Vascular risk factors and cognitive impairment in a stroke-free cohort
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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REFERENCES
1.
Ong KL, Cheung BMY, Man YB, Lau CP, Lam KSL. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 2007;49:69–75.
2.
National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
3.
Van Dijk EJ, Prins ND, Vrooman HA, Hofman A, Koudstaal PJ, Breteler MMB. Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences: Rotterdam Scan Study. Stroke 2008;39:2712–2719.
4.
Knopman DS, Mosley TH, Catellier DJ, Coker LH, Atherosclerosis Risk Communities Study. Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study. Alzheimers Dement 2009;5:207–214.
5.
Barnes DE, Alexopoulos GS, Lopez OL, Williamson JD, Yaffe K. Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Arch Gen Psychiatry 2006;63:273–280.
6.
Kivipelto M, Helkala EL, Hanninen T, et al. Midlife vascular risk factors and late-life mild cognitive impairment: a population-based study. Neurology 2001;56:1683–1689.
7.
Reitz C, Tang MX, Manly J, Mayeux R, Luchsinger JA. Hypertension and the risk of mild cognitive impairment. Arch Neurol 2007;64:1734–1740.
8.
Kuller LH, Lopez OL, Newman A, et al. Risk factors for dementia in the cardiovascular health cognition study. Neuroepidemiology 2003;22:13–22.
9.
Launer LJ, Ross GW, Petrovitch H, et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000;21:49–55.
10.
Schrijvers EMC, Witteman JCM, Sijbrands EJG, Hofman A, Koudstaal PJ, Breteler MMB. Insulin metabolism and the risk of Alzheimer disease: The Rotterdam Study. Neurology 2010;75:1982–1987.
11.
D'Agostino RB, Wolf PA, Belanger AJ, Kannel WB. Stroke risk profile: adjustment for antihypertensive medication: The Framingham Study. Stroke 1994;25:40–43.
12.
Wolf PA, D'Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke 1991;22:312–318.
13.
Llewellyn DJ, Lang IA, Xie J, Huppert FA, Melzer D, Langa KM. Framingham stroke risk profile and poor cognitive function: a population-based study. BMC Neurol 2008;8:1–8.
14.
Elias MF, Sullivan LM, D'Agostino RB, et al. Framingham stroke risk profile and lowered cognitive performance. Stroke 2004;35:404–409.
15.
Howard VJ, Cushman M, Pulley L, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology 2005;25:135–143.
16.
Howard VJ, Woolson RF, Egan BM, et al. Prevalence of hypertension by duration and age at exposure to the stroke belt. J Am Soc Hypertens 2010;4:32–41.
17.
Meschia JF, Brott TG, Chukwudelunzu FE, et al. Verifying the stroke-free phenotype by structured telephone interview. Stroke 2000;31:1076–1080.
18.
Callahan CM, Unverzagt FW, Hui SL, Perkins A, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care 2002;40:771–781.
19.
Wilber ST, Lofgren SD, Mager TG, Blanda M, Gerson LW. An evaluation of two screening tools for cognitive impairment in older emergency department patients. Acad Emerg Med 2005;12:612–616.
20.
Steffens DC, Snowden M, Fan MY, Hendrie H, Katon WJ, Unutzer J. Cognitive impairment and depression outcomes in the IMPACT study. Am J Geriatr Psychiatry 2006;14:401–409.
21.
Wadley VG, McClure LA, Howard VJ, et al. Cognitive status, stroke symptom reports, and modifiable risk factors among individuals with no diagnosis of stroke or transient ischemic attack in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke 2007;38:1143–1147.
22.
Tsivgoulis G, Alexandrov AV, Wadley VG, et al. Association of higher diastolic blood pressure levels with cognitive impairment. Neurology 2009;73:589–595.
23.
Pullicino PM, Wadley VG, McClure LA, et al. Factors contributing to global cognitive impairment in heart failure: results from a population-based cohort. J Card Fail 2008;14:290–295.
24.
Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis 2008;52:227–234.
25.
Melchior LA, Huba GJ, Brown VB, Reback CJ. A short depression index for women. Educ Psychol Meas 1993;53:1117–1125.
26.
Soliman EZ, Howard G, Prineas RJ, McClure LA, Howard VJ. Calculating Cornell voltage from nonstandard chest electrode recording site in the Reasons for Geographic and Racial Differences in Stroke study. J Electrocardiol 2010;43:209–214.
27.
Vasan RS, Levy D. The role of hypertension in the pathogenesis of heart failure: a clinical mechanistic overview. Arch Intern Med 1996;156:1789–1796.
28.
Brady CB, Spiro A, Glinchey-Berroth R, Milberg W, Gaziano JM. Stroke risk predicts verbal fluency decline in healthy older men: evidence from the Normative Aging Study. J Gerontol Ser B Psychol Sci Soc Sci 2001;56:340–346.
29.
Elias MF, Sullivan LM, Elias PK, et al. Left ventricular mass, blood pressure, and lowered cognitive performance in the Framingham Offspring. Hypertension 2007;49:439–445.
30.
Elias PK, Elias MF, Robbins MA, Budge MM. Blood pressure-related cognitive decline: does age make a difference? Hypertension 2004;44:631–636.
31.
Knopman D, Boland LL, Mosley T, et al. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 2001;56:42–48.
32.
Crowe M, Sartori A, Clay OJ, et al. Diabetes and cognitive decline: Investigating the potential influence of factors related to health disparities. J Aging Health 2010;22:292–306.
33.
Arvanitakis Z, Wilson RS, Bienias JL, Evans DA, Bennett DA. Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Arch Neurol 2004;61:661–666.
34.
Luchsinger JA, Reitz C, Patel B, Tang MX, Manly JJ, Mayeux R. Relation of diabetes to mild cognitive impairment. Arch Neurol 2007;64:570–575.
35.
Tervo S, Kivipelto M, Hanninen T, et al. Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects. Dement Geriatr Cogn Disord 2004;17:196–203.
36.
Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes : systematic overview of prospective observational studies. Diabetologia 2005;48:2460–2469.
37.
Das RR, Seshadri S, Beiser AS, et al. Prevalence and correlates of silent cerebral infarcts in the Framingham Offspring Study. Stroke 2008;39:2929–2935.
38.
Seshadri S, Wolf PA, Beiser A, et al. Stroke risk profile, brain volume, and cognitive function: The Framingham Offspring Study. Neurology 2004;63:1591–1599.
39.
Euser SM, Schram MT, Hofman A, Westendorp RGJ, Breteler MMB. Measuring cognitive function with age: the influence of selection by health and survival. Epidemiology 2008;19:440–447.
40.
Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 1992;40:922–935.
Information & Authors
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Copyright © 2011 by AAN Enterprises, Inc.
Publication History
Received: March 11, 2011
Accepted: August 2, 2011
Published online: November 7, 2011
Published in print: November 8, 2011
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
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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