Traumatic Brain Injury and The Aging Brain: Predictors of Clinical Trajectories

创伤性脑损伤和大脑老化：临床轨迹的预测因素

• 批准号: 8965799
• 负责人: Raquel C. Gardner
• 金额: $ 17.39万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-15 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8965799
• 关键词: Acute; Address; Adult; Advanced Development; Affect; Age; Aging; Alzheimer' s Disease; American; Area; Behavior; Behavioral; Biological; Biological Markers; Biometry; Clinical; Clinical assessments; Cognition; Cognitive; Comorbidity; Consensus; Data; Dementia; Diagnosis; Disease; Early Intervention; Educational Background; Elderly; Epidemic; Epidemiology; Etiology; Fellowship; Frequencies; Gender; Goals; Grant; Group Meetings; Hospitalization; Hospitals; Incidence; Intervention; Journals; K-Series Research Career Programs; Knowledge; Lead; Life; Medical; Mentors; Moods; Motor; Nerve Degeneration; Neurodegenerative Disorders; Neurologic; Neurologist; Outcome; Parkinson Disease; Parkinson' s Dementia; Patients; Pattern; Phase; Population; Prevention; Productivity; Qualifying; Recording of previous events; Research; Research Infrastructure; Research Methodology; Resources; Risk; Risk Factors; Severities; Site; Soldier; Staging; Stratification; Subgroup; TBI Patients; Time; Training; Training Programs; Traumatic Brain Injury; United States National Institutes of Health; Veterans; Vulnerable Populations; Wages; Work; age related; aged; aging brain; career; clinical phenotype; clinical predictors; design; experience; field study; functional decline; functional outcomes; high risk; improved; innovation; lifestyle factors; normal aging; novel; patient oriented research; pre-clinical; prevent; programs; public health relevance; resilience; sedentary lifestyle; skills; success; symposium; tool; treatment strategy

 DESCRIPTION (provided by applicant): In this Paul B. Beeson Patient-Oriented Research Career Development Award (K23) application, the applicant requests 5 years of research and salary support to provide protected time and dedicated training to study the effects of traumatic brain injury (TBI) on the aging brain. The long-term career goal is to become a leader in the nascent field of the study of TBI and brain aging with a focus on clinical predictors and mechanisms of post-TBI neurodegeneration. The specific long-term goal of this research program would be to uncover novel targets for treatment and prevention of post-TBI cognitive, behavioral, motor, and functional decline in high-risk, vulnerable, aging adults. While the candidate - a fellowship-trained behavioral neurologist with a record of productivity in this and related fields - is uniquely qualified to pursue this career trajectory, there are three specific areas in which further training will be critical for optimal success: (1) advanced training in research methods and biostatistics, (2) advanced training in epidemiology of aging with a focus on inter- disciplinary neurological and geriatric predictors and outcomes, and (3) TBI-focused research. Together with her mentoring team, the candidate has developed a rigorous training program that includes the research plan outlined below, formal coursework, one-on-one tutorials, and multi-disciplinary research group meetings, journal clubs, and conferences. The immediate goals of this application are to acquire sufficient preliminary data and skills to submit a successful NIH R01 application and to launch the PI's independent research career. Remarkably, TBI affects nearly 2 million American each year with the highest incidence in late life. While TBI is increasingly recognized as an important risk factor for a variety of neurodegenerative diseases, most notably dementia and Parkinson's disease, the etiology and pattern of cognitive, behavioral, motor, and functional trajectories of older adults after acute or remote TBI as well as clinical predictors of these trajectories are largely unknown. This knowledge gap has stunted research on diagnosis, treatment, and prevention of post-TBI neurodegenerative diseases of aging. The proposed research seeks to address this critical knowledge gap via the following 2 specific aims: (1) to define detailed clinical trajectories and predictors of trajectories after acute TBI in older adults, (2) to define detailed clinical trajectries and predictors of trajectories after remote TBI in older adults. This innovative work will lead to significant advances in the understanding of specific cognitive, behavioral, motor, and functional outcomes after acute and remote TBI in older adults, will identify potentially modifiable clinical predictors of these outcomes, and may generate new hypotheses regarding treatment strategies or biological underpinnings of these outcomes. Thus, the results from this research will directly guide clinical assessment, prognostication, and risk-stratification of older adults wth acute or remote TBI and will advance research to treat or prevent post-TBI neurodegeneration.

 描述（由申请人提供）：在此保罗B。Beeson面向患者的研究职业发展奖（K23）申请，申请人要求5年的研究和工资支持，以提供受保护的时间和专门的培训，研究创伤性脑损伤（TBI）对衰老大脑的影响。长期的职业目标是成为TBI和脑老化研究的新兴领域的领导者，重点是TBI后神经退行性变的临床预测因素和机制。这项研究计划的具体长期目标将是发现治疗和预防高风险，脆弱，老年人TBI后认知，行为，运动和功能下降的新目标。虽然候选人-一个受过奖学金培训的行为神经学家，在这一领域和相关领域的生产力记录-是唯一有资格追求这一职业轨迹，有三个具体领域的进一步培训将是最佳成功的关键：（1）研究方法和生物统计学方面的高级培训，（2）老龄化流行病学的高级培训，重点是跨学科的神经和老年预测因子和结果，以及（3）以TBI为重点的研究。与她的指导团队一起，候选人制定了严格的培训计划，其中包括以下概述的研究计划，正式的课程，一对一的辅导，以及多学科研究小组会议，期刊俱乐部和会议。此应用程序的直接目标是获得足够的初步数据和技能提交 一个成功的NIH R 01申请，并启动PI的独立研究生涯。 值得注意的是，TBI每年影响近200万美国人，其中老年发病率最高。虽然TBI越来越被认为是各种神经退行性疾病的重要危险因素，最显著的是痴呆和帕金森病，但急性或慢性TBI后老年人的认知、行为、运动和功能轨迹的病因和模式， 远程TBI以及这些轨迹的临床预测因素在很大程度上是未知的。这种知识差距阻碍了对TBI后神经退行性疾病的诊断、治疗和预防的研究。拟议的研究旨在通过以下两个具体目标来解决这一关键的知识差距：（1）定义老年人急性TBI后的详细临床轨迹和轨迹预测因素，（2）定义老年人远程TBI后的详细临床轨迹和轨迹预测因素。这项创新工作将导致对老年人急性和远程TBI后特定认知，行为，运动和功能结果的理解取得重大进展，将确定这些结果的潜在可修改的临床预测因素，并可能产生关于治疗策略或这些结果的生物学基础的新假设。因此，这项研究的结果将直接指导患有急性或远程TBI的老年人的临床评估，诊断和风险分层，并将推进治疗或预防TBI后神经变性的研究。