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Response to Letter Regarding Article, "Carotid Intima-Media Thickness Is Associated With the Progression of Cognitive Impairment in Older Adults".

We appreciate the interest of Dr Kawada in our recently published article with reference to an important issue about the statistical validity and causality of observational studies. We conducted a 5-year cohort study to evaluate the association between carotid atherosclerosis and progression of cognitive impairment in 348 older adults. We used multivariate logistic regression analyses with adjustment for age, education, mood, and general health status to predict the progress of cognitive impairment or mild cognitive impairment. In our analyses, 56 (16.1%) of the 348 included subjects showed progression of cognitive dysfunction, and 50 (18.2%) of 275 subjects who were cognitively normal at the baseline evaluation were newly diagnosed with mild cognitive impairment.

We agree that sex is an important cardiovascular disease risk factor. The objective of our study …