Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: The ARIC MRI Study

David S Knopman, Thomas H. Mosley, Diane J. Catellier, Laura H. Coker

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Background: Strokes, vascular risk factors, and apolipoprotein E (APOE) genotype are associated with cognitive decline in the elderly, but definitive evidence that these affect cognition as early as middle age is limited. Objective: We describe the relationships of APOE genotype, stroke, and vascular risk factors with cognitive change over a 14-year follow-up in the Atherosclerosis Risk in Communities (ARIC) Study cohort recruited while in middle age. Methods: Participants included a subset of the ARIC Study who underwent assessments of cognitive function and vascular risk factors. Four cognitive assessments were performed between 1990-1992 and 2004-2006. Cognitive assessments included the Delayed Word Recall (DWR) Test, the Digit Symbol Substitution (DSS) Test, and the Word Fluency (WF) Test. Vascular risk factors were assessed during the baseline visit in 1990-1992. Incident stroke was recorded over the 14 years of follow-up. Results: There were 1130 participants (mean age, 59 ± 4.3 [SD] years; 62% women; 52% African-American) with longitudinal data. In multivariate, random-effects linear models adjusted for age, education, gender, and race, the risk factors diabetes and APOE ε4 genotype were independently associated with a decline in performance on the DSS test (both P < .005), whereas hypertension and stroke were not. For DWR, stroke and APOE ε4 genotype were independent predictors of decline (both P < .001). For the WF test, metabolic syndrome, hypertension, and stroke were independently associated with decline (all P < .005). No evidence of differential effects of risk factors on cognitive decline by race, gender, or interactions between risk factors was found. Conclusions: The vascular risk factors diabetes and hypertension, a history of stroke itself, and APOE ε4 genotype independently contribute to cognitive decline in late middle age and early elderly years.

Original languageEnglish (US)
Pages (from-to)207-214
Number of pages8
JournalAlzheimer's and Dementia
Volume5
Issue number3
DOIs
StatePublished - May 2009

Fingerprint

Apolipoproteins E
Cognition
Longitudinal Studies
Atherosclerosis
Genotype
Stroke
Apolipoprotein E4
Hypertension
vascular factor
African Americans
Linear Models
Cohort Studies
Education
Cognitive Dysfunction

Keywords

  • Apolipoprotein E
  • Cognition
  • Diabetes
  • Hypertension
  • Stroke

ASJC Scopus subject areas

  • Health Policy
  • Epidemiology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition : The ARIC MRI Study. / Knopman, David S; Mosley, Thomas H.; Catellier, Diane J.; Coker, Laura H.

In: Alzheimer's and Dementia, Vol. 5, No. 3, 05.2009, p. 207-214.

Research output: Contribution to journalArticle

Knopman, David S ; Mosley, Thomas H. ; Catellier, Diane J. ; Coker, Laura H. / Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition : The ARIC MRI Study. In: Alzheimer's and Dementia. 2009 ; Vol. 5, No. 3. pp. 207-214.
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AB - Background: Strokes, vascular risk factors, and apolipoprotein E (APOE) genotype are associated with cognitive decline in the elderly, but definitive evidence that these affect cognition as early as middle age is limited. Objective: We describe the relationships of APOE genotype, stroke, and vascular risk factors with cognitive change over a 14-year follow-up in the Atherosclerosis Risk in Communities (ARIC) Study cohort recruited while in middle age. Methods: Participants included a subset of the ARIC Study who underwent assessments of cognitive function and vascular risk factors. Four cognitive assessments were performed between 1990-1992 and 2004-2006. Cognitive assessments included the Delayed Word Recall (DWR) Test, the Digit Symbol Substitution (DSS) Test, and the Word Fluency (WF) Test. Vascular risk factors were assessed during the baseline visit in 1990-1992. Incident stroke was recorded over the 14 years of follow-up. Results: There were 1130 participants (mean age, 59 ± 4.3 [SD] years; 62% women; 52% African-American) with longitudinal data. In multivariate, random-effects linear models adjusted for age, education, gender, and race, the risk factors diabetes and APOE ε4 genotype were independently associated with a decline in performance on the DSS test (both P < .005), whereas hypertension and stroke were not. For DWR, stroke and APOE ε4 genotype were independent predictors of decline (both P < .001). For the WF test, metabolic syndrome, hypertension, and stroke were independently associated with decline (all P < .005). No evidence of differential effects of risk factors on cognitive decline by race, gender, or interactions between risk factors was found. Conclusions: The vascular risk factors diabetes and hypertension, a history of stroke itself, and APOE ε4 genotype independently contribute to cognitive decline in late middle age and early elderly years.

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