Study Protocol: The Heart and Brain Study
Sana Suri1,2, Daniel Bulte3, Scott T Chiesa4
1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.
Insights
The Heart and Brain Study investigates how midlife vascular risk impacts brain health and cognitive decline. Findings will help identify individuals for interventions to prevent or delay dementia.
Area of Science:
- Neuroscience
- Cardiovascular Science
- Gerontology
Background:
- The link between cardiovascular health and brain function is well-established, with vascular risk factors increasing dementia risk.
- Mechanisms connecting heart health to brain health, particularly cerebrovascular reactivity (CVR), are under investigation.
- Impaired vascular phenotypes and CVR are implicated in cognitive decline.
Purpose of the Study:
- To examine the long-term effects of midlife vascular risk on cerebrovascular health and cognitive decline.
- To investigate the relationship between vascular phenotypes, CVR, and brain structure and function.
- To identify optimal windows for vascular risk management to delay cognitive decline.
Main Methods:
- Utilizing data from the Whitehall II Imaging cohort, including 3T brain MRI, neuropsychological tests, and vascular assessments.
- Conducting ultrasound of the aorta and carotid arteries, blood pressure measurements, and advanced MRI to assess CVR, cerebral blood flow, and lesions.
- Analyzing 30-year trajectories of vascular risk from midlife (40-70 years) to older age.
Main Results:
- This study is designed to generate a comprehensive dataset on the heart-brain association.
- It will provide insights into physiological processes linking vascular health to cognitive function.
- The research aims to establish how vascular risk throughout life influences brain aging.
Conclusions:
- The Heart and Brain Study will yield a detailed dataset for understanding the longitudinal determinants of the heart-brain link.
- Findings will inform strategies for early identification of individuals at risk for cognitive decline.
- The study aims to guide interventions for preventing or delaying dementia by optimizing vascular risk management.
Background:
It is well-established that what is good for the heart is good for the brain. Vascular factors such as hypertension, diabetes, and high cholesterol, and genetic factors such as the apolipoprotein E4 allele increase the risk of developing both cardiovascular disease and dementia. However, the mechanisms underlying the heart-brain association remain unclear. Recent evidence suggests that impairments in vascular phenotypes and cerebrovascular reactivity (CVR) may play an important role in cognitive decline. The Heart and Brain Study combines state-of-the-art vascular ultrasound, cerebrovascular magnetic resonance imaging (MRI) and cognitive testing in participants of the long-running Whitehall II Imaging cohort to examine these processes together. This paper describes the study protocol, data pre-processing and overarching objectives.
Methods And Design:
The 775 participants of the Whitehall II Imaging cohort, aged 65 years or older in 2019, have received clinical and vascular risk assessments at 5-year-intervals since 1985, as well as a 3T brain MRI scan and neuropsychological tests between 2012 and 2016 (Whitehall II Wave MRI-1). Approximately 25% of this cohort are selected for the Heart and Brain Study, which involves a single testing session at the University of Oxford (Wave MRI-2). Between 2019 and 2023, participants will undergo ultrasound scans of the ascending aorta and common carotid arteries, measures of central and peripheral blood pressure, and 3T MRI scans to measure CVR in response to 5% carbon dioxide in air, vessel-selective cerebral blood flow (CBF), and cerebrovascular lesions. The structural and diffusion MRI scans and neuropsychological battery conducted at Wave MRI-1 will also be repeated. Using this extensive life-course data, the Heart and Brain Study will examine how 30-year trajectories of vascular risk throughout midlife (40-70 years) affect vascular phenotypes, cerebrovascular health, longitudinal brain atrophy and cognitive decline at older ages.
Discussion:
The study will generate one of the most comprehensive datasets to examine the longitudinal determinants of the heart-brain association. It will evaluate novel physiological processes in order to describe the optimal window for managing vascular risk in order to delay cognitive decline. Ultimately, the Heart and Brain Study will inform strategies to identify at-risk individuals for targeted interventions to prevent or delay dementia.
