HEART DISEASE, CNS DYSFUNCTION & OUTCOME IN THE ELDERLY

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Cardiovascular disease (CVD, a leading cause of death and morbidity in Western society, is a particular concern for the elderly. Cardiac rehabilitation (CR) is recognized as essential in CVD management, though its effectiveness is often limited. Our research indicates that this is at partially due to an inability of many patients to learn, apply, and modify behavior towards a healthier lifestyle. We previously demonstrated that neurocognitive impairments were common among elderly CVD patients, reducing their ability to benefit from CR, modify their behavior, and experience improved quality of life. Our research shows that specific cardiovascular factors (e.g., hypertension, cardiac failure) influence these problems. Functional deficits seem to reflect brain dysfunction of cerebrovascular origin, with common vascular etiology. We propose to study the longer-term effect of CVD on the brain, its functions, and its impact on the health status of the elderly. Our long-term objectives are to: 1) show that brain in dysfunction is associated with CVD- severity, 2) caused by specific age-related vascular problems, and 3) that associated functional impairments affect both immediate CR- benefit, and longer-term clinical and functional outcome. To accomplish these goals, we will study 200 patients prior to their enrollment in CR, and for 36 months thereafter. We will assess cardiovascular and neurocognitive functions, along with brain MRI to determine the effect of specific vascular disturbances on brain structure and function. We will also determine the effect of that such impairments have on CR outcome, quality of life, and longer-term health status of the elderly.