BRAIN-ICU-2 Study: Bringing to Light the Risk Factors And Incidence of Neuropsychological Dysfunction (Dementia) in ICU Survivors, 2nd Study

项目摘要 在因呼吸衰竭或休克而紧急进入重症监护室（ICU）的患者中，50%至70% 出现谵妄（迄今为止在任何医疗保健环境中最高）。这种精神错乱的持续时间 预测更早的死亡，更长的住院时间和每年更高的医疗费用。ICU患者谵妄 已被证明是发展长期认知障碍的最强的潜在可改变的风险因素。 这是一种类似于中度至重度阿尔茨海默病和相关痴呆（ADRD）的疾病。 因此，使用呼吸机或休克的内科和外科ICU患者是研究 谵妄和痴呆的关系我们的NIA资助，NEJM出版，PAR-18-029引用了BRAIN- ICU-1研究[揭示ICU中神经心理功能障碍的危险因素和发病率] 幸存者，第一项研究]显示，超过三分之一的ICU幸存者（没有预先存在的痴呆症）出现了 1年时新发认知障碍或ADRD。一些BRAIN-ICU-1患者的认知恢复力 ADRD，但其他人发展为持续性或进行性痴呆样疾病。我们渴望发展 针对这种ICU相关痴呆症的干预措施，但由于对这种形式的脑损伤了解不多， 非常有限。现在，我们有飞行员神经成像（MRI）数据显示，急性ICU谵妄与以下因素有关： 整个大脑、额叶和海马体萎缩，但这个问题需要深入研究。 我们知道异常的脑蛋白（淀粉样蛋白，tau蛋白）与阿尔茨海默病有关，然而，我们几乎知道， 没有任何关于蛋白质病理学或其他原因的ICU相关痴呆症。理解为什么 ICU幸存者正在失去工作，以及作为家庭女族长和族长的领导。这 BRAIN-ICU-2研究[揭示神经心理功能障碍的危险因素和发病率 ICU幸存者中的痴呆（第2次研究）]直接响应PAR-18-029，并将决定ICU患者的 脑功能衰退、维持或恢复的主要途径。我们将回答知识的差距， ICU后脑病的长期结局，通过随访最初ICU中剩余的幸存者 BRAIN-ICU-1研究，首次进行完整的认知测试，长达14年（AIM 1）。我们同意 并在范德比尔特和拉什大学（即，新的ICU队列），并确定如何 详细的神经成像和脑脊液样本可以帮助揭示损伤的位置和机制 超出了我们从原始研究（AIM 2）中收集的临床信息中了解到的。重要的是我们 正在与世界著名的拉什阿尔茨海默病研究中心脑库计划合作， 所有参加目标1和2的患者都将能够将他们的大脑捐献给科学， 对那些患有和未患有ICU后痴呆的患者进行病理学研究，以正式定义这种疾病（AIM 3）。

Project Summary Of people admitted emergently to the Intensive Care Unit (ICU) in respiratory failure or shock, 50% to 70% develop delirium (by far the highest in any healthcare setting). The duration of this delirium independently predicts earlier death, longer hospital stay, and higher healthcare expenses annually. Delirium in ICU patients has been shown to be the strongest potentially modifiable risk factor for development of a long-term cognitive impairment, which resembles moderate to severe Alzheimer’s Disease and Related Dementias (ADRDs). Thus, medical and surgical ICU patients on ventilators or in shock are a prime population in whom to study the relationship between delirium and dementia. Our NIA-funded, NEJM published, and PAR-18-029 cited BRAIN- ICU-1 study [Bringing to light the Risk factors And Incidence of Neuropsychological dysfunction in ICU Survivors, 1st Study] showed over that one-third of ICU survivors (without preexisting dementia) emerged with new cognitive impairments or ADRD at 1 year. Some BRAIN-ICU-1 patients had cognitive resilience against ADRD, but others developed a persistent or progressive dementia-like illness. We are eager to develop interventions against this ICU-related dementia, but without knowing more about this form of brain injury, we are very limited. Now, we have pilot neuroimaging (MRI) data show that acute ICU delirium is associated with atrophy of the whole brain, frontal lobe, and hippocampus, but this problem requires an in-depth investigation. We know abnormal brain proteins (amyloid, tau) relate to Alzheimer’s disease, however, we know nearly nothing about protein pathology or other causes of this ICU-related dementia. It is critical to understand why ICU survivors are losing their jobs, and the leadership as matriarchs and patriarchs of their families. This BRAIN-ICU-2 study [Bringing to light the Risk factors And Incidence of Neuropsychological dysfunction (dementia) in ICU Survivors, 2nd Study] is in direct response to PAR-18-029 and will determine ICU patients’ main paths to decline, maintenance, or recovery of brain function. We will answer gaps in knowledge about long-term outcome of post-ICU brain disease by following the remaining ICU survivors from the original BRAIN-ICU-1 study with complete cognitive testing for the first time ever to 14 years (AIM 1). We will consent and enroll 567 new ICU patients at Vanderbilt and Rush Universities (i.e., new ICU cohort) and determine how detailed neuroimaging and cerebrospinal fluid samples can help reveal locations and mechanisms of injury beyond what we learned from the clinical information collected in our original study (AIM 2). Importantly, we are partnering with the world-renowned Rush Alzheimer's Disease Research Center brain bank program so that all patients enrolled in Aims 1 and 2 will able to donate their brains to science for the first-ever in-depth pathological study of those who do and do not get post-ICU dementia to define this disease formally (AIM 3).