1
|
Abstract
Memory impairment occurs in over a third of patients after symptomatic stroke. Memory deficits rarely occur in isolation but are an important component of the poststroke cognitive syndrome because of the strong relationship with the risk of poststroke dementia. In this review, we summarize available data on impairment of episodic memory, with a particular emphasis on the natural history of memory impairment after stroke and the factors influencing trajectory informed by an updated systematic review. We next discuss the pathophysiology of memory impairment and mechanisms of both decline and recovery of function. We then turn to the practical issue of measurement of memory deficits after stroke, emerging biomarkers, and therapeutic approaches. Our review identifies critical gaps, particularly in studies of the natural history that properly map the long-term trajectory of memory and the associations with factors that modulate prognosis. Few studies have used advanced neuroimaging and this, in conjunction with other biomarker approaches, has the potential to provide a much richer understanding of the mechanisms at play and promising therapeutic avenues.
Collapse
Affiliation(s)
- Michael J O'Sullivan
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Australia (M.J.O.).,UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia (M.J.O., X.L., D.G.).,Department of Neurology, Royal Brisbane and Women's Hospital, QLD, Australia (M.J.O.)
| | - Xuqian Li
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia (M.J.O., X.L., D.G.)
| | - Dana Galligan
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia (M.J.O., X.L., D.G.)
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (S.T.P.).,Departments of Medicine and Geratology and UK National Institute for Health and Care Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, United Kingdom (S.T.P.)
| |
Collapse
|
2
|
Garner IW, Burgess AP, Holland CA. Developing and validating the Community-Oriented Frailty Index (COM-FI). Arch Gerontol Geriatr 2020; 91:104232. [PMID: 32827944 DOI: 10.1016/j.archger.2020.104232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Methods for measuring frailty over-emphasise physical health, and consensus for a more holistic approach is increasing. However, holistic tools have had mixed success in meeting the validation criteria required of a frailty index. We report on the further development and validation of a Frailty Tool designed for use in the community with a greater emphasis on psychological markers, Holland et al's Community-Oriented Frailty Index (COM-FI). METHOD A total of 351 participants aged 58-96 were recruited from Retirement Villages and local communities across the West Midlands of the UK. Participants completed a series of measures designed to assess frailty and outcomes associated with frailty over a 2-year period. RESULTS All three candidate items ('polypharmacy', 'exercise frequency', and the Coronary Heart Disease and Diabetes 'joint effect') were incorporated into the tool, and one variable, 'falls' was removed from the index. The revised COM-FI was shown to be valid and met Rockwood's validation criteria (Rockwood et al., 2006), with the exception that in this specific sample there was no significant gender difference and the index did not predict mortality. DISCUSSION Overall, the COM-FI is a valid and reliable tool, although the capacity for the COM-FI to predict mortality over a 2-year period remains inconclusive given the small numbers of people at the higher ends of the frailty range. Prediction of need for social care was good, showing the utility of this community based tool.
Collapse
Affiliation(s)
- Ian W Garner
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, B4 7ET, UK.
| | - Adrian P Burgess
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, B4 7ET, UK; Department of Psychology, Aston University, Birmingham, B4 7ET, UK
| | - Carol A Holland
- Centre for Ageing Research, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| |
Collapse
|
3
|
Armstrong NM, Bangen KJ, Au R, Gross AL. Associations Between Midlife (but Not Late-Life) Elevated Coronary Heart Disease Risk and Lower Cognitive Performance: Results From the Framingham Offspring Study. Am J Epidemiol 2019; 188:2175-2187. [PMID: 31576397 DOI: 10.1093/aje/kwz210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/29/2019] [Accepted: 09/09/2019] [Indexed: 12/19/2022] Open
Abstract
It is unclear how coronary heart disease (CHD) risk across the adult life span affects late-life cognition. We estimated associations of midlife and late-life elevated CHD risk with cognitive trajectories (general cognitive performance, processing speed/executive function, memory) in later life (after age 55 years or age 70 years) among 2,892 Framingham Offspring Study participants who had completed CHD risk assessments approximately every 4 years since 1971 and had undergone neuropsychological testing between 1999 and 2014. We stratified analyses by apolipoprotein E gene (APOE) Ɛ4 allele carrier status. Using linear mixed-effects models, elevated CHD risk in midlife (age 55 years) was associated with lower levels of general cognitive performance (β = -0.560 standard deviation (SD) units, 95% confidence interval (CI): -0.874, -0.246), executive function (β = -0.624 SD units, 95% CI: -0.916, -0.332), and memory (β = -0.560 SD units, 95% CI: -0.907, -0.213) at age 70 years but not with rates of cognitive change. Late-life (age 70 years) elevated CHD risk, however, was associated with somewhat better levels of general cognitive performance and memory. There were associations between duration of elevated CHD risk during midlife and levels (but not trajectories) of later-life cognitive outcomes. Associations were not modified by APOE-ɛ4 status. These findings suggest that midlife elevated CHD risk is associated with lower cognition, independently of APOE-ɛ4 status, suggesting that risk of vascular disease may not contribute a "second hit" to AD risk.
Collapse
Affiliation(s)
- Nicole M Armstrong
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, CA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Neurology & Framingham Heart Study, University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| |
Collapse
|
4
|
Elgh E, Hu X. Dynamic Trajectory of Long-Term Cognitive Improvement Up to 10 Years in Young Community-Dwelling Stroke Survivors: A Cohort Study. Front Neurol 2019; 10:97. [PMID: 30853930 PMCID: PMC6396723 DOI: 10.3389/fneur.2019.00097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/24/2019] [Indexed: 11/18/2022] Open
Abstract
Background and objective: The trajectories of long-term and domain-specific cognitive alterations over a decade after stroke are largely unknown. This study aims to investigate the dynamic alterations of domain-specific cognitive performance among young stroke survivors over 10 years after their first stroke. Methods: A prospective cohort study was carried out on 38 young stroke survivors (aged 18–65 at stroke onset) living in the community at 10 years after their first stroke. The cognitive outcomes were assessed repeatedly at 1 week, 7 months, and 10 years after their first stroke on the sub-domains: process speed (Symbol search and Coding from WAIS, TMT-A), visual attention (Bells test), visuospatial function (Block design from WAIS, RCFT), executive function (TMT-B, verbal fluency), verbal function [Letter fluency (FAS) from D-KEFS and CD], working memory (Digit Span from WAIS), immediate memory (RCFT and CD), and delayed memory (RCFT and CD). Global cognition was evaluated with Mini mental state examination at the two later time-points. Results: We found a delayed significant improvement of working memory with total recovery 10 years after participants' stroke. Visuospatial function recovered already at 7 months and remained stable at 10-year follow-up. Process speed demonstrated a significant decrease at 10 years compared to 7 months after stroke onset, a decrease which could be compensated by enhancements of other cognitive domains. No further deterioration was found in verbal function, immediate-, and delayed memory, and executive function during 10-year follow-up. Global cognition improved by on average two points between 7 months and 10 years. Education level and fatigue showed low to moderate positive correlations with cognitive improvements. Conclusions: The concordance of cognitive improvements between domain-specific and global cognitions strongly suggest that some young stroke survivors do improve their cognitive outcome over a 10-year period following their first stroke. This finding fills a gap of knowledge with respect to the dynamic trajectory of post-stroke cognition, with important implications in clinical practice.
Collapse
Affiliation(s)
- Eva Elgh
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| |
Collapse
|
5
|
Marseglia A, Dahl Aslan AK, Fratiglioni L, Santoni G, Pedersen NL, Xu W. Cognitive Trajectories of Older Adults With Prediabetes and Diabetes: A Population-Based Cohort Study. J Gerontol A Biol Sci Med Sci 2018; 73:400-406. [PMID: 28633303 PMCID: PMC5861913 DOI: 10.1093/gerona/glx112] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background Diabetes has been linked to dementia risk; however, the cognitive trajectories in older adults with diabetes remain unclear. We aimed to investigate the effect of prediabetes and diabetes on cognitive trajectories among cognitively intact older adults in a long-term follow-up study. Methods Within the Swedish Adoption/Twin Study of Aging, 793 cognitively intact older adults aged ≥50 were identified at baseline and followed for up to 23 years. Based on standardized scores from 11 cognitive tests, administered at baseline and up to seven follow-ups, four cognitive domains (verbal abilities, spatial/fluid, memory, perceptual speed) were identified by principal-component analysis. Prediabetes was defined according to blood glucose levels in diabetes-free participants. Diabetes was ascertained based on self-report, hypoglycemic medication use and blood glucose levels. Data were analyzed with linear mixed-effect models adjusting for potential confounders. Results At baseline, 68 participants (8.6%) had prediabetes and 45 (5.7%) had diabetes. Compared to diabetes-free individuals, people with diabetes had a steeper decline over time in perceptual speed and verbal abilities. The annual declines in these domains were greater than the annual decline in memory. Prediabetes was associated with lower performance in memory in middle-age, but also associated with a less steep memory decline over the follow-up. Conclusions Diabetes is associated with a faster decline in perceptual speed and verbal abilities, while prediabetes is associated with lower memory performance in middle-age. However, the detrimental effects of hyperglycemia seem to not affect memory over time.
Collapse
Affiliation(s)
- Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Anna K Dahl Aslan
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
- Stockholm Gerontology Research Center, Sweden
| | - Giola Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, China
| |
Collapse
|
6
|
Demographic factors and retrieval of object and proper names after age 70. PLoS One 2018; 13:e0191876. [PMID: 29370264 PMCID: PMC5785012 DOI: 10.1371/journal.pone.0191876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 01/05/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose This research aimed to investigate whether demographic factors are similarly related to retrieval of object and proper names. Methods The sample included 5,907 individuals above age 70 who participated in the Health and Retirement Study between 2004 and 2012. Participants were asked to name two objects as well as the US President and Vice President. Latent growth curve models examined the associations of age, education, and self-rated health with baseline levels and change trajectories in retrieval. Results Age and education were more strongly related to retrieval of proper names than to retrieval of object names, both for baseline scores and for change trajectory. Similar effects of self-rated health emerged for both types of stimuli. Conclusions The results show that examining object names and proper names together as indication of cognitive status in the HRS might overlook important differences between the two types of stimuli, in both baseline performance and longitudinal change.
Collapse
|
7
|
Tang EY, Amiesimaka O, Harrison SL, Green E, Price C, Robinson L, Siervo M, Stephan BC. Longitudinal Effect of Stroke on Cognition: A Systematic Review. J Am Heart Assoc 2018; 7:e006443. [PMID: 29335318 PMCID: PMC5850140 DOI: 10.1161/jaha.117.006443] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Stroke is associated with an increased risk of dementia; however, the impact of stroke on cognition has been found to be variable, such that stroke survivors can show decline, remain stable, or revert to baseline cognitive functioning. Knowing the natural history of cognitive impairment after stroke is important for intervention. The aim of this systematic review is to investigate the longitudinal course of cognitive function in stroke survivors. METHODS AND RESULTS Three electronic databases (Medline, Embase, PsycINFO) were searched using OvidSP from inception to July 15, 2016. Longitudinal studies with ≥2 time points of cognitive assessment after stroke were included. In total, 5952 articles were retrieved and 14 were included. There was a trend toward significant deterioration in cognitive test scores in stroke survivors (8 studies). Cognitive stability (3 studies) and improvement (3 studies) were also demonstrated, although follow-up time tended to be shorter in these studies. Variables associated with impairment included age, ethnicity, premorbid cognitive performance, depression, stroke location, and history of previous stroke. Associations with APOE*E4 (apolipoprotein E with the E4 allele) allele status and sex were mixed. CONCLUSIONS Stroke is associated with an increased risk of cognitive decline, but cognitive decline is not a consequence. Factors associated with decline, such as sociodemographic status, health-related comorbidity, stroke history, and clinical features could be used in models to predict future risk of dementia after stroke. A risk model approach could identify patients at greatest risk for timely intervention to reduce the frequency or delay the onset of poststroke cognitive impairment and dementia.
Collapse
Affiliation(s)
- Eugene Yh Tang
- Institute of Health and Society, Newcastle University Institute of Ageing Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Obreniokibo Amiesimaka
- Institute of Health and Society, Newcastle University Institute of Ageing Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie L Harrison
- Department of Rehabilitation, Aged and Extended Care, Repatriation General Hospital, Flinders University, Daw Park, South Australia
| | - Emma Green
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Christopher Price
- Institute of Neuroscience, Stroke Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University Institute of Ageing Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Mario Siervo
- Institute of Cellular Medicine, Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom Cm Stephan
- Institute of Health and Society, Newcastle University Institute of Ageing Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
8
|
Tomlin A, Sinclair A. The influence of cognition on self-management of type 2 diabetes in older people. Psychol Res Behav Manag 2016; 9:7-20. [PMID: 26855601 PMCID: PMC4727517 DOI: 10.2147/prbm.s36238] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Diabetes is a growing public health issue, increasing in prevalence, eroding quality of life, and burdening health care systems. The complications of diabetes can be avoided or delayed by maintaining good glycemic control, which is achievable through self-management and, where necessary, medication. Older people with diabetes are at increased risk for cognitive impairment. This review aims to bring together current research that has investigated both cognition and diabetes self-management together. The Cumulative Index to Nursing and Allied Health (Cinahl), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System (Medline), and Psychological Information (PsychInfo) databases were searched. Studies were included if they featured older people with type 2 diabetes and had looked for associations between at least one distinct measure of cognition and at least one distinct measure of diabetes self-management. English language publications from the year 2000 were included. Cognitive measures of executive function, memory, and low scores on tests of global cognitive functioning showed significant correlations with multiple areas of diabetes self-management, including diabetes-specific numeracy ability, diabetes knowledge, insulin adjustment skills, ability to learn to perform insulin injections, worse adherence to medications, decreased frequency of self-care activities, missed appointments, decreased frequency of diabetes monitoring, and increased inaccuracies in reporting blood glucose monitoring. The nature of the subjects studied was quite variable in terms of their disease duration, previous medical histories, associated medical comorbidities, and educational level attained prior to being diagnosed with diabetes. The majority of studies were of an associational nature and not findings confirmed by repeat testing or by the effects of an intervention, neither were the majority of studies designed to give a view or conclusion on the clinical value or implications of the research. This only allows speculation of their importance. Most studies do not separate out the influence of aging itself in altering diabetes self-care behavior. We conclude that older people with type 2 diabetes are at increased risk for cognitive dysfunction. Changes in cognition may negatively affect diabetes self-management behaviors, influencing self-care outcomes. Age and depression may exacerbate any cognitive impairment.
Collapse
Affiliation(s)
- Ali Tomlin
- Institute of Diabetes for Older People, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Alan Sinclair
- Institute of Diabetes for Older People, University of Bedfordshire, Luton, Bedfordshire, UK
| |
Collapse
|
9
|
Marseglia A, Xu W, Rizzuto D, Ferrari C, Whisstock C, Brocco E, Fratiglioni L, Crepaldi G, Maggi S. Cognitive functioning among patients with diabetic foot. J Diabetes Complications 2014; 28:863-8. [PMID: 25127250 DOI: 10.1016/j.jdiacomp.2014.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/10/2014] [Accepted: 07/09/2014] [Indexed: 01/09/2023]
Abstract
AIMS Using diabetic foot (DF) as an indicator of severe diabetes, we aimed to investigate the cognitive profile of DF patients and the relations between cognitive functioning and both diabetes complications and comorbidities. METHODS Dementia-free patients with DF aged 30-90 (n=153) were assessed through medical records and a cognitive battery. Information on diabetes complications and comorbidities was collected via interview; glycated hemoglobin (HbA1c) was tested. Data were analyzed using robust logistic or quantile regression adjusted for potential confounders. RESULTS The mean Mini-Mental Examination (MMSE) score of patients was 24.6 (SD=3.6), and 40% had global cognitive dysfunction (MMSE ≤24). Among elderly patients (aged ≥65), MMSE impairment was related to amputation (OR 3.59, 95% CI 1.07-12.11). Episodic memory impairment was associated with foot amputation (OR 4.13, 95% CI 1.11-15.28) and microvascular complications (OR 9.68, 95% CI 1.67-56.06). Further, elderly patients with HbA1c <7% had increased odds of psychomotor slowness (OR 7.75, 95% CI 1.55-38.73) and abstract reasoning impairment (OR 4.49, 95% CI: 1.15-17.46). However, such significant associations were not shown in adult patients aged <65. CONCLUSION Amputation, microvascular diseases and glycemic control were associated with impaired global cognitive function and its domains among patients aged ≥65.
Collapse
Affiliation(s)
- Anna Marseglia
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of NeuroscienceAging section, Italian National Council Research (CNR), Padua, Italy.
| | - Weili Xu
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Debora Rizzuto
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Camilla Ferrari
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Christine Whisstock
- Leonardo Foundation and Diabetic Foot Unit, Policlinico Abano Terme, Abano Terme, Italy
| | - Enrico Brocco
- Leonardo Foundation and Diabetic Foot Unit, Policlinico Abano Terme, Abano Terme, Italy
| | - Laura Fratiglioni
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Gaetano Crepaldi
- Institute of NeuroscienceAging section, Italian National Council Research (CNR), Padua, Italy; Leonardo Foundation and Diabetic Foot Unit, Policlinico Abano Terme, Abano Terme, Italy
| | - Stefania Maggi
- Institute of NeuroscienceAging section, Italian National Council Research (CNR), Padua, Italy; Leonardo Foundation and Diabetic Foot Unit, Policlinico Abano Terme, Abano Terme, Italy
| |
Collapse
|
10
|
Schneider BC, Gross AL, Bangen KJ, Skinner JC, Benitez A, Glymour MM, Sachs BC, Shih RA, Sisco S, Manly JJ, Luchsinger JA. Association of vascular risk factors with cognition in a multiethnic sample. J Gerontol B Psychol Sci Soc Sci 2014; 70:532-44. [PMID: 24821298 DOI: 10.1093/geronb/gbu040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 03/24/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine the relationship between cardiovascular risk factors (CVRFs) and cognitive performance in a multiethnic sample of older adults. METHOD We used longitudinal data from the Washington Heights-Inwood Columbia Aging Project. A composite score including smoking, stroke, heart disease, diabetes, hypertension, and central obesity represented CVRFs. Multiple group parallel process multivariate random effects regression models were used to model cognitive functioning and examine the contribution of CVRFs to baseline performance and change in general cognitive processing, memory, and executive functioning. RESULTS Presence of each CVRF was associated with a 0.1 SD lower score in general cognitive processing, memory, and executive functioning in black and Hispanic participants relative to whites. Baseline CVRFs were associated with poorer baseline cognitive performances among black women and Hispanic men. CVRF increase was related to baseline cognitive performance only among Hispanics. CVRFs were not related to cognitive decline. After adjustment for medications, CVRFs were not associated with cognition in Hispanic participants. DISCUSSION CVRFs are associated with poorer cognitive functioning, but not cognitive decline, among minority older adults. These relationships vary by gender and medication use. Consideration of unique racial, ethnic, and cultural factors is needed when examining relationships between CVRFs and cognition.
Collapse
Affiliation(s)
- Brooke C Schneider
- Psychology Service, VA Greater Los Angeles Healthcare System, California
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Jeannine C Skinner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Andreana Benitez
- Department of Radiology and Radiological Sciences, Center for Biomedical Imaging, Medical University of South Carolina, Charleston
| | - M Maria Glymour
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts. Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Bonnie C Sachs
- Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond
| | | | - Shannon Sisco
- North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville
| | - Jennifer J Manly
- Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - José A Luchsinger
- Department of Epidemiology, Joseph P. Mailman School of Public Health, and Department of Medicine, Columbia University Medical Center, New York.
| |
Collapse
|
11
|
Castanho TC, Amorim L, Zihl J, Palha JA, Sousa N, Santos NC. Telephone-based screening tools for mild cognitive impairment and dementia in aging studies: a review of validated instruments. Front Aging Neurosci 2014; 6:16. [PMID: 24611046 PMCID: PMC3933813 DOI: 10.3389/fnagi.2014.00016] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/25/2014] [Indexed: 11/13/2022] Open
Abstract
The decline of cognitive function in old age is a great challenge for modern society. The simultaneous increase in dementia and other neurodegenerative diseases justifies a growing need for accurate and valid cognitive assessment instruments. Although in-person testing is considered the most effective and preferred administration mode of assessment, it can pose not only a research difficulty in reaching large and diverse population samples, but it may also limit the assessment and follow-up of individuals with either physical or health limitations or reduced motivation. Therefore, telephone-based cognitive screening instruments can be an alternative and attractive strategy to in-person assessments. In order to give a current view of the state of the art of telephone-based tools for cognitive assessment in aging, this review highlights some of the existing instruments with particular focus on data validation, cognitive domains assessed, administration time and instrument limitations and advantages. From the review of the literature, performed using the databases EBSCO, Science Direct and PubMed, it was possible to verify that while telephone-based tools are useful in research and clinical practice, providing a promising approach, the methodologies still need refinement in the validation steps, including comparison with either single instruments or neurocognitive test batteries, to improve specificity and sensitivity to validly detect subtle changes in cognition that may precede cognitive impairment.
Collapse
Affiliation(s)
- Teresa C Castanho
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Liliana Amorim
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Joseph Zihl
- Department of Psychology-Neuropsychology, University of Munich Munich, Germany
| | - Joana A Palha
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Nuno Sousa
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Nadine C Santos
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| |
Collapse
|
12
|
Santos NC, Costa PS, Cunha P, Portugal-Nunes C, Amorim L, Cotter J, Cerqueira JJ, Palha JA, Sousa N. Clinical, physical and lifestyle variables and relationship with cognition and mood in aging: a cross-sectional analysis of distinct educational groups. Front Aging Neurosci 2014; 6:21. [PMID: 24605100 PMCID: PMC3932406 DOI: 10.3389/fnagi.2014.00021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/04/2014] [Indexed: 12/01/2022] Open
Abstract
It is relevant to unravel the factors that may mediate the cognitive decline observed during aging. Previous reports indicate that education has a positive influence on cognitive performance, while age, female gender and, especially, depressed mood were associated with poorer performances across multiple cognitive dimensions (memory and general executive function). Herein, the present study aimed to characterize the cognitive performance of community-dwelling individuals within distinct educational groups categorized by the number of completed formal school years: “less than 4,” “4, completed primary education,” and “more than 4.” Participants (n = 1051) were randomly selected from local health registries and representative of the Portuguese population for age and gender. Neurocognitive and clinical assessments were conducted in local health care centers. Structural equation modeling was used to derive a cognitive score, and hierarchical linear regressions were conducted for each educational group. Education, age and depressed mood were significant variables in directly explaining the obtained cognitive score, while gender was found to be an indirect variable. In all educational groups, mood was the most significant factor with effect on cognitive performance. Specifically, a depressed mood led to lower cognitive performance. The clinical disease indices cardiac and stroke associated with a more negative mood, while moderate increases in BMI, alcohol consumption and physical activity associated positively with improved mood and thus benefitted cognitive performance. Results warrant further research on the cause-effect (longitudinal) relationship between clinical indices of disease and risk factors and mood and cognition throughout aging.
Collapse
Affiliation(s)
- Nadine C Santos
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Clinical Academic Center - Braga Braga, Portugal
| | - Patrício S Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Clinical Academic Center - Braga Braga, Portugal
| | - Pedro Cunha
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Centro Hospitalar do Alto Ave - EPE Guimarães, Portugal
| | - Carlos Portugal-Nunes
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Clinical Academic Center - Braga Braga, Portugal
| | - Liliana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Clinical Academic Center - Braga Braga, Portugal
| | - Jorge Cotter
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Centro Hospitalar do Alto Ave - EPE Guimarães, Portugal
| | - João J Cerqueira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Clinical Academic Center - Braga Braga, Portugal
| | - Joana A Palha
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Clinical Academic Center - Braga Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho Braga, Portugal ; ICVS/3B's, PT Government Associate Laboratory Braga/Guimarães, Portugal ; Clinical Academic Center - Braga Braga, Portugal
| |
Collapse
|