Assessment of Sleep and Circadian Rhythms in Elderly Persons with Cognitive Concerns Evaluated for Alzheimer's Disease and Related Dementias (ADRD)

这个拟议的K23职业发展奖将提供南希肯纳，医学博士，精神病学助理教授 在哥伦比亚大学，与指导的职业发展，以建立一个独立的研究生涯， 研究睡眠不良和昼夜节律紊乱与轻度认知障碍（MCI）的关系， 痴呆睡眠不佳和昼夜节律紊乱在轻度认知障碍的老年人中很常见 (MCI)和痴呆症，包括阿尔茨海默病和相关痴呆症（ADRD），而超过一半的 65岁或以上的成年人有睡眠障碍，不到一半被诊断出来。同时，有强有力的证据表明 阻塞性睡眠呼吸暂停（OSA）在老年人中非常普遍，一些患有未经治疗的OSA的人 从正常认知到轻度认知障碍，从轻度认知障碍到痴呆的认知转变都很迅速。但 睡眠不好和昼夜节律紊乱与临床认知诊断之间的联系还没有 本文研究了这个K23奖的目标是通过（a）提供指导， 全国睡眠和昼夜节律紊乱领域以患者为导向的研究（POR）的职业发展和培训 以及（B）进行研究以评估PROMIS睡眠的睡眠和昼夜节律 在初级保健实践中评估ADRD的老年人中进行问卷调查和活动记录。拟议 该项目是一项辅助研究，以进行一项正在进行的项目，在65岁或65岁以上的老年人中进行痴呆症检测， 初级保健中的认知问题，其中主要导师Luchsinger和共同导师Devanand是 首席调查员主要目的是从横截面和纵向上审查贫困人口的关联， 睡眠和昼夜节律紊乱，认知诊断类别基于NIA-AA标准， 包括痴呆、遗忘型MCI单域、遗忘型MCI多域和认知功能障碍。 MCI。OSA与诊断类别的关系也将被探讨。第二个目的是检查 认知转变与新的异常睡眠和昼夜节律紊乱的关系。的 探索性的目的是探索睡眠不良和昼夜节律紊乱与AD危险因素的相互作用 (e.g. APOE基因型）与从正常认知到MCI以及从MCI到痴呆的转变有关。这些 研究目标将通过（1）认知测试和诊断，（2）睡眠和昼夜节律 节律评分，（3）昼夜节律度量分析，（4）横截面和纵向数据的统计分析， (4)评估关联的时间性的方法，如路径分析，以及（5）中介和适度 分析。总体而言，职业发展计划，研究项目和培训活动将建立一个健全的 Kerner博士成为睡眠/昼夜节律和ADRD研究的独立研究者的平台。

This proposed K23 career development award will provide Nancy Kerner, MD, Assistant professor of Psychiatry at Columbia University, with mentored career development to establish an independent research career in the study of the association of poor sleep and disrupted circadian rhythms with mild cognitive impairment (MCI) and dementia. Poor sleep and disrupted circadian rhythms are common in older adults with mild cognitive impairment (MCI) and dementia, including Alzheimer’s disease and related dementias (ADRD), whereas more than half of adults aged 65 years or older have sleep disorders, less than half are diagnosed. Also, there is strong evidence that obstructive sleep apnea (OSA) is highly prevalent in older adults, and some individuals with untreated OSA have rapid cognitive transitions from normal cognition to MCI and from MCI to dementia. However, the associations between poor sleep and disrupted circadian rhythms with clinical cognitive diagnoses have not been studied. The goal of this K23 award is to advance Dr. Kerner’s research career by (a) providing mentored career development and training in patient-oriented research (POR) in sleep and circadian disturbances across all stages and (b) conducting a study to assess sleep and circadian rhythms with the PROMIS sleep questionnaires and actigraphy among the elderly evaluated for ADRD in primary care practices. The proposed project is an ancillary study to an ongoing project of dementia detection among persons 65 years or older with cognitive concerns in primary care, in which the primary mentor Luchsinger and co-mentor Devanand are the principal investigators. The primary aim is to examine cross-sectionally and longitudinally the association of poor sleep and disrupted circadian rhythms with cognitive diagnostic categories based on the NIA-AA criteria, including dementia, amnestic MCI single domain, amnestic MCI multiple domain, and cognitive impairment no MCI. The relation of OSA with diagnostic categories will also be explored. The secondary aim is to examine the relationship of cognitive transitions with new onset of abnormal sleep and disrupted circadian rhythms. The exploratory aim is to explore the interactions of poor sleep and disrupted circadian rhythms with AD risk factors (e.g. APOE genotype) in relation to transitions from normal cognition to MCI and from MCI to dementia. These research aims will be complemented by training in (1) cognitive testing and diagnosis, (2) sleep and circadian rhythm scoring, (3) circadian metrics analyses, (4) statistical analyses of cross-sectional and longitudinal data, (4) methods to assess temporality of associations, such as path analysis, and (5) mediation and moderation analyses. Collectively, the career development plan, research project, and training activities will build a sound platform for Dr. Kerner to become an independent investigator in sleep/circadian rhythms and ADRD research.