Highlights
- •The role of white matter hyperintensity on cognition in older adults with cardiovascular risk varied by aspirin use.
- •Aspirin use exacerbated the negative effect of white matter hyperintensity burden on cognition.
- •The underlying pathways to cognitive decline may differ among aspirin users.
- •Considering aspirin use in addition to white matter hyperintensity and cardiovascular risk could improve the prediction of cognition in older adults.
Abstract
Objectives
Cardiovascular risk is associated with cognitive decline and this effect is attributed
to brain pathology, including white matter hyperintensity (WMH) burden. Low-dose aspirin
is frequently recommended for reducing vascular events. We investigated the effect
of taking aspirin on the association between cardiovascular risk, WMH burden and cognitive
function.
Study design
The study sample was drawn from 318 dementia-free adults aged 67–71 years. Brain magnetic
resonance imaging (MRI) scans were acquired from 239 participants.
Main outcome measures
WMH total lesion volumes (TLV) were extracted using the automated lesion segmentation
algorithm. We measured cardiovascular risk by calculating ASSIGN score. Cognitive
ability was measured using a test of processing speed. We developed structural equation
models to test our hypothesis.
Results
Sixty-eight participants (47.1 % male, mean age = 68.8 years) reported that they took
aspirin. The demographic measures did not differ significantly by aspirin use. Among
aspirin users, there was a strong negative association between WMH TLV and cognition
(β = −0.43, p-value < 0.001), while in non-users of aspirin the only significant predictor
of poorer cognition was cardiovascular risk (β = −0.17, p-value = 0.001).
Conclusions
Aspirin use moderates the negative effect of WMH burden on cognition. Considering
WMH burden in addition to cardiovascular risk could improve the prediction of cognitive
decline in older adults with aspirin use.
Keywords
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Article info
Publication history
Published online: January 07, 2020
Accepted:
January 4,
2020
Received in revised form:
December 9,
2019
Received:
July 9,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
