Recovery among Older Adults Following Head Injury

老年人头部受伤后的康复

• 批准号: 10656334
• 负责人: Jennifer S. Albrecht
• 金额: $ 72.42万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656334
• 关键词: Adult; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Caring; Characteristics; Cognition; Cognitive; Craniocerebral Trauma; Data; Development; Early identification; Elderly; Emergency department visit; Frontotemporal Dementia; Future; Health; Heterogeneity; Hospitalization; Impaired cognition; Impairment; Individual; Injury; Intervention; Knowledge; Literature; Lower Extremity; Measures; Modeling; Outcome; Participant; Patients; Pattern; Physical Function; Pilot Projects; Population; Prospective, cohort study; Public Health; Recovery; Rehabilitation therapy; Research; Risk; Shock; Signal Transduction; Traumatic Brain Injury; Vulnerable Populations; Work; acute care; adverse outcome; aged; cognitive function; cognitive recovery; cognitive rehabilitation; comorbidity; dementia risk; experience; fall injury; falls; follow-up; high risk; human old age (65+); improved; long term recovery; mild traumatic brain injury; psychologic; psychological distress; sleep quality; targeted treatment; trauma centers; young adult

Development of Alzheimer's disease and related dementias (ADRD) is multifactorial, and some causal factors can be influenced or modified. Recently, the Lancet Commission included traumatic brain injury (TBI) in its list of 12 key potentially modifiable ADRD risk factors. TBI is a very common injury among older adults, resulting in over 123,000 hospitalizations and 485,000 emergency department visits annually. Importantly, rates of TBI are rapidly increasing in this population. TBI results in cognitive impairment and increases risk for both Alzheimer's disease and fronto-temporal dementia. Furthermore, TBI can result in worsened health outcomes (e.g., poor physical functioning, psychological distress, worsened sleep quality), which in turn increase risk for ADRD. Yet, despite the large public health impact of TBI among older adults, little is known about changes in cognition and related domains following discharge from acute care in this population. Although such information is urgently needed to guide rehabilitation, care planning, and promotion of optimal long-term recovery in this vulnerable population, these data are severely lacking in the literature. One major reason for this lack of knowledge is that most prior research on TBI has focused on younger adults. Unfortunately, many findings from younger adults do not generalize to older adults due to their higher comorbidity burden and poorer cognitive and physical functioning at discharge from acute care. The objective of the proposed research is to gain an in-depth understanding of recovery of cognition, psychological and physical functioning, and sleep quality following TBI among older adults. To achieve this objective, we propose to conduct a prospective cohort study of 250 patients aged 65 years and older treated for mild TBI at the R Adams Cowley Shock Trauma Center with follow-up at 3, 6, and 12 months to complete three Specific Aims: 1) Assess recovery of cognitive functioning and identify predictors of poor recovery; 2) Assess recovery of physical and psychological functioning and sleep quality and identify predictors of poor recovery; 3) Identify interactions between recovery trajectories. The significance of this research is that it will identify unique recovery patterns across important domains of functioning (including cognitive function) and factors that impact the course of recovery following mild TBI among older adults. Identification of individuals at risk for poor cognitive recovery following TBI will highlight a population at high risk of ADRD and would permit targeting those individuals with cognitive rehabilitation interventions, potentially reducing ADRD risk. The rationale for the proposed study is that early identification of patients with poorer recovery trajectories will permit development and targeting of appropriately timed interventions to mitigate ADRD risk and other adverse outcomes. The potential impact of this work is that it will generate new knowledge that will guide targeted treatment efforts and inform development of a geriatric-TBI focused rehabilitation intervention that will be the focus of a future R01 application.

阿尔茨海默氏病和相关痴呆症（ADRD）的发展是多因素的，某些因果因素可能受到影响或修改。最近，柳叶刀委员会包括创伤性脑损伤（TBI）在其12个主要可修改的ADRD风险因素的列表中。 TBI是老年人非常普遍的伤害，每年导致超过123,000次住院和485,000个急诊室访问。重要的是，该人群的TBI速度正在迅速提高。 TBI导致认知障碍，并增加了阿尔茨海默氏病和额颞痴呆的风险。此外，TBI可能会导致健康结果恶化（例如身体功能不良，心理困扰，睡眠质量恶化），进而增加ADRD的风险。然而，尽管TBI在老年人中对公共卫生的影响很大，但对于该人群的急性护理出院后，认知和相关领域的变化知之甚少。尽管迫切需要此类信息来指导这种脆弱人群的康复，护理计划和促进最佳的长期恢复，但文献中这些数据严重缺乏。缺乏这种知识的主要原因是，大多数先前关于TBI的研究都集中在年轻人上。不幸的是，许多年轻人的发现没有概括为老年人，因为他们的合并症负担更高，并且在急性护理中出院时的认知和身体功能较差。拟议的研究的目的是深入了解老年人的认知，心理和身体机能的恢复以及TBI后的睡眠质量。为了实现这一目标，我们建议对250名65岁及65岁及以上的患者进行预期队列研究，以在R Adams Cowley休克创伤中心接受轻度TBI治疗，并在3、6和12个月的随访中进行随访，以完成三个具体目标：1）评估认知功能的恢复并确定恢复差的预测者； 2）评估身体和心理功能和睡眠质量的恢复，并确定恢复不良的预测因素； 3）确定恢复轨迹之间的相互作用。这项研究的意义在于，它将确定功能的重要领域（包括认知功能）以及影响老年人轻度TBI后恢复进程的因素。识别TBI后认知能力恢复差的人的个人将突出有ADRD高风险的人口，并将允许针对那些患有认知康复干预措施的人，从而可能降低ADRD风险。拟议的研究的理由是，早期鉴定恢复轨迹较差的患者将允许开发和靶向适当定时的干预措施，以减轻ADRD风险和其他不良结果。这项工作的潜在影响是，它将产生新的知识，以指导有针对性的治疗工作，并为以老年-TBI为中心的康复干预措施开发，这将成为未来R01应用的重点。