Cognitive Pathways to Disability

导致残疾的认知途径

• 批准号: 6930418
• 负责人: MICHELLE C CARLSON
• 金额: $ 40.88万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6930418
• 关键词: aging; body physical activity; clinical research; cognition; cognition disorders; epidemiology; female; functional ability; human old age (65+); human subject; memory; pathologic process; psychomotor function

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.

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自然史中的作用的数据很少。我们建议通过建立在一个既定的正在进行的前瞻性队列研究，最初高功能的妇女，年龄在基线70-80，妇女健康和老龄化研究II（WHAS II），以解决这一差距。因此，我们这项辅助研究的第一个目的是描述9年时间间隔内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自我报告的临床前困难的转变，而不依赖于充分研究的移动途径。因此，我们的第二个目标将是测试认知途径对三组功能结果中的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要求进行分类。我们的第三组目标将与WHAS II的创新努力平行，通过开发更有效和更敏感的评估方法来评估移动路径中的临床前功能困难，以更好地捕获通常使用标准自我报告方法报告的复杂日常生活活动中的功能变化和补偿。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对应于认知障碍的标准临床指标，将这些流行病学研究结果转化为临床术语。WHAS II提供了一个独特的机会，可以深入探索认知与身体残疾进展之间的因果关系。大多数妇女已被保留，并使用最先进的自我报告措施的流动性，基本和复杂的身体功能的综合评估，以及一个独特的丰富的认知协议，广泛开发的主要研究者在重复的时间间隔进行评估。我们将综合这项研究的研究结果，为WHAS II更新研究的更广泛目标提供信息，以制定一个概念框架，前瞻性地确定残疾自然史中的前兆和主要途径。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初级和二级预防干预措施提供机会。