The Cardiovascular Health Study: 1998-2004 Background and Summary of Cognitive Function Data

Introduction Overview of CHS Cognitive Function Data in CHS Cranial MRI exams Findings to date on cognitive function

Design Population-based cohort study of risk factors for stroke and coronary disease in adults aged >=65 funded by NHLBI 5888 older adults recruited from HCFA sampling frames in 4 U.S. sites in 1989-90 and 1992-93 2 cohorts: second AA Sampling in age and sex groups Fried LP. Ann Epidemiol 1991; 1: 263-276.

Exclusions Institutionalized Unable to give informed consent Needing a proxy to respond Expecting to move from area in < 3 years Under active treatment for cancer Wheel-chair bound in the home

Baseline examination Medical history and medication use Blood pressure and anthropometry Diet, physical activity, psychosocial factors Physical and cognitive function ECG and pulmonary function Laboratory measures Carotid ultrasound Echocardiography

Follow-up of cohort Methods Semi-annual contact through 6/99 phone call alternating with clinic visit Phone contacts continue Purpose Repeat exam components Addition of new exam components Identify potential events

Repeat exams Blood pressure, ECGs, medical history, height, weight and medications yearly Carotid ultrasound, years 5 & 11 Echocardiography, year 7 Pulmonary function, years 6 & 9 Baseline=Year 2 for original cohort; year 5 for new cohort

New exam components Funded by the main study Cerebral MRI in years 5-6 and 10-11 Retinal photograph in year 10 Benton visual retention in yrs 6-9,11 Funded by ancillary studies Endothelial function in year 10 Bone density in year 7 Determination of dementia

Events Main endpoints--myocardial infarction, angina, heart failure, stroke, TIA and total mortality--reviewed by committees All diagnoses and procedures from all hospitalizations captured Cohort retention 95% through 06/99; 88% through 06/2004

Cohort at Baseline Age 72.8 yrs (65-100) Male 2495 (42.4%) Black race 2495 (42.4%) Black race 924 (15.7%) CVD 1826 (31.0%) HS grad 4139 (70.3%)

Self-reported health Excellent 790 (13.4%) Very Good 1415 (24.0%) Good 790 (13.4%) Very Good 1415 (24.0%) Good 2175 (36.9%) Fair 1256 (21.3%) Poor 239 ( 4.1%)

Cognitive Function Mean DSS=37; mean MMSE=31=89% Original cohort

Cognitive Function Mean DSS=29; 3MSE=83 New cohort

Cranial MRI 3660 participants had an MRI between March 1992 and June 1994 Infarct-like lesions > 3mm White matter abnormalities, scale 0-10 Ventricle grade, scale 0-10 Bryan et al AJNR 1994;15:1625-1633

MRI completion status MRI done 3660 Deceased 411 No clinic visit 244 Refused 557 Ineligible 277 Unable to complete 466 Technical problems 39 Other 234

MRI (dementia) cohort Characteristic MRI No MRI Age < 75 yrs 70.7 59.4** White 84.0 83.2 Female 58.3 56.6 HS Grad 73.9 65.0** Income > $50,000 14.3 10.6** MRI cohort younger, more educated, wealthier Values in table are percents **p<.001

MRI (dementia) Cohort Characteristic MRI No MRI Coronary heart disease 23.0 30.4** Congestive heart failure 1.7 4.6** Stroke 4.7 6.3* Hypertension 44.8 51.7** Diabetes 10.1 13.1** MRI cohort healthier * .001<p<.01; **p<.001

White matter & 3MSE

3MSE & WMG change

Cognitive Decline DSS 3MSE Scale range 0-90 0-100 Mean chg/year -0.92 -0.58 Median chg/year -0.67 Range of change -20 to 13.5 -41.5 to 9.0 Change in 7 yr -6.43 -4.07 Change over 7 yr period. Haan et al. JAMA 1999

Change in 3MSE Risk Factor Absent Present Apo-E4 -0.42 -2.94 Sys bp >158 mm Hg -0.16 -1.12 Low AAI -0.66 -4.62 Int Carotid >2mm -0.22 -1.54 Stroke at bl -0.64 -4.47 Change over 7 yrs. (adjusted for age, sex, education) Haan et al.

Final Comments No work to date on items of 3 MSE or BVRT MRI (dementia) cohort healthier, younger than full CHS cohort Covariates at MRI for dementia analyses Addition of 2nd cohort 3 years later may complicate some analyses