October 27, 2012Stroke110 citationsOpen Access
View Full PaperCarotid Atherosclerosis and Prospective Risk of Dementia
Key Result
Being in the upper quintile of carotid intimal medial thickness was associated with a >2.5-fold increased risk of developing dementia and Alzheimer disease.
Study Design
Type
Cohort (n=364)
Structured PICO
Is subclinical carotid atherosclerosis associated with an increased prospective risk of dementia and Alzheimer disease in older adults?
P
Population
364 adults aged 60-95 years (median age 73, 40% female) from the Baltimore Longitudinal Study of Aging, followed for a median of 7.0 years to assess prospective risk of dementia.
E
Exposure
Upper quintile of carotid intimal medial thickness or bilateral carotid plaque (exposure)
C
Comparator
Lower quintiles of carotid intimal medial thickness or no plaque at baseline
O
Outcome
All-cause dementia and Alzheimer disease (AD)hard clinical
Subclinical carotid atherosclerosis, specifically increased intimal medial thickness and bilateral plaque, is associated with a significantly higher prospective risk of developing all-cause dementia and Alzheimer's disease.
Main Result
Hazard Ratio: 2.5
Abstract
BACKGROUND AND PURPOSE: Although vascular risk factors have been implicated in the development of all-cause dementia and Alzheimer disease (AD), few studies have examined the association between subclinical atherosclerosis and prospective risk of dementia. METHODS: Participants from the Baltimore Longitudinal Study of Aging (n=364; age, 60-95 years; median age, 73; 60% male; 82% white) underwent initial carotid atherosclerosis assessment and subsequently were assessed for dementia and AD annually for up to 14 years (median, 7.0). Cox proportional hazards models predicting all-cause dementia and AD were adjusted for age, sex, race, education, blood pressure, cholesterol, cardiovascular disease, diabetes mellitus, and smoking. RESULTS: Sixty participants developed dementia, with 53 diagnosed as AD. Raw rates of future dementia and AD among individuals initially in the upper quintile of carotid intimal medial thickness or with bilateral carotid plaque were generally double the rates of individuals with intimal medial thickness in the lower quintiles or no plaque at baseline. Adjusted proportional hazards models revealed >2.5-fold increased risk of dementia and AD among individuals in the upper quintile of carotid intimal medial thickness, and approximately 2.0-fold increased risk of dementia among individuals with bilateral plaque. CONCLUSIONS: Multiple measures of carotid atherosclerosis are associated with prospective risk of dementia. Individuals in the upper quintile of carotid intimal medial thickness or bilateral carotid plaque were at greatest risk. These findings underscore the possibility that early intervention to reduce atherosclerosis may help delay or prevent onset of dementia and AD.