Cognition and vascular factors: Insights from carotid intima-media thickness and ankle-brachial index in a cohort

BackgroundLimited research has explored the intercorrelation between peripheral and central vascular factors on cognition incorporated longitudinal cognitive measures.ObjectiveExplore associations between central and peripheral vascular factors and cognition.MethodsThis prospective cohort study recruited 516 older adults at baseline (2011-2013) with three follow-ups until 2019. Global and domain-specific cognition (memory, executive function, verbal fluency) were assessed biennially. The ankle-brachial index (ABI) and carotid intima-media thickness (CIMT) were the peripheral and central vascular markers. Generalized linear mixed models were utilized to explore the relationship between vascular factors and cognition adjusting for relevant covariates.ResultsOver time, one unit increment in the ABI was associated with decreased attention performance (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math> = -1.26). At baseline, one unit increase in CIMT (1 mm) was associated with better attention performance (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math> = 0.93) while the association decreased over time (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math> = -0.23). Over time, a unit increase in CIMT was associated with poor performance in global cognition (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math> = -0.52), memory (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math> = -0.21), executive function (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math> = -0.16), and verbal fluency (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math> = -0.15). These associations were particularly evident in <i>APOE</i> ε4 non-carriers, participants without lacunar infarct, and participants with hyperintensities. A significant interaction was found between lacunar infarct and CIMT on attention performance over time. Participants with both abnormal ABI (either low or high) and elevated CIMT showed the most pronounced decline in attention and memory domains, suggesting that the joint effect of these vascular markers affects cognitive performance.ConclusionsPeripheral and central vascular factors differentially and jointly affect cognitive performance, emphasizing the importance of promoting vascular health to prevent dementia in the preclinical phase.