Dr. Gottesman's lab work focuses on the cognitive impacts of stroke and other vascular disease, both in the short-term and the long-term, and on the association between vascular disease and dementia (including Alzheimer's disease). She evaluates this in large community-based populations, as well as smaller hospital-based studies, and has particular interest in neuroimaging as a way to evaluate cerebrovascular changes in the brain, as well as neurodegenerative changes in the brain, such as those due to Alzheimer's disease.
Cognition in individuals hospitalized with congestive heart failure
Congestive heart failure (CHF) is a growing epidemic in this country, as the population ages. Prior studies have demonstrated that CHF patients may be at particular risk for not only stroke, but also for impaired cognition. This may be due to reduced perfusion to the brain in individuals with low cardiac function, or may be due to other factors such as circulating inflammatory markers or reduced oxygenation during a heart failure exacerbation. Little is understood about how cognition in CHF patients is related to “typical” markers of CHF worsening, such as edema or shortness of breath, or whether cognition improves as these other symptoms improve. In this study, we are recruiting hospitalized patients with acute worsening of their CHF, and performing cognitive testing at one or two time points during their hospital stays. We hypothesize specifically that level of cognitive performance will be improved after the other symptoms typically associated with CHF, such as edema and shortness of breath, improve.
Stroke and cognition after coronary artery bypass graft surgery
The goal of this study is to evaluate factors that contribute to stroke and short-term cognitive problems after coronary artery bypass graft (CABG) surgery. Specifically, we are interested in the importance of changes in blood pressure during surgery and how these relate to the development of different types of stroke postoperatively. Individuals enrolled in this study are recruited preoperatively, and undergo preoperative and postoperative cognitive testing, as well as postoperative brain imaging. The major hypothesis is that a larger decrease in blood pressure will be associated with more postoperative strokes, and that this will be especially true in individuals with large-vessel stenosis as seen on postoperative magnetic resonance angiography (MRA). Funded by American Heart Association
The ARIC-PET Amyloid Imaging Study
This study is an ancillary study to the larger Atherosclerosis Risk in Communities (ARIC) study and the ARIC-Neurocognitive (ARIC-NCS) studies. The ARIC study is a large, community-based cohort study from 4 community sites across the U.S. (http://drupal.cscc.unc.edu/aric/) designed to evaluate the natural history of atherosclerosis and its risk factors. The ARIC-NCS study is designed to evaluate the relationship between these vascular risk factors and cognitive impairment and dementia. The ARIC-PET study, for which Dr. Gottesman is the PI, is designed to evaluate the contribution of these vascular risk factors specifically to the deposition of amyloid in the brain, measured using PET scanning with 18F-AV-45 (florbetapir). Some existing studies suggest that vascular risk factors, such as hypertension, actually cause deposition of amyloid (the protein felt to be responsible for the development of Alzheimer’s disease) in the brain, but others suggest that these risk factors are only related to Alzheimer’s because the combination of Alzheimer’s neuropathology and vascular neuropathology make an individual more likely to experience cognitive impairment. This study, conducted at the Comstock center in Hagerstown, MD, and also at the University of Mississippi Medical Center in Jackson, MS, is designed to evaluate both of these possibilities in this existing ARIC cohort. Funded by NIH/ NIA