The Relationship of Coronary Atherosclerosis Progression to Cognition

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Subclinical atherosclerosis has been linked to poorer cognitive performance. Most of the literature investigating the relationship between atherosclerosis and cognitive functioning has utilized the carotid artery as an indicator. Few studies have examined the association between cognitive performance and atherosclerosis in areas where it accumulates early in the progression process, such as the coronary artery. This project aimed to examine the relationship between change in subclinical coronary atherosclerosis and cognitive performance in a large, community-based sample. Participants included 1,386 individuals with Dallas Heart Study data for coronary artery calcium (CAC) levels obtained at two time points (DHS-1 and DHS-2, approximately 7 years later) and Montreal Cognitive Assessment (MoCA) scores at DHS-2 (mean age in years (SD)=52 (9.0); 57% female, 48% Black). A subset of DHS participants (N=101, mean age (SD)= 66 (5.1), 58% female, 38% Black) returned 5 years later for comprehensive neuropsychological testing as part of the Dallas Heart and Brain Aging Study (DHBAS) at the UT Southwestern Alzheimer Disease Center. CAC progression was examined as an increase from baseline calcium levels and based on CAC progression groups (i.e., None, Incidence, Non-Progressor, Progressor) in relationship to MoCA Total Score using linear multiple regression and ANOVA to compare MoCA performance between groups. Neuropsychological test data were aggregated into functional domains, and then into a Global Composite Score. The relationship between CAC progression and this global score was examined using linear multiple regression and MANOVA. ANCOVA and MANCOVA were also used to control for sociodemographic variables, traditional vascular risk factors, and baseline CAC. In the DHS sample, CAC progression was weakly but significantly associated with MoCA scores, but this relationship was attenuated by sociodemographic factors. Membership in the CAC Progressor group was significantly associated with poorer MoCA scores after controlling for baseline CAC, race, age, sex, education, hypertension, diabetes, hypercholesterolemia, and waist to hip ratio; however, when participants with stroke were excluded Progressor group membership was no longer a predictor. There was no relationship between CAC change and subsequent cognitive performance on comprehensive neuropsychological testing. Overall, there was minimal relationship between CAC progression and global cognitive performance in a large, relatively young, community-based sample.

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