Vascular Cognitive Impairment in Otherwise Healthy Older Women

Miss Kate Thompson (). Vascular Cognitive Impairment in Otherwise Healthy Older Women Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Miss Kate Thompson
Thesis Title Vascular Cognitive Impairment in Otherwise Healthy Older Women
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Dr Nancy Pachana
Dr Gerard Byrne
Total pages 222
Total black and white pages 222
Abstract/Summary Abstract With the development and wider availability of neuroimaging techniques, researchers have now been afforded greater scope to study structural and functional changes to the central nervous system across the lifespan. One such change pertains to commonly occurring incidental lesions of the cerebral white matter in otherwise neurologically asymptomatic healthy older adults. With advances in medical imaging over recent decades researchers have begun exploring the neuropsychological correlates of these incidental findings. These cognitive manifestations have been labelled ‘vascular cognitive impairment’ occurring along a continuum with vascular dementia at the more severe end. Significant debate remains within the literature regarding the precise nature of the associated cognitive and psychological sequelae associated with the spectrum of vascular cognitive impairment. In recent years research on vascular cognitive impairment has moved toward developing a greater understanding of the aetiology of incidental cerebrovascular disease in older people, and exploring the association between cardiovascular risk factors and cognitive affective symptoms in the absence of cerebrovascular disease. The current investigations consist of two cross-sectional studies as part of a larger longitudinal project (the Longitudinal study of Aging in Women; LAW project) examining socio-demographic, health and psychological/psychiatric functioning in a large sample of 511 women from Brisbane, Australia. Study one examined a subsample of 166 women aged between 48 and 85 years who were eligible to undergo MRI. The aim of this study was to compare the performance of young-older (under 65) and old-older women (65 and over) further classified according to ratings of neuroradiologically identified cerebrovascular disease (age appropriate scan, mild lesion burden and severe lesion burden) across measures of neuropsychological functioning and subjective ratings of cognitive functioning. Study two aimed to explore the degree to which cardiovascular risk factors and depressive symptomatology explain variance on the objective and subjective cognitive measures after accounting for demographic variables (n = 358). The results of study one revealed no differences in performance on the neuropsychological measures or scores on the subjective rating scales across the three MRI groups. However, cognitive scores did vary according to age, with the old-older adults performing significantly worse than their younger counterparts. The results of study two emphasise the role of depression as a significant predictor for both objective and subjective measurements of cognitive functioning. With regard to the cardiovascular risk factors, diabetes and a history of smoking emerged as the most consistent risk factors predictive of cognitive dysfunction. Consistent with previous research, we also observed variable trends toward the protective effects of some cardiovascular risk factors in maintaining and/or enhancing cognitive function. The findings of this study are discussed in the context of broader theories regarding the clinical sequelae of incidental white matter lesions in otherwise healthy older adults. Furthermore, the clinical and research implications of the current study are discussed, with reference to previous work that provides both congruent as well as discrepant findings. Finally, the strengths and weaknesses of the current study are discussed with recommendations provided as to directions for future research.
Keyword White matter lesions
cognition
Women
depression
cardiovascular risk factors
cerebrovascular disease
Executive function
subjective cognitive function

 
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Created: Thu, 19 Aug 2010, 13:40:18 EST by Miss Kate Thompson