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Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study.
Alzheimers Dement. 2009 May; 5(3):207-14.AD

Abstract

BACKGROUND

Strokes, vascular risk factors, and apolipoprotein E (APOE) genotype are associated with cognitive decline in the elderly, but definitive evidence that these affect cognition as early as middle age is limited.

OBJECTIVE

We describe the relationships of APOE genotype, stroke, and vascular risk factors with cognitive change over a 14-year follow-up in the Atherosclerosis Risk in Communities (ARIC) Study cohort recruited while in middle age.

METHODS

Participants included a subset of the ARIC Study who underwent assessments of cognitive function and vascular risk factors. Four cognitive assessments were performed between 1990-1992 and 2004-2006. Cognitive assessments included the Delayed Word Recall (DWR) Test, the Digit Symbol Substitution (DSS) Test, and the Word Fluency (WF) Test. Vascular risk factors were assessed during the baseline visit in 1990-1992. Incident stroke was recorded over the 14 years of follow-up.

RESULTS

There were 1130 participants (mean age, 59 +/- 4.3 [SD] years; 62% women; 52% African-American) with longitudinal data. In multivariate, random-effects linear models adjusted for age, education, gender, and race, the risk factors diabetes and APOE epsilon4 genotype were independently associated with a decline in performance on the DSS test (both P < .005), whereas hypertension and stroke were not. For DWR, stroke and APOE epsilon4 genotype were independent predictors of decline (both P < .001). For the WF test, metabolic syndrome, hypertension, and stroke were independently associated with decline (all P < .005). No evidence of differential effects of risk factors on cognitive decline by race, gender, or interactions between risk factors was found.

CONCLUSIONS

The vascular risk factors diabetes and hypertension, a history of stroke itself, and APOE epsilon4 genotype independently contribute to cognitive decline in late middle age and early elderly years.

Authors+Show Affiliations

Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA. knopman@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19362884

Citation

Knopman, David S., et al. "Fourteen-year Longitudinal Study of Vascular Risk Factors, APOE Genotype, and Cognition: the ARIC MRI Study." Alzheimer's & Dementia : the Journal of the Alzheimer's Association, vol. 5, no. 3, 2009, pp. 207-14.
Knopman DS, Mosley TH, Catellier DJ, et al. Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study. Alzheimers Dement. 2009;5(3):207-14.
Knopman, D. S., Mosley, T. H., Catellier, D. J., & Coker, L. H. (2009). Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study. Alzheimer's & Dementia : the Journal of the Alzheimer's Association, 5(3), 207-14. https://doi.org/10.1016/j.jalz.2009.01.027
Knopman DS, et al. Fourteen-year Longitudinal Study of Vascular Risk Factors, APOE Genotype, and Cognition: the ARIC MRI Study. Alzheimers Dement. 2009;5(3):207-14. PubMed PMID: 19362884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study. AU - Knopman,David S, AU - Mosley,Thomas H, AU - Catellier,Diane J, AU - Coker,Laura H, AU - ,, Y1 - 2009/04/11/ PY - 2008/12/01/received PY - 2009/01/23/revised PY - 2009/01/27/accepted PY - 2009/4/14/entrez PY - 2009/4/14/pubmed PY - 2009/6/26/medline SP - 207 EP - 14 JF - Alzheimer's & dementia : the journal of the Alzheimer's Association JO - Alzheimers Dement VL - 5 IS - 3 N2 - BACKGROUND: Strokes, vascular risk factors, and apolipoprotein E (APOE) genotype are associated with cognitive decline in the elderly, but definitive evidence that these affect cognition as early as middle age is limited. OBJECTIVE: We describe the relationships of APOE genotype, stroke, and vascular risk factors with cognitive change over a 14-year follow-up in the Atherosclerosis Risk in Communities (ARIC) Study cohort recruited while in middle age. METHODS: Participants included a subset of the ARIC Study who underwent assessments of cognitive function and vascular risk factors. Four cognitive assessments were performed between 1990-1992 and 2004-2006. Cognitive assessments included the Delayed Word Recall (DWR) Test, the Digit Symbol Substitution (DSS) Test, and the Word Fluency (WF) Test. Vascular risk factors were assessed during the baseline visit in 1990-1992. Incident stroke was recorded over the 14 years of follow-up. RESULTS: There were 1130 participants (mean age, 59 +/- 4.3 [SD] years; 62% women; 52% African-American) with longitudinal data. In multivariate, random-effects linear models adjusted for age, education, gender, and race, the risk factors diabetes and APOE epsilon4 genotype were independently associated with a decline in performance on the DSS test (both P < .005), whereas hypertension and stroke were not. For DWR, stroke and APOE epsilon4 genotype were independent predictors of decline (both P < .001). For the WF test, metabolic syndrome, hypertension, and stroke were independently associated with decline (all P < .005). No evidence of differential effects of risk factors on cognitive decline by race, gender, or interactions between risk factors was found. CONCLUSIONS: The vascular risk factors diabetes and hypertension, a history of stroke itself, and APOE epsilon4 genotype independently contribute to cognitive decline in late middle age and early elderly years. SN - 1552-5279 UR - https://www.unboundmedicine.com/medline/citation/19362884/Fourteen_year_longitudinal_study_of_vascular_risk_factors_APOE_genotype_and_cognition:_the_ARIC_MRI_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1552-5260(09)00030-2 DB - PRIME DP - Unbound Medicine ER -