Psychometrically matched measures of global cognition, memory, and executive function for assesment of cognitive decline in older persons.

2003 ◽  
Vol 17 (3) ◽  
pp. 380-392 ◽  
Author(s):  
Dan Mungas ◽  
Bruce R. Reed ◽  
Joel H. Kramer
Keyword(s):  
Executive Function ◽  
Cognitive Decline ◽  
Older Persons ◽  
Global Cognition

Abstract WP495: Sex Differences in Cognitive Decline: A Pooled Cohort Analysis of ARIC, CARDIA, CHS, FOS, NOMAS

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Deborah A Levine ◽  
Alden L Gross ◽  
Emily M Briceño ◽  
Nicholas Tilton ◽  
Mohammed U Kabeto ◽  
...  
Keyword(s):  
Sex Differences ◽  
Executive Function ◽  
Cognitive Decline ◽  
Cognitive Assessment ◽  
Cohort Analysis ◽  
Cognitive Outcome ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Global Cognition

Background: Sex differences in dementia risk are unclear but some have found greater risk for women. We hypothesized that women have greater cognitive decline than men, after adjusting for potential confounders. Objective: Determine associations between sex and cognitive decline. Methods: We pooled data from 19,378 participants free of stroke and dementia (mean [SD] age 59.8 [10.4] years at first cognitive assessment), of whom 8,654 (44.7%) were men and 3,852 (19.9%) were black, from 5 longitudinal cohorts between 1971 and 2017: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. The primary outcome was change in global cognition. Secondary outcomes were change in memory and executive function. Linear mixed-effects models measured changes in each continuous cognitive outcome over time by sex, adjusted for demographics, education, vascular risk factors, and age*follow-up time, race*follow-up time, systolic blood pressure*follow-up time, and use of antihypertensive medication*follow-up time interaction terms. Cognitive outcomes were set to a t-score metric (mean 50, standard deviation [SD] 10) at a participant’s first cognitive assessment; a 1-point difference represents a 0.1 SD difference in the distribution of cognition across the 5 cohorts. Median follow-up was 12.4 (IQR: 5.9, 21.0) years. Results: Women had significantly higher baseline performance than men in global cognition, executive function, and memory (adjusted differences in intercepts, 2.09 to 2.15 points; all P<0.001) ( Figure ). Compared with men, women had significantly faster declines in global cognition, executive function, and memory (adjusted differences in slopes, 0.04 to 0.06 points per year faster; P <0.001) ( Figure ). Conclusion: These results are consistent with women having greater cognitive reserve but faster cognitive decline than men.

scholarly journals SAT-LB115 Metformin-Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes Mellitus: The Sydney Memory and Ageing Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D Crawford ◽  
Nicole A Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Executive Function ◽  
Older People ◽  
Cognitive Decline ◽  
Community Dwelling ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition ◽  
Rate Of Decline

Abstract Background Metformin use in diabetes has been associated with both increased and decreased dementia rates in observational studies of people with diabetes. Objective: To examine changes in global cognition and specific cognitive domains over 6 years in older adults with diabetes treated with metformin, compared to other glucose lowering medications, and to people without diabetes. Methods Data were examined from the Sydney Memory and Ageing Study, a prospective observational study of 6 years duration of 1037 non-demented community-dwelling elderly aged 70-90 at baseline, derived from a compulsory electoral roll. Neuropsychological testing was performed every 2 years with domain measures of memory, executive function, language, visuospatial function, attention and processing speed and a composite of global cognition. Data were analysed by linear mixed modelling, including age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking and apolipoprotein E ε4 carriage as covariates. Results: At baseline, 123 participants had diabetes (DM) with 67 receiving metformin (DM+MF) who were similar in demographics to those not receiving metformin (DM-noMF) and those without diabetes (no-DM). Participants with diabetes had higher BMI, lower HDL- and LDL-cholesterol and more prevalent heart disease, hypertension and smoking, compared to no-DM. Over 6-years, DM+MF participants had significantly slower rates of decline in global cognition and executive function, compared to DM-noMF, adjusted for covariates. The rate of decline for each cognitive domain was similar between DM+MF and controls. No impact was found in analyses examining interactions with sex, ApoEε4 carriage or hyperlipidemia. No difference was found in the rate of decline in brain volumes between the groups over 2 years. Incident dementia was significantly higher in DM-noMF, compared to DM+MF (adjusted OR 5.29 [95% CI 1.17-23.88], p,0.05), whereas risk of incident dementia was similar between DM+MF and participants without diabetes. Conclusions: In older people with diabetes receiving metformin, rates of cognitive decline and dementia were similar to that found in people without diabetes and significantly less than that found in people with diabetes not receiving metformin. Large randomized studies in people with and without diabetes are required to determine whether these associations can be attributed to metformin alone or if other factors explain these observations. Future studies will clarify if this cheap and safe medication can be repurposed for prevention of cognitive decline in older people.

scholarly journals Metformin-use is associated with slowed cognitive decline and reduced incident dementia in older adults with type 2 diabetes mellitus: the Sydney Memory and Ageing Study

2020 ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D. Crawford ◽  
Nicole A. Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Executive Function ◽  
Cognitive Decline ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition

<b>Objective:</b> Type 2 diabetes mellitus (diabetes) is characterized by accelerated cognitive decline and higher dementia risk. Controversy exists regarding the impact of metformin which is associated with both increased and decreased dementia rates. The objective of this study was to determine the association of metformin-use with incident dementia and cognitive decline over 6 years in diabetes, compared to those not receiving metformin and those without diabetes. <p><b>Research</b> <b>Design and Methods</b>: Prospective observational study of N=1037 non-demented community-dwelling older participants aged 70-90 at baseline (the Sydney Memory and Ageing Study). Exclusion criteria were dementia, major neurological or psychiatric disease or progressive malignancy. Neuropsychological testing measured cognitive function every two years; a battery of tests measured executive function, memory, attention/speed, language and visuospatial function individually and to a construct of global cognition. Incident dementia was ascertained by a multidisciplinary panel. Total brain, hippocampal and parahippocampal volumes were measured by magnetic resonance at baseline and 2 years (n=526). Data were analyzed by linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, hypertension, stroke, smoking and apolipoprotein Ee4 carriage. </p> <p><b>Results</b>: Of n=1037, 123 had diabetes; 67 received metformin (DM+MF) and were demographically similar to those not (DM-noMF) and participants without diabetes (no-DM). DM+MF had significantly slower global cognition and executive function decline compared to DM-noM. Incident dementia was significantly higher in DM-noMF compared to DM+MF (OR 5.29, 95%CI 1.17-23.88, p=0.05).</p> <p><b>Conclusions</b>: Older people with diabetes receiving metformin have slower cognitive decline and lower dementia risk. Large randomized studies in people with and without diabetes will determine whether these associations can be attributed to metformin. </p>

Abstract 47: Subclinical Atherosclerosis and 20-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Shelly-Ann M Love ◽  
Priya Palta ◽  
Corey A Kalbaugh ◽  
A.Richey Sharrett ◽  
Alden L Gross ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Decline ◽  
Subclinical Atherosclerosis ◽  
Word Recall ◽  
Digit Symbol Substitution Test ◽  
Z Score ◽  
Domain Specific ◽  
Z Scores ◽  
Global Cognition ◽  
Rate Of Decline

Introduction: Cardiovascular risk factors are reportedly predictive of cognitive decline and dementia but the association between the extent and severity of subclinical atherosclerosis with cognitive decline remains understudied. Hypothesis: The systemic burden of atherosclerosis measured non-invasively is associated with the rate of decline in domain-specific (memory, executive function and language) and global cognition from mid-life to late life. Methods: Members of the ARIC cohort (N=12313; 58% women, 24% African American (AA), 76% white) aged 46-70 years at their 1990-1992 examination were followed through 2011-2013. Participants with prevalent stroke, myocardial infarction or coronary heart disease were excluded. Atherosclerosis at baseline (n=5217) was assessed by carotid artery b-mode ultrasound (presence and number of plaques, bilaterally) and by ankle-brachial index <0.9 measured with an oscillometric device. Tests of memory (Delayed Word Recall Test), executive function (Digit Symbol Substitution Test), and language (Word Fluency Test) were administered in 1990-92, 1996-98 and 2011-13. Test-specific z scores were calculated at each exam based on the means and standard deviations at baseline. A global cognition z score was estimated by averaging the 3 test-specific z scores and standardizing to baseline. Race-stratified linear random effects regression was used to estimate the association between subclinical atherosclerosis and 20-year declines in domain-specific cognition and global cognition. We adjusted for age, sex and level of education. Inverse probability weighting (IPW) was used to limit bias due to attrition. Results: In AA, the presence of carotid plaque and/or ABI <0.90 (n=490) was associated with a lower memory z score (Beta=-0.10, 95% confidence interval, CI: -0.18, -0.02), a lower language z score (Beta=-0.07, 95% CI: -0.14,-0.002) and a lower global cognition z score at baseline (Beta=-0.09, 95% CI: -0.16, -0.02), but not with rates of change in any cognitive score. Among whites at baseline, individuals with subclinical atherosclerosis (n=4099) exhibited lower executive function (Beta=-0.05, 95% CI: -0.08, -0.02) and global cognition (Beta=-0.04, 95% CI: -0.07, -0.01). White participants with subclinical atherosclerosis had a greater 20-year rate of decline in global cognition (Beta=-0.06, 95% CI: -0.10, -0.00) compared to those without subclinical atherosclerosis. Conclusions: Baseline memory, language, and global cognition in AA and executive function and global cognition in whites were lower among those with non-invasively ascertained atherosclerosis compared to those without, independent of covariates in the model. Among whites, subclinical clinical measures of atherosclerosis in mid-life may be indicative of modest, but measurable declines in cognition after additional adjustment for potential bias due to attrition.

scholarly journals TOMM40′523 variant and cognitive decline in older persons with APOE ε3/3 genotype

Neurology ◽  
2017 ◽  
Vol 88 (7) ◽  
pp. 661-668 ◽  
Author(s):  
Lei Yu ◽  
Michael W. Lutz ◽  
Robert S. Wilson ◽  
Daniel K. Burns ◽  
Allen D. Roses ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Semantic Memory ◽  
Mixed Models ◽  
Older Persons ◽  
European Ancestry ◽  
Perceptual Speed ◽  
Visuospatial Ability ◽  
Community Based ◽  
Clinical Evaluations ◽  
Global Cognition

Objective:To interrogate a poly-T variant (rs10524523, ′523) in TOMM40, a gene adjacent to the APOE gene on chromosome 19, in older persons with APOE ε3/3 homozygosity for association with cognitive decline, the clinical hallmark of Alzheimer disease (AD).Methods:Data came from participants in 2 cohort studies of aging and dementia who underwent annual clinical evaluations for up to 21 years. APOE and TOMM40′523 genotypes were determined from DNA from blood or brain samples. Linear mixed models compared the rates of decline in cognition among APOE ε3/3 carriers with different ′523 genotypes.Results:The 1,170 APOE ε3/3 homozygotes were of European ancestry, were free of dementia at baseline, and had an average age of 78.5 years at baseline. Three major genotypes at the ′523 variant were linked to APOE ε3/3; 26.5% had 2 short poly-Ts (S/S), 48.5% had 1 short and 1 very long poly-T (S/VL), and 24.0% had 2 very long poly-Ts (VL/VL). Participants with '523-S/S had faster decline in global cognition than participants with '523-S/VL or VL/VL (p = 0.002). The same association was observed for episodic memory (p < 0.001) and semantic memory (p = 0.003) but not for working memory, perceptual speed, or visuospatial ability.Conclusions:Our data reveal an association of APOE ε3/3-TOMM40′523 haplotypes with cognitive decline in community-based older persons such that the S/S poly-T genotype is related to faster cognitive decline, primarily in the domains of episodic and semantic memory.

scholarly journals Metformin-use is associated with slowed cognitive decline and reduced incident dementia in older adults with type 2 diabetes mellitus: the Sydney Memory and Ageing Study

2020 ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D. Crawford ◽  
Nicole A. Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Executive Function ◽  
Cognitive Decline ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition

<b>Objective:</b> Type 2 diabetes mellitus (diabetes) is characterized by accelerated cognitive decline and higher dementia risk. Controversy exists regarding the impact of metformin which is associated with both increased and decreased dementia rates. The objective of this study was to determine the association of metformin-use with incident dementia and cognitive decline over 6 years in diabetes, compared to those not receiving metformin and those without diabetes. <p><b>Research</b> <b>Design and Methods</b>: Prospective observational study of N=1037 non-demented community-dwelling older participants aged 70-90 at baseline (the Sydney Memory and Ageing Study). Exclusion criteria were dementia, major neurological or psychiatric disease or progressive malignancy. Neuropsychological testing measured cognitive function every two years; a battery of tests measured executive function, memory, attention/speed, language and visuospatial function individually and to a construct of global cognition. Incident dementia was ascertained by a multidisciplinary panel. Total brain, hippocampal and parahippocampal volumes were measured by magnetic resonance at baseline and 2 years (n=526). Data were analyzed by linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, hypertension, stroke, smoking and apolipoprotein Ee4 carriage. </p> <p><b>Results</b>: Of n=1037, 123 had diabetes; 67 received metformin (DM+MF) and were demographically similar to those not (DM-noMF) and participants without diabetes (no-DM). DM+MF had significantly slower global cognition and executive function decline compared to DM-noM. Incident dementia was significantly higher in DM-noMF compared to DM+MF (OR 5.29, 95%CI 1.17-23.88, p=0.05).</p> <p><b>Conclusions</b>: Older people with diabetes receiving metformin have slower cognitive decline and lower dementia risk. Large randomized studies in people with and without diabetes will determine whether these associations can be attributed to metformin. </p>

scholarly journals Self-Rated Health Status as a Predictor of Executive Function in Older Latinos

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 331-332
Author(s):  
Jacqueline Guzman ◽  
Yuliana Soto ◽  
David Marquez ◽  
Susan Aguinaga
Keyword(s):  
Executive Function ◽  
High Risk ◽  
Cognitive Decline ◽  
Behavioral Interventions ◽  
Controlled Trial ◽  
Self Rated Health ◽  
Excellent Health ◽  
Trail Making ◽  
Fair Poor ◽  
The Relationship

Abstract Latinos have high risk of Alzheimer’s disease and related dementias (ADRD). Self-rated health (SRH) has been used to predict cognitive decline. Early detection of executive function changes may help identify those at higher risk of cognitive decline. The purpose of this study was to examine the relationship between SRH and executive function in Latinos. Latinos (N=333, 84.4% female, Mage= 64.9 ± 7.08) from the BAILA randomized controlled trial self-rated their health as 1) poor/fair, 2) good, and 3) very good/excellent. Executive function was assessed by the Trail-making B, Verbal Fluency, Stroop C & CW, and the Digit Modality tests and stratified by SRH. One-way analysis of variance showed that the effect of SRH was significant for Trails B, F(2,298)=4.01, p=.019 and Stroop CW, F(2,298)=3.07, p=.048. Tukey’s test indicated that participants who rated their health as fair/poor took longer to complete Trails B (M=196.78±83.0 seconds) compared to those who rated their health as good (M=185.25 ± 85.1 seconds) and very good/excellent (M=149.25±95.3 seconds). Stroop CW results demonstrated that those in the fair/poor health category scored lower (M=17.22±6.6) than those in good (M=19.70±8.5 words/minutes) and very good/excellent health categories (M=18.73±8.2 words/minute). In sum, the results suggest SRH is related to executive function such that lower categories of SRH are indicative of poorer executive function. SRH might be used as a proxy for executive function and as a tool that community leaders can use to identify individuals at high risk of ADRD in need of behavioral interventions.

scholarly journals Which Neuropsychological Tests? Predicting Cognitive Decline and Dementia in Parkinson’s Disease in the ICICLE-PD Cohort

2021 ◽  
pp. 1-12
Author(s):  
Rachael A. Lawson ◽  
Caroline H. Williams-Gray ◽  
Marta Camacho ◽  
Gordon W. Duncan ◽  
Tien K. Khoo ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Verbal Fluency ◽  
Neuropsychological Tests ◽  
Visual Memory ◽  
Attention And Memory ◽  
Memory And Attention ◽  
Global Cognition

Background: Cognitive impairment is common in Parkinson’s disease (PD), with 80% cumulatively developing dementia (PDD). Objective: We sought to identify tests that are sensitive to change over time above normal ageing so as to refine the neuropsychological tests predictive of PDD. Methods: Participants with newly diagnosed PD (n = 211) and age-matched controls (n = 99) completed a range of clinical and neuropsychological tests as part of the ICICLE-PD study at 18-month intervals over 72 months. Impairments on tests were determined using control means (<1-2SD) and median scores. Mild cognitive impairment (PD-MCI) was classified using 1-2SD below normative values. Linear mixed effects modelling assessed cognitive decline, while Cox regression identified baseline predictors of PDD. Results: At 72 months, 46 (cumulative probability 33.9%) participants had developed PDD; these participants declined at a faster rate in tests of global cognition, verbal fluency, memory and attention (p <  0.05) compared to those who remained dementia-free. Impaired baseline global cognition, visual memory and attention using median cut-offs were the best predictors of early PDD (area under the curve [AUC] = 0.88, p <  0.001) compared to control-generated cut-offs (AUC = 0.76–0.84, p <  0.001) and PD-MCI (AUC] = 0.64–0.81, p <  0.001). Impaired global cognition and semantic fluency were the most useful brief tests employable in a clinical setting (AUC = 0.79, p <  0.001). Conclusion: Verbal fluency, attention and memory were sensitive to change in early PDD and may be suitable tests to measure therapeutic response in future interventions. Impaired global cognition, attention and visual memory were the most accurate predictors for developing a PDD. Future studies could consider adopting these tests for patient clinical trial stratification.

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