Association of lung function with cognitive decline and dementia: the Atherosclerosis Risk in Communities (ARIC) Study.
BACKGROUND
Previous studies reported a higher risk of cognitive decline and dementia amongst individuals with impaired lung function. However, many did not adjust for important confounders or did not include women and non-whites.


METHODS
We studied 10,975 men and women aged 47-70 years (23% African-Americans) enrolled in the Atherosclerosis Risk in Communities Study. Pulmonary function tests and a cognitive assessment, including the Delayed Word Recall, the Digit Symbol Substitution, and the World Fluency Tests, were carried out in 1990-1992. Repeated cognitive assessments were performed in 1996-1998 for the entire cohort, and in 1993-1995, and 2004-2006 in 904 eligible individuals. Dementia hospitalization was ascertained through 2005.


RESULTS
In analysis adjusted for lifestyles, APOE genotype, and cardiovascular risk factors, impaired lung function was associated with worse cognitive function at baseline. No association was found between lung function and cognitive decline over time. Impaired lung function at baseline was associated with higher risk of dementia hospitalization during follow-up, particularly amongst younger individuals. The hazard ratios (95% confidence intervals) of dementia hospitalization were 1.6 (0.9, 2.8) and 2.1 (1.2, 3.7) comparing the lowest with the highest quartile of forced expiratory volume in 1 s and forced vital capacity, respectively. Presence of a restrictive ventilatory pattern, but not of an obstructive pattern, was associated with reduced cognitive scores and higher dementia risk.


CONCLUSIONS
Reduced lung function was associated with worse performance in cognitive assessments and with an increased risk of dementia hospitalization. Future research should determine whether maintaining optimal pulmonary health might prevent cognitive impairment and dementia.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
S S
SS
Pathan
R F
RF
Gottesman
T H
TH
Mosley
D S
DS
Knopman
A R
AR
Sharrett
A
A
Alonso
D001741:Black or African American; D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology* / Q000517:prevention & control; D003072:Cognition Disorders / Q000453:epidemiology* / Q000503:physiopathology* / Q000517:prevention & control; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012129:Respiratory Function Tests / Q000379:methods; D040242:Risk Reduction Behavior; D014797:Vital Capacity / Q000502:physiology
Am J Epidemiol. 1989 Apr;129(4):687-702
2646917
Am J Epidemiol. 2003 Dec 15;158(12):1171-81
14652302
Epidemiology. 2008 May;19(3):448-50
18414087
Respir Med. 2008 Sep;102(9):1349-54
18599282
Circulation. 2002 Nov 12;106(20):2555-60
12427651
Neurology. 2001 Jan 9;56(1):42-8
11148234
Am J Epidemiol. 2006 Aug 15;164(4):342-8
16760224
Am J Epidemiol. 1996 Apr 15;143(8):750-6
8610684
Gerontology. 1998;44(2):95-105
9523221
J Am Geriatr Soc. 2005 Jul;53(7):1101-7
16108925
Psychol Aging. 1995 Dec;10(4):578-89
8749585
Diabetes Care. 2005 Jun;28(6):1472-9
15920070
Alzheimer Dis Assoc Disord. 1999 Oct-Dec;13(4):216-21
10609670
Diabetes Care. 2010 Sep;33(9):1990-6
20519659
J Gerontol B Psychol Sci Soc Sci. 1998 Sep;53(5):P311-7
9750568
Am J Epidemiol. 2008 Sep 15;168(6):602-10
18687665
J Neuropsychiatry Clin Neurosci. 2002 Winter;14(1):80-3
11884660
Neurobiol Aging. 2007 Mar;28(3):343-50
16513221
Int J Cardiol. 1987 Oct;17(1):15-24
3666994
J Neurol Neurosurg Psychiatry. 2009 Nov;80(11):1194-201
19692426
Atherosclerosis. 2005 Jun;180(2):367-73
15910864
J Neurol Neurosurg Psychiatry. 2004 May;75(5):733-6
15090569
Neurology. 2007 Jan 30;68(5):326-37
17261678
Eur Respir J. 2010 Apr;35(4):913-22
20356988
Thorax. 2010 Jun;65(6):499-504
20522846
Ann Neurol. 2002 Aug;52(2):168-74
12210786
J Psychosom Res. 2004 Aug;57(2):183-8
15465074
Dement Geriatr Cogn Disord. 2009;28(5):433-41
19907180
Arch Neurol. 1989 Feb;46(2):141-5
2916953
J Neurol Sci. 2009 May 15;280(1-2):79-83
19251275
Comput Methods Programs Biomed. 2007 Nov;88(2):95-101
17850917
Am J Clin Nutr. 1982 Nov;36(5):936-42
7137077
Stroke. 2006 Jul;37(7):1658-62
16728692
Psychosom Med. 2005 Jul-Aug;67(4):602-8
16046374
Ann N Y Acad Sci. 2009 Oct;1177:169-77
19845619