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Williams IC, Park MH, Tsang S, Sperling SA, Manning C. Cognitive Function and Vascular Risk Factors Among Older African American Adults. J Immigr Minor Health 2019; 20:612-618. [PMID: 28417319 DOI: 10.1007/s10903-017-0583-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
To evaluate the association between vascular risk factors and cognitive impairment among older African American (AA) adults in a primary care clinic. Participants included 96 AA adults aged 60 years or older who were evaluated for global and domain-specific cognition. Participants were interviewed using the Computerized Assessment of Memory and Cognitive Impairment (CAMCI). The relationship between CAMCI cognitive domain scores and vascular risk factors were examined using hierarchical regression models. Patients who smoked, those with higher SBP/DBP values had lower accuracy rates on CAMCI cognitive domains (attention, executive, memory).Those with higher BMI had better attention scores. Patients with higher HbA1C values had worse verbal memory. Patients with higher blood pressure were significantly faster in responding to tasks in the executive domain. Primary care providers working with older AA adults with these VRFs could implement cognitive screening earlier into their practice to reduce barriers of seeking treatment.
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Affiliation(s)
- Ishan C Williams
- School of Nursing, University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Moon Ho Park
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea
| | - Siny Tsang
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Scott A Sperling
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Carol Manning
- Department of Neurology, Memory Disorders Clinic, University of Virginia, Charlottesville, VA, USA
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Lee S, Zhou X, Gao Y, Vardarajan B, Reyes-Dumeyer D, Rajan KB, Wilson RS, Evans DA, Besser LM, Kukull WA, Bennett DA, Brickman AM, Schupf N, Mayeux R, Barral S. Episodic memory performance in a multi-ethnic longitudinal study of 13,037 elderly. PLoS One 2018; 13:e0206803. [PMID: 30462667 PMCID: PMC6248922 DOI: 10.1371/journal.pone.0206803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 10/21/2018] [Indexed: 02/02/2023] Open
Abstract
Age-related changes in memory are not uniform, even in the absence of dementia. Characterization of non-disease associated cognitive changes is crucial to gain a more complete understanding of brain aging. Episodic memory was investigated in 13,037 ethnically diverse elderly (ages 72 to 85 years) with two to 15 years of follow-up, and with known dementia status, age, sex, education, and APOE genotypes. Adjusted trajectories of episodic memory performance over time were estimated using Latent Class Mixed Models. Analysis was conducted using two samples at baseline evaluation: i) non-cognitively impaired individuals, and ii) all individuals regardless of dementia status. We calculated the age-specific annual incidence rates of dementia in the non-demented elderly (n = 10,220). Two major episodic memory trajectories were estimated: 1) Stable-consisting of individuals exhibiting a constant or improved memory function, and 2) Decliner-consisting of individuals whose memory function declined. The majority of the study participants maintain their memory performance over time. Compared to those with Stable trajectory, individuals characterized as Decliners were more likely to have non-white ethnic background, fewer years of education, a higher frequency of ε4 allele at APOE gene and five times more likely to develop dementia. The steepest decline in episodic memory was observed in Caribbean-Hispanics compared to non-Hispanic whites (p = 4.3 x 10(-15)). The highest incident rates of dementia were observed in the oldest age group, among those of Caribbean-Hispanics ancestry and among Decliners who exhibited rates five times higher than those with Stable trajectories (11 per 100 person-years versus 3 per 100 person-years. Age, education, ethnic background and APOE genotype influence the maintenance of episodic memory. Declining memory is one of the strongest predictors of incident dementia.
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Affiliation(s)
- Seonjoo Lee
- Research Foundation for Mental Hygiene and the Department of Biostatics, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
| | - Xingtao Zhou
- The Georgetown University Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., United States of America
| | - Yizhe Gao
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Badri Vardarajan
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Dolly Reyes-Dumeyer
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Kumar B. Rajan
- Department of Public Health Sciences, University of California at Davis, Davis, California, United States of America
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Denis A. Evans
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Lilah M. Besser
- School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Walter A. Kukull
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Adam M. Brickman
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Nicole Schupf
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Richard Mayeux
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Sandra Barral
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
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Abstract
We examined several vascular factors in relation to the rates of decline in 5 cognitive domains in a population-based cohort. In an age-stratified random sample (N=1982) aged 65+ years, we assessed at baseline the cognitive domains of attention, executive function, memory, language, and visuospatial function, and also vascular, inflammatory, and metabolic indices. Random effects models generated slopes of cognitive decline over the next 4 years; linear models identified vascular factors associated with these slopes, adjusting for demographics, baseline cognition, and potential interactions. Several vascular risk factors (history of stroke, diabetes, central obesity, C-reactive protein), although associated with lower baseline cognitive performance, did not predict rate of subsequent decline. APOE*4 genotype was associated with accelerated decline in language, memory, and executive functions. Homocysteine elevation was associated with faster decline in executive function. Hypertension (history or systolic blood pressure >140 mm Hg) was associated with slower decline in memory. Baseline alcohol consumption was associated with slower decline in attention, language, and memory. Different indices of vascular risk are associated with low performance and with rates of decline in different cognitive domains. Cardiovascular mechanisms explain at least some of the variance in cognitive decline. Selective survival may also play a role.
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Crenshaw DG, Gottschalk WK, Lutz MW, Grossman I, Saunders AM, Burke JR, Welsh-Bohmer KA, Brannan SK, Burns DK, Roses AD. Using genetics to enable studies on the prevention of Alzheimer's disease. Clin Pharmacol Ther 2013; 93:177-85. [PMID: 23249780 PMCID: PMC4131283 DOI: 10.1038/clpt.2012.222] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Curing Alzheimer's disease (AD) remains an elusive goal; indeed, it may even prove to be impossible, given the nature of the disease. Although modulating disease progression is an attractive target and will alleviate the burden of the most severe stages, this strategy will not reduce the prevalence of the disease itself. Preventing or (as described in this article) delaying the onset of cognitive impairment and AD will provide the greatest benefit to individuals and society by pushing the onset of disease into the later years of life. Because of the high variability in the age of onset of the disease, AD prevention studies that do not stratify participants by age-dependent disease risk will be operationally challenging, being large in size and of long duration. We present a composite genetic biomarker to stratify disease risk so as to facilitate clinical studies in high-risk populations. In addition, we discuss the rationale for the use of pioglitazone to delay the onset of AD in individuals at high risk.
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Affiliation(s)
- D G Crenshaw
- Joseph & Kathleen Bryan Alzheimer's Disease Research Center, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
SUMMARY Before dementia becomes manifest, it is preceded by a long period during which neuropathology exists without clinical symptoms, termed the prodromal stage of dementia (ProD). Owing to its relevance for clinical and research aspects, many efforts are being made to define, diagnose and investigate ProD in greater detail. The ProD state has often been studied in Alzheimer’s disease (AD), whereas less is known about the prodromes of the vascular, extrapyramidal and frontotemporal dementias. Since the operational criteria of ProD are unclear, many studies act on the assumption that ProD and mild cognitive impairment are equivalent concepts. However, owing to several methodological problems with the mild cognitive impairment construct, the viewpoint taken here is that ProD can be understood more profoundly in cohorts of normal elderly subjects. This article discusses the neuropsychological findings of longitudinal, population-based studies, which included elderly, normal subjects, who were followed for years, and made case–control comparisons. Neuropsychological findings clearly revealed deficits in cases (subjects who developed dementia later, mostly AD), which were present already at baseline. Cognitive abnormalities were apparent in the domains of episodic memory, but also in tasks tapping executive, psychomotor and visuospatial functions, attention and naming. Although subtle, these impairments were significant at the group level and often demonstrated deterioration to dementia. Early cognitive deficits of the ProD stage therefore represent markers for the identification of incident AD. It is concluded that neuropsychology is a useful method to screen subjects for ProD at an early time point, when individuals are still normally functioning.
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Affiliation(s)
- Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
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