Abstract 1641: Executive Function and Decline Are Predictors of Cardiovascular Disease Mortality in the San Luis Valley Health & Aging Study
While cognitive impairment and decline have been shown to predict all-cause mortality, assessing the relationship between cardiovascular disease (CVD) mortality and impairment, and decline, in executive cognitive functioning (the capacity for behavioral self-regulation) is still a relatively new topic. This study examined the relationship between CVD mortality, and executive functioning and its decline, as measured by the Behavioral Dyscontrol Scale (BDS) over a 22-month interval, in the San Luis Valley Health and Aging Study (SLVHAS). The SLVHAS is a population-based longitudinal study of 1,358 community-dwelling Hispanic and non-Hispanic white, elderly participants (age=74.4±8.6), living in two rural counties in Colorado. The BDS and a measure of general mental status, the Mini-Mental State Examination (MMSE), were administered at baseline and follow-up interviews. The BDS evaluates the ability to regulate one’s behavior; that is, to initiate action based on instructions and intentions, and to inhibit irrelevant activity. The mean and median baseline BDS scores in this elderly cohort were 14.9 (SD=4.2) and 16 (interquartile range=13–18), respectively. The interquartile range for overall change in BDS over 22 months extended between an increase of 1 point to a drop of 2 points between baseline and follow-up scores. The mean decline in BDS was 1.65 points (SD=2.42). Baseline BDS was correlated with age (rho=−0.33, p<0.0001), education (rho=0.57, p<0.0001, BMI (rho=0.10, p= 0.0002), and MMSE (rho=0.71, p<0.0001). There were 177 CVD deaths (based on death certificate classification) over an 8 year follow-up period. Using Cox regression, baseline BDS score significantly predicted CVD mortality (for each 1-unit lower BDS score, HR=1.09; 95% CI:1.03–1.15; p=0.002), independent of demographic covariates, history of CVD, and baseline MMSE score. So, every one-point lower BDS score (about 1?4 the standard deviation) was associated with a 9% increase in CVD mortality hazard. Decline in BDS score was also associated with CVD mortality (HR=1.14; 95% CI:1.06 –1.24; p<0.001), adjusting for the above covariates and baseline BDS. Therefore, both the capacity for behavioral self-regulation and its decline over time predicted CVD mortality in the SLVHAS.