title: Coronary artery disease is associated with cognitive decline independent of changes on magnetic resonance imaging in cognitively normal elderly adults.
abstract: OBJECTIVE
  To examine in cognitively normal elderly adults whether vascular factors predict cognitive decline and whether these associations are mediated by magnetic resonance imaging (MRI) measures of subclinical vascular brain injury.
  
  
  METHODS
  Prospective multisite longitudinal study of subcortical ischemic vascular diseases.
  
  
  METHODS
  Memory and aging centers in California.
  
  
  METHODS
  Seventy-four participants who were cognitively normal at entry and underwent at least two neuropsychological evaluations and two MRI examinations over an average follow-up of 6.9 years.
  
  
  METHODS
  Item response theory was used to create composite scores of global, verbal memory, and executive functioning. Volumetric MRI measures included white matter hyperintensities (WMHs), silent brain infarcts (SBIs), hippocampus, and cortical gray matter (CGM). Linear mixed-effects models were used to examine the associations between vascular factors, MRI measures, and cognitive scores.
  
  
  RESULTS
  History of coronary artery disease (CAD) was associated with greater declines in global cognition, verbal memory, and executive function. The CAD associations remained after controlling for changes in WMHs, SBIs, and hippocampal and CGM volumes.
  
  
  CONCLUSIONS
  History of CAD may be a surrogate marker for clinically significant atherosclerosis, which also affects the brain. Structural MRI measures of WMHs and SBIs do not fully capture the potential adverse effects of atherosclerosis on the brain. Future longitudinal studies of cognition should incorporate direct measures of atherosclerosis in cerebral arteries, as well as more sensitive neuroimaging measures.
authors.affiliation: Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. lzheng@usc.edu
authors.forename: Ling
authors.initials: L
authors.lastname: Zheng
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Mack
authors.forename: Helena C
authors.initials: HC
authors.lastname: Chui
authors.forename: Lara
authors.initials: L
authors.lastname: Heflin
authors.forename: Dan
authors.initials: D
authors.lastname: Mungas
authors.forename: Bruce
authors.initials: B
authors.lastname: Reed
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.forename: Michael W
authors.initials: MW
authors.lastname: Weiner
authors.forename: Joel H
authors.initials: JH
authors.lastname: Kramer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003072:Cognition Disorders / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies