Zeynep TÜFEKÇİOĞLU, Özlem Güngör TUNCER, Rita KRESPİ, Yakup KRESPİ

VASKÜLER RİSK FAKTÖRLERİNİN KOGNİTİF DURUMLA İLİŞKİSİ

Giriş: Vasküler risk faktörlerinin kognitif bozukluğun değiştirilebilir risk faktörlerinden olduğu öne sürülmektedir. Çalışmamızda, kardiyovasküler hastalık ve demans öyküsü olmayan, 60 yaş ve üzerindeki bireylerde on yıllık koroner kalp hastalığı ve inme risk skorları ile kognitif durum arasındaki ilişki araştırıldı. Gereç ve Yöntem:İnme Merkezi “İnme ve Demans Primer Koruma Polikliniği” ne ardışık olarak başvurmuş olan bireylerin verileri retrospektif olarak incelendi. On yıllık koroner kalp hastalığı ve inme risklerini değerlendirmek amacıyla sırasıyla Framingham Risk Skoru (FRS) ve ModifiyeFramingham İnme Risk Profili (FSRP) kullanıldı. Kognitif fonksiyonlar Montreal Bilişsel Değerlendirme Ölçeği (MoCA) ile değerlendirilmişti. Bu testin Türkiye standardizasyon çalışmasına göre MoCA≤ 21 olanlar kognisyonu bozuk olarak kabul edildi. Kognitif durum ile vasküler risk arasındaki ilişki multivariat lojistik regresyon analizi ile araştırıldı. Yaş, cinsiyet, eğitim düzeyi, diğer kognisyonla ilişkili olabilecek etkenler, antihiperlipidemik, antidiyabetik ve antihipertansif tedavi kullanımı analize alındı. Bulgular: Örneklem 167 bireyden (40 erkek ve 127 kadın) oluşmaktaydı. Ortalama yaş 68 (SD: 6 Aralık: 28) idi. Ortalama FRS ve FSRP sırasıyla 8(20-3) ve 7(11-4) idi. Elli beş kişinin (%33) kognitif durumu bozuktu. Framingham Risk Skorundaki her %10’ luk artış kognisyonun bozuk olmasıyla ilişkiliydi (OR:1,669, 95%CI 1,038-2,682). İleri yaş, düşük eğitim düzeyi, alkol ve antihiperlipimik tedavi kullanmıyor olmak da ilişkili diğer bağımsız faktörlerdi. Ancak FSRP ile kognitif durum arasında ilişki saptanmadı. Sonuç: Kardiyovasküler hastalık öyküsü olmayan yaşlı bireylerde, FRS ile ölçülen global vasküler risk kognitif bozuklukla ilişkiliyken FSRP ile benzer ilişki saptanmamıştır. Bu ilişki, rutin klinik değerlendirmede kullanılan ve hafif kognitif bozukluğa duyarlı nöropsikolojik bir test olan MoCA ile gösterilmiştir.

COGNITIVE STATUS ASSOCIATED WITH VASCULAR RISK FACTORS

Introduction:Vascular risk factors have been showed to contribute to cognitive impairment. This study examined the relationship between 10-year risk for coronary heart disease (CHD) or stroke and cognitive function in older people, free of cardiovascular disease. Material and Method: Participants were consecutive attenders of a “stroke and dementia primary prevention clinic”. The Framingham Risk Score (FRS) and Modified Framingham Stroke Risk Profile (FSRP) were used to assess 10-year risk of CHD and stroke, respectively. Cognitive function was measured with Montreal Cognitive Assessment Scale (MoCA). Cognitive status (CS) was classified as impaired (MoCA≤21) vs. normal, which had been previously validated in theTurkish population. Correlations between cognitive status and global vascular risk were analyzed with ultivariate logistic regression analyses. Age, gender, education level, other potential correlates of cognitiveability, treatment for hyperlipidemia, hypertension and diabetes were included in the analyses. Results:The sample consisted of 167 individuals (40 men and 127 women). Mean age was 68 (SD: 6 Range: 28). Mean FRS and FSRP were 8(20-3) and 7(11-4), respectively. Fiftyfive individuals (%33) had impaired CS. Individuals with higher FRS (increments by 10% in FRS) had more impaired CS (adjusted OR:1, 669, 95%CI 1,038 to 2,682). No association was shown between FSRP and CS. Higher age, lower education level, absence of alcohol consumption and absence of treatment for hyperlipidemia were the other independent predictors of impaired CS. Conclusion: Our findings indicated that in older individuals free of cardiovasculardisease, global vascular risk is associated with impaired cognitive function which was accounted forby FRS rather than FSRP. This association was demonstrated with the use of a neuropsychological test which is sensitive for mild cognitive impaiment in routine clinical setting.

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