Adverse Vascular Risk is Related to Cognitive Decline in Older Adults

Article type: Research Article

Authors: Jefferson, Angela L.^{a; *} | Hohman, Timothy J.^a | Liu, Dandan^b | Haj-Hassan, Shereen^a | Gifford, Katherine A.^a | Benson, Elleena M.^a | Skinner, Jeannine S.^c | Lu, Zengqi^b | Sparling, Jamie^{d; e} | Sumner, Emily C.^a | Bell, Susan^{a; f; g} | Ruberg, Frederick L.^{d; h}

Affiliations: [a] Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA | [b] Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA | [c] Vanderbilt-Meharry Alliance, Nashville, TN, USA | [d] Boston University School of Medicine, Boston, MA, USA | [e] Newton Wellesley Hospital, Department of Medicine, Newton, MA, USA | [f] Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA | [g] Center for Quality Aging, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA | [h] Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, USA

Correspondence: [*] Correspondence to: Angela L. Jefferson, PhD, Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, 2525 West End Ave, 12th Floor, Suite 1200, Nashville, TN 37203, USA. Tel.: +1 615 322 8676; Fax: +1 615 875 2727; E-mail: [email protected].

Abstract: Background:Cardiovascular disease (CVD) and related risk factors are associated with Alzheimer's disease (AD). This association is less well-defined in normal cognition (NC) or prodromal AD (mild cognitive impairment, MCI). Objective:Cross-sectionally and longitudinally relate a vascular risk index to cognitive outcomes among elders free of clinical dementia. Methods:3,117 MCI (74 ± 8 years, 56% female) and 6,603 NC participants (72 ± 8 years, 68% female) were drawn from the National Alzheimer's Coordinating Center. A composite measure of vascular risk was defined using the Framingham Stroke Risk Profile (FSRP) score (i.e., age, systolic blood pressure, anti-hypertensive medication, diabetes, cigarette smoking, CVD history, atrial fibrillation). Ordinary linear regressions and generalized linear mixed models related baseline FSRP to cross-sectional and longitudinal cognitive outcomes, separately for NC and MCI, adjusting for age, gender, race, education, and follow-up time (in longitudinal models). Results:In NC participants, increasing FSRP was related to worse baseline global cognition, information processing speed, and sequencing abilities (p-values <0.0001) and a worse longitudinal trajectory on all cognitive measures (p-values <0.0001). In MCI, increasing FSRP correlated with worse longitudinal delayed memory (p = 0.004). In secondary models using an age-excluded FSRP score, associations persisted in NC participants for global cognition, naming, information processing speed, and sequencing abilities. Conclusions:An adverse vascular risk profile is associated with worse cognitive trajectory, especially global cognition, naming, and information processing speed, among NC elders. Future studies are needed to understand how effective management of CVD and related risk factors can modify cognitive decline to identify the ideal timeframe for primary prevention implementation.

Keywords: Blood pressure, diabetes mellitus, Framingham Stroke Risk Profile, smoking, stroke

DOI: 10.3233/JAD-141812

Journal: Journal of Alzheimer's Disease, vol. 44, no. 4, pp. 1361-1373, 2015