Addressing Hearing Loss as a Common Unmet Contributor to Neuropsychiatric Symptoms

解决听力损失作为神经精神症状的常见未得到解决的原因

• 批准号: 10641903
• 负责人: CARRIE L NIEMAN
• 金额: $ 80.69万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641903
• 关键词: Address; Admission activity; Adult; Adverse event; Age; Agitation; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Ambulatory Care; Attenuated; Behavior Therapy; Caring; Characteristics; Clinic; Clinical; Communication; Communication impairment; Consultations; Control Groups; Dementia; Devices; Disease; Disease Progression; Distress; Elderly; Elements; Ensure; Environmental Risk Factor; Equation; Equipment and supply inventories; Ethnic Origin; Etiology; Exposure to; Goals; Health; Hearing; Hearing Aids; Hearing Tests; Heterogeneity; High Prevalence; Home; Impaired cognition; Individual; Institution; Intervention; Interview; Knowledge; Link; Maintenance; Manuals; Measures; Mental Depression; Methodology; Methods; Modeling; Nature; Nursing Homes; Outcome; Outcome Measure; Outpatients; Patients; Perception; Personal Satisfaction; Pharmaceutical Preparations; Pilot Projects; Presbycusis; Prevalence; Process; Protocols documentation; Public Health; Quality of life; Questionnaires; Race; Randomized, Controlled Trials; Recommendation; Research; Role; Safety; Series; Severities; Sleep disturbances; Specific qualifier value; Structure; Surveys; Symptoms; Target Populations; Technology; Testing; Therapeutic; Time; Translating; Waiting Lists; Work; cohort; comorbidity; cost; dementia care; efficacy trial; experience; functional decline; hearing impairment; holistic approach; human old age (65+); implementation barriers; improved; innovation; insight; intervention refinement; mild cognitive impairment; neuropsychiatric symptom; neuropsychiatry; post intervention; primary outcome; recruit; reduce symptoms; responders and non-responders; response; socioeconomics; symptom management; tertiary prevention; theories; therapy design

PROJECT SUMMARY As the number of adults age 65 and older continue to increase, the prevalence of Alzheimer’s disease and other related dementias (ADRD) is also expected to increase in the U.S. Neuropsychiatric symptoms (NPS) such as agitation, apathy, depression, and sleep disturbance are highly prevalent in patients with ADRD, with up to 97% of the individuals suffering at least one NPS over the disease course. NPS requires considerable management and time by care partners, and are associated with rapid cognitive and functional decline, worse quality of life, greater care partner burden, and earlier nursing home admissions. Although nonpharmacological intervention for NPS is recommended, psychotropic medications continue to be widely prescribed, resulting in adverse events. Similar to ADRD, the prevalence of hearing loss increases with age. However, hearing care as tertiary prevention for older adults who have already developed cognitive impairment has largely been ignored. MPIs and the Co-Is of the current proposal have been working together for many years, demonstrating that i) there is a high prevalence of hearing loss among indiviudals with mild cognitive impairment (MCI) and ADRD, ii) increasing severity of hearing loss is associated with greater number of NPS and NPS severity, and that iii) a user-centered hearing care intervention that utilizes emerging over-the-counter (OTC) hearing technology may ameliorate NPS. The current proposal is based upon a prior NIA Stage 1b trial that involved an initial pilot study of a hearing care intervention that utilized OTC hearing devices and was delivered in an outpatient setting. The proposed study returns to Stage 1a and 1b to refine and test the preliminary efficacy of a revised hearing care intervention strategy that targets NPS and examines the underlying mechanism(s) of action. Aim 1 seeks to refine the hearing care intervention through a Stage 1a study that involves consultation with experts and end-users to develop a revised intervention protocol that integrates the latest evidence-informed approaches to NPS along with alignment with theoretical frameworks, consideration of implementation challenges encountered in the initial pilot study, and the ability to deliver the intervention in various settings, including the home. Aim 2 will then assess the preliminary efficacy of the revised hearing care intervention through a larger Stage 1b randomized controlled trial, which will allow for greater rigor in assessing the intervention than prior work. Aim 3 will employ a mixed methods approach to characterize response heterogeneity and underlying mechanism(s) of action. The proposed study embraces the iterative and multidirectional nature of the NIA Stage Model with the goal of developing impactful behavioral interventions that reach the maximum level of potency and potentially implementable to the maximum number of older adults. This proposal builds critical foundational knowledge regarding the role of hearing care as an integral component of managing NPS. These findings will directly translate to a larger Stage 2/3 efficacy trial.

项目摘要 随着65岁及以上的成年人数量继续增加，阿尔茨海默病的患病率和 其他相关痴呆（ADRD）预计也将在美国增加。 例如激越、冷漠、抑郁和睡眠障碍在ADRD患者中非常普遍， 高达97%的个体在疾病过程中遭受至少一次癫痫。这需要相当大的 护理伙伴的管理和时间，并与快速认知和功能下降，更糟 生活质量，更大的护理伴侣负担，以及更早的养老院入院。虽然非药理学 虽然建议对精神病进行干预，但精神药物继续被广泛使用， 不良事件。与ADRD相似，听力损失的患病率随着年龄的增长而增加。听力保健作为 对已经出现认知障碍的老年人的三级预防在很大程度上被忽视了。 本提案中的MPI和Co-Is已经合作多年，证明i） 在轻度认知障碍（MCI）和ADRD患者中听力损失的患病率很高， ii）听力损失的严重程度增加与更大数量的听力损失和听力损失严重程度相关，并且iii）a 利用新兴的非处方（OTC）听力技术的以用户为中心的听力护理干预可以 改善的目前的建议是基于先前的NIA第1b阶段试验，该试验涉及初始试点 一项使用OTC助听器并在门诊患者中进行的听力护理干预研究 设置.拟议的研究返回到第1a和1b阶段，以完善和测试经修订的 听力保健干预策略，以听力障碍为目标，并检查潜在的作用机制。目的 1旨在通过第1a阶段研究（包括咨询专家）来完善听力护理干预措施 和最终用户制定一个修订的干预协议，整合最新的证据， 沿着与理论框架保持一致的方法，考虑实施 在最初的试点研究中遇到的挑战，以及在各种环境中提供干预的能力， 包括家里。目标2将评估修订后的听力保健干预措施的初步疗效 通过一项更大的1b期随机对照试验，这将允许更严格地评估 比以前的工作。目标3将采用混合方法来描述缓解特征 异质性和潜在作用机制。拟议的研究包括迭代和 NIA阶段模型的多向性，目标是制定有影响力的行为干预措施 达到最高水平的效力和潜在的实施，以最大数量的老年人， 成年人了该提案建立了关于听力保健作为一个整体的作用的关键基础知识， 管理的组成部分。这些发现将直接转化为更大规模的2/3期疗效试验。

项目成果

ACR Appropriateness Criteria® Tinnitus: 2023 Update.

• DOI: 10.1016/j.jacr.2023.08.017
• 发表时间: 2023-11
• 期刊: Journal of the American College of Radiology : JACR
• 作者: Vikas Jain;B. Policeni;A. Juliano;O. Adunka;Mohit Agarwal;Prachi Dubey;Elliott R Friedman;M. Gule-Monroe;Mari Hagiwara;Christopher H Hunt;Bruce M Lo;Esther S Oh;Tanya J Rath;J. K. Roberts;David Schultz;M. R. Taheri;D. Zander;Judah Burns