Microvascular and Macrovascular Abnormalities and Cognitive and Physical Function in Older Adults: Cardiovascular Health Study.
OBJECTIVE
To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function


METHODS
Cross-sectional analysis of the Cardiovascular Health Study (1998-1999).


METHODS
Community.


METHODS
Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5).


METHODS
Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test (TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand)


RESULTS
Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = -0.30, 95% confidence interval (CI) = -0.37 to -0.24) and physical (mean score difference = -0.32, 95% CI = -0.38 to -0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: -0.16, 95% CI = -0.24 to -0.08 vs -0.13, 95% CI = -0.20 to -0.06; physical function: -0.15, 95% CI = -0.22 to -0.08 vs -0.12, 95% CI = -0.18 to -0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function.


CONCLUSIONS
Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication.
Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
Dae Hyun
DH
Kim
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Francine
F
Grodstein
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Anne B
AB
Newman
Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
Paulo H M
PH
Chaves
School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon.
Michelle C
MC
Odden
Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
Ronald
R
Klein
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
Mark J
MJ
Sarnak
Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
Lewis A
LA
Lipsitz
D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D054079:Vascular Malformations / Q000503:physiopathology* / Q000523:psychology*
cognitive function; microvascular disease; physical function; vascular disease