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Specifically, interpretation of individual or group differences in blood oxygenation level dependent magnetic resonance imaging (BOLD MRI) or positron emission tomography (PET H) signals as reflective of differences in neural activation underlying a cognitive operation of interest requires assumptions of intact vascular health amongst the study participants. Without adequate screening, inclusion of individuals with T2DM or hypertension in “healthy” samples may introduce unwanted variability and bias to brain and/or cognitive measures, and increase potential for error.
To reinforce the notion that individuals with T2DM and hypertension should not be overlooked as a potential source of bias, we also provide an overview of metabolic and vascular changes associated with T2DM and hypertension, as they relate to cerebrovascular and brain health.
Amongst middle-aged and older adults, the rising prevalence of T2DM, hypertension, and other conditions that comprise the metabolic syndrome is a global health epidemic, attributed largely to sedentary lifestyles, poor diet, and lack of exercise.
Any research study whose population of interest has high prevalence rates of T2DM or hypertension should be cognizant of these issues. Effects of adult age and blood pressure on executive function and speed of processing.
For example, psychiatric populations have a higher incidence of metabolic disruption and T2DM that is mediated, at least partially, by the use of mood stabilizers, anticonvulsants, and antipsychotic medications (Regenold et al., 2002; Newcomer and Haupt, 2006). doi: 10.1016/j.jdiacomp.20 Pubmed Abstract | Pubmed Full Text | Cross Ref Full Text Bucur, B., and Madden, D.
A large portion had exclusion criteria that made it difficult to determine whether T2DM or hypertension were excluded (44 and 37%), and many did not mention any selection criteria related to T2DM or hypertension (34 and 22%). Age differences in the frontoparietal cognitive control network: implications for distractibility. doi: 10.1016/j.neuropsychologia.20 Pubmed Abstract | Pubmed Full Text | Cross Ref Full Text Cappell, K.
Of all the surveyed studies, only 29% acknowledged or addressed the potential influence of intersubject vascular variability on the measured BOLD or PET signals.
Even normal, age-related changes in the integrity of the cerebrovascular system can undermine these assumptions (D' Esposito et al., 1999).
Yet, it was our impression that relatively few studies in the cognitive aging neuroimaging literature consider T2DM or hypertension during recruitment, or control for potential confounds associated with these conditions during analysis.
The growing number of middle-aged and older adults living with T2DM and/or hypertension makes these conditions important topics of study in their own right.
Better long-term health care and disease management allow middle-aged and older adults to live with T2DM and hypertension for many years; however, both of these conditions have long-term deleterious effects on cerebrovascular and brain health, and contribute to cognitive impairment and decline (Gorelick et al., 2011). doi: 10.1093/cercor/bhg133 Pubmed Abstract | Pubmed Full Text | Cross Ref Full Text Cabeza, R., Grady, C.