HEART DISEASE, CNS DYSFUNCTION & OUTCOME IN THE ELDERLY

心血管疾病(CVD)是西方社会死亡和发病的主要原因，是老年人特别关注的问题。心脏康复(CR)在心血管疾病治疗中被认为是必不可少的，尽管其有效性往往是有限的。我们的研究表明，这在一定程度上是由于许多患者无法学习、应用和改变行为，走向更健康的生活方式。我们先前证明，神经认知障碍在老年CVD患者中很常见，降低了他们从CR中受益的能力，改变了他们的行为，并体验到了改善的生活质量。我们的研究表明，特定的心血管因素(如高血压、心力衰竭)会影响这些问题。功能缺陷似乎反映了脑血管起源的脑功能障碍，具有常见的血管病因。我们建议研究心血管疾病对大脑的长期影响、其功能及其对老年人健康状况的影响。我们的长期目标是：1)证明大脑功能障碍与CVD的严重程度有关，2)由特定的年龄相关血管问题引起，3)相关的功能障碍影响近期的CR效益以及长期的临床和功能结果。为了实现这些目标，我们将对200名患者在参加CR之前以及之后的36个月内进行研究。我们将评估心血管和神经认知功能，以及脑MRI，以确定特定血管障碍对大脑结构和功能的影响。我们还将确定这种损伤对老年人的CR结局、生活质量和长期健康状况的影响。

Cardiovascular disease (CVD, a leading cause of death and morbidity in Western society, is a particular concern for the elderly. Cardiac rehabilitation (CR) is recognized as essential in CVD management, though its effectiveness is often limited. Our research indicates that this is at partially due to an inability of many patients to learn, apply, and modify behavior towards a healthier lifestyle. We previously demonstrated that neurocognitive impairments were common among elderly CVD patients, reducing their ability to benefit from CR, modify their behavior, and experience improved quality of life. Our research shows that specific cardiovascular factors (e.g., hypertension, cardiac failure) influence these problems. Functional deficits seem to reflect brain dysfunction of cerebrovascular origin, with common vascular etiology. We propose to study the longer-term effect of CVD on the brain, its functions, and its impact on the health status of the elderly. Our long-term objectives are to: 1) show that brain in dysfunction is associated with CVD- severity, 2) caused by specific age-related vascular problems, and 3) that associated functional impairments affect both immediate CR- benefit, and longer-term clinical and functional outcome. To accomplish these goals, we will study 200 patients prior to their enrollment in CR, and for 36 months thereafter. We will assess cardiovascular and neurocognitive functions, along with brain MRI to determine the effect of specific vascular disturbances on brain structure and function. We will also determine the effect of that such impairments have on CR outcome, quality of life, and longer-term health status of the elderly.