Does vestibular loss predict falls in patients with Alzheimer's Disease?

前庭丧失是否预示着阿尔茨海默病患者会跌倒？

• 批准号: 9763435
• 负责人: Yuri Agrawal
• 金额: $ 41.44万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9763435
• 关键词: Age; Alzheimer' s Disease; Automobile Driving; Behavior; Calendar; Caregivers; Clinical Trials; Cognition; Cognitive; Data; Discrimination; Elderly; Enrollment; Equilibrium; Event; Evoked Potentials; Executive Dysfunction; Exercise; Fall prevention; Gait; Impaired cognition; Impairment; Incidence; Infrastructure; Intervention; Intervention Trial; Investigation; Labyrinth; Maps; Measures; Mediator of activation protein; Memory; Mental Depression; Morbidity - disease rate; Nursing Homes; Observational Study; Participant; Patients; Performance; Pharmaceutical Preparations; Physical therapy; Physiology; Prevalence; Process; Public Health; Research; Resources; Risk Factors; Rotation; Source; System; Testing; Text Messaging; Vestibular loss; Visit; Visual; Work; adjudication; base; caregiver strain; clinically significant; cognitive function; cognitive skill; cognitive testing; equilibration disorder; executive function; experience; fall risk; falls; follow-up; mortality; novel; primary outcome; recruit; spatial memory; therapy design; treatment center; way finding

Project summary This project investigates whether vestibular loss predicts falls in patients with Alzheimer’s disease (AD). The proposed research is an observational study of 150 patients with AD to evaluate the association between baseline vestibular function and 2-year incidence of falls. We will also explore whether vestibular function is associated with balance and gait function, as well as spatial cognitive function, as potential mechanisms by which vestibular function contributes to fall risk. Specifically, Aim 1 is to determine whether vestibular loss predicts falls in patients with mild-moderate AD. We hypothesize that poorer vestibular function at baseline predicts a higher 2-year incidence of falls. Additionally, we hypothesize that the attributable risk of falls associated with vestibular loss will be substantial enough (>~10%) to warrant further investigation of vestibular therapy as a clinically significant modifier of fall risk. Aim 2 is to evaluate whether vestibular loss in AD predicts impaired static and dynamic balance, measured using the Berg Balance Scale (BBS) and the Timed-Up-and-Go (TUG) test. We hypothesize that greater reduction in vestibular function over the 2-year follow-up period predicts greater decline in BBS and TUG performance. Aim 3 is to evaluate whether vestibular loss in AD predicts impaired spatial cognitive skills. We will administer cognitive tests of spatial cognition (including the Money Road Map test, the Card Rotations test, the Visual Form Discrimination test and the Clock Drawing test), and we will also query participants and caregivers about difficulty with driving, losing objects, getting lost and wandering behaviors as functional manifestations of impaired spatial cognition in AD patients. We hypothesize that greater reduction in vestibular function over the 2-year follow-up period predicts greater decline in spatial cognitive test scores, and a higher incidence of functional spatial cognitive impairment. Moreover, we hypothesize that impaired balance measures (from Aim 2) and impaired spatial cognitive skills will both be independent mediators of the association between vestibular loss and incident falls. To accomplish these aims, we will leverage well-established resources at Johns Hopkins including the Johns Hopkins Alzheimer’s Disease Research Center and the Memory and Alzheimer’s Treatment Center. Falls are a major source of morbidity in AD and current interventions are not uniformly effective. If our observational studies demonstrate that vestibular loss is associated with poorer balance and spatial cognition and incident falls, these results will inform the design of interventional trials to prevent falls in AD patients.

项目摘要 本项目研究前庭功能丧失是否预示着阿尔茨海默病（AD）患者的福尔斯。 这项拟议的研究是对150名AD患者进行的观察性研究，以评估 基线前庭功能和2年福尔斯发生率之间的关系。我们还将探讨前庭是否 功能与平衡和步态功能，以及空间认知功能，作为潜在的 前庭功能导致跌倒风险的机制。具体而言，目标1是确定 前庭丧失是否预示着轻中度AD患者的福尔斯。我们假设穷人 基线前庭功能预测2年内福尔斯发生率较高。此外，我们假设， 与前庭功能丧失相关的福尔斯跌倒的归因风险将足够大（>~10%）， 进一步研究前庭疗法作为跌倒风险的临床显著调节剂。目标2：评估 AD患者的前庭功能丧失是否预示着静态和动态平衡受损，使用贝格量表进行测量 平衡量表（BBS）和计时起立行走（TUG）测试。我们假设， 在2年随访期内前庭功能预测BBS和TUG性能的更大下降。 目的3是评估AD患者的前庭功能丧失是否预示着空间认知能力受损。我们将 管理空间认知的认知测试（包括金钱路线图测试，卡片旋转测试） 测试，视觉形式识别测试和时钟绘制测试），我们还将询问参与者 和照顾者关于驾驶困难，丢失物品，迷路和流浪行为， AD患者空间认知功能损害的临床表现。我们假设， 2年随访期内前庭功能下降预示着空间认知能力的更大下降 测试成绩，以及功能性空间认知障碍的发生率较高。此外，我们假设 受损的平衡测量（来自目标2）和受损的空间认知技能都是独立的 前庭损失和意外福尔斯之间的关联的介质。为了实现这些目标，我们将 充分利用约翰霍普金斯的资源，包括约翰霍普金斯阿尔茨海默病 研究中心和记忆和阿尔茨海默氏症治疗中心。福尔斯是 AD的发病率和目前的干预措施并不一致有效。如果我们的观察性研究 表明前庭丧失与较差的平衡和空间认知以及意外的福尔斯有关， 这些结果将为预防AD患者福尔斯跌倒的干预性试验的设计提供信息。