Midlife vascular risk factors and late-life mild cognitive impairment

Kivipelto, Miia; Helkala, Eeva‐Liisa; Hänninen, Tuomo; Laakso, Mikko P.; Hallikainen, Merja; Alhainen, Kari; Soininen, Hilkka; Tuomilehto, Jaakko; Nissinen, Aulikki

doi:10.1212/wnl.56.12.1683

Cited by 650 publications

(478 citation statements)

References 32 publications

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“…Higher midlife SBP levels have been consistently associated with lower cognitive function in later life 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Most studies have assessed cognitive function at a single time point,4, 5, 6, 7, 8, 9 and, thus, our results have extended our understanding of this relationship by taking cognitive decline into account.…”

Section: Discussionsupporting

confidence: 60%

“…Most studies have assessed cognitive function at a single time point,4, 5, 6, 7, 8, 9 and, thus, our results have extended our understanding of this relationship by taking cognitive decline into account. In contrast, prior findings on the relationships between midlife DBP levels and late‐life cognitive function have been inconsistent 5, 6, 8, 30. In a cohort of Swedish men (n=999), DBP ≥70 mm Hg (versus DBP <70 mm Hg) at the age of 50 years was associated with lower cognitive function at the age of 70 years 6.…”

Section: Discussionmentioning

confidence: 51%

“…In a cohort of Swedish men (n=999), DBP ≥70 mm Hg (versus DBP <70 mm Hg) at the age of 50 years was associated with lower cognitive function at the age of 70 years 6. In a Finnish cohort (n=1449; 62% women), no relationship was observed between DBP (≥90 versus <90 mm Hg) at ≈50 years of age and the presence of cognitive dysfunction 21 years later 5. In contrast, analyses of data from a multiethnic cohort in the United Kingdom (n=1484) yielded a U‐shaped association between low and high DBP measured at the age of 40 to 67 years and cognitive dysfunction 20 years later 30.…”

Section: Discussionmentioning

confidence: 90%

“…Consequently, PP (SBP minus DBP) increases steeply after middle age. Therefore, characterization of individual DBP in midlife by a single measurement may be limited, and this might have contributed to the inconsistent results 5, 6, 8, 30. Indeed, a prior study from the ARIC Study demonstrated that higher DBP at visit 2 was associated with a steeper decline in global cognition from visit 2 to visit 5 11.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence supporting a link between midlife blood pressure (BP) levels and late‐life cognitive outcomes continues to accumulate 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. In addition to BP levels, BP variability may be associated with cognitive function 12, 13, 14, 15, 16, 17, 18.…”

Section: Introductionmentioning

confidence: 99%

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Long‐Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study

Yano

Griswold

Wang

et al. 2018

JAHA

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BackgroundTo understand how blood pressure (BP) from midlife and beyond is related to cognition in older age, a lifespan approach is needed. We assessed the associations of BP levels and variability from midlife on with subsequent cognitive change.Methods and ResultsThe ARIC (Atherosclerosis Risk in Communities) Study participants underwent 4 clinic BP measurements (visit 1, 2, 3, and 4 BPs) between 1987 and 1998, and their mean levels and average real variability (ARV) were assessed as exposures. A global cognitive z score, estimated from the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test scores, was calculated at 1996 to 1998 (visit 4) and 2011 to 2013 (visit 5). Among 11 408 participants (mean age, 54 years; 56% women; 21% black race), mean systolic BP (SBP)/diastolic BP (DBP) level was 123/72 mm Hg, and ARVSBP/ARVDBP was 11/7 mm Hg. With linear mixed models, 1‐SD increases of ARVSBP (standardized regression coefficient [95% confidence interval], −0.03 [−0.04 to −0.01] points) and ARVDBP (standardized regression coefficient [95% confidence interval], −0.02 [−0.03 to −0.002] points; both P<0.05), but not mean SBP or DBP levels, were associated with lower global cognitive z scores at visit 4. In contrast, mean SBP (standardized regression coefficient [95% confidence interval], −0.04 [−0.06 to −0.02] points) or DBP (standardized regression coefficient [95% confidence interval], 0.04 [0.02–0.06] points; both P<0.001) level, but not ARVSBP or ARVDBP, was associated with change in global cognitive z scores from visits 4 to 5.ConclusionsGreater visit‐to‐visit SBP or DBP variability from midlife on is modestly associated with lower cognitive function, whereas higher mean SBP and lower DBP levels from midlife to later life are modestly associated with cognitive decline in later life.

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