Gorelick Philip B, Furie Karen L, Iadecola Costantino, Smith Eric E, Waddy Salina P, Lloyd-Jones Donald M, Bae Hee-Joon, Bauman Mary Ann, Dichgans Martin, Duncan Pamela W, Girgus Meighan, Howard Virginia J, Lazar Ronald M, Seshadri Sudha, Testai Fernando D, van Gaal Stephen, Yaffe Kristine, Wasiak Hank, Zerna Charlotte
Also a member of Maintenance of Brain Health writing group section. Also a member of Optimal Brain Health writing group section. Lead of Maintenance of Brain Health writing group section. Lead of Public Health Impact of Cognitive Impairment, Dementia, Stroke, and Cardiovascular and Stroke Risks writing group section. Senior reviewer.
Stroke. 2017 Oct;48(10):e284-e303. doi: 10.1161/STR.0000000000000148. Epub 2017 Sep 7.
Cognitive function is an important component of aging and predicts quality of life, functional independence, and risk of institutionalization. Advances in our understanding of the role of cardiovascular risks have shown them to be closely associated with cognitive impairment and dementia. Because many cardiovascular risks are modifiable, it may be possible to maintain brain health and to prevent dementia in later life. The purpose of this American Heart Association (AHA)/American Stroke Association presidential advisory is to provide an initial definition of optimal brain health in adults and guidance on how to maintain brain health. We identify metrics to define optimal brain health in adults based on inclusion of factors that could be measured, monitored, and modified. From these practical considerations, we identified 7 metrics to define optimal brain health in adults that originated from AHA's Life's Simple 7: 4 ideal health behaviors (nonsmoking, physical activity at goal levels, healthy diet consistent with current guideline levels, and body mass index <25 kg/m) and 3 ideal health factors (untreated blood pressure <120/<80 mm Hg, untreated total cholesterol <200 mg/dL, and fasting blood glucose <100 mg/dL). In addition, in relation to maintenance of cognitive health, we recommend following previously published guidance from the AHA/American Stroke Association, Institute of Medicine, and Alzheimer's Association that incorporates control of cardiovascular risks and suggest social engagement and other related strategies. We define optimal brain health but recognize that the truly ideal circumstance may be uncommon because there is a continuum of brain health as demonstrated by AHA's Life's Simple 7. Therefore, there is opportunity to improve brain health through primordial prevention and other interventions. Furthermore, although cardiovascular risks align well with brain health, we acknowledge that other factors differing from those related to cardiovascular health may drive cognitive health. Defining optimal brain health in adults and its maintenance is consistent with the AHA's Strategic Impact Goal to improve cardiovascular health of all Americans by 20% and to reduce deaths resulting from cardiovascular disease and stroke by 20% by the year 2020. This work in defining optimal brain health in adults serves to provide the AHA/American Stroke Association with a foundation for a new strategic direction going forward in cardiovascular health promotion and disease prevention.
认知功能是衰老的一个重要组成部分，并且能够预测生活质量、功能独立性以及进入养老机构的风险。我们对心血管风险作用的认识进展表明，它们与认知障碍和痴呆密切相关。由于许多心血管风险是可以改变的，因此有可能在晚年维持大脑健康并预防痴呆。本美国心脏协会（AHA）/美国中风协会主席咨询报告的目的是提供成人最佳脑健康的初步定义以及关于如何维持脑健康的指导。我们基于纳入可测量、监测和改变的因素来确定定义成人最佳脑健康的指标。基于这些实际考量，我们确定了7项定义成人最佳脑健康的指标，这些指标源自AHA的“生活简单7要素”：4项理想健康行为（不吸烟、达到目标水平的身体活动、符合当前指南水平的健康饮食以及体重指数<25kg/m²）和3项理想健康因素（未治疗的血压<120/<80mmHg、未治疗的总胆固醇<200mg/dL以及空腹血糖<100mg/dL）。此外，关于维持认知健康，我们建议遵循AHA/美国中风协会、医学研究所和阿尔茨海默病协会先前发布的包含心血管风险控制的指导意见，并建议进行社交参与及其他相关策略。我们定义了最佳脑健康，但认识到真正理想的情况可能并不常见，因为正如AHA的“生活简单7要素”所表明的，脑健康是一个连续体。因此，有机会通过一级预防和其他干预措施来改善脑健康。此外，尽管心血管风险与脑健康密切相关，但我们承认，与心血管健康相关因素不同的其他因素可能会影响认知健康。定义成人最佳脑健康及其维持与AHA的战略影响目标一致，即到2020年将所有美国人的心血管健康改善20%，并将心血管疾病和中风导致的死亡减少20%。这项定义成人最佳脑健康的工作旨在为AHA/美国中风协会在促进心血管健康和疾病预防方面提供一个新的战略方向基础。
