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Arterioscler Thromb Vasc Biol. 2016 Jan;36(1):204-10. doi: 10.1161/ATVBAHA.115.306768. Epub 2015 Nov 19.

Cerebral Vasoreactivity, Apolipoprotein E, and the Risk of Dementia: A Population-Based Study.

Author information

1
From the Departments of Neurology (F.J.W., R.F.A.G.d.B., P.J.K., M.A.I.), Epidemiology (F.J.W., R.F.A.G.d.B., A.H., M.A.I.), and Radiology (M.A.I.), Erasmus Medical Centre, Rotterdam, The Netherlands.
2
From the Departments of Neurology (F.J.W., R.F.A.G.d.B., P.J.K., M.A.I.), Epidemiology (F.J.W., R.F.A.G.d.B., A.H., M.A.I.), and Radiology (M.A.I.), Erasmus Medical Centre, Rotterdam, The Netherlands. m.a.ikram@erasmusmc.nl.

Abstract

OBJECTIVE:

Cerebral vasoreactivity (CVR) is a key factor in maintenance of continuous cerebral perfusion and a marker of (micro)vascular damage. We aimed to determine the longitudinal relation between CVR and the risk of dementia in the general population.

APPROACH AND RESULTS:

We determined CVR in nondemented participants who underwent transcranial Doppler with induced hypercapnia from 1997 to 1999, as part of the ongoing population-based Rotterdam Study. We used a Cox model to determine the risk of dementia in relation to CVR, adjusted for age, sex, cardiovascular risk factors, and carotid intima-media thickness. We furthermore determined decline on a cognitive test battery in relation to CVR, using linear mixed models. Among 1629 participants (mean ± SD age 70.6 ± 6.2 years, 46.2% female) with a mean follow-up of 11.5 years, 209 were diagnosed with dementia, of whom 171 had Alzheimer disease. Higher CVR at baseline was associated with lower risk of dementia (adjusted hazard ratio, 95% confidence interval, per SD increase: 0.87, 0.75-1.00) and Alzheimer disease (adjusted hazard ratio, 0.84; 0.71-0.99). This association was more profound in APOEε4 carriers than in noncarriers (adjusted hazard ratio for all dementia: 0.77, 0.60-0.98 versus 0.89, 0.73-1.07). Performance on cognitive tests at baseline was better with higher CVR (g-factor: P=0.02), but during 3 cognitive assessments over 11 years of follow-up, higher CVR at baseline was associated with less decline in test scores on the Stroop reading and interference tasks in APOEε4 carriers only (P=0.01 and 0.02, respectively).

CONCLUSIONS:

Impaired CVR is associated with an increased risk of dementia in the general population.

KEYWORDS:

Alzheimer disease; apolipoprotein E; dementia; epidemiology; hypercapnia; vasoreactivity

PMID:
26586657
DOI:
10.1161/ATVBAHA.115.306768
[Indexed for MEDLINE]

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