Every year, more than two million older Americans (aged 65 and older) suffer from an episode of delirium during their intensive care unit (ICU) stay. Advances in the management of critical illness have improved critical illness survival rates especially among older adults. However, as many as 70% of ICU older survivors who had an episode of delirium are left with newly acquired cognitive impairment that can have disabling long- term consequences for both patients and their informal caregivers. Currently, there are no effective and scalable recovery models to remediate or treat ICU acquired cognitive impairment and its deleterious effects on quality of life and independence of this growing segment of older ICU survivors. Over the past five years, interdisciplinary team of scientists at Indiana University Center for Aging Research developed a novel, home-based cognitive and physical exercise program to reduce the societal impact of cognitive impairment. The team is proposing to conduct a randomized controlled trial (RCT) called ?Decreasing Alzheimer's Disease and Related Dementias after Delirium-Exercise and Cognitive Training (DDD-ECT)? to evaluate the efficacy of 12 weeks of combined physical exercise and cognitive training intervention on the primary outcome of cognitive function among older ICU survivors in central Indiana who had an episode of delirium during their ICU stay. Importantly, we propose to deliver these interventions via a facilitator-led, small group format using internet-enabled, multiparty-videoconference delivered directly into the participants' homes. The trial has the following aims: 1. Determine the effect of the combined physical exercise and cognitive training on the cognitive function of older ICU survivors at 3 and 6-months follow-up. 2. Determine the effect of the combined physical exercise and cognitive training on physical performance, anxiety and depressive symptoms, and quality of life of older ICU survivors at 3 and 6-months follow-up. 3. To examine the mechanisms of action of combined training. Achievement of the aforementioned aims will provide an efficacious therapy to improve cognitive outcomes among ICU survivors along with highlighting the involved neurobiological pathways. The findings will aid in moving the field forward towards reducing the burden of Alzheimer's disease and related dementias.

Public Health Relevance

Two million older Americans (aged 65 and older) suffer from an episode of delirium during their intensive care unit (ICU) stay, which predisposes these older ICU survivors to develop newly acquired cognitive impairment that interferes with their functional and psychological recovery, leading to long-term disability and poor quality of life. Early evidence suggests that a recovery program that incudes both physical and cognitive training may reduce the impact of post-ICU cognitive impairment. The primary goal of this proposal is to conduct a randomized controlled clinical trial that will evaluate the efficacy of home-based, 12-week course of combined physical exercise and cognitive training on cognitive function of older ICU survivors.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG055391-04
Application #
9919490
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Roberts, Luci
Project Start
2017-05-01
Project End
2022-04-30
Budget Start
2020-05-01
Budget End
2021-04-30
Support Year
4
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Indiana University-Purdue University at Indianapolis
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603007902
City
Indianapolis
State
IN
Country
United States
Zip Code
46202
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Wang, Sophia; Allen, Duane; Kheir, You Na et al. (2018) Aging and Post-Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry. Am J Geriatr Psychiatry 26:212-221
Wang, Sophia; Hammes, Jessica; Khan, Sikandar et al. (2018) Improving Recovery and Outcomes Every Day after the ICU (IMPROVE): study protocol for a randomized controlled trial. Trials 19:196
Khan, Babar A (2017) The author replies. Crit Care Med 45:e1193