Prescription opioids, cognitive decline, and Alzheimer's disease in older adults

项目摘要/摘要 慢性疼痛和处方阿片类药物的使用在老年人中很常见，其中10%的人普遍使用阿片类药物 年龄超过65岁的。流行病学调查发现认知功能减退的速度加快。 在患有慢性疼痛的老年人中，1和最近的证据表明，阿片类药物的使用可能是一个危险因素。 梅奥老年诊所研究(MCSA)的初步数据显示，患老年疾病的几率增加30%以上 处方使用者普遍存在的轻度认知障碍或阿尔茨海默病痴呆 研究登记中的阿片类药物。如果阿片类药物的使用与临床相关的认知能力下降之间的联系是 如果得到证实，它将对老年人慢性疼痛的管理产生深远的影响。 申请者的长期目标是成为一名成功的独立翻译临床医生-科学家 领导一个多学科团队，优化老年人的止痛药、认知和生活质量。 本申请的科学目的是：1)评估处方阿片类药物之间的关系 在一项基于人群的老年人研究中，整体和特定领域认知功能的纵向变化 成人，2)评估处方阿片类药物与大脑纵向变化之间的关系 形态计量学，以及3)探索患有慢性疼痛的老年人对阿片类药物的影响 通过定性分析进行止痛和认知。申请者的培训目标涉及4个方面： 流行病学、认知结果评估、结构神经成像和定性方法。 目的1：评估阿片类药物处方、全球和领域的纵向变化之间的关系。 以人群为基础的老年人队列中的特定认知z分数和事件MCI或痴呆症。 利用通过MCSA提供的资源，包括对全球和 MCI和痴呆的特定领域认知和诊断评估，我们将评估它们之间的关系 处方阿片类药物使用和认知之间的关系，并对混杂变量进行适当调整。 目的2：评估处方阿片类药物与脑形态计量学纵向变化的关系 在参加MCSA的广泛的以人口为基础的老年人队列中。 利用来自MCSA的纵向MRI数据，我们将评估处方之间的关系 阿片类药物、脑结构变化和神经心理学结果。 目标3：描述患有慢性疼痛的老年人对阿片类药物影响的经历和看法 通过定性分析对镇痛和认知的影响。 我们将采用定性的方法，探索对慢性阿片类药物治疗的看法和经验。 疼痛管理，包括止痛效果和对认知的短期和长期变化的关注。

PROJECT SUMMARY/ABSTRACT Chronic pain and prescription opioid use are common in older adults, with prevalent opioid use in 10% of those greater than 65 years of age. Epidemiological investigations have noted accelerated rates of cognitive decline in older adults with chronic pain,1 and recent evidence suggests that opioid use may be a risk factor.2–4 Our preliminary data from the Mayo Clinic Study of Aging (MCSA) shows a more than 30% increase in the odds of prevalent mild cognitive impairment (MCI) or Alzheimer’s disease dementia in those utilizing prescription opioids at study enrollment. If the association between opioid use and clinically-relevant cognitive decline is confirmed, it would have profound consequences for the management of chronic pain in older adults. The long-range goal of the applicant is to become a successful independent translational clinician-scientist leading a multidisciplinary team to optimize analgesic, cognitive, and quality of life outcomes in older adults. The scientific objectives of this application are: 1) to evaluate the relationships between prescribed opioids and longitudinal changes in global and domain-specific cognitive function in a population-based study of older adults, 2) to assess the relationships between prescribed opioids and longitudinal changes in brain morphometry, and 3) to explore the perceptions of older adults with chronic pain on the impact of opioids on analgesia and cognition through qualitative analysis. The training goals of the applicant involve 4 areas: epidemiology, cognitive outcome assessment, structural neuroimaging, and qualitative methods. Aim 1: To evaluate the relationships between opioid prescriptions, longitudinal changes in global and domain- specific cognitive z-scores, and incident MCI or dementia in a population-based cohort of older adults. Utilizing the resources available through the MCSA, including longitudinal assessments of global and domain-specific cognition and diagnostic evaluations for MCI and dementia, we will assess the relationships between prescription opioid use and cognition with appropriate adjustment for confounding variables. Aim 2: To assess the relationships between prescribed opioids and longitudinal changes in brain morphometry in a broad population-based cohort of older adults enrolled in the MCSA. Utilizing longitudinal MRI data from the MCSA, we will assess the relationships between prescription opioids, changes in brain structure, and neuropsychological outcomes. Aim 3: To describe the experiences and perceptions of older adults with chronic pain on the impact of opioids on analgesia and cognition through qualitative analysis. We will employ qualitative methods to explore perceptions and experiences of opioid therapy for chronic pain management, including analgesic efficacy and concerns for short- and long-term changes in cognition.