This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Alzheimer's dementia is merely the final stage of a psychological process that spans decades. Before clinicians can detect dementia, AD pathology may have already reached the insular cortex, which is related to autonomic control of heart rate and blood pressure. Insular lesions, particularly on the right, are associated with bradyarrhythmias, decreased heart rate variability and increased mortality. Preclinical AD should be considered as a possible explanation for cardiovascular/fall related morbidity and mortality in non-demented elderly persons. The study will examine the association between right hemisphere dysfunction and autonomic control at three levels of cognitive impairment. All subject will be free of significant cardiac disease. Right hemisphere function will be assessed by measures of constructional praxis, and regional cerebral blood flow by functional MRI. Autonomic control will be assessed by statistical analyses of HRV derived from 24 Holter records, supplemented by the frequency and severity of selected cardiac arrhythmias, orthostatic blood pressure, and symptom self-reports. Subjects will be male and female non-institutionalized elderly persons, aged 75 years or older. Normal controls, cognitively impaired subjects meeting criteria for 'Mild Cognitive Impairment' (MCI), and cases with mild AD will be included. Subjects will have anatomical and functional MRI.
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