CVD Predictors of Cognitive Function Trajectory over 20 Years

20 年来认知功能轨迹的 CVD 预测因素

• 批准号: 7806599
• 负责人: ELIZABETH L BARRETT-CONNOR
• 金额: $ 17.91万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-05-15 至 2011-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7806599
• 关键词: Address; Adrenal hormone preparation; Adult; Age; Aging; Apolipoprotein E; Biological Markers; Blood Pressure; Body Size; Body Weight Changes; Body mass index; Cardiovascular Diseases; Cardiovascular system; Categories; Cholesterol; Clinic; Clinic Visits; Clinical; Cognitive; Cognitive aging; Cohort Studies; Communities; Comorbidity; Cox Proportional Hazards Models; Cross-Sectional Studies; Data; Data Set; Databases; Dementia; Depressed mood; Diabetes Mellitus; Diastolic blood pressure; Education; Elderly; Epidemiology; Etiology; Factor Analysis; Fatty acid glycerol esters; Funding; Genotype; Goals; Health; Heart Diseases; High Density Lipoprotein Cholesterol; Hypertension; Impaired cognition; Individual; Insulin-Like Growth Factor I; Interleukin-6; Internet; Laboratories; Life; Life Style; Lipids; Lipoproteins; Literature; Longitudinal Studies; Low-Density Lipoproteins; Maintenance; Measures; Mediating; Medical History; Memory Loss; Metabolic syndrome; Methods; Modification; Moods; Morbidity - disease rate; Osteoporosis; Participant; Performance; Pharmaceutical Preparations; Platelet Factor 4; Population; Prevalence Study; Prospective Studies; Recording of previous events; Reporting; Research; Research Personnel; Risk; Risk Factors; Sex Education; Socioeconomic Status; Stroke; Testing; Thick; Triglycerides; Update; Visit; Weight; Woman; aged; apolipoprotein E-4; base; cardiovascular disorder risk; cognitive function; cohort; coronary artery calcification; fasting plasma glucose; follow-up; health related quality of life; healthy aging; inflammatory marker; interest; intima media; men; mental state; performance tests; population based; programs; satisfaction; steroid hormone

DESCRIPTION (provided by applicant): Cognitive impairment and dementia preclude healthy aging. Several lines of evidence suggest that cardiovascular disease (CVD) and its risk factors (and related biomarkers) accelerate decline in cognitive function, but most studies are cross-sectional or have a < 5 year follow-up. We propose to use >20 years of CVD and cognitive function test (CFT) data from the Rancho Bernardo Study (RBS) of older community-dwelling adults to examine the association of baseline and changing CVD risk factors with change in CFT performance. The RBS was established as a Lipid Research Prevalence Study in 1972, when history of heart disease, diabetes, stroke, and hypertension was obtained, and body mass index, fasting plasma glucose, triglycerides and cholesterol were measured in 82% of adult residents. Beginning in 1984, 60-87% of surviving community-dwelling participants returned to our research clinic every four years, when CVD risk factors were measured, and lifestyle, medication, and medical history were updated. Beginning in 1988, 3 or more standard CFTs were completed at each of six clinic visits about 4 years apart. To date, 1172 men and women have been retested on at least three occasions, and 721 have had four or more CFT visits. We propose a prospective study of the association of CVD risk factors (4 risk factor groups and 3 composite risk factor scores) and clinical and subclinical CVD with successful cognitive aging. We define successful cognitive aging as survival without clinical dementia and maintenance of predefined performance on CFTs (3 standard tests assessing 3 cognitive domains). We will first establish whether favorable CVD risk factors are prospectively related to short term (4 year) maintained cognitive function, followed by longer term (20 year) trajectory studies which will include change in risk factors as well as change in CFTs. We will examine predictors of categorically-defined successful cognitive aging using Cox proportional hazard models. Associations will be examined in the context of education, depressed mood, weight and weight change, Apo E genotype, medications and comorbidities; mechanisms will be studied using measured biomarkers including CRP, IL-6, IGF-1, steroid hormones, and adipocytokines. All analyses will be based on specific a priori hypotheses. Our goal is to define a plausible web of causation for CVD risk factors and biomarkers as exposure variables, with more favorable attributes predicting less or no loss of cognitive function. Longitudinal studies are the strongest method for addressing the strength, independence, temporality, and effect modification of multiple observed associations. The rich RBS dataset, unique for its long-term repeated CVD & CFT measures, will allow us to determine how CVD exposure variables influence different domains of cognitive function. This information is important given the aging of the population, the fact that CVD risk factors are modifiable, and because the maintenance of cognitive function is an essential component of healthy aging.

描述（由申请人提供）：认知障碍和痴呆妨碍健康衰老。几条证据表明，心血管疾病（CVD）及其危险因素（和相关生物标志物）加速认知功能下降，但大多数研究是横断面的，或者有< 5 year follow-up. We propose to use >20年的CVD和认知功能测试（CFT）数据，来自Rancho Bernardo研究（RBS）的老年社区居民成年人，以检查基线和不断变化的CVD危险因素与CFT表现变化的相关性。RBS于1972年作为脂质研究流行率研究建立，当时获得了心脏病，糖尿病，中风和高血压的病史，并测量了82%成年居民的体重指数，空腹血糖，甘油三酯和胆固醇。从1984年开始，60-87%的幸存社区居民参与者每四年返回我们的研究诊所，测量CVD风险因素，并更新生活方式，药物和病史。从1988年开始，在间隔约4年的6次门诊访视中，每次完成3次或更多的标准CFT。到目前为止，1 172名男性和女性至少接受了三次重新测试，721人接受了四次或四次以上的CFT访问。我们提出了一项前瞻性研究CVD危险因素（4个危险因素组和3个复合危险因素评分）和临床和亚临床CVD与成功的认知老化的关联。我们将成功的认知老化定义为没有临床痴呆的存活率和在CFT（评估3个认知领域的3个标准测试）上保持预定义的表现。我们将首先确定有利的CVD风险因素是否与短期（4年）维持的认知功能前瞻性相关，然后进行长期（20年）轨迹研究，其中包括风险因素的变化以及CFTs的变化。我们将使用考克斯比例风险模型研究分类定义的成功认知老化的预测因素。将在教育、抑郁情绪、体重和体重变化、载脂蛋白E基因型、药物和合并症的背景下检查相关性;将使用测量的生物标志物（包括CRP、IL-6、IGF-1、类固醇激素和脂肪细胞因子）研究机制。所有分析都将基于特定的先验假设。我们的目标是为CVD风险因素和生物标志物定义一个合理的因果关系网络作为暴露变量，更有利的属性预测较少或没有认知功能丧失。纵向研究是解决多个观察到的关联的强度，独立性，时间性和效果修改的最强有力的方法。丰富的RBS数据集，其长期重复的CVD和CFT测量是独一无二的，将使我们能够确定CVD暴露变量如何影响认知功能的不同领域。考虑到人口老龄化，CVD风险因素是可改变的，并且因为认知功能的维持是健康老龄化的重要组成部分，这些信息非常重要。