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Vascular factors predict rate of progression in Alzheimer disease
Mielke MM, Rosenberg PB, Tschanz J, Cook L, Corcoran C, Hayden KM, Norton M, Rabins PV et al.. Neurology, 2007-11-01
Topic: Amyloid, tau and blood-test diagnosis
Background While there is considerable epidemiologic evidence that cardiovascular risk factors increase risk of incident Alzheimer disease (AD), few studies have examined their effect on progression after an established AD diagnosis. Objective To examine the effect of vascular factors, and potential age modification, on rate of progression in a longitudinal study of incident dementia. Methods A total of 135 individuals with incident AD, identified in a population-based sample of elderly persons in Cache County, UT, were followed with in-home visits for a mean of 3.0 years (range: 0.8 to 9.5) and 2.1 follow-up visits (range: 1 to 5). The Clinical Dementia Rating (CDR) Scale and Mini-Mental State Examination (MMSE) were administered at each visit. Baseline vascular factors were determined by interview and physical examination. Generalized least-squares random-effects regression was performed with CDR Sum of Boxes (CDR-Sum) or MMSE as the outcome, and vascular index or individual vascular factors as independent variables. Results Atrial fibrillation, systolic hypertension, and angina were associated with more rapid decline on both the CDR-Sum and MMSE, while history of coronary artery bypass graft surgery, diabetes, and antihypertensive medications were associated with a slower rate of decline. There was an age interaction such that systolic hypertension, angina, and myocardial infarction were associated with greater decline with increasing baseline age. Conclusion Atrial fibrillation, hypertension, and angina were associated with a greater rate of decline and may represent modifiable risk factors for secondary prevention in Alzheimer disease. The attenuated decline for diabetes and coronary artery bypass graft surgery may be due to selective survival. Some of these effects appear to vary with age.
Key findings
- Results Atrial fibrillation, systolic hypertension, and angina were associated with more rapid decline on both the CDR-Sum and MMSE, while history of coronary artery bypass graft surgery, diabetes, and antihypertensive medications were associated with a slower rate of decline.
- There was an age interaction such that systolic hypertension, angina, and myocardial infarction were associated with greater decline with increasing baseline age.
- Conclusion Atrial fibrillation, hypertension, and angina were associated with a greater rate of decline and may represent modifiable risk factors for secondary prevention in Alzheimer disease.
Why it matters
In people already diagnosed with Alzheimer's disease, atrial fibrillation, systolic hypertension, and angina were linked to faster decline, while bypass surgery, diabetes, and antihypertensive medications were linked to slower decline. This concerns progression after diagnosis, not prevention or cure.
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Study details
- Study designlongitudinal study
- Participants135
- Evidence strengthModerate
How this study scored 67/100
Published in a leading specialty journal, and it is a longitudinal study following the same people over time. Scored zero for effect reported and randomised / blinded because the record does not state it.
| 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 longitudinal study following the same people over time |
| 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 | 1 / 5 | 2007 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 135 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| 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 | 6 / 7 | Cited 309 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 14.7 citations a year over 21 year(s) since 2007 |
| Impact for its field and year | 4 / 6 | Cited 14.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 18 other studies in this library |
| Still being cited | 1 / 4 | Cited 9 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Constantine George Lyketsos: h-index 130 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 17984453) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 67 / 100 | — |
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Read the original
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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. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Mielke, M. M., Rosenberg, P. B., Tschanz, J., Cook, L., Corcoran, C., Hayden, K. M., et al. (2007). Vascular factors predict rate of progression in Alzheimer disease. Neurology. https://doi.org/10.1212/01.wnl.0000279520.59792.fe
Vancouver
Mielke MM, Rosenberg PB, Tschanz J, Cook L, Corcoran C, Hayden KM, et al. Vascular factors predict rate of progression in Alzheimer disease. Neurology. 2007. doi:10.1212/01.wnl.0000279520.59792.fe. PMID: 17984453.
BibTeX
@article{mielke2007-17984453,
author = {Mielke, M. M. and Rosenberg, P. B. and Tschanz, J. and Cook, L. and Corcoran, C. and Hayden, K. M. and Norton, M. and Rabins, P. V. and others},
title = {{Vascular factors predict rate of progression in Alzheimer disease}},
journal = {Neurology},
year = {2007},
doi = {10.1212/01.wnl.0000279520.59792.fe},
pmid = {17984453},
url = {https://doi.org/10.1212/01.wnl.0000279520.59792.fe}
}
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