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15-04-2013 | Cardiology | Article

Global vascular risk factors for cognitive decline modifiable

Abstract

Free abstract

medwireNews: Vascular risk factors that are potentially modifiable are associated with cognitive decline in aging populations, show research findings.

In a study of 1162 participants from a substudy of the Northern Manhattan Study (NOMAS), the NOMAS Global Vascular Risk Score (GVRS), which is predictive for stroke, myocardial infarction (MI), and vascular death, was inversely associated with successful aging without subsequent cognitive decline (SA-ND).

"Although aging is unavoidable, VCI [vascular cognitive impairment] is potentially preventable if means to identify those at risk are available and the risk factors themselves are modifiable," say Clinton Wright (University of Miami, Florida, USA) and colleagues. "Improvements in GVRSs could help promote healthy longevity in the aging population."

The findings come from an analysis of data available for NOMAS participants who were administered the Mini-Mental State Examination (MMSE) at baseline enrolment and at the time of enrolment in a magnetic resonance imaging (MRI) substudy of NOMAS, an average of 6.1 years later.

Criteria for meeting SA-ND were based on MMSE scores and disease, disability and cognitive function using definitions of SA used in other large studies.

As reported in the Journal of the American Geriatrics Society, the prevalence of SA-ND in the population was 37%.

The researchers observed an inverse association between GVRS and SA-ND among the participants, with each 1-point decrease in GVRS associated with a 56% greater likelihood of SA-ND, after adjustment for level of education and socioeconomic status. Stratification of the patients by GVRS quartile showed that those in the lowest quartile for GVRS were more than three times as likely to achieve SA-ND than those in the highest quartile, while those in the second and third quartiles were 1.6 and 1.5 times more likely to achieve SA-ND, respectively.

Analysis of individual GVRS components showed that older age, greater diastolic blood pressure in individuals taking antihypertensive medication, and a history of claudication or peripheral artery disease were significantly associated with a lower likelihood of SA-ND.

"Given the importance of avoiding vascular outcomes such as stroke, MI, peripheral vascular disease, and vascular death, global risk scores such as the GVRS add value if they identify those at risk early on," remark Wright and team.

"With early detection of at-risk persons crucial to the success of medical management and behavioral interventions, comprehensive global risk assessment tools such as the GVRS, if found to predict successful aging, may be an effective means of guiding comprehensive public health efforts," they conclude.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Sally Robertson, medwireNews Reporter

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