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Stroke risk factors and loss of high cognitive function

From the University of California (Drs. Elkins and Johnston), San Francisco; University of Washington (Drs. O’Meara and Longstreth), Seattle; and Johns Hopkins Bloomberg School of Public Health (Dr. Carlson), Baltimore, and National Heart, Lung, and Blood Institute (Dr. Manolio), Bethesda, MD.

Address correspondence and reprint requests to Dr. S.C. Johnston, Department of Neurology, Box 0114, University of California, San Francisco, 505 Parnassus Ave., M-798, San Francisco, CA 94143-0114; e-mail: Clay.Johnston{at}ucsfmedctr.org

Background: Modifiable stroke risk factors may contribute to age-associated declines in cognitive function. Individuals with high levels of cognitive function after midlife may have less exposure to these stroke risk factors or may be less susceptible to their effects on cognition.

Methods: The Cardiovascular Health Study (CHS)* is a population-based, longitudinal cohort study of 5,888 people age 65 years and older. Participants (n = 4,129) who were free of dementia, stroke, or TIA at the time of baseline cranial MRI were selected for analysis. High cognitive function at baseline was defined by performance at or above midlife norms on the Modified Mini-Mental State Examination (3MS).

Results: The odds of having high cognitive function at baseline decreased by quartile of stroke risk (highest vs lowest risk quartile, adjusted odds ratio [OR] 0.68; 95% CI 0.52 to 0.88; p for trend = 0.005). Stroke risk was a predictor of decline on the 3MS in those with typical levels of cognitive function at baseline, even in the absence of incident stroke or TIA (highest vs lowest risk quartile for 3MS decline, adjusted OR 2.11; 95% CI 1.42 to 3.13; p for trend < 0.001). In contrast, stroke risk was not associated with decline on the 3MS in those with high cognitive function at baseline (p = 0.03 for interaction).

Conclusions: In a cohort of older adults without stroke, TIA, or dementia, cognitive function and incident cognitive decline were associated with risk for stroke. Additional studies are needed to determine whether modification of stroke risk factors can reduce the cognitive decline that is often attributed to normal aging.

Received February 13, 2004. Accepted in final form May 12, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 14 issue to find the title link for this article.

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