Long-term Neuropsychiatric Sequelae of SARS-CoV-2 Infection in Late Life

晚年 SARS-CoV-2 感染的长期神经精神后遗症

• 批准号: 10586560
• 负责人: Amy Lynn Byers
• 金额: $ 76.62万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10586560
• 关键词: 2019-nCoV; Acute; Admission activity; Adult; Age; Aging; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Anosmia; Anxiety Disorders; Behavioral; Blood Vessels; Brain; COVID-19; COVID-19 diagnosis; COVID-19 impact; COVID-19 patient; COVID-19 severity; COVID-19 survivors; COVID-19 test; Caregivers; Case Study; Central Nervous System; Clinical; Code; Data; Data Linkages; Data Sources; Dementia; Development; Diagnosis; Disease; Disease Management; Early Intervention; Elderly; Epidemiology; Event; Geography; Goals; Headache; Health; Health Services; Healthcare Systems; Hospitalization; Immune response; Incidence; Individual; Infection; International Classification of Diseases; Intervention; Knowledge; Laboratories; Link; Medical; Medicare; Mental Health; Mental disorders; Mood Disorders; Nature; Nerve Degeneration; Neurologic; Newly Diagnosed; Nursing Homes; Outcome; Outcome Assessment; Patients; Pharmaceutical Preparations; Phase; Phenotype; Policies; Polymerase Chain Reaction; Prevention strategy; Psyche structure; Psychological Impact; Psychoses; Public Health; Publishing; Recording of previous events; Recovery; Reporting; Research; Risk; Risk Adjustment; Risk Factors; SARS-CoV-2 infection; SARS-CoV-2 negative; Sampling; Social Impacts; Source; Statistical Methods; Symptoms; United States Centers for Medicare and Medicaid Services; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; acute symptom; adverse outcome; age related; age related neurodegeneration; aged; cohort; comorbidity; data resource; data sharing networks; dementia risk; demographics; functional decline; functional disability; high risk; human old age (65+); improved; innovation; long term consequences of COVID-19; military veteran; mobility aid; nervous system disorder; neurologic sequelae of COVID-19; neuropsychiatric disorder; neuropsychiatric sequelae of COVID-19; neuropsychiatry; older patient; pandemic impact; persistent symptom; post SARS-CoV-2 infection; psychiatric comorbidity; psychiatric symptom; racial diversity; response; screening; ventilation

The psychological and social impact of the pandemic have been severe and likely will have significant mental effects over the long term. There is also emerging evidence that suggests that COVID-19 may have direct effects on the brain or trigger immune responses that have additional adverse consequences on brain function and mental health in patients with COVID-19. COVID-19 has disproportionately impacted older adults, with those 65 years and older at heightened risk of severe illness. In fact, most older adults with COVID-19 survive initial infection and enter a clinical recovery phase for months or longer, which is often marked by persistent symptoms and adverse health outcomes. Thus, there is an urgent need to understand the neuropsychiatric sequelae of COVID-19, especially in older adults. The primary goal of the proposed research is to determine whether COVID-19 is associated with increased incidence of dementia (Alzheimer’s disease and related dementias) and new or reemergence of psychiatric disorders in a national sample of patients 65 years and older, with complete outcome ascertainment from Veterans Health Administration and Medicare data. The secondary aim is to examine risk factors associated with development of these neuropsychiatric disorders (i.e., Alzheimer’s disease and related dementias [AD/ADRD], mood disorders, anxiety disorders, and psychosis) among older adults with history of COVID-19. The intent of the current proposal isn’t to be deterministic about the mechanisms of these associations, but to move the field forward informing current knowledge gaps about COVID-19 as a risk factor for neuropsychiatric disorders in late life. The current proposal will substantiate the early reports of neuropsychiatric effects from COVID-19 in small studies in a large geographically and racially diverse national sample using comprehensive data sources and advanced statistical methods and will improve our understanding of whether COVID-19 is a risk factor for the development of AD/ADRD and psychiatric disorders (Aim 1). Furthermore, this study will identify the baseline risk factors for development of AD/ADRD and psychiatric disorders among individuals with COVID-19 (Aim 2) and determine whether certain acute and post- acute symptoms are indicative of a higher risk for developing AD/ADRD (Aim 3). Given that over 79 million Americans have been diagnosed with COVID-19, even small increases in risk of AD/ADRD and psychiatric disorders may have significant consequences for patients, their caregivers, and the U.S. health care system. It is likely that the proposed research will help to identify individuals that may be at higher risk and support engagement in early intervention strategies that will lead to mitigation of AD and related diseases and late-life mental health disorders.

这一流行病的心理和社会影响是严重的，并可能在长期内产生重大的心理影响。还有新的证据表明，COVID-19可能对大脑产生直接影响，或引发免疫反应，对COVID-19患者的脑功能和心理健康产生额外的不利影响。COVID-19对老年人的影响不成比例，65岁及以上的老年人患重病的风险更高。事实上，大多数患有COVID-19的老年人在最初感染后存活，并进入临床恢复期数月或更长时间，这通常以持续症状和不良健康结果为标志。因此，迫切需要了解COVID-19的神经精神后遗症，特别是在老年人中。拟议研究的主要目标是确定COVID-19是否与痴呆症（阿尔茨海默病和相关痴呆症）的发病率增加以及65岁及以上患者的全国样本中精神疾病的新发或复发相关，并从退伍军人健康管理局和医疗保险数据中确定完整的结果。第二个目的是检查与这些神经精神疾病发展相关的风险因素（即，阿尔茨海默病和相关痴呆[AD/ADRD]、情绪障碍、焦虑症和精神病）。当前提案的目的不是确定这些关联的机制，而是推动该领域向前发展，告知当前关于COVID-19作为晚年神经精神疾病风险因素的知识差距。目前的提案将使用全面的数据来源和先进的统计方法，在地理和种族多样化的大型国家样本中进行小型研究，证实COVID-19对神经精神影响的早期报告，并将提高我们对COVID-19是否是AD/ADRD和精神疾病发展的风险因素的理解（目标1）。此外，本研究将确定COVID-19患者发生AD/ADRD和精神疾病的基线风险因素（目标2），并确定某些急性和急性后症状是否表明发生AD/ADRD的风险较高（目标3）。鉴于超过7900万美国人被诊断患有COVID-19，即使AD/ADRD和精神疾病风险的小幅增加也可能对患者、其护理人员和美国医疗保健系统产生重大影响。拟议的研究可能有助于识别可能处于较高风险的个体，并支持参与早期干预策略，从而减轻AD和相关疾病以及晚年精神健康障碍。