Impact of Hourly Neurochecks in Critically Ill Older Adults

Project Summary/Abstract As a neurocritical care physician, I have a strong background in neurophysiology, clinical neurology, and critical care; as a post-graduate student who studied neuroscience, I have a background in cognitive neuroscience. I also have a research passion for neuroscience topics such as sleep and cognition, including how to optimize or enhance cognition. Within this K-23 proposal, I merge these clinical and research passions and outline a thorough five-year curriculum with hands-on and didactic education to address deficiencies and to achieve my goal of improving outcomes in older adults with acute brain injury (ABI). I have assembled a mentorship team consisting of experts in sleep, aging, delirium, critical care, geriatric neuropsychology (including Alzheimer’s disease and related dementias; ADRD) and biostatistics. The proposed research plan seeks to understand the impact of sleep disruption in the Neurological Intensive Care Unit (ICU) on older patients with ABI. In current practice, the neurocritical care community performs frequent serial neurological examinations (“neurochecks”) in an effort to monitor patients for neurological deterioration following ABI. Many neurocritical patients are older and/or cognitively fragile, and delirium is common. Although ICU delirium is multifaceted, frequent neurochecks may represent a modifiable risk factor if we can better understand the risks and benefits of various neurocheck frequencies. My hypothesis is that the sleep interruption we induce in the Neurological ICU in our patients following ABI may actually negatively impact their post-ICU recovery because of the known associations between: 1) sleep disruption and delirium, 2) aging and delirium, 3) aging and dementia such as ADRD, and 4) sleep and cognition. It is possible that sleep interruption during critical illness exerts an effect on new or progressive dementia in part through delirium. In this context, this innovative, impactful, carefully considered, and feasible proposal will first [Aim 1] randomize patients with acute spontaneous intracerebral hemorrhage (ICH) to either hourly (Q1) or every-other-hour (Q2) neurochecks and evaluate the impact of neurocheck frequency on delirium duration. Second [Aim 2], to better understand the effect of Q1 versus Q2 on sleep, non-sedated patients without structural brain injury will be randomized to either Q1 or Q2 neurochecks with evaluation of objective and subjective sleep characteristics. Lastly [Aim 3], longer-term cognitive outcomes will be investigated in patients with ICH randomized to Q1 versus Q2 neurochecks with the goal of identifying whether hourly neurochecks increase the risk for dementia/ADRD. We have designed our studies with a particular emphasis on human subjects’ protections and developed a protocol that is well within standard of care at institutions across the USA. This grant will be instrumental to my vision as it will provide me with the protected time for training that I require to attain first-rate patient-oriented research skills. Ultimately, I endeavor to become an independent R01-funded neurocritical care physician scientist focused on improving the neurocognitive health of ICU patients at risk for cognitive decline including ADRD.