Trajectory of Recovery in the Elderly
老年人康复轨迹
基本信息
- 批准号:9474553
- 负责人:
- 金额:$ 48.37万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2014
- 资助国家:美国
- 起止时间:2014-09-15 至 2020-04-30
- 项目状态:已结题
- 来源:
- 关键词:AccelerationAdultAffectAgeAgingAlzheimer&aposs DiseaseAmnesiaAnesthesia proceduresAnestheticsAreaBiochemistryBrainCaringCerebrovascular CirculationClinicalClinical ResearchClinical assessmentsCognitionCognitiveComprehensionDataDay SurgeryDevelopmentDiagnosisDiffusion Magnetic Resonance ImagingDiseaseElderlyEtiologyEyeFailureFunctional Magnetic Resonance ImagingFunctional disorderGeneral AnesthesiaGeriatricsHealthcareHome environmentHospitalsHypnosisImaging TechniquesImpaired cognitionImpairmentIndividualInflammatoryInpatientsInstructionLifeLinkLiteratureLongitudinal StudiesMagnetic Resonance ImagingMeasuresModernizationNeuraxisNeuropsychological TestsOperative Surgical ProceduresOutcomeParticipantPatientsPerioperativePharmaceutical PreparationsPhysiologicalPlayPopulationPopulations at RiskPostoperative PeriodPrincipal InvestigatorProcessRecoveryResearchResourcesRestRiskRoleSelf CareSignal TransductionSpecific qualifier valueSpin LabelsStressSurgeonSyndromeTestingTheoretical modelTimeUnited States National Institutes of HealthWorkanimal dataclinical practicecognitive capacitycognitive processcognitive recoverycognitive reservecohortcostexpectationexperiencefollow-uphealthy volunteerhospital readmissionhuman datahuman old age (65+)improvedneuroinflammationneurotoxicolder patientpatient populationpost-operative cognitive dysfunctionpostoperative deliriumpreventpublic health relevancereadmission ratesvolunteerwillingness
项目摘要
DESCRIPTION (provided by applicant): Elderly patients undergoing anesthesia and surgery frequently suffer from postoperative cognitive dysfunction (POCD) and postoperative delirium (PD). The cause of these entities is unknown; specifically it is unclear what part the anesthetics play in the development of POCD and PD. We hypothesize that elderly patient's cognitive capacities recover more slowly after receiving general anesthesia, perhaps because they have more limited cognitive reserve. A more prolonged recovery would confound diagnoses of POCD and PD and potentially puts patients who are discharged on the day of surgery at risk of not understanding postoperative instructions. The trajectory of postoperative cognitive recovery has never been explored and elderly participants have been explicitly not included in any type of emergence research. To explore this vital area we propose to study young and elderly volunteers with a combination of two state of the art neuropsychological tests (postoperative quality of recovery scale and the NIH Toolbox) and magnetic resonance imaging. Starting from baseline, we will determine multiple cognitive domains and resting state networks, treat the volunteers with general anesthesia, and then explore the recovery of the cognitive domains and alterations in functional networks. The data acquired in this project will have both clinical and
theoretical relevance. Apart from distinguishing immediate drug effects from POCD and PD, characterization of the trajectory of cognitive recovery in the elderly could affect changes in clinical practice vis a vis the criteria we employ to determine, for example, hospital discharge in
this population. Currently many elderly patients are (perhaps inappropriately) sent home on the day of surgery. Furthermore, characterization of the trajectory of recovery in this population would enable us to better educate our patients and those who help care for them as to the proper expectations and time course for their recovery from anesthesia. Most fundamentally, the trajectory at which various patients recover from anesthesia is the most unappreciated confounding factor in this debate on the direct and indirect effects of anesthetic drugs. The effects of the anesthesia itself are theoretically (and as we propose here, practically) separable
from those due to surgery, by studying the former in the absence of the latter we can delineate the trajectory of cognitive recovery from anesthesia itself, developing an understanding that is currently lacking and yet necessary to understand POCD and PD in general.
描述(申请人提供):接受麻醉和手术的老年患者经常出现术后认知功能障碍(POCD)和术后谵妄(PD)。这些实体的原因尚不清楚;具体而言,尚不清楚麻醉剂在 POCD 和 PD 的发展中发挥什么作用。 我们假设老年患者接受全身麻醉后认知能力恢复较慢,可能是因为他们的认知储备更有限。 恢复时间较长可能会混淆 POCD 和 PD 的诊断,并可能使手术当天出院的患者面临不理解术后说明的风险。 术后认知恢复的轨迹从未被探索过,老年参与者也被明确排除在任何类型的突发研究中。 为了探索这一重要领域,我们建议结合两种最先进的神经心理学测试(术后恢复质量量表和 NIH 工具箱)和磁共振成像来研究年轻和老年志愿者。 从基线开始,我们将确定多个认知域和静息状态网络,对志愿者进行全身麻醉,然后探索认知域的恢复和功能网络的改变。 该项目获得的数据将具有临床和
理论相关性。 除了区分 POCD 和 PD 的直接药物效应外,老年人认知恢复轨迹的特征可能会影响临床实践相对于我们用来确定标准的变化,例如,老年人的出院情况。
这个人口。 目前,许多老年患者在手术当天就被送回家(也许是不恰当的)。此外,描述该人群的康复轨迹将使我们能够更好地教育我们的患者和帮助照顾他们的人,了解他们从麻醉中恢复的适当期望和时间进程。 最根本的是,在关于麻醉药物的直接和间接影响的争论中,不同患者从麻醉中恢复的轨迹是最不被重视的混杂因素。 麻醉本身的效果在理论上(正如我们在这里提出的,实际上)是可分离的
与手术引起的认知障碍相比,通过在没有后者的情况下研究前者,我们可以描绘麻醉本身认知恢复的轨迹,形成目前缺乏但对于总体理解 POCD 和 PD 所必需的理解。
项目成果
期刊论文数量(5)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Transient changes in white matter microstructure during general anesthesia.
- DOI:10.1371/journal.pone.0247678
- 发表时间:2021
- 期刊:
- 影响因子:3.7
- 作者:Tang CY;Wang VX;Lun MY;Mincer JS;Ng JC;Brallier JW;Schwartz AE;Ahn H;McCormick PJ;Nir T;Delman B;Sano M;Deiner SG;Baxter MG
- 通讯作者:Baxter MG
Lateralisation of subcortical functional connectivity during and after general anaesthesia.
全身麻醉期间和之后皮质下功能连接的侧化。
- DOI:10.1016/j.bja.2021.08.033
- 发表时间:2022
- 期刊:
- 影响因子:9.8
- 作者:Nir,Tommer;Raizman,Reut;Meningher,Inbar;Jacob,Yael;Huang,Kuang-Han;Schwartz,ArthurE;Brallier,JessW;Ahn,Helen;Kundu,Prantik;Tang,CheukY;Delman,BradleyN;McCormick,PatrickJ;Scarpa,Julia;Sano,Mary;Deiner,StacieG;Livny,Abig
- 通讯作者:Livny,Abig
Resting-state functional connectivity in early postanaesthesia recovery is characterised by globally reduced anticorrelations.
麻醉后早期恢复中静息态功能连接的特点是整体反相关性降低。
- DOI:10.1016/j.bja.2020.06.058
- 发表时间:2020
- 期刊:
- 影响因子:9.8
- 作者:Nir,Tommer;Jacob,Yael;Huang,Kuang-Han;Schwartz,ArthurE;Brallier,JessW;Ahn,Helen;Kundu,Prantik;Tang,CheukY;Delman,BradleyN;McCormick,PatrickJ;Sano,Mary;Deiner,Stacie;Baxter,MarkG;Mincer,JoshuaS
- 通讯作者:Mincer,JoshuaS
Cognitive Recovery by Decade in Healthy 40- to 80-Year-Old Volunteers After Anesthesia Without Surgery.
- DOI:10.1213/ane.0000000000005824
- 发表时间:2022-02-01
- 期刊:
- 影响因子:5.7
- 作者:Baxter MG;Mincer JS;Brallier JW;Schwartz A;Ahn H;Nir T;McCormick PJ;Ismail M;Sewell M;Allore HG;Ramsey CM;Sano M;Deiner SG
- 通讯作者:Deiner SG
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Mark G Baxter其他文献
Mark G Baxter的其他文献
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{{ truncateString('Mark G Baxter', 18)}}的其他基金
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10475169 - 财政年份:2021
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