Cognitive function after chemotherapy in adults with solid tumours

BACKGROUND: Evidence is emerging that some cancer survivors suffer cognitive impairment after chemotherapy; the cause is unknown. METHODS: Here we review studies evaluating cognitive impairment in adult cancer survivors and discuss methodological challenges associated with this research. We evaluate evidence for cognitive impairment in cancer patients, the incidence of self-reported impairment, and identify potential mechanisms and confounders. RESULTS: Most studies of cognitive function are cross-sectional and report impairment in 15-45% of subjects. Longitudinal studies suggest that some impairment is present prior to receiving chemotherapy, and that this worsens in some patients. The aetiology is unknown. A larger number of subjects self-report changes in cognitive function after chemotherapy; this does not correlate with objective testing. CONCLUSIONS: Cognitive impairment occurs in a subset of cancer survivors and is generally subtle. Most evidence suggests an association with chemotherapy although other factors associated with the diagnosis and treatment of cancer may contribute.     

Cognitive dysfunction in adult survivors of allogeneic marrow transplantation: relationship to dose of total body irradiation

Bone marrow transplant (BMT) patients are exposed to several potential sources of neurologic damage including the neurotoxicity of pre-BMT preparative regimens. The latter generally include a combination of total body irradiation (TBI) and high-dose chemotherapy. Cognitive functioning in 30 adult allogeneic BMT patients (mean of 47 months post-BMT) treated for either acute or chronic leukemia was assessed by two standardized self-report questionnaires. Consistent with hypothesis, results of both univariate and multivariate analyses indicated that increased dose of TBI was associated with increased cognitive dysfunction. Furthermore, this relationship remained even after the impact of psychological distress upon cognitive functioning was accounted for. TBI-related cognitive impairment primarily involved slowed reaction time, reduced attention and concentration, and difficulties in reasoning and problem-solving. These results complement previous findings of an inverse association between dose of TBI and self-perceptions of health and physical functioning in BMT survivors and indicate the importance of including quality of life measures in clinical trials of therapeutic innovations in the field of BMT.     

A systematic review of the association of diabetic retinopathy and cognitive impairment in people with Type 2 diabetes

A systematic review of studies reporting data on the relationship between diabetic eye disease and cognitive impairment in Type 2 diabetes was conducted. The increase in cognitive impairment has mirrored the global increase in diabetes. The aim of the systematic review was to determine the level of association between diabetic retinopathy and cognitive impairment. Item selection, data extraction and critical appraisal were undertaken using standard procedures and independently verified by two researchers. 3 out of 10 potentially relevant studies were included. All studies showed a level of association between diabetic retinopathy and cognitive impairment, suggesting a near threefold increased risk of cognitive impairment in patients with diabetic retinopathy compared to those without. An association of cognitive impairment and severity of diabetic retinopathy was found in males. Diabetic retinopathy was more strongly linked to impairment in the cognitive domains of verbal learning and recent memory. An increased risk of cognitive impairment in patients with diabetic retinopathy was found in the reviewed studies. However, the relationship of severity of diabetic retinopathy and cognitive impairment has not been established. Further studies with standardized measurements for cognitive impairment and diabetic retinopathy are required to delineate this relationship and the role of other factors in this relationship.     

Chemotherapy-induced emesis in elderly cancer patients: the role of 5-HT3-receptor antagonists in the first 24 hours

OBJECTIVE: This review highlights the need to optimize 5-HT3-receptor-antagonist-based antiemetic therapy for elderly cancer patients, particularly during the first 24 h after receiving chemotherapy, based on knowledge of the chemotherapeutic regimen, comorbidity, polypharmacy, dosing convenience and age-related health. BACKGROUND: The proportion of elderly people (over 65 years of age) in the general population is increasing. Compared with the general population, elderly people have a greater risk of serious diseases, such as cancer and cardiovascular disease. Their chemotherapy can be compromised by factors including comorbidity, declining organ function, polypharmacy, drug-drug interactions and cognitive impairments. The use of aprepitant in this elderly population with many concomitant medications is not discussed. Many chemotherapeutic regimens are highly emetogenic, and nausea and vomiting are rated among the most distressing side effects of chemotherapy. The emetogenic potential of various chemotherapy regimens is reviewed, demonstrating clear differences in severity and time of symptom onset. Such differences are particularly important during the first 24 h after administration, when control of emetic symptoms can help to prevent the occurrence of subsequent episodes. The matter is further complicated by inter-patient differences in susceptibility to nausea and vomiting resulting from multiple factors including gender, age and alcohol intake. Individual patient evaluation is essential to identify those patients most at risk. Elderly patients may also be particularly sensitive to the serious physiological and physical effects of nausea and vomiting. Education about symptom management needs to recognize specific learning barriers in the elderly, such as declining sensory perception or cognitive impairment. 5-HT3-receptor antagonists have long been the gold standard for treating chemotherapy-induced nausea and vomiting. Pharmacological differences between 5-HT3-receptor antagonists suggest the need for careful consideration of individual patient characteristics. Selection of the most appropriate agent will optimize antiemetic therapy for elderly cancer patients. CONCLUSION: Chemotherapy-induced emesis in elderly cancer patients needs optimal control by a 5-HT3-receptor antagonist with uncomplicated 24-hour efficacy and good tolerability. Choosing a 5-HT3-receptor antagonist with a long duration of action, low risk of drug-drug interactions and once-daily dosing is important to ensure effective prophylaxis against nausea and vomiting in the elderly and simplify management for patients with cognitive impairment, declining organ function and comorbidity.     

Cognitive Impairment in Rheumatoid Arthritis: A Systematic Review

Objective

Rheumatoid arthritis (RA) is not commonly associated with central nervous system and brain changes. However, a number of studies have reported high rates of cognitive impairment in adults with RA. The objective of this systematic review was to identify and explore the rates and types of cognitive impairment in RA.

Methods

Multiple databases were searched for articles published between 1994 and 2016, to identify studies that have included: adults with RA; standardized neuropsychological tests; and sufficient information to ascertain the relationship between cognitive impairment and demographic, clinical, and psychological factors. Of 1,980 titles, 75 were retained at the abstract level, 36 at the full‐text level, and 15 studies in the final review. These were evaluated using a modified Newcastle‐Ottawa Scale, and the findings were synthesized using a narrative approach.

Results

Ten of 15 studies compared RA to other clinical groups and/or a control group. Based on summed effect size analyses, individuals with RA significantly underperformed on cognitive function tests compared to the control groups, particularly on verbal function, memory, and attention. Less clear differences were found between RA and other clinical groups. Some demographic (age and education), clinical (disease activity), and psychological (depression) factors were associated with cognitive impairment, but inconsistently so across studies. A number of limitations were identified: small and predominantly female samples, limited cognitive domain inclusion, lack of study details, and management of confounding variables.

Conclusion

There is evidence of cognitive impairment in adults with RA. Further studies are needed to confirm prevalence rates and examine potential mechanisms.     

Does chemotherapy-induced leukopenia predict a response in small-cell lung cancer?

The correlation between chemotherapy-induced toxicity and treatment outcome in cancer patients has not been studied thoroughly. Our aim was to evaluate whether there is any relationship between chemotherapy-induced leukopenia and response to treatment in small-cell lung cancer (SCLC). Data derived from records of 228 patients treated within two prospective multicentre phase II studies were analysed. In the first study (101 patients) chemotherapy included vincristine, epirubicin and cyclophosphamide and, in the second (127 patients), cyclophosphamide, etoposide and epirubicin; both regimens were given every 3 weeks. In the present analysis, the correlation between treatment outcome (response rate and survival) and highest scores of leukopenia within the first two and up to the fourth chemotherapy cycle, respectively, was evaluated. The objective response rate for the entire group was 66%; 53% in patients whose white blood cells remained normal and 85% in those who developed leukopenia within the first two cycles (P=0.000). In multifactorial analysis, also including other treatment- and patient-related factors, independent correlation with response to chemotherapy was found for leukopenia (P=0.001), chemotherapy regimen (P=0.002) and the combined relative dose intensity (P=0.018), but not for patient sex, age, performance status, pre-study weight loss, extent of disease and initial white blood cell count. Leukopenia within the first two cycles of chemotherapy was not correlated with survival, whereas such correlation for leukopenia occurring up to the fourth cycle was at the borderline level (P=0.06). These findings suggest a relationship between chemotherapy-induced leukopenia and tumour response in SCLC. Received: 11 August 1997 / Accepted: 24 November 1997     

Elevated serum alkaline phosphatase as a predictor of cognitive impairment in patients with acute ischaemic stroke: A retrospective cohort study

BackgroundIn the present study, we assessed the relationship between serum alkaline phosphatase (ALP) levels and cognitive function changes in acute ischaemic stroke patients.MethodsWe retrospectively collected the demographic data and clinical information from the medical records of patients after the onset of ischaemic stroke. We used the Chinese version of the Mini-Mental State Examination to assess cognitive function. Mixed linear and logistic regression models adjusted for several factors were used to explore the relationship between ALP and cognitive impairment.ResultsA total of 1019 patients were included in the analysis, including 523 poststroke patients with cognitive impairment (PSCI) and 496 patients with non-PSCI. The incidence of poststroke cognitive impairment was 51.3 %. The serum ALP level in the PSCI group was significantly higher than that in the non-PSCI group (86.5 ± 18.9 U/L vs 68.6 ± 15.5 U/L, P < 0.001). The mixed linear model fully adjusted for all variables indicated that the ALP level was positively associated with cognitive impairment (based on the Mini-mental State Examination score) decline, with changes from -0.54 to -0.16 per unit increase in ALP. The logistic regression revealed that the odds of cognitive impairment increased by 42 % when the ALP concentration increased by one U/L (odds ratio (OR) = 1.42, 95 %CI: 1.17−3.09, P = 0.012). The spline regression model further confirmed the dose-response relationships between ALP levels and three-month cognitive impairment (P for nonlinear trend = 0.012).ConclusionThe present study revealed that relatively high serum ALP levels at baseline might be an independent risk factor for cognitive impairment in patients with acute ischaemic stroke.     

乳腺癌术后放疗致肺放射性损伤的临床分析

目的 研究乳腺癌术后放疗致放射性的肺损伤.方法 对106例乳腺癌术后放疗的患者行分析.结果 106例乳腺癌术后放疗患者发生放射性肺损伤22例,与年龄、肺部照射体积、照射剂量、联合化疗和肺部基础疾病有关.结论 乳腺癌术后放疗的老年患者随着照射体积和剂量增加、联合化疗和伴有肺部基础疾病会增加放射性的肺损伤.     

The effect of anthracycline-based (epirubicin) adjuvant chemotherapy on plasma TAFI and PAI-1 levels in operable breast cancer.

An increased incidence of thromboembolic events has been described in women receiving systemic chemotherapy for breast cancer. The effect of anthracycline-based adjuvant chemotherapy regimens on fibrinolytic system markers of plasminogen activator inhibitor-1 (PAI-1) and thrombin activitable fibrinolysis inhibitor (TAFI) was investigated in patients with operable breast cancer. Twenty-four patients with operable breast cancer (median age, 54.5 years; range, 37-72 years) enrolled in our study. Stage I-II and stage IIIA cases received EC (Epirubicin 90 mg/m(2)/d1, I.V. and cyclophosphamide 600 mg/m(2)/d1, I.V.) and FEC (5-fluorouracil 500 mg/m(2)/d1, I.V., epirubicin 100 mg/m(2)/d1, I.V., and cyclophosphamide 500 mg/m(2)/d1, I.V.) as an adjuvant chemotherapy regimen, respectively. Each group consisted of 12 patients. Blood samples were obtained at baseline and just before the third cycle of EC and fourth cycle of FEC chemotherapy regimens. Plasma TAFI antigen and PAI-1 levels did not disclose any statistical difference between basal and postchemotherapy levels within each group and between two groups. Although postchemotherapy D-dimer levels were statistically higher in the FEC group than in the EC group, results in both groups were within normal ranges. More studies concerning the role of fibrinolytic system in breast cancer patients receiving chemotherapy, probably including cases with advanced stage and with different chemotherapy regimens and dose intensities, are needed.     

Study of the relationship between cigarette smoking,alcohol drinking and cognitive impairment among elderly people in China

OBJECTIVE: the incidence of cognitive impairment is increasing; however, little is known about the prevalence and risk factors for cognitive impairment of elderly people in China. This report focuses on investigating the relationship between cigarette smoking, alcohol drinking and cognitive impairment in elderly people. METHODS: 3012 participants aged 60 years old and over were enrolled from six communities of Chongqing. Cognitive function was measured by the Mini-Mental State Examination and Activities of Daily Living. The chi(2) test and logistic regression was used to find the relationship between cigarette smoking, alcohol drinking and cognitive impairment. RESULT: the rate of abnormal cognitive function in elderly people was 11.95%. Smoking was closely related to cognitive impairment (chi(2)=6.59, P=0.027). Alcohol drinking was also associated with cognitive impairment (chi(2)=6.31, P=0.025). In all smokers, current smoking was associated with a significantly increased risk of cognitive impairment (RR 2.33; 95% CI=1.37-5.82). In all people who drink every day, there was a significantly increased risk of cognitive impairment (RR 3.47; 95% CI=1.79-6.71). CONCLUSION: smoking and drinking are risk factors for cognitive impairment among elderly people. Cessation of smoking and reduction of drinking could be considered as part of a strategy to reduce the incidence of cognitive impairment.     

A review of relative dose intensity and survival in patients with metastatic solid tumors

Studies have shown that in the curative setting patients with cancer receiving chemotherapy at higher relative dose intensity (RDI) had better clinical outcomes than those receiving treatment at lower RDI. However, the impact of RDI in advanced/metastatic disease remains unclear. A review of the literature was performed to evaluate the relationship between RDI and survival in patients with metastatic lung, breast, or ovarian cancer receiving chemotherapy. Few studies attempted to specifically associate RDI with survival in a systematic way. Findings from studies that analyzed overall survival with a prespecified RDI threshold support the emerging perception that maintaining an RDI ≥ 85% has a favorable impact on survival. Nonetheless, these studies were limited by their retrospective nature. More studies are needed to further evaluate the impact of maintaining planned chemotherapy dose intensity on outcomes in metastatic solid tumors.     

Cognitive impairment in COPD: a systematic review

The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD.     

Agitated Behavior and Cognitive Functioning in Nursing Home Residents

Agitation is a significant problem for nursing home residents, their families, and their caretakers. Previous literature suggests that agitation is related to dementia and cognitive deterioration in the elderly, but no empirical studies support this relationship. This study tests the relationship between level of cognitive functioning and the nature and level of agitation in nursing home residents. Nurses rated one hundred sixty-five nursing home residents on cognitive functioning and agitation. Results indicate that agitation is prevalent among all types of nursing home residents and that cognitively impaired residents exhibit more agitation than cognitively intact residents. The highest levels of agitation appear to be exhibited by those with moderate levels of cognitive impairment. Manifestations of agitation differ between cognitively intact and cognitively impaired residents: agitated behaviors of cognitively intact residents resemble coping mechanisms, while cognitively impaired residents manifest a wide range of inappropriate behaviors.     

High-dose chemotherapy in advanced breast cancer

Based on in vitro and animals studies which assess dose effect relationship specially for alkylating agent, and on the importance on dose intensity in human protocols, high-dose chemotherapy with stem cell support has been widely evaluated in various tumours, particularly in breast cancer. Moreover, in the last few years, the utilization of hematopoietic growth factors and peripheral stem cells has permitted a large diffusion of this approach. However, there is not yet clear data on the place of such a treatment in breast cancer. Few randomized trials are available, with mature data. Only one shows an advantage for high-dose therapy in metastatic disease. In adjuvant setting, sample sizes are too small or follow-up not long enough to draw any definitive conclusion on the place of high-dose consolidation chemotherapy in breast cancer. In inflammatory breast cancer, which is a much more less frequent disease, encouraging results have been published in phase two studies, looking at pathological response, or in pilot studies. The next few years will give a mature date of randomized trials which evaluate high-dose chemotherapy given after conventional treatment in metastatic or high risk disease. Effort should be done to better evaluate this strategy in terms of cost and quality of life and to design new studies aimed to evaluate front line multiple intensification.     

Cognitive function and hypertension

The importance of lowering blood pressure (BP) in hypertensive subjects is well known but the relationship between hypertension and cognitive function is controversial. This article reviews the role of hypertension in the aetiology of cognitive impairment and the relationships between BP, cerebral perfusion and cognition. It also summarizes findings of studies addressing the effect of antihypertensive therapy and cognition. An electronic database search of MEDLINE, EMBASE and the Cochrane Library and extensive manual searching of articles were conducted to identify studies that have used objective measurements of BP and neuropsychological tests to investigate the relationship among hypertension, cognitive function and/or antihypertensive treatment. In total, 28 cross-sectional studies, 22 longitudinal studies and 8 randomized placebo-controlled trials met the inclusion criteria. Cross-sectional studies showed mixed relationships between higher BP and cognition, with many studies showing no correlation or even J- or U-shaped associations. The majority of longitudinal studies demonstrated elevated BP to be associated with cognitive decline. Randomized studies demonstrated heterogeneous and, sometimes conflicting, effects of BP lowering on cognitive function. Suggested reasons for this heterogeneity include multiple mechanisms by which hypertension affects the brain, the variety of cognitive instruments used for assessment and differences in antihypertensive treatments. Although lowering the BP is beneficial in most patients with vascular risk factors, the effects of BP reduction on cognition remain unclear. Given the predicted upswing in people with cognitive impairments, the time is right for randomized clinical trials with specific cognitive end points to examine the relationship between cognitive function and hypertension and guide practice.     

Testosterone and cognitive function: current clinical evidence of a relationship

BACKGROUND: Testosterone levels decline as men age, as does cognitive function. Whether there is more than a temporal relationship between testosterone and cognitive function is unclear. Chemical castration studies in men with prostate cancer suggest that low serum testosterone may be associated with cognitive dysfunction. Low testosterone levels have also been observed in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). This paper reviews the current clinical evidence of the relationship between serum testosterone levels and cognitive function in older men. METHODS: A systematic literature search was conducted using PubMed and EMBASE to identify clinical studies and relevant reviews that evaluated cognitive function and endogenous testosterone levels or the effects of testosterone substitution in older men. RESULTS: Low levels of endogenous testosterone in healthy older men may be associated with poor performance on at least some cognitive tests. The results of randomized, placebo-controlled studies have been mixed, but generally indicate that testosterone substitution may have moderate positive effects on selective cognitive domains (e.g. spatial ability) in older men with and without hypogonadism. Similar results have been found in studies in patients with existing AD or MCI. CONCLUSIONS: Low endogenous levels of testosterone may be related to reduced cognitive ability, and testosterone substitution may improve some aspects of cognitive ability. Measurement of serum testosterone should be considered in older men with cognitive dysfunction. For men with both cognitive impairment and low testosterone, testosterone substitution may be considered. Large, long-term studies evaluating the effects of testosterone substitution on cognitive function in older men are warranted.     

Cigarette smoking and cognitive impairment: A 10-year cohort study in Taiwan

The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ ≥ 6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio = OR = 0.31; 95% CI = 0.18-0.53; p < 0.001) and those who continued to smoke (OR = 0.37; 95% CI = 0.20-0.70; p < 0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose-response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.     

5 050例肺结核病患者病理学观察

目的总结肺结核病的病理形态学改变及其与联合化疗方案之间的关系。方法观察５０５０例肺结核患者的病理学改变,并对ＨＳＰ、ＨＲＳ和ＨＲＺＳ三种不同联合化疗方案与各型肺结核病理变化的关系进行分析。结果经ＨＲＳ和ＨＲＺＳ治疗的病例中,干酪空洞和纤维空洞手术切除率明显下降,与ＨＳＰ联合化疗方案相比有显著性差异（Ｐ＜０．０１）。经ＨＳＰ、ＨＲＳ和ＨＲＳＰ化疗方案治疗后,结核球的手术切除率分别为２６．８２％（８９７／３３４５）、４１．２４％（４６４／１１２５）和４７．８％（２７７／５８０）,呈现上升趋势（Ｐ＜０．０１）。并发现４２例净化性空洞患者。结论并用利福平和吡嗪酰胺的联合化疗对肺结核病理类型有一定影响,导致结核球比例上升,干酪和纤维空洞比例下降。在肺结核的分类中对结核球应加以考虑     

Evaluation of the effectiveness of treatment with erythropoietin on anemia, cognitive functioning and functions studied by comprehensive geriatric assessment in elderly cancer patients with anemia related to cancer chemotherapy

The primary aim of the present study was to examine the relationship of changes in hemoglobin levels following recombinant human erythropoietin (rHuEPO) treatment to changes in cognitive functioning studied by Mini Mental State Examination (MMSE) in elderly cancer patients undergoing chemotherapy treatment. The secondary aim was that to assess the relationship of changes in hemoglobin levels following rHuEPO treatment to changes in functions studied by Comprehensive Geriatic Assessment (CGA), such as Activity of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Geriatric Depression Scale (GDS) and the Mini Nutritional Assessment (MNA). To this end, hemoglobin levels and cognitive functioning were evaluated in a sample of cancer patients prior to the start of chemotherapy treatment and again after 4, 8 and 12 weeks of treatment with chemotherapy plus rHuEPO. Ten elderly patients (mean age 71.4 years) were enrolled. At baseline, enrolled patients had a mean Hb value of 10.3g/dl. After 4 weeks of rHuEPO treatment, Hb values increased significantly (p<0.0001), with a mean increase of 1.2g/dl (range: 0.2-2.1). Remarkably, 8 out of 10 (80%) showed an increase of Hb levels >or=1g/dl in comparison to baseline and therefore were considered responders. At baseline, four patients (40%) showed a moderate cognitive impairment, whilst six patients (60%) showed a normal cognitive function. After 4 weeks of rHuEPO treatment nine patients (90%) showed a significant improvement of cognitive functions in comparison to baseline (p<0.005): eight of them were responders also to rHuEPO in terms of correction of anemia. The Spearman's rank correlation test showed a statistical significant correlation between Hb increase and increase in cognitive functioning assessed by MMSE after 4 weeks (p=0.049), 8 weeks (p=0.044) and 12 weeks (p=0.031) of rHuEPO treatment. Therefore, the findings of this study provide support for the hypothesis that significant increases in hemoglobin over the course of chemotherapy supplemented with rHuEPO administration would be accompanied by significant improvement in cognitive performance over the same interval.     

Comparative analysis of cognitive impairment among Mexicans and Spanish-speaking immigrant's elders

OBJECTIVE: This study aims to compare the prevalence of cognitive impairment among older Mexicans and Spanish-speaking U.S. immigrants. METHODS: The relationship of cognitive impairment with social and demographic variables was explored using data from five different population based survey studies. RESULTS: Prevalence rates increased with age, with low educational level, didn't show a clear association with gender and decreased in married subjects. Estimates of cognitive and functional impairment combined are greater in the immigrant samples than those for Mexican residents. Primary memory measures are the least discriminative for cognitive impairment, whereas orientation, attention, and secondary verbal memory measures discriminate better. DISCUSSION: Mexicans and Spanish-speaking USA immigrants have similar prevalence estimates of cognitive impairment. However, prevalence of functional impairment differs between Mexicans and immigrants because of measurement issues and cultural factors.