The Predictors and Long-Term Trajectory of Poststroke Cognitive Decline

描述（由申请人提供）：随着人口老龄化和卒中生存率的提高，卒中后认知功能下降（PSCD）的发生率正在增加。PSCD与不良的健康结果、增加的健康成本和较差的生活质量相关。卒中患者发生PSCD的情况有很大的差异。许多因素可能导致这种变异性，包括卒中年龄、卒中发作时间、卒中特征、社会人口统计学、地理、健康状况、行为和医疗保健因素。然而，对私营部门合作与发展仍然知之甚少。这个职业发展奖的长期目标是促进候选人发展成为老年人中PSCD的领导者和独立资助的医生-科学家。本项目的目的是：1）确定卒中对认知功能的短期和长期影响; 2）确定PSCD的社会人口统计学、地理、医学和行为预测因素; 3）使用原始和二级数据评估血压或抗高血压药物依从性是否与卒中幸存者的认知功能相关。该项目将结合来自美国2项领先前瞻性卒中队列研究的联合收割机数据：1）一项大型、地理分散、种族和性别平衡的中老年队列，随访卒中和认知功能下降，并进行卒中前和卒中后认知评估; 2）一项在双种族社区开展的基于人群的卒中监测项目，并进行卒中后即刻认知评估。两项队列研究都有对PSCD敏感的认知指标和卒中特征数据。这项研究将通过更好地识别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，更好的治疗和老年人更好的结果。 候选人Deborah Levine博士将把研究重点放在不断增长的中风幸存者人口上，她将实施一项指导性研究计划，旨在提高她在研究PSCD所需方法方面的技能。详细的职业发展计划将促进候选人在四个领域的专业知识发展：1）分析和进行老年人的纵向流行病学研究; 2）认知结果的测量; 3）患者治疗依从性和慢性疾病干预;以及4）老年病和中风护理。职业发展计划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。一流大学的特殊资源和指导团队在这些主题领域开发初级医生科学家方面取得了成功，使密歇根大学成为该项目的理想环境。

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.