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Levassort H, Boucquemont J, Alencar de Pinho N, Lambert O, Helmer C, Metzger M, Teillet L, Frimat L, Combe C, Fouque D, Laville M, Jacquelinet C, Liabeuf S, Stengel B, Massy ZA, Pépin M. A new approach for cognitive impairment pattern in chronic kidney disease. Nephrol Dial Transplant 2024; 39:848-859. [PMID: 37950574 PMCID: PMC11181866 DOI: 10.1093/ndt/gfad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with an elevated risk of neurocognitive disorders (NCDs). It remains unclear whether CKD-related NCDs have a specific cognitive pattern or are earlier-onset phenotypes of the main NCDs (vascular NCDs and Alzheimer's disease). METHODS We used the Mini Mental State Examination score (MMSE) to assess cognitive patterns in 3003 CKD patients (stage 3-4) followed up over 5 years in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort. After normalizing MMSE scores to a 0-to-100 scale, the associations between the baseline estimated glomerular filtration rate (eGFR, using the Chronic Kidney Disease Epidemiology Collaboration creatinine formula) and changes in each MMSE domain score were assessed in linear mixed models. RESULTS Patients (age: 67 ± 13 years old; males: 65%, mean eGFR: 33± 12 mL/min/1.73 m2) had a good baseline cognitive functions: the mean MMSE score was 26.9/30 ± 2.9. After adjustment for age, sex, educational level, depression (past or present), cardiovascular risk factors and cerebrovascular disease, a lower baseline eGFR (per 10 mL/min/1.73 m2) was associated with a 0.53-point decrement [P < .001; 95% confidence interval (CI) (-0.98, -0.08)] for orientation, a 1.04-point decrement [P = .03; 95% CI (-1.96, -0.13)] for attention and calculation, a 0.78-point decrement [P = .003; 95% CI (-1.30, -0.27)] for language, and a 0.94-point decrement [P = .02; 95% CI (-1.75, -0.13)] for praxis. Baseline eGFR was not, however, associated with significant changes over time in MMSE domain scores. CONCLUSION A lower eGFR in CKD patients was associated with early impairments in certain cognitive domains: praxis, language and attention domains before an obvious cognitive decline. Early detection of NCD in CKD patients must be performed before clinically cognitive decline using preferably tests assessing executive, attentional functions and language, rather than memory tests. This early cognitive screening could lead to a better management of cognitive impairment and their consequences on CKD management.
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Affiliation(s)
- Hélène Levassort
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
- Department of Nephrology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Julie Boucquemont
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Natalia Alencar de Pinho
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Oriane Lambert
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Marie Metzger
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Laurent Teillet
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Luc Frimat
- Department of Nephrology, CHRU-Nancy, Lorraine University, Vandoeuvre, France
- EA 4360, INSERM CIC-EC CIE6, Medicine Faculty, Lorraine University, Apemac, France
| | - Christian Combe
- Department of Nephrology, Bordeaux University Hospital, INSERM, Univ. Bordeaux, Bordeaux, France
| | - Denis Fouque
- Department of Nephrology, LyonSud hospital – Hospices Civils de Lyon, Claude Bernard Lyon1 University, Pierre Benite, France
| | - Maurice Laville
- Carmen INSERM U1060, Claude Bernard Lyon 1 University, Pierre-Bénite, France
| | - Christian Jacquelinet
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Medical and Scientific Department, Agence de la biomédecine, Saint-Denis la Plaine, France
| | - Sophie Liabeuf
- Pharmacology Department, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
| | - Bénédicte Stengel
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
| | - Ziad A Massy
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Nephrology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Marion Pépin
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Inserm, Villejuif, France
- Department of Geriatric Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
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Brett BL, Aggarwal NT, Chandran A, Kerr ZY, Walton SR, DeFreese JD, Guskiewicz KM, Echemendia RJ, Meehan WP, McCrea MA, Mannix R. Incorporation of concussion history as part of the LIfestyle for BRAin Health (LIBRA) modifiable factors risk score and associations with cognition in older former National Football League players. Alzheimers Dement 2023; 19:3087-3097. [PMID: 36708229 PMCID: PMC10374874 DOI: 10.1002/alz.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Investigate associations between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function, incorporating concussion history. METHODS Former National Football League (NFL) players (N = 1050; mean age = 64.8 ± 9.0-years) completed initial testing for integration of concussion history into LIBRA scores (i.e., modified-LIBRA) and completed the Brief Test of Adult Cognition by Telephone (BTACT). Modified-LIBRA score (including concussion history) associations with odds of MCI and cognitive dysfunction were assessed via logistic and linear regression. RESULTS The highest quartile LIBRA scores were six times more likely to have a diagnosis of MCI compared to the lowest quartile (OR = 6.27[3.61, 10.91], p < 0.001). Modified-LIBRA scores significantly improved model fit for odds of MCI above original LIBRA scores (χ2 (1) = 7.76, p = 0.005) and accounted for a greater fraction of variance in executive function (ΔR2 = 0.02, p = 0.003) and episodic memory (ΔR2 = 0.02, p = 0.002). CONCLUSIONS Modified-LIBRA score, incorporating concussion history, may help monitoring risk status in former contact sport athletes, by targeting modifiable, lifestyle-related risk factors.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Samuel R. Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - William P. Meehan
- Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Rebekah Mannix
- Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
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Yang K, Chen M, Wang Y, Jiang G, Hou N, Wang L, Wen K, Li W. Development of a predictive risk stratification tool to identify the population over age 45 at risk for new-onset stroke within 7 years. Front Aging Neurosci 2023; 15:1101867. [PMID: 37388187 PMCID: PMC10301757 DOI: 10.3389/fnagi.2023.1101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/09/2023] [Indexed: 07/01/2023] Open
Abstract
Background and purpose With the acceleration of the aging process of society, stroke has become a major health problem in the middle-aged and elderly population. A number of new stroke risk factors have been recently found. It is necessary to develop a predictive risk stratification tool using multidimensional risk factors to identify people at high risk for stroke. Methods The study included 5,844 people (age ≥ 45 years) who participated in the China Health and Retirement Longitudinal Study in 2011 and its follow-up up to 2018. The population samples were divided into training set and validation set according to 1:1. A LASSO Cox screening was performed to identify the predictors of new-onset stroke. A nomogram was developed, and the population was stratified according to the score calculated through the X-tile program. Internal and external verifications of the nomogram were performed by ROC and calibration curves, and the Kaplan-Meier method was applied to identify the performance of the risk stratification system. Results The LASSO Cox regression screened out 13 candidate predictors from 50 risk factors. Finally, nine predictors, including low physical performance and the triglyceride-glucose index, were included in the nomogram. The nomogram's overall performance was good in both internal and external validations (AUCs at 3-, 5-, and 7-year periods were 0.71, 0.71, and 0.71 in the training set and 0.67, 0.65, and 0.66 in the validation set, respectively). The nomogram was proven to excellently discriminate between the low-, moderate-, and high-risk groups, with a prevalence of 7-year new-onset stroke of 3.36, 8.32, and 20.13%, respectively (P < 0.001). Conclusion This research developed a clinical predictive risk stratification tool that can effectively identify the different risks of new-onset stroke in 7 years in the middle-aged and elderly Chinese population.
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Affiliation(s)
- Kang Yang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minfang Chen
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaoling Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gege Jiang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Niuniu Hou
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Liping Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Wen
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Wei Li
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Eslami A, Nassif NT, Lal S. Neuropsychological Performance and Cardiac Autonomic Function in Blue- and White-Collar Workers: A Psychometric and Heart Rate Variability Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4203. [PMID: 36901213 PMCID: PMC10002343 DOI: 10.3390/ijerph20054203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The 21st century has brought a growing and significant focus on performance and health within the workforce, with the aim of improving the health and performance of the blue- and white-collar workforce. The present research investigated heart rate variability (HRV) and psychological performance between blue and white-collar workers to determine if differences were evident. A total of 101 workers (n = 48 white-collar, n = 53 blue-collar, aged 19-61 years) underwent a three lead electrocardiogram to obtain HRV data during baseline (10 min) and active (working memory and attention) phases. The Cambridge Neuropsychological Test Automated Battery, specifically the spatial working memory, attention switching task, rapid visual processing and the spatial span, were used. Differences in neurocognitive performance measures indicated that white-collar workers were better able to detect sequences and make less errors than blue-collar workers. The heart rate variability differences showed that white-collar workers exhibit lower levels of cardiac vagal control during these neuropsychological tasks. These initial findings provide some novel insights into the relationship between occupation and psychophysiological processes and further highlight the interactions between cardiac autonomic variables and neurocognitive performance in blue and white-collar workers.
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Affiliation(s)
- Ardalan Eslami
- Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Sydney 2007, Australia
- Neuroscience Research Unit, Transdisciplinary School, School of Public Health, University of Technology Sydney, Sydney 2007, Australia
| | - Najah T. Nassif
- School of Life Sciences, University of Technology Sydney, Sydney 2007, Australia
| | - Sara Lal
- Neuroscience Research Unit, Transdisciplinary School, School of Public Health, University of Technology Sydney, Sydney 2007, Australia
- Honorary, School of Psychology, Faculty of Science, University of New South Wales, Sydney 2052, Australia
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Halabicky OM, Ji X, Gur RE, Gur RC, Yan C, Chen A, Liu J. Childhood lead exposure and sex-based neurobehavioral functioning in adolescence. Neurotoxicology 2022; 93:1-8. [PMID: 35988749 PMCID: PMC10433489 DOI: 10.1016/j.neuro.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
It is well documented that childhood lead exposure is associated with long-term decreases in intelligence quotients (IQ). Lesser known is the relationship with neurobehavioral domains, especially in adolescence. This study sought to identify cross-sectional and longitudinal associations between lead exposure and adolescent executive and visual-motor functioning and examine sex-based differences. Participants were 681 children from Jintan, China who had their blood lead levels (BLLs) assessed at age 3-5 years and 12 years old and neurobehavioral functioning assessed through the University of Pennsylvania Computerized Neurocognitive Battery (PennCNB) platform http://www.med.upenn.edu/bbl at 12 years old. Mean BLLs were 6.41 mcg/dl at age 3-5 years and 3.10 mcg/dl at 12. BLLs at 3-5 years and 12 years were used as predictors for the individual neurobehavioral domains in general linear models while controlling for father and mother occupation and education, residence location, age, and adolescent IQ. Models were run separately for males and females. In adjusted models, males BLLs at 3-5 years were associated with increased time to correctly complete tasks in multiple domains including abstraction/flexibility (β = 19.90, 95% CI( 4.26, 35.54) and spatial processing (β = 96.00, 95% CI 6.18, 185.82) at 12 years. For females in adjusted models, BLLs at 3-5 years were associated with increasing time to correctly complete tasks on the episodic memory domain task (β = 34.59, 95% CI 5.33, 63.84) at 12 years. Two adolescent cross-sectional relationships remained in the adjusted models for males only, suggesting a positive association between BLLs and increasing time for correct responses on the attentional domain task (β = 15.08, 95% CI 0.65, 29.51) and decreasing time for correct responses on the episodic memory task (β = -73.49, 95% CI -138.91, -8.06) in males at 12 years. These associations remained with and without controlling for IQ. These results suggest that lead exposure is associated with overall deficits in male and female neurobehavioral functioning, though in different domains and different timing of exposure.
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Affiliation(s)
| | - Xiaopeng Ji
- School of Nursing, University of Delaware, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Chonghuai Yan
- Division of Environmental Science, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University, China
| | - Aimin Chen
- Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, USA
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Schievink SHJ, van Boxtel MPJ, Deckers K, van Oostenbrugge RJ, Verhey FRJ, Köhler S. Cognitive changes in prevalent and incident cardiovascular disease: a 12-year follow-up in the Maastricht Aging Study (MAAS). Eur Heart J 2022; 43:e2-e9. [PMID: 29020327 DOI: 10.1093/eurheartj/ehx365] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/18/2017] [Accepted: 06/07/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS Cardiovascular disease (CVD) has been suggested to accelerate cognitive decline and to be a risk factor for dementia, but still little is known about the cognitive course after a first cardiovascular event. Therefore, the present study aims to investigate the cognitive trajectories in both prevalent and incident CVD over a 12-year time period in the general population. METHODS AND RESULTS Cognitively healthy participants (age 24-82 years, n = 1823) of a prospective cohort study were serially assessed at baseline, 6 and 12 years. Verbal memory, executive function, and information processing speed were analysed in adults with prevalent, incident, and no CVD. Random effects models were used to test the association between CVD and change in cognitive function over time. At baseline, participants with prevalent CVD showed more decline in memory and information processing speed than healthy controls. Participants with incident CVD also showed more decline in these cognitive domains, but this was only significant in the follow-up period from 6 to 12 years. Associations were more pronounced in participants aged younger than 65 years at baseline, and in sub-analyses with angina pectoris or myocardial infarction as the most prevalent CVD conditions. CONCLUSION Prevalent and incident CVD predict cognitive decline in middle-aged individuals. Findings for incident CVD suggest that the onset of decline is linked in time with the vascular event itself. Timely CVD management may delay the onset of decline.
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Affiliation(s)
- Syenna H J Schievink
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Dr Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Dr Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Dr Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Dr Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centre Limburg, Maastricht University, Dr Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
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Rostamian S, le. Cessie S, Marijt KA, Jukema JW, Mooijaart SP, van Buchem MA, van Hall T, Gussekloo J, Trompet S. Association of cognitive function with increased risk of cancer death and all-cause mortality: Longitudinal analysis, systematic review, and meta-analysis of prospective observational studies. PLoS One 2022; 17:e0261826. [PMID: 34995287 PMCID: PMC8741047 DOI: 10.1371/journal.pone.0261826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Disturbed cognitive function is associated with several causes of mortality; however, the association between cognitive function and the risk of cancer death has not been extensively investigated yet. We aimed to evaluate the association of cognitive function with the risk of cancer death and all-cause mortality in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) and Leiden 85-plus Study. Additionally, a systematic review and meta-analysis of longitudinal studies were conducted to evaluate the association of cognitive function and risk of cancer death. Methods Risk of cancer death and all-cause mortality were reported using hazard ratios (HRs) with 95% confidence interval (CI) in tertiles of cognitive function of PROSPER and Leiden85-Plus Study. Additionally, PubMed, Embase, Web of Science, Cochrane, PsycINFO, Academic Search Premier, CINHAL, and Emcare were searched up to November 1st, 2020 to perform a systematic review and meta-analysis. The relative risks (RRs) with 95%CI of cancer death per each standard deviation lower performance in cognitive measurements were calculated. Results Participants of PROSPER had 1.65-fold (95%CI 1.11–2.47) greater risk of cancer death (P for trend = 0.016) and 1.85-fold (95%CI 1.46–2.34) higher risk of all-cause mortality (P for trend<0.001), in multivariable models. Results of the Leiden-85 Plus Study showed that subjects with MMSE score below 24 had a lower chance of cancer death (HR 0.79, 95%CI 0.36–1.70, P for trend = 0.820) but had 2.18-fold (95%CI 1.57–3.02) higher risk of all-cause mortality compared to the reference group (P for trend<0.001). Besides, the results of systematic review and meta-analysis showed that per each standard deviation lower performance in cognitive function, individuals were at a 10% higher chance of cancer death (RR 1.10, 95%CI 1.00–1.20, P-value = 0.044). Conclusions Lower cognitive function performance is associated with a marginally increased risk of cancer death, in line with a significantly greater risk of all-cause mortality.
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Affiliation(s)
- Somayeh Rostamian
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Saskia le. Cessie
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Koen A. Marijt
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thorbald van Hall
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
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Zhao Z, Cai H, Zheng W, Liu T, Sun D, Han G, Zhang Y, Wu D. Atrophic Pattern of Hippocampal Subfields in Post-Stroke Demented Patient. J Alzheimers Dis 2021; 80:1299-1309. [PMID: 33646148 DOI: 10.3233/jad-200804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies have demonstrated that hippocampal atrophy is a hallmark of dementia and can be used to predict the outcome of post-stroke demented (PSD) patients. The hippocampus consists of several subfields but their involvement in the pathophysiology of the PSD remains unclear. OBJECTIVE The present study aimed to investigate volumetric alterations of hippocampal subfields in patients with PSD. METHODS High-resolution T1-weighted images were collected from 27 PSD and 28 post-stroke nondemented (PSND) patients who recovered from ischemic stroke, and 17 age-matched normal control (NC). We estimated the volumes of the hippocampal subfields using FreeSurfer 6.0 which segmented the hippocampus into 12 subfields in each hemisphere. The volumetric differences between the groups were evaluated by the two-sample tests after regressing out the age, sex, education, and total intracranial volume. RESULTS Compared with NC group, PSD group showed smaller volumes in the entire hippocampus and its subfields, and such differences were not found in PSND group. Moreover, we found the dementia-specific atrophy in the left granule cell layer of dentate gyrus (GC-DG) and CA4 in the PSD patients compared with NC and PSND. Regression analysis showed positive correlations between the changes of cognitive performance and the asymmetry index in the CA3/4 and GC-DG of the PSD group. Furthermore, we found that the volumes of hippocampal subfields provided a better classification performance than the entire hippocampus. CONCLUSION Our findings suggest that the hippocampus is reduced in the PSD patients and it presents a selective subfield involvement.
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Affiliation(s)
- Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Weihao Zheng
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Tingting Liu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Di Sun
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Guocan Han
- Department of Radiology, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.,Department of Neurology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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Van Rheenen TE, McIntyre RS, Balanzá-Martínez V, Berk M, Rossell SL. Cumulative Cardiovascular Disease Risk and Triglycerides Differentially Relate to Subdomains of Executive Function in Bipolar Disorder; preliminary findings. J Affect Disord 2021; 278:556-562. [PMID: 33022441 DOI: 10.1016/j.jad.2020.09.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 09/26/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Cardiovascular disease is disproportionally prevalent in bipolar disorder (BD) and has been linked to cognition in preliminary studies. Herein we evaluate the association between known risk factors for cardiovascular disease and executive function in BD patients compared to healthy controls. METHODS In a sample of n=57 individuals (n=23 BD, n=34 controls) we assessed two subdomains of executive function; cognitive flexibility (using the Trail Making Test - Part B) and cognitive inhibition (using the Stroop Colour Word Interference Task). Cardiovascular risk was assessed by means of serum triglyceride levels, body mass index (BMI) and waist circumference, as well as dietary saturated fat intake and a sex-specific cumulative cardiovascular risk score calculated using the Framingham Heart Study method. RESULTS Patients with BD had higher BMI and waist circumference, with more BD patients categorized as having central obesity than controls. In the BD group only, higher triglyceride levels were associated with worse cognitive flexibility, and elevated cumulative cardiovascular disease risk was associated with worse cognitive inhibition. No correlations between cardiovascular risk factors and executive function were evident in the control group. LIMITATIONS The study was limited by the small sample size and should be considered hypothesis-generating CONCLUSIONS: The associations between triglyceride levels, cumulative cardiovascular disease risk and executive functioning evident in BD in this study preliminarily indicate the potential for mechanistic overlap of physical health and cognitive function in the disorder.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia; Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia.
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation University of Toronto, Toronto, Canada
| | - Vicent Balanzá-Martínez
- Teaching unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia; Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, VIC, Australia
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10
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Rivera D, Mascialino G, Brooks BL, Olabarrieta-Landa L, Longoni M, Galarza-Del-Angel J, Arango-Lasprilla JC. Multivariate Base Rates of Low Scores on Tests of Executive Functions in a Multi-Country Latin American Sample. Dev Neuropsychol 2020; 46:1-15. [PMID: 33356560 DOI: 10.1080/87565641.2020.1863407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of the study was to determine the prevalence of low scores in a diverse Latin American population for two neuropsychological commonly used tests to evaluate executive functions and to compare the number of low scores obtained using normative data from a Spanish-speaking population from Latin America versus an English-speaking population from U.S.A. Healthy adults (N = 5402) were administered the Modified Wisconsin Card Sorting Test and Stroop Color-Word. Low scores on measures of executive functioning are common. Clinicians working with Spanish-speaking adults should take into account the higher probability of low scores on these measures to reduce false-positive diagnoses of cognitive deficits in an individual.
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Affiliation(s)
- Diego Rivera
- Departamento De Ciencias De La Salud, Universidad Pública De Navarra , Pamplona, Spain
| | - Guido Mascialino
- Escuela De Psicología, Universidad De Las Américas , Quito, Ecuador
| | - Brian L Brooks
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada
| | | | - Melina Longoni
- Dirección de Discapacidad de Ituzaingo , Buenos Aires, Argentina
| | | | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute. Cruces University Hospital . Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science ., Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU) , Bizkaia, Spain
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11
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Relationship between self-care adherence, time perspective, readiness to change and executive function in patients with heart failure. J Behav Med 2020; 43:1-11. [DOI: 10.1007/s10865-019-00080-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/06/2019] [Indexed: 12/13/2022]
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12
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Trossman R, Mielke JG, McAuley T. Global executive dysfunction, not core executive skills, mediate the relationship between adversity exposure and later health in undergraduate students. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:405-411. [PMID: 32449393 DOI: 10.1080/23279095.2020.1764561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Executive function (EF) represents a set of higher-order cognitive skills that permit engagement in goal-oriented behavior. EF deficits are associated with wide-ranging negative health-related consequences, including psychopathology and engagement in risky health-related behaviors. Because neural substrates supporting EF develop over a protracted period of time, an extended window of vulnerability exists whereby environmental stressors can interrupt development, culminating in lifelong EF deficits. We capitalized on this understanding of the vulnerability of EF-relevant neural structures to elucidate the link between adverse childhood experiences (ACEs) and early mortality. ACEs are highly prevalent in the general population and exert negative downstream implications for many health-related behaviors, ultimately hastening mortality. However, underlying mechanisms linking ACEs with poor health remain less understood. To address this gap in the literature, we assessed ACE history and health factors, including psychopathology and risky alcohol use behaviors in undergraduates. We further assessed EF using performance-based and rating scale measures. Results revealed that some measures of EF mediated the relationship between ACEs and current mental health, but EF did not mediate the association between ACEs and engagement in risky health-related behaviors. These results partially support a neurodevelopmental model of ACE exposure vis-à-vis future health, focusing on the role of EF.
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Affiliation(s)
- Rebecca Trossman
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Ontario, Canada
| | - John G Mielke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Tara McAuley
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Ontario, Canada
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13
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Iverson GL, Karr JE, Terry DP, Garcia-Barrera MA, Holdnack JA, Ivins BJ, Silverberg ND. Developing an Executive Functioning Composite Score for Research and Clinical Trials. Arch Clin Neuropsychol 2020; 35:312-325. [PMID: 31965141 DOI: 10.1093/arclin/acz070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/30/2019] [Accepted: 10/20/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Executive functioning encompasses interactive cognitive processes such as planning, organization, set-shifting, inhibition, self-monitoring, working memory, and initiating and sustaining motor and mental activity. Researchers therefore typically assess executive functioning with multiple tests, each yielding multiple scores. A single composite score of executive functioning, which summarizes deficits across a battery of tests, would be useful in research and clinical trials. This study examines multiple candidate composite scores of executive functioning using tests from the Delis-Kaplan Executive Function System (D-KEFS). METHOD Participants were 875 adults between the ages of 20 and 89 years from the D-KEFS standardization sample. Seven Total Achievement scores were used from three tests (i.e., Trail Making, Verbal Fluency, and Color-Word Interference) to form eight composite scores that were compared based on their psychometric properties and association with intelligence (IQ). RESULTS The distributions of most composite scores were mildly to severely skewed, and some had a pronounced ceiling effect. The composite scores all showed a medium positive correlation with IQ. The composite scores were highly intercorrelated in the total sample and in four IQ subgroups (i.e., IQ <89, 90-99, 100-109, 110+), with some being so highly correlated that they appear redundant. CONCLUSIONS This study is part of a larger research program developing a cognition endpoint for research and clinical trials with sound psychometric properties and utility across discrepant test batteries. Future research is needed to examine the reliability and ecological validity of these composite scores.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA 02129, USA
| | - Justin E Karr
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA 02129, USA
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA 02129, USA
| | | | | | - Brian J Ivins
- Defense and Veterans Brain Injury Center, Silver Spring, MD 20910, USA
| | - Noah D Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia; Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia V5Z 2G9, Canada
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14
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Cognitive Function in Dementia-Free Subjects and Survival in Old Age: The PROSPER Study. Am J Med 2019; 132:1466-1474.e4. [PMID: 31228412 DOI: 10.1016/j.amjmed.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/05/2019] [Accepted: 06/02/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Impairment in domain-specific cognitive function is associated with the increased risk of mortality. We prospectively evaluated the association of executive function and memory with the risk of long-term mortality in dementia-free older subjects. Moreover, we investigated the role of structural brain abnormalities in this association. METHODS We included 547 dementia-free participants (mean age 78 years, 56.5% male) from the nested magnetic resonance imaging sub-study of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Cox proportional hazard models were used to model 10-year risk of all-cause, cardiovascular, and noncardiovascular mortality in relation to performance in executive function and memory. Moreover, we evaluated the role of total brain parenchymal volume, cerebral blood flow, white matter hyperintensity, and the presence of microbleeds and infarcts in the link between cognitive function and mortality. RESULTS In the multivariable model, lower performance in executive function was associated with greater risk of all-cause (hazard ratio [HR] 1.49; 95% confidence interval [CI], 1.31-1.70), cardiovascular (HR 1.69; 95% CI, 1.36-2.11), and noncardiovascular (HR 1.36; 95% CI, 1.15-1.62) mortality. Similarly, poorer performance in memory tests associated with higher risk of all-cause (HR 1.47; 95% CI, 1.29-1.68), cardiovascular (HR 1.45; 95% CI, 1.15-1.83), and noncardiovascular (HR 1.49; 95% CI, 1.27-1.76) mortality. The associations were similar in subjects with various levels of brain structural abnormalities and cerebral blood flow (all P for interaction ≫ .05). CONCLUSIONS Poorer performance in both executive function and memory tests associates with all-cause, cardiovascular, and noncardiovascular mortality in elderly individuals. This association is independent of cardiovascular risk factors and diseases, brain structural abnormalities, and cerebral blood flow.
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15
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Stute P, von Bergen M, Bitterlich N, Meissner F, von Wolff M, Poethig D. Measuring cognitive performance in way that incorporates the concept of active and healthy ageing (AHA). Maturitas 2019; 125:27-32. [DOI: 10.1016/j.maturitas.2019.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/15/2019] [Accepted: 03/24/2019] [Indexed: 11/26/2022]
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16
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Madsen TE, Howard VJ, Jiménez M, Rexrode KM, Acelajado MC, Kleindorfer D, Chaturvedi S. Impact of Conventional Stroke Risk Factors on Stroke in Women: An Update. Stroke 2018; 49:536-542. [PMID: 29438086 PMCID: PMC5828997 DOI: 10.1161/strokeaha.117.018418] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Tracy E Madsen
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.).
| | - Virginia J Howard
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Monik Jiménez
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Kathryn M Rexrode
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Maria Czarina Acelajado
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Dawn Kleindorfer
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Seemant Chaturvedi
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
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17
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Tarraf W, Criqui MH, Allison MA, Wright CB, Fornage M, Daviglus M, Kaplan RC, Davis S, Conceicao AS, González HM. Ankle brachial index and cognitive function among Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos. Atherosclerosis 2018; 271:61-69. [PMID: 29459267 DOI: 10.1016/j.atherosclerosis.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/17/2018] [Accepted: 02/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS The Ankle-Brachial index (ABI) is a well-accepted measure of peripheral artery disease (arterial stenosis and stiffness) and has been shown to be associated with cognitive function and disorders; however, these associations have not been examined in Hispanics/Latinos. Therefore, we sought to examine relationships between ABI and cognitive function among diverse middle-age and older Hispanics/Latinos. METHODS We used cross-sectional data on n = 7991 participants aged 45-74 years, without stroke or coronary heart disease, from the Hispanic Community Health Study/Study of Latinos. Our primary outcome, global cognition (GC), was a continuous composite score of four cognitive domains (verbal learning and memory, verbal fluency, executive function, and mental status). Secondary outcomes were the individual tests representing these domains. The ABI was analyzed continuously and categorically with standard clinical cut-points. We tested associations using generalized survey regression models incrementally adjusting for confounding factors. Age, sex, hypertension, diabetes, and dyslipidemia moderations were examined through interactions with the primary exposure. RESULTS In age, sex, and education adjusted models, continuous ABI had an inverse u-shape association with worse GC. We found similar associations with measures of verbal learning and memory, verbal fluency, executive function, but not with low mental status. The associations were attenuated, but not completely explained, by accounting for the confounders and not modified by age, sex, education, and vascular disease risks. CONCLUSIONS In addition to being a robust indicator of arterial compromise, our study suggests that abnormal ABI readings may also be useful for early signaling of subtle cognitive deficits.
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Affiliation(s)
- Wassim Tarraf
- Institute of Gerontology & Department of Health Care Sciences, Wayne State University, 87 East Ferry St., 240 Knapp Building, Detroit, MI, 48202, USA
| | - Michael H Criqui
- Family and Preventative Medicine, University of California San Diego, 9500 Gilman Drive, MC 0607, SCRB 352, La Jolla, CA, 92093-0607, USA
| | - Matthew A Allison
- Family and Preventative Medicine, University of California San Diego, 9500 Gilman Drive, MC 0965, La Jolla, CA, 92093-0607, USA
| | - Clinton B Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 6001 Executive Boulevard Suite 3309, Bethesda, MD, 20892-9531, USA
| | - Myriam Fornage
- University of Texas Health Science Center at Houston, 1825 Pressler Street, Building SRB-530G, Houston, TX, 77030, USA
| | - Martha Daviglus
- Department of Preventative Medicine, University of Illinois-Chicago, Feinberg School of Medicine, 1819 W. Polk Street, MC 764, Suite 246, Chicago, IL, 60612, USA
| | - Robert C Kaplan
- Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Belfer Building Room 1306C, Bronx, NY, 10461, USA
| | - Sonia Davis
- Department of Biostatistics, University of North Carolina at Chapel Hill, 137 East Franklin St, Suite 203, Chapel Hill, NC, 27514, USA
| | - Alan S Conceicao
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Hector M González
- UC San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, 92093-0949, USA.
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18
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Rostamian S, van Buchem MA, Jukema JW, Gussekloo J, Poortvliet RKE, de Cren AJM, Sabayan B. Lower Performance in Orientation to Time and Place Associates with Greater Risk of Cardiovascular Events and Mortality in the Oldest Old: Leiden 85-Plus Study. Front Aging Neurosci 2017; 9:307. [PMID: 29021754 PMCID: PMC5623724 DOI: 10.3389/fnagi.2017.00307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 09/08/2017] [Indexed: 01/01/2023] Open
Abstract
Background: Impairment in orientation to time and place is commonly observed in community-dwelling older individuals. Nevertheless, the clinical significance of this has been not fully explored. In this study, we investigated the link between performance in orientation domains and future risk of cardiovascular events and mortality in a non-hospital setting of the oldest old adults. Methods: We included 528 subjects free of myocardial infarction (Group A), 477 individuals free of stroke/transient ischemic attack (Group B), and 432 subjects free of both myocardial infarction and stroke/transient ischemic attack (Group C) at baseline from the population-based Leiden 85-plus cohort study. Participants were asked to answer five questions related to orientation to time and five questions related to orientation to place. 5-year risks of first-time fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, as well as cardiovascular and non-cardiovascular mortality, were estimated using the multivariate Cox regression analysis. Results: In the multivariable analyses, adjusted for sociodemographic characteristics and cardiovascular risk factors, each point lower performance in "orientation to time" was significantly associated with higher risk of first-time myocardial infarction (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.09-1.67, P = 0.007), first-time stroke (HR 1.35, 95% CI 1.12-1.64, P = 0.002), cardiovascular mortality (HR 1.28, 95% CI 1.06-1.54, P = 0.009) and non-cardiovascular mortality (HR 1.37, 95% CI 1.20-1.56, P < 0.001). Similarly, each point lower performance in "orientation to place" was significantly associated with higher risk of first-time myocardial infarction (HR 1.67, 95% CI 1.25-2.22, P = 0.001), first-time stroke (HR 1.39, 95% CI 1.05-1.82, P = 0.016), cardiovascular mortality (HR 1.35, 95% CI 1.00-1.82, P = 0.054) and non-cardiovascular mortality (HR 1.45, 95% CI 1.20-1.77, P < 0.001). Conclusions: Lower performance in orientation to time and place in advanced age is independently related to higher risk of myocardial infarction, stroke and mortality. Impaired orientation might be an early sign of covert vascular injuries, putting subjects at greater risk of cardiovascular events and mortality.
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Affiliation(s)
- Somayeh Rostamian
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anton J M de Cren
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Behnam Sabayan
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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19
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Sanfratello L, Lundy SL, Qualls C, Knoefel JE, Adair JC, Caprihan A, Stephen JM, Aine CJ. Brain structure and verbal function across adulthood while controlling for cerebrovascular risks. Hum Brain Mapp 2017; 38:3472-3490. [PMID: 28390167 DOI: 10.1002/hbm.23602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/01/2017] [Accepted: 03/26/2017] [Indexed: 11/08/2022] Open
Abstract
The development and decline of brain structure and function throughout adulthood is a complex issue, with cognitive aging trajectories influenced by a host of factors including cerebrovascular risk. Neuroimaging studies of age-related cognitive decline typically reveal a linear decrease in gray matter (GM) volume/density in frontal regions across adulthood. However, white matter (WM) tracts mature later than GM, particularly in regions necessary for executive functions and memory. Therefore, it was predicted that a middle-aged group (MC: 35-45 years) would perform best on a verbal working memory task and reveal greater regional WM integrity, compared with both young (YC: 18-25 years) and elder groups (EC: 60+ years). Diffusion tensor imaging (DTI) and magnetoencephalography (MEG) were obtained from 80 healthy participants. Objective measures of cerebrovascular risk and cognition were also obtained. As predicted, MC revealed best verbal working memory accuracy overall indicating some maturation of brain function between YC and MC. However, contrary to the prediction fractional anisotropy values (FA), a measure of WM integrity, were not greater in MC (i.e., there were no significant differences in FA between YC and MC but both groups showed greater FA than EC). An overall multivariate model for MEG ROIs showed greater peak amplitudes for MC and YC, compared with EC. Subclinical cerebrovascular risk factors (systolic blood pressure and blood glucose) were negatively associated with FA in frontal callosal, limbic, and thalamic radiation regions which correlated with executive dysfunction and slower processing speed, suggesting their contribution to age-related cognitive decline. Hum Brain Mapp 38:3472-3490, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- L Sanfratello
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, New Mexico, 87106.,Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 87131
| | - S L Lundy
- Center for Neuropsychological Services, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 87131
| | - C Qualls
- Clinical and Translational Science Center (Biostatistics),University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 87131
| | - J E Knoefel
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 87131.,Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 87131
| | - J C Adair
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 87131.,New Mexico VA Health Care System, Albuquerque, New Mexico, 87108
| | - A Caprihan
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, New Mexico, 87106
| | - J M Stephen
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, New Mexico, 87106
| | - C J Aine
- The Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, New Mexico, 87106.,Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 87131
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20
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Marengoni A, Bandinelli S, Maietti E, Guralnik J, Zuliani G, Ferrucci L, Volpato S. Combining Gait Speed and Recall Memory to Predict Survival in Late Life: Population-Based Study. J Am Geriatr Soc 2016; 65:614-618. [PMID: 28029688 DOI: 10.1111/jgs.14705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the relationship between gait speed, recall memory, and mortality. DESIGN A cohort study (last follow-up December 2009). SETTING Tuscany, Italy. PARTICIPANTS Individual data from 1,014 community-dwelling older adults aged 60 years or older with baseline gait speed and recall memory measurements and follow-up for a median time of 9.10 (IQR 7.1;9.3) years. Participants were a mean (SD) age of 73.9 (7.3) years, and 55.8% women. Participants walking faster than 0.8 m/s were defined as fast walkers; good recall memory was defined as a score of 2 or 3 in the 3-word delayed recall section of the Mini-Mental State Examination. MEASUREMENTS All-cause mortality. RESULTS There were 302 deaths and the overall 100 person-year death rate was 3.77 (95% CI: 3.37-4.22). Both low gait speed and poor recall memory were associated with mortality when analysed separately (HR = 2.47; 95% CI: 1.87-3.27 and HR = 1.47; 95% CI: 1.16-1.87, respectively). When we grouped participants according to both recall and gait speed, death rates (100 person-years) progressively increased from those with both good gait speed and memory (2.0; 95% CI: 1.6-2.5), to those with fast walk but poor memory (3.4; 95% CI: 2.8-4.2), to those with slow walk and good memory (8.8; 95% CI: 6.4-12.1), to those with both slow walk and poor memory (13.0; 95% CI: 10.6-16.1). In multivariate analysis, poor memory significantly increases mortality risk among persons with fast gait speed (HR = 1.40; 95% CI: 1.04-1.89). CONCLUSION In older persons, gait speed and recall memory are independent predictors of expected survival. Information on memory function might better stratify mortality risk among persons with fast gait speed.
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Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia Health & Wealth, Brescia, Italy
| | | | - Elisa Maietti
- Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology, and Clinical Nutrition, University of Ferrara, Ferrara, Italy
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Giovanni Zuliani
- Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology, and Clinical Nutrition, University of Ferrara, Ferrara, Italy
| | | | - Stefano Volpato
- Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology, and Clinical Nutrition, University of Ferrara, Ferrara, Italy
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Murdock KW, LeRoy AS, Lacourt TE, Duke DC, Heijnen CJ, Fagundes CP. Executive functioning and diabetes: The role of anxious arousal and inflammation. Psychoneuroendocrinology 2016; 71:102-9. [PMID: 27261922 PMCID: PMC5662196 DOI: 10.1016/j.psyneuen.2016.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/19/2022]
Abstract
Individuals who perform poorly on measures of the executive function of inhibition have higher anxious arousal in comparison to those with better performance. High anxious arousal is associated with a pro-inflammatory response. Chronically high anxious arousal and inflammation increase one's risk of developing type 2 diabetes. We sought to evaluate anxious arousal and inflammation as underlying mechanisms linking inhibition with diabetes incidence. Participants (N=835) completed measures of cognitive abilities, a self-report measure of anxious arousal, and donated blood to assess interleukin-6 (IL-6) and glycated hemoglobin (HbA1c). Individuals with low inhibition were more likely to have diabetes than those with high inhibition due to the serial pathway from high anxious arousal to IL-6. Findings remained when entering other indicators of cognitive abilities as covariates, suggesting that inhibition is a unique cognitive ability associated with diabetes incidence. On the basis of our results, we propose several avenues to explore for improved prevention and treatment efforts for type 2 diabetes.
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Affiliation(s)
- Kyle W. Murdock
- Department of Psychology, Rice University, Bioscience Research Collaborative Room 773, 6500 Main Street, Houston, Texas 77005
| | - Angie S. LeRoy
- Department of Psychology, Rice University, Bioscience Research Collaborative Room 773, 6500 Main Street, Houston, Texas 77005,Department of Psychology, University of Houston, 3695 Cullen Boulevard Room 126 Houston, Texas 77204
| | - Tamara E. Lacourt
- Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030
| | - Danny C. Duke
- Division of Psychology, Institute on Development and Disability, Oregon Health and Science University, 707 SW Gaines Street, Portland, Oregon 97239
| | - Cobi J. Heijnen
- Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030
| | - Christopher P. Fagundes
- Department of Psychology, Rice University, Bioscience Research Collaborative Room 773, 6500 Main Street, Houston, Texas 77005,Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030,Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, Texas 77030
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22
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Yaffe K, Peltz CB, Ewing SK, McCulloch CE, Cummings SR, Cauley JA, Hillier TA, Ensrud KE. Long-term Cognitive Trajectories and Mortality in Older Women. J Gerontol A Biol Sci Med Sci 2016; 71:1074-80. [PMID: 26843186 PMCID: PMC4945886 DOI: 10.1093/gerona/glw003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 01/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have examined whether change in cognition is linked to mortality. This study examined the relationship between cognitive trajectories in older age and risk of death. METHODS We studied community-dwelling, nondemented women aged 65+ (mean age = 71) enrolled in a prospective study of aging and followed up to 25 years. A modified Mini-Mental State Examination (mMMSE) and Trail Making Task Part B (TMTB) were administered at multiple visits during follow-up. We examined the association between cognitive trajectories (analyzed by quintiles) from baseline to age 80 (n = 7,477 for mMMSE and n = 6,503 for TMTB) and all-cause mortality after age 80 using Cox regression models, both unadjusted and adjusted for education, physical activity, alcohol, depression score, current smoking and history of hypertension and diabetes. Cause of death was determined from death certificates, classified as cardiovascular, cancer and other. RESULTS Women with greater rate of decline were older, less educated, less physically active, had higher depression score and were more likely to have a history of hypertension and diabetes (all p < .01). Participants with the greatest decline (quintile 1) had an increased risk of death (mMMSE hazard ratio [HR] = 1.28; TMTB HR = 1.43] and those with the least decline (quintile 5) had a decreased risk of death (mMMSE HR = 0.73; TMTB HR = 0.61) compared with intermediate decliners (quintiles 2-4). Cognitive trajectories were associated with cardiovascular mortality and other causes of death, but not cancer deaths. CONCLUSIONS Our study suggests that greater decline in general cognition or executive function is associated with higher rates of mortality in oldest-old women.
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Affiliation(s)
- Kristine Yaffe
- Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco. Department of Mental Health, San Francisco VA Medical Center, California
| | - Carrie B Peltz
- Department of Mental Health, San Francisco VA Medical Center, California. NCIRE-The Veterans Health Research Institute, San Francisco, California.
| | - Susan K Ewing
- Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco
| | - Charles E McCulloch
- Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco
| | - Steve R Cummings
- Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Teresa A Hillier
- Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
| | - Kristine E Ensrud
- School of Public Health, University of Minnesota, Minneapolis. Department of Medicine, Minneapolis VA Health Care System, Minnesota
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23
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Wen K, Nguyen NT, Hofman A, Ikram MA, Franco OH. Migraine is associated with better cognition in the middle‐aged and elderly: the Rotterdam Study. Eur J Neurol 2016; 23:1510-6. [DOI: 10.1111/ene.13066] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 05/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
- K. Wen
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - N. T. Nguyen
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - A. Hofman
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - M. A. Ikram
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
- Department of Radiology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - O. H. Franco
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
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24
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Anazodo UC, Shoemaker JK, Suskin N, Ssali T, Wang DJJ, St Lawrence KS. Impaired Cerebrovascular Function in Coronary Artery Disease Patients and Recovery Following Cardiac Rehabilitation. Front Aging Neurosci 2016; 7:224. [PMID: 26779011 PMCID: PMC4700211 DOI: 10.3389/fnagi.2015.00224] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/19/2015] [Indexed: 01/01/2023] Open
Abstract
Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV) images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.
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Affiliation(s)
- Udunna C Anazodo
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada
| | - J K Shoemaker
- Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada
| | - Neville Suskin
- London Health Sciences Cardiology Rehabilitation Program, London ON, Canada
| | - Tracy Ssali
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada
| | - Danny J J Wang
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles CA, USA
| | - Keith S St Lawrence
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada
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