Sickle cell trait and risk of cognitive impairment in African-Americans: The REGARDS cohort

Christina R. Cahill, Justin M. Leach, Leslie A. McClure, Marguerite Ryan Irvin, Neil A. Zakai, Rakhi Naik, Frederick Unverzagt, Virginia G. Wadley, Hyacinth I. Hyacinth, Jennifer Manly, Suzanne E. Judd, Cheryl Winkler, Mary Cushman

Research output: Contribution to journalArticle

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Abstract

Background: Sickle cell anemia may be associated with cognitive dysfunction, and some complications of sickle cell anemia might affect those with sickle cell trait (SCT), so we hypothesized that SCT is a risk factor for cognitive impairment. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled a national cohort of 30,239 white and black Americans from 2003 to 7, who are followed every 6 months. Baseline and annual global cognitive function testing used the Six-Item Screener (SIS), a validated instrument (scores range 0–6; ≤ 4 indicates cognitive impairment). Participants with baseline cognitive impairment and whites were excluded. Logistic regression was used to calculate the association of SCT with incident cognitive impairment, adjusted for risk factors. Linear mixed models assessed multivariable-adjusted change in test scores on a biennially administered 3-test battery measuring learning, memory, and semantic and phonemic fluency. Findings: Among 7743 participants followed for a median of 7·1 years, 85 of 583 participants with SCT (14·6%) developed incident cognitive impairment compared to 902 of 7160 (12·6%) without SCT. In univariate analysis, the odds ratio (OR) of incident cognitive impairment was 1·18 (95% CI: 0·93, 1·51) for those with SCT vs. those without. Adjustment did not impact the OR. There was no difference in change on 3-test battery scores by SCT status (all p > 0·11). Interpretation: In this prospective cohort study of black Americans, SCT was not associated with incident cognitive impairment or decline in test scores of learning, memory and executive function. Funding: National Institutes of Health, American Society of Hematology.

Original languageEnglish (US)
JournalEClinicalMedicine
DOIs
StatePublished - Jan 1 2019

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Sickle Cell Trait
African Americans
Stroke
Sickle Cell Anemia
Odds Ratio
Learning
Social Adjustment
Cognitive Dysfunction
Executive Function
National Institutes of Health (U.S.)
Semantics
Cognition
Linear Models
Cohort Studies
Logistic Models
Prospective Studies

Keywords

  • Cognition
  • Cognitive dysfunction
  • Epidemiology
  • Prospective studies
  • Risk factors
  • Sickle cell trait

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cahill, C. R., Leach, J. M., McClure, L. A., Irvin, M. R., Zakai, N. A., Naik, R., ... Cushman, M. (2019). Sickle cell trait and risk of cognitive impairment in African-Americans: The REGARDS cohort. EClinicalMedicine. https://doi.org/10.1016/j.eclinm.2019.05.003

Sickle cell trait and risk of cognitive impairment in African-Americans : The REGARDS cohort. / Cahill, Christina R.; Leach, Justin M.; McClure, Leslie A.; Irvin, Marguerite Ryan; Zakai, Neil A.; Naik, Rakhi; Unverzagt, Frederick; Wadley, Virginia G.; Hyacinth, Hyacinth I.; Manly, Jennifer; Judd, Suzanne E.; Winkler, Cheryl; Cushman, Mary.

In: EClinicalMedicine, 01.01.2019.

Research output: Contribution to journalArticle

Cahill, CR, Leach, JM, McClure, LA, Irvin, MR, Zakai, NA, Naik, R, Unverzagt, F, Wadley, VG, Hyacinth, HI, Manly, J, Judd, SE, Winkler, C & Cushman, M 2019, 'Sickle cell trait and risk of cognitive impairment in African-Americans: The REGARDS cohort', EClinicalMedicine. https://doi.org/10.1016/j.eclinm.2019.05.003
Cahill, Christina R. ; Leach, Justin M. ; McClure, Leslie A. ; Irvin, Marguerite Ryan ; Zakai, Neil A. ; Naik, Rakhi ; Unverzagt, Frederick ; Wadley, Virginia G. ; Hyacinth, Hyacinth I. ; Manly, Jennifer ; Judd, Suzanne E. ; Winkler, Cheryl ; Cushman, Mary. / Sickle cell trait and risk of cognitive impairment in African-Americans : The REGARDS cohort. In: EClinicalMedicine. 2019.
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abstract = "Background: Sickle cell anemia may be associated with cognitive dysfunction, and some complications of sickle cell anemia might affect those with sickle cell trait (SCT), so we hypothesized that SCT is a risk factor for cognitive impairment. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled a national cohort of 30,239 white and black Americans from 2003 to 7, who are followed every 6 months. Baseline and annual global cognitive function testing used the Six-Item Screener (SIS), a validated instrument (scores range 0–6; ≤ 4 indicates cognitive impairment). Participants with baseline cognitive impairment and whites were excluded. Logistic regression was used to calculate the association of SCT with incident cognitive impairment, adjusted for risk factors. Linear mixed models assessed multivariable-adjusted change in test scores on a biennially administered 3-test battery measuring learning, memory, and semantic and phonemic fluency. Findings: Among 7743 participants followed for a median of 7·1 years, 85 of 583 participants with SCT (14·6{\%}) developed incident cognitive impairment compared to 902 of 7160 (12·6{\%}) without SCT. In univariate analysis, the odds ratio (OR) of incident cognitive impairment was 1·18 (95{\%} CI: 0·93, 1·51) for those with SCT vs. those without. Adjustment did not impact the OR. There was no difference in change on 3-test battery scores by SCT status (all p > 0·11). Interpretation: In this prospective cohort study of black Americans, SCT was not associated with incident cognitive impairment or decline in test scores of learning, memory and executive function. Funding: National Institutes of Health, American Society of Hematology.",
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AU - Irvin, Marguerite Ryan

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AU - Naik, Rakhi

AU - Unverzagt, Frederick

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