Hemostatic factor levels and cognitive decline in older adults: the Cardiovascular Health Study

OBJECTIVE: To determine whether older adults who develop incident heart failure (HF) experience faster cognitive decline than those without HF. METHODS: We analyzed longitudinal cognitive test data from the Cardiovascular Health Study, a community-based study of adults aged 65 years and older. Participants in this analysis did not have HF or history of stroke at baseline and were censored when they experienced incident clinical stroke. Incident HF was identified by self-report of physician-diagnosed HF and confirmed by adjudicated review of inpatient and outpatient medical records and medication use. Outcomes were mean score and rate of decline in mean score on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to nine times from 1990 to 1998. A linear mixed effects model was used to model the relationship of cognitive decline with HF and age, adjusted for demographics, health behaviors, and comorbid conditions including hypertension and diabetes. RESULTS: Analyses included 5,211 participants with mean age 74 years at baseline, of whom 545 (10.5%) developed incident HF over a median follow-up of 7.8 years. Mean 3MSE score was lower at the time of HF diagnosis compared with no HF, and declined faster after incident HF compared with no HF. For example, at age 80, covariate-adjusted predicted mean 3MSE score was 88.6 points (95% CI: 88.3, 89.0) in participants without HF, but 87.6 points (95% CI: 87.3, 87.9) in those with newly diagnosed HF. Predicted five-year decline in mean 3MSE score from age 80 to age 85 was 5.9 points (95% CI: 5.7, 6.0) in participants without HF, but 10.0 points (95% CI: 8.6, 11.3) in those diagnosed with incident HF at age 80. Faster decline in 3MSE score after HF diagnosis was seen at all ages studied. The figure shows predicted mean 3MSE score trajectories without HF (solid line) and after HF diagnosed at ages 70, 75, 80, and 85 (dashed lines), with 95% CI shaded. CONCLUSIONS: Older adults diagnosed with incident HF experience faster average cognitive decline than those without HF.

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Trajectories Of Physical Disability And Cognitive Decline And The Risk Of Severe Sepsis Hospitalizations In Older Adults: The Cardiovascular Health Study

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a2284 ◽

2012 ◽

Author(s):

Faraaz A. Shah ◽

Karina Alvarez ◽

Judith Tate ◽

Francis Pike ◽

Nadia Hansel ◽

...

Keyword(s):

Older Adults ◽

Severe Sepsis ◽

Cognitive Decline ◽

Physical Disability ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study

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Abstract 029: Cardiovascular Health and Cognitive Decline in Older Adults: The Cardiovascular Health Study

Circulation ◽

10.1161/circ.139.suppl_1.029 ◽

2019 ◽

Vol 139 (Suppl_1) ◽

Author(s):

Kristine MaWhinney ◽

Mamadou D Tounkara ◽

Kirsten Evans ◽

Emily Startup ◽

Alexa Ehlert ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study

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Balance and cognitive decline in older adults in the cardiovascular health study

Age and Ageing ◽

10.1093/ageing/afab038 ◽

2021 ◽

Author(s):

Claire C Meunier ◽

Ellen Smit ◽

Annette L Fitzpatrick ◽

Michelle C Odden

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

P Value ◽

Digit Symbol Substitution Test ◽

Cross Sectional ◽

Symbol Substitution ◽

Rate Of Decline

Abstract Background Previous studies have demonstrated an association between gait speed and cognitive function. However, the relationship between balance and cognition remains less well explored. This study examined the cross-sectional and longitudinal relationship of balance and cognitive decline in older adults. Methods A cohort of 4,811 adults, aged ≥65 years, participating in the Cardiovascular Health Study was followed for 6 years. Modified Mini-Mental State Examination (3MSE) and Digit Symbol Substitution Test (DSST) were used to measure cognition. Tandem balance measures were used to evaluate balance. Regression models were adjusted for demographics, behavioural and disease factors. Results Worse balance was independently associated with worse cognition in cross-sectional analysis. Longitudinally, participants aged ≥76 years with poorer balance had a faster rate of decline after adjustment for co-variates: −0.97 points faster decline in 3MSE per year (95% confidence interval (CI): −1.32, −0.63) compared to the participants with good balance. There was no association of balance and change in 3MSE among adults aged <76 years (P value for balance and age interaction < 0.0001). DSST scores reflected −0.21 (95% CI: −0.37, −0.05) points greater decline when adjusted for co-variates. In Cox proportional hazard models, participants with worse balance had a higher risk of being cognitively impaired over the 6 years of follow-up visits (adjusted HR:1.72, 95% CI: 1.30, 2.29). Conclusions Future studies should evaluate standing balance as a potential screening technique to identify individuals at risk of cognitive decline. Furthermore, a better understanding of the pathophysiological link between balance and cognition may inform strategies to prevent cognitive decline.

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Abstract P348: Long-term Cognitive Decline in Older Adults After Incident Coronary Heart Disease or After First Receipt of Coronary Artery Bypass Grafting Surgery or Percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.141.suppl_1.p348 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Jacqueline E Kunzelman ◽

Rachel M Gabor ◽

Monica Scrobotovici ◽

Natalie J Blades ◽

W T Longstreth ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Cardiovascular Health ◽

Artery Bypass ◽

Coronary Intervention ◽

Health Study ◽

Cardiovascular Health Study ◽

Percutaneous Coronary

Objective: We investigated two hypotheses: First, incident CHD, defined as myocardial infarction or definite angina, leads to faster long-term cognitive decline. Second, among those with CHD, treatment with CABG surgery or PCI leads to slower long-term cognitive decline. Methods: The Cardiovascular Health Study is a cohort of US adults aged 65+. Global cognitive ability was assessed annually up to 9 times from 1990 to 1998 with the 100-point Modified Mini-Mental State Examination (3MS). We estimated trajectories of 3MS scores in the absence of stroke, adjusting for demographics, health behaviors, and comorbidities. For hypothesis 1, we compared 3MS trajectory after incident CHD with 3MS trajectory in the absence of CHD, censoring at first receipt of CABG/PCI. For hypothesis 2, among participants with CHD, we compared 3MS trajectory after first receipt of CABG/PCI with 3MS trajectory without CABG/PCI. Results: For hypothesis 1, of 4,122 participants, 398 had incident CHD during a mean of 5.9 years of follow-up. Figure Panel A shows model-predicted mean 3MS trajectories without CHD (blue) and after incident CHD (red) diagnosed at ages 70, 75, 80, or 85. Model-predicted 3MS score declined faster after incident CHD, especially for CHD diagnosed at age 80 or later. For example, after incident CHD at age 85, predicted 5-year decline in mean 3MS score through age 90 was 13.9 points (95% CI: 11.0, 16.7) versus 8.9 points (95% CI: 8.1, 9.7) among those without CHD. For hypothesis 2, of 1,183 participants who had prevalent or incident CHD, 118 had their first CABG/PCI during a mean of 4.1 years of follow-up. Model-predicted 3MS score declined faster after first receipt of CABG/PCI ( Figure Panel B ). Conclusions: Older adults diagnosed with incident CHD had faster average cognitive decline than those without CHD. However, treatment with CABG/PCI did not slow cognitive decline among those with CHD. This finding may be due to adverse effects of CABG/PCI on brain health or CABG/PCI recipients having more severe CHD or more cerebral atherosclerosis.

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