Sarah A Gaussoin1, Nicholas M Pajewski1, Gordon Chelune2, Maryjo L Cleveland3, Michael G Crowe4, Lenore J Launer5, Alan J Lerner6, Jennifer Martindale-Adams7, Linda O Nichols8, Paula K Ogrocki6, Bonnie C Sachs9, Kaycee M Sink10, Mark A Supiano11,12, Virginia G Wadley13, Valerie M Wilson3, Clinton B Wright14, Jeff D Williamson3, David M Reboussin1, Stephen R Rapp15. 1. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. 2. Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA. 3. Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. 4. Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA. 5. Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA. 6. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. 7. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA. 8. Veterans Affairs Medical Center, Memphis, Tennessee, USA. 9. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. 10. Genentech, South San Francisco, California, USA. 11. Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Ohio, USA. 12. VA Geriatric Research, Education and Clinical Center, Salt Lake City, Ohio, USA. 13. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 14. Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA. 15. Department of Social Sciences and Health Policy, Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Abstract
BACKGROUND: To examine the effect of intensive blood pressure control on the occurrence of subtypes of mild cognitive impairment (MCI) and determine the risk of progression to dementia or death. METHODS: Secondary analysis of a randomized trial of community-dwelling adults (≥50 years) with hypertension. Participants were randomized to a systolic blood pressure (SBP) goal of <120 mm Hg (intensive treatment; n = 4678) or <140 mm Hg (Standard treatment; n = 4683). Outcomes included adjudicated MCI, MCI subtype (amnestic, non-amnestic, multi-domain, single domain), and probable dementia. Multistate survival models were used to examine transitions in cognitive status accounting for the competing risk of death. RESULTS: Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 640 participants met the protocol definition for MCI, with intensive treatment reducing the risk of MCI overall (hazard ratio [HR], 0.81 [95% confidence interval {CI}, 0.69-0.94]), as previously reported. This effect was largely reflected in amnestic subtypes (HR, 0.78 [95% CI, 0.66-0.92]) and multi-domain subtypes (HR, 0.78 [95% CI, 0.65-0.93]). An adjudication of MCI, as compared with normal cognitive function, substantially increased the probability of progressing to probable dementia (5.9% [95% CI: 4.5%-7.7%] vs. 0.6% [95% CI: 0.3%-0.9%]) and to death (10.0% [95% CI: 8.3%-11.9%] vs. 2.3% [95% CI: 2.0%-2.7%]) within 2 years. CONCLUSIONS: Intensive treatment reduced the risk for amnestic and multi-domain subtypes of MCI. An adjudication of MCI was associated with increased risk of progression to dementia and death, highlighting the relevance of MCI as a primary outcome in clinical and research settings.
BACKGROUND: To examine the effect of intensive blood pressure control on the occurrence of subtypes of mild cognitive impairment (MCI) and determine the risk of progression to dementia or death. METHODS: Secondary analysis of a randomized trial of community-dwelling adults (≥50 years) with hypertension. Participants were randomized to a systolic blood pressure (SBP) goal of <120 mm Hg (intensive treatment; n = 4678) or <140 mm Hg (Standard treatment; n = 4683). Outcomes included adjudicated MCI, MCI subtype (amnestic, non-amnestic, multi-domain, single domain), and probable dementia. Multistate survival models were used to examine transitions in cognitive status accounting for the competing risk of death. RESULTS: Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 640 participants met the protocol definition for MCI, with intensive treatment reducing the risk of MCI overall (hazard ratio [HR], 0.81 [95% confidence interval {CI}, 0.69-0.94]), as previously reported. This effect was largely reflected in amnestic subtypes (HR, 0.78 [95% CI, 0.66-0.92]) and multi-domain subtypes (HR, 0.78 [95% CI, 0.65-0.93]). An adjudication of MCI, as compared with normal cognitive function, substantially increased the probability of progressing to probable dementia (5.9% [95% CI: 4.5%-7.7%] vs. 0.6% [95% CI: 0.3%-0.9%]) and to death (10.0% [95% CI: 8.3%-11.9%] vs. 2.3% [95% CI: 2.0%-2.7%]) within 2 years. CONCLUSIONS: Intensive treatment reduced the risk for amnestic and multi-domain subtypes of MCI. An adjudication of MCI was associated with increased risk of progression to dementia and death, highlighting the relevance of MCI as a primary outcome in clinical and research settings.
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