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Serum Cholesterol and Cognitive Performance in the Framingham Heart Study

Elias, Penelope K. PhD; Elias, Merrill F. PhD; D’Agostino, Ralph B. PhD; Sullivan, Lisa M. PhD; Wolf, Philip A. MD

doi: 10.1097/01.psy.0000151745.67285.c2
Original Articles

Objective: The objective of this study was to examine the relationship between total cholesterol (TC) and cognitive performance within the context of the Framingham Heart Study, a large, community-based, prospective investigation of cardiovascular risk factors.

Methods: Participants were 789 men and 1105 women from the Framingham Heart Study original cohort who were free of dementia and stroke and who received biennial TC determinations over a 16- to 18-year surveillance period. Cognitive tests were administered 4 to 6 years subsequent to the surveillance period and consisted of measures of learning, memory, attention/concentration, abstract reasoning, concept formation, and organizational abilities. Statistical models were adjusted for multiple demographic and biological covariates.

Results: There was a significant positive linear association between TC and measures of verbal fluency, attention/concentration, abstract reasoning, and a composite score measuring multiple cognitive domains. Performance levels for three clinically defined groups were examined. Participants with “desirable” TC levels (<200 mg/dL) performed less well than participants with borderline-high TC levels (200–239 mg/dL) and participants with high TC levels (∃240 mg/dL).

Conclusions: Lower naturally occurring TC levels are associated with poorer performance on cognitive measures, which place high demands on abstract reasoning, attention/concentration, word fluency, and executive functioning.

CVD = cardiovascular disease; TC = total cholesterol; MAP = mean arterial pressure; BMI = body mass index.

From the Department of Mathematics and Statistics, Boston University, Boston, Massachusetts (P.K.E., M.F.E., R.B.D.); the Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts (L.M.S.); and the Department of Neurology, Boston University School of Medicine, Boston, Massachusetts (P.A.W.).

Address correspondence and reprint requests to Penelope K. Elias, PhD, Statistics and Consulting Unit, Department of Mathematics and Statistics, Boston University, 111 Cummington St., Boston, MA 02215. E-mail:

Received for publication December 16, 2002; revision received August 17, 2004.

This research was supported by NHLBI’s Framingham Heart Study (NHLBI/NIH Contract # N01–25195), and Grants: NIA 5R01-AG 16495, NIA 5R01-AG08122, NIA 4RO1 HL65177, NINDS 5R01-NS17950, Boston University ADC P30 AG13846 and NHLBI 3RO1 HL67358.

Copyright © 2005 by American Psychosomatic Society
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