Association of Vascular Risk Scores and Cognitive Performance in a Diverse Cohort: The Multi-Ethnic Study of Atherosclerosis

Abstract

Background Vascular risk scores are associated with incident dementia. Information regarding their association with cognitive performance and decline in racially/ethnically diverse cohorts is lacking. Methods In 4392 Multi-Ethnic Study of Atherosclerosis participants (aged 60.1±9.4 years; 53% women; 41% white, 11% Chinese-American, 26% African-American, 21% Hispanic), we compared associations of Exam 1 (2000-02) Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE), Framingham stroke (FSRP), and atherosclerotic disease pooled cohort equation (ASCVD-PCE) risk scores with Exam 5 (2010-12) Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span (DS) cognitive test performance using multivariable linear regression, and examined racial/ethnic interactions. In 1838 participants with repeat CASI data at Exam 6 (2016-18), we related risk scores to odds of a 1-standard deviation (SD) decline in CASI performance using multivariable logistic regression. Results SD increments in each risk score were associated with worse cognitive performance. CAIDE had stronger associations with CASI performance than the FSRP and ASCVD-PCE, but associations of ASCVD-PCE with the DSC and DS were similar to CAIDE (difference in β [95% CI] = -0.57 [-1.48, 0.34] and -0.21 [-0.43, 0.01], respectively). Race/ethnicity modified associations. For example, associations between CAIDE and CASI were greater in African-Americans and Hispanics than whites (difference in β = 0.69 [0.02, 1.36] and 1.67 [0.95, 2.39], respectively). Risk scores were comparably associated with decline in CASI performance. Conclusions Antecedent vascular risk scores are associated with cognitive performance and decline in the four most common US racial/ethnic groups, but associations differ among risk scores and by race/ethnicity.

Subclinical Vascular Composites Predict Clinical Cardiovascular Disease, Stroke, and Dementia: The Multi-Ethnic Study of Atherosclerosis (MESA)

“…These findings extend recent work from our group which showed that these same conventional clinical risk scores for CHD, stroke, and CAIDE were significantly associated with cross sectional cognitive performance, cognitive decline over 6 years, as well as, lower cortical thickness, greater white matter hyperintensity burden, and amyloid deposition on neuroimaging in this MESA cohort. 5,6 Taken together, this work suggests the potential research utility of including subclinical pathways of vascular risk in future work looking at the vascular contributions to cognitive impairment and dementia.…”

“…Standard vascular risk scores for each MESA participant were calculated using published equations including the Atherosclerotic Cardiovascular Disease -Pooled Cohort Equation (ASCVD-PCE), 9 Framingham Global CVD risk score (FRS), 10 Framingham 10year Stroke Risk Score (FRS-Stroke), 11 and Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) 12 drawn from questionnaire and clinical examination during the MESA Exam 1 visit as previously described. 5 Subclinical cardiovascular assessments at baseline included: carotid ultrasound for carotid plaque, adventitial diameter, and intima-media thickness; 13,14 coronary artery calcium score by cardiac computed tomography; 15 augmentation index, large and small artery elasticity, total vascular impedance, estimated cardiac output, stroke volume, and radial tonometry. 16 Cardiac MRI and brachial flow mediated dilation were only completed on a subset of participants at the baseline examination.…”

“…Cardiovascular risk summarizes important modifiable and non-modifiable risk factors for cardiovascular disease (CVD), which includes coronary heart disease (CHD) and stroke, that extend to the risk of dementia, and even dementia-related neuropathology. [1][2][3][4][5][6] Clinical CVD risk scores applied to dementia are generally summarized by combinations of conventional clinical CVD risk factors into risk scores, and may include education, physical inactivity, and apolipoprotein epsilon 4 (APOE-ε4) status. 7,8 These can include shared or divergent risk factors summarized together as clinical risk factor scores, polygenic risk scores, 1 and social determinants of health, 2 which may relate to the biomarkers and risk for dementia.…”

Expanding the scope of health disparities research in Alzheimer's disease and related dementias

“…Studies focused on identifying biological mechanisms that generate racial disparities have revealed that Black and White patients with dementia demonstrate different neuropathological changes, suggesting differences in the manifestations of the underlying pathophysiological processes 39,40 . Observational studies of diverse cohorts demonstrate important differences in vascular and metabolic risk factors for AD/ADRD and their treatment that may explain excess risk in both mortality and ADRD among Black and Hispanic older adults 41–44 . However, although biological and genetic factors are associated with higher AD/ADRD risk in certain racial groups, 2 social determinants of health account for more than half of the variance in health outcomes 45 …”

“…39,40 Observational studies of diverse cohorts demonstrate important dif-ferences in vascular and metabolic risk factors for AD/ADRD and their treatment that may explain excess risk in both mortality and ADRD among Black and Hispanic older adults. [41][42][43][44] However, although biological and genetic factors are associated with higher AD/ADRD risk in certain racial groups, 2 social determinants of health account for more than half of the variance in health outcomes. 45 Future studies of race/ethnicity-related disparities in AD/ADRD should focus on remedying the limitations described above.…”