Abstract P237: Measuring Cognition in the Atherosclerosis Risk in Communities (ARIC) Study Cohort: An approach to Account for Informative Attrition

Introduction: Understanding the role of risk factors associated with accelerated cognitive decline has important public health relevance for the aging US population. To test hypotheses that mid-life cardiovascular (CV) risk factors increase risk of dementia in old age, the Atherosclerosis Risk in Communities (ARIC) cohort was evaluated for dementia in 2011-2013. Anticipating challenges of complete dementia ascertainment in an elderly population, supplementary data sources were collected to aid analysis accounting for potentially informative attrition. Methods: ARIC enrolled 15,792 participants 45-64 years old at baseline (1987-1989) from four US communities and collected baseline CV exposure data. A complete neurocognitive battery including informant interview was completed 2011-2013, yielding an algorithmic diagnosis of dementia, mild cognitive impairment (MCI) or normal cognition. Cognitively impaired and a random sample of cognitively normal were selected for further clinical evaluation. Syndromic diagnoses (dementia/MCI/normal) and etiologic diagnoses were made by a panel of experts using standardized criteria. Standardized protocols, timely reports of reviewer reliability, ongoing training of reviewers and a web-based data management system were developed to ensure reliability, consistency and efficiency of data collection and review. Living participants not attending the visit were asked to complete the Telephone Interview for Cognitive Status (TICS). Based on dementia discharge codes and death codes identified during cohort surveillance, interviewer impression of hearing loss or cognitive impairment or need for a proxy during semi-annual calls, or random sampling, participants refusing the TICS are eligible for proxy dementia interview. Medicare claims are being examined to identify missed dementia discharge codes. Results: Of 11,017 participants alive as of 2011, 6495 (59%) completed the neurocognitive battery; 2937 of these (45%) were selected for, and completed, additional clinical assessments and classification by committee (algorithmic or reviewer diagnosis: dementia 5%, MCI 21%). Of the 4522 participants who did not undergo the neurocognitive battery, 1463 (32%) completed the TICS (dementia 7%), while 1627 of the remaining participants were eligible for proxy calls (903 completed to date, dementia 58%). Conclusions: Participants who were not examined were more likely to be cognitively impaired, highlighting the importance of collecting supplementary data to support analyses of midlife CV risk factors accounting for informative attrition. Collection of exam data in an elderly cohort is difficult and requires a multi-pronged approach, especially for an outcome highly correlated with attrition. The strategy described here could be applied in other settings.

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Midlife vascular risk factors and midlife cognitive status in relation to prevalence of mild cognitive impairment and dementia in later life: The Atherosclerosis Risk in Communities Study

Alzheimer s & Dementia ◽

10.1016/j.jalz.2018.03.011 ◽

2018 ◽

Vol 14 (11) ◽

pp. 1406-1415 ◽

Cited By ~ 24

Author(s):

David S. Knopman ◽

Rebecca F. Gottesman ◽

A. Richey Sharrett ◽

Amanda L. Tapia ◽

Sonia DavisThomas ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Later Life ◽

Cognitive Status ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk

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Epidemiology of Heart Failure Stages in Middle‐Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities Study

Journal of the American Heart Association ◽

10.1161/jaha.120.016524 ◽

2021 ◽

Author(s):

Ramachandran S. Vasan ◽

Solomon K. Musani ◽

Kunihiro Matsushita ◽

Walter Beard ◽

Olushola B. Obafemi ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Disease ◽

Left Ventricular ◽

Study Cohort ◽

Atherosclerosis Risk In Communities ◽

Cardiovascular Morbidity And Mortality ◽

Atherosclerosis Risk

Background Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling. Methods and Results We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993–1996, median age 58 years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1) Stage 0 : no risk factors; (2) Stage A : presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural/functional abnormality; (3) Stage B : presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4) Stage C/D : prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all‐cause mortality on follow‐up according to HF stage. The prevalence of HF Stages 0, A, B, and C/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow‐up (median 19.0 years), 309 participants developed overt HF, 390 incurred new‐onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person‐years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5‐ to 2‐fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0/A. Conclusions In our large community‐based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.

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Differences in Cardiovascular Mortality Risk among African Americans in the Minnesota Heart Survey: 1985-2015 vs The Atherosclerosis Risk in Communities Study Cohort: 1987-2015

Ethnicity & Disease ◽

10.18865/ed.29.1.47 ◽

2019 ◽

Vol 29 (1) ◽

pp. 47-52 ◽

Cited By ~ 3

Author(s):

Kristen M. George ◽

Aaron R. Folsom ◽

Lyn M. Steffen ◽

Lynne E. Wagenknecht ◽

Thomas H. Mosley

Keyword(s):

Risk Factors ◽

Risk Factor ◽

African Americans ◽

Population Based ◽

Study Cohort ◽

Cvd Risk ◽

Atherosclerosis Risk In Communities ◽

Hazard Ratios ◽

Atherosclerosis Risk ◽

Cvd Mortality

Geographic differences in cardiovascular disease (CVD) mortality among African Americans (AAs) are well-established, but not well-characterized. Using the Minnesota Heart Survey (MHS) and Atherosclerosis Risk in Communities (ARIC) Study, we aimed to assess whether CVD risk factors drive geographic disparities in CVD mortality among AAs.ARIC risk factors were measured between1987-1989 from a population-based sample of AAs, aged 45 to 64 years, living in Jackson, MS and Forsyth County, NC. Similar measures were made at MHS baseline, 1985, in AAs from Minneapolis-St. Paul, MN. CVD mortality was identified using ICD codes for underlying cause of death. We compared MHS and ARIC on CVD death rates using Poisson regression, risk factor prevalences, and hazard ratios using Cox regression.After CVD risk factor adjustment, AA men in MHS had 3.4 (95% CI: 2.1, 4.7) CVD deaths per 1000 person-years vs 9.9 (95% CI: 8.7, 11.1) in ARIC. AA women in MHS had 2.7 (95% CI: 1.8, 3.6) CVD deaths per 1000 person-years vs 6.7 (95% CI: 6.0, 7.4) in ARIC. A 2-fold higher CVD mortality rate remained in ARIC vs MHS after additional adjustment for education and income. ARIC had higher total cholesterol, hypertension, diabetes, and BMI, as well as less education and income than MHS. Risk factor hazard ratios of CVD death did not differ.The CVD death rate was lower in AAs in Minnesota (MHS) than AAs in the Southeast (ARIC). While our findings support maintaining low risk for CVD prevention, differences in CVD mortality reflect unidentified geographic variation.Ethn Dis. 2019;29(1):47-52; doi:10.18865/ ed.29.1.47

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Cognitive impairment and intracranial atherosclerotic stenosis in general population

Neurology ◽

10.1212/wnl.0000000000005250 ◽

2018 ◽

Vol 90 (14) ◽

pp. e1240-e1247 ◽

Cited By ~ 11

Author(s):

M. Fareed K. Suri ◽

Jincheng Zhou ◽

Ye Qiao ◽

Haitao Chu ◽

Adnan I. Qureshi ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Expert Panel ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Atherosclerosis Risk In Communities ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Atherosclerosis Risk ◽

History Of

ObjectiveTo investigate the association between asymptomatic intracranial atherosclerosis and cognitive impairment in the Atherosclerosis Risk in Communities (ARIC) cohort.MethodsARIC participants underwent high-resolution 3T magnetic resonance angiography and a neuropsychology battery and neurologic examination adjudicated by an expert panel to detect mild cognitive impairment (MCI) and dementia. We adjusted for demographic and vascular risk factors in weighted logistic regression analysis, accounting for stratified sampling design and attrition, to determine the association of intracranial atherosclerotic stenosis (ICAS) with cognitive impairment.ResultsIn 1,701 participants (mean age 76 ± 5.3, 41% men, 71% whites, 29% blacks) with adequate imaging quality and no history of stroke, MCI was identified in 578 (34%) and dementia in 79 (4.6%). In white participants, after adjustment for demographic and vascular risk factors, ICAS ≥50% (vs no ICAS) was strongly associated with dementia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7–10.0) and with any cognitive impairment (OR 1.7, 95% CI 1.1–2.8). In contrast, no association was found between ICAS ≥50% and MCI or dementia in blacks, although the sample size was limited and estimates were imprecise.ConclusionOur results suggest that asymptomatic ICAS is independently associated with cognitive impairment and dementia in whites.

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PREDICTORS OF GLOBAL COGNITIVE IMPAIRMENT 1 YEAR AFTER SUBARACHNOID HEMORRHAGE

Neurosurgery ◽

10.1227/01.neu.0000359317.15269.20 ◽

2009 ◽

Vol 65 (6) ◽

pp. 1043-1051 ◽

Cited By ~ 65

Author(s):

Mellanie V. Springer ◽

J. Michael Schmidt ◽

Katja E. Wartenberg ◽

Jennifer A. Frontera ◽

Neeraj Badjatia ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Activities Of Daily Living ◽

Daily Living ◽

Delayed Cerebral Ischemia ◽

Cognitive Status ◽

Cognitively Impaired

Abstract OBJECTIVE We sought to determine the frequency, risk factors, and impact on functional outcome and quality of life (QOL) of global cognitive impairment 1 year after subarachnoid hemorrhage. METHODS We prospectively evaluated global cognitive status 3 and 12 months after hospitalization with the Telephone Interview for Cognitive Status in 232 subarachnoid hemorrhage survivors. Cognitive impairment was defined as a score of 30 or less (scaled 0 = worst, 51 = best). Logistic regression was performed to calculate adjusted odds ratios (AORs) for impairment at 1 year. Basic activities of daily living were evaluated with the Barthel Index, instrumental activities of daily living were assessed with the Lawton scale, and QOL was evaluated with the Sickness Impact Profile. RESULTS The frequency of cognitive impairment was 27% at 3 months and 21% at 12 months. After the effects of age, education, and race/ethnicity were controlled for, risk factors for cognitive impairment at 12 months included anemia treated with transfusion (AOR, 3.4; P = 0.006), any temperature level higher than 38.6°C (AOR, 2.7; P = 0.016), and delayed cerebral ischemia (AOR, 3.6; P = 0.01). Among cognitively impaired patients at 3 months, improvement at 1 year occurred in 34% and was associated with more than 12 years of education and the absence of fever higher than 38.6°C during hospitalization (P = 0.015). Patients with cognitive impairment at 1 year had worse concurrent QOL and less ability to perform instrumental and basic activities of daily living (all P < 0.001). CONCLUSION Global cognitive impairment affects more than 20% of subarachnoid hemorrhage survivors at 1 year, is predicted by fever, anemia treated with transfusion, and delayed cerebral ischemia, and adversely affects functional recovery and QOL.

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Association of Posture, Gait, and Auditory Functioning with Cognitive Status in a Cohort of Community−Dwelling Older Adults

Applied Sciences ◽

10.3390/app11219970 ◽

2021 ◽

Vol 11 (21) ◽

pp. 9970

Author(s):

Emilija Kostic ◽

Kiyoung Kwak ◽

Dongwook Kim

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Early Detection ◽

Postural Stability ◽

Predictive Ability ◽

Cognitive Status ◽

Community Dwelling ◽

Home Healthcare ◽

Control Group ◽

Cognitively Impaired

Postural stability, hearing, and gait function deterioration are the risk factors associated with cognitive impairment. Although no method has been reported for treating severe cognitive impairment to date, developing an early detection model based on these risk factors could aid in slowing down or even reversing the deterioration process. In this study, the association between cognitive impairment and the combined predictive ability of sensory and gait features was assessed. Fifty−seven healthy community−dwelling men over the age of sixty−five participated in cognitive, postural stability, auditory, and level walking evaluations. They were divided into two groups: healthy control group (n = 39) and lower cognition group (n = 18), based on their Montreal cognitive assessment score. During gait, the center of mass of the cognitively impaired participants was confined to a smaller volume. Furthermore, the cognitively healthy participants were found to have better postural stability. Both groups possessed similar hearing ability; however, the cognitively impaired group made a significantly higher number of errors when repeating words or sentences. A logistic regression model utilizing each of these function quantifiers exhibited a high area under the receiver operating characteristic curve, suggesting excellent predictive ability. These models can be applied to smartphone or smart home healthcare technologies to detect the possibility of cognitive impairment, thus facilitating early detection.

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