Cardiovascular Disease in Older Greek Adults and Cognitive Impairment

RESEARCH PROPOSAL
Topic: Cardiovascular Disease in Older Greek Adults and Cognitive Impairment
PS14021
International Faculty of the University of Sheffield, CITY College
BSc Psychology
CPY3330: Research Project in Psychology
Supervisor: Dr. Anna Emmanouel

07/12/2018
ABSTRACT
The objective of this study is to determine the impact of cardiovascular disease no cognitive
functions such memory or visual abilities of Greek patients who are 65 years both male and
female, both matched in educational level in years. The sample size is thirty (30) Greek elderly
adults. Fifteen(15) are unhealthy that is they have had the previous history of cardiac surgery,
myocardial infarction or any other heart disease while the other fifteen (15) are healthy elderly
patients with no history of cardiovascular disease. The exclusion criteria are those elderly
patients who have a history of mental disease. The tools for this study are ten (10) cognitive test
but first, mini-mental state examination, screening, and measuring of blood pressure was done
before the cognitive test. Cognitive tests include Montreal cognitive assessment, California
verbal learning test, digit span test which has forward and backward option, digit symbol
modalities test, Trail making test, letter-number sequencing test, Rey-osterrieth complex figure

test, semantic and phonetic test. Multiple independent was used to compare the results between
the two groups. This will help in assessing any abnormality or normalit
The findings of this study will be used as the primary source of data that will indicate the
connection between cognitive variable to cognitive dysfunction which is related to
cardiovascular disease in elderly patients. Comparison of samples will be done using the
multiple independent t-tests to get the similarities and differences of performances of the elderly
with chronic CVD and those of healthy older adults. For cognitive measures, to predict
deficiencies related to CVD linear regression method will be used. And therefore I would
recommend that same investigations should be carried out regularly in future for confirmation
and to also expand the results of this research.
Introduction
Literature Review
According to WHO cardiovascular disease is a variety of heart and blood vessel disorders for
example heart failure and myocardial infarction. CVD is the number one cause of death
worldwide, many people die from CVD than from another cause annually and especially among
the old patients, by 2012 CVDs were among the leading causes of non-communicable diseases
and are mainly prevalent in underdeveloped and developing countries because many people are
not accessible to effective and equitable health care services. WHO recommended that most of
the cardiovascular disease can be addressed by emphasizing on avoidance of behavioral risk
factors for example use of tobacco, physical inactivity, obesity and diet which is not good to
health and harmful consumption of excess alcohol and stimulants such as caffeine. Risk factors
stated by WHO include: hypertension, diabetes, and hyperlipidemia which need early diagnosis

and management using appropriate drugs and counseling therapy. WHO was able to put the
mechanism in place to reduce the avoidable disease burdens by implementing a global action
plan for prevention and control of NCDs 2013-2020 and the sixth target is reduction of blood
pressure which the main contributing factor to cardiovascular disease and the eighth target is to
implement the use of drugs and guiding counseling on stress to prevent attacks and strokes
In Greece, 38% of the mortality rate has been due to CVD mainly caused by ischemic attacks,
more than17.5 million deaths are from CVD and are associated with risk factors which are
modifiable and can be controlled such as hypertension, diabetes, and obesity, increasing rate of
depression has made it even worse (Lim et al., 2012). Hazzouri et al. (2014) found an important
connection between cognitive impairment and CVD risk factors in elderly people, incidences of
CVD risk factors increase with age and they are considered the source of cognitive changes that
are thought to be part of the aging process which is actually not but rather cognitive impairment
due to cardiovascular disease, it is important to consider these factors and to recommend them
more routine cognitive screening because this will lead to early diagnosis and management of
risk for example hypertension.
Loss of memory and dementia are among the disorders that old people suffer from and CVD is a
secondary cause of these disorders. Gikas et al. (2016) also show a strong relationship between
severe cognitive decline and CVD in the elderly that it is the most frequent as aging causes the
heart and its blood vessels to stiffen which can lead to cardiovascular disease. CVD functions
and noted the association between high obesity, diabetes, and blood pressure with cognition of
human's brain (Leritz et al, 2011). These three conditions have been associated with both
cardiovascular disease and dementia and a decrease in cognit ive function. Diabetes particularly

those patients who are insulin depended, high glucose level causes damage to vessels and nerves
that control the heart and its blood vessels which increases chances of having heart pressure or
stroke (Salina et al, 2016) as high blood pressure even when glucose level is under control it still
increases chances of heart disease and stroke, diabetes has an unhealthy cholesterol level
including high-density lipoprotein which causes coronary disease. According to Etterhad et al,
2016, High blood pressure causes strain on heart vessels causing damage which will, in turn,
causes ischemic heart attacks, stroke and even eye damage. On the other hand, health behaviors
such as engaging in moderate but intensive exercise, nonsmoking and adopting diet which has a
lot of fruits, vegetables and fish leads to a lowered risk of dementia (Steinberger et al,2016).
According to the American Heart Association which mostly emphasized on prevention against
cardiovascular disease. It developed a 7-item tool which included mainly 4 health behaviors such
as nonsmoking, physical activity, dietary management and three biological measures which
included treating high blood cholesterol, regulating blood glucose and regulating blood pressure.
This effort by the American heart association tool has helped prevent cardiovascular disease
which is a secondary benefit of preventing dementia and cognitive impairment.
Embolic stroke or chronic cerebral hypoperfusion has a connection between CVD and cognitive
impairment (Abete et al, 2014) and they out that found out that embolic stroke and
hypoperfusion increases the risk of causing cognitive impairment by inducing neuronal energy
crisis which causes degeneration of brain nerves and vessels which causes damage of brain tissue
which eventually leads to no or less blood flow to brain because of reduced metabolic demand
which then causes impaired cognitive function in brain for example impaired memory, attention,

learning, calculation, visual perception and impairment in skilled movement because there will
be a lack of muscle coordination and weakness.
Cognitive development of a cardiovascular incident was introduced (Schievink et al., 2017) this
study was done in Maastricht among the old. This cognitive impairment includes troubles in
remembering new things or old things and making daily life decisions which affect their living.
This incidence ranges from mild to severe. In mild cognitive deficiency, people begin to notice
changes in cognitive function but they are able to perform their daily activities while Severe one
causes the loss of ability to understand meaning or importance of simple things, they are unable
to write or talk making them very hard to live independently as they will require a full-time
caregiver.
Research Gap
Many people fear to lose cognitive function. We fear to lose our mental capacity than physical
ability and therefore adults are worried about memory loss. Taking a step to address this issue
will eventually have a positive impact on the entire community and state that's why am carrying
out this study to address this issue. A lot of research on cardiovascular diseases has been
conducted among older Greek adults but there has been an increasing prevalence of CVD with
age, there has not been any improvement on morbidity and mortality among the older people
with CVD. Risk factors of cardiovascular disease have always been underrepresented especially
on the knowledge about risk factors among this population that contribute to cardiovascular
disease which eventually cause cognitive impairment and dementia, improved understanding of