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

这项拟议的K23职业发展奖将为精神病学助理教授、医学博士南希·科纳提供 在哥伦比亚大学，通过指导职业发展，在 睡眠不佳和昼夜节律紊乱与轻度认知障碍(MCI)和 痴呆症。睡眠不佳和昼夜节律紊乱在患有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)，而超过一半的人 65岁或65岁以上的成年人有睡眠障碍，确诊的不到一半。此外，有强有力的证据表明 阻塞性睡眠呼吸暂停(OSA)在老年人和一些未经治疗的OSA患者中非常普遍 有从正常认知到MCI和从MCI到痴呆症的快速认知转变。然而， 睡眠不良和昼夜节律紊乱与临床认知诊断之间的关系尚未见报道 已经研究过了。这个K23奖项的目标是通过(A)提供被指导的 以患者为中心的睡眠和昼夜节律紊乱研究(POR)中的职业发展和培训 所有阶段和(B)进行一项研究，以评估睡眠和夜间睡眠的昼夜节律 在初级保健实践中对老年人进行ADRD评估的问卷和行动图。建议数 该项目是一个正在进行的项目的辅助研究，该项目在65岁或以上的老年人中进行痴呆症检测 初级保健中的认知问题，其中主要导师卢辛格和共同导师德瓦南德是 首席调查员。主要目的是横向和纵向地检查穷人的关联。 睡眠和扰乱的昼夜节律，基于NIA-AA标准的认知诊断类别， 包括痴呆、遗忘性MCI单域、遗忘性MCI多域和认知障碍NO MCI。还将探讨阻塞性睡眠呼吸暂停综合征与诊断类别的关系。次要目标是检查 认知转变与新出现的异常睡眠和昼夜节律紊乱的关系。这个 探索性目的是探索睡眠不佳和昼夜节律紊乱与AD危险因素的相互作用 (例如，APOE基因)与从正常认知到MCI和从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)睡眠和昼夜节律方面的培训来补充 节律评分，(3)昼夜节律分析，(4)横截面和纵向数据的统计分析， (4)评估协会的时间性的方法，如通径分析；(5)调解和缓和 分析。总体而言，职业发展规划、研究项目和培训活动将构建健全 科纳博士成为睡眠/昼夜节律和ADRD研究的独立研究员的平台。

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.