scholarly journals Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yerim Kim ◽  
Jae-Sung Lim ◽  
Mi Sun Oh ◽  
Kyung-Ho Yu ◽  
Ji Sung Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Repeated Measures ◽  
Blood Pressure Variability ◽  
Cognitive Test ◽  
Multiple Variables ◽  
Over Time

AbstractBlood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood–based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.

Abstract 22: Visit-to-Visit Variability in Blood Pressure is Related to Late-Life Cognitive Decline

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Bo Qin ◽  
Anthony J Viera ◽  
Linda S Adair ◽  
Brenda L Plassman ◽  
Lloyd J Edwards ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Verbal Memory ◽  
Repeated Measures ◽  
Community Dwelling ◽  
Cognitive Testing ◽  
Cognitive Test ◽  
Nutrition Survey

Introduction: Recent studies suggest higher visit-to-visit variability of blood pressure (BP) is associated with worse cognitive function, but evidence based on longitudinal cognitive testing has not been reported. Hypothesis: We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. Methods: This prospective cohort study comprised 1213 adults who had two or more waves of BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed a cognitive screening test at two or more waves in 1997, 2000 or 2004. Mean (SD) age at first cognitive test was 64 (6) y. Outcomes were repeated measures of global cognitive scores (baseline mean ± SD: 19 ± 6 points), standardized composite cognitive and verbal memory scores (standardized units [SU]). Visit-to visit BP variability was expressed as the standard deviation [SD] or as the variation independent of mean (SD/mean^x, with x derived from curve fitting) in BP measures obtained at a mean interval of 3.6 years. Multivariable-adjusted linear mixed-effects models were used to determine the association of changes in cognitive scores with visit-to visit BP variability. Results: Higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD in variability (Figure): global score -0.23 points/y [-0.41 to -0.04], composite scores -0.029 SU/y [-0.056 to -0.002] and verbal memory -0.044 SU/y [-0.075 to -0.012]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of global cognitive function only among adults 55-64 years, independent of mean diastolic BP. Conclusion: Higher long-term BP visit-to-visit variability predicted a faster rate of cognitive decline among older adults.

scholarly journals Impact of Model Choice When Studying the Relationship Between Blood Pressure Variability and Risk of Stroke Recurrence

Hypertension ◽  
2021 ◽  
Author(s):  
Hugues de Courson ◽  
Loïc Ferrer ◽  
Antoine Barbieri ◽  
Phillip J. Tully ◽  
Mark Woodward ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Cox Model ◽  
Positive Association ◽  
Vascular Risk Factor ◽  
Stroke Recurrence ◽  
The Impact ◽  
Over Time

Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to analyze. The objective was to assess the impact of BPV modeling on its estimated effect on the risk of stroke. We used data from a secondary stroke prevention trial, PROGRESS (Perindopril Protection Against Stroke Study), which included 6105 subjects. The median number of blood pressure (BP) measurements was 12 per patient and 727 patients experienced a first stroke recurrence over a mean follow-up of 4.3 years. Hazard ratios (HRs) of BPV were estimated from 6 proportional hazards models using different BPV modeling for comparison purposes. The 3 commonly used methods first derived SD of BP measures observed over a given period of follow-up and then used it as a fixed covariate in a Cox model. The 3 more advanced modeling accounted for changes in BP or BPV over time in a single-stage analysis. While the 3 commonly used methods produced contradictory results (for a 5 mmHg increase in BPV, HR=0.75 [95% CI, 0.68–0.82], HR=0.99 [0.91–1.08], HR=1.19 [1.10–1.30]), the 3 more advanced modeling resulted in a similar moderate positive association (HR=1.08 [95% CI, 0.99–1.17]), whether adjusted for BP at randomization or mean BP over the follow-up. The method used to assess BPV strongly affects its estimated effect on the risk of stroke, and should be chosen with caution. Further methodological developments are needed to account for the dynamics of both BP and BPV over time, to clarify the specific role of BPV.

scholarly journals Blood Pressure and Cognitive Decline in Prevalent Hemodialysis Patients

2019 ◽  
Vol 49 (6) ◽  
pp. 460-469 ◽  
Author(s):  
David A. Drew ◽  
Hocine Tighiouart ◽  
Sarah Duncan ◽  
Jasmine Rollins ◽  
Aditi Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Executive Function ◽  
Cognitive Decline ◽  
Pulse Pressure ◽  
Memory Function ◽  
Cognitive Test ◽  
Maintenance Hemodialysis ◽  
Joint Models ◽  
High Pulse

Background: Hypertension is associated with cognitive decline in the general population. It is unclear what impact blood pressure (BP) has on cognitive decline in patients receiving maintenance hemodialysis (HD). Methods: Using a longitudinal cohort of 314 prevalent HD patients without dementia at baseline, we examined the association of predialysis systolic BP (SBP) and diastolic BP (DBP), pulse pressure, and intradialytic SBP change (pre minus post), averaged for a month, with cognitive decline. Cognitive function was determined by a neurocognitive battery, administered yearly. Individual cognitive test results were reduced into 2 domain scores using principal components analysis (by definition mean of 0 and SD of 1), representing memory and executive function. Joint models, allowing for characterization of cognitive score slopes and including adjustment for potential confounders, were utilized to account for competing risks from death, dropout, or kidney transplantation. Results: Mean age was 62 years; 54% were men, 23% were black, and 90% had at least a high school education. During median follow-up of 2.1 years (25th–75th: 1.0–4.5), 191 had at least one follow-up test, 148 died, and 43 received kidney transplants. Low predialysis DBP and high pulse pressure were both associated with steeper executive function decline (each 10 mm Hg lower DBP = –0.03 SD [–0.01 to –0.05] per year steeper decline) in executive function (each 10 mm Hg higher pulse pressure = –0.03 SD [–0.06 to –0.01] steeper decline) but not for memory function. SBP and intradialytic change were not associated with steeper decline for either memory or executive function. Conclusions: No relationship was seen between SBP or intradialytic change in BP with cognitive decline. In prevalent HD patients, lower predialysis DBP and wider predialysis pulse pressure are associated with steeper cognitive decline in executive function but not memory.

scholarly journals Benefit of Musical Training for Speech Perception and Cognition Later in Life

2021 ◽  
pp. 1-12
Author(s):  
Natascha Merten ◽  
Mary E. Fischer ◽  
Lauren K. Dillard ◽  
Barbara E. K. Klein ◽  
Ted S. Tweed ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cognitive Impairment ◽  
Speech Perception ◽  
Cognitive Function ◽  
Musical Training ◽  
Cognitive Test ◽  
Health Differences ◽  
Study Participants ◽  
Over Time

Purpose The aim of this study was to determine the long-term associations of musical training with speech perception in adverse conditions and cognition in a longitudinal cohort study of middle-age to older adults. Method This study is based on Epidemiology of Hearing Loss Study participants. We asked participants at baseline (1993–1995) about their musical training. Speech perception (word recognition in competing message; Northwestern University Auditory Test Number 6), cognitive function (cognitive test battery), and impairment (self-report or surrogate report of Alzheimer's disease or dementia, and/or a Mini-Mental State Examination score ≤ 24) were assessed up to 5 times over the 20-year follow-up. We included 2,938 Epidemiology of Hearing Loss Study participants who had musical training data and at least one follow-up of speech perception and/or cognitive assessment. We used linear mixed-effects models to determine associations between musicianship and decline in speech perception and cognitive function over time and Cox regression models to evaluate associations of musical training with 20-year cumulative incidence of speech perception and cognitive impairment. Models were adjusted for age, sex, and occupation and repeated with additional adjustment for health-related confounders and education. Results Musicians showed less speech perception decline over time with stronger effects in women (0.16% difference, 95% confidence interval [CI] [0.05, 0.26]). Among men, musicians had, on average, better speech perception than nonmusicians (3.41% difference, 95% CI [0.62, 6.20]) and were less likely to develop a cognitive impairment than nonmusicians (hazard ratio = 0.58, 95% CI [0.37, 0.91]). Conclusions Musicians showed an advantage in speech perception abilities and cognition later in life and less decline over time with different magnitudes of effect sizes in men and women. Associations remained with further adjustment, indicating that some degree of the advantage of musical training is independent of socioeconomic or health differences. If confirmed, these findings could have implications for developing speech perception intervention and prevention strategies. Supplemental Material https://doi.org/10.23641/asha.14825454

scholarly journals Hearing loss and cognitive decline in the general population: a prospective cohort study

2020 ◽  
Author(s):  
Pauline H. Croll ◽  
Elisabeth J. Vinke ◽  
Nicole M. Armstrong ◽  
Silvan Licher ◽  
Meike W. Vernooij ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Risk Factor ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Linear Regression Analysis ◽  
Memory Test ◽  
Modifiable Risk Factor ◽  
Non Linear ◽  
Over Time

Abstract Background Previous studies identifying hearing loss as a promising modifiable risk factor for cognitive decline mostly adjusted for baseline age solely. As such a faster cognitive decline at a higher age, which is expected considering the non-linear relationship between cognition and age, may have been overlooked. Therefore it remains uncertain whether effects of hearing loss on cognitive decline extend beyond age-related declines of cognitive function. Methods 3,590 non-demented participants were eligible for analysis at baseline, and a maximum of 837 participants were eligible for the longitudinal analysis. Hearing loss was defined at baseline. Cognitive function was measured at baseline and at follow-up (4.4 years [SD: 0.2]). Multivariable linear regression analysis was used for the cross-sectional analysis. Linear mixed models were used to assess the longitudinal association between hearing loss and cognitive decline over time while adjusting for confounders and the interaction of age and follow-up time. Results Hearing loss was associated with lower cognitive function at baseline. Moreover, hearing loss was associated with accelerated cognitive decline over time on a memory test. After additionally adjusting for the interaction between age and follow-up time, we found that hearing loss did not accelerate cognitive decline anymore. Conclusions Hearing loss was associated with lower cognitive function at baseline and accelerated cognitive decline on a memory test. The association between hearing loss and accelerated cognitive decline was non-significant after additional adjustment for non-linear age effects. More evidence is needed to ensure the role of hearing loss as a modifiable risk factor for cognitive decline.

scholarly journals Preliminary Experiment on the Effect of 18% Substitute Salt on Home Blood Pressure Variability in Hypertensives

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jing Li ◽  
Lisha Mu ◽  
Huakun Rao ◽  
Yangfeng Wu ◽  
Hao Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Adverse Events ◽  
Phase I ◽  
Blood Pressure Variability ◽  
Sodium Intake ◽  
Home Blood Pressure ◽  
Intervention Period ◽  
Over Time

At present, the effect of substitute salt in reducing sodium intake and blood pressure is relatively clear. The present study is a phase I clinical trial involving 43 hypertensives in which the effect of 18% sodium substitute salt on the home blood pressure variability (BPV) was observed for 8 weeks with weekly follow-up. Finally, 4 patients were lost, and 39 patients completed the intervention and were included in the analysis. Daily home blood pressure and weekly adverse events were collected. The systolic blood pressure (SBP) in the morning (−10.0 mmHg, 95% CI: −16.5 to −3.5, P  = 0.003), SBP at night (−10.2 mmHg, 95% CI: −16.1 to −4.3, P  = 0.001), and diastolic blood pressure (DBP) at night (−4.0 mmHg, 95% CI: −7.1 to −0.8, P  = 0.014) decreased significantly. Also, there was no statistically significant change in morning (F = 1.137, P  = 0.352) and night diastolic (F = 0.344, P  = 0.481) BPV and morning systolic BPV (F = 0.663, P  = 0.930) over time during the intervention period, except for that night systolic BPV had a downward trend (F = 2.778, P  = 0.016) and had decreased 2.04 mmHg (95% CI: 0.84 to 3.23, P  = 0.001) after intervention. The use of 18% of the substitute salt did not increase BPV during the intervention and even may decrease it, which indicates its control effects on blood pressure. This study is the first one to observe the effect of 18% sodium substitute salt on the home blood pressure variability, providing a basis for further experiments.

scholarly journals THE COURSE OF DEPRESSIVE SYMPTOMS IN OLDER ADULTS RECEIVING IN-HOME CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S270-S270
Author(s):  
Anne-Sofie Helvik ◽  
maria Barca ◽  
Sverre Bergh ◽  
Jūratė Šaltytė –Benth ◽  
Tom Borza
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Function ◽  
Home Care ◽  
Older People ◽  
Cognitive Decline ◽  
Cumulative Incidence ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Status ◽  
Over Time

Abstract The aim of the study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older people receiving in-home care, and to explore the association between cognitive function and the course of depressive symptoms. In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study over 36 months. Depressive symptoms, cognitive function, general medical health, activities of daily living, neuropsychiatric symptoms and use psychotropic drugs were assessed at three assessments. Dementia and mild cognitive impairment were diagnosed at all assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. We found the prevalence and cumulative incidence of individual depressive symptoms to be higher in those with dementia at baseline than in those without. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive decline and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. In conclusion: The differences in prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, and the association found between degree of cognitive decline and depressive symptoms over time shows that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older people receiving in-home care.

scholarly journals Markers of Kidney Function and Longitudinal Cognitive Ability Among Older Community-Dwelling Adults: The Rancho Bernardo Study

2021 ◽  
pp. 1-13
Author(s):  
Erin L. Richard ◽  
Linda K. McEvoy ◽  
Eyal Oren ◽  
John E. Alcaraz ◽  
Gail A. Laughlin ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Cognitive Ability ◽  
Cognitive Performance ◽  
Kidney Function ◽  
Community Dwelling ◽  
Cognitive Test ◽  
Additional Time ◽  
Urine Albumin ◽  
Over Time

Background: Reduced kidney function has been associated with cognitive decline. Most studies have examined a single marker of kidney function and have limited duration of follow-up. Objective: This study evaluated associations between markers of kidney function (urine albumin, estimated glomerular filtration rate [eGFR], and hyperuricemia) with cognitive performance over time. Methods: This is a longitudinal study of 1,634 community-dwelling adults (mean age = 71.7 years), with kidney function markers and cognitive ability measured at baseline (1992–1996) and at up to five additional time points with a maximum of 23.4 years (mean = 8.1 years) of follow-up. Associations between kidney function and cognitive performance were assessed using linear mixed effects models. Testing for interaction by sex was conducted. Results: Albuminuria (urine albumin-to-creatinine ratio [ACR]≥30 mg/g) was associated with steeper annual declines in global cognitive function (MMSE, β= –0.12, p = 0.003), executive function (Trails B, β= 4.50, p <  0.0001) and episodic memory (Buschke total recall, β= –0.62, p = 0.02) scores in men. Results were similar when cognitive test scores were regressed on latent trajectory classes of ACR. In men, hyperuricemia (serum uric acid [SUA]≥6.8 mg/dl for men and SUA≥6.0 mg/dl for women) was associated with lower baseline MMSE (β= –0.70, p = 0.009) scores but not with MMSE change over time. No such associations were detected in women. There were no significant associations between eGFR and cognitive performance for either sex. Conclusion: In older men, albuminuria is an independent predictor of subsequent cognitive decline. More investigations are needed to explain the observed sex differences and the potential relationship between hyperuricemia and poorer global cognition.

scholarly journals Global Sensory Impairment Independently Predicts Decreased Social Function Over Time

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 414-414
Author(s):  
Anna Huang ◽  
Kristen Wroblewski ◽  
Ashwin Kotwal ◽  
Linda Waite ◽  
Martha McClintock ◽  
...  
Keyword(s):  
Mental Health ◽  
Logistic Regression ◽  
Cognitive Function ◽  
Social Engagement ◽  
Social Function ◽  
Ordinal Logistic Regression ◽  
Sensory Function ◽  
Sensory Impairment ◽  
Over Time

Abstract The classical senses (vision, hearing, touch, taste, and smell) play a key role in social function by allowing interaction and communication. We assessed whether sensory impairment across all 5 modalities (global sensory impairment [GSI]) was associated with social function in older adults. Sensory function was measured in 3,005 home-dwelling older U.S. adults at baseline in the National Social Life, Health, and Aging Project and GSI, a validated measure, was calculated. Social network size and kin composition, number of close friends, and social engagement were assessed at baseline and 5- and 10-year follow-up. Ordinal logistic regression and mixed effects ordinal logistic regression analyzed cross-sectional and longitudinal relationships respectively, controlling for demographics, physical/mental health, disability, and cognitive function (at baseline). Adults with worse GSI had smaller networks (β=-0.159, p=0.021), fewer close friends (β=-0.262, p=0.003) and lower engagement (β=-0.252, p=0.006) at baseline, relationships that persisted at 5 and 10 year follow-up. Men, older people, African-Americans, and those with less education, fewer assets, poor mental health, worse cognitive function, and more disability had worse GSI. Men and those with fewer assets, worse cognitive function, and less education had smaller networks and lower engagement. African-American and Hispanic individuals had smaller networks and fewer close friends, but more engagement. Older respondents also had more engagement. In summary, GSI independently predicts smaller social networks, fewer close friends, and lower social engagement over time, suggesting that sensory decline results in decreased social function. Thus, rehabilitating multisensory impairment may be a strategy to enhance social function as people age.

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