Swallowing Trajectories and DysPHagia Predictors in AlzheimER’s DisEase (SPHERE)

阿尔茨海默病 (SPHERE) 的吞咽轨迹和吞咽困难预测因子

• 批准号: 10662922
• 负责人: Nicole M Rogus-Pulia
• 金额: $ 75.07万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662922
• 关键词: Address; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Aspiration Pneumonia; Biological Markers; Biomechanics; Caregiver Burden; Caring; Characteristics; Clinical; Clinical Management; Clinical dementia rating scale; Clinical stratification; Cognition; Complex; Cross-Sectional Studies; Deglutition; Deglutition Disorders; Dementia; Detection; Deterioration; Development; Disease Progression; Disease stratification; Enrollment; Epidemiology; Evaluation; Food; Foundations; Functional disorder; Generations; Goals; Health; Impaired cognition; Impairment; Intervention; Knowledge; Malnutrition; Manometry; Measures; Methods; Nature; Nerve Degeneration; Neuropsychological Tests; Neuropsychology; Nutritional status; Oral; Oral health; Outcome; Outcome Measure; Participant; Patient Outcomes Assessments; Perception; Persons; Pharyngeal structure; Phase; Physiology; Plasma; Pneumonia; Population; Prevalence; Prevention; Production; Prospective cohort; Prospective, cohort study; Quality of life; Rehabilitation therapy; Reporting; Research; Resolution; Respiratory physiology; Risk; Risk Factors; Saliva; Subgroup; Symptoms; System; Therapeutic; Time Factors; Visit; Work; clinical care; cohort; comorbidity; demographics; dysphagia rehabilitation; effective therapy; effectiveness evaluation; efficacy evaluation; experience; follow-up; functional decline; high risk population; improved; innovation; mortality; multi-site trial; multidisciplinary; multimodality; neural; novel; pressure; prevent; respiratory; sarcopenia; screening; therapy development

PROJECT SUMMARY Dysphagia frequently develops in persons with AD/ADRD and leads to serious health consequences, including increased caregiver burden, malnutrition, pneumonia, decreased quality of life, and mortality. Targeted, efficacious rehabilitative interventions for dysphagia have been developed in other neurodegenerative populations, but there are currently no effective treatments for dysphagia in AD/ADRD that have lasting effects on swallowing physiology. Prior to developing interventions to prevent dysphagia-related adverse sequelae in patients with AD/ADRD, in-depth understanding of factors contributing to dysphagia risk and trajectories of swallowing change across disease progression is urgently needed, especially in early stages when interventions can be most effective and impactful. Small, cross-sectional studies in AD/ADRD have suggested changes in swallowing beginning early in disease progression. However, these prior studies examining dysphagia in AD/ADRD lack the comprehensive and longitudinal characterization of swallowing function across the dementia continuum necessary to improve clinical management. Additionally, while novel, multi-modality swallowing assessments have enabled detection of subclinical swallowing impairments in other neurogenerative populations, the nature of subclinical changes in AD/ADRD remains unknown. To address these critical knowledge gaps, we propose a prospective cohort study of persons with AD/ADRD stratified by disease stage (very mild to moderate) and their care partners. Participants will undergo comprehensive dementia characterization, including neuropsychological testing and plasma-based biomarkers, as well as multi-modal swallowing assessments at baseline and every six months. We will also collect a variety of clinical factors (e.g., demographics, comorbidities) and measures of oral function (e.g., saliva production, oral health, lingual pressures), respiratory pressures, sarcopenia, and nutritional status at baseline. The overarching goal of this research is to inform development of intervention strategies for persons with AD/ADRD through enhanced clinical and epidemiologic understandings of the onset, nature, and progression of swallowing deficits. Our multidisciplinary team of experts will achieve this objective via the following specific aims: 1. Define swallowing changes from very mild to moderate AD/ADRD to: 1a) characterize subclinical dysphagia features; and 1b) identify clinical factors and swallowing measures that contribute to symptom reporting; 2. Identify risk factors for swallowing dysfunction from very mild to moderate AD/ADRD; and 3. Determine trajectories of change in swallowing function in persons with AD/ADRD and association with risk factors. The proposed work represents the first longitudinal, comprehensive study of swallowing function in a well-characterized cohort of persons with AD/ADRD. Improved understanding of swallowing function across disease progression will inform development of targeted interventions to address identification, prevention, and rehabilitation of dysphagia in AD/ADRD.

项目概要 AD/ADRD 患者经常出现吞咽困难，并导致严重的健康后果，包括 护理人员负担增加、营养不良、肺炎、生活质量下降和死亡率。有针对性， 在其他神经退行性疾病中，已经开发出针对吞咽困难的有效康复干预措施 人群，但目前尚无针对 AD/ADRD 吞咽困难的有效治疗方法且具有持久效果 关于吞咽生理学。在制定预防吞咽困难相关不良反应的干预措施之前 AD/ADRD 患者后遗症，深入了解导致吞咽困难风险的因素 迫切需要了解疾病进展过程中吞咽变化的轨迹，特别是在早期 干预措施最有效和最有影响力的阶段。 AD/ADRD 的小型横断面研究 已经表明吞咽的变化在疾病进展的早期就开始了。然而，这些先前的研究 检查 AD/ADRD 吞咽困难缺乏吞咽的全面和纵向特征 整个痴呆症连续体的功能是改善临床管理所必需的。此外，虽然新颖， 多模式吞咽评估已能够检测其他患者的亚临床吞咽障碍 对于神经再生人群，AD/ADRD 亚临床变化的性质仍然未知。为了解决这些 为了弥补关键的知识差距，我们提出了一项针对 AD/ADRD 患者的前瞻性队列研究，按疾病进行分层 阶段（非常轻度到中度）及其护理伙伴。参与者将经历全面的痴呆症 表征，包括神经心理学测试和基于血浆的生物标志物，以及多模式 基线和每六个月进行一次吞咽评估。我们还将收集各种临床因素（例如， 人口统计、合并症）和口腔功能测量（例如唾液分泌、口腔健康、舌功能） 压力）、呼吸压力、肌肉减少症和基线营养状况。本次活动的总体目标是 研究的目的是通过加强临床，为 AD/ADRD 患者制定干预策略提供信息 以及对吞咽缺陷的发生、性质和进展的流行病学理解。我们的 多学科专家团队将通过以下具体目标来实现这一目标： 1. 定义吞咽 从非常轻微到中度 AD/ADRD 的变化： 1a) 表征亚临床吞咽困难的特征；和 1b) 确定有助于症状报告的临床因素和吞咽措施； 2. 识别风险因素 吞咽功能障碍（从极轻度到中度 AD/ADRD）； 3. 确定变化轨迹 AD/ADRD 患者的吞咽功能及其与危险因素的关系。拟议的工作代表 对一组特征明确的患有吞咽功能障碍的人进行的第一项纵向、全面的吞咽功能研究 AD/ADRD。更好地了解疾病进展过程中的吞咽功能将为发育提供信息 旨在解决 AD/ADRD 吞咽困难的识别、预防和康复问题的有针对性的干预措施。