Evaluating the association between surgery and subsequent cognitive function, everyday functioning, and independence

项目摘要 这个K23职业发展奖的目的是支持博士. Ackenbom的长期职业目标 成为一名独立的外科医生-科学家，提高手术后认知障碍的知识 改善老年患者的手术效果和生活质量。识别术后神经认知 手术患者的认知功能障碍（pNCD），以前称为术后认知功能障碍（POCD）， 这是必要的，因为它与术后恢复延迟，更大的独立性丧失，增加 发病率，死亡率和大量的医疗保健费用。在美国，大约35%的手术 在≥ 65岁的成年人中进行，随着人口老龄化的增加，手术和 因此，pNCD发病率预计将上升。pNCD/POCD的特征在于， 注意力，信息处理和记忆通常持续几天到几个月，但有研究表明， 报告称手术后认知障碍持续数年认知障碍发生超过12 术后3个月的持续性轻度认知功能障碍或其他认知功能障碍的诊断 诊断，包括阿尔茨海默病和相关痴呆症（ADRD）。有一个关键的研究需要， 检查术后认知障碍的纵向过程及其对日常生活的影响 功能，独立性和生活质量，因为它不是很好地理解。我们提出了一项研究， 2011 - 2017年的数据来自国家健康和老龄化趋势研究（NHATS），这是一项基于人口的研究， 老年功能随着时间的推移，与医疗保险索赔数据，包括手术数据变量，以及 基于具有可用的详细神经心理学测试结果的外科患者队列， 以下目的：1）比较≥ 65岁的人接受主要 非心脏择期手术和未行非心脏择期手术的患者，2）比较≥ 65岁人群的日常功能变化 年进行重大非心脏择期手术和那些谁没有，3）评估认知的变化 既往入组研究的≥ 70岁女性中脱垂手术后2年的表现和诊断 阿肯博姆等评估pNCD的al研究。本建议的培训目标是：1）建立在基础 在临床研究环境中测量一系列认知能力的知识; 2）为了提高我的 认知功能障碍研究、临床诊断和管理方面的知识和理解 一般疾病，特别是ADRD，纳入未来涉及认知功能障碍的研究设计中。 在围手术期环境中进行评价。本研究将确定适当的效应量，为将来的研究做准备。 进行认知表现和认知诊断扩展评估的研究，包括 年龄≥ 70岁的患者在接受重大非心脏择期手术后， 5-年期间。此外，实现这些培训目标将推动阿肯博姆博士过渡到 作为一个独立的临床研究人员在这个重要的研究领域。

PROJECT ABSTRACT The purpose of this K23 career development award is to support Dr. Ackenbom's long term career goal of becoming an independent surgeon-scientist advancing knowledge on cognitive impairment after surgery used to improve surgical outcomes and quality of life for older patients. Recognizing postoperative neurocognitive disorder (pNCD), previously termed postoperative cognitive dysfunction (POCD), in surgical patients is essential as it is associated with delayed postoperative recovery, greater loss of independence, increased morbidity, mortality, and substantial health care costs. In the United States, approximately 35% of all surgeries are performed on adults ≥65 years, and with the increase in the aging population, the number of surgeries and thus pNCD incidence is expected to rise. pNCD/POCD is characterized as a largely transient deterioration of concentration, information processing, and memory often lasting days to months, but there are studies reporting cognitive impairment after surgery lasting years. Cognitive impairment occurring more than 12 months after surgery is concerning for an ongoing diagnosis of mild cognitive impairment or other cognitive diagnoses, inclusive of Alzheimer's disease and related dementias (ADRD).There is a critical research need to examine the longitudinal course of cognitive impairment after surgery and its influence on everyday functioning, independence, and quality of life as it is not well understood. We propose a study using linked 2011-2017 data from the National Health and Aging Trends Study (NHATS), a population-based study focused on late-life functioning over time, with Medicare claims data, inclusive of surgical data variables as well as building upon a surgical patient cohort with available detailed neuropsychological testing results to address the following aims: 1) compare change in cognitive performance of persons ≥65 years who underwent major noncardiac elective surgery and those who did not, 2) compare change in everyday functioning in persons ≥65 years who underwent major noncardiac elective surgery and those who did not, 3) assess change in cognitive performance and diagnosis two years after prolapse surgery in women ≥70 years previously enrolled in Ackenbom et. al study assessing pNCD. The training aims in this proposal are: 1) To build on foundational knowledge in measurement of a range of cognitive abilities in clinical research settings and 2) To enhance my knowledge and understanding in research and clinical diagnosis and management of cognitive impairment disorders in general and in particular, ADRD, to incorporate into future study designs involving cognitive evaluation in perioperative settings. This study will determine appropriate effect sizes in preparation for future studies to conduct an extended assessment of cognitive performance and cognitive diagnoses, including pNCD and incident dementia, after undergoing major noncardiac elective surgery in persons ≥70 years over a 5-year period. Further, achievement of these training aims will propel Dr. Ackenbom in her transition to independence as a clinical researcher in this important area of study.