Predict Midlife Cognitive Decline With Heart Disease Risk Scores

Heart disease and stroke risk prediction tools may be more useful in predicting cognitive decline in middle-aged patients than a dementia risk test, according to a new study.

“Many physicians may be aware of the link between cardiovascular disease risk factors and cognitive function, but they are not likely to educate their patients about this risk,” lead author Sara Kaffashian, PhD, with the French National Institute of Health and Medical Research in Paris, told ConsultantLive.

“The knowledge that these risk factors increase not only the risk of cardiovascular disease, such as myocardial infarction and stroke, but also the risk of cognitive decline may provide an added incentive for early treatment and management of these risk factors.”

In a longitudinal cohort study, French researchers assessed vascular risk factors of 4827 patients, mean age 55 years. They compared the Framingham general cardiovascular disease risk score and the Framingham stroke risk score with the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score that uses risk factors in midlife to estimate risk of late-life dementia.

Although all 3 risk scores predicted cognitive decline over 10 years, the Framingham cardiovascular and stroke risk scores were associated with decline in more cognitive domains than the dementia risk score.

“The Framingham cardiovascular and stroke risk scores are composed of risk factors for cardiovascular disease that have been shown to be associated with cognitive function as well as subclinical markers of brain pathology,” said Dr Kaffashian. “Therefore, they may be more sensitive in distinguishing individuals with subclinical brain pathology.”

The Framingham cardiovascular risk scores (and other cardiovascular risk scores) often are used in primary care and are featured in various clinical practice guidelines.

“It is important to note that the predicted cardiovascular risk does not correspond to the same risk of cognitive decline, so these risk scores cannot be used in this way,” Dr Kaffashian said. “However, individuals who are at high risk for cardiovascular disease may be told that cardiovascular disease risk factors can also affect their brain health, putting them at higher risk for cognitive decline.”

Currently there are no dementia risk scores that can reliably predict risk of cognitive decline or dementia based on midlife risk factors. Dr Kaffashian noted that the majority of existing dementia risk scores are intended for use in older adults. They are different from the CAIDE risk score, which uses midlife risk factors.

“Our research highlights the importance of cardiovascular disease risk factors in affecting cognitive function starting in midlife,” she said.

In an editorial, Hans-Christoph Diener of the Department of Neurology and Stroke Centre, University Hospital Essen, Germany, wrote: “The results clearly indicate that we should not wait to identify possible vascular risk factors in the population until people reach retirement age. Prevention programs need to start at age 50 at the latest. At present, we tell persons with vascular risk about the risk of myocardial infarction and stroke. In future, we should also tell them that vascular risk factors are also risk factors for cognitive decline and most probably dementia.”

The researchers published their results in the April 2, 2013, print issue of Neurology.