Association of Cardiovascular Risk Trajectory With Cognitive Decline and Incident Dementia

Abstract

Background and Objectives:Cardiovascular risk factors have a recently established association with cognitive decline and dementia, yet most studies examine this association through cross-sectional data, precluding an understanding of the longitudinal dynamics of such risk. The current study aims to explore how the ongoing trajectory of cardiovascular risk impacts subsequent dementia and memory decline risk. We hypothesize that an accelerated, long-term accumulation of cardiovascular risk, as determined by the Framingham Risk Score (FRS), will be more detrimental to cognitive and dementia state outcomes than a stable cardiovascular risk.Methods:We assessed an initially healthy, community-dwelling sample recruited from the prospective cohort Betula study. Cardiovascular disease risk, as assessed by the Framingham Risk Score, episodic memory performance, and dementia status were measured at each 5-year timepoint (T) across 20-25 years. Analysis was performed with Bayesian additive regression testing (BART), a semi-parametric machine-learning method, applied herein as a multi-state survival analysis method.Results:Of the 1244 participants, cardiovascular risk increased moderately over time in 60% of sample, with observations of an accelerated increase in 18% of individuals, and minimal change in 22% of individuals. An accelerated, as opposed to a stable cardiovascular risk trajectory, predicted an increased risk of developing Alzheimer’s disease dementia (average risk ratio (RR): 3.3-5.7, 95% CI: 2.6–17.5 at T2, 1.9-6.7 at T5) or vascular dementia (average RR: 3.3-4.1, 95% CI: 1.1–16.6 at T2, 1.5-7.6 at T5), and was associated with an increased risk of memory decline (average RR: 1.4-1.2, 95% CI: 1-1.9 at T2, 1-1.5 at T5). A stable cardiovascular risk trajectory appeared to partially mitigate Alzheimer’s disease dementia risk for APOE4 carriers.Discussion:The findings of the current study show that the longitudinal, cumulative trajectory of cardiovascular risk is predictive of dementia risk and associated with the emergence of memory decline. As a result, clinical practice may benefit from directing interventions towards individuals with accelerating cardiovascular risk.