Is carotid artery atherosclerosis associated with poor cognitive function assessed using the Mini-Mental State Examination? A systematic review and meta-analysis

Objectives: To determine associations between carotid atherosclerosis assessed by ultrasound and the Mini-Mental State Examination (MMSE), a measure of global cognitive function. Design: Systematic review and meta-analysis. Methods: MEDLINE and EMBASE databases were searched up to 1 May 2020 to identify studies assessed the associations between asymptomatic carotid atherosclerosis and the MMSE. Studies reporting OR for associations between carotid plaque or intima-media thickness (cIMT) and dichotomised MMSE were meta-analysed. Publication bias of included studies was assessed. Results: A total of 31 of 378 reviewed articles met the inclusion criteria; together they included 27 738 participants (age 35–95 years). Fifteen studies reported some evidence of a positive association between measures of atherosclerosis and poorer cognitive performance in either cross-sectional or longitudinal studies. The remaining 16 studies found no evidence of an association. Seven cross-sectional studies provided data suitable for meta-analysis. Meta-analysis of three studies that assessed carotid plaque (n=3549) showed an association between the presence of plaque and impaired MMSE with pooled estimate for the OR (95% CI) being 2.72 (0.85 to 4.59). An association between cIMT and impaired MMSE was reported in six studies (n=4443) with a pooled estimate for the OR (95% CI) being 1.13 (1.04 to 1.22). Heterogeneity across studies was moderate to small (carotid plaque with MMSE, I2=40.9%; cIMT with MMSE, I2=4.9%). There was evidence of publication bias for carotid plaque studies (p=0.02), but not cIMT studies (p=0.2). Conclusions: There is some, limited cross-sectional evidence indicating an association between cIMT and poorer global cognitive function assessed with MMSE. Estimates of the association between plaques and poor cognition are too imprecise to draw firm conclusions and evidence from studies of longitudinal associations between carotid atherosclerosis and MMSE is limited. PROSPERO registration number: CRD42021240077.</p

Flow diagram of exclusions and follow-up of participants from the SABRE study, UK.

<p>Flow diagram of exclusions and follow-up of participants from the SABRE study, UK.</p

Baseline characteristics by number of health behaviours of 1,090 Europeans and 1,006 South Asians aged 40–69 (without prevalent cardiovascular disease) at baseline (1988–1990); the SABRE study, UK.

<p>Values are shown as means (SD) for normally distributed continuous variables, medians (IQR) for non-normally distributed continuous variables, and numbers (percentages) for categorical variables.</p><p>* P value for difference using ANOVA, Kruskal-Wallis, or χ2, as appropriate.</p><p>Baseline characteristics by number of health behaviours of 1,090 Europeans and 1,006 South Asians aged 40–69 (without prevalent cardiovascular disease) at baseline (1988–1990); the SABRE study, UK.</p

Hazard ratios (95%CI) of incident cardiovascular disease (CVD) and coronary heart disease (CHD) by individual health behaviors in Europeans and South Asians (without prevalent cardiovascular disease) using multivariable Cox regression models; the SABRE study, UK.

<p>Model 3: adjusted for age, sex, BMI (kg/m²), diastolic blood pressure (mmHg), systolic blood pressure (mmHg), hypertension treatment (0 = no, 1 = yes), total cholesterol (mmHg), HDL cholesterol (mmHg), social class (1 = non-manual, 2 = manual), employment (0 = no, 1 = yes), OPA (MJ/week, quartiles) and mutually adjusted for the other health behaviours.</p><p>* women: 14 units/week, men 21 units/week.</p><p>Hazard ratios (95%CI) of incident cardiovascular disease (CVD) and coronary heart disease (CHD) by individual health behaviors in Europeans and South Asians (without prevalent cardiovascular disease) using multivariable Cox regression models; the SABRE study, UK.</p

Distribution of four individual health behaviours by ethnicity; the SABRE study, UK.

<p>Distribution of four individual health behaviours by ethnicity; the SABRE study, UK.</p

Additional file 1: of Patterns of adiposity, vascular phenotypes and cognitive function in the 1946 British Birth Cohort

Additional Methods and Results (including additional Tables and Figures). (DOC 688 kb

Distinct body mass index trajectories to young-adulthood obesity and their different cardiometabolic consequences

Objective: Different body mass index (BMI) trajectories that result in obesity may have diverse health consequences, yet this heterogeneity is poorly understood. We aimed to identify distinct classes of individuals who share similar BMI trajectories and examine associations with cardiometabolic health. Approach and Results: Using data on 3,549 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC), a growth mixture model was developed to capture heterogeneity in BMI trajectories between 7·5 and 24·5 years. Differences between identified classes in height growth curves, body composition trajectories, early-life characteristics, and a panel of cardiometabolic health measures at 24·5 years were investigated. The best mixture model had six classes. There were two normal-weight classes: “normal-weight [non-linear]” (35% of sample) and “normal-weight [linear]” (21%). Two classes resulted in young-adulthood overweight: “normal-weight increasing to overweight” (18%) and “normal-weight or overweight” (16%). Two classes resulted in young-adulthood obesity: “normal-weight increasing to obesity” (6%) and “overweight or obesity” (4%). The “normal weight increasing to overweight” class had more unfavourable levels of trunk fat, blood pressure, insulin, high density lipoprotein cholesterol, left ventricular mass, and E/e′ ratio compared to the “always normal weight or overweight” class, despite the average BMI trajectories for both classes converging at ~26 kg/m2 at 24·5 years. Similarly, the “normal-weight increasing to obesity” class had a worse cardiometabolic profile than the “always overweight or obese” class. Conclusions: Individuals with high and stable BMI across childhood may have lower cardiometabolic disease risk than individuals who do not become overweight or obese until late adolescence

19 P 07 On-line measurement of particle size and composition

Comparison of reproducibility of invasive and CMR data. The top row shows invasive vs invasive data, the middle row CMR vs CMR data and the bottom row invasive vs CMR data. (PPTX 164 kb

Additional file 1: Figure S1. of Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis

Stepwise analysis of invasive and CMR data. Ad = diastolic aortic area, As = systolic aortic area, Ps = brachial systolic pressure, Pd = brachial diastolic pressure, ∝ = scaling factor. ρ = blood density (taken as 1050 kg/m3). (PPTX 103 kb

Additional file 5: Figure S5. of Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis

Bland Altman plots for reproducibility of individual waves using invasive (top row) and CMR (middle row) modalities. Comparison of individual waves using CMR compared to invasive data acquisition are presented in the bottom row. (PPTX 222 kb