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Vascular risk and cognitive impairment in an older, British, African-Caribbean population
R Stewart1, M Richards, C Brayne
1Section of Old Age Psychiatry, Institute of Psychiatry, London, United Kingdom.
Insights
Vascular risk factors like hypertension and diabetes are linked to cognitive impairment in older British African-Caribbeans. Physical activity showed a protective effect against cognitive decline in this population.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- High prevalence of hypertension and diabetes in older British African-Caribbeans.
- Need to understand links between vascular health and cognitive function in this demographic.
Purpose of the Study:
- Investigate associations between clinical vascular disease, vascular risk factors, and cognitive impairment.
- Examine the role of educational attainment in these associations.
Main Methods:
- Cross-sectional community-based study of 278 individuals (age 55-75) born in the Caribbean.
- Assessed cardiovascular risk factors (hypertension, diabetes, lipid profile) and cognitive function using psychometric tests.
- Analyzed associations, considering educational level and physical activity.
Main Results:
- 28% of subjects had relative cognitive impairment.
- Hypertension, diabetes, and raised triglycerides were associated with impairment in lower education groups.
- High cholesterol and manual occupation were significant in higher education groups.
- Physical exercise was negatively associated with cognitive impairment, even after adjustments.
Conclusions:
- Vascular risk factors are associated with cognitive impairment in this population.
- Educational attainment modifies these associations.
- Physical activity demonstrates a protective association with cognitive function.
Objectives:
In an older, British, African-Caribbean population with high prevalence rates of hypertension and diabetes mellitus, we ascertained clinical vascular disease (stroke or ischemic heart disease) and vascular risk (including hypertension, diabetes, and lipid profile) and investigated their associations with cognitive impairment.
Design:
Cross-sectional community-based study.
Setting:
The sample was drawn from registration lists for seven primary care services in south London, United Kingdom.
Participants:
278 individuals, age 55 to 75, who were born in a Caribbean nation.
Measurements:
Participants were interviewed and examined for cardiovascular risk factors, including a blood test for lipid profile and fibrinogen. A battery of 11 psychometric tests was administered blind to medical status. Cognitive impairment was defined on the basis of a composite measure derived from individual test scores.
Results:
Seventy-nine (28%) subjects were classified as having relative cognitive impairment and were compared with the remainder of the sample. Marked differences were seen between low and normal/high educational levels in the strength of associations between measures of vascular risk and cognitive impairment. Hypertension, diabetes, and raised triglycerides were significant factors in those with lower levels of education. Low fibrinogen (negatively associated), high cholesterol, and manual occupation were significant factors in those with normal/high levels of education. Physical exercise was negatively associated with cognitive impairment: an association that persisted after adjustment for age, occupation, depression, and physical disability and after excluding subjects with the most severe imipairment.
Conclusion:
Measures of vascular risk were associated with relative cognitive impairment in this population. These associations were modified by previous educational attainment. Physical activity was negatively associated with cognitive impairment.