Serum folate levels and cognitive performance in the ELSA-Brasil baseline assessment

ABSTRACT Background: Most studies that analyze the association between serum folate levels and cognitive function either restrict their assessments to specific clinical scenarios or do not include middle-aged individuals, to whom strategies for preventing cognitive impairment may be more feasible. Objective: To examine the association between serum folate levels and cognitive function in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: Data from 4,571 ELSA-Brasil participants who live in the state of São Paulo, aged 35-74 years, were analyzed. The word list learning, delayed recall, word recognition, verbal fluency, and Trail Making Test Part B consisted in the cognitive tests. For each test, age, sex, and education-specific standardized scores and a global cognitive score were calculated. Crude and adjusted linear regression models were used to examine the associations of serum folate levels with cognitive test scores. Results: In multivariable-adjusted models, serum folate was not associated with global cognitive score (β=-0.043; 95% confidence interval [95%CI] -0.135 to 0.050 for lowest vs. highest quintile group), nor with any cognitive test performance. We did not find associations between serum folate and global cognitive scores in subgroups stratified by age, sex, or use of vitamin supplements either. Conclusions: We did not find significant associations between serum folate and cognitive performance in this large sample, which is characterized by a context of food fortification policies and a consequent low frequency of folate deficiency. Positive results from previous studies may not apply to the increasingly common contexts in which food fortification is implemented, or to younger individuals.

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High Folate and Vitamin Low B12 Status: Potential Interactions with Cognitive Function Among U.S. Older Adults, NHANES 2011–2014

Current Developments in Nutrition ◽

10.1093/cdn/nzaa057_005 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1189-1189

Author(s):

Regan Bailey ◽

Shinyoung Jun ◽

Lisa Murphy ◽

Ralph Green ◽

Josh Miller

Keyword(s):

Older Adults ◽

Folic Acid ◽

Cognitive Function ◽

Vitamin B12 ◽

Cognitive Performance ◽

High Serum ◽

Serum Folate ◽

Cognitive Test ◽

Digit Symbol Substitution Test ◽

Cut Points

Abstract Objectives Potential safety concerns may exist with high folate/folic acid exposures combined with low vitamin B12 (B12) status relative to cognitive function; therefore, we investigated this relationship, leveraging cognitive test performance with folate and B12 biomarker data among a nationally-representative survey of U.S. older adults. Methods We analyzed data from 2420 older adults (≥60 y) from the 2011–2014 NHANES. High folate status was defined as unmetabolized serum folic acid (UMFA) > 1 nmol/L or serum folate > 74.1 nmol/L. Low B12 status was defined using age-specific cut-points for serum B12 [≤429 pmol/L (in 60–69 y) and ≤370 pmol/L (in ≥70 y)] or using a combination of traditional cut-points [elevated methylmalonic acid (>271 nmol/L) and deficient serum B12 (< 150 pmol/L)]. Multivariable logistic regression models estimated odds ratios (OR) of scoring low on one of four cognitive tests: Digit Symbol Substitution Test (DSST), Consortium to Establish a Registry for Alzheimer's Disease [CERAD; Word Learning (WL) and Delayed Recall (DR)], and Animal Fluency Test (AF). Results Among older adults with low B12 status, high UMFA was associated with a higher OR of having a low score on the DSST (<34, OR 2.16; 95% CI 1.05–4.47) and high serum folate was associated with a higher OR of having a low score on the AF (<14, OR 1.93; 95% CI 1.08–3.45), only when using traditional cut-points for B12. Among those with normal B12 status, having a high UMFA was protective on the CERAD-DR, regardless of B12 status being defined using age-specific or traditional cut-points. Compared to those with normal B12 (using traditional cut-points) and high UMFA, those with low B12 and high UMFA had a higher risk of scoring low on the DSST (<40, OR 2.22; 95% CI 1.31–3.75) and AF (<14, OR 1.97; 95% CI 1.30–2.97), those with low B12 and lower UMFA had a higher risk of scoring low on the DSST (<40, OR 1.69; 95% CI 1.16–2.47), and those with normal B12 and lower UMFA had a higher risk of scoring low on the CERAD-DR (<17, OR 1.38; 95% CI 1.02–1.85); similar patterns were found with serum folate. Conclusions In older adults, high folate was associated with better cognitive performance when vitamin B12 status is normal, whereas high folate was associated with poorer cognitive performance when vitamin B12 status is low. Funding Sources N/A.

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Higher Handgrip Strength Is Linked to Better Cognitive Performance in Chinese Adults with Hypertension

Brain Sciences ◽

10.3390/brainsci11080985 ◽

2021 ◽

Vol 11 (8) ◽

pp. 985

Author(s):

Shenghua Lu ◽

Fabian Herold ◽

Yanjie Zhang ◽

Yuruo Lei ◽

Arthur F. Kramer ◽

...

Keyword(s):

Cognitive Performance ◽

Short Term Memory ◽

Handgrip Strength ◽

Adult Health ◽

Linear Regression Models ◽

Chinese Adults ◽

Short Term ◽

Term Memory ◽

Using Data ◽

The Relationship

Objective: There is growing evidence that in adults, higher levels of handgrip strength (HGS) are linked to better cognitive performance. However, the relationship between HGS and cognitive performance has not been sufficiently investigated in special cohorts, such as individuals with hypertension who have an intrinsically higher risk of cognitive decline. Thus, the purpose of this study was to examine the relationship between HGS and cognitive performance in adults with hypertension using data from the Global Ageing and Adult Health Survey (SAGE). Methods: A total of 4486 Chinese adults with hypertension from the SAGE were included in this study. Absolute handgrip strength (aHGS in kilograms) was measured using a handheld electronic dynamometer, and cognitive performance was assessed in the domains of short-term memory, delayed memory, and language ability. Multiple linear regression models were fitted to examine the association between relative handgrip strength (rHGS; aHGS divided by body mass index) and measures of cognitive performance. Results: Overall, higher levels of rHGS were associated with higher scores in short-term memory (β = 0.20) and language (β = 0.63) compared with the lowest tertiles of rHGS. In male participants, higher HGS was associated with higher scores in short-term memory (β = 0.31), language (β = 0.64), and delayed memory (β = 0.22). There were no associations between rHGS and cognitive performance measures in females. Conclusion: We observed that a higher level of rHGS was associated with better cognitive performance among hypertensive male individuals. Further studies are needed to investigate the neurobiological mechanisms, including sex-specific differences driving the relationship between measures of HGS and cognitive performance in individuals with hypertension.

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Concussion History and Cognitive Function in a Large Cohort of Adolescent Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546518798801 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3262-3270 ◽

Cited By ~ 4

Author(s):

Kathryn M. Taylor ◽

Marianthi-Anna Kioumourtzoglou ◽

Jim Clover ◽

Brent A. Coull ◽

Jack T. Dennerlein ◽

...

Keyword(s):

High School ◽

Cognitive Function ◽

Verbal Memory ◽

Impulse Control ◽

Visual Memory ◽

Test Battery ◽

Cognitive Test ◽

Effect Estimate ◽

Cognitive Score ◽

And Performance

Background: The incidence of reported concussions in the adolescent population is increasing, yet research on the effects of concussions in this population is minimal and inconclusive. Purpose: To assess the association between concussion and performance on a cognitive test battery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Using multivariate models, the authors assessed the association between concussion and performance on a cognitive test battery among 5616 high school and junior high school athletes. The researchers utilized a global cognitive score and scores for 5 domains: verbal memory, visual memory, visual motor, reaction time, and impulse control. Each cognitive score was converted to a z score with the mean and SD of the nonconcussed population. Results from each model were then interpreted as change in the standardized unit score. In the models, concussion was evaluated as ever having a concussion, number of concussions, time since last concussion, and age at first concussion. Results: Ever having a concussion was associated with a mean decrease of 0.11 standardized units (95% CI, −0.20 to −0.01) on the global cognitive score and lower scores in all cognitive domains. Each additional concussion was associated with lower scores on global cognitive function (effect estimate, −0.06; 95% CI, −0.11 to −0.02), verbal memory, visual memory, and impulse control. Concussion in early childhood was associated with lower global cognition (effect estimate, −0.05; 95% CI, −0.08 to −0.01), visual memory, and motor visual scores as compared with concussions in later childhood. The associations between time since last concussion and cognitive test scores were nonlinear, and on all tests, lower scores were observed even ≥1 year after the concussion. Conclusion: On the basis of objective performance metrics for cognitive function, concussions had a more persistent effect on cognitive function than previously thought. The age at which an individual has his or her first concussion may be an important factor in determining long-lasting cognitive effects.

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Hypertension, Prehypertension, and Hypertension Control

Hypertension ◽

10.1161/hypertensionaha.120.16080 ◽

2021 ◽

Vol 77 (2) ◽

pp. 672-681

Author(s):

Sara Teles de Menezes ◽

Luana Giatti ◽

Luisa Campos Caldeira Brant ◽

Rosane Harter Griep ◽

Maria Inês Schmidt ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Function ◽

Cognitive Decline ◽

Cognitive Performance ◽

Blood Pressure Control ◽

Test Scores ◽

Pressure Control ◽

Memory Test ◽

Young Cohort ◽

Cognitive Score

Hypertension, particularly in middle age, has been associated with worse cognitive function, but evidence is inconclusive. This study investigated whether hypertension, prehypertension, age, and duration of diagnosis, as well as blood pressure control, are associated with a decline in cognitive performance in ELSA-Brasil participants. This longitudinal study included 7063 participants, mean age 58.9 years at baseline (2008–2010), who attended visit 2 (2012–2014). Cognitive performance was measured in both visits and evaluated by the standardized scores of the memory, verbal fluency, trail B tests, and global cognitive score. The associations were investigated using linear mixed models. Hypertension and prehypertension at baseline were associated with decline in global cognitive score; being hypertension associated with reduction in memory test; and prehypertension with reduction in fluency test. Hypertension diagnose ≥55 years was associated with lower global cognitive and memory test scores, and hypertension diagnose <55 years with lower memory test scores. Duration of hypertension diagnoses was not associated with any marker of cognitive function decline. Among treated individuals, blood pressure control at baseline was inversely associated with the decline in both global cognitive and memory test scores. In this relatively young cohort, hypertension, prehypertension, and blood pressure control were independent predictors of cognitive decline in distinct abilities. Our findings suggest that both lower and older age of hypertension, but not duration of diagnosis, were associated with cognitive decline in different abilities. In addition to hypertension, prehypertension and pressure control might be critical for the preservation of cognitive function.

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Carotenoid-rich dietary patterns during midlife and subsequent cognitive function

British Journal Of Nutrition ◽

10.1017/s0007114513003188 ◽

2013 ◽

Vol 111 (5) ◽

pp. 915-923 ◽

Cited By ~ 38

Author(s):

Emmanuelle Kesse-Guyot ◽

Valentina A. Andreeva ◽

Véronique Ducros ◽

Claude Jeandel ◽

Chantal Julia ◽

...

Keyword(s):

Cognitive Function ◽

Cognitive Performance ◽

Fruits And Vegetables ◽

Digit Span ◽

Plasma Concentrations ◽

Mean Difference ◽

Cued Recall ◽

Semantic Fluency ◽

Cognitive Score ◽

Β Carotene

Carotenoids may help to prevent the ageing of the brain. Previous findings regarding β-carotene alone are not consistent. In the present study, we evaluated the cross-time association between a carotenoid-rich dietary pattern (CDP) and subsequent cognitive performance using a sample of 2983 middle-aged adults participating in the SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydants) study. Cognitive performance was assessed in 2007–9 using six neuropsychological tests, and a composite cognitive score was computed. The cognitive data were related to dietary data obtained by repeated 24 h dietary records (1994–6) and to measurements of baseline plasma concentrations of carotenoids (lutein, zeaxanthin, β-cryptoxanthin, lycopene, α-carotene, trans-β-carotene and cis-β-carotene). DP were extracted using the reduced rank regression method for 381 participants and then extrapolated to the whole sample using plasma carotenoid concentrations as response variables. Associations between a CDP and cognitive function measured 13 years later were estimated with ANCOVA providing mean difference values and 95 % CI across the tertiles of CDP. A correlation between CDP and consumption of orange- and green-coloured fruits and vegetables, vegetable oils and soup was observed. CDP was found to be associated with a higher composite cognitive score (mean difference 1·04, 95 % CI 0·20, 1·87, P for trend 0·02), after adjustment for sociodemographic, lifestyle and health factors. Similar findings were obtained for scores obtained in the cued recall task, backward digit span task, trail making test and semantic fluency task (all P for trend < 0·05). Further studies ought to confirm whether a diet providing sufficient quantity and variety of coloured fruits and vegetables may contribute to the preservation of cognitive function during ageing.

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IMPACT OF DIETARY FACTORS AND INFLAMMATION ON COGNITION AMONG OLDER ADULTS

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2015.50 ◽

2015 ◽

pp. 1-7

Author(s):

E.P. Handing ◽

B.J. Small ◽

S.L. Reynolds ◽

N.B. Kumar

Keyword(s):

Older Adults ◽

Vitamin D ◽

Cognitive Function ◽

Cognitive Performance ◽

Serum Vitamin ◽

Plasma Homocysteine ◽

Dietary Factors ◽

Serum Folate ◽

Serum Vitamin D ◽

Age Related

OBJECTIVE: This study examined the influence of age, nutrition (as measured through food diaries and serum/plasma biomarkers) and inflammatory markers on cognitive performance in adults 60 years of age and older. DESIGN: A cross-sectional population based study, data from the National Health and Nutrition Examination Survey (NHANES; 2001-2002 wave). PARTICIPANTS: This study included 1,048 adults who had valid dietary data, blood biomarkers, were 60 years or older, completed the cognitive test, and had complete demographic information. METHOD: A series of regression models were used to examine the relationship between cognitive function as measured by the Digit Symbol Substitution Task (DSST), dietary factors/biomarkers and inflammation. Mediation analyses were then utilized to examine whether individual nutrients accounted for the relationships between age and DSST performance. RESULTS: Dietary fat intake, serum vitamin E, serum folate, serum iron, plasma homocysteine, and serum vitamin D were significantly associated with better DSST performance. Elevated fibrinogen and C-reactive protein, were significantly associated with poorer cognitive function, but did not remain statistically significant after controlling for age, gender, education, ethnicity, income, and total calorie intake. Serum vitamin D and plasma homocysteine accounted for a portion of age-related variance in DSST. Specifically, higher levels of vitamin D were related to better DSST performance, while higher homocysteine resulted in poorer cognitive performance. CONCLUSION: Diet and nutrition are important modifiable factors that can influence health outcomes and may be beneficial to remediate age-related declines in cognition. Adequate nutrition may provide a primary preventive approach to healthy aging and maintenance of cognitive functioning in older adults.

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Relation of a Socioeconomic Index with Cognitive Function and Neuroimaging in Hypertensive Individuals

Journal of Alzheimer s Disease ◽

10.3233/jad-210143 ◽

2021 ◽

pp. 1-12

Author(s):

Regina Silva Paradela ◽

Naomi Vidal Ferreira ◽

Mariana Penteado Nucci ◽

Brenno Cabella ◽

Luiza Menoni Martino ◽

...

Keyword(s):

Cognitive Function ◽

White Matter ◽

Cognitive Performance ◽

White Matter Hyperintensities ◽

Social Inequalities ◽

Parietal Lobe ◽

Brain Volume ◽

Linear Regression Models ◽

Socioeconomic Index ◽

The Relationship

Background: Socioeconomic factors are important contributors to brain health. However, data from developing countries (where social inequalities are the most prominent) are still scarce, particularly about hypertensive individuals. Objective: To evaluate the relationship between socioeconomic index, cognitive function, and cortical brain volume, as well as determine whether white matter hyperintensities are mediators of the association of the socioeconomic index with cognitive function in hypertensive individuals. Methods: We assessed 92 hypertensive participants (mean age = 58±8.6 years, 65.2%female). Cognitive evaluation and neuroimaging were performed and clinical and sociodemographic data were collected using questionnaires. A socioeconomic index was created using education, income, occupation (manual or non-manual work), and race. The associations of the socioeconomic index with cognitive performance and brain volume were investigated using linear regression models adjusted for age, sex, time of hypertension since diagnosis, and comorbidities. A causal mediation analysis was also conducted. Results: Better socioeconomic status was associated with better visuospatial ability, executive function, and global cognition. We found associations between a better socioeconomic index and a higher parietal lobe volume. White matter hyperintensities were also not mediators in the relationship between the socioeconomic index and cognitive performance. Conclusion: Socioeconomic disadvantages are associated with worse cognitive performance and brain volume in individuals with hypertension.

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Effects of Folic Acid and Vitamin B12, Alone and in Combination on Cognitive Function and Inflammatory Factors in the Elderly with Mild Cognitive Impairment: A Single-blind Experimental Design

Current Alzheimer Research ◽

10.2174/1567205016666190725144629 ◽

2019 ◽

Vol 16 (7) ◽

pp. 622-632 ◽

Cited By ~ 5

Author(s):

Fei Ma ◽

Xuan Zhou ◽

Qing Li ◽

Jiangang Zhao ◽

Aili Song ◽

...

Keyword(s):

Folic Acid ◽

Cognitive Function ◽

Vitamin B12 ◽

Cognitive Performance ◽

Inflammatory Cytokines ◽

Effect Size ◽

Serum Folate ◽

Control Group ◽

Equal Proportion ◽

Vitamin B12 Supplementation

Background: Folate and vitamin B12 are well-known as essential nutrients that play key roles in the normal functions of the brain. Inflammatory processes play at least some role in the pathology of AD. Effective nutritional intervention approaches for improving cognitive deficits that reduce the peripheral inflammatory cytokine levels have garnered special attention. Objective: The present study aimed to determine whether supplementation with folic acid and vitamin B12, alone and in combination improves cognitive performance via reducing levels of peripheral inflammatory cytokines. Methods: 240 participants with MCI were randomly assigned in equal proportion to four treatment groups: folic acid alone, vitamin B12 alone, folic acid plus vitamin B12 or control without treatment daily for 6 months. Cognition was measured with WAIS-RC. The levels of inflammatory cytokines were measured using ELISA. Changes in cognitive function or blood biomarkers were analyzed by repeatedmeasure analysis of variance or mixed-effects models. This trial has been registered with trial number ChiCTR-ROC-16008305. Results: Compared with control group, the folic acid plus vitamin B12 group had significantly greater improvements in serum folate, homocysteine, vitamin B12 and IL-6, TNF-α, MCP-1. The folic acid plus vitamin B12 supplementation significantly changed the Full Scale IQ (effect size d = 0.169; P = 0.024), verbal IQ (effect size d = 0.146; P = 0.033), Information (d = 0.172; P = 0.019) and Digit Span (d = 0.187; P = 0.009) scores. Post hoc Turkey tests found that folic acid and vitamin B12 supplementation was significantly more effective than folic acid alone for all endpoints. Conclusions: The combination of oral folic acid plus vitamin B12 in MCI elderly for six months can significantly improve cognitive performance and reduce the levels of inflammatory cytokines in human peripheral blood. The combination of folic acid and vitamin B12 was significantly superior to either folic acid or vitamin B12 alone.

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Association of the Irregular 3-Dimensional Shape of White Matter Hyperintensities with Cognitive Function

European Neurology ◽

10.1159/000515836 ◽

2021 ◽

pp. 1-8

Author(s):

Ji Won Han ◽

Hyunna Lee ◽

Subin Lee ◽

Haejin Kim ◽

Grace Eun Kim ◽

...

Keyword(s):

Cognitive Function ◽

White Matter ◽

White Matter Hyperintensities ◽

Shape Index ◽

Cognitive Test ◽

Linear Regression Models ◽

Multinomial Regression ◽

Subcortical Vascular Dementia ◽

Poor Cognitive Function ◽

Multinomial Regression Model

Introduction: The irregular shapes of white matter hyperintensities (WMHs) are associated with poor cognitive function, diabetes, or lacunes. However, the association between the WMH shape and dementia remains understudied. We investigated the association between the calculated shape index of WMH and the diagnosis of dementia and cognitive function. Methods: The inverse sphericity index (ISIWMH) and volume of WMHs (VOLWMH) were compared among 82 participants with normal cognition, 82 with Alzheimer’s dementia (AD), and 82 with subcortical vascular dementia (SVD). We examined the associations of ISIWMH and VOLWMH with the modified Hachinski Ischemic Score (mHIS), diagnosis of AD and SVD, and cognitive test scores, using linear, multinomial, or hierarchical linear regression models. Results: The mHIS was associated with both ISIWMH (β = 0.326, p < 0.001) and VOLWMH (β = 0.299, p < 0.001). Both ISIWMH and VOLWMH were associated with the SVD diagnosis (odds ratio [OR] = 2.685, p = 0.002, ISIWMH; OR = 2.597, p = 0.005, VOLWMH), but not with AD. The SVD diagnosis was better explained when the multinomial regression model included both ISIWMH and VOLWMH instead of VOLWMH alone (χ2 = 20.768, df = 2, p < 0.001). The Trail Making Test-D (TMT-D) scores of the SVD patients were associated with both ISIWMH (β = 0.308) and VOLWMH (β = 0.293). Conclusion: An irregular WMH shape may be associated with the high cerebrovascular component of cognitive impairment and the diagnosis and low cognitive flexibility of SVD, which may improve the prediction of SVD diagnosis when used in combination with WMH volume.

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Resting heart rate variability as a possible marker of cognitive decline

Kinesiology ◽

10.26582/k.52.1.9 ◽

2020 ◽

Vol 52 (1) ◽

pp. 72-84

Author(s):

Bernhard Grässler ◽

Anita Hökelmann ◽

Richard Halti Cabral

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Nervous System ◽

Cognitive Impairment ◽

Cognitive Function ◽

Cognitive Decline ◽

Cognitive Performance ◽

Processing Speed ◽

Early Stage ◽

Cognitive Test

Cognition is a major subject to be addressed nowadays due to the increasing number of cognitively affected people in most societies. Because of a lack of pharmaceutical therapies treating cognitive decline, its indicators should be diagnosed before it becomes prevalent. Scientific evidence indicates a relationship between cognition and the nervous system, especially its autonomic part. Heart rate variability (HRV) as an indicator of the autonomic nervous system functioning has been studied as a biological marker for the evaluation of cognitive performance. Therefore, HRV is a possible indicator of cognitive impairment. The aim was to provide a systematic literature review about the association between resting HRV and the cognitive performance. Five cognitive functions were analysed separately: executive functions, memory and learning, language abilities, visuospatial functioning, and processing speed. Furthermore, the global cognitive function evaluated with cognitive test batteries was considered too. An electronic database search was conducted with five databases. Three search fields comprised HRV, cognitive performance, and adult subjects. The final dataset consisted of 27 articles. Significant correlations in each cognitive function were found, except for processing speed, suggesting a positive association between resting HRV and cognitive performance. Mechanisms underlying this association between cardiovascular health and cognition are discussed. For the future, HRV could be used in diagnostics as an indicator of cognitive impairment before symptoms of dementia get apparent. With a timely diagnosis, preventative tools could be initiated at an early stage of dementia.

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