Cardiovascular predictors of cerebrovascular health in older adults

随着人口的持续老龄化，认知能力下降和痴呆症正变得越来越重要 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 在所有经病理确诊的痴呆症和混合病理病例中，至少有三分之一是致病原因 至少占所有临床痴呆症病例的一半。脑血管损伤在一定程度上是由血管风险驱动的 因素，这也是心血管损伤和疾病的原因。心血管功能的改变可能 构成加速年龄相关脑损伤的风险，与共同的血管风险因素无关。我们的 初步研究表明，亚临床心功能障碍与适应性不良的脑老化有关，例如 认知障碍和偶发痴呆症，包括阿尔茨海默病。尽管有大量证据表明 心血管变化对应较差的认知结果，这是损伤联系的确切机制 亚临床心血管改变对脑部改变的影响尚不清楚。一种可能的机制是亚临床 小血管疾病。我们建议利用来自现有队列Vanderbilt Memory&的遗留数据 老龄化项目，以评估系统血流量、心脏收缩能力和动脉硬化与认知能力的关系 小血管疾病的进展和神经影像标志物。自范德比尔特记忆和老龄化项目以来 自2012年队列成立以来，我们已经完成了连续(基线、18个月跟踪、36个月跟踪)访问 通过关键的协变量确定、神经心理评估、多模式脑MRI、心脏MRI和 登记时没有临床中风和痴呆症的老年人的空腹采血。对于这个奖项，我们 将从与之前的拨款无关的原始数据中对新变量进行后期处理和编码，目的是测试我们的 假设。这一跨学科努力的结果将对潜在的机制产生重要的见解 老年人心血管功能和大脑变化之间的联系。这些洞察力将提供 关于认知障碍、阿尔茨海默氏病和 痴呆症，这将有助于未来延缓或预防认知障碍和 进步。

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.