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Cerebrovasc Dis Extra. 2017;7(3):140-152. doi: 10.1159/000480738. Epub 2017 Oct 10.

The Missing Link in the Pathophysiology of Vascular Cognitive Impairment: Design of the Heart-Brain Study.

Author information

1
Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.
2
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
3
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
4
Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
5
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
6
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
7
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
8
Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
9
Imaging Physics, Applied Sciences, Delft University of Technology, Delft, the Netherlands.
10
Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
11
C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
12
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
13
Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands.
14
Department of Epidemiology, VU University Medical Center, Amsterdam, the Netherlands.

Abstract

BACKGROUND:

Hemodynamic balance in the heart-brain axis is increasingly recognized as a crucial factor in maintaining functional and structural integrity of the brain and thereby cognitive functioning. Patients with heart failure (HF), carotid occlusive disease (COD), and vascular cognitive impairment (VCI) present themselves with complaints attributed to specific parts of the heart-brain axis, but hemodynamic changes often go beyond the part of the axis for which they primarily seek medical advice. The Heart-Brain Study hypothesizes that the hemodynamic status of the heart and the brain is an important but underestimated cause of VCI. We investigate this by studying to what extent hemodynamic changes contribute to VCI and what the mechanisms involved are. Here, we provide an overview of the design and protocol.

METHODS:

The Heart-Brain Study is a multicenter cohort study with a follow-up measurement after 2 years among 645 participants (175 VCI, 175 COD, 175 HF, and 120 controls). Enrollment criteria are the following: 1 of the 3 diseases diagnosed according to current guidelines, age ≥50 years, no magnetic resonance contraindications, ability to undergo cognitive testing, and independence in daily life. A core clinical dataset is collected including sociodemographic factors, cardiovascular risk factors, detailed neurologic, cardiac, and medical history, medication, and a physical examination. In addition, we perform standardized neuropsychological testing, cardiac, vascular and brain MRI, and blood sampling. In subsets of participants we assess Alz-heimer biomarkers in cerebrospinal fluid, and assess echocardiography and 24-hour blood pressure monitoring. Follow-up measurements after 2 years include neuropsychological testing, brain MRI, and blood samples for all participants. We use centralized state-of-the-art storage platforms for clinical and imaging data. Imaging data are processed centrally with automated standardized pipelines.

RESULTS AND CONCLUSIONS:

The Heart-Brain Study investigates relationships between (cardio-)vascular factors, the hemodynamic status of the heart and the brain, and cognitive impairment. By studying the complete heart-brain axis in patient groups that represent components of this axis, we have the opportunity to assess a combination of clinical and subclinical manifestations of disorders of the heart, vascular system and brain, with hemodynamic status as a possible binding factor.

KEYWORDS:

Cardiovascular dysfunction; Carotid occlusive disease; Cerebral blood flow; Cerebral hypoperfusion; Cognitive decline; Heart failure; Small vessel disease

PMID:
29017156
PMCID:
PMC5730112
DOI:
10.1159/000480738
[Indexed for MEDLINE]
Free PMC Article

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