Heart Failure and Cognitive Impairment in the Atherosclerosis Risk in Communities (ARIC) Study
Lucy S WittJason RotterSally C. StearnsRebecca F. GottesmanAnna Kucharska‐NewtonA. Richey SharrettLisa WruckJan BresslerCarla A. SuetaPatricia P. Chang
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Cognitive Decline
Verbal fluency test
Neurocognitive
Cognitive test
Cross-sectional study
Main Outcome Measures: The cognitive test battery was composed of tests of memory, vocabulary, executive function (composed of 1 reasoning and 2 fluency tests), and a global cognitive score summarizing performance across all 5 tests. Smoking status was assessed over the entire study period. Linear mixed models were used to assess the association between smoking history and 10-year cognitive decline, expressed as z scores. Results: In men, 10-year cognitive decline in all tests except vocabulary among never smokers ranged from a quarter to a third of the baseline standard deviation. Faster cognitive decline was observed among current smokers compared with never smokers in men (mean difference in 10-year decline in global cognition=−0.09 [95% CI, −0.15 to −0.03] and executive function=−0.11 [95% CI, −0.17 to −0.05]). Recent ex-smokers had greater decline in executive function (−0.08 [95% CI, −0.14 to −0.02]), while the decline in long-term ex-smokers was similar to that among never smokers. In analyses that additionally took dropout and death into account, these differences were 1.2 to 1.5 times larger. In women, cognitive decline did not vary as a function of smoking status.
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Cognitive Decline
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Abstract Background The effects of combined training can be affected by training characteristics such as frequency, session length, and duration. No empirical studies to date have directly compared how combined physical and cognitive training offered at different training frequencies affects cognitive function for older adults with cognitive decline. This study investigated the impact of training frequency on cognitive outcomes after combined physical and cognitive training for older adults with cognitive decline. Methods A quasi-experimental study was conducted in community facilities and day care centers. The study assigned 89 older adults with cognitive decline into high-frequency (HF) or low-frequency (LF) training groups. The participants received 90- to 105-min training sessions, one (LF) or three (HF) times a week, for 12 weeks. Outcome measures were the Montreal Cognitive Assessment, Word List subtest of the Wechsler Memory Scale, Digit Symbol Substitution Test (DSST), and Stroop Color Word Test. Results The HF group demonstrated greater improvement in immediate memory measured by the WL-IM ( F = 8.7, P = 0.004) and in executive function measured by the SCWT ( F = 5.89, P = 0.017) than the LF group. Compared with the HF group, the LF group showed a great improvement in delayed memory measured by the WL-DM ( F = 9.62, P = 0.003). The HF and LF groups both increased in processing speed and global cognitive function. Conclusions Our study indicated that the different training frequency of combined physical and cognitive training may result in benefits on different cognitive functions in older adults with cognitive decline. These findings may assist clinical practitioners in choosing appropriate training frequencies based on various intervention purposes for the elderly with cognitive decline. Trial registration ClinicalTrials.gov Identifier NCT03619577 (08/08/2018).
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Highly educated individuals have a lower risk of developing dementia and Alzheimer’s disease (AD). A common assumption is that their “cognitive reserve” protects them from cognitive decline and postpones the clinical manifestation of dementia. These highly educated individuals usually obtain normal scores on cognitive screening tests, although at the same time they can experience subjective cognitive decline and difficulty in multiple cognitive domains. Although comprehensive neuropsychological evaluations usually identify subtle changes in cognition, they demand extensive resources and thus are expensive and difficult to obtain. Therefore, lack of sensitivity of screening tests on the one hand, along with difficulty to acquire a comprehensive neuropsychological evaluation on the other hand, impede identification of cognitive decline at its earliest stages in this special population. Accordingly, this study aims to identify which neuropsychological tests have the highest sensitivity to detect the earliest stages of cognitive decline among highly educated elderly [n = 27, ages 66–80 (mean = 72.6 SD = 4.54), mean education level = 17.14 (SD = 3.21 range: 12–24 years)]. Baseline scores and scores at one-year follow up were obtained. We also conducted MRI scans to characterize the relation between brain volume and cognitive performance. Results show significant reductions in RVALT, Semantic verbal Fluency, ROCF copy, and MoCA scores whereas PF, TMT, ROCF delay, digit span, and knowledge tests were not significant. The study stresses the importance of using sensitive neuropsychological tests to examine this special population and the need to create norms that combine an individual’s education with age.
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Our objectives were (1) to test the association between the report of subjective cognitive decline (SCD) and prospective objective cognitive performance in high age individuals and (2) to study the course of longitudinal cognitive performance before and after the first report of SCD.Cognitively normal elderly participants of the German Study on Ageing, Cognition, and Dementia study (N = 2330) with SCD (subjective decline in memory with and without associated concerns) and without SCD at baseline were assessed over 8 years with regard to immediate and delayed verbal recall, verbal fluency, working memory, and global cognition. Baseline performance and cognitive trajectories were compared between groups. In addition, cognitive trajectories before and after the initial report of SCD (incident SCD) were modelled in those without SCD at baseline.Baseline performance in the SCD group was lower and declined more steeply in immediate and delayed verbal recall than in the control group (no SCD at baseline). This effect was more pronounced in the SCD group with concerns. Incident SCD was preceded by decline in immediate and delayed memory and word fluency.SCD predicts future memory decline. Incident SCD is related to previous cognitive decline. The latter finding supports the concept of SCD indicating first subtle decline in cognitive performance that characterizes preclinical Alzheimer's disease.
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Abstract Healthy aging is associated with a heterogeneous decline across cognitive functions, typically observed between language comprehension and language production (LP). Examining resting-state fMRI and neuropsychological data from 628 healthy adults (age 18-88) from the CamCAN cohort, we performed state-of-the-art graph theoretical analysis to uncover the neural mechanisms underlying this variability. At the cognitive level, our findings suggest that LP is not an isolated function but is modulated throughout the lifespan by the extent of inter-cognitive synergy between semantic and domain-general processes. At the cerebral level, we show that DMN (Default Mode Network) suppression coupled with FPN (Fronto-Parietal Network) integration is the way for the brain to compensate for the effects of dedifferentiation at a minimal cost, efficiently mitigating the age-related decline in LP. Relatedly, reduced DMN suppression in midlife could compromise the ability to manage the cost of FPN integration. This may prompt older adults to adopt a more cost-efficient compensatory strategy that maintains global homeostasis at the expense of LP performances. Taken together, we propose that midlife represents a critical neurocognitive juncture that signifies the onset of LP decline, as older adults gradually lose control over semantic representations. We summarize our findings in a novel SENECA model (Synergistic, Economical, Nonlinear, Emergent, Cognitive Aging), integrating connectomic and cognitive dimensions within a complex system perspective. Highlights Lexical production ( LP ) relies on the interplay between domain-general and semantic processes throughout life. DMN ( Default Mode Network ) suppression cooperates with FPN ( Fronto-Parietal Network ) integration to maintain LP performance at a minimal cost. Midlife marks a neurocognitive shift, with reduced DMN suppression prompting a more cost-efficient compensatory strategy that prioritizes homeostasis over LP performance.
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Background: Although physical activity has been associated with better cognitive function and reduced dementia risk, its association with cognitive decline in normal aging remains uncertain. Objective: To determine whether physical activity in youth and older age are associated with age-related cognitive change. Methods: Over a period of 27 years, 2,027 community-dwelling adults (mean age 73.5; 60% women) of the Rancho Bernardo Study of Healthy Aging completed up to seven cognitive assessments, including tests of global cognitive function, executive function, verbal fluency, and episodic memory. At each visit, participants reported concurrent physical activity. At baseline (1988– 1992), participants additionally reported physical activity as a teenager and at age 30. For each age period, participants were classified as regularly active (3+ times/week) or inactive. Results: Associations between concurrent physical activity and better cognitive function were stronger with advancing age on all tests, even after accounting for education, health, and lifestyle factors, as well as survival differences ( ps < 0.05). Baseline physical activity did not predict rates of cognitive decline ( ps > 0.40). Individuals who were physically active at age 30 and older age maintained the highest global cognitive function with advancing age ( p = 0.002). Conclusion: Regular physical activity is associated with better cognitive function with advancing age. Physical activity in young adulthood may contribute to cognitive reserve, which together with physical activity in later years, may act to preserve cognitive function with age.
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Aging is a major risk factor for both normal and pathological cognitive decline. However, individuals vary in their rate of age-related decline. We developed an easily interpretable composite measure of cognitive age, and related both the level of cognitive age and cognitive slope to sociodemographic, genetic, and disease indicators and examined its prediction of dementia transition. Using a sample of 19,594 participants from the Health and Retirement Study, cognitive age was derived from a set of performance tests administered at each wave. Our findings reveal different conclusions as they relate to levels versus slopes of cognitive age, with more pronounced differences by sex and race/ethnicity for absolute levels of cognitive decline rather than for rates of declines. We also find that both level and slope of cognitive age are inversely related to education, as well as increased for persons with APOE Ɛ4 and/or diabetes. Finally, results show that the slope in cognitive age predicts subsequent dementia among non-demented older adults. Overall, our study suggests that this measure is applicable to cross-sectional and longitudinal studies on cognitive aging, decline, and dementia with the goal of better understanding individual differences in cognitive decline.
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Author(s): Mayeda, Elizabeth Rose | Advisor(s): Haan, Mary N | Abstract: Type 2 diabetes is highly prevalent and has been linked with an increased risk of dementia and premature mortality. Earlier death among people with diabetes may impact the association between diabetes and dementia. This is particularly important for populations with a high burden of diabetes, including Mexican Americans and African Americans. The objective of this dissertation was to evaluate the association of diabetes with incidence of dementia and cognitive impairment without dementia (CIND) and cognitive decline in late-life among Mexican Americans and in mid-life among African Americans and whites while accounting for the competing risk of mortality. The study populations included: 1) a cohort of dementia-free older Mexican Americans (n=1617) aged 60-98 from the Sacramento Area Latino Study on Aging (SALSA) followed for 10 years beginning in 1998 and 2) a cohort of middle-aged African Americans and whites (n=1886) aged 48-70 from the Atherosclerosis Risk in Communities (ARIC) Study followed for 14 years beginning in 1990. The association between diabetes and incidence of dementia/CIND was examined with competing risk regression models in the SALSA cohort and the association between diabetes and cognitive decline was examined with joint longitudinal-survival models in the SALSA and ARIC cohorts. In the SALSA cohort, Mexican Americans with treated and untreated diabetes had an increased risk of dementia/CIND compared to those without diabetes (HR=2.05, 95% CI: 1.41-2.97 and HR=1.55, 95% CI: 0.93-2.58) after accounting for the competing risk of death. Additionally, Mexican Americans with diabetes experienced modestly accelerated cognitive decline compared to those without diabetes. In the ARIC cohort, earlier onset of diabetes was associated with greater cognitive decline in mid-life among African Americans. No association between diabetes and cognitive decline was observed among whites. These findings provide evidence that the association between diabetes and dementia/CIND among Mexican Americans remains strong after accounting for the competing risk of mortality. The association between diabetes and cognitive decline is less evident. Future research is needed to identify how diabetes treatments influence cognitive decline among people with diabetes.
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