title: Subclinical atherosclerotic calcification and cognitive functioning in middle-aged adults: the CARDIA study.
abstract: OBJECTIVE
  Cardiovascular risk factors in middle-age are associated with cognitive impairment and dementia in older age. Less is known about the burden of calcified subclinical atherosclerosis and cognition, especially in midlife. We examined the association of coronary artery and abdominal aortic calcified plaque (CAC and AAC, respectively) with cognitive functioning in middle-aged adults.
  
  
  METHODS
  This cross-sectional study included 2510 black and white adults (age: 43-55 years) without heart disease or stroke who completed a year 25 follow-up exam (2010-11) as part of the Coronary Artery Risk Development in Young Adults Study. CAC and AAC were measured with non-contrast computed tomography. Cognition was assessed with the Digit Symbol Substitution Test (DSST) (psychomotor speed), Stroop Test (executive function), and Rey Auditory Verbal Learning Test (RAVLT) (verbal memory).
  
  
  RESULTS
  A greater amount of CAC and AAC was associated with worse performance on each test of cognitive function after adjustment for age, sex, race, education, and study center. Associations were attenuated, but remained significant for the DSST and RAVLT following additional adjustment for vascular risk factors, including adiposity, smoking, alcohol use, dyslipidemia, hypertension, and diabetes. Compared to participants without CAC or AAC, those with both CAC and AAC, but not CAC or AAC alone was associated with lower DSST scores (p < 0.05).
  
  
  CONCLUSIONS
  In this community-based sample, greater subclinical atherosclerotic calcification was associated with worse psychomotor speed and memory in midlife. These findings underscore the importance of a life course approach to the study of cognitive impairment with aging.
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA. Electronic address: reisjp@mail.nih.gov.
authors.forename: Jared P
authors.initials: JP
authors.lastname: Reis
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.forename: James G
authors.initials: JG
authors.lastname: Terry
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Loria
authors.forename: Adina
authors.initials: A
authors.lastname: Zeki Al Hazzouri
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Whitlow
authors.forename: Na
authors.initials: N
authors.lastname: Zhu
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
mesh_terms: D001012:Aorta, Abdominal / Q000473:pathology; D050197:Atherosclerosis / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: Atherosclerosis; Cognition; Risk factors; Subclinical disease