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.

项目摘要 吞咽困难经常在AD/ADRD的人中发育，并带来严重的健康后果，包括 增加照料者负担，营养不良，肺炎，生活质量降低和死亡率。针对性， 在其他神经退行性中已经开发了有效的吞咽困难的康复干预措施 人群，但目前没有对广告/ADRD中吞咽困难的有效治疗方法 关于吞咽生理学。在制定干预措施之前，以防止吞咽困难相关的不良 AD/ADRD患者的后遗症，深入了解导致吞咽困难风险的因素 迫切需要迫切需要在疾病进展的吞咽变化的轨迹，尤其是在早期 干预措施最有效和有影响力的阶段。 AD/ADRD的小型横断面研究 已经提出吞咽的变化，从疾病进展早期开始。但是，这些先前的研究 检查AD/ADRD中的吞咽困难缺乏吞咽的全面和纵向表征 整个痴呆症连续性的功能都需要改善临床管理。另外，虽然是新颖的 多模式吞咽评估已使其他亚临床吞咽损伤的检测 神经生成种群，AD/ADRD的亚临床变化的性质仍然未知。解决这些 批判性知识差距，我们提出了一项针对疾病分层的AD/ADRD患者的前瞻性队列研究 舞台（非常轻度至中度）及其护理伙伴。参与者将接受全面的痴呆症 表征，包括神经心理学测试和基于等离子体的生物标志物以及多模式 在基线和每六个月的吞咽评估。我们还将收集各种临床因素（例如， 人口统计学，合并症）和口服功能的度量（例如唾液生产，口腔健康，舌 压力），呼吸压力，肌肉减少症和基线营养状况。总体目标 研究是通过增强的临床来告知针对AD/ADRD患者的干预策略的制定 以及对吞咽缺陷的发作，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特定目的实现这一目标：1。定义吞咽 从非常轻度到中度的AD/ADRD到以下方面的变化是亚临床吞咽困难特征的特征；和1b） 确定导致症状报告的临床因素和吞咽措施； 2。确定风险因素 吞咽功能障碍从非常轻度到中度的广告/ADRD；和3。确定变化的轨迹 吞咽广告/ADRD的人，并与风险因素相关。拟议的工作代表 在特征良好的人群中，对吞咽功能的首次纵向，全面研究 广告/adrd。对跨疾病进展的吞咽功能的了解得以提高将为发展提供信息 针对广告/ADRD中吞咽困难的识别，预防和康复的有针对性干预措施。