Cognitive and Physical Exercise to Improve Outcomes after Surgery in the Elderly

认知和身体锻炼可改善老年人手术后的结果

基本信息

批准号：
10565909
负责人：
Christopher Hughes
金额：
$ 81.34万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10565909
关键词：
Activities of Daily Living Acute Age Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk Anatomy Anesthesia procedures Attention Biological Markers Blood Blood brain barrier dysfunction Brain Clinical Cognition Cognitive Cognitive aging Cognitive deficits Computers Critical Illness Data Delirium Dementia Elderly Endothelium Evaluation Exercise Exhibits Functional Magnetic Resonance Imaging Habilitation Health education Hospitalization Hospitals Impaired cognition Individual Injury Intervention Lead Life Link Medical Memory Mental Depression Older Population Operative Surgical Procedures Outcome Patients Perioperative Physical Exercise Physical Function Physical Rehabilitation Physical therapy Plasma Population Postoperative Period Process Public Health Quality of life Randomized Recommendation Rehabilitation therapy Reporting Research Sedation procedure Subgroup Survivors Testing Time Training Training Programs United States National Institutes of Health active control blood-brain barrier function cerebral atrophy cognitive function cognitive rehabilitation cognitive training computer game computerized disability frailty functional decline functional disability functional outcomes functional status high risk improved improved outcome mind/body multitask neuroimaging preservation prevent processing speed programs response stressor success white matter

项目摘要

Project Summary Cognitive decline with aging, including Alzheimer's Disease and Related Dementias (ADRD), is a public health imperative that impacts quality of life and disability. Survivors of acute surgical or medical illness contribute greatly to the crisis of cognitive decline. Hospitalization confers a 1.5-2-fold increase in the odds of new onset dementia. Furthermore, over a third of critically ill patients have new ADRD by 1 year. Major risk factors for ADRD after acute illness include pre-illness frailty and cognitive deficits and delirium in the hospital. Endothelial and blood brain barrier (BBB) dysfunction, cerebral atrophy, and white matter connectivity changes have all been linked to delirium and ADRD. Surgery is common in older adults but it (and its resulting hospitalization) is associated with significant cognitive decline. Individual interventions to reduce this decline have exhibited limited success. Prehabilitation is the process of enhancing capacity and reserve before an acute stressor to improve tolerance of the upcoming insult. Older major surgical patients provide an ideal population for prehabilitation. These patients have lead time prior to surgery, are frequently frail, have prolonged post-surgery ICU and hospital courses, and are at high risk for new ADRD. Prehabilitation studies to date have primarily focused on physical training to improve physical outcomes. Combined physical and computer-based cognitive training programs have been associated with significant improvements in global cognitive function, and computerized brain training exercises have demonstrated enhancement in memory, processing speed, and multitasking. This training, however, has not been examined in surgical or hospitalized patients. We have demonstrated that cognitive training and physical exercises are feasible prior to major surgery and in the hospital, that a combined cognitive and physical rehabilitation program after discharge can reduce ADRD, and that a computerized cognitive rehabilitation program can improve multiple cognitive domains in ICU survivors. Further, exercise enhances endothelial and BBB function, reduces cerebral atrophy, and increases functional connectivity, providing potential mechanistic basis for these improvements. Thus, a comprehensive mind and body training program prior to (prehabilitation), during, and after (rehabilitation) hospitalization may be most effective in reducing ADRD and disability after major surgery but has yet to be evaluated. The main hypothesis of the COgnitive and Physical Exercise to improve Outcomes after Surgery (COPE-iOS) study is that a program of cognitive and physical training throughout the perioperative period will improve long-term cognitive and disability outcomes in older surgical patients at high risk for decline. We will randomize 250 patients ≥60 years old undergoing elective major non-cardiac surgery with expected hospitalization >3 days to a comprehensive training program or to active control prior to surgery, during the surgical hospitalization, and after discharge. We will assess global cognition (Aim 1), disability (Aim 2), and plasma biomarkers and neuroimaging (Aim 3) at baseline and up to 12 months after discharge.

项目摘要随着老龄化的认知能力下降，包括阿尔茨海默氏病和相关痴呆症（ADRD）是公共卫生势在可能影响生活质量和残疾的必要性。急性手术或医疗疾病的幸存者有贡献极大地应对认知能力下降的危机。住院供认新发作的几率增加了1.5-2倍失智。此外，超过三分之一的重症患者在1年左右有新的ADRD。主要风险因素急性疾病后的ADRD包括胸膜前脆弱和认知缺陷和医院的del妄。内皮和血脑屏障（BBB）功能障碍，脑萎缩和白质连通性的变化都与Delirum和Adrd有关。手术在老年人中很常见，但它（及其由此导致的住院）是与认知大幅下降有关。减少这种下降的个人干预措施已经暴露有限的成功。预植物是在急性压力源之前增强能力和预备的过程提高对即将发生的伤害的容忍度。年长的主要手术患者为预居住。这些患者有手术前的提前时间，经常脆弱，手术后延长 ICU和医院课程，新ADRD的风险很高。迄今为止的居民研究有主要专注于体育锻炼以改善体育成果。结合物理和基于计算机的认知培训计划与全球认知功能的显着改善有关，并且计算机化的大脑训练练习表明记忆，处理速度和多任务。但是，在手术或住院的患者中尚未检查这种培训。我们有证明认知训练和体育锻炼是在大手术之前和医院，出院后的认知和身体康复计划可以减少ADRD，并且计算机化的认知康复计划可以改善ICU表面上的多个认知领域。此外，运动可以增强内皮和BBB功能，减少脑萎缩并增加功能连通性，为这些改进提供潜在的机械基础。那是一个全面的思想和（预居住），（康复）住院期间和之后的身体训练计划可能是最多的大手术后有效减少ADRD和残疾，但尚未评估。主认知和体育锻炼的假设以改善手术后的预后（COPE-OIS）研究是在整个周期期间的认知和体育锻炼计划将改善老年外科患者的长期认知和残疾结局，高降低风险。我们将在选修课的非心脏手术中随机分配250名≥60岁的患者住院> 3天的全面培训计划或在手术前进行主动控制外科住院和出院后。我们将评估全球认知（目标1），残疾（目标2）和血浆生物标志物和神经影像学（AIM 3）在基线和出院后长达12个月。