The Predictors and Long-Term Trajectory of Poststroke Cognitive Decline

描述(申请人提供)：随着人口老龄化和卒中存活率的提高，卒中后认知衰退(PSCD)的比率正在增加。PSCD与不良的健康结局、增加的医疗费用和较差的生活质量有关。卒中患者发生PSCD的情况有显著的变异性。许多因素可能导致这种变异性，包括中风年龄、中风发病时间、中风特征、社会人口学、地理、健康状况、行为和医疗保健因素。然而，PSCD仍然鲜为人知。这一职业发展奖的长期目标是促进候选人在老年人中发展成为PSCD领域的领导者和独立资助的内科科学家。该项目的目标是：1)确定中风对认知功能的短期和长期影响；2)确定PSCD的社会人口学、地理、医学和行为预测因素；3)使用原始和次要数据评估血压或抗高血压药物的依从性是否与中风幸存者的认知功能有关。该项目将结合美国两项领先的前瞻性中风队列研究的数据：1)大规模、地理上分散的、种族和性别平衡的中老年人中风和认知衰退跟踪队列，以及中风病前和中风后认知评估；2)双民族社区的一个基于人群的中风监测项目，立即进行中风后认知评估。这两项队列研究都有对PSCD敏感的认知测量和关于中风特征的数据。这项研究将通过更好地确定PSCD的潜在机制来产生知识，并将有助于规划干预措施，以改善对中风和PSCD的护理和预防。这项研究最终将导致对PSCD的更好理解，更好的治疗，以及对老年人更好的结果。候选人黛博拉·莱文博士将把她的研究重点放在越来越多的中风幸存者身上，她将实施一项有指导的研究计划，旨在提高她研究PSCD所需方法的技能。详细的职业发展计划将促进应聘者在四个领域的专业知识发展：1)对老年人的纵向流行病学研究的分析和实施；2)认知结果的测量；3)患者治疗的坚持和慢性病干预；以及4)老年病和中风护理。职业发展计划由一个由经验丰富的导师和顾问组成的多学科团队组成，他们将监督这些领域的一系列正式课程和实践经验，以确保候选人未来的成功。一所顶尖大学的特殊资源和一支在这些主题领域成功培养初级内科科学家的指导团队使密歇根大学成为该项目的理想环境。 公共卫生相关性：三分之一的人会在一生中经历痴呆症、中风或两者兼而有之。新世纪的一个关键问题是：在这个人口老龄化的时代 和改善中风存活率，如何才能减少或推迟中风造成的认知障碍？为了开始面对这个问题，我们将建立一个研究计划，研究中风后认知功能下降的流行病学，并确定可能成为未来干预研究目标的危险因素。减少卒中后认知功能下降对于降低卒中和痴呆的风险和人群负担将是重要的。这项研究的信息将更好地确定中风后认知下降的潜在机制，并可能有助于规划干预措施，以减少或预防老年人中风后认知下降。

DESCRIPTION (provided by applicant): With population aging and improved stroke survival, the rates of post stroke cognitive decline (PSCD) are increasing. PSCD is associated with adverse health outcomes, increased health costs, and poorer quality of life. There is significant variability in which stroke patients develop PSCD. Many factors likely drive this variability, including age at stroke, time from stroke onset, stroke features, socio-demographics, geography, health conditions, behaviors and medical care factors. Yet, PSCD remains poorly understood. The long-term goal of this career development award is to promote the candidate's development into a leader and independently funded physician-scientist in PSCD among older adults. The aims of this project are: 1) To determine the impact of stroke on cognitive function, both in the short-term and the long-term; 2) To determine the socio-demographic, geographic, medical, and behavioral predictors of PSCD; 3) To assess whether blood pressure or anti-hypertensive medication adherence are associated with cognitive function in stroke survivors using primary and secondary data. This project will combine data from 2 leading prospective stroke cohort studies in the US: 1) a large, geographically dispersed, race- and gender-balanced cohort of middle-aged and older adults being followed for stroke and cognitive decline and with premorbid and post stroke cognitive assessments, and 2) a population-based stroke surveillance project in a bi-ethnic community with immediate post stroke cognitive assessments. Both cohort studies have cognitive measures sensitive to PSCD and data on stroke features. This research will generate knowledge by better identifying potential mechanisms of PSCD and will assist in planning interventions to improve the care and prevention of stroke and PSCD. This research ultimately will lead to greater understanding of PSCD, better treatments, and better outcomes in older people. The candidate, Dr. Deborah Levine, who will focus her research on the growing population of stroke survivors, will pursue a mentored research plan designed to enhance her skills in the methods needed to study PSCD. A detailed career development plan will promote the candidate's development of expertise in four areas: 1) the analysis and conduct of longitudinal epidemiologic studies of older adults; 2) the measurement of cognitive outcomes; 3) patient treatment adherence and chronic illness interventions; and 4) geriatrics and stroke care. The career development plan consists of a multidisciplinary team of experienced mentors and advisors who will oversee a range of formal coursework and practical experiences in these areas to ensure the candidate's future success. Exceptional resources of a top university and a mentoring team with proven success in developing junior physician-scientists in these topic areas makes the University of Michigan an ideal environment for this project. PUBLIC HEALTH RELEVANCE: One in three individuals will experience dementia, a stroke, or both during their lifetime. A key question for this new century is: In this era of population aging and improved stroke survival, how can cognitive disability from stroke be reduced or delayed? To begin to confront this problem, we will establish a research program to study the epidemiology of post stroke cognitive decline and to identify risk factors that may be targets for future intervention studies. Reducing post stroke cognitive decline will be important to decrease the risk and population burden of stroke and dementia. Information from this study will better identify potential mechanisms of post stroke cognitive decline and may assist in planning interventions to reduce or prevent post stroke cognitive decline in older adults.