Cardiovascular predictors of cerebrovascular health in older adults

随着人口的不断老龄化，认知能力下降和痴呆症正成为越来越重要的公众 健康问题。虽然阿尔茨海默病是痴呆症最常见的原因，但脑血管病理学 导致至少三分之一的病理确诊的痴呆和混合病理病例 占所有临床痴呆病例的至少一半。脑血管损伤部分是由血管风险驱动的 这些因素也会导致心血管损伤和疾病。心血管功能的改变可能 构成加速与年龄相关的脑损伤的风险，独立于共同的血管风险因素。我们 初步研究表明，亚临床心功能障碍与适应不良的大脑衰老有关， 认知障碍和痴呆症，包括阿尔茨海默病。尽管有大量证据表明 心血管变化对应于更差的认知结果，损伤联系的确切机制 亚临床心血管变化与脑变化仍不清楚。一个合理的机制是亚临床 小血管疾病我们建议利用现有队列的遗留数据，即范德比尔特记忆和 老化项目，评估与认知功能相关的全身血流量、心肌收缩力和动脉硬化 小血管疾病的进展和神经影像学标志物。自从范德比尔特记忆与衰老项目 队列于2012年开始，我们完成了系列（基线、18个月随访、36个月随访）访视 关键协变量确定、神经心理学评估、多模态脑MRI、心脏MRI， 在入组时无临床卒中和痴呆的老年人中进行空腹采血。为了这个奖项，我们 将后处理和编码新的变量从原始数据无关，以前的赠款旨在测试我们的 假设这一跨学科努力的结果将产生对潜在机制的重要见解 老年人心血管功能和大脑变化之间的联系。这些见解将提供 关于诱发认知障碍、阿尔茨海默病的亚临床因素的丰富信息， 痴呆症，这将有助于未来的新战略，以延迟或预防认知障碍， 进展

As the population continues to age, cognitive decline and dementia are becoming increasingly important public health issues. While Alzheimer's disease is the most common cause of dementia, cerebrovascular pathology contributes to at least one third of all pathologically-confirmed cases of dementia and mixed pathology accounts for at least half of all clinical dementia cases. Cerebrovascular injury is in part driven by vascular risk factors, which also contribute to cardiovascular injury and disease. Alterations in cardiovascular function may pose a risk for accelerating age-related brain injury, independent of shared vascular risk factors. Our preliminary research suggests that subclinical cardiac dysfunction is related to maladaptive brain aging, such as cognitive impairment and incident dementia, including Alzheimer's disease. Despite extensive evidence that cardiovascular changes correspond to worse cognitive outcomes, the exact mechanism of injury linking subclinical cardiovascular changes to brain changes remains unclear. One plausible mechanism is subclinical small vessel disease. We propose to leverage legacy data from an existing cohort, the Vanderbilt Memory & Aging project, to evaluate systemic blood flow, cardiac contractility, and arterial stiffening in relation to cognitive progression and neuroimaging markers of small vessel disease. Since the Vanderbilt Memory & Aging Project cohort's inception in 2012, we have completed serial (baseline, 18-month follow-up, 36-month follow-up) visits with key covariate ascertainment, neuropsychological assessment, multi-modal brain MRI, cardiac MRI, and fasting blood acquisition on older adults free of clinical stroke and dementia at enrollment. For this award, we will post-process and code new variables from raw data unrelated to previous grant aims to test our hypotheses. Results from this interdisciplinary effort will yield important insights into mechanisms underlying the association between cardiovascular function and brain changes in older adults. Such insights will provide rich information regarding subclinical factors predisposing to cognitive impairment, Alzheimer's disease, and dementia, which will contribute to future novel strategies to delay or prevent cognitive impairment and progression.