Correlation Between Cardiovascular Risk and Cognitive Decline

^{By: Yvette C. Terrie, Consultant Pharmacist/ Medical Writer}

The impact of cardiovascular (CV) risk burden on cognitive trajectories and brain structure changes remains uncertain. Results from a study published in the May 26 issue of the Journal of the American College of Cardiology indicates that there is a greater CV risk burden associated with cognitive decline and neurodegeneration. Song et al aimed to evaluate whether cardiovascular risk burden assessed by the Framingham General Cardiovascular Risk Score (FGCRS) is associated with cognitive decline and structural brain differences. A total of 1,588 dementia-free participants within the Rush Memory and Aging Project were followed for up to 21 years. FGCRS was assessed at baseline and classified into tertiles. In the study, episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed were assessed annually with a battery of 19 tests, from which composite scores were derived. A subsample (n = 378) of participants underwent magnetic resonance imaging. Structural total and regional brain volumes were estimated. Data were examined using linear mixed-effects models and linear regression models.

Song et al found that in all participants, FGCRS ranged from 4 to 28 (mean score: 15.6 ± 3.7). Compared with the lowest tertile of FGCRS, the highest tertile was associated with faster decline in global cognition (β = −0.019; 95% confidence interval [CI]: −0.035 to −0.003), episodic memory (β = −0.023; 95% CI: −0.041 to −0.004), working memory (β = −0.021; 95% CI: −0.035 to −0.007), and perceptual speed (β = −0.027; 95% CI: −0.042 to −0.011) over the follow-up. In magnetic resonance imaging data analyses, higher FGCRS was related to smaller volumes of the hippocampus (β = −0.021; 95% CI: −0.042 to −0.000), gray matter (β = −1.569; 95% CI: −2.757 to −0.382), and total brain (β = −1.588; 95% CI: −2.832 to −0.344), and greater volume of white matter hyperintensities (β = 0.035; 95% CI: 0.001 to 0.069). The researchers found that the highest tertile of FGCRS was linked with faster deterioration in global cognition, episodic memory, working memory, and perceptual speed during the follow-up period compared with the lowest tertile. In data analyses for a subsample of 378 participants who underwent magnetic resonance imaging, higher FGCRS was associated with smaller volumes of the hippocampus, gray matter, and total brain and greater volume of white matter hyperintensities.

They concluded that in this patient population-based cohort study of dementia-free older adults, there was a higher cardiovascular risk burden evaluated by FGCRS accelerates cognitive decline in episodic memory, working memory, and perceptual speed. Moreover, higher cardiovascular risk burden is associated with markers of neurodegeneration and vascular lesions in the brain. The findings emphasize the need to monitor and control cardiovascular burden to maintain cognitive health in late life.

In an accompanying editorial, the authors noted that, “Rigorous randomized studies of interventions to prevent dementia through treatment of individual cardiovascular risk factors are urgently needed. Until then, the results of this study suggest a useful tool for assessing dementia risk and support recommendations to aggressively manage cardiovascular risk factors in midlife.”

Yvette C. Terrie, R.Ph., Consultant Pharmacist and Medical Writer and creator of A Pharmacist’s Perspective (https://apharmacistsperspective.blogspot.com/).

References:

1. Song R, Xu H, Dintica CS, et al. Associations Between Cardiovascular Risk, Structural Brain Changes, and Cognitive Decline. J Am Coll Cardiol. 2020;75(20):2525‐2534. doi:10.1016/j.jacc.2020.03.053
2. Higher Burden of Cardiovascular Risk Associated with Cognitive Decline. Neurology Advisor website. https://www.neurologyadvisor.com/topics/neurocognitive-disorders/higher-burden-of-cardiovascular-risk-associated-with-cognitive-decline/  Published May 28, 2020. Accessed May 28, 2020.