Calcification in Large Vessels Linked to Cognitive Decline

Pam Harrison

March 26, 2013

VIENNA, Austria — Calcification in large vessel beds, identified on computerized tomography (CT), is associated with a global cognitive decline in otherwise healthy people, according to a prospective study.

"There is increasing evidence that vascular factors play a role in the etiology of cognitive impairment and dementia," said investigator Daniel Bos, MD, from Erasmus MC–University Medical Center Rotterdam in the Netherlands.

Identifying the relation between atherosclerosis and cognitive decline is important, he explained, because modification of known risk factors for atherosclerosis could help stave off deterioration into dementia in people who show early signs of cognitive decline.

He presented the findings here at the European Congress of Radiology 2013.

Dr. Bos and his team examined the relation between cognitive decline and atherosclerotic calcification, as a marker of atherosclerosis, in 4 different vessel beds: coronary arteries, the aortic arch, the extracranial carotid arteries, and the intracranial carotid arteries.

"To our knowledge, this is the first study in which atherosclerotic multiple vessel beds has been assessed in relation to cognitive decline," Dr. Bos told Medscape Medical News.

The investigators recruited a random sample of participants from the population-based Rotterdam Study who underwent a CT assessment of multiple blood vessels.

Cognition was assessed with the Mini-Mental State Exam (MMSE) and an extensive battery of neuropsychologic tests. From these, the researchers constructed a global cognition domain and other domains that represent memory, executive function, and information processing speed.

Promoting ideal cardiovascular health will not only help reduce stroke risk, it will also improve brain health.

The investigators also used 2 measures of global cognitive decline — one based on the neuropsychologic test results and the other based purely on MMSE results.

After adjustment for known cardiovascular confounders, including body mass index, systolic and diastolic blood pressure, smoking, cholesterol, and diabetes, "we found that calcification in most vessel beds was associated with global cognitive decline," Dr. Bos reported.

Specifically, calcification in all vessel beds except the extracranial carotid arteries was associated with a lower MMSE score, signifying cognitive impairment. Arterial calcification in the same 3 vessel beds was also associated with a decrease in global cognition domain score.

For the other domains, larger calcification volumes were mainly associated with a decrease in executive function.

However, there was no statistically significant association between arterial calcification and memory, Dr. Bos noted. The same was true for information processing speed, although patterns seem to indicate worse cognitive performance with larger calcification volumes, he explained.

Ralph Sacco, MD, from the University of Miami Miller School of Medicine in Florida, who was asked by Medscape Medical News to comment on the study, noted that there is mounting evidence that cognitive decline is influenced by vascular risk factors, such as hypertension, diabetes, and lifestyle.

"In this study, arterial calcification, which may be an indicator of atherosclerosis, was associated with cognitive decline, particularly for executive function," Dr. Sacco told Medscape Medical News. This study "helps establish the links between vascular disease and cognitive function and decline."

He added that if we could control vascular risk factors more adequately, "we could reduce atherosclerosis and improve brain health and cognitive function. Promoting ideal cardiovascular health will not only help reduce stroke risk, it will also improve brain health."

In a previous study, Dr. Bos and colleagues reported that not only were cognitive scores lower with larger calcification volumes in the 4 vessel beds, but larger coronary artery calcification volumes were related to smaller gray matter volumes (Alzheimers Dement. 2012;8:S104-S111). In addition, both extracranial and intracranial carotid calcification volumes were related to smaller white matter volumes.

In another study, Dr. Bos and colleagues reported that larger calcification volume relates to smaller brain tissue volumes and worse white matter microstructural integrity (Arterioscler Thromb Vasc Biol. 2011;31:2331-2337). This suggests that atherosclerosis contributes to cerebral atrophy, which, in turn, can impair cognitive performance.

Dr. Bos has disclosed no relevant financial relationships. Dr. Sacco is the immediate past president of the American Heart Association for 2011/12; he has disclosed no relevant financial relationships.

European Congress of Radiology (ECR) 2013: Abstract B-350. Presented March 8, 2013.