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Midlife Cardiovascular Risk Impacts Executive Function: Framingham Offspring Study

Nishtala, Arvind BA*; Preis, Sarah R. ScD, MPH; Beiser, Alexa PhD*,†; Devine, Sherral PhD*; Hankee, Lisa PhD*; Seshadri, Sudha MD*; Wolf, Philip A. MD*; Au, Rhoda PhD*

Alzheimer Disease & Associated Disorders: January-March 2014 - Volume 28 - Issue 1 - p 16–22
doi: 10.1097/WAD.0b013e3182a715bc
Original Articles

Introduction: Novel error scores and traditional indices of executive function (EF) were related to cardiovascular risk factors measured 10 to 15 years earlier.

Methods: From 1991 to 1995, the Framingham Stroke Risk Profile (FSRP), a composite score of cardiovascular risk, was ascertained in 1755 Framingham Offspring participants (54% women, mean age=54±9 y). Participants were administered EF tests, which included: FAS and Animals Fluency tests, Trail Making Test B (TrB), and Digit Span-Backwards (DS-B), from 2005 to 2009. Linear and logistic regression were used to relate the FSRP and its components to both error responses and traditional scores.

Results: Consistent with previous findings, the FSRP and the individual components, diabetes and sex, were associated with several traditional measures of EF. Of interest were relationships between the FSRP score and TrB Total Errors (P=0.04), DS-B% Total Errors (P=0.02) and DS-B Capacity Score (P=0.03), and prevalent CVD related to making FAS Perseverations in the 75th percentile (P=0.03). By comparison, FSRP and CVD were not related to the traditional DS-B or FAS scores. In addition, age was associated with higher Animals % Total Errors and % Perseverations among ApoE4+ individuals and with higher TrB Total Errors among ApoE4− individuals.

Conclusions: For those middle-aged and healthy, including those who are ApoE4+, cardiovascular risk factors are related to impairments in EF as ascertained by novel errors and traditional measures.

*Framingham Heart Study, Department of Neurology, Boston University School of Medicine

Framingham Heart Study, Department of Biostatistics, Boston University School of Public Health, Boston, MA

Supported by the Framingham Heart Study’s National Heart, Lung, and Blood Institute contract (N01-HC-25195) and by grants from the National Institute of Neurological Disorders and Stroke (R01 NS17950) and from the National Institute on Aging (R01 AG16495; AG08122).

The authors declare no conflicts of interest.

Reprints: Rhoda Au, PhD, Framingham Heart Study, Department of Neurology, Boston University School of Medicine, 72 East Concord St., Boston, MA 02118 (e-mail:

Received February 13, 2013

Accepted July 17, 2013

© 2014 by Lippincott Williams & Wilkins.