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PubMed2006

Somatropin therapy and cognitive function in adults with growth hormone deficiency : a critical review.

Both growth hormone (GH) and insulin-like growth factor (IGF)-I have receptors in the brain, in particular in areas that are involved in cognitive function. Therefore, it has been hypothesized that GH deficiency can lead to cognitive dysfunction, and that somatropin replacement therapy may have beneficial effects on cognitive function in GH-deficient patients. In this review, an overview is given regarding the possible effects of decreased activity of the GH/IGF-I axis and somatropin therapy in GH deficiency in relation to cognitive function. The available data regarding cognitive function in GH-deficient patients are limited, but suggest that this condition can lead to specific cognitive changes, in particular attentional deficits and altered processing speed. The underlying mechanisms and the effects of somatropin treatment on cognitive function in GH deficiency are still unclear. Similar studies to those performed in patients with GH deficiency have been performed regarding the cognitive changes in elderly patients with relatively low GH and/or IGF-I levels. Large controlled studies regarding the effects and safety of somatropin treatment in healthy elderly patients have not been performed.

Adult↗

PubMed1997

Estrogen replacement therapy and cognitive function in postmenopausal women without dementia.

The epidemiologic evidence for an association between estrogen and cognitive function among healthy postmenopausal women remains controversial. Equivocal findings may be explained, in part, by differences in the methodologic approaches of these studies. Overall, the evidence for a positive relationship comes primarily from randomized clinical trials. These trials suggest an acute effect on specific tests of recent verbal memory and tasks incorporating concept formation and reasoning. The potential long-term effects of estrogen in slowing or delaying the age-related decline in cognitive function require further study. More data are needed to determine the effects of estrogen replacement therapy on cognitive function, independent of changes in mood and depressive symptoms. In addition, evidence suggests that progesterone may mitigate the beneficial effects of estrogen on mood. Research should be undertaken to determine the interactive effects of estrogen and progesterone on cognitive function. Lastly, there should be continued investigation by both epidemiologic and basic neuroscientific studies to further elucidate the specific cognitive domains that may respond to estrogen.

Cognition↗

PubMed2006

Cognitive functioning as a predictor of functional disability in later life.

OBJECTIVE: The contribution of cognitive functioning on multiple levels of functional disability and mortality over two years as well as individual activities of daily living (ADLs) and instrumental activities of daily living (IADLs) tasks, in a sample of older U.S. adults was examined. METHODS: A total of 4,077 U.S. adults (1,493 males and 2,584 females) aged > or =70 years (mean = 76.35 years) from the Second Longitudinal Study of Aging (1997/1998-1999/2000) were examined using an adapted Telephone Interview of Cognitive Status (TICS), ADLs, and IADLs. RESULTS: Multivariate logistic regression investigated cognition as a predictor of five mutually exclusive levels of functional disability. People with the lowest level of cognition had greater odds of mortality at follow-up (adjusted odds ratio [AOR] = 2.86, 95% confidence interval [CI] = 1.94-4.20), ADL and IADL disability (AOR = 1.58, 95% CI = 1.15-2.16), ADL disability (AOR = 1.83, 95% CI = 1.27-2.64), or IADL disability (AOR = 1.22, 95% CI = 0.86-1.71) than those who were disability-free. Cognitive functioning was not predictive of individual ADL tasks but was predictive of the IADL tasks of preparing meals, shopping for groceries, managing money, telephone use, light housework, and medications but not heavy housework. CONCLUSION: Persons with lower levels of cognitive functioning were more likely to die or become disabled than those with higher levels of cognition. Changes in cognitive functioning might serve as an early indicator of neurologic and medical factors.

Activities of Daily Living↗

PubMed2004

The effect of previous alcohol abuse on cognitive function in HIV infection.

OBJECTIVE: The authors' goal was to study the potential effect on cognitive function of an interaction of HIV infection and a history of alcohol abuse. METHOD: The subjects were 30 HIV-negative and 50 HIV-positive men with and without a past history of alcohol abuse. Thirty-three of the men (12 HIV negative and 21 HIV positive) had a past history of alcohol abuse, and 47 (18 HIV negative and 29 HIV positive) had never abused alcohol. Each subject's history of alcohol use was obtained by using a syndromal approach based on the Structured Clinical Interview for DSM-III-R and a quantitative approach. Each subject was given a battery of neuropsychological tests assessing verbal reasoning, reaction time, intelligence, memory, and dexterity. The subjects were then compared on a summary neuropsychological impairment rating. RESULTS: There were no significant differences in CD4 level, age, education, depression, anxiety, or other drug abuse history between the HIV-positive and HIV-negative groups with and without a history of alcohol abuse. Significant effects on cognitive function were found for past alcohol abuse and HIV infection, with significant interactions in verbal reasoning, auditory processing, and reaction time. This demonstrates that HIV infection and a history of alcohol abuse have independent effects on some aspects of higher cognitive function but may have synergistic effects on other cognitive domains. In the HIV-negative subjects there were no differences in cognitive function between subjects with and without a history of alcohol abuse. Among the HIV-positive subjects, those with a history of alcohol abuse performed more poorly on tests of verbal IQ, verbal reasoning, and reaction time. CONCLUSIONS: There are both additive and interactive effects of previous alcohol abuse and HIV infection on cognition. Individuals with a history of past alcohol abuse may be at greater risk for cognitive dysfunction in the context of HIV infection.

Adult↗

PubMed2001

Role of thyroid hormones in the effects of selenium on mood, behavior, and cognitive function.

Changes in thyroid function may affect mood, behavior, and cognitive function. Selenium is required for appropriate thyroid hormone synthesis, activation, and metabolism. Selenium status influences thyroid function. Selenium status also affects psychological condition and cognitive function. The author suggests that the effects of selenium status on mood, behavior, and cognition may be partly mediated by changes induced by selenium deficiency or selenium supplementation in thyroid function. Selenium deficiency decreases immunocompetence and promotes viral infections. The author proposes that patients who have a combination of depression, hypothyroidism, and increased susceptibility to viral infections, could reasonably be assessed for selenium deficiency, especially if they live in an area where the soil is low in selenium.

Affect↗

PubMed1999

Early versus late extubation after coronary artery bypass grafting: effects on cognitive function.

OBJECTIVE: To compare the effects of a short period of mechanical ventilation and sedation and a longer one on cognitive functioning of patients exposed to cardiopulmonary bypass (CPB). DESIGN: A randomized, prospective study. SETTING: Tertiary-care university hospital. PARTICIPANTS: Forty-eight adult patients with surgical coronary artery disease. INTERVENTION: Elective coronary artery bypass surgery. MEASUREMENT AND MAIN RESULTS: Patients (n = 48; mean age, 60.12+/-9.30 years) were randomized to either group I (mean delay, 3.49+/-2.21 hours) or group II (mean delay, 10.32+/-1.75 hours). Cognitive functioning was evaluated before surgery, postoperatively, and at the 8-week follow-up. Tests included measures of central nervous system integrity, attention/concentration and psychomotor performance, verbal fluency, visual scanning speed, mental flexibility, auditory and visual attention, and verbal memory. Covariance analyses were used for group comparisons. Covariates were age, education, and baseline or postoperative performance. No differences in cognitive functioning were found between the two groups. Globally, performance deteriorated for 34.1% of the patients at the posttest evaluation, whereas 2.3% improved and 63.6% remained unchanged. At follow-up, nearly 40.5% of the patients showed an improvement from baseline, 2.4% still had deficits, and 57.1% had no change. None of the cognitive functions appeared to be more affected than others. CONCLUSION: Early extubation and a shortened period of anesthesia/analgesia do not appear to positively or negatively affect cognitive functioning at 3 to 5 days and 8 weeks postoperatively. Early extubation is suggested because it has no deleterious effect (besides the low risk for reintubation) and it may facilitate patients' care in the intensive care unit.

Adult↗

PubMed2001

Effect of vitamin and trace-element supplementation on cognitive function in elderly subjects.

OBJECTIVE: To determine whether supplementation with vitamins and trace elements in modest amounts influences cognitive function in apparently healthy, elderly subjects. METHODS: The study was designed as a randomized, double-blind, placebo-controlled trial. Ninety-six, apparently healthy, independent men and women older than 65 y of age were recruited and randomized to receive a supplement of trace elements and vitamins or a placebo daily for 12 mo. Blood-nutrient levels were estimated at baseline and at the end of the study. The major outcome measure assessed was cognitive function consisting of immediate and long-term memory, abstract thinking, problem-solving ability, and attention. RESULTS: Eighty-six subjects completed the 1-y trial. The supplemented group showed a significant improvement in all cognitive tests (P < 0.001 to 0.05) except long-term memory recall (P > 0.1). Those whose blood-nutrient levels were below the reference standard showed lower responses on cognitive tests. There was no significant correlation between individual nutrient levels and performance on various cognitive function tests. CONCLUSIONS: Cognitive functions improved after oral supplementation with modest amounts of vitamins and trace elements. This has considerable clinical and public health significance. We recommend that such a supplement be provided to all elderly subjects because it should significantly improve cognition and thus quality of life and the ability to perform activities of daily living. Such a nutritional approach may delay the onset of Alzheimer's disease.

Aged↗

PubMed2006

Growth and cognitive function of Indonesian children: Zero-inflated proportion models.

This is a study of the cognitive function of Indonesian children. The cognitive function assessment consisted of 17 items and the number of correct answers a child could score therefore ranged between 0 and 17. In this upper bounded situation, a zero-inflated binomial model and a zero-inflated beta-binomial model were considered. The purpose of the analysis was to examine whether the growth status in infancy and at the age of 7 years was related to the cognitive function of the children. The four regression models proposed by Lucas, Fewtrell and Cole were fitted, i.e. an 'early model' relating early body size to the outcome, a 'later model' relating later body size to the outcome, a 'combined model' including both early and later anthropometry measures, and an 'interaction model' further including an interaction term calculated as the product of early and later body size. It was found that social variables predicted the probability of zero-inflation, while weight-for-age at 7 years predicted the proportion of correct answers. The results do not support the existence of a critical window of cognitive development in infancy. Rather they suggest that it is the lack of catch-up growth after poor growth in infancy that is hazardous, and that childhood weight gain is influential regardless of weight in infancy.

Body Weight↗

PubMedDate not supplied

The association of self-reported sleep duration, difficulty sleeping, and snoring with cognitive function in older women.

We examined the association of sleep duration, snoring, and difficulty sleeping with cognitive function in a cohort of community-dwelling women. Women (n = 1844), aged 70 to 81 years at initial cognitive interview in 2000, are members of the Nurses' Health Study cohort. Women completed six tests of cognitive function encompassing general cognition, verbal memory, category fluency, and attention. We repeated the assessment 2 years later. We used linear regression models to obtain multivariate-adjusted mean differences in initial test performance, and in cognitive decline over time, across categories of sleep duration (< or =5,6,7,8,9+ hours/night), frequency of snoring (never, occasionally, regularly), and sleep difficulties (rarely/never, occasionally, regularly). In analyses of initial test performance, women sleeping < or =5 hours/night scored worse than women sleeping 7 hours/night (mean difference on global score combining all cognitive tests = 0.15 standard units, 95% CI: -0.28, -0.02). Women who regularly had difficulty falling or staying asleep scored 0.11 units lower on the global score (95% CI: -0.22, 0.01) compared with those who rarely had difficulty sleeping. These differences were equivalent to the mean differences in score observed between participants who were 4 to 5 years apart in age. We found no associations with snoring or with any of the sleep variables and cognitive decline over 2 years. Associations between sleep patterns and initial cognitive function may be clinically relevant given that diminished cognition is a risk factor for dementia. However, the lack of an association with prospective cognitive decline warrants further investigation.

Adult↗

PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. III. Assessment of cognitive function in elderly women and men (65-78 years old)].

There are commonly used simple tests for cognitive function that allow for rather superficial assessment in population based study. The goal of the paper was to present the results of cognitive function assessment in elderly men and women recruited from Polish rural population obtained using the battery of tests designed for the CASCADE Project and to assess the relations between the results of tests included in the battery. Studied group were 182 persons at the age of 65-78 years. The battery of tests included: MMSE, Stroop Test, Test Purdue Pegboard (TPP), letter-digit substitution test, word recall test (3 word lists including one with distraction), word fluency test and prospective memory test. The battery allowed for the assessment of short, semantic and prospective memory, attention, speed of perception and processing, word fluency and motoric function. The results of all tests were strongly correlated and indicated for a decreased cognitive function in men and women at the age of 65-78 years with low level of education. Decreased level of cognitive function could be related both to physiological ageing of the brain and to the presence of pathological process.

Aged↗

PubMed2006

Basic forms of cognitive plasticity extended into the oldest-old: retest learning, age, and cognitive functioning.

To address the question of whether cognitive plasticity varies by age and level of cognitive functioning in the older population, the authors used a self-guided retest paradigm to assess the basic forms of plasticity of 34 young-olds (M=74.4 years, range=70-79) and 34 oldest-olds (M=84.0 years, range=80-91), with half in each age group screened for high or low (midrange) level of cognitive functioning. As a whole, members of the sample represent about the upper two thirds of their age cohorts. Results show persistent, though age-reduced, learning in all samples and across all tests. However, age is not differentially "kinder" to the more able with respect to the age-graded decline in learning.

Aged↗

PubMedDate not supplied

[Gender differences in cognitive functions and influence of sex hormones].

OBJECTIVE: To review scientific evidence on gender differences in cognitive functions and influence of sex hormones on cognitive performance. METHOD: Systematical search of related studies identified in Medline. RESULTS: Women outperform men on verbal fluency, perceptual speed tasks, fine motor skills, verbal memory and verbal learning. Men outperform women on visuospatial ability, mathematical problem solving and visual memory. No gender differences on attention and working memory are found. Researchers distinguish four methods to investigate hormonal influence on cognitive performance: a) patient with hormonal disorders; b) neuroimaging in individuals during hormone administration; c) in women during different phases of menstrual cycle, and d) in patients receiving hormonal treatment (idiopathic hypogonadotropic hypogonadism, postmenopausal women and transsexuals). The findings mostly suggest an influence of sex hormones on some cognitive functions, but they are not conclusive because of limitations and scarcity of the studies. CONCLUSIONS: There are gender differences on cognitive functions. Sex hormones seem to influence cognitive performance.

Adult↗

PubMed2003

Terminal decline in cognitive function.

BACKGROUND: Impending death is thought to be associated with age-related cognitive decline, but this association has not been well studied. METHODS: Participants were 763 older Roman Catholic nuns, priests, and brothers without dementia at baseline. They completed an average of 5.6 annual evaluations (range 2 to 9), with >95% follow-up participation in survivors. Each evaluation included administration of 19 cognitive function tests from which previously established measures of global cognition (mean = 0.108, SD = 0.502) and specific cognitive functions were derived. In a series of change point random effects models, the average point before death when rate of cognitive decline changed was identified, and rates of cognitive decline before and after the optimal change point were estimated, controlling for the effects of age, sex, and education. RESULTS: There were 122 deaths during the observation period. Those who died had lower global cognitive function at baseline than survivors (by 0.103 unit; p = 0.03), and beginning about 43 months before death, their annual rate of global cognitive decline sharply accelerated from an annual loss of 0.026 to 0.173 unit, a more than sixfold increase. Results were comparable in analyses that controlled for baseline health and disability. Terminal cognitive decline was evident in nearly all of those who died, but at highly variable rates. Remarkably little cognitive decline was evident in survivors. Decline in episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability also greatly increased about 3 to 6 years prior to death. CONCLUSION: On average, cognitive decline sharply accelerates in the last years of life.

Age Factors↗

PubMed2005

Plasma C peptide level and cognitive function among older women without diabetes mellitus.

BACKGROUND: Growing evidence suggests that type 2 diabetes mellitus and hyperinsulinemia may be related to diminished cognition. To help differentiate between the effects of diabetes and insulin, we examined the relation of insulin to cognitive function among nondiabetic participants of the Nurses' Health Study. METHODS: We measured the C peptide level, representing insulin secretion, in blood samples provided by 718 women from June 14, 1989, to October 4, 1990, when they were aged 61 to 69 years. We administered telephone interviews an average of 10 years after blood collection, testing general cognition, verbal memory, category fluency, and attention; second cognitive assessments were conducted 2 years later. The primary outcomes were global cognitive function across all tests and verbal memory. We used regression models to estimate multivariable-adjusted mean differences in cognitive function and cognitive decline, and odds of cognitive impairment, across C peptide levels. RESULTS: Cognitive function was worse among women in the fourth C peptide quartile compared with those in the first quartile (eg, on the global score combining all cognitive tests, the multivariable-adjusted mean difference was -1.7 standard units [95% confidence interval, -2.9 to -0.6 standard units]; P = .002); the odds of cognitive impairment (defined as the worst 10% of the distribution) were 3-fold higher among women in the fourth vs first quartile (95% confidence interval, 1.3-7.8). On verbal memory, women in the fourth quartile scored significantly worse than those in the first quartile; the odds of impairment were 2.8-fold higher (95% confidence interval, 1.1-7.0). Consistent findings were observed for cognitive decline. CONCLUSION: Higher insulin secretion may be related to worse cognition, even among those without diabetes.

Aged↗

PubMed2026

Extended Long-Term Effects of Cognitive and Aerobic Training on Cognitive Function in Patients With Stress-Related Exhaustion Disorder: A 4.5-Year Follow-Up of a Randomized Controlled Trial.

Stress-related conditions like clinical burnout and exhaustion disorder (ED) are associated with enduring cognitive problems. We have previously demonstrated that the addition of computerised cognitive training (CCT) and aerobic training (AT) to a multimodal rehabilitation programme (MMR) yielded greater improvements in cognitive function compared to MMR alone in patients with ED. These effects were maintained at the 1-year follow-up for CCT, but not for AT. Building on these findings, the present study examined the extended long-term effects of CCT and AT on cognitive function, psychological health, and work ability, 4.5 years after the interventions. Participants were recruited from a stress-rehabilitation clinic and 56 of the initial 132 participants returned for the 4.5-year follow-up. Assessments were conducted before (T1), immediately after (T2), 1-year after (T3) and 4.5-years after (T4) the interventions. Mixed model analyses assessed changes in the intervention groups relative to the control group from T1 to T4, with follow-up comparisons examining within-group stability of outcomes between T3 to T4. The primary outcome was cognitive performance on a global cognitive score. Secondary outcomes included domain-specific cognitive functioning, self-reported cognitive function, psychological health (burnout, depression, anxiety, and fatigue), and work ability. The analysis revealed sustained long-term effects on the global cognitive score, a trained updating task and episodic memory in the CCT group, with stable performance between one- and 4.5-year follow-up. The addition of AT did not yield any extended long-term effects on cognitive performance. Both groups showed extended long-term improvements in self-reported memory problems, although findings were mixed. Extended long-term improvements were observed on burnout for both groups, with additional effects on anxiety and work ability in the AT group. Notably, these effects were not present at the 1-year follow-up and are more plausibly explained by selective attrition rather than a delayed intervention effect. In conclusion, the result indicates that cognitive interventions such as CCT can have lasting positive effects on cognitive function in patients with ED, whereas the long-term psychological effects should be interpreted with caution. TRIAL REGISTRATION: ClinicalTrials.gov: NCT0073772.

Adult↗

PubMed2006

Pulmonary function, cognitive impairment and brain atrophy in a middle-aged community sample.

OBJECTIVE: To determine the relationship of lung function to brain anatomical parameters and cognitive function and to examine the mediating factors for any relationships. METHODS: A random sub-sample of 469 persons (men = 252) aged 60-64 years from a larger community sample underwent brain magnetic resonance imaging scans and pulmonary function tests (forced vital capacity, FVC, forced expiratory volume in the first second, FEV(1)). Subjects were assessed for global cognitive function, episodic memory, working memory, information processing speed, fine motor dexterity and grip strength. The magnetic resonance imaging scans were analysed for overall brain atrophy, subcortical atrophy (ventricle-to-brain ratio, VBR), hippocampal volume, and white matter hyperintensity (WMH) volume. RESULTS: FEV(1) had a significant negative correlation with overall brain atrophy and VBR in men. The FEV(1)/FVC ratio had a significant correlation with WMHs in both men and women. In regression models that controlled for sex, age, height, level of activity, smoking, chronic respiratory disease and education, FEV(1) and FVC were significant predictors of VBR but no other structural brain measure. Pulmonary function was also significantly related to information processing speed and fine motor dexterity. Male subjects with chronic respiratory disease had more deep WMHs. Path analyses to examine if structural measures mediated between lung function and cognition, and whether markers of inflammation and oxidative stress or cortisol mediated between lung function and brain measures were negative. CONCLUSIONS: Decreased lung function is related to poorer cognitive function and increased subcortical atrophy in mid-adult life. Presence of chronic respiratory disease may be related to deep WMHs in men.

Atrophy↗

PubMed2006

The Nutrition, Aging, and Memory in Elders (NAME) study: design and methods for a study of micronutrients and cognitive function in a homebound elderly population.

BACKGROUND: Micronutrient status can affect cognitive function in the elderly; however, there is much to learn about the precise effects. Understanding mediating factors by which micronutrient status affects cognitive function would contribute to elders' quality of life and their ability to remain in the home. OBJECTIVES: The Nutrition, Aging, and Memory in Elders (NAME) Study is designed to advance the current level of knowledge by investigating potential mediating factors by which micronutrient status contributes to cognitive impairment and central nervous system abnormalities in the elderly. NAME targets homebound elders because they are understudied and particularly at risk for poor nutritional status. METHODS: Subjects are community-based elders aged 60 and older, recruited through area Aging Services Access Points. The NAME core data include demographics; neuropsychological testing and activities of daily living measures; food frequency, health and behavioral questionnaires; anthropometrics; gene status; plasma micronutrients, homocysteine, and other blood determinants. A neurological examination, psychiatric examination, and brain MRI and volumetric measurements are obtained from a sub-sample. RESULTS: Preliminary data from first 300 subjects are reported. These data show that the NAME protocol is feasible and that the enrolled subjects are racially diverse, at-risk, and had similar basic demographics to the population from which they were drawn. CONCLUSION: The goal of the NAME study is to evaluate novel relationships between nutritional factors and cognitive impairment. These data may provide important information on potential new therapeutic strategies and supplementation standards for the elderly to maintain cognitive function and potentially reduce the public health costs of dementia.

Activities of Daily Living↗

PubMed1997

A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women.

OBJECTIVE: To compare the sleep patterns, mood states, and cognitive functioning of primiparous mothers during the first 3 weeks postpartum with those of a control group of nonpostpartum women and to assess the relationships among these variables. METHODS: For the first 3 weeks postpartum, 30 primiparous women and 28 nonpostpartum mothers completed daily assessments of mood and recorded multiple aspects of sleep including time of retiring, occurrence and duration of sleep interruption, time of awakening, and morning alertness. Objective measures of memory, attention/concentration, and psychomotor performance were obtained on three occasions. RESULTS: Postpartum women reported more evening awakenings, more time awake after retiring, and more naps than controls, but overall sleep time was similar. New mothers experienced a higher level of dysphoric mood during the first week than nonpostpartum controls; however, controlling for the effect for "time awake" at night eliminated the significant effect for dysphoric mood. Few differences were observed on the multiple assessments of cognitive function; however, performances of new mothers on memory and psychomotor tasks were likely to be influenced by sleep loss. CONCLUSION: Women must make important adjustments in their sleep patterns during the postpartum period. In the study group, these adjustments were largely successful, particularly after the first week postpartum, in avoiding the negative consequences of sleep disturbances such as dysphoric mood and impaired cognitive function. Nevertheless, the significant associations between sleep indices and mood and objective measures of cognitive function point to the importance of encouraging appropriate amounts of sleep for recently delivered women.

Adult↗