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PubMed1998

Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands.

OBJECTIVE: To relate dietary patterns to cognitive function in elderly men. DESIGN: Cross-sectional study. SETTING: Population based. SUBJECTS: 1049 men aged 70-91 years around 1990 in five cohorts from the Seven Countries Study: Finland (2 cohorts), the Netherlands (1 cohort), and Italy (2 cohorts). INTERVENTIONS: Food intake was estimated by a cross-check dietary history. Based on the WHO guidelines for the prevention of chronic diseases, a healthy diet indicator was calculated (HDI). A higher HDI indicates a diet more in accordance with the WHO guidelines, and previously we showed that HDI predicted reduced all-cause mortality in our cohorts. Cognitive function was measured using the Mini-Mental State Examination (MMSE), and a score of 23 or lower was used to indicate cognitive impairment. RESULTS: The prevalence of cognitive impairment varied from 14.4% in Zutphen (The Netherlands) to 42.1% in Crevalcore (Italy). There was a tendency towards a lower prevalence of cognitive impairment associated with increased HDI in four out of five cohorts (not in East Finland). In Zutphen this association was borderline significant (OR=0.81; 95% CI 0.63-1.04) after adjustment for age, education, cigarette smoking, alcohol consumption and energy intake. In Crevalcore the association was statistically significant (OR = 0.75; 95% CI 0.58-0.97). CONCLUSIONS: A healthy diet might be associated with a better cognitive function in elderly men. However, since the results were not consistent over all five cohorts, further research is needed to confirm this finding and to decide whether this association is causal.

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PubMed2001

The heritability of cognitive functioning in very old adults: evidence from Danish twins aged 75 years and older.

Heritable influences on cognitive functioning were investigated in a sample of 403 pairs of like-sex Danish twins aged 75 years and older. Twins completed the Mini-Mental State Examination and 3 other cognitive tests. Genetic factors accounted for 26-54% of the variance on these measures, with the balance being due to environmental factors that create differences rather than similarities among reared-together relatives. Deleting twins with severe cognitive impairment had little effect on the results, indicating that the heritability of cognitive functioning was not due entirely to genes affecting dementia. Neither age nor gender moderated twin similarity, and differential social contact could not account for correlation differences between monozygotic and dizygotic twins. These results replicate G. E. McClearn et al.'s (1997) study in indicating substantial genetic influences on late-life cognitive functioning.

Age Factors↗

PubMed2006

Prospective study of plasma folate, vitamin B12, and cognitive function and decline.

BACKGROUND: The relation between B vitamins and cognitive decline is controversial. In this study, we explored the association of plasma folate and vitamin B12 with cognitive function measured approximately 10 years later. METHODS: We determined plasma folate and vitamin B12 levels from blood samples collected in 1989 to 1990 and initially evaluated cognition in 1995 to 2001 among 635 women, age 70+ years, from the Nurses' Health Study. In a subset of 391, 3 repeated cognitive tests were completed for evaluation of cognitive decline over 4 years; repeated testing is ongoing for the remaining women. Our primary outcome was a global composite score of 6 neuropsychologic tests administered by telephone. We used linear regression models to estimate multivariable-adjusted mean cognitive performance across quartiles of the vitamins and longitudinal models for cognitive decline. RESULTS: Higher vitamin levels were not associated with either initial cognitive performance or subsequent cognitive decline. Mean difference in initial global score for top versus bottom quartiles was 0.06 standard units for folate (95% confidence interval [CI] = -0.10 to 0.22) and 0.15 units for vitamin B12 (0.00 to 0.31). There were no dose-response trends for either nutrient. Women with high levels of both nutrients initially performed better than women low in both nutrients (global score, mean difference = 0.34; 95% CI = 0.05 to 0.62); this association did not hold for subsequent cognitive decline. CONCLUSIONS: Combined B vitamin deficiency may be associated with impaired cognition, but in these healthy, well-nourished women, plasma folate and vitamin B12 were not related to cognitive function.

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PubMed1995

Cognitive function in patients with insulin-dependent diabetes mellitus during hyperglycemia and hypoglycemia.

BACKGROUND: To determine the impact of glycemic control, gender, and other relevant parameters on cognitive function during exposure to different blood glucose levels in patients with insulin-dependent diabetes mellitus (IDDM), we examined neuropsychologic function during experimentally induced periods of hyperglycemia and hypoglycemia. METHODS: We studied 20 men and 22 women, aged 18 to 44 years, with IDDM duration of 3 to 14 years and HbA1 values ranging from 5.8% to 18.0% (nondiabetic range 5.4% to 7.4%). We used a controlled experimental setting involving tests of sensory perceptual processing, simple motor abilities, attention, learning and memory, language, and spatial and constructional abilities at plasma glucose levels of 2.2, 5.6, 8.9, 14.4, and 21.1 mmol/L. Patients were blind to the glucose level. Tests used at each glucose level included reaction time (simple and choice), digit vigilance, trail making part B, word recall, digit sequence learning, and verbal fluency. RESULTS: All aspects of neuropsychologic function were diminished at 2.2 mmol/L when compared with basal levels of performance at 8.9 mmol/L, whereas no alterations were observed at 14.4 or 21.1 mmol/L. Tests involving associative learning, attention, and mental flexibility were the most affected during hypoglycemia. Glycemic control was not correlated with neuropsychologic function at any glucose level. Women demonstrated less of an impairment in neuropsychologic function than men at 2.2 mmol/L. CONCLUSIONS: Cognitive function in IDDM patients was generally well-preserved even at substantially elevated blood glucose levels. Deficits in all relevant areas of cognitive function occurred during hypoglycemia (2.2 mmol/L), irrespective of prior glycemic control, and women with IDDM were less cognitively impaired than men with IDDM during hypoglycemia.

Adult↗

PubMed2006

Intracranial pressure parameters in idiopathic normal pressure hydrocephalus patients with or without improvement of cognitive function after shunt treatment.

BACKGROUND/AIMS: Previous research has shown improvements in the clinical triad (gait, incontinence and cognitive dysfunction) after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH) patients with intracranial pulse pressure amplitudes >4-5 mm Hg, the pulse amplitudes being <4 mm Hg in the nonresponders. However, it is unknown whether similar differences exist regarding change in cognitive functioning after shunt surgery. The aim of this study was to compare preoperative intracranial pressure (ICP) parameters between iNPH that either improved or not improved in cognitive function after shunt treatment. METHODS: Neuropsychological testing was performed before and after surgery in 27 consecutive iNPH patients treated with ventriculoperitoneal shunts. The ICP recordings were performed as part of routine preoperative assessment, stored as raw data files, and analyzed retrospectively. The mean ICP as well as single ICP wave amplitudes were computed and analyzed in consecutive 6-second time windows. RESULTS: Significant improvement in neuropsychological tests, defined as a 4-point improvement in Folstein Mini-Mental State Examination or improvement by one standard deviation in 50% of subtests of Dementia Rating Scale, was found in 12 patients (44%; shunt responders). In these patients, mean ICP was similar though the mean ICP wave amplitude was significantly higher than in the shunt nonresponders. CONCLUSIONS: While preoperative mean ICP was similar, the mean ICP wave amplitudes were considerably higher in iNPH patients with significant change in cognitive function following shunt surgery.

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PubMed2006

Impact of androgen deprivation therapy on physical and cognitive function, as well as quality of life of patients with nonmetastatic prostate cancer.

PURPOSE: Many patients with prostate cancer receive androgen deprivation therapy for long periods. We compared physical and cognitive function, and quality of life in a cross-sectional study of 57 patients receiving androgen deprivation therapy for nonmetastatic prostate cancer and 51 healthy age matched controls. MATERIALS AND METHODS: Physical and daily function were measured by the 6-minute walk test, grip strength, the timed up and go test, and activities of daily living measures. Cognitive function was evaluated by the High Sensitivity Cognitive Screen and by a self-report prototype Functional Assessment of Cancer Therapy cognitive function subscale. Quality of life was assessed by the Functional Assessment of Cancer Therapy-General with the subscale for fatigue and by the Patient-Oriented Prostate Utility Scale. RESULTS: Androgen deprivation therapy was given for a median of 1.8 years (range 0.4 to 7.4). Patients had lower median hemoglobin than controls (134 vs 148 gm/l, p <0.0001). Performance on physical tests was similar in the 2 groups. Moderate or severe cognitive impairment by the High Sensitivity Cognitive Screen was similar for patients (23%) and controls (35%, p = 0.2). Self-reported cognitive dysfunction was also similar. Scores for the Functional Assessment of Cancer Therapy-General were similar but the Patient Oriented Prostate Utility Scale summary score was worse for patients (median 71 vs 86, p <0.001). More patients reported severe fatigue (Functional Assessment of Cancer Therapy-Fatigue score less than 35, p = 0.03). Low energy, poor bladder control and loss of sexual function were reported in 36%, 47% and 95% of patients, and in 16%, 34% and 33% of controls, respectively. CONCLUSIONS: Patients treated with androgen deprivation therapy experience more symptoms and have worse fatigue than controls, but this study did not detect any effect on physical or cognitive function.

Aged↗

PubMedDate not supplied

Cognitive function in Japanese elderly with type 2 diabetes mellitus.

The current study was conducted to investigate the cognitive function in Japanese elderly with type 2 diabetes mellitus (DM). Participants included 69 diabetic and 27 nondiabetic subjects (60 to 85 years old). The cognitive functional tests conducted were the Mini-Mental State Examination (MMSE), Word Lists Recall (immediate, delayed), Digit Symbol Test (Wechsler Adult Intelligence Scale-Revised [WAIS-R]), and the Stroop Color Word Test. Hemoglobin A1c (HbA1c) was measured as the index of glycemic control, and information about recent hypoglycemic episodes was gathered by using questionnaires. Student's t test showed that DM subjects had significantly lower scores in the MMSE (P<.01) and Digit Symbol Test (P<.05) than non-DM subjects. The scores of the Digit Symbol Test in diabetes subjects had a significant negative relationship with HbA1c (r=-.433; P<.001), and insulin-use had a significant relationship with the scores of the MMSE and Digit Symbol Test. Subjects in the DM group were further divided by insulin use. Comparison of insulin-treated DM subjects, non-insulin-treated DM subjects, and nondiabetic subjects by analysis of variance followed by Bonferroni's post hoc test showed that insulin-treated DM subjects had significantly lower scores in the MMSE and Digit Symbol Tests than both non-insulin-treated DM subjects (P<.05) and nondiabetic subjects (P<.01). Our study suggests that Japanese elderly DM subjects, especially those with insulin treatment, have poor cognitive function.

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PubMed1982

Reminiscence: a nonformal technique for improving cognitive functioning in the aged.

This study investigated the effect of a structured reminiscent intervention program upon cognitive functioning of the elderly. The sample consisted of 105 volunteers residing in a public housing complex in central Pennsylvania. Using an experimental design, the volunteers were randomly assigned to one of three treatment groups. One group was given learning tasks to be performed using material from their past personal lives. A second group was asked to perform operations on new material and a control group was pre and posttested but given no treatment. It was found that females in the reminiscent group significantly improved scores of cognitive functioning as measured by the Raven Standard Progressive Matrices. Secondly, compared with the control Group, both the reminiscent and new material groups improved performance as a result of the planned learning activities. Both findings suggest that attempts to stimulate cognitive functioning in older people are worth undertaking, and that memories can provide the material for such activities.

Aged↗

PubMed2005

The influence of the dopaminergic system on cognitive functioning: A molecular genetic approach.

Many pharmacological and clinical studies have demonstrated the importance of the dopaminergic (DA) system for cognitive functioning but little is known about the genetic basis of general cognitive ability that has been demonstrated to be highly heritable. Attempts to detect associations between certain gene loci and endophenotypes of general cognitive ability have turned out to be more promising. Therefore, the aim of the present study was to investigate two dopaminergic candidate genes (COMT VAL158MET and DRD2 TAQ IA) for endophenotypes of cognitive functioning i.e. attention, vigilance, interference, time estimation and sensoric and motoric reaction times. Out of a gene data bank of more than 600 healthy Caucasian participants, 96 subjects (n = 48 males and n = 48 females) were recruited according to their genotype/allele pattern, resulting in six independent groups (COMT: VAL/VAL, VAL/MET, MET/MET)x(DRD2: A1-, A1+) of n = 16 subjects each. Results showed associations of the COMT gene with attention and with time estimation but most noteworthy was an interaction effect DRD2xVAL on interference performance as measured by the STROOP-test explaining 13% of the variance. Findings suggest that a balance between DA related catabolic enzyme activity and receptor density are good predictors for the endophenotype of cognitive interference and that the COMT gene is in accordance with previous studies related to cognitive functioning.

Analysis of Variance↗

PubMed1997

The effect of estrogen replacement therapy on cognitive function in women: a critical review of the literature.

OBJECTIVE: To conduct a review of the available clinical trials to determine whether sufficient evidence exists to support the conclusion that estrogen replacement therapy has a beneficial effect on cognitive performance in post-menopausal women and in women with Alzheimer's disease. Studies were identified through a MEDLINE search of all English-language publications between 1970 and 1996 in which the words estrogen and cognition or estrogen and memory appeared. DATA EXTRACTION: Data were extracted for each study, including features of subjects and eligibility criteria, duration of follow-up, and treatment regimen. Baseline characteristics were evaluated, including age; menopausal status; follicle-stimulating hormone, luteinizing hormone, and estradiol levels; mood; and measures of cognitive function. Psychological tests were evaluated for construct validity. RESULTS: Nineteen studies were reviewed, including 10 randomized trials of estrogen replacement therapy versus placebo. Extreme heterogeneity among subjects and variability in the use of cognitive measures across the studies precluded performing a quantitative summary. Of the 10 randomized trials, eight claimed therapeutic benefits for estrogen therapy, three of which reported significant improvements in memory and two of which showed improvements in attention. These studies did not control for potential confounds such as depression and vasomotor symptoms. Of the nine observational studies, five found a significant association between estrogen use and cognitive function. CONCLUSION: Although several observational studies provide encouraging evidence for the beneficial effect of estrogen on cognitive function, there is currently inadequate evidence available from randomized, controlled trials to support the conclusion that estrogen replacement therapy improves cognitive function in post-menopausal women or women with Alzheimer's dementia.

Alzheimer Disease↗

PubMed2005

Impact of cognitive function on assessments of nursing home residents' pain.

OBJECTIVES: We sought to examine the impact of residents' cognitive function on the quality of Minimum Data Set (MDS) pain data using the latent variable approach. RESEARCH DESIGN: Using the Resident Assessment Instrument (RAI) protocol, nursing home (NH) staff and well-trained study nurses independently assessed 3736 NH residents. MEASURES: Inter-rater agreement of pain ratings between NH staff and study nurses was quantified by weighted kappas and polychoric correlations and compared among groups of residents with no/mild, moderate, and severe cognitive impairment. Probit models were built to examine the effect of residents' cognitive function on thresholds raters used to rate pain. RESULTS: Of 3736 residents, 40.4% had no/mild, 35.9% moderate, and 23.7% severe cognitive impairment. Both NH staff and study nurses recorded less frequent and less severe pain for residents with more severe cognitive impairment. The inter-rater agreement on pain ratings between NH staff and study nurses was good-weighted kappas were greater than 0.5 and polychoric correlations greater than 0.7. The thresholds raters used to record pain were similar for NH staff and study nurses and progressively increased when raters recorded pain for residents with more severe cognitive impairment. CONCLUSIONS: Given the RAI protocols, the quality of MDS pain data collected by NH staff was similar to that of well-trained nurses regardless of residents' cognitive function. Our results strongly support the notion that specialized pain assessment instruments are needed to adequately detect pain for the large proportion of cognitive impaired NH residents.

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PubMed1996

Estrogen replacement therapy and cognitive functioning in the Atherosclerosis Risk in Communities (ARIC) Study.

The association of estrogen replacement therapy (ERT) with cognitive functioning was assessed in 6,110 women aged 48-67 years participating in the Atherosclerosis Risk in Communities (ARIC) study, a multicenter longitudinal investigation. ERT was evaluated in relation to results of three cognitive tests (the Delayed Word Recall (DWR) Test, the Digit Symbol Subtest of the Wechsler Adult intelligence Scale-Revised (DSS/WAIS-R), and the Word Fluency (WF) Test) using data from the first follow-up visit of the cohort (1990-1992). No consistent associations were seen between ERT and either the DWR test or the DSS/WAIS-R after adjusting for age, education, and additional covariates previously found to be associated with cognitive function scores. Among surgically menopausal women aged 48-57 years, adjusted mean WF scores were slightly greater in ERT current users (mean WF 35.9) than in never users (mean WF 33.5) (p < 0.02); and within current users, adjusted WF scores increased with duration of ERT use. However, the finding that ERT was associated with a slightly higher level of performance on only one of three measures offers little support for the hypothesis that ERT has a major protective effect on cognitive function in women less than 68 years of age. The generalizability of these findings to older women who are more likely to experience cognitive decline and who may be using ERT for longer periods of time is limited by the relatively young age of the cohort.

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PubMed2006

Association between cognitive function, behavioral syndromes and two-year clinical outcome in Chinese subjects with late-onset Alzheimer's disease.

OBJECTIVE: To examine associations between behavioral and psychological symptoms of dementia (BPSD), cognitive function and clinical deterioration over 2 years. METHODS: One hundred and four Chinese subjects with late-onset Alzheimer's Disease (AD) who presented to psychogeriatric clinics were followed for an average of 22.5 months. BPSD subgroups were categorized by latent class analysis using the Neuropsychiatric Inventory. Comprehensive cognitive profiles were performed with the Mattis Dementia Scale, the Hong Kong List Learning Test (HKLLT) and the Category Verbal Fluency Test. Interactions between cognitive function and behavioral syndromes were evaluated. Potential predictors for clinical deterioration were computed with logistic regression analysis. RESULTS: Three latent classes of subjects with similar behavioral syndromes were identified: Low BPSD (44%), Affective (32%) and Psychosis (24%) groups. Association between cognitive functions and BPSD was not significant. At follow-up, a higher proportion of subjects in the Affective (70%) and Low BPSD (49%) groups remained stable at the same Clinical Dementia Rating. Baseline scores in the "recognition" test of the HKLLT and age were significant predictors for "deceased" status at 2-year follow-up. CONCLUSION: The lack of association between behavioral syndromes and cognitive function suggests that these relatively independent dimensions of dementia should be examined individually for different prognostic significance.

Aged↗

PubMed2005

Vitamin status and cognitive function in a long-term care population.

BACKGROUND: Ageing can be associated with poor dietary intake, reduced nutrient absorption, and less efficient utilization of nutrients. Loss of memory and related cognitive function are also common among older persons. This study aimed to measure the prevalence of inadequate vitamin status among long-term care patients and determine if an association exists between vitamin status and each of three variables; cognitive function, vitamin supplementation, and medications which alter gastric acid levels. METHODS: Seventy-five patients in a long-term care hospital in Guelph, Ontario were recruited to a cross-sectional study. 47 were female and the mean age was 80.7 (+/-11.5) years, ranging from 48 to 100 years. Blood was used to measure levels of vitamins B12 (cobalamin), B6 (pyridoxal-5'-phosphate/PLP), erythrocyte folate, vitamin B3 (niacin) and homocysteine (Hcy). The Standardized Mini-Mental State Examination (SMMSE) was administered to measure cognitive function. A list of medications and vitamin supplementation for each patient was provided by the pharmacy. RESULTS: The prevalence of low vitamin (B12, B6, erythrocyte folate, niacin) or high metabolite (homocysteine) levels among 75 patients were as follows: B12 <148 pmol/L in 5/75 (6.7%); B12 between 148 and 221 pmol/L in 26/75 (34.7%); B6 13.3 micromol/L in 31/75 (41.3%). There was no significant difference among residents grouped into marked (n = 44), mild (n = 14), or normal (n = 9) cognitive function when evaluating the effect of vitamin status. There were no significant differences in mean B12 and homocysteine levels between users and non-users of drug therapy (Losec, Zantac, or Axid). Compared to vitamin supplement non-users, supplemented residents had significantly higher mean B12 (p < 0.0001) and erythrocyte folate (p < 0.05) concentrations and significantly lower mean homocysteine (p < 0.01) levels; 229.1 versus 423.6 pmol/L for B12, 882.9 versus 1043.6 nmol/L for erythrocyte folate and 14.4 versus 12.0 micromol/L for homocysteine. CONCLUSION: Given the prevalence data on vitamin status in this sample population, the possible benefits of vitamin supplementation should be considered in clinical intervention studies using these populations of elderly.

Aged↗

PubMed2005

The relative effect of size at birth, postnatal growth and social factors on cognitive function in late childhood.

PURPOSE: To investigate if fetal, head, and somatic postnatal growth are independent predictors of cognition and estimate their relative importance compared to the effect size of social factors on cognitive function at 10 years. METHODS: Longitudinal population-based data from the birth questionnaire and the 5- and 10-year sweeps of the 1970 British Birth Cohort Study were used, including 11,244 subjects. Multiple linear regression and structural equation modeling were used in the statistical analysis. Standardized coefficients were used to measure and compare effect sizes. RESULTS: Fetal growth, head, and somatic postnatal growth were significant independent predictors of cognition at age 10. These associations remained even among children born within the normal birth-weight range and those who did not experience neonatal problems. Effect of head size on cognition was greater than the effect of birth weight. Weight at 10 had a small negative effect on cognition. Gestational age was not directly associated with cognitive function, but it had a weak indirect effect. Parent's socioeconomic status was strongly associated with child's cognitive function. CONCLUSION: Although effect sizes of prenatal and postnatal growth on cognition are modest compared with the strong effect size of social factors, they might have greater impact at the population level, since most children are born without low birth weight.

Birth Weight↗

PubMed1985

Long-latency event-related potentials in the evaluation of cognitive function in children.

The endogenous auditory P300 event-related potential (P3) has been used to differentiate functional and organic cognitive disorders in adults. We found that children with organic cognitive impairments (as determined by the Halstead-Reitan [HR] test) had greater P3 latencies than children with normal HR evaluations. The P3 and HR showed 85% agreement in independent assessments of functional or organically based cognitive impairment in children. Mini-Mental-State, IQ, EEG evaluations, and clinical suspicions of "organicity" with respect to cognitive function were similarly associated with P3 latency.

Adolescent↗

PubMed2000

Genes for cognitive function: developments on the X.

Developments in human genome research enabled the first steps toward a molecular understanding of cognitive function. That there are numerous genes on the X chromosome affecting intelligence at the lower end of the cognitive range is no longer in doubt. Naturally occurring mutations have so far led to the identification of seven genes accounting for a small proportion of familial nonspecific X-linked mental retardation. These new data indicate that normal expression of many more X-linked and autosomal genes contribute to cognitive function. The emerging knowledge implicating genes in intracellular signaling pathways provides the insight to identify as candidates other X-linked and autosomal genes regulating the normal development of cognitive function. Recent advances in unravelling the underlying molecular complexity have been spectacular but represent only the beginning, and new technologies will need to be introduced to complete the picture.

Animals↗

PubMed2005

Socioeconomic position across the lifecourse: how does it relate to cognitive function in mid-life?

PURPOSE: To examine the association between socioeconomic position (SEP) over the lifecourse and cognitive function in middle age. Two alternative models were assessed: the "direct effects model" where temporally distinct measures of SEP have only direct effects on adult cognition, and the "indirect effects" model where the effect of early life SEP are mediated through later life measures of SEP. METHODS: Data are from the Whitehall II study (N=10,308 at baseline), a longitudinal cohort study of British civil servants, aged between 46 and 68 years at the time of cognitive testing. Structural equation models were used to compare the fit of direct and indirect effects models, and quantify the effects of different measures of SEP on cognition. Childhood SEP, education, and adult SEP were used to model SEP across the lifecourse. Cognitive function was assessed as a latent construct composed of the following: verbal memory, AH 4-I, Mill Hill, phonemic and semantic fluency. RESULTS: The indirect effects model provided a better fit to the data. Childhood SEP had no direct effect on cognitive function but had a substantial "indirect effect," mediated through education and adult SEP. 78.4% of the effect of education in men and 100% in women was indirect. CONCLUSIONS: Socioeconomic differences in adult cognition are a result of the socioeconomic trajectory of individuals throughout their lifecourse. Early measures of SEP influence cognition indirectly, through their influence on later measures of SEP.

Adult↗