Seizure, cognitive change and dementia: Understanding the use and safety of anti-seizure medications

癫痫、认知改变和痴呆：了解抗癫痫药物的使用和安全性

• 批准号: 10740534
• 负责人: Leah Blank
• 金额: $ 16.57万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740534
• 关键词: Adult; Adverse effects; Age; Aging; Alzheimer' s disease related dementia; Anticonvulsants; Applied Skills; Attention; Attitude; Award; Behavior Therapy; Behavioral; Benzodiazepines; Biometry; Caring; Central Nervous System; Clinical; Clinical Trials; Cognition; Cognitive; Cohort Studies; Data; Decision Making; Dementia; Development; Disease; Dose; Drug Monitoring; Drug Prescriptions; Elderly; Emergency Medicine; Epilepsy; Evaluation; Evidence based treatment; Foundations; Frequencies; Generations; Geriatrics; Goals; Guidelines; Health Services; Health Services Research; Health and Retirement Study; Impaired cognition; Insurance; Internal Medicine; Intervention; Knowledge; Laboratories; Learning; Levetiracetam; Link; Longitudinal Surveys; Medicare; Medication Systems; Mentors; Mentorship; Modeling; Monitor; Nerve Degeneration; Neurodegenerative Disorders; Neurologist; Neurology; Outcome; Patients; Pharmaceutical Preparations; Pharmacoepidemiology; Physical Function; Physiological; Population; Positioning Attribute; Prevalence; Primary Care; Provider; Qualitative Methods; Quality Indicator; Quality of life; Randomized, Controlled Trials; Reaction; Recommendation; Recurrence; Research Methodology; Research Personnel; Resources; Risk; Safety; Sampling; Science; Sedation procedure; Seizures; Severities; Socioeconomic Status; Subgroup; System; Testing; Therapeutic; Titrations; Training; Translating; Vertebral column; Work; care coordination; career; caregiver education; cognitive change; cognitive function; cognitive reserve; cohort; comorbidity; comparative; comparative safety; dementia care; demographics; design; evidence base; experience; follow-up; frailty; gabapentin; health literacy; improved; medical specialties; mild cognitive impairment; multi-component intervention; nervous system disorder; pregabalin; programs; recruit; skills; success; support tools; therapy development; treatment strategy

PROJECT SUMMARY Guidelines for anti-seizure medications in older adult populations are incomplete or non-existent, even though the risk of recurrent unprovoked seizures (epilepsy) in adults peaks at 80 years old. As a group, anti- seizure medications are generally thought to be equally efficacious and medication choice should be informed by the secondary effects of these drugs. Older adults are likely to be particularly vulnerable to cognitive adverse effects because they may have lower cognitive reserve, undetected/undiagnosed neurodegeneration, competing cognitive impairing disorders, and often take other CNS-active drugs. Despite the increased risk and abundance of new prescriptions in older adults, most evaluation of the safety and effects of anti-seizure medications on cognition have been done in short-term studies in younger cohorts. No anti-seizure medication prescribing guidelines exist for older adults with mild cognitive impairment (MCI) or Alzheimer’s Disease and related dementias (ADRD). Currently, little information exists regarding anti-seizure medication use including: whether and how drug titration occurs, therapeutic drug monitoring, or how use may differ in older adults with dementia. In order to improve care, we must understand how and why particular anti-seizure medications are prescribed. We currently have limited understanding of how prescribers make decisions, including weighing any possible cognitive adverse effects, when adding and removing anti-seizure medications in older adults. These knowledge gaps are barriers to developing safe, effective and evidence-based treatment strategies. This study will use a large representative study of older adults (the Health and Retirement Study linked to Medicare data) to (1) understand differences in current use, titration, continuation, and laboratory monitoring of anti-seizure medications in older adults with seizures, with and without ADRD, (2) examine the comparative effect of commonly prescribed anti-seizure medications on cognitive decline and incident dementia, and (3) recruit a national sample of prescribers (e.g. primary care, internal medicine, geriatrics, emergency medicine, neurology) to understand decision-making in the context of anti-seizure medication prescription in older adults. My long-term goal is to develop an independent program focused on health services research to improve the care for older adults with seizure and dementia. The completion of this project will lay the foundation for a career of translating best evidence into practice. This project will form the backbone of an integrated training plan that will refine my existing pharmacoepidemiologic and biostatistical skills. Further, it will allow me to develop new knowledge in qualitative methods, geriatrics and cognitive decline. The training plan, focused mentorship and proposed project will allow me to learn, develop and apply the skills necessary for a successful transition to become an independent health services and outcomes researcher, and lay the groundwork for a trial of a multimodality intervention to improve prescribing in older adults with seizure, cognitive impairment and dementia.

项目总结 老年人群中的抗癫痫药物指南不完整或根本不存在，甚至 尽管成年人反复发作无故癫痫(癫痫)的风险在80岁时达到顶峰。作为一个团体，反- 癫痫药物通常被认为是同样有效的，应该告知药物选择 这些药物的次要作用。老年人可能特别容易受到认知障碍的影响。 影响，因为他们可能有较低的认知储备，未被发现/未诊断的神经变性，竞争 认知障碍，并经常服用其他中枢神经系统活性药物。尽管风险和丰富性增加 在老年人的新处方中，大多数对抗癫痫药物的安全性和疗效的评估 认知方面的研究已经在较年轻的人群中进行了短期研究。没有抗癫痫药物处方 有针对患有轻度认知障碍(MCI)或阿尔茨海默病及相关疾病的老年人的指南 痴呆(ADRD)。目前，关于抗癫痫药物使用的信息很少，包括： 以及药物滴定是如何发生的，治疗性药物监测，或者在患有痴呆症的老年人中使用可能有什么不同。 为了改善护理，我们必须了解特定的抗癫痫药物是如何以及为什么 开了处方。我们目前对处方者如何做出决定的了解有限，包括权衡任何 在老年人中添加和移除抗癫痫药物时，可能会产生认知不良影响。这些 知识差距是制定安全、有效和循证治疗战略的障碍。 这项研究将使用一项对老年人的大型代表性研究(健康和退休研究与 联邦医疗保险数据)以(1)了解当前使用、滴定、延续和实验室监测方面的差异 抗癫痫药物在伴有和不伴有ADRD的老年人癫痫发作中的应用，(2)比较 常用抗癫痫药物对认知功能减退和偶发性痴呆的影响 招募全国处方医生样本(例如初级保健、内科、老年病、急诊、 神经学)以了解老年人在抗癫痫药物处方的背景下的决策。 我的长期目标是开发一个专注于卫生服务研究的独立计划，以改善 照顾患有癫痫和痴呆症的老年人。这个项目的完成将为自己的职业生涯奠定基础 把最好的证据转化为实践。该项目将构成综合培训计划的支柱， 将完善我现有的药物流行病学和生物统计学技能。此外，它将使我能够开发新的 在定性方法、老年病学和认知衰退方面的知识。培训计划，重点指导和 拟议的项目将使我能够学习、发展和应用成功过渡到 成为一名独立的健康服务和结果研究人员，并为一项 多模式干预以改善患有癫痫、认知障碍和痴呆症的老年人的处方。