Cardiovascular burden, cognition, and depression as predictors of daily function in a sample of multiethnic JEANNINE SKINNER

RESEARCH ASSOCIATE

MEHARRY-VANDERBILT ALLIANCE

Data Description • Washington Heights-Inwood Columbia Aging Project (WHICAP)

•Longitudinal study of aging and dementia in community-dwelling adults aged

65+yrs

• Race/ethnically diverse sample

• Data from cohort 2- study entry in 1999

• Follow/up data every 18-30 months

• Average follow-up time 7.6 years

• Sub-sample of interest includes n=2141

Specific Aims & Hypothesis • Aims

• Examine the contributions of cardiovascular diseases and risk factors (CVDRFs), cognitive function, and depressed mood on trajectories of daily function

•Hypothesis

• A higher burden of CVDRFs will be associated with poorer functional abilities and steeper rates of functional decline

• Poorer cognitive function and more severe depressive symptomatology will be associated with poorer daily function and steeper rates of functional decline

Primary variables of interests Variable Description

Cardiovascular diseases & risk factors (CVDRFs)

Summary factory score based on presence of DM, HTN, heart disease, stroke, smoking (current), and central obesity. Each condition was assigned a value of 1 if present and 0 if absent

Depression (CES-D) 10-item scale reporting frequency of depressed feelings, higher scores indicated more depressive symptomatology

Executive function (EF) Composite score based on 6 cognitive test of executive function

General cognitive performance (GCP) Composite score based on 6 EF test + 4 tests of learning and memory

Daily Functional Status 39 self-reported and informant-reported indicators of ADLs, IADLs, & social functioning

*Each factor was scaled to have a mean of 50 and SD of 10, higher scores indicated better cognitive performance * Factors were calibrated to an external standard using data from the Aging, Demographics, and Memory Study (ADAMs), a sub-study of the Health and Retirement study

Statistical Analysis- Completed • Functional ability indicators (ADLs, IADLs, social functioning) were subjected parallel analysis to examine dimensionality

•Factor analysis to derive summary score of daily functional ability

•Random effect growth models to determine contributions of demographics, CVDRFs, cognition, and depressive sxs to change in daily function

Baseline Characteristics Variable White Non-

Hispanic Non-Hispanic

Black Hispanic P-value for

group differences

Total, n

Males, n (%)

Age, m (SD)

Education, n (%)

7 years or less

8 or more years

Follow-up time, m

(SD)

Sum of CVDRFs, n

(%)

0

1

2

3

4

GCP, mean (SD)

646

242( 37.5)

77.5 (7.3)

57 (8.9)

583 (91.1)

4.9 (3.9)

88(13.6)

227 (35.1)

226 (35.0)

90 (13.9)

15 (2.3)

54.5 (10.7)

53.9 (9.9)

707

200( 28.3)

77.3 (7.2)

148 (21.0)

557 (79.0)

4.3(3.7)

50 (7.1)

247 (34.9)

248 (35.1)

121 (17.1)

41 (5.8)

48.2 (10.7)

47.5 (10.4)

792

266(33.6)

76.2 (6.6)

589 (74.5)

202 (25.5)

4.4 (3.9)

75 (9.5)

281 (35.5)

264 (33.3)

135 (17.0)

37 (4.7)

43.8 (9.5)

42.4 (9.0)

0.001

<0.001

<0.001

0.009

0.001

<0.001

<0.001

Table 2: Random effect growth model for level and change in daily function: general cognition

 

Regression of baseline on the

predictor

Regression of slope on the

predictor

  Estimate (Beta) 95%CI Estimate (Beta)

95%CI

Model 1

GCP

CVDRF

Model 2

CVDRF X GCP

Model 3

CES-D

Model 4

CVDRF X CES-D

 

-0.14*

1.08*

 

-0.01

 

1.45*

 

0.00

 

(-0.16, -0.12)

(0.90, 1.25)

 

(-0.03, 0.01)

 

(1.29, 1.61)

 

(-0.18, 0.18)

 

-0.00

0.04*

 

-0.00

 

-0.02*

 

-0.01

 

(0.00, 0.00)

(0.02, 0.06)

 

(0.00, 0.00)

 

(-0.04, -0.02)

 

(-0.03, 0.01)

Table 3: Random effect growth model: executive function

 Regression of baseline on the predictor Regression of slope on the predictor

  Estimate (Beta) 95%CI Estimate (Beta) 95%CI

Model 1

EF

CVDRF

Model 2

CVDRF X EF

Model 3

CES-D

Model 4

CVDRF X CES-D

 

-0.19*

1.07*

 

-0.03*

 

1.46*

 

0.00

 

(-0.21, -0.17)

(0.89, 1.25)

 

(-0.05, -0.01)

 

(1.30, 1.62)

 

(-0.18, 0.18)

 

-0.00

0.04*

 

-0.00

 

-0.01

 

-0.01

 

(0.00, 0.00)

(0.02, 0.06)

 

(0.00, 0.00)

 

(-0.03, 0.01)

 

(-0.03, 0.01)

Biostat needs • In response to the results showing a) a NS relationship between executive function

and CVDRFs and change in function and b) a NS relationship between general

cognition and CVDRFS and change in function

• 1- Show the above findings graphically

• 2- Analysis of the data to determine whether the results differ by age groups

(younger vs. older by medial age split)

• Assistance with interpretation