title: Subclinical carotid artery atherosclerosis and performance on cognitive tests in middle-aged adults: Baseline results from the ELSA-Brasil.
abstract: OBJECTIVE
  Carotid artery intima-media thickness (CIMT) may be used as a biomarker for early cognitive impairment. However, the results of the association between CIMT and cognitive function in middle-aged subjects are mixed. We aimed to investigate this association in a large Brazilian sample with no history of stroke at baseline. Additionally, we tested the effect of interactions between CIMT and cardiovascular risk factors on cognitive performance.
  
  
  METHODS
  In this cross-sectional study, cognition was evaluated using the delayed word recall (DWRT), the category fluency, and the trail making tests (TMT). CIMT was measured at the common carotid artery. The association between CIMT and cognitive tests was investigated using linear regression models, adjusted for an extensive set of possible confounding variables. We also included interaction terms with selected risk factors.
  
  
  RESULTS
  The mean age of the 8208 participants was 49.6 ± 7.3 years, 44% were male, and 56% White. Increase in CIMT was associated with worse performance on the DWRT (β = -0.433, 95%CI = -0.724;-0.142, p = 0.004). We found effect modification of the association between cognitive function and CMIT by self-reported heart failure and alcohol intake. Participants had worse performance in the TMT if they had greater CIMT and current alcohol use (p < 0.0001). The interaction between CIMT and heart failure on TMT performance was not significant after adjustment for multiple comparisons (p = 0.07).
  
  
  CONCLUSIONS
  In this sample of middle-aged adults, CIMT was inversely associated with memory function. Additionally, the presence of alcohol use resulted in a stronger association of CIMT with worse performance on an executive function test.
authors.affiliation: Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Global Health and Population, Harvard School of Public Health, Boston, USA. Electronic address: cksuemoto@usp.br.
authors.forename: Claudia K
authors.initials: CK
authors.lastname: Suemoto
authors.affiliation: Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Marcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Laboratory of Genetics and Molecular Cardiology, Division of Cardiology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Alexandre C
authors.initials: AC
authors.lastname: Pereira
authors.affiliation: Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: Departments of Neurology and Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: Department of Internal Medicine, Federal University of Minas Gerais Medical School, Minas Gerais, Brazil.
authors.forename: Valeria M
authors.initials: VM
authors.lastname: Passos
authors.affiliation: Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Lotufo
authors.affiliation: Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000523:psychology; D058070:Asymptomatic Diseases; D001938:Brazil; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology; D006801:Humans; D016014:Linear Models; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012307:Risk Factors; D014145:Trail Making Test
keywords: Atherosclerosis; Carotid intima media thickness; Cognition disorders