Cognitive prehabilitation to prevent Alzheimer's disease after kidney transplantation

认知预康复预防肾移植后阿尔茨海默病

• 批准号: 10557957
• 负责人: Mara A. McAdams DeMarco
• 金额: $ 15.17万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557957
• 关键词: 12 year old; Address; Aging; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Award; Chronic Disease; Classification; Clinical Research; Cognitive; Cognitive aging; Collaborations; Communities; Consensus; Data; Dedications; Dementia; Dependence; Diagnosis; Diagnostic; Disease Management; Elderly; End stage renal failure; Epidemiology; Faculty; Fostering; Foundations; Funding; Geriatrics; Goals; Habilitation; Hemodialysis; Impaired cognition; Interdisciplinary Study; International; Intervention; Kidney; Kidney Transplantation; Knowledge; Knowledge acquisition; Learning; Mentors; Nephrology; Neurocognitive; Neuropsychology; Older Population; Outcome; Patient risk; Patients; Peer Review; Persons; Pharmaceutical Preparations; Phenotype; Prospective, cohort study; Protocols documentation; Provider; Publications; Publishing; Research; Research Design; Research Infrastructure; Research Personnel; Risk; Scientist; Self Care; Subgroup; Testing; Time; Training; Transplant Recipients; Transplant Surgeon; Transplantation; United States National Institutes of Health; Work; career; career development; cognitive function; dementia risk; diagnostic criteria; disability; experience; frailty; high risk; interest; meetings; mortality risk; next generation; novel; preservation; prevent; programs; skills; symposium; virtual

ABSTRACT Of the 130,000 older (≥50) kidney transplant (KT) recipients in the US, we have estimated that 19% experience post-KT cognitive decline putting them at elevated risk of Alzheimer’s disease and related dementias (ADRD). Compared to a 10-year ADRD risk of 0.6-0.9% for community-dwelling older adults, the risk of ADRD diagnosis is 1.0%-6.7% for older recipients; overall, 7.2-17.0% of older recipients receive a dementia diagnosis within 10 years of KT. Yet, the true burden of ADRD is substantially higher given that only half of patients who would meet diagnostic criteria for dementia receive a diagnosis. A post-KT ADRD diagnosis leads to disability and dependence, and increases a patient’s risk of mortality 2.4-fold and their risk of graft loss 1.5-fold. Within 10 years of an ADRD diagnosis, 88.6% of older recipients have died and 38.9% have experienced graft loss. These preliminary data arise from my current NIH funded research: 1. Prospective cohort study: 12-year-old study of frailty and cognitive function among KT patients; and 2. RCT: 2x2 factorial RCT of interventions to preserve cognitive function among patients initiating hemodialysis. I have established a strong track record and built a research program at the intersection of aging and renal epidemiology which serves as a foundation for this mid-career Independent Scientist (K02) award application. Through this research I have realized that focusing on physical aging without also understanding cognitive aging provides an incomplete picture of older KT patients. As I transition to more administrative duties in 2022, I am unable to expand to ADRD research and develop collaborative relationships with neurocognitive investigators. This K02 will advance my research career by affording me the opportunity for dedicated time to concentrate efforts on career development to expand my research portfolio to include ADRD. My long-term career objective is to establish a sustainable research program focused on physical and cognitive aging among KT recipients. To accomplish these goals, I seek protected time to acquire the knowledge and skills needed: 1. To integrate ADRD research into my existing research portfolio; 2. To develop scientific protocols to study cognitive prehabilitation for older KT recipients; and 3. To establish a national renal aging research network that will collaborate on new research and mentor junior faculty. By replacing administrative duties with protected time, the K02 mechanism will allow me to achieve my long-term career goal of establishing a sustainable research program focused on physical and cognitive aging among KT patients. I will take full advantage of what the K02 Independent Scientist mechanism offers: training in ADRD research, developing a sustainable research infrastructure, and ultimately impacting the lives of the 100,000 patients who experience physical and cognitive decline while waiting for KT.

抽象的 在美国，在130,000肾移植（KT）接受者中，我们估计有19％的经验 KT后认知下降使他们处于阿尔茨海默氏病和相关痴呆症（ADRD）的风险升高。 与社区居住的老年人的10年ADRD风险为0.6-0.9％，ADRD诊断的风险 年龄较大的接受者为1.0％-6.7％；总体而言，7.2-17.0％的老年接受者在10次内接受痴呆诊断 Kt年。但是，鉴于只有一半的患者 满足痴呆症的诊断标准会接受诊断。 KT后ADRD诊断导致残疾和 依赖性，并增加了患者死亡率2.4倍的风险，其移植损失的风险为1.5倍。 10之内 多年的诊断时间，有88.6％的老年接受者死亡，38.9％的人经历了移植物损失。 这些初步数据来自我目前的NIH资助研究：1。前瞻性队列研究：12岁 研究KT患者脆弱和认知功能的研究；和2。RCT：2x2阶乘RCT干预措施 在开始血液透析的患者中保留认知功能。我已经建立了很强的往绩，并且 在衰老和肾脏流行病学的交集中建立了研究计划，该计划是 这位中级独立科学家（K02）奖项申请。通过这项研究，我意识到 专注于身体衰老而不理解认知衰老，这是不完整的较老的情况 KT患者。当我在2022年过渡到更多的行政职责时，我无法扩展到ADRD研究和 与神经认知研究人员建立协作关系。这个K02将推进我的研究 通过为我提供有机会付出专门时间将努力集中在职业发展上的机会来进行的职业 将我的研究组合扩展到包括ADRD。我的长期职业目标是建立可持续性 研究计划的重点是KT接受者的身体和认知衰老。为了实现这些目标，我 寻找受保护的时间来获取所需的知识和技能：1。将ADRD研究整合到我的 现有的研究组合； 2。开发科学方案来研究老年KT的认知预居住 接收者； 3。建立一个国家肾脏老化研究网络，该网络将在新研究上合作 和精神少年教师。通过用受保护的时间替换行政职责，K02机制将允许 我要实现我的长期职业目标，即建立一个专注于身体的可持续研究计划 KT患者的认知衰老。我将充分利用K02独立科学家 机制提供：ADRD研究的培训，开发可持续研究基础设施，最终 在等待KT时影响100,000名身体和认知能力下降的患者的生活。