HYPERTENSION, COGNITION, AND THE BRAIN IN OLDER ADULTS

描述：高血压是脑梗塞的主要危险因素， 颅内出血和血管性痴呆，特别是在老年人中 成年人。以往脑血管疾病的临床表现，微妙 所有年龄段的高血压患者都存在神经心理缺陷。 在老年人中，高血压非常普遍，被认为是 认知老化的关键因素。其潜在的发病机制 人们对这一过程知之甚少。神经心理学中的微妙缺陷 表现以及伴随的中枢神经系统异常，可能 构成老年人脑血管风险升高的早期标志 高血压。在这项提议中，假设高血压将 与神经心理功能减退有关，增加 微血管疾病、更大的大血管疾病和脑血管减少 灌流。这三种中枢神经系统机制将导致 非痴呆性老年高血压患者存在微妙的神经心理缺陷。 这个项目的第一个具体目标是比较100名未服用药物的人， 轻度至中度高血压患者(60-80岁)至100人 类似的血压正常者：(1)神经心理学 表现；(2)磁共振成像(MRI)对微血管的分级 累及脑室周围和深部白质的疾病；(3)磁性 磁共振血管成像(MRA)对脑部大血管病变的分级 和颈-脑动脉；(4)脑/小脑相对比值 单光子发射计算机断层扫描(SPECT)评价血流灌注。一个 第二个目的是检查微血管的MRI、MRA和SPECT指标 疾病、大血管疾病和脑血流灌注可作为预测 神经心理表现。这项研究将是第一个检查 伴随而来的三种中枢神经系统机制作为预测 老年人的神经心理功能。对发病机制的认识 老年人高血压相关认知障碍的风险可能会导致 加大预防和干预力度，减少脑血管疾病 风险和提高生活质量。

DESCRIPTION: Hypertension is a major risk factor for cerebral infarction, intracranial hemorrhage, and vascular dementia, particularly among older adults. Prior to clinical manifestations of cerebrovascular disease, subtle neuropsychological deficits are noted in hypertensives of all age ranges. In older adults, hypertension is highly prevalent, and is considered a critical factor in cognitive aging. The underlying pathogenesis of this process is poorly understood. Subtle deficits in neuropsychological performance, and accompanying central nervous system abnormalities, may constitute early markers of elevated cerebrovascular risk among older hypertensives. In this proposal, it is hypothesized that hypertension will be associated with diminished neuropsychological function, increased microvascular disease, greater macrovascular disease, and reduced cerebral perfusion. These three central nervous system mechanisms will result in subtle neuropsychological deficits among non-demented, older hypertensives. The first specific aim of this project is to compare 100 unmedicated, mild-to-moderate essential hypertensives (ages 60-80) to 100 demographically comparable normotensives with respect to: (1) neuropsychological performance; (2) magnetic resonance imaging (MRI) ratings of microvascular disease involving periventricular and deep white matter; (3) magnetic resonance angiography (MRA) ratings of macrovascular disease of the cerebral and cervicocerebral arteries; and (4) relative ratios of cerebral:cerebellar perfusion assessed by single photon emission computed tomography (SPECT). A second aim is to examine MRI, MRA, and SPECT indices of microvascular disease, macrovascular disease, and cerebral perfusion as predictors of neuropsychological performance. This study will be the first to examine concomitantly three central nervous system mechanisms as predictors of neuropsychological function in older adults. Understanding the pathogenesis of hypertension-related cognitive impairment in older adults may lead to enhanced efforts in prevention, and intervention to reduce cerebrovascular risk and improve quality of life.