Cognitive and Physical Exercise to Improve Outcomes after Surgery in the Elderly

认知和身体锻炼可改善老年人手术后的结果

• 批准号: 10565909
• 负责人: Christopher Hughes
• 金额: $ 81.34万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10565909
• 关键词: Activities of Daily Living; Acute; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Anatomy; Anesthesia procedures; Attention; Biological Markers; Blood; Blood brain barrier dysfunction; Brain; Clinical; Cognition; Cognitive; Cognitive aging; Cognitive deficits; Computers; Critical Illness; Data; Delirium; Dementia; Elderly; Endothelium; Evaluation; Exercise; Exhibits; Functional Magnetic Resonance Imaging; Habilitation; Health education; Hospitalization; Hospitals; Impaired cognition; Individual; Injury; Intervention; Lead; Life; Link; Medical; Memory; Mental Depression; Older Population; Operative Surgical Procedures; Outcome; Patients; Perioperative; Physical Exercise; Physical Function; Physical Rehabilitation; Physical therapy; Plasma; Population; Postoperative Period; Process; Public Health; Quality of life; Randomized; Recommendation; Rehabilitation therapy; Reporting; Research; Sedation procedure; Subgroup; Survivors; Testing; Time; Training; Training Programs; United States National Institutes of Health; active control; blood-brain barrier function; cerebral atrophy; cognitive function; cognitive rehabilitation; cognitive training; computer game; computerized; disability; frailty; functional decline; functional disability; functional outcomes; functional status; high risk; improved; improved outcome; mind/body; multitask; neuroimaging; preservation; prevent; processing speed; programs; response; stressor; success; white matter

Project Summary Cognitive decline with aging, including Alzheimer's Disease and Related Dementias (ADRD), is a public health imperative that impacts quality of life and disability. Survivors of acute surgical or medical illness contribute greatly to the crisis of cognitive decline. Hospitalization confers a 1.5-2-fold increase in the odds of new onset dementia. Furthermore, over a third of critically ill patients have new ADRD by 1 year. Major risk factors for ADRD after acute illness include pre-illness frailty and cognitive deficits and delirium in the hospital. Endothelial and blood brain barrier (BBB) dysfunction, cerebral atrophy, and white matter connectivity changes have all been linked to delirium and ADRD. Surgery is common in older adults but it (and its resulting hospitalization) is associated with significant cognitive decline. Individual interventions to reduce this decline have exhibited limited success. Prehabilitation is the process of enhancing capacity and reserve before an acute stressor to improve tolerance of the upcoming insult. Older major surgical patients provide an ideal population for prehabilitation. These patients have lead time prior to surgery, are frequently frail, have prolonged post-surgery ICU and hospital courses, and are at high risk for new ADRD. Prehabilitation studies to date have primarily focused on physical training to improve physical outcomes. Combined physical and computer-based cognitive training programs have been associated with significant improvements in global cognitive function, and computerized brain training exercises have demonstrated enhancement in memory, processing speed, and multitasking. This training, however, has not been examined in surgical or hospitalized patients. We have demonstrated that cognitive training and physical exercises are feasible prior to major surgery and in the hospital, that a combined cognitive and physical rehabilitation program after discharge can reduce ADRD, and that a computerized cognitive rehabilitation program can improve multiple cognitive domains in ICU survivors. Further, exercise enhances endothelial and BBB function, reduces cerebral atrophy, and increases functional connectivity, providing potential mechanistic basis for these improvements. Thus, a comprehensive mind and body training program prior to (prehabilitation), during, and after (rehabilitation) hospitalization may be most effective in reducing ADRD and disability after major surgery but has yet to be evaluated. The main hypothesis of the COgnitive and Physical Exercise to improve Outcomes after Surgery (COPE-iOS) study is that a program of cognitive and physical training throughout the perioperative period will improve long-term cognitive and disability outcomes in older surgical patients at high risk for decline. We will randomize 250 patients ≥60 years old undergoing elective major non-cardiac surgery with expected hospitalization >3 days to a comprehensive training program or to active control prior to surgery, during the surgical hospitalization, and after discharge. We will assess global cognition (Aim 1), disability (Aim 2), and plasma biomarkers and neuroimaging (Aim 3) at baseline and up to 12 months after discharge.

项目概要 随着年龄的增长认知能力下降，包括阿尔茨海默病和相关痴呆症 (ADRD)，是一种公共卫生问题 影响生活质量和残疾的迫切需要。急性手术或内科疾病的幸存者贡献 极大地导致了认知衰退的危机。住院治疗会使新发病的几率增加 1.5-2 倍 失智。此外，超过三分之一的重症患者在一年内出现新的 ADRD。主要风险因素 急性疾病后的 ADRD 包括病前虚弱、认知缺陷和住院期间的谵妄。内皮细胞 血脑屏障（BBB）功能障碍、脑萎缩和白质连接性改变都 与谵妄和 ADRD 有关。手术在老年人中很常见，但它（及其导致的住院治疗） 与显着的认知能力下降有关。减少这种下降的个人干预措施已显示 成功有限。预康复是在急性应激源面前增强能力和储备的过程。 提高对即将到来的侮辱的容忍度。老年大外科患者为手术提供了理想的人群 预康复。这些患者在手术前需要等待一段时间，通常身体虚弱，术后时间较长 ICU 和医院课程，并且处于新 ADRD 的高风险中。迄今为止的康复研究主要是 注重体能训练，以改善身体状况。结合物理和计算机认知 培训计划与整体认知功能的显着改善有关，并且 计算机化的大脑训练练习已证明记忆力、处理速度和 多任务处理。然而，这种训练尚未在手术或住院患者中进行过检验。我们有 证明认知训练和体育锻炼在大手术前和手术中是可行的 医院认为，出院后的认知和身体康复联合计划可以减少 ADRD，并且 计算机化认知康复计划可以改善 ICU 幸存者的多个认知领域。 此外，运动可增强内皮和血脑屏障功能，减少脑萎缩，并增强功能 连接性，为这些改进提供潜在的机制基础。因此，要有全面的头脑和 住院前（预康复）、住院期间和住院后（康复）的身体训练计划可能是最重要的 可以有效减少大手术后 ADRD 和残疾，但尚未得到评估。主要 认知和身体锻炼可改善手术后结果的假设 (COPE-iOS) 研究表明，整个围手术期的认知和身体训练计划将 改善具有衰退高风险的老年手术患者的长期认知和残疾结果。 我们将随机抽取 250 名 ≥ 60 岁的患者进行选择性重大非心脏手术，预期 住院>3天以进行综合训练计划或在手术前、手术期间进行主动控制 手术住院，出院后。我们将评估整体认知（目标 1）、残疾（目标 2）和 基线和出院后 12 个月内的血浆生物标志物和神经影像学（目标 3）。