Serum high sensitivity C-reactive protein and cognitive function in elderly women

BACKGROUND: Inflammation has been linked to cognitive impairment. However, limited data are available on the association between inflammatory markers and cognitive function. OBJECTIVES: We tested the hypothesis that elevated serum concentration of high sensitivity C-reactive protein (hs-CRP), an established marker of low-grade inflammation, predicts cognitive impairment in elderly women. DESIGN: A 12-year population-based follow-up study. PARTICIPANTS: A total of 97 women between 60 and 70 years of age at baseline. METHODS: Serum hs-CRP concentration was measured by a high sensitivity assay. Global cognitive function was measured with the Mini-Mental State Examination (MMSE), and memory and cognitive speed were measured with a detailed cognitive test battery. RESULTS: Higher baseline hs-CRP was associated with poorer memory at 12-year follow-up without adjustment and after adjustment for age, education and depression (standardised regression coefficient beta -0.842, 95% confidence interval -1.602 to -0.083, P = 0.030), and further adjustment for the use of hormone replacement therapy, smoking, serum LDL cholesterol and body mass index (standardised regression coefficient beta -0.817, 95% confidence interval -1.630 to -0.004, P = 0.049). Memory at 12-year follow-up worsened linearly with increasing hs-CRP at baseline (P = 0.048 for linear trend). There was no association between hs-CRP at baseline and cognitive speed or MMSE score at 12-year follow-up. CONCLUSIONS: High serum hs-CRP concentration predicts poorer memory 12 years later in elderly women. Hs-CRP may be a useful biomarker to identify individuals at an increased risk for cognitive decline.     

Plasma homocysteine and inflammation in elderly patients with cardiovascular disease and dementia

Increased levels of plasma total homocysteine (tHcy) may play a role in both cardiovascular diseases (CVD) and old-age dementias via enhancement of vascular inflammation. However, the association between plasma tHcy and serum C-reactive protein (sCRP), taken as a marker of low-grade inflammation, is still uncertain. We investigated this association in normal aging, CVD, and dementia, and examined whether it was modified by the presence of two major comorbid diseases of older age: chronic obstructive pulmonary disease (CPOD) and peptic ulcer (PU). Six hundred-twenty-seven individuals aged > or = 65 yr (74+/-7 yr) were selected for this study: 373 healthy controls; 160 patients with CVD but no evidence of comorbid diseases (CVD+/comorbidity-); 46 patients with CVD and concurrent CPOD and/or PU (CVD+/comorbidity+); and 48 patients with dementia. A positive association between plasma tHcy and serum CRP, independent of several confounders (socio-demographic status, known tHcy and sCRP determinants, inflammation markers, traditional vascular risk factors), was found for CVD+/comorbidity+ (p=0.001; not affected by dementia type) and dementia (p=0.001; not affected by dementia type), but not for CVD+/comorbidity- and controls. The results suggest that the association between plasma tHcy and sCRP is more an aspecific reflection of poor health than a specific correlate of vascular inflammation.     

Relation of age-related macular degeneration and cognitive impairment in an older population

BACKGROUND: The aetiology of age-related macular degeneration (AMD) and cognitive impairment is poorly understood. A link between cognitive impairment and AMD has been proposed although only a weak association was found in population-based studies. PURPOSE: To assess cross-sectional associations between AMD and cognitive impairment in an older Australian population. METHODS: The Blue Mountains Eye Study examined 3,509 persons aged 49+ years during 1997-2000. AMD lesions were assessed from retinal photographs using the Wisconsin System. Mini-mental state examination (MMSE), demographics, lifestyle factors and medical history were collected at interview. MMSE score was categorised as high-normal (28-30), low-normal (24-27) and impaired (< 24). A modified MMSE excluded five vision related items and was dichotomised as normal (18-22) and impaired (0-17). Logistic regression was used to assess associations after adjusting for age, sex, visual impairment, stroke, current smoking status, hypertension, alcohol consumption and post-high-school qualification. RESULTS: Prevalence rates for late and early AMD were 1.5% (n = 50) and 8.3% (n = 273), respectively. Cognitive impairment was present in 18.0% in persons with late AMD and 8.4% with early AMD, compared to 2.6% in persons without AMD. After multivariate adjustment, late AMD was associated with low normal MMSE (odds ratio (OR): 2.2, 95% confidence interval (CI): 1.1-5.0) and cognitive impairment (OR: 3.7, CI: 1.3-10.6). Using the modified MMSE, the multivariate association between late AMD and cognitive impairment remained (OR: 2.2, CI: 1.0-5.0). No significant association was found between cognitive impairment and early AMD. CONCLUSIONS: We found a significant, cross-sectional association between late AMD and cognitive impairment in a sample of older Australians that appeared to be independent of visual impairment. The association was weaker but remained significant after excluding vision-related items from the MMSE.     

Quality of life determinants and hearing function in an elderly population: Osservatorio Geriatrico Campano Study Group

BACKGROUND: Hearing impairment (HI) is a very common condition in elderly people and the epidemiology together with hearing-related problems is still poorly investigated. Moreover, the cognitive status may be impaired in relation to hearing function. OBJECTIVE: The goal of the study was to evaluate: (a) the prevalence of HI in a random sample of elderly people aged 65 and over (n = 1,750) living in Campania, a region of southern Italy; (b) the cross-sectional relationship between hearing function and cognitive status and also depressive symptomatology and disability, and (c) to assess the role of hearing aids on depressive symptomatology. METHODS: Cross-sectional study on a random sample of elderly population. RESULTS: The overall participation rate in the study was 74.8% (n = 1,332, mean age was 74.2 +/- 6.4 years). The prevalence rate of HI (evaluated by questionnaire) was 27.2%, cognitive impairment prevalence (evaluated by the Mini-Mental State Examination (MMSE)) was 27.9%, mean depressive symptomatology score (evaluated by Geriatric Depression Scale (GDS)) was 11.4 +/- 6.6, while disability assessed by Activity of Daily Living (ADL) was present in 7.0% of the whole population. A strong relationship was found between both decreasing hearing function and MMSE decline, independently by the effect of age and education (r = 0.97; p < 0.01). A positive relationship (r = 0.85; p < 0.01) between GDS score and hearing function was also found. Moreover, at an increased level of hearing loss, a lower ADL score was recorded (r = 0.98; p < 0.01). Finally, the use of hearing aids reduced GDS score. In logistic regression analysis, gender, age and educational level indicate that hearing loss risk increased with age (odds ratio 1.60; 95% confidence interval 1.53-1.71), whereas education plays a protective role (odds ratio 0.75; 95% confidence interval 0.72-0.80). CONCLUSION: HI is very prevalent among elderly people and is associated with either cognitive impairment and/or depression and reduction of functional status. This study suggests that hearing aids may protect against cognitive impairment and disability, improving quality of life of aged people. Copyrightz1999S.KargerAG,Basel     

Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints

OBJECTIVE: To evaluate the relationship between antihypertensive treatments and cognitive function in elderly hypertensive patients with memory complaints. METHODS: The association between cognitive function and antihypertensive drug therapy was studied in 1241 hypertensive elderly patients with memory complaints attending a geriatric outpatient clinic. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and validated neuropsychological tests (Cognitive Efficiency Profile; CEP). Patients were classified into four categories according to their cognitive status: normal cognitive function, mild cognitive impairment (MCI), Alzheimer's disease (AD) or vascular dementia (VaD). RESULTS: In this population aged 78 +/- 8 years, with a mean blood pressure of 152 +/- 19/86 +/- 12 mmHg, antihypertensive treatment was prescribed for 57% of patients. After adjustment for age, sex and education, treated hypertensive patients had better cognitive function than untreated patients (MMSE score 23.9 +/- 5.6/30 versus 22.7 +/- 6.4/30, P < 0.001, CEP score 49.1 +/- 24.9/100 versus 45.4 +/- 23.7/100, P < 0.001). This association was observed independently of the cognitive status, both in normal, MCI, AD and VaD hypertensive patients. The odds ratio (OR) for AD was 0.58 [95% confidence interval (CI) 0.42-0.81] in treated compared with untreated hypertensive patients. In patients on antihypertensive therapy, higher cognitive function was observed in patients using calcium antagonists compared with those without calcium antagonists (CEP 52.9 +/- 24.6/100 versus 46.4 +/- 23.4/100, P < 0.001; OR for AD 0.67; 95% CI 0.45-0.99), independently of blood pressure level. CONCLUSIONS: Antihypertensive therapy was associated with a lower risk of cognitive impairment and AD. In particular, the use of calcium antagonists was associated with a decreased risk of cognitive impairment and AD independently of the blood pressure level, suggesting a specific neuroprotective effect of these antihypertensive agents.     

Cognitive decline is associated with systemic oxidative stress: the EVA study. Etude du Vieillissement Artériel

OBJECTIVE: To determine whether systemic oxidative stress status is associated with cognitive decline. DESIGN: A longitudinal population-based study. SETTING: A cohort study of older subjects in Nantes, France. PARTICIPANTS: A total of 1166 high cognitive functioning subjects aged 60 to 70 in the Etude du Vieillissement Arteriel (EVA) cohort with a 4 year follow-up. MEASUREMENTS: Subjects completed a baseline interview and a global cognitive test (Mini-Mental Status Examination (MMSE)). Blood samples were obtained at baseline to determine plasma levels of selenium, carotenoids, thiobarbituric acid reactant substances (TBARS), an indicator of lipoperoxidation, and red blood cell vitamin E. Risk of cognitive decline, defined as a loss of 3 points in MMSE score between baseline and the 4 year follow-up, was assessed by oxidative stress level. RESULTS: Subjects with the highest levels of TBARS show an increased risk of cognitive decline (adjusted odds ratio (OR) = 2.25; confidence interval (CI) 95% = 1.26-4.02). This result is reinforced in the lower antioxidant status subgroup. Subjects with low levels of selenium have an increased risk of cognitive decline (OR = 1.58; CI 95% = 1.08-2.31) after adjustment for various confounding factors. CONCLUSIONS: These results suggest that increased levels of oxidative stress and/or antioxidant deficiencies may pose risk factors for cognitive decline. The direct implication of oxidative stress in vascular and neurodegenerative mechanisms that lead to cognitive impairment should be further explored.     

Increased iron and oxidative stress are separately related to cognitive decline in elderly

Aim: The aim of this study is to examine the relation between body iron, oxidative stress and cognitive function in elderly. Methods: Eighty‐seven elderly residents from nursing homes were the subjects of our study. Cognitive status was screened by the Mini‐Mental State Examination (MMSE). Of the 87 eligible subjects, 46 patients who obtained 24 or fewer points on the MMSE scale were considered as subjects with cognitive dysfunction. The control group consisted of 41 subjects who obtained more than 24 points on the MMSE. Routine biochemical analyses, parameters of iron metabolism, malondialdehyde (MDA) and glutathione peroxidase (GSH‐Px) were determined in all subjects. Results: There were statistically significant increases in serum iron, transferrin saturation, ferritin and MDA levels; whereas there was a statistically significant decrease in serum GSH‐Px enzyme activity and serum sodium levels in subjects with cognitive dysfunction. A significant negative correlation was found between serum iron, transferrin saturation, ferritin and MMSE score. There was a negative correlation between MMSE score and serum MDA; however, a positive significant correlation was found between MMSE score and both GSH‐Px enzyme activity and serum sodium. Conclusion: Our study provides evidence of increased markers of iron deposition and oxidative stress in patients with cognitive dysfunction. It seems likely that these markers negatively affect the MMSE score. Interestingly, we did not find any correlation between the markers of iron deposition and oxidative stress. Future studies will be required to demonstrate whether diminishing iron and oxidative stress will enhance MMSE score and thereby ameliorate cognitive impairment. Geriatr Gerontol Int 2011; 11: 504–509.     

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.     

Albumin, Apolipoprotein E-ɛ4 and Cognitive Decline in Community-Dwelling Chinese Older Adults

OBJECTIVES: To examine the association between serum albumin and cognitive impairment and decline in community-living older adults.
DESIGNS: Population-based cohort study, followed up to 2 years; serum albumin, apolipoprotein E (APOE)-ɛ4, and cognitive impairment measured at baseline and cognitive decline (≥2-point drop in Mini-Mental State Examination (MMSE) score). Odds ratios were controlled for age, sex, education, medical comorbidity, hypertension, diabetes mellitus, cardiac disease, stroke, smoking, alcohol drinking, depression, APOE-ɛ4, nutritional status, body mass index, anemia, glomerular filtration rate, and baseline MMSE.
SETTINGS: Local area whole population.
PARTICIPANTS: One thousand six hundred sixty-four Chinese older adults aged 55 and older.
RESULTS: The mean age of the cohort was 66.0±7.3, 65% were women, mean serum albumin was 42.3±3.1 g/L, and mean MMSE score was 27.2±3.2. Lower albumin tertile was associated with greater risk of cognitive impairment in cross-sectional analysis (low, odds ratio (OR)=2.30, 95% confidence interval (CI)=1.31–4.03); medium, OR=1.59, 95% CI=0.88–2.88) versus high ( P for trend=.002); and with cognitive decline in longitudinal analyses: low, OR=1.73, 95% CI=1.18–2.55; medium, OR=1.32, 95% CI=0.89–1.95, vs high ( P for trend=.004). In cognitively unimpaired respondents at baseline (MMSE≥24), similar associations with cognitive decline were observed ( P for trends <.002). APOE-ɛ4 appeared to modify the association, due mainly to low rates of cognitive decline in subjects with the APOE-ɛ4 allele and high albumin.
CONCLUSION: Low albumin was an independent risk marker for cognitive decline in community-living older adults.     

Association of body mass index with cognitive function in elderly hypertensive Japanese

BACKGROUND: As hypertension, obesity, and leanness are reported to be associated with poor cognitive function, it is possible that obesity or leanness in hypertensive patients may also be associated strongly with poor cognitive function. METHODS: We recruited 184 elderly hypertensive patients comprising 93 very elderly (aged >or=80 years) and 91 younger elderly (aged 61-79 years) subjects. A mini-mental state examination (MMSE) and 24-h ambulatory blood pressure monitoring (ABPM) were performed in all participants. Patients were classified as either lean, normal physique, or obese according to the body mass index (BMI) quartile. The prevalence of poor cognitive function, total MMSE score, and MMSE subscores were compared between the groups. RESULTS: The prevalence of poor cognitive function, total MMSE score, and MMSE subscore attention/calculation were significantly different between the groups both in the total study population and in the very elderly patients. The multiple logistic regression model showed that leanness was a significant determinant of poor cognitive function in both the total study population (odds ratio (OR) 2.54, 95% confidence interval (CI) 1.13-5.73, P = 0.02) and the very elderly patients (OR 3.94, 95% CI 1.31-11.82, P = 0.01). Obesity was not a significant determinant in either the total study population, very elderly, or younger elderly groups. CONCLUSION: While obesity in hypertensive elderly patients was not associated with poor cognitive function, leanness in hypertensive elderly patients was, especially in the very elderly.     

Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes

OBJECTIVES: To identify factors that were associated with cognitive impairment 3 months after stroke, and to examine the associations of cognitive impairment with stroke outcomes up to 4 years after stroke. DESIGN: Observational study. SETTING: Population-based stroke register. PARTICIPANTS: Six hundred forty-five subjects with first-ever stroke, identified from the register. MEASUREMENTS: Subjects were assessed for cognition using the Mini-Mental State Examination (MMSE) 3 months after stroke. Cognitively impaired subjects (MMSE <24, n = 248 (38%)) were compared with cognitively intact subjects (MMSE 24-30, n = 397) in terms of demographic details, stroke risk factors, laterality of stroke, and initial poststroke impairments. Outcome data collected at 1, 3, and 4 years poststroke included disability assessed by the Barthel Index (BI) and the Frenchay Activity Index, case fatality, and institutionalization. RESULTS: Two hundred forty-eight (38%) of 645 subjects were cognitively impaired 3 months after stroke. Using multivariate analyses, cognitive impairment was associated with age of 75 and older (odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.5-4.2), ethnicity (Caribbean/African (OR = 1.9, 95% CI = 1.2-3.2) and Asian (OR = 3.4, 95% CI = 1.1-10.2), lower socioeconomic class (OR = 2.1, 95% CI = 1.3-3.3), left hemispheric lesion (OR = 1.6, 95% CI = 1.01-2.4), visual field defect (OR = 2.0, 95% CI = 1.2-3.2), and urinary incontinence (OR = 4.8, 95% CI = 3.1-7.3). Using multivariate analyses, cognitive impairment was associated with death or disability (BI <15) at 4 years after stroke (OR = 2.2, 95% CI = 1.1-4.5). In univariate analyses, it was also associated with higher institutionalization 4 years after stroke (P =.001). CONCLUSIONS: Cognitive impairment is common 3 months after stroke and is independently associated with older age, ethnicity, lower social class, left hemispheric stroke, visual field defect, and urinary incontinence. It is associated with poor long-term outcomes, including survival and disability, up to 4 years after stroke. Because physical and cognitive impairments after stroke have independent prognostic implications, measures that evaluate both functions should be used in future studies of stroke outcome and in care of stroke patients.     

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.     

晚发抑郁患者基线记忆功能与6个月神经认知结局的关系

目的探讨首次发作晚发抑郁(LOD)患者基线记忆功能与6个月神经认知结局的关系。方法选择LOD患者49例,随访6个月,根据认知评分标准,将33例患者分为认知正常组19例和认知障碍组14例。被试基线和随访6个月时,均接受简易智能状态检查量表、认知筛检测验及神经心理成套测验评估。采用3.0 T MRI仪行头颅扫描,液体衰减反转恢复序列采集图像,测量脑白质高密度信号体积;采用聚合酶链反应技术进行载脂蛋白E基因分型。结果与认知正常组比较,认知障碍组患者基线简易智能状态检查量表及认知筛检测验总分、言语记忆和视觉记忆各测验评分、言语流畅性(1 min)、视空间功能评分及定向力均明显降低,差异有统计学意义(P<0.05)。logistic回归分析显示,LOD患者基线物品即刻回忆评分与神经认知结局呈负相关。结论 LOD患者基线即刻回忆能力可预测其认知转归,基线时即刻记忆越差,神经认知恶化的风险越大。     

Brief report: Patient cognitive status and the identification and management of depression by primary care physicians

OBJECTIVES: No known study has examined the role of patients' cognitive impairment in the identification and management of depression by primary care physicians. DESIGN: A cross-sectional survey conducted between 2001 and 2003. PARTICIPANTS: A sample of 330 adults aged 65 and older from Maryland primary care practices with complete information on cognitive and psychological status, and physician assessments. MEASUREMENTS: Primary care physicians were asked to rate cognition and depression on a Likert scale, as well as report management of depression within 6 months of the index visit. Patient interviews included standardized measures of psychological and cognitive status. RESULTS: Older adults identified as depressed by their physician were more likely to be identified as cognitively impaired (unadjusted odds ratio [OR] = 3.71, [95% confidence interval] [CI] [1.93, 7.16]). Older adults identified as cognitively impaired had a tendency to be managed for depression (unadjusted OR = 2.62, 95% CI [0.96, 7.19]). In adjusted multivariate models, these associations remained unchanged. CONCLUSIONS: When physicians identified a patient as cognitively impaired, they were more likely to identify the patient as depressed and to report treatment of the depression. An understanding of how physicians think about depression in the context of cognitive impairment is important for designing depression interventions for older adults.     

Cognition in older women: the importance of daytime movement

OBJECTIVES: To determine whether an objective measure of daytime movement is associated with better cognitive function in women in their 80s. DESIGN: Cross‐sectional. SETTING: A study of health and aging. PARTICIPANTS: Two thousand seven hundred thirty‐six older women without evidence of dementia. MEASUREMENTS: Daytime movement was assessed using actigraphy, which involved wearing a watch‐like device that objectively quantified accelerometer motion over a mean of 3.0±0.8 days. Cognitive function was measured using the Trail‐Making Test, Part B (Trails B) and the Mini‐Mental State Examination (MMSE). Cognitive impairment was defined as performing 1.5 standard deviations (SDs) worse than the mean on a given test. RESULTS: Participants had a mean age of 83±4; 10% were African American. After adjustment for age, race, and education, women in the highest movement quartiles had better mean cognitive test scores (20±0.3 seconds faster on Trails B and 0.3±0.2 points higher on MMSE, both P<.001) than those in the lowest quartile and were less likely to be cognitively impaired (odds ratio (OR)=0.61, 95% confidence interval (CI)=0.41–0.92 for Trails B; OR=0.68, 95% CI=0.44–1.07 for MMSE). Associations were similar in different subgroups and were independent of self‐reported walking, medical comorbidities, physical function, and other health‐related behaviors. CONCLUSION: Daytime movement as measured objectively using actigraphy was associated with better cognitive function and lower odds of cognitive impairment in women in their 80s. Additional studies are needed to clarify the direction of the association and to explore potential mechanisms.     

Cross-sectional and longitudinal association between antihypertensive medications and cognitive impairment in an elderly population

BACKGROUND: The effect of antihypertensive medications on cognitive function has not been well studied. The authors' objectives were to investigate the cross-sectional and longitudinal association between the use of antihypertensive medications and cognitive function and to compare different antihypertensive medication classes with regard to this association in an elderly population. METHODS: The medical records of a convenience sample of patients (n = 993 cross-sectional and 350 longitudinal; mean age, 76.8 +/- 0.3 years; 74% women; 87% White) followed at a geriatric practice were reviewed. Data abstracted included demographics, medical history (Alzheimer's disease [AD] or vascular dementia [VaD]), use of antihypertensive medications, and results of cognitive assessments (the Mini-Mental Status Examination [MMSE] and the Clock Draw Test [CDT]). RESULTS: In the cross-sectional analysis, antihypertensive use was not associated with MMSE (p >.05), CDT (p >.05), or dementia diagnosis (odds ratio for AD, 0.8; 95% confidence interval [CI], 0.6 to 1.2; odds ratio for VaD, 1.6; 95% CI, 0.6 to 4.0). In the longitudinal analysis, antihypertensive use was associated with a lower rate of cognitive decline on the MMSE (-0.8 +/- 2 points in users vs -5.8 +/- 2.5 points in nonusers; p =.007) and on the CDT (-0.3 +/- 0.8 points in users vs -2.2 +/- 0.8 points in nonusers; p =.002), and with a lower risk for the development of cognitive impairment (odds ratio, 0.56; 95% CI, 0.38 to 0.83; p =.004). The trend was similar in patients with baseline AD (p =.02). Patients taking diuretics (p =.007), angiotensin-converting enzyme inhibitors (p =.016), and beta-blockers (p =.014) had a lower rate of cognitive decline, and patients taking angiotensin receptor blockers (p =.016) had improved cognitive scores. CONCLUSIONS: Antihypertensive use, particularly diuretics, angiotensin-converting enzymes inhibitors, beta-blockers, and angiotensin receptor blockers, may be associated with a lower rate of cognitive decline in older adults, including those with AD. Until a randomized clinical trial confirms our results, findings of this observational study should be interpreted with caution.     

Arterial pulse wave velocity as a marker of poor cognitive function in an elderly community-dwelling population

BACKGROUND: Knowledge about potentially modifiable risk factors for cognitive decline is limited at this time. The aim of this study was to determine the cross-sectional relationship between a low level of cognitive function and brachial-ankle pulse wave velocity (baPWV) in a community-dwelling elderly population. METHODS: The study population included 352 community-dwelling Japanese persons ages 70 years and older who participated in a comprehensive health examination in April 2003. None had any history of cardiovascular disease. In addition to conventional medical examinations such as blood pressure and routine blood analyses, cognitive function was tested using the Mini-Mental State Examination (MMSE), and baPWV was determined using a recently developed noninvasive and automatic arterial waveform analyzer (AT-Form). This measure, with well-established validity and reproducibility, reflects both central and peripheral arterial flow. A multivariate logistic regression model tested the possible association between poor cognitive function (an MMSE score < 24) and baPWV. RESULTS: Poor cognitive function was independently associated with the middle tertile of baPWV (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 1.15 to 80.93), age (1-year increment; OR = 1.12, 95% CI = 1.04 to 1.22), and the highest tertile of pulse pressure (OR = 4.70, 95% CI = 1.08 to 20.48) even after multivariate adjustment of data for the effects of age, educational level, and hemodynamic and metabolic antecedents of atherosclerosis. CONCLUSIONS: A high baPWV may be a potent risk factor for poor cognitive function in an elderly community-dwelling population, and this effect is independent of another marker of arterial stiffness: pulse pressure.     

Predictors of successful rehabilitation in geriatric patients: subgroup analysis of patients with cognitive impairment

BACKGROUND AND AIMS: Understanding which patients benefit from rehabilitation programs may be useful in balancing resources and needs. The aim of this study was to evaluate whether cognitive and nutritional status are associated with functional improvement after rehabilitation in old persons. METHODS: 2650 patients (aged > or =60 years) consecutively admitted to a geriatric rehabilitation unit in Italy between August 2001 and December 2005, were included. Functional status was evaluated with the Tinetti scale, cognitive status with the Mini-Mental State Examination (MMSE), and nutritional status with the Mini-Nutritional Assessment Short Form (MNA-SF). To identify predictors of functional recovery, multiple logistic regression models were run, with improvement on the Tinetti scale score as dependent variable. RESULTS: Eighty per cent of old persons functionally improved after rehabilitation, ranges being 84% of those with MMSE> or =24 to 58% of those with MMSE<10. Persons with both good cognition and good nutritional status were most likely to improve [odds ratio (OR)=2.5; 95% confidence interval (95% CI)=1.9-3.2]. Stratifying the sample according to cognitive status, we found that in patients with MMSE> or =18 better nutritional status emerged as a factor associated with functional improvement, whereas in patients with severe cognitive impairment (MMSE<18), the only associated factor was a higher MMSE score. CONCLUSIONS: The results of the present study suggest that both good cognition and good nutritional status are associated with functional improvement in older persons. However, patients with poor cognition can also improve, depending on their degree of cognitive impairment, and they should not be routinely excluded from rehabilitation.     

Olfaction and the 5-year incidence of cognitive impairment in an epidemiological study of older adults

OBJECTIVES: To determine whether odor identification ability is associated with the 5‐year incidence of cognitive impairment in a large population of older adults with normal cognition at baseline and whether olfactory impairment contributes to the prediction of cognitive decline. DESIGN: Population‐based longitudinal study. SETTING: Beaver Dam, Wisconsin. PARTICIPANTS: One thousand nine hundred twenty participants in the Epidemiology of Hearing Loss Study (mean age 66.9). MEASUREMENTS: Olfaction was measured using the San Diego Odor Identification Test (SDOIT). Incident cognitive impairment was defined as a Mini‐Mental State Examination (MMSE) score of less than 24 or reported diagnosis of dementia or Alzheimer's disease (AD) at follow‐up in participants with a MMSE score of 24 or greater and no diagnosis of dementia or AD at baseline. RESULTS: There was a significant association between olfactory impairment at baseline and 5‐year incidence of cognitive impairment (odds ratio (OR)=6.62, 95% confidence interval (CI)=4.36–10.05). The association remained significant after adjusting for possible confounders (OR=3.72, 95% CI=2.31–5.99). The positive predictive value of the SDOIT was 15.9%, the negative predictive value was 97.2%, the sensitivity was 55.1%, and the specificity was 84.4% for 5‐year incidence of cognitive impairment. CONCLUSION: Olfactory impairment at baseline was strongly associated with 5‐year incidence of cognitive impairment as measured using the MMSE. Odor identification testing may be useful in high‐risk settings, but not in the general population, to identify patients at risk for cognitive decline.     

Retinal Microvascular Signs and Cognitive Impairment

OBJECTIVES: To examine the association between retinal microvascular signs, as a proxy for cerebral microvascular disease, and cognitive impairment.
DESIGN: Cross-sectional population-based study.
SETTING: Urban population survey
PARTICIPANTS: One thousand nine hundred eighty-eight persons aged 49 to 97.
MEASUREMENTS: All participants underwent retinal photography and had the Mini-Mental State Examination (MMSE) administered by trained personnel. Retinal photographs were masked and graded for retinopathy signs (microaneurysms, hemorrhages, hard exudates, cotton wool spots), and retinal vessel calibers were measured using a validated computer-assisted method. Cognitive impairment was defined as an MMSE score of 23 or less, in line with other epidemiological studies.
RESULTS: Cognitive impairment was present in 121 participants (6.1%). In the total population, after adjusting for age, sex, blood pressure, diabetes mellitus, smoking, cardiovascular disease, education, and other factors, retinal venular dilation was associated with cognitive impairment (odds ratio (OR)=1.8, 95% confidence interval (95% CI)=1.0–3.2, P =.03). In persons with hypertension, retinopathy signs (adjusted OR=1.7, 95% CI=1.0–3.2, P =.05) and retinal venular dilation (adjusted OR=2.7, 95% CI=1.2–6.1, P =.01) were associated with cognitive impairment.
CONCLUSION: Retinal microvascular signs are associated with significant cognitive impairment, particularly in older persons with hypertension. These findings suggest that cerebral microvascular changes may contribute to cognitive deterioration.