Associations Between Cardiovascular Risk, Structural Brain Changes, and Cognitive Decline

Song, Ruixue; Xu, Hui; Dintica, Christina S.; Pan, Kuan‐Yu; Qi, Xiaojuan; Buchman, Aron S.; Bennett, David A.; Xu, Weili

doi:10.1016/j.jacc.2020.03.053

Cited by 119 publications

(103 citation statements)

References 51 publications

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“…Finally, CVRFs seemed to explain a larger part of the sex difference in information processing speed than of episodic memory, suggesting that CVRFs have a larger influence on information processing speed [ 61, 62 ]. An explanation may be that impaired memory function likely results from damage to a specific brain area, the hippocampus, while impaired information processing speed likely results from damage to the more widespread white matter tracts covering various brain areas, and CVRFs appear to affect the brain more generally than a single area [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

Do Cardiovascular Risk Factors and Cardiovascular Disease Explain Sex Differences in Cognitive Functioning in Old Age?

Zutphen

Rijnhart

Rhebergen

et al. 2021

JAD

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Background: Sex differences in cognitive functioning in old age are known to exist yet are still poorly understood. Objective: This study examines to what extent differences in cardiovascular risk factors and cardiovascular disease between men and women explain sex differences in cognitive functioning. Methods: Data from 2,724 older adults from the Longitudinal Aging Study Amsterdam were used. Information processing speed and episodic memory, measured three times during six years of follow-up, served as outcomes. The mediating role of cardiovascular risk factors and cardiovascular disease was examined in single and multiple mediator models. Determinant-mediator effects were estimated using linear or logistic regression, and determinant-outcome and mediator-outcome effects were estimated using linear mixed models. Indirect effects were estimated using the product-of-coefficients estimator. Results: Women scored 1.58 points higher on information processing speed and 1.53 points higher on episodic memory. Several cardiovascular risk factors had small mediating effects. The sex difference in information processing speed was mediated by smoking, depressive symptoms, obesity, and systolic blood pressure. The sex difference in episodic memory was mediated by smoking, physical activity, and depressive symptoms. Effects of smoking, LDL cholesterol, and diabetes mellitus on information processing speed differed between men and women. Conclusion: Differences in cardiovascular risk factors between women and men partially explained why women had better cognitive functioning. A healthy cardiovascular lifestyle seems beneficial for cognition and sex-specific strategies may be important to preserve cognitive functioning at older age.

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Section: Discussionmentioning

confidence: 99%

Do Cardiovascular Risk Factors and Cardiovascular Disease Explain Sex Differences in Cognitive Functioning in Old Age?

Zutphen

Rijnhart

Rhebergen

et al. 2021

JAD

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“…Previous studies have shown that CVD risk estimation based on multivariable risk assessment is a useful tool to predict not only a CVD event but also cognitive decline ( Samieri et al, 2018 ; Song et al, 2020 ). Samieri et al (2018) showed that baseline cardiovascular health levels, estimated according to the American Heart Association’s Life’s Simple seven metrics (smoking, body mass index, physical activity, diet, total cholesterol, fasting glucose, and blood pressure), predicted rates of cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding potential mechanisms, exposure to CVD risk factors might accelerate cognitive decline due to cerebral hypoperfusion, hypoxia, emboli, or infarcts, which lead to vascular and degenerative brain lesions ( Qiu and Fratiglioni, 2015 ; Cohen, 2016 ). The point here is that CVD risk factors are correlated with each other, making it difficult to isolate their individual effects on cognitive decline remains challenging ( Song et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…Over the past decades, several CVD risk estimation tools involving multivariable risk factors have been developed to establish accurate estimation models for an individual’s absolute risk of a CVD event ( Conroy et al, 2003 ; Hippisley-Cox et al, 2007 ; D’Agostino et al, 2008 ). Previous large-scale cohort studies have shown that some CVD risk estimation tools have been useful in predicting not only a CVD event but also cognitive decline ( Samieri et al, 2018 ; Song et al, 2020 ) and dementia (both all-cause dementia and AD) ( Viticchi et al, 2017 ; Fayosse et al, 2020 ). Therefore, absolute CVD risk, estimated using multivariable risk factors, may be a useful surrogate marker of cognitive decline.…”

Section: Introductionmentioning

confidence: 99%

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Absolute Cardiovascular Disease Risk Is Associated With the Incidence of Non-amnestic Cognitive Impairment in Japanese Older Adults

Makino

Lee

Bae

et al. 2021

Front. Aging Neurosci.

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BackgroundThe estimated absolute cardiovascular disease (CVD) risk level is known to be a useful surrogate marker for future cognitive impairment; however, evidence regarding its predictive validity in terms of cognitive subtypes is limited. We aimed to examine subtype-dependent differences in the associations between absolute CVD risk and the incidence of cognitive impairment in a community-dwelling older Japanese cohort.Methods and ResultsThis study comprised 1,641 cognitively intact older Japanese participants without CVDs at baseline. We estimated absolute CVD risk using WHO region-specific risk estimation charts and included age, sex, diabetes mellitus, smoking, systolic blood pressure, and total cholesterol at baseline, and the CVD risk level was stratified into the three following risk categories: low (<10%), moderate (10 to <20%), and high (≥20%). Objective cognitive screening was performed using a multicomponent neurocognitive test at baseline and follow-up, and the incidence of cognitive impairment over 48 ± 2 months was determined. The incidence of cognitive impairment in low-, moderate-, and high-CVD risk participants was 1.2, 3.0, and 5.4%, respectively, for amnestic subtypes and 5.8, 10.1, and 14.0%, respectively, for non-amnestic subtypes. After adjusting for potential confounding factors, the absolute CVD risk level was significantly associated with non-amnestic impairment but not with amnestic impairment.ConclusionsThe absolute CVD risk estimated using region-specific risk estimation charts in old age is useful to predict incidence of cognitive impairment. Strategies to screen populations at risk of cognitive impairment and to prevent progression to dementia should be cognitive subtype-specific.

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“…Goals are based around the participants current diet and PA levels (which they can monitor online during the study) and food and PA preferences, in order to strengthen motivation and improve behaviour change. [38][39][40][41] Given the evidence that cardiovascular risk factors are associated with greater cognitive decline and predict future risk of Alzheimer's disease and other forms of dementia, [42][43][44] and the fact that both a MedDiet and PA positively influence CVD phenotype, we recruited individuals at higher CVD risk.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Feasibility and acceptability of a multi-domain intervention to increase Mediterranean diet adherence and physical activity in older UK adults at risk of dementia: protocol for the MedEx-UK randomised controlled trial

et al. 2021

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IntroductionDementia prevalence continues to increase, and effective interventions are needed to prevent, delay or slow its progression. Higher adherence to the Mediterranean diet (MedDiet) and increased physical activity (PA) have been proposed as strategies to facilitate healthy brain ageing and reduce dementia risk. However, to date, there have been no dementia prevention trials in the UK focussed on combined dietary and PA interventions. This study aims to: (1) assess feasibility and acceptability of a theory-underpinned digital and group-based intervention for dementia risk reduction in an ‘at risk’ UK cohort; (2) evaluate behaviour change responses to the intervention; and, (3) provide information on cognitive, neurological, vascular and physiological outcomes to inform the design of a follow-on, full-scale efficacy trial.MethodsOne hundred and eight participants aged 55 to 74 years with a QRISK2 score of ≥10% will be recruited to take part in this 24-week multi-site study. Participants will be randomised into three parallel arms: (1) Control; (2) MedDiet; and, (3) MedDiet+PA. The study will evaluate a personalised website, group session and food delivery intervention to increase MedDiet adherence and PA in older adults at risk of dementia. Diet and PA will be monitored prior to, during and following the intervention. Feasibility, acceptability and hypothesised mediators will be assessed in addition to measures of cognitive function, brain structure/perfusion (MRI), vascular function and metabolic markers (blood, urine and faecal) prior to, and following, the intervention.DiscussionThis trial will provide insights into the feasibility, acceptability and mechanism of effect of a multi-domain intervention focussed on the MedDiet alone and PA for dementia risk reduction in an ‘at risk’ UK cohort.Ethics and disseminationThe study has received NHS REC and HRA approval (18/NI/0191). Findings will be disseminated via conference presentations, public lectures, and peer-reviewed publications.Trial registration detailsClinicalTrials.gov NCT03673722.

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Associations Between Cardiovascular Risk, Structural Brain Changes, and Cognitive Decline

Cited by 119 publications

References 51 publications

Do Cardiovascular Risk Factors and Cardiovascular Disease Explain Sex Differences in Cognitive Functioning in Old Age?

Do Cardiovascular Risk Factors and Cardiovascular Disease Explain Sex Differences in Cognitive Functioning in Old Age?

Absolute Cardiovascular Disease Risk Is Associated With the Incidence of Non-amnestic Cognitive Impairment in Japanese Older Adults

Feasibility and acceptability of a multi-domain intervention to increase Mediterranean diet adherence and physical activity in older UK adults at risk of dementia: protocol for the MedEx-UK randomised controlled trial

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