This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background and Objectives Carotid intima-media thickness (c-IMT) is a measurement of atherosclerosis, a progressive disease that develops as early as childhood and has been linked with cognitive impairment and dementia in the elderly. However, the relationship between c-IMT and midlife cognitive function and the race and social disparities in this relationship remain unclear. We examined the association between c-IMT and cognitive function in midlife among Black and White participants from a semirural community-based cohort in Bogalusa, Louisiana.
Methods In this cross-sectional analysis of participants from the Bogalusa Heart Study, linear regression models were used to determine the association between c-IMT dichotomized above the 50th percentile (>0.87 mm), an a demographically standardized global cognitive score (GCS), and individual cognitive domain–based z scores. Stratified analyses were performed to evaluate the impact of race and the individual's education status.
Results A total of 1,217 participants (age 48 ± 5.28 years) were included; 66% (804) self-identified as White, and 34% (413) self-identified as Black. Of those, 58% (708) were women, and 42% (509) were men. Having a c-IMT ≥50th percentile was inversely associated with GCS (B ± SE −0.39 ± 0.18, p = 0.03), independently of cardiovascular risk factors (CVRFs) and achieved education. The effect remained significant in Black and White participants after adjustment for CVRFs (Black participants: B ± SE −1.25 ± 0.45, p = 0.005; White participants: B ± SE −0.92 ± 0.35, p = 0.008) but not for education. The interaction between c-IMT ≥50th percentile and education was significant (p = 0.03), and stratified analysis showed an association with GCS among those with lower achieved education (B ± SE −0.81 ± 0.33, p = 0.013) independently of major CVRFs.
Discussion Subclinical atherosclerosis, measured as c-IMT, was associated with worse midlife cognitive function, independently of major CVRFs. The association was buffered by education and may be stronger among Black than White participants, likely due to corresponding structural and social determinants. These findings underscore the importance of establishing preventive measures in midlife and suggest subclinical atherosclerosis as a potential target to prevent cognitive decline.
Glossary
- AD=
- Alzheimer disease;
- ADRD=
- AD and related dementias;
- BHS=
- Bogalusa Heart Study;
- BMI=
- body mass index;
- BP=
- blood pressure;
- c-IMT=
- carotid intima-media thickness;
- CARDIA=
- Coronary Artery Risk Development in Young Adults;
- CVRF=
- cardiovascular risk factors;
- DBP=
- diastolic BP;
- GCS=
- global cognitive z score;
- HDL=
- high-density lipoprotein;
- LCC=
- left common carotid;
- LIC=
- left internal carotid;
- NP=
- neuropsychological;
- RCB=
- right carotid bulb;
- RCC=
- right common carotid;
- SBP=
- systolic BP;
- WAIS-IV=
- Wechsler Adult Intelligence Scale 4th edition;
- WRAT=
- Wide Range Achievement Test
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
eReferences e1–e3 at links.lww.com/WNL/B843.
- Received August 23, 2021.
- Accepted in final form January 18, 2022.
- © 2022 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
