Generalized atherosclerosis, cognitive decline, and depressive symptoms in old age

Vinkers, David J.; Stek, Max L.; Mast, Roos C. van der; Craen, Anton J. M. de; Cessie, Saskia le; Jolles, Jelle; Westendorp, Rudi G.J.; Gussekloo, Jacobijn

doi:10.1212/01.wnl.0000167544.54228.95

Cited by 87 publications

(72 citation statements)

References 49 publications

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“…The associations between lower cognitive function and macrovascular disease were not specific for the diabetic group. Similar associations have been shown for the whole Leiden 85-plus population [19]. The repeated analysis of the association between diabetes and cognition while adjusting for the presence of macrovascular disease (myocardial infarction, arterial surgery, intermittent claudication, or stroke) showed a 5-10% reduction in the estimates of the difference between diabetic and non-diabetic participants, as presented in …”

Section: Resultssupporting

confidence: 77%

“…In our study, worse cognitive performance in the diabetes group was associated with macrovascular disease. However, this association did not appear to be specific for diabetes [19] and adjustment for macrovascular disease in the analyses had only a modest effect on the difference in cognitive performance between diabetic and non-diabetic participants. While hypertension has been suggested to be an important determinant of impaired cognition in diabetes [4], in the present study no clear relationship was found between hypertension and cognitive function within the group of diabetes patients, in line with other recent studies [27,29].…”

Section: Discussionmentioning

confidence: 75%

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The impact of diabetes mellitus on cognitive decline in the oldest of the old: a prospective population-based study

et al. 2006

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Aims/hypothesis Diabetes mellitus is a risk factor for the development of cognitive impairment and dementia in the general population up to 75 years of age. As part of the Leiden 85-plus Study we studied the effects of diabetes on cognition in the oldest old. Subjects and methods The Leiden 85-plus Study is a prospective population-based study of 599 persons from age 85 onward. Cognitive function was assessed each year from ages 85 to 90 by means of four neuropsychological tests. The presence of diabetes and vascular disease was recorded at baseline, HbA 1c was assessed by means of a blood sample at ages 85 and 90. The cross-sectional and prospective associations between diabetes and cognitive function were analysed with linear mixed models, adjusted for sex and level of education. Results At age 85, diabetes was associated with a lower level of cognitive functioning on the Letter Digit Coding test and the Stroop Test. Diabetes was not associated with accelerated cognitive decline during follow-up. Within the group of diabetic patients, macrovascular disease was the most important determinant of cognitive dysfunction. Conclusions/interpretation The association between diabetes and accelerated cognitive decline, which has been documented previously in patients up to 75 years of age, may be less evident after age 85. This suggests that the damage occurs in previous years and that therapies aimed at preventing cognitive decline and dementia should focus on the younger old.

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Section: Resultssupporting

confidence: 77%

Section: Discussionmentioning

confidence: 75%

The impact of diabetes mellitus on cognitive decline in the oldest of the old: a prospective population-based study

et al. 2006

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“…Cardiovascular diseases, such as myocardial infarction, generalized atherosclerosis, and stroke have been associated with increased dementia risk and cognitive decline. [1][2][3][4] Hypertension, however, is only a risk factor for dementia when present in middle age, whereas most studies show that dementia and cognitive decline in the oldest old associate with lower blood pressures. 5 In the oldest old, blood pressures decrease over time, 6,7 and stronger declines are related to the presence of dementia and cognitive decline.…”

Section: Resultsmentioning

confidence: 99%

NT-proBNP, blood pressure, and cognitive decline in the oldest old

et al. 2014

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Objective: To study the relation between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, used as a marker of heart failure in clinical practice, blood pressure (BP), and cognitive decline in the oldest old.Methods: In 560 participants of the Leiden 85-plus Study, we measured NT-proBNP levels and BP at age 85 years, at baseline, and global cognitive function (Mini-Mental State Examination [MMSE]) annually during the follow-up of 5 years.Results: Subjects in the highest tertile of NT-proBNP levels scored 1.7 points lower on the MMSE at age 85 years than subjects in the lowest tertile (p 5 0.004), and had a 0.24-point-steeper decline in MMSE score per year (p 5 0.021). The longitudinal association disappeared after full adjustment for possible confounders (0.14-point-steeper decline, p 5 0.187). Subjects in the category "highest tertile of NT-proBNP and the lowest tertile of systolic BP" had a 3.7-point-lower MMSE score at baseline (p , 0.001) and a 0.49-point-steeper decline in MMSE score per year (p , 0.001) compared with subjects in the other categories. Conclusions:In the oldest old, high NT-proBNP levels are associated with lower MMSE scores. The combination of high NT-proBNP levels and low systolic BP is associated with worst global cognitive function and the steepest cognitive decline. Possibly, a failing pump function of the heart results in lower BP and lower brain perfusion with resultant brain dysfunction. Cardiovascular diseases, such as myocardial infarction, generalized atherosclerosis, and stroke have been associated with increased dementia risk and cognitive decline.1-4 Hypertension, however, is only a risk factor for dementia when present in middle age, whereas most studies show that dementia and cognitive decline in the oldest old associate with lower blood pressures. 5In the oldest old, blood pressures decrease over time, 6,7 and stronger declines are related to the presence of dementia and cognitive decline. 8,9 One possible explanation for the blood pressure decline in the oldest old might be the increasing prevalence of (subclinical) congestive heart failure.10 Despite this dynamic correlation between blood pressure and cardiac function in relation to cognitive function in old age, previous studies have mainly focused on either the association of blood pressure or cardiac function with cognitive impairment.Congestive heart failure has been associated with an increased risk of cognitive impairment. 11-13A frequently used serum marker of heart failure is the N-terminal pro-brain natriuretic peptide (NT-proBNP), the inactive fragment of the proBNP hormone. 14 NT-proBNP has proven to be a quantitative marker of acute heart failure in clinical practice, with high sensitivity and reasonable specificity, 15 although elevated NT-proBNP levels are not specific for heart failure in the general population. Several studies have shown that higher NT-proBNP levels associate with lower cognitive function. 16,17 However, the relation among NT-proBNP levels, blood pressure, and cognitive f...

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“…The decrease of exercise capacity associated with mildly compromised cognitive performance was only partially explained by a positive history of previous cerebrovascular disease, which has been demonstrated to influence both cognitive function (36) and exercise tolerance (37).…”

confidence: 98%

Relationship between cognitive function and 6-minute walking test in older outpatients with chronic heart failure

et al. 2010

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Generalized atherosclerosis, cognitive decline, and depressive symptoms in old age

Abstract: In the population at large, generalized atherosclerosis contributes to cognitive decline in old age but not to depression.

Cited by 87 publications

References 49 publications

The impact of diabetes mellitus on cognitive decline in the oldest of the old: a prospective population-based study

The impact of diabetes mellitus on cognitive decline in the oldest of the old: a prospective population-based study

NT-proBNP, blood pressure, and cognitive decline in the oldest old

Relationship between cognitive function and 6-minute walking test in older outpatients with chronic heart failure

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