Contribution of vascular risk factors to the progression in Alzheimer disease

Abstract

Background: Vascular factors including medical history (heart disease, stroke, diabetes, and hypertension), smoking, and prediagnosis blood lipid measurements (cholesterol: total, high-density lipoprotein, lowdensity lipoprotein [LDL-C], and triglyceride concentrations) may be predictors for progression of Alzheimer disease (AD). Objective: To determine whether prediagnosis vascular risk factors are associated with progression of AD. Design: Inception cohort followed up longitudinally for a mean of 3.5 (up to 10.2) years. Setting: Washington Heights/Inwood Columbia Aging Project, New York, New York. Patients: One hundred fifty-six patients with incident AD (mean age at diagnosis, 83 years). Main Outcome Measure: Change in a composite score of cognitive ability from diagnosis onward. Results: In generalized estimating equation models (adjusted for age, race/ethnicity, and years of education), higher cholesterol (total cholesterol and LDL-C) concentrations and history of diabetes were associated with faster cognitive decline. Each 10-U increase in cholesterol and LDL-C was associated with a 0.10-SD decrease in cognitive score per year of follow-up (P