Vascular risk factors and cognitive impairment in a stroke-free cohort

F. W. Unverzagt, L. A. McClure, V. G. Wadley, N. S. Jenny, R. C. Go, M. Cushman, B. M. Kissela, B. J. Kelley, R. Kennedy, C. S. Moy, V. Howard, G. Howard

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Abstract

Objective: To examine vascular risk factors, as measured by the Framingham Stroke Risk Profile (FSRP), to predict incident cognitive impairment in a large, national sample of black and white adults age 45 years and older. Methods: Participants included subjects without stroke at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with at least 2 cognitive function assessments during the follow-up (n=23,752). Incident cognitive impairment was defined as decline from a baseline score of 5 or 6 (of possible 6 points) to the most recent follow-up score of 4 or less on the Six-item Screener (SIS). Subjects with suspected stroke during follow-up were censored. Results: During a mean follow-up of 4.1 years, 1,907 participants met criteria for incident cognitive impairment. Baseline FSRP score was associated with incident cognitive impairment. An adjusted model revealed that male sex (odds ratio [OR]=1.59, 95% confidence interval [CI] 1.43-1.77), black race (OR=2.09, 95% CI 1.88-2.35), less education (less than high school graduate vs college graduate, OR=2.21, 95% CI 1.88-2.60), older age (10-year increments, OR=2.11, per 10-year increase in age, 95% CI 2.05-2.18), and presence of left ventricular hypertrophy (LVH, OR=1.29, 95% CI 1.06-1.58) were related to development of cognitive impairment. When LVH was excluded from the model, elevated systolic blood pressure was related to incident cognitive impairment. Conclusions: Total FSRP score, elevated blood pressure, and LVH predict development of clinically significant cognitive dysfunction. Prevention and treatment of high blood pressure may be effective in preserving cognitive health.

Original languageEnglish (US)
Pages (from-to)1729-1736
Number of pages8
JournalNeurology
Volume77
Issue number19
DOIs
StatePublished - Nov 8 2011

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Stroke
Odds Ratio
Confidence Intervals
Blood Pressure
Sex Ratio
Left Ventricular Hypertrophy
vascular factor
Cognitive Dysfunction
Cognition
Hypertension
Education
Health
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Unverzagt, F. W., McClure, L. A., Wadley, V. G., Jenny, N. S., Go, R. C., Cushman, M., ... Howard, G. (2011). Vascular risk factors and cognitive impairment in a stroke-free cohort. Neurology, 77(19), 1729-1736. https://doi.org/10.1212/WNL.0b013e318236ef23

Vascular risk factors and cognitive impairment in a stroke-free cohort. / Unverzagt, F. W.; McClure, L. A.; Wadley, V. G.; Jenny, N. S.; Go, R. C.; Cushman, M.; Kissela, B. M.; Kelley, B. J.; Kennedy, R.; Moy, C. S.; Howard, V.; Howard, G.

In: Neurology, Vol. 77, No. 19, 08.11.2011, p. 1729-1736.

Research output: Contribution to journalArticle

Unverzagt, FW, McClure, LA, Wadley, VG, Jenny, NS, Go, RC, Cushman, M, Kissela, BM, Kelley, BJ, Kennedy, R, Moy, CS, Howard, V & Howard, G 2011, 'Vascular risk factors and cognitive impairment in a stroke-free cohort', Neurology, vol. 77, no. 19, pp. 1729-1736. https://doi.org/10.1212/WNL.0b013e318236ef23
Unverzagt FW, McClure LA, Wadley VG, Jenny NS, Go RC, Cushman M et al. Vascular risk factors and cognitive impairment in a stroke-free cohort. Neurology. 2011 Nov 8;77(19):1729-1736. https://doi.org/10.1212/WNL.0b013e318236ef23
Unverzagt, F. W. ; McClure, L. A. ; Wadley, V. G. ; Jenny, N. S. ; Go, R. C. ; Cushman, M. ; Kissela, B. M. ; Kelley, B. J. ; Kennedy, R. ; Moy, C. S. ; Howard, V. ; Howard, G. / Vascular risk factors and cognitive impairment in a stroke-free cohort. In: Neurology. 2011 ; Vol. 77, No. 19. pp. 1729-1736.
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abstract = "Objective: To examine vascular risk factors, as measured by the Framingham Stroke Risk Profile (FSRP), to predict incident cognitive impairment in a large, national sample of black and white adults age 45 years and older. Methods: Participants included subjects without stroke at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with at least 2 cognitive function assessments during the follow-up (n=23,752). Incident cognitive impairment was defined as decline from a baseline score of 5 or 6 (of possible 6 points) to the most recent follow-up score of 4 or less on the Six-item Screener (SIS). Subjects with suspected stroke during follow-up were censored. Results: During a mean follow-up of 4.1 years, 1,907 participants met criteria for incident cognitive impairment. Baseline FSRP score was associated with incident cognitive impairment. An adjusted model revealed that male sex (odds ratio [OR]=1.59, 95{\%} confidence interval [CI] 1.43-1.77), black race (OR=2.09, 95{\%} CI 1.88-2.35), less education (less than high school graduate vs college graduate, OR=2.21, 95{\%} CI 1.88-2.60), older age (10-year increments, OR=2.11, per 10-year increase in age, 95{\%} CI 2.05-2.18), and presence of left ventricular hypertrophy (LVH, OR=1.29, 95{\%} CI 1.06-1.58) were related to development of cognitive impairment. When LVH was excluded from the model, elevated systolic blood pressure was related to incident cognitive impairment. Conclusions: Total FSRP score, elevated blood pressure, and LVH predict development of clinically significant cognitive dysfunction. Prevention and treatment of high blood pressure may be effective in preserving cognitive health.",
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AU - Go, R. C.

AU - Cushman, M.

AU - Kissela, B. M.

AU - Kelley, B. J.

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