Can Cognitive Decline Be Predicted By Cardio Risk Scores?

In this study those with the highest cardiovascular risk scores experienced more rapid loss of episodic memory, working memory, and perceptual speed scores compared to those with the lowest cardiovascular risk scores. Those with the highest cardiovascular risk scores also had smaller hippocampus, gray matter, and total brain volumes and more white matter damage reports Weili Xu, PhD, of Tianjin Medical University of Tianjin, China, and colleagues.

"In the absence of effective treatments for dementia, we need to monitor and control cardiovascular risk burden as a way to maintain patient's cognitive health as they age," Xu said in a statement. "Given the progressive increase in the number of dementia cases worldwide, our findings have both clinical and public health relevance."

1,588 Rush Memory and Aging Project participants were involved in this study who were followed for up to 21 years. In the analysis the researchers compared the Framingham General Cardiovascular Risk Score with participant long term cognitive decline; higher FGCRS indicates a greater risk of future cardiovascular events. 

Participants were grouped by baseline cardiovascular risk scores: 28.6% were in the lowest tertile of 4-13 FGCRS, 29.9% in the middle 14-16, 41.6% were in the highest 17-28, and the mean baseline FGCRS was 15.6. Baseline mean age was 79.5 and they were dementia free, 78.5% were female, and MRI data was available for 328 of the participants. 

As compared to the lowest tertile those with the highest cardiovascular risk had faster declines in global cognition, episodic memory, working memory, and perceptual speed over a 5.8 month median follow up; stratified analysis showed these associations were present mainly in those who didn’t carry the APOE e4 allele. With MRI analysis the increased cardiovascular risk was linked to a smaller hippocampus, gray matter, total brain volumes, and a greater volume of white matter hyperintensities. 

"The results of this study suggest a useful tool for assessing dementia risk and support recommendations to aggressively manage cardiovascular risk factors in midlife," said Costantino Ladecola, MD, and Neal Parikh, MD, both of Weill Cornell Medicine in New York City in an accompanying editorial.

"In both continuous and categorical analyses of the FGCRS, effect sizes were small but consistent and statistically significant," Ladecola and Parikh observed. "Results stratified by APOE e4 status suggest that individuals without a strong genetic predisposition to Alzheimer's disease may be more susceptible to vascular risk factors," they added. "If confirmed, the latter finding may inform the design of future preventive studies."

The study was noted not to be free from limitations such as being made up of mostly older white women, and while the study was adjusted for a number of variables atrial fibrillation was not taken into account, and the risk factors that contributed most to cognitive impairment could not be identified in the analysis.