Electronic Health Record-Based Dementia Prediction for HIV Primary Care

项目总结 Jennifer Lam博士，公共卫生硕士，传染病流行病学家，其研究重点是改善 老龄化的艾滋病毒人口的健康。她之前的研究探索了慢性病对人的影响 艾滋病毒携带者。她最近将她的工作扩展到艾滋病毒背景下的痴呆症评估 感染。越来越多的证据表明，随着年龄的增长，艾滋病毒携带者经历了一条独特的认知轨迹 尽管接受了抗逆转录病毒治疗，但发病率仍在下降。这可能是由于艾滋病毒介导的综合作用。 炎症和非艾滋病毒因素，如药物使用、精神疾病和心血管疾病。 由于美国许多艾滋病毒携带者现在已经超过50岁，与年龄相关的痴呆症将成为一种 日益严重的健康问题。到目前为止，很少有研究描述患有老年痴呆症的老年人 艾滋病毒感染得到了很好的控制。这项拟议的研究旨在：1)量化社会人口的贡献， 与50岁以上艾滋病毒携带者患痴呆症风险的行为和共病相关因素比较 那些没有感染艾滋病毒的人，2)开发和验证一个模型来预测艾滋病毒携带者的痴呆症事件，使用 电子健康记录数据，并纳入艾滋病毒感染严重程度和持续时间等艾滋病毒特有因素， 以及3)制定策略以优化痴呆症预测模型的临床实用性。中国的一大强项 拟议的研究是，将在大型医疗保健范围内进行初始模型开发和验证 该系统有一个特点良好的艾滋病毒老年人口和稳定的纵向后续行动。这将是 然后在外部HIV队列中进行验证，以评估普适性，开发原型临床医生- 面对风险分层工具，并与利益相关者面谈，以获得对未来临床实施的意见。小说 研究的组成部分包括社区样本中痴呆症风险的特征 与来自相同环境的未感染艾滋病毒的人进行比较，并使用高级分析来 使用电子健康记录中的初级保健数据评估痴呆的多个纵向预测因素。至 支持拟议的研究和林博士未来在艾滋病毒和痴呆症方面进行独立研究的目标， K01提案包括一个正式的、有指导的培训计划，以发展以下方面的技能：1)风险因素评估 针对HIV感染者的神经认知障碍，2)发育和分析建模技术 基于电子健康记录数据的痴呆预测模型的验证，3)翻译和 将研究成果落实到临床护理环境中，以及4)专业技能发展。培训 将由一个具有艾滋病毒方面综合专业知识的导师团队提供课程作业和量身定做的教程， 神经学、老年学、生物统计学和医疗保健服务科学。拟议的研究结果将 告知艾滋病毒携带者预防痴呆症的战略，并支持实施和测试 痴呆风险分层工具在临床实践中的应用。它还将使林博士为独立人士的职业生涯做好准备 美国国立卫生研究院资助的预防和管理艾滋病毒携带者痴呆症研究的研究员。

PROJECT SUMMARY Jennifer Lam PhD, MPH is an infectious disease epidemiologist whose research focuses on improving the health of the aging HIV population. Her prior research has explored the impact of chronic disease on persons living with HIV. She has recently extended her work to the evaluation of dementia in the context of HIV infection. Mounting evidence suggests that people aging with HIV experience a unique trajectory of cognitive decline despite treatment with antiretroviral therapy. This may be due to the combined effects of HIV-mediated inflammation and non-HIV factors such as substance use, psychiatric comorbidity, and cardiovascular disease. As many people with HIV in the U.S. are now over 50 years old, age-associated dementias will become an increasingly critical health concern. To date, few studies have characterized dementia in older individuals with well-controlled HIV infection. The proposed research aims to: 1) quantify the contribution of sociodemographic, behavioral, and comorbidity-related factors to risk of dementia in people aged 50+ years with HIV compared to those without HIV, 2) develop and validate a model to predict incident dementia in people with HIV, using electronic health record data and incorporating HIV-specific factors such as HIV infection severity and duration, and 3) develop strategies to optimize the clinical utility of a dementia prediction model. A major strength of the proposed research is that initial model development and validation will be conducted within a large healthcare system with a well-characterized older population with HIV and stable, longitudinal follow-up. This will be followed by validation in an external HIV cohort to assess generalizability, development of a prototype clinician- facing risk stratification tool, and stakeholder interviews to obtain input on future clinical implementation. Novel components of the research include characterization of dementia risk in a community-based sample of people with HIV, comparison with HIV-uninfected individuals from the same setting, and use of advanced analytics to evaluate multiple longitudinal predictors of dementia using primary care data in electronic health records. To support the proposed research and Dr. Lam’s goal of future independent research in HIV and dementia, this K01 proposal includes a formal, mentored training program to develop skills in: 1) the evaluation of risk factors for neurocognitive disorders in people with HIV, 2) analytic modeling techniques for development and validation of electronic health record data-based dementia prediction models, 3) translation and implementation of research findings into clinical care settings, and 4) professional skills development. Trainings will consist of coursework and tailored tutorials delivered by a mentorship team with combined expertise in HIV, neurology, aging, biostatistics, and healthcare delivery science. The results of the proposed research will inform strategies for dementia prevention in people with HIV and support plans to implement and test a dementia risk stratification tool in clinical practice. It will also prepare Dr. Lam for a career as an independent investigator conducting NIH-funded research on prevention and management of dementia in people with HIV.