02251nas a2200181 4500008004100000022001400041245005100055210005000106260001700156300001100173490000700184520175500191100002001946700002301966700002401989700002102013856003502034 2004 eng d a1532-851100aProgressive cognitive impairment after stroke.0 aProgressive cognitive impairment after stroke c2004 May-Jun a99-1030 v133 a

OBJECTIVE: We examined the putative relationship between stroke and cognitive function in the population-based prospective cohort of the Cardiovascular Health Study (CHS).

METHODS: Of the 5888 participants of the CHS aged 65 years or older, there were 5364 with more than one modified mini-mental (3MS) examination between 1992 and 1998. To determine the effect of baseline stroke before first and subsequent (stroke between two consecutive examinations) 3MS examination on cognitive function, linear regression models were computed with potential confounders entered as additional independent variables. Stroke was divided into right and left hemispheres or posterior circulation on the basis of the clinical and/or imaging information by the hospital that treated the event and subsequent adjudication by CHS committee.

RESULTS: Participants with baseline stroke had an average 3MS decline of 1.2 (95% confidence interval [CI]: -0.7 - -1.7) points per year more than those without one. Those with a history of subsequent stroke had an average first year 3MS decline of 6.2 (CI -8.7 - -3.7) for left hemisphere, 3.5 (CI -5.3 - -1.8) for right hemisphere, and 1.1 (CI -3.9 - 1.6) for posterior circulation more than those without stroke. The effect of stroke on the rate of cognitive decline appeared to ameliorate after the first year (test for linear trend among those with stroke, P = .003).

CONCLUSION: Results from this prospective population-based data study show that stroke in the left hemisphere results in a more pronounced decline in cognition than that in the right hemisphere and that cognitive loss because of stroke appears to attenuate over time, perhaps as a result of relearning.

1 aToole, James, F1 aBhadelia, Rafeeque1 aWilliamson, Jeff, D1 aVeltkamp, Roland uhttps://chs-nhlbi.org/node/99003476nas a2200409 4500008004100000022001400041245012100055210006900176260001300245300001000258490000700268520227900275653000902554653003002563653002402593653001602617653001302633653002302646653002402669653001102693653002202704653002502726653001102751653002502762653000902787653002402796653003702820653001702857653002102874653002202895100002302917700002702940700002002967700002402987700002003011856003503031 2006 eng d a0003-990X00aDepressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study.0 aDepressive symptoms vascular disease and mild cognitive impairme c2006 Mar a273-90 v633 a

CONTEXT: Depressive symptoms are common in patients with dementia and may be associated with increased risk of developing dementia. It has been hypothesized that depressive symptoms and dementia may be attributable to underlying vascular disease in some older persons.

OBJECTIVES: To test the hypotheses (1) that depressive symptoms are associated with increased risk of developing mild cognitive impairment (MCI), a preclinical state that often precedes dementia, and (2) that the association between depressive symptoms and MCI is attributable to underlying vascular disease.

DESIGN: Prospective, population-based, longitudinal study.

SETTING: Random sample of adults 65 years or older recruited from 4 US communities.

PARTICIPANTS: Subjects were 2220 participants in the Cardiovascular Health Study Cognition Study with high cognitive function at baseline. Depressive symptoms were measured at baseline using the 10-item Center for Epidemiological Studies Depression Scale and were classified as none (0-2 points), low (3-7 points), and moderate or high (>/=8 points). Vascular disease measures at baseline included confirmed history of stroke, transient ischemic attack, diabetes mellitus, or hypertension; carotid artery stenosis; ankle-arm blood pressure index; and small or large infarcts or white matter disease on cerebral magnetic resonance imaging. Mild cognitive impairment was diagnosed after 6 years of follow-up based on the consensus of a team of dementia experts using standard clinical criteria.

MAIN OUTCOME MEASURE: Diagnosis of MCI.

RESULTS: Depressive symptoms at baseline were associated with increased risk of MCI (10.0%, 13.3%, and 19.7% for those with no, low, and moderate or high depressive symptoms, respectively). This association was diminished only slightly by adjustment for vascular disease measures and demographics. Vascular disease measures also were associated with increased risk of MCI, and these associations were not diminished by adjustment for depressive symptoms or demographics.

CONCLUSION: Depressive symptoms were associated with increased risk of MCI, and this association was independent of underlying vascular disease.

10aAged10aCerebrovascular Disorders10aCognition Disorders10aComorbidity10aDementia10aDementia, Vascular10aDepressive Disorder10aFemale10aFollow-Up Studies10aGeriatric Assessment10aHumans10aLongitudinal Studies10aMale10aProspective Studies10aPsychiatric Status Rating Scales10aRisk Factors10aSampling Studies10aVascular Diseases1 aBarnes, Deborah, E1 aAlexopoulos, George, S1 aLopez, Oscar, L1 aWilliamson, Jeff, D1 aYaffe, Kristine uhttps://chs-nhlbi.org/node/89102877nas a2200361 4500008004100000022001400041245011400055210006900169260001300238300001100251490000700262520185800269653000902127653002202136653002802158653002002186653001102206653001102217653000902228653000902237653002202246100002002268700002102288700002202309700002102331700002202352700002002374700002002394700002402414700002102438700002002459856003602479 2011 eng d a1758-535X00aSubclinical vascular disease burden and risk for death and cardiovascular events in older community dwellers.0 aSubclinical vascular disease burden and risk for death and cardi c2011 Sep a986-930 v663 a

BACKGROUND: Individual measures and previous composite measures of subclinical vascular disease defined high risk for cardiovascular events, but did not detect low and modest risk. A different approach might better describe the spectrum from low to high risk. Methods and Results. In the Cardiovascular Health Study, 3,252 participants without history of clinical cardiovascular disease (M ± SD 74.3 years ± 5.1, 63% women, 17% African Americans) had noninvasive vascular assessments in 1992-1993. We assigned a score of 0, 1, or 2 (no, mild, or severe abnormalities) to ankle-arm index, electrocardiogram, and common carotid intima-media thickness, based on clinical cutoffs. A summary index (range 0-6, absent to severe disease) summed individual scores. Abdominal aortic ultrasound and brain magnetic resonance imaging were collected in a subsample. Mortality and incident cardiovascular events were identified through June 2008. Event and death rates increased across index grades. Comparing grades 1 to 5+ with absent disease, and adjusting for demographics, hazard ratios for cardiovascular events within 8 years ranged from 1.1 (95% confidence interval 0.8-1.6) to 4.7 (3.4-6.9) and, for mortality, from 1.5 (1.0-2.3) to 5.0 (3.3-7.7) (p for trend across grades <.001 for both outcomes). Adjustment for cardiovascular risk factors did not substantially change the associations. The index improved mortality risk classification over demographics and risk factors in participants who did not die during the follow-up. Including in the index the aortic ultrasound and the brain magnetic resonance imaging further improved risk classification.

CONCLUSIONS: Older adults with minimal subclinical vascular disease had low cardiovascular events risk and mortality. This approach might more fully account for vascular burden.

10aAged10aAged, 80 and over10aCardiovascular Diseases10aCost of Illness10aFemale10aHumans10aMale10aRisk10aVascular Diseases1 aInzitari, Marco1 aArnold, Alice, M1 aPatel, Kushang, V1 aMercer, Laina, D1 aKarlamangla, Arun1 aDing, Jingzhong1 aPsaty, Bruce, M1 aWilliamson, Jeff, D1 aKuller, Lewis, H1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/1300