Impact of Novel Rehabilitative Approaches FOR Dysphagia in Patients with Alzheimer's Disease and Related Dementias

项目摘要/摘要 这份职业发展提案旨在为Nicole Rogus-Pulia博士、CCC-SLP提供演讲- 语言病理学家，威斯康星大学吞咽困难(吞咽障碍)专家- 麦迪逊医学和公共卫生学院拥有作为一名独立临床医生取得成功所需的培训- 科学家研究改善阿尔茨海默病患者吞咽困难护理的干预措施 相关痴呆症(ADRD)。ADRD患者经常出现吞咽困难，并导致严重健康 后果，包括照顾者负担增加，营养不良，肺炎，生活质量下降，以及 死亡率。ADRD患者吞咽困难的常见治疗方法是采用代偿性方法，改变 推注以避免吸入(食物或液体进入呼吸道)。这些方法不会导致 吞咽生理的持续改善，常常对生活质量产生负面影响。目前有 对于ADRD患者的吞咽困难没有有效的治疗方法，可以实际应用或具有持久的效果 关于燕子的生理学。罗格斯-普利亚博士提出的研究的目标是开发出有效的 对有不良健康后果风险的ADRD患者进行吞咽困难康复干预。 渐进性语言强化和唾液替代是两种已被证明的干预措施 在对老年人吞咽功能有积极影响的初步研究中。这项提案将包括一个 小规模、前瞻性随机临床试验，以确定两种新干预措施对吞咽的影响。 轻、中度ADRD患者的相关结局并确定最有可能受益的患者亚组 从这些干预措施中。患者-照顾者二人组将随机接受语言强化、唾液替代品 使用，两者结合使用，或者只进行常规护理。唾液和吞咽相关的结果将在 基线和8周干预期后。作为第三个目标，对非裔美国人进行定性采访 将对ADRD患者和他们的照顾者进行分析，以探索对研究方案或 干预材料，以改善这一代表性不足的群体未来的试验参与度。这些数据将 支持一项由R01资助的大型多点研究，以确定吞咽困难干预预防的有效性 在不同的ADRD患者队列中的不良健康后果。作为一家机构的初级教员 拥有广泛的基础设施来支持早期研究人员，罗格斯-普利亚博士处于理想的环境中 完成建议的研究并继续进行高级培训。她的职业发展计划包括这两项 在1)临床试验设计和分析，2)ADRD临床护理和 照顾，3)先进的统计技术，4)定性方法，5)文化能力。为了确保 成功，她已经在这些学科中找到了忠诚的专家导师，并为此获得了受保护的时间 工作。该奖项解决了ADRD研究中的一个重大临床困境和严重差距，同时为 教育和指导对罗格斯-普利亚博士领导独立的吞咽困难研究项目至关重要。

PROJECT SUMMARY/ABSTRACT This career development proposal is designed to provide Nicole Rogus-Pulia, PhD, CCC-SLP, a Speech- Language Pathologist and an expert in dysphagia (swallowing dysfunction) at the University of Wisconsin- Madison School of Medicine and Public Health with the training required for success as an independent, clinician- scientist researching interventions to improve the care of dysphagia in patients with Alzheimer’s Disease and Related Dementias (ADRD). Dysphagia frequently develops in patients with ADRD and leads to serious health consequences, including increased caregiver burden, malnutrition, pneumonia, decreased quality of life, and mortality. Common treatments for dysphagia in patients with ADRD employ compensatory approaches that alter bolus flow to avoid aspiration (entrance of food or liquid into the airway). These approaches do not result in sustained improvements in swallowing physiology and often negatively affect quality of life. There are currently no effective treatments for dysphagia in patients with ADRD that can be practically applied or have lasting effects on the physiology of the swallow. The goal of Dr. Rogus-Pulia’s proposed research is to develop effective dysphagia rehabilitative interventions for patients with ADRD at risk for adverse health consequences. Progressive-resistance lingual strengthening and saliva substitute are two interventions that have been shown in preliminary studies to positively influence swallowing function in older adults. This proposal will consist of a small, prospective randomized clinical trial to determine the impact of two novel interventions on swallowing- related outcomes in patients with mild-moderate ADRD and identify subgroups of patients most likely to benefit from these interventions. Patient-caregiver dyads will be randomized to lingual strengthening, saliva substitute use, a combination of the two, or only usual care. Saliva and swallowing-related outcomes will be collected at baseline and following the 8 week intervention period. As a third aim, qualitative interviews with African American patients with ADRD and their caregivers will be analyzed to explore cultural adaptations to the study protocol or intervention materials to improve future trial participation among this underrepresented group. These data will support a large, multi-site R01 funded study to determine effectiveness of dysphagia interventions for prevention of adverse health outcomes in a diverse cohort of patients with ADRD. As a junior faculty member at an institution with extensive infrastructure to support early stage investigators, Dr. Rogus-Pulia is in an ideal environment to complete the proposed research and pursue advanced training. Her career development plan includes both coursework and mentored training in the areas of 1) clinical trials design and analysis, 2) ADRD clinical care and caregiving, 3) advanced statistical techniques, 4) qualitative methods, and 5) cultural competence. To ensure success, she has identified committed, expert mentors in these disciplines and secured protected time for this work. This award addresses a significant clinical dilemma and serious gap in ADRD research while affording the education and mentorship critical for Dr. Rogus-Pulia to lead an independent dysphagia research program.