title: Adverse vascular risk is related to cognitive decline in older adults.
abstract: BACKGROUND
  Cardiovascular disease (CVD) and related risk factors are associated with Alzheimer's disease (AD). This association is less well-defined in normal cognition (NC) or prodromal AD (mild cognitive impairment, MCI).
  
  
  OBJECTIVE
  Cross-sectionally and longitudinally relate a vascular risk index to cognitive outcomes among elders free of clinical dementia.
  
  
  METHODS
  3,117 MCI (74 ± 8 years, 56% female) and 6,603 NC participants (72 ± 8 years, 68% female) were drawn from the National Alzheimer's Coordinating Center. A composite measure of vascular risk was defined using the Framingham Stroke Risk Profile (FSRP) score (i.e., age, systolic blood pressure, anti-hypertensive medication, diabetes, cigarette smoking, CVD history, atrial fibrillation). Ordinary linear regressions and generalized linear mixed models related baseline FSRP to cross-sectional and longitudinal cognitive outcomes, separately for NC and MCI, adjusting for age, gender, race, education, and follow-up time (in longitudinal models).
  
  
  RESULTS
  In NC participants, increasing FSRP was related to worse baseline global cognition, information processing speed, and sequencing abilities (p-values <0.0001) and a worse longitudinal trajectory on all cognitive measures (p-values <0.0001). In MCI, increasing FSRP correlated with worse longitudinal delayed memory (p = 0.004). In secondary models using an age-excluded FSRP score, associations persisted in NC participants for global cognition, naming, information processing speed, and sequencing abilities.
  
  
  CONCLUSIONS
  An adverse vascular risk profile is associated with worse cognitive trajectory, especially global cognition, naming, and information processing speed, among NC elders. Future studies are needed to understand how effective management of CVD and related risk factors can modify cognitive decline to identify the ideal timeframe for primary prevention implementation.
authors.affiliation: Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Jefferson
authors.affiliation: Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Hohman
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Dandan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Shereen
authors.initials: S
authors.lastname: Haj-Hassan
authors.affiliation: Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Gifford
authors.affiliation: Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Elleena M
authors.initials: EM
authors.lastname: Benson
authors.affiliation: Vanderbilt-Meharry Alliance, Nashville, TN, USA.
authors.forename: Jeannine S
authors.initials: JS
authors.lastname: Skinner
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Zengqi
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Boston University School of Medicine, Boston, MA, USA Newton Wellesley Hospital, Department of Medicine, Newton, MA, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Sparling
authors.affiliation: Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Sumner
authors.affiliation: Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA Center for Quality Aging, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Bell
authors.affiliation: Boston University School of Medicine, Boston, MA, USA Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Ruberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications*; D003072:Cognition Disorders / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D012307:Risk Factors
keywords: Blood pressure; Framingham Stroke Risk Profile; diabetes mellitus; smoking; stroke