The Division of
Health Care Policy and Research

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The Cognition, Behavior, and Health program has a focus on cognitive functioning, and on its implications for health and health care. Our basic assumption is that cognitive deficits are associated with a number of different medical disorders, and that these deficits not only affect the capacity for everyday functioning, but also have direct effects on an individual's ability to maintain one's health, and consequently on one's utilization of health care services.

One study, funded by the National Institute on Neurological Disorders and Stroke (NINDS), has as its objective the characterization of the Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS), a late-onset neurodegenerative disorder first identified in 2000. FXTAS affects individuals who are carriers of an X-linked genetic disorder known as Fragile X Syndrome. In addition to problems with movement (they experience a sometimes disabling tremor during movement, in addition to incoordination and an unstable gait), a high percentage of people with FXTAS have a very specific pattern of progressive cognitive deficits. Importantly, these include difficulty in monitoring and regulating their own behavior.

A link to the Colorado Fragile X Consortium.

A second study, funded by the National Institute on Aging (NIA), is studying the effects on cognitive functioning among women with breast cancer of chemotherapy. Reports of what has been labelled "chemobrain" have been around for some time now, and this study is designed to examine the nature and prevalence of cognitive impairment experienced by cancer patients undergoing chemotherapy. The study also aims to identify women who are at increased risk of chemobrain, and to test a theory about the cause of the disorder. We also have studied the effects on cognition of hormone therapies that inhibit testosterone production among men with advanced prostate cancer.

We are especially interested in the efffects of cognitive impairment on an individual's ability to manage chronic diseases such as diabetes, congestive heart failure, and HIV infection. Improved treatments for many chronic conditions, and published treatment guidelines, may allow people with these disorders to maintain their health and functional status. These diseases may, however, affect cognition adversely, which in turn may make it more difficult for them to take care of themselves, and may lead to a greater need for health services. This is an area of research into which we are planning to move over the coming months.

Recently, we have begun to study psychoneuroimmunology, or the interaction between the brain, the immune system, and cognitive-emotional functioning. Inflammation has been associated with depression, autoimmune disorders, fibromyalgia, self-rated health, and various aspects of cognition. In our study of breast cancer chemotherapy, we are testing the idea that the cause of chemobrain is inflammatory.