title: The KEEPS-Cognitive and Affective Study: baseline associations between vascular risk factors and cognition.
abstract: Midlife vascular risk factors influence later cognitive decline and Alzheimer's disease (AD). The decrease in serum estradiol levels during menopause has been associated with cognitive impairment and increased vascular risk, such as high blood pressure (BP), which independently contributes to cognitive dysfunction and AD. We describe the extent to which vascular risk factors relate to cognition in healthy, middle-aged, recently postmenopausal women enrolled in the Kronos Early Estrogen Prevention Cognitive and Affective Study (KEEPS-Cog) at baseline. KEEPS-Cog is a double-blind, randomized, placebo-controlled, parallel group, clinical trial, investigating the efficacy of low-dose, transdermal 17β-estradiol and oral conjugated equine estrogen on cognition. All results are cross-sectional and represent baseline data only. Analyses confirm that the KEEPS-Cog cohort (n = 571) was middle aged (mean 52.7 years, range 42-59 years), healthy, and free of cognitive dysfunction. Higher systolic BP was weakly related to poorer performance in auditory working memory and attention (p = 0.004; adjusted for multiple comparisons p = 0.10). This relationship was not associated with endogenous hormone levels, and systolic BP was not related to any other cognitive domain. BP levels may be more sensitive than other vascular risk factors in detecting subtle differences in cognitive task performance in healthy, recently menopausal women. Lower BP early in menopause may affect cognitive domains known to be associated with AD.
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Emory Alzheimer's Disease Research Center, (ADRC) Atlanta, GA, USA.
authors.forename: Whitney
authors.initials: W
authors.lastname: Wharton
authors.affiliation: Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA.
authors.forename: Carey E
authors.initials: CE
authors.lastname: Gleason
authors.affiliation: Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA University of Wisconsin, Department of Biostatistics and Medical Informatics, Madison, WI, USA.
authors.forename: N Maritza
authors.initials: NM
authors.lastname: Dowling
authors.affiliation: Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Carlsson
authors.affiliation: Cardiovascular Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Eliot A
authors.initials: EA
authors.lastname: Brinton
authors.affiliation: Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: M Nanette
authors.initials: MN
authors.lastname: Santoro
authors.affiliation: Obstetrics & Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Neal-Perry
authors.affiliation: Obstetrics & Gynecology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Hugh
authors.initials: H
authors.lastname: Taylor
authors.affiliation: Obstetrics & Gynecology, New York University, New York, NY, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Naftolin
authors.affiliation: Obstetrics & Gynecology, Columbia University School of Medicine, New York, NY, USA.
authors.forename: Rogerio A
authors.initials: RA
authors.lastname: Lobo
authors.affiliation: VA Puget Sound Health Care System and Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Merriam
authors.affiliation: Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Joann E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: Obstetrics & Gynecology, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.affiliation: Surgery & Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
authors.forename: Virginia M
authors.initials: VM
authors.lastname: Miller
authors.affiliation: Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
authors.affiliation: Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA, USA.
authors.forename: Howard N
authors.initials: HN
authors.lastname: Hodis
authors.affiliation: Kronos Longevity Research Institute and Phoenix VA Medical Center, Phoenix, AZ, USA.
authors.forename: S Mitchell
authors.initials: SM
authors.lastname: Harman
authors.affiliation: Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA Wisconsin Alzheimer's Disease Research Center, (ADRC) Madison, WI, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Asthana
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D001288:Attention / Q000187:drug effects; D001786:Blood Glucose / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003072:Cognition Disorders / Q000517:prevention & control*; D004311:Double-Blind Method; D004958:Estradiol / Q000008:administration & dosage*; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D019964:Mood Disorders / Q000517:prevention & control*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004967:Estrogens; D006728:Hormones; D004958:Estradiol
keywords: Attention; blood pressure; clinical trial; cognition; estradiol; estrogen; hormone therapy; memory; vascular risk