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Cognitive and Physical Exercise to Improve Outcomes after Surgery in the Elderly

认知和身体锻炼可改善老年人手术后的结果

基本信息

批准号：
10355502
负责人：
Christopher Hughes
金额：
$ 83.17万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10355502
关键词：
Activities of Daily Living Acute Age Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk Anatomy Anesthesia procedures Attention Biological Markers Blood Blood - brain barrier anatomy Brain Clinical Cognition Cognitive Cognitive aging Cognitive deficits Computers Critical Illness Data Delirium Dementia Elderly Endothelium Evaluation Exercise Exhibits Functional Magnetic Resonance Imaging Functional disorder Health education Hospitalization Hospitals Impaired cognition Individual Injury Intervention Lead Life Link Medical Mental Depression Mind Older Population Operative Surgical Procedures Outcome Patients Perioperative Physical Exercise Physical Function Physical Rehabilitation Physical therapy Plasma Population Postoperative Period Process Public Health Quality of life Randomized Recommendation Rehabilitation therapy Research Sedation procedure Subgroup Survivors Testing Time Training Training Programs United States National Institutes of Health active control base blood-brain barrier function cerebral atrophy cognitive disability cognitive function cognitive rehabilitation cognitive training computer game computerized disability frailty functional decline functional disability functional outcomes functional status high risk improved improved outcome memory process multitask neuroimaging preservation prevent processing speed programs response stressor success white matter

项目摘要

Project Summary Cognitive decline with aging, including Alzheimer's Disease and Related Dementias (ADRD), is a public health imperative that impacts quality of life and disability. Survivors of acute surgical or medical illness contribute greatly to the crisis of cognitive decline. Hospitalization confers a 1.5-2-fold increase in the odds of new onset dementia. Furthermore, over a third of critically ill patients have new ADRD by 1 year. Major risk factors for ADRD after acute illness include pre-illness frailty and cognitive deficits and delirium in the hospital. Endothelial and blood brain barrier (BBB) dysfunction, cerebral atrophy, and white matter connectivity changes have all been linked to delirium and ADRD. Surgery is common in older adults but it (and its resulting hospitalization) is associated with significant cognitive decline. Individual interventions to reduce this decline have exhibited limited success. Prehabilitation is the process of enhancing capacity and reserve before an acute stressor to improve tolerance of the upcoming insult. Older major surgical patients provide an ideal population for prehabilitation. These patients have lead time prior to surgery, are frequently frail, have prolonged post-surgery ICU and hospital courses, and are at high risk for new ADRD. Prehabilitation studies to date have primarily focused on physical training to improve physical outcomes. Combined physical and computer-based cognitive training programs have been associated with significant improvements in global cognitive function, and computerized brain training exercises have demonstrated enhancement in memory, processing speed, and multitasking. This training, however, has not been examined in surgical or hospitalized patients. We have demonstrated that cognitive training and physical exercises are feasible prior to major surgery and in the hospital, that a combined cognitive and physical rehabilitation program after discharge can reduce ADRD, and that a computerized cognitive rehabilitation program can improve multiple cognitive domains in ICU survivors. Further, exercise enhances endothelial and BBB function, reduces cerebral atrophy, and increases functional connectivity, providing potential mechanistic basis for these improvements. Thus, a comprehensive mind and body training program prior to (prehabilitation), during, and after (rehabilitation) hospitalization may be most effective in reducing ADRD and disability after major surgery but has yet to be evaluated. The main hypothesis of the COgnitive and Physical Exercise to improve Outcomes after Surgery (COPE-iOS) study is that a program of cognitive and physical training throughout the perioperative period will improve long-term cognitive and disability outcomes in older surgical patients at high risk for decline. We will randomize 250 patients ≥60 years old undergoing elective major non-cardiac surgery with expected hospitalization >3 days to a comprehensive training program or to active control prior to surgery, during the surgical hospitalization, and after discharge. We will assess global cognition (Aim 1), disability (Aim 2), and plasma biomarkers and neuroimaging (Aim 3) at baseline and up to 12 months after discharge.

项目总结