Abstract 3781: Harm Avoidance: A Novel Risk Factor for Cerebral Infarction
BACKGROUND: Harm avoidance, a trait indicative of behavioral inhibition, is associated with disability and dementia in old age, but the basis of these associations is uncertain.
OBJECTIVE: To test the hypothesis that higher level of harm avoidance is associated with increased risk of cerebral infarction.
METHODS: Longitudinal clinical-pathologic cohort study. Subjects were from the Rush Memory and Aging Project. As part of this longitudinal study, 1,082 older persons without dementia completed a standard measure of harm avoidance: the 35-item Harm Avoidance Scale from Cloninger’s Temperament and Character Inventory. During a mean of 3.5 years of follow-up, 258 individuals died of whom 206 (80%) underwent brain autopsy, the results of which are currently available in 192. Main Outcome Measures: Number of chronic gross and microscopic cerebral infarctions (each expressed as 0,1, or >1) identified on a uniform neuropathologic examination. RESULTS: Trait scores ranged from 0 to 32 and were approximately normally distributed (mean 11.6 ± 7.0 SD). On postmortem examination, chronic microscopic infarction was found in 45 (28 with 1, 17 with >1) and chronic gross infarction was found in 66 (31 with 1, 35 with > 1). In a Bivariate Dale Model adjusted for age, sex, and education, higher harm avoidance was associated with higher likelihood of both microscopic (estimate = -0.08, SE = 0.02, p = 0.002) and gross (estimate = -0.06, SE = 0.02, p = 0.011) cerebral infarction. A high level of the trait (score=17, 75th percentile) was associated with an approximate doubling of the likelihood of each type of infarction (2.4- fold increase for microscopic, 1.8-fold increase for gross) compared to a low level of the trait (score = 6, 25th percentile). These associations persisted in subsequent models that controlled for cognitive and motor function, cardiovascular risk factors and conditions, or neuroticism, and it was stronger for subcortical than cortical infarction.
CONCLUSIONS: Higher level of the harm avoidance trait may be a risk factor for cerebral infarction, both gross and microscopic. The mechanism appears independent of known cardiovascular risk factors and warrants further study.
- © 2012 by American Heart Association, Inc.