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. 2024 Jul:273:10-20.
doi: 10.1016/j.ahj.2024.03.016. Epub 2024 Apr 2.

Association of cardiovascular diseases with cognitive performance in older adults

Dae Yong Park  1 , Yasser Jamil  2 , Golsa Babapour  3 , Junglee Kim  1 , Greta Campbell  4 , Zafer Akman  5 , Ajar Kochar  6 , Sounok Sen  3 , Marc D Samsky  3 , Nikhil V Sikand  3 , Jennifer Frampton  3 , Abdulla Al Damluji  7 , Michael G Nanna  8
Affiliations

Association of cardiovascular diseases with cognitive performance in older adults

Dae Yong Park et al. Am Heart J. 2024 Jul.

Abstract

Background: Cognitive function and cardiovascular disease (CVD) have a bidirectional relationship, but studies on the impact of CVD subtypes and aging spectrum have been scarce.

Methods: We assessed older adults aged ≥60 years from the 2011 to 2012 and 2013 to 2014 cycles of the National Health and Nutrition Examination Survey who had coronary heart disease, angina, prior myocardial infarction, congestive heart failure, or prior stroke. We compared CERAD-IR, CERAD-DR, Animal Fluency test, and DSST scores to assess cognitive performance in older adults with and without CVD.

Results: We included 3,131 older adults, representing 55,479,673 older adults at the national level. Older adults with CVD had lower CERAD-IR (mean difference 1.8, 95% CI 1.4-2.1, P < .001), CERAD-DR (mean difference 0.8, 95% CI 0.6-1.0, P < .001), Animal Fluency test (mean difference 2.1, 95% CI 1.6-2.6, P < .001), and DSST (mean difference 9.5, 95% CI 8.0-10.9, P < .001) scores compared with those without CVD. After adjustment, no difference in CERAD-IR, CERAD-DR, and Animal Fluency test scores was observed, but DSST scores were lower in older adults with CVD (adjusted mean difference 2.9, 95% CI 1.1-4.7, P = .001). Across CVD subtypes, individuals with congestive heart failure had lower performance on the DSST score. The oldest-old cohort of patients ≥80 years old with CVD had lower performance than those without CVD on both the DSST and Animal Fluency test.

Conclusion: Older adults with CVD had lower cognitive performance as measured than those free of CVD, driven by pronounced differences among those with CHF and those ≥80 years old with CVD.

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Conflict of interest statement

Conflict of interest Sikand NV: Dr. Sikand reports being a consultant for Bristol Myers Squibb; Frampton: Dr. Frampton reports current research support from the Patient-Centered Outcomes Research Institution (PCORI); Damluji AA: Dr. Damluji receives research funding from the Pepper Scholars Program of the Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the National Institute on Aging P30-AG021334 and receives mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute K23-HL153771-01; Nanna MG: Dr. Nanna reports current research support from the American College of Cardiology Foundation supported by the George F. and Ann Harris Bellows Foundation, the Patient-Centered Outcomes Research Institute (PCORI), the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), and the National Institute on Aging/National Institutes of Health from R03AG074067 (GEMSSTAR award). Dr. Nanna also reports being a consultant for Heartflow and Merck. The rest of the authors have nothing to disclose.

Figures

Figure 1.
Figure 1.. Flowchart of this study
The flowchart illustrates the process whereby the older adults who were tested for cognitive performance were included from the NHANES 2011–2012 and 2013–2014 cycles. Abbreviation: NHANES, National Health and Nutrition Examination Survey
Figure 2.
Figure 2.. Subgroup analysis in different cardiovascular diseases
The plots demonstrate the adjusted mean differences between older adults with and without individual cardiovascular disease. Positive values are observed when patients without any cardiovascular disease scored higher than those with the specified cardiovascular disease on the specific measure. Negative values imply that the individuals with cardiovascular disease had higher performance than those without cardiovascular disease. The circle represents the adjusted mean difference, and the horizontal lines represent 95% confidence intervals. The vertical dotted red line represents 0, or no mean difference. Horizontal lines that overlap the vertical dotted line are non-significant. Asterisk (*) marks adjusted mean differences with statistical significance (p<0.05). Abbreviation: CERAD-DR, Consortium to Establish a Registry for Alzheimer’s Disease – Delayed Recall; CERAD-IR, Consortium to Establish a Registry for Alzheimer’s Disease – Immediate Recall; DSST, Digit Symbol Substitution test
Figure 3.
Figure 3.. Subgroup analysis in different age groups
The plots show the adjusted mean differences between older adults with and without cardiovascular disease in different age groups. Positive values show that patients without cardiovascular diseases scored higher than those with cardiovascular diseases and negative values show the opposite. The circle represents the adjusted mean difference, and the horizontal lines represent 95% confidence intervals. The vertical dotted red line represents 0, or no mean difference. Horizontal lines that overlap the vertical dotted line are non-significant. Asterisk (*) marks adjusted mean differences with statistical significance (p<0.05). Abbreviation: CERAD-DR, Consortium to Establish a Registry for Alzheimer’s Disease – Delayed Recall; CERAD-IR, Consortium to Establish a Registry for Alzheimer’s Disease – Immediate Recall; DSST, Digit Symbol Substitution test
Central Illustration
Central Illustration
The central figure summarizes the main findings of this study. Positive mean differences are observed when patients without any cardiovascular disease scored higher than those with the specified cardiovascular disease on the specific measure. Negative values imply that the individuals with cardiovascular disease had higher performance than those without cardiovascular disease. Abbreviation: CERAD-DR, Consortium to Establish a Registry for Alzheimer’s Disease – Delayed Recall; CERAD-IR, Consortium to Establish a Registry for Alzheimer’s Disease – Immediate Recall; NHANES, National Health and Nutrition Examination Survey
See this image and copyright information in PMC

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