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: 9915832
• 负责人: Yuri Agrawal
• 金额: $ 40.34万
• 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/9915832
• 关键词: Age; Alzheimer' s Disease; Alzheimer' s disease patient; 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.

项目总结 该项目调查阿尔茨海默病(AD)患者前庭缺失是否预示跌倒。 这项拟议的研究是对150名AD患者进行的观察性研究，以评估这种联系 基线前庭功能和两年内跌倒发生率之间的关系。我们还将探索前庭是否 功能与平衡和步态功能以及空间认知功能作为潜能联系在一起 前庭功能导致跌倒风险的机制。具体地说，目标1是确定 前庭丧失是否预示轻中度AD患者的跌倒。我们假设更贫穷的人 前庭功能在基线时预示着2年内较高的跌倒发生率。此外，我们假设 与前庭缺失相关的跌倒归因性风险将足够大(~10%)，以保证 前庭疗法作为跌倒风险的临床重要修饰物的进一步研究。目标2是评估 阿尔茨海默病患者前庭功能丧失是否预示静态和动态平衡受损 平衡量表(BBS)和计时起跑(TUG)测试。我们假设更大幅度的减少 在两年的随访期内，前庭功能预示着BBS和TUG性能的更大下降。 目的3是评估AD患者前庭缺失是否预示空间认知能力受损。我们会 管理空间认知的认知测试(包括货币路线图测试、卡片旋转 测试、视觉形状辨别测试和钟画测试)，我们还将询问参与者 以及照顾者对驾驶困难、丢失物品、迷路和走失行为的担忧 阿尔茨海默病患者空间认知功能损害的功能表现我们假设更大的 两年随访期前庭功能减退预示空间认知功能下降幅度更大 测试分数越高，功能性空间认知障碍的发生率越高。此外，我们假设 平衡能力受损(来自目标2)和空间认知能力受损都将是独立的 前庭缺失和意外跌倒之间关系的中介。为了实现这些目标，我们将 利用约翰霍普金斯大学完善的资源，包括约翰霍普金斯阿尔茨海默氏症 研究中心和记忆和阿尔茨海默氏症治疗中心。瀑布是一个主要来源 AD的发病率和目前的干预措施并不是一致有效的。如果我们的观测研究 证明前庭丧失与较差的平衡、空间认知和意外跌倒有关， 这些结果将为AD患者预防跌倒的干预性试验设计提供参考。