AGE OF DEMENTIA ONSET AND CARDIOVASCULAR RISK FACTORS

一些正在进行的纵向研究发现，许多心血管疾病危险因素(CvRF)也是阿尔茨海默病(AD)的危险因素。然而，大多数研究队列并不包括许多年龄最大的老年人，而且当他们出现时，他们主要是女性。来自我们中心的数据表明，CvRF可能对非常年长的AD患者特别有效。基于先前的研究，我们选择了糖尿病、总胆固醇、高血压和血浆同型半胱氨酸浓度进行初步假设检验。我们将在一个老年男性退伍军人群体中调查这四个认知功能减退的CvRF是否与AD之间存在关系，并探索这种影响是否随着年龄的增长而增强。将在退伍军人事务部布朗克斯设立一个专门为该项目服务的“老龄研究诊所”。合资格 受试者必须超过75岁(特别强调招募年纪很大的人)，并且没有痴呆症。除了四个主要的CvRF外，受试者还将在Bronx VA的心血管研究项目中接受全面的CvRF检查。将在每个受试者的基线上直接评估四个主要风险因素。此外，基线风险因素评估将包括：年龄、吸烟、家族史、体重和腰围、心血管事件既往病史、载脂蛋白E(和其他相关基因分型)、C反应蛋白、体力活动和其他风险因素。受试者还将在基线水平上通过放射动脉脉搏波分析评估左心室肥厚、颈动脉内膜中层厚度和近端容量性或大动脉顺应性，以及远端振荡小动脉顺应性。所有受试者将在基线时进行核磁共振检查，并对有认知功能减退证据的受试者进行随访(CDR30.5)，以评估脑血管的作用。 疾病。每年将对受试者进行纵向跟踪，以确定他们中哪些人表现出认知能力下降(CDR&GT；OR=0.5)和阿尔茨海默病(AD)以及其他可能形式的痴呆(例如，血管性痴呆)的证据。因为这些CvRF中的许多都是可以修改的，这意味着它们是极晚发病的认知能力下降的风险因素，而AD有可能为高龄人群--美国人口中增长最快的部分--带来重大的公共健康收益。

Several ongoing longitudinal studies have found evidence that many cardiovascular disease risk factors (CvRFs) are also risk factors for Alzheimer disease (AD). Most study cohorts, however, do not include many of the oldest old, and when present, they are predominantly female. Data from our center suggest CvRFs may be especially potent for AD in the very old. We selected diabetes, total cholesterol, hypertension, and plasma homocysteine concentration, based on prior research, for primary hypothesis testing. We will investigate whether there is a relationship between each one of these four CvRFs with cognitive decline and AD in an elderly male veteran population and explore whether this effect is strengthened with increased age. An "Aging Research Clinic" will be established at the Bronx VA specifically dedicated to this project. Eligible subjects must be older than 75 (with special emphasis on recruiting the very old) and be free of dementia. In addition to the four primary CvRFs, subjects will receive a comprehensive CvRF examination in conjunction with the cardiovascular research program at the Bronx VA. The four primary risk factors will be directly assessed at baseline in each subject. In addition, the baseline risk factor assessment will include: age, smoking, family history, weight and waistline, prior medical history for cardiovascular events, apolipoprotein E (and other relevant genotyping), C reactive protein, physical activity and other risk factors. Subjects will also be evaluated at baseline for left ventricular hypertrophy, carotid artery intima media thickness and proximal capacitative or large artery compliance, and distal oscillatory small artery compliance by radial artery pulse wave analysis. MRIs will be conducted at baseline in all subjects and at follow up in those who show evidence of cognitive decline (CDR30.5) to assess the role of cerebrovascular disease. The subjects will be followed longitudinally on an annual basis to determine who among them show evidence of cognitive decline (CDR > or = 0.5) and AD, as well as other possible forms of dementias (e.g. vascular dementia). As many of these CvRFs are modifiable, implicating them as risk factors for very late onset cognitive decline and AD holds the potential for making major public health gains for the very old--the fastest growing segment of the U.S. population.