Risk Factors for Mild Cognitive Impairment in the Cardiovascular Health Study Cognition Study

López, Oscar L.; Jagust, William J.; Dulberg, Corinne; Becker, James T.; DeKosky, Steven T.; Fitzpatrick, Annette L.; Breitner, John C.S.; Lyketsos, Constantine G.; Jones, Beverly N.; Kawas, Claudia H.; Carlson, Michelle C.; Kuller, Lewis H.

doi:10.1001/archneur.60.10.1394

Cited by 401 publications

(313 citation statements)

References 17 publications

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“…31 Association of silent cerebral infarctions with the development of MCI was also reported in another community-based longitudinal study. 32 By considering these findings together with our present data, asymptomatic cerebrovascular damages were thought to be one of possible mechanisms explainable for the relation between abnormal nocturnal BP profile and MCI in apparently healthy elderly persons.…”

Section: Discussionsupporting

confidence: 77%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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Mild cognitive impairment (MCI), a syndrome characteristic of the transition phase between normal cognitive function and dementia, has been shown to carry the risk of progression to dementia. Dysregulation of blood pressure (BP) is thought to be an indicator of cerebrovascular damage, including cognitive impairment. Here, we investigated the possible association of circadian BP variation with MCI in community-dwelling persons exhibiting no definitive dementia. Our study enrolled 144 persons (68 ± 7 years). Nocturnal BP profile was defined as dipper, with a 10-19% drop in nocturnal systolic BP; extreme dipper, X20% drop; non-dipper, 0-10% drop; and riser, any increase in nocturnal BP. MCI was assessed using the MCI screen, a cross-validated, staff-administered battery of tests. Subjects with MCI (n¼38) were significantly older (74±6, 67±6 years, Po0.001) and had higher frequency of apolipoprotein E e4 allele (36.8, 18.9%, P¼0.018). Although the ambulatory measured BP and the percent changes in nocturnal systolic BP (À10 ± 12% and À12 ± 8%, respectively; P¼0.291) did not differ between MCI subjects and normal controls, frequency of MCI was significantly higher in the extreme dippers (32.0%), non-dippers (30.0%) and risers (50.0%) than in dippers (13.2%, P¼0.018). Multiple logistic regression analysis identified a blunted nocturnal BP decline, non-dipping or increase in nocturnal BP and extreme drop in BP as potent determinants of MCI (odds ratio 3.062, P¼0.039), after adjustment for possible confounding factors, including apolipoprotein E e4 genotype. Abnormal nocturnal BP profile was found to be a strong indicator of MCI in otherwise apparently healthy community-dwelling elderly persons. Keywords: ambulatory blood pressure monitoring; mild cognitive impairment; nocturnal blood pressure INTRODUCTION Mild cognitive impairment (MCI) is a syndrome defined as cognitive decline greater than expected for an individual's age and education level that does not notably interfere with activities of daily life. 1 MCI is classified into four subtypes: amnestic MCI involving only memory impairment (single domain) or memory impairment along with deficits in another cognitive domain such as language function, visuospatial skills, or executive function (multiple domain) and non-amnestic MCI involving discrete cognitive impairments in single or multiple domains other than memory function. 2 MCI prevalence has been estimated to be between 6 and 10% based on community assessments, 3 a frequency about four times that of dementia. MCI also exhibits Alzheimer-type dementia-like neuropathology on autopsy, and at least half of those diagnosed with MCI, in particular amnestic MCI subtype, eventually progress into Alzheimer-type dementia (AD) with a smaller percentage progression to other forms of dementia,

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Section: Discussionsupporting

confidence: 77%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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“…Although some evidence suggests that WMH may increase the risk of MCI, data come mainly from studies that included small or highly selected samples (i.e., clinic‐based persons), used semi‐quantitative ratings of WMH, and did not involve annual assessments of cognition 2, 8, 9. Furthermore, findings are inconsistent; whereas one study of 67 cognitively intact persons found that WMH were associated with the development of MCI, a considerably larger study did not, particularly when other MRI indices were included in the analyses 8, 9. The degree to which WMH contribute to progressive cognitive decline among older persons initially free of cognitive impairment also is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

White matter hyperintensities, incident mild cognitive impairment, and cognitive decline in old age

Boyle

Fleischman

et al. 2016

Ann Clin Transl Neurol

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ObjectiveExamine the association of white matter hyperintensities (WMH) with risk of incident mild cognitive impairment (MCI) and rate of decline in multiple cognitive systems in community‐based older persons.MethodsParticipants (n = 354) were older persons initially free of cognitive impairment from two ongoing longitudinal epidemiologic studies of aging. All underwent brain magnetic resonance imaging (MRI) for quantification of WMH and gray matter volumes and detailed annual clinical evaluations including 17 cognitive tests. Proportional hazards models were used to examine the relationship between WMH and incident MCI, and mixed‐effects models were used to examine the relationship between WMH and decline in global cognition and five specific cognitive systems.ResultsDuring up to about 6 years of follow‐up (mean = 4.1), 106 (30% of 354) persons developed MCI. In a proportional hazards model adjusted for age, gender, and education, WMH volume was associated with a substantially increased risk of MCI (P < 0.001). Thus, a person with a high WMH volume (90th percentile) was about 2.7 times more likely to develop MCI compared to a person with a low volume (10th percentile). WMH volume also was associated with an increased rate of decline in global cognition (P < 0.001), perceptual speed, working memory, episodic memory, and semantic memory. Associations persisted after adjustment for total gray matter volume, vascular risk factors, and vascular diseases.Interpretation WMH contribute to the development of MCI and are associated with progressive decline in multiple cognitive systems in old age.

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“…In particular, baseline volumes of temporal lobe structures, estimated by manually or semi-manually tracing structures on MR images, have shown initial promise for predicting cognitive decline in small groups of elderly normal or MCI subjects at follow-up evaluations one to three years later [13,42,27,9,45]. Semiquantitative MR image ratings, evaluated by trained radiologists, have also shown potential for assessing risk of future cognitive decline in much larger, community-based subject pools [37,44,29,32].…”

Section: Introductionmentioning

confidence: 99%

Ventricular volume and dementia progression in the Cardiovascular Health Study

Carmichael

Kuller

López

et al. 2007

Neurobiology of Aging

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Elevated cerebral ventricular volume may be associated with dementia risk and progression. A fullyautomated technique that agreed highly with radiological readings was used to estimate lateral ventricle volume on MR scans done at baseline in 1997-99 of 377 subjects in the Cardiovascular Health Study (CHS) from the Pittsburgh Center. 327 subjects were normal or diagnosed with mild cognitive impairment (MCI) at baseline and were evaluated 4 years later. Baseline ventricular volume was analyzed in multivariate models with age, gender, education level, presence and incidence of cerebral infarcts, and dementia category (normal, MCI, or dementia) at baseline and follow-up as fixed effects. Ventricular volume at baseline was significantly higher among subjects normal at baseline and demented 4 years later. Age, gender, education level, and dementia progression were significant factors affecting ventricular volume. Ventricular volume was higher in dementia compared to MCI, higher in MCI compared to controls, and higher in Possible-Alzheimer's-disease (AD) dementia compared to Probable-AD. Larger ventricles in healthy subjects may indicate susceptibility to, or progression of, dementia-related pathology.

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Risk Factors for Mild Cognitive Impairment in the Cardiovascular Health Study Cognition Study

Cited by 401 publications

References 17 publications

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

White matter hyperintensities, incident mild cognitive impairment, and cognitive decline in old age

Ventricular volume and dementia progression in the Cardiovascular Health Study

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