Association of Cardiovascular Risk Trajectory With Cognitive Decline and Incident Dementia
Farnsworth von Cederwald B, Josefsson M, Wåhlin A, Nyberg L, Karalija N.. Neurology, 2022-04-20
Topic: Risk, prevention and care in population studies
Background and objectives Cardiovascular risk factors have a recently established association with cognitive decline and dementia, yet most studies examine this association through cross-sectional data, precluding an understanding of the longitudinal dynamics of such risk. The current study aims to explore how the ongoing trajectory of cardiovascular risk affects subsequent dementia and memory decline risk. We hypothesize that an accelerated, long-term accumulation of cardiovascular risk, as determined by the Framingham Risk Score (FRS), will be more detrimental to cognitive and dementia state outcomes than a stable cardiovascular risk. Methods We assessed an initially healthy, community-dwelling sample recruited from the prospective cohort Betula study. Cardiovascular disease risk, as assessed by the FRS, episodic memory performance, and dementia status were measured at each 5-year time point (T) across 20 to 25 years. Analysis was performed with bayesian additive regression tree, a semiparametric machine-learning method, applied herein as a multistate survival analysis method. Results Of the 1,244 participants, cardiovascular risk increased moderately over time in 60% of sample, with observations of an accelerated increase in 18% of individuals and minimal change in 22% of individuals. An accelerated, as opposed to a stable, cardiovascular risk trajectory predicted an increased risk of developing Alzheimer disease dementia (average risk ratio [RR] 3.3-5.7, 95% CI 2.6-17.5 at T2, 1.9-6.7 at T5) or vascular dementia (average RR 3.3-4.1, 95% CI 1.1-16.6 at T2, 1.5-7.6 at T5) and was associated with an increased risk of memory decline (average RR 1.4-1.2, 95% CI 1-1.9 at T2, 1-1.5 at T5). A stable cardiovascular risk trajectory appeared to partially mitigate Alzheimer disease dementia risk for APOE ε4 carriers. Discussion The findings of the current study show that the longitudinal, cumulative trajectory of cardiovascular risk is predictive of dementia risk and associated with the emergence of memory decline. As a result, clinical practice may benefit from directing interventions at individuals with accelerating cardiovascular risk.
Key findings
- Results Of the 1,244 participants, cardiovascular risk increased moderately over time in 60% of sample, with observations of an accelerated increase in 18% of individuals and minimal change in 22% of individuals.
- An accelerated, as opposed to a stable, cardiovascular risk trajectory predicted an increased risk of developing Alzheimer disease dementia (average risk ratio [RR] 3.3-5.7, 95% CI 2.6-17.5 at T2, 1.9-6.7 at T5) or vascular dementia (average RR 3.3-4.1, 95% CI 1.1-16.6 at T2, 1.5-7.6 at T5) and was associated with an increased risk of memory decline (average RR 1.4-1.2, 95% CI 1-1.9 at T2, 1-1.5 at T5).
- Discussion The findings of the current study show that the longitudinal, cumulative trajectory of cardiovascular risk is predictive of dementia risk and associated with the emergence of memory decline.
- As a result, clinical practice may benefit from directing interventions at individuals with accelerating cardiovascular risk.
Why it matters
In this long-term cohort, people whose cardiovascular risk rose faster over time had a higher risk of later developing Alzheimer disease dementia or vascular dementia. This suggests that tracking and managing cardiovascular risk over many years may help lower dementia risk, though the study cannot prove cause and effect.
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Study details
- Study designprospective cohort
- Participants1,244
- Effect sizeRR 3.3-4.1; RR 1.4-1.2
- Evidence strengthModerate
How this study scored 69/100
Published in a leading specialty journal, and it is a prospective cohort study, followed forward from enrollment. Scored zero for randomised / blinded because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 66 of the 96 points we could judge it on, which is 69 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A prospective cohort study, followed forward from enrollment |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,244 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 90 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 15.0 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 4 / 6 | Cited 10.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 3 other studies in this library |
| Still being cited | 3 / 4 | Cited 68 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 1 / 3 | Umeå University: institution h-index 813 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 35444051) |
| Free to read | 2 / 2 | Free to read |
| Points | 66 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 66 of the 96 points we could judge it on is 69 out of 100. |
| Total | 69 / 100 | — |
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Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Farnsworth von Cederwald, B., Josefsson, M., Wåhlin, A., Nyberg, L., & Karalija, N. (2022). Association of Cardiovascular Risk Trajectory With Cognitive Decline and Incident Dementia. Neurology. https://doi.org/10.1212/wnl.0000000000200255
Vancouver
Farnsworth von Cederwald B, Josefsson M, Wåhlin A, Nyberg L, Karalija N. Association of Cardiovascular Risk Trajectory With Cognitive Decline and Incident Dementia. Neurology. 2022. doi:10.1212/wnl.0000000000200255. PMID: 35444051.
BibTeX
@article{farnsworthvoncederwald2022-35444051,
author = {Farnsworth von Cederwald, B. and Josefsson, M. and Wåhlin, A. and Nyberg, L. and Karalija, N.},
title = {{Association of Cardiovascular Risk Trajectory With Cognitive Decline and Incident Dementia}},
journal = {Neurology},
year = {2022},
doi = {10.1212/wnl.0000000000200255},
pmid = {35444051},
url = {https://doi.org/10.1212/wnl.0000000000200255}
}
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