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[The QDF-HF (Quality of life, Depression and Cognitive Functioning in Heart Failure). The project and study protocol].

The QDF (Quality of life, Depression Cognitive Function) is a project by nursing personnel, as companion study of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico- Heart Failure). The study aims at describing the evolution of the QDF variables in the patients randomised for the GISSI-HF; at evaluating the reliability of the assessments with standardised instruments (Kansas City Quality of life Questionnaire (KCQQ); Geriatric Depression Scale (GDS) and Mini Mental State Examination (MMSE) compared to the clinical judgement of the nurses; and at describing whether and how the assessment of QDF variables influences decision making and care for these patients (i.e. drug therapies, psychosocial interventions etc). The QDF data are collected at baseline and at 6 months and at 1, 2 and 3 years. The greatest majority of patients are expected to comply with the self administered questionnaires (KCQQ and QDF) while the MMSE will be proposed, via a didactical presentation, only to patients older than 70 years. A specific goal of the project focuses on the degree of independence between the results of the questionnaire and the judgement of nurses. Expected outcomes: epidemiology and distribution of QDF variables among patients of different age-groups and disease severity; description of the prevalence and incidence of severe problems. Up to 2000 patients are expected to be included in this prospective protocol which has already been activated in a network of more then 70 centres.

Adult↗

PubMed1999

Association between hyperactivity and executive cognitive functioning in childhood and substance use in early adolescence.

OBJECTIVE: To determine whether deficient executive cognitive functioning (ECF) in association with high behavioral activity level comprise components of the liability to substance abuse. METHOD: A high-risk (HR) group having fathers with a lifetime DSM-III-R diagnosis of a psychoactive substance use disorder was compared with a low-average-risk (LAR) group whose fathers had neither psychoactive substance use disorder nor another adult Axis I psychiatric disorder. ECF and behavioral activity were measured using neuropsychological tests, activity monitor, diagnostic interview, and informant ratings when the subjects were 10 to 12 years of age. Alcohol, tobacco, and cannabis use were measured at 2-year follow-up. RESULTS: At baseline, the HR group had a significantly higher behavioral activity level and exhibited poorer performance on ECF tests than the LAR group. By early adolescence, HR subjects had a higher lifetime rate of tobacco and cannabis use and earlier age at onset of cannabis use. ECF capacity, but not behavioral activity level, predicted tobacco and cannabis use, total number of drugs ever tried, and severity of drug involvement. ECF accounted for additional variance beyond the effects of conduct problems on these outcomes. CONCLUSION: Whereas behavioral activity and ECF capacity in late childhood distinguishes HR from LAR youth, childhood ECF capacity is the more salient predictor of drug use in early adolescence.

Adaptation, Psychological↗

PubMed2004

Effects of neonatal excitotoxic lesions of the entorhinal cortex on cognitive functions in the adult rat.

The entorhinal cortex (EC) is involved in a variety of cognitive functions by virtue of its neuronal input from the neocortex and projection to the hippocampal formation and the limbic-striatal system. Neonatal lesions are increasingly considered useful models for disconnection syndromes such as schizophrenia. Therefore, we investigated the effects of neonatal EC lesions on adult rat behavior. Neonatal (postnatal day 7) lesions were inflicted by bilateral injections of ibotenate into the EC. Sham-lesioned (vehicle injection) and naive (unoperated) rats served as controls. Locomotor activity was measured in prepubertal and young adult rats. Adult rats were then tested for spatial learning in an eight-arm radial maze (reinforced delayed alternation) and for motivation (progressive ratio schedule of operant behavior). Finally, prepulse inhibition (PPI) of the acoustic startle reflex and locomotor activity were investigated with and without apomorphine (APO) challenge. Brain tissue damage was assessed using Nissl-staining. The total volume of the adult rat EC was reduced after neonatal ibotenate-injection. Neonatal EC-lesions increased perseveration only in a delayed task in the radial maze and induced a leftward-shift of breakpoints in operant responding. Lesions did not alter baseline locomotor activity, but enhanced the locomotor stimulating effect of APO. PPI was not affected by neonatal lesions of the EC with and without APO challenge. Neonatal lesions of the EC impaired the ability to hold information during delays and reduced motivation during operant behavior which reflects a state of anhedonia. Thus, they may serve as an animal model for certain aspects of schizophrenia.

Aging↗

PubMed2005

Effect of smoking and time on cognitive function in the elderly without dementia.

OBJECTIVE: To examine the association between smoking and changes in cognitive function over time in elderly persons without dementia. METHODS: The results of neuropsychological tests grouped into domains of memory, abstract-visuospatial, and language, from several intervals over a 5-year period in 791 elderly patients without dementia or cognitive impairment. Smoking history was categorized as never, current, or past smokers and related to the slope of performance in each cognitive domain using generalized estimating equations. RESULTS: Performance in all cognitive domains declined over time. Memory performance declined more rapidly among current smokers aged >75 years than in nonsmokers similar in age, including those who never smoked or had quit smoking. The effect was stronger among those without an APOE-epsilon4 allele. There was no association between smoking and performance in any cognitive domain in persons aged <75 years, and there was no association between past smoking and performance on any of the three cognitive factors at any time interval in either age group. CONCLUSION: Current smokers aged >75 years perform more poorly on cognitive tests and appear to decline in memory more rapidly than their peers who do not smoke, especially if they lack the APOE-epsilon4 allele. Smoking does not affect cognitive performance in those persons aged <75 years.

Age Factors↗

PubMed2006

Arnold-Chiari-II malformation and cognitive functioning in spina bifida.

Spina bifida is a multifaceted neurological condition with complex neuropsychological sequelae. The cognitive outcome in spina bifida has frequently been attributed to the severity of the hydrocephalus. However, because of complex neuropathology, the influence of hydrocephalus alone does not sufficiently explain the deficits in the cognitive profile in spina bifida. To date, little is known of the role of Arnold-Chiari-II malformation (ACM) in the cognitive profile of these patients. Aim of the current study is to delineate the specific contribution of the ACM in spina bifida by comparing children with ACM and those without ACM. 46 children between 6 and 15 years of age underwent a neuropsychological assessment covering intelligence and a wide range of cognitive functions, such as visuo-motor processing, attention, memory, word fluency and speed of information processing. Comparisons were made between patients with ACM (ACM+) and those without ACM (ACM-); all children with ACM+ also had hydrocephalus. Confounding effects of global cognitive impairment were excluded, such that groups were matched on verbal IQ. Because of complex neuropathology, which is inherent to spina bifida, the method applied was based on a comparison of cognitive profiles of the study group with profiles of patients with cerebellar damage and hydrocephalus found in the literature. Impaired visual analysis and synthesis, verbal memory, and verbal fluency, even after correction for global cognitive impairment, were observed in children with ACM. The hypothesis that in addition to impairment in visual analysis and synthesis, which are related to both hydrocephalus and ACM, specific deficiencies in verbal memory and fluency may be attributed to ACM is supported.

Adolescent↗

PubMed2006

An investigation of whether factors associated with short-term attrition change or persist over ten years: data from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

BACKGROUND: Factors associated with the loss of participants in long-term longitudinal studies of ageing, due to refusal or moves, have been discussed less than those with short term follow-up. METHODS: In a population-based study of cognition and ageing (the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS)), factors associated with dropout due to refusal and moving in the first follow-up period (over two years) are compared with factors associated with dropout over ten years. Participants at 10-year follow-up are compared with their age-standardised baseline contemporaries. RESULTS: Some consistent trends are found over the longer term. Refusers tended to have poorer cognition, less years of education, not have a family history of dementia and be women. Characteristics of people who moved differed between waves, but the oldest and people in worse health moved more. When surviving and responding individuals at ten years are compared with those of the same age at baseline many differences are found. Individuals of lower social class, education, cognitive ability, in residential care, with sight/hearing problems and poor/fair self-reported health are less likely to be seen after 10 years of follow-up. Individuals report more health problems when they participate in multiple interviews. CONCLUSION: The characteristics of refusers in the longer term are similar to those refusing to participate over the shorter term. Long-term follow-up studies will under represent the disadvantaged and disabled but represent full health status of participating individuals better. There are advantages and disadvantages to both short-term and long-term follow-up.

Aged↗

PubMed2005

Alcohol consumption and cognitive function in late life: a longitudinal community study.

OBJECTIVE: To examine the association between alcohol use and cognitive decline in a longitudinal study of a representative elderly community sample free of dementia at baseline. METHODS: Cognitive functions and self-reported drinking habits were assessed at 2-year intervals over an average of 7 years of follow-up. Cognitive measures, grouped into composites, were examined in association with alcohol consumption. Trajectory analyses identified latent homogeneous groups with respect to alcohol use frequency over time, and their association with average decline over the same period in each cognitive domain. Models controlled for age, sex, education, depression, smoking, general mental status (Mini-Mental State Examination [MMSE]), performance on the given test at baseline, and subsequent new-onset dementia during follow-up. RESULTS: The authors found three homogeneous trajectories that they characterized as no drinking, minimal drinking, and moderate drinking. Few heavy drinkers were identified in this elderly cohort. Compared to no drinking, both minimal and moderate drinking were associated with lesser decline on the MMSE and Trailmaking tests. Minimal drinking was also associated with lesser decline on tests of learning and naming. These associations were more pronounced when comparing current drinkers to former drinkers (quitters) than to lifelong abstainers. CONCLUSION: In a representative elderly cohort over an average of 7 years, a pattern of mild-to-moderate drinking, compared to not drinking, was associated with lesser average decline in cognitive domains over the same period.

Age Factors↗

PubMed2003

Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study.

OBJECTIVE: To determine the independent effects of obesity and hypertension on cognitive functioning. METHODS: Using a prospective design, male (n=551) and female (n=872) participants of the Framingham Heart Study were classified by presence or absence of obesity and hypertension based on data collected over an 18-y surveillance period. All subjects were free from dementia, stroke, and clinically diagnosed cardiovascular disease up to the time of cognitive testing. Statistical models were adjusted for age, education, occupation, cigarette smoking, alcohol consumption, total cholesterol, and a diagnosis of type II diabetes. Body mass index status (nonobese or obese) and blood pressure status (normotensive or hypertensive) were then related to cognitive performance (learning, memory, executive functioning, and abstract reasoning) on tests administered 4-6 y later. RESULTS: Adverse effects of obesity and hypertension on cognitive performance were observed for men only. Obese and hypertensive men performed more poorly than men classified as either obese or hypertensive, and the best performance was observed in nonobese, normotensive men. CONCLUSIONS: The adverse effects of obesity and hypertension in men are independent and cumulative with respect to cognitive deficit.

Aged↗

PubMed2004

The relationship between cerebral blood flow and cognitive function in patients with brain insult of various etiology.

The relationship between the mean cerebral blood flow (CBF) and cognitive function was investigated in patients with brain insult. This study included 72 patients aged 24-85 years treated for the following diseases: cerebral infarction (21), intracerebral hemorrhage (4), subarachnoid hemorrhage (2), brain tumor (14), cerebral contusion (12), normal pressure hydrocephalus (13), Alzheimer's disease (2), and others (4). First-pass radionuclide angiography using Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) was performed for the measurement of the mean CBF, and the Sturb-Black Mental Status Examination for the neuropsychological evaluation. The mean CBF and the score of the neuropsychological test were significantly reduced compared with those of the age-matched controls. Regardless of etiology, the mean CBF and the score of neuropsychological test were significantly reduced, and a significant correlation was observed except for the patients with cerebral contusion. The quantitative measurement of CBF using 99mTc-HMPAO is reliable to estimate the neuropsychological state.

Adult↗

PubMed2004

Cognitive functions in depressive disorders: evidence from a population-based study.

BACKGROUND: Most of the available evidence on the effects of depression is based on in- and out-patient samples focusing on individuals suffering from major depression. The aims of this study were to examine cognitive functioning in population-based samples and to determine whether cognitive performance varies as a function of depression subgroup. METHOD: Population-based samples (aged 20-64 years) with major depression (N = 68), dysthymia (N = 28), mixed anxiety-depressive disorder (N = 25) and minor depression (N = 66) were examined on a variety of cognitive tasks (i.e. episodic memory, verbal fluency, perceptual-motor speed and mental flexibility). One hundred and seventy-five non-depressed individuals served as controls. RESULTS: The total group of depressed individuals showed impairments in tasks tapping episodic memory and mental flexibility. Of more interest, however, was the observation that the pattern of impairments varied as a function of depression subgroup: the major depression and mixed anxiety-depressive disorder groups exhibited significant memory dysfunction, whereas individuals with dysthymia showed pronounced difficulties in mental flexibility. Minor depression did not affect cognitive performance. Verbal fluency and perceptual-motor speed were not affected by depression. CONCLUSIONS: These results indicate that persons with depressive disorders in the population exhibit cognitive impairments in tasks tapping episodic memory and mental flexibility and that cognitive impairment varies as a function of depressive disorder.

Adult↗

PubMed2004

Cerebral atrophy as predictor of cognitive function in old, community-dwelling individuals.

OBJECTIVES: The impact of cortical and subcortical atrophy on cognitive function was examined in a sample of older community-dwelling men and women. MATERIAL AND METHODS: Magnetic resonance imaging was performed on a sample of 129 individuals [age: 68.4 +/- 3.6 years (mean +/- SD), range 64-74 years, 64 women and 65 men, Mini-Mental State Examination scores above 23] to assess cortical and subcortical atrophy. Participants also performed a number of cognitive tasks, and the measures of atrophy were used to predict performance in these tasks. RESULTS: In men, frontal cortical atrophy predicted worse performance in word fluency and the Stroop test, and occipital cortical atrophy was associated with poor performance in motor speed. In women, poor performance in motor speed was associated with subcortical atrophy at the level of the caudate nucleus. CONCLUSION: Atrophy in certain areas was associated with poor performance in specific cognitive tasks, although the amount of explained variance was rather limited in this quite homogeneous sample.

Aged↗

PubMed1992

Changes in cognitive functioning of the oldest old.

Cognitive changes during a 2-year interval in a representative sample of the oldest old were investigated. Respondents were 324 people aged 84 to 90 at baseline who were selected from census records in the Jönköping region of Sweden. Following a 2-year interval, it was possible to reinterview 213 people, or 94% of individuals, still alive. Performance on a battery of five cognitive tests showed a small decline in mean scores, and a 10% increase in the number of people meeting criteria for significant cognitive impairment. Respondents with better functioning at baseline tended to have stable performance over this period.

Aged↗

PubMed1992

Cognitive function in non-demented older adults with hypothyroidism.

PURPOSE: (1) to evaluate objectively changes in cognitive function and electrophysiologic characteristics associated with hypothyroidism of varying severity and duration in primarily older persons; (2) to determine whether these changes are reversible when a euthyroid state has been attained after treatment with thyroid hormone. SUBJECTS AND METHODS: We enrolled 54 non-demented hypothyroid patients (31-99, mean 68.6 +/- 16.4 years) with biochemical evidence of hypothyroidism (38 had overt and 14 had minimal hypothyroidism) and 30 euthyroid controls (31-96, mean 63.7 +/- 18.4 years) screened for good general health. We evaluated attention, orientation, memory, learning, visual-spatial abilities, calculation, language, visual scanning, and motor speed using standardized neuropsychological tests. Electrophysiological measures of neurocognitive function included the P300 latency component of the auditory Event-Related Potentials (ERP) and conduction speed from eye to cortex, the P100 latency component of the Patterned Visual-Evoked Potential (PVEP). All patients were studied when hypothyroid. A subset of patients with minimal initial test abnormalities were available to be retested when euthyroid, 5 and 9 months after onset of thyroid replacement therapy. RESULTS: Hypothyroid patients showed significantly lower scores on the Mini-Mental Status Test (MMS) and on five of 14 neuropsychological tests as compared to controls. The neuropsychological tests affected were copying a cube (visual-spatial function), the Inglis Paired Associates Learning Test-Low and Medium association items (memory and learning), Animal Naming (word fluency/production), and the Trail Making A test (attention, visual scanning and psychomotor function. Hypothyroidism also was associated with longer P100 latencies of PVEPs to 20' checks, but showed no significant differences in PVEP P100 latency to 50' checks, nor in the latency of the auditory ERP component P300. There was a statistically significant correlation between a laboratory index of the severity of hypothyroidism (serum T4) and the Inglis Medium Association items and Animal Naming. There was a statistically significant improvement after 5 months of treatment on three of the timed performance tests that previous studies have shown to be most sensitive to brain dysfunction. CONCLUSION: Hypothyroidism in non-demented older adults is associated with impairments in learning, word fluency, visual-spatial abilities, and some aspect of attention, visual scanning, and motor speed. The MMS by itself was sensitive in differentiating hypothyroid patients with cognitive deficits from controls, while electrophysiological measures did not generally differentiate the hypothyroid patients from normal controls. The MMS was not sensitive to treatment effects, but treatment was associated with significant improvements in three of the most sensitive measures of cognitive dysfunction.

Adult↗

PubMed2002

Cerebral amyloid angiopathy and cognitive function: the HAAS autopsy study.

OBJECTIVE: To investigate the relationship between cerebral amyloid angiopathy (CAA), dementia, and cognitive function in an autopsy sample of 211 Japanese-American men from the population-based Honolulu-Asia Aging Study. METHODS: Starting in 1991, participants were assessed with the Cognitive Abilities Screening Instrument (CASI) and diagnosed with dementia (including subtype) based on published criteria. At autopsy, neuropathologists blinded to clinical data examined brains for neurofibrillary tangles (NFT), neuritic plaques (NP), and a number of vascular pathologies, including CAA. CAA was detected by immunostaining for betaA4 amyloid in parenchymal vessels in the neocortex and semiquantitatively rated. Linear regression models were used to examine the association of CASI score, dementia subtype, and CAA controlling for age at death, time between CASI administration and death, education, NP and NFT counts, infarcts, hemorrhage, and APOE genotype. RESULTS: A total of 44.1% of subjects had CAA in at least one neocortical area. The presence of CAA was associated with higher mean NFT and NP counts and having at least one APOE-epsilon4 allele. The interaction between CAA and AD on the adjusted mean CASI score was significant; compared with nondemented men without CAA, the CASI score was 16.6% lower in men with AD and no CAA and 45.9% lower in men with AD plus CAA. CONCLUSIONS: CAA may contribute to the clinical presentation of dementia by interacting with other neuronal pathologies, leading to more severe cognitive impairment in men with both CAA and AD compared with men with only AD or CAA.

Aged↗

PubMed1996

Interrelations of age, visual acuity, and cognitive functioning.

It has recently been suggested that a large proportion of the age-related influences on many measures of cognitive functioning is mediated through a single common factor. This hypothesis has been supported by the discovery that much of the age-related variance in different cognitive measures is shared, and is not distinct or independent. These earlier results were replicated in this project, and it was also discovered that measures of corrected visual acuity and processing speed share a very large proportion of the age-related variance in measures of working memory, associative learning, and concept identification. The apparent implication is that the common factor that appears to contribute to age-related differences in many cognitive measures is quite broad and may reflect a relatively general reduction in central nervous system functioning.

Adult↗

PubMed2004

Metabolic markers of cobalamin deficiency and cognitive function in normal older adults.

OBJECTIVES: To investigate the relationship between metabolic markers of cobalamin deficiency and cognitive function in normal older adults. DESIGN: Cross-sectional study. SETTING: Queen's University and St. Mary's of the Lake Hospital, Kingston, Ontario, Canada. PARTICIPANTS: Two hundred eighty-one cognitively normal, community-dwelling participants aged 65 and older. MEASUREMENTS: Serum cobalamin, red blood cell folate, methylcitric acid, homocysteine, and methylmalonic acid were determined. Cognitive instruments included the California Verbal Learning Test, Mattis Dementia Rating Scale, and the Stroop Neuropsychological Screening Inventory (Stroop). RESULTS: Serum levels of methylcitric acid had a significant negative correlation with recall, learning, and discriminability (factor 1) of the California Verbal Learning Test after adjusting for age and sex (beta=-0.138, P=.019). Subjects with elevated methylcitric acid had significantly lower scores (factor 1) than subjects with normal methylcitric acid (P<.01). Bivariate analysis showed significant correlations between levels of homocysteine and the Stroop score and between cobalamin, methylmalonic acid, and homocysteine and some scores of the California Verbal Learning Test, but these relationships did not remain significant after multivariate analysis. Subjects with high homocysteine (tHcy) had lower Stroop scores than subjects with normal tHcy (P<.05). No biochemical parameters were associated with the Mattis Dementia Rating Scale scores. CONCLUSION: This study indicates that, in normal elderly subjects, some cognitive scores are related to serum methylcitric acid and possibly homocysteine.

Aged↗

PubMed2005

High blood pressure was associated with cognitive function in middle-age in the Whitehall II study.

BACKGROUND AND OBJECTIVES: Research shows elevated levels of blood pressure in midlife to be linked to impaired cognitive performance in old age. However, it remains unclear if this association extends to younger age groups. The objective of this study was to examine the association between hypertension and a range of cognitive abilities in middle aged men and women. METHODS: Data are from the Whitehall II study. Measures of blood pressure were obtained at baseline (1985-1988) and two subsequent phases of data collection (1991-1994 and 1997-1999). Cognitive function (memory test, AH 4-I, Mill-Hill, phonemic and semantic fluency) was assessed (1997-1999) when participants (N = 5,838) were aged 46-68 years old. RESULTS: Results show a small inverse association between both diastolic and systolic blood pressure and cognitive performance, independent of age, education, employment grade, smoking status, alcohol consumption, use of antihypertensive medication, diagnoses of diabetes, and cardiovascular disease. Similar associations were seen with prospective and cross-sectional analyses. The effect of hypertension was stronger in women, and stronger for cognitive measures assessing executive function. CONCLUSION: Expanding on previous studies on older participants, the present study reports a small, but significant association between hypertension and poor cognitive performance in middle-aged men and women.

Adult↗

PubMed2003

Executive-cognitive functioning in the development of antisocial personality disorder.

The present study examined the association of cognitive-executive abilities to two risk factors for alcoholism, i.e., antisocial behaviors and a family history (FH+) of alcohol dependence. A sample of 91 right-handed, non-substance-dependent, young male adults recruited from the community were classified into three groups: (1) a control group of n=32 men with no history of DSM-III-R childhood conduct disorder (CD) or antisocial personality disorder (ASPD); (2) n=25 men who met criteria for a DSM-III-R childhood CD diagnosis, but did not meet diagnostic criteria for ASPD (i.e., CD/ASPD-); and (3) n=34 men who met DSM-III-R criteria for ASPD. They were further divided into those with and without a positive family history of alcoholism. A two-way (Antisocial Profile (3)x Family History of Alcoholism (2)) ANOVA was used to compare several neuropsychological measures of executive-cognitive functioning (ECF) ability. Verbal abstraction ability was found to be significantly lower in ASPD subjects compared with controls and CD-only subjects, inversely related to antisocial behavior severity (as measured by symptom count). CD-only and control subjects' abstraction ability were statistically indistinguishable. FH+ was associated with increased errors in planning performance on the Porteus Maze Test and diminished performance on Luria's simple alternate-tapping motor tasks. The effect was more pronounced when inhibition of prepotent motor planning was required. Results are consistent with previous work examining ECF ability in antisocial samples that find subtle differences in ECF ability compared to controls. The findings suggest that normal versus abnormal behavioral outcome for children with conduct problems may be influenced by cognitive ability profile, perhaps because of varying maturational processes.

Adult↗