Examining the Risk of Alzheimer s Disease and Related Dementia Among People with Spinal Cord Injury: A Mixed-Methods Study Comparing Veterans and Civilians
Abstract
Traumatic spinal cord injury (TSCI) is often associated with life-long debilitating consequences that negatively impact physical functioning, secondary morbidities, and quality of life. With advances in healthcare, life expectancy for persons afflicted with TSCI has increased substantially. Emerging evidence suggests that neuronal damage from TSCI – mostly caused by motor vehicle accidents, falls, or acts of violence – may worsen certain biological mechanisms that elevate the risk for Alzheimer’s disease and related dementia (ADRD). Early identification of ADRD risk factors is important, not only to improve our understanding of the pathophysiology of ADRD, but also to help identify potential preventative, therapeutic, and rehabilitative services or targeted treatment to promote healthy brain aging. Without appropriate and timely intervention, persons with TSCI are likely prone to premature physical, emotional, and cognitive aging. By examining the risk of developing ADRD, comparing adults with TSCI to those without, we will (1) unravel the link between TSCI and ADRD, with and without considering the additional risk of psychological, cardiometabolic, and musculoskeletal conditions and other comorbidities on incident ADRD, (2) examine early and consistent use of various preventative, therapeutic, and rehabilitative services among persons with TSCI that may reduce the likelihood of ADRD (e.g., continuity of rehabilitative care – including type and level of physical and occupational therapies to keep persons with TSCI physically active – and some therapeutic and preventative services, such as taking anti-depressant medications and use of psychological counseling), and (3) explore the barriers and facilitators in access to and use of these services among civilian and Veteran populations with TSCI. This study will affirm the importance of the contributions of the environment, comorbid conditions, and early preventative care in promoting healthy brain aging among persons with TSCI. Such information is needed not only to enable the development of appropriate clinical screening procedures for this population, but also for the design of targeted, early interventions aimed at reducing the risk of cognitive decline and ADRD. This is an important topic for all stakeholders involved: persons with TSCI, their caregivers and families, healthcare providers and clinicians, and rehabilitative service providers and policy makers. In this proposed 3-year mixed-methods (quantitative and qualitative) investigation, we will comprehensively analyze large data from nationally representative private health insurance claims, as well as the VA electronic health records, to examine the relationship between TSCI and ADRD among privately insured individuals and Veterans, respectively. The objective is to propose a bundle of care that has shown evidence of protection against developing ADRD. We will also interview privately insured civilians and Veterans with TSCI and their caregivers to examine their barriers and facilitators in use of and access to preventative, therapeutic, and rehabilitative services that have shown promising results in healthy aging. To maximize the study’s impact, we will share the results throughout the 3-year time period of the study to all stakeholders through various communication mechanisms: webinars, policy briefs, clinical recommendations, engagement of the Paralyzed Veterans of America organization, scientific publications, and conference presentations. The results of this study will also inform future clinical trials on the effectiveness of model clinics targeted toward healthy physical and cognitive aging for persons with TSCI. This innovative Investigator-Initiated Research Award proposal will foster a new direction in the field of TSCI research by focusing on heightened risk of incident ADRD among individuals with TSCI. The findings from this study will yield a recommended bundle of care and inform future efforts
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110751
Entities
People
- Elham Mahmoudi
Organizations
- United States Army
- University of Michigan