Independent and interactive impacts of hypertension and diabetes mellitus on verbal memory: A coordinated analysis of longitudinal data from England, Sweden, and the United States

Investigating the impact of hypertension with and without diabetes on Alzheimer's disease risk: A clinico-pathological study

INTRODUCTION

Hypertension and diabetes are common cardiovascular risk factors that increase Alzheimer's disease (AD) risk. However, it is unclear whether AD risk differs in hypertensive individuals with and without diabetes.

METHODS

Cognitively normal individuals (N = 11,074) from the National Alzheimer's Coordinating Center (NACC) were categorized as having (1) hypertension with diabetes (HTN+/DM+), (2) hypertension without diabetes (HTN+/DM-), or (3) neither (HTN-/DM-). AD risk in HTN+/DM+ and HTN+/DM- was compared to HTN-/DM-. This risk was then investigated in those with AD neuropathology (ADNP), cerebral amyloid angiopathy (CAA), cerebrovascular neuropathology (CVNP), arteriolosclerosis, and atherosclerosis. Finally, AD risk in HTN-/DM+ was compared to HTN-/DM-.

RESULTS

Seven percent (N = 830) of individuals developed AD. HTN+/DM+ (hazard ratio [HR] = 1.31 [1.19-1.44]) and HTN+/DM- (HR = 1.24 [1.17-1.32]) increased AD risk compared to HTN-/DM-. AD risk was greater in HTN+/DM+ with ADNP (HR = 2.10 [1.16-3.79]) and CAA (HR = 1.52 [1.09-2.12]), and in HTN+/DM- with CVNP (HR = 1.54 [1.17-2.03]). HTN-/DM+ also increased AD risk (HR = 1.88 [1.30-2.72]) compared to HTN-/DM-.

DISCUSSION

HTN+/DM+ and HTN+/DM- increased AD risk compared to HTN-/DM-, but pathological differences between groups suggest targeted therapies may be warranted based on cardiovascular risk profiles.

HIGHLIGHTS

AD risk was studied in hypertensive (HTN+) individuals with/without diabetes (DM+/-). HTN+/DM+ and HTN+/DM- both had an increased risk of AD compared to HTN-/DM-. Post mortem analysis identified neuropathological differences between HTN+/DM+ and HTN+/DM-. In HTN+/DM+, AD risk was greater in those with AD neuropathology and CAA. In HTN+/DM-, AD risk was greater in those with cerebrovascular neuropathology.

Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs)

Background

The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores.

Methods

We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment.

Findings

IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment.

Interpretation

We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes.

Funding

National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).

Independent and interactive effect of type 2 diabetes and hypertension on memory functions in middle aged adults

BACKGROUND

The study distinguishes the effect of type 2 diabetes and hypertension on cognitive functions when the two diseases are alone or when they occur together, compared to healthy individuals.

METHODS

A total of 143 middle-aged adults were screened using the Wechsler Memory Scale - Revised psychometric test (verbal memory, visual memory, attention/concentration and delayed memory). Participants were divided into four groups based on their diseases: patients with type 2 diabetes (36), patients with hypertension (30), patients having both diseases (33), and healthy controls (44).

RESULTS

This study found no differences among investigated groups in verbal and visual memory, however, hypertension and both-disease group performed unfavorably compared to patients with diabetes and to healthy individuals in attention/concentration and delayed memory.

CONCLUSIONS

The findings of this study suggest that there is a relationship between hypertension and cognitive dysfunction, whereas type 2 diabetes without consequences was not proved to have an association with cognitive decline in middle-aged people.

Derivation and validation of the Rapid Assessment of Dementia Risk (RADaR) for older adults

BACKGROUND

There is no practical dementia risk score in the clinical setting.

OBJECTIVE

To derive and validate a score obtained by a rapid and simple assessment, which guides primary care providers in predicting the risk of dementia among older adults.

DESIGN

A total of 4178 participants from three longitudinal cohorts (mean age at baseline = 76.8 [SD = 7.6] years), without baseline dementia, followed annually for a median of 10 years (IQR: 5 to16 years, Reverse Kaplan-Meier).

PARTICIPANTS

To derive the score, we used data from 1,780 participants from the Rush Memory and Aging Project (93% White). To validate the score, we used data from 1,299 participants from the Religious Order Study (92% White), and to assess generalizability, 679 participants from the Minority Aging Research Study (100% Black).

MEASUREMENTS

Clinician-based dementia diagnosis at any time after baseline and predictive variables associated with dementia risk that can be collected in a primary care setting: demographics, clinical indicators, medical history, memory complaints, cognitive and motor tests, and questions to assess functional disability, depressive symptoms, sleep, social isolation, and genetics (APOE e4 and AD polygenic risk score).

RESULTS

At baseline, age, memory complaint, the ability to handle finances, the recall of the month, recall of the room, and recall of three words, were associated with the cumulative incidence of dementia, in the derivation cohort. The discrimination of the RADaR (Rapid Risk Assessment of Dementia) was good for the derivation and external-validation cohorts (AUC3 years = 0.82-0.86), compared to the overall discrimination of age alone (AUC3 years = 0.73), a major risk factor for dementia. Adding genetic data did not increase discrimination.

LIMITATIONS

Participants were volunteers, may not represent the general population.

CONCLUSIONS

The RADaR, derived from community-dwelling older persons, is a brief and valid tool to predict dementia risk at 3 years in older White and Black persons.

Coordinated data analysis: Knowledge accumulation in lifespan developmental psychology

Coordinated analysis is a powerful form of integrative analysis, and is well suited in its capacity to promote cumulative scientific knowledge, particularly in subfields of psychology that focus on the processes of lifespan development and aging. Coordinated analysis uses raw data from individual studies to create similar hypothesis tests for a given research question across multiple datasets, thereby making it less vulnerable to common criticisms of meta-analysis such as file drawer effects or publication bias. Coordinated analysis can sometimes use random effects meta-analysis to summarize results, which does not assume a single true effect size for a given statistical test. By fitting parallel models in separate datasets, coordinated analysis preserves the heterogeneity among studies, and provides a window into the generalizability and external validity of a set of results. The current article achieves three goals: First, it describes the phases of a coordinated analysis so that interested researchers can more easily adopt these methods in their labs. Second, it discusses the importance of coordinated analysis within the context of the credibility revolution in psychology. Third, it encourages the use of existing data networks and repositories for conducting coordinated analysis, in order to enhance accessibility and inclusivity. Subfields of research that require time- or resource- intensive data collection, such as longitudinal aging research, would benefit by adopting these methods. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Association of Strawberries and Anthocyanidin Intake with Alzheimer's Dementia Risk

Background: Strawberries have been identified to have antioxidant and anti-inflammatory properties that improve neuronal function and cognition, mostly in animal studies. It is unknown if the consumption of strawberries or related bioactives may reduce the risk of Alzheimer’s dementia risk. Material and Methods: The study was conducted in 925 participants, aged 58–98 years of the Rush Memory and Aging Project. Participants were dementia-free at baseline, completed a food frequency questionnaire, and had at least two annual neurological evaluations. The diagnosis of Alzheimer’s dementia was based on structured clinical neurological examination and standardized diagnostic criteria. The association of strawberry intake and incident Alzheimer’s dementia was analyzed using proportional hazard models adjusted for age, sex, education, physical activity, participation in cognitive activities, APOE-ɛ4 genotype, dietary intake of other fruits, and total calorie intake. Results: A total of 245 participants developed Alzheimer’s dementia over the mean follow-up of 6.7 (±3.6) years. Higher strawberry intake was associated with reduced risk of Alzheimer’s dementia (HR = 0.76, 95% CI: 0.60–0.96). In separate adjusted models, highest vs. lowest quartile intakes of Vitamin C (HR = 0.64, 95% CI: 0.45, 0.92), Pelargonidin (0.63, 95% CI: 0.43, 0.92), total anthocyanidins (0.69, 95% CI: 0.48, 0.99), and total flavonoids (0.67, 95% CI: 0.46, 0.98) were each associated with lower Alzheimer’s dementia risk. These associations remained after further adjustment for cardiovascular conditions. Conclusion: Consumption of strawberries and foods rich in vitamin C, pelargonidin, anthocyanidins, and total flavonoids may reduce the risk of Alzheimer’s dementia.

Thiazide therapy is not related to any changes in cognitive function in older hypertensive patients with or without dementia: a 26-week follow-up study

AIM

The study aimed to evaluate the effect of thiazide diuretics, a first-line antihypertensive therapy, on cognitive function in elderly hypertensive patients with or without cognitive impairment.

METHODS

This retrospective and observational study assessed 286 elderly patients with hypertension. Patients were divided based on thiazide diuretic usage and then into dementia and non-dementia groups. The comprehensive geriatric assessment was performed for all patients. All participants were re-evaluated after a 26-week period.

RESULTS

In total, 133 patients, including 62 with dementia, took thiazide. There were no significant differences between baseline and follow-up laboratory findings, comprehensive geriatric assessment parameters, including detailed neurocognitive assessment, or electrolytes in the thiazide group, the non-thiazide group, and the dementia group (P > 0.05).

CONCLUSION

Thiazide therapy does not show any effect on cognitive function in older hypertensive adults regardless of dementia status.

Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation

PURPOSE OF REVIEW

The study aims to examine the effects of diabetes and depression on executive functioning (EF) and to review the effects of EF deficits on diabetes management.

RECENT FINDINGS

Both type 2 diabetes and depression influence EF, and in turn, EF has an impact on diabetes management. Individuals with both comorbidities (i.e., diabetes and depression) experience greater deficits in EF than individuals with just one of the morbidities (i.e., depression or diabetes). The disruption in EF results in poor diabetes management and poor emotion regulation which ultimately increases the probability of a recursive cycle of depression and hyperglycemia. This recursive cycle can ultimately lead to diabetes-related complications.

Effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China

BACKGROUND

The incidence of hypertension in China is high, which seriously affects people's health, including occupational population in mining areas. Cognitive dysfunction has a serious impact on the work and life of patients. Lifestyle intervention can improve diabetes and cardiovascular diseases. However, there are few studies on the effects of lifestyle interventions on cognitive function in hypertensive patients. So the aim of this study was to analyze the effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China.

METHODS

In September 2013, a cluster sampling was conducted for the workers in the Shaanxi Jinduicheng (intervention group) and Hancheng (control group) mining areas. In both groups, according to the blood pressure (BP) level, they were divided into hypertension stage 1 to 3 subgroups; according to their age, they were divided into between 45 and 59 and under 45 years subgroups; and according to whether or not taking medicine, they were divided into Lifestyle intervention, Lifestyle intervention plus medication, Medication, and No lifestyle intervention nor medication subgroups. The intervention group received regular lifestyle intervention for 2 years, which included diet, smoke, drink, and exercise intervention. Mild cognitive impairment was measured by the Montreal Cognitive Assessment (MoCA). The arterial stiffness was measured by Omron Automatic Atherosclerosis Tester. We conducted BP measurement and MoCA questionnaire at baseline, 6, 12, and 24 months.

RESULTS

We analyzed a total of 510 mine workers, whose average age was 45.6 ± 13.4 years old. With the increase of BP level, the MoCA scores decreased significantly both in control and lifestyle intervention groups (P < .05). There was no obvious difference between the hypertensive patients whose age was between 45 and 59 to those under 45 in MoCA scores (P > .05). After 2 years, the BP, total cholesterol, glucose, and brachial-ankle pulse wave velocity of the Lifestyle intervention subgroup and Lifestyle intervention plus medication subgroup decreased (P < .05), and the MoCA scores and ankle-brachial index increased (P < .05), and the latter improved more significantly. Compared with the No lifestyle intervention nor medication subgroup, the BP and MoCA scores had no obvious changes at 6 months (P > .05), but the BP decreased and the MoCA scores increased significantly in the Lifestyle intervention and Lifestyle intervention plus medication subgroups after 1 and 2 years of lifestyle intervention (P < .05).

CONCLUSION

Long-term lifestyle intervention can be used as adjunctive therapy to improve the BP and cognitive function of hypertensive occupational population in China.

Executive functions and memory in patients at risk of vascular brain pathology

Hypertension is a common problem in the elderly population. It is one of the factors determining the pattern of cognitive functioning of the patients, however the nature and severity of neuropsychological deficits are unclear. The main aim of the study was to assess effectiveness of cognitive task performance and the strategies of verbal material organization in patients with varying levels of productivity and control. The outpatients treated for hypertension (n = 46) were tested with the following neuropsychological tests and the experimental task: Ruff Figural Fluency Test (RFFT), California Verbal Learning Test (CVLT), Semantic Verbal Fluency Task (VF). The level of productivity and control in older hypertensive patients appeared to be important variables differentiating the effectiveness of structured task performance involving the memory and learning of verbal material. Patients with weaker productivity and control show less efficiency in formulating and sustaining a learning plan expressed by the compatibility of responses in subsequent attempts. Weaker productivity and control are associated with high risk of memory problems, especially in situations characterized by a high degree of structure. It is advisable to include an evaluation of certain aspects of executive functions at the initial stage of assessment of patients at risk of brain dysfunction.

Religious Orders Study and Rush Memory and Aging Project

BACKGROUND

The Religious Orders Study and Rush Memory and Aging Project are both ongoing longitudinal clinical-pathologic cohort studies of aging and Alzheimer's disease (AD).

OBJECTIVES

To summarize progress over the past five years and its implications for understanding neurodegenerative diseases.

METHODS

Participants in both studies are older adults who enroll without dementia and agree to detailed longitudinal clinical evaluations and organ donation. The last review summarized findings through the end of 2011. Here we summarize progress and study findings over the past five years and discuss new directions for how these studies can inform on aging and AD in the future.

RESULTS

We summarize 1) findings on the relation of neurobiology to clinical AD; 2) neurobiologic pathways linking risk factors to clinical AD; 3) non-cognitive AD phenotypes including motor function and decision making; 4) the development of a novel drug discovery platform.

CONCLUSION

Complexity at multiple levels needs to be understood and overcome to develop effective treatments and preventions for cognitive decline and AD dementia.

Longitudinal association of hypertension and diabetes mellitus with cognitive functioning in a general 70-year-old population: the SONIC study

Both hypertension and diabetes in middle-aged individuals have been suggested to be predictive indicators of cognitive decline. However, the association of hypertension, diabetes and their combination with cognitive functioning is still controversial in older people. The purpose of this study was to investigate the association between cognitive decline and hypertension, diabetes, and their combination in 70-year-old people based on a 3-year longitudinal analysis. Four hundred and fifty-four people aged 70 (±1) years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians (SONIC) were recruited randomly from a general population and were monitored for 3 years. The data, including most of the demographics, cognitive functioning measured by the Montreal Cognitive Assessment Japanese version (MoCA-J), blood pressure, blood chemistry and other medical histories, were collected at baseline and during the follow-up. The prevalence of hypertension noted in the follow-up survey was significantly higher than than noted at baseline. The mean MoCA-J score at follow-up was not significantly different from the score obtained at baseline. However, the participants with diabetes, especially combined with hypertension at baseline, had significantly lower MoCA-J scores than those without lifestyle-related diseases. The combination of hypertension and diabetes was still a significant risk factor for cognitive decline, considering the MoCA-J scores obtained during the follow-up after adjustments at baseline, relative to sex, body mass index, dyslipidemia, smoking, excessive alcohol intake, antihypertensive treatment and education level (β=-0.14; P<0.01). Our findings indicate that diabetes and the combination of hypertension and diabetes are clear risk factors for future cognitive decline in elderly individuals who are 70 years of age.

Evaluation of cognitive impairment in elderly population with hypertension from a low-resource setting: Agreement and bias between screening tools

INTRODUCTION

The evaluation of cognitive impairment in adulthood merits attention in societies in transition and especially in people with chronic diseases. Screening tools available for clinical practice and epidemiological studies have been designed in high-income but not in resource-constrained settings. The aim of this study was to assess the agreement and bias of three common tools used for screening of cognitive impairment in people with hypertension: the modified Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Leganés Cognitive Test (LCT).

METHODS

A cross-sectional study enrolling participants with hypertension from a semi-urban area in Peru was performed. The three screening tools for cognitive impairment were applied on three consecutive days. The prevalence of cognitive impairment was calculated for each test. Pearson's correlation coefficients, Bland-Altman plots, and Kappa statistics were used to assess agreement and bias between screening tools.

RESULTS

We evaluated 139 participants, mean age 76.5 years (SD ± 6.9), 56.1% females. Cognitive impairment was found in 28.1% of individuals using LCT, 63.3% using MMSE, and 100% using MoCA. Correlation coefficients ranged from 0.501 between LCT and MoCA, to 0.698 between MMSE and MoCA. Bland-Altman plots confirmed bias between screening tests. The agreement between MMSE and LCT was 60.4%, between MMSE and MoCA was 63.3%, and between MoCA and LCT was 28.1%.

CONCLUSIONS

Three of the most commonly used screening tests to evaluate cognitive impairment showed major discrepancies in a resource-constrained setting, signaling towards a sorely need to develop and validate appropriate tools.