Project Summary/Abstract Applicant: I am a consultation-liaison psychiatrist keenly interested in delirium and the role that sleep-wake disturbance (SWD) plays in delirium vulnerability, its pathogenesis, and its relationship with subsequent Alzheimer’s disease and related dementias (ADRD). My mission is to improve the care and clinical outcomes of those with and at risk for delirium and to be a champion for excellence in care for older adults. This application is designed for me to obtain expertise in longitudinal study conduct and design, assessment of SWD, neuropsychological training relevant to delirium and the two neurocognitive disorders associated with it (Alzheimer’s disease and vascular neurocognitive disorder), and a solid background in statistical methods to become an independent physician-scientist. Project: I am proposing a prospective cohort study of subjects undergoing surgical aortic valve replacement with the goal of investigating objective SWD before surgery—both actigraphy and unattended type II home sleep tests (HST)—for its association with postoperative delirium and subsequent ADRD. This study represents a novel application of type II HST, which provides comprehensive assessment of sleep architecture, to characterize preoperative SWD as a marker of delirium risk and evidence in support of a mechanistic link between delirium and subsequent Alzheimer’s disease or vascular neurocognitive disorder. Professional development: I will obtain practical experience in empirical methods by conducting a longitudinal study with expertise in assessing SWD using unattended methods, neuropsychological testing, and relevant statistics. My training plan incorporates hands-on experiences in sleep medicine, neuropsychology, and statistics, complemented by coursework and directed readings that will provide the necessary theoretical foundation. Goals: My career goals are to establish an interdisciplinary research program at URMC with cardiac surgery and sleep medicine, to explore how SWD is mechanistically involved in delirium risk, onset, and its dire outcomes, and to advance the science of delirium pathophysiology and subsequent risk of ADRD.

Project Narrative Delirium is terrifying, costs an estimated $164 billion annually in the US alone and is associated with a greater risk of death, institutionalization, and Alzheimer’s disease and related dementias (ADRD); ADRD, in turn, affects more than 5 million Americans and exacts an incalculable human toll. Sleep-wake disturbance (SWD) is an observable, measurable, and potentially modifiable aspect of both delirium and ADRD. It may offer novel opportunities to prevent and treat delirium as well as to mitigate the development of subsequent ADRD. This project aims to examine home-based measures of SWD as physiological markers for delirium risk in aortic valve surgery patients while serving as a vehicle for career development for the PI to become an independent physician-scientist in delirium pathophysiology and its relation to ADRD.