Sleep-Wake Disturbance as a Predictor of Delirium and Subsequent Alzheimer's Disease and Related Dementias after Surgical Aortic Valve Replacement

睡眠-觉醒障碍是主动脉瓣置换术后谵妄和随后的阿尔茨海默病及相关痴呆的预测因素

• 批准号: 10576388
• 负责人: Mark Alan Oldham
• 金额: $ 18.1万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10576388
• 关键词: Adult; Affect; Age; Alzheimer disease prevention; Alzheimer' s Disease; Alzheimer' s disease pathology; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Apnea; Biological Markers; Blood Vessels; Cardiac Surgery procedures; Caring; Cerebrovascular Disorders; Clinical; Cognition; Cognitive; Complement; Consultations; Delirium; Development; Elderly; Enrollment; Environmental Exposure; FDA approved; Family; Foundations; Functional disorder; Goals; Guidelines; High Prevalence; Home; Hospitals; Hour; Human; Impaired cognition; Incidence; Individual; Institutionalization; Interdisciplinary Study; Intervention; Investigation; Light; Link; Longitudinal Studies; Measurable; Measures; Medicine; Mental Health; Methods; Mission; Morbidity - disease rate; Neuropsychological Tests; Neuropsychology; Operative Surgical Procedures; Outcome; Pathogenesis; Pathology; Patients; Perioperative; Physicians; Physiological; Pilot Projects; Play; Postoperative Period; Prevention trial; Prospective, cohort study; Provider; Psychiatrist; Public Health; Research; Resources; Rest; Risk; Risk Factors; Role; Science; Scientist; Severities; Signal Transduction; Sleep; Sleep Apnea Syndromes; Sleep Architecture; Solid; Statistical Methods; Study Subject; System; Testing; Time; Training; Vascular Dementia; Vulnerable Populations; actigraphy; aortic valve; aortic valve replacement; career; career development; circadian; cohort; cost estimate; demographics; design; experience; functional outcomes; glymphatic clearance; glymphatic dysfunction; high risk; improved; indexing; insight; interest; mortality risk; neurocognitive disorder; novel; postoperative delirium; prevent; programs; risk stratification; sleep physiology; statistics; translational potential; treatment trial; trend

Project Summary/Abstract Applicant: I am a consultation-liaison psychiatrist keenly interested in delirium and the role that sleep-wake disturbance (SWD) plays in delirium vulnerability, its pathogenesis, and its relationship with subsequent Alzheimer’s disease and related dementias (ADRD). My mission is to improve the care and clinical outcomes of those with and at risk for delirium and to be a champion for excellence in care for older adults. This application is designed for me to obtain expertise in longitudinal study conduct and design, assessment of SWD, neuropsychological training relevant to delirium and the two neurocognitive disorders associated with it (Alzheimer’s disease and vascular neurocognitive disorder), and a solid background in statistical methods to become an independent physician-scientist. Project: I am proposing a prospective cohort study of subjects undergoing surgical aortic valve replacement with the goal of investigating objective SWD before surgery—both actigraphy and unattended type II home sleep tests (HST)—for its association with postoperative delirium and subsequent ADRD. This study represents a novel application of type II HST, which provides comprehensive assessment of sleep architecture, to characterize preoperative SWD as a marker of delirium risk and evidence in support of a mechanistic link between delirium and subsequent Alzheimer’s disease or vascular neurocognitive disorder. Professional development: I will obtain practical experience in empirical methods by conducting a longitudinal study with expertise in assessing SWD using unattended methods, neuropsychological testing, and relevant statistics. My training plan incorporates hands-on experiences in sleep medicine, neuropsychology, and statistics, complemented by coursework and directed readings that will provide the necessary theoretical foundation. Goals: My career goals are to establish an interdisciplinary research program at URMC with cardiac surgery and sleep medicine, to explore how SWD is mechanistically involved in delirium risk, onset, and its dire outcomes, and to advance the science of delirium pathophysiology and subsequent risk of ADRD.

项目概要/摘要 申请人：我是一名咨询联络精神病患者，对谵妄和睡眠-觉醒的作用非常感兴趣 干扰（SWD）在谵妄脆弱性、其发病机制及其与随后的关系中的作用 我的使命是改善阿尔茨海默病和相关痴呆症 (ADRD) 的护理和临床结果。 帮助那些患有谵妄症或有谵妄症风险的人，并成为老年人护理卓越的倡导者。 该应用程序旨在让我获得纵向研究实施和设计、评估方面的专业知识 SWD，与谵妄相关的神经心理学训练以及与之相关的两种神经认知障碍 （阿尔茨海默病和血管神经认知障碍），以及统计方法的坚实背景 成为一名独立的医师科学家。 项目：我提议对接受主动脉瓣置换术的受试者进行前瞻性队列研究 目的是在手术前调查客观的 SWD——体动记录仪和无人值守的 II 型家庭 睡眠测试 (HST)——其与术后谵妄和随后的 ADRD 的关系。 代表 II 型 HST 的新颖应用，可提供睡眠结构的综合评估， 将术前 SWD 描述为谵妄风险的标志和支持机械联系的证据 谵妄与随后的阿尔茨海默病或血管神经认知障碍之间的关系。 专业发展：我将通过进行纵向研究来获得实证方法的实践经验 具有使用无人值守方法、神经心理学测试和相关方法评估 SWD 的专业知识的研究 我的培训计划包括睡眠医学、神经心理学和统计学方面的实践经验。 统计，辅以课程作业和定向阅读，提供必要的理论知识 基础。 目标：我的职业目标是在 URMC 建立心脏外科跨学科研究项目 和睡眠医学，探讨 SWD 如何在机制上参与谵妄的风险、发作及其可怕的后果 结果，并推进谵妄病理生理学和随后的 ADRD 风险的科学。