Activation of hemostasis and decline in cognitive function in older people

Area of Science:

• Gerontology
• Neurology
• Hematology

Background:

• Cognitive decline is a significant concern in aging populations.
• Hemostatic function, including thrombosis and fibrinolysis, plays a critical role in vascular health.
• The relationship between hemostasis and cognitive function in older adults requires further investigation.

Purpose of the Study:

• To investigate the association between markers of hemostatic activation and cognitive decline in elderly individuals.
• To determine if increased thrombin generation predicts cognitive impairment and functional deterioration.

Main Methods:

• The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) cohort included 5804 participants aged 70-82 years.
• Cognitive function (information processing speed, verbal memory) and activities of daily living were assessed annually over a mean follow-up of 3.2 years.
• Levels of thrombin generation markers (d-dimer, prothrombin fragment 1+2) and inflammation markers (C-reactive protein, IL-6) were measured.

Main Results:

• Elevated levels of d-dimer and prothrombin fragment 1+2 were independently associated with an accelerated rate of cognitive decline.
• These hemostatic markers also predicted a faster deterioration in basic and instrumental activities of daily living.
• The association between thrombin generation and cognitive decline persisted even after excluding stroke patients and adjusting for inflammation.

Conclusions:

• Older individuals with heightened markers of thrombin generation face an increased risk of cognitive decline.
• Deterioration in activities of daily living is also associated with increased thrombin generation.
• Prothrombotic states, indicated by elevated thrombin markers, likely contribute to cognitive decline through increased risk of cerebral ischemic damage, including subclinical disease.