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，一些因果因素可以受到影响或改变。最近，柳叶刀委员会将创伤性脑损伤（TBI）列入其12个关键的潜在可改变的ADRD风险因素清单。TBI是老年人中非常常见的损伤，每年导致超过123，000例住院和485，000例急诊。重要的是，TBI的发病率在这一人群中迅速增加。TBI导致认知障碍，并增加阿尔茨海默病和额颞叶痴呆的风险。此外，TBI可导致恶化的健康结果（例如，身体机能不良、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TBI对老年人的公共卫生影响很大，但对这一人群从急性护理中出院后认知和相关领域的变化知之甚少。虽然这些信息是迫切需要的，以指导康复，护理规划，并促进最佳的长期恢复，在这一弱势群体，这些数据是严重缺乏的文献。这种知识缺乏的一个主要原因是，大多数先前对TBI的研究都集中在年轻人身上。不幸的是，许多年轻人的研究结果并不能推广到老年人，因为他们的合并症负担更高，出院时的认知和身体功能更差。拟议研究的目的是深入了解老年人TBI后认知，心理和身体功能以及睡眠质量的恢复。为了实现这一目标，我们建议对在R亚当斯考利休克创伤中心接受轻度TBI治疗的250名年龄在65岁及以上的患者进行前瞻性队列研究，并在3、6和12个月时进行随访，以完成三个特定目的：1）评估认知功能的恢复并确定恢复不良的预测因素; 2）评估身体和心理功能的恢复以及睡眠质量，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，它将确定功能（包括认知功能）重要领域的独特恢复模式以及影响老年人轻度TBI后恢复过程的因素。识别TBI后认知恢复不良风险的个体将突出ADRD高风险人群，并允许针对这些个体进行认知康复干预，从而可能降低ADRD风险。拟议研究的基本原理是，早期识别恢复轨迹较差的患者将允许开发和定向适当的时间干预措施，以减轻ADRD风险和其他不良结局。这项工作的潜在影响是，它将产生新的知识，这些知识将指导有针对性的治疗工作，并为开发以老年人TBI为重点的康复干预提供信息，这将是未来R 01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.