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Selective Impairment of Frontal-Executive Cognitive Function in African Americans with Cardiovascular Risk Factors

Authors

  • Kenneth G. Pugh MD,

    1. From the Beth Israel Deaconess Medical Center, Department of Medicine, Gerontology Division, Boston, Massachusetts
    2. Hebrew Rehabilitation Center for Aged, Boston, Massachusetts
    3. Division on Aging, Harvard Medical School, Boston, Massachusetts
    4. U.S. Navy, Naval School of Health Sciences, Bethesda, Maryland
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  • Dan K. Kiely MA, MPH,

    1. Hebrew Rehabilitation Center for Aged, Boston, Massachusetts
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  • William P. Milberg PhD,

    1. Division on Aging, Harvard Medical School, Boston, Massachusetts
    2. Geriatric Neuropsychology Laboratory, Geriatric, Research, Education and Clinical Center (GRECC), Brockton/West Roxbury Department of Veterans Affairs Medical Center, Boston, Massachusetts
    3. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
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  • Lewis A. Lipsitz MD

    1. From the Beth Israel Deaconess Medical Center, Department of Medicine, Gerontology Division, Boston, Massachusetts
    2. Hebrew Rehabilitation Center for Aged, Boston, Massachusetts
    3. Division on Aging, Harvard Medical School, Boston, Massachusetts
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  • The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. Dr. Lipsitz holds the Irving and Edith S. Usen and Family Chair in Geriatric Medicine at the Hebrew Rehabilitation Center for Aged, Boston, Massachusetts. This work was supported by Grants AG05134, AG08812, and AG04390 from the National Institutes of Health and a Hartford Foundation Center of Excellence in Geriatric Medicine Grant to Harvard Medical School. Dr. Pugh was supported by a Harvard Hartford Foundation Junior Faculty Development Grant and by the U.S. Navy, Naval School of Health Sciences. This research was further supported in part by the Department of Veterans Affairs Medical Research Service VA Merit Review Award to William Milberg.

Address correspondence to Kenneth G. Pugh, MD, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889. E-mail: kgpugh@bethesda.med.navy.mil

Abstract

Objectives: To determine whether a summary cardiovascular risk score is associated with an increased risk of frontal-executive cognitive impairment.

Design: Cross-sectional study.

Setting: Subjects were recruited from senior centers, senior housing complexes, and communities in the Boston metropolitan area.

Participants: Forty-three predominantly female elderly African Americans.

Measurements: Cardiovascular risk factors were assessed during an interview and clinical examination. For each subject, the total number of cardiovascular (CV) risk factors was summed to compute a CV risk score. A battery of neuropsychological tests was administered that examined memory, visuospatial abilities, and frontal-executive functions. Cognitive test scores were transformed into domain-specific (memory, visuospatial, frontal-executive) composite z scores. Cognitive impairment for each composite z score was defined as performance less than the median for the study group. Multivariate logistic regression was used to examine the relationship between the CV risk score and the risk for cognitive impairment in the three cognitive domains of interest.

Results: After controlling for age and education, the CV risk score was associated only with frontal-executive cognitive impairment (odds ratio (OR)=2.44, 95% confidence interval (CI)=1.06–5.65). The CV risk score was not associated with the risk of memory (OR=1.30, 95% CI=0.64–2.67) or visuospatial impairment (OR=1.49, 95% CI=0.66–3.36). Greater CV risk scores were associated with an increased likelihood of having frontal-executive cognitive impairment.

Conclusion: CV risk factors may exert a specific deleterious effect on frontal-executive cognitive abilities as opposed to memory or visuospatial functions. Associated executive dysfunction may compromise the ability of patients with CV risk factors to comply with recommendations for risk reduction.

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