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

项目摘要/摘要 申请者：我是一名咨询联络精神病学家，对精神错乱和睡眠觉醒的作用非常感兴趣。 精神障碍(SWD)在精神错乱的易感性、发病机制及其与后遗症的关系中发挥作用 阿尔茨海默病和相关痴呆(ADRD)。我的使命是改善护理和临床结果 为那些有精神错乱和有精神错乱风险的人服务，并在照顾老年人方面成为卓越的拥护者。这 应用程序是为我在纵向研究中获得专业知识而设计、评估的 与妄想症相关的神经心理训练以及与之相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)，并在统计方法方面有坚实的背景 成为一名独立的内科医生兼科学家。 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社会保障署--行动记录仪和无人看管的第二类家庭 睡眠测试(HST)--其与术后精神错乱和随后的ADRD的相关性。本研究 代表了类型II HST的新应用，它提供了对睡眠结构的全面评估， 将术前社会功能障碍定性为精神错乱风险的标志和支持机械性联系的证据 在精神错乱和随后的阿尔茨海默病或血管神经认知障碍之间。 职业发展：我将通过进行纵向调查获得实证方法方面的实践经验。 在使用无人看管的方法、神经心理测试和相关的方法评估SWD方面具有专业知识的研究 统计数据。我的培训计划结合了睡眠医学、神经心理学和 统计，辅以课程作业和定向阅读，将提供必要的理论 基金会。 目标：我的职业目标是在URMC建立一个心脏外科的跨学科研究项目 以及睡眠医学，以探索社会保障如何机械地参与精神错乱的风险、发病及其严重程度。 结果，并促进精神错乱的病理生理学和随后的ADRD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.