J Shen1,2, K Reesink3, S Köhler4,5, K Deckers4,5, M Schram1,2,5,6,7, A Koster8,9, CG Schalkwijk1,2, MMJ van Greevenbroek1,2
1CARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands. 2Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands. 3Department of Biomedical Engineering, Maastricht University, Maastricht, the Netherlands. 4Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands. 5 Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Maastricht, the Netherlands. 6Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands. 7Heart and Vascular Center, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands. 8CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. 9Department of Social Medicine, Maastricht University, Maastricht, the Netherlands.
Email address: jie.shen@maastrichtuniversity.nl
Background: Arterial stiffness (AS) may cause brain damage and cognitive impairment, but previous reports showed inconsistent findings and used limited phenotypes for AS and cognition. Therefore, we investigated cross-sectional and longitudinal associations between various AS measures and cognitive domains in individuals with and without type 2 diabetes (T2D).
Methods: In The Maastricht Study (population-based, aged 40-79 years), we measured aortic stiffness as carotid-femoral pulse wave velocity (cfPWV, n=6120 [1380 with T2D]) and carotid stiffness (n=3160 [835 with T2D]) as distensibility coefficient (CarDC), compliance coefficient (CarCC) and Young’s elastic modulus (CarYEM) at baseline. Three cognitive domains, i.e. memory, processing speed and executive functioning, were assessed at baseline and after 10-year follow-up (n=1831 [290 with T2D]). An overall cognitive function score was calculated combining these three domains. Multiple linear regression analyses adjusted for demographics, heart rate, mean arterial pressure, physical activity, diet and body mass index was used with standardized (std) baseline stiffness as main determinants and either std baseline cognitive variables or std Δ (10 yrs – baseline cognitive values) as the outcomes.
Results: In the cross-sectional analyses, in participants with T2D, both greater CarDC and greater CarCC (indicating less stiffness) were associated with better processing speed (std β:0.10 [0.03;0.17] and (0.09 [0.03;0.16]), respectively. CarCC was also associated with executive functioning (0.07 [0.00;0.14]). These associations were not significant in participants without T2D (P for interaction< 0.1). These associations were not significant in the longitudinal analyses. Aortic stiffness was not associated with cognitive decline.
Conclusions: In our middle-to-elderly population, carotid stiffness was associated with worse cognitive functioning in persons with T2D, but not in participants without T2D. The null findings for associations of carotid stiffness with cognition decline may be attributable to limited power. A larger sample size is needed for future longitudinal studies.