The Impact of Depression and Preclinical Alzheimer Disease on Driving Among Older Adults

抑郁症和临床前阿尔茨海默病对老年人驾驶的影响

• 批准号: 10394313
• 负责人: Ganesh M Babulal
• 金额: $ 57.31万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10394313
• 关键词: Acceleration; Accelerometer; Affect; Age-Years; Aging; Alzheimer' s Disease; Alzheimer’s disease biomarker; Amyloid; Antidepressive Agents; Area; Automobile Driving; Behavior; Biological Markers; Biostatistical Methods; Cerebrospinal Fluid; Cessation of life; Clinical; Cognition; Cognitive; Data; Dementia; Destinations; Diagnosis; Disease Progression; Elderly; Enrollment; Environment; Evaluation; Event; Exclusion Criteria; Exhibits; Goals; Habits; Health; Image; Individual; Infrastructure; Injury; International; Interview; Knowledge; Left; Longitudinal Studies; Major Depressive Disorder; Measures; Mental Depression; Methodology; Motor; Neuropsychological Tests; Outcome; Participant; Patient Self-Report; Patients; Performance; Persons; Pharmaceutical Preparations; Population; Proxy; Psychometrics; Questionnaires; Recording of previous events; Research; Risk; Risk Behaviors; Safety; Speed; Standardization; System; Testing; Time; United States; Vehicle crash; Visit; aged; aging brain; amyloid imaging; base; cohort; depressive symptoms; driving behavior; follow-up; health care availability; human old age (65+); imaging biomarker; multidisciplinary; neuroimaging marker; neuropsychiatry; older driver; pre-clinical; prospective; recruit; self-reported depression; social engagement; synergism; tau Proteins; trend; unsafe driving

PROJECT SUMMARY/ABSTRACT Our long-term goal is to accurately identify who is at risk of decline in driving, to forecast when decline will occur, and to intervene before decline, thereby reducing the numbers of crashes, injuries, and death in older adults. Our findings indicate that the long preclinical stage of Alzheimer disease (AD), as reflected in amyloid imaging and cerebrospinal fluid (CSF) biomarkers among cognitively normal persons, is associated with poorer driving performance on a standardized road test. This project will assess how depression, preclinical AD, and antidepressants affect driving behavior in cognitively normal older adults (≥ 65 years). This research is significant because 36 million licensed drivers are aged 65 years or older, and the number of older adults in the United States is expected to double by 2050, when 1 in 4 drivers will be 65 years or older. Motor vehicle crashes are a leading cause of injury and death in older adults (814 daily crashes). Driving is a cognitively demanding and highly dynamic activity. Depression and symptomatic AD independently increase the risk of an automobile crash. Depression is also a factor for conversion to symptomatic AD, yet it is often used as an exclusion criterion for aging studies. The adverse impact of depression and antidepressant use on driving, and the impact of depression on AD is documented; yet an understanding of the synergy between these three areas is lacking. Our Specific Aims will (1) characterize the relationship between major depression (diagnosis) and naturalistic driving behavior in a prospective, longitudinal study, (2) examine whether major depression and preclinical AD, combined, predict faster longitudinal change in driving behavior among older adults, (3) assess the impact of medications (antidepressants), major depression, and preclinical AD on naturalistic driving. To test these Specific Aims, we have assembled a multidisciplinary team with expertise in AD, depression, neuroimaging biomarkers, CSF biomarkers, naturalistic driving, cognitive and brain aging, and longitudinal biostatistical methods. We will capitalize on existing infrastructure to follow 70 currently enrolled individuals and enroll an additional 70 participants with depression, to create a cohort of 140 individuals. This cohort will utilize a naturalistic driving methodology that will capture their driving behaviors on an everyday basis. Their cognition will be tested annually using the Clinical Dementia Rating and various psychometric measures. Participant depression will be characterized using the Mini-International Neuropsychiatric Interview (MINI) and the 9-item Patient Health Questionnaire (PHQ-9). Once obtained, this knowledge can be used to create stage-appropriate, personalized, driving-related safety strategies that can be implemented upon diagnosis, and adjusted throughout disease progression.

项目摘要/摘要 我们的长期目标是准确地确定谁有驾驶的风险，以预测下降时 将发生并在下降之前进行干预，从而减少坠机，伤害和死亡的数量 老年人。我们的发现表明，阿尔茨海默氏病（AD）的长临床前阶段，反映在 认知正常人中的淀粉样蛋白成像和脑脊液（CSF）生物标志物是相关的 在标准化的道路测试中，驾驶性能较差。该项目将评估抑郁症如何 临床前AD和抗抑郁药会影响认知正常的老年人（≥65岁）的驾驶行为。 这项研究很重要，因为3600万许可的驾驶员年龄在65岁以上，以及 预计到2050年，美国的老年人人数预计将翻一番，而四分之一的司机将为65年 或年龄较大。汽车撞车是老年人受伤和死亡的主要原因（每天814起撞车事故）。 驾驶是一种认知要求和高度动态的活动。抑郁和有症状的广告独立 增加汽车撞车的风险。抑郁也是转换为有症状广告的因素，但它是 通常用作老化研究的排除标准。抑郁和抗抑郁药的不利影响 记录在驾驶中的使用以及抑郁症对AD的影响；但是对协同作用的理解 在这三个领域之间缺乏。 我们的具体目的（1）表征了严重抑郁（诊断）和 在一项前瞻性，纵向研究中的自然主义驾驶行为，（2）检查重度抑郁和是否 临床前广告，合并，预测老年人驾驶行为的纵向变化更快，（3）评估 药物（抗抑郁药），严重抑郁症和临床前广告对自然主义驾驶的影响。 为了测试这些特定目标，我们组建了一个具有广告专业知识的多学科团队， 抑郁症，神经影像学，CSF生物标志物，自然主义驾驶，认知和脑衰老，以及 纵向生物统计学方法。我们将利用现有的基础设施，以遵循目前注册的70个 个人并招募了另外70名患有抑郁症的参与者，以创建140个人群。这 队列将使用一种自然主义的驾驶方法，该方法将每天捕获其驾驶行为 基础。他们的认知将每年使用临床痴呆评级和各种心理测量测试 措施。参与者的抑郁症将通过迷你国际神经精神访谈进行特征 （MINI）和9个项目患者健康问卷（PHQ-9）。 一旦获得，这些知识可用于创建适合阶段，个性化，与驾驶有关的阶段 可以在诊断后实施并在整个疾病进展过程中进行调整的安全策略。