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Vascular Risk Linked with Cognitive Decline

JAMA Neurology; ePub 2018 May 21; Rabin, et al

Vascular risk was associated with prospective cognitive decline in clinically normal older adults, both alone and synergistically with β-amyloid (Aβ) burden, according to a recent study. Furthermore, vascular risk may complement imaging biomarkers in assessing risk of prospective cognitive decline in preclinical Alzheimer disease. In this longitudinal observational study, researchers examined clinically normal older adults from the Harvard Aging Brain Study (n=223, 130 [58.3%] women, mean [SD] age 73.7 [6.0] years, and mean [SD] follow-up time 3.7 [1.2] years). Participants were required to have baseline imaging data (FDG-PET, Aβ-PET, and MRI), baseline medical data to quantify vascular risk, and at least 1 follow-up neuropsychological visit. They found:

  • Faster cognitive decline was associated with both a higher Framingham Heart Study-Cardiovascular Disease (FHS-CVD) risk score (β = −0.064) and higher Aβ burden (β = −0.058).
  • The interaction of the FHS-CVD risk score and Aβ burden with time was significant (β = −0.040), suggesting a synergistic effect.
  • The FHS-CVD risk score remained robustly associated with prospective cognitive decline (β = −0.055), even after adjustment for Aβ burden, hippocampal volume, F-18 labeled positron emission tomography (FDG-PET) uptake, and white matter hyperintensities.

Rabin JS, Schultz AP, Hedden T, et al. Interactive associations of vascular risk and β-amyloid burden with cognitive decline in clinically normal elderly individuals. Findings from the Harvard Aging Brain Study. [Published online ahead print May 21, 2018]. JAMA Neurology. doi:10.1001/jamaneurol.2018.1123.