Carotid artery atherosclerosis, MRI-defined structural brain abnormalities, and cognitive performance in elderly
Tauqeer Ali1, Dedra Buchwald2, Dean Shibata3
1Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States.
Insights
Midlife carotid atherosclerosis, a condition common in American Indians, is linked to brain changes and cognitive decline later in life, particularly affecting verbal fluency. This study highlights the importance of vascular health for long-term brain health in this population.
Area of Science:
- Neuroscience
- Cardiovascular Medicine
- Public Health
Background:
- American Indian populations experience high rates of atherosclerotic cardiovascular disease (CVD).
- The impact of mid-life carotid atherosclerosis on cognitive function and brain health in later life is not well understood, especially in underserved populations.
- This study investigates these associations in American Indian adults.
Purpose of the Study:
- To evaluate the association between subclinical carotid atherosclerosis in midlife and later-life brain structure and cognitive performance.
- To address a critical knowledge gap regarding vascular contributions to cognitive decline in American Indians.
- To utilize longitudinal data from the Strong Heart Study.
Main Methods:
- 783 American Indian adults underwent carotid ultrasonography for intima-media thickness and plaque assessment (1998-1999).
- Brain MRI was performed to evaluate infarcts, hemorrhages, white matter lesions, and brain atrophy (2010-2013).
- Cognitive function, including verbal fluency, was assessed; multivariable regression models were used for analysis.
Main Results:
- Increased intima-media thickness correlated with more severe sulcal widening (brain atrophy).
- Carotid plaque presence and extent were associated with poorer verbal fluency.
- These associations remained significant after adjusting for CVD risk factors; no link was found with infarcts, hemorrhages, or white matter lesions.
Conclusions:
- Subclinical carotid atherosclerosis in midlife may contribute to brain atrophy and cognitive deficits, specifically in verbal fluency, in later life among American Indians.
- Vascular health in midlife is crucial for maintaining cognitive function and brain structure in older age.
- Findings underscore the need for targeted interventions for CVD risk reduction in American Indian communities to protect brain health.
Background And Objective:
American Indian populations face disproportionately high rates of atherosclerotic cardiovascular disease (CVD), yet the potential consequences of mid-life carotid atherosclerosis on brain health and cognition later in life remain poorly understood. This study addresses a critical knowledge gap by evaluating whether subclinical carotid atherosclerosis in midlife is associated with later-life structural brain abnormalities and cognitive performance in a large cohort of American Indian adults from the Strong Heart Study. This is the first investigation to explore these associations in this underserved and understudied population, using longitudinal data with vascular, neuroimaging, and cognitive measures.
Methods:
A total of 783 participants (mean age 59.9 years) underwent carotid ultrasonography between 1998 and 1999 to assess intima-media thickness and plaque. Between 2010 and 2013, participants received brain magnetic resonance imaging to assess infarcts, hemorrhages, white matter lesions, and brain atrophy. Cognitive function was also evaluated during this period. Multivariable regression models adjusted for sociodemographic, behavioral, and clinical CVD risk factors were used to assess associations.
Results:
Greater intima-media thickness was associated with more severe sulcal widening, and presence and extent of plaque were associated with poorer verbal fluency; both findings remained significant after adjustment for sociodemographic, behavioral, and clinical risk factors. No significant associations were observed between carotid measures and the presence of infarcts, hemorrhages, or white matter lesions.
Conclusion:
These findings suggest that subclinical carotid atherosclerosis in midlife may contribute to later-life brain atrophy and cognitive vulnerability, particularly in verbal fluency, among American Indians.
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