Journal of Physiology & Pathology in Korean Medicine (동의생리병리학회지)

The Physiological Society of Korean Medicine and The Society of Pathology in Korean Medicine (대한동의생리학회·한의병리학회)
권호 표지

Age and Gender Differences in the Relationship of Cognitive Impairment, Vascular Risk Factors, and Subclinical Carotid Atherosclerosis from Community-based Elderly

나이와 성별에 따른 지역사회 거주 노인에서 무증상 경동맥 죽상경화증에 대한 혈관위험인자 및 인지장애와의 관련성

  • Kim, Ji-Hee (Department of Physical Medicine and Rehabilitation, Wonkwang University College of Medicine and Hospital) ;
  • Park, Hyun-Young (Department of Neurology, Wonkwang University College of Medicine and Hospital) ;
  • Kim, Dae-Won (Department of Neurosurgery, Wonkwang University College of Medicine and Hospital) ;
  • Byun, Seung-Jae (Department of Surgery, Wonkwang University College of Medicine and Hospital) ;
  • Moon, Hyo-Jeong (Department of Physical Medicine and Rehabilitation, Wonkwang University College of Medicine and Hospital) ;
  • Lee, In (Department of Korean Medicine, School of Korean Medicine, Pusan National University) ;
  • Yang, Chung-Yong (Department of Physical Medicine and Rehabilitation, Wonkwang University College of Medicine and Hospital)
  • 김지희 (원광대학교 의과대학 재활의학교실) ;
  • 박현영 (원광대학교 의과대학 신경과학교실) ;
  • 김대원 (원광대학교 의과대학 신경외과학교실) ;
  • 변승재 (원광대학교 의과대학 외과학교실) ;
  • 문효정 (원광대학교 의과대학 재활의학교실) ;
  • 이인 (부산대학교 한의학전문대학원 한의학과) ;
  • 양충용 (원광대학교 의과대학 재활의학교실)
  • Received : 2012.05.15
  • Accepted : 2012.06.12
  • Published : 2012.06.25
Download PDF
⟨ Previous Next ⟩

Abstract

To evaluate age and gender differences in the relation of cardiovascular risk factors, cognitive impairment, and subclinical carotid atherosclerosis from aged people using by a cross sectional method. Sixty-nine healthy elders living in the community who had not previously undergone carotid ultrasonography were included. We conducted life style surveys, and cognitive function tests including Korean-mini-mental state examination (K-MMSE) and clinical dementia rating-Korean. Various biomarkers from blood were assessed; fasting insulin-like growth factor-1, lipid-profile, high sensitivity C-reactive protein, total homocysteine, glucose, insulin, Homeostasis model assessment (HOMA) for insulin resistance index, vitamin B12, and folate level. Carotid intima-media thickness (C-IMT), and plaques were measured using carotid ultrasonography and aortic ultrasonography, a valid index of atherosclerosis. For the elderly subjects (aged 65-82 years), cognition impairment was more prevalent in females while subclinical atherosclerosis was more prevalentin males. Increased C-IMT has been kept in males, and C-IMT shows increasing trend and the peak at about 80 year-old in females with increasing age. The significant correlations between C-IMT and many vascular risk factors including age, triglyceride, abnormal homocysteinein male, and K-MMSE, insulin, HOMA index and abnormal aortic ultrasonography in female were different in each gender, with the exception of homocysteine (p<0.05). This data suggests that there were differences of age and gender characteristics in terms of subclinical atherosclerosis, cognitive impairment and vascular risk factors in community-living elders. Further larger and longitudinal studies across entire age are required to better understand the effects of risk factors on subclinical atherosclerosis.

Keywords

References

  1. Joakimsen, O., Bonaa, K.H., Stensland-Bugge, E., Jacobsen, B.K. Age and sex differences in the distribution and ultrasound morphology of carotid atherosclerosis: the Tromso Study. Arterioscler Thromb Vasc Biol 19: 3007-3013, 1999. https://doi.org/10.1161/01.ATV.19.12.3007
  2. O'Leary, D.H., Polak, J.F., Kronmal, R.A., Manolio, T.A., Burke, G.L., Wolfson, S.K., Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 340: 14-22, 1999. https://doi.org/10.1056/NEJM199901073400103
  3. Chambless, L.E., Heiss, G., Folsom, A.R., Rosamond, W., Szklo, M., Sharrett, A.R., Clegg, L.X. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol 146: 483-494, 1997. https://doi.org/10.1093/oxfordjournals.aje.a009302
  4. Whiteley, W., Chong, W.L., Sengupta, A., Sandercock, P. Blood markers for the prognosis of ischemic stroke: a systematic review. Stroke 40: e380-389, 2009. https://doi.org/10.1161/STROKEAHA.108.528752
  5. O'Leary, D.H., Polak, J.F., Kronmal, R.A., Kittner, S.J., Bond, M.G., Wolfson, S.K., Jr., Bommer, W., Price, T.R., Gardin, J.M., Savage, P.J. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group. Stroke 23: 1752-1760, 1992. https://doi.org/10.1161/01.STR.23.12.1752
  6. Graham, J.E., Rockwood, K., Beattie, B.L., Eastwood, R., Gauthier, S., Tuokko, H., McDowell, I. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 349: 1793-1796, 1997. https://doi.org/10.1016/S0140-6736(97)01007-6
  7. Price, T.R., Manolio, T.A., Kronmal, R.A., Kittner, S.J., Yue, N.C., Robbins, J., Anton-Culver, H., O'Leary, D.H. Silent brain infarction on magnetic resonance imaging and neurological abnormalities in community-dwelling older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Stroke 28: 1158-1164, 1997. https://doi.org/10.1161/01.STR.28.6.1158
  8. Gaviria, M., Pliskin, N., Kney, A. Cognitive impairment in patients with advanced heart failure and its implications on decision-making capacity. Congest Heart Fail 17: 175-179, 2011. https://doi.org/10.1111/j.1751-7133.2011.00242.x
  9. Johnston, S.C., O'Meara, E.S., Manolio, T.A., Lefkowitz, D., O'Leary, D.H., Goldstein, S., Carlson, M.C., Fried, L.P., Longstreth, W.T., Jr. Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Intern Med 140: 237-247, 2004. https://doi.org/10.7326/0003-4819-140-4-200402170-00005
  10. Rao, R. The role of carotid stenosis in vascular cognitive impairment. Eur Neurol 46: 63-69, 2001. https://doi.org/10.1159/000050765
  11. Zhong, W., Cruickshanks, K.J., Huang, G.H., Klein, B.E., Klein, R., Nieto, F.J., Pankow, J.S., Schubert, C.R. Carotid atherosclerosis and cognitive function in midlife: the Beaver Dam Offspring Study. Atherosclerosis 219: 330-333, 2011. https://doi.org/10.1016/j.atherosclerosis.2011.07.013
  12. Goldstein, L.B., Adams, R., Becker, K., Furberg, C.D., Gorelick, P.B., Hademenos, G., Hill, M., Howard, G., Howard, V.J., Jacobs, B., Levine, S.R., Mosca, L., Sacco, R.L., Sherman, D.G., Wolf, P.A., del Zoppo, G.J. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 32: 280-299, 2001. https://doi.org/10.1161/01.STR.32.1.280
  13. Korczyn, A.D. Mixed dementia--the most common cause of dementia. Ann N Y Acad Sci 977: 129-134, 2002. https://doi.org/10.1111/j.1749-6632.2002.tb04807.x
  14. Stensland-Bugge, E., Bonaa, K.H., Joakimsen, O., Njolstad, I. Sex differences in the relationship of risk factors to subclinical carotid atherosclerosis measured 15 years later: the Tromso study. Stroke 31: 574-581, 2000. https://doi.org/10.1161/01.STR.31.3.574
  15. Sinning, C., Wild, P.S., Echevarria, F.M., Wilde, S., Schnabel, R., Lubos, E., Herkenhoff, S., Bickel, C., Klimpe, S., Gori, T., Munzel, T.F., Blankenberg, S., Espinola-Klein, C. Sex differences in early carotid atherosclerosis (from the community-based Gutenberg-Heart Study). Am J Cardiol 107: 1841-1847, 2011. https://doi.org/10.1016/j.amjcard.2011.02.318
  16. Stensland-Bugge, E., Bonaa, K.H., Joakimsen, O. Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: the Tromso study. Atherosclerosis 154: 437-448, 2001. https://doi.org/10.1016/S0021-9150(00)00486-X
  17. Grigoletto, F., Zappala, G., Anderson, D.W., Lebowitz, B.D. Norms for the Mini-Mental State Examination in a healthy population. Neurology 53: 315-320, 1999. https://doi.org/10.1212/WNL.53.2.315
  18. Morris, J.C. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 43: 2412-2414, 1993.
  19. Kwon, Y.C., Park, J.H. Korean Version of Mini-Mental State Examination (K-MMSE). J Korean Neuropsychiatr Assoc 28: 125-135, 1989.
  20. Anstey, K.J., Burns, R.A., Birrell, C.L., Steel, D., Kiely, K.M., Luszcz, M.A. Estimates of probable dementia prevalence from population-based surveys compared with dementia prevalence estimates based on meta-analyses. BMC Neurol 10: 62, 2010. https://doi.org/10.1186/1471-2377-10-62
  21. Berg, L., Hughes, C.P., Coben, L.A., Danziger, W.L., Martin, R.L., Knesevich, J. Mild senile dementia of Alzheimer type: research diagnostic criteria, recruitment, and description of a study population. J Neurol Neurosurg Psychiatry 45: 962-968, 1982. https://doi.org/10.1136/jnnp.45.11.962
  22. Al-Delaimy, W.K., von Muhlen, D., Barrett-Connor, E. Insulinlike growth factor-1, insulinlike growth factor binding protein-1, and cognitive function in older men and women. J Am Geriatr Soc 57: 1441-1446, 2009. https://doi.org/10.1111/j.1532-5415.2009.02343.x
  23. Matthews, D.R., Hosker, J.P., Rudenski, A.S., Naylor, B.A., Treacher, D.F., Turner, R.C. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28: 412-419, 1985. https://doi.org/10.1007/BF00280883
  24. Touboul, P.J., Hennerici, M.G., Meairs, S., Adams, H., Amarenco, P., Bornstein, N., Csiba, L., Desvarieux, M., Ebrahim, S., Fatar, M., Hernandez, R., Jaff, M., Kownator, S., Prati, P., Rundek, T., Sitzer, M., Schminke, U., Tardif, J.C., Taylor, A., Vicaut, E., Woo, K.S., Zannad, F., Zureik, M. Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 23: 75-80, 2007. https://doi.org/10.1159/000097034
  25. Lorenz, M.W., Markus, H.S., Bots, M.L., Rosvall, M., Sitzer, M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115: 459-467, 2007. https://doi.org/10.1161/CIRCULATIONAHA.106.628875
  26. Sutton-Tyrrell, K., Lassila, H.C., Meilahn, E., Bunker, C., Matthews, K.A., Kuller, L.H. Carotid atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured after menopause. Stroke 29: 1116-1121, 1998. https://doi.org/10.1161/01.STR.29.6.1116
  27. Roldan, C.A., Joson, J., Sharrar, J., Qualls, C.R., Sibbitt, W.L., Jr. Premature aortic atherosclerosis in systemic lupus erythematosus: a controlled transesophageal echocardiographic study. J Rheumatol 37: 71-78, 2010. https://doi.org/10.3899/jrheum.090665
  28. Talelli, P., Ellul, J., Terzis, G., Lekka, N.P., Gioldasis, G., Chrysanthopoulou, A., Papapetropoulos, T. Common carotid artery intima media thickness and post-stroke cognitive impairment. J Neurol Sci 223: 129-134, 2004. https://doi.org/10.1016/j.jns.2004.05.013
  29. Bots, M.L., Hofman, A., Grobbee, D.E. Increased common carotid intima-media thickness. Adaptive response or a reflection of atherosclerosis? Findings from the Rotterdam Study. Stroke 28: 2442-2447, 1997. https://doi.org/10.1161/01.STR.28.12.2442
  30. Grace, J., Nadler, J.D., White, D.A., Guilmette, T.J., Giuliano, A.J., Monsch, A.U., Snow, M.G. Folstein vs modified Mini-Mental State Examination in geriatric stroke. Stability, validity, and screening utility. Arch Neurol 52: 477-484, 1995. https://doi.org/10.1001/archneur.1995.00540290067019
  31. Cho, S., Thompson, C.K. What Goes Wrong during Passive Sentence Production in Agrammatic Aphasia: An Eyetracking Study. Aphasiology 24: 1576-1592, 2010. https://doi.org/10.1080/02687031003714442
  32. Sachdev, P.S. Homocysteine and brain atrophy. Prog Neuropsychopharmacol Biol Psychiatry 29: 1152-1161, 2005. https://doi.org/10.1016/j.pnpbp.2005.06.026
  33. Vermeulen, E.G., Stehouwer, C.D., Twisk, J.W., van den Berg, M., de Jong, S.C., Mackaay, A.J., van Campen, C.M., Visser, F.C., Jakobs, C.A., Bulterjis, E.J., Rauwerda, J.A. Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis: a randomised, placebo-controlled trial. Lancet 355: 517-522, 2000. https://doi.org/10.1016/S0140-6736(99)07391-2
  34. Gorgone, G., Ursini, F., Altamura, C., Bressi, F., Tombini, M., Curcio, G., Chiovenda, P., Squitti, R., Silvestrini, M., Ientile, R., Pisani, F., Rossini, P.M., Vernieri, F. Hyperhomocysteinemia, intima-media thickness and C677T MTHFR gene polymorphism: a correlation study in patients with cognitive impairment. Atherosclerosis 206: 309-313, 2009. https://doi.org/10.1016/j.atherosclerosis.2009.02.028
  35. Okura, T., Heisler, M., Langa, K.M. Association between cognitive function and social support with glycemic control in adults with diabetes mellitus. J Am Geriatr Soc 57: 1816-1824, 2009. https://doi.org/10.1111/j.1532-5415.2009.02431.x
  36. Knopman, D., Boland, L.L., Mosley, T., Howard, G., Liao, D., Szklo, M., McGovern, P., Folsom, A.R. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 56: 42-48, 2001. https://doi.org/10.1212/WNL.56.1.42
  37. Saleh, C. Carotid artery intima media thickness: a predictor of cognitive impairment? Front Biosci (Elite Ed) 2: 980-990, 2010.
  38. Elias, M.F., Elias, P.K., Robbins, M.A., Wolf, P.A., D'Agostino, R.B. Cardiovascular risk factors and cognitive functioning: An epidemiological perspective. In S.R. Waldstein & M.F. Elias (Eds.), Neuropsychology of cardiovascular disease (pp 83-104). Mahwah, NJ:Erlbaum, 2001.