A Multi-Modal Combination Intervention to Promote Cognitive Function in Older Intensive Care Unit Survivors

促进老年重症监护病房幸存者认知功能的多模式组合干预

• 批准号: 10662893
• 负责人: Maya Elias
• 金额: $ 14.95万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662893
• 关键词: Adult; Affect; Age; Alzheimer' s disease related dementia; Behavior Therapy; Behavioral; Biological; Body Temperature; COVID-19; Chronotherapy; Circadian Rhythms; Clinical; Clinical Trials; Clinical Trials Design; Cognition; Cognitive; Cohort Studies; Critical Care; Critical Illness; Data; Delirium; Development; Distress; Dose; Earplug; Educational Intervention; Elderly; Enrollment; Ensure; Equation; Eye; Foundations; Funding; Future; Goals; Grant; Heart failure; Hip Fractures; Hospitalization; Hospitals; Impaired cognition; Individual; Intensive Care; Intensive Care Units; Intervention; Intervention Trial; K-Series Research Career Programs; Knowledge; Malignant Neoplasms; Masks; Mediating; Mentored Patient-Oriented Research Career Development Award; Methodology; Modeling; Obstructive Sleep Apnea; Outcome; Outcome Study; Participant; Patients; Pharmaceutical Preparations; Polysomnography; Postdoctoral Fellow; Principal Investigator; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Research; Risk Reduction; Sample Size; Science; Series; Severities; Severity of illness; Sleep; Sleep Deprivation; Sleep disturbances; Statistical Data Interpretation; Sum; Survivors; Symptoms; Syndrome; Testing; Training; Training Activity; Treatment Efficacy; United States National Institutes of Health; actigraphy; active control; circadian; cognitive function; cognitive training; computerized; design; executive function; experience; high risk; improved; improved outcome; intervention effect; multimodality; post-doctoral training; prevent; programs; psychological outcomes; risk mitigation; sex; symptom management; symptom science; symptomatic improvement; wearable sensor technology

The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare the candidate, Dr. Maya Elias, for an independent program of geriatric critical care research. More than 60% of intensive care unit (ICU) patients are adults ages 60 and older. Following hospital discharge, about 25% of ICU survivors experience cognitive impairment comparable in severity to mild Alzheimer’s disease and related dementias. Moreover, ICU survivors often experience sleep disturbances and inactivity, and almost 80% of ICU patients experience disturbances in circadian rhythm, which may affect cognitive function. The scientific premises of the proposed study are: 1) a combined sleep promotion and cognitive training intervention will have synergistic effects to mitigate the risk of cognitive impairment and development of Alzheimer’s disease and related dementias in older ICU survivors; and 2) chronotherapeutic timing of interventions (i.e., adjusting timing of interventions according to circadian rhythm profiles) may improve intervention efficacy. The proposed research and training build upon prior NIH-funded postdoctoral research conducted by Dr. Elias (F32NR018585). Training Aim 1 will develop expertise in designing and refining behavioral sleep and cognitive interventions through training in clinical trial methodologies and statistical analyses. Training Aim 2 will expand knowledge of circadian science and chronotherapy to examine circadian rhythm as a mechanistic factor underlying delirium and cognitive decline related to Alzheimer’s disease and related dementias in older ICU survivors. This Career Development Award will also support Dr. Elias to lead a clinical trial, which will evaluate feasibility of existing behavioral sleep and cognitive interventions to inform the design of a larger randomized controlled trial. Using a 2 x 2 factorial design, 100 English- or Spanish-speaking older ICU survivors will be enrolled after discharge out of the ICU and randomized to one of 4 combinations of two interventions: SLEEP [nighttime use of earplugs and eye masks] and COG [daily computerized cognitive training sessions]. Specific Aim 1 will test the separate and combined effects of SLEEP and COG, versus AC [active control], in improving cognitive function for older ICU survivors. Specific Aim 2 will examine circadian rhythm parameters of continuous body temperature to determine the optimal window for timing of the COG intervention. Specific Aim 3 will examine if the effects of each intervention [SLEEP + COG, SLEEP, COG] on cognitive function are mediated by sleep and activity, and will examine if selected biological and clinical factors moderate the intervention effects. Exploratory Aim 4 will explore the effect of each intervention on cognitive function at 1 month and incident Alzheimer’s disease and related dementias at 6 months and 12 months after hospital discharge. Results will yield crucial preliminary data for future clinical trials and will guide Dr. Elias to establish a program of research testing interventions that will improve outcomes for older ICU survivors throughout recovery from critical illness.

这项以患者为导向的导师研究职业发展奖的目的是为候选人玛雅·伊莱亚斯博士为老年危重护理研究的独立项目做准备。超过60%的重症监护病房(ICU)患者是60岁及以上的成年人。出院后，大约25%的ICU幸存者经历了与轻度阿尔茨海默病和相关痴呆相当的严重认知障碍。此外，ICU幸存者经常经历睡眠障碍和缺乏活动，几乎80%的ICU患者经历昼夜节律紊乱，这可能会影响认知功能。这项拟议研究的科学前提是：1)促进睡眠和认知训练相结合的干预将具有协同效应，以减轻老年ICU幸存者的认知损害和阿尔茨海默病及相关痴呆的风险；以及2)干预的时间治疗时机(即根据昼夜节律曲线调整干预时间)可能会提高干预效果。拟议的研究和培训建立在先前由NIH资助的由Elias博士(F32NR018585)进行的博士后研究的基础上。培训目标1将通过临床试验方法学和统计分析方面的培训，发展设计和改进行为睡眠和认知干预的专业知识。培训目标2将扩展昼夜节律科学和时间疗法的知识，以研究昼夜节律是导致老年ICU幸存者阿尔茨海默病和相关痴呆的精神错乱和认知衰退的机制因素。这项职业发展奖还将支持伊莱亚斯博士领导一项临床试验，该试验将评估现有行为睡眠和认知干预的可行性，为更大规模的随机对照试验的设计提供信息。采用2×2析因设计，100名讲英语或西班牙语的老年ICU幸存者将在出院后登记，并随机分为两种干预措施的4种组合之一：睡眠[夜间使用耳塞和眼罩]和COG[每日计算机化认知训练课程]。具体目标1将测试睡眠和COG与AC[主动控制]在改善老年ICU幸存者认知功能方面的单独和联合影响。具体目标2将检查连续体温的昼夜节律参数，以确定COG干预的最佳时机。具体目标3将检查每种干预[睡眠+COG，睡眠，COG]对认知功能的影响是否通过睡眠和活动来调节，并将检查选定的生物和临床因素是否调节了干预效果。探索性目标4将探讨每次干预对出院后1个月认知功能的影响以及出院后6个月和12个月阿尔茨海默病及相关痴呆的发生率。结果将为未来的临床试验提供关键的初步数据，并将指导Elias博士建立一个研究测试干预计划，在危重疾病恢复期间改善老年ICU幸存者的预后。

项目成果

Inactivity May Identify Older Intensive Care Unit Survivors at Risk for Post-Intensive Care Syndrome.

不活动可能会导致重症监护病房的老年幸存者面临重症监护后综合症的风险。

• DOI: 10.4037/ajcc2024785
• 发表时间: 2024
• 期刊: American journal of critical care : an official publication, American Association of Critical-Care Nurses
• 作者: Elias,MayaN;Ahrens,EmilyA;Tsai,Chi-Shan;Liang,Zhan;Munro,CindyL
• 通讯作者: Munro,CindyL