Neuro-vascular Disease as a Cause of Impaired Mobility

神经血管疾病导致活动能力受损

• 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
• 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

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，还涉及持续正常的身体功能。身体功能异常的衡量标准之一是步态和平衡异常（活动能力受损），这是老年流行病学的一个重要结果。活动能力受损与跌倒、住院、中风和死亡有关。一些传统的血管疾病危险因素（例如缺乏运动、血脂异常）与活动能力受损有关，但对于新兴血管危险因素（例如炎症生物标志物）的证据较少。血管疾病危险因素（例如体力活动下降）的一系列测量尚未用于检查活动能力受损风险的研究中。很少有关于行动障碍的研究包括西班牙裔。亚临床神经血管疾病被定义为磁共振成像 (MRI) 上看到的白质高信号和无症状脑梗塞，与血管疾病危险因素相关，并与活动能力受损有关。很少有研究探讨这三者（血管危险因素、亚临床神经血管疾病和活动能力受损）之间的关联途径。这项 K23 提案将利用北曼哈顿研究 (NOMAS) 的现有基础设施，这是一项备受推崇的流行病学研究，其中西班牙裔人口比例很高，旨在阐明血管结果的危险因素（中风、心肌梗死、血管性死亡）。将对 MRI 子研究的参与者进行活动性检查，这些参与者已经返回进行 5 年的神经心理学评估。我们的目标是描述血管疾病危险因素（身体缺乏活动、血脂异常、炎症生物标志物）与活动能力测量（步态速度、Tinetti 步态和平衡量表作为主要结果）之间的关联。我们将分析在包括白质高信号的全球和区域（例如额叶与心室周围）测量和无症状脑梗塞作为中介因素后，这些关联是否仍然存在。为了实现这些科学目标，我需要在三个领域进行培训：老年医学的选定主题、老年人群的步态和平衡措施以及先进的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转变为一名独立资助的学术神经科医生，重点关注亚临床中风对不成功衰老的影响，并扩大我在老年人群中风方面的专业知识。 公共健康相关性：成功的老龄化不仅涉及维持认知功能，还涉及持续的正常身体功能，其中活动能力是一个关键组成部分。大脑多次无声中风可能会损害老年人的活动能力。该项目的目标是更好地了解血管疾病对活动能力受损的作用，从而制定治疗干预措施。