RISK OF COGNITIVE IMPAIRMENT AND DEMENTIA IN TOTAL JOINT ARTHROPLASTY

全关节置换术中认知障碍和痴呆的风险

• 批准号: 10064124
• 负责人: Hilal Maradit Kremers
• 金额: $ 65.52万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064124
• 关键词: Address; Age; Aging; Alzheimer' s Disease; American; Amyloid beta-Protein; Autopsy; Brain; Case Study; Ceramics; Characteristics; Chromium; Chronic; Clinic; Clinical; Cobalt; Cognition; Cognitive; Corrosion; Data; Dementia; Education; Eligibility Determination; Epidemic; Epidemiology; Exposure to; Fibrinogen; Funding; Future; Genotype; Goals; Hip Joint; Hip Prosthesis; Immune response; Impaired cognition; Implant; Individual; Infrastructure; Ions; Kidney Diseases; Knee Prosthesis; Knee joint; Knowledge; Long-Term Effects; Measures; Medical Record Linkage; Metals; Monitor; Morbidity - disease rate; Negative Finding; Nerve Degeneration; Neurocognitive; Neurocognitive Deficit; Obesity; Operative Surgical Procedures; Patient risk; Patients; Policies; Polyethylenes; Population Study; Procedures; Public Health; Publishing; Quality of life; Registries; Replacement Arthroplasty; Research; Risk; Role; Safety; Series; Serum; Structure; Surface; Synovial Fluid; System; Time; Tissues; Titanium; United States; cerebrovascular pathology; clinical risk; cognitive function; cognitive testing; cohort; data registry; data resource; dementia risk; experience; high risk; improved mobility; mortality; neuroimaging; neuroimaging marker; neurotoxicity; population based; procedure safety; prospective; public health relevance; recruit; sex; vascular risk factor

ABSTRACT Total joint arthroplasty (TJA) is the fastest growing elective surgery in the nation. Over 7 million Americans are currently living artificial hip or knee joints and this is expected to reach epidemic proportions as a result of growing demand for improved mobility and quality of life. Although TJA is a safe and effective procedure, there is growing concern about the long-term safety of chronic exposure to TJA implants. Indeed, in a growing number of published case reports, TJA is associated with neurocognitive deficits several years after surgery. Yet, the long-term effects of implant debris from TJA implants on brain structure and cognitive function are unknown. Large scale, population-based studies are needed to assess the potential contribution of chronic exposure to TJA implant debris and subtypes (cobalt/chromium, polyethylene) to the risk of cognitive decline and dementia. We propose to leverage the unique data resources of the Rochester Epidemiology Project (REP, R01-AG034676), the Mayo Clinic Study of Aging (MCSA, U01-AG006786) and the Mayo Alzheimer's Disease Research Center (ADRC; P50 AG016574) as well as the Mayo Clinic TJA registry to elucidate the long-term risk of dementia and cognitive impairment in TJA patients. Using 5-decades of historical data from the REP, we will compare the risk of dementia and subtypes in population-based cohorts of TJA patients and matched non-TJA subjects adjusting for well-known confounders (age, sex, obesity). We will further examine the risk according to implant types. Using cross-sectional and longitudinal cognition and neuroimaging measures collected as part of the MCSA cohort, we will determine whether cognitive status and neuroimaging markers of cognitive function are worse in TJA patients compared with non-TJA subjects. Finally, we will correlate metal ion levels with cognitive function and structural changes on neuroimaging and postmortem tissues. Successful completion of the proposed series of studies will be a key step towards understanding whether chronic exposure to TJA implants is associated with cognitive impairment. Our unique data resources offer a rare opportunity to efficiently address this unknown risk. Potential downstream effects are significant including eligibility criteria for TJA, and monitoring high risk TJA implants and patients who are most likely to suffer from systemic effects. Even negative findings can exert a significant public health impact by providing reassurance about the safety of TJA to millions of current and future TJA patients.

抽象的 全关节置换术（TJA）是全美增长最快的择期手术。超过700万 美国人目前正在使用人工髋关节或膝关节，这预计将成为流行病 由于对改善流动性和生活质量的需求不断增长。虽然 TJA 是一种安全有效的手术，人们越来越关注 TJA 的长期安全性 长期接触 TJA 植入物。事实上，在越来越多的已发表案例报告中，TJA 与手术后数年的神经认知缺陷有关。然而，长期影响 TJA 植入物碎片对大脑结构和认知功能的影响尚不清楚。 需要大规模、以人群为基础的研究来评估慢性病的潜在贡献 暴露于 TJA 植入物碎片和亚型（钴/铬、聚乙烯）的风险 认知能力下降和痴呆。我们建议利用独特的数据资源 罗切斯特流行病学项目（REP，R01-AG034676），梅奥诊所衰老研究 （MCSA，U01-AG006786）和梅奥阿尔茨海默病研究中心（ADRC；P50 AG016574）以及 Mayo Clinic TJA 注册表，以阐明痴呆症的长期风险 TJA 患者的认知障碍。 使用 REP 的 5 个十年的历史数据，我们将比较痴呆症的风险和 基于人群的 TJA 患者队列和匹配的非 TJA 受试者的亚型调整 对于众所周知的混杂因素（年龄、性别、肥胖）。我们将根据以下情况进一步审查风险 植入物类型。使用横向和纵向认知和神经影像测量 作为 MCSA 队列的一部分收集，我们将确定认知状态和 与非 TJA 患者相比，TJA 患者的认知功能神经影像标志物较差 科目。最后，我们将金属离子水平与认知功能和结构联系起来 神经影像学和死后组织的变化。 成功完成拟议的系列研究将是迈向这一目标的关键一步 了解长期接触 TJA 植入物是否与认知能力相关 损害。我们独特的数据资源为有效解决这一问题提供了难得的机会 未知的风险。潜在的下游影响是显着的，包括 TJA 的资格标准、 监测高风险 TJA 植入物和最有可能患有全身性疾病的患者 影响。即使是负面的结果也可以通过提供对公共健康产生重大影响 向数百万当前和未来的 TJA 患者保证 TJA 的安全性。