The association between vascular risk factor-mediating medications and cognition and dementia diagnosis in a community-based sample of african-americans

S. S. Richards, C. L. Emsley, J. Roberts, Michael Murray, Kathleen Hall, Sujuan Gao, Hugh Hendrie

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

OBJECTIVE: To determine the association between medications that ameliorate vascular risk factors and the prevalence of cognitive impairment and dementia in an older African-American population. DESIGN: A community-based survey to identify subjects with and without evidence of cognitive impairment and subsequent diagnostic evaluation of a stratified sample of these subjects using formal diagnostic criteria for dementia and Alzheimer's disease (AD). SETTING: Urban neighborhoods in Indianapolis, Indiana. SUBJECTS: A random sample of 2212 African-American adults aged 65 years and older residing in 29 contiguous census tracts. MEASUREMENTS: Subjects' scores on the Community Screening Instrument for Dementia (CSID), formal diagnostic and clinical assessments for dementia, current medication use and history of medical illnesses, both self-report and, where possible, from an informant. Four outcome measures were defined by the following criteria: (1) cognitive impairment as defined by the subject's performance on the CSID cognitive scale; (2) cognitive/functional impairment as defined by the total CSID score that included a relative's assessment of the subject's functional abilities; (3) dementia as defined by explicit diagnostic criteria; and (4) possible or probable Alzheimer's Disease as defined by explicit criteria. RESULTS: The vascular risk factor mediating medications, when analyzed together, were associated with a significantly decreased risk of diagnosis of cognitive impairment after controlling for age, education, and stroke (OR 0.73, P = .01) and also a significantly decreased risk of cognitive/functional impairment (OR 0.66, P = .02). Antihypertensive agents, excluding centrally acting sympatholytic drugs were associated with a significantly reduced risk of diagnosis of cognitive impairment (OR 0.56, P < .01) and cognitive/functional impairment (OR 0.64, P = .01). Centrally acting sympatholytic agents were associated with an increased risk of diagnosis of cognitive impairment (OR 2.24, P < .01). There was a trend toward protection from a diagnosis of AD and dementia for the vascular risk factor mediating medications and for the antihypertensive medication, but this did not reach significant levels. CONCLUSIONS: These data suggest that the use of medications to ameliorate vascular risk factors, particularly antihypertensive medication, may also be useful in reducing the risk of cognitive impairment in older subjects. However, they also suggest that physicians should be cautious in prescribing antihypertensive drugs with centrally acting sympatholytic properties to older subjects.

Original languageEnglish
Pages (from-to)1035-1041
Number of pages7
JournalJournal of the American Geriatrics Society
Volume48
Issue number9
StatePublished - 2000

Fingerprint

African Americans
Cognition
Dementia
Sympatholytics
Antihypertensive Agents
Alzheimer Disease
Cognitive Dysfunction
vascular factor
Aptitude
Censuses
Self Report
Stroke
Outcome Assessment (Health Care)
Physicians
Education

Keywords

  • African American
  • Antihypertensive medication
  • Cognitive impairment
  • Dementia
  • Vascular risk

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

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title = "The association between vascular risk factor-mediating medications and cognition and dementia diagnosis in a community-based sample of african-americans",
abstract = "OBJECTIVE: To determine the association between medications that ameliorate vascular risk factors and the prevalence of cognitive impairment and dementia in an older African-American population. DESIGN: A community-based survey to identify subjects with and without evidence of cognitive impairment and subsequent diagnostic evaluation of a stratified sample of these subjects using formal diagnostic criteria for dementia and Alzheimer's disease (AD). SETTING: Urban neighborhoods in Indianapolis, Indiana. SUBJECTS: A random sample of 2212 African-American adults aged 65 years and older residing in 29 contiguous census tracts. MEASUREMENTS: Subjects' scores on the Community Screening Instrument for Dementia (CSID), formal diagnostic and clinical assessments for dementia, current medication use and history of medical illnesses, both self-report and, where possible, from an informant. Four outcome measures were defined by the following criteria: (1) cognitive impairment as defined by the subject's performance on the CSID cognitive scale; (2) cognitive/functional impairment as defined by the total CSID score that included a relative's assessment of the subject's functional abilities; (3) dementia as defined by explicit diagnostic criteria; and (4) possible or probable Alzheimer's Disease as defined by explicit criteria. RESULTS: The vascular risk factor mediating medications, when analyzed together, were associated with a significantly decreased risk of diagnosis of cognitive impairment after controlling for age, education, and stroke (OR 0.73, P = .01) and also a significantly decreased risk of cognitive/functional impairment (OR 0.66, P = .02). Antihypertensive agents, excluding centrally acting sympatholytic drugs were associated with a significantly reduced risk of diagnosis of cognitive impairment (OR 0.56, P < .01) and cognitive/functional impairment (OR 0.64, P = .01). Centrally acting sympatholytic agents were associated with an increased risk of diagnosis of cognitive impairment (OR 2.24, P < .01). There was a trend toward protection from a diagnosis of AD and dementia for the vascular risk factor mediating medications and for the antihypertensive medication, but this did not reach significant levels. CONCLUSIONS: These data suggest that the use of medications to ameliorate vascular risk factors, particularly antihypertensive medication, may also be useful in reducing the risk of cognitive impairment in older subjects. However, they also suggest that physicians should be cautious in prescribing antihypertensive drugs with centrally acting sympatholytic properties to older subjects.",
keywords = "African American, Antihypertensive medication, Cognitive impairment, Dementia, Vascular risk",
author = "Richards, {S. S.} and Emsley, {C. L.} and J. Roberts and Michael Murray and Kathleen Hall and Sujuan Gao and Hugh Hendrie",
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T1 - The association between vascular risk factor-mediating medications and cognition and dementia diagnosis in a community-based sample of african-americans

AU - Richards, S. S.

AU - Emsley, C. L.

AU - Roberts, J.

AU - Murray, Michael

AU - Hall, Kathleen

AU - Gao, Sujuan

AU - Hendrie, Hugh

PY - 2000

Y1 - 2000

N2 - OBJECTIVE: To determine the association between medications that ameliorate vascular risk factors and the prevalence of cognitive impairment and dementia in an older African-American population. DESIGN: A community-based survey to identify subjects with and without evidence of cognitive impairment and subsequent diagnostic evaluation of a stratified sample of these subjects using formal diagnostic criteria for dementia and Alzheimer's disease (AD). SETTING: Urban neighborhoods in Indianapolis, Indiana. SUBJECTS: A random sample of 2212 African-American adults aged 65 years and older residing in 29 contiguous census tracts. MEASUREMENTS: Subjects' scores on the Community Screening Instrument for Dementia (CSID), formal diagnostic and clinical assessments for dementia, current medication use and history of medical illnesses, both self-report and, where possible, from an informant. Four outcome measures were defined by the following criteria: (1) cognitive impairment as defined by the subject's performance on the CSID cognitive scale; (2) cognitive/functional impairment as defined by the total CSID score that included a relative's assessment of the subject's functional abilities; (3) dementia as defined by explicit diagnostic criteria; and (4) possible or probable Alzheimer's Disease as defined by explicit criteria. RESULTS: The vascular risk factor mediating medications, when analyzed together, were associated with a significantly decreased risk of diagnosis of cognitive impairment after controlling for age, education, and stroke (OR 0.73, P = .01) and also a significantly decreased risk of cognitive/functional impairment (OR 0.66, P = .02). Antihypertensive agents, excluding centrally acting sympatholytic drugs were associated with a significantly reduced risk of diagnosis of cognitive impairment (OR 0.56, P < .01) and cognitive/functional impairment (OR 0.64, P = .01). Centrally acting sympatholytic agents were associated with an increased risk of diagnosis of cognitive impairment (OR 2.24, P < .01). There was a trend toward protection from a diagnosis of AD and dementia for the vascular risk factor mediating medications and for the antihypertensive medication, but this did not reach significant levels. CONCLUSIONS: These data suggest that the use of medications to ameliorate vascular risk factors, particularly antihypertensive medication, may also be useful in reducing the risk of cognitive impairment in older subjects. However, they also suggest that physicians should be cautious in prescribing antihypertensive drugs with centrally acting sympatholytic properties to older subjects.

AB - OBJECTIVE: To determine the association between medications that ameliorate vascular risk factors and the prevalence of cognitive impairment and dementia in an older African-American population. DESIGN: A community-based survey to identify subjects with and without evidence of cognitive impairment and subsequent diagnostic evaluation of a stratified sample of these subjects using formal diagnostic criteria for dementia and Alzheimer's disease (AD). SETTING: Urban neighborhoods in Indianapolis, Indiana. SUBJECTS: A random sample of 2212 African-American adults aged 65 years and older residing in 29 contiguous census tracts. MEASUREMENTS: Subjects' scores on the Community Screening Instrument for Dementia (CSID), formal diagnostic and clinical assessments for dementia, current medication use and history of medical illnesses, both self-report and, where possible, from an informant. Four outcome measures were defined by the following criteria: (1) cognitive impairment as defined by the subject's performance on the CSID cognitive scale; (2) cognitive/functional impairment as defined by the total CSID score that included a relative's assessment of the subject's functional abilities; (3) dementia as defined by explicit diagnostic criteria; and (4) possible or probable Alzheimer's Disease as defined by explicit criteria. RESULTS: The vascular risk factor mediating medications, when analyzed together, were associated with a significantly decreased risk of diagnosis of cognitive impairment after controlling for age, education, and stroke (OR 0.73, P = .01) and also a significantly decreased risk of cognitive/functional impairment (OR 0.66, P = .02). Antihypertensive agents, excluding centrally acting sympatholytic drugs were associated with a significantly reduced risk of diagnosis of cognitive impairment (OR 0.56, P < .01) and cognitive/functional impairment (OR 0.64, P = .01). Centrally acting sympatholytic agents were associated with an increased risk of diagnosis of cognitive impairment (OR 2.24, P < .01). There was a trend toward protection from a diagnosis of AD and dementia for the vascular risk factor mediating medications and for the antihypertensive medication, but this did not reach significant levels. CONCLUSIONS: These data suggest that the use of medications to ameliorate vascular risk factors, particularly antihypertensive medication, may also be useful in reducing the risk of cognitive impairment in older subjects. However, they also suggest that physicians should be cautious in prescribing antihypertensive drugs with centrally acting sympatholytic properties to older subjects.

KW - African American

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KW - Dementia

KW - Vascular risk

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