Longitudinal Impact of Health and Lifestyle Behaviors on Cognition in Individuals with Multiple Sclerosis

项目总结/摘要 该CDA提案旨在调查可改变的健康相关行为的长期影响（例如， 吸烟、运动）对多发性硬化症（MS;特异性 目标1）。鉴于MS中认知障碍的不利影响，这一点很重要， 症状管理、工具性日常生活活动和独立性。由于没有 认知障碍的有效治疗方法，必须确定可改变的风险因素- 特别是与健康有关的行为-可以作为潜在的治疗目标。而且为了 修改这些行为，本提案将探讨疾病（MS）相关的，个人特定的， 环境促进者和参与健康相关行为的障碍（具体目标2）。等 目标与国家医疗康复研究中心的使命一致 （NCMRR）以“确定可改变的生活方式和健康相关行为对 预防继发性疾病、心理社会功能和社区参与”， 在2016年NIH康复研究计划中概述。 具体目标将通过在以下人群中进行的两项纵向观察性研究来实现： 女士将通过标准化神经心理学评估建立认知轨迹。健康-- 相关行为将使用自我报告清单进行评估。参与的促进因素/障碍 与健康有关的行为将通过定量清单和定性半结构化 采访本次调查的数据将作为R 01赠款的试点数据， 多成分的生活方式干预，以改善认知与MS的人将提出。 这种干预最近在有患痴呆症风险的老年人中进行， 正在世界各地进行复制。该项目的信息将有助于适应这种类型的 通过解释MS特定的促进者和参与的障碍，对MS患者进行干预 健康行为。 我组建了一个多学科的指导团队，拥有临床神经心理学的专业知识， 认知康复、流行病学、高级生物统计学和临床试验设计。通过完成 提出培训和研究计划后，我就能实现我的培训目标，包括：（1）申请 以人群为基础的调查研究设计，以健康的社会决定因素对生活方式的作用 行为;（2）学习定性研究设计和先进的统计技术;（3）学习如何 进行临床试验;（4）磨练我的专业发展技能，如手稿写作， 实验室管理和指导。实现这些目标将帮助我过渡到 成为一名独立的临床研究者，有着长期的资助研究生涯。

Project Summary/Abstract This CDA proposal seeks to investigate the long-term impact of modifiable health-related behaviors (e.g., smoking, exercise) on cognitive decline over time among persons with multiple sclerosis (MS; Specific Aim 1). This is important given the detrimental impact of cognitive impairment in MS, affecting symptom management, instrumental activities of daily living, and independence. Since there are no proven treatments for cognitive impairment, it is imperative to identify modifiable risk factors – specifically health-related behaviors – that can serve as potential treatment targets. Moreover, in order to modify these behaviors, this proposal will explore disease (MS)-related, person-specific, and environmental facilitators and barriers to engaging in health-related behaviors (Specific Aim 2). Such aims are consistent with the mission of the National Center for Medical Rehabilitation Research (NCMRR) to “determine the impact of modifiable lifestyle and health-related behaviors on prevention of secondary conditions, psychosocial functioning, and community participation,” as outlined in the 2016 NIH Research Plan on Rehabilitation. The Specific Aims will be accomplished via two longitudinal, observational studies among persons with MS. Cognitive trajectories will be established by standardized neuropsychological assessments. Health- related behaviors will be evaluated using self-report inventories. Facilitators/barriers to engaging in health-related behaviors will be determined by quantitative inventories and qualitative semi-structured interviews. Data from this investigation will serve as pilot data for a R01 grant in which a multicomponent lifestyle intervention to improve cognition among persons with MS will be proposed. Such intervention has been recently conducted in older adults at-risk of developing dementia, with ongoing replications around the world. Information from this project will help adapt this type of intervention to individuals with MS by accounting for MS-specific facilitators and barriers to engaging in health behaviors. I have assembled a multidisciplinary mentoring team, with expertise in clinical neuropsychology, cognitive rehabilitation, epidemiology, advanced biostatistics, and clinical trial design. By completing the proposed training and research plans, I will be able to achieve my training goals, including: (1) applying population-based survey research design to the role of the social determinants of health on lifestyle behaviors; (2) learning qualitative research design and advanced statistical techniques; (3) learning how to conduct clinical trials; and (4) honing my professional development skills, such as manuscript writing, grantsmanship, laboratory management, and mentorship. Achieving these goals will help me transition into an independent clinical investigator, with a long career of grant-funded research.