The Impact of Depression and Preclinical Alzheimer Disease on Driving Among Older Adults

抑郁症和临床前阿尔茨海默病对老年人驾驶的影响

• 批准号: 10188393
• 负责人: Ganesh M Babulal
• 金额: $ 121.57万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10188393
• 关键词: Acceleration; Accelerometer; Affect; Age-Years; Aging; Alzheimer' s Disease; Alzheimer’s disease biomarker; Amyloid; Antidepressive Agents; Area; Automobile Driving; Behavior; Biological Markers; Biostatistical Methods; Cerebrospinal Fluid; Cessation of life; Clinical; Cognition; Cognitive; Data; Dementia; Destinations; Diagnosis; Disease Progression; Elderly; Enrollment; Environment; Evaluation; Event; Exclusion Criteria; Exhibits; Goals; Habits; Health; Image; Individual; Infrastructure; Injury; International; Interview; Knowledge; Left; Longitudinal Studies; Major Depressive Disorder; Measures; Mental Depression; Methodology; Motor; Neuropsychological Tests; Outcome; Participant; Patient Self-Report; Patients; Performance; Persons; Pharmaceutical Preparations; Population; Proxy; Psychometrics; Questionnaires; Recording of previous events; Research; Risk; Risk Behaviors; Safety; Speed; Standardization; System; Testing; Time; United States; Vehicle crash; Visit; aged; aging brain; amyloid imaging; base; cohort; depressive symptoms; driving behavior; follow-up; health care availability; human old age (65+); imaging biomarker; multidisciplinary; neuroimaging marker; neuropsychiatry; older driver; pre-clinical; prospective; recruit; social engagement; synergism; tau Proteins; trend; unsafe driving

PROJECT SUMMARY/ABSTRACT Our long-term goal is to accurately identify who is at risk of decline in driving, to forecast when decline will occur, and to intervene before decline, thereby reducing the numbers of crashes, injuries, and death in older adults. Our findings indicate that the long preclinical stage of Alzheimer disease (AD), as reflected in amyloid imaging and cerebrospinal fluid (CSF) biomarkers among cognitively normal persons, is associated with poorer driving performance on a standardized road test. This project will assess how depression, preclinical AD, and antidepressants affect driving behavior in cognitively normal older adults (≥ 65 years). This research is significant because 36 million licensed drivers are aged 65 years or older, and the number of older adults in the United States is expected to double by 2050, when 1 in 4 drivers will be 65 years or older. Motor vehicle crashes are a leading cause of injury and death in older adults (814 daily crashes). Driving is a cognitively demanding and highly dynamic activity. Depression and symptomatic AD independently increase the risk of an automobile crash. Depression is also a factor for conversion to symptomatic AD, yet it is often used as an exclusion criterion for aging studies. The adverse impact of depression and antidepressant use on driving, and the impact of depression on AD is documented; yet an understanding of the synergy between these three areas is lacking. Our Specific Aims will (1) characterize the relationship between major depression (diagnosis) and naturalistic driving behavior in a prospective, longitudinal study, (2) examine whether major depression and preclinical AD, combined, predict faster longitudinal change in driving behavior among older adults, (3) assess the impact of medications (antidepressants), major depression, and preclinical AD on naturalistic driving. To test these Specific Aims, we have assembled a multidisciplinary team with expertise in AD, depression, neuroimaging biomarkers, CSF biomarkers, naturalistic driving, cognitive and brain aging, and longitudinal biostatistical methods. We will capitalize on existing infrastructure to follow 70 currently enrolled individuals and enroll an additional 70 participants with depression, to create a cohort of 140 individuals. This cohort will utilize a naturalistic driving methodology that will capture their driving behaviors on an everyday basis. Their cognition will be tested annually using the Clinical Dementia Rating and various psychometric measures. Participant depression will be characterized using the Mini-International Neuropsychiatric Interview (MINI) and the 9-item Patient Health Questionnaire (PHQ-9). Once obtained, this knowledge can be used to create stage-appropriate, personalized, driving-related safety strategies that can be implemented upon diagnosis, and adjusted throughout disease progression.

项目概要/摘要 我们的长期目标是准确识别哪些人面临驾驶能力下降的风险，并预测驾驶能力下降的时间 会发生，并在下降之前进行干预，从而减少事故、受伤和死亡的数量 老年人。我们的研究结果表明，阿尔茨海默病 (AD) 的长期临床前阶段，如 认知正常人中淀粉样蛋白成像和脑脊液 (CSF) 生物标志物相关 在标准化道路测试中驾驶表现较差。该项目将评估抑郁症如何 临床前 AD 和抗抑郁药会影响认知正常的老年人（≥ 65 岁）的驾驶行为。 这项研究意义重大，因为 3600 万持有执照的驾驶员年龄在 65 岁或以上，而且 到 2050 年，美国老年人数量预计将增加一倍，届时四分之一的驾驶员将年满 65 岁 或更老。机动车碰撞事故是老年人受伤和死亡的主要原因（每天 814 起碰撞事故）。 驾驶是一项认知要求高且高度动态的活动。抑郁症和症状性 AD 独立 增加车祸的风险。抑郁症也是转化为症状性 AD 的一个因素，但它是 通常用作衰老研究的排除标准。抑郁症和抗抑郁药的不利影响 驾驶时的使用，以及抑郁症对 AD 的影响都有记录；但对协同作用的理解 这三个领域之间缺乏。 我们的具体目标将 (1) 描述重度抑郁症（诊断）与 在一项前瞻性、纵向研究中的自然驾驶行为，(2) 检验重度抑郁症和 临床前 AD 综合预测老年人驾驶行为的更快纵向变化，(3) 评估 药物（抗抑郁药）、重度抑郁症和临床前 AD 对自然驾驶的影响。 为了测试这些具体目标，我们组建了一支具有 AD 专业知识的多学科团队， 抑郁症、神经影像生物标志物、脑脊液生物标志物、自然驾驶、认知和大脑衰老，以及 纵向生物统计方法。我们将利用现有基础设施来追踪目前注册的 70 名学生 并招募了另外 70 名患有抑郁症的参与者，以创建一个由 140 人组成的队列。这 队列将利用自然主义驾驶方法来捕捉他们每天的驾驶行为 基础。他们的认知能力将每年使用临床痴呆评级和各种心理测量进行测试 措施。将使用小型国际神经精神病学访谈来描述参与者的抑郁症特征 (MINI) 和 9 项患者健康调查问卷 (PHQ-9)。 一旦获得，这些知识可用于创建适合舞台的、个性化的、与驾驶相关的 可以在诊断后实施并在疾病进展过程中进行调整的安全策略。