Vascular Risk Factors and Cognitive Impairment

Vascular risk factors and cognitive impairment in a stroke-free cohort

F.W. Unverzagt, PhD, L.A. McClure, PhD, V.G. Wadley, PhD, N.S. Jenny, PhD, R.C. Go, PhD, M. Cushman, MD, B.M. Kissela, MD, B.J. Kelley, MD,R. Kennedy, MD, C.S. Moy, PhD, V. Howard, PhD and G. Howard, PhD+Author Affiliations

  1. From the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis; Departments of Biostatistics, Medicine, and Epidemiology (L.A.M., V.G.W., R.C.G., R.K., V.H., G.H.), University of Alabama Birmingham, Birmingham; Departments of Pathology (N.S.J.) and Medicine (M.C.), University of Vermont, Burlington; Department of Neurology (B.M.K., B.J.K.), University of Cincinnati, Cincinnati, OH; and National Institute of Neurological Disorders and Stroke (C.S.M.), Bethesda, MD.
  1. Address correspondence and reprint requests to Dr. Frederick W. Unverzagt,Department of Psychiatry, Indiana University School of Medicine, 1111 W. 10th Street, Suite PB 218A, Indianapolis, IN 46202


Objective: To examine vascular risk factors, as measured by the Framingham Stroke Risk Profile (FSRP), to predict incident cognitive impairment in a large, national sample of black and white adults age 45 years and older.

Methods: Participants included subjects without stroke at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with at least 2 cognitive function assessments during the follow-up (n = 23,752). Incident cognitive impairment was defined as decline from a baseline score of 5 or 6 (of possible 6 points) to the most recent follow-up score of 4 or less on the Six-item Screener (SIS). Subjects with suspected stroke during follow-up were censored.

Results: During a mean follow-up of 4.1 years, 1,907 participants met criteria for incident cognitive impairment. Baseline FSRP score was associated with incident cognitive impairment. An adjusted model revealed that male sex (odds ratio [OR] = 1.59, 95% confidence interval [CI] 1.43–1.77), black race (OR = 2.09, 95% CI 1.88–2.35), less education (less than high school graduate vs college graduate, OR = 2.21, 95% CI 1.88–2.60), older age (10-year increments, OR = 2.11, per 10-year increase in age, 95% CI 2.05–2.18), and presence of left ventricular hypertrophy (LVH, OR = 1.29, 95% CI 1.06–1.58) were related to development of cognitive impairment. When LVH was excluded from the model, elevated systolic blood pressure was related to incident cognitive impairment.

Conclusions: Total FSRP score, elevated blood pressure, and LVH predict development of clinically significant cognitive dysfunction. Prevention and treatment of high blood pressure may be effective in preserving cognitive health.


Study funding: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data.

CES-D=Center for Epidemiologic Studies–Depression;
CI=confidence interval;
FSRP=Framingham Stroke Risk Profile;
LVH=left ventricular hypertrophy;
MI=myocardial infarction;
OR=odds ratio;
REGARDS=Reasons for Geographic and Racial Differences in Stroke;
SIS=Six-item Screener

Received March 11, 2011.
Accepted August 2, 2011.
Copyright © 2011 by AAN Enterprises, Inc.