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PubMed1997

Cognitive function, vascular risk factors and education. A cross-sectional study based on a cohort of 70-year-old men.

OBJECTIVES: A low level of education is associated with an increased risk of developing a dementia disorder, as well as with a higher risk of cardiovascular disease. The aim of this study was to investigate the association between education and cardiovascular risk factors, and to study the relation between these factors and cognitive function in elderly men. DESIGN: Cross-sectional population-based study. SETTING: Uppsala, Sweden. SUBJECTS: 504 men aged 69-74 years, participants in a longitudinal health survey concerning cardiovascular risk factors. MAIN OUTCOME MEASURE: Cognitive function as measured by a composite score of 13 standard psychometric tests. RESULTS: A low level of education was associated with poorer cognitive performance, as well as with obesity, smoking, diabetes, high concentrations of serum triglycerides and plasma fibrinogen. In the entire cohort, subjects with obesity, smoking, diabetes or hypertriglyceridaemia showed impaired cognitive test results, independent of socio-economic factors. When stroke cases were excluded, obesity and smoking were still related to impaired cognitive function. CONCLUSIONS: Smoking and obesity with associated metabolic disturbances are inversely related both to educational level and to cognitive function. Cognitive decline of vascular origin is potentially preventable by treatment of risk factors. The question of whether the increased vascular risk contributes to the higher prevalence of cognitive disorders in individuals with low socio-economic status, needs to be further evaluated in longitudinal population-based studies.

Aged↗

PubMed2005

Age, hormones, and cognitive functioning among middle-aged and elderly men: cross-sectional evidence from the Massachusetts Male Aging Study.

BACKGROUND: This study examines interrelationships among age, hormones, and cognition for middle-aged and elderly men, and tests whether hormones predict lower cognitive functioning and mediate the age-cognition relationship. METHODS: We analyzed Time 2 data from the Massachusetts Male Aging Study, a population-based cohort study. Selection criteria included complete information on cognition and hormones (n = 981). Cognitive measures included working memory (Backward Digit Span test), speed/attention (Digit Symbol Substitution test), and spatial ability (Figural Relations test). Hormones included free testosterone, total testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), androstanediol glucuronide (3 alpha-A-diol-gluc), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (alternatively known as a "binding protein") (SHBG), prolactin (PRL), estrone (E1), and cortisol (CRT). Age was measured in years. Adjusted analyses added educational attainment, health conditions and behaviors, body mass index, and depression. RESULTS: Older age was associated with lower cognitive functioning. In unadjusted models, logged free and total testosterone, DHEA, and DHEAS related to higher functioning in at least one cognitive domain; logged FSH, SHBG, and LH related to lower functioning in at least one cognitive domain; and logged E1, CRT, and PRL were not significant. In adjusted models, logged hormones did not relate to cognitive function except for logged E1 and CRT, which had negative effects. Logged hormones did not mediate the age-cognition relationship. CONCLUSIONS: The direct effects of hormones on cognition are not significant when salient factors are considered. Further, hormones do not mediate the age-cognition relationship; it is necessary to look to other explanatory pathways.

Age Factors↗

PubMed1995

The event-related P300 potential approach to cognitive functions of nondemented patients with cerebral and peripheral arteriosclerosis.

OBJECTIVES: To detect subtle cognitive dysfunction in non-demented patients with either cerebral (cAD) or peripheral (pAD) arteriosclerotic disease, and to evaluate in these patients the effects on cognitive functions of carotid endarterectomy and bypass surgery, respectively. DESIGN: Case-control study. SETTING: Tertiary care referral center. PARTICIPANTS: Eighty consecutive patients with moderate to high-grade stenosis of the internal carotid artery (ICA) (mean age +/- SD, 62 +/- 8 years), 53 patients with stenoses of the peripheral arteries (60 +/- 10 years), and 80 healthy volunteers (58 +/- 15 years) enrolled in a study on healthy aging. Cerebral and peripheral arteriosclerotic disease was verified by digital subtraction angiography, and all patients were screened for confounding effects of concomitant diseases. MAIN OUTCOME MEASURES: Cognitive functions by event-related visual P300 potentials. RESULTS: Patients with cAD showed prolonged P300 latencies and reduced P300 amplitudes, whereas pAD patients had reduced P300 amplitudes only. On an individual scale, 25% of cAD patients, but only 6% of pAD patients, revealed P300 abnormalities. In the cAD, but not in the pAD patients, the P300 latencies were especially prolonged in the older patients, but other factors such as sex, cerebral symptoms, degree of ICA stenosis, and premorbid intelligence did not play any role in either group. Within 1 to 2 weeks of surgery, the P300 latencies shortened in both cAD and pAD patients with high initial values. CONCLUSIONS: As demonstrated by P300 potentials, even nondemented arteriosclerotic patients reveal signs of subtle cognitive dysfunction affecting especially the older cAD patient. In the short-term, carotid endarterectomy presumably improves cognitive functions unspecifically in nondemented patients with a higher initial degree of P300 abnormality.

Adult↗

PubMed1996

Research on cognitive complaints and cognitive functioning in patients with chronic fatigue syndrome (CFS): What conclusions can we draw?

People with chronic fatigue syndrome (CFS) complain of difficulties with concentration and memory yet studies suggest that they do not suffer gross deficits in cognitive functioning. Depressed patients make similar cognitive complaints, and there is symptomatic overlap between CFS and depression. Cognitive complaints and depressed mood are positively correlated in CFS patients but, except on tasks which are particularly sensitive to depression, cognitive performance and depression are not. The inconsistency between cognitive complaints and results of tests of cognitive functioning resembles that found in other subject groups and may be due in part to the inappropriate use of laboratory memory tests for assessing "everyday" cognitive functioning. Even when cognitive capacity is intact, cognitive performance may be affected by factors such as arousal, mood, and strategy. In CFS patients, everyday cognitive tasks may require excessive processing resources leaving patients with diminished spare attentional capacity or flexibility.

Cognition Disorders↗

PubMed2001

The effect of non-invasive positive pressure ventilation (NIPPV) on cognitive function in amyotrophic lateral sclerosis (ALS): a prospective study.

OBJECTIVES: Neuropsychological investigations have shown a degree of cognitive dysfunction in a proportion of non-demented patients with ALS. Respiratory muscle weakness in ALS can lead to nocturnal hypoventilation, resulting in sleep disturbance and daytime somnolence. Sleep deprivation of this type may cause impairments in cognitive function, but this has not been formally evaluated in ALS. METHODS: Cognitive functioning was evaluated in nine patients with ALS with sleep disturbance caused by nocturnal hypoventilation (NIPPV group), and in a comparison group of 10 similar patients without ventilation problems (control group). The NIPPV group then started non-invasive positive pressure ventilation (NIPPV) at night. After about 6 weeks, change in cognitive function was evaluated. RESULTS: Statistically significant improvement in scores on two of the seven cognitive tests was demonstrated in the NIPPV group postventilation, and a trend towards significant improvement was found for two further tests. Scores in the control group did not improve significantly for these four tests, although an improvement was found on one other test. CONCLUSIONS: Nocturnal hypoventilation and sleep disturbance may cause cognitive dysfunction in ALS. These deficits may be partially improved by NIPPV over a 6 week period. This has important implications for investigations of both cognitive dysfunction in non-demented patients with ALS, and the effect of ventilation on quality of life.

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PubMed2002

Effects of rivastigmine on cognitive function in dementia with lewy bodies: a randomised placebo-controlled international study using the cognitive drug research computerised assessment system.

This study was designed to assess the effects of rivastigmine (Exelon) on the cognitive functioning of patients suffering from dementia with Lewy bodies. This was a prospective, multi-centre, randomised, double-blind, placebo-controlled exploratory study conducted at sites in the UK, Spain and Italy. The treatment period was 20 weeks with a 3-week posttreatment follow-up. The primary outcome measures were the Cognitive Drug Research (CDR) computerised assessment system and the Neuropsychiatric Inventory. Testing was conducted prior to dosing and then again at weeks 12, 20 and 23. Analysis of the data from the 92 patients who completed the study identified a significant pattern of benefits of rivastigmine over placebo on the CDR system. These benefits were seen on tests of attention, working memory and episodic secondary memory. Taking attention for example, patients given placebo showed a significant deterioration from predosing scores at 12 and 20 weeks, whereas patients on rivastigmine performed significantly above their predosing levels. These effects were also large in magnitude, the decline under placebo at week 12 being 19%, while the improvement under rivastigmine was 23%. The clinical relevance of this 23% improvement was that it took the patients 33% towards being normal for their age on this assessment of attention. These benefits to cognitive function were accompanied by a significant improvement of the other primary outcome measure, the Neuropsychiatric Inventory. Three weeks after discontinuation of rivastigmine, most parameters of cognitive performance returned to predrug levels.

Aged↗

PubMed2004

Does caregiving stress affect cognitive function in older women?

Increasing numbers of women provide care to their ill spouses; however, no studies have examined possible effects of caregiving stress on cognitive function. We administered 6 tests of cognitive function to 13740 Nurses' Health Study participants aged 70-79 years. We collected information on caregiving and numerous potential confounding variables via biennial mailed questionnaires. After adjustment for potential confounders (age, education, mental health index, vitality index, use of antidepressants, and history of high blood pressure, diabetes, and heart disease), we found modest but significantly increased risks of low cognitive function on three of the cognitive tests among women who provided care to a disabled or ill spouse compared with women who did not provide any care. For example, on the TICS, a test of general cognition, the risk of a low score was 31% higher in women who provided care compared with women who did not (RR = 1.31, 95% CI 1.10, 1.56). We found a moderately increased risk of poor performance on several cognitive tests among women who provided care to their disabled or ill husbands.

Aged↗

PubMed1997

Substance abuse and cognitive functioning in schizophrenia.

Individuals with schizophrenia have an increased vulnerability to abuse drugs or alcohol. This vulnerability can interfere with the course and treatment of the disorder and may also have a detrimental effect on already compromised cognitive functioning. This study has a matched, cross-sectional design and compares the social and cognitive functioning and the symptoms of 33 schizophrenia subjects who abuse substances with 33 nonabusing schizophrenia subjects. Subjects were matched on sex, age, and education variables and were all outpatients. Measures of social functioning and quality of life were used. Assessment of cognitive functioning included measures of verbal ability, attention, executive functioning, and verbal and visual memory. Substance-abusing subjects had significantly lower quality of life. There were no other differences between the 2 groups. Several explanations are offered for the lack of observed differences in cognitive functioning.

Adult↗

PubMed2002

Measures of cognitive function in persons with varying degrees of sleep-disordered breathing: the Sleep Heart Health Study.

Epidemiologic literature suggests that persons with clinically diagnosed sleep apnoea frequently have impaired cognitive function, but whether milder degrees of sleep-disordered breathing (SDB) are associated with cognitive dysfunction in the general population is largely unknown. Approximately 1700 subjects free of clinically diagnosed SDB underwent at-home polysomnography (PSG) as part of the Sleep Heart Health Study (SHHS) and completed three cognitive function tests within 1-2 years of their PSG: the Delayed Word Recall Test (DWR), the WAIS-R Digit Symbol Subtest (DSS), and the Word Fluency test (WF). A respiratory disturbance index (RDI) was calculated as the number of apnoeas and hypopnoeas per hour of sleep. After adjustment for age, education, occupation, field centre, diabetes, hypertension, body-mass index, use of CNS medications, and alcohol drinking status, there was no consistent association between the RDI and any of the three cognitive function measures. There was no evidence of a dose-response relation between the RDI and cognitive function scores and the adjusted mean scores by quartiles of RDI never differed from one another by more than 5% for any of the tests. In this sample of free-living individuals with mostly mild to moderate levels of SDB, the degree of SDB appeared to be unrelated to three measures of cognitive performance.

Aged↗

PubMed2006

Short-term monitoring of cognitive functions before and during the first course of treatment.

PURPOSE: Side effects of chemotherapy on cognitive functions in older patients have rarely been investigated. Addressing this lack of research, the present study evaluated cognitive functions in older cancer patients. METHODS: A total of 130 younger (n=59; age<60) and older (n=71; age>or=60) cancer patients with hematological disease or cancer of the intestinal tract took part in the study. To explore short-term effects of chemotherapy, a group of patients assessed before the start of chemotherapy was compared with patients who already received their first course of chemotherapy. RESULTS: Cognitive impairments of verbal learning, word fluency, and memory were observed following the first few days after treatment onset. Older patients showed stronger memory impairments after start of chemotherapy than younger cancer patients. Additionally, depression was neither associated with short-term effect of chemotherapy nor with age. CONCLUSIONS: The results suggest that chemotherapy has negative short-term effects on some cognitive functions. But age-dependent effects were only found for memory.

Adult↗

PubMed2003

Effect of sleep deprivation on medical resident and student cognitive function: A prospective study.

OBJECTIVE: The purpose of this study was to determine whether cognitive function test results decrease after a typical night of on-call duty, on the basis of the amount of sleep that is obtained. STUDY DESIGN: Two standard cognitive functions tests (the Grooved Pegboard and California Verbal Learning Test II) were administered to the 30 participants who were members of the obstetrics and gynecology house staff and to medical students at Emory University School of Medicine. Each test was administered twice, before and after on-call duty. The data were analyzed with a paired two-tailed Student t test. RESULTS: For the California Verbal Learning Test II, trial 5 showed a decrease in score of 0.8 (P =.05) after on-call duty. Trials 1 through 5 showed a decrease in score of 3.5 (P =.01). CONCLUSION: This finding suggests that cognitive function test scores do decrease after on-call duty. Scrutiny of this issue by the Accreditation Council of Graduate Medical Education is justified, and the issue should continue to be evaluated. Our finding suggests that a change in our current educational structure is warranted.

Adult↗

PubMed1975

Can hyperbaric oxygenation improve cognitive functioning in the organically impaired elderly?: a critical review.

The present article reviews experimental investigation concerned with the effect of hyperbaric oxygenation upon cognitive functioning in the organically-impaired elderly. The conclusion of the Jacobs et al. studies was that hyperbaric oxygenation in cases of chronic organic brain damage (regardless of etiology) leads to improvement in cognitive functioning and general behavior on the ward. Goldfarb et al. (1972) found no evidence to support this conclusion. A critique of the above studies indicates several methodological weaknesses. First, there are serious reservations concerning the makeup of the samples employed in the Jacobs et al. (1969, 1971, 1972, 1973) investigations: it is highly uncertain that most of the Jacobs et al. subjects were suffering from moderate or severe chronic organic brain damage. One reason for the discrepancy between the Jacobs and Goldfarb studies is that the subjects in the later study were more deteriorated and perhaps not as amenable to hyperbaric oxygenation. Secondly, the Bender-Gestalt Test and Tien's Organic Integrity Test have not been validated in an elderly sample. The gain evidenced on the Stockton Geriatric Rating Scale (Jacobs et al., 1969, 1971, 1972) may have little practical significance, and since the data were pooled across groups, the so-called falloff effect could not have been measured. Third, and most significantly, the experimental designs employed in the Jacobs et al., the Goldfarb et al., and the Jacobs followup investigations have such serious shortcomings that the findings must be regarded as inconclusive. Such factors as experimenter attention, testing effects, and familiarity with the experimenter could account for the change in cognitive functioning. Further, in the case of the Jacobs et al. study, the ward personnel may have treated the control group differently after learning that they were expected to improve. Additionally, the subjects in the Jacobs et al. study (1969) themselves may have heard about this prognosis and may have become more interested in performing well on the psychological tests. Thuse, there is no unambiguous evidence that hyperbaric oxygenation was responsible for the changes or lack of changes in cognitive functioning in the samples presented in these studies.

Bender-Gestalt Test↗

PubMed2002

[Impaired cognitive function as an independent risk factor for the in-hospital mortality in the elderly with chronic heart failure].

Heart failure (HF) and impaired cognitive function are frequent causes of hospitalization in elderly patients. Independently, both clinical syndromes are associated with increased mortality. The aim of the study was to evaluate the influence of impaired cognitive function on in-hospital mortality in old patients with HF. A modified Mini-Mental State Exam (MMMSE) was performed in 598 consecutive patients (65-102 years old; 355 female) with heart failure. All patients were stratified into low (6.3 +/- 1.2 points), medium (19.7 +/- 4.7 points) or high (29.1 +/- 2.1 points) tertile group according to MMMSE results. Total in-hospital mortality was 52.0% in the lowest, 34.2% in the medium and 15.1% in the highest tertile (Pearson Chi-square p < 0.0001 for trend). The comparison of in-hospital mortality between tertiles of MMMSE was done with the use of logistic regression adjusted to age, sex, and the presence of diabetes mellitus, renal failure and anemia. Comparison of in-hospital mortality between patients from the lowest tertile of MMSE with the highest one revealed that odds ratio was 5.93 (95% CI: 3.58-9.80; p < 0.0001) whereas it was 2.67 (95% CI: 1.60-4.67; p = 0.0002) for patients from the medium tertile. The obtained results show that the worse cognitive function is, the worse in-hospital prognosis can be observed in older patients with HF. Moreover, it also suggests that impaired cognitive function may be an independent risk factor for mortality in elderly HF patients.

Aged↗

PubMed1996

Effects of captopril and propranolol on cognitive function and cerebral blood flow in aged hypertensive rats.

Chronic hypertension has been reported to produce adverse cognitive effects in elderly individuals, perhaps by altering central nervous system hemodynamics. The beneficial or adverse effects of antihypertensive drugs on these processes are not well understood. We examined the effects of captopril (90 mg/kg/day) and propranolol (80 mg/kg/day) on cognitive function and brain blood flow in hypertensive and normotensive rats. Cognitive function was assessed by the Morris water maze, and regional brain blood flow was measured by the [14C]iodoantipyrine method. Nineteen-month-old propranolol-treated hypertensive rats exhibited poorer performance (p < .05) than control rats and had lower brain blood flows, particularly in white matter regions (p < .01). Captopril-treated hypertensive rats did not differ significantly from control rats with regard to either cognitive performance or brain blood flow. In the normotensive rats, there were no effects of either drug on cognitive performance or brain blood flow. Thus, blood pressure reduction by propranolol but not captopril has an adverse effect on cognitive function and brain blood flow in hypertensive rats.

Animals↗

PubMed2006

Disease progression in vascular cognitive impairment: cognitive, functional and behavioural outcomes in the Consortium to Investigate Vascular Impairment of Cognition (CIVIC) cohort study.

BACKGROUND AND PURPOSE: Empirical studies to clarify the outcomes in Vascular Cognitive Impairment (VCI) are needed. We compared cognitive, functional, and behavioural outcomes in patients with VCI to patients with no cognitive impairment (NCI), and Alzheimer's disease (AD). METHODS: Secondary analysis of the Consortium to Investigate Vascular Impairment of Cognition (CIVIC), a multi-centre Canadian memory clinic 30-month cohort study. RESULTS: Of 1347 patients, 938 were eligible for follow-up, of whom 239 (24.5%) were lost and 29 (3%) had died. Of the remaining 697 patients, 125 had NCI, 229 had VCI, and 343 had AD at baseline. Compared to people with NCI, of whom 20-40% showed progression based on cognitive and functional measures, those with VCI were more likely to progress (50-65%), as were people with AD (50-80%) (p<0.01). More people with VCI showed progression of affective symptoms (30%) than those with NCI (12%) or AD (15% p<0.01). Progression of impaired judgment (rated clinically) in VCI (15%) was similar to AD (11%) but more common than in NCI (4%, p<0.01). CONCLUSIONS: Most people with VCI show readily detectable progression by 30 months. Depressive symptoms were more common and more progressive in VCI than in Alzheimer's disease, whereas clinical evidence of progressive executive dysfunction was common in both AD and VCI.

Aged↗

PubMed2000

The effects of propranolol on cognitive function and quality of life: a randomized trial among patients with diastolic hypertension.

PURPOSE: We sought to determine whether propranolol has adverse effects on cognitive function, depressive symptoms, and sexual function in patients treated for diastolic hypertension. SUBJECTS AND METHODS: We performed a placebo-controlled trial among 312 men and women, 22 to 59 years of age, who had untreated diastolic hypertension (90 to 104 mm Hg). Patients were randomly assigned to treatment with propranolol (80 to 400 mg/day) or matching placebo tablets. Thirteen tests of cognitive function were assessed at baseline, 3 months, and 12 months. Five tests measured reaction time to, or accuracy in, interpreting visual stimuli; one test measured the ability to acquire, reproduce, and change a set of arbitrary stimulus-response sets; and seven tests measured memory or learning verbal information. Depressive symptoms and sexual function were assessed by questionnaires at baseline and 12 months. RESULTS: There were no significant differences by treatment assignment for 11 of the 13 tests of cognitive function at either 3 or 12 months of follow-up. Compared with placebo, participants treated with propranolol had slightly fewer correct responses at 3 months (33 +/- 3 [mean +/- SD] versus 34 +/- 2, P = 0.02) and slightly more errors of commission at 3 months (4 +/-5 versus 3 +/- 3, P = 0.04) and at 12 months (4 +/- 4 versus 3 +/- 3, P = 0.05). At 12 months, depressive symptoms and sexual function and desire did not differ by treatment assignment. CONCLUSIONS: Treatment of hypertension with propranolol had limited adverse effects on tests of cognitive function that were of questionable clinical relevance, and there were no documented adverse effects on depressive symptoms or sexual function. Selection of beta-blockers for treatment of hypertension should be based on other factors.

Adrenergic beta-Antagonists↗

PubMed2002

Cognitive functioning and social problem-solving skills in schizophrenia.

INTRODUCTION: This study examined the relationships between symptoms, cognitive functioning, and social skill deficits in schizophrenia. Few studies have incorporated measures of cognitive functioning and symptoms in predictive models for social problem solving. METHOD: For our study, 44 participants were recruited from consecutive outpatient admissions. Neuropsychological tests were given to assess cognitive function, and social problem solving was assessed using structured vignettes designed to evoke the participant's ability to generate, evaluate, and apply solutions to social problems. A sequential model-fitting method of analysis was used to incorporate social problem solving, symptom presentation, and cognitive impairment into linear regression models. Predictor variables were drawn from demographic, cognitive, and symptom domains. Because this method of analysis was exploratory and not intended as hierarchical modelling, no a priori hypotheses were proposed. RESULTS: Participants with higher scores on tests of cognitive flexibility were better able to generate accurate, appropriate, and relevant responses to the social problem-solving vignettes. CONCLUSIONS: The results suggest that cognitive flexibility is a potentially important mediating factor in social problem-solving competence. While other factors are related to social problem-solving skill, this study supports the importance of cognition and understanding how it relates to the complex and multifaceted nature of social functioning.

Journal Article↗

PubMed1996

[Cognitive function and MRI findings in very low birth weight infants].

Twenty-two very low birth weight infants at preschool ages of 5-6 years were studied to clarify the correlation between cognitive function and MRI findings. Cognitive function was evaluated by the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the Frostig developmental test of visual perception. Ventricular enlargement, assessed by the bioccipital index (B. I.) measured on MRI, was correlated to cognitive disorders. Children with periventricular high intensity areas (T2-weighted images) extending from the posterior periventricular region to the parietal lobe tend to highly suffer from cerebral palsy and visuo-perceptual impairment. These results indicate that the disorders of cognitive function in very low birth weight infants were caused by a damage of association fibers in periventricular areas which was detectable by MRI.

Brain↗