Effects of the dietary approaches to stop hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure.

Psychosocial factors and coronary heart disease, including such factors as social support, Type A behavior and hostility, and depression, exercise training and depression in the elderly; behavioral approaches to the treatment of hypertension (e.g., weight loss and exercise); cardiac rehabilitation; neuropsychological outcomes following cardiac surgery; psychosocial aspects of heart and lung transplantation; exercise training and osteoarthritis and fibromyalgia; compliance.

Since coming to Duke as an intern in 1994 I have collaborated as a biostatistician and co-investigator at Duke on numerous observational and experimental studies involving behavior, psychosocial factors, health, and disease. The substantive topics have ranged across questions concerning exercise and depression, hypertension, weight loss, the genetics of stress and heart disease, sickle cell disease, to name a few. I am particularly interested in the issue of improving reproducibility and transparency in data analysis.

Dr. Kathleen Welsh-Bohmer is a Professor of Psychiatry with a secondary appointment in the Department of Neurology.   

Clinically trained as a neuropsychologist, Dr. Welsh-Bohmer's research activities have been focused around developing effective prevention and treatment strategies to delay the onset of cognitive disorders occurring in later life.  From 2006 through 2018 she directed the Joseph and Kathleen Bryan Alzheimer’s Center in the Department of Neurology. She also oversaw the neuropsychology scientific operations of a ground-breaking Phase III global clinical trial to delay the onset of early clinical symptoms of Alzheimer’s disease entitled the “TOMMORROW” study (Takeda Pharmaceutical Company funded) which concluded in 2018.

Currently, she directs the Alzheimer's disease therapeutic area within the Duke Clinical Research Institute and she collaborates actively with VeraSci, a Durham based company, to develop reliable digital cognitive and functional assessment tools of early Alzheimer's disease and related dementias.  The methods her team is developing are informed by advances in neuroscience and technology and fill an information void in early pre-clinical Alzheimer's disease. Her work has implications for clinical practice and for the acceleration of global clinical trials aimed at the prevention of Alzheimer’s disease and related dementias.

Dr. Browndyke is an Associate Professor of Behavioral Health & Neurosciences in the Department of Psychiatry & Behavioral Sciences.  He has a secondary appointment as Assistant Professor of Cardiovascular & Thoracic Surgery.

Dr. Browndyke's research interests involve the use of advanced neurocognitive and neuroimaging techniques for perioperative contributions to delirium and later dementia risk, monitoring of late-life neuropathological disease progression, and intervention/treatment outcomes.  His research also involves novel telehealth methods for remote neurocognitive evaluation and implementation of non-invasive neuromodulatory techniques to assist in postoperative recovery and dementia risk reduction.

Dr. Browndyke's clinical expertise is focused upon geriatric neuropsychology with an emphasis in the assessment, diagnosis, and treatment of dementia and related disorders in adults and US veteran patient populations.

My current research focus is on biological, behavioral and sociocultural factors involved in the etiology and management of hypertension, coronary artery disease, and congestive heart failure. The role of stress and the sympathetic nervous system in disease onset and progression is of central interest. Current research issues being studied include: (i) Ethnicity and gender as factors related to the pathogenesis of hypertension; (ii) Mechanisms by which menopause increases the risk of cardiovascular disease in women; (iii) Mechanisms by which stress may provoke episodes of myocardial ischemia in patients with coronary artery disease; (iv) Stress biomarkers that are associated with adverse clinical outcomes in cardiac patients; (v) The development of coping skills interventions to improve prognosis and quality of life in patients with congestive heart failure; (vi) Circadian blood pressure profiles for risk stratification in patients with hypertension; (vii) Biological and behavioral factors contributing to elevated nighttime blood pressure and blunted nighttime blood pressure dipping.

Comprehensive assessments of cardiovascular regulatory systems define the daily activity in the biobehavioral research laboratory. Assessments include: (i) hemodynamic (blood pressure, cardiac output, systemic vascular resistance) and neurohumoral responses (plasma epinephrine and norepinephrine) during psychological and physical stress testing; (ii) alpha and beta adrenergic receptor function, the baroreceptor reflex, and cardiac vagal control; (iii) endothelial function, and vascular structure and compliance; (iv) left ventricular structure and function by echocardiography; (v) 24-hour ambulatory blood pressure and cardiac output monitoring; (vi) Noninvasive assessments of arterial stiffness and central aortic pressure; (vii) Psychometric assessments of personality and lifestyle characteristics related to cardiovascular disease.

A secondary research interest is in the use and development of noninvasive techniques for evaluating the cardiovascular system. Developments include an ambulatory impedance cardiography system, permitting assessment of 24-hour hemodynamics during normal daily activities, and biomarkers of cardiovascular risk obtained using ultrasound imaging.

RESINT.DOC 1/5/99