The Effect of Cardiovascular Risk Factors on Cognitive Scores of Patients Obtained Through BNA-SF Assessment

Abstract

<h3>Introduction</h3> Cardiovascular risk factors (CVRFs) such as hypertension (HTN) and hypercholesterolemia (HCL) have been associated with an increased risk of cognitive impairment as measured by the Mini Mental State Exam (MMSE) and Montreal Cognitive Assessment (MOCA) (Ettorre et al., 2012). Previous studies have not addressed the extent to which age and CVRFs may interact to specifically drive diminished cognitive scores in more comprehensive cognitive test batteries such as the Behavioural Neurology Assessment-Short Form (BNA-SF) (Darvesh et al., 2005). <h3>Objective</h3> To further understanding of the relationship between the CVRFs of HTN and HCL and their potential effect on patients' BNA-SF scores across a diverse age range. The effect of CVRFs in relation to all the BNA testing domains (including; orientation, immediate memory recall, delayed memory recall, delayed recognition, visuospatial, working memory, and language) was analyzed and compared across age groups. <h3>Methods</h3> Mann-Whitney U tests and Kruskal-Wallis one-way ANOVAs were conducted on two primary cohorts of participants, above age 65 (n=130) and under 65 (n=98) from the St. Michael's Hospital Memory Clinic database. These groups were examined for histories of HTN and HCL and further subdivided into four testing cohorts consisting of: Below 65 controls (n=56), above 65 controls (n=39), below 65 with either or both HTN and HCL (n=42), and above 65 with either or both HTN and HCL (n=91). Mann-Whitney U tests were used to compare test scores of control patients and patients with either CVRFs within one age group. Kruskal-Wallis one-way ANOVAs were conducted to compare test scores between the four testing cohorts to further analyze the effect of age. <h3>Results</h3> When compared within one age group, there was no significant difference for BNA scores of patients with either HCL or HTN and the age specific controls. Comparative analyses between cohorts below 65 and above 65 revealed significantly higher scores in the subcategory of memory immediate recall in control patients below 65 vs patients above 65 with one or both CRVFs (p<.05). Additionally, for the BNA category memory delayed recall, control patients below 65 scored significantly higher than control patients above 65 and those above 65 with one or both CVRFs (p<.05). For the BNA category memory delayed recognition, control patients below 65 scored significantly higher than control patients above 65 and those above 65 with one or both CVRFs (p<.05). Furthermore, in both delayed memory recall and delayed memory recognition, patients below 65 with one or both CVRFs scored significantly higher than patients above 65 with one or both CVRFs. Lastly in the visuospatial category, control patients below 65 scored significantly higher than control patients above 65 (p<0.05). <h3>Conclusions</h3> Our findings suggest that CVRFs have an effect on scores of specific BNA categories when patients from different age ranges are cross analyzed. The BNA subcategories of immediate memory recall, delayed memory recall, and delayed memory recognition are particularly sensitive to the combined influence of CVRFs and age related cognitive decline. This illustrates the importance of a higher CVRF burden in relation to increased age, and its potential impact on cognitive performance. <h3>Funding</h3> St Michael's Hospital Foundation, Eric and Heather Donnelly Endowment Fund