Cardiovascular Health and Rate of Cognitive Decline in Preclinical Dementia: A 12-Year Population-Based Study

• Published in: Neuropsychology Vol. 38; no. 3; pp. 211 - 222
• Main Authors: Speh, Andreja, Payton, Nicola Maria, Kramberger, Milica G., Grande, Giulia, Qiu, Chengxuan, Winblad, Bengt, Fratiglioni, Laura, Bäckman, Lars, Laukka, Erika J.
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-03-2024
• Subjects: Aging; Cardiovascular Health; Cognition; Cognitive Impairment; Dementia; Epidemiology; Female; Human; Male; Medicin och hälsovetenskap; preclinical dementia; Risk Factors; vascular risk factors; preclinical dementia; epidemiology; aging; cognition; vascular risk factors
• ISSN: 0894-4105; 1931-1559; 1931-1559
• DOI: 10.1037/neu0000925

Objective: We investigated whether vascular risk factors (VRFs), assessed with Life's Simple 7 (LS7), are associated with the rate of cognitive decline in the years preceding a dementia diagnosis. Method: This study included 1,449 stroke-free participants aged ≥60 years from the Swedish National Study on Aging and Care in Kungsholmen, who underwent repeated neuropsychological testing (episodic memory, semantic memory, verbal fluency, perceptual speed) across 12 years. The LS7 score, assessed at baseline, included smoking, diet, physical activity, body mass index, plasma glucose, total cholesterol, and blood pressure. Preclinical dementia was defined as being dementia-free at baseline and diagnosed with dementia during follow-up. Level and change in cognitive performance as a function of LS7 category (poor vs. intermediate to optimal) and future dementia status were estimated using linear mixed-effect models. Results: Participants who later developed dementia had, on average, a poorer LS7 score compared to those who remained dementia-free. For individuals aged 60-72 years, poor diet was associated with accelerated decline in perceptual speed (β = −0.05, 95% CI [−0.08, −0.02]), and a poor glucose score was associated with faster rates of verbal fluency (β = −0.019, 95% CI [−0.09, −0.01]) and global cognitive (β = −0.028, 95% CI [−0.06, 0.00]) decline in the preclinical dementia group. Conclusions: VRFs exacerbate rate of cognitive decline in the years preceding a dementia diagnosis. This effect was most pronounced in young-old age and primarily driven by diet and glucose. The effect of VRFs may be especially detrimental for cognitive decline trajectories of individuals with impending dementia.
Key Points
Question: This study investigated whether vascular risk factors (smoking, diet, physical activity, body mass index, plasma glucose, total serum cholesterol, and blood pressure) are associated with accelerated cognitive decline in the preclinical dementia phase. Findings: The results indicated that poor cardiovascular health might be associated with further acceleration of cognitive decline in the years preceding a dementia diagnosis. Importance: The preclinical dementia stage could be the last opportunity to influence the rate of cognitive decline by altering vascular risk factors. Next Steps: Future studies should investigate the extent to which management of VRFs in individuals at increased risk of dementia may slow down cognitive decline.