Pharmacological treatment of increased vascular risk and cognitive performance in middle-aged and old persons: six-year observational longitudinal study

Marlise E A Van Eersel,Ron T Gansevoort,Gerbrand J Izaks,Hanneke Joosten,Joris P J Slaets,Sipke T Visser

doi:10.1186/s12883-020-01822-0

Marlise E A Van Eersel, Ron T Gansevoort + Show 4 more

Open Access

https://doi.org/10.1186/s12883-020-01822-0

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Abstract

BackgroundLowering vascular risk is associated with a decrease in the prevalence of cardiovascular disease and dementia. However, it is still unknown whether lowering of vascular risk with pharmacological treatment preserves cognitive performance in general. Therefore, we compared the change in cognitive performance in persons with and without treatment of vascular risk factors.MethodsIn this longitudinal observational study, 256 persons (mean age, 58 years) were treated for increased vascular risk during a mean follow-up period of 5.5 years (treatment group), whereas 1678 persons (mean age, 50 years) did not receive treatment (control group). Cognitive performance was three times measured during follow-up using the Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT), and calculated as the average of standardized RFFT and VAT score per participant. Because treatment allocation was nonrandomized, additional analyses were performed in demographic and vascular risk-matched samples and adjusted for propensity scores.ResultsIn the treatment group, mean (SD) cognitive performance changed from − 0.30 (0.80) to − 0.23 (0.80) to 0.02 (0.87), and in control group, from 0.08 (0.77) to 0.24 (0.79) to 0.49 (0.74) at the first, second and third measurement, respectively (ptrend < 0.001). After adjustment for demographics and vascular risk, the change in cognitive performance during follow-up was not statistically significantly different between the treatment and control group: mean estimated difference, − 0.10 (95%CI − 0.21 to 0.01; p = 0.08). Similar results were found in matched samples and after adjustment for propensity score.ConclusionChange in cognitive performance during follow-up was similar in treated and untreated persons. This suggests that lowering vascular risk preserves cognitive performance.

Highlights

Lowering vascular risk is associated with a decrease in the prevalence of cardiovascular disease and dementia
As this limitation was acknowledged in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), Prevention of Dementia by Intensive Vascular Care study and Multidomain Alzheimer Preventive Trial (MAPT), these trials investigated the effect of a multidomain vascular intervention [9,10,11]
484 (13%) persons were excluded because of missing data on pharmacological treatment and 1154 (32%) persons because of pharmacological treatment of vascular risk factors before the first measurement or treatment started during follow-up (Fig. 1)

Summary

Introduction

Lowering vascular risk is associated with a decrease in the prevalence of cardiovascular disease and dementia It is still unknown whether lowering of vascular risk with pharmacological treatment preserves cognitive performance in general. Intensified treatment of diabetes mellitus or hypercholesterolemia had no effect on cognitive performance in RCTs like the ADVANCE study and the PROSPER trial [7, 8] These negative findings may be explained by the fact that the intervention in these RCTs was focused on only one vascular risk factor. This multidomain intervention included besides treatment of vascular risk factors physical activity, cognitive training and nutritional advice [11] It is still unknown whether only pharmacological treatment of all vascular risk factors is positively associated with cognitive performance

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