Cognitive Function, Self-Management, and Health Outcomes among Liver Transplant Recipients: the LivCog Cohort

肝移植受者的认知功能、自我管理和健康结果：LivCog 队列

基本信息

批准号：
10617339
负责人：
Marina Serper
金额：
$ 69.91万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-04 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10617339
关键词：
Accounting Active Learning Affect Age Alcohol consumption Alcoholic Liver Diseases Behavior Cardiovascular system Caregiver support Caregivers Caring Chronic Cirrhosis Clinical Cognition Cognitive Cohort Studies Communities Complex Dose Elderly Future Health Health Care Costs Health Status Health behavior Health behavior and outcomes Health system Healthcare Heart Transplantation Hepatic Encephalopathy High Prevalence Immunosuppression Impaired cognition Impairment Infection Intervention Investigation Kidney Transplantation Life Life Style Liquid substance Malnutrition Mediating Mediator Medical Memory Metabolic Monitor Nature Neurologic North America Outcome Pathway interactions Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacists Physical Function Physical activity Population Prevalence Problem Solving Recommendation Regimen Reporting Resources Risk Factors Sampling Self Assessment Self Care Self Management Sleep Substance abuse problem Time Transplant Recipients Transplantation United States National Institutes of Health Waiting Lists baby boomer cardiometabolism care coordination care delivery cognitive ability cognitive function cognitive load cognitive performance cognitive recovery cohort comorbidity cost end stage liver disease executive function frailty functional independence functional status health care service health literacy health management high risk human old age (65+)improved insight liver transplantation longitudinal care mortality multiple chronic conditions novel physical inactivity poor sleep post-transplant postoperative delirium prevent processing speed response sarcopenia side effect skills sleep quality transplant centers treatment adherence

项目摘要

PROJECT SUMMARY This study will provide novel insights on cognitive trajectories among new liver transplant recipients, and the impact of cognitive function on self-management, health behaviors, and patient outcomes. The prevalence of cirrhosis and end-stage liver disease (ESLD) in North America is estimated at up to 1,000 per 100,000 population and has nearly doubled over the past two decades with baby boomers (born 1945-1965) accounting for half of cases. From 2009 to 2016, there has been a 65% increase in cirrhosis mortality in the U.S. Decompensated cirrhosis has a 5-year survival of only 34-56% with liver transplantation (LT) as the only life- saving option. By 2033, LT demand will increase by 23% and per-patient LT-associated costs will rise from $1.4 to $2.1 million, resulting in a total of $26.7 billion in transplant-related medical expenses over a 10-year time horizon. To maximize the benefits of LT, liver transplant recipients (LTRs) must have strong self-management skills to navigate health systems, adhere to clinical monitoring, and take complex, multi-drug regimens. All of these tasks require formidable cognitive abilities for active learning and problem solving. LTRs are at higher risk for poorer cognition due to high prevalence of pre-transplant cognitive impairment (hepatic encephalopathy), multiple chronic conditions, alcohol use, and increasing age. The cognitive status of LTRs over time could affect self-management and transplant outcomes, yet these issues have not been thoroughly investigated. Our proposed cohort study (`LivCog') will longitudinally characterize cognitive performance using the NIH Toolbox among 450 new LTRs from 3 diverse transplant centers, beginning at transplant waitlisting and then at 1, 4, 12, and 24 months post-LT. We will also serially assess self-management skills, physical function, health behaviors, patient-reported and clinical outcomes. Potentially modifiable post-transplant targets will be investigated, including caregiver support, physical activity, sleep, and treatment adherence to understand causal pathways that could inform future health system responses. Our specific aims are to: 1) assess pre to post-LT cognitive trajectories and identify risk factors for persistent cognitive impairment, 2) evaluate associations between cognitive function and self-management skills, health behaviors, functional health status, and post- transplant outcomes, and 3) investigate potential mediators and moderators of associations between cognitive function and post-transplant outcomes. Our proposed LivCog study will fill critical gaps in understanding cognitive recovery and function, risk factors and consequences of cognitive impairment among LTRs. Findings will directly inform future interventions to improve post-transplant outcomes.

项目概要这项研究将为新肝移植受者的认知轨迹提供新的见解，以及认知功能对自我管理、健康行为和患者结果的影响。北美地区肝硬化和终末期肝病 (ESLD) 的患病率估计高达每人 1,000 人婴儿潮一代（1945-1965 年出生）人口已达 100,000 人，在过去二十年中几乎翻了一番占案件的一半。从 2009 年到 2016 年，美国肝硬化死亡率增加了 65%。失代偿性肝硬化的 5 年生存率仅为 34-56%，肝移植 (LT) 是唯一的生存方法。保存选项。到 2033 年，LT 需求将增加 23%，每位患者的 LT 相关成本将从 1.4 美元上涨至 210 万美元，导致 10 年间移植相关医疗费用总计 267 亿美元地平线。为了最大限度地发挥 LT 的益处，肝移植受者 (LTR) 必须具有强大的自我管理能力掌握卫生系统、坚持临床监测以及采取复杂的多药物治疗方案的技能。所有的这些任务需要强大的认知能力来主动学习和解决问题。 LTR 面临更高的风险由于移植前认知障碍（肝性脑病）患病率较高而导致认知能力较差，多种慢性病、饮酒和年龄增长。随着时间的推移，LTR 的认知状态可能会影响自我管理和移植结果，但这些问题尚未得到彻底研究。我们提出的队列研究（“LivCog”）将使用 NIH 纵向描述认知表现来自 3 个不同移植中心的 450 个新 LTR 的工具箱，从移植等候名单开始，然后在 LT 后 1、4、12 和 24 个月。我们还将连续评估自我管理能力、身体机能、健康状况行为、患者报告和临床结果。潜在可修改的移植后目标将是调查，包括护理人员支持、体力活动、睡眠和治疗依从性，以了解因果关系可以为未来卫生系统应对措施提供信息的途径。我们的具体目标是： 1) 评估 LT 前后的情况认知轨迹并识别持续性认知障碍的危险因素，2) 评估关联认知功能与自我管理技能、健康行为、功能健康状况和术后恢复之间的关系移植结果，3) 研究认知之间关联的潜在中介和调节因素功能和移植后结果。我们提出的 LivCog 研究将填补理解方面的关键空白 LTR 的认知恢复和功能、认知障碍的危险因素和后果。发现将直接为未来改善移植后结果的干预措施提供信息。