Elsevier

Atherosclerosis

Volume 314, December 2020, Pages 27-32
Atherosclerosis

Carotid atherosclerosis among middle-aged individuals predicts cognition: A 10-year follow-up study

https://doi.org/10.1016/j.atherosclerosis.2020.10.015Get rights and content

Highlights

  • Atherosclerosis can be assessed on the basis of its structural or functional aspects.

  • Both structural and functional atherosclerosis markers had significant impact on 10-year future cognitive performance.

  • Interaction effect of both markers compromised 10-year future cognition, especially on executive and language function.

Abstract

Background and aims

There is a lack of studies simultaneously evaluating the impact of structural and functional atherosclerosis on cognition. We investigated the long-term predictive and interaction effects of structural and functional carotid atherosclerosis markers on future cognitive decline.

Methods

Five hundred and twenty-eight middle-aged participants enrolled in the carotid atherosclerosis examination in Kaohsiung Atherosclerosis Longitudinal Study (KALS) between 2006 and 2009 were tested for cognition between 2016 and 2019. The Montreal Cognitive Assessment (MoCA) was used for the cognitive test. Baseline structural atherosclerosis was assessed by carotid intima–media thickness (cIMT) and plaque, whereas functional atherosclerosis was evaluated by carotid stiffness (β, Ep, and pulse wave velocity). Participants in the top quartile of cIMT and those with plaques were considered to have advanced structural atherosclerosis, whereas participants with all three stiffness parameters in the top quartile were defined to have advanced functional atherosclerosis.

Results

The mean participant age at baseline was 53.88 ± 8.37 years. Each case of advanced structural atherosclerosis and advanced functional atherosclerosis was associated with low 10-year MoCA scores with p < 0.001 and p = 0.03, respectively. An interaction effect was observed between structural and functional atherosclerosis on the MoCA score 10 years later (p = 0.02). Participants with both advanced structural and functional markers showed a marked impact on future cognitive function, especially executive and language domains.

Conclusion

Carotid atherosclerosis in middle-aged individuals can predict their cognitive function in 10 years. Integrated information regarding both arterial wall and stiffness could help improve the predictive power for cognitive decline.

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.

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