Novel Therapeutic Interventions for Patients with Alzheimer's Disease and Comorbid Dysphagia

针对阿尔茨海默病和吞咽困难患者的新型治疗干预措施

• 批准号: 9756286
• 负责人: Nicole M Rogus-Pulia
• 金额: $ 16.8万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9756286
• 关键词: Address; Alzheimer' s Disease; Area; Aspiration Pneumonia; Award; Biomechanics; Bolus Infusion; Caregiver Burden; Caregivers; Caring; Clinical; Clinical Trials Design; Cognition; Comorbidity; Data; Deglutition; Deglutition Disorders; Development; Development Plans; Diagnosis; Diet Modification; Discipline; Disease Progression; Doctor of Philosophy; Education; Effectiveness of Interventions; Elderly; Engineering; Ensure; Environment; Evidence based treatment; Faculty; Food; Foundations; Functional disorder; Funding; Future; Goals; Health; Healthcare Systems; Hospitalization; Human; Impaired cognition; Impairment; Infrastructure; Institution; Intake; Intervention; K-Series Research Career Programs; Language; Lead; Least-Squares Analysis; Liquid substance; Logistic Regressions; Malnutrition; Measures; Mentors; Modeling; Oral; Oropharyngeal; Outcome; Pathologist; Patients; Personal Satisfaction; Physiological; Physiology; Pneumonia; Posture; Prevention; Preventive Intervention; Production; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Rehabilitation therapy; Research; Research Personnel; Resistance; Risk; Safety; Saliva; Salivary; Scientist; Secure; Site; Speech; Subgroup; Techniques; Testing; Time; Tongue; Training; Translating; Universities; Viscosity; Wisconsin; Work; career development; caregiving; clinical care; common treatment; design; dysphagia rehabilitation; effective therapy; evidence base; experience; implementation science; improved; medical schools; member; mortality; negative affect; novel; novel therapeutic intervention; novel therapeutics; patient subsets; post intervention; pressure; prevent; primary outcome; programs; recruit; saliva secretion; success; therapy development; treatment as usual; treatment response

PROJECT SUMMARY/ABSTRACT This career development proposal is designed to provide Nicole Rogus-Pulia, PhD, CCC-SLP, a Speech- Language Pathologist and an expert in dysphagia (swallowing dysfunction) at the University of Wisconsin- Madison School of Medicine and Public Health with the training required for success as an independent, clinician- scientist researching interventions to improve the care of dysphagia in patients with Alzheimer's Disease (AD). Dysphagia frequently develops in patients with AD and leads to serious health consequences, including decreased quality of life, caregiver burden, malnutrition, pneumonia, and mortality. Common treatments for dysphagia in patients with AD employ compensatory approaches that alter bolus flow to avoid aspiration (entrance of food or liquid into the airway). These approaches do not result in sustained improvements in swallowing physiology and often negatively affect quality of life. There are currently no effective treatments for dysphagia in patients with AD that can be practically applied or have lasting effects on the physiology of the swallow. The goal of Dr. Rogus-Pulia's proposed research is to develop effective dysphagia rehabilitative interventions for patients with AD at risk for adverse health consequences. Progressive-resistance lingual strengthening and saliva substitute are two interventions that have been shown in preliminary studies to positively influence swallowing function in older adults. This proposal will consist of a small, pilot randomized clinical trial to 1) determine the impact of two novel interventions on swallowing-related outcomes in patients with mild-moderate AD and 2) identify subgroups of patients most likely to benefit from these interventions. Patient- caregiver dyads will be randomized to lingual strengthening, saliva substitute use, a combination of the two, or usual care. Saliva and swallowing-related outcomes will be collected at baseline and following the 8 week intervention period. These data will support a larger, multi-site R01 funded study to determine effectiveness of these interventions for prevention of adverse health outcomes in patients with mild-moderate AD. As a junior faculty member at an institution with extensive infrastructure to support early stage investigators, Dr. Rogus- Pulia is in an ideal environment to complete the proposed research and pursue advanced training. Her career development plan includes both coursework and mentored training in the areas of 1) clinical trials design and analysis, 2) Alzheimer's disease clinical care and caregiving, 3) advanced statistical techniques, 4) implementation science, and 5) human factors and healthcare systems engineering. To ensure success, she has identified committed, expert mentors in these disciplines and secured protected time for this work. This award addresses a significant clinical dilemma and serious gap in AD research while affording the education and mentored research experience critical for Dr. Rogus-Pulia to lead an independent dysphagia research program.

项目总结/摘要 这个职业发展建议的目的是提供妮可Rogus-Pulia，博士，CCC-SLP，演讲- 威斯康星州大学的语言病理学家和吞咽困难（吞咽功能障碍）专家- 医学和公共卫生的麦迪逊学校与成功所需的培训作为一个独立的，临床医生- 研究干预措施以改善阿尔茨海默病（AD）患者吞咽困难护理的科学家。 AD患者经常出现吞咽困难，并导致严重的健康后果，包括 生活质量下降、照顾者负担、营养不良、肺炎和死亡率。的普通疗法 AD患者的吞咽困难采用补偿方法，改变推注流量以避免误吸 （食物或液体进入气道）。这些方法并没有带来持续的改善， 吞咽生理学，并经常对生活质量产生负面影响。目前没有有效的治疗方法， AD患者的吞咽困难，可以实际应用或对患者的生理学具有持久影响。 燕子Rogus-Pulia博士提出的研究目标是开发有效的吞咽障碍康复药物， 对有不良健康后果风险的AD患者进行干预。进行性阻力舌 强化和唾液替代品是两种干预措施，已在初步研究中显示， 积极影响老年人的吞咽功能。这项建议将包括一个小的，试点随机 临床试验：1）确定两种新型干预措施对患有吞咽相关疾病的患者的影响 轻度-中度AD和2）确定最有可能从这些干预措施中获益的患者亚组。病人- 护理者二人组将被随机分配到舌强化、唾液替代品使用、两者的组合，或 常规护理将在基线和8周后收集唾液和吞咽相关结局 干预期。这些数据将支持一项更大规模的多中心R 01资助的研究，以确定 这些干预措施用于预防轻中度AD患者的不良健康结果。作为一个初级 在一个拥有广泛基础设施的机构，以支持早期阶段的研究人员，博士Rogus教员- 普利亚是在一个理想的环境，以完成拟议的研究和追求先进的培训。她的职业生涯 发展计划包括以下领域的课程作业和指导培训：1）临床试验设计， 分析，2）阿尔茨海默病的临床护理和诊断，3）先进的统计技术，4） 实施科学，以及5）人为因素和医疗保健系统工程。为了确保成功，她 已经确定了这些学科的专家导师，并为这项工作提供了受保护的时间。这 该奖项解决了AD研究中的一个重大临床困境和严重差距，同时提供教育和 导师的研究经验对于Rogus-Pulia博士领导独立的吞咽困难研究计划至关重要。