Neuro-vascular Disease as a Cause of Impaired Mobility

神经血管疾病导致活动能力受损

基本信息

批准号：
8189900
负责人：
Joshua Zebadiah Willey
金额：
$ 17.51万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8189900
关键词：
Accounting Aging American Area Arthritis Biological Markers Blood Vessels Brain Brain Infarction C-reactive protein Cessation of life Chronic Data Demographic Aging Diabetes Mellitus Disease Dyslipidemias Elderly Enrollment Epidemiologic Methods Epidemiologic Studies Epidemiology Equilibrium Ethnic Origin Evaluation Funding Future Gait Gait abnormality Geriatrics Goals Health High Density Lipoproteins Hispanics Hypertension Infarction Infection Inflammation Inflammatory Institutionalization Intervention Intervention Trial LDL Cholesterol Lipoproteins Lead Leg Link Magnetic Resonance Imaging Maintenance Measures Mediating Mediator of activation protein Modeling Myocardial Infarction National Institute of Neurological Disorders and Stroke National Institute on Aging Neuraxis Neurologist Neuropathy Outcome Pain Participant Pathway interactions Pattern Performance Persons Physical Function Physical activity Population Prospective Studies Public Health Race Research Research Infrastructure Risk Risk Factors Role Societies Speed Statistical Methods Stroke Sum Testing Time Tobacco use Training United States National Institutes of Health Vascular Diseases Ventricular base cognitive function disorder risk equilibration disorder falls follow-up frailty frontal lobe indexing interest longitudinal design mortality novel primary outcome prognostic psychologic sarcopenia secondary outcome sex symposium white matter

项目摘要

DESCRIPTION (provided by applicant): Successful aging involves not only the maintenance of cognitive function, but sustained normal physical function. One measure of abnormal physical function is abnormal gait and balance (impaired mobility), an important outcome in geriatric epidemiology. Impaired mobility is associated with falls, institutionalization, incident stroke, and mortality. Some conventional vascular disease risk factors (such as physical inactivity, dyslipidemia) have been associated with impaired mobility, though less has been demonstrated regarding emerging vascular risk factors, such as inflammatory biomarkers. Serial measures of vascular disease risk factors, such as decline in physical activity, have not been used in studies examining risk of impaired mobility. Few studies on impaired mobility have included Hispanics. Subclinical neurovascular disease, defined as white matter hyperintensities and silent brain infarcts seen on magnetic resonance imaging (MRI), is associated with vascular disease risk factors and has been linked to impaired mobility. There have been few studies examining the pathway by which all three (vascular risk factors, subclinical neurovascular disease and impaired mobility) may be linked. This K23 proposal will take advantage of the existing infrastructure in the Northern Manhattan Study (NOMAS), a well respected epidemiological study with a high proportion of Hispanics aimed at elucidating risk factors for vascular outcomes (stroke, myocardial infarction, vascular death). Mobility examinations will be performed on participants in the MRI sub-study who have been returning for a 5 year neuro-psychological evaluation. Our aim is to characterize the association between vascular disease risk factors (physical inactivity, dyslipidemia, inflammatory biomarkers) with measures of mobility (gait speed and Tinetti gait and balance scale as the primary outcomes). We will analyze whether these associations remain after including global and regional (frontal lobe versus peri-ventricular for example) measures of white matter hyperintensities and silent brain infarction is acting as mediators. In order to achieve these scientific goals I will need training in three areas: selected topics in geriatric medicine, gait and balance measures in the geriatric population, and advanced statistical and epidemiological methods. Achieving these scientific and training goals will allow me to transition into being an independently funded academic neurologist with a focus on the contributions of subclinical stroke to unsuccessful aging, as well as broaden my expertise on stroke in the geriatric population. PUBLIC HEALTH RELEVANCE: Successful aging involves not only the maintenance of cognitive function, but also sustained normal physical function, of which mobility is a critical component. Multiple silent strokes to the brain may impair mobility in the elderly. The goal of this project is to better understand the role of vascular disease on impaired mobility so as to derive treatment interventions.

描述（由申请人提供）：成功的衰老不仅涉及认知功能的维持，而且还涉及正常的身体机能。一种异常身体机能的一种度量是步态异常和平衡（流动性受损），这是老年流行病学的重要结果。流动性受损与跌倒，制度化，事件中风和死亡率有关。一些常规的血管疾病危险因素（例如身体不活跃，血脂异常）与活动性受损有关，尽管在新兴的血管危险因素（例如炎症生物标志物）方面已经证明了较少的证明。血管疾病危险因素（例如体育锻炼下降）的系列测量尚未用于检查流动性障碍风险的研究。关于流动性受损的研究很少包括西班牙裔。亚临床神经血管疾病被定义为白质高强度和在磁共振成像（MRI）上看到的沉默的脑梗塞，与血管疾病危险因素有关，并且与流动性受损有关。很少有研究检查所有三个途径（血管危险因素，亚临床神经血管疾病和流动性受损）的途径。该K23提案将利用曼哈顿北部研究（NOMAS）中现有的基础设施，这是一项备受推崇的流行病学研究，其比例很高，旨在阐明血管结果的危险因素（中风，心肌梗死，血管死亡，血管死亡）。将对正在返回5年神经心理学评估的MRI子研究参与者进行移动性检查。我们的目的是表征血管疾病危险因素（身体不活跃，血脂异常，炎症生物标志物）与迁移率（步态速度和Tinetti步态和平衡量表的主要结果）之间的关联。我们将分析这些关联是否在包括全球和区域性（例如，额叶与室周周围）之后保持白质超强度和沉默的脑梗塞的量度是介体。为了实现这些科学目标，我将需要在三个领域进行培训：老年医学，步态和平衡措施的精选主题，以及高级统计和流行病学方法。实现这些科学和培训目标将使我能够过渡为一名独立资助的学术神经科医生，重点是亚临床中风对失败的衰老的贡献，并扩大了我在老年人群中的中风方面的专业知识。公共卫生相关性：成功的衰老不仅涉及维持认知功能，而且还涉及持续正常的身体机能，其中移动性是关键的组成部分。大脑的多次沉默中风可能会损害老年人的流动性。该项目的目的是更好地了解血管疾病对流动性受损的作用，从而获得治疗干预措施。