Cognitive Pathways to Disability

描述（由申请人提供）：越来越多的证据表明，与年龄相关的认知变化，特别是执行功能的变化可能对身体功能产生下游影响。然而，关于这些功能在身体残疾的自然史中的作用的数据缺乏。我们建议通过一项已建立的、正在进行的前瞻性队列研究来解决这一差距，该研究针对基线年龄为70-80岁的高功能女性，即妇女健康与老龄化研究II （WHAS II）。因此，我们这项辅助研究的首要目的是在9年的时间间隔内描述认知功能各个领域的变化率。不太清楚的是，这些认知变化是否预测了基于表现的变化和独立于充分研究的活动途径的自我报告的临床前困难的转变。因此，我们的第二个目标是在三组功能结果中测试认知途径对临床前困难和残疾的价值，根据他们对移动性、认知或两种途径的假定需求进行分类。我们的第三组目标将与WHAS II的创新工作相平行，通过开发更有效和敏感的评估方法来更好地捕捉日常生活中复杂活动的功能变化和补偿，这些变化和补偿通常是使用标准自我报告方法无法报告的，从而评估活动途径中的临床前功能困难。我们的第四个目标是通过探索认知和身体功能之间的阈值关系如何与认知障碍的标准临床指标相对应，将这些流行病学发现转化为临床术语。WHAS II提供了一个独特的机会，深入探索认知和发展到身体残疾之间的因果途径，原因很多。大多数女性在重复的时间间隔内被保留和评估，使用最先进的自我报告测量，对活动能力，基本和复杂的身体功能进行综合评估，以及由首席研究员广泛开发的独特丰富的认知协议。我们将综合本研究的研究结果，为WHAS II更新研究的更广泛目标提供信息，以开发一个概念性框架，前瞻性地识别残疾自然史中的前体和主要途径。了解认知在向残疾过渡过程中可能发挥的作用，将为更好地识别高危个体和制定有针对性的一级和二级预防干预措施提供机会。

DESCRIPTION (provided by applicant): Converging lines of evidence suggest that age-related changes in cognition, and particularly, executive function may exert downstream effects on physical function. However, there is a paucity of data regarding the role of these functions in the natural history of physical disability. We propose to address this gap by building on an established ongoing prospective cohort study of initially high-functioning women, aged 70-80 at baseline, the Women's Health and Aging Study II (WHAS II). Thus, our first aim of this ancillary study is to characterize rates of change in various domains of cognitive function over a 9-year interval. Less clear is whether these changes in cognition predict performance-based changes and self-reported transitions to preclinical difficulty independent of the well-studied mobility pathway. Thus, our second aim will be to test the value of a cognitive pathway to preclinical difficulty and disability in three groups of functional outcomes, categorized according to the putative demands they place on mobility, cognition, or both pathways. Our third set of aims will parallel the WHAS II's innovative efforts to assess preclinical functional difficulty in the mobility pathway by developing more valid and sensitive assessment method to better capture functional changes and compensations in complex activities of daily living typically not reported using standard self-report methods. Our fourth aim seeks to translate these epidemiologic findings into clinical terms by exploring how threshold relationships between cognition and physical function correspond to standard clinical indices of cognitive impairment. The WHAS II offers a unique opportunity to explore in-depth causal pathways between cognition and progression to physical disability for numerous reasons. The majority of women have been retained and evaluated over repeated intervals using state-of-the-art self-report measures comprehensive assessments of mobility, basic, and complex physical functions, and, a uniquely enriched cognitive protocol, developed extensively by the principal investigator. We will synthesize research findings from this study toinform the broader aims of the WHAS II renewal study to develop a conceptual framework that prospectively identifies precursors and major pathways in the natural history of disability. Understanding the roles that cognition may play in the transitions to disability will provide opportunities for better identifying at-risk individuals and developing targeted primary and secondary preventive interventions.