Swallowing Trajectories and DysPHagia Predictors in AlzheimER’s DisEase (SPHERE)

项目总结 吞咽困难经常发生在AD/ADRD患者身上，并导致严重的健康后果，包括 照顾者负担增加、营养不良、肺炎、生活质量下降和死亡率下降。有针对性的， 对吞咽困难的有效康复干预已经在其他神经退行性疾病中被开发出来 人群，但目前还没有对AD/ADRD患者吞咽困难有持久影响的有效治疗方法 关于吞咽生理学。在制定干预措施以预防吞咽困难相关的不良反应之前 AD/ADRD患者的后遗症：对吞咽困难风险因素的深入了解 迫切需要疾病进展过程中吞咽变化的轨迹，特别是在早期 干预措施最有效和最有影响力的阶段。AD/ADRD中的小型横断面研究 表明在疾病进展的早期就开始吞咽的变化。然而，这些先前的研究 检查AD/ADRD患者的吞咽困难缺乏全面和纵向的吞咽特征 在痴呆症的整个过程中发挥作用，以改善临床管理。另外，虽然很新奇， 多模式吞咽评估能够检测到其他患者的亚临床吞咽障碍 在神经发生人群中，AD/ADRD亚临床变化的性质尚不清楚。要解决这些问题 关键知识差距，我们建议对AD/ADRD患者进行按疾病分层的前瞻性队列研究 阶段(非常轻到中度)和他们的护理伙伴。参与者将经历全面的痴呆症 特征，包括神经心理测试和基于血浆的生物标记物，以及多模式 在基线和每六个月吞下评估。我们还将收集各种临床因素(例如， 人口统计学、合并症)和口腔功能的测量(例如，唾液产生、口腔健康、语言 压力)、呼吸压力、骨质疏松症和基线营养状况。这件事的首要目标是 研究将通过加强临床为AD/ADRD患者制定干预策略提供信息 以及对吞咽障碍的发病、性质和发展的流行病学理解。我们的 多学科专家团队将通过以下具体目标实现这一目标：1.定义吞咽 从极轻到中度的AD/ADRD变化为：1a)表征亚临床吞咽困难特征；以及1b) 确定有助于症状报告的临床因素和吞咽措施；2.确定风险因素 从非常轻到中度的AD/ADRD吞咽功能障碍；以及3.确定 AD/ADRD患者的吞咽功能及其与危险因素的关系拟议的工作代表了 首次对一组特征明确的患者进行吞咽功能的纵向、全面研究 AD/ADRD。对疾病进展过程中吞咽功能的更好理解将为发育提供信息 有针对性的干预措施，以解决AD/ADRD患者吞咽困难的识别、预防和康复问题。

PROJECT SUMMARY Dysphagia frequently develops in persons with AD/ADRD and leads to serious health consequences, including increased caregiver burden, malnutrition, pneumonia, decreased quality of life, and mortality. Targeted, efficacious rehabilitative interventions for dysphagia have been developed in other neurodegenerative populations, but there are currently no effective treatments for dysphagia in AD/ADRD that have lasting effects on swallowing physiology. Prior to developing interventions to prevent dysphagia-related adverse sequelae in patients with AD/ADRD, in-depth understanding of factors contributing to dysphagia risk and trajectories of swallowing change across disease progression is urgently needed, especially in early stages when interventions can be most effective and impactful. Small, cross-sectional studies in AD/ADRD have suggested changes in swallowing beginning early in disease progression. However, these prior studies examining dysphagia in AD/ADRD lack the comprehensive and longitudinal characterization of swallowing function across the dementia continuum necessary to improve clinical management. Additionally, while novel, multi-modality swallowing assessments have enabled detection of subclinical swallowing impairments in other neurogenerative populations, the nature of subclinical changes in AD/ADRD remains unknown. To address these critical knowledge gaps, we propose a prospective cohort study of persons with AD/ADRD stratified by disease stage (very mild to moderate) and their care partners. Participants will undergo comprehensive dementia characterization, including neuropsychological testing and plasma-based biomarkers, as well as multi-modal swallowing assessments at baseline and every six months. We will also collect a variety of clinical factors (e.g., demographics, comorbidities) and measures of oral function (e.g., saliva production, oral health, lingual pressures), respiratory pressures, sarcopenia, and nutritional status at baseline. The overarching goal of this research is to inform development of intervention strategies for persons with AD/ADRD through enhanced clinical and epidemiologic understandings of the onset, nature, and progression of swallowing deficits. Our multidisciplinary team of experts will achieve this objective via the following specific aims: 1. Define swallowing changes from very mild to moderate AD/ADRD to: 1a) characterize subclinical dysphagia features; and 1b) identify clinical factors and swallowing measures that contribute to symptom reporting; 2. Identify risk factors for swallowing dysfunction from very mild to moderate AD/ADRD; and 3. Determine trajectories of change in swallowing function in persons with AD/ADRD and association with risk factors. The proposed work represents the first longitudinal, comprehensive study of swallowing function in a well-characterized cohort of persons with AD/ADRD. Improved understanding of swallowing function across disease progression will inform development of targeted interventions to address identification, prevention, and rehabilitation of dysphagia in AD/ADRD.