The MIND ICU Study
Southern Community Cohort Study (SCCS)
The MIND ICU Study Among Intensive Care Unit (ICU) survivors, subsequent cognitive and functional decline are the greatest threats to meaningful recovery. Six small cohorts indicate that an alarming 30% to 80% of the increasingly older millions of ICU survivors develop an acquired long-term cognitive impairment (LTCI) functionally equivalent to mild/moderate dementia that may last years. Additionally, major deficits in health-related quality of life (HRQL), functional status, and an “ICU accelerated” frailty are common, especially in the elderly. A leading and potentially modifiable risk factor for these devastating outcomes may be ICU delirium, which is a predictor of higher mortality, higher cost, and poor cognitive function at discharge. Additionally, heavy and prolonged exposure to potent psychoactive medications routinely administered in high doses to ventilated patients may have lasting yet preventable cognitive and functional effects. In this proposal, Aims 1 and 3 will determine whether delirium is an independent risk factor for the incidence, severity, and/or duration of LTCI (Aim 1) and impaired HRQL (Aim 3) in ICU survivors. Likewise, Aims 2 and 4 will determine whether degree of exposure to sedative and analgesic medications in ICU patients is an independent risk factor for the incidence, severity, and/or duration of LTCI (Aim 2) and impaired HRQL (Aim 4). The MIND- ICU study will be a prospective cohort study enrolling 800 mechanically ventilated medical and surgical patients from 3 diverse medical centers over a 39 month period with comprehensive follow-up testing at 3 and 12 months after hospital discharge. This study will quantify whether delirium and sedative/analgesic exposure are indeed risk factors for LTCI and HRQL, controlling for other covariates such as age, medical vs. surgical ICU admission, pre-existing cognitive impairment, sepsis, and apoE genotype. This will pave the way for development of preventive and/or treatment strategies to reduce long-term cognitive impairment and improve the functional recovery of older and younger ICU patients for decades to come. Funded by the National Institute on AgingInvestigators: Wes Ely, M.D., M.P.H.
Southern Community Cohort Study (SCCS) It has long been known that cancer incidence and mortality are elevated among African Americans. The Southern Community Cohort Study (SCCS) is a landmark prospective investigation into the determinants of these disparities. Over the past five years, by partnering with Community Health Centers (CHCs), facilities providing basic health care mainly to the uninsured across 12 southern states, we have overcome barriers that have traditionally restricted participation of African Americans in health studies. The current phase of the SCCS, proposed herein, will enable completion of enrollment so that the cohort will include approximately 90,000 men and women, nearly 70% African American, age 40-79. The new enrollees will be recruited from CHCs and complete an in-person interview about medical, lifestyle and other characteristics, with > 90% expected to provide biologic specimens (blood, buccal cells, and/or urine). Follow up of the entire cohort to identify deaths and incident cancers and update exposure profiles will be carried out. We will implement enhanced approaches to active follow up. Longitudinal analyses and nested case-cohort studies using the interview data and biologic specimens will be initiated during this funding period to evaluate specific hypotheses about cancer among African Americans which can uniquely or with special advantage be assessed within the SCCS. The hypotheses are related to energy balance (weight gain, obesity and physical inactivity), vitamin D, inflammation, selenium and other nutrient intakes, tobacco metabolism, and cancer screening practices and their impact on incidence and/or mortality of the major cancers (lung, prostate, breast, and colon/rectum). Initial SCCS data show sometimes marked racial differences in these variables. The cohort possesses attributes, such as a 44% prevalence of obesity (reaching 57% among Black women) and a 44% prevalence of current smoking which place it at exceptionally high risk of cancer. The SCCS is thus unique among all cohorts and comprises a population of urban and rural blacks and whites, often of low income, seldom if ever included in previous studies. The SCCS is a national resource, with comprehensive biologic and questionnaire data available for assessing, both within the SCCS and in combination with other molecular epidemiology consortia, the etiology of cancer and reasons for the largely unexplained higher rates among blacks. The ultimate public health benefit will be progress towards the development of measures aimed at cancer prevention, the elimination of cancer inequalities, and reduction of the cancer burden among all groups. Funded by the National Cancer Institute Investigators: William Blot, Ph.D. (PI); Lisa Signorello, Ph.D. (PI); Maciej Buchowski, Ph.D.; Raymond Burk, M.D.; Qiuyin Cai, M.D., Ph.D.; Robert Dittus, M.D., M.P.H.; Jay H. Fowke, M.P.H., Ph.D.; Jirong Long, Ph.D.; Chun Li, Ph.D.; Charles E. Matthews, Ph.D.; Pierre Massion, M.D.; Joseph McLaughlin, Ph.D.; Neeraja Peterson, M.D.; David Schlundt, Ph.D., ; Martha Shrubsole, Ph.D.; Xiao Ou Shu, M.D., Ph.D.; Robert Tarone, Ph.D.; Scott Williams, Ph.D.; Wei Zheng, M.D., Ph.D.