Carotid atherosclerosis among middle-aged individuals predicts cognition: A 10-year follow-up study
Graphical abstract
Introduction
Prevention of cognitive deterioration has become a major public health challenge in aging societies. Accumulating evidence suggests that vascular diseases are important and independent causes of cognitive dysfunction [1]. Recognition of the status of vascular function during middle age may predict future cognitive impairment and enable the initiation of an earlier intervention to prevent or slow the decline of cognitive function.
Atherosclerosis can be assessed on the basis of its structural or functional aspects. Carotid intima–media thickness (cIMT) and plaque are common atherosclerosis structural markers, whereas stiffness is an atherosclerosis functional marker. These markers represent biologically distinct phenomena of atherosclerosis [2,3]. Therefore, it will be reasonable to investigate these different biological aspects of atherosclerosis markers to assess their individual and combined effects on the clinical outcome.
Previous studies have addressed the association between cognitive impairment and carotid atherosclerosis. Most studies have shown a positive correlation [[4], [5], [6]]; however, some studies have reported conflicting results [[7], [8], [9], [10]]. Differences in the age range of the study populations, durations of follow-up, cognitive outcome, and races may partly explain some discrepancies. Moreover, none of these studies simultaneously adapted structural and functional atherosclerosis markers as atherosclerosis surrogates and addressed a longitudinal cognitive domain-specific status for a middle-aged population. Thus, we studied participants enrolled in an ongoing longitudinal study on atherosclerosis in Taiwan [11]. We aimed to investigate the predictive effect of functional (carotid stiffness) and structural (cIMT and carotid plaque) atherosclerosis markers on cognitive status and its domains after 10 years of follow-up. We also aimed to analyze the combined effects of these two surrogates on cognitive decline.
Section snippets
Participants
The participants were part of an ongoing longitudinal cohort study called “Kaohsiung Atherosclerosis Longitudinal Study (KALS).” This cohort study recruited individuals without stroke, myocardial infarction, and dementia through an advertisement posted in the Kaohsiung Medical University Hospital. The hospital is a health management center of a university teaching hospital located in Kaohsiung, Taiwan. In total, 1378 participants were enrolled from August 2006 to December 2011 [11]. They were
Demographic data
Among all 620 participants who have been enrolled for 10 years by December 2019, 528 (85.16%) participants completed the re-visit evaluation and cognitive function assessment. Among the dropouts, 63 participants were unwilling to undergo follow-up, 10 could not be contacted, 12 died, and 7 failed to complete the cognitive test. The baseline demographic and clinical profiles were compared between the followed up participants and dropouts. Participants who dropped out were relatively older, worse
Discussion
Over 10 years of follow-up, we found that both structural and functional atherosclerosis markers had predictive effects on future cognition in a middle-aged cohort. The originality of this study is simultaneously evaluation the impact of structural and functional atherosclerosis markers on future cognitive performance in the general population. Importantly, the functional and structural atherosclerosis markers have an interactive domain-specific effect on cognitive performance especially on
Financial support
This study was supported by funding from National Health Research Institutes (Taiwan, NHRI-EX106-10605PI), Ministry of Science and Technology (Taiwan, MOST103-2314-B-037-026-MY3, MOST 103-2314-B-037-027-MY2, MOST 105-2314-B-039-050, MOST 106-2314-B-037-041-MY3, MOST 106-2314-B-039-021, MOST 107-2314-B-037-038), Kaohsiung Medical University Hospital intramural grants (Taiwan, KMUH104-4R54), and Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10601010036) in Taiwan. The sponsors had
Author contributions
Hsiu-Fen Lin: Conceptualization, Methodology, Writing- Original draft preparation. Ling-Chun Huang: Data curation, Writing- Original draft preparation. Chun-Kai Chen: Data curation, Investigation. Suh-Hang H Juo: Conceptualization, Reviewing and Editing. Cheng-Sheng Chen: Supervision, Writing- Reviewing and Editing.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
We express our appreciation to KLAS participants and the research team member for their contribution to the study.
References (36)
- et al.
Carotid atherosclerosis and cognitive function in midlife: the beaver dam offspring study
Atherosclerosis
(2011) - et al.
Subclinical carotid artery atherosclerosis and performance on cognitive tests in middle-aged adults: baseline results from the ELSA-Brasil
Atherosclerosis
(2015) - et al.
The risk of the metabolic syndrome on carotid thickness and stiffness: sex and age specific effects
Atherosclerosis
(2010) - et al.
Age and sex differences in the effect of parental stroke on the progression of carotid intima-media thickness
Atherosclerosis
(2015) - et al.
Carotid atherosclerosis and 10-year changes in cognitive function
Atherosclerosis
(2012) - et al.
Different susceptibility of medial temporal lobe and basal ganglia atrophy rates to vascular risk factors
Neurobiol. Aging
(2014) - et al.
Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association
Stroke
(2011) - et al.
Mechanisms, pathophysiology, and therapy of arterial stiffness
Arterioscler. Thromb. Vasc. Biol.
(2005) - et al.
Carotid plaque and intima-media thickness assessed by b-mode ultrasonography in subjects ranging from young adults to centenarians
Stroke
(2001) - et al.
Prospective study of arterial stiffness and subsequent cognitive decline among community-dwelling older Japanese
J. Epidemiol.
(2015)