Carotid Intima-media Thickness, Cognitive Performance and Cognitive Decline in Stroke-free Middle-aged and Older Adults. The Atahualpa Project

J Stroke Cerebrovasc Dis. 2020 Feb;29(2):104576. doi: 10.1016/j.jstrokecerebrovasdis.2019.104576. Epub 2019 Dec 13.

Abstract

Background: Little is known on factors influencing cognitive function in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the carotid intima-media thickness (cIMT) - used as a surrogate of extracranial carotid atherosclerosis - is associated with cognitive performance and further decline in community-dwelling adults living in a rural setting.

Methods: The study included Atahualpa residents aged greater than or equal to 40 years who had ultrasound examination of the extracranial carotid arteries and a baseline Montreal Cognitive Assessment (MoCA), as well as the subset of individuals who also had a follow-up MoCA at least 1 year after baseline. Relationship between cIMT and cognitive function was assessed by means of generalized linear and longitudinal models, adjusted for relevant covariates. Mediation analysis was utilized to establish the proportion of the effect between increased cIMT and cognitive performance, which is mediated by age.

Results: A total of 561 individuals were included for the cross-sectional study, and 510 of them were assessed for the prospective cohort. Univariate analysis showed a significant association between increased cIMT and worse cognitive performance (P < .001), which vanishes after considering the effect of age and low scholarity. Causal mediation analysis confirms that age captures 82.6% (95% C.I.: 63.9% to 100%) of the effect of this association. There was no relationship between increased cIMT and cognitive decline in the follow-up.

Conclusions: In this rural population, the association between increased cIMT and cognitive dysfunction is mostly mediated by increasing age.

Keywords: Carotid intima-media thickness; aging; cognitive decline; cognitive performance; extracranial carotid atherosclerosis; population study.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carotid Artery Diseases / diagnostic imaging*
  • Carotid Artery Diseases / epidemiology
  • Carotid Intima-Media Thickness*
  • Cognition*
  • Cognitive Aging / psychology*
  • Cognitive Dysfunction / diagnosis
  • Cognitive Dysfunction / epidemiology
  • Cognitive Dysfunction / psychology*
  • Cross-Sectional Studies
  • Ecuador / epidemiology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Rural Health*
  • Time Factors