Cognitive Aging Trajectories in Survivors of Trauma

创伤幸存者的认知老化轨迹

• 批准号: 10662957
• 负责人: KAREN Ann LAWRENCE
• 金额: $ 12.38万
• 依托单位: UNIVERSITY OF KENTUCKY
• 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 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662957
• 关键词: Accidents; Address; Adult; Affect; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anxiety; COVID-19; COVID-19 pandemic; Clinical; Clinical Sciences; Cognition; Cognitive; Cognitive aging; Cross-Sectional Studies; DSM-V; Data; Data Collection; Dementia; Diagnosis; Diagnostic; Diagnostic and Statistical Manual of Mental Disorders; Disasters; Elderly; Epidemiology; Episodic memory; Event; Funding; Goals; Health; Impaired cognition; Incidence; Intervention; Investigation; Kentucky; Link; Longitudinal Studies; Medical; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Modeling; Modification; National Center for Advancing Translational Sciences; Neuropsychology; Participant; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Prevalence; Prevention; Psychologist; Public Health; Recording of previous events; Research; Research Design; Research Personnel; Risk; Risk Factors; Severities; Sex Differences; Short-Term Memory; Survivors; Symptoms; Testing; Training; Translational Research; Trauma; Traumatic Brain Injury; United States; Universities; War; Woman; aged; apolipoprotein E-4; biopsychosocial factor; carrier status; clinical center; cognitive function; cohort; comorbidity; dementia risk; disability; executive function; first responder; functional decline; human old age (65+); meetings; men; mild cognitive impairment; military veteran; multilevel analysis; pandemic disease; post-pandemic; pre-clinical; pre-pandemic; processing speed; prospective; recruit; sex; sexual assault; statistics; traumatic stress; young adult

Dementia and the prodromal stages of cognitive decline, together, affect approximately 25-30% of older adults across the United States (U.S.). Posttraumatic Stress Disorder (PTSD) has been linked to a 111% increased risk of developing dementia of any type, even after controlling for potential confounders such as traumatic brain injury (TBI). Therefore, PTSD may be an important target for early prevention of cognitive decline and potential progression to dementia. Most studies on PTSD and cognition have used a cross-sectional study design and have not examined important potential effect modifiers (e.g., sex and APOE4 carrier status), leaving a gap in our fundamental understanding of the effect of PTSD on longitudinal trajectories of cognitive functioning. Further, although PTSD is more prevalent in women, most research on PTSD and cognition has been conducted in men. This proposal is of timely public health importance, as the pre-pandemic lifetime prevalence of PTSD in the U.S. was 6%, but post-pandemic epidemiological findings have indicated a rise to approximately 32% among young adults. COVID-19 events have also resulted in PTSD symptoms without meeting Diagnostics and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Criterion A. Therefore, critical research gaps in our understanding of the effect of PTSD on cognitive aging include: 1) prospective investigation wherein temporal sequencing and rate of cognitive decline can be evaluated in the context of PTSD, 2) testing the potential modifying effects of sex and APOE4 carrier status on the relationship between PTSD status and cognitive decline and, 3) understanding whether Criterion A is necessary when determining the relationship between PTSD and cognitive decline. Aims 1 and 2 will leverage existing data from the National Alzheimer's Coordinating Center (NACC). In adults aged 55+ years, multilevel modeling and interaction analyses will determine the impact of PTSD status on trajectories, rate, and temporal sequence of domain-specific cognitive decline and will test sex and APOE4 carrier status as potential effect modifiers. For Aim 3, men and women participants, aged 65+, with and without Criterion A trauma, will be recruited and multiple regression will be used to unambiguously clarify if PTSD severity (Criteria B through E) is associated with cognitive functioning without meeting Criterion A. This K01 award will provide training and mentorship in aging health, cognitive aging, sex-specific health effects of PTSD, neuropsychology of PTSD, longitudinal study design, and advanced statistics and propel the PI to become an independent investigator with expertise in the effects of traumatic stress and biopsychosocial factors on cognitive aging, with a sex-specific focus and in alignment with Goals B-3, B-4, and F-4 of NIA’s Strategic Directions 2020-2025.

痴呆症和认知下降的前驱阶段共同影响了约25-30％的老年人 整个美国（美国）。创伤后应激障碍（PTSD）与增长111％有关 即使控制了诸如创伤大脑之类的潜在混杂因素，也有任何类型的痴呆症的风险 受伤（TBI）。因此，PTSD可能是早期预防认知能力下降和潜力的重要目标 发展为痴呆症。大多数有关PTSD和认知的研究都使用了横断面研究设计和 尚未检查重要的潜在效应修饰符（例如，性别和APOE4载体状态），留下了差距 我们对PTSD对认知功能纵向轨迹的影响的基本理解。 尽管PTSD在女性中更为普遍，但有关PTSD和认知的大多数研究是 在男人中进行。这项提议及时公共健康的重要性，因为流行前的终身患病率 美国的PTSD为6％，但是大掌流的流行病学发现表明 年轻人约为32％。 COVID-19还导致了PTSD症状，没有 符合精神障碍的诊断和统计手册，第五版（DSM-5）标准A。 在我们对PTSD对认知衰老影响的理解中的批判性研究差距包括：1） 调查可以评估临时测序和认知下降速率 PTSD，2）测试性别和APOE4载体状态对之间关系的潜在修改影响 PTSD状态和认知能力下降，3）了解确定标准A是否需要 PTSD与认知能力下降之间的关系。目标1和2将利用现有数据 国家阿尔茨海默氏症协调中心（NACC）。在55岁以上的成年人中，多级建模和 交互分析将确定PTSD状态对轨迹，速率和临时顺序的影响 域特异性认知能力下降，并将测试性别和APOE4载体状态作为潜在效应修饰符。为了 AIM 3，年龄在65岁以上的男性和女性参与者将被招募和不带有创伤的情况 多元回归将被用来明确阐明PTSD严重程度（标准B至E）是否相关 在没有符合标准的情况下，认知功能A.该K01奖将提供培训和心态 衰老的健康，认知衰老，PTSD的性别特定健康影响，PTSD的神经心理学，纵向 研究设计和高级统计数据，并推动PI成为具有专业知识的独立研究者 在创伤性压力和生物心理社会因素对认知衰老的影响中，性别特定的重点和 与NIA战略指示2020-2025的目标B-3，B-4和F-4的目标保持一致。