Comprehensive Investigation of the Clinical Course of Traumatic Brain Injury

脑外伤临床过程的综合调查

• 批准号: 8633829
• 负责人: Kristen Dams-O'Connor
• 金额: $ 10.73万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-12-11 至 2018-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8633829
• 关键词: Accounting; Address; Adult; Age; Aging; Alleles; Autopsy; Award; Biological Markers; Brain; Caring; Cerebrum; Clinical; Clinical Data; Clinical Research; Clinical Trials; Cognitive; Cohort Studies; Common Data Element; Comorbidity; Consent; Data; Data Set; Dementia; Development; Development Plans; Discipline; Elderly; Evaluation; Event; Exhibits; Face; Family; Frequencies; Funding; Future; Genetic; Genotype; Glasgow Outcome Scale; Goals; Health; Heterogeneity; Hospitals; Impaired cognition; Individual; Injury; Intervention; Knowledge; Lead; Lewy Bodies; Life; Linear Regressions; Longevity; Measurement; Measures; Mediating; Medical; Mental Depression; Mentored Research Scientist Development Award; Methods; Modeling; Neurofibrillary Tangles; Observational Study; Outcome; Outcome Measure; Participant; Pathology; Patients; Pattern; Peripheral; Physical activity; Prevalence; Procedures; Property; Psychometrics; Public Health; Quality of life; Recording of previous events; Recovery; Recovery of Function; Research; Research Training; Resources; Role; Sample Size; Secure; Senile Plaques; Serum; Severities; Statistical Methods; Statistical Models; Survivors; Techniques; Testing; Time; Traumatic Brain Injury; United States National Institutes of Health; Work; care systems; career; career development; experience; follow-up; frailty; improved; instrument; meetings; neuroimaging; neuropathology; novel; population based; prospective; public health relevance; research and development; screening; sex; tau aggregation; tool

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is a major public health concern in the US, and the current prevalence of TBI in the US is unprecedented. Individuals with TBI experience diverse patterns of early recovery and long- term clinical outcomes, and some TBI survivors experience accelerated cognitive and health decline as they age. Little is known about factors that predict different trajectories of outcome. The extent to which factors associated with cognitive and health decline in older adults in general (e.g., physical inactivity, medical comorbidity) applies to older adults with a history of TBI is not known. Many existing studies face methodological challenges that limit their usefulness in evaluating cognitive and health outcomes over time, such as small sample sizes, limited follow-up, use of imprecise functional measures, and application of traditional regression approaches whose assumptions are typically not met in longitudinal clinical studies. Our current knowledge of TBI outcomes is confined by these limitations. Recent methodological developments in psychometrics and statistical modeling can be applied to existing data sets, as proposed here, to significantly advance understanding of TBI outcomes and the factors that influence these outcomes over time. The proposed research and career development plan will first evaluate and account for measurement imprecision in commonly used TBI outcome measures, and then evaluate trajectories of temporal change in cognitive and health outcomes for individuals with TBI using advanced statistical methods ideally suited to this purpose. The research and career development plan outlined in this application consists of four complementary objectives that will be implemented during the award period. Objective 1 aims to develop proficiency in the application of advanced psychometric methods to evaluate and adjust for measurement error and bias in commonly used TBI assessment tools. Objective 2 is to acquire mastery in applying sophisticated statistical methods that are capable of evaluating longitudinal relationships among factors that influence TBI outcomes over time, and relate individual clinical trajectories to postmortem neuropathological features of TBI. Objective 3 involves establishing broad fluency in related disciplines of neuropathology, neuroimaging, and genetics that are necessary for interdisciplinary TBI research. Objective 4 is to secure independent research funding. Results from the research related to this K01 award will advance knowledge regarding potentially modifiable factors that are associated with heterogeneity in clinical outcomes over time after TBI, paving the way for appropriately timed and individually tailored interventions throughout the lifespan for TBI survivors. The knowledge gained can direct efforts to improve health and life quality for TBI survivors, and to help patients, families, and care systems plan for the future.

描述（由申请人提供）：创伤性脑损伤（TBI）是美国的一个主要公共卫生问题，目前 TBI 在美国的患病率是前所未有的。 TBI 患者会经历不同的早期恢复模式和长期临床结果，并且一些 TBI 幸存者随着年龄的增长，认知能力和健康状况会加速下降。人们对预测不同结果轨迹的因素知之甚少。老年人中与认知和健康相关的因素总体下降的程度（例如缺乏身体活动、 医疗合并症）是否适用于有 TBI 病史的老年人尚不清楚。许多现有研究面临方法论挑战，这些挑战限制了它们随着时间的推移评估认知和健康结果的有用性，例如样本量小、随访有限、使用不精确的功能测量以及应用传统回归方法，而这些方法的假设通常在纵向临床研究中不得到满足。我们目前对 TBI 结果的了解受到这些限制。正如本文所提出的，心理测量学和统计模型的最新方法论发展可以应用于现有数据集，以显着促进对 TBI 结果以及随时间影响这些结果的因素的理解。拟议的研究和职业发展计划将首先评估和解释常用 TBI 结果测量中的测量不精确性，然后使用非常适合此目的的先进统计方法来评估 TBI 个体认知和健康结果的时间变化轨迹。 本申请中概述的研究和职业发展计划由四个补充目标组成，这些目标将在奖励期间实施。目标 1 旨在提高应用先进心理测量方法的能力，以评估和调整常用 TBI 评估工具中的测量误差和偏差。目标 2 是掌握应用复杂的统计方法，这些方法能够评估随着时间的推移影响 TBI 结果的因素之间的纵向关系，并将个体临床轨迹与 TBI 死后神经病理学特征联系起来。目标 3 涉及建立跨学科 TBI 研究所必需的神经病理学、神经影像学和遗传学相关学科的广泛流畅性。目标 4 是确保独立研究经费。 与该 K01 奖项相关的研究结果将增进对与 TBI 后一段时间内临床结果异质性相关的潜在可改变因素的认识，为 TBI 幸存者在整个生命周期中适时和个性化的干预措施铺平道路。获得的知识可以指导改善 TBI 幸存者的健康和生活质量，并帮助患者、家庭和护理系统规划未来。