Association between electrocardiographic age and cognitive function: findings from the UK biobank and Framingham Heart Study

TL;DR

This study finds that a biological age calculated from heart scans is linked to worse cognitive performance in two large groups of people.

Contribution

The novel contribution is establishing a link between ECG-derived biological age and cognitive decline in two independent population cohorts.

Findings

Higher ECG-age compared to chronological age was associated with lower global cognitive performance in both UK Biobank and Framingham Heart Study participants.

Poorer cognitive performance was observed across multiple cognitive domains in individuals with accelerated ECG-age.

ECG-based biological age metrics may serve as low-cost digital markers for identifying individuals at risk of cognitive decline.

Abstract

Biological age derived from 12-lead electrocardiograms (ECGs) using deep learning has emerged as a promising marker of physiological ageing. However, its relationship with cognitive performance remains poorly understood. To investigate the association between ECG-derived ageing and cognitive performance in two large population-based cohorts.

We analysed data from the UK Biobank (UKB) and the Framingham Heart Study (FHS). A deep learning model estimated ECG-based biological age (ECG-age) from ECG waveforms. We calculated the difference between ECG-age and chronological age (Δage), which was used to classify participants into ageing groups: accelerated ageing, normal ageing, and decelerated ageing. Cognitive performance was measured with standardized neuropsychological tests, which were grouped into six cognitive domains and a global cognitive score. Multivariable linear regression models were used to examine the associations of Δage and ageing groups with cognitive performance. Among 59 213 UKB participants (mean age 64.7 ± 7.8 years; 51.7% women) and 6534 FHS participants (mean age 59.5 ± 14.5 years; 55.7% women), the mean absolute error between ECG-age and chronological age was 4.7 and 7.5 years, respectively. In both cohorts, higher Δage was associated with lower global cognitive performance (UKB: β = −0.02, 95% CI: −0.03, −0.02; FHS: β = −0.04, 95% CI: −0.06, −0.02) and poorer performance across multiple cognitive domains.

Electrocardiogram-derived age acceleration is associated with poorer cognitive performance across two independent cohorts. Electrocardiogram-based ageing metrics may serve as scalable, low-cost digital markers to identify individuals at elevated risk for cognitive decline.

Graphical AbstractFor image description, please refer to the figure legend and surrounding text.

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