The Potential Role of Selection Bias in the Association Between Coronary Atherosclerosis and Cognitive Impairment

Authors

Maristella Yahagi-Estevam, Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Daniela Souza Farias-Itao, Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Renata Elaine Leite, Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Roberta Diehl Rodriguez, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Carlos Augusto Pasqualucci, Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Ricardo Nitrini, Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Wilson Jacob-Filho, Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Melinda C. Power, Department of Epidemiology, George Washington University, Washington, DC, USA.
Claudia Kimie Suemoto, Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Document Type

Journal Article

Publication Date

5-5-2023

Journal

Journal of Alzheimer's disease : JAD

DOI

10.3233/JAD-220820

Keywords

Aging; Alzheimer’s disease; atherosclerosis; bias; cognitive impairment; dementia

Abstract

BACKGROUND: Coronary atherosclerosis assessed in vivo was associated with cognitive impairment; however, conflicting findings have been reported in autopsy samples. OBJECTIVE: Our aims were to assess the association between atherosclerotic stenosis in the coronary arteries and cognitive impairment and to investigate the possibility of selection bias in an autopsy study. METHODS: Coronary arteries were collected, and the largest luminal stenosis was measured. Sociodemographic, clinical, and cognitive information were reported by a reliable next-of-kin. The association was tested using logistic and linear regressions adjusted for sociodemographic and clinical variables. We restricted the sample to individuals that were born in 1935 or earlier and stratified the analysis by cause of death to investigate the role of selection bias. RESULTS: In 253 participants (mean age = 78.0±8.5 years old, 48% male), stenosis was not associated with cognitive impairment (OR = 0.85, 95% CI = 0.69; 1.06, p = 0.15). In individuals who were born before 1936 in the absence of cardiovascular disease as the cause of death, greater stenosis was associated with cognitive impairment (OR = 4.02, 95% CI = 1.39; 11.6, p = 0.01). On the other hand, this association was not present among those born in 1935 or earlier who died of cardiovascular diseases (OR = 0.83, 95% CI = 0.60; 1.16, p = 0.28). CONCLUSION: We found that higher coronary stenosis was associated with cognitive impairment only in individuals born in 1935 or earlier and who had not died from cardiovascular diseases. Selection bias may be an important issue when investigating risk factors for chronic degenerative diseases in older individuals using autopsy samples.

APA Citation

Yahagi-Estevam, Maristella; Farias-Itao, Daniela Souza; Leite, Renata Elaine; Rodriguez, Roberta Diehl; Pasqualucci, Carlos Augusto; Nitrini, Ricardo; Jacob-Filho, Wilson; Power, Melinda C.; and Suemoto, Claudia Kimie, "The Potential Role of Selection Bias in the Association Between Coronary Atherosclerosis and Cognitive Impairment" (2023). GW Authored Works. Paper 2937.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2937

Department

Epidemiology