HEART DISEASE, CNS DYSFUNCTION & OUTCOME IN THE ELDERLY

心血管疾病（CVD）是西方社会死亡和发病的主要原因，是老年人特别关注的问题。 心脏康复（CR）被认为是心血管疾病管理的关键，尽管其有效性往往有限。我们的研究表明，这在一定程度上是由于许多患者无法学习，应用和修改行为，以实现更健康的生活方式。 我们以前证明，神经认知障碍在老年CVD患者中很常见，降低了他们从CR中获益的能力，改变了他们的行为，并改善了生活质量。 我们的研究表明，特定的心血管因素（例如，高血压、心力衰竭）影响这些问题。 功能缺陷似乎反映了脑血管起源的脑功能障碍，具有常见的血管病因。 我们建议研究CVD对大脑的长期影响，其功能，以及对老年人健康状况的影响。 我们的长期目标是：1）表明脑功能障碍与CVD严重程度相关，2）由特定的年龄相关血管问题引起，3）相关的功能障碍影响即时CR获益和长期临床和功能结局。 为了实现这些目标，我们将在CR入组前对200例患者进行研究，并在此后进行36个月的研究。我们将评估心血管和神经认知功能，沿着脑MRI以确定特定血管紊乱对脑结构和功能的影响。 我们还将确定这种损害对CR结局、生活质量和老年人长期健康状况的影响。

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.