Predictors of Cognitive Impairment in Survivors of Critical Illness

描述（由申请人提供）：这个指导患者为导向的研究职业发展奖（K23）将提供博士。吉拉德有机会发展他的职业生涯作为一个临床研究者在老年重症监护领域，并建立一个独立的老龄化研究计划，重点是临床和分子流行病学的危重病相关的认知障碍。通过在老年医学，临床和分子流行病学和神经心理学的教学活动和课程工作的综合计划;由当地专家密集的指导;和实践经验的设计，实施和分析的前瞻性临床调查，博士吉拉德将利用这个奖项，成为一个训练有素的研究人员在老龄化研究。该提案的主要科学目标是确定和研究危重病后长期认知障碍（LTCI）的临床和分子预测因子。老年患者占ICU入院的大多数，认知障碍是这一脆弱人群实现有意义康复的主要障碍;危重病幸存者发生LTCI的风险为25%-75%，这是一种与生活质量降低和重大社会成本相关的持续性脑功能障碍的表现。利用前瞻性队列研究，吉拉德博士将确定那些ICU患者的LTCI的最高风险，并量化重要的危险因素的贡献LTCI后，危重病。具体而言，候选人将确定危重病后长期认知障碍发生率和严重程度增加的临床风险因素（目标1）。此外，他将确定炎症和凝血障碍是否是危重病后LTCI发生率和严重程度增加的风险因素（目标2）。最后，吉拉德博士将确定危重患者中由临床风险因素定义的谵妄类别与危重病后LTCI的发生率和严重程度增加相关（目标3）。这项工作将为预防和治疗干预措施的研究铺平道路，确保这些努力将重点放在风险最高的患者身上。吉拉德博士的长期研究目标是通过预防和治疗重症相关的认知障碍来改善老年重症患者的预后。 相关性：重症监护医学的进步提高了危重病患者的生存可能性，但研究表明，许多幸存者会出现持续的认知障碍，从而降低生活质量。本研究旨在确定危重症后认知障碍的危险因素，以指导制定预防和治疗这种潜在的毁灭性危重症并发症的策略。

DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award (K23) will provide Dr. Timothy D. Girard the opportunity to develop his career as a clinical investigator in the field of geriatric critical care and to establish an independent program of aging research focused on the clinical and molecular epidemiology of critical-illness associated cognitive impairment. Through an integrated program of didactic activities and course work in geriatrics, clinical and molecular epidemiology, and neuropsychology; intensive mentorship by local experts; and hands-on experience in the design, implementation, and analysis of a prospective clinical investigation, Dr. Girard will use this award to become a highly trained investigator in aging research. The primary scientific goal of this proposal is to identify and study the clinical and molecular predictors of long-term cognitive impairment (LTCI) after critical illness. Older patients account for the majority of ICU admissions, and cognitive impairment is a major impediment to meaningful recovery in this vulnerable population; survivors of critical illness have a 25%-75% risk of developing LTCI, a manifestation of persistent brain dysfunction associated with reduced quality of life and significant societal costs. Utilizing a prospective cohort investigation, Dr. Girard will identify those ICU patients at highest risk for LTCI and quantify the contribution of important risk factors to LTCI after critical illness. Specifically, the candidate will identify clinical risk factors for an increased incidence and severity of long-term cognitive impairment after critical illness (Aim 1). Furthermore, he will determine whether inflammation and coagulopathy are risk factors for an increased incidence and severity of LTCI after critical illness (Aim 2). Finally, Dr. Girard will determine which categories of delirium defined by clinical risk factors in critically ill patients are associated with an increased incidence and severity of LTCI after critical illness (Aim 3). This work will pave the way for the study of preventive and therapeutic interventions by ensuring that such efforts will be focused on patients at highest risk. Dr. Girard's long-term research goal is to improve the outcomes of older critically ill patients through the prevention and treatment of critical illness-associated cognitive impairment. RELEVANCE: Advances in intensive care medicine have improved the likelihood of survival for patients with critical illness, but studies have shown that many survivors develop persistent cognitive impairment, which reduces quality of life. This study seeks to identify risk factors for cognitive impairment after critical illness in order to guide the development of strategies to prevent and treat this potentially devastating complication of critical illness.