van Buchem Mark A, Biessels Geert Jan, Brunner la Rocca Hans Peter, de Craen Anton J M, van der Flier Wiesje M, Ikram M Arfan, Kappelle L Jaap, Koudstaal Peter J, Mooijaart Simon P, Niessen Wiro, van Oostenbrugge Robert, de Roos Albert, van Rossum Albert C, Daemen Mat J A P
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Alzheimers Dis. 2014;42 Suppl 4:S443-51. doi: 10.3233/JAD-141542.
While both cardiac dysfunction and progressive loss of cognitive functioning are prominent features of an aging population, surprisingly few studies have addressed the link between heart and brain function. This is probably due to the monodisciplinary approach to these problems by cardiologists, neurologists, and geriatricians. Recent data indicate that autoregulation of cerebral flow cannot always protect the brain from hypoperfusion when cardiac output is reduced or atherosclerosis is prominent. This suggests a close link between cardiac function and large vessel atherosclerosis on the one hand and brain perfusion and cognitive functioning on the other. In a national research program, we will test the hypothesis that impaired hemodynamic status of both heart and brain is an important and potentially reversible cause of vascular cognitive impairment (VCI) offering promising opportunities for treatment. Using a multidisciplinary approach, we will address the following questions: 1) To what extent do hemodynamic changes contribute to VCI? 2) What are the mechanisms involved? 3) Does improvement of the hemodynamic status lead to improvement of cognitive dysfunction? To this end we will perform clinical studies in elderly patients with clinically manifest VCI, carotid occlusive disease, or heart failure and evaluate their cardiac and large vascular function, atherosclerotic load, and cerebral perfusion with a comprehensive magnetic resonance imaging protocol and thoroughly test their cognitive function. We will also analyze epidemiological data from the Rotterdam Study.
虽然心脏功能障碍和认知功能的逐渐丧失都是老年人群的突出特征，但令人惊讶的是，很少有研究探讨心脏与大脑功能之间的联系。这可能是由于心脏病专家、神经科医生和老年病医生对这些问题采用的是单一学科方法。最近的数据表明，当心脏输出量减少或动脉粥样硬化显著时，脑血流的自动调节并不总能保护大脑免受灌注不足的影响。这表明一方面心脏功能与大血管动脉粥样硬化之间存在密切联系，另一方面大脑灌注与认知功能之间也存在密切联系。在一项国家研究计划中，我们将检验以下假设：心脏和大脑的血流动力学状态受损是血管性认知障碍（VCI）的一个重要且可能可逆的原因，这为治疗提供了有希望的机会。我们将采用多学科方法来解决以下问题：1）血流动力学变化在多大程度上导致VCI？2）涉及哪些机制？3）血流动力学状态的改善是否会导致认知功能障碍的改善？为此，我们将对患有临床明显VCI、颈动脉闭塞性疾病或心力衰竭的老年患者进行临床研究，并用全面的磁共振成像方案评估他们的心脏和大血管功能、动脉粥样硬化负荷和脑灌注，并全面测试他们的认知功能。我们还将分析鹿特丹研究的流行病学数据。
