Even for the heartiest of souls, giving up a home with its comforts and memories can be traumatic. More and more, the trend in eldercare is to find ways to keep people in their communities as they age. For that reason, investigators in the Institute for Aging Research at Hebrew SeniorLife have studied the relationship between cardiovascular disease and brain function, which could have profound implications for maintaining independence in old age.
A common fear among older adults is developing dementis. Although Alzheimer's disease may be the first condition that comes to mind, studies have shown that a condition referred to as vascular dementia is actually the second leading cause of cognitive decline in elders in western countries, and the number one cause in Asia. Vascular dementia is linked to vascular lesions in the brain resulting from stroke and brain hemorrhage, as well as other, less dramatic events. In the United States, large epidemiological studies have shown that a condition called ‘silent stroke' was found to exist in 15-50% of the studies' participants, 65 years of age and older.
Silent strokes cause damage that appears on brain imaging studies such as CAT scan or magnetic resonance imaging (MRI), but have no obvious signs like paralysis, or speech troubles that often accompany symptomatic strokes. A person can suffer a silent stroke and not know it has occurred. Because of this, researchers at IFAR feel that cerebrovascular disease is under-appreciated as a significant factor involved in cognitive decline among seniors. Moreover, vascular lesions may also be present in those suffering from Alzheimer's disease, accelerating its progression.
Along with cognitive decline, falls, incontinence and depression lead the pack in terms of syndromes that land older people in nursing homes. These may seem like unrelated conditions and all part and parcel of growing old. However, evidence suggests that changes in the frontal lobes of the brain caused by cardiovascular disease may contribute to the development of these conditions. Silent strokes tend to occur in the deep structures of the brain (basal ganglia) and the frontal subcortical white matter. These two regions form a critical set of electrical connections that help control cognition, movement and balance, mood, and even urination. Under the direction of Lewis A. Lipsitz, MD, Usen Co-Director of Research and Training, IFAR researchers looked, for the first time, at the broad implications of cardiovascular disease on mobility and incontinence as well as cognitive function. Age, hypertension, diabetes, and smoking top the list of factors that predispose a person to silent stroke. IFAR researchers hope that if people at risk can be identified and treated early, they may be spared the brain changes that lead to later disabilities.