Recovery among Older Adults Following Head Injury

阿尔茨海默病和相关痴呆(ADRD)的发展是多因素的，一些原因可以影响或改变。最近，柳叶刀委员会将创伤性脑损伤(TBI)列入了12个可能改变ADRD的关键危险因素。颅脑损伤是老年人中非常常见的一种伤害，每年导致超过12.3万人住院和485,000人去急诊科就诊。重要的是，在这一人群中，创伤性脑损伤的发生率正在迅速上升。脑外伤会导致认知障碍，并增加阿尔茨海默病和额颞痴呆的风险。此外，脑外伤可能导致健康结果恶化(例如，身体功能不佳、心理困扰、睡眠质量恶化)，这反过来又增加了ADRD的风险。然而，尽管脑外伤对老年人的公共健康有很大的影响，但在这一人群中，人们对急性护理出院后认知和相关领域的变化知之甚少。尽管迫切需要这样的信息来指导康复、护理规划和促进这一弱势群体的最佳长期康复，但文献中严重缺乏这些数据。缺乏知识的一个主要原因是，以前大多数关于脑外伤的研究都集中在年轻人身上。不幸的是，年轻人的许多发现并不适用于老年人，因为他们在急性护理出院时合并症负担较高，认知和身体功能较差。这项研究的目的是深入了解老年人脑外伤后认知、心理和生理功能的恢复以及睡眠质量。为了实现这一目标，我们建议在R Adams Cowley休克创伤中心对250名年龄在65岁及以上的轻度脑外伤患者进行前瞻性队列研究，并在3、6和12个月进行随访，以完成三个具体目标：1)评估认知功能的恢复，并确定恢复不良的预测因素；2)评估生理和心理功能恢复以及睡眠质量，并确定恢复不良的预测因素；3)确定恢复轨迹之间的相互作用。这项研究的意义在于，它将确定重要功能领域(包括认知功能)的独特恢复模式，以及影响老年人轻度脑外伤后恢复过程的因素。确定脑外伤后认知恢复不良的风险个人将突出ADRD的高风险人群，并将允许针对这些个人进行认知康复干预，潜在地降低ADRD的风险。这项拟议研究的基本原理是，及早识别康复轨迹较差的患者将允许制定和确定适当时机的干预措施，以减轻ADRD风险和其他不良后果。这项工作的潜在影响是，它将产生新的知识，指导有针对性的治疗努力，并为以老年脑外伤为重点的康复干预的发展提供信息，这将是未来R01应用的重点。

Development of Alzheimer's disease and related dementias (ADRD) is multifactorial, and some causal factors can be influenced or modified. Recently, the Lancet Commission included traumatic brain injury (TBI) in its list of 12 key potentially modifiable ADRD risk factors. TBI is a very common injury among older adults, resulting in over 123,000 hospitalizations and 485,000 emergency department visits annually. Importantly, rates of TBI are rapidly increasing in this population. TBI results in cognitive impairment and increases risk for both Alzheimer's disease and fronto-temporal dementia. Furthermore, TBI can result in worsened health outcomes (e.g., poor physical functioning, psychological distress, worsened sleep quality), which in turn increase risk for ADRD. Yet, despite the large public health impact of TBI among older adults, little is known about changes in cognition and related domains following discharge from acute care in this population. Although such information is urgently needed to guide rehabilitation, care planning, and promotion of optimal long-term recovery in this vulnerable population, these data are severely lacking in the literature. One major reason for this lack of knowledge is that most prior research on TBI has focused on younger adults. Unfortunately, many findings from younger adults do not generalize to older adults due to their higher comorbidity burden and poorer cognitive and physical functioning at discharge from acute care. The objective of the proposed research is to gain an in-depth understanding of recovery of cognition, psychological and physical functioning, and sleep quality following TBI among older adults. To achieve this objective, we propose to conduct a prospective cohort study of 250 patients aged 65 years and older treated for mild TBI at the R Adams Cowley Shock Trauma Center with follow-up at 3, 6, and 12 months to complete three Specific Aims: 1) Assess recovery of cognitive functioning and identify predictors of poor recovery; 2) Assess recovery of physical and psychological functioning and sleep quality and identify predictors of poor recovery; 3) Identify interactions between recovery trajectories. The significance of this research is that it will identify unique recovery patterns across important domains of functioning (including cognitive function) and factors that impact the course of recovery following mild TBI among older adults. Identification of individuals at risk for poor cognitive recovery following TBI will highlight a population at high risk of ADRD and would permit targeting those individuals with cognitive rehabilitation interventions, potentially reducing ADRD risk. The rationale for the proposed study is that early identification of patients with poorer recovery trajectories will permit development and targeting of appropriately timed interventions to mitigate ADRD risk and other adverse outcomes. The potential impact of this work is that it will generate new knowledge that will guide targeted treatment efforts and inform development of a geriatric-TBI focused rehabilitation intervention that will be the focus of a future R01 application.