Vascular Health and Cognitive Function in Older Adults with Cardiovascular Disease

BACKGROUND: We hypothesized that changes in vascular flow dynamics resulting from age and cardiovascular disease (CVD) would correlate to neurocognitive capacities, even in adults screened to exclude dementia and neurological disease. We studied endothelial-dependent as well as endothelial-independent brachial responses in older adults with CVD to study the associations of vascular responses with cognition. Comprehensive neurocognitive testing was used to discern which specific cognitive domain(s) correlated to the vascular responses. METHODS: Eighty-eight independent, community-dwelling older adults (70.02+7.67 years) with mild to severe CVD were recruited. Enrollees were thoroughly screened to exclude neurological disease and dementia. Flow-mediated (endothelial-dependent) and nitroglycerin-mediated (endothelial-independent) brachial artery responses were assessed using 2-d ultrasound. Cognitive functioning was assessed using comprehensive neuropsychological testing. Linear regression analyses were used to evaluate the relationships between the endothelial-dependent and endothelial-independent vascular flow dynamics and specific domains of neurocognitive function. RESULTS: Endothelial-dependent and endothelial-independent brachial artery responses both correlated with neurocognitive testing indices. The strongest independent relationship was between endothelial function and measures of attention-executive functioning. CONCLUSIONS: Endothelial-dependent and endothelial-independent vascular responsiveness correlate with neurocognitive performance among older CVD patients, particularly in the attention-executive domain. While further study is needed to substantiate causal relationships, our data demonstrate that brachial responses serve as important markers of risk for common neurocognitive changes. Learning and behavior-modifying therapeutic strategies that compensate for such common, insidious neurocognitive limitations will likely improve caregiving efficacy.     

Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

OBJECTIVES: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors. DESIGN: Cross‐sectional. SETTING: Chronic Renal Insufficiency Cohort Study. PARTICIPANTS: Eight hundred twenty‐five adults aged 55 and older with CKD. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m²) was estimated using the four‐variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score ≤1 standard deviations from the mean). RESULTS: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1–3.9), naming (AOR=1.9, 95% CI=1.0–3.3), attention (AOR=2.4, 95% CI=1.3–4.5), executive function (AOR=2.5, 95% CI=1.9–4.4), and delayed memory (AOR=1.5, 95% CI=0.9–2.6) but not on category fluency (AOR=1.1, 95% CI=0.6–2.0) than those with mild to moderate CKD (eGFR 45–59). CONCLUSION: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment.     

Long-Term Function in an Older Cohort—The Cardiovascular Health Study All Stars Study

OBJECTIVES: To evaluate shared and unique risk factors for maintaining physical and cognitive function into the ninth decade and beyond.
DESIGN: Longitudinal cohort study.
SETTING: Four U.S. communities.
PARTICIPANTS: One thousand six hundred seventy-seven participants in the Cardiovascular Health Study All Stars Study, assessed in 2005/06. Median age was 85 (range 77–102), 66.5% were women, and 16.6% were black.
MEASUREMENTS: Intact function was defined as no difficulty with any activities of daily living and a score of 80 or higher on the Modified Mini-Mental State Examination. Baseline characteristics assessed in 1992/93 included demographics, behavioral health factors, chronic disease history, subclinical disease markers, cardiovascular risk factors, and inflammatory markers. Multinomial logistic regression was used to compare risk for physical disability, cognitive impairment,and combined impairments with no functional impairment.
RESULTS: Of the 1,677 participants evaluated in both domains, 891 (53%) were functionally intact. Continuous measures of function, including the Digit Symbol Substitution Test and gait speed, showed that all groups, including the most functional, had declined over time. The functional group had less decline but also tended to have higher starting values. Functional individuals had a higher baseline health profile than those with either or cognitive impairment or both impairments combined. Women and individuals with greater weight had higher rates of physical impairment but not cognitive impairment. Risk factors common to both types of impairment included cardiovascular disease and hypertension.
CONCLUSION: Intact function was found in only approximately half of these older adults in the ninth decade and beyond. High baseline function and low vascular disease risk characterized functional aging.     

Nutritional Status and Cognitive Function in Community‐Living Rural Bangladeshi Older Adults: Data from the Poverty and Health in Ageing Project

OBJECTIVES: To investigate the association between nutritional status and general and specific (fluid and crystallized) cognitive functioning in a group of older people living in a rural area in Bangladesh. DESIGN: Cross‐sectional study. SETTING: Matlab, Bangladesh. PARTICIPANTS: Four hundred fifty‐seven randomly selected persons aged 60 and older (mean age 69.5 ± 6.8), 55% female. MEASUREMENTS: Nutritional status was evaluated using a modified form of the Mini Nutritional Assessment (MNA). General cognitive function was assessed using the Bangla Adaptation of the Mini‐Mental State Examination, and a word synonym test was used to test semantic memory function (a crystallized ability). To assess cognitive processing speed (a fluid ability), “cross balls” and “complete boxes” tests (scores/time unit) were used. Clinical diagnoses were registered. Structured questionnaires were used to assess demographic and socioeconomic status of the participants. RESULTS: Twenty‐six percent of the participants were undernourished, and 62% were at risk of malnutrition according to the MNA. The MNA scores were significantly lower in women than in men (P=.01). Women performed worse than men in all three cognitive tasks (P<.001). Poorer cognitive performance was independently associated with older age, female sex, illiteracy, visual impairment, severity of disease, and depressive symptoms. There were significant associations between better nutritional status and better cognitive performance tests of general ability and processing speed, whereas semantic memory appeared to be less affected. CONCLUSION: The association between nutritional status and cognitive function involves general and specific cognitive abilities, with fluid ability seeming to be affected but crystalized functions being relatively spared.     

Evaluation of Rewind Yoga on Physical Function Outcomes in Older Adults: A Preliminary Study

Yoga is growing in popularity and has the potential to improve strength, flexibility, mobility, and balance in older adults. However, few yoga programs tailored to the unique needs of older adults exist. Rewind Yoga? was created to address this gap and a pilot study was conducted to evaluate the effectiveness of the program on physical function parameters. Healthy, older adults (n = 16) residing in a retirement community (55 and older) enrolled in a study examining the effect of Rewind Yoga? on strength, flexibility, dynamic balance, and endurance as measured by the Senior Fitness Test. A single group design (n = 14) with three repeated measures (baseline, 6 weeks, and 12 weeks) was used. Results from repeated measures analysis of variance indicated significant (P < 0.05) improvements in all measures of the Senior Fitness Test at 6 and 12 weeks. Rewind Yoga? appears to improve flexibility, strength, dynamic balance, and muscular endurance in older adults.