Effect of Hypertension Duration and Blood Pressure Control During Early Adulthood on Cognitive Function in Middle Age

2021 ◽  
pp. 1-11
Author(s):  
Haobin Zhou ◽  
Zongyuan Zhu ◽  
Changsong Liu ◽  
Yujia Bai ◽  
Qiong Zhan ◽  
...  

Background: Elevated blood pressure (BP) is a risk factor for cognitive impairment. Objective: We aim to explore the association between the duration of hypertension in early adulthood, with cognitive function in midlife. Furthermore, we investigate whether this asssociation is altered among participants with controlled BP. Methods: This prospective study included 2,718 adults aged 18–30 years without hypertension at baseline who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Duration of hypertension was calculated based on repeat measurements of BP performed at 2, 5, 7, 10, 15, 20, and 25 years after baseline. Cognitive function was assessed at Year-25 using the Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop test. Results: After multivariable adjustment, a longer hypertension duration was associated with worse verbal memory (RAVLT, p trend = 0.002) but not with processing speed (DSST, p trend = 0.112) and executive function (Stroop test, p trend = 0.975). Among subgroups of participants with controlled (BP < 140/90 mmHg) and uncontrolled (SBP≥140 mmHg or DBP≥90 mmHg) BP at the time of cognitive assessment (i.e., Year-25 BP), longer duration of hypertension was associated with worse verbal memory. Similar results were observed in subgroups with controlled and uncontrolled average BP prior to cognitive assessment. Conclusion: Longer duration of hypertension during early adulthood is associated with worse verbal memory in midlife regardless of current or long-term BP control status. The potential risk of hypertension associated cognitive decline should not be overlooked in individuals with a long duration of hypertension, even if BP levels are controlled.

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Na Zhu ◽  
David R Jacobs ◽  
Katie A Meyer ◽  
Ka He ◽  
Lenore J Launer ◽  
...  

Primary prevention of cognitive function decline is important for a middle-aged population, but further evidence about the influence of dietary pattern is needed. An A Priori Diet Quality Score (diet score) and cognitive function were studied in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) study of black and white men and women aged 18-30 in 1985-86 (year 0, Y0). We hypothesized that a higher diet score, measured at Y0 and Y20, predicts better cognitive function measured at Y25. The diet scores incorporated 46 foods groups (each in servings/day categorized into quintiles), with higher scores indicating higher quality diets. The score was the sum of quintile ranks of foods rated healthy, 0 for foods rated neutral, and reversed quintile ranks of foods rated less healthy. Cognitive tests at Y25 measured verbal memory (Rey Auditory-Verbal Learning Test (RAVLT)), psychomotor speed (Digit Symbol Substitution Test (DSST)) and executive function (Stroop Test). Higher cognitive function is reflected by higher RAVLT and DSST scores and lower Stroop Test scores. For each additional 10 units of diet score at Y20, the RAVLT was 0.23 words recalled higher, the DSST was 0.87 digits higher, and the Stroop Test score was 0.69 lower. Diet score measured at Y0 was less strongly but still significantly associated with cognitive scores. In exploratory analysis, we found that education modified the relation between diet pattern and cognitive function measures, e.g. diet and DSST at Y20 were associated in less educated subjects, but not in higher educated subjects (P for interaction =0.02). In conclusion, higher diet score was associated with better cognitive function 5 years later in apparently healthy middle-aged adults. However, diet pattern was not related to some measures of cognitive function in better educated subjects, conceivably because of compensatory behaviors in better educated people that would maintain higher cognitive function scores, despite lower quality diet.


Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Yuichiro Yano ◽  
Hongyan Ning ◽  
Norrina Allen ◽  
Jared P. Reis ◽  
Kiang Liu ◽  
...  

Background: Blood pressure variability (BPV) consists of short-term BPV (e.g., diurnal BPV) and long-term BPV (e.g., visit-to-visit BPV). The prospective association of long-term BPV though young adulthood with cognition in midlife is unknown. Methods: CARDIA is a multicenter community-based study that included participants (ppts) aged 18 to 30 years at baseline (Year 0: Y 0 ) in 1985-86 with follow-up examinations at Y 2 , Y 5 , Y 7 , Y 10 , Y 15 , Y 20 , and Y 25 . BP was measured at each exam, and visit-to-visit BPV was assessed by standard deviation (SD), coefficient of variation (CV), maximum minus minimum BP difference (MMD), and average real variability (ARV) across 7 visits (Y 0-20 ). Cognitive function was assessed at Y 25 by the Digit Symbol Substitution Test (DSST, a measure of psychomotor speed; n=2,318), the Rey Auditory Verbal Learning Test (RAVLT, a measure of short-term verbal memory; n=2,321), and the modified Stroop test (executive function; n=2,307). We performed separate multivariable-adjusted linear regression models, and also adjusted for baseline BP (Y 0 ), change of BP (Y 20 -Y 0 ), or cumulative BP from Y 0 to Y 20 (mmHg х year) to determine whether BPV is associated with cognition independent of long-term BP level. Results: At the Y 25 examination, included ppts had a mean age of 50 years, 57% were women and 43% were black. BPV measured by higher SD and ARV in both systolic and diastolic BP was significantly associated with lower DSST and lower RAVLT. SD and ARV remained significant even after further adjustment for baseline BP, change of BP, or cumulative BP (Table). Measures of BPV were not associated with the Stroop test. Associations between the CV and MMD measures of BPV with cognitive function were similar to those of SD (not shown). Conclusions: Long-term BPV over 20-years through young adulthood is associated with worse psychomotor speed and verbal memory in midlife, independent of BP levels. These results may have implications for understanding the pathogenesis of cognitive dysfunction in older adults.


2017 ◽  
Vol 24 (3) ◽  
pp. 354-357 ◽  
Author(s):  
Lisa F Barcellos ◽  
Kalliope H Bellesis ◽  
Ling Shen ◽  
Xiaorong Shao ◽  
Terrence Chinn ◽  
...  

We used the California Verbal Learning Test, Second Edition (CVLT-II), one component of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), to determine feasibility of a remote assessment protocol. We compared telephone-administered CVLT-II data from MS patients to data acquired in person from an independent sample of patients and healthy controls. Mixed factor analyses of variance (ANOVAs) showed no significant differences between patient groups, but between-group effects comparing patients and healthy controls were significant. In this study, CVLT-II assessment by conventional in-person and remote telephone assessment yielded indistinguishable results. The findings indicate that telephone-administered CVLT-II is feasible. Further validation studies are underway.


Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Jared P Reis ◽  
Catherine M Loria ◽  
Lenore J Launer ◽  
Stephen Sidney ◽  
Kiang Liu ◽  
...  

Background: Accumulating evidence suggests the presence of cardiovascular risk factors in middle-age is associated with later adulthood cognitive dysfunction; however, the consequences of suboptimal cardiovascular health in young adulthood are unclear. Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a cohort of white and black men and women who were 18-30 years when a series of health behaviors (smoking status, body mass index, physical activity, diet) and health factors (total cholesterol, blood pressure, fasting glucose) were measured during a baseline clinic examination in 1985-1986. Included in the current study were 2,577 participants who completed an examination 25 years later when a cognitive battery to assess psychomotor speed (Digit Symbol Substitution Test [DSST]), executive function (modified Stroop Test), and verbal memory (Rey Auditory Verbal Learning Test [RAVLT]) were administered. Ideal levels for each behavior and factor were defined according to the 2020 American Heart Association Goals for Cardiovascular Health. Associations were adjusted for age, sex, race, midlife educational attainment, and study center. Results: At baseline, the percentage of participants with 0-1, 2, 3, 4, 5, and 6-7 ideal health factors were 1.2%, 7.2%, 19.6%, 34.9%, 29.2%, and 7.8%, respectively. Adjusted mean DSST and RAVLT scores were higher among those with a greater number of ideal health factors ( Table ). Each additional factor at the ideal level was associated with a 0.78-point higher DSST score (95% CI: 0.28 to 1.28) and a 0.13-point higher memory score (95% CI: 0.02 to 0.25). Results did not differ by race or sex (p-interaction > 0.05). The ideal cardiovascular health score was not associated with performance on the Stroop Test. Conclusion: In this population-based sample, ideal cardiovascular health in young adulthood was independently associated with cognitive functioning in midlife. Table. Adjusted * mean (standard error) cognitive function scores at Year 25 by number of ideal health behaviors and factors at baseline: CARDIA (n=2,577). No. of Ideal Health Factors at Baseline (% of population) 0-1 (1.2%) 2 (7.2%) 3 (19.6%) 4 (34.9%) 5 (29.2%) 6-7 (7.8%) p-trend DSST 70.0 (2.5) 65.7 (1.0) 68.7 (0.6) 69.4 (0.5) 70.0 (0.5) 69.9 (1.0) 0.003 Stroop Test 21.5 (1.6) 21.2 (0.6) 21.0 (0.3) 20.6 (0.3) 20.6 (0.3) 20.4 (0.5) 0.14 RAVLT 7.4 (0.6) 7.6 (0.2) 8.0 (0.1) 8.2 (0.1) 8.3 (0.1) 8.1 (0.2) 0.02 * Adjusted for age, sex, race, midlife educational attainment, and study center. DSST=Digit Symbol Substitution Test; RAVLT=Rey Auditory Verbal Learning Test


2019 ◽  
Vol 149 (8) ◽  
pp. 1424-1433
Author(s):  
Xuanxia Mao ◽  
Cheng Chen ◽  
Pengcheng Xun ◽  
Martha L Daviglus ◽  
Lyn M Steffen ◽  
...  

ABSTRACT Background Vegetables and fruits (VF) may differentially affect cognitive functions, presumably due to their various nutrient contents, but evidence from epidemiologic studies is limited. Objectives The aim of this study was to examine the long-term association between VF intakes, including VF subgroups, in young adulthood and cognitive function in midlife. Methods A biracial cohort of 3231 men and women aged 18–30 y at baseline in 1985–1986 were followed up for 25 y in the Coronary Artery Risk Development in Young Adults Study. Diet was measured at baseline, and in examination years 7 and 20. Cognitive function was assessed at examination year 25 through the use of 3 tests: the Rey Auditory Verbal Learning Test (RAVLT), the Digit Symbol Substitution Test (DSST), and the Stroop test. The mean differences (MDs) with 95% CIs in cognitive scores across intake categories were estimated through the use of the multivariable-adjusted general linear regression model. Results Excluding potatoes, intake of whole vegetables was significantly associated with a better cognitive performance after adjustment for potential confounders in all 3 cognitive tests (quintile 5 compared with quintile 1—RAVLT, MD: 0.33; 95% CI: 0.01, 0.64; P-trend = 0.08; DSST, MD: 2.84; 95% CI: 0.93, 4.75; P-trend < 0.01; Stroop test, MD: −2.87; 95% CI: −4.24, −1.50; P-trend < 0.01]. Similarly, intake of fruits, except fruit juices, was significantly related to a better cognitive performance (quintile 5 compared with quintile 1—DSST, MD: 2.41; 95% CI: 0.70, 4.12; P-trend = 0.03). Conclusions This study supports the long-term benefits of VF consumption on cognitive performance, except those VF with relatively low fiber content such as potatoes and fruit juices, among the middle-aged US general population.


2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Kara M. Whitaker ◽  
Dong Zhang ◽  
Kelley Pettee Gabriel ◽  
Monica Ahrens ◽  
Barbara Sternfeld ◽  
...  

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.


Neurology ◽  
2019 ◽  
Vol 92 (14) ◽  
pp. e1589-e1599 ◽  
Author(s):  
Claire T. McEvoy ◽  
Tina Hoang ◽  
Stephen Sidney ◽  
Lyn M. Steffen ◽  
David R. Jacobs ◽  
...  

ObjectiveTo investigate whether dietary patterns (Mediterranean diet [MedDiet], Dietary Approaches to Stop Hypertension [DASH], and A Priori Diet Quality Score [APDQS]) during adulthood are associated with midlife cognitive performance.MethodsWe studied 2,621 Coronary Artery Risk Development in Young Adults (CARDIA) participants; 45% were black, 57% were female, and mean age was 25 ± 3.5 years at baseline (year 0). Mean diet scores were calculated from diet history at baseline, year 7, and year 20 (mean age 25, 32, and 45 years, respectively). Cognitive function was assessed at years 25 and 30 (mean age 50 and 55 years, respectively). Linear models were used to examine association between tertiles of diet score and change in composite cognitive function and cognitive z scores (verbal memory [Rey Auditory Verbal Learning Test], processing speed [Digit Symbol Substitution Test], and executive function [Stroop Interference test]) and the Montreal Cognitive Assessment (MoCA) at year 30.ResultsDASH was not associated with change in cognitive performance. Higher MedDiet and APDQS scores were associated with less decline in cognitive function (MedDiet: low −0.04, middle 0.03, high 0.03, p = 0.03; APDQS: low −0.04, middle −0.00, high 0.06, p < 0.01) and Stroop Interference (MedDiet: low 0.09, middle −0.06, high −0.03; APDQS: low 0.10, middle 0.01, high −0.09, both p < 0.01). Odds ratios (95% confidence interval) for poor global cognitive function (≥1 SD below mean MoCA score) comparing extreme tertiles of diet scores were 0.54 (0.39–0.74) for MedDiet, 0.48 (0.33–0.69) for APDQS, and 0.89 (0.68–1.17) for DASH.ConclusionGreater adherence to MedDiet and APDQS dietary patterns during adulthood was associated with better midlife cognitive performance. Additional studies are needed to define the combination of foods and nutrients for optimal brain health across the life course.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuichiro Yano ◽  
Hongyan Ning ◽  
Paul Muntner ◽  
Jared Reis ◽  
David Calhoun ◽  
...  

Nocturnal blood pressure (BP) is associated with risk for cardiovascular events. However, the effect of nocturnal BP in young adults on cognitive function in midlife remains unclear. We used data from the ambulatory BP monitoring substudy of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, including 224 participants (mean age 30 years, 45% men, 63% African Americans) followed for 20 years (6 visits). At the 20-year follow-up, the Stroop test (higher score indicates worse executive function), Digit Symbol Substitution Test (DSST, lower score indicates worse psychomotor speed), and Rey Auditory Verbal Learning Test (RAVLT, lower score indicates worse verbal memory) were assessed. Baseline mean office, daytime, and nocturnal BP were 109/73mmHg, 120/74mmHg, and 107/59mmHg, respectively. Nocturnal BP dipping, calculated as (nocturnal systolic BP [SBP]-daytime SBP)х100/daytime SBP, was divided into quartiles (Q1;-39.3% to -16.9%, Q2;-16.8% to -13.2%, Q3 [reference];-13.1% to -7.8%, and Q4;-7.7% to +56.4%). Cognitive function score according to the quartile of nocturnal SBP dipping is shown in Figure. In linear regression models, the least nocturnal SBP dipping (Q4 vs. reference) and higher nocturnal diastolic BP (DBP) level were associated with worse Stroop scores, with adjustments for demographic and clinical characteristics, and cumulative exposure of BP during follow-up (β [standard error]: 0.37[0.18] and 0.19[0.07] respectively; all P<0.05). Neither DSST nor RALVT was associated with either nocturnal BP dipping or nocturnal SBP/DBP levels. Among healthy young adults, less nocturnal SBP dipping and higher nocturnal DBP levels were associated with lower executive function in midlife, independent of long-term office BP levels. Nocturnal BP measures in young adults could be potentially useful to identify those who may be at risk for developing lower cognitive function in midlife.


Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Na Zhu ◽  
David R Jacobs ◽  
Pamela J Schreiner ◽  
R. Nick Bryan ◽  
Lenore J Launer ◽  
...  

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.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kara M Whitaker ◽  
Kelley Pettee Gabriel ◽  
Baojiang Chen ◽  
Monica Ahrens ◽  
Barbara Sternfeld ◽  
...  

Introduction: Evidence suggests moderate to vigorous intensity physical activity (MVPA) has beneficial effects on various domains of cognitive function; however, less than half of adults meet MVPA guidelines. Alternate approaches, such as reducing sedentary behavior (SED) with concurrent increases in light-intensity physical activity (LPA) may resonate more strongly with the adult population. Objective: To determine if accelerometer measured SED, LPA, and MVPA at ages 38-50 years is prospectively associated with measures of cognitive function. Methods: We studied 1,842 Black and White men and women enrolled in CARDIA who participated in the year 20 (2005-06) and year 25 (2010-11) and/or year 30 (2015-16) exams. SED, LPA, and MVPA were measured by the ActiGraph 7164 accelerometer at year 20. Cognitive function tests at the year 25 and 30 exams included the Rey Auditory Verbal Learning Test (RAVLT, memory), Digit Symbol Substitution Test (DSST, processing speed), and Stroop Test (executive function). Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA at year 20 with repeated measures (unstructured covariance) of the cognitive function raw test scores at years 25 and 30. Results: In men, substituting 30 minutes of SED with 30 minutes of LPA was associated with a decrease in the RAVLT (-0.05) and DSST (-0.76), and increase in Stroop (0.45) scores, indicating worse performance (see Table ). Substituting SED or LPA with MVPA was associated with an increase in RAVLT (0.15, 0.20) and DSST (1.21, 2.00), and decrease in Stroop (-0.68, -1.17) scores, respectively, indicating better performance. In women, who had higher cognitive function scores than men, substituting SED or LPA with MVPA was associated with worse performance on the Stroop test (0.70, 0.63), contrary to our hypothesis. Conclusions: Statistical substitution of time from lower-intensity activities (SED or LPA) with MVPA, but not SED with LPA, resulted in better cognitive performance in men, but not women, over 10 years.


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