Cognition and mortality from the major causes of death: the Health and Lifestyle Survey

The impact of cognitive functions, psychological disorders, and coping strategies on quality of life and disease outcomes in patients with inflammatory bowel diseases: A cross-sectional study

Quality of life (QoL) in patients with inflammatory bowel disease (IBD) is influenced by several factors, many of which may also impact cognitive function. However, the extent of the interaction among these factors, QoL, and disease outcomes in IBD patients remains unknown. We thus aim to characterize the relationships among psychological disorders, coping mechanisms, cognitive function, and the overall impact on QoL and disease outcomes in patients with IBD. This cross-sectional observational study was conducted at an academic care center. QoL was evaluated using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and disease severity was evaluated using the Harvey-Bradshaw Index (HBI) for Crohn's disease (CD) and the Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). We also used the Hospital Anxiety and Depression scale (HADS). Regression models were used to test the associations among QoL, number of hospitalizations, disease severity, cognitive functioning (working memory [WM] and reaction time), and coping strategies while controlling for anxiety and depressive symptoms, age, and sex. This study included 41 patients (24 patients with CD and 17 with UC) whose mean age was 28.2 (±8.4) years (23 males) and mean SIBDQ score was 51.5 (±10.0). Patients with more WM errors had lower QoL scores (P = .041), whereas patients with higher anxiety levels had lower QoL and more active UC (P = .008 and P = .016, respectively). The use of avoidant coping mechanisms was associated with a significantly higher number of hospitalizations (P = .038), and patients who adopted more emotion-focused coping strategies had a longer illness duration (P = .021). Finally, patients with higher education levels were found to use more active coping mechanisms than others. These results confirm the impact of cognitive, psychological, and coping factors on QoL and disease outcomes in patients with IBD; however, the mechanisms by which these factors interrelate remain unclear. Therapies aimed at improving both cognitive functions and psychological conditions may thus be effective at improving QoL and disease outcomes in IBD patients, and education may play a positive role in promoting the adoption of more effective coping strategies among IBD patients.

Exploring cognitive progression subtypes in the Framingham Heart Study

INTRODUCTION

Alzheimer's disease (AD) is a heterogeneous disorder characterized by complex underlying neuropathology that is not fully understood. This study aimed to identify cognitive progression subtypes and examine their correlation with clinical outcomes.

METHODS

Participants of this study were recruited from the Framingham Heart Study. The Subtype and Stage Inference (SuStaIn) method was used to identify cognitive progression subtypes based on eight cognitive domains.

RESULTS

Three cognitive progression subtypes were identified, including verbal learning (Subtype 1), abstract reasoning (Subtype 2), and visual memory (Subtype 3). These subtypes represent different domains of cognitive decline during the progression of AD. Significant differences in age of onset among the different subtypes were also observed. A higher SuStaIn stage was significantly associated with increased mortality risk.

DISCUSSION

This study provides a characterization of AD heterogeneity in cognitive progression, emphasizing the importance of developing personalized approaches for risk stratification and intervention.

Highlights

We used the Subtype and Stage Inference (SuStaIn) method to identify three cognitive progression subtypes.Different subtypes have significant variations in age of onset.Higher stages of progression are associated with increased mortality risk.

Blunted cardiovascular reactivity to psychological stress and prospective health: a systematic review

Novel research demonstrates that lower or 'blunted' cardiovascular reactions to stress are associated with a range of adverse outcomes. The aim of the current review was (1) to examine the prospective outcomes predicted by blunted cardiovascular reactivity and (2) to identify a range of blunted cardiovascular reaction levels that predict these outcomes. Electronic databases were systematically searched (Medline, PsycArticles, PsycInfo, CINAHL, PubMed, Web of Science). Studies were included if they examined the prospective influence of blunted cardiovascular reactivity to psychological stress (SBP, DBP or HR) on a negative health, behavioural or psychological outcome. A total of 23 studies were included in the review. Blunted reactivity predicted (1) adverse cardiovascular health, primarily in cardiac samples (e.g., myocardial infarction, carotid atherosclerosis) and (2) outcomes associated with motivational and behavioural dysregulation in healthy samples (e.g., obesity, smoking addiction, depression). The cardiovascular reactivity threshold levels that were predictive of adverse health outcomes ranged between -3.00-12.59 bpm (14.41% to 136.59% lower than the sample mean) and -2.4-5.00 mmhg (65.99% to 133.80% lower than sample mean), for HR and DBP respectively. We posit that blunted reactions lower than, or equal to, the ranges reported here may be utilised by clinicians and researchers to identify individuals who are at increased risk of adverse cardiovascular health outcomes, as well as outcomes associated with motivational and behavioural dysregulation.

Dual-Task-Based Drum Playing with Rhythmic Cueing on Motor and Attention Control in Patients with Parkinson's Disease: A Preliminary Randomized Study

Although there have been increasing reports regarding the effectiveness of dual-task interventions in rehabilitation, the scope of this research is limited to gross motor movement, such as gait among patients with Parkinson's disease (PD). To expand the dual-task paradigm to upper extremity motor and attention control in PD, drum playing with modulation of musical elements was attempted. The objective of this study was to evaluate the effects of a drum playing intervention with rhythmic cueing on upper extremity motor control and attention control in patients with PD. Twelve participants were randomly assigned to the drum playing intervention with rhythmic cueing group or the control group. The results showed that the drum playing with rhythmic cueing (DPRC) group significantly increased their sustained time of entrainment (45 BPM) and their latency time until entrainment from pretest to posttest. For the DPRC group, the latency time until entrainment was significantly improved, and improvements in cognitive measures were also found. This study shows that DPRC has great potential to improve upper extremity motor control and attention control and supports the development of new interventions that include this technique for rehabilitation in patients with PD.

Is simple reaction time or choice reaction time an indicator of all-cause mortality or CVD mortality?

OBJECTIVES

Simple reaction time (SRT) and choice reaction time (CRT) have been shown to be good indicators for quantitatively assessing the level of human cognitive impairment, but these parameters have also been linked to the risk of human death. This study aimed to quantitatively assess the independent predictive value of SRT or CRT for all-cause mortality or cardiovascular disease (CVD) mortality by conducting a meta-analysis of prospective studies.

STUDY DESIGN

The study design of this study is a prospective cohort study.

METHODS

We conducted a meta-analysis by combining hazard ratios (HRs) and 95% confidence intervals (95% CIs) of SRT or CRT with all-cause mortality or CVD mortality in healthy community residents aged 18 and over. Heterogeneity was evaluated by using Q statistics and Cochrane's I² statistics.

RESULTS

A total of seven prospective studies that examined all-cause mortality and CVD mortality were included. The pooled HR of all-cause mortality in SRT was 1.099 (1.065-1.134, I² = 11.9%), and an increased risk of CVD mortality was associated with lower SRT (HR = 1.186, 95% CI = 1.137-1.236; I² = 52.4%). Similarly, the pooled HR of all-cause mortality in CRT was 1.140 (95% CI = 1.085-1.197, I² = 33.7%). However, lower CRT was not statistically associated with an increased risk of CVD mortality.

CONCLUSION

SRT may be a predictor of all-cause-mortality and CVD mortality, and CRT is significantly associated with an increased risk of all-cause mortality.

Impaired neurocognitive and psychomotor performance in patients with inflammatory bowel disease

Limited evidence exists regarding cognitive and psychomotor function in patients with inflammatory bowel disease (IBD). Therefore, we aimed to compare the neurocognitive and psychomotor function of 60 IBD patients with 60 age/sex-matched controls. Computer-based instrument Complex Reactinometer Drenovac (CRD) was used for assessment of cognitive domains: convergent thinking (simple mathematical tasks; CRD-11), perceptive abilities (light signal position discrimination; CRD-311) and sophisticated operative thinking (complex psychomotor coordination; CRD-411). The most important analyzed parameters were total test solving time (T_TTS); minimal time of particular test solving (T_MIN) and total number of wrong reactions (N_ER). Performance in all three cognitive tests showed statistically significantly longer T_TTS and T_MIN in IBD patients (P < 0.05), while there was no significant difference in N_ER. Aforementioned findings were adjusted for BMI, age and duration of education. Our study has shown impaired neurocognitive and psychomotor function in IBD patients compared to controls, especially in mental processing speed and mental endurance of perceptive abilities, convergent thinking and complex operative thinking.

Impaired neurocognitive and psychomotor performance in patients with inflammatory bowel disease

Limited evidence exists regarding cognitive and psychomotor function in patients with inflammatory bowel disease (IBD). Therefore, we aimed to compare the neurocognitive and psychomotor function of 60 IBD patients with 60 age/sex-matched controls. Computer-based instrument Complex Reactinometer Drenovac (CRD) was used for assessment of cognitive domains: convergent thinking (simple mathematical tasks; CRD-11), perceptive abilities (light signal position discrimination; CRD-311) and sophisticated operative thinking (complex psychomotor coordination; CRD-411). The most important analyzed parameters were total test solving time (T_TTS); minimal time of particular test solving (T_MIN) and total number of wrong reactions (N_ER). Performance in all three cognitive tests showed statistically significantly longer T_TTS and T_MIN in IBD patients (P < 0.05), while there was no significant difference in N_ER. Aforementioned findings were adjusted for BMI, age and duration of education. Our study has shown impaired neurocognitive and psychomotor function in IBD patients compared to controls, especially in mental processing speed and mental endurance of perceptive abilities, convergent thinking and complex operative thinking.

The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment

Objective: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. Method: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index (n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death. Results: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity. Discussion: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation.

Understanding the relationship between cognition and death: a within cohort examination of cognitive measures and mortality

Despite several studies demonstrating an independent and inverse association between cognition and mortality, the nature of this association still remains unclear. To examine the association of cognition and mortality after accounting for sociodemographic, health and lifestyle factors and to explore both test and population characteristics influencing this relationship. In a population based cohort of 8585 men and women aged 48-92 years, who had cognitive assessments in 2006-2011 and were followed up till 2016 for mortality, we examined the relationship between individual cognitive tests as well as a global cognition score to compare their ability in predicting mortality and whether these differed by population characteristics. Risk of death was estimated using Cox proportional hazard regression models including sociodemographic, lifestyle and health variables, and self-reported comorbidities, as covariates in the models. Poor cognitive performance (bottom quartile of combined cognition score) was associated with higher risk of mortality, Hazard Ratio = 1.32 (95% Confidence Interval 1.09, 1.60); individual cognitive tests varied in their mortality associations and also performed differently in middle-age and older age groups. Poor cognitive performance is independently associated with higher mortality. This association is observed for global cognition and for specific cognitive abilities. Associations vary depending on the cognitive test (and domain) as well as population characteristics, namely age and education.

Reaction times match IQ for major causes of mortality: Evidence from a population based prospective cohort study

Introduction

The association of premorbid cognitive ability with all-cause mortality is now well established. However, since all-cause mortality is relatively uninformative about aetiology, evidence has been sought, and is beginning to accumulate, for associations with specific causes of mortality. Likewise, the underlying causal pathways may be illuminated by considering associations with different measures of cognitive ability. For example, critics of IQ type measures point to possible cultural or social biases and there is, consequently, a need for more culturally neutral measures such as reaction times. We examine the associations of cognitive ability with major causes of mortality, including: cardiovascular disease, cancer and respiratory disease and compare the results for a standard IQ test, the Alice Heim 4 (AH4), with those for simple and four-choice reaction times.

Methods

Data were derived from the oldest cohort of the West of Scotland Twenty-07 Study. Participants were randomly sampled from the Central Clydeside Conurbation, a mainly urban area centred on Glasgow city. At baseline, aged 56, they were interviewed in their homes by trained interviewers; the AH4 was administered and reaction times measured using a portable electronic device. Vital status was ascertained via linkage to the NHS central register. Cox regression was used in SAS 9.4 for the main analyses. Adjustments were made for sex, smoking status and social class.

Results

Full data on AH4, RT and covariates were available for 1350 out of 1551. During 29 years of follow-up, there were 833 deaths: 279 cardiovascular disease (CVD) (168 CHD; 68 stroke); 291 cancer; 97 respiratory disease; 42 digestive disease; and 39 dementia. The 85 remaining deaths were a heterogeneous mixture with no cause accounting for more than 14.

AH4 scores were associated with most major causes. Digestive disease and dementia had similar effect sizes but were not significant. Within cardiovascular disease, there was an association with coronary heart disease but not stroke. The association with cancer was primarily due to those cancers related to smoking.

RT measures were mostly associated with the same causes of death. Where significant, effects were in the same directions and of similar magnitude. That is, lower AH4 scores, longer reaction times, and more variable reaction times were all associated with increased mortality risk from the major causes of death. A summary measure of RT outperformed the AH4 for most causes.

Conclusion

The association between intelligence with mortality from the major causes is also seen with reaction times. That effect sizes are of similar magnitude is suggestive of a common cause. It also implies that the association of cognitive ability with mortality is unlikely to be due to any social, cultural or educational biases that are sometimes ascribed to intelligence measures.

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Intelligence and reaction times are both associated with most major causes of mortality

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Effect sizes are of similar magnitude

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A summary RT measure provides the more parsimonious explanation for most causes

Intraindividual Variability of Neuromotor Function Predicts Falls Risk in Older Adults and those with Type 2 Diabetes

This study was designed to examine the effect of increasing age and type 2 diabetes on the average responses and inter- and intraindividual variability of falls risk, reaction time, strength, and walking speed for healthy older adults and older persons with type 2 diabetes (T2DM). Seventy-five older individuals (controls) and 75 persons with T2DM aged between 50 and 79 years participated in the study. Assessments of falls risk, reaction time (RT), knee extension strength, and walking speed were conducted. The results revealed that advancing age for both control and T2DM groups was reflected by a progressive increase in falls risk, decreased leg strength and a decline (i.e., slowing) of reactions and gait speed. Conversely, the level of intraindividual variability for the RT, strength and gait measures increased with increasing age for both groups, with T2DM persons tending to be more variable compared to the healthy controls of similar age. In contrast to the intraindividual changes, measures of interindividual variability revealed few differences between the healthy elderly and T2DM individuals. Taken together, the findings support the proposition that intraindividual variability of neuromotor measures may be useful as a biomarker for the early detection of decline in physiological function due to age or disease.

Performance on Specific Cognitive Domains and Cause of Death: A Prospective Population-Based Study in Non-Demented Older Adults (NEDICES)

Evidence regarding the relationship between performance on specific cognitive domains and cause of death is scarce. We assessed whether specific cognitive domains predicted mortality and the presence of any association with specific causes of death in a population-dwelling sample of non-demented older adults. In this population-based, prospective study (NEDICES), 2,390 non-demented subjects ≥65 years completed a brief neuropsychological battery. Cox's proportional hazards models, adjusted by sociodemographic and comorbidity factors, global cognitive performance, educational level, and premorbid intelligence were used to assess the risk of death. Participants were followed for a median of 9.2 years (range 0.01-10.7), after which the death certificates of those who died were examined. 880 (36.8%) of 2,390 participants died over a median follow-up of 5.5 years (range 0.01-10.5). Using adjusted Cox regression models, we found that hazard ratios for mortality in participants within the lowest tertiles (worse performance) were 1.31 (speed of cognitive processing, p = 0.03); 1.22 (semantic fluency, p = 0.04), 1.32 (delayed free recall, p = 0.003), and 1.23 (delayed logical memory, p = 0.03). Poor performance on delayed recall and speed of cognitive processing tests were associated with dementia and cerebrovascular disease mortality, respectively. Further, poor performance on semantic fluency was associated with decreased cancer mortality. In this study of community dwelling non-demented older adults, worse neuropsychological performance was associated with increased risk of mortality. Performance on specific cognitive domains were related to different causes of death. Of particular note there appears to be an inverse association between poor semantic fluency and cancer mortality.

Executive Cognitive Functioning and Cardiovascular Autonomic Regulation in a Population-Based Sample of Working Adults

Objective: Executive cognitive functioning is essential in private and working life and is sensitive to stress and aging. Cardiovascular (CV) health factors are related to cognitive decline and dementia, but there is relatively few studies of the role of CV autonomic regulation, a key component in stress responses and risk factor for cardiovascular disease (CVD), and executive processes. An emerging pattern of results from previous studies suggest that different executive processes may be differentially associated with CV autonomic regulation. The aim was thus to study the associations between multiple measures of CV autonomic regulation and measures of different executive cognitive processes. Method: Participants were 119 healthy working adults (79% women), from the Swedish Longitudinal Occupational Survey of Health. Electrocardiogram was sampled for analysis of heart rate variability (HRV) measures, including the Standard Deviation of NN, here heart beats (SDNN), root of the mean squares of successive differences (RMSSD), high frequency (HF) power band from spectral analyses, and QT variability index (QTVI), a measure of myocardial repolarization patterns. Executive cognitive functioning was measured by seven neuropsychological tests. The relationships between CV autonomic regulation measures and executive cognitive measures were tested with bivariate and partial correlational analyses, controlling for demographic variables, and mental health symptoms. Results: Higher SDNN and RMSSD and lower QTVI were significantly associated with better performance on cognitive tests tapping inhibition, updating, shifting, and psychomotor speed. After adjustments for demographic factors however (age being the greatest confounder), only QTVI was clearly associated with these executive tests. No such associations were seen for working memory capacity. Conclusion: Poorer CV autonomic regulation in terms of lower SDNN and RMSSD and higher QTVI was associated with poorer executive cognitive functioning in terms of inhibition, shifting, updating, and speed in healthy working adults. Age could largely explain the associations between the executive measures and SDNN and RMSSD, while associations with QTVI remained. QTVI may be a useful measure of autonomic regulation and promising as an early indicator of risk among otherwise healthy adults, compared to traditional HRV measures, as associations between QTVI and executive functioning was not affected by age.

What else should we know about experiencing COPD? A narrative review in search of patients' psychological burden alleviation

The present paper is a narrative review focusing on the psychological impact, identification of protective factors, and interventions minimizing the psychological burdens of chronic obstructive pulmonary disease (COPD). The research reviews studies on neurocognitive functions, personality, emotional problems, and health-related quality of life. This is done with regard to resources as well as activities enabling or enhancing a patient's adaptation. PubMed and PsychArticles databases were searched for relevant medical (eg, CODP, emphysema), psychopathology (eg, depression), and psychological (eg, personality) keywords, followed by hand search. After application of the inclusion and exclusion criteria, the search resulted in 82 articles and book chapters. The choice was based on evidence accepted by evidence-based medicine, although at different levels of strength. Psychological experiencing of COPD appears to be very unequally represented with scientific research on emotional problems and functioning decrease significantly outnumbering those addressing resources or effective interventions. As our initial literature search called for an urgent need for further exploration, we have carefully pointed out numerous areas where the knowledge on how to protect or restore psychological well-being among COPD patients should be broadened.

The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population

Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988-94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males.

Verbal memory and search speed in early midlife are associated with mortality over 25 years' follow-up, independently of health status and early life factors: a British birth cohort study

BACKGROUND

Cognitive capabilities in childhood and in late life are inversely associated with mortality rates. However, it is unclear if adult cognition, at a time still relatively free from comorbidity, is associated with subsequent mortality, and whether this explains the associations of early life factors with adult mortality.

METHODS

We used data from the MRC National Survey of Health and Development, a birth cohort study prospectively assessing 5362 participants born in 1946. The present analysis includes participants followed up from age 43 and undergoing cognitive assessment (verbal memory and search speed). Mortality outcomes were notified through linkage with a national register. Cox regression was used to estimate mortality hazards in relation to cognitive performance at age 43, adjusting for early life factors, socioeconomic position and health status.

RESULTS

Data were available on 3192 individuals. Univariable analyses indicated that adult verbal memory and search speed, parental factors, childhood cognition and educational attainment were associated with mortality. However, multivariable models showed that the mortality associations with earlier life factors were explained by adult cognitive capability. A standard deviation increase in verbal memory and search speed scores was associated with lower mortality rates [hazard ratio (HR) = 0.86, 95% confidence interval (CI) 0.77-0.97, P = 0.02; HR = 0.88, 95% CI 0.78-1.00, P = 0.05, respectively), after adjustment for adult health.

CONCLUSIONS

Cognitive capability in early midlife was inversely associated with mortality rates over 25 years and accounted for the associations of family background, childhood cognitive ability and educational attainment with mortality. These findings, in a nationally representative cohort with long-term follow-up, suggest that building cognitive reserve may improve later life health and survival chances.

A chapter a day: Association of book reading with longevity

Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline. Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2 = 0.83, p < 0.001, HRT3 = 0.77, p < 0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression. Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2 = 90.6, p < 0.001; tT3 = 67.9, p < 0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage (p = 0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.

Racial Differences in Cognitive Function and Risk of Incident Stroke

BACKGROUND AND PURPOSE

Cognitive impairment is associated with increased risk of stroke; however, it is not known whether this association varies by race. Our objective was to examine the association between cognitive function and the risk of stroke among non-Hispanic blacks and whites with no history of stroke.

METHODS

Participants were from a population-based cohort study of 7205 older adults (61% black and 59% female) from Chicago's South Side. A standardized composite cognitive function score based on 3 components--global cognition (Mini-Mental State Examination), executive function (Symbol Digits Modalities test), and episodic memory (Delayed and Immediate Story Recall tests)--was used to predict risk of stroke (from Medicare hospitalization data) using a Cox model.

RESULTS

During 72,868 person-years of follow-up, 16% (N = 1185) developed stroke. After adjusting for vascular risk factors, 1 standard deviation lower composite cognitive function score was associated with increased risk of stroke in blacks (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.66-1.88), which was twofold higher than whites (HR = 1.38; 95% CI, 1.26-1.55) (Pdifference = .002). Lower global cognition and executive function were associated with a similarly increased risk of stroke in blacks and whites. Lower episodic memory (composite of recall tests) was associated with increased risk of stroke that was twofold higher in blacks (HR = 1.12; 95% CI, 1.10-1.14) than in whites (HR = 1.06; 95% CI, 1.04-1.09).

CONCLUSIONS

Lower cognitive function was associated with increased risk of stroke and this association was stronger among blacks than whites. Future studies are needed to determine factors that can explain this finding.

Cognitive impairment and risk of future stroke: a systematic review and meta-analysis

BACKGROUND

Several studies have assessed the link between cognitive impairment and risk of future stroke, but results have been inconsistent. We conducted a systematic review and meta-analysis of cohort studies to determine the association between cognitive impairment and risk of future stroke.

METHODS

We searched MEDLINE and Embase (1966 to November 2013) and conducted a manual search of bibliographies of relevant retrieved articles and reviews. We included cohort studies that reported multivariable adjusted relative risks and 95% confidence intervals or standard errors for stroke with respect to baseline cognitive impairment.

RESULTS

We identified 18 cohort studies (total 121 879 participants) and 7799 stroke events. Pooled analysis of results from all studies showed that stroke risk increased among patients with cognitive impairment at baseline (relative risk [RR] 1.39, 95% confidence interval [CI] 1.24-1.56). The results were similar when we restricted the analysis to studies that used a widely adopted definition of cognitive impairment (i.e., Mini-Mental State Examination score < 25 or nearest equivalent) (RR 1.64, 95% CI 1.46-1.84). Cognitive impairment at baseline was also associated with an increased risk of fatal stroke (RR 1.68, 95% CI 1.21-2.33) and ischemic stroke (RR 1.65, 95% CI 1.41-1.93).

INTERPRETATION

Baseline cognitive impairment was associated with a significantly higher risk of future stroke, especially ischemic and fatal stroke.

Cognitive impairment and cancer mortality: a biological or health care explanation?

PURPOSE

To examine whether the documented association of suboptimal cognitive function with total and cardiovascular (CVD) mortality also applies to cancer mortality and probe whether the explanation for this association is biomedical or health care related.

METHODS

In a subsample of 733 participants of the EPIC-Greece cohort from Athens and surrounding area, we assessed cognitive function at age 65 or older in the period 2004-2006, using the Mini-Mental State Examination (MMSE). Incidence of cancer, mortality from cancer and CVD, and overall mortality were ascertained through active follow-up for a median of 4 years after MMSE assessment using Cox proportional hazards models.

RESULTS

A total of 86 participants died during follow-up. A 2-point decrease in MMSE score was associated with increase in overall (hazard ratio (HR) 1.26, 95 % confidence interval (CI) 1.11-1.43), CVD (HR 1.26, 95 % CI 1.02-1.56), and cancer (HR 1.32, 95 % CI 1.02-1.70) mortality. In contrast, there was no noticeable difference in cancer incidence associated with a 2-point decrease in MMSE score (HR 1.07, 95 % CI 0.79-1.45).

CONCLUSIONS

Cognitive function appears to be inversely associated not only with CVD and overall, but also with cancer mortality. Although for CVD mortality there is a biomedical explanation invoking vascular mechanisms, for cancer mortality we may need to focus on socially conditioned factors, such as compromised ability to identify early signs and suboptimal compliance to treatment. Our hypothesis-generating results need to be confirmed in larger studies, as the issue is of major importance, since cognitive decline is not uncommon among the elderly.

Associations between cognitive and gait performance during single- and dual-task walking in people with Parkinson disease

BACKGROUND

Cognitive impairments in Parkinson disease (PD) manifest as deficits in speed of processing, working memory, and executive function and attention abilities. The gait impairment in PD is well documented to include reduced speed, shortened step lengths, and increased step-to-step variability. However, there is a paucity of research examining the relationship between overground walking and cognitive performance in people with PD.

OBJECTIVE

This study sought to examine the relationship between both the mean and variability of gait spatiotemporal parameters and cognitive performance across a broad range of cognitive domains.

DESIGN

A cross-sectional design was used.

METHODS

Thirty-five participants with no dementia and diagnosed with idiopathic PD completed a battery of 12 cognitive tests that yielded 3 orthogonal factors: processing speed, working memory, and executive function and attention. Participants completed 10 trials of overground walking (single-task walking) and 5 trials of overground walking while counting backward by 3's (dual-task walking).

RESULTS

All gait measures were impaired by the dual task. Cognitive processing speed correlated with stride length and walking speed. Executive function correlated with step width variability. There were no significant associations with working memory. Regression models relating speed of processing to gait spatiotemporal variables revealed that including dual-task costs in the model significantly improved the fit of the model.

LIMITATIONS

Participants with PD were tested only in the on-medication state.

CONCLUSIONS

Different characteristics of gait are related to distinct types of cognitive processing, which may be differentially affected by dual-task walking due to the pathology of PD.

Reaction time and incident cancer: 25 years of follow-up of study members in the UK Health and Lifestyle Survey

OBJECTIVES

To investigate the association of reaction time with cancer incidence.

METHODS

6900 individuals aged 18 to 94 years who participated in the UK Health and Lifestyle Survey in 1984/1985 and were followed for a cancer registration for 25 years.

RESULTS

Disease surveillance gave rise to 1015 cancer events from all sites. In general, there was essentially no clear pattern of association for either simple or choice reaction time with cancer of all sites combined, nor specific malignancies. However, selected associations were found for lung cancer, colorectal cancer and skin cancer.

CONCLUSIONS

In the present study, reaction time and its components were not generally related to cancer risk.

Cognitive impairment and risk of stroke: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND AND PURPOSE

Cognitive impairment is linked to vascular risk factors and brain vascular pathologies. Several studies have tested whether subjects with cognitive impairment have higher risk for stroke. The aim of this study was to systematically review available evidence on the association between cognitive impairment and risk of stroke to obtain precise effect estimates of the association and to identify which cognitive domains associate most with incident stroke.

METHODS

PubMed, EMBASE, and Web of Science were searched from January 1, 1980, to October 1, 2013, without language restriction. Only prospective cohort studies were included. From each study, data on the association between cognitive impairment and stroke estimated with hazard ratios or relative risks with 95% confidence interval (CI) were extracted. For each study, risk of stroke per SD lower performance in various cognitive tests was calculated.

RESULTS

Twelve studies were included, comprising 82,899 participants of whom 3043 had an incident stroke. The pooled relative risk per SD lower global cognitive performance was 1.19 (95% CI, 1.12-1.27). Each SD lower score in executive function or attention was associated with 1.14-fold (95% CI, 1.06-1.24) higher risk of stroke. Lower scores in memory were associated with 1.07-fold (95% CI, 1.02-1.12) higher risk of stroke, and lower scores in language were associated with 1.08-fold (95% CI, 1.02-1.16) higher risk of stroke.

CONCLUSIONS

Cognitive impairment is associated with higher risk of stroke. The associations were not significantly different for executive function, memory, and language.

Reaction time and mortality from the major causes of death: the NHANES-III study

OBJECTIVE

Studies examining the relation of information processing speed, as measured by reaction time, with mortality are scarce. We explored these associations in a representative sample of the US population.

METHODS

Participants were 5,134 adults (2,342 men) aged 20-59 years from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94).

RESULTS

Adjusted for age, sex, and ethnic minority status, a 1 SD slower reaction time was associated with a raised risk of mortality from all-causes (HR = 1.25, 95% CI 1.12, 1.39) and cardiovascular disease (CVD) (HR = 1.36, 95% CI 1.17, 1.58). Having 1 SD more variable reaction time was also associated with greater risk of all-cause (HR = 1.36, 95% CI 1.19, 1.55) and CVD (HR = 1.50, 95% CI 1.33, 1.70) mortality. No associations were observed for cancer mortality. The magnitude of the relationships was comparable in size to established risk factors in this dataset, such as smoking.

INTERPRETATION

Alongside better-established risk factors, reaction time is associated with increased risk of premature death and cardiovascular disease. It is a candidate risk factor for all-cause and cause-specific mortality.

Cause of death in mild cognitive impairment: a prospective study (NEDICES)

BACKGROUND AND PURPOSE

Previous studies have reported the occurrence of increased mortality rates among individuals with mild cognitive impairment (MCI), but possible links between MCI subtypes and cause-specific mortality need to be explored. To examine short-term mortality (5 years), long-term mortality (13 years) and cause-specific mortality of individuals over 65 years of age suffering from MCI compared with cognitively unimpaired individuals in the Neurological Disorders in Central Spain (NEDICES) cohort.

METHODS

Mild cognitive impairment was classified using standardized psychometric and functional assessment in accordance with diagnostic convention. Cox's proportional hazards models, adjusted by sociodemographics and comorbidity factors, were used to assess the risk of death at 5 and 13 years of MCI subtypes compared with a reference group of older people without cognitive impairment (N = 2329). Causes of death were obtained from the National Population Register of Spain.

RESULTS

There were 1484 deceased individuals at 13 years. MCI subtypes were defined as amnestic single domain (N = 259), amnestic multiple domain (N = 197) and non-amnestic (N = 641). After adjusting for covariates, only the amnestic multiple domain MCI subtype showed an increased hazard ratio (HR) for mortality at 5 years versus the reference group. However, the HR for mortality at 13 years was increased for all MCI subtypes. The HR by MCI subtype was 1.19 in the non-amnestic subtype (95% CI 1.05-1.36), 1.31 in the amnestic single domain subtype (95% CI 1.10-1.56) and 1.67 in the amnestic multiple domain subtype (95% CI 1.38-2.02). In terms of cause-specific mortality, the chance of death from dementia was statistically higher in all MCI subtypes.

CONCLUSION

Amnestic multiple domain MCI showed the greatest risk of mortality in comparison with other MCI subtypes at different intervals. Dementia was the only cause-specific mortality that was increased in MCI individuals.

Fetal alcohol exposure and IQ at age 8: evidence from a population-based birth-cohort study

Background

Observational studies have generated conflicting evidence on the effects of moderate maternal alcohol consumption during pregnancy on offspring cognition mainly reflecting problems of confounding. Among mothers who drink during pregnancy fetal alcohol exposure is influenced not only by mother’s intake but also by genetic variants carried by both the mother and the fetus. Associations between children’s cognitive function and both maternal and child genotype at these loci can shed light on the effects of maternal alcohol consumption on offspring cognitive development.

Methods

We used a large population based study of women recruited during pregnancy to determine whether genetic variants in alcohol metabolising genes in this cohort of women and their children were related to the child’s cognitive score (measured by the Weschler Intelligence Scale) at age 8.

Findings

We found that four genetic variants in alcohol metabolising genes in 4167 children were strongly related to lower IQ at age 8, as was a risk allele score based on these 4 variants. This effect was only seen amongst the offspring of mothers who were moderate drinkers (1–6 units alcohol per week during pregnancy (per allele effect estimates were −1.80 (95% CI = −2.63 to −0.97) p = 0.00002, with no effect among children whose mothers abstained during pregnancy (0.16 (95%CI = −1.05 to 1.36) p = 0.80), p-value for interaction  = 0.009). A further genetic variant associated with alcohol metabolism in mothers was associated with their child’s IQ, but again only among mothers who drank during pregnancy.

A novel clinical test of recognition reaction time in healthy adults

We evaluated a clinical "go/no-go" reaction time test (recognition RTclin) that is portable and does not require a computer, and used it to quantify the effect of age on recognition RTclin test scores. Fifty-two healthy adults 19-83 years old completed simple and recognition RTclin testing. Simple RTclin was measured as the elapsed time from initial release of a suspended vertical shaft by the examiner until its arrest by participant pinch grip. Recognition RTclin was similar except that a light on the apparatus randomly illuminated in 50% of the trials to signal the participant to arrest the device. To help interpret the RTclin results, we partitioned them into premovement time (PMT) and movement time (MT) using an optoelectronic camera system that is not ordinarily part of the RTclin test. Recognition RTclin scores were significantly slower than simple RTclin scores, with 71% of the prolongation attributable to PMT. While simple RTclin test scores correlated with age, recognition RTclin scores did not. A strong negative association between recognition RTclin accuracy and age was found. Recognition RTclin is feasible to measure in healthy adults and appears to represent a portable, computer-independent measure of cognitive processing speed and inhibitory capacity. Potential applications include assessment of brain injury, dementing illness, medication side effects, fall risk, and safe driving.

Sibling analysis of adolescent intelligence and chronic diseases in older adulthood

PURPOSE

We examined whether associations of adolescent intelligence with chronic diseases in adulthood are explained by socioeconomic factors, health behaviors, or common sources of variance in intelligence and chronic disease risk.

METHODS

A prospective cohort study (Wisconsin Longitudinal Study) of high school graduates and their siblings with intelligence assessed in adolescence and chronic diseases reported in adulthood (n = 10,168; mean age 53.9 and n = 9051; mean age 64.8 in two follow-ups).

RESULTS

After adjustment for age and sex, greater intelligence was associated with lower risk of heart disease (odds ratio per 1 SD advantage in intelligence 0.93; 95% confidence interval 0.87-0.99), circulation problems (0.85; 0.79-0.92), stroke (0.80; 0.70-0.91), and diabetes (0.88; 0.81-0.95). Participants' risk of stroke and circulation problems also was predicted by their sibling's intelligence, suggesting potential common causes for intelligence and cerebrovascular diseases. Sibling analysis provided no support for shared family environment in explaining associations between intelligence and disease outcomes because between-families and within-siblings regression models were not different. Adjusting for common risk factors had little impact on these associations. In contrast, adjusting for adult socioeconomic status attenuated the associations by 25%-100% (66% on average).

CONCLUSIONS

Multiple mechanisms may link intelligence with occurrence of chronic diseases of major public health importance.

Cognitive function in families with exceptional survival

The authors investigated whether cognitive function may be used as an endophenotype for longevity by assessing the cognitive performance of a family-based cohort consisting of 1380 individuals from 283 families recruited for exceptional survival in field centers in Boston, New York, Pittsburgh, and Denmark. Cognitive performance was assessed in the combined offspring of the Long Life Family Study (LLFS) probands and their LLFS siblings as compared with their spouses' cognitive performance. Our results indicate that the combined offspring of the LLFS probands and their siblings achieve significantly higher scores on both digit forward and backward tasks (p = 5 10(-5) and p = 8 10(-4) respectively) as well as on a verbal fluency task (p = 0.008) when compared with their spouse controls. No differences between groups were found for the other cognitive tests assessed. We conclude that LLFS family members in the offspring generation demonstrate significantly better performance on multiple tasks requiring attention, working memory, and semantic processing when compared with individuals without a family history of exceptional survival, suggesting that cognitive performance may serve as an important endophenotype for longevity.

Direct and indirect pathways connecting cognitive ability with cardiovascular disease risk: socioeconomic status and multiple health behaviors

OBJECTIVE

To model and test direct and indirect pathways connecting general cognitive ability (g) with cardiovascular disease risk factors, via socioeconomic status (SES) and multiple health behaviors.

METHODS

A sample comprising participants in the Health and Lifestyle Survey, a prospective cohort study of a representative sample of U.K. adults in 1984/5 (n = 4939, 2426 males).

RESULTS

Two mediating latent variables were proposed that connected a latent cognitive trait (named g) with a latent trait of cardiovascular disease (CVD) risk: multiple health behaviors (defined by smoking, physical inactivity, and weekly saturated fat intake) and SES (defined by educational attainment, occupational social class, and income). In males and females, SES mediated the association between g and CVD risk, but the mediation was moderated by years of age. A direct effect from g to CVD risk was also significant, but this was restricted to older males. Multiple health behaviors offered no explanatory power, because they were not influenced by g.

CONCLUSIONS

SES may connect g with CVD risk in males, but not systematically across the life course. Moderated mediation is a novel way to illustrate that direct and indirect pathways can vary as a function of age. Explanations that emphasize g or SES are not mutually exclusive; there are direct and indirect contributions to CVD risk from each source, and these vary across the life course.

Which aspects of subjectively reported quality of life are important in predicting mortality beyond known risk factors? The Lothian Birth Cohort 1921 Study

PURPOSE

To investigate which aspects of Quality of Life (QoL) (physical health, psychological, social-relationships, and environment) are important in predicting mortality.

METHODS

A sample of 448 (194 men and 254 women) relatively healthy older adults reported their QoL using the WHOQOL-BREF. After a 9-year follow-up, survival analysis was carried out using Cox's proportional hazards regression.

RESULTS

Only the General Health item (HR = 0.75, 95% CI: 0.64-0.89) and Physical Health Domain mean score (HR = 0.90, 95% CI: 86-0.95) significantly predicted mortality when controlling for age and sex. The single-item General Health measure was the stronger predictor of mortality and remained significant after socio-demographic, psychological (personality and cognition), health behaviour and health status measures were controlled for independently. When all measures were simultaneously controlled for, none of the items or domains on the WHOQOL-BREF significantly predicted mortality.

CONCLUSION

Items addressing health-related QoL are the most important when predicting mortality. The findings support research demonstrating that subjectively rated, single-item general health questions accurately predict survival over and above socio-demographic, psychological, health behaviour and health status measures.

Does IQ predict cardiovascular disease mortality as strongly as established risk factors? Comparison of effect estimates using the West of Scotland Twenty-07 cohort study

OBJECTIVE

To compare the strength of the association between intelligence quotient (IQ) and cardiovascular disease (CVD) mortality with the predictive power for established risk factors.

DESIGN

Population-based cohort study of 1145 men and women with IQ test scores, a range of established risk factors, and 20-year mortality surveillance.

RESULTS

When CVD mortality was the outcome of interest, the relative index of inequality (sex-adjusted hazard ratio, 95% confidence interval) for the most disadvantaged relative to the advantaged persons was (in descending order of magnitude for the top five risk factors): 5.58 (2.89, 10.8) for cigarette smoking; 3.76 (2.14, 6.61) for IQ; 3.20 (1.85, 5.54) for income; 2.61 (1.49, 4.57) for systolic blood pressure and 2.06 (1.07, 3.99) for physical activity. Mutual adjustment led to some attenuation of these relationships. Similar observations were made in the analyses featuring all deaths where, again, IQ was the second most powerful predictor of mortality risk.

CONCLUSION

In this cohort, lower intelligence scores were associated with increased rates of CVD and total mortality at a level of magnitude greater than most established risk factors.