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Microvascular and Macrovascular Abnormalities and Cognitive and Physical Function in Older Adults: Cardiovascular
Dae Hyun Kim1,2, Francine Grodstein3, Anne B Newman4
1Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Insights
Vascular abnormalities, both microvascular and macrovascular, are linked to declines in cognitive and physical function in older adults. Noninvasive tests for these conditions may aid in prognostication.
Area of Science:
- Gerontology and Geriatric Medicine
- Cardiovascular Health
- Neuroscience
Background:
- Vascular abnormalities, encompassing both microvascular and macrovascular changes, are prevalent in older adults.
- These abnormalities can affect multiple organ systems, including the brain, kidneys, and peripheral arteries.
- The impact of combined microvascular and macrovascular burden on cognitive and physical function requires further elucidation.
Purpose of the Study:
- To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function in older adults.
- To identify specific vascular abnormalities independently associated with functional decline.
Main Methods:
- Cross-sectional analysis of the Cardiovascular Health Study (N = 2,452; mean age 79.5).
- Assessment of microvascular (brain, retina, kidney) and macrovascular (brain, carotid artery, heart, peripheral artery) abnormalities.
- Standardized composite scores for cognitive (MMSE, DSST, TMT) and physical (gait speed, grip strength, 5-time sit to stand) function were derived.
Main Results:
- Participants with high microvascular and macrovascular burden exhibited significantly worse cognitive and physical function compared to those with low burden.
- Both high microvascular burden alone and high macrovascular burden alone were associated with lower cognitive and physical function scores.
- White matter hyperintensity, reduced glomerular filtration rate, large brain infarct, and low ankle-arm index were independently associated with poorer function.
Conclusions:
- Microvascular and macrovascular abnormalities, detectable through noninvasive tests, are independently associated with diminished cognitive and physical function in the elderly.
- Specific abnormalities like white matter hyperintensity and impaired kidney function are key indicators.
- These noninvasive tests show potential utility in predicting functional decline and guiding clinical management.
Objectives:
To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function
Design:
Cross-sectional analysis of the Cardiovascular Health Study (1998-1999).
Setting:
Community.
Participants:
Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5).
Measurements:
Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test (TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand)
Results:
Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = -0.30, 95% confidence interval (CI) = -0.37 to -0.24) and physical (mean score difference = -0.32, 95% CI = -0.38 to -0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: -0.16, 95% CI = -0.24 to -0.08 vs -0.13, 95% CI = -0.20 to -0.06; physical function: -0.15, 95% CI = -0.22 to -0.08 vs -0.12, 95% CI = -0.18 to -0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function.
Conclusion:
Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication.
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