Lifecourse cardiovascular risk, depression and cognition in black & white adults

描述（由申请人提供）：认知功能和抑郁症状有许多共同的心血管起源，其患病率随着年龄的增长而急剧增加。新出现的证据表明，心血管危险因素对认知和抑郁症状结局的影响在整个生命过程中不断发展，与中年和年轻人相比，老年人可能有所不同。心血管危险因素的种族差异和他们发展的年龄可能会进一步加剧这些关联。这项为期5年的K 01奖申请旨在提高我们对心血管危险因素对黑人和白色成年人一生中认知功能和抑郁症状影响的认识。此外，该提案将阐明心血管危险因素在生命过程中与潜在脑结构变化的作用。该提案涉及对两个大型birdose流行病学队列的分析：（1）正在进行的心（年轻人冠状动脉风险发展）对5，115名青年至中年男性和女性的研究（52%黑人和48%白人），以及2）正在进行的健康ABC（健康，衰老和身体成分）研究3,075名老年男性和女性（42%黑人和58%白人）。我们假设，在黑人和白人的整个生命过程中，更多地暴露于非最佳心血管测量将与更差的认知功能、更多的抑郁症状和更差的结构性脑指数（如更多的白色物质病变和海马萎缩）相关。队列的数据结构将使我们能够评估几种生命过程流行病学模型，例如早期与晚期的心血管暴露，并有可能评估敏感期。这种生命历程的方法反映在这项建议的科学目标中。在目标1中，我们将确定青年和中年心血管暴露（CARDIA）和晚年心血管暴露（健康ABC）如何影响抑郁症状的轨迹。在目标2和3中，我们将确定青年期心血管暴露如何影响中年时的认知能力和结构性大脑完整性（CARDIA），以及晚年心血管暴露如何影响晚年的认知能力下降和结构性大脑完整性（健康ABC）。建议的分析嵌入在培训和指导计划中，该计划将（1）促进我在认知和抑郁症状结局的临床方面，特别是心血管和脑血管方面的概念培训;（2）在神经成像和结构脑完整性标记方面培训我;以及（3）提高我在纵向和神经影像学相关统计方法方面的方法学培训以及我对生命过程模型的了解。我的培训计划将包括正式课程、临床评估和大查房、参加学术研讨会、指导性阅读和专门为我的培训目标量身定制的专业发展活动。拥有K 01的支持将导致初步的数据和必要的指导，以更有力地确立自己作为一个独立的研究者，并促进成功的R 01应用程序的发展。

DESCRIPTION (provided by applicant): Cognitive function and depressive symptoms share many cardiovascular origins and their prevalence increases dramatically with age. Emerging evidence suggests that the influence of cardiovascular risk factors on cognition and depressive symptoms outcomes progresses over the life course and may be different in older adults compared to middle-aged and younger adults. Racial disparities in cardiovascular risk factors and the age at which they develop may further exacerbate these associations. This 5-year K01 award application seeks to improve our knowledge of the influence of cardiovascular risk factors on cognitive function and depressive symptoms over the life course in black and white adults. Additionally, this proposal will elucidate the role of cardiovascular risk factors with underlying structural brain changes over the life course. This proposal involves analyses of two large biracial epidemiologic cohorts: including 1) the ongoing CARDIA (Coronary Artery Risk Development in Young Adults) study of 5,115 young adult to middle-aged men and women (52% blacks and 48% whites), and 2) the ongoing Health ABC (Health, Aging and Body Composition) study of 3,075 older adult men and women (42% blacks and 58% whites). We hypothesize that greater exposure to non-optimal cardiovascular measures will be associated with worse cognitive function, greater number of depressive symptoms, and worse structural brain indices such as greater white matter lesions and hippocampal atrophy across the life course in blacks and whites. The data structure of the cohorts will enable us to evaluate several life course epidemiologic models such as early vs. late life cardiovascular exposure, with the possibility of evaluating sensitive periods. This life course approach is mirrored in the scientifi aims of this proposal. In Aim 1, we will determine how young adulthood and midlife cardiovascular exposure (CARDIA) and late life cardiovascular exposure (Health ABC) influence trajectories of depressive symptoms. In Aims 2 and 3, we will determine how young adulthood cardiovascular exposure influences cognitive performance and structural brain integrity at midlife (CARDIA) and how late life cardiovascular exposure influences cognitive decline and structural brain integrity in late life (Health ABC). The proposed analyses are embedded in a training and mentoring plan that will (1) advance my conceptual training in the clinical aspect of cognition and depressive symptoms outcomes, cardiovascular and cerebrovascular aspects in particular; (2) train me in neuroimaging and markers of structural brain integrity; and (3) advance my methodologic training in longitudinal and neuroimaging related statistical methods and my knowledge of life course models. My training plan will include formal courses, clinical assessment and grand rounds, attendance at scholarly seminars, directed readings and professional development activities specifically tailored to my training goals. Having the K01 support will result in preliminary data and the mentoring necessary to establish myself more strongly as an independent investigator and promote the development of a successful R01 application.