Framingham scores could predict cognitive decline better than a standard dementia score

Paris, France - Two Framingham risk scores are more strongly associated with cognitive decline than a dementia risk score and could be a better fit for use in primary prevention in targeting modifiable risk factors, according to new research [1].

The study, published in the April 2, 2013 issue of Neurology, suggests that both the Framingham general cardiovascular disease (CVD) risk profile and especially the Framingham stroke risk profile are more strongly predictive of 10-year cognitive decline than the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score. The Framingham scores could provide physicians with more information about the link between midlife cardiovascular disease risk factors and later cognitive decline to pass on to their patients, said lead author Dr Sara Kaffashian (INSERM Center for Research in Epidemiology and Population Health, Paris, France).

"Physicians can tell patients who have hypertension or high cholesterol levels that they are at high risk of having heart disease or stroke—but they can also tell these patients that their brain may be at risk, too," she said in an interview. "Cardiovascular risk factors should be managed and treated early on, in middle age for example, to have a more favorable effect on cognition."

However, Dr Miia Kivipelto (Karolinska Institutet, Stockholm, Sweden), who helped develop the CAIDE dementia risk score and isn't connected to the current study, said that while she is pleased to see increasing interest in risk scores that predict cognitive decline and dementia, she doesn't believe the scores are conducive to comparison, as they have different outcomes.

These scores were developed to predict different events, are composed of different risk factors and populations, and are calibrated differently, so it's not surprising that their predictive values are different, Kaffashian agreed. She cautioned against concluding that the Framingham scores are necessarily superior to the dementia risk score.

Both Framingham scores include age, systolic blood pressure, hypertension treatment, smoking, and diabetes. The Framingham CVD risk score also includes sex, HDL cholesterol, and total cholesterol. The Framingham stroke risk score incorporates prior CVD, atrial fibrillation, and left ventricular hypertrophy and includes five categories of systolic blood pressure.

The CAIDE risk score was developed to predict late-life dementia based on midlife risk factors, including age, sex, systolic blood pressure, body-mass index, total cholesterol, physical activity, APOE genotype (in one version), and education, a marker of cognitive decline.

Study participants were from Whitehall II, an ongoing prospective cohort study that was established in 1985 and enrolled male and female office-based employees aged 35 to 55 years. The comparison of the Framingham CVD score and CAIDE dementia risk score was based on 4374 participants, while the comparison of the Framingham stroke and CAIDE score included 5157 subjects.