Evaluating the association between surgery and subsequent cognitive function, everyday functioning, and independence

项目摘要 这个K23职业发展奖的目的是支持Ackenbom博士的长期职业目标 成为一名独立的外科医生-科学家，促进对手术后认知障碍的认识 以改善手术结果和老年患者的生活质量。再认术后神经认知 外科患者的认知障碍(PNCD)，以前被称为术后认知功能障碍(POCD) 这是必要的，因为它与术后恢复延迟，更大的独立性丧失，增加 发病率、死亡率和高昂的医疗费用。在美国，大约35%的手术 是对65岁的成年人进行的，随着老龄化人口的增加，手术和≥的数量 因此，pNCD的发病率预计将上升。PNCD/POCD的特点是在很大程度上是短暂的恶化 注意力、信息处理和记忆通常持续几天到几个月，但有研究表明 报告持续数年的手术后认知障碍。认知障碍发生在12岁以上 手术后几个月可能会被诊断为轻度认知障碍或其他认知障碍 诊断，包括阿尔茨海默病和相关痴呆(ADRD)。有必要进行关键的研究 观察认知功能障碍术后的纵向病程及其对日常生活的影响 功能、独立性和生活质量，因为它还没有被很好地理解。我们提出了一项研究，使用Link. 2011-2017年的数据来自国家健康和老龄化趋势研究(NHATS)，这是一项以人口为基础的研究，重点是 关于随时间推移的晚年功能，以及医疗保险索赔数据，包括手术数据变量以及 以手术患者队列为基础，提供详细的神经心理测试结果，以解决 目的如下：1)比较65岁≥患者的认知能力变化 非心脏择期手术和非心脏择期手术，2)比较≥65患者的日常功能变化 接受大型非心脏择期手术的患者和未接受该手术的患者，评估认知能力的变化 ≥70年前登记的女性脱垂手术后两年的表现和诊断 Ackenbom et.评估pNCD的ALL研究。这项建议的培训目标是：1)在基础设施的基础上 在临床研究环境中测量一系列认知能力的知识，以及2)提高我的 对认知功能障碍的研究、临床诊断和治疗有一定的认识和理解 一般障碍，特别是ADRD，纳入涉及认知的未来研究设计 围手术期的评估。本研究将确定合适的效应大小，为将来的研究做准备 对认知表现和认知诊断进行扩展评估的研究，包括 70岁以上≥患者接受大型非心脏择期手术后pNCD与偶发痴呆症 5年期。此外，这些培训目标的实现将推动Ackenbom博士过渡到 作为临床研究人员在这一重要研究领域的独立性。

PROJECT ABSTRACT The purpose of this K23 career development award is to support Dr. Ackenbom's long term career goal of becoming an independent surgeon-scientist advancing knowledge on cognitive impairment after surgery used to improve surgical outcomes and quality of life for older patients. Recognizing postoperative neurocognitive disorder (pNCD), previously termed postoperative cognitive dysfunction (POCD), in surgical patients is essential as it is associated with delayed postoperative recovery, greater loss of independence, increased morbidity, mortality, and substantial health care costs. In the United States, approximately 35% of all surgeries are performed on adults ≥65 years, and with the increase in the aging population, the number of surgeries and thus pNCD incidence is expected to rise. pNCD/POCD is characterized as a largely transient deterioration of concentration, information processing, and memory often lasting days to months, but there are studies reporting cognitive impairment after surgery lasting years. Cognitive impairment occurring more than 12 months after surgery is concerning for an ongoing diagnosis of mild cognitive impairment or other cognitive diagnoses, inclusive of Alzheimer's disease and related dementias (ADRD).There is a critical research need to examine the longitudinal course of cognitive impairment after surgery and its influence on everyday functioning, independence, and quality of life as it is not well understood. We propose a study using linked 2011-2017 data from the National Health and Aging Trends Study (NHATS), a population-based study focused on late-life functioning over time, with Medicare claims data, inclusive of surgical data variables as well as building upon a surgical patient cohort with available detailed neuropsychological testing results to address the following aims: 1) compare change in cognitive performance of persons ≥65 years who underwent major noncardiac elective surgery and those who did not, 2) compare change in everyday functioning in persons ≥65 years who underwent major noncardiac elective surgery and those who did not, 3) assess change in cognitive performance and diagnosis two years after prolapse surgery in women ≥70 years previously enrolled in Ackenbom et. al study assessing pNCD. The training aims in this proposal are: 1) To build on foundational knowledge in measurement of a range of cognitive abilities in clinical research settings and 2) To enhance my knowledge and understanding in research and clinical diagnosis and management of cognitive impairment disorders in general and in particular, ADRD, to incorporate into future study designs involving cognitive evaluation in perioperative settings. This study will determine appropriate effect sizes in preparation for future studies to conduct an extended assessment of cognitive performance and cognitive diagnoses, including pNCD and incident dementia, after undergoing major noncardiac elective surgery in persons ≥70 years over a 5-year period. Further, achievement of these training aims will propel Dr. Ackenbom in her transition to independence as a clinical researcher in this important area of study.