Development and Validation of Models to Estimate the Incident Risk of Cognitive Impairment and Atherosclerotic Cardiovascular Disease in Older Adults

作者：Michael G. Nanna, Daniel Wojdyla, Eric D. Peterson, Ann Marie Návar, Jeff D. Williamson, Lisandro D. Colantonio, Stephen Y. Wang, Yasser Jamil, Alain G. Bertoni, Musarrat Nahid, Abdulla A. Damluji, Parag Goyal, Sarwat I. Chaudhry, Thomas M. Gill, Karen P. Alexander · 发表于：Journal of the American Heart Association · 年份：2025 · DOI：10.1161/jaha.124.038949 · 被引用次数：7 · 研究领域：Dementia and Cognitive Impairment Research、Cardiac Health and Mental Health、Machine Learning in Healthcare

BACKGROUND: Guidelines emphasize using atherosclerotic cardiovascular disease (ASCVD) risk prediction models for treatment decisions, but risk of cognitive impairment is an equally important concern in older adults. Current ASCVD risk prediction models were derived in younger adults and do not include holistic measures of health or predict cognitive impairment. METHODS: We utilized data from the Framingham, Framingham Offspring, CHS (Cardiovascular Health Study), and ARIC (Atherosclerosis Risk in Communities) cohorts to derive and validate 2 Selective Functional Prediction models to estimate an older person's (aged ≥75 years) risk within 5 years of developing incident: (1) cognitive impairment; and (2) ASCVD, while accounting for the competing risk of death. Variable selection, including functional status, was based on the least absolute shrinkage and selection operator method. The cognitive impairment (N=3466) and ASCVD (N=4403) model populations were split into derivation and validation cohorts with external validation, then performed in MESA (Multi-Ethnic Study of Atherosclerosis). RESULTS: In the derivation and external validation cohorts (median age, 79 years), 579 (16.7%) and 67 (15.3%) participants developed incident cognitive impairment, respectively; 748 (17.0%) and 80 (8.4%), respectively, experienced an ASCVD event. The cognitive impairment model (baseline Mini-Mental State Examination (MMSE), atrial fibrillation, antidepressant use, mobility impairment, and depend...