An integrated epidemiological approach to understanding the relationship between lung health and multi-morbidity

英国医疗保健预算的70%用于护理患有多种长期健康状况的患者，如痴呆症和慢性阻塞性肺疾病(COPD)；在人口老龄化和生活方式因素的推动下，这一数字预计还会上升。因此，慢性肺病和痴呆症是关键的全球卫生挑战。认知描述的是思维、解决问题和记忆等心理能力。认知问题(认知功能障碍)可导致痴呆症，在慢性肺部疾病患者中非常常见。尽管认知功能障碍一开始可能是轻微的，没有被注意到，但它可能会逐渐使患者更难进行日常活动，包括正确服药。慢性肺病患者的认知功能障碍最终会导致健康状况恶化、住院时间延长和生存期缩短。由于多种因素的综合作用，慢性肺病患者患轻度认知障碍(MCI)和痴呆症的风险可能会增加，这些因素在肺部疾病患者中更为常见，已知会对认知产生负面影响(例如吸烟和高血压)，或者是肺部疾病(例如低氧水平)的直接结果。然而，在认知障碍和肺部疾病之间似乎确实存在着独立于这些共同因素的一致联系，这表明了呼吸受限的特有机制。这个项目的目的是确定慢性肺部疾病和认知障碍是否有共同的因果关系。它将通过汇集流行病学和统计学的跨学科专业知识来实现这一点，以了解决定肺部健康和认知的遗传、发育和早期生命事件之间的复杂相互作用(MRC战略目标4)。它还将使用雅芳父母和孩子纵向研究(ALSPAC)队列中应用的基于人群的生命过程视角来探索早期生活认知、共病和肺功能轨迹之间的关系。(MRC战略目标1)。目标是：a)应用我们团队开发的集成遗传流行病学方法(2个样本孟德尔随机抽样)，以确定肺功能、认知障碍和痴呆症风险之间的因果关系。利用ALSPAC队列的现有数据，确定肺功能的早期生活变化是否与认知功能障碍和多种疾病相关。好处和应用是：1)帮助确定可改变的风险因素和潜在的治疗目标，以降低发展为痴呆症的风险。2)加深对慢性肺病认知功能障碍机制的认识。3)开始开发新的方法来检测、预防或延缓高危人群认知功能障碍的进展。这将有助于患者管理他们的治疗，保持他们的健康和远离医院。4)增加我们对慢性肺部疾病和多发病的早期生命风险因素的了解5)通过与负责提供医疗服务和管理两种主要长期疾病--慢性阻塞性肺疾病(COPD)和痴呆--的组织接触，为公共卫生政策提供信息。认知功能障碍与多发病的认识b。告知自我管理和教育。让患有慢性阻塞性肺病和痴呆症的人在家中保持健康6)为长期疾病和肺部健康(如心血管疾病、抑郁症和糖尿病)之间的相互作用提供信息，并提出新的研究问题。

The UK spends 70% of its healthcare budget caring for patients with multiple long-term health conditions such as dementia and chronic obstructive pulmonary disease (COPD); driven by aging populations and lifestyle factors, this figure is expected to rise. Chronic lung disease and dementia are therefore key global health challenges. Cognition describes mental abilities, such as thinking, problem solving and remembering. Problems with cognition (cognitive dysfunction) can lead to dementia and appear very common in people with chronic lung disease. Although cognitive dysfunction may be mild and unnoticed at first, it may gradually make it more difficult for patients to perform their daily activities including taking medicines correctly. Cognitive dysfunction in chronic lung disease eventually leads to worse health, more time in hospital and shorter survival.Individuals with chronic lung disease may be at increased risk of mild cognitive impairment (MCI) and dementia due to a combination of factors, which are both more frequent among those with lung disease and known to negatively impact on cognition (e.g., smoking and high blood pressure) or as a direct result of lung disease (e.g., low oxygen levels). However, there does seem to be a consistent link between cognitive impairment and lung disease independent of these shared factors, suggesting mechanisms specific to respiratory limitation. The aim of this project is to determine whether chronic lung disease and cognitive impairment share a common causal pathway. It will do this by bringing together interdisciplinary expertise in epidemiology and statistics, to understand the complex interaction between genetic, developmental and early life events which determine lung health and cognition (MRC strategic aim 4). It will also explore the relationship between early life cognition, co-morbidity and lung function trajectories using a population-based life course perspective applied to the Avon Longitudinal Study of Parents And Children (ALSPAC) cohort. (MRC strategic aim 1). The objectives are:a) Apply integrated genetic epidemiological methods developed by our team (2 sample Mendelian Randomisation) from large European populations to determine the causal association between lung function, cognitive impairment and risk of dementiab) Determine if early life changes in lung function are associated with cognitive dysfunction and multi-morbidity using existing data from the ALSPAC cohort.Benefits and applications are:1) Help to identify modifiable risk factors and potential therapeutic targets to reduce the risk of developing dementia. 2) Advance our understanding behind the mechanisms of cognitive dysfunction in chronic lung disease. 3) Initiate the development of new ways to detect, prevent or delay progression of cognitive dysfunction in at risk populations. This will help patients to manage their treatment, maintain their health and keep out of hospital. It could also prolong survival.4) Increase our understanding about early life risk factors for chronic lung disease and multi-morbidity5) Inform public health policy through engagement with organisations responsible for health services delivery and management of two major long-term conditions, Chronic Obstructive Pulmonary Disease (COPD) and Dementia.a. Awareness of cognitive dysfunction & multi-morbidityb. Inform self-management and educationc. Keeping people with COPD and Dementia healthy at home6) Inform and open new research questions about the interaction between long-term conditions and lung health such as cardiovascular disease, depression and diabetes.