Abstract
Backgrounds and aims: Evidence of an association between arterial calcification and worse cognitive performance comes, for the most part, from cross-sectional studies focusing solely on coronary arteries and, even so, with some conflicting results. We sought to investigate whether the presence and severity of calcification in the coronary artery (CAC), total thoracic aorta (TAC) and its segments [ascending thoracic aorta (ATAC), aortic arch (AAC) and descending thoracic aorta (DTAC)] are longitudinally associated with changes in cognitive performance at 4 years of follow-up in Brazilian adults from the ELSA-Brasil cohort, independently of major cardiovascular risk factors.
Methods: Our study included 1,331 individuals (mean age 62.4 years) from the ELSA-Brasil cohort in the state of Minas Gerais who participated in two subsequent waves (2012-2014 and 2017-2019). Measurements of arterial calcification (CAC, TAC, ATAC, DTAC) were obtained by computed tomography during our study baseline and analyzed dichotomously (present or absent) and in levels (0, 1-399UA and ≥ 400UA); cognitive performance was evaluated in tests (trail B test, verbal fluency, memory test and G-factor) applied in baseline and follow-up visit. Sociodemographic parameters (gender, education, race/ color), behavioral (smoking and leisure-time physical activity) and clinical parameters (hypertension, diabetes and body mass index)] were ascertained through face-to-face interviews at baseline. For the statistical analysis, linear regression models with mixed effects were used.
Results: In the dichotomous analyzes of calcification, only the presence of any DTAC was associated with worse cognitive performance at baseline. When levels of calcification were considered, higher values (≥ 400UA) of CAC, TAC and AAC were also associated with worse cognitive performance either in trail B test or G-factor at baseline. In regard to DTAC, not only both medium (1-399UA) and higher values were associated with worse cognitive performance at baseline in several cognitive tests at baseline, but higher DTAC was found to be related to an accelerated decline in performances in memory tests and G-factor.
Conclusion: Although higher levels of CAC and total and segmental thoracic aorta calcification were both independently associated with worse cognitive performance in this cohort of Brazilian adults, only higher DTAC was implied in a decline in cognitive performance over approximately 4 year of follow-up.