Lifestyle, CVD Risk and Cognitive Impairment

生活方式、CVD 风险和认知障碍

• 批准号: 8326610
• 负责人: James A Blumenthal
• 金额: $ 75.31万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8326610
• 关键词: Accounting; Activities of Daily Living; Adult; Aerobic Exercise; Affect; Alzheimer' s Disease; American; Arteries; Attention; Biological Markers; Blood - brain barrier anatomy; Blood Vessels; Brain; Brain region; Cardiovascular Diseases; Carotid Arteries; Cause of Death; Cerebrovascular Circulation; Cessation of life; Cognitive; Cognitive deficits; Control Groups; Cross-Sectional Studies; DASH diet; Data; Dementia; Diabetes Mellitus; Diagnosis; Diet; Diet Modification; Dietary Factors; Dietary Intervention; Disease; Effectiveness; Exhibits; Food Supplements; Genetic; Habits; Health; Health education; Heart; Heart Diseases; Hyperlipidemia; Hypertension; Impaired cognition; Impairment; Individual; Inflammation; Insulin Resistance; Intervention Studies; Knowledge; Lesion; Life Style; Link; Longitudinal Studies; Measurement; Measures; Mediating; Medical; Myocardial Ischemia; Neurocognition; Neurocognitive; Neurocognitive Deficit; Nutrient; Organ; Participant; Patients; Persons; Prevention; Prevention approach; Prevention strategy; Preventive; Proteins; Randomized; Randomized Clinical Trials; Risk; Risk Factors; Staging; Stroke; Testing; Thick; Time; United States; Vulnerable Populations; cardiovascular disorder risk; clinically significant; cognitive impairment no dementia; design; diet and exercise; disability; economic cost; epidemiologic data; glucose metabolism; high risk; improved; indexing; interest; intima media; normal aging; patient population; prevent; public health priorities; white matter

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the leading cause of death and disability in the United States, affecting more than 81 million American adults. It is well established that risk factors such as hypertension, diabetes, and hyperlipidemia not only place individuals at risk for CVD, but also place them at risk for neurocognitive impairment and dementia. CVD risk factors have been shown to be associated with a cascade of neurophysiologic and neuroanatomic changes (e.g., narrowing of the small arteries in the subcortical regions of the brain, reduced cerebral blood flow, disruption of the blood-brain barrier), resulting in cognitive impairment and dementia. Patients with CVD risk factors who exhibit cognitive impairment without dementia (CIND) are considered to be in a transition stage between normal aging and early dementia. There is great interest in CIND because longitudinal studies have documented that such individuals are highly vulnerable to developing dementia. Exercise and diet have been shown to improve CVD risk factors and also appear particularly promising lifestyle approaches for preventing dementia. In this application, we propose a randomized clinical trial of patients with CVD risk factors who also are characterized by subjective cognitive complaints and objective evidence of neurocognitive deficits without dementia (CIND). A 2 by 2 design is proposed to examine the independent and combined effects of diet and exercise on neurocognition. Participants will be randomly assigned to 6 months of aerobic exercise, dietary modification using the DASH diet, or a combination of both exercise and diet; a fourth (control) group will receive health education but otherwise will maintain their usual dietary and activity habits. The study will aim to (a) evaluate the effectiveness of aerobic exercise and the DASH diet in improving neurocognitive functioning in patients with CVD risk factors and CIND; (b) examine possible mechanisms by which exercise and diet improve neurocognition; and (c) consider potential moderators of treatment, including subclinical CVD. These data will have important clinical significance by determining the extent to which lifestyle may improve neurocognition in patients vulnerable to neurocognitive decline and will identify key vascular and related biomarkers that may account for improved neurocognition among persons with CIND.

心血管疾病（CVD）是美国死亡和残疾的主要原因，影响超过8100万美国成年人。众所周知，高血压、糖尿病和高脂血症等风险因素不仅使个体处于CVD的风险中，而且还使其处于神经认知障碍和痴呆的风险中。CVD风险因素已被证明与神经生理学和神经解剖学变化的级联相关（例如，大脑皮层下区域的小动脉狭窄、脑血流量减少、血脑屏障破坏），导致认知障碍和痴呆。具有CVD风险因素的患者表现出无痴呆的认知障碍（CIND），被认为处于正常衰老和早期痴呆之间的过渡阶段。人们对CIND非常感兴趣，因为纵向研究已经证明，这些人非常容易患痴呆症。运动和饮食已被证明可以改善心血管疾病的风险因素，并且似乎特别有希望的生活方式方法来预防痴呆症。在本申请中，我们提出了一项随机临床试验的患者与心血管疾病的危险因素，其特征也是主观认知投诉和客观证据的神经认知缺陷无痴呆症（CIND）。一个2乘2的设计，提出了检查饮食和运动对神经认知的独立和联合作用。参与者将被随机分配到6个月的有氧运动，使用DASH饮食的饮食调整，或运动和饮食的组合;第四组（对照组）将接受健康教育，但在其他方面将保持他们通常的饮食和活动习惯。该研究的目的是：（a）评估有氧运动和DASH饮食在改善有心血管疾病危险因素和CIND的患者神经认知功能方面的有效性;（B）检查运动和饮食改善神经认知的可能机制;（c）考虑治疗的潜在调节因素，包括亚临床心血管疾病。这些数据将具有重要的临床意义，通过确定生活方式在何种程度上可以改善易受神经认知下降影响的患者的神经认知，并将确定关键的血管和相关的生物标志物，可以解释CIND患者神经认知的改善。