Vascular health and cognitive function in older adults with cardiovascular disease

Forman, Daniel E.; Cohen, Ronald A.; Hoth, Karin F.; Haley, Andreana P.; Poppas, Athena; Moser, David J.; Gunstad, John; Paul, Robert H.; Jefferson, Angela L.; Tate, David F.; Ono, Makoto; Wake, Nicole; Gerhard-Herman, Marie

doi:10.1016/j.artres.2008.01.001

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Volume 2, Issue 1 , Pages 35-43, February 2008

Vascular health and cognitive function in older adults with cardiovascular disease

Daniel E. Forman
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
- Geriatric Research, Education, and Clinical Care, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
- Corresponding author at: Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA. Tel.: +1 617 732 5672; fax: +1 617 732 7134.
Ronald A. Cohen
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA
Karin F. Hoth
- Department of Medicine, National Jewish and Medical Research Centre, Denver, CO, USA
- Department of Psychiatry, University of Colorado at Denver and Health Sciences Centre, Denver, CO, USA
Andreana P. Haley
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
Athena Poppas
- Department of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, RI, USA
David J. Moser
- Department of Psychiatry, University of Iowa, IA, USA
John Gunstad
- Department of Psychology, Kent State University, Kent, OH, USA
Robert H. Paul
- Department of Psychology, University of Missouri, St Louis, MO, USA
Angela L. Jefferson
- Department of Neurology, Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA, USA
David F. Tate
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
Makoto Ono
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA
Nicole Wake
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
Marie Gerhard-Herman
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA

Received 10 August 2007; received in revised form 15 December 2007; accepted 10 January 2008. published online 04 March 2008.

Summary

Background

We hypothesized that changes in vascular flow dynamics resulting from age and cardiovascular disease (CVD) would correlate to neurocognitive capacities, even in adults screened to exclude dementia and neurological disease. We studied endothelial-dependent as well as endothelial-independent brachial responses in older adults with CVD to study the associations of vascular responses with cognition. Comprehensive neurocognitive testing was used to discern which specific cognitive domain(s) correlated with the vascular responses.

Methods

Eighty-eight independent, community-dwelling older adults (70.02±7.67years) with mild to severe CVD were recruited. Enrollees were thoroughly screened to exclude neurological disease and dementia. Flow-mediated (endothelial-dependent) and nitroglycerin-mediated (endothelial-independent) brachial artery responses were assessed using 2-D ultrasound. Cognitive functioning was assessed using comprehensive neuropsychological testing. Linear regression analyses were used to evaluate the relationships between the endothelial-dependent and endothelial-independent vascular flow dynamics and specific domains of neurocognitive function.

Results

Endothelial-dependent and endothelial-independent brachial artery responses both correlated with neurocognitive testing indices. The strongest independent relationship was between endothelial function and measures of attention-executive functioning.

Conclusions

Endothelial-dependent and endothelial-independent vascular responsiveness correlate with neurocognitive performance among older CVD patients, particularly in the attention-executive domain. While further study is needed to substantiate causal relationships, our data demonstrate that brachial responses serve as important markers of risk for common neurocognitive changes. Learning and behavior-modifying therapeutic strategies that compensate for such common, insidious neurocognitive limitations will likely improve caregiving efficacy.

Keywords: Cardiovascular disease, Vascular function, Age, Endothelium, Neurocognitive performance