Longitudinal Impact of Health and Lifestyle Behaviors on Cognition in Individuals with Multiple Sclerosis

项目摘要/摘要 该CDA提案寻求调查可修改的健康相关行为的长期影响(例如， 吸烟、运动)对多发性硬化症(MS)患者随时间的认知功能下降的影响 目标1)。考虑到认知障碍对多发性硬化症的有害影响，这一点很重要，影响 症状管理，日常生活的工具性活动，以及独立性。因为没有 经过验证的认知障碍治疗方法，必须确定可改变的风险因素- 特别是与健康相关的行为--可以作为潜在的治疗目标。此外，为了 修改这些行为，此建议将探索与疾病(MS)相关、特定于个人和 环境促进者和从事与健康有关的行为的障碍(具体目标2)。是这样的 目标与国家医疗康复研究中心的使命是一致的 (NCMRR)旨在“确定可改变的生活方式和与健康相关的行为对 预防继发性疾病、心理社会功能和社区参与 在2016年NIH康复研究计划中概述了这一点。 具体目标将通过两项纵向的观察性研究来实现，这些研究对象是 认知轨迹将通过标准化的神经心理评估来确定。健康- 相关行为将使用自我报告清单进行评估。推动者/参与的障碍 与健康相关的行为将由定量清单和定性半结构化来确定 采访。本次调查的数据将作为R01拨款的试点数据，在该拨款中， 将提出多成分生活方式干预以改善多发性硬化症患者的认知。 最近在有患痴呆症风险的老年人中进行了这种干预， 世界各地的持续复制。来自该项目的信息将有助于适应这种类型的 通过考虑特定于多发性硬化症的促进者和参与的障碍来干预多发性硬化患者 健康行为。 我已经组建了一个多学科的指导团队，拥有临床神经心理学方面的专业知识， 认知康复、流行病学、高级生物统计学和临床试验设计。通过填写 提出培训和研究计划，我将能够实现我的培训目标，包括：(1)申请 基于人群的健康社会决定因素对生活方式影响的调查研究设计 行为；(2)学习定性研究设计和高级统计技术；(3)学习如何 进行临床试验；(4)磨练我的专业发展技能，如手稿写作， 资质、实验室管理和指导。实现这些目标将帮助我过渡 成为一名独立的临床研究员，长期从事赠款资助的研究。

Project Summary/Abstract This CDA proposal seeks to investigate the long-term impact of modifiable health-related behaviors (e.g., smoking, exercise) on cognitive decline over time among persons with multiple sclerosis (MS; Specific Aim 1). This is important given the detrimental impact of cognitive impairment in MS, affecting symptom management, instrumental activities of daily living, and independence. Since there are no proven treatments for cognitive impairment, it is imperative to identify modifiable risk factors – specifically health-related behaviors – that can serve as potential treatment targets. Moreover, in order to modify these behaviors, this proposal will explore disease (MS)-related, person-specific, and environmental facilitators and barriers to engaging in health-related behaviors (Specific Aim 2). Such aims are consistent with the mission of the National Center for Medical Rehabilitation Research (NCMRR) to “determine the impact of modifiable lifestyle and health-related behaviors on prevention of secondary conditions, psychosocial functioning, and community participation,” as outlined in the 2016 NIH Research Plan on Rehabilitation. The Specific Aims will be accomplished via two longitudinal, observational studies among persons with MS. Cognitive trajectories will be established by standardized neuropsychological assessments. Health- related behaviors will be evaluated using self-report inventories. Facilitators/barriers to engaging in health-related behaviors will be determined by quantitative inventories and qualitative semi-structured interviews. Data from this investigation will serve as pilot data for a R01 grant in which a multicomponent lifestyle intervention to improve cognition among persons with MS will be proposed. Such intervention has been recently conducted in older adults at-risk of developing dementia, with ongoing replications around the world. Information from this project will help adapt this type of intervention to individuals with MS by accounting for MS-specific facilitators and barriers to engaging in health behaviors. I have assembled a multidisciplinary mentoring team, with expertise in clinical neuropsychology, cognitive rehabilitation, epidemiology, advanced biostatistics, and clinical trial design. By completing the proposed training and research plans, I will be able to achieve my training goals, including: (1) applying population-based survey research design to the role of the social determinants of health on lifestyle behaviors; (2) learning qualitative research design and advanced statistical techniques; (3) learning how to conduct clinical trials; and (4) honing my professional development skills, such as manuscript writing, grantsmanship, laboratory management, and mentorship. Achieving these goals will help me transition into an independent clinical investigator, with a long career of grant-funded research.