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Zhu X, Ding L, Zhang X, Xiong Z. Association of cognitive frailty and abdominal obesity with cardiometabolic multimorbidity among middle-aged and older adults: A longitudinal study. J Affect Disord 2023; 340:523-528. [PMID: 37595895 DOI: 10.1016/j.jad.2023.08.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Cognitive frailty and abdominal obesity are deemed to be important targets for disease prevention. However, a possible cardiometabolic multimorbidity (CMM) link with cognitive frailty and abdominal obesity is unknown. The aim of this study was to investigate the association of cognitive frailty and abdominal obesity with CMM in the middle-aged and older people. METHODS The sample comprised 11,503 participants aged 45 and over from the China Health and Retirement Longitudinal Study (CHARLS) 2011. Cognitive frailty was defined as the coexisting cognitive impairment and physical frailty. Abdominal obesity was assessed using waist circumference. CMM was defined as the presence of two or more cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke. A total of 9177 participants without CMM recruited from CHARLS 2011 and were followed up in 2018. RESULTS Compared with 0 CMD, coexisting cognitive frailty and abdominal obesity was associated with the risk of 1 CMD (OR: 1.734, 95 % CI: 1.133-2.655), and ≥ 2 CMDs (OR: 7.218, 95%CI: 3.216-16.198). Longitudinal analysis showed that individuals with both cognitive frailty and abdominal obesity (HR: 2.162, 95%CI: 1.032-4.531) were more likely to have new onset CMM than cognitive frailty alone peers (HR: 1.667, 95 % CI: 0.721-3.853). Among the participants with first CMD, the likelihood of CMM was substantially higher in the co-existence of cognitive frailty and abdominal obesity (HR: 3.073, 95%CI: 1.254-7.527) than in the abdominal obesity alone (HR: 1.708, 95%CI: 1.201-2.427). Cognitive frailty alone was not significantly associated with CMM. CONCLUSION Cognitive frailty is not independently associated with the risk of CMM, but cognitive frailty and abdominal obesity together has a greater risk of CMM.
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Affiliation(s)
- Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China.
| | - Linlin Ding
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xiaona Zhang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Zhenfang Xiong
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
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Cognitive decline and risk of dementia in individuals with heart failure: A systematic review and meta-analysis. J Card Fail 2021; 28:1337-1348. [PMID: 34971812 DOI: 10.1016/j.cardfail.2021.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
AIM To determine the association between heart failure (HF) and cognitive change and dementia. METHODS AND RESULTS Systematic search of three electronic databases was performed and 29 eligible studies involving approximately 3 million participants were identified. Twelve studies examined dementia and 20 cognitive change, but only a subset of studies could be included in the meta-analysis. These findings indicated that HF was not significantly associated with dementia (n=8, hazard ratio [HR] 1.18, 95% confidence interval [CI] [0.93, 1.50]), but increased the risk of cognitive impairment (n=3, HR 1.80, 95%CI [1.14,2.86]) . Additionally, HF was associated with poorer mean cognitive performance in global cognition (Hedges' g -0.73, 95%CI [-1.12, -0.35]), memory (Hedges' g -0.57, 95%CI [-0.72, -0.42]), executive function (Hedges' g -0.58, 95%CI [-0.72, -0.43]), attention/speed (Hedges' g -0.50, 95%CI [-0.63, -0.37]) and language (Hedges' g -0.61, 95%CI [-1.05, -0.17]). CONCLUSION Patients with HF perform worse on all cognitive tests, and have an increased risk of cognitive impairment. These findings highlight the need for clinicians to consider cognition as part of routine care for patients with HF.
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Leiton CV, Chen E, Cutrone A, Conn K, Mellanson K, Malik DM, Klingener M, Lamm R, Cutrone M, Petrie J, Sheikh J, DiBua A, Cohen B, Floyd TF. Astrocyte HIF-2α supports learning in a passive avoidance paradigm under hypoxic stress. HYPOXIA (AUCKLAND, N.Z.) 2018; 6:35-56. [PMID: 30519596 PMCID: PMC6234990 DOI: 10.2147/hp.s173589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The brain is extensively vascularized, useŝ20% of the body's oxygen, and is highly sensitive to changes in oxygen. While synaptic plasticity and memory are impaired in healthy individuals by exposure to mild hypoxia, aged individuals appear to be even more sensitive. Aging is associated with progressive failure in pulmonary and cardiovascular systems, exposing the aged to both chronic and superimposed acute hypoxia. The HIF proteins, the "master regulators" of the cellular response to hypoxia, are robustly expressed in neurons and astrocytes. Astrocytes support neurons and synaptic plasticity via complex metabolic and trophic mechanisms. The activity of HIF proteins in the brain is diminished with aging, and the increased exposure to chronic and acute hypoxia with aging combined with diminished HIF activity may impair synaptic plasticity. PURPOSE Herein, we test the hypothesis that astrocyte HIF supports synaptic plasticity and learning upon hypoxia. MATERIALS AND METHODS An Astrocyte-specific HIF loss-of-function model was employed, where knock-out of HIF-1α or HIF-2α in GFAP expressing cells was accomplished by cre-mediated recombination. Animals were tested for behavioral (open field and rotarod), learning (passive avoidance paradigm), and electrophysiological (long term potentiation) responses to mild hypoxic challenge. RESULTS In an astrocyte-specific HIF loss-of-function model followed by mild hypoxia, we identified that the depletion of HIF-2α resulted in an impaired passive avoidance learning performance. This was accompanied by an attenuated response to induction in long-term potentiation (LTP), suggesting that the hippocampal circuitry was perturbed upon hypoxic exposure following HIF-2α loss in astrocytes, and not due to hippocampal cell death. We investigated HIF-regulated trophic and metabolic target genes and found that they were not regulated by HIF-2α, suggesting that these specific targets may not be involved in mediating the phenotypes observed. CONCLUSION Together, these results point to a role for HIF-2α in the astrocyte's regulatory role in synaptic plasticity and learning under hypoxia and suggest that even mild, acute hypoxic challenges can impair cognitive performance in the aged population who harbor impaired HIF function.
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Affiliation(s)
- Cindy V Leiton
- Department of Pathology, Stony Brook University, Stony Brook, NY, USA
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Elyssa Chen
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Alissa Cutrone
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kristy Conn
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Kennelia Mellanson
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY, USA
| | - Dania M Malik
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Klingener
- Department of Genetics, Stony Brook University, Stony Brook, NY, USA
| | - Ryan Lamm
- Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael Cutrone
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - John Petrie
- Department of Biochemistry & Molecular Biology, Bloomberg School of Public health, Johns Hopkins University, Baltimore, MD, USA
| | - Joher Sheikh
- Department of Physiology and Biophysics, Georgetown University, Washington, DC, USA
| | - Adriana DiBua
- Department of Chemistry, Hofstra University, Hempstead, NY, USA
| | - Betsy Cohen
- Computer Science Department, Swarthmore College, Swarthmore, PA, USA
| | - Thomas F Floyd
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, USA,
- Department of Cardiothoracic Surgery, University of Texas Southwestern, Dallas, TX, USA,
- Department of Radiology, University of Texas Southwestern, Dallas, TX, USA,
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Witt LS, Rotter J, Stearns SC, Gottesman RF, Kucharska-Newton AM, Richey Sharrett A, Wruck LM, Bressler J, Sueta CA, Chang PP. Heart Failure and Cognitive Impairment in the Atherosclerosis Risk in Communities (ARIC) Study. J Gen Intern Med 2018; 33:1721-1728. [PMID: 30030736 PMCID: PMC6153245 DOI: 10.1007/s11606-018-4556-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/26/2018] [Accepted: 06/27/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggest that heart failure (HF) is an independent risk factor for cognitive decline. A better understanding of the relationship between HF, cognitive status, and cognitive decline in a community-based sample may help clinicians understand disease risk. OBJECTIVE To examine whether persons with HF have a higher prevalence of cognitive impairment and whether persons developing HF have more rapid cognitive decline. DESIGN This observational cohort study of American adults in the Atherosclerosis Risk in Communities (ARIC) study has two components: cross-sectional analysis examining the association between prevalent HF and cognition using multinomial logistic regression, and change over time analysis detailing the association between incident HF and change in cognition over 15 years. PARTICIPANTS Among visit 5 (2011-2013) participants (median age 75 years), 6495 had neurocognitive information available for cross-sectional analysis. Change over time analysis examined the 5414 participants who had cognitive scores and no prevalent HF at visit 4 (1996-1998). MEASUREMENTS The primary outcome was cognitive status, classified as normal, mild cognitive impairment [MCI], and dementia on the basis of standardized cognitive tests (delayed word recall, word fluency, and digit symbol substitution). Cognitive change was examined over a 15-year period. Control variables included socio-demographic, vascular, and smoking/drinking measures. RESULTS At visit 5, participants with HF had a higher prevalence of dementia (adjusted relative risk ratio [RRR] = 1.60 [95% CI 1.13, 2.25]) and MCI (RRR = 1.36 [1.12, 1.64]) than those without HF. A decline in cognition between visits 4 and 5 was - 0.07 standard deviation units [- 0.13, - 0.01] greater among persons who developed HF compared to those who did not. Results did not differ by ejection fraction. CONCLUSION HF is associated with neurocognitive dysfunction and decline independent of other co-morbid conditions. Further study is needed to determine the underlying pathophysiology.
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Affiliation(s)
- Lucy S Witt
- Department of Hospital Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.
| | - Jason Rotter
- Department of Health Policy & Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sally C Stearns
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa M Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Jan Bressler
- Human Genetics, and Environmental Sciences, University of Texas Health School of Public Health Department of Epidemiology, Austin, TX, USA
| | - Carla A Sueta
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia P Chang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Leng X, Espeland MA, Manson JE, Stefanick ML, Gower EW, Hayden KM, Limacher MC, Vaughan L, Robinson J, Wallace R, Wassertheil-Smoller S, Yaffe K, Shumaker SA. Cognitive Function and Changes in Cognitive Function as Predictors of Incident Cardiovascular Disease: The Women's Health Initiative Memory Study. J Gerontol A Biol Sci Med Sci 2018; 73:779-785. [PMID: 28977360 PMCID: PMC5946937 DOI: 10.1093/gerona/glx138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 01/08/2023] Open
Abstract
Background Cognitive impairment and decline may signal the increased risk of incident cardiovascular disease (CVD). We examined associations of global cognitive function, as measured by the Modified Mini-Mental State Examination (3MS) and changes in 3MS over time, with incident CVD, individual CVD outcomes, CVD death, and all-cause mortality. Methods A total of 5,596 women (≥ 60) from the Women's Health Initiative Memory Study free of CVD at baseline were followed for an average of 7.1 years. The 3MS was measured at baseline and annually thereafter. Cox proportional hazards regressions were used to model associations between baseline 3MS and changes in 3MS and time to events. Results In the fully-adjusted models for every 5-point lower baseline 3MS score, the risk was 12% greater for incident CVD, 37% for HF, 35% for CVD death, and 24% for all-cause mortality. No significant relationships were found for coronary heart disease (CHD), angina, stroke/transient ischemic attack (TIA), or coronary revascularization. When change in 3MS was added as a time-varying covariate in the fully-adjusted models, for every 1-point/year greater decline in 3MS, the risk was 4% greater for incident CVD, 10% for CHD, 9% for Stroke/TIA, 17% for CVD death, and 13% for all-cause mortality. Conclusions In older women free of prevalent CVD at baseline, lower baseline global cognitive function or decline in global cognitive function over time, increased risk of incident CVD, CVD death, and all-cause mortality.
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Affiliation(s)
- Xiaoyan Leng
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mark A Espeland
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marcia L Stefanick
- Center for Disease Prevention Research, Stanford University, Palo Alto, California
| | - Emily W Gower
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Kathleen M Hayden
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Marian C Limacher
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Leslie Vaughan
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jennifer Robinson
- Department of Epidemiology, University of Iowa College of Medicine
- Department of Internal Medicine, University of Iowa College of Medicine
| | - Robert Wallace
- Department of Epidemiology, University of Iowa College of Medicine
- Department of Internal Medicine, University of Iowa College of Medicine
| | | | - Kristine Yaffe
- Departments of Epidemiology and Biostatistics and Psychiatry and Neurology, University of California, San Francisco
| | - Sally A Shumaker
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Arruda CS, Pereira JDMV, Figueiredo LDS, Scofano BDS, Flores PVP, Cavalcanti ACD. Effect of an orientation group for patients with chronic heart failure: randomized controlled trial. Rev Lat Am Enfermagem 2018; 25:e2982. [PMID: 29319747 PMCID: PMC5768213 DOI: 10.1590/1518-8345.2167.2982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the effect of the orientation group on therapeutic adherence and self-care among patients with chronic heart failure. METHOD Randomized controlled trial with 27 patients with chronic heart failure. The intervention group received nursing consultations and participated in group meetings with the multi-professional team. The control group only received nursing consultations in a period of four months. Questionnaires validated for use in Brazil were applied in the beginning and in the end of the study to assess self-care outcomes and adherence to treatment. Categorical variables were expressed through frequency and percentage distributions and the continuous variables through mean and standard deviation. The comparison between the initial and final scores of the intervention and control groups was done through the Student's t-test. RESULTS The mean adherence in the intervention group was 13.9 ± 3.6 before the study and 4.8 ± 2.3 after the study. In the control group it was 14.2 ± 3.4 before the study and 14.7 ± 3.5 after the study. The self-care confidence score was lower after the intervention (p=0.01). CONCLUSION The orientation group does not improve adherence to treatment and self-care management and maintenance and it may reduce confidence in self-care. Registry REBEC RBR-7r9f2m.
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Affiliation(s)
- Cristina Silva Arruda
- MSc, RN, Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, RJ, Brazil
| | - Juliana de Melo Vellozo Pereira
- Doctoral student, Universidade Federal Fluminense, Niterói, RJ, Brazil. RN, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lyvia da Silva Figueiredo
- Doctoral student, Universidade Federal Fluminense, Niterói, RJ, Brazil. Scholarship holder at Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Paula Vanessa Peclat Flores
- Doctoral student, Universidade Federal Fluminense, Niterói, RJ, Brazil. Assistant Professor, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Weisenbach SL, Forester BP. Vascular Risk Profile and Cognitive Functioning among Patients with Bipolar Disorder: Cause for Concern? Am J Geriatr Psychiatry 2017; 25:277-278. [PMID: 28110877 DOI: 10.1016/j.jagp.2016.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Sara L Weisenbach
- Department of Psychiatry, University of Utah, Salt Lake City, UT; Research Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT.
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