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Cognitive deficits and accelerated brain ageing in older adults with undiagnosed sleep apnoea and pulmonary dysfunctions
Secondary Supervisor(s): Dr Joseph Welch
University of Registration: University of Birmingham
BBSRC Research Themes: Integrated Understanding of Health (Ageing)
Project Outline
Cognitive ageing is inevitable but numerous studies indicate large heterogeneity in the rate of cognitive deterioration, ranging from a gradual drop in cognitive functioning, to dementia. With an increasingly ageing UK population, one of the key research challenges is understanding factors associated with a risk of hastened cognitive decline. The proposed project tests the fundamental hypothesis that undetected obstructive sleep apnoea (OSA) and associated pulmonary dysfunction in older adults leads to accelerated brain and cognitive ageing. Thus, we aim to expand understanding of the mechanisms of OSA-mediated cognitive decline in the elderly.
OSA is one of the leading causes of poor cardiovascular and cerebrovascular health and has been associated with increased risk of hypertension, coronary heart disease, and stroke. The links between OSA and cognitive deficits are poorly understood and often controversial. The negative health and cognitive consequences of OSA are exacerbated by comorbidities, such as pulmonary dysfunction.
In the last few years, OSA has emerged as a potentially modifiable risk factor for cognitive decline and dementia in the elderly population. It has been further suggested that OSA and dementia might share several common pathophysiology, such as cerebrovascular and glymphatic changes, and neurodegeneration (atrophy). Despite the increasing awareness of the negative health and cognitive consequences of OSA, current statistics indicate that only a relatively small number of older adults are tested and treated for OSA. In middle-aged individuals who are overweight or obese, loud snoring, waking up during the night, mental fatigue associated with concentration problems and memory lapses, excessive daytime sleepiness and napping, are considered symptoms of OSA and trigger medical referral. By contrast, the same symptoms in older individuals are frequently attributed to normal ageing and not medically investigated. In one recent study (n=1,052), 56% of community-dwelling older adults, were classified as being at high risk of OSA based on detailed questionnaire screening, and in 94% of these cases OSA was medically confirmed. Strikingly, only 8% of these adults were previously referred to be tested for OSA.
Research addressing the mechanistic processes underpinning the link between OSA and cognitive decline in older adults is only beginning to emerge. While recently published studies firmly indicate that robust structural brain changes contribute to cognitive deficits in older adults diagnosed with OSA, there is a paucity of studies exploring mechanisms underpinning the observed brain changes in terms of common and separate contributions of sleep disordered breathing (OSA) and pulmonary dysfunctions. Thus, the proposed project tests the specific hypothesis that atrophy, cerebrovascular and glymphatic changes in older adults with undiagnosed OSA and/or pulmonary dysfunctions results in accelerated brain ageing and cognitive decline. By combining detailed characterization of sleep patterns, physiological markers of sleep disordered breathing and pulmonary function with comprehensive cognitive testing and advanced MRI methods, the project aims to comprehensively examine the association between undiagnosed OSA and/or pulmonary dysfunctions on accelerated brain and cognitive decline putting elderly individuals at increased risk of dementia.
References
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