RT Journal Article
SR Electronic
T1 Association of Cardiovascular Risk Trajectory With Cognitive Decline and Incident Dementia
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e2013
OP e2022
DO 10.1212/WNL.0000000000200255
VO 98
IS 20
A1 Farnsworth von Cederwald, Bryn
A1 Josefsson, Maria
A1 Wåhlin, Anders
A1 Nyberg, Lars
A1 Karalija, Nina
YR 2022
UL http://n.neurology.org/content/98/20/e2013.abstract
AB Background and Objectives Cardiovascular risk factors have a recently established association with cognitive decline and dementia, yet most studies examine this association through cross-sectional data, precluding an understanding of the longitudinal dynamics of such risk. The current study aims to explore how the ongoing trajectory of cardiovascular risk affects subsequent dementia and memory decline risk. We hypothesize that an accelerated, long-term accumulation of cardiovascular risk, as determined by the Framingham Risk Score (FRS), will be more detrimental to cognitive and dementia state outcomes than a stable cardiovascular risk.Methods We assessed an initially healthy, community-dwelling sample recruited from the prospective cohort Betula study. Cardiovascular disease risk, as assessed by the FRS, episodic memory performance, and dementia status were measured at each 5-year time point (T) across 20 to 25 years. Analysis was performed with bayesian additive regression tree, a semiparametric machine-learning method, applied herein as a multistate survival analysis method.Results Of the 1,244 participants, cardiovascular risk increased moderately over time in 60% of sample, with observations of an accelerated increase in 18% of individuals and minimal change in 22% of individuals. An accelerated, as opposed to a stable, cardiovascular risk trajectory predicted an increased risk of developing Alzheimer disease dementia (average risk ratio [RR] 3.3–5.7, 95% CI 2.6–17.5 at T2, 1.9–6.7 at T5) or vascular dementia (average RR 3.3–4.1, 95% CI 1.1–16.6 at T2, 1.5–7.6 at T5) and was associated with an increased risk of memory decline (average RR 1.4–1.2, 95% CI 1–1.9 at T2, 1–1.5 at T5). A stable cardiovascular risk trajectory appeared to partially mitigate Alzheimer disease dementia risk for APOE ε4 carriers.Discussion The findings of the current study show that the longitudinal, cumulative trajectory of cardiovascular risk is predictive of dementia risk and associated with the emergence of memory decline. As a result, clinical practice may benefit from directing interventions at individuals with accelerating cardiovascular risk.AD=Alzheimer disease; ARR=absolute risk reduction; BART=bayesian additive regression tree; CVD=cardiovascular disease; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, 4th edition; EM=episodic memory; FRS=Framingham Risk Score; NNT=number needed to treat; RR=risk ratio; VaD=vascular dementia