Alzheimer’s & Dementia - (2014) 1
Correspondence Midlife stroke risk and cognitive decline Kaffashian et al. [1] presented the results of the longterm follow up of a large cohort study concerning the higher risk of cognitive decline in patients with higher risk of stroke. This last feature was synthesized by the score of the Framingham Stroke Risk Profile (FSRP), which has been studied in the past also to predict cognitive performance in middle-aged adults and elderly. A first finding of the study was the absence of an association between cognitive changes and single vascular risk factors, with the exception of diabetes mellitus and in line with previous studies [2]. Higher significant changes in cognition might probably come from an addition of other cognitive tests (i.e., Trail Making Test part B or simplified Tower of London test) to better assess executive functions, which are involved in vascular cognitive impairment especially. Emerging evidences are also concerning about the influence of carotid disease on cognitive impairment by alteration of blood cerebral flow above all [3,4]. In a previous study, an increased risk of cognitive impairment up to 14 times higher was observed in patients with left significant carotid stenosis [5]. The prevalence of the carotid disease is between 1% and 9% in the general population, considering a moderate-to-severe stenosis [6]. The carotid disease is not included in FSRP, but it might be interesting to also consider this vascular and stroke highrisk factor in the analysis of alteration of cognition. The influence of genetics is still under debate. In this study, the APOE ε4 status did not modify the association between FSRP and cognitive decline. On the contrary, in a very recent work, significant interactions were observed between this genetic condition with FSRP score and neuropsychological outcome measures and related error responses [7]. In particular, a positive APOE ε4 might influence fluency tests. Finally, physical activity has been considered only as a covariate. It might be interesting to evaluate the influence of the level of physical activity on
cognitive changes, as reported in some studies [8], considering also the concomitant FSRP components. This could contribute to identify the importance of this health-related factor in relation to the control of classical vascular risk factors in preventive strategies against the cognitive impairment. Simone Vidale* Stroke Unit Department of Neurology Sant’Anna Hospital Como, Italy References [1] Kaffashian S, Dugravot A, Brunner EJ, Sabia S, Ankri J, Kivimaki M , et al. Midlife stroke risk and cognitive decline: a 10-year follow-up of the Whitehall II cohort study. Alzheimers Dement 2013;9:572–9. [2] Verdelho A, Madureira S, Moleiro C, Ferro JM, Santos CO, Erkinjuntti T, et al. White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study. Neurology 2010;75:160–7. [3] Demarin V, Zavoreo I, Kes VB. Carotid artery disease and cognitive impairment. J Neurol Sci 2012;322:107–11. [4] Sztriha LK, Nemeth D, Sefcsin T, Vecsei L. Carotid stenosis and the cognitive function. J Neurol Sci 2009;283:36–40. [5] Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. AHA/ASA Guideline on the management of patients with extracranial carotid and vertebral artery disease. Circulation 2011;124:e54–130. [6] Johnston SC, O’Meara ES, Manolio TA, Lefkowitz D, O’Leary DH, Goldstein S, et al. Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Intern Med 2004;140:237–47. [7] Nishtala A, Preis S, Beiser A, Devine S, Hankee L, Seshadri S, et al. Midlife cardiovascular risk impacts executive function. Framingham Offspring Study. Alzheimer Dis Assoc Disord 2014;28:16–22. [8] Verdelho A, Madureira S, Ferro JM, Baezner H, Blahak C, Poggesi A, et al. Physical activity prevents progression for cognitive impairment and vascular dementia: results from the LADIS (Leukoaraiosis and Disability) study. Stroke 2012;43:3331–5.
http://dx.doi.org/10.1016/j.jalz.2014.01.010
*Corresponding author. Tel.: 139-0315859282; Fax: 139-0315854891. E-mail address: [email protected] 1552-5260/$ - see front matter Ó 2014 The Alzheimer’s Association. All rights reserved.
Correspondence Midlife stroke risk and cognitive decline Kaffashian et al. [1] presented the results of the longterm follow up of a large cohort study concerning the higher risk of cognitive decline in patients with higher risk of stroke. This last feature was synthesized by the score of the Framingham Stroke Risk Profile (FSRP), which has been studied in the past also to predict cognitive performance in middle-aged adults and elderly. A first finding of the study was the absence of an association between cognitive changes and single vascular risk factors, with the exception of diabetes mellitus and in line with previous studies [2]. Higher significant changes in cognition might probably come from an addition of other cognitive tests (i.e., Trail Making Test part B or simplified Tower of London test) to better assess executive functions, which are involved in vascular cognitive impairment especially. Emerging evidences are also concerning about the influence of carotid disease on cognitive impairment by alteration of blood cerebral flow above all [3,4]. In a previous study, an increased risk of cognitive impairment up to 14 times higher was observed in patients with left significant carotid stenosis [5]. The prevalence of the carotid disease is between 1% and 9% in the general population, considering a moderate-to-severe stenosis [6]. The carotid disease is not included in FSRP, but it might be interesting to also consider this vascular and stroke highrisk factor in the analysis of alteration of cognition. The influence of genetics is still under debate. In this study, the APOE ε4 status did not modify the association between FSRP and cognitive decline. On the contrary, in a very recent work, significant interactions were observed between this genetic condition with FSRP score and neuropsychological outcome measures and related error responses [7]. In particular, a positive APOE ε4 might influence fluency tests. Finally, physical activity has been considered only as a covariate. It might be interesting to evaluate the influence of the level of physical activity on
cognitive changes, as reported in some studies [8], considering also the concomitant FSRP components. This could contribute to identify the importance of this health-related factor in relation to the control of classical vascular risk factors in preventive strategies against the cognitive impairment. Simone Vidale* Stroke Unit Department of Neurology Sant’Anna Hospital Como, Italy References [1] Kaffashian S, Dugravot A, Brunner EJ, Sabia S, Ankri J, Kivimaki M , et al. Midlife stroke risk and cognitive decline: a 10-year follow-up of the Whitehall II cohort study. Alzheimers Dement 2013;9:572–9. [2] Verdelho A, Madureira S, Moleiro C, Ferro JM, Santos CO, Erkinjuntti T, et al. White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study. Neurology 2010;75:160–7. [3] Demarin V, Zavoreo I, Kes VB. Carotid artery disease and cognitive impairment. J Neurol Sci 2012;322:107–11. [4] Sztriha LK, Nemeth D, Sefcsin T, Vecsei L. Carotid stenosis and the cognitive function. J Neurol Sci 2009;283:36–40. [5] Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. AHA/ASA Guideline on the management of patients with extracranial carotid and vertebral artery disease. Circulation 2011;124:e54–130. [6] Johnston SC, O’Meara ES, Manolio TA, Lefkowitz D, O’Leary DH, Goldstein S, et al. Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Intern Med 2004;140:237–47. [7] Nishtala A, Preis S, Beiser A, Devine S, Hankee L, Seshadri S, et al. Midlife cardiovascular risk impacts executive function. Framingham Offspring Study. Alzheimer Dis Assoc Disord 2014;28:16–22. [8] Verdelho A, Madureira S, Ferro JM, Baezner H, Blahak C, Poggesi A, et al. Physical activity prevents progression for cognitive impairment and vascular dementia: results from the LADIS (Leukoaraiosis and Disability) study. Stroke 2012;43:3331–5.
http://dx.doi.org/10.1016/j.jalz.2014.01.010
*Corresponding author. Tel.: 139-0315859282; Fax: 139-0315854891. E-mail address: [email protected] 1552-5260/$ - see front matter Ó 2014 The Alzheimer’s Association. All rights reserved.
