Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study

Jennifer A Eastman; Allison R Kaup; Amber L Bahorik; Xochitl Butcher; Mouna Attarha; Gregory M Marcus; Mark J Pletcher; Jeffrey E Olgin; Deborah E Barnes; Kristine Yaffe

doi:10.2196/30410

Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study

JMIR Form Res. 2022 Feb 2;6(2):e30410. doi: 10.2196/30410.

Authors

Jennifer A Eastman^#^{1

2}, Allison R Kaup^#^{1

2

3}, Amber L Bahorik^#², Xochitl Butcher^#⁴, Mouna Attarha^#⁵, Gregory M Marcus⁴, Mark J Pletcher⁶, Jeffrey E Olgin^#⁴, Deborah E Barnes^#^{1

2

6}, Kristine Yaffe^#^{1

2

6

7}

Affiliations

¹ San Francisco VA Medical Center, San Francisco, CA, United States.
² Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States.
³ The Neurology Center of Southern California, Carlsbad, CA, United States.
⁴ Department of Medicine, University of California, San Francisco, CA, United States.
⁵ Posit Science Corporation, San Francisco, CA, United States.
⁶ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
⁷ Department of Neurology, University of California, San Francisco, CA, United States.

^# Contributed equally.

PMID: 35107430
PMCID: PMC8851369
DOI: 10.2196/30410

Abstract

Background: Adults with cardiovascular disease risk factors (CVRFs) are also at increased risk of developing cognitive decline and dementia. However, it is often difficult to study the relationships between CVRFs and cognitive function because cognitive assessment typically requires time-consuming in-person neuropsychological evaluations that may not be feasible for real-world situations.

Objective: We conducted a proof-of-concept study to determine if the association between CVRFs and cognitive function could be detected using web-based, self-administered cognitive tasks and CVRF assessment.

Methods: We recruited 239 participants aged ≥50 years (mean age 62.7 years, SD 8.8; 42.7% [n=102] female, 88.7% [n=212] White) who were enrolled in the Health eHeart Study, a web-based platform focused on cardiac disease. The participants self-reported CVRFs (hypertension, high cholesterol, diabetes, and atrial fibrillation) using web-based health surveys between August 2016 and July 2018. After an average of 3 years of follow-up, we remotely evaluated episodic memory, working memory, and executive function via the web-based Posit Science platform, BrainHQ. Raw data were normalized and averaged into 3 domain scores. We used linear regression models to examine the association between CVRFs and cognitive function.

Results: CVRF prevalence was 62.8% (n=150) for high cholesterol, 45.2% (n=108) for hypertension, 10.9% (n=26) for atrial fibrillation, and 7.5% (n=18) for diabetes. In multivariable models, atrial fibrillation was associated with worse working memory (β=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (β=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (β=-.27, 95% CI -0.44 to -0.11). Diabetes and high cholesterol were not associated with cognitive performance.

Conclusions: Self-administered web-based tools can be used to detect both CVRFs and cognitive health. We observed that atrial fibrillation and hypertension were associated with worse cognitive function even in those in their 60s and 70s. The potential of mobile assessments to detect risk factors for cognitive aging merits further investigation.

Keywords: aging; cardiovascular; cognition; cognitive impairment; digital health; eHealth; internet; mHealth; mobile health; remote cognitive assessment; risk factors.

©Jennifer A Eastman, Allison R Kaup, Amber L Bahorik, Xochitl Butcher, Mouna Attarha, Gregory M Marcus, Mark J Pletcher, Jeffrey E Olgin, Deborah E Barnes, Kristine Yaffe. Originally published in JMIR Formative Research (https://formative.jmir.org), 02.02.2022.