Lifestyle, CVD Risk and Cognitive Impairment

生活方式、CVD 风险和认知障碍

• 批准号: 8461635
• 负责人: James A Blumenthal
• 金额: $ 71.13万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8461635
• 关键词: Accounting; Activities of Daily Living; Adult; Aerobic Exercise; Affect; Alzheimer' s Disease; American; Arteries; Attention; Biological Markers; Blood - brain barrier anatomy; Blood Vessels; Brain; Brain region; Cardiovascular Diseases; Carotid Arteries; Cause of Death; Cerebrovascular Circulation; Cessation of life; Cognitive; Cognitive deficits; Control Groups; Cross-Sectional Studies; DASH diet; Data; Dementia; Diabetes Mellitus; Diagnosis; Diet; Diet Modification; Dietary Factors; Dietary Intervention; Disease; Effectiveness; Exhibits; Food Supplements; Genetic Markers; Habits; Health; Health education; Heart; Heart Diseases; Hyperlipidemia; Hypertension; Impaired cognition; Impairment; Individual; Inflammation; Insulin Resistance; Intervention Studies; Knowledge; Lesion; Life Style; Link; Longitudinal Studies; Measurement; Measures; Mediating; Medical; Myocardial Ischemia; Neurocognition; Neurocognitive; Neurocognitive Deficit; Nutrient; Organ; Participant; Patients; Persons; Prevention; Prevention approach; Prevention strategy; Preventive; Proteins; Randomized; Randomized Clinical Trials; Risk; Risk Factors; Staging; Stroke; Testing; Thick; Time; United States; Vulnerable Populations; cardiovascular disorder risk; clinically significant; cognitive impairment no dementia; design; diet and exercise; disability; economic cost; epidemiologic data; glucose metabolism; high risk; improved; indexing; interest; intima media; normal aging; patient population; prevent; public health priorities; white matter

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the leading cause of death and disability in the United States, affecting more than 81 million American adults. It is well established that risk factors such as hypertension, diabetes, and hyperlipidemia not only place individuals at risk for CVD, but also place them at risk for neurocognitive impairment and dementia. CVD risk factors have been shown to be associated with a cascade of neurophysiologic and neuroanatomic changes (e.g., narrowing of the small arteries in the subcortical regions of the brain, reduced cerebral blood flow, disruption of the blood-brain barrier), resulting in cognitive impairment and dementia. Patients with CVD risk factors who exhibit cognitive impairment without dementia (CIND) are considered to be in a transition stage between normal aging and early dementia. There is great interest in CIND because longitudinal studies have documented that such individuals are highly vulnerable to developing dementia. Exercise and diet have been shown to improve CVD risk factors and also appear particularly promising lifestyle approaches for preventing dementia. In this application, we propose a randomized clinical trial of patients with CVD risk factors who also are characterized by subjective cognitive complaints and objective evidence of neurocognitive deficits without dementia (CIND). A 2 by 2 design is proposed to examine the independent and combined effects of diet and exercise on neurocognition. Participants will be randomly assigned to 6 months of aerobic exercise, dietary modification using the DASH diet, or a combination of both exercise and diet; a fourth (control) group will receive health education but otherwise will maintain their usual dietary and activity habits. The study will aim to (a) evaluate the effectiveness of aerobic exercise and the DASH diet in improving neurocognitive functioning in patients with CVD risk factors and CIND; (b) examine possible mechanisms by which exercise and diet improve neurocognition; and (c) consider potential moderators of treatment, including subclinical CVD. These data will have important clinical significance by determining the extent to which lifestyle may improve neurocognition in patients vulnerable to neurocognitive decline and will identify key vascular and related biomarkers that may account for improved neurocognition among persons with CIND.

描述（由申请人提供）：心血管疾病（CVD）是美国死亡和残疾的主要原因，影响了超过8100万的美国成年人。众所周知，高血压，糖尿病和高脂血症等危险因素不仅使个人处于CVD的危险中，而且还使他们处于神经认知障碍和痴呆症的风险。 CVD危险因素已被证明与一系列神经生理学和神经解剖学变化有关（例如，大脑皮层下区域的小动脉的狭窄，大脑血液流量减少，血液障碍的破坏），导致认知障碍和dementia。 CVD危险因素表现出认知障碍而没有痴呆症（CIND）的患者被认为处于正常衰老和早期痴呆症之间的过渡阶段。人们对CIND非常感兴趣，因为纵向研究表明，此类人非常容易受到发展痴呆症的影响。运动和饮食已被证明可以改善CVD危险因素，并且似乎特别有希望预防痴呆症的生活方式方法。在此应用中，我们提出了一项随机临床试验，该试验的CVD危险因素的患者也以主观认知投诉和无痴呆症神经认知缺陷的客观证据为特征。提出了2 x 2的设计，以检查饮食和运动对神经认知的独立和综合影响。参与者将随机分配到6个月的有氧运动，使用破折号饮食或锻炼和饮食的结合；第四组（控制）小组将接受健康教育，但否则将保持其通常的饮食和活动习惯。该研究的目的是（a）评估有氧运动的有效性和破折号在改善CVD危险因素和CIND患者神经认知功能方面的有效性； （b）检查运动和饮食改善神经认知的可能机制； （c）考虑治疗的潜在调节剂，包括亚临床CVD。这些数据将通过确定生活方式可以改善容易受到神经认知能力下降的患者的神经认知的程度，并确定关键的血管和相关生物标志物，这可能会改善CIND患者的神经认知，这将具有重要的临床意义。