Role of cumulative biological risk in mediating socioeconomic disparities in cognitive function in the elderly: a mediation analysis

ObjectivesTo evaluate whether allostatic load (AL), a measure of cumulative biological risk, fully or partially mediates observed socioeconomic status (SES) differences in cognitive function in the elderly.DesignCross-sectional mediation analysis.SettingCommunity-dwelling US elderly who participated in the National Health and Nutrition Examination Survey (NHANES).ParticipantsThe NHANES uses a complex, multistage, probability sampling design to select a nationally representative sample. Of the 4976 elderly (60 years or older) who were selected, 3234 agreed to participate in the household and medical exam interviews (65% response rate).Primary and secondary outcome measuresPerformance on the Digit Symbol Substitution Test (DSST)—a measure of cognitive function.ResultsRelative to participants with the lowest level of education or family income, participants who were college graduates (β=24.4, 95% CI 22 to 26.8, p<0.0001) or in the highest income quartile (β=17.3, 95% CI 15.2 to 19.4, p<0.0001) had the highest DSST scores and the least AL burden (β=−0.72, 95% CI −0.98 to −0.47 and β=−0.82, 95% CI −1 to −0.57; p<0.0001, respectively). Although, AL was significantly negatively associated with cognitive performance (β = −1, 95% CI −1.4 to −0.5, p<0.0001), it mediated at most 4.5% of the SES effect on DSST performance.ConclusionsThe findings suggest that AL, as measured by a summary index of parameters for cardiovascular function, metabolism and chronic inflammation, is not a significant mediator of SES-related differences in cognitive function in the elderly. Further efforts are required to elucidate the exact physiological pathways and mechanisms through which SES impacts cognitive function in late life.

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Serum sodium in relation to various domains of cognitive function in the elderly US population

BMC Geriatrics ◽

10.1186/s12877-021-02260-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sohyae Lee ◽

Jin-young Min ◽

Beom Kim ◽

Sang-Won Ha ◽

Jeohng Ho Han ◽

...

Keyword(s):

Executive Function ◽

Cognitive Function ◽

Serum Sodium ◽

Verbal Memory ◽

The Elderly ◽

Cognitive Change ◽

Cognitive Test ◽

P Value ◽

Digit Symbol Substitution Test ◽

Cross Sectional

Abstract Background Recent evidence suggests that sodium imbalances may be associated with cognitive impairment; however, the association between specific domains of cognition remains unclear. This study examines the association between serum sodium levels and immediate and delayed verbal memory as measured by the CERAD Word Learning Test (CERAD WLT), executive function as measured by the Animal Fluency test (AFT), and sustained attention, working memory, and processing speed as measured by the Digit Symbol Substitution test (DSST) in the elderly population of the US aged 60 and older who participated in the 2011–2014 National Health and Nutrition Examination Surveys (n = 2,541). Methods Cognitive function tests were performed by trained interviewers and sodium levels were measured using indirect ion selective electrode methodology. Results After adjusting for all covariates, quintiles of CERAD WLT scores showed significant positive associations with log-transformed sodium levels (Immediate recall (IR) β = 4.25 (SE = 1.83, p-value 0.027); Delayed recall (DR) β = 6.54 (SE = 1.82, p-value 0.001)). Compared to normal sodium levels, hyponatremia was significantly associated with lower CERAD WLT-IR (β = -0.34, SE = 0.15, p-value 0.035) and CERAD WLT-DR scores (β -0.48, SE = 0.10, p-value < 0.001) and showed borderline significance with AFT scores (β = = -0.38, SE = 0.19, p-value 0.052). Hypernatremia did not show any significant relationships with cognitive test scores, compared to normal sodium levels. Conclusions Our cross-sectional study showed that lower sodium levels were associated with cognitive change, especially regarding memory and executive function.

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Factors associated with risk of malnutrition in the elderly in south-eastern Brazil

Revista Brasileira de Epidemiologia ◽

10.1590/1980-5497201700040004 ◽

2017 ◽

Vol 20 (4) ◽

pp. 598-610 ◽

Cited By ~ 13

Author(s):

Renata Damião ◽

Álvaro da Silva Santos ◽

Alicia Matijasevich ◽

Paulo Rossi Menezes

Keyword(s):

At Risk ◽

Formal Education ◽

Family Income ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

The Elderly ◽

Cross Sectional Study ◽

Community Dwelling ◽

Hierarchical Regression ◽

Cross Sectional

ABSTRACT: Objective: The aim of this study was to evaluate the prevalence of malnutrition risk and its association with socioeconomic, behavioral, and health characteristics in the community-dwelling elderly. Methods: A cross-sectional study with individuals aged ≥ 60 years. Nutritional status was evaluated using the Mini Nutritional Assessment. Socioeconomic, behavioral, and health information was also collected from all participants. The association between each variable and the risk of malnutrition was calculated and adjusted using Poisson hierarchical regression. Results: The initial sample consisted of 3,101 elderly people, of whom 28.3% (95%CI 25.3 - 31.4%) were at risk of malnutrition. The multivariate analysis showed that the risk of malnutrition was significantly higher in women without formal education, who did not live with a partner, and identified as black-skinned. The risk of malnutrition was twice as high in individuals with no family income as compared to those who earned at least three minimum wages. Smokers were also more likely to be at risk of malnutrition than individuals who had never smoked. Participants suffering from kidney, respiratory or heart disease were at higher risk of malnutrition than those with no history of such illnesses. Conclusion: These findings could be used to help in the development of health policies and in the establishment of adequate programs aimed at reducing the risk of malnutrition in this population.

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Chloroform and Cognitive Function in the General Population of the US Elderly: A Cross-Sectional Study

10.21203/rs.3.rs-1102490/v1 ◽

2021 ◽

Author(s):

Sohyae Lee ◽

Jin-Young Min ◽

Kyoung-Bok Min

Keyword(s):

Cognitive Function ◽

Elderly Population ◽

The Elderly ◽

Cross Sectional Study ◽

Water Disinfection ◽

P Value ◽

Digit Symbol Substitution Test ◽

Selected Ion Monitoring ◽

Cross Sectional ◽

The Us

Abstract Background Chloroform is a water disinfection by-product associated with hepatic, renal and neurotoxicity. High concentrations of chloroform are known to cause central nervous system depression; however, the association between blood chloroform levels and cognitive function in the general elderly population is unknown. In this study, we investigated the association between blood chloroform levels and cognitive function in the elderly US population (n=782). Methods We analyzed blood chloroform levels and cognitive function, as measured by the digit symbol substitution test (DSST), from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES) for participants aged 60 years and older. Blood chloroform levels were measured using capillary gas chromatography and mass spectrometry with selected-ion monitoring detection and istotope-dilution. Results After adjusting for all covariates, increases in log-transformed blood chloroform levels were significantly associated with decreased DSST scores (β = -1.56, SE = 0.57, p-value 0.010). Compared with individuals in the lowest quartile of blood chloroform, the regression coefficients were significantly lower among those in the second and third tertile (tertile 2 β = -3.00 (SE = 1.25, p-value 0.022); tertile 3 β = -4.05 (SE = 1.22, p-value 0.002)). After stratification by obesity status, increases in log-transformed chloroform levels showed borderline significant associations with decreased DSST scores among the obese (β = -1.71, SE = 0.85, p-value 0.052). Conclusions Our finding suggest a possible link between blood chloroform levels and cognitive function in the US elderly population.

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Serum Sodium in Relation to Various Domains of Cognitive Function in the Elderly US Population

10.21203/rs.3.rs-71448/v1 ◽

2020 ◽

Author(s):

Sohyae Lee ◽

Jin-young Min ◽

Beom Kim ◽

Sang-Won Ha ◽

Jeohng Ho Han ◽

...

Keyword(s):

Executive Function ◽

Cognitive Function ◽

Serum Sodium ◽

Verbal Memory ◽

The Elderly ◽

Cognitive Change ◽

Cognitive Test ◽

P Value ◽

Digit Symbol Substitution Test ◽

Cross Sectional

Abstract Background:Recent evidence suggests that sodium imbalances may be associated with cognitive impairment; however, the association between specific domains of cognition remains unclear. This study examines the association between serum sodium levels and immediate and delayed verbal memory as measured by the CERAD Word Learning Test (CERAD WLT), executive function as measured by the Animal Fluency test (AFT), and sustained attention, working memory, and processing speed as measured by the Digit Symbol Substitution test (DSST) in the elderly population of the US aged 60 and older who participated in the 2011–2014 National Health and Nutrition Examination Surveys (n=2,700). Methods:Cognitive function tests were performed by trained interviewers and sodium levels were measured using indirect ion selective electrode methodology. Results:After adjusting for all covariates, CERAD WLT scores showed significant positive associations with sodium levels (Immediate recall (IR) β = 0.11 (SE = 0.04, p-value 0.018); Delayed recall (DR) β = 0.07 (SE = 0.03, p-value 0.009)). Compared to individuals with normal sodium levels, individuals with hyponatremia were significantly associated with lower CERAD WLT-DR (β = -0.71, SE = 0.23, p-value 0.005) and AFT scores (β = -1.58, SE = 0.68, p-value 0.027), and showed a borderline significant relationship with lower CERAD WLT-DR scores (β = -1.11, SE = 0.56, p-value 0.057). Individuals with hypernatremia did not show any significant relationships with cognitive test scores, compared to those with normal sodium levels. Conclusions:Our cross-sectional study showed that lower sodium levels were associated with cognitive change, especially regarding memory and executive function.

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FACTORS ASSOCIATED WITH DURATION OF NAPS AMONG COMMUNITY-DWELLING ELDERLY: DATA FROM THE MULTICENTER STUDY FIBRA

Texto & Contexto - Enfermagem ◽

10.1590/0104-07072016001200014 ◽

2016 ◽

Vol 25 (1) ◽

Author(s):

Ariene Angelini dos Santos-Orlandi ◽

Maria Filomena Ceolim ◽

Sofia Cristina Iost Pavarini ◽

Simone Camargo de Oliveira-Rossignolo ◽

Aline Maino Pergola-Marconato ◽

...

Keyword(s):

Family Income ◽

Descriptive Analysis ◽

Leisure Activity ◽

The Elderly ◽

Cross Sectional Study ◽

Community Dwelling ◽

Cross Sectional ◽

Hand Grip ◽

Frailty Criterion ◽

State Examination

This study aimed to analyze the association between the duration of the nap and the variables gender, age, education, family income, frailty levels and frailty criteria of community-dwelling elderly. This was a descriptive and cross-sectional study, an excerpt from the multicenter project Frailty in Elderly Brazilians. A total of 3,075 older adults were evaluated, aged 65 and over, using a sociodemographic questionnaire, question about nap (Minnesota Leisure Activity Questionnaire), phenotype of frailty proposed by Fried and screening test for cognitive impairment (Mini Mental State Examination). Descriptive analysis, Mann-Whitney and Kruskal-Wallis tests (p<0.05) and multiple linear regression were applied. Ethical principles were respected. Most of the elderly participants napped (61.7%), with an average of 53.4±42.7 min/day. There was an association between duration of naps and variables gender (p=0.002), frailty (p=0.022) and frailty criterion "hand grip strength" (p=0.008). It was observed that the length of the naps is greater for male and frail elderly.

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Association of Mild Anemia and Executive Cognitive Function Impairment in High Functioning Community-Dwelling Older Women.

Blood ◽

10.1182/blood.v106.11.3552.3552 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3552-3552

Author(s):

Paulo H.M. Chaves ◽

Linda P. Fried ◽

Michelle Carlson

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Older Women ◽

The Elderly ◽

Forced Expiratory Volume ◽

Community Dwelling ◽

Cross Sectional ◽

High Functioning ◽

Mild Anemia ◽

The Impact

Abstract Background: Anemia in the elderly is common and may be associated with atypical clinical presentations. Although the impact of severe anemia on cognition has been studied in patients with cancer, less is known about the association of mild anemia on cognitive function in the elderly. Executive cognitive functioning (ECF) refers to the execution of complex activities that involve a set of higher-order cognitive abilities primarily dependent on the frontal lobes. ECF plays a major role in the maintenance of the functional status of older adults. Knowledge about potentially modifiable risk factors for ECF impairment in older adults is limited. The goal of this study was to test the hypothesis that mild anemia is associated with ECF impairment in high functioning, community-dwelling older women. Methods: Cross-sectional analysis of baseline data from the Women’s Health and Aging Study (WHAS) II, 1994–1996, Baltimore, MD. WHAS II is a population-based study of 436 cognitively intact (Mini-Mental State Exam >24) and highly physically functioning women aged 70–80 years. The analytic sample included 364 subjects with Hb >10 g/dL and the following ECF test components: Trail Making Tests part B (TMTB) - primary outcome - and part A (TMTA), and the difference TMTB-TMTA. Multivariate polytomous logistic regression models were used to model the relationship between performance (based on tertiles) on each ECF test as a function of Hb, while controlling for age, education, cardiovascular disease, and a number of other potential confounders, such as hypertension, diabetes, depressive symptoms, calculated creatinine clearance, forced expiratory volume in the first second, thyroid stimulating hormone, total cholesterol levels, body mass index, walking speed, and prevalent mobility difficulty. Results: Subjects with mild anemia (Hb 10–12 g/dL) performed worst in all ECF tests; i.e., the percentage of subjects in the best performance tertile for each test was lowest for those with Hb within 10–12 g/dL. Estimates from multivariate models revealed that, as compared to those with Hb≥12 g/dL, those with Hb within 10–12 g/dL were substantially less likely to be in the best performance tertile of the TMTB [odds ratio (OR).23, 95% confidence interval (CI):.06–.86; p=.029], TMTA (OR.27, 95%CI:.07–.98; p=.047), and TMTB-TMTA (OR.30, 95%CI:.10–.89; p=.031), even after comprehensive adjustment. Conclusion: In this cross-sectional study, mild anemia was an independent risk factor for prevalent ECF impairment in high functioning community-dwelling older women. This raises the hypothesis that correction of mild anemia could potentially provide an opportunity for prevention of cognitive and functional decline in older adults. To test this hypothesis, prospective observational studies and clinical trials are warranted.

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Association of Drug Burden Index With Measures of Cognitive Function Among Older Adults

Current Developments in Nutrition ◽

10.1093/cdn/nzab033_011 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 11-11

Author(s):

Janie DiNatale ◽

Kristi Crowe-White ◽

Amy Ellis ◽

Joy Douglas ◽

Ian McDonough ◽

...

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Apoe Genotype ◽

Community Dwelling ◽

Cognitive Test ◽

Digit Symbol Substitution Test ◽

Full Cohort ◽

Cross Sectional ◽

Drug Burden Index ◽

Daily Dose

Abstract Objectives Many conditions associated with aging result in polypharmacy, and certain medications may impact cognition. One way to assess exposure to such medications is through the use of the drug burden index (DBI)- a validated measure of exposure to anticholinergic and sedative medications, with a higher DBI score indicating a higher drug burden. The objective of this cross-sectional analysis was to investigate the association between DBI and cognitive function assessed by two widely utilized cognitive tests among older adults. Methods The Health, Aging, and Body Composition Study was a prospective study of community-dwelling adults ages 70–79 years at enrollment. Using baseline data, DBI was calculated by dividing the daily dose of the medication taken by the sum of the daily dose taken and the minimum efficacious dose as approved by the Food and Drug Association. After adjusting for biological sex, race, education, and APOE genotype, the association between DBI and the Digit Symbol Substitution Test (DSST) and Modified Mini-Mental Status Exam (3MS) score was assessed by partial Spearman's rank correlation. Kruskal-Wallis tests were employed to assess significance among DBI scores by tertile. Results Among those with completed measures (n = 790, 52.4% male, 63.3% white), mean scores were as follows: DBI 0.84 ± 0.48, 3MS 90.12 ± 7.9, and DSST 34.7 ± 14.6. Results suggest that DBI was not significantly associated with either 3MS or DSST. However, DBI scores by tertile were significantly associated with DSST scores. Compared to tertile 2, participants in the lowest tertile had significantly lower DBI scores along with significantly higher DSST scores. Mean differences between tertile 1 and 2 were as follows: DBI = 0.1666 and DSST = 3.39. Conclusions Analyses among the full cohort suggest that DBI was not associated with slower processing speed as assessed by the DSST or with global cognition as assessed by 3MS. Yet with expanded analysis by tertile, results suggest that DBI scores were significantly associated with DSST scores. Future investigations on cognitive function among older adults may benefit from including the DBI analysis by tertile to explain some variance in cognitive test scores. Funding Sources This is an ancillary analysis, there is no funding applicable.

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SEX AND AGE DIFFERENCES IN THE ASSOCIATION OF BLOOD PRESSURE AND HYPERTENSION WITH COGNITIVE FUNCTION IN THE ELDERLY: THE RANCHO BERNARDO STUDY

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2017.6 ◽

2017 ◽

pp. 1-9

Author(s):

D. Kritz-Silverstein ◽

G.A. Laughlin ◽

L.K. McEvoy ◽

E. Barrett-Connor

Keyword(s):

Blood Pressure ◽

Cognitive Function ◽

Age Differences ◽

Pulse Pressure ◽

Poor Performance ◽

The Elderly ◽

Community Dwelling ◽

Cross Sectional ◽

Function Tests ◽

Sex And Age Differences

Objectives: This study examines sex and age differences in associations of systolic and diastolic blood pressure (SBP, DBP), pulse pressure and hypertension with cognitive function in a community-dwelling population. Design: Cross-sectional study. Setting: Research clinic visit in 1988-91. Participants: Participants were 693 men and 1022 women aged 50-97 Measurements: Blood pressure was measured and 12 cognitive function tests were administered. Results: Average age was 73.8±9.9 in men and 73.2±9.3 in women; 62.6% of men and 63.4% of women were hypertensive (SBP≥140 mmHg, DBP≥90 mmHg, or antihypertensive medication use). Each 5-unit increment in SBP, DBP, or pulse pressure and categorical hypertension was associated with significantly increased odds of poor verbal fluency performance in men and poor Trails B performance in women, with strongest associations for hypertension (OR=1.97, CI:1.01,3.85 in men; OR=1.51, CI:1.01,2.26 in women). After age stratification, associations remained statistically significant in younger (<80 years ) but not older (≥80 years) participants. Conclusion: Blood pressure as a continuous or categorical variable was associated with poor performance on cognitive function tests, but domains varied by sex and associations were found only in those younger than 80 years. The absent associations in those aged 80 years and older could support the hypothesis that increased blood flow is required to maintain cerebral perfusion with advancing age, or could reflect a survivor effect.

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The Association between Peanut and Peanut Butter Consumption and Cognitive Function among Community-Dwelling Older Adults

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2021.32 ◽

2021 ◽

pp. 1-6

Author(s):

E.W. Katzman ◽

S.J. Nielsen

Keyword(s):

Cognitive Function ◽

Peanut Butter ◽

Cross Sectional Study ◽

Community Dwelling ◽

Digit Symbol Substitution Test ◽

Sectional Study ◽

Cross Sectional ◽

Logistic Regression Models ◽

Symbol Substitution ◽

History Of

Background: Many studies have focused on the association between diet and cognitive function. While a subset of these studies focused on a diet that includes tree nuts (TN), there is limited data on the association between peanut and peanut butter consumption (P/PB) and cognitive health. Objective: This study investigated the association of P/PB consumption and cognitive function. Design: This was a cross-sectional study using 2011-2014 NHANES data. Participants/setting: Individuals 60-80 years old in 2011-2014 NHANES who had two 24-hour dietary recalls, cognitive function tests, and education level and with no history of stroke. Measurements: P/PB and TN consumption was measured as well as participant performance on the CERAD Word Learning subtest (CERAD W-L), Animal Fluency test (AFT), and the Digit Symbol Substitution test (DSST). Scores from the three cognitive tests were dichotomized. Individuals were classified as either P/PB consumers or non-consumers and TN consumers or non-consumers. Logistic regression models examined associations between P/PB consumption, tree nut consumption, and cognitive function with adjusted models including age, sex, and education as covariates. Results: A total of 2,454 adults, aged 60-80 years old (mean age=69.4) participated. Approximately half were male (48%), 18% were P/PB consumers, and 14% consumed TN. Participants who did not consume P/PB were more likely to do poorly on the CERAD W-L (adjusted OR=1.56, 95% CI 1.24-1.97; p<0.05), AFT (adjusted OR=1.29, 95% CI 1.03-1.61; p<0.05), and DSST (adjusted OR=1.43, 95% CI 1.12-1.82; p<0.05) when compared to those who did consume P/PB. Conclusions: These findings suggest an association between P/PB consumption and cognitive function; however, this is a cross sectional study and a causal relationship cannot be established. More studies are needed to determine causality.

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Concern About Falling Is Associated With Gait Speed, Independently From Physical and Cognitive Function

Physical Therapy ◽

10.1093/ptj/pzz032 ◽

2019 ◽

Vol 99 (8) ◽

pp. 989-997 ◽

Cited By ~ 7

Author(s):

Kimberley S van Schooten ◽

Ellen Freiberger ◽

Myriam Sillevis Smitt ◽

Veronika Keppner ◽

Cornel Sieber ◽

...

Keyword(s):

Cognitive Function ◽

Older People ◽

Dual Task ◽

Gait Speed ◽

Fall Risk ◽

Walking Speed ◽

Community Dwelling ◽

Digit Symbol Substitution Test ◽

Cross Sectional ◽

Increased Risk

AbstractBackgroundHigher levels of concern about falling in older people have been associated with slower walking speed and an increased risk of falls. However, it is unclear whether this relationship is independent or confounded by other fall risk factors, such as physical and cognitive function.ObjectiveThe aim of this study was to examine the effects of concern about falling on gait speed, adjusted for physiological fall risk and cognitive function.DesignThis was an observational, cross-sectional study.MethodsA total of 204 community-dwelling older people aged 70 years or older were recruited from 2 sites (Germany, n = 94; Australia, n = 110). Walking speed was measured over 6 m under 4 conditions: preferred speed, fast speed, speed while carrying a tray (functional dual task), and speed while answering a question (cognitive dual task). The Falls Efficacy Scale–International was used to assess concern about falling, the Physiological Profile Assessment was used to assess physiological fall risk, and the Digit Symbol Substitution Test and Trail Making Test were used to assess attention and executive function.ResultsHigher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized β = 0.18 ± 0.08; P = .037).LimitationsThe use of walking speed as a sole measure of gait was a limitation of this study.ConclusionsGait speed, especially under dual-task conditions, was affected by concern about falling. Concern about falling was the strongest predictor of gait speed under all 4 conditions and should be included in routine geriatric assessments.

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