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Abstract
Objective Cardiovascular risk factors (CVRFs) are associated with increased risk of cognitive decline, but little is known about how early adult CVRFs and those across the life course might influence late-life cognition. To test the hypothesis that CVRFs across the adult life course are associated with late-life cognitive changes, we pooled data from 4 prospective cohorts (n = 15,001, ages 18–95).
Methods We imputed trajectories of body mass index (BMI), fasting glucose (FG), systolic blood pressure (SBP), and total cholesterol (TC) for older adults. We used linear mixed models to determine the association of early adult, midlife, and late-life CVRFs with late-life decline on global cognition (Modified Mini-Mental State Examination [3MS]) and processing speed (Digit Symbol Substitution Test [DSST]), adjusting for demographics, education, and cohort.
Results Elevated BMI, FG, and SBP (but not TC) at each time period were associated with greater late-life decline. Early life CVRFs were associated with the greatest change, an approximate doubling of mean 10-year decline (an additional 3–4 points for 3MS or DSST). Late-life CVRFs were associated with declines in early late life (<80 years) but with gains in very late life (≥80 years). After adjusting for CVRF exposures at all time periods, the associations for early adult and late-life CVRFs persisted.
Conclusions We found that imputed CVRFs across the life course, especially in early adulthood, were associated with greater late-life cognitive decline. Our results suggest that CVRF treatment in early adulthood could benefit late-life cognition, but that treatment in very late life may not be as helpful for these outcomes.
Glossary
- 3MS=
- modified Mini-Mental State Examination;
- BMI=
- body mass index;
- CARDIA=
- Coronary Artery Risk Development in Young Adults Study;
- CHS=
- Cardiovascular Health Study;
- CI=
- confidence interval;
- CVRF=
- cardiovascular risk factor;
- DSST=
- Digit Symbol Substitution Test;
- FG=
- fasting glucose;
- Health ABC=
- Health, Aging and Body Composition Study;
- LMM=
- linear mixed model;
- MESA=
- Multi Ethnic Study of Atherosclerosis;
- SBP=
- systolic blood pressure;
- TC=
- total cholesterol;
- TWA=
- time-weighted average
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received July 6, 2020.
- Accepted in final form January 28, 2021.
- © 2021 American Academy of Neurology
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