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: 8304918
• 负责人: Joshua Zebadiah Willey
• 金额: $ 19.08万
• 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/8304918
• 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.

描述（由申请人提供）：成功的衰老不仅包括认知功能的维持，还包括持续的正常身体功能。身体功能异常的一个衡量标准是步态和平衡异常（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、意外中风和死亡率有关。一些传统的血管疾病危险因素（如缺乏运动、血脂异常）与活动能力受损有关，但对新出现的血管危险因素（如炎症生物标志物）的研究较少。血管疾病风险因素的一系列测量，如体力活动的减少，尚未用于检查活动能力受损风险的研究。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，定义为磁共振成像（MRI）上看到的白质高信号和无症状脑梗死，与血管疾病危险因素相关，并与活动能力受损有关。很少有研究考察这三者（血管危险因素、亚临床神经血管疾病和活动能力受损）之间的联系途径。这项K23提案将利用北曼哈顿研究（NOMAS）的现有基础设施，这是一项备受尊敬的流行病学研究，拉美裔人的比例很高，旨在阐明血管结局（中风、心肌梗死、血管性死亡）的危险因素。活动能力检查将对MRI子研究的参与者进行，这些参与者已返回进行5年的神经心理评估。我们的目的是表征血管疾病危险因素（缺乏运动、血脂异常、炎症生物标志物）与活动度测量（步态速度、Tinetti步态和平衡量表作为主要结果）之间的关系。我们将分析在包括整体和区域（例如额叶与心室周围）白质高信号和无症状脑梗死作为介质的测量后，这些关联是否仍然存在。为了实现这些科学目标，我将需要在三个方面进行培训：老年医学的选定主题，老年人口的步态和平衡测量，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成为一名独立资助的学术神经科医生，专注于亚临床中风对不成功衰老的贡献，并拓宽我在老年人群中风方面的专业知识。