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Cardiovascular Diseases and Decline in Cognitive Function in an Elderly Community Population: The Edinburgh Artery Study

From the Wolfson Unit for Prevention of Peripheral Vascular Diseases (S.B.R., F.B.S., F.G.R.F.), Public Health Sciences, Medical School, University of Edinburgh, Edinburgh, Scotland; Department of Psychology (I.J.D., M.C.W.), School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, Scotland.

Address correspondence and reprint requests to Snorri B. Rafnsson, Wolfson Unit for Prevention of Peripheral Vascular Diseases, Public Health Sciences, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK. E-mail: S.B.Rafnsson{at}ed.ac.uk

Objective: To investigate cognitive performance and 4-year change in cognitive function in relation to different clinical manifestations of atherosclerotic disease in an elderly community population.

Methods: The Edinburgh Artery Study is a population cohort study of men and women who were recruited to a baseline survey in 1987 and 1988. From the time of study entry, the participants have been invited to two follow-up clinical examinations and continuously monitored for major fatal and nonfatal vascular events. All alive and eligible subjects were invited for cognitive testing in two study years when the mean age of the sample was 73.1 (standard deviation = 5.0) years. A follow-up cognitive assessment was performed in 2002 and 2003 on 452 survivors.

Results: In multivariate analyses controlling for demographic characteristics, depression, and major atherosclerotic risk factors, stroke was associated with a significantly worse performance on tests of verbal memory (p = .02) and letter fluency (p = .002). In addition, stroke was related to a significantly steeper 4-year decline in verbal memory performance (p = .04). Among the subjects who had not had an overt stroke, those with symptomatic peripheral arterial disease experienced a significantly greater 4-year decline in verbal memory functioning (p = .04).

Conclusions: In older people, stroke is associated with both worse performance on cognitive tests and progressive verbal memory decline. Elderly individuals with vascular diseases other than stroke may also be vulnerable to a greater decline in verbal memory function. A relationship between vascular diseases and verbal memory decline may exist independently of depressed mood and major atherosclerotic risk factors.

Key Words: cognitive decline • cardiovascular diseases • elderly population • atherosclerosis • aging

Abbreviations: CVD = cardiovascular disease; PAD = peripheral arterial disease; IC = intermittent claudication; MI = myocardial infarction; WHO = World Health Organization; ECG = electrocardiogram; MRI = magnetic resonance imaging; LMT = logical memory test; RPM = Raven’s progressive matrices; VFT = verbal fluency test; DST = digit symbol test; NART = national adult reading test; GCF = general cognitive factor; SD = standard deviation; MMSE = mini-mental state examination; CHD = coronary heart disease; SBP = systolic blood pressure.

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