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 Volume 56, Number 1, January 09, 2001
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Neurology 2001;56:42-48
© 2001 American Academy of Neurology
Articles

Cardiovascular risk factors and cognitive decline in middle-aged adults

D. Knopman, MD;, L.L. Boland, MPH;, T. Mosley, PhD;, G. Howard, DrPH;, D. Liao, MD, PhD;, M. Szklo, MD, DrPH;, P. McGovern, MD;, A. R. Folsom, MD and for the Atherosclerosis Risk in Communities (ARIC) Study Investigators

From the Department of Neurology (Dr. Knopman), Mayo Clinic, Rochester, MN; Division of Epidemiology (L.L. Boland and Drs. McGovern and Folsom), School of Public Health, University of Minnesota, Minneapolis; Department of Medicine (Geriatrics) (Dr. Mosley), Medical Center, University of Mississippi, Jackson; Department of Biostatistics (Dr. Howard), University of Alabama, Birmingham; Health Evaluation Sciences (Dr. Liao), Penn State College of Medicine, Hershey, PA; and Department of Epidemiology (Dr. Szklo), The Johns Hopkins Medical Institutions, Baltimore, MD.

Address correspondence and reprint requests to Dr. David Knopman, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

OBJECTIVE: To perform serial neuropsychological assessments to detect vascular risk factors for cognitive decline in the Atherosclerosis Risk in Communities cohort, a large biracial, multisite, longitudinal investigation of initially middle-aged individuals.

METHODS: The authors administered cognitive assessments to 10,963 individuals (8,729 white individuals and 2,234 black individuals) on two occasions separated by 6 years. Subjects ranged in age at the first assessment from 47 to 70 years. The cognitive assessments included the delayed word recall (DWR) test, a 10-word delayed free recall task in which the learning phase included sentence generation with the study words, the digit symbol subtest (DSS) of the Wechsler Adult Intelligence Scale–Revised and the first-letter word fluency (WF) test using letters F, A, and S.

RESULTS: In multivariate analyses (controlling for demographic factors), the presence of diabetes at baseline was associated with greater decline in scores on both the DSS and WF (p < 0.05), and the presence of hypertension at baseline was associated with greater decline on the DSS alone (p < 0.05). The association of diabetes with cognitive decline persisted when analysis was restricted to the 47- to 57-year-old subgroup. Smoking status, carotid intima–media wall thickness, and hyperlipidemia at baseline were not associated with change in cognitive test scores.

CONCLUSIONS: Hypertension and diabetes mellitus were positively associated with cognitive decline over 6 years in this late middle-aged population. Interventions aimed at hypertension or diabetes that begin before age 60 might lessen the burden of cognitive impairment in later life.




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