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INtervention for Cognitive Reserve Enhancement in delaying the onset of Alzheimer’s Symptomatic Expression: The INCREASE study

认知储备增强干预可延缓阿尔茨海默病症状表现的发作：INCREASE 研究

基本信息

批准号：
9890996
负责人：
GREGORY A JICHA
金额：
$ 25.46万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-15 至 2021-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9890996
关键词：
Address Adverse drug effect Aerobic Exercise Affect Alzheimer&apos s Disease Alzheimer&apos s disease pathology Alzheimer&apos s disease risk American Amyloid beta-Protein Anti-Cholinergics Beer Biological Brain Clinical Cognitive Communities Complex Data Dementia Diet Disease Disease Progression Drug usage Elderly Enrollment Health Health Care Costs Health Expenditures Impaired cognition Intervention Intervention Trial Measures Medical Medication Management Neurocognitive Neurofibrillary Tangles Onset of illness Outcome Measure Pathologic Patients Pharmaceutical Preparations Pharmacists Pharmacology Pharmacy facility Phase Physicians Population Positron-Emission Tomography Prevalence Prevention strategy Public Health Reporting Research Scopolamine Senile Plaques Societies Standardization Symptoms Testing Time United States aging population base clinical practice cognitive reserve comorbidity disability exhaust functional decline human old age (65+)indexing insight non-demented older patient patient oriented placebo group post intervention pre-clinical preservation primary outcome psychosocial public health relevance randomized placebo controlled trial randomized trial stressor therapy design uptake β-amyloid burden

项目摘要

Alzheimer's disease (AD) represents one of the most important public health issues our society is facing today. An estimated 5 million people age 65 and older in the United States (US) are currently living with AD, and this number may nearly triple by 2050. To address this impeding population burden, the National Alzheimer's Project Act (NAPA) 2015 report emphasized the need for identifying preventive strategies that can delay symptomatic disease onset. While much emphasis has been placed on developing and testing effective disease-modifying strategies targeting this asymptomatic preclinical phase of AD (pAD), little emphasis has been placed on currently available strategies that target cognitive reserve, resulting in (1) delaying symptom onset, (2) shortening the overall course of symptomatic disease, and (3) substantially reducing the financial and societal impact of AD. We hypothesize that targeted reductions in inappropriate medication use (Beers Criteria 2015), will bolster cognitive reserve in subjects at risk for AD, delaying the onset of clinical symptoms, and reducing the prevalence and duration of symptomatic disease. The impact of this strategy, if successful, includes a dramatic reduction in overall health care expenditures for the millions affected by AD by delaying the symptomatic phase of disease in accord with NAPA aims. Our specific aims are: Specific Aim 1. Conduct a 12-month, randomized, placebo-controlled trial to evaluate the impact of our patient- centered, pharmacist-physician team MTM intervention in reducing unnecessary and inappropriate medication use in community-dwelling, elderly, non-demented subjects. Primary outcome measures will include pre- to post- intervention measures of: (1) use of inappropriate medications as measured by the Medication Appropriateness Index (MAI); 2) Cognitive Reserve Change Score (CRCS) defined as the difference in the scopolamine- challenged vs unchallenged measures on the neurocognitive score. Specific Aim 2 Evaluate the impact of preclinical amyloid burden on cognitive reserve deficits and decline (measured as CRCS) to evaluate efficacy of delaying symptomatic disease progression in pAD. While not eliminating AD or shortening duration of biological disease, the delay in symptom onset and progression to functional decline resulting from reduction in inappropriate medication use could lessen AD prevalence and significantly reduce healthcare expenditures related to not only AD, but potentially all forms of dementia involving a prodromal asymptomatic period. Study results would enable the larger implementation of similar medication management strategies in clinical practice to address the need for multifaceted preventive strategies to maintain cognitive health in the aging population.

阿尔茨海默病（AD）是当今社会面临的最重要的公共卫生问题之一。