Affiliation:
1. Universitätsmedizin Greifswald
2. NVS, Karolinska Institutet
3. Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin
Abstract
Abstract
Introduction: Growing evidence suggests a causal role for atherosclerotic vascular disease in cognitive impairment and dementia. Atherosclerosis may present as monovascular disease (monoVD) or as widespread polyvascular atherosclerotic disease polyVD). Evidence on the relationship between monoVD or polyVD and cognitive impairment is limited.
Methods: We conducted a cross-sectional analysis of baseline data from the LipidCardio Study. The main outcome measure was the presence of cognitive impairment, defined as a Mini-Mental State Examination (MMSE) score < 26.
Results: The mean age was 71.5 years, 30.3% were female, 17.3% had no evidence of large-vessel atherosclerosis, 71.1% had monoVD, and 11.7% had polyVD, defined as the presence of atherosclerosis in ≥2 vascular territories (coronary, cerebral, aortic, or lower extremity). A total of 21.6% had cognitive impairment according to the prespecified cutoff (MMSE < 26). Overall, the odds of cognitive impairment increased for each additional vascular territory affected by atherosclerosis (adjusted odds ratio 1.76, 95% confidence interval (CI) 1.21-2.57, p = 0.003). Furthermore, there is evidence for an interaction between vascular disease and chronic kidney disease (CKD). The odds of cognitive impairment were not greater in the monoVD subgroup than in the no atherosclerosis subgroup (OR 1.05, 95% CI 0.50-2.19; p = 0.906), while the odds ratio (OR) of cognitive impairment with polyVD compared to no atherosclerosis was 3.15 (95% CI 1.24-8.00; p = 0.015). In contrast, in patients with CKD, both monoVD and polyVD were associated with significantly greater odds of cognitive impairment than was no atherosclerosis.
Conclusions: PolyVD is associated with increased odds of cognitive impairment. MonoVD is associated with cognitive impairment only in the presence of CKD.
Publisher
Research Square Platform LLC