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Microvascular Dysfunction Is Associated With Worse Cognitive Performance: The Maastricht Study
Sytze P Rensma1,2, Thomas T van Sloten1,2, Alfons J H M Houben1,2
1From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands.
Abstract:
Microvascular dysfunction may be associated with worse cognitive performance. Most previous studies did not adjust for important confounders, evaluated only individual measures of microvascular dysfunction, and showed inconsistent results. We evaluated the association between a comprehensive set of measures of microvascular dysfunction and cognitive performance in the population-based Maastricht Study. We used cross-sectional data including 3011 participants (age 59.5±8.2; 48.9% women; 26.5% type 2 diabetes mellitus [oversampled by design]). Measures of microvascular dysfunction included magnetic resonance imaging features of cerebral small vessel disease, plasma biomarkers of microvascular dysfunction, albuminuria, flicker light-induced retinal arteriolar and venular dilation response and heat-induced skin hyperemia. These measures were summarized into a microvascular dysfunction composite score. Cognitive domains assessed were memory, processing speed, and executive function. A cognitive function score was calculated as the sum of the scores on these 3 cognitive domains. The microvascular dysfunction score was associated with a worse cognitive function score (standardized β, -0.087 [95% CI, -0.127 to -0.047]), independent of age, education level, sex, type 2 diabetes mellitus, smoking, alcohol use, hypertension, total/HDL (high-density lipoprotein) cholesterol ratio, triglycerides, lipid-modifying medication, prior cardiovascular disease, depression and plasma biomarkers of low-grade inflammation. The fully adjusted β-coefficient of the association between the microvascular dysfunction score and the cognitive function score was equivalent to 2 (range, 1-3) years of aging for each SD higher microvascular dysfunction score. The microvascular dysfunction score was associated with worse memory and processing speed but not with worse executive function. The present study shows that microvascular dysfunction is associated with worse cognitive performance.
Insights
Microvascular dysfunction is linked to poorer cognitive function, including memory and processing speed. This association persists even after accounting for numerous health factors, suggesting a significant impact on brain health.
Area of Science:
- Neuroscience
- Vascular Biology
- Public Health
Background:
- Microvascular dysfunction is a potential contributor to cognitive decline.
- Previous research has been limited by a lack of comprehensive measures and adjustment for confounders.
- Inconsistent findings highlight the need for robust investigation into this association.
Purpose of the Study:
- To investigate the relationship between a wide range of microvascular dysfunction markers and cognitive performance.
- To assess this association in a large, population-based cohort, the Maastricht Study.
- To determine if the association remains significant after controlling for multiple potential confounders.
Main Methods:
- Utilized cross-sectional data from 3011 participants in the Maastricht Study.
- Assessed microvascular dysfunction using MRI, plasma biomarkers, albuminuria, retinal vasodilation, and skin hyperemia.
- Calculated a composite microvascular dysfunction score and cognitive function score (memory, processing speed, executive function).
Main Results:
- A higher microvascular dysfunction score was significantly associated with lower cognitive function (standardized β = -0.087).
- This association remained independent of age, education, diabetes, smoking, hypertension, and other factors.
- Each standard deviation increase in the microvascular dysfunction score was equivalent to 2 years of cognitive aging.
Conclusions:
- Microvascular dysfunction is demonstrably linked to worse cognitive performance, particularly in memory and processing speed.
- The findings underscore the importance of vascular health for maintaining cognitive function.
- This study provides strong evidence for microvascular dysfunction as a key factor in cognitive impairment.
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