Investigating the Impact of Cognition on Capacity in Multiple Sclerosis

项目摘要/摘要 这份K23申请的目的是为了进一步促进Adam Gertenecker博士在 多发性硬化症(MS)调查认知障碍、财务和医疗决策能力以及大脑 成像。应聘者是一位神经心理学家，他的长期职业目标是发展康复 为那些在经济和医疗能力方面有特殊风险的人提供的计划。的研究。 例如，财务和医疗决策能力似乎与女士特别相关， 50%- 75%的多发性硬化症患者在确诊后十年内不再工作；因此，经济困难和经济困难 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 资金紧张，投资规划重组，并重新确定优先顺序。这些人还面临着新的问题 在选择与变化相关的非治愈性疗法时考虑医疗 副作用。然而，高达65%的多发性硬化症患者有认知障碍，这可能会对 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检查能力 在MS中，它有一些限制。关于神经成像，尽管之前的研究表明 弥散成像(DI)指标与多发性硬化症认知功能障碍相关，研究 DI指标与MS中的财务或医疗能力之间的关联不可用。 此K23应用程序的目标是调查MS的财务和医疗能力，并检查 它们的临床和神经解剖学相关。该项目将为今后的干预提供初步数据 在财政和医疗能力方面的研究将成为未来R01拨款提案的主题。具体的 研究目的是：(1)考察多发性硬化症、脑外伤和健康人群在财务和医疗能力方面的差异 对照；(2)检查神经认知、人口统计学和疾病与复发能力的相关性- 缓解性和进展性多发性硬化症；(3)在多发性硬化症中建立DI指标和能力之间的相关性。 此外，还将进行一些调解和缓和分析。这款K23将提供 确保成功过渡到独立性的基本培训、受保护的时间和研究数据，包括： (1)提高对多发性硬化症的病程、治疗和临床表现的认识；(2) 在决策能力方面发展更多关于法律和道德问题的知识并获得 提高能力相关技能的熟练程度；(3)增加神经成像方面的知识 程序和神经影像数据的处理；(4)在干预研究中获得更多的知识 和设计，重点是发展有针对性的认知康复；和(5)接受更多 高级统计方法方面的培训。导师团队由库拉姆·巴希尔博士领导，他是一名国际 公认的MS专家、导师和科学家，有出色的指导记录。

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.