Predictors of Cognitive Impairment in Survivors of Critical Illness

描述(由申请者提供)：这项以患者为导向的研究职业发展奖(K23)将为Timothy D.Girard博士提供机会，发展他在老年危重护理领域的临床研究人员的职业生涯，并建立一个专注于危重疾病相关认知障碍的临床和分子流行病学的老龄化研究独立计划。通过老年病学、临床和分子流行病学以及神经心理学方面的教学活动和课程工作的综合计划；当地专家的密集指导；以及在设计、实施和分析前瞻性临床研究方面的实践经验，吉拉德博士将利用这一奖项成为一名在老龄研究方面训练有素的研究员。这项建议的主要科学目标是确定和研究危重疾病后长期认知障碍(LTCI)的临床和分子预测因素。老年患者占ICU入院人数的大多数，认知障碍是这一弱势群体有意义康复的主要障碍；危重疾病的幸存者有25%-75%的风险患上LTCI，这是与生活质量下降和重大社会成本相关的持续性脑功能障碍的表现。利用前瞻性队列调查，吉拉德博士将确定哪些ICU患者的LTCI风险最高，并量化危重疾病后重要风险因素对LTCI的影响。具体地说，候选人将确定危重疾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疾病后LTCI发生率和严重程度增加的危险因素(目标2)。最后，吉拉德博士将确定危重患者的临床风险因素定义的哪些类型的精神错乱与危重疾病后LTCI的发病率和严重程度的增加有关(目标3)。这项工作将确保将这种努力的重点放在高危患者身上，从而为预防和治疗干预措施的研究铺平道路。吉拉德博士的长期研究目标是通过预防和治疗与危重疾病相关的认知障碍来改善老年危重患者的预后。 相关性：重症监护医学的进步提高了危重疾病患者的生存可能性，但研究表明，许多幸存者患有持续性认知障碍，这降低了生活质量。本研究旨在确定危重疾病后认知障碍的危险因素，以指导制定预防和治疗这一危重疾病潜在破坏性并发症的策略。

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.