Cardiovascular disease and cognitive performance in middle-aged and elderly men

BACKGROUND: Decline of cognitive function with age may be due, in part, to atherosclerotic changes. The aim of the present study was to determine the relative contribution of cardiovascular disease (CVD) to cognitive functioning in middle-aged and elderly men. METHODS: In a cross-sectional study, cognitive tests were administered to 400 independently living men aged 40-80 years. Compound scores were calculated for memory function, processing capacity/speed, and executive function. The MMSE was used as a measure of global cognitive function. Carotid intima-media thickness, pulse wave velocity and ankle brachial blood pressure index were assessed as measures of sub-clinical CVD. The adjusted association of sub-clinical and prevalent CVD with neuropsychological test scores in the total group and in subgroups was assessed by linear regression analysis. RESULTS: Increased IMT was associated with lower scores on memory performance, and increased PWV was associated with lower scores on processing capacity and executive functioning. Compared with subjects with no CVD, both sub-clinical and prevalent cardiovascular diseases were related to a lower memory performance, beta's (95% CI) were -0.45 (-0.83, -0.07) and -0.45 (-0.84, 0.01), respectively. These associations were present in both middle-aged and elderly men. Furthermore, we observed that for subjects who had sub-clinical or prevalent cardiovascular disease the distribution of MMSE-scores was shifted toward lower values; the distributions were statistically different (p=0.003). CONCLUSIONS: The results of this study support a relation of sub-clinical CVD with cognitive functioning in middle-aged and elderly men. These results suggest that actions to prevent cognitive decline by preventing atherosclerosis should be taken before middle age.     

Association between sex steroids and cognition in elderly men

Objective To examine the association of cognitive function with sex steroid and sex hormone binding globulin (SHBG) levels among elderly men. Design Prospective cohort study, The Osteoporotic Fractures in Men Study (MrOS), consisting of 5995 US community dwelling men of 65 years or older. Patients One thousand six hundred and two men were chosen randomly from MrOS cohort for sex steroid level measurements by Mass Spectrometry (MS) at baseline. Two thousand six hundred and twenty‐three MrOS participants with sex steroids measured using RIA were also examined. Measurements Baseline and follow‐up (4·5 years later) performance on two cognitive tests: Trails B (executive function and motor speed) and 3MS (global cognitive function). Baseline total testosterone and oestradiol were measured by MS. Free testosterone (free‐T) and free oestradiol (free‐E) were calculated. SHBG was measured by radioimmunoassay. Data were analysed using linear regression. Results Baseline free‐T and free‐E levels were not associated with cognitive performance or change in cognition, following adjustment for age, education, race, health status and alcohol use. Baseline SHBG levels were inversely associated with follow‐up trails B (P = 0·03) and 3MS performance (P = 0·02). Higher SHBG was associated with an increased risk of cognitive decline. Total sex steroid levels were not associated with cognitive performance. Conclusions Despite large numbers of participants and rigorous sex steroid measurements, we did not observe an association between cognition and either testosterone or oestradiol levels. We conclude that endogenous sex steroids in the normal range are not related to executive function or global cognitive function in elderly men. High SHBG deserves further examination as a risk factor for cognitive decline.     

Nonlinear relations of blood pressure to cognitive function: the Baltimore Longitudinal Study of Aging

This investigation examined cross-sectional and longitudinal relations, both linear and nonlinear, of blood pressure (BP) and its interaction with demographic and lifestyle variables to a broad spectrum of cognitive functions. Eight hundred forty-seven participants (503 men and 344 women) from the Baltimore Longitudinal Study of Aging completed tests of verbal and nonverbal memory, attention, perceptuo-motor speed, executive functions, and confrontation naming, and clinical assessment of BP on 1 to 7 occasions over 11 years. Mixed-effects regression models, adjusted for age, education, gender, alcohol consumption, smoking status, depression scores, and use of antihypertensive medications, revealed nonlinear relations of systolic BP with longitudinal change on tests of nonverbal memory and confrontation naming; cognitive decline was apparent among older (80 years) individuals with higher systolic BP. Cross-sectional findings, across testing sessions, indicated moderated U- and J-shaped relations between BP and cognitive function. Both high and low diastolic BP were associated with poorer performance on tests of executive function and confrontation naming among less-educated persons; with tests of perceptuo-motor speed and confrontation naming among nonmedicated (antihypertensives) individuals; and with executive function among older individuals. Cross-sectional linear relations included higher systolic BP and poorer nonverbal memory in nondrinkers, and higher diastolic BP and poorer working memory among less-educated individuals. Results indicate that cross-sectional and longitudinal relations of BP to cognitive function are predominantly nonlinear and moderated by age, education, and antihypertensive medications. Careful monitoring and treatment of both high and low BP levels may be critical to the preservation of cognitive function.     

Memory Dysfunction,Psychomotor Slowing,and Decreased Executive Function Predict Mortality in Patients With Heart Failure and Low Ejection Fraction

BackgroundThe purpose of this study was to evaluate whether dysfunction of specific cognitive abilities is a predictor of impending mortality in adults with systolic heart failure (HF).MethodsA total of 166 stable outpatients with HF completed cognitive function evaluation in language, working memory, memory, visuospatial ability, psychomotor speed, and executive function using a neuropsychological test battery. Demographic and clinical variables, comorbidity, depressive symptoms, and health-related quality of life were also measured. Patients were followed for 12 months to determine all-cause mortality.ResultsThere were 145 survivors and 21 deaths. In logistic regression analyses, significant predictors of mortality were lower left ventricular ejection fraction (LVEF) and poorer scores on measures of global congnitive function Mini-Mental State Examination [MMSE], working memory, memory, psychomotor speed, and executive function. Memory loss was the most predictive cognitive function variable (overall χ² = 17.97, df = 2, P < .001; Nagelkerke R² = 0.20). Gender was a significant covariate in 2 models, with men more likely to die. Age, comorbidity, depressive symptoms, and health-related quality of life were not significant predictors. In further analyses, significant predictors of mortality were lower systolic blood pressure and poorer global cognitive function, working memory, memory, psychomotor speed, and executive function, with memory being the most predictive.ConclusionsAs hypothesized, lower LVEF and memory dysfunction predicted mortality. Poorer global cognitive score as determined by the MMSE, working memory, psychomotor speed, and executive function were also significant predictors. LVEF or systolic blood pressure had similar predictive values. Interventions are urgently needed to prevent and manage memory loss in HF.     

Association between executive function and physical performance in older Korean adults: findings from the Korean Longitudinal Study on Health and Aging (KLoSHA)

Reduced executive function and physical performance are common age-related conditions. This study evaluated the associations between executive function and physical performance in a representative sample of older adults. Cross-sectional data were analyzed from a population-based sample of 629 men and women aged 65 or older and living in one typical city in Korea. Specific aspects of executive function were assessed using the trail making test, digit span test, and lexical fluency test to measure set shifting, working memory and cognitive flexibility functions. Physical performance was measured using performance-oriented mobility assessment (POMA) scores and isokinetic muscle strength. Subjects’ self-efficacy was also assessed using the activities-specific balance confidence (ABC) scale. Results of the lexical fluency test were associated with POMA scores and muscle strength, independent of age, gender, education, comorbidity, physical activity status, depression, and global cognition, suggesting that reduced cognitive flexibility is associated with reduced physical performance and muscle strength. Self-efficacy was also independently associated with physical performance and muscle strength. Clinicians need to consider the association between executive function and physical performance when working to improve physical functioning in an aged population.     

Physical frailty and cognitive function among men with cardiovascular disease

AimsTo assess the relationship between physical frailty and cognitive function among elderly men with a history of cardiovascular disease (CVD).MethodsThree-hundred-twenty-four community-dwelling men with chronic CVD (mean age 77.2 ± 6.4 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990–1998) underwent assessment of frailty and cognitive function between 2011 and 2013. Physical frailty was assessed using the Fried phenotypic model, and cognitive performance overall and in memory, executive function, visuospatial and attention domains was evaluated using a validated set of computerized cognitive tests. Linear regression models were used to assess the cross-sectional relationship of frailty status and its components (gait speed, grip strength, weight loss, exhaustion and activity) with cognitive function overall and in specific domains, adjusting for age, education, smoking status, physical activity, history of myocardial infarction, hypertension, diabetes and dyslipidemia, systolic blood pressure, BMI and depression.ResultsOf the 324 men, 91 (28%) were frail and 121 (37%) were pre-frail. After controlling for potential confounders, severity of frailty was strongly associated with global cognitive function (β = −8.0, 95%CI = −11.9,−4.1 and β = −3.3, 95%CI = −6.0,−0.5 comparing frail and pre-frail to non-frail, respectively), with the most profound associations observed in executive function and attention. Gait speed was associated with overall cognitive performance and with all cognitive domains assessed in this study, and activity with none.ConclusionCognitive function is poor among frail and pre-frail men with CVD, particularly in non-memory domains. Future research is warranted to address mechanisms and to assess the efficacy of interventions to improve physical and cognitive health.     

The Met66 allele of the functional Val66Met polymorphism in the brain-derived neurotrophic factor gene confers protection against neurocognitive dysfunction in systemic lupus erythematosus

BACKGROUND: A common functional polymorphism of the brain-derived neurotrophic factor gene (BDNF Val66Met) was previously associated with diminished episodic memory performance in healthy people. As cognitive function is commonly impaired in patients with systemic lupus erythematosus (SLE), the association of the BDNF Val66Met with neurocognitive function was studied. OBJECTIVE: To study the association of the BDNF Val66Met with neurocognitive function in a cohort of patients with SLE. METHODS: Cognitive function was assessed in 59 patients with SLE with no previous or current central nervous system involvement. Cognitive tests were grouped into five domains (memory, attention/executive function, visuospatial skills, motor function and psychomotor speed) and used to obtain domain Z scores, reflecting the difference between averaged scores of performance on individual tests and published norms in each domain. Genotyping was carried out using a 5'-nuclease assay with 99.9% accuracy. Unpaired t test was used to assess the relationship between genotypes and cognitive function, whereas the effect of possible confounders was assessed in a multivariate analysis. RESULTS: Patients carrying the Met66 allele scored significantly higher on psychomotor, attention/executive and motor function tests, resulting in significantly higher domain Z scores for the psychomotor (p = 0.005) and motor (p = 0.002) domains. CONCLUSIONS: The BDNF Met66 allele was associated with better cognitive functioning in the psychomotor and motor domains, even after controlling for differences in ethnicity, sex, depression status and prednisone treatment. These data suggest that the BDNF Met66 allele confers protection against the decline of motor and psychomotor cognitive functions in patients with longstanding SLE.     

Changes in Neuropsychological Functioning with Progression of HIV-1 Infection: Results of an 8-Year Longitudinal Investigation

Despite the advent of more effective treatments for HIV-1 infection, cognitive impairment is still frequent and questions remain regarding which areas of impairment are more common in the different disease stages. This study investigated cognitive performance over an 8-year period of time in 59 HIV-1 seropositive (HIV-1+) men who were clinically asymptomatic at study entry, in comparison to a cohort of 55 HIV-1 seronegative (HIV-1-) men. Every 6 months we examined cognitive functioning in 5 domains-fine motor speed, attention, verbal memory, executive functioning, and speed of information processing. We found that patients with AIDS scored significantly worse on fine motor speed and speed of information processing than HIV-1- individuals and the HIV-1+ non-AIDS patients. In addition, the HIV-1+ non-AIDS patients performed more poorly than the HIV-1- group on speed of information processing. Depressive symptoms were also associated with diminished performance on measures of attention, executive functioning, and speed of information processing. Further research is needed to examine the effects of disease stage and depression on cognitive impairment in the era of new HIV treatments.     

Relationship between mild cognitive decline and oral motor functions in metropolitan community-dwelling older Japanese: The Takashimadaira study

BackgroundDiminished oral motor function is considered to be a factor influencing cognitive decline, but this association has not been clarified. The aim of the present study was to clarify the association between cognitive and oral motor function in older people with either from normal cognitive function or mild cognitive decline.MethodsA cross-sectional study was conducted across 1118 older people (445 men, 673 women) aged ≥70 years (mean age, 77.0 ± 4.7 years) who lived in a city of Tokyo Metropolis, Japan. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Older people who had an MMSE score of 23 points or lower were excluded. To investigate the relationship between cognitive and oral motor function, Pearson’s correlation, multiple linear regression, and path analysis were performed.ResultsPearson’s correlation revealed that, among the oral motor functions assessed, masticatory performance, occlusal force, and tongue pressure were correlated with MMSE score. Multiple linear regression showed that tongue pressure and oral diadochokinesis (ODK) were significantly associated with MMSE score. Path analysis revealed that decreases in tongue pressure and in ODK were directly associated with decreases in MMSE score. Decreases in tongue pressure were also indirectly associated with decreases in MMSE score via decreases in ODK.ConclusionsAmong the oral motor functions assessed, tongue pressure and ODK were associated with cognitive function in older people ranging from those with normal cognitive function to those with mild cognitive decline. Diminished tongue pressure and ODK might thus lead to cognitive decline.     

Kidney function and cognitive performance and decline in older men

OBJECTIVES: To examine the association between kidney function and cognitive impairment and decline in elderly men. DESIGN: Observational prospective cohort. SETTING: Community based. PARTICIPANTS: Five thousand five hundred twenty‐nine community dwelling men aged 65 and older (mean age 73.6 ± 5.9). MEASUREMENTS: Estimated glomerular filtration rate (eGFR) calculated using the standardized Modification of Diet in Renal Disease (MDRD) equation; cognitive function assessed using the Modified Mini‐Mental State Examination (3MS) and Trail Making Test B (Trails B). RESULTS: At baseline, 148 (2.7%) and 494 (9.1%) men were classified as cognitively impaired and, in the 5‐year prospective analysis, 931 (23%) and 432 (11.6%) met the criteria for cognitive decline at follow‐up defined according to 3MS and Trails B performance, respectively. In unadjusted analysis, the odds of prevalent cognitive impairment and risk of cognitive decline were significantly higher in men with an eGFR less than 45 and 45 to 59 mL/min per 1.73 m² than in men with an eGFR 60 mL/min per 1.73 m² or greater. Differences in age, race, and education between eGFR categories largely explained these associations, with the exception of the association between poorer renal function and higher odds of impairment based on Trails B test score, which persisted despite adjustment for multiple potential confounders. CONCLUSION: This study found evidence of an independent association between mild to moderate reductions in kidney function and poor executive function at baseline but not with global cognitive impairment or risk of cognitive decline in older men.     

Depressive Symptoms and Incident Cognitive Impairment in Cognitively Well-Functioning Older Men and Women

OBJECTIVES: To investigate whether the effect of depressive symptoms on the risk of cognitive decline and incident cognitive impairment (CI) in cognitively well-functioning older persons differed between men and women and whether sex differences in cerebrovascular factors might explain this.
DESIGN: Prospective cohort study.
SETTING: General community.
PARTICIPANTS: One thousand four hundred eighty-seven well-functioning Chinese older adults (Mini-Mental State Examination (MMSE) score ≥24) assessed at baseline for the presence of depressive symptoms (Geriatric Depression Scale score ≥5), and covariates (age, apolipoprotein E ɛ4, education, smoking, alcohol drinking, and vascular risk factors and diseases).
MAIN OUTCOME MEASURES: Incident CI and change in MMSE were assessed at 2-year follow-up.
RESULTS: In the whole sample, participants with depression showed significantly more incident CI than those without (5.7% vs 2.6%, P =.04; adjusted odds ratio (OR)=2.29, 95% confidence interval (CI)=1.05–5.00. Significantly higher OR was observed only in men (OR=4.75, 95% CI=1.22–18.5) and not for women (OR=1.29). There was a correspondingly greater rate of cognitive decline in participants with depressive symptoms that was observed to be marked only in men and not in women. The association was accentuated in subgroups with hypertension or vascular factors, but the sex differences in association were consistently observed.
CONCLUSION: The association between depressive symptoms and risk of cognitive decline was observed only in men and was not explained by sex differences in vascular factors. The comorbid presence of underlying cerebral vascular pathology or multi-infarct disease was possibly not a mediating factor but might amplify the process of cognitive decline.     

Does Low to Moderate Alcohol Intake Protect Against Cognitive Decline in Older People?

OBJECTIVES: To determine whether low to moderate alcohol intake is protective against cognitive decline in older people. DESIGN: Prospective cohort study. SETTING: Community‐based study in Ireland, the Netherlands, and Scotland. PARTICIPANTS: Five thousand eight hundred four people (3,000 women) aged 70 to 82 and randomized to pravastatin or placebo in the Prospective Study of Pravastatin in the Elderly at Risk. MEASUREMENTS: Alcohol consumption was determined at study baseline. Serial measures of cognitive function over 3.2 years mean follow‐up included Mini‐Mental‐State‐Examination (MMSE), speed of information processing (Stroop and Letter‐Digit Coding tests), and immediate and delayed memory (Picture‐Word Learning test). RESULTS: Forty‐two percent of women and 71% of men were alcohol drinkers. Cognitive performance was better for female drinkers than nondrinkers for all cognitive domains over the 3.2‐year follow‐up; no significant effects were seen for men (linear mixed model, including adjusting for possible confounders). The rate of cognitive decline was similar for drinkers and nondrinkers for all cognitive domains, except for MMSE, which declined significantly less in female drinkers than nondrinkers (linear mixed model attenuated rate of decline=0.05 MMSE units per annum, P=.001). CONCLUSION: Drinking low to moderate amounts of alcohol may delay age‐associated cognitive decline in older women (including slowing deterioration in global cognitive function), but these apparent benefits were not clearly seen in older men.     

The association between low diastolic blood pressure in middle age and cognitive function in old age. A population-based study

BACKGROUND: previous longitudinal studies have shown an inverse relation between blood pressure and cognitive function. OBJECTIVE: to determine the association between mid-life blood pressure and performance in different areas of cognitive function in late life. SUBJECTS AND METHODS: we recruited 502 men, aged 69-74 years, from a population-based cohort in Uppsala, Sweden. Blood pressure had been measured at age 50 and we examined performance in 13 psychometric tests about 20 years later. RESULTS: after the 39 men with a previous stroke had been excluded, there was an inverse relation between diastolic blood pressure at age 50 and performance 20 years later in the digit span test, the trail-making tests and in verbal fluency. The relationships were significant, independently of age, education and previous occupational level. Men within the lowest category of diastolic blood pressure (< or = 70 mmHg, n = 59) showed the best results. Baseline blood pressure levels were not linked to performance in tasks on vocabulary, verbal learning and memory or figure copying. CONCLUSIONS: low blood pressure in mid-life indicates a low long-term cerebrovascular risk and is associated with higher late-life performance in cognitive tests that mainly assess subcortico-frontal cognitive functions.     

The clock drawing test is an independent predictor of incident use of 24-hour care in a retirement community

BACKGROUND: It is unclear how early cognitive impairment affects future care needs. Furthermore, the Mini-Mental State Examination (MMSE), a commonly used screening tool in the clinical setting, tends to have a ceiling effect for early cognitive decline. One of the earliest changes in cognitive function is executive impairment. We examined the relationship between executive function, measured with a clock drawing protocol (CLOX1) designed to capture executive impairment, and incident need for increased level of care and total mortality. METHODS: Residents (n = 230) in independent living at a continuing care retirement community were followed for incident need for 24-hour care (mean 2.5 years). Baseline assessment included health status and physical and cognitive function. Time to event analysis was performed to determine the association of the CLOX1 score with the outcomes. RESULTS: Forty percent of residents had a CLOX1 score <12, and 10% had an MMSE score <26. The event rate for a CLOX1 score <12 was 30 per 100 person-years (p-y) and 13 per 100 p-y for a score > or =12. Similarly, the event rate was 34 per 100 p-y versus 17 per 100 p-y for MMSE <26 and MMSE > or =26, respectively. A CLOX1 score <12 was associated with a twofold higher risk of incident use of 24-hour care (hazard ratio 2.2; 95% confidence interval: 1.5-3.4) and death (hazard ratio 2.3; 95% confidence interval: 1.1-4.8) even after controlling for age, sex, comorbidity, and MMSE scores. The MMSE score was not an independent predictor of incident use of 24-hour care or mortality. CONCLUSION: The clock drawing test, scored for executive impairment, but not the MMSE, predicted incident use of 24-hour care and mortality in this cohort of independent older adults.     

脑皮质下小血管梗塞后认知功能损害的恢复及其影响因素

目的 研究脑皮质下小血管梗塞（SSVI）后12周认知功能恢复的发生率、行为神经病学特点及认知功能恢复的影响因素。方法 采用前瞻性队列研究方法，选取首次发病，病程〈2周的SSVI患者60例，同时选取日常生活能自理的社区老年人52例作为对照组。SSVI后2和12周采用简易精神状态检查（MMSE）量表与洛文斯顿认知功能成套测验（LOTCA，包括LOTCA总分、定向力、视空间能力及执行功能）进行认知功能评分，并进行神经功能缺损及日常生活能力评价（修订版Barthel指数，MBI）。分析影响各类型认知功能恢复的因素。比较各类型认知功能恢复与未恢复患者日常生活能力的差异。结果 ①SSVI后2周内共有44例患者出现认知功能损害，与SSVI后2周比较，SSVI后12周MMSE、定向力、视空间能力、执行功能评分及LOTCA总分均有所改善，但除定向力评分恢复至对照组水平外（P〉0．05），其余各项评分仍低于对照组水平（P〈0．01）；恢复率分别为36．8％（14／38）、87．5％（14／16）、33．3％（4／12）、26．1％（12／46）及30．2％（13／44）。②多因素Logistic回归分析显示，男性（OR：3．49，95％CI：1．18～7．81）与SSVI后12周MMSE评分有关；受教育程度（初中及其以上，OR=2．53，95％CI：1．23～6．87）及脑白质病变（OR=0．23，95％CI：0．07—0．79）与执行功能评分有关。③与SSVI后2周比较，SSVI后12周NIHSS评分差异无统计学意义（P〉0．05）；而MBI评分显著提高，差异有统计学：鼓义（P〈0．05）；SSVI后12周，在各类型认知功能中，仅执行功能及LOTCA总分恢复者与未恢复者之间，MBI评分差异有统计学意义（P〈0.05）。结论 SSVI后12周各类型的认知功能均有显著的改善。但大部分患者仍存在某一类型的认知功能损害。执行功能的恢复有助于日常生活能力的提高。男性是MMSE总分恢复?     

Component cognitive and motor processes of the digit symbol test: differential deficits in alcoholism, HIV infection, and their comorbidity

BACKGROUND: Alcoholism (ALC) is highly prevalent in patients with human immunodeficiency virus (HIV) infection (HIV), and those with comorbidity (ALC+HIV) may suffer compounded deficits in cognitive and motor functions affected by both conditions. Given that each disease can adversely affect motor, visuospatial, and executive functions, we used an expanded version of the Digit Symbol (DS) test to assess the separate and combined effects of ALC and HIV infection on these cognitive and motor components. METHODS: Participants were 44 ALC, 43 HIV, 55 ALC+HIV, and 49 normal controls (NC). We modified DS test administration to assess sustained attention (grid completion speed), associative learning (number of boxes completed in 15-second epochs), and incidental learning (total number-symbol pairs correctly recalled) and also used ancillary tests of fine motor, visuospatial, and executive functions to assess their relationship with the different components of DS performance. All scores were corrected for age and education based on NC performance. RESULTS: Neither single diagnosis group-ALC nor HIV-was impaired on DS score or grid completion speed compared with the NC group, but the dual-diagnosis ALC+HIV group was impaired. Greater lifetime alcohol consumption was associated with longer grid completion time in both ALC and ALC+HIV. The HIV group demonstrated associative learning on DS but ALC+HIV and ALC did not. All groups performed similarly on incidental learning. Multiple regression analyses demonstrated that executive functions, assessed by Color Trails 2, predicted traditional DS performance in all groups. Fine Finger Movement additionally predicted traditional DS performance and grid completion speed in HIV. Visuospatial function, assessed by ability to copy the Rey-Osterrieth complex figure, did not contribute independently to DS performance in either alcohol group. CONCLUSIONS: Alcoholism combined with HIV infection resulted in deficits in visuospatial psychomotor function, as assessed by the DS test, although deficits were not observed in either disease condition alone. Neither alcohol group showed associative learning, and both had compromised sustained attention. Combined cognitive and motor adverse effects of alcoholism and HIV infection were manifest in psychomotor speed, sustained attention, and associative learning of visuospatial material and are testimony to the dangers of alcohol abuse even in relatively healthy patients with HIV infection.     

On the impact of age,gender and educational level on cognitive function in Alzheimer’s disease: A quantitative approach

BackgroundThe Mini-Mental State Examination (MMSE) test is a brief and useful tool widely utilized to measure dementia severity. The effects of education, age and gender on the total MMSE scores are less well-understood. Also, there are few studies about cognitive domains involvement in Alzheimer’s disease and the effects of demographic factors on it. The aim of this study is to assess the relationship between seven areas of cognitive function in the MMSE test with age, gender and education level.MethodsIn this study, 182 patients with Alzheimer (125 women and 57 men) were evaluated. We investigated the impact of age, sex and education on total score of MMSE and each areas of cognitive function. The results were analyzed by MATLAB software.ResultsThe most cognitive domain that was impaired in the MMSE test was orientation to time. Moreover, the most involved cognitive areas based on age, gender and educational level were recall, orientation to place and language, respectively.ConclusionWe found that there were meaningful correlations between the demographic factors and subsets of the MMSE score.     

Cognitive and fine motor deficits in a pediatric sickle cell disease cohort of mixed ethnic origin

Cerebrovascular disease is an important feature of pediatric sickle cell disease (SCD) and may lead to cognitive and motor impairment. Our cross-sectional study examined the incidence and severity of these impairments in a pediatric cohort without clinical cerebrovascular events from Berlin of mixed ethnic origin. Thirty-two SCD patients (mean age 11.14 years, range 7.0–17.25 years; males 14) were evaluated for full-scale intelligence (IQ) (German version WISC-III), fine motor function (digital writing tablet), and executive function (planning, attention, working memory, and visual-spatial abilities) with the Amsterdam Neuropsychological Tasks (ANT) program and the Tower of London (ToL). Data on clinical risk factors were retrieved from medical records. Full-scale IQ of patients was preserved, whereas performance IQ was significantly reduced (91.19 (SD 12.17) d?=?0.7, p?=?0.007). SCD patients scored significantly lower than healthy peers when tested for executive and fine motor functions, e.g., planning time in the ToL (6.73 s (SD 3.21) vs. 5.9 s in healthy peers (SD 2.33), d?=?0.5, p?=?<0.001) and frequency on the writing tablet (mean z score ?0.79, d?=?0.7, p?<?0.001). No clinical risk factors were significantly associated with incidence and severity of cognitive and motor deficits. Despite the preservation of full-scale IQ, our SCD cohort of mixed origin exhibited inferior executive abilities and reduced fine motor skills. Our study is limited by the small size of our cohort as well as the lack for control of sociodemographic and socioeconomic factors modulating higher functions but highlights the need for early screening, prevention, and specific interventions for these deficits.     

Cognitive Reserve and Emotional Stimuli in Older Individuals: Level of Education Moderates the Age-Related Positivity Effect

Background/Study Context: A frequently observed age-related effect is a preference in older individuals for positive stimuli. The cognitive control model proposes that this positivity effect may be mediated by executive functions. We propose that cognitive reserve, operationally defined as years of education, which tempers cognitive decline and has been linked to executive functions, should also influence the age-related positivity effect, especially as age advances.

Methods: An emotional free recall test was administered to a group of 84 cognitively intact individuals aged 60 to 88, who varied in years of education. As part of a larger test battery, data were obtained on measures of executive functioning and depression.

Results: Multiple regression and moderation analyses were performed, controlling for general cognitive function, severity of depressive symptoms, and executive function. In our data, years of education appeared to moderate the effect of age on the positivity effect; age was negatively associated with recall of positive words in participants with fewer years of education, whereas a nonsignificant positive correlation was observed between age and positivity in participants with more education.

Conclusion: Cognitive reserve appears to play a role in explaining individual differences in the positivity effect in healthy older individuals. Future studies should investigate whether cognitive reserve is also implicated in the ability to process a wide range of emotional stimuli and whether greater reserve is reflected in improved emotional regulation.     

Examining the influence of gender, education, social class and birth cohort on MMSE tracking over time: a population-based prospective cohort study

ABSTRACT: BACKGROUND: Whilst many studies have analysed predictors of longitudinal cognitive decline, few have described their impact on population distributions of cognition by age cohort. The aim of this paper was to examine whether gender, education, social class and birth cohort affect how mean population cognition changes with age. METHODS: The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) is a multi-centre population based longitudinal study of 13,004 individuals in England and Wales. Using ten years of follow-up data, mean Mini-mental State Examination (MMSE) scores were modelled by age and birth cohort adjusting for non-random drop-out. The model included terms to estimate cohort effects. Results are presented for five year age bands between 65-95 years. RESULTS: At a population level, women show greater change in MMSE scores with age than men. Populations with lower education level and manual work also show similar effects. More recent birth cohorts have slightly higher scores. CONCLUSION: Longitudinal data can allow examination of population patterns by gender, educational level, social class and cohort. Each of these major socio-demographic factors shows some effect on whole population change in MMSE with age.