Skip to main content

Advertisement

Log in

Cardiovascular Disease Risk Factors and Cognition in the Elderly

  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Although it is relatively widely known that cardiovascular disease (CVD) can result in cognitive decline, it is becoming increasingly clearer that actual risk factors for CVD, such as high blood pressure, diabetes, and obesity, are also associated with alterations to brain structure and cognition. The prevalence of CVD risk factors increases exponentially with age and these risk factors are often overlooked as a source of cognitive changes that are otherwise thought to be part of the “normal” aging process. Associated cognitive changes are observed even at levels of risk that would be considered subclinical by current diagnostic convention, and they are often significant enough to interfere with daily functional abilities. More importantly, if not controlled, CVD risk can lead to further decline, including cerebrovascular disease and dementia. Thus, it is critically important to consider these factors in the elderly, and we recommend more routine cognitive screenings, particularly when CVD risk factors are involved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Heart Association, http://www.heart.org/HEARTORG/, 2011.

  2. Morbidity and Mortality Weekly Report. 2001;50:120–25.

  3. Raz N, Rodrigue KM. Differential aging of the brain: patterns, cognitive correlates and modifiers. Neurosci Biobehav Rev. 2006;30(6):730–48.

    Article  PubMed  Google Scholar 

  4. Kivipelto M et al. Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease. Ann Intern Med. 2002;137(3):149–55.

    PubMed  CAS  Google Scholar 

  5. Hajjar I et al. Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the cardiovascular health study. Circulation. 2011;123(8):858–65.

    Article  PubMed  Google Scholar 

  6. •• Flicker L. Cardiovascular risk factors, cerebrovascular disease burden, and healthy brain aging. Clin Geriatr Med. 2010;26(1):17–27. This article discusses the relationship between common cardiovascular risk factors, including hypertension, smoking, high cholesterol, and diabetes, and cognitive function. The author discusses the importance of interventions, despite inconclusive studies in the literature, as they can potentially positively affect brain function.

    Article  PubMed  Google Scholar 

  7. • Bucur B, Madden DJ. Effects of adult age and blood pressure on executive function and speed of processing. Exp Aging Res. 2010;36(2):153–68. This study found that although age was associated with generalized declines in executive function and perceptual speed, high blood pressure contributed to additional deficits in executive function. This demonstrates that in older adults, higher blood pressure may have an enhanced effect on cognition.

    Article  PubMed  Google Scholar 

  8. Tsivgoulis G et al. Association of higher diastolic blood pressure levels with cognitive impairment. Neurology. 2009;73(8):589–95.

    Article  PubMed  CAS  Google Scholar 

  9. Oveisgharan S, Hachinski V. Hypertension, executive dysfunction, and progression to dementia: the Canadian study of health and aging. Arch Neurol. 2010;67(2):187–92.

    Article  PubMed  Google Scholar 

  10. Wiberg B et al. Cognitive function and risk of stroke in elderly men. Neurology. 2010;74(5):379–85.

    Article  PubMed  CAS  Google Scholar 

  11. Rasgon NL, et al. Insulin resistance and hippocampal volume in women at risk for Alzheimer’s disease. Neurobiol Aging. 2009. doi:10.1016/j.neurobiolaging.2009.12.005.

  12. Christman AL et al. Cranial volume, mild cognitive deficits, and functional limitations associated with diabetes in a community sample. Arch Clin Neuropsychol. 2010;25(1):49–59.

    Article  PubMed  Google Scholar 

  13. Allen KV, Frier BM, Strachan MW. The relationship between type 2 diabetes and cognitive dysfunction: longitudinal studies and their methodological limitations. Eur J Pharmacol. 2004;490(1–3):169–75.

    Article  PubMed  CAS  Google Scholar 

  14. Kuo HK et al. Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort. J Am Geriatr Soc. 2005;53(7):1154–61.

    Article  PubMed  Google Scholar 

  15. Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes–systematic overview of prospective observational studies. Diabetologia. 2005;48(12):2460–9.

    Article  PubMed  CAS  Google Scholar 

  16. Walther K, et al. Structural brain differences and cognitive functioning related to body mass index in older females. Hum Brain Mapp. 2010;31(7):1052–63.

    Google Scholar 

  17. Fitzpatrick AL et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol. 2009;66(3):336–42.

    Article  PubMed  Google Scholar 

  18. Curtis JP et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005;165(1):55–61.

    Article  PubMed  Google Scholar 

  19. Almeida OP et al. Smoking is associated with reduced cortical regional gray matter density in brain regions associated with incipient Alzheimer disease. Am J Geriatr Psychiatr. 2008;16(1):92–8.

    Article  Google Scholar 

  20. Kalmijn S et al. Cigarette smoking and alcohol consumption in relation to cognitive performance in middle age. Am J Epidemiol. 2002;156(10):936–44.

    Article  PubMed  Google Scholar 

  21. Barnes DE et al. Secondhand smoke, vascular disease, and dementia incidence: findings from the cardiovascular health cognition study. Am J Epidemiol. 2010;171(3):292–302.

    Article  PubMed  Google Scholar 

  22. Knopman D et al. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology. 2001;56(1):42–8.

    PubMed  CAS  Google Scholar 

  23. Wendell CR et al. Carotid intimal medial thickness predicts cognitive decline among adults without clinical vascular disease. Stroke. 2009;40(10):3180–5.

    Article  PubMed  Google Scholar 

  24. Yaffe K et al. The metabolic syndrome and development of cognitive impairment among older women. Arch Neurol. 2009;66(3):324–8.

    Article  PubMed  Google Scholar 

  25. Zade D et al. Interactive effects of apolipoprotein E type 4 genotype and cerebrovascular risk on neuropsychological performance and structural brain changes. J Stroke Cerebrovasc Dis. 2010;19(4):261–8.

    Article  PubMed  Google Scholar 

  26. •• Leritz EC et al. Variation in blood pressure is associated with white matter microstructure but not cognition in African Americans. Neuropsychology. 2010;24(2):199–208. This is one of the first studies to systematically examine how common cardiovascular risk factors (blood pressure, cholesterol, and glucose) are related to brain structure. This study demonstrates that even subclinical levels of these factors are related to alterations in specific brain regions.

    Article  PubMed  Google Scholar 

  27. Kennedy KM, Raz N. Pattern of normal age-related regional differences in white matter microstructure is modified by vascular risk. Brain Res. 2009;1297:41–56.

    Article  PubMed  CAS  Google Scholar 

  28. Dahle CL, Jacobs BS, Raz N. Aging, vascular risk, and cognition: blood glucose, pulse pressure, and cognitive performance in healthy adults. Psychol Aging. 2009;24(1):154–62.

    Article  PubMed  Google Scholar 

  29. Leritz EC et al. Thickness of the human cerebral cortex is associated with metrics of cerebrovascular health in a normative sample of community dwelling older adults. NeuroImage. 2011;54(4):2659–71.

    Article  PubMed  Google Scholar 

  30. Insel K et al. Executive function, working memory, and medication adherence among older adults. J Gerontol B Psychol Sci Soc Sci. 2006;61(2):P102–7.

    PubMed  Google Scholar 

  31. Royall DR, Chiodo LK, Polk MJ. Correlates of disability among elderly retirees with “subclinical” cognitive impairment. J Gerontol A Biol Sci Med Sci. 2000;55(9):M541–6.

    Article  PubMed  CAS  Google Scholar 

  32. Folstein MF, Robins LN, Helzer JE. The Mini-Mental State Examination. Arch Gen Psychiatr. 1983;40(7):812.

    PubMed  CAS  Google Scholar 

  33. Teng EL, Chui HC. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatr. 1987;48(8):314–8.

    CAS  Google Scholar 

  34. •• Grande LJ, et al. Detecting cognitive impairment in individuals at risk for cardiovascular disease: the “Clock-in-the-Box” screening test. Int J Geriatr Psychiatr. 2010. doi:10.1002/gps.2635. This article reports on a brief screening measure for cognitive function, the Clock-in-the-Box (CIB). The CIB was found to have good reliability and predictive validity in a population with cardiovascular risk factors. The CIB is a potentially very useful screening tool for clinicians.

  35. Munshi M et al. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006;29(8):1794–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a grant from the National Institute of Neurologic Disorders and Stroke (K23NS062148) and by Medical Research Service VA Merit Review Awards to William Milberg and Regina McGlinchey.

Disclosure

No conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elizabeth C. Leritz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leritz, E.C., McGlinchey, R.E., Kellison, I. et al. Cardiovascular Disease Risk Factors and Cognition in the Elderly. Curr Cardiovasc Risk Rep 5, 407–412 (2011). https://doi.org/10.1007/s12170-011-0189-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12170-011-0189-x

Keywords

Navigation