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.

痴呆症和认知能力下降的前驱期共同影响大约25-30%的老年人 在美国（美国）。创伤后应激障碍（PTSD）与111%的增加有关。 发生任何类型痴呆的风险，即使在控制了潜在的混杂因素（如创伤性脑损伤）后， 创伤（TBI）。因此，PTSD可能是早期预防认知功能下降的重要靶点， 进展为痴呆症。大多数关于创伤后应激障碍和认知的研究都采用了横断面研究设计， 尚未检查重要的潜在效果调节剂（例如，性别和APOE 4携带者状态）， 我们对创伤后应激障碍对认知功能纵向轨迹影响的基本理解。 此外，尽管PTSD在女性中更普遍，但大多数关于PTSD和认知的研究都是在 在男人身上进行。这一建议具有及时的公共卫生重要性，因为大流行前的终生患病率 在美国，PTSD的发病率为6%，但大流行后的流行病学调查结果表明， 约32%的年轻人。COVID-19事件也导致PTSD症状， 符合精神障碍诊断和统计手册，第5版（DSM-5）标准A。因此，我们认为， 在我们理解PTSD对认知老化的影响方面，关键的研究空白包括：1）前瞻性 调查，其中时间顺序和认知下降率可以在以下背景下进行评估： PTSD，2）测试性别和APOE 4携带状态对PTSD之间关系的潜在修饰作用， 创伤后应激障碍状态和认知能力下降，3）了解标准A是否是必要的， 创伤后应激障碍和认知能力下降之间的关系目标1和2将利用来自 国家阿尔茨海默氏症协调中心（NACC）。在55岁以上的成年人中，多水平建模和 交互作用分析将确定PTSD状态对创伤后应激障碍的轨迹、发生率和时间顺序的影响。 领域特异性认知下降，并将测试性别和APOE 4携带者状态作为潜在的效应调节剂。为 目标3，招募65岁以上的男性和女性受试者，有和没有标准A创伤， 多元回归将被用于明确地澄清PTSD的严重程度（标准B至E）是否与 认知功能不符合A标准该K 01奖将提供培训和指导， 老年健康，认知老化，PTSD的性别特异性健康影响，PTSD的神经心理学，纵向 研究设计和先进的统计学，并推动PI成为具有专业知识的独立研究者 创伤应激和生物心理社会因素对认知老化的影响，重点关注性别， 符合NIA 2020-2025战略方向的目标B-3、B-4和F-4。