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Carotid intimal medial thickness predicts cognitive decline among adults without clinical vascular disease.

ABSTRACT: BACKGROUND AND PURPOSE:Though clinical cardiovascular and cerebrovascular diseases are established risk factors for cognitive decline and dementia, less is known about the relations between vascular health and cognition among individuals without these diseases. Carotid intimal medial thickness (IMT), a measure of subclinical vascular disease, is associated with concurrent decrements in cognitive function, but relatively little research has examined longitudinal relations between carotid IMT and prospective cognitive decline. METHODS:We examined relations of carotid IMT to prospective trajectories of cognitive function among 538 (aged 20 to 93, 39% male, 66% white) participants in the Baltimore Longitudinal Study of Aging (BLSA) free of known cardiovascular, cerebrovascular, and neurological disease. Participants underwent initial carotid ultrasonography and repeat neuropsychological testing on up to 8 occasions over up to 11 years of follow-up. Mixed-effects regression analyses were adjusted for age, gender, race, education, mean arterial pressure, body mass index, total cholesterol, smoking, depressive symptoms, and cardiovascular medication use. RESULTS:Individuals with greater carotid IMT displayed accelerated decline in performance over time on multiple tests of verbal and nonverbal memory, as well as a test of semantic association fluency and executive function. CONCLUSIONS:Carotid IMT predicts accelerated cognitive decline, particularly in the domain of memory, among community-dwelling individuals free of vascular and neurological disease.

SUBMITTER: Wendell CR

PROVIDER: S-EPMC2753681 | biostudies-literature | 2009 Oct

REPOSITORIES: biostudies-literature

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Carotid intimal medial thickness predicts cognitive decline among adults without clinical vascular disease.

Wendell Carrington Rice CR Zonderman Alan B AB Metter E Jeffrey EJ Najjar Samer S SS Waldstein Shari R SR

Stroke 20090730 10

<h4>Background and purpose</h4>Though clinical cardiovascular and cerebrovascular diseases are established risk factors for cognitive decline and dementia, less is known about the relations between vascular health and cognition among individuals without these diseases. Carotid intimal medial thickness (IMT), a measure of subclinical vascular disease, is associated with concurrent decrements in cognitive function, but relatively little research has examined longitudinal relations between carotid ...[more]

PMID: 19644063

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Project description:Preclinical studies demonstrate that generalized endothelial cell dysfunction and microvascular impairment are potentially reversible causes of age-related vascular cognitive impairment and dementia (VCID). The present study was designed to test the hypothesis that severity of age-related macro- and microvascular dysfunction measured in the peripheral circulation is an independent predictor of cognitive performance in older adults. In this study, we enrolled 63 healthy individuals into young (< 45 years old) and aged (> 65 years old) groups. We used principal component analysis (PCA) to construct a comprehensive peripheral vascular health index (VHI) encompassing peripheral microvascular reactivity, arterial endothelial function, and vascular stiffness, as a marker of aging-induced generalized vascular dysfunction. Peripheral macrovascular and microvascular endothelial function were assessed using flow-mediated dilation (FMD) and laser speckle contrast imaging tests. Pulse waveform analysis was used to evaluate the augmentation index (AIx), a measure of arterial stiffness. Cognitive function was measured using a panel of CANTAB cognitive tests, and PCA was then applied to generate a cognitive impairment index (CII) for each participant. Aged subjects exhibited significantly impaired macrovascular endothelial function (FMD, 5.6 ± 0.7% vs. 8.3 ± 0.6% in young, p = 0.0061), increased arterial stiffness (AIx 29.3 ± 1.8% vs 4.5 ± 2.6% in young, p < 0.0001), and microvascular dysfunction (2.8 ± 0.2 vs 3.4 ± 0.1-fold change of perfusion in young, p = 0.032). VHI showed a significant negative correlation with age (r = - 0.54, p < 0.0001) and CII significantly correlated with age (r = 0.79, p < 0.0001). VHI significantly correlated with the CII (r = - 0.46, p = 0.0003). A decline in peripheral vascular health may reflect generalized vascular dysfunction and predict cognitive impairment in older adults.

Project description:ImportanceRetinal layer thickness is hypothesized to be related to cognitive function in patients with mild cognitive impairment (MCI) and Alzheimer disease (AD). However, longitudinal cohort studies of the healthy older population are scarce.ObjectiveTo investigate the association between retinal layer thickness and cognitive impairment and future cognitive decline in a community-based population cohort.Design, setting, and participantsA total of 430 randomly sampled community-dwelling Korean individuals 60 years or older participated in the baseline assessment (mean [SD], 76.3 [6.6] years) 215 of whom completed a mean (SD) of 5.4 (0.6) years (range, 4.1-6.2 years) of follow-up. Using spectral-domain optical coherence tomography, the study team assessed the thickness of 6 retinal layers in the macular region, the peripapillary retinal nerve fiber layers (RNFLs), and the subfoveal choroid at baseline.ExposuresAge, sex, education, diabetes, hypertension, and apolipoprotein E4 gene status.Main outcomes and measuresRetinal layer thickness and cognitive function test scores were analyzed.ResultsThis study included 430 participants (female, 208 [48.6%]). Baseline macular RNFL thickness was associated with baseline Consortium to Establish a Registry for Alzheimer's Disease (CERAD) score (coefficient [β] = 0.077; 95% CI, 0.054-0.100; P = .04 for total macular area) and Mini-Mental State Examination (MMSE) score (coefficient [β] = 0.082; 95% CI, 0.063-0.101; P = .03 for total macular area). A thinner baseline total macular RNFL thickness (lowest quartile, <231 μm) was associated with a larger decline in the CERAD and MMSE scores during the follow-up period (P = .003 and P = .01, respectively). Furthermore, participants with baseline total macular RNFL thickness below the lowest quartile cutoff value presented a greater decline in cognitive scores and a higher prevalence of cognitive impairment and Alzheimer disease than those with RNFL thickness above the lowest quartile cutoff value.Conclusions and relevanceIn this study, macular RNFL thickness could be used as a prognostic biomarker of long-term cognitive decline in adults 60 years or older. However, to confirm these results, further large-scale population-based studies should be performed.

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Carotid intimal medial thickness predicts cognitive decline among adults without clinical vascular disease.

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Carotid intimal medial thickness predicts cognitive decline among adults without clinical vascular disease.

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