Abstract P304: High Cardiovascular Health Metrics Score Predicts Slower Cognitive Performance Decline in Coronary Patients

Introduction: In 2010, the American Heart Association introduced a metric defining the concept of ideal cardiovascular health (CVH) metrics as part of its 2020 Impact Goals definition designed for the health general population. Several studies have demonstrated that a higher number of ideal CVH metrics were associated with a lower rate of cardiovascular events, stroke and all-cause mortality. Hypothesis: We hypothesized that a modified cardiovascular health (CVH) metrics score among patients with CHD may be associated with the change in cognitive functions two decades later in patients. Methods: CVH metrics were assessed in a subgroup of men, who had previously participated in a secondary prevention trial and two successive examinations of cognitive function (N=200, mean age at baseline 57.3±6.3 yrs.). A CVH metrics score at baseline was calculated including 3 health parameters, glucose, LDL-cholesterol, blood-pressure; and 4 health behaviors, smoking, obesity, physical-activity and adherence to Mediterranean diet. We scored each of these CVH metrics into best (2 points), intermediate (1 point), and poor levels (0 points). Cognitive performance was evaluated 14.7±1.9 and 19.9±1.0 years after entry to the trial. Cognitive function was assessed using the NeuroTrax Computerized Cognitive Battery. Linear mixed model was used to assess change in cognitive functions between T1 and T2 cognitive evaluations. Results: Among the 200 patients, 68 (34.0%) had less than 7 (bottom group), 85 (42.5%) had 8-9 (middle group) and 47 (23.5%) had at least 10 CVH metrics points (top group). After adjustments, the top group of CVH score vs. others was associated with slower decline in overall cognitive performance composite z-score [0.23±0.09; p=0.009] and on tests of executive and visual spatial functions [0.23±0.11; p=0.047 and 0.49±0.17; p=0.004, respectively]. A 3 point-Increment in the health behaviors component was related to a slower decline in visuospatial functions [0.325±0.12; p=0.01]. Conclusion: an inverse association was observed between the score of best CVH metrics and cognitive decline among men with pre-existing CHD.

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Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention

American Journal of Nephrology ◽

10.1159/000516130 ◽

2021 ◽

pp. 1-9

Author(s):

Anoop Sheshadri ◽

Piyawan Kittiskulnam ◽

Cynthia Delgado ◽

Rebecca L. Sudore ◽

Jennifer C. Lai ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Physical Performance ◽

Mixed Model ◽

Linear Mixed Model ◽

Controlled Trial ◽

Cognitive Status ◽

Dialysis Patients ◽

Exercise Interventions ◽

And Performance

Introduction: A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. Methods: Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26–32: ambiguous impairment, 21–25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. Results: One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: −620 [95% CI −174, −1,415], MCI: −1,653 [95% CI −120, −3,187]); less improvement in SPPB (ambiguous: −0.22 points [95% CI −0.08, −0.44], MCI: −0.45 [95% CI −0.13, −0.77]); and less improvement in PF (ambiguous: −4.0 points [95% CI −12.2, 4.1], MCI: −14.0 [95% CI −24.9, −3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: −0.54 [95% CI −1.27, 0.19], MCI: −0.97 [95% CI −0.37, −1.58]) and PF (ambiguous: −3.3 [95% CI −6.5, −0.04], MCI: −10.5 [95% CI −18.7, −2.3]). Discussion/Conclusion: Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.

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The acute and medium-term effects of treatment with electroconvulsive therapy on memory in patients with major depressive disorder

Psychological Medicine ◽

10.1017/s0033291715002287 ◽

2015 ◽

Vol 46 (4) ◽

pp. 797-806 ◽

Cited By ~ 13

Author(s):

N. P. Maric ◽

Z. Stojanovic ◽

S. Andric ◽

I. Soldatovic ◽

M. Dolic ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Electroconvulsive Therapy ◽

Visual Memory ◽

Mixed Model ◽

Linear Mixed Model ◽

Neuropsychological Test ◽

Medium Term ◽

Major Depressive ◽

Visual Spatial

BackgroundCurrent literature provides insufficient information on the degree of cognitive impairment during and after electroconvulsive therapy (ECT), mostly due to the fact that applied tests lacked sensitivity and flexibility. Our goal was to evaluate cognitive functioning in adult depressed patients treated with bi-temporal ECT, using tests sensitive for detection of possible acute and medium-term memory changes.MethodThirty adult patients with major depressive disorder, treated with a course of bi-temporal ECT, underwent clinical and cognitive measurements three times: at baseline, immediately after a course of ECT, and 1 month later. For cognition assessment, we used learning and visual, spatial and figural memory tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB).ResultsBi-temporal ECT has proven to be an effective treatment. The linear mixed model, used to analyze changes in depression severity and patients’ cognitive performances over time and to assess dynamic correlations between aforementioned features, did not show any significant memory impairment as a potential acute or medium-term ECT effect. However, it yielded significant improvement on visual memory and learning at the follow-up, which positively correlated with the improvement of depression.ConclusionGood progress is being made in the search for ECT-related acute and medium-term cognitive side-effects by using the tests sensitive to detect memory dysfunction with parallel forms of the tasks (to counter practice effects on repeat testing). Our results on learning and memory in relation to ECT during treatment of depression did not bring forth any prolonged and significant bi-temporal ECT-related memory deficit.

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Abstract 015: Critical Periods in Cardiovascular Health Across the Life Course: A Pooled Cohort Analysis

Circulation ◽

10.1161/circ.137.suppl_1.015 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Norrina B Allen ◽

Amy Krefman ◽

Darwin Labarthe ◽

Philip Greenland ◽

Markus Juonala ◽

...

Keyword(s):

Change Point ◽

Mixed Model ◽

Cardiovascular Health ◽

Linear Mixed Model ◽

Cohort Analysis ◽

Change Points ◽

Rapid Decline ◽

Critical Periods ◽

Ideal Cardiovascular Health ◽

Inflection Points

Background: The prevalence of Ideal Cardiovascular Health (CVH) decreases with age, beginning in childhood. However, more precise estimates of trajectories of CVH across the lifespan are needed to guide intervention. The aims of this analysis are to describe trajectories in CVH from childhood through middle age and examine whether there are critical inflection points in the decline in CVH. Methods: We pooled data from five prospective childhood/early adulthood cohorts including Bogalusa, Young Finns, HB!, CARDIA, and STRIP. Clinical CVH factors—blood pressure, BMI, cholesterol, glucose—were categorized as poor, intermediate and ideal then summed to create a clinical CVH score, ranging from 0 to 8 (higher score= more ideal CVH). The association between clinical CVH score and age in years was modeled using a segmented linear mixed model, with a random participant intercept, fixed slopes, and fixed change points. Change points were estimated using an extension of the R package ‘segmented’ which utilizes a likelihood based approach to iteratively determine one or more change points. All models were adjusted for race, gender and cohort. Results: This study included 18,290 participants (51% female, 67% White, 46% between the ages of 8-11 at baseline). CVH scores decline with age from 8 through 55 years. We found two ages at which the slope of the CVH trajectories change significantly. CVH scores are generally stable from age 8 until the first change point at age 17 (95% CI 16.3-17.4), when they begin to decline more rapidly with a 0.08 CVH unit loss per year from age 17 to 30. The second change point occurs at age 30 (26.7-33.6) when the rate of decline increases by an additional 0.01 units per year. Conclusion: The clinical CVH score declines from favorable levels from childhood through adulthood, with a rapid decline starting at age 17 that becomes slightly steeper from age 30 to 55 years. These inflection points signal that there are critical periods in an individual’s clinical CVH trajectory during which prevention efforts may be targeted.

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Influencing cardiovascular health habits in the rural, deep south: results of a cluster randomized trial

Health Education Research ◽

10.1093/her/cyy052 ◽

2019 ◽

Vol 34 (2) ◽

pp. 200-208

Author(s):

Laurie S Abbott ◽

Elizabeth H Slate ◽

Jennifer L Lemacks

Keyword(s):

Health Program ◽

Mixed Model ◽

Cardiovascular Health ◽

Linear Mixed Model ◽

Intervention Group ◽

The United States ◽

Control Group ◽

Cvd Risk ◽

Health Habits ◽

Cluster Randomized

Abstract Cardiovascular disease (CVD) is a major cause of death among people living in the United States. Populations, especially minorities, living in the rural South are disproportionately affected by CVD and have greater CVD risk, morbidity and mortality. Culturally relevant cardiovascular health programs implemented in rural community settings can potentially reduce CVD risk and facilitate health behavior modification. The purpose of this study was to examine the effects of a cardiovascular health promotion intervention on the health habits of a group of rural African American adults. The study had a cluster randomized controlled trial design involving 12 rural churches that served as statistical clusters. From the churches (n = 6) randomized to the intervention group, 115 participants were enrolled, received the 6-week health program and completed pretest–posttest measures. The 114 participants from the control group churches (n = 6) did not receive the health program and completed the same pretest–posttest measures. The linear mixed model was used to compare group differences from pretest to posttest. The educational health intervention positively influenced select dietary and confidence factors that may contribute toward CVD risk reduction.

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Poorer Visual Acuity Is Associated with Declines in Cognitive Performance Across Multiple Cognitive Domains: The Maine-Syracuse Longitudinal Study

Journal of the International Neuropsychological Society ◽

10.1017/s1355617718000358 ◽

2018 ◽

Vol 24 (7) ◽

pp. 746-754 ◽

Cited By ~ 3

Author(s):

Peter J. Dearborn ◽

Merrill F. Elias ◽

Kevin J. Sullivan ◽

Cara E. Sullivan ◽

Michael A. Robbins

Keyword(s):

Visual Acuity ◽

Longitudinal Study ◽

Cognitive Function ◽

Episodic Memory ◽

Cognitive Performance ◽

Spatial Organization ◽

Disease Risk ◽

Community Dwelling ◽

Visual Spatial ◽

Verbal Episodic Memory

AbstractObjectives: Prior studies have found associations between visual acuity (VA) and cognitive function. However, these studies used a limited range of cognitive measures and did not control for cardiovascular disease risk factors (CVD-RFs) and baseline function. The primary objective of this study was to analyze the associations of VA and cognitive performance using a thorough neuropsychological test battery. Methods: This study used community-dwelling sample data across the sixth (2001–2006) and seventh (2006–2010) waves of the Maine-Syracuse Longitudinal Study (n=655). Wave 6 VA as measured by the Snellen Eye Test was the primary predictor of wave 6 and wave 7 Global cognitive performance, Visual-Spatial Organization and Memory, Verbal Episodic Memory, Working Memory, Scanning and Tracking, and Executive Function. Additionally, VA was used to predict longitudinal changes in wave 7 cognitive performance (wave 6 performance adjusted). We analyzed these relationships with multiple linear and logistic regression models adjusted for age, sex, education, ethnicity, depressive symptoms, physical function deficits in addition to CVD-RFs, chronic kidney disease, homocysteine, continuous systolic blood pressure, and hypertension status. Results: Adjusted for demographic covariates and CVD-RFs, poorer VA was associated with concurrent and approximate 5-year declines in Global cognitive function, Visual-Spatial Organization and Memory, and Verbal Episodic Memory. Discussion: VA may be used in combination with other screening measures to determine risk for cognitive decline. (JINS, 2018, 24, 1–9)

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The association between circulating levels of vitamin D and inflammatory markers in the first 2 years after colorectal cancer diagnosis

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820923922 ◽

2020 ◽

Vol 13 ◽

pp. 175628482092392 ◽

Cited By ~ 1

Author(s):

Evertine Wesselink ◽

Michiel Balvers ◽

Martijn J. L. Bours ◽

Johannes H. W. de Wilt ◽

Renger F. Witkamp ◽

...

Keyword(s):

Colorectal Cancer ◽

Vitamin D ◽

Cancer Progression ◽

Inflammatory Markers ◽

Mixed Model ◽

Linear Mixed Model ◽

Active Form ◽

Inverse Association ◽

Z Score ◽

Regression Analyses

Background: Calcitriol, the active form of vitamin D, may inhibit colorectal cancer (CRC) progression, which has been mechanistically linked to an attenuation of a pro-inflammatory state. The present study investigated the associations between circulating 25 hydroxy vitamin D3 (25(OH)D3) levels and inflammatory markers (IL10, IL8, IL6, TNFα and hsCRP) in the 2 years following CRC diagnosis. Methods: Circulating 25(OH)D3 levels and inflammatory markers were assessed at diagnosis, after 6, 12 and 24 months from 798 patients with sporadic CRC participating in two prospective cohort studies. Associations between 25(OH)D3 levels and individual inflammatory markers as well as a summary inflammatory z-score were assessed at each time point by multiple linear regression analyses. To assess the association between 25(OH)D3 and inflammatory markers over the course of 2 years, linear mixed model regression analyses were conducted. Results: Higher 25(OH)D3 levels were associated with lower IL6 levels at diagnosis, at 6 months after diagnosis and over the course of 2 years (β −0.06, 95% CI −0.08 to −0.04). In addition, 25(OH)D3 levels were inversely associated with the summary inflammatory z-score at diagnosis and over the course of 2 years (β −0.17, 95% CI −0.25 to −0.08). In addition, a significant inverse association between 25(OH)D3 levels and IL10 was found over the course of 2 years. Intra-individual analyses showed an inverse association between 25(OH)D3 and IL10, IL6 and TNFα. No statistically significant associations between 25(OH)D3 and IL8 and hsCRP levels were observed. Conclusions: Serum 25(OH)D3 levels were inversely associated with the summary inflammatory z-score and in particular with IL6 in the years following CRC diagnosis. This is of potential clinical relevance as IL6 has an important role in chronic inflammation and is also suggested to stimulate cancer progression. Further observational studies should investigate whether a possible 25(OH)D3-associated reduction of inflammatory mediators influences treatment efficacy and CRC recurrence.

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Serum Adiponectin in Alzheimer’s Disease (AD): Association with AD Biomarkers and Cognitive Outcome

Journal of Alzheimer s Disease ◽

10.3233/jad-210722 ◽

2021 ◽

pp. 1-10

Author(s):

Heeyoung Kim ◽

Sungmin Jun ◽

Bum Soo Kim ◽

In-Joo Kim ◽

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Function ◽

Mixed Model ◽

Linear Mixed Model ◽

Adiponectin Level ◽

Cognitive Outcome ◽

Serum Adiponectin ◽

Carrier Status ◽

Serum Adiponectin Level

Background: The association between dementia and serum adiponectin has been evaluated in many studies; however, conclusions remain mixed. Objective: We investigated the cross-sectional associations of adiponectin with cognitive function and Alzheimer’s disease (AD) biomarkers and whether serum adiponectin levels can predict cognitive outcomes. Methods: This study included 496 participants from the Alzheimer’s Disease Neuroimaging Initiative 1 (ADNI1) with available serum adiponectin levels at baseline and ≥65 years of age. Subjects were stratified based on sex and apolipoprotein ɛ4 (APOE4) carrier status to determine associations between adiponectin and cognitive function. The linear mixed model was used to analyze associations between adiponectin level and cognitive outcome in amnestic mild cognitive impairment (aMCI) patients. Results: Serum adiponectin levels were higher in aMCI and AD than in CN subjects among APOE4 non-carrier males (adiponectin in CN, aMCI, and AD: 0.54±0.24, 0.74±0.25, and 0.85±0.25, respectively, p < 0.001). In this group, serum adiponectin levels were associated with age (p = 0.001), ADAS13 (p < 0.001), memory function (p < 0.001), executive function (p < 0.001), total tau (p < 0.001), and phosphorylated tau (p < 0.001) measures in cerebrospinal fluid (CSF). Higher adiponectin level was not associated with cognitive outcome in aMCI patients in the linear mixed model analysis over 5.3±2.6 years of mean follow-up. Conclusion: Serum adiponectin level was associated with cognitive function and CSF AD biomarkers among APOE4 non-carrier males. However, serum adiponectin level was not associated with longitudinal cognitive function outcome in aMCI.

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Disparity in Educational Attainment Partially Explains Cognitive Gender Differences in Older Rural South Africans

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa035 ◽

2020 ◽

Vol 75 (7) ◽

pp. e161-e173 ◽

Cited By ~ 1

Author(s):

Meagan T Farrell ◽

Lindsay C Kobayashi ◽

Livia Montana ◽

Ryan G Wagner ◽

Nele Demeyere ◽

...

Keyword(s):

South Africa ◽

Gender Differences ◽

Executive Function ◽

Cognitive Function ◽

Episodic Memory ◽

Cognitive Performance ◽

Structural Equation Models ◽

Gender Effects ◽

Rural South ◽

Visual Spatial

Abstract Objectives Direction and magnitude of gender differences in late-life cognitive function are inextricably tied to sociocultural context. Our study evaluates education and literacy as primary drivers of gender equality in cognitive performance among middle-aged and older adults in rural South Africa. Method Data were collected on 1,938 participants aged 40–79 from Agincourt, South Africa. Cognitive function was measured via the Oxford Cognitive Screen-Plus, a tablet-based assessment with low literacy demands. Four cognitive domains were derived through confirmatory factor analysis: episodic memory, executive function, visual spatial, and language. Structural equation models tested domain-specific gender effects, incrementally controlling for demographic, education, health, and socioeconomic variables. Results In the model adjusting only for demographic factors, men outperformed women on executive function and visual-spatial domains. Adding education and literacy to the model revealed a robust female advantage in episodic memory, and reduced the magnitude of male advantage in executive function and visual and spatial by 47% and 42%, respectively. Health and socioeconomic factors did not alter patterns of gender associations in subsequent models. Discussion In this older South African cohort, gender inequality in cognitive performance was partially attributable to educational differences. Understanding biopsychosocial mechanisms that promote cognitive resilience in older women is critically important given the predominantly female composition of aging populations worldwide.

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0106 The Effects of Caffeine on Blood Pressure and Cognitive Performance in Hypoxic Conditions on the Slopes of Mt. Everest

SLEEP ◽

10.1093/sleep/zsaa056.104 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A42-A42

Author(s):

K Sparks ◽

R R Wehling ◽

S Acharya ◽

T Musliu ◽

S Baniya ◽

...

Keyword(s):

Blood Pressure ◽

Placebo Group ◽

Cognitive Function ◽

Cognitive Performance ◽

Mixed Model ◽

Acute Mountain Sickness ◽

Study Drug ◽

Major Effect ◽

Hypoxic Conditions ◽

Before And After

Abstract Introduction 140 million people live above 2,400m worldwide. High altitude (HA) exposure can lead to sleep disruption, impaired cognitive performance, acute mountain sickness (AMS), elevated blood pressure (BP) and an increase in cardiovascular events in healthy people. Because caffeine can also increase BP, caffeine might need to be avoided at HA. Caffeine is the most widely used drug in the world but has yet to be studied extensively in hypoxic conditions. Therefore, the aim of the current study was to examine the effects of caffeine on cardiovascular variables and cognitive function at HA. Methods We conducted a non-randomized, single-blind, mixed model design at 4,300m on Mt. Everest. Thirty-three trekkers (nine females), aged 29.5±10.4 (mean±SD), ingested the study drug (placebo or 200 mg of caffeine) 1.5 hours after awakening. To control for withdrawal effects of caffeine, participants that self-reported consuming less than 47 mg of caffeine per day received the placebo while those that consumed more than that received caffeine. Cognitive function was tested using the Stroop task before and after the pill administration. BP was measured by a trained clinician using auscultatory method prior to and 30, 60 and 90 min after the pill administration. Results Caffeine improved cognitive performance when compared to the pretreatment measurement but was worse in the caffeine group prior to the pill administration when compared to the pretreatment placebo group. Additionally, caffeine did not have any major effect on BP when compared to pretreatment measures or the placebo group. Conclusion Caffeine does not seem to have an additive effect on increasing BP with HA. Additionally, because cognitive performance was worse in the chronic caffeine users prior to the pill administration, caffeine users might be more dependent on caffeine to perform optimally at HA. Based off of these data, caffeine seems to be a safe and beneficial drug at HA. Support NIH BUILD EXITO, University of Alaska Faculty Development Grant

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Genital Chlamydia trachomatis Seroprevalence and Uterine Fibroid Development: Cohort Study of Young African-American Women

Microorganisms ◽

10.3390/microorganisms10010010 ◽

2021 ◽

Vol 10 (1) ◽

pp. 10

Author(s):

Kristen Moore ◽

Donna Baird

Keyword(s):

African American ◽

Chlamydia Trachomatis ◽

African American Women ◽

Mixed Model ◽

Linear Mixed Model ◽

Cox Proportional Hazards ◽

Current Evidence ◽

Inverse Association ◽

American Women ◽

Tract Infections

Few studies have investigated the 1930s hypothesis that reproductive tract infections are risk factors for fibroid development. In our 2017 cross-sectional analysis from the Study of Environment, Lifestyle, and Fibroids (2010–2018), a large Detroit community-based cohort of 23–35 year-old African-American women with ultrasound fibroid screening, we found an inverse association between seropositivity for genital Chlamydia trachomatis (gCT) infection and fibroids. With prospective data from the cohort (standardized ultrasounds every 20 months over 5 years), we examined gCT’s associations with fibroid incidence (among 1158 women fibroid-free at baseline) and growth. We computed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incidence by gCT serostatus using Cox proportional hazards models. GCT’s influence on growth was assessed by estimating the difference between fibroid size change for seropositive vs. seronegative between successive ultrasounds (1254 growth measures) using a linear mixed model. Growth was scaled to change over 18 months. GCT seropositivity was not associated with fibroid incidence (aHR, 1.0 95% CI: 0.79, 1.29) or growth (4.4%, 95% CI: −5.02, 14.64). The current evidence based on both biomarker gCT data, which can capture the common undiagnosed infections, and prospective ultrasound data for fibroids suggests that Chlamydia is unlikely to increase fibroid risk.

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