Deborah A Levine1,2,3, Alden L Gross4, Emily M Briceño5, Nicholas Tilton1, Mohammed U Kabeto1, Stephanie M Hingtgen1, Bruno J Giordani6, Jeremy B Sussman1,3,7, Rodney A Hayward1,3,7, James F Burke2,3,7, Mitchell S V Elkind8,9, Jennifer J Manly8,10, Andrew E Moran11, Erin R Kulick12, Rebecca F Gottesman13, Keenan A Walker13, Yuichiro Yano14, Darrell J Gaskin15, Stephen Sidney16, Kristine Yaffe17,18,19, Ralph L Sacco20, Clinton B Wright21, Veronique L Roger22, Norrina Bai Allen23, Andrzej T Galecki1,24. 1. Cognitive Health Services Research Program, Department of Internal Medicine, University of Michigan, Ann Arbor. 2. Stroke Program, Department of Neurology, University of Michigan, Ann Arbor. 3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor. 4. Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, John Hopkins University, Baltimore, Maryland. 5. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor. 6. Michigan Alzheimer's Disease Center, Department of Psychiatry, University of Michigan, Ann Arbor. 7. VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 8. Department of Neurology, Vagelos College of Physicians and Surgeons, New York, New York. 9. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. 10. Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York. 11. Division of General Medicine, Department of Medicine, Columbia University, New York, New York. 12. Department of Epidemiology, Brown University, Providence, Rhode Island. 13. Department of Neurology, Johns Hopkins University, Baltimore, Maryland. 14. Department of Community & Family Medicine, Duke University, Durham, North Carolina. 15. Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland. 16. Kaiser Permanente Northern California Division of Research, Oakland. 17. Department of Psychiatry, University of California, San Francisco, San Francisco. 18. Department of Neurology, University of California, San Francisco, San Francisco. 19. Department of Epidemiology, University of California, San Francisco, San Francisco. 20. Department of Neurology, University of Miami, Miami, Florida. 21. Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland. 22. Department of Cardiology and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. 23. Department of Internal Medicine, Northwestern University, Chicago, Illinois. 24. Department of Biostatistics, University of Michigan, Ann Arbor.
Abstract
Importance: Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain. Objective: To determine whether cumulative BP levels explain racial differences in cognitive decline. Design, Setting, and Participants: Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018. Main Outcomes and Measures: The primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function. Exposures: Race (black vs white). Results: Among 34 349 participants, 19 378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19 378 individuals, 10 724 (55.3%) were female and 15 526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (-0.03 points per year faster [95% CI, -0.05 to -0.01]; P = .004) and memory (-0.08 points per year faster [95% CI, -0.11 to -0.06]; P < .001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10]; P < .001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (-0.018 points per year faster per each 10-mm Hg increase [95% CI, -0.023 to -0.014]; P < .001), memory (-0.028 points per year faster per each 10-mm Hg increase [95% CI, -0.035 to -0.021]; P < .001), and executive function (-0.01 points per year faster per each 10-mm Hg increase [95% CI, -0.014 to -0.007]; P < .001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (-0.01 points per year [95% CI, -0.03 to 0.01]; P = .56) and memory (-0.06 points per year [95% CI, -0.08 to -0.03]; P < .001) but not executive function (0.10 points per year [95% CI, 0.09-0.11]; P < .001). Conclusions and Relevance: These results suggest that black individuals' higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.
Importance: Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain. Objective: To determine whether cumulative BP levels explain racial differences in cognitive decline. Design, Setting, and Participants: Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018. Main Outcomes and Measures: The primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function. Exposures: Race (black vs white). Results: Among 34 349 participants, 19 378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19 378 individuals, 10 724 (55.3%) were female and 15 526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (-0.03 points per year faster [95% CI, -0.05 to -0.01]; P = .004) and memory (-0.08 points per year faster [95% CI, -0.11 to -0.06]; P < .001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10]; P < .001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (-0.018 points per year faster per each 10-mm Hg increase [95% CI, -0.023 to -0.014]; P < .001), memory (-0.028 points per year faster per each 10-mm Hg increase [95% CI, -0.035 to -0.021]; P < .001), and executive function (-0.01 points per year faster per each 10-mm Hg increase [95% CI, -0.014 to -0.007]; P < .001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (-0.01 points per year [95% CI, -0.03 to 0.01]; P = .56) and memory (-0.06 points per year [95% CI, -0.08 to -0.03]; P < .001) but not executive function (0.10 points per year [95% CI, 0.09-0.11]; P < .001). Conclusions and Relevance: These results suggest that black individuals' higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.
Authors: Adam M Brickman; Nicole Schupf; Jennifer J Manly; José A Luchsinger; Howard Andrews; Ming X Tang; Christiane Reitz; Scott A Small; Richard Mayeux; Charles DeCarli; Truman R Brown Journal: Arch Neurol Date: 2008-08
Authors: L P Fried; N O Borhani; P Enright; C D Furberg; J M Gardin; R A Kronmal; L H Kuller; T A Manolio; M B Mittelmark; A Newman Journal: Ann Epidemiol Date: 1991-02 Impact factor: 3.797
Authors: Ronald G Victor; Kathleen Lynch; Ning Li; Ciantel Blyler; Eric Muhammad; Joel Handler; Jeffrey Brettler; Mohamad Rashid; Brent Hsu; Davontae Foxx-Drew; Norma Moy; Anthony E Reid; Robert M Elashoff Journal: N Engl J Med Date: 2018-03-12 Impact factor: 91.245
Authors: Deborah A Levine; Cora E Lewis; O Dale Williams; Monika M Safford; Kiang Liu; David A Calhoun; Yongin Kim; David R Jacobs; Catarina I Kiefe Journal: Hypertension Date: 2010-12-06 Impact factor: 10.190
Authors: George Howard; Daniel T Lackland; Dawn O Kleindorfer; Brett M Kissela; Claudia S Moy; Suzanne E Judd; Monika M Safford; Mary Cushman; Stephen P Glasser; Virginia J Howard Journal: JAMA Intern Med Date: 2013-01-14 Impact factor: 21.873
Authors: Christopher A Lane; Josephine Barnes; Jennifer M Nicholas; Carole H Sudre; David M Cash; Thomas D Parker; Ian B Malone; Kirsty Lu; Sarah-Naomi James; Ashvini Keshavan; Heidi Murray-Smith; Andrew Wong; Sarah M Buchanan; Sarah E Keuss; Elizabeth Gordon; William Coath; Anna Barnes; John Dickson; Marc Modat; David Thomas; Sebastian J Crutch; Rebecca Hardy; Marcus Richards; Nick C Fox; Jonathan M Schott Journal: Lancet Neurol Date: 2019-08-20 Impact factor: 44.182
Authors: Emily M Briceño; Alden L Gross; Bruno J Giordani; Jennifer J Manly; Rebecca F Gottesman; Mitchell S V Elkind; Stephen Sidney; Stephanie Hingtgen; Ralph L Sacco; Clinton B Wright; Annette Fitzpatrick; Alison E Fohner; Thomas H Mosley; Kristine Yaffe; Deborah A Levine Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.160
Authors: Madeline R Farron; Mohammed U Kabeto; Aparajit Ballav Dey; Joyita Banerjee; Deborah A Levine; Kenneth M Langa Journal: J Am Geriatr Soc Date: 2020-08 Impact factor: 5.562
Authors: Rachel L Peterson; Kristen M George; Paola Gilsanz; Sarah Ackley; Elizabeth R Mayeda; M M Glymour; Dan M Mungas; Charles DeCarli; Rachel A Whitmer Journal: Alzheimer Dis Assoc Disord Date: 2021 Apr-Jun 01 Impact factor: 2.703