INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
Alzheimers Dement. 2013 Sep;9(5):572-9. doi: 10.1016/j.jalz.2012.07.001. Epub 2012 Nov 28.
Stroke is associated with an increased risk of dementia. However, it is unclear whether risk of stroke in those free of stroke, particularly in nonelderly populations, leads to differential rates of cognitive decline. Our aim was to assess whether risk of stroke in mid life is associated with cognitive decline over 10 years of follow-up.
We studied 4153 men and 1657 women (mean age, 55.6 years at baseline) from the Whitehall II study, a longitudinal British cohort study. We used the Framingham Stroke Risk Profile (FSRP), which incorporates age, sex, systolic blood pressure, diabetes mellitus, smoking, prior cardiovascular disease, atrial fibrillation, left ventricular hypertrophy, and use of antihypertensive medication. Cognitive tests included reasoning, memory, verbal fluency, and vocabulary assessed three times over 10 years. Longitudinal associations between FSRP and its components were tested using mixed-effects models, and rates of cognitive change over 10 years were estimated.
Higher stroke risk was associated with faster decline in verbal fluency, vocabulary, and global cognition. For example, for global cognition there was a greater decline in the highest FSRP quartile (-0.25 of a standard deviation; 95% confidence interval: -0.28 to -0.21) compared with the lowest risk quartile (P = .03). No association was observed for memory and reasoning. Of the individual components of FSRP, only diabetes mellitus was associated independently with faster cognitive decline (β = -0.06; 95% confidence interval, -0.01 to 0.003; P = .03).
Elevated stroke risk at midlife is associated with accelerated cognitive decline over 10 years. Aggregation of risk factors may be especially important in this association.
中风与痴呆风险增加有关。然而，中风风险是否会导致认知能力下降，特别是在非老年人群中，目前尚不清楚。我们的目的是评估中年时期的中风风险是否与 10 年随访期间的认知能力下降有关。
我们研究了来自白厅 II 研究的 4153 名男性和 1657 名女性（基线时的平均年龄为 55.6 岁），这是一项英国纵向队列研究。我们使用 Framingham 中风风险评分（FSRP），该评分包含年龄、性别、收缩压、糖尿病、吸烟、既往心血管疾病、心房颤动、左心室肥厚和使用抗高血压药物。认知测试包括推理、记忆、言语流畅性和词汇，在 10 年内评估了 3 次。使用混合效应模型测试了 FSRP 及其组成部分之间的纵向关联，并估计了 10 年内认知变化的速度。
较高的中风风险与言语流畅性、词汇和整体认知能力下降较快有关。例如，在最高 FSRP 四分位数中（下降 0.25 个标准差；95%置信区间：0.28 至 0.21），认知下降速度比最低风险四分位数更快（P=0.03）。记忆和推理方面没有观察到关联。在 FSRP 的各个组成部分中，只有糖尿病与认知能力下降速度加快独立相关（β= -0.06；95%置信区间，-0.01 至 0.003；P=0.03）。
中年时期的中风风险升高与 10 年内认知能力下降加速有关。风险因素的聚集在这种关联中可能尤为重要。
