Exceptional aging: 12 year trajectories to function

描述(由研究人员提供)：随着老年人达到80岁及以上，功能性衰老或无残疾生存变得越来越特殊。在心血管健康研究(CHS)的长期幸存者队列中，我们将确定维持功能的可能性，确定区分那些注定要做得好的人的轨迹，并确定功能的生理学预测因素的重要性、独立性和相互作用。CHS队列现在年龄在80岁到100岁以上，有超过12年的随访，但已经4年没有检查过了。通过长期的纵向数据和对功能状态的重新评估，我们可以确定可能导致潜在干预以延长功能寿命的关键目标和时间点。我们已经证明，在没有任何临床公认的心血管事件的情况下，亚临床心血管疾病本身就预示着身体和认知功能的损害。然而，心血管疾病并不能完全解释年龄本身对功能衰退的强烈影响。我们还可以确定在CVD存在的情况下维持功能的潜力。我们注意到，尽管存在广泛的亚临床脑血管病，但许多80岁以上的参与者仍保持着身体和认知功能。本申请的目的是：1)识别和表征80岁后仍保持功能的CHS参与者，特别是确定导致功能老化的心血管危险因素和行为因素，特别是体力活动和CVD治疗的轨迹，2)确定低水平的IL-6和TNF-α以及高水平的肾上腺雄激素、高水平的胰岛素样生长因子-1和脂联素，以及较低的空腹胰岛素和葡萄糖是否将预测继续功能独立于心血管疾病，3)识别在存在巨大动脉粥样硬化负担的情况下保持功能老化的个人，并检查尽管存在心血管疾病但可能促进功能的因素，4)确定功能老化的预测因素是否可以预测连续的功能参数，包括腿部肌肉力量、握力、步态速度和认知处理速度。凭借多年来收集的纵向数据，CHS现在处于独特的地位，可以回答这些关于老龄化的问题。这项研究是确定老年保留功能干预的目标和时间点的关键一步。

DESCRIPTION (provided by investigator): Functional aging, or disability-free survival, becomes increasingly exceptional as older adults reach age 80 and beyond. In the long- term survivors of the Cardiovascular Health Study (CHS) cohort, we will determine the likelihood of maintaining function, identify the trajectories that distinguish those destined to do well, and define the importance, independence and interactions of physiologic predictors of function. The CHS cohort is now aged 80 to 100+ with over 12 years of follow-up, but have not been examined for 4 years. With the long term, longitudinal data and a reassessment of functional status, we can identify critical targets and time points that could lead to potential intervention to extend functional years of life. We have shown that subclinical cardiovascular disease alone, in the absence of any clinically recognized CVD event, predicts impaired physical and cognitive function. However, CVD does not fully explain the very strong effect of age itself on decline in function. We can also determine the potential for maintaining function in the presence of CVD. We have noted that many participants over age 80 have maintained physical and cognitive function in spite of extensive subclinical CVD. The aims of this application are: 1) to identify and characterize CHS participants who have remained functional after age 80, specifically to determine the trajectories of CVD risk factors and behavioral factors, especially physical activity and CVD treatment that lead to functional aging, 2) to determine whether low levels of IL-6 and TNF-alpha, as well as CRP, high levels of adrenal androgens, and insulin-like growth factor-1 and adiponectin, and lower fasting insulin and glucose will predict continued functioning independently of cardiovascular disease, 3) to identify individuals who have maintained functional aging in the presence of a large atherosclerotic burden and to examine factors that may promote function in spite of CVD, 4) to determine whether the predictors of a functional aging predict continuous parameters of function including leg muscle strength, grip strength, gait speed, and cognitive processing speed. With longitudinal data collected over many years, the CHS is now uniquely positioned to answer these questions about aging. This study is a critical step towards the identification of the targets and the time points for intervention to preserve function in old age.