1
|
Joyce OC, McHugh C, Mockler D, Wilson F, Kelly ÁM. Midlife hypertension is a risk factor for some, but not all, domains of cognitive decline in later life: a systematic review and meta-analysis. J Hypertens 2024; 42:205-223. [PMID: 37937515 PMCID: PMC10763710 DOI: 10.1097/hjh.0000000000003614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Management of midlife blood pressure and hypertension status may provide a window of intervention to mitigate cognitive decline with advancing age. The aim of this review was to investigate the relationship between midlife hypertension and cognition in midlife and later life. METHODS Online electronic databases were searched from their inception to May 2022. Studies assessing midlife (40-65 years) hypertension and cognition at mid and/or later-life were included. A random effects meta-analysis was deemed appropriate. RESULTS One hundred forty-nine studies across 26 countries were included. Qualitative synthesis found negative relationships between midlife hypertension and later life cognition in the domains of memory, executive function, and global cognition. Metanalytical evidence revealed midlife hypertension negatively impacts memory, executive function, and global cognition but had no observed effect on attention at midlife. DISCUSSION Hypertension at midlife has a significant negative impact on cognition in mid-life and later life, namely memory, executive function, and global cognition.
Collapse
Affiliation(s)
- Oisín Cormac Joyce
- Department of Physiology, School of Medicine, Level 2, Trinity Biomedical Sciences Institute, Trinity College Dublin
| | - Clíodhna McHugh
- Department of Physiology, School of Medicine, Level 2, Trinity Biomedical Sciences Institute, Trinity College Dublin
| | | | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Áine M. Kelly
- Department of Physiology, School of Medicine, Level 2, Trinity Biomedical Sciences Institute, Trinity College Dublin
| |
Collapse
|
2
|
Basalely A, Hill-Horowitz T, Sethna CB. Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes. Curr Hypertens Rep 2023; 25:1-11. [PMID: 36434426 DOI: 10.1007/s11906-022-01231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review highlights the major changes reflected in the 2022 American Heart Association (AHA) Scientific Statement on Ambulatory Blood Pressure Monitoring (ABPM) in Children and Adolescents with a specific focus on the newly defined phenotypes of hypertension and their epidemiology and associated outcomes. RECENT FINDINGS The 2022 AHA guidelines' most notable changes include the following: (1) alignment of blood pressure (BP) thresholds with the 2017 American Academy of Pediatrics (AAP) clinical practice guidelines, 2017 American College of Cardiology (ACC)/AHA hypertension guidelines, and 2016 European Society of Hypertension (ESH) pediatric recommendations; (2) expansion of the use of ABPM to diagnose and phenotype pediatric hypertension in all pediatric patients; (3) removal of BP loads from diagnostic criteria; and (4) simplified classification of new hypertension phenotypes to prognosticate risks and guide clinical management. Recent studies suggest that utilizing the 2022 AHA pediatric ABPM guidelines will increase the prevalence of pediatric ambulatory hypertension, especially for wake ambulatory hypertension in older, taller males and for nocturnal hypertension in both males and females ≥ 8 years of age. The new definitions simplify the ambulatory hypertension criteria to include only the elements most predictive of future health outcomes, increase the sensitivity of BP thresholds in alignment with recent data and other guidelines, and thus make hypertension diagnoses more clinically meaningful. This guideline will also aid in the transition of adolescents and young adults to adult medical care. Further studies will be necessary to study ambulatory BP norms in a more diverse pediatric population and evaluate the impact of these guidelines on prevalence and future outcomes.
Collapse
Affiliation(s)
- Abby Basalely
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA.,Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Taylor Hill-Horowitz
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA
| | - Christine B Sethna
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA. .,Feinstein Institutes for Medical Research, Manhasset, NY, USA.
| |
Collapse
|
3
|
Butler JE, Vincent C, South AM, Chanchlani R. Updates to Pediatric Ambulatory Blood Pressure Monitoring in Clinical Practice: a Review and Strategies for Expanding Access. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00273-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
4
|
Dawson AE, Kallash M, Spencer JD, Wilson CS. The pressure's on: understanding neurocognitive and psychological associations with pediatric hypertension to inform comprehensive care. Pediatr Nephrol 2021; 36:3869-3883. [PMID: 33890179 DOI: 10.1007/s00467-021-05077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The prevalence of hypertension is increasing in pediatric populations. While clinical data and practice guidelines identify the impact of hypertension on organ dysfunction and emphasize the importance for end-organ damage screening, the bidirectional effects of pediatric hypertension on neurocognitive and psychological outcomes are understudied. The objective of this review is to highlight the association between hypertension and cognition, attention, learning, and mental health in children and adolescents. In doing so, this review provides a framework and toolkit to integrate neuropsychology and psychology into the screening and management stages of pediatric hypertension. By recognizing the effects of hypertension on cognition, behavior, and mental health, screenings and interventions can be implemented to proactively and comprehensively improve the health outcomes for children with blood pressure concerns.
Collapse
Affiliation(s)
- Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Mahmoud Kallash
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - John D Spencer
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - Camille S Wilson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA
| |
Collapse
|
5
|
Pallangyo P, Mkojera ZS, Komba M, Mgopa LR, Bhalia S, Mayala H, Wibonela S, Misidai N, Swai HJ, Millinga J, Chavala E, Kisenge PR, Janabi M. Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study. BMC Neurol 2021; 21:433. [PMID: 34749692 PMCID: PMC8573988 DOI: 10.1186/s12883-021-02467-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. METHODOLOGY A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. RESULTS A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4-5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2-2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1-2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p = 0.04) to have independent association with cognitive impairment. CONCLUSION This present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.
Collapse
Affiliation(s)
- Pedro Pallangyo
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | | | - Makrina Komba
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | | | - Jalack Millinga
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Ester Chavala
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Peter R. Kisenge
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| |
Collapse
|
6
|
Suvila K, Lima JA, Yano Y, Tan ZS, Cheng S, Niiranen TJ. Early-but Not Late-Onset Hypertension Is Related to Midlife Cognitive Function. Hypertension 2021; 77:972-979. [PMID: 33461314 PMCID: PMC7878356 DOI: 10.1161/hypertensionaha.120.16556] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022]
Abstract
Hypertension is related to increased risk of cognitive decline in a highly age-dependent manner. However, conflicting evidence exists on the relation between age of hypertension onset and cognition. Our goal was to investigate the association between early- versus late-onset hypertension and midlife cognitive performance in 2946 CARDIA study (Coronary Artery Risk Development in Young Adults) participants (mean age 55±4, 57% women). The participants underwent 9 repeat examinations, including blood pressure measurements, between 1985 to 1986 and 2015 to 2016. The participants underwent brain magnetic resonance imaging and completed Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Stroop interference test, and the Montreal Cognitive Assessment to evaluate cognitive function at the year 30 exam. We assessed the relation between age of hypertension onset and cognitive function using linear regression models adjusted for cognitive decline risk factors, including systolic blood pressure. We observed that individuals with early-onset hypertension (onset at <35 years) had 0.24±0.09, 0.22±0.10, 0.27±0.09, and 0.19±0.07 lower standardized Z-scores in Digit Symbol Substitution Test, Stroop test, Montreal Cognitive Assessment, and a composite cognitive score than participants without hypertension (P<0.05 for all). In contrast, hypertension onset at ≥35 years was not associated with cognitive function (P >0.05 for all). In a subgroup of 559 participants, neither early- nor late-onset hypertension was related to macrostructural brain alterations (P >0.05 for all). Our results indicate that early-onset hypertension is a potent risk factor for midlife cognitive impairment. Thus, age of hypertension onset assessment in clinical practice could improve risk stratification of cognitive decline in patients with hypertension.
Collapse
Affiliation(s)
- Karri Suvila
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Joao A.C. Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, USA
| | - Zaldy S. Tan
- Department of Neurology, Jona Goldrich Center for Alzheimer’s and Memory Disorders, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Susan Cheng
- Division of Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
- Framingham Heart Study, Framingham, USA
| | - Teemu J. Niiranen
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
| |
Collapse
|
7
|
Baroni C, Lionetti V. The impact of sex and gender on heart-brain axis dysfunction: current concepts and novel perspectives. Can J Physiol Pharmacol 2021; 99:151-160. [PMID: 33002366 DOI: 10.1139/cjpp-2020-0391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The heart-brain axis (HBA) recapitulates all the circuits that regulate bidirectional flow of communication between heart and brain. Several mechanisms may underlie the interdependent relationship involving heterogeneous tissues at rest and during specific target organ injury such as myocardial infarction, heart failure, arrhythmia, stroke, mood disorders, or dementia. In-depth translational studies of the HBA dysfunction under single-organ injury should include both male and female animals to develop sex- and gender-oriented prevention, diagnosis, and treatment strategies. Indeed, sex and gender are determining factors as females and males exhibit significant differences in terms of susceptibility to risk factors, age of onset, severity of symptoms, and outcome. Despite most studies having focused on the male population, we have conducted a careful appraisal of the literature investigating HBA in females. In particular, we have (i) analyzed sex-related heart and brain illnesses, (ii) recapitulated the most significant studies simultaneously conducted on cardio- and cerebro-vascular systems in female populations, and (iii) hypothesized future perspectives for the development of a gender-based approach to HBA dysfunction. Although sex- and gender-oriented research is at its infancy, the impact of sex on HBA dysfunction is opening unexpected new avenues for managing the health of female subjects exposed to risk of lifestyle multi-organ disease.
Collapse
Affiliation(s)
- Carlotta Baroni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vincenzo Lionetti
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- UOS Anesthesiology and Intensive Care Medicine, Fondazione Toscana G. Monasterio, Pisa, Italy
| |
Collapse
|
8
|
The brain in pediatric chronic kidney disease-the intersection of cognition, neuroimaging, and clinical biomarkers. Pediatr Nephrol 2020; 35:2221-2229. [PMID: 31897717 PMCID: PMC8493603 DOI: 10.1007/s00467-019-04417-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
Brain growth and development occur at peak rates in early childhood through adolescence, and for some children, this must happen in conjunction with chronic kidney disease (CKD), associated medical conditions, and their treatment(s). This review provides an overview of key findings to date on the topic of the brain in pediatric CKD. Here, we specifically address the topics of neuroimaging and cognition in pediatric CKD with consideration to biomarkers of disease progression that may impact cognition. Current cognitive data suggest that most children with mild to moderate CKD do not exhibit significant cognitive impairments, but, rather, the presence of somewhat lower intellectual abilities and subtle deficits in selected executive functions. Although promising, modern neuroimaging data remain inconclusive in linking cognitive findings to neuroimaging correlates in the pediatric CKD population. Certainly, it is important to note that even subtle cognitive concerns can present barriers to learning, social functioning, and overall quality of life if not appropriately recognized or addressed. Further longitudinal research utilizing concurrent and targeted cognitive and neuroimaging evaluations is warranted to better understand the impact of CKD progression on brain development and associated neurocognitive outcomes.
Collapse
|
9
|
Veldsman M, Tai XY, Nichols T, Smith S, Peixoto J, Manohar S, Husain M. Cerebrovascular risk factors impact frontoparietal network integrity and executive function in healthy ageing. Nat Commun 2020; 11:4340. [PMID: 32895386 PMCID: PMC7477206 DOI: 10.1038/s41467-020-18201-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Healthy cognitive ageing is a societal and public health priority. Cerebrovascular risk factors increase the likelihood of dementia in older people but their impact on cognitive ageing in younger, healthy brains is less clear. The UK Biobank provides cognition and brain imaging measures in the largest population cohort studied to date. Here we show that cognitive abilities of healthy individuals (N = 22,059) in this sample are detrimentally affected by cerebrovascular risk factors. Structural equation modelling revealed that cerebrovascular risk is associated with reduced cerebral grey matter and white matter integrity within a fronto-parietal brain network underlying executive function. Notably, higher systolic blood pressure was associated with worse executive cognitive function in mid-life (44-69 years), but not in late-life (>70 years). During mid-life this association did not occur in the systolic range of 110-140 mmHg. These findings suggest cerebrovascular risk factors impact on brain structure and cognitive function in healthy people.
Collapse
Affiliation(s)
- Michele Veldsman
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Xin-You Tai
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Thomas Nichols
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Steve Smith
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - João Peixoto
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sanjay Manohar
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Masud Husain
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| |
Collapse
|
10
|
Lande MB, Kupferman JC. Blood Pressure and Cognitive Function in Children and Adolescents. Hypertension 2019; 73:532-540. [PMID: 30686086 DOI: 10.1161/hypertensionaha.118.11686] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc B Lande
- From the Department of Pediatrics, University of Rochester, NY (M.B.L.)
| | - Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY (J.C.K.)
| |
Collapse
|
11
|
Volgman AS, Bairey Merz CN, Aggarwal NT, Bittner V, Bunch TJ, Gorelick PB, Maki P, Patel HN, Poppas A, Ruskin J, Russo AM, Waldstein SR, Wenger NK, Yaffe K, Pepine CJ. Sex Differences in Cardiovascular Disease and Cognitive Impairment: Another Health Disparity for Women? J Am Heart Assoc 2019; 8:e013154. [PMID: 31549581 PMCID: PMC6806032 DOI: 10.1161/jaha.119.013154] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Neelum T Aggarwal
- Departments of Neurological Sciences Rush Alzheimer's Disease Center Rush Medical College Chicago IL
| | - Vera Bittner
- Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham AL
| | - T Jared Bunch
- Section of Cardiology Department of Medicine Stanford University Palo Alto California.,Department of Cardiology Intermountain Heart Institute Intermountain Medical Center Salt Lake City UT
| | - Philip B Gorelick
- Department of Translational Neuroscience Michigan State University College of Human Medicine Grand Rapids MI
| | - Pauline Maki
- Department of Psychiatry, Psychology and Obstetrics & Gynecology University of Illinois at Chicago IL
| | - Hena N Patel
- Section of Cardiology Department of Medicine Rush Medical College Chicago IL
| | - Athena Poppas
- Section of Cardiology Department of Medicine Brown University School of Medicine Providence RI
| | - Jeremy Ruskin
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Andrea M Russo
- Section of Cardiology Department of Medicine Cooper Medical School of Rowan University Camden NJ
| | - Shari R Waldstein
- Department of Psychology University of Maryland, Baltimore County Baltimore MD
| | - Nanette K Wenger
- Section of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology University of California San Francisco San Francisco CA
| | - Carl J Pepine
- Division of Cardiovascular Medicine Department of Medicine University of Florida Gainesville FL
| |
Collapse
|
12
|
Golive A, May HT, Bair TL, Jacobs V, Crandall BG, Cutler MJ, Day JD, Mallender C, Osborn JS, Weiss JP, Bunch TJ. The Impact of Gender on Atrial Fibrillation Incidence and Progression to Dementia. Am J Cardiol 2018; 122:1489-1495. [PMID: 30195396 DOI: 10.1016/j.amjcard.2018.07.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
Abstract
There are a paucity of data regarding the role of gender and atrial fibrillation (AF) on cognitive decline and incidence of dementia. Such data may provide insight into the disproportionate incidence of dementia in women and may help identify high-risk characteristics to target for prevention. We examined patients who underwent coronary angiography at an Intermountain Healthcare Medical Center and enrolled in a prospective cardiovascular database. To be included, patients could not have a previous diagnosis of AF or dementia and had to have 5years of follow-up. Endpoints included incident AF and dementia. Study cohort consisted of 35,608 patients without a previous history of AF or dementia, with 14,377 (40.4%) being woman. Women had lower rates of hypertension, diabetes, coronary artery disease, and prior myocardial infarction, but higher rates of prior stroke. Men had a higher incidence of 5-year and long-term AF. However, women trended toward a higher incidence of 5-year and long-term dementia and stroke compared with men. In all groups of patients with and without AF, prior stroke predicted cognitive decline. In patients without a history of or development of AF, diabetes significantly increased risk of dementia. Women have higher rates of dementia over time than men, driven by higher baseline stroke rates and nontraditional cardiovascular risk factors. The higher dementia rates were in the setting of lower AF rates. However, in both men and women who develop AF, dementia rates are increased and do not show gender-based differences in risk.
Collapse
Affiliation(s)
- Anjani Golive
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Heidi T May
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Tami L Bair
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Victoria Jacobs
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Brian G Crandall
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - John D Day
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Charles Mallender
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Jeffrey S Osborn
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - J Peter Weiss
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah
| | - T Jared Bunch
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah; Stanford University, Department of Internal Medicine, Palo Alto, California.
| |
Collapse
|
13
|
Urbina EM, Lande MB, Hooper SR, Daniels SR. Target Organ Abnormalities in Pediatric Hypertension. J Pediatr 2018; 202:14-22. [PMID: 30122368 DOI: 10.1016/j.jpeds.2018.07.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati Children's, Cincinnati, OH
| | - Marc B Lande
- Department of Pediatrics, Pediatric Nephrology, University of Rochester School of Medicine, Rochester, NY
| | - Stephen R Hooper
- Department of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
| |
Collapse
|
14
|
Lande MB, Batisky DL, Kupferman JC, Samuels J, Hooper SR, Falkner B, Waldstein SR, Szilagyi PG, Wang H, Staskiewicz J, Adams HR. Neurocognitive Function in Children with Primary Hypertension after Initiation of Antihypertensive Therapy. J Pediatr 2018; 195:85-94.e1. [PMID: 29398058 PMCID: PMC5869096 DOI: 10.1016/j.jpeds.2017.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/26/2017] [Accepted: 12/04/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the change in neurocognitive test performance in children with primary hypertension after initiation of antihypertensive therapy. STUDY DESIGN Subjects with hypertension and normotensive control subjects had neurocognitive testing at baseline and again after 1 year, during which time the subjects with hypertension received antihypertensive therapy. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed, and parents completed rating scales of executive function. RESULTS Fifty-five subjects with hypertension and 66 normotensive control subjects underwent both baseline and 1-year assessments. Overall, the blood pressure (BP) of subjects with hypertension improved (24-hour systolic BP load: mean baseline vs 1 year, 58% vs 38%, P < .001). Primary multivariable analyses showed that the hypertension group improved in scores of subtests of the Rey Auditory Verbal Learning Test, Grooved Pegboard, and Delis-Kaplan Executive Function System Tower Test (P < .05). However, the control group also improved in the same measures with similar effects sizes. Secondary analyses by effectiveness of antihypertensive therapy showed that subjects with persistent ambulatory hypertension at 1 year (n = 17) did not improve in subtests of Rey Auditory Verbal Learning Test and had limited improvement in Grooved Pegboard. CONCLUSIONS Overall, children with hypertension did not improve in neurocognitive test performance after 1 year of antihypertensive therapy, beyond that also seen in normotensive controls, suggesting improvements with age or practice effects because of repeated neurocognitive testing. However, the degree to which antihypertensive therapy improves BP may affect its impact upon neurocognitive function.
Collapse
Affiliation(s)
- Marc B. Lande
- Department of Pediatrics, University of Rochester, Rochester, NY
| | | | | | - Joshua Samuels
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX
| | - Stephen R. Hooper
- Departments of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Bonita Falkner
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA
| | - Shari R. Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Peter G. Szilagyi
- Department of Pediatrics, University of California at Los Angeles (UCLA), Los Angeles, CA
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester, Rochester, NY
| | | | | |
Collapse
|
15
|
Age modifies the relation between intraindividual measurement-to-measurement variation in blood pressure and cognitive function: the Maine-Syracuse Study. J Hypertens 2017; 36:268-276. [PMID: 28787305 DOI: 10.1097/hjh.0000000000001510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence to suggest that intraindividual variability in blood pressure (BP IIV) may be superior to mean BP for predicting cognitive function, taken from both within a single visit and between-visits. BP IIV increases with age in studies of persons middle-aged and older. The aim was therefore to investigate age by BP IIV (SBP and DBP) interactions with regard to cognitive functioning while considering medication class and polypharmacy, which may also affect BP IIV with advancing age. METHOD AND RESULTS Cross-sectional analyses were performed on 980 community-dwelling individuals from the Maine-Syracuse Longitudinal Study. Automated BP measures were taken 15 times (five times each in sitting, reclining, and standing positions). Cognitive function was assessed using a thorough neuropsychological test battery following the BP assessment. A significant age by BP IIV interaction was observed. For individuals aged over age 60 years, IIV in SBP and DBP was inversely associated with Global Composite, Scanning and Tracking, and the Similarities test. IIV in SBP was additionally associated with Verbal Memory and the Mini-Mental State Examination. DBP IIV was additionally related to the Visual-Spatial Memory and Organization composite. There were no significant associations between BP IIV and cognitive function in those aged less than 60 years. CONCLUSION BP IIV is an important predictor of cognition with advancing age.
Collapse
|
16
|
Lande MB, Batisky DL, Kupferman JC, Samuels J, Hooper SR, Falkner B, Waldstein SR, Szilagyi PG, Wang H, Staskiewicz J, Adams HR. Neurocognitive Function in Children with Primary Hypertension. J Pediatr 2017; 180:148-155.e1. [PMID: 27692987 PMCID: PMC5183510 DOI: 10.1016/j.jpeds.2016.08.076] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/21/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare neurocognitive test performance of children with primary hypertension with that of normotensive controls. STUDY DESIGN Seventy-five children (10-18 years of age) with newly diagnosed, untreated hypertension and 75 frequency-matched normotensive controls had baseline neurocognitive testing as part of a prospective multicenter study of cognition in primary hypertension. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed. Parents completed rating scales of executive function and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD). RESULTS Hypertension and control groups did not differ significantly in age, sex, maternal education, income, race, ethnicity, obesity, anxiety, depression, cholesterol, glucose, insulin, and C-reactive protein. Subjects with hypertension had greater PSQ-SRBD scores (P = .04) and triglycerides (P = .037). Multivariate analyses showed that hypertension was independently associated with worse performance on the Rey Auditory Verbal Learning Test (List A Trial 1, P = .034; List A Total, P = .009; Short delay recall, P = .013), CogState Groton Maze Learning Test delayed recall (P = .002), Grooved Pegboard dominant hand (P = .045), and Wechsler Abbreviated Scales of Intelligence Vocabulary (P = .016). Results indicated a significant interaction between disordered sleep (PSQ-SRBD score) and hypertension on ratings of executive function (P = .04), such that hypertension heightened the association between increased disordered sleep and worse executive function. CONCLUSIONS Youth with primary hypertension demonstrated significantly lower performance on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, and executive functions.
Collapse
Affiliation(s)
- Marc B Lande
- Department of Pediatrics, University of Rochester, Rochester, NY.
| | | | - Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY
| | - Joshua Samuels
- Department of Pediatrics, University of Texas at Houston, Houston, TX
| | - Stephen R Hooper
- Departments of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Bonita Falkner
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA
| | - Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Peter G Szilagyi
- Department of Pediatrics, University of California at Los Angeles (UCLA), Los Angeles, CA
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester, Rochester, NY
| | | | - Heather R Adams
- Department of Neurology, University of Rochester, Rochester, NY
| |
Collapse
|
17
|
Lande MB, Mendley SR, Matheson MB, Shinnar S, Gerson AC, Samuels JA, Warady BA, Furth SL, Hooper SR. Association of blood pressure variability and neurocognition in children with chronic kidney disease. Pediatr Nephrol 2016; 31:2137-44. [PMID: 27263021 PMCID: PMC5042825 DOI: 10.1007/s00467-016-3425-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/11/2016] [Accepted: 05/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) and hypertension have increased blood pressure variability (BPV), which has been associated with lower neurocognitive test scores in adults. Children with CKD are at risk for decreased neurocognitive function. Our objective was to determine whether children with CKD and increased BPV had worse performance on neurocognitive testing compared with children with CKD and lower BPV. METHODS This was a cross-sectional and longitudinal analysis of the relation between BPV and neurocognitive test performance in children ≥6 years enrolled in the Chronic Kidney Disease in Children (CKiD) study. Visit-to-visit BPV was assessed by the standard deviation of visit BPs (BPV-SD) and average real variability (ARV). Ambulatory BPV was assessed by SD of wake and sleep periods on 24-h ambulatory BP monitoring. RESULTS We assessed 650 children with a mean follow-up period of 4.0 years. Children with systolic visit-to-visit BPV in the upper tertile had lower scores on Delis-Kaplan Executive Function System (D-KEFS) Verbal Category Switching than those with BPV in the lower tertile (BPV-SD, 8.3 vs. 9.5, p = 0.006; ARV, 8.5 vs. 9.6, p = 0.02). On multivariate analysis, the association between lower Category Switching score and increased BPV remained significant after controlling for mean BP, demographic characteristics, and disease-related variables [BPV-SD, β = -0.7, 95 % confidence interval (CI) -1.28 to -0.12; ARV, β = -0.54, CI -1.05 to -0.02). Ambulatory BPV was not independently associated with any cognitive measure. CONCLUSIONS Higher systolic visit-to-visit BPV was independently associated with decreased D-KEFS Category Switching scores in children with mild-to-moderate CKD.
Collapse
Affiliation(s)
- Marc B Lande
- Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave., Box 777, Rochester, NY, 14642, USA.
| | - Susan R Mendley
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Arlene C Gerson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua A Samuels
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA
| | - Bradley A Warady
- Division of Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen R Hooper
- Departments of Allied Health Sciences and Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
18
|
Fischer AL, O’Rourke N, Loken Thornton W. Age Differences in Cognitive and Affective Theory of Mind: Concurrent Contributions of Neurocognitive Performance, Sex, and Pulse Pressure. J Gerontol B Psychol Sci Soc Sci 2016; 72:71-81. [DOI: 10.1093/geronb/gbw088] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/06/2016] [Indexed: 12/19/2022] Open
|
19
|
Hansson JA, Hagberg B. Determinant Factors Contributing to Variations in Memory Performance in Centenarians. Int J Aging Hum Dev 2016; 60:19-51. [PMID: 15757360 DOI: 10.2190/wfup-2j25-lwqf-pq3w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The role of environmental markers in memory performance among centenarians was examined in a study comparing non-cognitive factors to various aspects of memory performance. The centenarian group participating in the study consisted of 100 individuals (82 females and 18 males). Selected as non-cognitive factors were Quality of Life, Life-Habits, Health, Personality, and Autonomy. These factors were later compared to memory performance in short-term memory, semantic memory, and episodic memory. Using a structural equation model, results showed that performance in short-term memory was best predicted by life-habits and personality, while performance in semantic and episodic memory were best predicted by autonomy and life-habits. Implementation of the result from a life-span perspective includes a closer monitoring of environmental markers in the future. In effect, this could preserve memory function and optimum health through old age, thus making interventions easier to realize.
Collapse
|
20
|
Waldstein SR. The Relation of Hypertension to Cognitive Function. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2016. [DOI: 10.1111/1467-8721.01212] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hypertension is an established risk factor for stroke. However, prior to such a major clinical event, hypertension exerts a more subtle impact on the brain that is revealed by diminished cognitive function. Studies comparing the performance of people with high and normal blood pressure levels have shown that high blood pressure or hypertension is related to poorer performance on tests of attention, learning and memory, executive functions, visuospatial skills, psychomotor abilities, and perceptual skills. Hypertension is also predictive of cognitive decline. Variables that may alter (i.e., moderate) the relation of hypertension to cognitive function include age, education, several biological characteristics of hypertension, and the presence of concurrent diseases. Although hypertensives are not clinically impaired, their diminished levels of cognitive performance could affect their perceived quality of life. Various brain mechanisms may explain the relation of hypertension to lower levels of cognitive function. Further understanding of the relation between hypertension and cognition is critical to the preservation of cognitive function across the life span.
Collapse
Affiliation(s)
- Shari R. Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland; Division of Gerontology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and Geriatrics Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
| |
Collapse
|
21
|
Hartung EA, Laney N, Kim JY, Ruebner RL, Detre JA, Liu HS, Davatzikos C, Erus G, Doshi JJ, Schultz RT, Herrington JD, Jawad AF, Moodalbail DG, Gur RC, Port AM, Radcliffe J, Hooper SR, Furth SL. Design and methods of the NiCK study: neurocognitive assessment and magnetic resonance imaging analysis of children and young adults with chronic kidney disease. BMC Nephrol 2015; 16:66. [PMID: 25924831 PMCID: PMC4419485 DOI: 10.1186/s12882-015-0061-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/22/2015] [Indexed: 12/04/2022] Open
Abstract
Background Chronic kidney disease is strongly linked to neurocognitive deficits in adults and children, but the pathophysiologic processes leading to these deficits remain poorly understood. The NiCK study (Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease) seeks to address critical gaps in our understanding of the biological basis for neurologic abnormalities in chronic kidney disease. In this report, we describe the objectives, design, and methods of the NiCK study. Design/methods The NiCK Study is a cross-sectional cohort study in which neurocognitive and neuroimaging phenotyping is performed in children and young adults, aged 8 to 25 years, with chronic kidney disease compared to healthy controls. Assessments include (1) comprehensive neurocognitive testing (using traditional and computerized methods); (2) detailed clinical phenotyping; and (3) multimodal magnetic resonance imaging (MRI) to assess brain structure (using T1-weighted MRI, T2-weighted MRI, and diffusion tensor imaging), functional connectivity (using functional MRI), and blood flow (using arterial spin labeled MRI). Primary analyses will examine group differences in neurocognitive testing and neuroimaging between subjects with chronic kidney disease and healthy controls. Mechanisms responsible for neurocognitive dysfunction resulting from kidney disease will be explored by examining associations between neurocognitive testing and regional changes in brain structure, functional connectivity, or blood flow. In addition, the neurologic impact of kidney disease comorbidities such as anemia and hypertension will be explored. We highlight aspects of our analytical approach that illustrate the challenges and opportunities posed by data of this scope. Discussion The NiCK study provides a unique opportunity to address key questions about the biological basis of neurocognitive deficits in chronic kidney disease. Understanding these mechanisms could have great public health impact by guiding screening strategies, delivery of health information, and targeted treatment strategies for chronic kidney disease and its related comorbidities.
Collapse
Affiliation(s)
- Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Nina Laney
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA.
| | - Ji Young Kim
- Biostatistics Core, Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Rebecca L Ruebner
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - John A Detre
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Hua-Shan Liu
- Graduate Institute of Clinical Medicine and Imaging Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Jimit J Doshi
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Robert T Schultz
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - John D Herrington
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Abbas F Jawad
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Divya G Moodalbail
- Division of Pediatric Nephrology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Allison M Port
- Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jerilynn Radcliffe
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
22
|
Prickett C, Brennan L, Stolwyk R. Examining the relationship between obesity and cognitive function: A systematic literature review. Obes Res Clin Pract 2015; 9:93-113. [DOI: 10.1016/j.orcp.2014.05.001] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/05/2014] [Accepted: 05/18/2014] [Indexed: 12/22/2022]
|
23
|
Sims RC, Thorpe RJ, Gamaldo AA, Aiken-Morgan AT, Hill LK, Allaire JC, Whitfield KE. Cognition and health in African American men. J Aging Health 2015; 27:195-219. [PMID: 25053802 PMCID: PMC4439206 DOI: 10.1177/0898264314543474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite high rates of poor health outcomes, little attention has been focused on associations between prominent health factors and cognitive function in African American men, exclusively. The objective was to examine relationships between cardiovascular and pulmonary health, and cognitive function in African American men. METHOD Data from 257 men were pooled from two studies of African American aging. The mean age of participants was 58.15 and mean educational attainment was 11.78 years. Participants provided self-reported health and demographic information, completed cognitive measures, and had their blood pressure and peak expiratory flow assessed. RESULTS After adjustment, significant relationships were found between average peak expiratory flow rate (APEFR) and cognitive performance measures. DISCUSSION Results suggest that lung function is important to consider when examining cognitive function in African American men. Understanding the role of health in cognition and implications for quality of life in this population will be critical as life expectancies increase.
Collapse
Affiliation(s)
| | - Roland J Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
Young hypertensive adults demonstrate decreased performance on neurocognitive testing compared with that of normotensive controls. There is emerging, preliminary evidence that children with hypertension also manifest cognitive differences when compared to normotensive controls. These preliminary studies consist mostly of database and single-center studies that focus primarily on differences in neurocognitive test performance and differences in cerebrovascular reactivity between hypertensive and normotensive subjects. Lessons from the literature on cognition in adult hypertensives and experience from the preliminary studies in children informed the design of a current, multicenter, ongoing study of cognition in children with primary hypertension.
Collapse
Affiliation(s)
- Marc B Lande
- Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave., Box 777, Rochester, NY, 14642, USA,
| | | |
Collapse
|
25
|
Kovács KR, Bajkó Z, Szekeres CC, Csapó K, Oláh L, Magyar MT, Molnár S, Czuriga D, Kardos L, Burainé AB, Bereczki D, Soltész P, Csiba L. Elevated LDL-C combined with hypertension worsens subclinical vascular impairment and cognitive function. ACTA ACUST UNITED AC 2014; 8:550-60. [PMID: 25151317 DOI: 10.1016/j.jash.2014.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
Hypertension and dyslipidemia belong to the most prevalent modifiable risk factors for cerebrovascular and cardiovascular diseases. Hereby, we aimed to examine the combined effects of newly diagnosed hypertension and hyperlipidemia on the characteristics of the arterial wall and on cognitive function. We examined 72 hypertensive and 85 apparently healthy individuals. Based on serum lipid levels, four subgroups were created ranging from normotensive-normolipidemic to hypertensive-hyperlipidemic subjects. Carotid intima-media thickness (IMT), arterial stiffness, and cognitive function were assessed. IMT of controls was the lowest, whereas that of patients with both risk factors the highest. Stiffness parameters increased when both risk factors were present, whereas subjects with only one risk factor exhibited intermediate values. Hypertensive patients performed worse when memory, attention, reaction time, and trait anxiety were assessed. Significant worsening of IMT, arterial stiffness, and sum of neuropsychological scores was observed along with increasing mean arterial pressure. Generally, hyperlipidemia combining with hypertension resulted in further worsening of all examined parameters. Subclinical changes of the vascular wall and cognitive performance are already present in recently diagnosed hypertensive patients. Combination of hyperlipidemia and hypertension results in more severe impairments, therefore, early and intensive treatment may be crucial to prevent further deterioration.
Collapse
Affiliation(s)
- Katalin Réka Kovács
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary.
| | - Zoltán Bajkó
- Department of Neurology, Mureş County Clinical Emergency Hospital, Târgu-Mureş, Romania
| | | | - Krisztina Csapó
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Oláh
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Mária Tünde Magyar
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Sándor Molnár
- Department of Neurology, Elisabeth Teaching Hospital of Sopron, Sopron, Hungary
| | - Dániel Czuriga
- Institute of Cardiology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Kardos
- Contract Medical Statistician, Kenézy Gyula Hospital, Debrecen, Hungary
| | | | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Pál Soltész
- Department of Angiology, Medical Faculty Clinical Center, University of Debrecen, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
26
|
Crichton GE, Elias MF, Davey A, Alkerwi A. Cardiovascular health and cognitive function: the Maine-Syracuse Longitudinal Study. PLoS One 2014; 9:e89317. [PMID: 24595096 PMCID: PMC3940600 DOI: 10.1371/journal.pone.0089317] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/18/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Smoking, physical inactivity, and poor diet, along with obesity, fasting glucose and blood pressure have been independently associated with poorer cognitive performance. Few studies have related scales representing a combination of these variables to multiple domains of cognitive performance. The aim of this study was to investigate the association between overall cardiovascular health, incorporating seven components, and cognitive function. METHODS A cross-sectional analysis employing 972 participants, from the Maine-Syracuse Longitudinal Study was undertaken. Four health behaviors (body mass index, physical activity, diet, smoking) and three health factors (total cholesterol, blood pressure, and fasting plasma glucose) were measured. Each was categorized according to the American Heart Association definitions for ideal cardiovascular health, except diet, for which two food scores were calculated. A Cardiovascular Health Score was determined by summing the number of cardiovascular metrics at ideal levels. Cognitive function was assessed using a thorough neuropsychological test battery. RESULTS Cardiovascular Health Score was positively associated with seven out of eight measures of cognitive function, with adjustment for age, education, and gender. With further adjustment for cardiovascular and psychological variables, these associations remained significant for Visual-Spatial Memory, Working Memory, Scanning and Tracking, Executive Function and the Global Composite score (p<0.05 for all). Ideal levels of a number of health factors and behaviors were positively associated with global cognitive performance. CONCLUSION Increasing cardiovascular health, indexed by a higher number of metrics at ideal levels, is associated with greater cognitive performance. Smoking, physical activity, and diet are important components of cardiovascular health that impact upon cognition.
Collapse
Affiliation(s)
- Georgina E. Crichton
- Nutritional Physiology Research Centre, University of South Australia, Adelaide, Australia
- Centre de Recherche Public Santé, Centre d'Etudes en Santé, Strassen, Grand-Duchy of Luxembourg
| | - Merrill F. Elias
- Department of Psychology, University of Maine, Orono, Maine, United States of America
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, Maine, United States of America
| | - Adam Davey
- Department of Public Health, Temple University, Philadelphia, PA, United States of America
| | - Ala'a Alkerwi
- Centre de Recherche Public Santé, Centre d'Etudes en Santé, Strassen, Grand-Duchy of Luxembourg
| |
Collapse
|
27
|
Köhler S, Baars MAE, Spauwen P, Schievink S, Verhey FRJ, van Boxtel MJP. Temporal evolution of cognitive changes in incident hypertension: prospective cohort study across the adult age span. Hypertension 2013; 63:245-51. [PMID: 24296281 DOI: 10.1161/hypertensionaha.113.02096] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Midlife hypertension is a risk factor for dementia, but little is known about the cognitive trajectories of individuals with incident hypertension. This study follows the cognitive functioning in prevalent and incident hypertension for 12 years and in relation to age and treatment status. Cognitively intact adults aged 25 to 84 years (n=1805) were serially assessed at baseline, 6 years, and 12 years. Hypertension was defined by sphygmomanometry or antihypertensive medication use, and its association with cognitive decline was tested in random-effects models. At baseline, 638 (35.3%) participants had hypertension. They showed faster decline in memory (χ(2) test for homogeneity=35.75; df=2; P<0.001), executive functions (χ(2)=21.68; df=2; P<0.001), and information processing speed (χ(2)=81.96; df= 2; P<0.001) than baseline normotensive participants. At follow-up, 352 individuals (30.2%) developed incident hypertension. They showed faster decline in memory (χ(2)=7.88; df=2; P=0.019) and information processing speed (χ(2)= 18.06; df=2; P<0.001), especially from 6- to 12-year follow-up. Effects were most pronounced and widespread in midlife for both prevalent and incident hypertension and in those with untreated and uncontrolled hypertension. This study shows that incident hypertension predicts cognitive decline in middle-aged individuals, and those with poorly controlled blood pressure are most at risk. In newly diagnosed individuals, decline evolves gradually, possibly opening a window for early intervention.
Collapse
Affiliation(s)
- Sebastian Köhler
- School for Mental Health and Neuroscience, Dr Tanslaan 10, PO Box 616 (DRT10), 6229 ET Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
28
|
Waldstein SR, Katzel LI. Gender differences in the relation of hypertension to cognitive function in older adults. Neurol Res 2013; 26:502-6. [PMID: 15265267 DOI: 10.1179/016164104225016173] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Here we examined potential interactive relations of hypertension and gender to cognitive function in 98 healthy, older adults (ages 55-83 years; 64% male; 92% White). After statistical adjustment for age and education, hypertensives performed significantly more poorly than normotensives on tests of motor speed and manual dexterity (p < 0.05). The adverse consequences of hypertension in older adults was more pronounced for female than male hypertensives on tests of delayed visual memory, visual attention and working memory, visuoconstructional ability, motor speed and manual dexterity for the non-dominant hand (p < 0.05); these are dimensions of performance for which female gender may be a relative disadvantage. The findings suggest the need to further examine subgroups that are vulnerable to the cognitive correlates of hypertension. The results also highlight the need for increased attention to blood pressure control in older adults for the preservation of cognitive function.
Collapse
Affiliation(s)
- Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore MD 21250, USA.
| | | |
Collapse
|
29
|
Abstract
OBJECTIVE To examine interactive relations of blood pressure (BP) and age to MRI indices of subclinical cerebrovascular disease in middle-aged to older adults. METHODS One hundred and thirteen stroke-free and dementia-free, community-dwelling adults (ages 54-81 years; 65% men; 91% white) engaged in (1) clinical assessment of resting SBP and DBP; (2) MRI rated for periventricular white matter hyperintensities (WMH) and deep WMH silent brain infarction (SBI) and brain atrophy (i.e. ventricular enlargement and sulcal widening ). Principal components analysis of the MRI ratings yielded a two-component solution--(1) periventricular and deep WMH SBI; and (2) ventricular enlargement, sulcal widening. RESULTS Relations of SBP, DBP and pulse pressure (PP) (and their interactions with age) to each MRI component were examined in multiple regression analyses adjusted for age, sex, fasting plasma glucose and cholesterol, and antihypertensives. For component 1, results indicated significant interactions of SBP and PP with age (P < 0.05); higher levels of SBP and PP were associated with greater white matter disease and brain infarction at younger ages (≤ 68 years). Significant interactions of SBP and DBP with age were also noted for component 2 (P < 0.05); higher levels of BP were associated with greater brain atrophy at younger ages (≤ 63 years). CONCLUSION : Higher BP and PP are associated with greater subclinical cerebrovascular disease most prominently in the 'young old'. Appropriate management of hypertension and arterial stiffening may be critical to the preservation of brain structure with ageing.
Collapse
|
30
|
Kupferman JC, Lande MB, Adams HR, Pavlakis SG. Primary hypertension and neurocognitive and executive functioning in school-age children. Pediatr Nephrol 2013; 28:401-8. [PMID: 22692504 PMCID: PMC3666570 DOI: 10.1007/s00467-012-2215-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
Data on neurocognitive function in hypertensive children are limited. In this review, we summarize recent preliminary, early studies that suggest that children with elevated blood pressure demonstrate evidence of worse performance on direct neurocognitive testing, as well as evidence of executive dysfunction based on parent ratings, compared with matched normotensive comparison groups. Furthermore, hypertensive children may have increased prevalence of learning disabilities as well as a blunted cerebrovascular reactivity compared with normotensive controls. Larger, prospective studies are needed to confirm and further explore these emerging but preliminary findings.
Collapse
Affiliation(s)
- Juan C. Kupferman
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY
| | - Marc B. Lande
- Division of Pediatric Nephrology, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, NY
| | - Heather R. Adams
- Division of Child Neurology, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, NY
| | | |
Collapse
|
31
|
Persson N, Viitanen M, Almkvist O, Wahlin Å. A principal component model of medical health: implications for cognitive deficits and decline among adults in a population-based sample. J Health Psychol 2012. [PMID: 23180878 DOI: 10.1177/1359105312459877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Longitudinal blood- and cognitive data from 879 adults were analyzed to extract a multidimensional health structure for prediction of cognitive change. Six health components were identified and replicated at two waves. Following, cognitive outcomes were regressed on the health components. Large proportions of cognitive age related variations were accounted for by baseline health in both cross-sectional and prospective analyses. Less variation was accounted for when health change and cognitive change were contrasted. Cardiovascular health was particularly important for prediction of cognitive change. Our study underlines causal relations between health and cognitive functions, and suggests that some effects are long term.
Collapse
|
32
|
Elias MF, Goodell AL, Dore GA. Hypertension and cognitive functioning: a perspective in historical context. Hypertension 2012; 60:260-8. [PMID: 22753214 DOI: 10.1161/hypertensionaha.111.186429] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Merrill F Elias
- Department of Psychology, University of Maine, 5714 Little Hall, Orono, ME 04469-5742, USA.
| | | | | |
Collapse
|
33
|
Lande MB, Kupferman JC, Adams HR. Neurocognitive alterations in hypertensive children and adolescents. J Clin Hypertens (Greenwich) 2012; 14:353-9. [PMID: 22672088 DOI: 10.1111/j.1751-7176.2012.00661.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertensive adults demonstrate performance deficits on neuropsychological testing compared with scores of normotensive controls. This article reviews emerging preliminary evidence that children with hypertension also manifest neurocognitive differences when compared with normotensive controls. Database and single-center studies suggest that children with hypertension manifest deficits on measures of neurocognition and have an increased prevalence of learning difficulties and that children with hypertension associated with obesity may be at increased risk for depression and anxiety. Studies suggesting blunted cerebrovascular reactivity in children with hypertension are also reviewed.
Collapse
Affiliation(s)
- Marc B Lande
- Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | | | | |
Collapse
|
34
|
Ginty AT, Phillips AC, Roseboom TJ, Carroll D, Derooij SR. Cardiovascular and cortisol reactions to acute psychological stress and cognitive ability in the Dutch Famine Birth Cohort Study. Psychophysiology 2011; 49:391-400. [PMID: 22091868 DOI: 10.1111/j.1469-8986.2011.01316.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 09/19/2011] [Indexed: 11/27/2022]
Abstract
Given evidence linking blunted cardiovascular and cortisol reactions to acute stress and a range of adverse behavioral outcomes, the present study examined the associations between cardiovascular and cortisol reactivity and cognitive ability measured independently of the stress task exposure. Cognitive ability was assessed using the Alice Heim-4 test of general intelligence and two memory tasks in 724 men and women who were part of the Dutch Famine Birth Cohort Study. Blood pressure and heart rate, as well as cortisol reactivity, were measured to a battery of three standard acute stress tasks. Poorer cognitive ability was associated with lower cardiovascular reactions to stress and lower cortisol area under the curve. Our results are consistent with recent findings implicating low physiological stress reactivity in a range of adverse behavioral and health outcomes.
Collapse
Affiliation(s)
- Annie T Ginty
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | | |
Collapse
|
35
|
Lande MB, Adams H, Falkner B, Waldstein SR, Schwartz GJ, Szilagyi PG, Wang H, Palumbo D. Parental assessment of executive function and internalizing and externalizing behavior in primary hypertension after anti-hypertensive therapy. J Pediatr 2010; 157:114-9. [PMID: 20227722 PMCID: PMC2904985 DOI: 10.1016/j.jpeds.2009.12.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/12/2009] [Accepted: 12/30/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the change in parental ratings of executive function and behavior in children with primary hypertension after anti-hypertensive therapy. STUDY DESIGN Parents of subjects with untreated hypertension and control subjects completed the Behavior Rating Inventory of Executive Function (BRIEF) to assess behavioral correlates of executive function and the Child Behavior Checklist (CBCL) to assess internalizing and externalizing behaviors. Subjects with hypertension subsequently received anti-hypertensive therapy to achieve casual blood pressure (BP)<95th percentile. After 12 months, all parents again completed the BRIEF and CBCL. RESULTS Twenty-two subjects with hypertension and 25 normotensive control subjects underwent both baseline and 12-month assessments. The BP of subjects with hypertension improved (24-hour systolic BP [SBP] load: mean baseline versus 12-months, 60% versus 25%, P<.001). Parent ratings of executive function improved from baseline to 12 months in the subjects with hypertension (BRIEF Global Executive Composite T-score, Delta=-5.9, P=0.001), but not in the normotensive control subjects (Delta=-0.36, P=.83). In contrast, T-scores on the CBCL Internalizing and Externalizing summary scales did not change significantly from baseline to 12 months in either subjects with hypertension or control subjects. CONCLUSIONS Children with hypertension demonstrated improvement in parental ratings of executive function after 12 months of anti-hypertensive therapy.
Collapse
Affiliation(s)
- Marc B. Lande
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Heather Adams
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Bonita Falkner
- Department of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA
| | - Shari R. Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - George J. Schwartz
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Peter G. Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Donna Palumbo
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| |
Collapse
|
36
|
Bucur B, Madden DJ. Effects of adult age and blood pressure on executive function and speed of processing. Exp Aging Res 2010; 36:153-68. [PMID: 20209419 DOI: 10.1080/03610731003613482] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Previous research has established that the effects of chronically increased blood pressure (BP) on cognition interact with adult age, but the relevant cognitive processes are not well defined. In this cross-sectional study, using a sample matched for age, years of education, and sex, 134 individuals with either normal BP (n = 71) or chronically high BP (n = 63) were categorized into younger (19-39 years), middle-aged (41-58 years), and older (60-79 years) groups. Using a between-subjects analysis of variance (ANOVA), covarying for race and years of education, composite measures of executive function and perceptual speed both exhibited age-related decline. The executive function measure, however, was associated with a differential decline in high BP older adults. This result held even when the executive function scores were covaried for speed, demonstrating an independent, age-related effect of higher BP on executive function.
Collapse
Affiliation(s)
- Barbara Bucur
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA.
| | | |
Collapse
|
37
|
Elias MF, Dore GA, Davey A, Robbins MA, Elias PK. From Blood Pressure to Physical Disability. Hypertension 2010; 55:1360-5. [DOI: 10.1161/hypertensionaha.110.149823] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Merrill F. Elias
- From the Department of Psychology (M.F.E., G.A.D., M.A.R., P.K.E.) and the Graduate School of Biomedical Sciences (M.F.E., M.A.R.), University of Maine, Orono, Maine; Department of Public Health (A.D.), Temple University, Philadelphia, Pa
| | - Gregory A. Dore
- From the Department of Psychology (M.F.E., G.A.D., M.A.R., P.K.E.) and the Graduate School of Biomedical Sciences (M.F.E., M.A.R.), University of Maine, Orono, Maine; Department of Public Health (A.D.), Temple University, Philadelphia, Pa
| | - Adam Davey
- From the Department of Psychology (M.F.E., G.A.D., M.A.R., P.K.E.) and the Graduate School of Biomedical Sciences (M.F.E., M.A.R.), University of Maine, Orono, Maine; Department of Public Health (A.D.), Temple University, Philadelphia, Pa
| | - Michael A. Robbins
- From the Department of Psychology (M.F.E., G.A.D., M.A.R., P.K.E.) and the Graduate School of Biomedical Sciences (M.F.E., M.A.R.), University of Maine, Orono, Maine; Department of Public Health (A.D.), Temple University, Philadelphia, Pa
| | - Penelope K. Elias
- From the Department of Psychology (M.F.E., G.A.D., M.A.R., P.K.E.) and the Graduate School of Biomedical Sciences (M.F.E., M.A.R.), University of Maine, Orono, Maine; Department of Public Health (A.D.), Temple University, Philadelphia, Pa
| |
Collapse
|
38
|
Aiken Morgan AT, Sims RC, Whitfield KE. Cardiovascular Health and Education as Sources of Individual Variability in Cognitive Aging Among African Americans. J Aging Health 2010; 22:477-503. [DOI: 10.1177/0898264310361627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To examine the interrelated effects of cardiovascular health, education, and cognitive functioning in African Americans. Method: The present study utilized data from the Baltimore Study of Black Aging to examine whether (a) cardiovascular health and educational attainment predicted cognitive functioning, after controlling for age, and (b) there was an interaction between cardiovascular health and education in predicting cognitive functioning. Results: Using hierarchical regression analyses, results showed education was significant for all cognitive measures; however, cardiovascular health was significant for only three. Discussion: These findings suggest that although self-reported cardiovascular health contributes to variability in late life cognition in African Americans, education is a more universal predictor that should be further examined.
Collapse
|
39
|
Edwards L, Ring C, Mcintyre D, Martin U, Winer JB. Effects of essential hypertension on short latency human somatosensory-evoked potentials. Psychophysiology 2010; 47:323-31. [DOI: 10.1111/j.1469-8986.2009.00939.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Brown JP, Sollers JJ, Thayer JF, Zonderman AB, Waldstein SR. Blood pressure reactivity and cognitive function in the Baltimore Longitudinal Study of Aging. Health Psychol 2009; 28:641-6. [PMID: 19751091 DOI: 10.1037/a0015215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Several blood pressure indexes of autonomic dysregulation, including stress-induced blood pressure responses (i.e., reactivity), have been associated previously with stroke, silent cerebrovascular disease, and decreased cognitive function. DESIGN The authors examined the cross-sectional relations among systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity and cognitive function in a sample of stroke- and dementia-free older adults (n = 73, 53% male, 72% Caucasian, mean age = 70.14 years) from the Baltimore Longitudinal Study of Aging. MAIN OUTCOME MEASURES Age, education, baseline, and reactive blood pressure levels were regressed on cognitive test scores measuring the domains of attention, learning and memory, verbal functions/language skills, and perceptuo-motor speed. A Bonferroni correction was employed and results significant at the standard p < .05 level are discussed as marginally significant. RESULTS After adjustment for age, education, and resting blood pressure, greater SBP reactivity was associated with poorer performance on Digits Forward (R2 = .110, p = .007) and greater DBP reactivity was associated with poorer performance on Digits Forward (R(2) = .124, p = .003) and the Boston Naming Test (R(2) = .118, p = .008); associations with DBP reactivity and Alpha Span (R(2) = .104; p = .019) and CVLT free recall short delay (R(2) = .066, p = .032) were marginally significant. CONCLUSIONS Greater BP reactivity was associated with poorer performance on tests of attention, verbal memory, and confrontation naming. BP reactivity may be a biobehavioral risk factor for lowered levels of cognitive performance.
Collapse
Affiliation(s)
- Jessica P Brown
- Department of Epidemiology & Preventive Medicine, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | | | | | | | | |
Collapse
|
41
|
Fischer AL, de Frias CM, Yeung SE, Dixon RA. Short-term longitudinal trends in cognitive performance in older adults with type 2 diabetes. J Clin Exp Neuropsychol 2009; 31:809-22. [PMID: 19142776 PMCID: PMC2829098 DOI: 10.1080/13803390802537636] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes is associated with cognitive deficits, although inconsistently across neuropsychological domains. We examined 3-year longitudinal data from the Victoria Longitudinal Study, comparing diabetes (n = 28) and control (n = 272) older adults on a comprehensive neuropsychological battery. Assessing potential change and stability, we found that (a) baseline diabetes group deficits in semantic speed and speed-intensive executive function were preserved, (b) new average deficits for reaction time and nonspeeded executive function appeared, and (c) no differential short-term change was observed. It is clinically and theoretically important to examine sequential change in multiple domains over time.
Collapse
Affiliation(s)
- Ashley L. Fischer
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Cindy M. de Frias
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Sophie E. Yeung
- Department of Psychology, Simon Fraser University, Burnaby, BC Canada
| | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
42
|
Yeung SE, Fischer AL, Dixon RA. Exploring effects of type 2 diabetes on cognitive functioning in older adults. Neuropsychology 2009; 23:1-9. [PMID: 19210028 DOI: 10.1037/a0013849] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Type 2 diabetes may be associated with exacerbated aging-related declines in cognitive neuropsychological performance. The authors examined whether such effects are systematic (i.e., broadly distributed across domains or domain-specific) or moderated by age (i.e., varying across age within older adults). The authors assembled recent cross-sectional data from the Victoria Longitudinal Study (VLS) Sample 3 (Wave 1; initial n = 570; initial age = 53-90 years). Using a comprehensive, multidimensional spectrum of cognitive neuropsychological tests, the authors examined performance differences by diabetes status (diabetes group vs. healthy controls) and age (young-old vs. old-old). Our results showed that healthy controls significantly outperformed the diabetes group only on markers of executive functioning and speed. Notably, the diabetes-related effects were robust across the two late-life age groups. Future research examining longitudinal changes is recommended.
Collapse
|
43
|
Elias MF, Robbins MA, Budge MM, Abhayaratna WP, Dore GA, Elias PK. Arterial pulse wave velocity and cognition with advancing age. Hypertension 2009; 53:668-73. [PMID: 19237680 DOI: 10.1161/hypertensionaha.108.126342] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We hypothesized that carotid-femoral pulse wave velocity (PWV), a marker of arterial stiffness, interacts with age such that the magnitude of associations between PWV and cognitive performance are greater with increasing age and that this interaction is observed despite adjustments for demographic variables, mean arterial pressure, and cardiovascular risk factors. PWV was estimated using applanation tonometry in 409 dementia- and stroke-free participants of the Maine-Syracuse Longitudinal Study (24 to 92 years of age; 62.3% women). Using linear regression analyses in a cross-sectional design, associations between PWV and age and the interaction of PWV and age were examined in relation to a global composite score, the Wechsler Adult Intelligence Scale Similarities test (abstract reasoning), and 4 cognitive domains indexed by multiple cognitive measures. Adjusting for age, gender, education, height, weight, heart rate, mean arterial pressure, and antihypertensive treatment, PWV-by-age interactions were obtained for the global, visual-spatial organization and memory, scanning and tracking, and verbal episodic memory composites, as well as similarities. The combination of higher PWV and age resulted in progressively lower cognitive performance. This finding was the same with an extended model, which also included adjustment for cardiovascular risk factors and other confounds. PWV interacts with age in a multiplicative way to exert a negative influence on cognitive performance level. Early interventions to prevent an increase in arterial stiffness could possibly play an important role in the preservation of cognitive ability.
Collapse
Affiliation(s)
- Merrill F Elias
- Department of Psychology and Graduate School of Biomedical Sciences, 5472 Little Hall, University of Maine, Orono, ME 04469, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Insel KC, Reminger SL, Hsiao CP. White matter hyperintensities and medication adherence. Biol Res Nurs 2008; 10:121-7. [PMID: 18829595 DOI: 10.1177/1099800408322216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
White matter hyperintensities (WMH) are associated with hypertension, age, and cognitive function, but the association between WMH and medication adherence has not been examined. The intent of this investigation was to consider the potential implications of hypertension-related brain morphological changes on medication adherence and thereby improve understanding of the self-management consequences of hypertension. The associations between WMH, blood pressure, age, cognitive function (specifically assessments of prefrontal function), and medication adherence were examined in 16 middle-aged and older adults self-managing at least one prescribed antihypertensive agent. Magnetic resonance imaging using an axial fluid attenuated inversion recovery (FLAIR) sequence was used to assess the presence of WMH. Cognitive assessments included measures of executive function, working memory, attention, and immediate recall. Adherence was monitored for 8 weeks using electronic medication monitoring. More WMH were associated with poorer adherence (rs = -.25) and with higher systolic blood pressure (rs = .46), although these relationships were not statistically significant. WMH were associated with cognitive assessments in the expected direction including Digit Span Backward (rs = -.53, p < .05). Adherence was associated with immediate memory (rs = .54, p < .05) and inversely associated with failure to maintain set on the Wisconsin Card Sorting Test (WCST; rs = -.61, p < .05). These findings provide preliminary evidence for the association between WMH, assessments of prefrontal function, and medication adherence.
Collapse
Affiliation(s)
- Kathleen C Insel
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA.
| | | | | |
Collapse
|
45
|
Sims RC, Madhere S, Gordon S, Clark E, Abayomi KA, Callender CO, Campbell AL. Relationships among blood pressure, triglycerides and verbal learning in African Americans. J Natl Med Assoc 2008; 100:1193-8. [PMID: 18942281 DOI: 10.1016/s0027-9684(15)31474-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals at greater risk for cardiovascular disease (CVD) display poorer cognitive functioning across various cognitive domains. This finding is particularly prevalent among older adults; however, few studies examine these relationships among younger adults or among African Americans. PURPOSE The objective was to examine the relationships among 2 cardiovascular risk factors, elevated blood pressure and elevated triglycerides, and verbal learning in a community-based sample of African Americans. METHODS Measurements of blood pressure and triglycerides were obtained in 121 African-American adults and compared to performance on 3 domains of the California Verbal Learning Test-II (CVLT-II). RESULTS Blood pressure was not related to CVLT-II performance. Triglyceride levels were inversely related to CVLT-II performance. Higher triglyceride levels were associated with poorer immediate, short delay and long delay recall. CONCLUSIONS Consistent with studies involving older participants, the current investigation shows that in a nonelderly sample of African Americans, triglyceride levels may be related to cognitive functioning. Because early detection and intervention of vascular-related cognitive impairment may have a salutary effect, future studies should include younger adults to highlight the impact of cardiovascular risk on cognition.
Collapse
Affiliation(s)
- Regina C Sims
- Center for the Study of Aging and Human Development, Department of Psychology and Neuroscience, Duke University Medical Center, Durham, NC 27706, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
Cercy SP, Wankmuller MM. Cognitive dysfunction associated with elemental mercury ingestion and inhalation: a case study. ACTA ACUST UNITED AC 2008; 15:79-91. [PMID: 18443944 DOI: 10.1080/09084280801917889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A 63-year-old man with a history of alcohol dependence ingested elemental mercury as a suicide gesture. Serial abdominal X-rays showed gradual but incomplete clearance of mercury from the colon. Routine chest X-ray showed evidence of punctate radiopaque materials in the lower lobe of the right lung. Blood and urine mercury levels both exceeded thresholds considered to be associated with cognitive dysfunction. Elicited cognitive deficits were most prominent in processing speed, flexibility, and response inhibition. Semantic fluency, visuospatial processing, and recall memory for visual and low-context verbal material were also affected. The deficits may have been attributable primarily to alcohol abuse. Elemental mercury is not readily absorbed from the gastrointestinal tract; however, mercury vapor, which was inhaled inadvertently, readily crosses the blood-brain barrier and is neurotoxic. We argue, therefore, that mercury toxicity is more likely than not to have been a factor contributing to the patient's cognitive dysfunction.
Collapse
Affiliation(s)
- Steven P Cercy
- Mental Health Service, Veterans Affairs New York Harbor Healthcare System, New York Campus, USA
| | | |
Collapse
|
47
|
Morgan AA, Marsiske M, Whitfield KE. Characterizing and explaining differences in cognitive test performance between african american and European American older adults. Exp Aging Res 2008; 34:80-100. [PMID: 18189169 PMCID: PMC2211729 DOI: 10.1080/03610730701776427] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study examined differences in cognitive performance of African American and European American older adults on cognitive and intellectual measures, and the extent to which literacy status or reading level was useful in explaining these group differences. African American elders performed more poorly than European American elders on 12 of 13 cognitive tests administered, p < .05. After controlling for reading level achievement, differences in performance became nonsignificant for 5 of these 12 tests. Nonetheless, some differences persisted, suggesting that other potential mediators of race differences remain to be explored in future research.
Collapse
Affiliation(s)
- Adrienne Aiken Morgan
- Department of Clinical and Health Psychology, University of Florida, Gainsville, Florida 32610-0165, USA
| | | | | |
Collapse
|
48
|
Insel KC, Palmer RF, Stroup-Benham CA, Markides KS, Espino DV. Association Between Change in Systolic Blood Pressure and Cognitive Decline Among Elderly Mexican Americans: Data from the Hispanic Established Population for Epidemiology Study of the Elderly. Exp Aging Res 2006; 31:35-54. [PMID: 15842072 DOI: 10.1080/03610730590882837] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The longitudinal association between the rate of change in blood pressure and cognitive decline was examined in an area probability sample from a population-based survey of elderly Mexican Americans, 65 years of age or older obtained in 1993--1994, 1995--1996, 1998--1999, and 2000--2001 (n = 2859). The sample was divided into two groups at baseline: hypertensives had a systolic blood pressure (SBP) > or = 140 mm Hg, a diastolic blood pressure (DBP) > or = 90 mm Hg, or indicated a prior diagnosis of hypertension, and the normotensive group. Cognition was indexed by the Mini-Mental State Examination (MMSE). Neither SBP nor DBP at baseline predicted cognitive decline. However, the mean slope for SBP in the normotensive group showed an increase of 4.55mm Hg (increase from Time 1 to Time 2 was 123mm Hg to 132 mm Hg) and was significant in a regression model predicting cognitive decline even after adjusting for covariates. These findings suggest an association between increasing SBP and cognitive decline for normotensive elderly in this study population.
Collapse
Affiliation(s)
- Kathleen C Insel
- University of Arizona, College of Nursing, Tuscon, AZ 85721-0203, USA.
| | | | | | | | | |
Collapse
|
49
|
Ditto B, Séguin JR, Tremblay RE. Neuropsychological characteristics of adolescent boys differing in risk for high blood pressure. Ann Behav Med 2006; 31:231-7. [PMID: 16700636 DOI: 10.1207/s15324796abm3103_4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Individuals with established hypertension have been found to display deficits in a number of neuropsychological abilities. In general, these are probably due to structural changes in the brain produced by sustained high blood pressure. However, a potentially important line of research suggests that some of these deficits may extend to younger individuals with less severe elevations of blood pressure, perhaps even children, and thus be related more to risk for hypertension than hypertension per se. PURPOSE The objective was to examine the relationships between neuropsychological function and risk for hypertension in children. METHODS Measurements of blood pressure and parental history of hypertension were obtained in 88 French-Canadian 14-year-old boys and used to predict performance on a neuropsychological battery. RESULTS Boys at greater risk of hypertension by virtue of having a parental history of high blood pressure and normatively elevated systolic blood pressure had significantly lower scores on a verbal learning factor score compared to boys at lower risk. Boys with normatively elevated systolic blood pressure also had significantly lower scores on a spatial learning and memory factor score compared to boys with lower blood pressure. The results could not be attributed to differences in family socioeconomic status. CONCLUSIONS Using a younger sample than typically employed in the area, the results support previous suggestions that some of the neuropsychological characteristics displayed by hypertensive individuals may predate the development of clinically elevated blood pressure and could be associated with risk for the disorder.
Collapse
Affiliation(s)
- Blaine Ditto
- Department of Psychology, McGill University, Montreal, Québec H3A 1B1, Canada.
| | | | | |
Collapse
|
50
|
Robbins MA, Elias MF, Elias PK, Budge MM. Blood pressure and cognitive function in an African-American and a Caucasian-American sample: the Maine-Syracuse Study. Psychosom Med 2005; 67:707-14. [PMID: 16204428 DOI: 10.1097/01.psy.0000171164.50990.80] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary purpose of this study was to examine associations between indices of blood pressure (BP) and cognitive function for African-American participants in the Maine-Syracuse Longitudinal Study (MSLS). Corresponding data for the Caucasian-American MSLS participants were included to provide a basis for comparison. Interactions of age with BP indices were also assessed in relation to cognitive function. METHODS Data were drawn from the baseline MSLS questionnaires, medical interviews and examinations, Wechsler Adult Intelligence Scale subtests, and measurements of BP for 1563 participants, of whom 147 were African American. Multiple linear regression analyses were employed to examine the relationship between several BP predictors and cognitive outcomes with statistical adjustment for demographic, psychosocial, and cardiovascular risk factors. RESULTS Significant inverse associations between BP indices and cognitive performance were obtained for both racial cohorts but were generally of higher magnitude for the African-American cohort. Interactions of BP with age were not obtained for any of the cognitive test scores. CONCLUSIONS Elevations in BP are associated with poorer cognitive function for African-American and Caucasian-American cohorts. These associations are similar for younger and older participants.
Collapse
Affiliation(s)
- Michael A Robbins
- Department of Psychology, University of Maine, Orono, ME 04469-5742, USA.
| | | | | | | |
Collapse
|