Relationship of Cigarette Smoking and Time of Quitting with Incident Dementia and Cognitive Decline

OBJECTIVES

Understanding how dementia risk is impacted by timing of smoking cessation has public health implications for prevention efforts. We investigated the relationship of cigarette smoking and cessation with dementia risk and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study.

DESIGN

Ongoing prospective cohort study.

SETTING

Begun in 1987-1989, ARIC was conducted in four US communities.

PARTICIPANTS

A total of 13 002 men and women (25% African American) aged 52 to 75 years.

MEASUREMENTS

All-cause dementia was defined using standardized algorithms incorporating longitudinal cognitive data, proxy report, and hospital and death certificate dementia codes. Cognitive decline was measured using a composite cognitive score created from three tests measured at two time points (1996-1998 and 2011-2013). Smoking and cessation status were defined by self-report using data from 1987-1989 (visit 1) and 1996-1998 (visit 4). Incident dementia risk and differences in cognitive change by smoking status were estimated with Cox proportional hazards and linear regression models, respectively. To address smoking-related attrition, cognitive scores were imputed for living participants with incomplete cognitive testing.

RESULTS

The proportion of never, former, and current smokers was 44%, 41%, and 14%; 79% of former smokers quit 9 years or more before baseline. A total of 1347 participants developed dementia. After adjustment, compared with never smoking, the hazard ratio for all-cause dementia for current smoking was 1.33 (95% confidence interval [CI] = 1.12-1.59) and for recent quitting (<9 y before baseline) was 1.24 (95% CI = 1.01-1.52). Quitting 9 years or more before baseline was not associated with dementia. We found no differences in rates of cognitive decline by smoking status.

CONCLUSION

Although quitting at any time suggested benefit, dementia risk depended on time since smoking cessation. Our study highlights the importance of early midlife cessation to decrease dementia risk. J Am Geriatr Soc 68:337-345, 2020.

Determinants of success in treating cervical intraepithelial neoplasia

OBJECTIVE

To determine the important factors affecting the long-term failure rate of treatment for cervical intraepithelial neoplasia (CIN).

DESIGN

Multivariate analysis of prospectively collected clinical data.

SETTING

Colposcopy clinic in a university teaching hospital.

POPULATION

A total of 2455 consecutive women treated for CIN for the first time between 1 January 1989 and 31 December 2004 using excisional techniques.

METHODS

The data were obtained from a clinical database into which information had been entered prospectively. Data on community follow-up were obtained from the national Exeter database of cervical screening results. The parameters studied were age, parity, severity of the lesion, extent to which the lesion involved the endocervical canal, seniority of the surgeon, type of treatment, anaesthesia used, dimensions of the treatment biopsy specimen, number of treatment biopsy fragments and completeness of excision.

MAIN OUTCOME MEASURES

High-grade post-treatment cervical disease detected by biopsy or cytology.

RESULTS

Univariate analysis eliminated several potential factors and identified interactions between some factors. Multivariate analysis identified the grade of disease (P < 0.001) and the extent to which the lesion involved the endocervical canal (P =0.008) as the most important determinants of high-grade post-treatment disease. Of the factors which the surgeon could control, depth of biopsy (P =0.002) and completeness of excision (P = 0.007) were the most important.

CONCLUSIONS

This study confirms that clear margins are important to reduce the failure rate of excisional treatment for CIN. An adequate depth of treatment is important when the lesion involves the endocervical canal.

A long-term study of women with normal colposcopy after referral with low-grade cytological abnormalities

BACKGROUND

About 50,000 women are referred annually to colposcopy in England because of a low-grade smear. About 35% of these women have no colposcopic abnormality but are followed up in the colposcopy clinic because of uncertainty about the risk of significant pathology.

OBJECTIVE

This study determined the 5-year rate of disease when initial colposcopy was normal and smear was non-dyskaryotic.

DESIGN

Retrospective study.

SETTING

Colposcopy clinic of an inner city postgraduate teaching hospital. Population Two thousand one hundred and fifty seven women referred between January 1990 and December 2001 with mild dyskaryosis (Low Grade Squamous Intraepithelial Lesion [LSIL]) or borderline nuclear changes (Abnormal Squamous Changes of Uncertain Significance [ASCUS]).

METHODS

Information was obtained from the colposcopy clinic database and Open-Exeter. Time plots of the disease-free rates were generated using the Kaplan-Meier method, and statistical comparisons were performed using Cox regression.

MAIN OUTCOME MEASURES

Cumulative rates of cytological and histological abnormalities.

RESULTS

High-grade or invasive disease was diagnosed histologically in 12.8% of 805 women referred with borderline nuclear changes and in 35.8% of 1352 referred with mild dyskaryosis. Among 620 women with normal colposcopy and a negative or borderline repeat smear, high-grade disease was found after 5 years of follow up in 1.3% of women originally referred with a borderline smear and in 8.5% referred because of mild dyskaryosis.

CONCLUSION

Women referred to colposcopy with borderline nuclear changes or mild dyskaryosis whose colposcopy findings are normal and whose repeat smear in the clinic is non-dyskaryotic may be discharged for routine 3-yearly screening in the community because the risk of high-grade disease in the next 5 years is small.

Route learning performance in Alzheimer disease patients

OBJECTIVE

To examine performance on an objective measure of route learning in Alzheimer disease (AD) patients.

BACKGROUND

Topographic disorientation (TD) is a common problem among AD patients. The underlying cognitive deficits that contribute to TD in AD patients are not well understood.

METHOD

This study examined 19 healthy older individuals (controls) and 16 AD patients who were administered a comprehensive neuropsychological battery along with a novel Route Learning Test (RLT). Areas assessed included incidental learning, spatial relations. recall of the walking route, and recognition of landmarks.

RESULTS

Despite comparable performance on basic visuospatial ability measures, AD patients performed significantly worse than controls on the RLT and evidenced poor incidental learning for environmental details. A measure of egocentric and allocentric orientation ability was the best predictor of RLT performance in AD patients. Among RLT subtests, AD patients performed best on recognition of landmarks compared with recognition and recall of spatial layout or recognition of incidental items in the environment.

CONCLUSIONS

Our findings suggest that poor performance on the RLT in AD patients is characteristic of poor spatial orientation or spatial reasoning. Therefore, episodes of TD in AD patients may occur secondary to poor spatial orientation.

Effects of muscarinic and adrenergic agonism on auditory P300 in the macaque

Homologs of human endogenous evoked potentials are known in several species of nonhuman primates, but the neurotransmitter substrates of these potentials remain uncertain. In particular, the role of central cholinergic and adrenergic systems is not yet clearly defined. We recorded cognitive evoked potentials from the scalp in four adult bonnet macaque monkeys during a passive version of the auditory oddball paradigm with unique novel stimuli under saline control conditions. In two subjects each, cognitive evoked potentials were also recorded following intramuscular administration of the m1 muscarinic agonist AF102B or of the alpha-2A noradrenergic agonist guanfacine. On saline, large positivities resembling the human P300 were recorded over midline sites in response to rare or novel auditory stimuli in all four monkeys. The amplitude of these positivities was sensitive to the delivery of fruit-juice reward in association with rare stimuli in three monkeys tested. At cognition-enhancing doses, AF102B enlarged the amplitude of P300-like positivities in both monkeys tested; guanfacine enlarged the amplitude of P300-like positivities in one of two monkeys tested. These results add to existing evidence of human-like endogenous late positivities in monkeys that are influenced by the cholinergic and adrenergic systems, and suggest a possible role of m1 muscarinic and alpha-2A noradrenergic receptor subtypes.

Effects of AF102B and tacrine on delayed match-to-sample in monkeys

1. Object working memory, a function which declines in aging and dementia, was tested in young and aged pretrained monkeys using a delayed match-to-sample task. 2. During drug treatment, monkeys were given the m 1 muscarinic agonist AF102B (0.1-2.1 mg/kg i.m.), the cholinesterase inhibitor tacrine (0.5-2.0 mg/kg p.o.), or vehicle controls in a repeated measures design to assess putative cognitive enhancement. 3. Both agents improved task performance in both young and aged monkeys, AF102B yielding equivalent or greater, and less variable, improvement than tacrine. 4. AF102B may represent a low-toxicity alternative to tacrine for the treatment of age-related memory disorders.

Cortical function in elderly non-insulin dependent diabetic patients. Behavioral and electrophysiologic studies

Neurobehavioral and electrophysiologic studies were carried out to determine the effect of diabetes mellitus on cognitive function in subjects over the age of 60 years. Forty-three non-insulin-dependent diabetic men were compared with 41 male nondiabetic age-matched controls. The diabetic patients were significantly inferior to the control group in the serial learning task and Benton's Visual Retention Test. The digit span test showed no difference between the groups. Electroencephalogram (EEG)-frequency-band analysis revealed slowing over the central cortex and reduction of alpha activity over the parietal area in diabetic patients. Acute hyperglycemia induced in healthy volunteers with the administration of 50 g of intravenous glucose did not have any effect on the dominant EEG rhythms. The checkerboard elicited P100 wave did not reveal a significant increase in latency nor were the P300 wave latencies significantly different in diabetic patients. However, a trend toward longer latencies in diabetics was evident at Fz and Cz recording sites. Acute hyperglycemia in healthy volunteers did not alter the P300 wave component. The results indicate that elderly type 2 diabetic patients have an impairment in retrieval of recently learned material with preservation of auditory attention and immediate recall. The EEG data suggest that there may be some central neural pathologic condition associated with diabetes.

Oral tacrine administration in middle-aged monkeys: effects on discrimination learning

We studied the effect of chronic, oral administration of 1,2,3,4 tetrahydro-9-aminoacridine (THA), an anticholinesterase, on the acquisition of a color discrimination task in five monkeys (Macaca radiata), aged 13-19 years. A two-phase experiment was performed: initially, one animal was used and served as his own control in a multiple dose, crossover, placebo controlled trial, designed to establish a dose-response curve and an optimal dose range based on THA serum concentrations. Thereafter, four monkeys were given the optimal dose of THA (5.0 mg/day) determined previously while learning up to four color pair discriminations. They also learned up to four other color pair discriminations while on placebo. Two monkeys received THA first, then placebo; the others received placebo first, then THA. No order effects were noted. When combined scores for THA tests were compared to their placebo scores, the difference was significant at p less than 0.01 with all four THA treated monkeys requiring fewer trials to reach learning criterion. These results indicate that THA has a significantly positive effect on the acquisition of a color discrimination task.

Long-term oral administration of memory-enhancing doses of tacrine in mice: a study of potential toxicity and side effects

Recently, tacrine (1, 2, 3, 4-tetrahydro-9-aminoacridine; THA; TAC) has received international attention as an oral agent capable of relieving some of the cognitive symptoms accompanying Alzheimer's disease (AD). When given acutely and parenterally (by injection), tacrine has also enhanced memory retention in animals and man. This study evaluates the clinical potential of this agent by assessing toxicity and major side effects of a memory-enhancing dose of tacrine in mice. Groups of mice received either tacrine or vehicle (placebo) orally for 4 to 6 months. A lack of toxicity after this prolonged treatment with TAC was indicated by: (a) no significant impairment on a battery of behavioral toxicity tests; (b) improved memory retention; (c) a significant but only slight elevation of ornithine transcarbamylase activity in blood serum; (d) no abnormality as revealed with light microscopy of liver tissue; and (e) no gross organ pathology in visceral organs.

Isolation and the fluorometric, high-performance liquid chromatographic determination of tacrine

Tacrine (THA; 1,2,3,4-tetrahydro-9-aminoacridine) is an anticholinesterase agent which has been used clinically, most recently in the treatment of Alzheimer-type dementias. This paper describes the methodology for the isolation and quantitation of THA at therapeutic levels in serum from human subjects. Using C18 Bond Elut columns and an HPLC/fluorometry system, this assay exhibits a considerable improvement in sensitivity over previous uv methods, and allows routine testing of THA levels in serum samples of reasonable volume from human subjects.