Ultrasound Imaging Markers of Carotid Atherosclerosis are Associated with Cognition Through Cerebral Small Vessel Disease on MRI (S15.001)

Objective:

Determine whether markers of carotid atherosclerosis are associated with cognitive function through the burden of white matter disease.

Background:

Atherosclerosis is a risk factor for cognitive decline. Ultrasonographic measures of carotid atherosclerosis (plaque and intima-media thickness) and MRI measures of small vessel disease (white matter hyperintensity volume) are subclinical markers of cerebrovascular disease that are associated with cognitive dysfunction.

Design/Methods:

We included 1290 subjects from the racially and ethnically diverse Northern Manhattan Study (age 64+/−8years, 60% women, 67% Hispanic, 18% Black, 15% White, education 10+/−5years). We assessed total plaque area (TPA) and intima-media thickness (cIMT) measures on carotid ultrasound and measures of white matter hyperintensity volume (WMHV) on MRI. Participants underwent neurocognitive evaluation to estimate global cognitive performance and domains of episodic memory, executive function, semantic memory, and processing speed. Associative mediation models were employed to determine if WMHV mediates the association of TPA and cIMT on global and domain-specific cognitive performance adjusting for age, sex, race, ethnicity, education, ApoE4 status, hypertension, hypercholesteremia, diabetes, and smoking.

Results:

Of the 1290 participants, 675 had carotid plaque (TPA 21+/−22mm², cIMT 0.95+/−0.09mm, and WMHV 0.77+/−0.93% TIV). WMHV(log) mediated the association of TPA on global cognition [b(indirect-effect)=−0.001, p<0.05], episodic memory [b(indirect-effect)=−0.001, p<0.05], and processing speed [b(indirect-effect)=−0.001, p<0.05)] after adjustment. WMHV(log) volume mediated the association of cIMT on global cognition [b(indirect-effect)=−0.073, p<0.05], episodic memory [b(indirect-effect)=−0.112, p<0.05], and processing speed [b(indirect-effect)=−0.097, p<0.05] after adjustment. No associations were present for executive function and semantic memory.

Conclusions:

Ultrasound measures of extracranial carotid arteriosclerosis are related to intracranial MRI measures of small vessel disease and associated with cognitive performance. White matter hyperintensity volume may be an important factor in understanding the biological link between atherosclerosis and cognitive dysfunction in middle to older age population. More research is needed to better understand vascular imaging biomarkers of age-related cognitive dysfunction. Disclosure: Ms. Ariko has nothing to disclose. Ms. Aimagambetova has nothing to disclose. Ms. Gardener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intersocietal Accreditation Commission. Ms. Gardener has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ellipse Analytics. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Baum Hedlund. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with A Green Slate Consulting. Bonnie Levin has nothing to disclose. Dr. Sun has nothing to disclose. Ms. Cabral has nothing to disclose. Carolina Gutierrez has nothing to disclose. Prof. Zhao has nothing to disclose. Noam Alperin has nothing to disclose. Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy. The institution of Dr. Elkind has received research support from BMS-Pfizer Alliance for Eliquis. The institution of Dr. Elkind has received research support from Roche. Dr. Elkind has received publishing royalties from a publication relating to health care. Dr. Elkind has a non-compensated relationship as a Officer with American Heart Association that is relevant to AAN interests or activities. Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy. The institution of Dr. Elkind has received research support from BMS-Pfizer Alliance for Eliquis. The institution of Dr. Elkind has received research support from Roche. Dr. Elkind has received publishing royalties from a publication relating to health care. Dr. Elkind has a non-compensated relationship as a Officer with American Heart Association that is relevant to AAN interests or activities. Dr. Gutierrez has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Roetzel & Andress, JOHN ASTUNO, JR. L.L.C.. The institution of Dr. Gutierrez has received research support from NIH. Dr. Gutierrez has received publishing royalties from a publication relating to health care. Dr. Gutierrez has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Wright has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. An immediate family member of Dr. Wright has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for MARSHALL DENNEHY. The institution of an immediate family member of Dr. Wright has received research support from Oncospace. Dr. Wright has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Wright has received personal compensation in the range of $500-$4,999 for serving as a surveyor with ASTRO. Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care. The institution of Dr. Rundek has received research support from NIH.