Decreasing Alzheimer's Disease and Related Dementias after Delirium-Exercise and Cognitive Training (DDD-ECT)

项目摘要 每年有200多万美国老年人(65岁及以上)患有精神错乱 在他们入住重症监护病房(ICU)期间。在危重疾病的管理方面取得了进展 危重疾病存活率，特别是在老年人中。然而，多达70%的ICU老年幸存者 有精神错乱发作的人会留下新获得的认知障碍，这种认知障碍可能会导致长期的残疾- 对患者和他们的非正式照顾者的长期后果。 目前，还没有有效和可扩展的康复模式来补救或治疗ICU获得性认知 老年ICU这一日益增长的群体的损害及其对生活质量和独立性的有害影响 幸存者。在过去的五年里，印第安纳大学老龄化中心的跨学科科学家团队 研究开发了一种新颖的、基于家庭的认知和体育锻炼计划，以减少社会负担 认知障碍的影响。该研究小组提议进行一项随机对照试验，名为 减少妄想运动和认知训练后的阿尔茨海默病和相关痴呆 (DDD-ECT)“以评估12周综合体育锻炼和认知训练的效果 印第安纳州中部老年ICU幸存者认知功能主要结局的干预 在ICU期间出现了一次精神错乱。重要的是，我们建议通过一个 辅导员主导的小组形式，使用支持互联网的多方视频会议直接传送到 参与者的家。 这项试验的目的如下： 1.确定体育锻炼与认知训练相结合对大鼠认知功能的影响 老年ICU存活者分别进行3个月和6个月的随访。 2.确定体育锻炼与认知训练相结合对体能的影响； 在3个月和6个月的随访中，老年ICU幸存者的焦虑和抑郁症状以及生活质量。 3.探讨联合训练的作用机制。 上述目标的实现将为改善认知结果提供有效的治疗方法。 在ICU幸存者中，并强调了涉及的神经生物学途径。这些发现将有助于 推动这一领域朝着减轻阿尔茨海默病和相关痴呆症的负担迈进。

PROJECT ABSTRACT Every year, more than two million older Americans (aged 65 and older) suffer from an episode of delirium during their intensive care unit (ICU) stay. Advances in the management of critical illness have improved critical illness survival rates especially among older adults. However, as many as 70% of ICU older survivors who had an episode of delirium are left with newly acquired cognitive impairment that can have disabling long- term consequences for both patients and their informal caregivers. Currently, there are no effective and scalable recovery models to remediate or treat ICU acquired cognitive impairment and its deleterious effects on quality of life and independence of this growing segment of older ICU survivors. Over the past five years, interdisciplinary team of scientists at Indiana University Center for Aging Research developed a novel, home-based cognitive and physical exercise program to reduce the societal impact of cognitive impairment. The team is proposing to conduct a randomized controlled trial (RCT) called “Decreasing Alzheimer's Disease and Related Dementias after Delirium-Exercise and Cognitive Training (DDD-ECT)” to evaluate the efficacy of 12 weeks of combined physical exercise and cognitive training intervention on the primary outcome of cognitive function among older ICU survivors in central Indiana who had an episode of delirium during their ICU stay. Importantly, we propose to deliver these interventions via a facilitator-led, small group format using internet-enabled, multiparty-videoconference delivered directly into the participants' homes. The trial has the following aims: 1. Determine the effect of the combined physical exercise and cognitive training on the cognitive function of older ICU survivors at 3 and 6-months follow-up. 2. Determine the effect of the combined physical exercise and cognitive training on physical performance, anxiety and depressive symptoms, and quality of life of older ICU survivors at 3 and 6-months follow-up. 3. To examine the mechanisms of action of combined training. Achievement of the aforementioned aims will provide an efficacious therapy to improve cognitive outcomes among ICU survivors along with highlighting the involved neurobiological pathways. The findings will aid in moving the field forward towards reducing the burden of Alzheimer's disease and related dementias.