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Abstract

Objective:

To examine vascular risk factors, as measured by the Framingham Stroke Risk Profile (FSRP), to predict incident cognitive impairment in a large, national sample of black and white adults age 45 years and older.

Methods:

Participants included subjects without stroke at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with at least 2 cognitive function assessments during the follow-up (n = 23,752). Incident cognitive impairment was defined as decline from a baseline score of 5 or 6 (of possible 6 points) to the most recent follow-up score of 4 or less on the Six-item Screener (SIS). Subjects with suspected stroke during follow-up were censored.

Results:

During a mean follow-up of 4.1 years, 1,907 participants met criteria for incident cognitive impairment. Baseline FSRP score was associated with incident cognitive impairment. An adjusted model revealed that male sex (odds ratio [OR] = 1.59, 95% confidence interval [CI] 1.43–1.77), black race (OR = 2.09, 95% CI 1.88–2.35), less education (less than high school graduate vs college graduate, OR = 2.21, 95% CI 1.88–2.60), older age (10-year increments, OR = 2.11, per 10-year increase in age, 95% CI 2.05–2.18), and presence of left ventricular hypertrophy (LVH, OR = 1.29, 95% CI 1.06–1.58) were related to development of cognitive impairment. When LVH was excluded from the model, elevated systolic blood pressure was related to incident cognitive impairment.

Conclusions:

Total FSRP score, elevated blood pressure, and LVH predict development of clinically significant cognitive dysfunction. Prevention and treatment of high blood pressure may be effective in preserving cognitive health.

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Information & Authors

Information

Published In

Neurology®
Volume 77Number 19November 8, 2011
Pages: 1729-1736
PubMed: 22067959

Publication History

Received: March 11, 2011
Accepted: August 2, 2011
Published online: November 7, 2011
Published in print: November 8, 2011

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Disclosure

Dr. Unverzagt has served as a consultant to Eli Lilly and Company; serves on the editorial boards of the Journal of the International Neuropsychological Association and Neuropsychology; receives research support from the NIH and Posit Science Inc; and holds stock in Eli Lilly and Company. Dr. McClure serves on a Data Monitoring Committee for the NIH/NINDS and receives research support from Genzyme Corporation, the NIH (NINDS, NICHD, NHLBI), and NASA. Dr. Wadley has received funding for travel from Amgen; serves on the editorial board of Current Gerontology and Geriatrics Research; and receives research support from Genzyme Corporation, the NIH, and the Jefferson County Office of Senior Citizens Services. Dr. Jenny serves on the editorial board of Arteriosclerosis, Thrombosis and Vascular Biology; serves as a consultant for Tethys Bioscience, Inc.; receives research support from GlaxoSmithKline, the NIH, and the American Diabetic Association; and holds stock in Haematologic Technologies, Inc. Dr. Go receives research support from the NIH/NINDS. Dr. Cushman serves on the editorial boards of the Journal of Thrombosis and Haemostasis, Circulation, Archives of Internal Medicine, and the Journal of Thrombosis and Thrombolysis; and receives/has received research support from Amgen, GlaxoSmithKline, and the NIH. Dr. Kissela serves on scientific advisory boards for Northstar Neuroscience and Allergan, Inc.; has received funding for travel and speaker honoraria from Allergan, Inc.; has received research support from NexStim and the NIH; and provides medico-legal reviews. Dr. Kelley receives/has received research support from Novartis and the NIH. Dr. Kennedy receives research support from the NIH (NINDS, NIA, NIDDK). Dr. Moy reports no disclosures. Dr. V. Howard serves/has served on scientific advisory boards for Amgen, Boehringer-Ingelheim, Mitsubishi, PhotoThera, and MediciNova; her spouse serves on a scientific advisory boards for Bayer Schering Pharma; has received funding for travel from Amgen; serves as a consultant for NIH review committees; her spouse has provided legal consulting for Merck Serono; and receives research support from the NIH (NINDS, NIDDK, NIOSH). Dr. G. Howard serves/has served on scientific advisory boards for Bayer Schering Pharma, Abbott, Boehringer Ingelheim, BrainsGate, Cerevast Therapeutics, Inc., CoAxia, Inc., MediciNova, Inc., Mitsubishi Tanabe Pharma Corporation, and PhotoThera; serves as Stroke Section Editor for the Journal of The American Society of Hypertension; and receives research support from Amgen and the NIH (NINDS, NIAMS, NICHD, NHLBI).

Authors

Affiliations & Disclosures

F.W. Unverzagt, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
L.A. McClure, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
V.G. Wadley, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
N.S. Jenny, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
R.C. Go, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
M. Cushman, MD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
B.M. Kissela, MD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
B.J. Kelley, MD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
R. Kennedy, MD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
C.S. Moy, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
V. Howard, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
G. Howard, PhD
From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.

Notes

Address correspondence and reprint requests to Dr. Frederick W. Unverzagt, Department of Psychiatry, Indiana University School of Medicine, 1111 W. 10th Street, Suite PB 218A, Indianapolis, IN 46202 [email protected]
Study funding: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data.

Author Contributions

Dr. Unverzagt: drafting/revising the manuscript for content, including medical writing for content, analysis or interpretation of data. Dr. McClure: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis, obtaining funding. Dr. Wadley: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, obtaining funding. Dr. Jenny: drafting/revising the manuscript for content, including medical writing for content. Dr. Go: drafting/revising the manuscript for content, including medical writing for content. Dr. Cushman: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, obtaining funding. Dr. Kissela: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, obtaining funding. Dr. Kelley: drafting/revising the manuscript for content, including medical writing for content. Dr. Kennedy: drafting/revising the manuscript for content, including medical writing for content, analysis or interpretation of data. Dr. Moy: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, obtaining funding. Dr. V. Howard: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, acquisition of data, study supervision or coordination, obtaining funding. Dr. G. Howard: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, acquisition of data, statistical analysis, study supervision or coordination, obtaining funding.

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