Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: The ARIC MRI Study
ABSTRACT Strokes, vascular risk factors, and apolipoprotein E (APOE) genotype are associated with cognitive decline in the elderly, but definitive evidence that these affect cognition as early as middle age is limited.
We describe the relationships of APOE genotype, stroke, and vascular risk factors with cognitive change over a 14-year follow-up in the Atherosclerosis Risk in Communities (ARIC) Study cohort recruited while in middle age.
Participants included a subset of the ARIC Study who underwent assessments of cognitive function and vascular risk factors. Four cognitive assessments were performed between 1990-1992 and 2004-2006. Cognitive assessments included the Delayed Word Recall (DWR) Test, the Digit Symbol Substitution (DSS) Test, and the Word Fluency (WF) Test. Vascular risk factors were assessed during the baseline visit in 1990-1992. Incident stroke was recorded over the 14 years of follow-up.
There were 1130 participants (mean age, 59 +/- 4.3 [SD] years; 62% women; 52% African-American) with longitudinal data. In multivariate, random-effects linear models adjusted for age, education, gender, and race, the risk factors diabetes and APOE epsilon4 genotype were independently associated with a decline in performance on the DSS test (both P < .005), whereas hypertension and stroke were not. For DWR, stroke and APOE epsilon4 genotype were independent predictors of decline (both P < .001). For the WF test, metabolic syndrome, hypertension, and stroke were independently associated with decline (all P < .005). No evidence of differential effects of risk factors on cognitive decline by race, gender, or interactions between risk factors was found.
The vascular risk factors diabetes and hypertension, a history of stroke itself, and APOE epsilon4 genotype independently contribute to cognitive decline in late middle age and early elderly years.
Journal of the American Geriatrics Society 04/2015; DOI:10.1111/jgs.13358/abstract · 4.22 Impact Factor
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ABSTRACT: To determine whether hospitalization is associated with subsequent cognitive decline or changes on brain MRI in a community-based cohort. Baseline and follow-up cognitive testing (n = 2,386) and MRI scans with standardized assessments (n = 885) were available from a subset of white and black participants in the Atherosclerosis Risk in Communities study. Cognitive tests included the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Hospitalization characteristics were determined using ICD-9 codes. Regression models adjusted for demographics, education, comorbidities, and APOE ε4 were used to estimate the independent association of hospitalization with changes in cognition or neuroimaging. Over a mean 14.1 years between visits, 1,266 participants (53.1%) were hospitalized. Hospitalization compared with no hospitalization was associated with greater decline in DSST scores (1.25 points greater decline, p < 0.001) but no difference in DWRT or WFT score change. Each additional hospitalization, as well as a critical illness vs noncritical illness hospitalization, was associated with greater decline in DSST scores. A subset of participants (n = 885) underwent MRI scans separated by 10.5 years. Hospitalization (n = 392) compared with no hospitalization was associated with a 57% higher odds of increasing ventricular size at follow-up. Each additional hospitalization, as well as having a critical illness vs noncritical illness hospitalization, and having a hospitalization with major surgery vs no surgery was associated with greater odds of increased ventricular size. Cognitive decline and neuroimaging changes may occur after hospitalization, independent of baseline demographics and comorbidities. © 2015 American Academy of Neurology.Neurology 03/2015; DOI:10.1212/WNL.0000000000001439 · 8.30 Impact Factor
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ABSTRACT: To determine, using data from the Newcastle 85+ Study, whether there is an association between modern diagnostic criteria for metabolic syndrome (MetS) and cognitive function in very old adults (≥85) and whether inflammation, physical activity, or diabetes mellitus status affects this association. Longitudinal, population-based cohort study. Newcastle and North Tyneside, United Kingdom. Community-dwelling and institutionalized men and women recruited through general practices (N = 845). MetS was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria. Cross-sectional and prospective (up to 5 years of follow-up) associations between MetS and global cognitive function (assessed using the Mini-Mental State Examination (MMSE)) and between MetS and attention and episodic memory (assessed using the Cognitive Drug Research battery) were performed. MetS was not associated with cognitive function at baseline or cognitive change over time. Lack of association was not because MetS was predictive of subsequent mortality. Of the individual components of the MetS criteria, high blood pressure was associated with better cognitive function at baseline (MMSE: β (standard error (SE)) = -0.716 (0.152), P < .001), and low high-density lipoprotein cholesterol was associated with poorer global cognitive function at baseline (MMSE: 0.436 (0.131), P = .001). The association between MetS and cognitive decline, which has been described in younger populations (<75), was not apparent in this population of individuals aged 85 and older at baseline. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.Journal of the American Geriatrics Society 04/2015; 63(4). DOI:10.1111/jgs.13358 · 4.22 Impact Factor