Pulmonary Function in Midlife as a Predictor of Later-Life Cognition: The Coronary Artery Risk Development in Adults (CARDIA) Study

Studies found associations between pulmonary function (PF) and cognition, but these are limited by mostly cross-sectional design and a single measure of PF (typically FEV1). Our objective was to prospectively analyze the association of repeatedly measured PF with cognition. We studied 3,499 participants in The Coronary Artery Risk Development in Young Adults cohort with cognition measured at year 25 (Y25) and Y30, and PF (FEV1 and FVC, reflecting better PF) measured up to six times from Y0-Y20. Cognition was measured via Stroop test, Rey-Auditory Verbal Learning Test [RAVLT], and Digit Symbol Substitution Test [DSST] which capture executive function, verbal learning and memory, and attention and psychomotor speed respectively; lower Stroop, and higher RAVLT and DSST scores indicate better cognition. We modeled linear, cross-sectional associations between cognition and PF at Y30 (mean age 55), and mixed models to examine associations between cognition at Y25-Y30 and longitudinal PF (both annual rate of change, and cumulative PF from Y0-Y20). At Y30 FEV1 and FVC were cross-sectionally associated with all three measures of cognition (β= 0.08-0.12, p<0.01-0.02). Annual change from peak FEV1/FVC ratio was associated with Stroop and DSST (β=18.06, 95% CI=7.71-28.40; β=10.30, 95% CI=0.26-20.34, respectively) but not RAVLT. Cumulative FEV1 and FVC were associated with Stroop and DSST (β= 0.07-0.12, p<0.01-0.02), but only cumulative FEV1 was associated with RAVLT (β=0.07, 95% CI=0.00-0.14). We identified prospective associations between measures of PF and cognition even at middle ages, adding evidence of a prospective association between reduced PF and cognitive decline.

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