Keenan A. Walker, PhD; Ron C. Hoogeveen, PhD; Aaron R. Folsom, MD, MPH; Christie M. Ballantyne, MD; David S. Knopman, MD B. Gwen Windham, MD, MHS; Clifford R. Jack, Jr. MD; Rebecca F. Gottesman, MD, PhD
Objective: To clarify the temporal relationship between systemic inflammation and neurodegeneration, we examined whether a higher level of circulating inflammatory markers during midlife was associated with smaller brain volumes in late life using a large biracial prospective cohort study.
Methods: Plasma levels of systemic inflammatory markers (fibrinogen, albumin, white blood cell count, von Willebrand factor, and Factor VIII) were assessed at baseline in 1,633 participants (mean age 53  years, 60% female, 27% African American) enrolled in the Atherosclerosis Risk in Communities Study. Using all 5 inflammatory markers, an inflammation composite score was created for each participant. We assessed episodic memory and regional brain volumes, using 3T MRI, 24 years later.
Results: Each SD increase in midlife inflammation composite score was associated with 1,788 mm3 greater ventricular (p 5 0.013), 110 mm3 smaller hippocampal (p 5 0.013), 519 mm3 smaller occipital (p 5 0.009), and 532 mm3 smaller Alzheimer disease signature region (p 5 0.008) volumes, and reduced episodic memory (p 5 0.046) 24 years later. Compared to participants with no elevated (4th quartile) midlife inflammatory markers, participants with ele- vations in 3 or more markers had, on average, 5% smaller hippocampal and Alzheimer disease signature region volumes. The association between midlife inflammation and late-life brain volume was modified by age and race, whereby younger participants and white participants with higher levels of systemic inflammation during midlife were more likely to show reduced brain volumes subsequently.
Conclusions: Our prospective findings provide evidence for what may be an early contributory role of systemic inflammation in neurodegeneration and cognitive aging.