Subclinical vascular burden in relation to cognitive decline and impairment: The Multi‐Ethnic Study of Atherosclerosis (MESA)

INTRODUCTION: Subclinical cardiovascular disorders may be differentially associated with cognitive function, decline, and impairment and point to pathways linking vascular disorders to dementia. METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) collected detailed subclinical vascular measures at baseline in 6814 participants with follow-up clinical examinations over 20 years. Baseline subclinical vascular measures aggregated into four uncorrelated factor composites: atherosclerosis, arteriosclerosis, blood pressure, and cardiac function. Cognitive performance was measured 10 years after baseline, repeated twice over the subsequent decade, along with detailed cognitive testing and adjudication. RESULTS: Higher baseline arteriosclerosis and atherosclerosis scores predicted greater cognitive decline, lower performance across multiple domains, and higher odds of mild cognitive impairment and dementia 20 years later. Associations were weaker for cardiac function and blood pressure composites. Stratified analyses confirmed generalizability across subgroups. DISCUSSION: Arteriosclerosis and atherosclerosis were more consistently associated with cognitive impairment and decline than cardiac function and blood pressure in a diverse population over 20 years. HIGHLIGHTS: Subclinical factor relationships varied by cognitive domain and race/ethnicity. These observed associations were independent of clinical risk for dementia. Arteriosclerosis most consistently associated with cognitive function and decline.