title: Carotid stiffness is associated with impairment of cognitive performance in individuals with and without type 2 diabetes. The Maastricht Study.
abstract: There is increasing evidence linking arterial (mainly aortic) stiffness and type 2 diabetes, a risk factor for arterial stiffness, to cognitive impairment and dementia. However, data on carotid stiffness, which may be especially relevant for cognitive performance, are scarce, and few studies have addressed the interplay between arterial stiffness, type 2 diabetes, and cognitive performance.
  
  
  
  We studied individuals with (n = 197) and without (n = 528) type 2 diabetes, who completed a neuropsychological test battery and underwent applanation tonometry and vascular ultrasound to evaluate aortic (i.e. carotid-to-femoral pulse wave velocity) and carotid stiffness (i.e. distensibility, compliance and Young's elastic modulus). Linear regression analyses were performed and adjusted for demographics, vascular risk factors, and depression.
  
  
  
  Overall, our results showed that carotid, but not aortic, stiffness was associated with worse cognitive performance, primarily in the domains of processing speed (standardized regression coefficient for distensibility -0.083, p = 0.040; compliance -0.077, p = 0.032) and executive function and attention (distensibility -0.133, p = 0.001; compliance -0.090, p = 0.015; Young's elastic modulus -0.081, p = 0.027). These associations did not differ by diabetes status. The differences in cognitive performance between individuals with and without type 2 diabetes (mean difference in domain scores relative to those without diabetes for free recall memory -0.23, processing speed -0.19, executive function and attention -0.23; all p ≤ 0.009 and adjusted for demographics, traditional vascular risk factors, and depression) were not substantially altered after additional adjustment for carotid stiffness.
  
  
  
  Our findings suggest that carotid stiffness is associated with cognitive performance in both individuals with and without diabetes, but does not mediate the relationship between type 2 diabetes and cognitive dysfunction.
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Stefan L C
authors: SL
authors: Geijselaers
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors: Simone J S
authors: SJ
authors: Sep
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors: Miranda T
authors: MT
authors: Schram
authors: Department of Psychiatry and Neuropsychology and MHeNS School for Mental Health and Neuroscience, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors: Martin P J
authors: MP
authors: van Boxtel
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
authors: Thomas T
authors: TT
authors: van Sloten
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors: Ronald M A
authors: RM
authors: Henry
authors: Department of Biomedical Engineering, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors: Koen D
authors: KD
authors: Reesink
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors: Abraham A
authors: AA
authors: Kroon
authors: Department of Social Medicine, Maastricht University, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors: Annemarie
authors: A
authors: Koster
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors: Nicolaas C
authors: NC
authors: Schaper
authors: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors: Pieter C
authors: PC
authors: Dagnelie
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors: Carla J H
authors: CJ
authors: van der Kallen
authors: Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Geert Jan
authors: GJ
authors: Biessels
authors: Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands. Electronic address: cda.stehouwer@mumc.nl.
authors: Coen D A
authors: CD
authors: Stehouwer
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D002339:Carotid Arteries / Q000503:physiopathology*; D003072:Cognition Disorders / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D003863:Depression / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009426:Netherlands; D009483:Neuropsychological Tests; D012307:Risk Factors; D014463:Ultrasonography; D059289:Vascular Stiffness
keywords: Arterial stiffness; Carotid artery; Cognitive performance; Epidemiology; Type 2 diabetes mellitus