Investigating the Impact of Cognition on Capacity in Multiple Sclerosis

项目总结/摘要 这个K23应用程序的目的是进一步博士亚当Gerstenecker的学术研究生涯， 多发性硬化症（MS）研究认知障碍，财务和医疗决策能力，以及大脑 显像候选人是一名神经心理学家，其长期职业目标是开发一种康复治疗方法。 该计划是为那些特别有经济和医疗能力受损风险的人提供的。研究 财务和医疗决策能力似乎与MS特别相关。例如， 百分之五十- 75%的MS患者在诊断后十年内不再工作;因此，经济困难和财务困难 问题成为多发性硬化症患者生活中迫在眉睫的挑战。因此，预算必须进一步增加 投资计划的调整和优先次序。这些人也面临着新的问题 关于医疗，同时选择与不同疾病相关的非治愈性治疗， 副作用.然而，高达65%的MS患者有认知障碍，这可能会对他们的健康产生负面影响。 他们做出合理医疗决定的能力目前，只有一项已发表的研究审查了 在MS中，它有许多限制。关于神经影像学，虽然以前的研究表明， 扩散成像（DI）指标与MS中的认知功能障碍相关， 在MS中，DI指标与财务或医疗能力之间的关联不可用。 这个K23应用程序的目的是调查MS的财务和医疗能力，并检查 他们的临床和神经解剖学相关性。该项目将为今后的干预提供初步数据 在金融和医疗能力的研究，这将是未来的R 01赠款提案的主题。具体 研究目的是：（1）检查MS，TBI和健康之间的经济和医疗能力的差异 对照组;（2）检查神经认知、人口统计学和疾病相关的复发能力- 缓解型和进展型MS;以及（3）建立MS中DI指标和容量之间的相关性。 此外，还将进行一些中介和适度分析。K23将提供 必要的培训、受保护的时间和研究数据，以确保成功过渡到独立，包括： (1)增加对MS的病程、治疗和临床表现的了解;（2） 提高决策能力中有关法律的和道德问题的知识， 提高能力相关的能力;（3）增加神经影像学知识 程序和神经影像学数据的处理;（4）增加干预研究的知识 和设计，重点是开发定制的认知康复;（5）接受更多的 高级统计方法培训。导师团队由Khurram Bashir博士领导， 公认的专家，导师和科学家在MS与杰出的指导跟踪记录。

Project Summary/Abstract The purpose of this K23 application is to further Dr. Adam Gerstenecker's academic research career in multiple sclerosis (MS) investigating cognitive impairment, financial and medical decisional capacity, and brain imaging. The candidate is a neuropsychologist whose long-term career goal is to develop a rehabilitation program for people who are at particular risk for financial and medical capacity compromise. The study of financial and medical decision-making capacity appears to have particular relevance in MS. For example, 50%- 75% of people with MS are no longer working a decade after diagnosis; thus, economic hardship and financial issues become imminent challenges in the lives of those with MS. As a result, budgets must be further stretched and investment planning retooled and reprioritized. These individuals also confront new questions regarding medical treatments while choosing among non-curative therapies that are associated with varying side effects. However, up to 65% of people with MS have cognitive impairment which can negatively affect their ability to make sound medical decisions. At present, there is only one published study examining capacity in MS and it has a number of limitations. In regards to neuroimaging, although previous studies have shown that diffusion imaging (DI) metrics are correlated with cognitive dysfunction in MS, studies examining the association between DI metrics and financial or medical capacity in MS are not available. The objective of this K23 application is to investigate financial and medical capacity in MS and to examine their clinical and neuroanatomic correlates. This project will provide preliminary data for future intervention studies in financial and medical capacity that will be the topic of a future R01 grant proposal. The specific research aims are to: (1) examine differences in financial and medical capacity between MS, TBI, and healthy controls; (2) examine the neurocognitive, demographic, and disease correlates of capacity in relapsing- remitting and progressive MS; and (3) establish correlations between DI metrics and capacity in MS. In addition, a number of mediational and moderational analyses will be conducted. This K23 will provide the essential training, protected time, and research data to ensure successful transition to independence including: (1) developing increased knowledge about the course, treatment, and clinical presentation of MS; (2) developing increased knowledge about legal and ethical issues in decision-making capacity and to gain increased proficiency in capacity-related grantsmanship; (3) gaining increased knowledge in neuroimaging procedures and the processing of neuroimaging data; (4) gaining increased knowledge in intervention research and design, with a focus on the development of tailored cognitive rehabilitation; and (5) receiving increased training in advanced statistical methods. The mentorship team is led by Dr. Khurram Bashir, an internationally recognized expert, mentor, and scientist in MS with an outstanding mentoring track record.