title: Intima-Media Thickness and Cognitive Function in Stroke-Free Middle-Aged Adults: Findings From the Coronary Artery Risk Development in Young Adults Study.
abstract: OBJECTIVE
  The relationship between carotid artery intima-media thickness (IMT) and cognitive function in midlife remains relatively unexplored. We examined the association between IMT and cognitive function in a middle-aged epidemiological cohort of 2618 stroke-free participants.
  
  
  METHODS
  At the year 20 visit (our study baseline), participants from the Coronary Artery Risk Development in Young Adults study had IMT measured by ultrasound at the common carotid artery. Five years later, participants completed a cognitive battery consisting of the Rey Auditory-Verbal Learning Test of verbal memory, the Digit Symbol Substitution Test of processing speed, and the Stroop test of executive function. We transformed cognitive scores into standardized z scores, with negative values indicating worse performance.
  
  
  RESULTS
  Mean age at baseline was 45.3 years (SD, 3.6). Greater IMT (per 1 SD difference of 0.12 mm) was significantly associated with worse performance on all cognitive tests (z scores) in unadjusted linear regression models (verbal memory, -0.16; 95% confidence interval [CI], -0.20 to -0.13; processing speed, -0.23; 95% CI, -0.27 to -0.19; and executive function, -0.17; 95% CI, -0.20 to -0.13). In models adjusted for sociodemographics and vascular risk factors that lie earlier in the causal pathway, greater IMT remained negatively associated with processing speed (-0.06; 95% CI, -0.09 to -0.02; P, 0.003) and borderline associated with executive function (-0.03; 95% CI, -0.07 to 0.00; P, 0.07) but not with verbal memory.
  
  
  CONCLUSIONS
  We observed an association between greater IMT and worse processing speed-a key component of cognitive functioning-at middle age above and beyond traditional vascular risk factors. Efforts targeted at preventing early stages of atherosclerosis may modify the course of cognitive aging.
authors.affiliation: From the Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, FL (A.Z.A.H.); Departments of Epidemiology and Biostatistics (E.V., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA (K.Y.); Kaiser Permanente Division of Research, Oakland, CA (S.S.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.P.R.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.). axz122@miami.edu.
authors.forename: Adina
authors.initials: A
authors.lastname: Zeki Al Hazzouri
authors.affiliation: From the Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, FL (A.Z.A.H.); Departments of Epidemiology and Biostatistics (E.V., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA (K.Y.); Kaiser Permanente Division of Research, Oakland, CA (S.S.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.P.R.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.).
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: From the Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, FL (A.Z.A.H.); Departments of Epidemiology and Biostatistics (E.V., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA (K.Y.); Kaiser Permanente Division of Research, Oakland, CA (S.S.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.P.R.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.affiliation: From the Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, FL (A.Z.A.H.); Departments of Epidemiology and Biostatistics (E.V., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA (K.Y.); Kaiser Permanente Division of Research, Oakland, CA (S.S.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.P.R.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.).
authors.forename: Jared P
authors.initials: JP
authors.lastname: Reis
authors.affiliation: From the Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, FL (A.Z.A.H.); Departments of Epidemiology and Biostatistics (E.V., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA (K.Y.); Kaiser Permanente Division of Research, Oakland, CA (S.S.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.P.R.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.).
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: From the Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, FL (A.Z.A.H.); Departments of Epidemiology and Biostatistics (E.V., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA (K.Y.); Kaiser Permanente Division of Research, Oakland, CA (S.S.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (J.P.R.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.).
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
mesh_terms: D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000523:psychology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness / Q000523:psychology; D003072:Cognition Disorders / Q000000981:diagnostic imaging* / Q000523:psychology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000523:psychology; D055815:Young Adult
keywords: carotid intima-media thickness; cognition; epidemiology; risk factors; stroke