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Vascular Risk Factors and Cognitive Decline in a Population Sample

Ganguli, Mary MD, MPH*,†,‡; Fu, Bo PhD*; Snitz, Beth E. PhD; Unverzagt, Frederick W. PhD§; Loewenstein, David A. PhD∥,¶; Hughes, Tiffany F. PhD*; Chang, Chung-Chou H. PhD#,**

Alzheimer Disease & Associated Disorders: January-March 2014 - Volume 28 - Issue 1 - p 9–15
doi: 10.1097/WAD.0000000000000004
Original Articles

We examined several vascular factors in relation to the rates of decline in 5 cognitive domains in a population-based cohort. In an age-stratified random sample (N=1982) aged 65+ years, we assessed at baseline the cognitive domains of attention, executive function, memory, language, and visuospatial function, and also vascular, inflammatory, and metabolic indices. Random effects models generated slopes of cognitive decline over the next 4 years; linear models identified vascular factors associated with these slopes, adjusting for demographics, baseline cognition, and potential interactions. Several vascular risk factors (history of stroke, diabetes, central obesity, C-reactive protein), although associated with lower baseline cognitive performance, did not predict rate of subsequent decline. APOE*4 genotype was associated with accelerated decline in language, memory, and executive functions. Homocysteine elevation was associated with faster decline in executive function. Hypertension (history or systolic blood pressure >140 mm Hg) was associated with slower decline in memory. Baseline alcohol consumption was associated with slower decline in attention, language, and memory. Different indices of vascular risk are associated with low performance and with rates of decline in different cognitive domains. Cardiovascular mechanisms explain at least some of the variance in cognitive decline. Selective survival may also play a role.

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Departments of *Psychiatry


#Medicine, University of Pittsburgh School of Medicine

Departments of Epidemiology

**Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

§Department of Psychiatry, School of Medicine, Indiana University, Bloomington, IN

Department of Psychiatry and Behavioral Sciences

Center on Aging, Miller School of Medicine, University of Miami, Miami, FL

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Supported in part by grants R01AG023651 and K24AG022035 (M.G.), K23AG038479 (B.E.S.), R01 AG026096 and P30 AG10133 (F.W.U.) from the National Institute on Aging, and U01 NR04508 from National Institute of Nursing Research (F.W.U.).

The authors declare no conflicts of interest.

Reprints: Mary Ganguli, MD, MPH, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213 (e-mail:

Received May 1, 2013

Accepted August 12, 2013

© 2014 by Lippincott Williams & Wilkins.