Winning Abstract from the 2007 Medical Student Abstract Competition: An Association between Cardiovascular Risk and Cognitive Status in Non-Demented, Elderly Women with a Family History of Alzheimer's Disease.
Sophia Wang, Mount Sinai School of Medicine
Alzheimer's disease (AD) is the commonest form of dementia in the elderly population, with an estimated prevalence in 2050 of 8.6 million cases in the US alone. Prevention or even delay of cognitive decline would significantly decrease caregiving hours and costs. Epidemiologic studies suggest that cardiovascular risk factors may be associated with cognitive impairment and AD. Therefore, better characterization of the role of preventable and/or treatable cardiovascular risk factors in milder forms of cognitive impairment would be extremely beneficial. Here, we tested the hypothesis that increased cardiovascular risk is associated with subtle cognitive deficits in non-demented older women with a family history of AD.
We recruited 477 asymptomatic women, age 65 or over with a family history of AD, to participate in a 5-year double-blind, placebo controlled trial to study whether hormone replacement therapy can delay the onset of AD and memory loss. Subjects were included if they had normal cognition and no active heart disease, and received an annual neuropsychological battery, medical exam, and functional assessment. A baseline memory composite score, consisting of 4 measures of memory (Immediate and Delayed Recall for Selective Reminding Test and Visual Reproductive Test for Weschler Memory Scale Revised), was calculated. Coronary heart disease (CHD) risk was estimated as per the Framingham Heart Study. The algorithm included age, lipid levels, hypertension, diabetes and smoking. Relative risk was calculated as the ratio of a subject's CHD risk to that of a low risk, age-matched female. Linear regression was performed with memory composite score as the dependent variable, with relative CHD risk, age, ethnicity and education level as covariates.
376 persons were evaluated. Mean age was 72.7 years; mean education was 14.2 years; and 19.4% were non-Caucasian. Mean (SD) baseline memory composite score was significantly increased in those with relative CHD risk below the population's median compared with those at or above the median: memory composite score 111.4 (21.4) 103.0 (21.7) (P < 0.05). Differences in the individual components of the memory composite scores were not significant. Except for age, none of the other cardiovascular risk factors significantly correlated with cognitive measures.
These findings suggest that even subtle elevation of cardiovascular risk plays a role in cognitive status and poorer memory. Further studies should investigate whether this also applies to the wider geriatric population, and if early, aggressive treatment of CHD risk factors can prevent or delay cognitive decline.
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