Compromised arterial oxygen saturation in elderly asthma sufferers results in selective cognitive impairment

Associations between asthma and cognitive functioning among older adults. Does the age of asthma diagnosis matter? Results from the RAND IFLS-5 study

OBJECTIVE

To assess the associations of asthma status or age at asthma diagnosis with cognition using the Telephone Survey of Cognitive Status from a large population-based sample. Further, we investigated the possibility that asthma treatment mediates these associations.

METHODS

This is a cross-sectional study from the Indonesian Family Life Survey Fifth Wave (IFLS-5) collected in 2014-2015. A weighted linear regression model was used to examine the associations between asthma and cognitive functioning scores in adults aged 50 years or older. Of the 6660 total samples included in this study, 176 participants had asthma (2.6%). We controlled for age, sex, and urbanicity with further adjustments for adult covariates or childhood covariates, as appropriate.

RESULTS

There was no association between overall asthma status and cognitive functioning scores. However, asthma diagnosed at 0-19 years was associated with significantly higher cognitive functioning scores (Beta coefficient = 2.24, 95% CI: 0.62 - 0.87), compared to those without asthma. In the analysis involving current treatment status (restricted analysis), the significant association disappeared among those under current asthma treatment status, indicating that asthma treatment may mediate the association.

CONCLUSION

Asthma might not be a risk factor for cognitive impairment. Observations of a significant association of pediatric asthma with higher cognitive scores need further investigation. Understanding cognitive functioning among older adults with asthma may improve the surveillance of cognitive decline inthis age group.

Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway?

Airway inflammation in asthma has been well recognized for several decades, with general agreement on its role in asthma pathogenesis, symptoms, propensity toward exacerbation, and decline in lung function. This has led to universal recommendation in asthma management guidelines to incorporate the use of inhaled corticosteroid as an anti-inflammatory therapy for all patients with persistent asthma symptoms. However, there has been limited attention paid to the presence and potential impact of systemic inflammation in asthma. Accumulating evidence from epidemiological observations and cohort studies points to a host of downstream organ dysfunction in asthma especially among patients with longstanding or more severe disease, frequent exacerbations, and underlying risk factors for organ dysfunction. Most studies to date have focused on cognitive impairment, depression/anxiety, metabolic syndrome, and cardiovascular abnormalities. In this review, we summarize some of the evidence demonstrating these abnormalities and highlight the proposed mechanisms and potential benefits of treatment in limiting these extrapulmonary abnormalities in patients with asthma. The goal of this commentary is to raise awareness of the importance of recognizing potential extrapulmonary conditions associated with systemic inflammation of asthma. This area of treatment of patients with asthma is a large unmet need.

Cognitive Impairments in Patients with Bronchial Asthma

The course of bronchial asthma can be accompanied by cognitive impairments. However, the relationship between cognitive dysfunction and asthma has not been fully revealed, nor has it been fully established what causes cognitive impairments in patients with asthma. There is an opinion that transient hypoxia and persistent systemic inflammation with insufficient control of bronchial asthma can be accompanied by neurotoxicity in relation to the hippocampus and indirectly lead to deterioration of cognitive functions. Comorbid conditions, such as obesity, allergic rhinitis, and depressive states can increase cognitive dysfunction in asthmatics. The review considers the pathophysiology of cognitive dysfunction in patients with bronchial asthma, as well as the impact of comorbid conditions on the cognitive status. This information will allow systematizing the available knowledge about the state of cognitive functions in asthma for timely detection and correction of their impairments and, ultimately, optimization of the management of these patients.

COVID-19 and clinical neuropsychology: A review of neuropsychological literature on acute and chronic pulmonary disease

Objective: The illness resulting from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as COVID-19, has quickly escalated to a worldwide pandemic. Although understanding of the short and long-term manifestations of COVID-19 remains incomplete, there is a preponderance of respiratory pathology in COVID-19 and potential for chronic loss of pulmonary function in recovered patients, raising concerns for associated cognitive impacts.Method: We conducted a narrative review of the existing literature on neuropsychological variables in acute/severe respiratory disease and various forms of chronic pulmonary disease to inform expectations about potential cognitive manifestations of COVID-19.Results: Cognitive dysfunction is common but not inevitable in acute and chronic pulmonary disease, although unique predictors and symptom trajectories appear to be associated with each.Conclusions: Although the full scope of neuropathophysiology associated with COVID-19 remains to be established, pulmonary insults associated with the disease are likely to produce cognitive dysfunction in a substantial percentage of patients.

Association between cognitive function and asthma in adults

BACKGROUND

Cognitive deficits are associated with asthma globally; however, the association between cognitive function and asthma has not been fully elucidated.

OBJECTIVE

To assess the relationship between asthma and cognitive function.

METHODS

A total of 202 patients with asthma aged older than 18 years were analyzed retrospectively from August 2019 to February 2020. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) test. We compared the associations of clinical parameters with cognitive function (MoCA, ≥23 vs <23) and lung function (forced expiratory volume in 1 second [FEV1], ≥70% vs <70%).

RESULTS

Of the total participants, 89 (44.1%) indicated cognitive impairment, of whom 23.1% were aged less than 65 years and 72.9% were aged 65 years or older. MoCA scores were significantly different according to age (24.91 ± 3.89 for ages <65 years vs 19.11 ± 5.11 for ages ≥65 years, P < .001) and lung function (23.29 ± 5.17 for FEV1 ≥70% vs 21.23 ± 5.21 for FEV1 <70%, P = .006), but not according to asthma control (22.35 ± 5.38 for nonsevere asthma vs 22.88 ± 4.91 for severe asthma, P = .55). Age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.014-1.13; P = .01), educational status (OR, 6.068; CI, 2.175-16.927; P = .001), and asthma duration (OR, 1.007; CI, 1.001-1.013; P = .02) were significantly associated with cognitive impairment.

CONCLUSION

Cognitive impairment was largely observed in adults (44.1%) with asthma and was more prevalent in older adults than in younger adults. Longer asthma duration and lower lung function were more associated with cognitive dysfunction.

Chronic Respiratory Disease and Cognitive Impairment in Older Mexican Adults

Background

Cognitive impairment has emerged as an important concern in clinical practice in aging population. Several comorbid factors contribute to etiopathogenesis; one disease of interest is chronic respiratory disease.

Aim

The aim of this study is to investigate the association of chronic respiratory disease with risk of cognitive impairment in older Mexicans.

Materials and Methods

Data were obtained from 2782 Mexicans, aged ≥60 years, enrolled in waves I (2001) and III (2012) of the Mexican Health and Aging Study, a prospective cohort of nationally representative sample of older Mexicans. Participants' self-reported responses were used to categorize them into having respiratory disease or not. Study outcome included participants categorized into "cognitively impaired" or "cognitively normal" groups. Multivariable logistic regression models were used to investigate the relationship.

Results

Overall, 16% of cohort participants reported cognitively impaired at Wave III. Compared with older Mexicans without chronic respiratory disease diagnosis, those diagnosed were not significantly associated with risk of cognitive impairment [adjusted odds ratio (OR): 0.94, 95% confidence interval (CI): 0.58-1.58].

Conclusion

Chronic respiratory disease is not significantly associated with risk of cognitive impairment in older Mexican adults.

Effects of Cardiorespiratory Exercise on Cognition in Older Women Exposed to Air Pollution

The aim was to analyze the effects of cardiorespiratory exercise and air pollution on cognition and cardiovascular markers in four groups of older women: the active/clean air group (AC), the active/polluted air group (AP), the sedentary/clean air group (SC), and the sedentary/polluted air group (SP). Active groups performed a training task based on progressive walking. Prior to and after the experiment, the following parameters were assessed: cognition, by Mini Mental State Examination (MMSE); maximum oxygen uptake (VO_2max), estimated by the Six-Minute Walk Test (6mWT); heart rate (HR); and oxygen saturation (SpO₂). There were significant differences (p < 0.05) between the AC and the SP in all the MMSE dimensions except “Registration”, and in all the physiological variables (VO_2max, SpO₂, HR). Aerobic exercise may be a protective factor against the effects that pollution have on cognition and on the mechanisms of oxygen transport.

Masters or pawns? Examining injury and chronic disease in male Masters Athletes and chess players compared to population norms from the Canadian Community Health Survey

Background

Identifying the optimal type and amount of activity for the maintenance of function in older adults has proved challenging. On the one hand, Masters Athletes have been proposed as the ideal model of successful aging but most of this research has focused on physical functioning. On the other hand, the importance of cognitive engagement has been emphasized, which may be more strongly related to activities such as playing chess. The current study aimed to compare physical health outcomes (i.e., prevalence of physical injury and chronic disease) among older athletes and chess players. Masters Athletes and chess players were recruited from track and field and chess competitions within the province of Ontario. In addition to these primary groups, moderately active and inactive older adults from Canadian Community Health Survey were also included for comparison.

Results

Masters Athletes had significantly higher rates of injury with the lowest rates of chronic disease, compared to all other activity groups. In contrast, chess players reported lower rates of injury compared to Masters Athletes as well as lower prevalence of chronic diseases compared to the moderately active and inactive groups. The normative groups reported the lowest rate of injury, but increased prevalence of chronic diseases compared to Masters Athletes and chess players.

Conclusions

Findings from this study indicate that both athletic and cognitive engagement may be positively related to the physical health of older adults, since Masters Athletes and chess players reported a lower prevalence of chronic disease. Importantly, the results expand our current understanding of health by providing evidence for physical health outcomes associated with an activity that is primarily associated with cognitive health.

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma

Background

Asthma is the most common potentially serious medical complication in pregnancy. The purpose of this study was to determine the association between maternal asthma and a spectrum of adverse neonatal and maternal outcomes.

Methods

Events during pregnancy and birth outcome were evaluated in 34 asthmatic as well as 1569 non-asthmatic pregnant women who were enrolled in a prospective cohort study undertaken at the antenatal clinics of Mobini Hospital in Iran. The women were interviewed and classified according to clinical severity and asthma control as per GINA guidelines. Information on asthma symptoms was collected by a questionnaire as well as by spirometry and physical examination. All subjects were followed until delivery, and postpartum charts were reviewed to assess neonatal and maternal outcomes. Eosinophil cells counts were obtained and total IgE was measured by ELISA. Results were assessed by multivariate logistic regression adjusting for maternal age and parity, and for birth outcomes, for gestational diabetes, and hypertension/pre-eclampsia.

Results

The well-known relationship between family history of asthma and asthma in pregnancy was again supported (p < 0.001). Women with asthma had more bleeding events 3 weeks or more before delivery (OR 3.30, 95% CI 1.41–7.26), more often placenta problems (OR 6.86, 95% CI 1.42–33.02), and gestational diabetes mellitus (OR 3.82, 95% CI 1.06–13.75). No significant differences between asthmatic and non-asthmatic mothers regarding duration of gestation, birthweight, low Apgar scores, or neonatal respiratory difficulties were found. Total IgE antibody levels and eosinophil counts did not differ by asthma control and severity.

Conclusions

Asthma in pregnancy poses some risk for pregnancy complications and adverse perinatal outcomes. Managing asthma effectively throughout pregnancy could benefit women and their babies and help to reduce the health burden associated with asthma during pregnancy.

Exploring the intersection of executive function and medication adherence in school-age children with asthma

Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma.

OBJECTIVE

The purpose of this study was to explore the relationship between executive function, asthma, and medication adherence among school-age children with asthma.

METHODS

Thirty-one children ages 7 to 11 years (M = 8.9 ± 1.51) and one of their parents were enrolled in this study. Parents reported on asthma control while children reported on asthma control, medication beliefs, medication adherence, and completed an executive function battery that assessed inhibition, updating, shifting and planning.

RESULTS

Compared to the reference sample, children in this study had significantly lower composite scores in inhibition, t (31) = -3.84, p =. 001, and shifting, t (30) = -3.73, p =. 001. Controlling for age and asthma control, hierarchical regression analyses revealed that shifting accounted for 16% of the variance in child-reported medication adherence.

CONCLUSIONS

This study revealed lowered executive functioning scores among school-age children with persistent asthma. Furthermore, it appears executive functioning and controller medication adherence are intertwined and warrant future exploration.

Comparing executive functions between patients with chronic asthma and healthy subjects

OBJECTIVE

Allergic diseases have different levels of prevalence all over the world. Among them, asthma is the most common chronic disease. Up to now, little attention has been paid to the impact of this chronic disease on people's executive functions. The present study aimed at comparing the executive functions in patients with chronic asthma and healthy subjects.

METHODS

The study population was patients with chronic asthma who were referred to Al-Zahra hospital in Isfahan Province and their visitors who were assigned as the control group. Thirty patients with chronic asthma and 30 patient visitors were enrolled in this study, and three software programs (Wisconsin, Stroop, and Continuous Performance Tests) were used.

RESULTS

The results of multivariate variance analysis showed that there is a significant difference between patients with chronic asthma and healthy subjects in terms of set shifting, inhibition, and attention performance.

CONCLUSIONS

This study revealed that the executive functions of patients with chronic asthma have significant defects.

Bidirectional Associations Between Self-Perceptions of Aging and Processing Speed Across 3 Years

Abstract. Background: Previous studies point to a potential relationship between self-perceptions of aging (SPA) and cognitive performance. However, most of these studies are limited by their experimental design. Previous longitudinal studies looked solely at memory as an outcome variable without examining the directionality of effects. The present study examines the direction of effects between two domains of SPA (personal growth and physical losses) and processing speed (PS). Methods: The sample consists of 8,198 participants of the German Ageing Survey (DEAS), aged between 40 and 93 years. A cross-lagged path model was estimated to examine directions of relationships across 3 years via chi-squared difference tests for each domain of SPA. Results: In the unconstrained models, the effect of SPA domain personal growth in 2008 on PS in 2011 and vice versa were marginally significant. For SPA domain physical losses, the effect of SPA on PS was significant, whereas the other direction of the effect did not reach significance. However, the cross-lagged paths of both domains of SPA on PS and vice versa could be set equal without a significant loss of model fit. The resulting associations indicate a significant bidirectional relationship between both domains of SPA and PS. Discussion and conclusion: This study provides initial evidence that SPA can influence trajectories of cognitive decline and vice versa. The results emphasize the detrimental and beneficial effects that stereotypes can have on individuals and add further evidence to the theory of stereotype embodiment.

Is asthma associated with cognitive impairments? A meta-analytic review

INTRODUCTION

Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators.

METHOD

Data on cognitive outcome measures and sociodemographic, illness-related, and study-related variables were extracted from studies reporting cognitive test performance in individuals with asthma compared to that in controls.

RESULTS

There was no evidence of publication bias. A random-effects model examining differences in task performance between 2017 individuals with asthma and 2131 healthy controls showed significant effects in the small to medium range. Cognitive deficits associated with asthma were global, with strongest effects on broader measures involving academic achievement and executive functioning, but with additional impact on processing speed, global intellect, attention, visuospatial functioning, language, learning, and memory. Severity of asthma was a key moderator, with greatest cognitive deficits associated with severe asthma. Cognitive burden was also greatest in asthma patients who were younger, males, from low socioeconomic backgrounds, and from racial/ethnic minorities. Effects were independent of type of population (child versus adult), type of study (norm-referenced versus control-referenced), or reported use of oral or inhaled corticosteroid medications.

CONCLUSIONS

There is cognitive burden associated with asthma, particularly among vulnerable groups with severe asthma. This could be due to increased risk of intermittent cerebral hypoxia in severe asthma. The clinical need to assess cognition in individuals with asthma is underscored.

Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD

COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression) and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety) in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes.

Prevalence of Cognitive Impairment in Recently Diagnosed Type 2 Diabetes Patients: Are Chronic Inflammatory Diseases Responsible for Cognitive Decline?

OBJECTIVE

To estimate the prevalence of cognitive impairment (CI) among patients recently diagnosed with type 2 diabetes (RDD) and to identify any relationships between CI and RDD comorbidities.

METHODS

One thousand seven hundred twelve patients with RDD participated in a cross-sectional study. The patients' sociodemographic and clinical data were registered.

RESULTS

The sample population had an average age of 51 ± 11 years, and 63.26% of the patients were female. CI was diagnosed in 38 patients (2.2%) and was more common among both females (2.8% vs. 1.3%, p = 0.063) and the elderly (0% at an age ≤ 30 years vs. 10.4% at an age > 70 years, p = 0.0001). Rheumatoid arthritis (present in 15.8% vs. absent in 2.1%) and asthma (13% vs. 2.1%) correlated significantly with CI based on the results of our logistic regression analysis.

CONCLUSION

Age, female gender, rheumatoid arthritis and asthma are risk factors for CI in the setting of RDD.

Asthma control and cognitive function in a cohort of elderly adults

OBJECTIVES

To determine whether poor asthma control is associated with cognitive impairment in a cohort of older, inner-city adults with asthma.

DESIGN

Prospective observational cohort study.

SETTING

Outpatient practices in New York City and Chicago.

PARTICIPANTS

Individuals aged 60 and older with a physician diagnosis of asthma and without chronic obstructive pulmonary disease or a smoking history of 10 pack-years or more (N = 452).

MEASUREMENTS

Cognitive assessments that included processing speed (pattern comparison, Trail-Making Test Part A), executive function (Trail-Making Test Part B), attention and working memory (letter number sequencing), immediate and delayed recall (Wechsler Memory Scale Story A), word fluency (animal naming), and global cognitive function (Mini-Mental State Examination) were administered. Asthma control was measured using the Asthma Control Questionnaire (ACQ) and airway obstruction using spirometry as the predicted forced expiratory volume at 1 second (FEV1) of less than 70%. Cognitive measures were modeled in linear and logistic regression models controlling for age, race, education, English proficiency, and income.

RESULTS

Participants had a mean age of 68; 41% had poor asthma control according to the ACQ, and 35% had FEV1 of less than 70%. Poor asthma control and FEV1 less than 70% were significantly associated with all measures of cognitive function in univariate analyses, although these associations lost their statistical significance after adjusting for age, education, English proficiency, and other covariates. The same pattern was observed when the outcomes were below-normal performance on the cognitive measures based on normative data.

CONCLUSION

Poor asthma control and airway obstruction are not associated with poor performance on various measures of cognitive function in older adults with asthma.

Associations between grades and physical activity and food choices

Purpose

– The purpose of this paper is to explore the relationship between television viewing time, physical activity level, food consumption patterns, and academic performance of adolescents in a large urban school district in the USA where health disparities are prevalent, particularly among minority residents.

Design/methodology/approach

– The 2010 Youth Risk Behavior Survey was used to analyze the relationship between academic grades and physical activity patterns and food consumption in a large urban school district serving over 77,000 students.

Findings

– Results indicated that students who self-reported grades of As and Bs had higher levels of physical activity and less screen time compared to students who reported grades of Ds and Fs. Further, as grades decreased the consumption of soda and fast food increased.

Originality/value

– Higher grades track significantly with improved physical activity and lower intake of soda and fast food. These findings provide additional support for the role of regular physical activity and its positive effect on academic performance.

Cognitive impairment and cardiovascular disease: so near, so far

In the spectrum of cognitive impairment, ranging from "pure" vascular dementia to Alzheimer's disease (AD), clinical interest has recently expanded from the brain to also include the vessels, shifting the pathophysiological focus from the leaves of synaptic dysfunction to the sap of cerebral microcirculation and the roots of cardiovascular function. From a diagnostic viewpoint, a thorough clinical evaluation of individuals presenting cognitive impairment might systematically include the assessment of the major cardiovascular rings of the chain linking regional perfusion to brain function: 1) lung (with assessment of asthma, chronic obstructive pulmonary disease, obstructive sleep apnea syndrome); 2) heart function (with clinical examination and echocardiography) and cardiovascular risk factors; 3) orthostatic hypotension (with medical history and measurement of heart rate and blood pressure in supine and upright positions); 4) aorta and large artery stiffness (with assessment of pulse wave velocity); 5) large cerebro-vascular vessel status (with neuroimaging techniques); 6) assessment of microcirculation (with cerebrovascular reactivity testing with transcranial Doppler sonography or MRI perfusion imaging); and 7) assessment of venous cerebral circulation. The apparent difference in approaches to "brain" and "vascular" environmental enrichment with physical, cognitive and sensorial training is conceptually identical to that of a constant gardener caring for an unhealthy tree, watering the leaves ("train the brain") or simply the roots ("mind the vessel"). The therapeutic difference probably consists in the amount and quality of water added to the tree, rather than by where one pours it, with either a top-down (leaves to roots) or bottom-up (roots to leaves) approach.

Relationship of subjective cognitive impairment and cognitive impairment no dementia to chronic disease and multimorbidity in a nation-wide twin study

We investigated the relation of subjective cognitive impairment (SCI) and cognitive impairment no dementia (CIND) to common chronic diseases of the elderly and multimorbidity, and assessed the contribution of genetic background and shared familial environment to these associations. Subjects were 11,379 dementia-free twin individuals aged ≥ 65 from the Swedish Twin Registry. SCI was defined as subjective complaint of cognitive change without objective cognitive impairment and CIND was defined according to current criteria. In unmatched, fully-adjusted regression models, mental, musculoskeletal, respiratory, and urological diseases were all significantly associated with increased odds ratios (ORs) of SCI and CIND. Circulatory and gastrointestinal diseases were related to SCI only, while endocrine diseases were associated with CIND. The adjusted ORs of multimorbidity were 2.1 [95% confidence intervals (95% CI): 1.8-2.3] for SCI and 1.5 for CIND (95% CI: 1.3-1.8). A dose-dependent relationship was observed between number of chronic diseases and ORs for SCI but not for CIND. In co-twin control analyses, the chronic diseases-SCI association was largely unchanged. On the other hand, the chronic diseases-CIND association was no longer statistically significant, except for cancer, where an increased OR was observed. In conclusion, chronic morbidity is associated with both SCI and CIND but disease profiles do not always overlap between the two cognitive syndromes. The association is stronger when diseases co-occur, especially for SCI. Genetic and early-life environmental factors may partially explain the association of CIND but not that of SCI with chronic diseases.

An examination of the mechanisms underlying the effects of physical activity on brain and cognition

Physical activity positively influences brain health and cognitive functioning in older adults. Several physiological and psychological mechanisms have been identified to underlie such a relationship. Cardiovascular fitness is accompanied with changes in mechanisms such as cerebral blood flow, neurotrophic factors, neurotransmitter systems and neural architecture that have themselves been associated with cognitive performance. Factors associated with exercise such as arousal, mood and self-perception of competence seem also to influence cognitive performance. Other explanation for the benefits of exercise in cognition, results from the fact that the performance of motor skills involve an important cognitive component (e.g., executive functions and information processing speed). Evidence of brain plasticity and behavior has been provided from studies where animals are exposed to enriched or complex environments. Exposure to such paradigms in which physical activity plays an important role has been found to influence various aspects of brain function and structure. Studies using neuroimaging techniques have established a link between the acquisition of different motor skills and the occurrence of neuroplasticity in human adults. This literature review indicates that the type of exercise and its specific perceptual and cognitive characteristics may influence cognitive performance. However, most of the research has been focused on self-paced movements or automatized skills and few intervention studies have examined the results of merging exercise and cognitive training in a single program. An important scientific challenge for the coming years is to design exercise programs capable of mobilizing several type of mechanisms underlying the effects of physical activity on brain and cognition.

Asthma prevalence among US elderly by age groups: age still matters

OBJECTIVE

For over three decades, the greatest burden of asthma deaths has occurred among persons aged 65 years and older. This study analyzed the association between increasing age and asthma prevalence among age groups within the US elderly population.

METHODS

We analyzed aggregated data on 54,485 civilian, noninstitutionalized US adults aged 65 years and older from the 2001-2010 National Health Interview Survey (NHIS). We estimated the prevalence of current asthma, lifetime asthma, and chronic obstructive pulmonary disease (COPD) among US elderly by 5-year age groups and age stages ("young elderly" aged 65-84 years and "oldest old" aged ≥85 years). We calculated adjusted odds ratios (AOR) and 95% confidence intervals (CI) to identify asthma prevalence patterns among elderly populations.

RESULTS

From 2001 to 2010, the estimated average annual prevalence of current asthma among US elderly was 7.0%. Estimates of lifetime asthma, COPD, and co-occurring current asthma and COPD were 9.9%, 9.7%, and 3.0%, respectively. Prevalence of asthma decreased with advancing age while prevalence of COPD increased with advancing age. When controlling for study variables and significant interactions (p = .05) with COPD, the odds of reporting current asthma decreased with advancing age: 0.87 (95% CI, 0.76-1.01) for 70- to 74-year-olds; 0.76 (95% CI, 0.66-0.87) for 75- to 79-year-olds; 0.62 (95% CI, 0.51-0.75) for 80- to 84-year-olds; and 0.45 (95% CI, 0.36-0.55) for ≥85-year-olds, as compared to 65- to 69-year-olds.

CONCLUSIONS

Asthma continues to affect a substantial proportion of the US elderly population. Increased diagnosis of COPD may overshadow correct diagnosis and treatment in populations with advancing age. Treatment guidelines should focus on preventable risk behaviors to increase the quality of life within this population.

Cognitive impairment in common, noncentral nervous system medical conditions of adults and the elderly

Common, noncentral nervous system medical conditions linked with cognitive impairment in adults and the elderly include: acute respiratory distress syndrome; cancer; chronic kidney disease; chronic obstructive pulmonary disease; coronary heart disease; hypertension; obesity (bariatric surgical candidates); obstructive sleep apnea; and type 2 diabetes. Cross-condition comparison of the nature and frequency of cognitive impairment is difficult as these conditions often coexist, and there exists no consensus as to the definition of cognitive impairment, nor the optimal number and type of neuropsychological tests required for evaluation. There is as yet no clear evidence for condition-specific profiles of cognitive impairment. Rather, a generalized profile consisting of subclinical levels of impairment in attention, processing speed, executive, and memory functions from bilateral frontal-subcortical ischemia fits across all conditions. This profile: occurs only in subgroups of patients; is inconsistently related to measures of illness severity; is unrelated to patient self-report or level of functional independence; is exacerbated by very high levels of emotional distress; and is reversible in some cases but can also progress to frank neurological disease (dementia) in others, especially the elderly, when multiple conditions coexist, and/or when medical condition severity progresses.

COPD and cognitive impairment: the role of hypoxemia and oxygen therapy

Background:

Several studies have shown an association between chronic obstructive pulmonary disease (COPD) and cognitive impairment. These studies have been limited by methodological issues such as diagnostic uncertainty, cross-sectional design, small sample size, or lack of appropriate referent group. This study aimed to elucidate the association between COPD and the risk of cognitive impairment compared to referent subjects without COPD. In patients with established COPD, we evaluated the impact of disease severity and impairment of respiratory physiology on cognitive impairment and the potential mitigating role of oxygen therapy.

Methods:

We used the Function, Living, Outcomes and Work (FLOW) cohort study of adults with COPD (n = 1202) and referent subjects matched by age, sex, and race (n = 302) to study the potential risk factors for cognitive impairment among subjects with COPD. Cognitive impairment was defined as a Mini-Mental State Exam score of <24 points. Disease severity was using Forced Expiratory Volume in one second (FEV₁); the validated COPD Severity Score; and the BMI (Body Mass Index), Obstruction, Dyspnea, Exercise Capacity (BODE) Index. Multivariable analysis was used to control for confounding by age, sex, race, educational attainment, and cigarette smoking.

Results:

COPD was associated with a substantive risk of cognitive impairment compared to referent subjects (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.043–6.64). Among COPD patients, none of the COPD severity measures were associated with the risk of cognitive impairment (P > 0.20 in all cases). Low baseline oxygen saturation was related to increased risk of cognitive impairment (OR for oxygen saturation ≤88% (OR 5.45; 95% CI 1.014–29.2; P = 0.048). Conversely, regular use of supplemental oxygen therapy decreased the risk for cognitive impairment (OR 0.14; 95% CI 0.07–0.27; P < 0.0001).

Conclusion:

COPD is a major risk factor for cognitive impairment. Among patients with COPD, hypoxemia is a major contributor and regular use of home oxygen is protective. Health care providers should consider screening their COPD patients for cognitive impairment.

Psychologic distress and maladaptive coping styles in patients with severe vs moderate asthma

BACKGROUND

Though several biologic factors have been suggested to play a role in the development and persistence of severe asthma, those associated with psychologic factors remain poorly understood. This study assessed levels of psychologic distress and a range of disease-relevant emotional and behavioral coping styles in patients with severe vs moderate asthma.

METHODS

Eighty-four patients (50% women, mean [M] age 46 years) with severe (n = 42) and moderate (n = 42) asthma were recruited. Severe asthma was defined according to American Thoracic Society criteria. Patients underwent demographic and medical history interviews and pulmonary function and allergy testing. Patients also completed questionnaires measuring asthma symptoms and the Millon Behavioral Medicine Diagnostic Inventory, which assesses psychologic distress and emotional/behavioral coping factors that influence disease progression and treatment.

RESULTS

After adjustment for covariates and applying a correction factor that reduced the significant P level to < .01, patients with severe vs moderate asthma reported experiencing more psychologic distress, including worse cognitive dysfunction (F = 6.72, P < .01) and marginally worse anxiety-tension (F = 4.02, P < .05). They also reported worse emotional coping (higher illness apprehension [F = 9.57, P < .01], pain sensitivity [F = 10.65, P < .01], future pessimism [F= 8.53, P < .01], and interventional fragility [F = 7.18, P < .01]), and marginally worse behavioral coping (more functional deficits [F = 5.48, P < .05] and problematic compliance [F = 4.32, P < .05]).

CONCLUSIONS

Patients with severe asthma have more psychologic distress and difficulty coping with their disease, both emotionally and behaviorally, relative to patients with moderate asthma. Future treatment studies should focus on helping patients with severe asthma manage distress and cope more effectively with their illness, which may improve outcomes in these high-risk patients.

Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced?

In this monograph, we ask whether various kinds of intellectual, physical, and social activities produce cognitive enrichment effects-that is, whether they improve cognitive performance at different points of the adult life span, with a particular emphasis on old age. We begin with a theoretical framework that emphasizes the potential of behavior to influence levels of cognitive functioning. According to this framework, the undeniable presence of age-related decline in cognition does not invalidate the view that behavior can enhance cognitive functioning. Instead, the course of normal aging shapes a zone of possible functioning, which reflects person-specific endowments and age-related constraints. Individuals influence whether they function in the higher or lower ranges of this zone by engaging in or refraining from beneficial intellectual, physical, and social activities. From this point of view, the potential for positive change, or plasticity, is maintained in adult cognition. It is an argument that is supported by newer research in neuroscience showing neural plasticity in various aspects of central nervous system functioning, neurochemistry, and architecture. This view of human potential contrasts with static conceptions of cognition in old age, according to which decline in abilities is fixed and individuals cannot slow its course. Furthermore, any understanding of cognition as it occurs in everyday life must make a distinction between basic cognitive mechanisms and skills (such as working-memory capacity) and the functional use of cognition to achieve goals in specific situations. In practice, knowledge and expertise are critical for effective functioning, and the available evidence suggests that older adults effectively employ specific knowledge and expertise and can gain new knowledge when it is required. We conclude that, on balance, the available evidence favors the hypothesis that maintaining an intellectually engaged and physically active lifestyle promotes successful cognitive aging. First, cognitive-training studies have demonstrated that older adults can improve cognitive functioning when provided with intensive training in strategies that promote thinking and remembering. The early training literature suggested little transfer of function from specifically trained skills to new cognitive tasks; learning was highly specific to the cognitive processes targeted by training. Recently, however, a new generation of studies suggests that providing structured experience in situations demanding executive coordination of skills-such as complex video games, task-switching paradigms, and divided attention tasks-train strategic control over cognition that does show transfer to different task environments. These studies suggest that there is considerable reserve potential in older adults' cognition that can be enhanced through training. Second, a considerable number of studies indicate that maintaining a lifestyle that is intellectually stimulating predicts better maintenance of cognitive skills and is associated with a reduced risk of developing Alzheimer's disease in late life. Our review focuses on longitudinal evidence of a connection between an active lifestyle and enhanced cognition, because such evidence admits fewer rival explanations of observed effects (or lack of effects) than does cross-sectional evidence. The longitudinal evidence consistently shows that engaging in intellectually stimulating activities is associated with better cognitive functioning at later points in time. Other studies show that meaningful social engagement is also predictive of better maintenance of cognitive functioning in old age. These longitudinal findings are also open to important rival explanations, but overall, the available evidence suggests that activities can postpone decline, attenuate decline, or provide prosthetic benefit in the face of normative cognitive decline, while at the same time indicating that late-life cognitive changes can result in curtailment of activities. Given the complexity of the dynamic reciprocal relationships between stimulating activities and cognitive function in old age, additional research will be needed to address the extent to which observed effects validate a causal influence of an intellectually engaged lifestyle on cognition. Nevertheless, the hypothesis that an active lifestyle that requires cognitive effort has long-term benefits for older adults' cognition is at least consistent with the available data. Furthermore, new intervention research that involves multimodal interventions focusing on goal-directed action requiring cognition (such as reading to children) and social interaction will help to address whether an active lifestyle enhances cognitive function. Third, there is a parallel literature suggesting that physical activity, and aerobic exercise in particular, enhances older adults' cognitive function. Unlike the literature on an active lifestyle, there is already an impressive array of work with humans and animal populations showing that exercise interventions have substantial benefits for cognitive function, particularly for aspects of fluid intelligence and executive function. Recent neuroscience research on this topic indicates that exercise has substantial effects on brain morphology and function, representing a plausible brain substrate for the observed effects of aerobic exercise and other activities on cognition. Our review identifies a number of areas where additional research is needed to address critical questions. For example, there is considerable epidemiological evidence that stress and chronic psychological distress are negatively associated with changes in cognition. In contrast, less is known about how positive attributes, such as self-efficacy, a sense of control, and a sense of meaning in life, might contribute to preservation of cognitive function in old age. It is well known that certain personality characteristics such as conscientiousness predict adherence to an exercise regimen, but we do not know whether these attributes are also relevant to predicting maintenance of cognitive function or effective compensation for cognitive decline when it occurs. Likewise, more information is needed on the factors that encourage maintenance of an active lifestyle in old age in the face of elevated risk for physiological decline, mechanical wear and tear on the body, and incidence of diseases with disabling consequences, and whether efforts to maintain an active lifestyle are associated with successful aging, both in terms of cognitive function and psychological and emotional well-being. We also discuss briefly some interesting issues for society and public policy regarding cognitive-enrichment effects. For example, should efforts to enhance cognitive function be included as part of a general prevention model for enhancing health and vitality in old age? We also comment on the recent trend of business marketing interventions claimed to build brain power and prevent age-related cognitive decline, and the desirability of direct research evidence to back claims of effectiveness for specific products.

The importance of impaired physical health and age in normal cognitive aging

The objective of this study was to investigate the importance of impaired physical health and age in normal cognitive aging. In our cross-sectional, clinical and explorative study, medical and neuropsychological data from 118 voluntary healthy controls aged 26-91 years were collected from five recruitment occasions. Health was assessed according to a criterion reflecting clinical and subclinical severity. The examinations included a clinical investigation, brain neuroimaging, and a comprehensive neuropsychological assessment. Regression analyses showed a significant incidence of clinical and subclinical medical disorders that explained 10.8% of the variation in cognitive performance, while age-related impairment explained 5.6%. Findings of the central nervous system were important but various other medical findings explained about half of the health-related variation. Cognitively demanding tasks were more susceptible to impaired physical health while tasks comprising salient motor- and visual spatial elements were more prone to be impaired by age. Our findings suggest (1) that impaired physical health is more important than chronological age in accounting for cognitive impairment across the adult lifespan, (2) that age and health dissociate with regard to cognitive functions affected, and (3) that selection for so-called "super healthy" elderly people might be justified in cognitive research. Because the prevalent diseases in normal aging are potentially preventable, the present findings promise good prospect for prevention of future cognitive disability among elderly people.

[Correlates of change in cognitive function during a two-year follow-up period in a comprehensive health examination for the community-dwelling elderly for the prevention of geriatric syndromes and bed-ridden state]

PURPOSE

We explored correlates of change in cognitive function during a two-year follow-up period among the community-dwelling elderly in Japan, using a population-based prospective approach.

METHOD

The participants analyzed in the present study were 260 men and 222 women aged 70 to 84 years at baseline, living in an urban Japanese community. Data such as change in cognitive function during two years (calculated by subtracting baseline Mini-Mental State Examination [MMSE] score from follow-up MMSE score: a negative value means a decrease in MMSE scores during the two-year period) as an outcome variable, age, education, hearing and vision problems, IADL deficit (measured by the Tokyo Metropolitan Institute of Gerontology of Index of Competence), problems related to memory complaint, living alone, hemoglobin level, as explanatory variables, and the baseline MMSE score, depressive status (measured by the Mini-International Neuropsychiatric Interview), chronic conditions (hypertension, stroke, and diabetes mellitus) as covariates, were collected during a comprehensive health examination survey for the elderly.

RESULTS AND CONCLUSION

We conducted multivariate regression analysis by genders to explore correlates of change in cognitive function. The results showed that higher age (beta = -0.18), presence of hearing problem (beta = -0.21), presence of IADL deficit (beta = -0.15), and memory complaint (beta = -0.20) in men, and higher age (beta = -0.27), low education level (beta = -0.25) and lower hemoglobin level (beta = 0.16) in women, were significantly associated with change in cognitive function when adjusting for the potential confounders. These factors may be reliable predictors for cognitive decline.

The role of chronic hypoxia in the development of neurocognitive abnormalities in preterm infants with bronchopulmonary dysplasia

Bronchopulmonary dysplasia is the most common pulmonary morbidity in preterm infants and is associated with chronic hypoxia. Animal studies have demonstrated structural, neurochemical and functional alterations due to chronic hypoxia in the developing brain. Long-term impairments in visual-motor, gross and fine motor, articulation, reading, mathematics, spatial memory and attention skills are prevalent in survivors of bronchopulmonary dysplasia, and impairments appear to correlate with the severity of hypoxia. However, due to the simultaneous occurrence of multiple neurodevelopmental risk factors, a primary or potentiating role for chronic hypoxia in these impairments has yet to be conclusively established.

A meta-regression to examine the relationship between aerobic fitness and cognitive performance

Many studies have been conducted to test the potentially beneficial effects of physical activity on cognition. The results of meta-analytic reviews of this literature suggest that there is a positive association between participation in physical activity and cognitive performance. The design of past research demonstrates the tacit assumption that changes in aerobic fitness contribute to the changes in cognitive performance. Therefore, the purpose of this meta-analysis was to use meta-regression techniques to statistically test the relationship between aerobic fitness and cognitive performance. Results indicated that there was not a significant linear or curvilinear relationship between fitness effect sizes (ESs) and cognitive ESs for studies using cross-sectional designs or posttest comparisons. However, there was a significant negative relationship between aerobic fitness and cognitive performance for pre-post comparisons. The effects for the cross-sectional and pre-post comparisons were moderated by the age group of the participants; however, the nature of this effect was not consistent for the two databases. Based on the findings of this meta-analytic review, it is concluded that the empirical literature does not support the cardiovascular fitness hypothesis. To confirm the findings of this review, future research should specifically test the dose-response relationship between aerobic fitness and cognitive performance. However, based upon the findings of this review, we also encourage future research to focus on other physiological and psychological variables that may serve to mediate the relationship between physical activity and cognitive performance.