Cardiovascular Disease Risk Models and Longitudinal Changes in Cognition: A Systematic Review

Abstract

BackgroundCardiovascular disease and its risk factors have consistently been associated with poor cognitive function and incident dementia. Whether cardiovascular disease prediction models, developed to predict an individual's risk of future cardiovascular disease or stroke, are also informative for predicting risk of cognitive decline and dementia is not known.ObjectiveThe objective of this systematic review was to compare cohort studies examining the association between cardiovascular disease risk models and longitudinal changes in cognitive function or risk of incident cognitive impairment or dementia.Materials and MethodsMedline, PsychINFO, and Embase were searched from inception to March 28, 2014. From 3,413 records initially screened, 21 were included.ResultsThe association between numerous different cardiovascular disease risk models and cognitive outcomes has been tested, including Framingham and non-Framingham risk models. Five studies examined dementia as an outcome; fourteen studies examined cognitive decline or incident cognitive impairment as an outcome; and two studies examined both dementia and cognitive changes as outcomes. In all studies, higher cardiovascular disease risk scores were associated with cognitive changes or risk of dementia. Only four studies reported model prognostic performance indices, such as Area Under the Curve (AUC), for predicting incident dementia or cognitive impairment and these studies all examined non-Framingham Risk models (AUC range: 0.74 to 0.78).ConclusionsCardiovascular risk prediction models are associated with cognitive changes over time and risk of dementia. Such models are easily obtainable in clinical and research settings and may be useful for identifying individuals at high risk of future cognitive decline and dementia.

Predicting Risk of Cognitive Decline in Very Old Adults Using Three Models: The Framingham Stroke Risk Profile; the Cardiovascular Risk Factors, Aging, and Dementia Model; and Oxi‐Inflammatory Biomarkers

“…Of 1,453 eligible people invited to participate, 845 had baseline data for the detailed multidimensional health assessment and general practice record review. Those with a history of stroke or dementia were excluded from all analyses, in line with previous studies examining associations between the Framingham Stroke Risk Profile and cognitive function . Six hundred sixteen participants had complete clinical and laboratory data and no previous history of stroke or dementia at baseline.…”

Pathophysiologic relationship between Alzheimer's disease, cerebrovascular disease, and cardiovascular risk: A review and synthesis

“…High FCRP scores are associated with worsening of cognitive abilities, both in cognitively intact subjects and in mild cognitive impairment (MCI) patients [38] and are a reliable predictor of progression from MCI to AD [39]. Other scores developed from Framingham, the Framingham Stroke Risk Profile, and the Framingham Coronary Heart Disease Risk Score, have been similarly associated with cognitive change over time, incident cognitive impairment, and dementia [35,[39][40][41][42][43]. These risk models are similar to one developed specifically to assess dementia risk, the Cardiovascular Risk Factors Aging and Dementia (CAIDE) risk score [44][45][46].…”

Association of anthropometry and weight change with risk of dementia and its major subtypes: A meta‐analysis consisting 2.8 million adults with 57 294 cases of dementia

“…It is a heterogeneous condition chiefly comprising Alzheimer disease (60‐70% of cases) and vascular dementia accounting for about 15% of cases, although the two subtypes frequently co‐occur . Aging, family history, and sarcopenia are important risk factors for dementia, and there is growing evidence that vascular risk factors, such as diabetes, may also confer increased risk, particularly for vascular dementia, although findings are inconsistent …”