Sleep-Wake Disturbance as a Predictor of Delirium and Subsequent Alzheimer's Disease and Related Dementias after Surgical Aortic Valve Replacement

项目总结/摘要 申请人：我是一名咨询联络精神病学家，对谵妄和睡眠-觉醒的作用非常感兴趣。 精神障碍（SWD）在谵妄易感性、其发病机制及其与后续 阿尔茨海默病和相关痴呆症（ADRD）。我的使命是改善护理和临床结果 那些有谵妄和风险的人，并成为老年人护理卓越的冠军。这 应用程序是专为我获得纵向研究的开展和设计，评估 社会福利署，与谵妄有关的神经心理学训练及与之有关的两种神经认知障碍 （阿尔茨海默病和血管神经认知障碍），以及统计方法的坚实背景， 成为一名独立的科学家。 项目：我提议对接受外科主动脉瓣置换术的受试者进行前瞻性队列研究 目的是在手术前调查客观的SWD-活动记录仪和无人值守的II型家庭 睡眠试验（HST）-与术后谵妄和随后的ADRD相关。本研究 代表了II型HST的新应用，其提供了睡眠结构的综合评估， 将术前SWD描述为谵妄风险的标志物，并提供证据支持机制联系 谵妄和随后的阿尔茨海默病或血管性神经认知障碍之间的联系。 专业发展：我将通过进行纵向研究，获得经验方法的实践经验。 研究，提供专业知识，以评估社署使用无人看管的方法，神经心理测试，以及相关的 统计我的培训计划包括睡眠医学、神经心理学和 统计，辅以课程作业和指导性阅读，将提供必要的理论 基金会 目标：我的职业目标是在URMC建立心脏外科跨学科研究项目 和睡眠医学，探讨社会福利署是如何机制参与谵妄的风险，发病，其可怕的 结果，并推进谵妄病理生理学和ADRD后续风险的科学。

Project Summary/Abstract Applicant: I am a consultation-liaison psychiatrist keenly interested in delirium and the role that sleep-wake disturbance (SWD) plays in delirium vulnerability, its pathogenesis, and its relationship with subsequent Alzheimer’s disease and related dementias (ADRD). My mission is to improve the care and clinical outcomes of those with and at risk for delirium and to be a champion for excellence in care for older adults. This application is designed for me to obtain expertise in longitudinal study conduct and design, assessment of SWD, neuropsychological training relevant to delirium and the two neurocognitive disorders associated with it (Alzheimer’s disease and vascular neurocognitive disorder), and a solid background in statistical methods to become an independent physician-scientist. Project: I am proposing a prospective cohort study of subjects undergoing surgical aortic valve replacement with the goal of investigating objective SWD before surgery—both actigraphy and unattended type II home sleep tests (HST)—for its association with postoperative delirium and subsequent ADRD. This study represents a novel application of type II HST, which provides comprehensive assessment of sleep architecture, to characterize preoperative SWD as a marker of delirium risk and evidence in support of a mechanistic link between delirium and subsequent Alzheimer’s disease or vascular neurocognitive disorder. Professional development: I will obtain practical experience in empirical methods by conducting a longitudinal study with expertise in assessing SWD using unattended methods, neuropsychological testing, and relevant statistics. My training plan incorporates hands-on experiences in sleep medicine, neuropsychology, and statistics, complemented by coursework and directed readings that will provide the necessary theoretical foundation. Goals: My career goals are to establish an interdisciplinary research program at URMC with cardiac surgery and sleep medicine, to explore how SWD is mechanistically involved in delirium risk, onset, and its dire outcomes, and to advance the science of delirium pathophysiology and subsequent risk of ADRD.