Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults’ Cognitive Function

Objectives: Many medications have cognitive impairment, memory loss, amnesia, or dementia as side effects (“cognitive side effects” hereafter), but little is known about trends in the prevalence of these medications or their implications for population-level cognitive impairment. Method: We use data from the National Health and Nutrition Examination Survey (1999–2016) to describe trends in the use of medications with cognitive side effects among adults aged 60+ ( N = 16,937) and their implications for cognitive functioning (measured using word learning and recall, animal fluency, and digit symbol substitution assessments). Results: Between 1999 to 2000 and 2015 to 2016, the prevalence of older adults taking one, two, and at least three medications with cognitive side effects increased by 10.2%, 57.3%, and 298.7%, respectively. Compared to non-users, respondents who simultaneously used three or more medications with cognitive side effects scored 0.22 to 0.27 standard deviations lower in word learning and recall ( p = .02), digit symbol substitution ( p < .01), and the average standardized score of the three assessments ( p < .001). Limitation: Dosage of medications associated with cognitive side effects was not measured. Discussion: Concurrent use of medications with cognitive side effects among older adults has increased dramatically over the past two decades. The use of such medications is associated with cognitive impairment and may explain for disparities in cognitive function across subgroups. These findings highlight the need for cognitive screenings among patients who consume medications with cognitive side effects. They also highlight the synergic effects of polypharmacy and potential drug-drug interactions that result in cognitive deficits.

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Discriminant Validity of the WAIS-R Digit Symbol Substitution Test in Subjective Cognitive Decline, Mild Cognitive Impairment (Amnestic Subtype) and Alzheimer’s Disease Dementia (ADD) in Greece

Brain Sciences ◽

10.3390/brainsci11070881 ◽

2021 ◽

Vol 11 (7) ◽

pp. 881

Author(s):

Marianna Tsatali ◽

Eleni Poptsi ◽

Despina Moraitou ◽

Christina Agogiatou ◽

Evaggelia Bakoglidou ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Decline ◽

Subjective Cognitive Decline ◽

Digit Symbol Substitution Test ◽

Digit Symbol ◽

Digit Symbol Substitution ◽

Symbol Substitution ◽

Alzheimer’S Disease Dementia

Objective: The aim of the current study was to estimate the discriminant potential and validity of the Digit Symbol Substitution Test (DSST) of the WAIS-R in the Greek elderly population meeting criteria for subjective cognitive decline (SCD), mild cognitive impairment (aMCI; amnestic subtype), or Alzheimer’s disease dementia (ADD). Method: Four hundred eighty-eight community-dwelling older adults, visitors of the Day Center of Alzheimer Hellas, participated in the study. Two hundred forty-three of them met the criteria for ADD, one hundred eighty-two for aMCI and sixty-three for SCD. Results: Path analysis indicated that the DSST score is affected by age group, educational level, and diagnostic category, but is not affected by gender. The ROC curve analysis showed that the DSST sum score could perfectly differentiate SCD from ADD patients, whereas test’s discriminant potential between aMCI and dementia ADD’s subtype was satisfactory. However, DSST was unable to separate the SCD from the aMCI group. Conclusion: It appears that the DSST is unable to separate the SCD from aMCI population. Therefore, the test in question may be insensitive to incipient cognitive decline. On the contrary, the discriminant potential of the DSST as regards SCD and ADD is excellent, while discrimination between aMCI and ADD is good.

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Peripheral Insulin Resistance in Cognitively Normal Older Adults Relates to Poorer Performance on a Test for Speed of Processing

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_076 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 76-76

Author(s):

Aaron Smith ◽

Matthew Taylor ◽

Jim Backes ◽

Juleah Littrell ◽

Caitlin Boeckman ◽

...

Keyword(s):

Insulin Resistance ◽

Older Adults ◽

Digit Symbol Substitution Test ◽

Digit Symbol ◽

Speed Of Processing ◽

Cognitively Normal ◽

Peripheral Insulin Resistance ◽

Digit Symbol Substitution ◽

Symbol Substitution ◽

The Relationship

Abstract Objectives Peripheral insulin resistance (IR) and impaired glucose metabolism increases the risk for cognitive decline. However, data looking at peripheral IR's relationship with cognition in cognitively normal adults is limited. This study aimed to assess the relationship between peripheral IR and tests of speed of processing (SOP) in cognitively normal older adults using a novel IR measure. Methods Baseline data from 56 cognitively normal older adults participating in a nutrition intervention study (Nutrition Interventions for Cognitive Enhancement study; NICE study) were analyzed. Fasting blood draws were attained, and peripheral IR was measured using Quest Diagnostics’ Cardio IQ Insulin Resistance Panel (Test Code: 36,509). A cognitive battery was conducted by a trained psychometrician. Z-Scores of the Digit Symbol Substitution Test, Stroop Color, Stroop Word, Stroop Interference, and Stroop Letter Number Sequencing and Crossing-Off tests were combined to give a global SOP score. We constructed ordinary least squares regression models to assess IR's relationships with individual SOP tests and global SOP, including age and education as covariates. Statistical analyses were performed using R (v. 3.6.2; R Foundation, Vienna, Austria). Statistical significance was set at P < 0.05. Results Participants were 77% female and had a mean age of 72.1 ± 4.9 years. Higher IR scores were related to poorer performance on the Digit Symbol Substitution Test (β = −0.26, P = 0.04). IR scores were not related to other individual cognitive tests: Stroop Color (β = −0.17, P = 0.20), Stroop Word (β = −0.19, P = 0.11), Stroop Interference (β = −0.14, P = 0.28), Stroop Letter Number Sequencing (β = 0.03, P = 0.83), Crossing-Off (β = −0.18, P = 0.15), or Global SOP (β = −0.20, P = 0.11). Conclusions There was a relationship between higher IR scores and poorer performance on the Digit Symbol Substitution Test. Although other SOP tests were not significantly correlated with IR scores, directionality of the relationships indicated trend for higher IR being related to lower SOP. Consequently, maintaining insulin sensitivity with healthy lifestyle choices may be important for healthy aging. Future analyses with a larger sample size will be more informative for understanding the relationship between IR and SOP. Funding Sources National Institute on Aging.

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Longitudinal Associations of Midlife Accelerometer Determined Sedentary Behavior and Physical Activity With Cognitive Function: The CARDIA Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018350 ◽

2021 ◽

Vol 10 (3) ◽

Author(s):

Kara M. Whitaker ◽

Dong Zhang ◽

Kelley Pettee Gabriel ◽

Monica Ahrens ◽

Barbara Sternfeld ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Function ◽

Verbal Learning ◽

Digit Symbol Substitution Test ◽

Digit Symbol ◽

Auditory Verbal Learning Test ◽

Digit Symbol Substitution ◽

Auditory Verbal Learning ◽

Symbol Substitution ◽

Learning Test

Background To determine if accelerometer measured sedentary behavior (SED), light‐intensity physical activity (LPA), and moderate‐to‐vigorous–intensity physical activity (MVPA) in midlife is prospectively associated with cognitive function. Methods and Results Participants were 1970 adults enrolled in the CARDIA (Coronary Artery Risk Development in Young Adults) study who wore an accelerometer in 2005 to 2006 (ages 38–50 years) and had cognitive function assessments completed 5 and/or 10 years later. SED, LPA, and MVPA were measured by an ActiGraph 7164 accelerometer. Cognitive function tests included the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop Test. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA with repeated measures of the cognitive function standardized scores. In men, statistical reallocation of 30 minutes of LPA with 30 minutes of MVPA resulted in an estimated difference of SD 0.07 (95% CI, 0.01–0.14), SD 0.09 (95% CI, 0.02–0.17), and SD −0.11 (95% CI, −0.19 to −0.04) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating better performance. Associations were similar when reallocating time in SED with MVPA, but results were less robust. Reallocation of time in SED with LPA resulted in an estimated difference of SD −0.05 (95% CI, −0.06 to −0.03), SD −0.03 (95% CI, −0.05 to −0.01), and SD 0.05 (95% CI, 0.03– 0.07) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating worse performance. Associations were largely nonsignificant among women. Conclusions Our findings support the idea that for men, higher‐intensity activities (MVPA) may be necessary in midlife to observe beneficial associations with cognition.

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Association Between Lower Digit Symbol Substitution Test Score and Slower Gait and Greater Risk of Mortality and of Developing Incident Disability in Well-Functioning Older Adults

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2008.01856.x ◽

2008 ◽

Vol 56 (9) ◽

pp. 1618-1625 ◽

Cited By ~ 145

Author(s):

Caterina Rosano ◽

Anne B. Newman ◽

Ronit Katz ◽

Calvin H. Hirsch ◽

Lewis H. Kuller

Keyword(s):

Older Adults ◽

Test Score ◽

Digit Symbol Substitution Test ◽

Digit Symbol ◽

Digit Symbol Substitution ◽

Risk Of Mortality ◽

Symbol Substitution

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Digit symbol substitution test score and hyperhomocysteinemia in older adults

Medicine ◽

10.1097/md.0000000000004535 ◽

2016 ◽

Vol 95 (35) ◽

pp. e4535 ◽

Cited By ~ 2

Author(s):

Wen-Chuin Hsu ◽

Yi-Chuan Chu ◽

Hon-Chung Fung ◽

Yau-Yau Wai ◽

Jiun-Jie Wang ◽

...

Keyword(s):

Older Adults ◽

Test Score ◽

Digit Symbol Substitution Test ◽

Digit Symbol ◽

Digit Symbol Substitution ◽

Symbol Substitution

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Association Between Diet And Cognitive Performance In Adults Aged 60 And Over: NHANES, 2011–2014

Innovation in Aging ◽

10.1093/geroni/igab046.2636 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 710-710

Author(s):

Md Towfiqul Alam ◽

Elizabeth Vasquez ◽

Sandra Echeverria

Keyword(s):

Older Adults ◽

Cognitive Performance ◽

Word List ◽

Healthy Eating Index ◽

Future Research ◽

Digit Symbol Substitution Test ◽

Digit Symbol ◽

Dietary Recommendations ◽

Digit Symbol Substitution ◽

Symbol Substitution

Abstract There is limited evidence examining associations between diet and cognitive performance (CP) in older adults. We used the 2011-2014 National Health and Nutrition Examination Survey to determine if meeting dietary recommendations was associated with CP in adults 60+ years of age. Diet was based on the healthy eating index (HEI) 2015 and categorized into quintiles (higher quintiles indicating healthier diet). CP was based on word list learning, animal naming, and digit symbol substitution test, with scores above 25th percentile indicating adequate performance. Multivariate logistic regression modeling was conducted and adjusted for potential cofounders. A total of 3,068 participants completed the CP tests. A slightly higher percentage of participants were female (54.0%), predominantly White (80.5%) and the largest percentage (54.7%) was 60 to 69 years of age. The mean HEI-2015 score (0-100) was 54.89 (SE = 0.56). High CP scores increased with healthier dietary quintiles. However, results were only significant (p for trend <0.05) for digit symbol substitution test when comparing those in the highest quintile (82.53%) to those in the lowest (70.23%). Compared with participants in the lowest quintile of HEI-2015, participants in the highest quintile had a two-fold increased odds of better digit symbol substitution test scores, after adjusting for confounders (Odds Ratio [OR]: 1.96, 95% Confidence Interval [CI]: 1.28-3.01). Results showed that meeting healthy diet recommendations is associated with improved digit symbol substitution test, a marker of attention, processing speed and executive function. Future research should consider the role of diet in older adults to improve cognitive performance.

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Abstract 007: Treadmill Duration Predicts Cognitive Function

Circulation ◽

10.1161/circ.125.suppl_10.a007 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Na Zhu ◽

David R Jacobs ◽

Pamela J Schreiner ◽

R. Nick Bryan ◽

Lenore J Launer ◽

...

Keyword(s):

Cognitive Function ◽

Verbal Learning ◽

Stroop Test ◽

Test Duration ◽

Digit Symbol Substitution Test ◽

Digit Symbol ◽

Digit Symbol Substitution ◽

Auditory Verbal Learning ◽

Diabetes Status ◽

Symbol Substitution

Evidence is scarce for an association between treadmill performance and cognitive function in healthy young and middle-aged adults. We assessed the hypothesis that duration on treadmill predicts cognitive function 25 years later. Participants were from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-center study of black and white men and women aged 18-30 at recruitment in 1985-86 (year 0). The main independent variable of interest was baseline symptom-limited maximal treadmill test duration as a measure of treadmill performance potential, including its major subcomponent cardiorespiratory fitness (CRF/TPP). Cognitive functions measured were verbal memory (with the Rey auditory-verbal learning (AVLT)), psychomotor speed (Digit Symbol Substitution Test (DSST)) and executive function (modified Stroop interference test, where lower is better). We analyzed 2444 participants who had y0 treadmill testing and y25 cognitive testing. For each additional SD of treadmill duration (2.8 minutes), the DSST was 2.4 digits correctly substituted higher, the AVLT was 0.36 words recalled higher, and the Stroop test time 1.7 seconds less, after accounting for race, sex, age, highest attained education level and center of clinic visit( Table ). Further adjustment for dietary pattern, physical activity, smoking, BMI, alcohol consumption, glomerular filtration rate, blood pressure, cholesterol and diabetes status yielded similar trends for these cognitive function tests. In conclusion, CRF/TPP predicts cognitive function 25 years later independently of other factors among apparently healthy adults. Prospective estimation of cognitive function by treadmill duration at baseline in minimally and fully adjusted model (see text for details), N=2444. Year 25 Digit Symbol Substitution Test: Digits correctly substituted mean±SD: 70.1±15.9 Year 25 Rey Auditory-Verbal Learning Test: Words correctly recalled mean±SD: 8.3±3.3 Year 25 Stroop Test : Seconds to correctly name colors mean±SD: 43.9±12.8 Slope * SE P Slope * SE P Slope * SE P Year 0 treadmill duration (SD) mean±SD: 10.0±2.8 minutes Minimally adjusted 2.4 0.36 <.0001 0.36 0.08 <.0001 -1.7 0.31 <.0001 Fully adjusted 2.3 0.45 <.0001 0.39 0.08 <.0001 -1.2 0.39 0.001 * “Slope” is the difference in the indicated cognitive function per SD (2.8 minutes) of treadmill duration.

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Associations of Walking Impairment With Visual Impairment, Depression, And Cognitive Function In US Older Adults: NHANES 2013-2014

10.21203/rs.3.rs-1042843/v1 ◽

2021 ◽

Author(s):

Wei Gao ◽

Pengfei Dai ◽

Yuqian Wang ◽

Yurong Zhang

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Cognitive Function ◽

Visual Impairment ◽

Reference Group ◽

The Elderly ◽

The United States ◽

Logistic Regression Models ◽

Symbol Substitution ◽

White Adults

Abstract Background: Walking impairment, a common health problem among older adults, has been linked to poor vision and mental health. This study aimed to investigate the associations of walking impairment with visual impairment, depression, and cognitive function in older adults. Methods: A total of 1,489 adults aged 60 years and older who had participated in the National Health and Examination Survey (NHANES) 2013-2014 in the United States were included. Multivariate logistic regression models were used to examine the associations of walking impairment with visual impairment, depression, and four subdomains of cognitive function. Sample weights were used to ensure the generalizability of the results.Results: Among all the participants (median age=68 years; 53.7% women), 17.5% reported walking impairment. Walking impairment was significantly associated with visual impairment (adjusted odds ratio [aOR] =2.76; 95% CI: 1.47-5.20) and depression (aOR=4.66; 95% CI: 3.11-6.99). Walking impairment was only associated with the Digit Symbol Substitution (DSST) subdomain of cognitive function in total participants (aOR=0.97; 95% CI: 0.95-0.99), and in non-Hispanic white adults (aOR=0.96; 95% CI: 0.94-0.98). Participants with more than 1 impairment indicators had higher OR of walking impairment (aOR = 3.64, 95% CI =2.46-5.38) than those with 0-1 (reference group) impairment indicator.Conclusions: Walking impairment was associated with visual impairment, depression, and cognitive impairment in the American older adults and also positively associated with the number of impairment indicators. The association between walking impairment and cognitive impairment varied according to race. Evaluations of vision, cognition, and depression should be conducted among the elderly with walking impairment, and that needs of the older adults with biological aspect of their particular race should be provided in the evaluations.

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A social dancing pilot intervention for older adults at high risk for Alzheimer's disease and related dementias

Neurodegenerative Disease Management ◽

10.2217/nmt-2020-0002 ◽

2020 ◽

Vol 10 (4) ◽

pp. 183-194

Author(s):

Helena M Blumen ◽

Emmeline Ayers ◽

Cuiling Wang ◽

Anne F Ambrose ◽

Joe Verghese

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Executive Function ◽

Secondary Outcome ◽

Digit Symbol ◽

Digit Symbol Substitution ◽

Increased Risk ◽

Symbol Substitution ◽

Flanker Interference

Close to 6 million older US adults have Alzheimer's disease or related dementias, yet there is currently no cure or effective treatment. This single-blind randomized controlled trial (clinicaltrials.gov: NCT03475316) aims to establish feasibility, and explore the relative efficacy, of a 6-month social ballroom dancing intervention versus a 6-month active control intervention (treadmill walking) for improving executive function in 32 older adults at increased risk for Alzheimer's disease or related dementias. Dementia-at-risk status is determined with cut-scores on the memory impairment screen (≥3 to ≤6) and/or the AD8 Dementia Screening Interview (≥1). The primary outcome is a composite executive function score from digit-symbol substitution, flanker interference and walking-while-talking tasks. The secondary outcome is functional neuroplasticity during fMRI-adapted versions of digit-symbol substitution, flanker interference and walking-while-talking.

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