Hypertension and changes of cognitive function in 81-year-old men: a 13-year follow-up of the population study "Men born in 1914", Sweden

BACKGROUND: The relationship between blood pressure levels and decline of cognition has been discussed previously, but little is known about the confounding effect of lifestyle factors, antihypertensive treatment and disease in the elderly. OBJECTIVE: To examine the association between systolic (SBP) and diastolic (DBP) blood pressure, changes of DBP and SBP and hypertension (HT) on cognitive function, while controlling for confounding factors. DESIGN: A longitudinal cohort study of men born in 1914 and residing in the municipality of Malm? studied at age 68 and 81 years. SETTING: Probands invited to a university clinic. SUBJECTS: One hundred and eighty-six out of 281 invited men still alive in 1995/6 participated in the most recent follow-up. MAIN OUTCOME: Change of the cognitive performance in the verbal (Paired Associates and Synonyms), spatial (Block Design and Benton Visual Retention test) and speed (Digit Symbol Substitution) functions. RESULTS: DBP by tertiles at 68 years, but not HT, was inversely related to verbal, spatial and speed performance at 81 years. Only spatial function was related to SBP at 68 years. The association between DBP and SBP by tertiles, and spatial functions (Block Design and Benton Visual Retention test) remained after controlling for education, marital status, smoking, alcohol and physical activity, and intermediates such as arteriosclerotic manifestations (block design, beta = 0.17; = 0.029) in multiple regression models. A decrease in DBP was likewise related to spatial (beta = 0.16; = 0.049) and speed performance (beta = 0.17; = 0.039) in the same regression model. CONCLUSIONS: Evidence is found to support the hypothesis that hypertension, especially high DBP in late midlife, is associated with a decline in spatial performance of cognitive functions in elderly men.     

Blood pressure and intellectual functioning in late midlife.

To determine how much change in cognitive performance can be attributed to blood pressure status, 103 adults were assessed on two occasions approximately 11 years apart. Subjects' ages ranged from 49 to 63 years on the second occasion. Regression analyses were performed to determine how much variance in change in performance on the Digit Span, Block Design, Object Assembly, and Digit Symbol tests was accounted for by blood pressure status. Time 1 and Time 2 diastolic blood pressure, and change in hypertension medication significantly predicted Time 2 performance on the Digit Span Forward test even after Time 1 test performance, age, education, and gender were accounted for. The results further confirm the importance of assessing health functioning when studying age-related changes in cognitive performance.     

Neuropsychological test performances and normal aging

This study was designed to assess the relevance of normal aging to performance in a variety of neuropsychological tests, in a wide range of age groups. The battery included tests of several cognitive abilities of varying complexity (attention, orientation, memory, self-regulation, categorial ability and so on). The results showed that some tests (Orientation, Attention, Digit Span, Naming, Block Design, Self-regulation, Calculation, Weigl) are not significantly affected by aging while in others performance clearly declines with age. However, the age at onset of the decline is far from uniform. In some tests (Logical Memory, delayed recall section of Supraspan Test, Hooper Test, Finger Tapping Test) it is manifest in early middle age while in others (Faces Recognition, Set Test, Reproduction of Geometric Designs) it does not appear until much later in life.     

Cannabis use and cognitive function: 8-year trajectory in a young adult cohort

Aim To evaluate the relationship between change in cannabis use and changed cognitive performance over 8 years. Design We used survey methodology with a cohort design. Setting and participants An Australian community sample aged 20–24 years at baseline. Measures We assessed cognitive performance with the California Verbal Learning Test (CVLT) (immediate and delayed), Spot‐the‐Word test (STW), Symbol Digit Modality test (SDMT) and Digit Backwards (DB). Groups of cannabis users were defined from self‐reports across three waves as: ‘never’ (n= 420) ‘remain light’ (n= 71), ‘former light’ (n= 231), ‘remain heavy’ (n= 60), ‘former heavy’ (n= 60) and ‘always former’ (since start of study) (n= 657). Planned contrasts within mixed model repeated‐measures analysis of variance was used for longitudinal analysis with an adjusted alpha of 0.01. Findings Data were obtained from 2404 participants with 1978 (82.3%) completing wave 3. At baseline there were significant differences between cannabis groups on CVLT (immediate and delayed) and SDMT. However, after controlling for education, gender, gender × group and gender × wave, there were no significant between‐group differences and only CVLT immediate recall reached adjusted statistically significant longitudinal change associated with changed cannabis use (group × wave P= 0.007). Specifically, former heavy users improved their performance relative to remaining heavy users (estimated marginal means: former heavy 6.1–7.5: remain heavy 6.4–6.6). Conclusions Cessation of cannabis use appears to be associated with an improvement in capacity for recall of information that has just been learned. No other measures of cognitive performance were related to cannabis after controlling for confounds.     

Sex differences after all those years? Heritability of cognitive abilities in old age

We investigated sex differences in genetic and environmental effects on cognitive abilities among older adult twins. We drew participants from the Swedish Twin Registry; our sample included 647 twin pairs. Our cognitive measures included Synonyms, Block Design, Digit Span, Thurstone's Picture Memory, Symbol Digit, and general cognitive ability tests. Higher age was related to lower performance in all cognitive measures, except synonyms. For digit span forward, symbol digit, and general cognitive ability tasks, there was a Sex x Age interaction, with greater deficits in the performance of women compared with those of men at higher ages. We found no sex-specific genetic influences. In other words, the same genetic effects were operating for men and women. Furthermore, the magnitude of genetic effect was similar for men and women.     

Age-related slowing on the Digit Symbol task: longitudinal and cross-sectional analyses

It is generally known that slowing on tasks like the Digit Symbol Substitution task occurs with age. However, simultaneous cross-sectional and longitudinal data are rare. The results from the cross-sectional analysis of Digit Symbol performance with age are compared to results from two occasion longitudinal analyses on the same task. The longitudinal data were obtained from 79 participants who were retested after 7 years and were between the ages of 48 and 73 years old at Time 1. Results indicated that the pattern of actual change observed in the longitudinal analyses replicated the simulated change indicated in the cross-sectional analysis. Antecedents were examined using the original cross-sectional sample of 150 participants. Significant relationships with Digit Symbol performance were found for age, education, and gender, but not for ratings of physical health.     

Death, dropout, and longitudinal measurements of cognitive change in old age

During a 20-year longitudinal study of cognitive change in old age 2,342 of 5,842 participants died and 3,204 dropped out. To study cognitive change as death approaches, we grouped participants by survival, death, dropout, or dropout followed by death. Linear mixed-effects pattern-mixture models compared rates of cognitive change before death and dropout from four quadrennial administrations of tests of fluid intelligence, vocabulary, and verbal learning. After we took into account the significant effects of age, gender, demographics, and recruitment cohorts, we found that approach to death and dropout caused strikingly similar reductions in mean test scores and amounts of practice gains between successive quadrennial testing sessions. Participants who neither dropped out nor died showed significant but slight cognitive declines. These analyses illustrate how neglect of dropout miscalculates effects of death, of worsening health, and of all other factors affecting rates of cognitive change.     

老年人脑白质损害与认知功能的关系

目的探讨老年人脑白质损害(WML)与认知功能的关系。方法选择457例男性老年人行头颅CT及数字广度、言语流畅、积木测验、词语延迟回忆、连线测验A、符号数字检查,按头颅CT表现将研究对象分为无WML(132例)、轻度WML(147例)、中度WML(105例)及重度WML(73例)4组。多因素协方差分析比较不同组别各项神经心理测验结果;用logistic回归分析不同WML状态下认知功能损害的相对危险性。结果重度WML组各项认知检测分数较无WML组有显著性差异(P<0.01),重度WML是各项认知功能损害的危险因素(P<0.01)。中度WML组在部分认知项目上与无WML组有显著性差异(P<0.01),轻度WML组与无WML组的认知功能无显著性差异(P>0.05)。结论轻度WML对认知的影响不明显,WML严重到一定程度时将使老年人认知功能产生广泛损害。     

Sources of influence on rate of cognitive change over time in Swedish twins: an application of latent growth models

The use of latent growth models to examine influence on individual differences on ability level versus rate of change were examined for measures of fluid ability, memory, and perceptual speed in a sample of twins from the Swedish Adoption/Twin Study of Aging. Results indicated a larger amount of individual variation for average ability level (i.e., intercept) than rate of change (i.e., slope) for all three traits: Block Design, Thurstone's Picture Memory, and Symbol Digit. Generally, genetic influences were of greater importance to individual variation in ability level whereas variation for rate of change exhibited a larger environmental component. These findings support theories of increasing environmental influences with age. When genetic and environmental sources of covariation between educational attainment and pulmonary function with latent growth parameters were considered, the sources of covariation between the latent cognitive growth model parameters (i.e., intercept and slope) and both covariates were primarily genetic for ability level (intercepts) but environmental for rate of change (slopes). Such findings suggest that the forces important to timing or entry into cognitive decline may reflect stochastic processes or external environmental factors, primarily nonshared, that may differentially hasten cognitive decline in twins. These same forces may overlap with those that influence higher or lower educational attainment or those leading to better or worse pulmonary functioning.     

Changes in objectively measured outdoor time and physical,psychological, and cognitive function among older adults with cognitive impairments

BackgroundOlder adults with cognitive impairment are at higher risk for various health problems. Although previous studies have suggested going outdoors more frequently might be effective to promote health, no longitudinal studies have examined objectively measured outdoor time in this population. This study examined the relationships between changes in objectively measured outdoor time and physical, psychological, and cognitive functions among older adults with cognitive impairments.MethodsThis study was a secondary analysis of a randomized controlled trial (n = 145). The baseline and 1-year follow-up data of outdoor time per day measured by the global positioning system, physical functions (6-minute walk test, 5-repetition chair stand test), psychological functions (Geriatric Depression Scale, simplified World Health Organization Five Well-being Index), and cognitive functions (tablet versions of the Trail-making Test, Symbol Digit Substitution Test, Word Memory Test, Story Memory Test) were used.ResultsMultiple regression analyses revealed that changes in outdoor time were significantly associated with changes in 6-minute walk (standardized beta = 0.20, p = 0.048) and 5-repetition chair stand tests (standardized beta = −0.19, p = 0.032) after adjusting for baseline data, basic factors, and trial allocation. However, significant relationships between changes in outdoor time and psychological and cognitive functions were not revealed.ConclusionsThe results indicate that maintaining or increasing outdoor time would be effective to prevent declines in physical functions but that a quantitative aspect of going outdoors would have limited impact on psychological and cognitive functions among older adults with cognitive impairment.     

Neuroticism does not affect cognitive functioning in later life

In a cross-sectional study, Jorm and colleagues (1993. Personality and Individual Differences, 15, 721-723) found that neuroticism was related to poorer cognitive performance in the elderly. The present study was initiated to expand their findings using both cross-sectional and longitudinal data from the Maastricht Aging Study. In contrast to the findings of Jorm and coworkers, neuroticism was not associated with either current cognitive performance or cognitive decline over a period of 3 years.     

Age, hormones, and cognitive functioning among middle-aged and elderly men: cross-sectional evidence from the Massachusetts Male Aging Study

BACKGROUND: This study examines interrelationships among age, hormones, and cognition for middle-aged and elderly men, and tests whether hormones predict lower cognitive functioning and mediate the age-cognition relationship. METHODS: We analyzed Time 2 data from the Massachusetts Male Aging Study, a population-based cohort study. Selection criteria included complete information on cognition and hormones (n = 981). Cognitive measures included working memory (Backward Digit Span test), speed/attention (Digit Symbol Substitution test), and spatial ability (Figural Relations test). Hormones included free testosterone, total testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), androstanediol glucuronide (3 alpha-A-diol-gluc), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (alternatively known as a "binding protein") (SHBG), prolactin (PRL), estrone (E1), and cortisol (CRT). Age was measured in years. Adjusted analyses added educational attainment, health conditions and behaviors, body mass index, and depression. RESULTS: Older age was associated with lower cognitive functioning. In unadjusted models, logged free and total testosterone, DHEA, and DHEAS related to higher functioning in at least one cognitive domain; logged FSH, SHBG, and LH related to lower functioning in at least one cognitive domain; and logged E1, CRT, and PRL were not significant. In adjusted models, logged hormones did not relate to cognitive function except for logged E1 and CRT, which had negative effects. Logged hormones did not mediate the age-cognition relationship. CONCLUSIONS: The direct effects of hormones on cognition are not significant when salient factors are considered. Further, hormones do not mediate the age-cognition relationship; it is necessary to look to other explanatory pathways.     

上海地区百岁老人认知状况调查

目的调查分析上海地区百岁老人的认知状况及其相关因素。方法以上海市范围内各区县随机抽取的3例百岁老人为调查对象,利用蒙特利尔认知评估表（MontrealCognitiveAssessment,MoCA）,简易精神状态检查（Mini—Mentalstate,MMSE）,以及老年抑郁量表（GeriatricDepressionScale,GDS）进行认知、情绪状况评估,并对性别、年龄、教育程度、居住环境、锻炼等因素进行相关性分析和回归分析。结果34例百岁老人中平均年龄（105．2±3．2）岁;其中男性18例（52．9％）,女性16例（47．1％）。MMSE提示认知正常的占41．2％,MoCA提示轻度认知障碍及认知正常的占26．5％,GDS提示无抑郁症状的占64％。不同性别、年龄、教育程度在MoCA、MMSE的认知评估中差异有统计学意义（P〈O．05）,有无失眠与锻炼习惯在MMSE、MoCA得分上差异无统计学意义。不同的性别、年龄、居住地、教育程度、锻炼习惯以及有无失眠在GDS得分上差异均无统计学意义（P〉0．05oMoCA、MMSE得分与性别、年龄与为负相关,与教育程度、GDS得分为正相关;MoCA、MMSE和GDS得分与睡眠、锻炼因素无明显相关性。结论上海地区百岁老人认知状况基本良好,同时抑郁情绪并不突出。提示高教育水平,良好心态,以及用脑锻炼,对保持良好的认知功能起到积极的作用。     

The relationship between changes in normal-range systolic blood pressure and cognitive function in middle-aged healthy women.

Little is known about the effect of normal-range blood pressure (BP) on cognitive function. In previous studies investigating the relationship between BP and cognitive function in elderly subjects, underlying cerebrovascular damage has complicated the interpretation of results. To reveal the relationship between BP levels that were within an absolutely normal range and cognitive function, we examined cognitive function in normotensive, healthy middle-aged women. BP levels were measured on three separate occasions at 1-month intervals, and the subjects exhibiting normotension (< 140/90 mmHg) throughout the evaluation period were recruited as normotensive subjects. Cognitive function was assessed using subtests of the Wechsler Adult Intelligence Scale-Revised. The study demonstrated that, among the subtests examined, the scores on the Digit Symbol Test, an index of psychomotor performance, had a significant correlation with normotensive-range systolic blood pressure (SBP) (r=-0.51, p<0.05); this relation was negative-that is, higher but still normal-range SBP levels were associated with impaired Digit Symbol Test scores. In addition, the relationship adjusted by age and educational level was also significant (partial correlation = -0.56, p<0.05). In contrast, diastolic BP was not related to the Digit Symbol Test (r = -0.33, p = 0.13). Furthermore, the Digit Symbol Test was not influenced by blood glucose or serum cholesterol levels. These findings suggested that, even within the normotensive range, lower levels of SBP might be protective against impairment of psychomotor speed in middle-aged women.     

Cohort differences in trajectories of cognitive aging

To separate age and cohort effects on decline in normal cognitive aging, we applied growth curve models to longitudinal data from the Swedish Adoption/Twin Study of Aging. Data from up to five measurement waves covering a 16-year period were available from 806 participants (age 50 to 88 at the first wave). We divided the sample into two cohorts by birth year: 1900-1925 and 1926-1948. We generated components to tap four cognitive domains: verbal and spatial ability, memory, and speed. We tested cohort differences by using two growth models: quadratic and two linear slopes. Results indicated significant cohort differences in average performance at age 67.5 for all components except speed. When we compared linear slopes during the same age range (age 62-78), we found no cohort differences. Trajectories of change with age in these four domains were fundamentally the same in middle-old age for individuals born during the first half of the 20th century.     

Predictors of cognitive complaints in older adults: a mixture regression approach

The present paper examined four hypotheses regarding the nature of cognitive complaints in older adults. Analyzing data from 607 participants (mean age=62.9 years, SD=0.92 years, 59–65 years), we tested the influence of actual cognitive test performance, negative age stereotypes, depressive symptoms, neuroticism, and conscientiousness on cognitive complaints. Bivariate correlations confirmed relations of all hypothesized predictors with cognitive complaints. However, considering all predictors simultaneously in an OLS regression analysis, particularly depressive symptoms and neuroticism were revealed as accounting for large proportions of variance in cognitive complaints. Utilizing mixture regression analyses, evidence for distinct subgroups was obtained in which cognitive complaints were explained by different predictor patterns.     

It's never too late to engage in lifestyle activities: significant concurrent but not change relationships between lifestyle activities and cognitive speed

Little is known about potential longitudinal relationships between participation in social, physical, and intellectual activities and later cognitive performance. Data from the Victoria Longitudinal Study (n = 530) were used to test whether baseline and change in lifestyle engagement were related to corresponding indicators of cognitive speed (measured by mean-level and intraindividual variability). Regressions based on random effects model estimates showed that cross-sectional activity participation predicted corresponding values of both mean-level and intraindividual variability, but few longitudinal relationships were significant. Overall, a higher frequency of participation in cognitively complex activities was related to faster response times and lower intraindividual variability. Findings suggest that activity level at one point in time may be a more important predictor of cognition than an individual's changes in activity level.     

Relationship between peripheral neuropathy and cognitive performance in the elderly population

There are only a few studies that have shown an association of peripheral neuropathy with cognitive impairment in elderly individuals. Therefore, we investigated the relationship between cognitive performance and peripheral neuropathy.From the database of the National Health and Nutrition Examination Survey (NHANES, 1999–2002), each participant completed a household interview, physical performance test, questionnaire regarding personal health, and Digit Symbol Substitution Test (DSST) to evaluate cognitive performance. The severity of peripheral neuropathy was assessed based on the number of insensate areas in both feet during monofilament examination. We used the multivariate linear regression to analyze the association of the DSST findings with insensate areas of the worse foot.There were 828 participants in our study from NHANES 1999 to 2002; their mean age was 69.96 ± 7.38 years, and 51.3% were male. The β coefficients of the number of insensate areas associated with the DSST findings were all negative values, and the absolute value increased as the number of insensate areas increased. After adjustment for pertinent variables, the correlations remained significantly negative (all P for trend <.001). In addition, subgroup analysis showed no gender differences in the negative association, but this association was not significant in obese participants (P > .05).Our study provides evidence that the severity of peripheral neuropathy is significantly negatively correlated with cognitive performance.     

Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: the PATH Through Life Project

AIMS: To investigate associations, including non-linear relationships, between cognitive function and alcohol consumption, testing for moderating effects of age and gender and for differences across outcome measures. Design Cross-sectional general population samples of three age cohorts. Setting Canberra and Queanbeyan, Australia. PARTICIPANTS: The total sample of 7485 consisted of 2404 men and women aged 20-24 years, 2530 aged 40-44 years, and 2551 aged 60-64 years, selected from the electoral rolls. Measurements Self-report data using hand-held computers provided weekly alcohol consumption from the Alcohol Use Disorders Identification Test (AUDIT) frequency, quantity and binge-drinking items, and socio-demographic factors. Spot-the-Word, digits backwards, the Symbol-Digit Modalities Test (SDMT), immediate recall and reaction-time tests were conducted by trained interviewers. FINDINGS: Findings varied across dependent variables, but there was a general tendency for light drinkers (up to 20/10 g alcohol per day in men/women, respectively) to perform better than abstainers, occasional drinkers or those drinking at hazardous/harmful levels (>40/20 g per day in men/women). Poorer performance of hazardous/harmful drinkers was seen only in men, whereas that of abstainers was evident in both sexes but was stronger in women. After adjustment for education and race, male hazardous/harmful drinkers no longer performed significantly less well than light drinkers, whereas male and female abstainers and occasional drinkers still did so. CONCLUSIONS: Abstainers have poorer cognitive function than light drinkers and further investigation is needed to determine what factors contribute to this.     

Higher levels of neuroticism in older adults predict lower executive functioning across time: the mediating role of perceived stress

Neuroticism has been associated with individual differences across multiple cognitive functions. Yet, the literature on its specific association with executive functions (EF) in older adults is scarce, especially using longitudinal designs. To disentangle the specific influence of neuroticism on EF and on coarse cognitive functioning in old adulthood, respectively, we examined the relationship between neuroticism, the Trail Making Test (TMT) and the Mini-Mental State Examination (MMSE) in a 6-year longitudinal study using Bayesian analyses. Data of 768 older adults (M_age?=?73.51 years at Wave 1) were included in a cross-lagged analysis. Results showed no cross-sectional link between neuroticism and TMT performance at Wave 1 and no longitudinal link between neuroticism at Wave 1 and MMSE at Wave 2. However, neuroticism at Wave 1 predicted TMT performance at Wave 2, indicating that the more neurotic participants were, the lower they performed on the TMT six years later. Additional analyses showed that this relation was fully mediated by participants’ perceived stress. Our results suggest that the more neurotic older adults are the more stress they may perceive six years later, which in turn negatively relates to their EF. In sum, this study demonstrates that neuroticism may lead to lower EF in older age across six years. It further suggests older adults’ perceived stress as mediator, thereby providing novel insights into the mechanisms underlying this relation. Possible intervention approaches to counter these effects are discussed.