Vascular Risk and Cognition in a Multi-ethnic Cohort

描述（由申请人提供）：Clinton Wright博士是一名神经学家和流行病学家，对血管危险因素对认知的影响感兴趣。这些关系知之甚少，因为过去对血管性痴呆的定义是从阿尔茨海默病的定义演变而来的。血管性认知障碍一词已发展到涵盖血管疾病对认知的广泛影响，从轻度功能障碍到血管性痴呆的纯粹形式，包括与退行性原因（如阿尔茨海默病）混合的形式。候选人计划致力于澄清血管性认知障碍的表型和识别潜在的可改变的风险因素的职业生涯。他对多民族人口特别感兴趣。该建议的假设是，暴露于血管危险因素会导致不同类型的认知功能障碍，这取决于脑损伤的类型。NINDS卒中进展审查组已将血管性认知障碍亚型的澄清以及影像学和生物学标记物和潜在可改变的风险因素的识别确定为优先领域。拟议研究的具体目的是：1）使用一组敏感的神经心理学测试来确定暴露于特定的血管危险因素和炎症标志物是否与特定的认知领域有关。传统和新的风险因素将包括心脏病、高血压和血压、糖尿病、胰岛素抵抗和代谢综合征、报告的饮酒量、总同型半胱氨酸和炎症标志物;和2）确定通过定量MRI测量的脑血管脑损伤，包括白色高信号体积、亚临床梗死、亚临床微出血和脑萎缩是否与特定的认知领域相关，调整传统和新的血管危险因素。将使用广义估计方程进行线性回归，以同时检查血管风险因素和亚临床脑疾病对多个认知领域的影响，以调整神经心理学测试之间的相关性。血管性认知障碍的检测具有公共卫生意义，因为在美国，在坦率的痴呆症之前患有早期形式的人数估计为300万，这个数字相当于痴呆症的患病率。

DESCRIPTION (provided by applicant): Dr. Clinton Wright is a neurologist and epidemiologist with an interest in the effects of vascular risk factors on cognition. These relationships are poorly understood because past definitions of vascular dementia evolved from those for Alzheimer disease. The term vascular cognitive impairment has evolved to cover the wide range of effects of vascular disease on cognition, from pure forms ranging from mild dysfunction to vascular dementia, and including those mixed with degenerative causes such as Alzheimer disease. The candidate plans a career devoted to clarifying the phenotype of vascular cognitive impairment and identifying potentially modifiable risk factors. He has a special interest in multi-ethnic populations. The hypothesis of this proposal is that exposure to vascular risk factors causes distinct patterns of cognitive dysfunction depending on the type of brain injury. Clarification of the subtypes of vascular cognitive impairment as well as the identification of imaging and biological markers and potentially modifiable risk factors has been identified as a priority area by the NINDS Stroke Progress Review Group. The specific aims of the proposed research are: 1) To determine if exposure to particular vascular risk factors and inflammatory markers is related to specific cognitive domains using a sensitive battery of neuropsychological tests. Conventional and novel risk factors will include cardiac diseases, hypertension and blood pressure, diabetes, insulin resistance and the metabolic syndrome, reported alcohol consumption, total homocysteine and inflammatory markers; and 2) To determine if cerebrovascular brain damage as measured by quantitative MRI, including white matter hyperintensity volume, subclinical infarcts, subclinical microbleeds and brain atrophy are related to specific cognitive domains, adjusting for conventional and novel vascular risk factors. Linear regression using generalized estimating equations will be carried out to examine the effect of vascular risk factors and subclinical brain disease on multiple cognitive domains simultaneously to adjust for correlation among the neuropsychological tests. The detection of vascular cognitive impairment has public health implications as the number of people with early forms before frank dementia is estimated at three million in the U.S., a number equaling the prevalence of forms with dementia.