Higher Framingham scores predict cognitive decline

The Framingham risk scores predicted cognitive decline in late middle age slightly more accurately than a score specifically designed to predict dementia in a recent study.

Researchers used data from the Whitehall II study, a longitudinal British cohort study. More than 7,000 study participants, with a mean age of 55.6 years at baseline, were assessed using the Framingham general cardiovascular disease risk score, the Framingham stroke risk score and the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score. To determine the incidence of cognitive decline, participants were given cognitive tests on reasoning, memory, verbal fluency, vocabulary and global cognition at three times over 10 years.

Patients who were at higher risk according to the Framingham scores also showed greater cognitive decline in all the tests except memory. Higher risk according to the CAIDE score was associated with decline in reasoning, vocabulary and global cognitive scores, but the Framingham scores had slightly stronger associations with overall 10-year cognitive decline, the study found. Diabetes, a factor in both Framingham scores, was found to be the biggest independent predictor of cognitive decline. Results were published in Neurology on April 2.

All three risk scores predicted cognitive decline, the study authors concluded. One explanation for the slight difference in accuracy might be the CAIDE score's inclusion of education, a factor that affects the risk of dementia but not the rate of cognitive decline. The Framingham scores also had more risk categories than the CAIDE for certain factors (for example, five systolic blood pressure ranges instead of two), which could make them more sensitive.

In addition to their greater predictive value, the Framingham scores might be more practical for primary prevention of cognitive decline, the authors suggested. A risk evaluation specifically for dementia could induce anxiety in patients, and the addition of another risk score is unlikely to be appealing to busy physicians. The Framingham scores are already used frequently in practice to alert patients to their risk for heart disease and stroke, so “in the future, they could also be told that they may be at higher risk of cognitive decline,” the authors said.