Related Experiment Videos
Risk factors for dementia in the cardiovascular health cognition study
Lewis H Kuller1, Oscar L Lopez, Anne Newman
1Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pa 15261, USA. kuller@pitt.edu
Insights
Cognitive function, brain MRI, and Apolipoprotein E epsilon4 (ApoE4) predict dementia risk. Specific MRI findings and low cognitive scores significantly increase dementia likelihood.
Area of Science:
- Neurology
- Neuroimaging
- Genetics
Background:
- The Cardiovascular Health Cognition Study investigated dementia predictors in 3,608 participants.
- Brain MRI scans were obtained in 1991, with follow-up through 1998-1999.
Purpose of the Study:
- To identify key determinants of dementia and Alzheimer's disease (AD).
- To assess the predictive value of cognitive tests, MRI findings, and genetic factors.
Main Methods:
- Analysis of 480 incident dementia cases (330 with AD) from the study cohort.
- Utilized univariate analysis and multivariate Cox proportional hazards models.
- Included Modified Mini-Mental State Examination (3MSE), Digit Symbol Substitution Test, brain MRI (ventricular/white matter grade, infarcts), and Apolipoprotein E epsilon4 (ApoE4) genotyping.
Main Results:
- Low 3MSE and Digit Symbol Substitution Test scores, and declines in these scores, predicted dementia.
- High ventricular grade (atrophy), white matter grade, brain infarcts, and ApoE4 genotype were significant predictors.
- A combination of ApoE4, low 3MSE (<90), high ventricular grade (≥5), and high white matter grade (≥3) indicated a 17-fold increased dementia risk.
Conclusions:
- Cognitive measures, ApoE4 status, and brain MRI findings are robust predictors of dementia and AD.
- Integrated assessment of these factors can identify individuals at high risk for dementia.
Background:
The Cardiovascular Health Cognition Study has evaluated the determinants of dementia among 3,608 participants that had a magnetic resonance imaging (MRI) of the brain in 1991 and were followed to 1998-1999.
Methods:
There were 480 incident dementia cases, 330 (69%) were classified as Alzheimer's disease (AD).
Results:
In univariate analysis, low scores on the Modified Mini-Mental State Examination (3MSE) and on the Digit Symbol Substitution Test as well as declines in scores over time prior to the development of dementia were significant predictors of dementia. A high ventricular grade on the MRI (atrophy) as well as high white matter grade, a number of brain infarcts on the MRI were all determinants of dementia. Apolipoprotein E epsilon4 (Apo(E-4)) was also a powerful predictor of dementia. In a multivariate Cox proportional hazards model controlling for race, gender and grade, the hazard ratios for age (1.1), 3MSE score (0.9), ventricular size (1.4), white matter grade (1.8), presence of large infarcts >3 mm (1.3) and Apo(E-4) (2.1) were significant predictors of dementia. The combination of an Apo(E-4) genotype, 3MSE score <90, > or =5 ventricular grade, > or =3 white matter grade at the time of the MRI were associated with a 17-fold increased risk (95% CI: 8.6-34.9) of dementia as compared to individuals with none of the above attributes.
Conclusions:
Measures of cognition, Apo(E-4) and MRI of the brain are strong predictors of both dementia and of AD.