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Cognitive Function, Self-Management, and Health Outcomes among Liver Transplant Recipients: the LivCog Cohort

肝移植受者的认知功能、自我管理和健康结果：LivCog 队列

基本信息

批准号：
10420311
负责人：
Marina Serper
金额：
$ 74.18万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-04 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10420311
关键词：
Accounting Active Learning Affect Age Alcohol consumption Alcohols Behavior Cardiovascular system Caregiver support Caregivers Caring Chronic Cirrhosis Clinical Cognition Cognitive Cohort Studies Communities Complex Dose Elderly Future Health Health Care Costs Health Status Health behavior Health behavior outcomes Health system Healthcare Heart Transplantation Hepatic Encephalopathy High Prevalence Immunosuppression Impaired cognition Impairment Infection Intervention Investigation Kidney Transplantation Life Life Style Liquid substance Liver diseases Malnutrition Mediating Mediator of activation protein Medical Memory Metabolic Monitor Nature Neurologic North America Outcome Pathway interactions Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacists Physical Function Physical activity Population Prevalence Problem Solving Recommendation Recovery of Function Regimen Reporting Resources Risk Factors Sampling Savings Self Care Self Management Sleep Substance abuse problem Time Transplant Recipients Transplantation United States National Institutes of Health Waiting Lists baby boomer cardiometabolism care coordination care delivery cognitive ability cognitive function cognitive load cognitive performance cognitive recovery cohort comorbidity cost end stage liver disease executive function frailty functional independence functional status health care service health literacy health management high risk improved insight liver transplantation mortality multiple chronic conditions novel physical inactivity poor sleep post-transplant postoperative delirium prevent processing speed response sarcopenia side effect skills sleep quality transplant centers treatment adherence

项目摘要

PROJECT SUMMARY This study will provide novel insights on cognitive trajectories among new liver transplant recipients, and the impact of cognitive function on self-management, health behaviors, and patient outcomes. The prevalence of cirrhosis and end-stage liver disease (ESLD) in North America is estimated at up to 1,000 per 100,000 population and has nearly doubled over the past two decades with baby boomers (born 1945-1965) accounting for half of cases. From 2009 to 2016, there has been a 65% increase in cirrhosis mortality in the U.S. Decompensated cirrhosis has a 5-year survival of only 34-56% with liver transplantation (LT) as the only life- saving option. By 2033, LT demand will increase by 23% and per-patient LT-associated costs will rise from $1.4 to $2.1 million, resulting in a total of $26.7 billion in transplant-related medical expenses over a 10-year time horizon. To maximize the benefits of LT, liver transplant recipients (LTRs) must have strong self-management skills to navigate health systems, adhere to clinical monitoring, and take complex, multi-drug regimens. All of these tasks require formidable cognitive abilities for active learning and problem solving. LTRs are at higher risk for poorer cognition due to high prevalence of pre-transplant cognitive impairment (hepatic encephalopathy), multiple chronic conditions, alcohol use, and increasing age. The cognitive status of LTRs over time could affect self-management and transplant outcomes, yet these issues have not been thoroughly investigated. Our proposed cohort study (`LivCog') will longitudinally characterize cognitive performance using the NIH Toolbox among 450 new LTRs from 3 diverse transplant centers, beginning at transplant waitlisting and then at 1, 4, 12, and 24 months post-LT. We will also serially assess self-management skills, physical function, health behaviors, patient-reported and clinical outcomes. Potentially modifiable post-transplant targets will be investigated, including caregiver support, physical activity, sleep, and treatment adherence to understand causal pathways that could inform future health system responses. Our specific aims are to: 1) assess pre to post-LT cognitive trajectories and identify risk factors for persistent cognitive impairment, 2) evaluate associations between cognitive function and self-management skills, health behaviors, functional health status, and post- transplant outcomes, and 3) investigate potential mediators and moderators of associations between cognitive function and post-transplant outcomes. Our proposed LivCog study will fill critical gaps in understanding cognitive recovery and function, risk factors and consequences of cognitive impairment among LTRs. Findings will directly inform future interventions to improve post-transplant outcomes.

项目总结