(16)心血管疾病,中风,肥胖和认知症的风险-Cardiovascular Disease, Stroke, Obesity and Dementia Risk?-公开课-关爱惟士
(16)心血管疾病,中风,肥胖和认知症的风险-Cardiovascular Disease, Stroke, Obesity and Dementia Risk?

课程视频:http://http://player.youku.com/embed/XMjY3ODM2MDk2NA



Professor Velandai Srikanth

When we talk about cardiovascular disease, we’re referring to major disease such as having strokes, or heart attacks, or having heart failure. Our research has clearly shown that people who have strokes, heart failure or heart attacks are at very high risk of dementia in the future. Strokes can directly destroy brain cells and hence reduce the capacity of the brain to withstand other insults that might occur in the brain later on, such as Alzheimer’s Disease. Now, while these major events are important in increasing the risk of dementia, it must be kept in mind that the risk factors that lead to these diseases are also important. So, by controlling risk factors such as high blood pressure, diabetes, cholesterol, maintaining activity, stopping smoking; these can all reduce the risk of major cardiovascular disease and, by that, reduce the risk of a future dementia.

当我们谈论心血管疾病时,我们主要指像中风,心脏病或心力衰竭这样的疾病。我们的研究清楚的表明心脏病或心力衰竭病人将来得认知症的风险会很高。中风可以直接破坏脑细胞,从而降低以后大脑经受像阿尔茨海默氏病之类发生在大脑中的伤害的能力。我们承认这些主要事件在增加患认知症的风险中是很重要的同时,还必须牢记导致这些疾病的风险因素也很重要。因此通过控制像高血压,糖尿病,胆固醇这些风险因素,保持运动和戒烟可以降低将来患认知症的风险。


Blood pressure tends to increase first as people reach middle age, so middle age is between 40 and 60 years of age. At this point in time, control of blood pressure is likely to reduce the risk of brain injury later on, so one advocates the careful monitoring and control of blood pressure during middle age. But as one gets older and gets a bit frailer so, for example, those in their late 70s or 80s might have difficulty walking, might have poor balance, can have a risk of falling; in such people we are a bit more careful about how aggressively we treat their blood pressure. As one gets even older, blood pressure drops and tends to go down to the lower side of things in some people. Hence at that age, it is quite important to maintain blood pressure at a reasonable level so they can actually function well, and such people we don’t tend to put on high doses of blood pressure reducing medication or even sometimes take them off blood pressure reducing medication.

人到中年后血压会升高。这里的中年是指40岁到60岁之间。在这个时间点,控制血压会大大降低后期脑损伤的风险。因此有人建议人在中年应该严格检测和控制血压。但当一个人变老时血管会更脆弱。例如那些七八十岁的老人也许会行走困难,也许平衡能力差,可能会有跌倒的危险。对于这样的人,我们就要小心的控制他们的血压了。因为人变得更老后,某些人的血压会下降并且血液会倾向于下降到身体的下方。因此到了那个年纪,维持血压在一个合理的水平上,从而使他们的身体功能正常是非常重要的。对于这样的人,我们不会用大剂量的降压药,甚至有时不给他们服用降压药。


The relationship between body weight and dementia is quite complicated. As people develop dementia in older age, they tend to lose weight because the brain is probably telling them not to eat much, in some fashion, and hence they lose not just body weight but muscle weight as well. So the risk or the association between body weight and dementia is different in older people compared with younger or middle aged people. In contrast, if you look at middle age, having greater levels of obesity is associated with the risk of dementia in the future. For example, people who have a very large waist circumference, what we call central adiposity, more fat around their hips, tend to have a higher risk of dementia. Such fat can be a source of chronic inflammation and this can affect blood vessel health and brain health directly. So treatment of adiposity or obesity in middle age should be quite aggressive, and can potentially reduce the risk of dementia in the future.

体重和认知症之间的关系是非常复杂的。人们在老年患认知症时,他们会体重减轻,因为大脑或许告诉他们不要多吃,因此在某些方面,他们不仅仅失去体重,还失去肌肉的重量。因此老年人体重和认知症之间的关系或风险,和青年人以及中年人相比,是不同的。相反,如果你观察中年人,就会发现肥胖与将来患认知症密切相关。例如,一个具有很大腰围,臀部有很多脂肪的人,也就是向心性肥胖的人,会有更高的患认知症的风险。


People with advanced dementia tend to lose weight. We don’t know exactly why this happens, but it is probably as a result of the hunger centre in their brains becoming different in the way it acts, so their appetite and their desire for food goes down and we can’t exactly work out, or haven’t been able to work out until now, how to offset this. Research is under way to try and understand what parts of the brain are signalling to stop hunger from happening in people with advanced dementia.

认知症晚期患者容易丧失体重。我们不知道发生这个的确切的原因,但也许是他们大脑的饥饿中心无法正常工作,以至于他们的食欲减退。迄今为止,我们无法阻止这个。目前正在进行的研究在试图搞清大脑的什么部位在发信号来阻止认知症晚期患者的饥饿感。


So in people who have already developed strokes or heart attacks, it is still not too late to make a difference to their risk of dementia in the future. We found in our studies that having one stroke by itself may not increase the risk of dementia too much, but having more than one stroke clearly increases the risk of dementia. So, in people who have had a stroke, it is important to do everything you can, with the help of your specialist, to try and have treatments in place that reduce the risk of a further stroke. Now this might mean having blood thinning medications, anti-coagulant medications such as Warfarin, blood pressure reducing medications, and controlling your diabetes. Apart from this, stopping smoking and increasing physical activity are also important. Again, if you haven’t developed major cardiovascular disease, but have risk factors such as high blood pressure and diabetes, it is still not too late to make a difference. In fact, the earlier we treat people before they develop cardiovascular disease, the better it is. So control of blood pressure during mid-life and early older life, control of diabetes, again stopping smoking, increasing your physical activity, reducing your weight, are all important things that need to be aggressively done during middle life.

因此已经有心脏病和发生中风的人想改变将来患认知症的风险仍为时不晚。我们在研究中发现一次中风本身也许不会怎么增加患认知症的风险。但是多次中风会明显增加患病风险。所以,发生过一次中风的人在医生专家的帮助下进行治疗,竭尽所能来降低再次发生中风的可能性是非常重要的。目前这可能意味着服用收缩血管的药物,像华法林这样的抗凝血药,降压药,以及控制糖尿病的药。除了这些,戒烟和增加体育锻炼也非常重要。还有如果你尚未患主要的心血管疾病,但有高血压和糖尿病这样的风险因素,想做出改变仍为时不晚。实际上,在人们发展为心血管疾病之前,我们越早治疗,效果越好。所以,在中年期和老年早期控制血压,在中年期控制血糖,戒烟,增加体育锻炼,降低体重都是需要积极去做的事情。


It is very important to treat vascular risk factors to prevent major cardiovascular disease, and by that I mean preventing strokes and heart attacks. We know that preventing strokes reduces the risk of dementia, and we know that preventing heart attacks reduces the risk of heart failure, which is a risk factor for dementia.

通过处理血管风险因素来预防中风和心脏病等主要的心血管疾病是非常重要的。我们知道预防中风会降低患认知症的风险,并且知道预防心脏病可以降低心脏衰竭的风险,这是患认知症的风险因素之一。


There are a lot of studies currently under way trying to find out if reducing blood pressure or diabetes by themselves can reduce the risk of future dementia. The difficulty with planning studies of this nature is that they require very large numbers of people to participate in these studies, and a very long follow up to see if they do develop cognitive impairment or not. We need to wait for the results of these studies to come out before we can conclusively say which way the evidence goes.

目前很多研究试图搞清降低血压和控制糖尿病本身是否能降低患认知症的风险。计划这些研究的困难之处在于需要大量的人来参与这些研究,并且需要长期随访来看看他们是否后来发展成为认知障碍。在我们能够做出结论之前,我们需要等待这些研究结果出来。


The most important focus needs to be on identifying people who are at highest risk of dementia and trying to design studies to intervene in such people. For example, people with clusters of vascular risk factors such as diabetes and hypertension could be most at risk of dementia, and trying to develop medications, or other lifestyle interventions, in such people will provide the maximum benefit in future dementia reduction.

我们要把最重要的焦点放在鉴定具有患认知症高风险的那些人身上,并试图设计研究来干预这样的人。例如,搜集有糖尿病和高血压这些血管风险因素的人群,然后进行药物和生活方式的干预,从而提供将来降低这些人患认知症风险的最大好处。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

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