CV RISK AND FRONTAL DYSFUNCTION IN BLACK ELDERS

Harvard University (Medical School), Boston MA

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Abstract

Description: Cerebrovascular disease (CVD) is highly prevalent in the African-American community, in part due to the exceedingly high prevalence of risk factors in this group. Furthermore, CVD is a common cause of cognitive dysfunction, gait abnormalities, and urinary incontinence. Our primary hypothesis is that persons with increased CVD risk will exhibit a constellation of deficits in cognition, gait, and bladder function that are associated with functional loss of frontal lobe control. Our specific aims are to determine whether: 1) traditional risk factors for CVD are associated with cognitive impairment, particularly executive dysfunction, 2) CVD risk factors are an independent contributor to gait and balance abnormalities, and 3) CVD risk factors are an independent contributor to the development of nocturia and urge urinary incontinence. 4) We will also assess the interrelationship between CVD risk factors, executive dysfunction, gait/balance abnormalities, and urinary dysfunction. Additionally, we will explore the relationship between CVD risk factors, specific morphologic brain changes, and cognitive/functional abilities through a pilot study in which a subsample of our study participants will receive a line-scan MR diffusion tensor imaging protocol to evaluate the coherence of white matter fibers. A total of 240 elderly African-American subjects, stratified by CVD risk and memory function, will be evaluated cross-sectionally for CVD risk, cognitive functions, gait and balance abnormalities, and voiding symptoms. Our results will hopefully elucidate the relation between modifiable risk factors and frontal lobe dysfunction, and provide important information about the executive abilities of patients with risk factors that may influence their compliance with traditional risk reduction interventions. Future interventions to prevent or ameliorate frontal lobe dysfunction will be designed that use risk abatement strategies more appropriate for the cognitive abilities of patients with executive dysfunction.