Epidemiology of potentially inappropriate medication use and risk for mild cognitive impairment and dementia among ARIC, Look AHEAD, and MESA

ARIC、Look AHEAD 和 MESA 中潜在不当用药以及轻度认知障碍和痴呆风险的流行病学

• 批准号: 10590111
• 负责人: Michael Patrick Bancks
• 金额: $ 15.5万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10590111
• 关键词: Acetylcholine; Address; Adult; Adverse event; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Anti-Cholinergics; Atherosclerosis; Atherosclerosis Risk in Communities; Behavioral; Benzodiazepines; Black race; Brain Pathology; Brain imaging; Central Nervous System; Classification; Clinical; Clinical Data; Clinical Research; Clinical Trials; Cognitive; Collection; Communities; Data; Dementia; Development; Diabetes Mellitus; Dose; Elderly; Epidemiology; Event; Future; Geography; Geriatrics; Goals; Health; Health Benefit; Health Care Costs; Health Status; Heart failure; Hispanic; Hospitalization; Impaired cognition; Incidence; Individual; Intervention; Link; Morbidity - disease rate; Multi-Ethnic Study of Atherosclerosis; Natural History; Neurotransmitters; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Overweight; Participant; Pathology; Patients; Peripheral Nervous System; Pharmaceutical Preparations; Population Heterogeneity; Positioning Attribute; Prevalence; Public Health; Registries; Research; Research Personnel; Resources; Risk; Societies; Subgroup; Testing; Time; United States; Woman; Work; adjudication; cognitive testing; cohort; comorbidity; dementia risk; design; epidemiologic data; epidemiology study; experience; follow-up; hospitalization rates; human old age (65+); innovation; insight; lifestyle intervention; mild cognitive impairment; mortality; multi-ethnic; obese person; phenotypic data; physical inactivity; prevent; racial diversity; response; skills; structural determinants; study population; treatment strategy; weight loss intervention

Project Summary/Abstract Use of potentially inappropriate medications (PIMs) among older adults (age ≥65 years) result in preventable adverse health events, including hospitalization and mortality. Certain individual medications that are classified as PIMs are associated with greater risk for dementia, demonstrated to act on the central and peripheral nervous system and block the action of specific neurotransmitters (e.g., anticholinergics block acetylcholine). Registry- based studies show that PIM use increases over older adulthood for individuals with Alzheimer’s disease and related dementias (AD/RD) and matched healthy controls. However, epidemiology of PIM use over older adulthood has not been assessed in multi-ethnic community-based cohorts or in response to a lifestyle intervention. Because PIM use results in avoidable complications, we need to understand epidemiology of PIM use in response to interventions and in relation to subsequent cognitive complications, respectively. Identifying whether lifestyle interventions can reduce PIM use and prevent mild cognitive impairment and dementia would have major clinical and public health implications. This proposal will leverage data from epidemiological studies and a clinical trial to provide estimates of PIM prevalence, incidence, and longitudinal change among three large multi-ethnic and geographically diverse study populations: the Atherosclerosis Risk in Communities (ARIC) Study, Action for Health in Diabetes Study, and Multi-Ethnic Study of Atherosclerosis. This research will estimate (Aim 1) prevalence of PIM use and factors associated with PIM use, (Aim 2) longitudinal change in PIM use during older adulthood and in response to an intensive lifestyle intervention for weight loss, and (Aim 3) the association between PIM use and incident MCI/dementia and brain pathology. This work is significant and innovative because it will provide estimates of PIM use among multi-ethnic cohorts and a new research resource for Look AHEAD and MESA investigators (characterization of PIM use). This proposal will also assess the effect of a lifestyle intervention on longitudinal change in PIM use and will help disentangle the temporal association between PIM use and AD/RD. We have designed each aim to address a critical gap in our understanding of the epidemiology of PIM use, and potential for interventions in older adulthood to reduce AD/RD-related morbidity and mortality due to PIM use. Our team has the research skills, experience, and resources to address these aims in a rigorous and efficient manner. The findings from this work will provide empirical evidence for treatment strategies to reduce PIM use and prevent AD/RD, and to assess whether PIM use is associated with other aging-related conditions.

项目摘要/摘要 在老年人中使用潜在的不当药物（PIM）（年龄≥65岁）可预防 不良健康事件，包括住院和死亡率。某些被分类的个人药物 由于PIM与更大的痴呆风险相关，因此被证明在中枢和周围神经上起作用 系统并阻止特定神经递质的作用（例如抗胆碱能阻断乙酰胆碱）。注册表 - 基于研究的研究表明，对老年人患有阿尔茨海默氏病和 相关痴呆症（AD/RD）和匹配的健康对照。但是，PIM在较旧的情况下使用的流行病学 尚未在多种族的社区人群中评估成年，也没有对生活方式进行回应 干涉。因为PIM使用会导致可避免的并发症，所以我们需要了解PIM的流行病学 用于响应干预措施和随后的认知并发症。识别 生活方式的干预措施是否可以减少PIM使用并防止轻度认知障碍，而痴呆症会 具有重大的临床和公共卫生影响。 该建议将利用流行病学研究和临床试验的数据来提供PIM的估计。 三个大型多种族和地理上多样的研究中的患病率，事件和纵向变化 人群：社区的动脉粥样硬化风险（ARIC）研究，糖尿病研究的健康行动和 动脉粥样硬化的多种族研究。这项研究将估计使用PIM的患病率和因素 与PIM使用相关，（AIM 2）较老的成年期PIM使用的纵向变化，并响应于 体重减轻的密集生活方式干预，以及（目标3）PIM使用与事件之间的关联 MCI/痴呆症和脑病理学。 这项工作具有重要的和创新性，因为它将估计多种族同类群体中的PIM使用 以及向前看的新研究资源和MESA研究人员（PIM使用的表征）。这 提案还将评估生活方式干预对PIM使用纵向变化的影响，并将有助于 解开PIM使用与AD/RD之间的临时关联。我们设计了每个目标，以解决 我们对PIM使用流行病学的理解的关键差距以及成年后的干预措施的潜力 降低由于使用PIM而引起的与AD/RD相关的发病率和死亡率。我们的团队具有研究技能，经验， 以及以严格有效的方式解决这些目标的资源。这项工作的发现将提供 用于减少PIM使用和预防AD/RD的治疗策略的经验证据，并评估PIM是否 使用与其他与衰老相关的疾病有关。