 老化与 TBI 的慢性影响，以及让我们准备好测试康复干预措施以促进 该人群的健康老龄化。