Abstract
BackgroundCardiovascular disease and its risk factors have consistently been associated with poor cognitive function and incident dementia. Whether cardiovascular disease prediction models, developed to predict an individual's risk of future cardiovascular disease or stroke, are also informative for predicting risk of cognitive decline and dementia is not known.ObjectiveThe objective of this systematic review was to compare cohort studies examining the association between cardiovascular disease risk models and longitudinal changes in cognitive function or risk of incident cognitive impairment or dementia.Materials and MethodsMedline, PsychINFO, and Embase were searched from inception to March 28, 2014. From 3,413 records initially screened, 21 were included.ResultsThe association between numerous different cardiovascular disease risk models and cognitive outcomes has been tested, including Framingham and non-Framingham risk models. Five studies examined dementia as an outcome; fourteen studies examined cognitive decline or incident cognitive impairment as an outcome; and two studies examined both dementia and cognitive changes as outcomes. In all studies, higher cardiovascular disease risk scores were associated with cognitive changes or risk of dementia. Only four studies reported model prognostic performance indices, such as Area Under the Curve (AUC), for predicting incident dementia or cognitive impairment and these studies all examined non-Framingham Risk models (AUC range: 0.74 to 0.78).ConclusionsCardiovascular risk prediction models are associated with cognitive changes over time and risk of dementia. Such models are easily obtainable in clinical and research settings and may be useful for identifying individuals at high risk of future cognitive decline and dementia.
Highlights
Modification of health and lifestyle factors could improve vascular heath and possibly reduce the risk of cognitive decline and dementia [1]
The main reasons for exclusion were that the articles were reviews or they examined individual cardiovascular risk factors, rather than using a cardiovascular disease risk model (Figure 1)
One study that compared the CAIDE models with the Framingham cardiovascular disease (CVD) model and the Framingham stroke risk model concluded that all of the models predicted cognitive decline, but the Framingham models were significantly better than the CAIDE models for predicting changes in semantic fluency and global cognition [7]
Summary
Modification of health and lifestyle factors could improve vascular heath and possibly reduce the risk of cognitive decline and dementia [1]. The most widely used in research and clinical settings are the Framingham risk models for predicting 10year incident stroke, coronary heart disease (CHD) and general CVD [3]. These models usually incorporate cholesterol and blood pressure (BP) with a number of different additional variables such as age, smoking status, and ECG measures of heart health. These models generally have reasonable predictive accuracy for CVD events [2]. Such models are obtainable in PLOS ONE | DOI:10.1371/journal.pone.0114431 December 5, 2014
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