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

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

3. 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 and
2 cohorts: second AA
Sampling in age and sex groups
Fried LP. Ann Epidemiol 1991; 1:

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

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

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

14. 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:

15. 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

16. 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

17. 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

18. White matter & 3MSE

19. 3MSE & WMG change

20. 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

21. 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.

22. 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