scholarly journals Association Between Z Drugs Use and Risk of Cognitive Impairment in Middle-Aged and Older Patients With Chronic Insomnia

2021 ◽  
Vol 15 ◽  
Author(s):  
Fang Guo ◽  
Li Yi ◽  
Wei Zhang ◽  
Zhi-Jie Bian ◽  
Yong-Bo Zhang
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Drug Use ◽  
Older Patients ◽  
Independent Risk Factor ◽  
Drug Exposure ◽  
Chronic Insomnia ◽  
Middle Aged ◽  
Global Cognitive Function

Background: Benzodiazepines (BZDs) and Non-BZDs (NBZDs) have been widely used for patients with chronic insomnia. Long-term uses of BZDs may cause cognitive impairment and increase the risk for dementia in older patients. NBZD as an agonist of the GABAA receptor complex includes eszopiclone, zopiclone, zolpidem, and zaleplon, also collectively known as Z drugs. However, evaluations for an association between cognitive impairment and Z drug use have been limitedly performed. This study aimed to investigate the association between the risk of cognitive decline and exposure to Z drugs in middle-aged and older patients with chronic insomnia.Methods: Investigations were performed on patients with chronic insomnia who visited the outpatient Department of Neurology, Beijing Friendship Hospital, and were assessed for the global cognitive function (MoCA) and memory (AVLT), executive function (TMT-B), visuospatial ability (CDT), verbal function (BNT-30), and attention (DST). Multiple regression analysis was conducted to determine the independent factors of cognition and evaluated the effect of Z drug use (zolpidem and zopiclone) on cognition.Results: A total of 120 subjects were identified. In our analysis, BZD exposure density (P = 0.025, OR = 1.43, 95% CI, 1.25–1.86) was an independent risk factor of cognitive impairment in middle-aged and older patients with chronic insomnia. Neither Z drug use (P = 0.103) nor Z drug exposure density (P = 0.765) correlated with global cognitive function. Moreover, there was a positive association between Z drug use and attention [(P = 0.002, OR = 0.42, 95% CI, 0.24–0.73)]. Additionally, income level (P = 0.001, OR = 0.23, 95% CI, 0.10–0.53), severity of insomnia (P = 0.019, OR = 1.20, 95% CI, 1.03–1.40) and age (P = 0.044, OR = 1.07, 95% CI, 1.00–1.14) were also independent factors of global cognitive function.Conclusion: BZD exposure density was an independent risk factor of cognitive impairment in middle-aged and older patients with chronic insomnia, but no correlation was found between Z drug use and cognitive impairment. Moreover, the use of Z drugs seemed to be associated with protection for attention. The use for prescription of BZDs, in this case, should be avoided or limited to low doses. Due to the addiction and tolerance, Z drugs should also be prescribed with great caution in middle-aged and elderly patients.

scholarly journals Association Between Z Drugs Use and Risk of Cognitive Impairment in Older Patients With Chronic Insomnia

2020 ◽  
Author(s):  
Fang Guo ◽  
Li Yi ◽  
Wei Zhang ◽  
Yong-bo Zhang
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older Patients ◽  
The Elderly ◽  
Chronic Insomnia ◽  
Cognitive Domains ◽  
Global Cognitive Function ◽  
Increased Risk ◽  
Friendship Hospital ◽  
Independent Risk Factors

Abstract Background Benzodiazepines (BZDs) and Z drugs are widely used for patients with chronic insomnia. The long term use of BZDs in older patients can cause cognitive impairment and potentially increase the risk of dementia. However, evidence for an association with Z drugs is limited. This study aimed to investigate the association between the risk of cognitive impairment and exposure to Z drugs in older patients with chronic insomnia.Methods We recorded older patients with chronic insomnia who visited the outpatient department of neurology, Beijing Friendship Hospital, and assessed the global cognitive function (MoCA) and five cognitive domains (CVLT, TMT-B, BNT-30, CDT and DST). Multiple regression analysis was conducted to determine the independent factors of cognition, and evaluate the effect of Z drugs use (zolpidem and zopiclone) on cognition.Results A total of 88 subjects were identified. BZDs use (P=0.03, B=2.67, 95% CI 0.36-4.97) and BZDs exposure density (P=0.01, B=1.22, 95% CI 0.33-2.11) were independent risk factors of cognitive impairment in older patients with chronic insomnia. Neither Z drugs use (P=0.11) nor Z drugs exposure density (P=0.92) correlated with global cognitive function. Moreover, compared with BZDs users, there were positive associations between Z drugs use and memory (P=0.00), attention (P=0.00) and verbal function (P=0.04). Additionlly, education level (P=0.02, OR=0.74, 95% CI 0.57-0.95), duration of insomnia (P=0.04, OR=1.05, 95% CI 1.00-1.11) and severity of insomnia (P=0.03, OR=1.27, 95% CI 1.02-1.57) were also independent factors of global cognitive function.Conclusion We found no evidence that Z drugs use and Z drugs exposure density were associated with cognitive impairment in older patients with chronic insomnia. However, the use of BZDs and BZDs exposure density were associated with an increased risk of cognitive impairment. Thus, BZDs use should be avoided，and Z drugs should be prescribed with extreme caution in the elderly.

scholarly journals Subclinical Carotid Artery Atherosclerosis and Cognitive Function: A Mini-Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Håkon Ihle-Hansen ◽  
Hege Ihle-Hansen ◽  
Else Charlotte Sandset ◽  
Guri Hagberg
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Carotid Artery ◽  
Independent Risk Factor ◽  
Carotid Atherosclerosis ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Carotid Artery Atherosclerosis ◽  
Non Invasive

Carotid artery atherosclerosis, the result of a multitude of vascular risk factors, is a promising marker for use in risk stratification. Recent evidence suggests that carotid artery atherosclerosis affects cognitive function and is an independent risk factor for the development of cognitive impairment. Both atherosclerosis and cognitive impairment develop over a prolonged period (years), and due to the aging population, markers to identify persons at risk are needed. Carotid artery atherosclerosis can easily be visualized using non-invasive ultrasound, potentially enabling early and intensified risk factor management to preserve cognitive function or delay further decline. However, the burden of atherosclerosis and temporal exposure required to pose a risk of cognitive impairment is unclear. This mini-review aims to explore the available evidence on the association between carotid atherosclerosis and cognition, and furthermore identify the remaining gaps in knowledge.

A paraoxonase gene polymorphism, PON 1 (55), as an independent risk factor for increased carotid intima-media thickness in middle-aged women

2003 ◽  
Vol 167 (1) ◽  
pp. 141-148 ◽  
Author(s):  
Giuliana Fortunato ◽  
Paolo Rubba ◽  
Salvatore Panico ◽  
Daniela Trono ◽  
Nadia Tinto ◽  
...  
Keyword(s):  
Risk Factor ◽  
Gene Polymorphism ◽  
Independent Risk Factor ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Middle Aged ◽  
Media Thickness

Cognitive Impairment and Depression in Older Patients

2017 ◽  
Author(s):  
Martin Steinberg ◽  
Paul B. Rosenberg
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
High Risk ◽  
Vascular Dementia ◽  
Psychosocial Functioning ◽  
Older Patients ◽  
The Elderly ◽  
Office Setting ◽  
Early Manifestation

Depression, mild cognitive impairment (MCI) and dementia in the elderly can present with similar features such as cognitive complaints, loss of initiative, and difficulties with psychosocial functioning. These can be difficult to distinguish in the office setting, especially when mild in severity. The relationships between the three syndromes remains incompletely understood. Patients with MCI are at high risk for conversion to dementia. Depression may be either a risk factor for or early manifestation of MCI. Depression in late life is associated with Alzheimer’s disease (AD) and other dementias, but the causal relationship remains controversial. Depression may also increase the risk of conversion from MCI to dementia and be more strongly associated with conversion to Vascular dementia (VaD) than to AD. This book will provide guidance to clinicians in the diagnosis and management of these complex conditions in the office setting.

scholarly journals AEROBIC TRAINING, THE DEFAULT MODE NETWORK, AND COGNITION IN OLDER ADULTS WITH MILD VASCULAR COGNITIVE IMPAIRMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S55-S55
Author(s):  
Rachel A Crockett ◽  
Chun Liang Hsu ◽  
Cindy Barha ◽  
Ging-Yuek Robin Hsiung ◽  
Teresa Liu-Ambrose
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Functional Connectivity ◽  
Default Mode Network ◽  
Resting State ◽  
Aerobic Training ◽  
Vascular Cognitive Impairment ◽  
Default Mode ◽  
Global Cognitive Function

Abstract Aerobic training has been shown to be effective at improving cognitive and brain outcomes in older adults with mild subcortical ischemic vascular cognitive impairment (SIVCI). However, uncertainty remains regarding the underlying neurobiological mechanisms by which exercise elicits these improvements in cognition. Increased aberrant functional connectivity of the default mode network has been highlighted as a factor contributing to cognitive decline in older adults with cognitive impairment. Greater connectivity of the DMN at rest is associated with poorer performance on attention-demanding tasks, indicative of a lack of ability to deactivate the network on task. Our previous work on a randomized controlled trial of participants with mild SIVCI, demonstrated that 6-months of thrice weekly aerobic training led to improved global cognitive function, as measured by Alzheimer’s disease Assessment Scale-Cognitive subscale (ADAS-Cog), compared with a health education program. Thus, we conducted secondary analyses to investigate whether these changes in global cognitive function were associated with changes in resting state DMN connectivity. A subsample of 21 participants underwent a resting state functional magnetic resonance imaging (fMRI) scan before and after trial completion. Change in resting state DMN connectivity was found to significantly predict change in ADAS-Cog score (β = -.442, p=.038) after controlling for age, intervention group, and baseline functional capacity (R2=.467, F(4,16)= 3.507, p=.031). These findings suggest that functional connectivity of the DMN may underlie changes in global cognitive function. Furthermore, aerobic exercise is a promising intervention by which to elicit these changes in older adults with mild SIVCI.

Effect of Baduanjin exercise on cognitive function in patients with post-stroke cognitive impairment: a randomized controlled trial

2020 ◽  
Vol 34 (8) ◽  
pp. 1028-1039 ◽  
Author(s):  
Guohua Zheng ◽  
Yuhui Zheng ◽  
Zhenyu Xiong ◽  
Bingzhao Ye
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Outcome Measures ◽  
Daily Living ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Control Group ◽  
Rehabilitation Treatment ◽  
Global Cognitive Function ◽  
Delayed Recognition

Objective: To investigate the effectiveness and safety of Baduanjin training on the cognitive function in stroke survivors with cognitive impairment. Design: A randomized, two-arm parallel controlled trial with allocation concealment and assessors blinding. Setting: Community centre of Fuzhou city, China. Subjects: A total of 48 participants were recruited and randomly allocated into the Baduanjin exercise intervention or control group. Interventions: The control group maintained original medication and rehabilitation treatment. The Baduanjin training group received 24-week Baduanjin training with a frequency of three days a week and 40 minutes a day based on original medication and rehabilitation treatment. Main outcome measures: The primary outcome was global cognitive function. Secondary outcome measures included the specific domains of cognition (i.e. memory, processing speed, execution, attention and visuospatial ability) and activities daily living. Results: In total, 41 (Baduanjin n = 22, control n = 19) participants completed 24-week treatment and data collection. Mean differences between groups at 24-week treatment were statistically significant for global cognitive function (MoCA: 2.54 (0.91 to 4.16)), execution (TMT-A: −42.4 (−75.0 to −9.8); TMT-B: −71.3 (−130.6 to −12.1)), memory (immediate recall: 2.11 (0.49 to 3.73); short-term delayed recognition: 2.47 (0.58 to 4.35) and long-term delayed recognition: 1.68(0.18 to 3.17)), attention (response time of alertness: −245.5 (−387 to −104)) and activities of daily living (modified Barthel Index). Conclusion: Regular Baduanjin training is associated with less loss of cognitive function in patients after stroke.

scholarly journals Carotid intima–media thickness relative to cognitive impairment in dialysis patients, and their relationship with brain volume and cerebral small vessel disease

2020 ◽  
Vol 11 ◽  
pp. 204062232095335
Author(s):  
Ke Zheng ◽  
Yujun Qian ◽  
Tiaye Lin ◽  
Fei Han ◽  
Hui You ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Brain Atrophy ◽  
Brain Volume ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Dialysis Patients ◽  
Matter Volume ◽  
Media Thickness

Background: Carotid intima–media thickness (cIMT) is considered a risk factor for and predictor of cerebrovascular disease. In this study, we explored the contribution of cIMT to cognitive impairment (CI) in dialysis patients and the role of cerebral small vascular disease (CSVD) and brain atrophy in this process. Methods: Cognitive function was assessed using a comprehensive cognitive test battery. CSVD and brain volume were assessed by magnetic resonance imaging, and cIMT was measured by ultrasonography. Multivariable analysis and mediation were used to explore the relevant relationships among cIMT, CI, CSVD and brain volume. Results: Seventy-three dialysis patients were enrolled. Approximately 54.8% were diagnosed with increased cIMT. The increased cIMT group was older and had lower serum albumin and creatinine levels than the normal cIMT group. There was no difference in the CSVD prevalence between the different cIMT groups. Patients in the normal, unilaterally and bilaterally increased cIMT subgroups demonstrated a gradual decrease in brain-matter volume and degenerate cognitive function. cIMT was related to cognitive function and gray-/white-matter volume. Increased cIMT was associated with a significantly increased risk of a reduced Mini Mental State Examination/Montreal Cognitive Assessment score and Trail A/B time delay. Mediation analysis showed that CI was mediated by brain-matter volume but not by CSVD. Conclusion: Increased cIMT was an independent risk factor for impairment of global cognitive function, memory, and executive function. The impact of cIMT on cognition was not induced by CSVD but by brain atrophy. cIMT may be a useful tool for screening patients at high risk of CI in the dialysis population.

scholarly journals The Relationship between Alcohol Consumption and Incidence of Glycometabolic Abnormality in Middle-Aged and Elderly Chinese Men

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Siwen Zhang ◽  
Yujia Liu ◽  
Gang Wang ◽  
Xianchao Xiao ◽  
Xiaokun Gang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Alcohol Consumption ◽  
Independent Risk Factor ◽  
Univariate Analysis ◽  
Middle Aged ◽  
Cross Sectional Survey ◽  
Chinese Men ◽  
Elderly Chinese ◽  
The Relationship

Aim. The relationship between alcohol consumption and glycometabolic abnormality is controversial, especially in different ethnic population. In this study, a cross-sectional survey was carried out to examine the relationship between alcohol consumption and glycometabolic abnormality in middle-aged and elderly Chinese men. Methods. Using cluster random sampling, Chinese men aged more than 40 years from Changchun, China, were given standardized questionnaires. In total, 1996 individuals, for whom complete data was available, were recruited into the study. We calculated the incidence of prediabetes and newly diagnosed diabetes by three levels of alcohol consumption: light, moderate, and heavy. Multivariate logistic regression models adjusted for socioeconomic variables and diabetes-related risk factors were used to analyze the association between alcohol consumption and the onset of prediabetes and diabetes. Results. The univariate analysis revealed higher incidence of prediabetes among drinkers (32.8%) compared with nondrinkers (28.6%), particularly in heavy alcohol consumers. The logistic regression analysis showed that alcohol consumption, especially heavy consumption, was an independent risk factor for prediabetes. Conclusions. Alcohol consumption, heavy consumption in particular, is an independent risk factor for the development of prediabetes, but not for diabetes.

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