Background and Purpose
Studies suggest that family caregiver well-being (ie,, depressive symptoms and life satisfaction) may affect stroke survivor depressive symptoms. We used mediation analysis to assess whether caregiver well-being might be a factor explaining stroke survivor depressive symptoms, after controlling for demographic factors and stroke survivor impairments and problems.
Caregiver/stroke participant dyads (N=146) completed measures of stroke survivor impairments and problems and depressive symptoms and caregiver depressive symptoms and life satisfaction. Mediation analysis was used to examine whether caregiver well-being mediated the relationship between stroke survivor impairments and problems and stroke survivor depressive symptoms.
As expected, more stroke survivor problems and impairments were associated with higher levels of stroke survivor depressive symptoms (P < .0001). After controlling for demographic factors, we found that this relationship was partially mediated by caregiver life satisfaction (29.29%) and caregiver depressive symptoms (32.95%). Although these measures combined to account for 40.50% of the relationship between survivor problems and impairments and depressive symptoms, the direct effect remained significant.
Findings indicate that stroke survivor impairments and problems may affect family caregivers and stroke survivors and a high level of caregiver distress may result in poorer outcomes for stroke survivors. Results highlight the likely importance of intervening with both stroke survivors and family caregivers to optimize recovery after stroke.
caregiver depressive symptoms; caregiver well-being; stroke depressive symptoms
Studies of the effect of air pollution on cognitive health are often limited to populations living near cities that have air monitoring stations. Little is known about whether the estimates from such studies can be generalized to the U.S. population, or whether the relationship differs between urban and rural areas. To address these questions, we used a satellite-derived estimate of fine particulate matter (PM2.5) concentration to determine whether PM2.5 was associated with incident cognitive impairment in a geographically diverse, biracial US cohort of men and women (n = 20,150). A 1-year mean baseline PM2.5 concentration was estimated for each participant, and cognitive status at the most recent follow-up was assessed over the telephone using the Six-Item Screener (SIS) in a subsample that was cognitively intact at baseline. Logistic regression was used to determine whether PM2.5 was related to the odds of incident cognitive impairment. A 10 µg/m3 increase in PM2.5 concentration was not reliably associated with an increased odds of incident impairment, after adjusting for temperature, season, incident stroke, and length of follow-up [OR (95% CI): 1.26 (0.97, 1.64)]. The odds ratio was attenuated towards 1 after adding demographic covariates, behavioral factors, and known comorbidities of cognitive impairment. A 10 µg/m3 increase in PM2.5 concentration was slightly associated with incident impairment in urban areas (1.40 [1.06–1.85]), but this relationship was also attenuated after including additional covariates in the model. Evidence is lacking that the effect of PM2.5 on incident cognitive impairment is robust in a heterogeneous US cohort, even in urban areas.
The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA.
We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.
Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p ≤ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03–5.92) and IADL impairment (OR 3.86, 95% CI 1.60–9.28).
Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population.
Several mechanisms may associate tooth loss and related oral
inflammation with cognitive impairment. The authors studied the relationship
between tooth loss and cognitive function.
The REasons for Geographic And Racial Differences in Stroke study is
a national longitudinal study of more than 30,000 African American and white
adults 45 years or older. Data for tooth loss, cognitive function and
potential confounding variables were available for 9,853 participants at the
time of analysis. The authors used incremental linear regression modeling to
investigate the cross-sectional association between self-reported tooth loss
and cognitive function.
In unadjusted analysis (mean learning followed by recall; α
level of significance of .05), the loss of six to 16 teeth and the loss of
more than 16 teeth were associated with poorer cognitive function compared
with the loss of no teeth. Attenuated associations persisted after the
authors adjusted for demographic and systemic risk factors. The full model,
which was adjusted for socioeconomic status (SES), revealed no association
between tooth loss and cognitive function.
Tooth loss may be associated with cognitive function; however, this
association is mediated by age and SES.
Tooth loss due to periodontal disease may be a marker for low SES,
and the interplay of these factors with advanced age may confer risk of
having poorer cognitive function. Further studies are needed to clarify
Cognitive function; tooth loss
Systematic cognitive training produces long-term improvement in cognitive function and less difficulty in performing activities of daily living. We examined whether cognitive training was associated with reduced rate of incident dementia. Participants were from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (n=2,802). Incident dementia was defined using a combination of interview- and performance-based methods. Survival analysis was used to determine if ACTIVE treatment affected the rate of incident dementia during 5 years of follow-up. A total of 189 participants met criteria for incident dementia. Baseline factors predictive of incident dementia were older age, male gender, African American race, fewer years of education, relationship other than married, no alcohol use, worse MMSE< worse SF-36 physical functioning, higher depressive symptomatology, diabetes, and stroke (all p<.05). A multivariable model with significant predictors of incident dementia and training group revealed that cognitive training was not associated with a lower rate of incident dementia. Cognitive training did not affect rates of incident dementia after 5 years of follow-up. Longer follow-up or enhanced training may be needed to fully explore the preventive capacity of cognitive training in forestalling onset of dementia.
Cognitive training; Intervention; Aging; Dementia; Prevention; Cognition
Albuminuria and estimated glomerular filtration rate (eGFR) are each associated with increased risk for cognitive impairment, but their joint association is unknown.
Prospective cohort study.
Setting and Participants
A US national sample of 19,399 adults without cognitive impairment at baseline participating in the REGARDS )REasons for Geographic And Racial Disparities in Stroke) study.
Albuminuria was assessed by the urine albumin-creatinine ratio (UACR) and GFR was estimated using the CKD-EPI (CKD Epidemiology Collaboration) equation.
Incident cognitive impairment was defined as a score of 4 or less on the Six-item Screener at the last follow-up visit.
Over a mean follow-up of 3.8 ± 1.5 years, UACR 30 – 299 and ≥300 mg/g were independently associated with 31% and 57% higher risk for cognitive impairment, respectively, relative to individuals with UACR <10 mg/g. This finding was strongest among those with high eGFR and attenuated at lower levels (P=0.04 for trend). Relative an eGFR ≥60 ml/min/1.73m2, eGFR <60 ml/min/1.73m2 was not independently associated with cognitive impairment. However, after stratifying by UACR, eGFR <60 ml/min/1.73m2 was associated with 30% higher risk for cognitive impairment among participants with UACR <10 mg/g but not higher UACR levels (P=0.04 for trend).
single measure of albuminuria and eGFR, screening test of cognition
When eGFR was preserved, albuminuria independently associated with incident cognitive impairment. When albuminuria was <10 mg/g, low eGFR independently associated with cognitive impairment. Albuminuria and low eGFR are complementary but not additive risk factors for incident cognitive impairment.
albuminuria; chronic kidney disease; cognitive impairment
Adults with HIV are at risk for deficits in speed of processing that can interfere with performing instrumental activities of daily living. In this pilot study, 46 middle-age and older adults with HIV were assigned to 10 hours of computerized speed of processing training (n = 22) or to a no-contact control condition (n = 24). ANCOVAs were used to examine treatment effects on a neurocognitive battery and the Timed Instrumental Activities of Daily Living (TIADL) Test. Treatment effects were detected on the Useful Field of View® Test, F(1, 43) = 4.29, p = .04 and the TIADL Test, F(1, 43) = 5.02, p = .03; those in the experimental condition improved on these measures. Many of the participants also indicated that they felt the training improved their cognitive functioning. This study demonstrated that speed of processing training may improve cognitive and everyday functioning in this growing population.
aging; cognitive intervention; cognitive remediation therapy; cognitive training; instrumental activities of daily living; speed of processing training
To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining U.S.
A national cohort of adults ≥ age 45 was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003–2007. Participants’ global cognitive status was assessed annually by telephone with the Six-item Screener (SIS) and every two years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS > 4 of 6) were included (N = 23,913, including 56% women, 38% African Americans and 62% European Americans, 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤ 4) were adjusted for age, sex, race, education, and time between first and last assessments.
1,937 participants (8.1%) declined to an SIS score ≤ 4 at their most recent assessment, over a mean of 4.1 (± 1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (OR = 1.18; 95% CI 1.07 – 1.30). All demographic factors and time independently predicted impairment.
Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt.
We hypothesized that patterns of elevated stroke mortality among those born in the US Stroke Belt (SB) states also prevailed for mortality related to all-cause dementia or Alzheimer Disease (AD). Cause specific mortality (contributing cause of death, including underlying cause cases) rates in 2000 for US-born African-Americans and whites aged 65–89 were calculated by linking national mortality records with population data based on race, sex, age, and birth state or state of residence in 2000. Birth in a SB state (North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, or Alabama) was cross-classified against SB residence at the 2000 Census. Compared to those who were not born in the SB, odds of all cause dementia mortality were significantly elevated by 29% for African-Americans and 19% for whites born in the SB. These patterns prevailed among individuals who no longer lived in the SB at death. Patterns were similar for AD-related mortality. Some non-SB states were also associated with significant elevations in dementia-related mortality. Dementia mortality rates follow geographic patterns similar to stroke mortality, with elevated rates among those born in the SB. This suggests important roles for geographically patterned childhood exposures in establishing cognitive reserve.
Dementia; cerebrovascular disease/stroke; geography; Stroke Belt; lifecourse; racial disparities
We examined the relationship of cognitive and functional measures with life space (a measure of spatial mobility examining extent of movement within a person’s environment) in older adults, and investigated the potential moderating role of personal control beliefs. Internal control beliefs reflect feelings of competence and personal agency, while attributions of external control imply a more dependent or passive point of view. Participants were 2,737 adults from the ACTIVE study, with a mean age of 74 years. Females comprised 76% of the sample, with good minority representation (27% African American). In multiple regression models controlling for demographic factors, cognitive domains of memory, reasoning, and processing speed were significantly associated with life space (p<.001 for each), and reasoning ability appeared most predictive (B=.117). Measures of everyday function also showed significant associations with life space, independent from the traditional cognitive measures. Interactions between cognitive function and control beliefs were tested, and external control beliefs moderated the relationship between memory and life space, with the combination of high objective memory and low external control beliefs yielding the highest life space (t=−2.07; p=.039). In conclusion, older adults with better cognitive function have a larger overall life space. Performance-based measures of everyday function may also be useful in assessing the functional outcome of life space. Additionally, subjective external control beliefs may moderate the relationship between objective cognitive function and life space. Future studies examining the relationships between these factors longitudinally appear worthwhile to further elucidate the interrelationships of cognitive function, control beliefs, and life space.
aging; cognition; control beliefs; life space
In 129 community-dwelling older adults, feedback regarding qualification for an insurance discount (based on a visual speed of processing test; Useful Field of View) was examined as a prospective predictor of change in self-reported driving ability, driving avoidance, and driving exposure over 3 months, along with physical, visual, health, and cognitive variables. Multiple regression models indicated that after controlling for baseline scores on the outcome measures, failure to qualify was a significant predictor of increased avoidance over 3 months (p = .02) but not change in self-rated driving ability or exposure. Female gender (p = .03) was a significant predictor of subsequent lower self-rated driving ability. Overall, the findings of this study provide support for the role of feedback in the self-monitoring of older adults’ driving behavior through avoidance of challenging driving situations but not through driving exposure or self-rated driving ability.
Older drivers; Driving ability; Self-regulation; Self-rated driving; Driving exposure; Driving avoidance
The purpose of this study was to: (1) examine cognitive performance differences in older and younger adults with and without HIV, and (2) determine if such differences were related to a laboratory measure of instrumental activities of daily living (IADLs). Ninety-eight HIV-positive (69 younger, 29 older) and 103 HIV-negative (84 younger, 19 older) adults were evaluated on a number of cognitive measures. Controlling for a number of confounders, age by HIV status interactions were found on two cognitive measures, indicating poorer cognitive performance for those aging with HIV. Poorer performance on these cognitive measures corresponded with poorer performance on the Timed Instrumental Activities of Daily Living (TIADL) test. These findings suggest that as adults age with HIV, they may be at risk for cognitive declines that would impair their ability to engage in activities important for maintaining independent living.
HIV; AIDS; Aging; Neuropsychology; Cognition; IADLs
Background and Purpose
Previous research has reported worse outcomes after stroke for women and for African Americans, but few prospective, population-based studies have systematically examined demographic differences on long-term stroke outcomes. Race and gender differences on one-year stroke outcomes were examined using an epidemiologically-derived sample of first-time stroke survivors from the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study.
Participants of REGARDS who reported a first-time stroke event during regular surveillance calls were interviewed by telephone and then completed an in-home evaluation approximately one year after the verified first-time stroke event (N = 112). A primary family caregiver was also enrolled and interviewed for each stroke survivor. Measures from the in-home evaluation included previously validated stroke outcomes assessments of neurological deficits, functional impairments, and patient-reported effects of stroke in multiple domains.
African American stroke survivors were less likely to be living with their primary family caregivers than White participants. Analyses that controlled for age, education, and whether the stroke survivors lived with their primary family caregivers indicated that African Americans and women showed significantly greater deficits on multiple one-year outcome measures compared to Whites and men, respectively.
Among community-dwelling stroke survivors with family caregivers, women and African Americans are at heightened risk for poor long-term outcomes one year after first-time stroke events. Rehabilitation services and public health policies aimed at enhancing stroke recovery rates should address these disparities in post-stroke outcomes.
Race differences; Gender differences; Stroke Outcomes; Family Caregivers
There is growing interest in determining the degree of anemia, which is clinically significant. The goal of this study was to determine the association between hemoglobin concentration and cognitive impairment in a large sample of U.S. adults.
We used cross-sectional data from 19,701 adults participating in the REasons for Geographic And Racial Differences in Stroke study. Cognitive impairment was defined as a score of 4 or less on the six-item screener. Hemoglobin was analyzed in 1 g/dL increments relative to the World Health Organization (WHO) threshold (<13 g/dL for men and <12 g/dL for women).
The mean hemoglobin concentration was 13.7 ± 1.5 g/dL. The prevalence of cognitive impairment increased from 4.3% among individuals with a hemoglobin >3 g/dL above the WHO threshold to 16.8% for those with a hemoglobin ≥2 g/dL below the WHO threshold. After adjustment for demographics, chronic health conditions, health status, and inflammation, the association between reduced hemoglobin and cognitive impairment was attenuated and no longer significant, including among those with hemoglobin ≥2 g/dL below the WHO threshold (odds ratio 1.39, 95% confidence interval = 0.94–2.04). A test for linear trend was of borderline significance (p value = .06). For 94% of the sample within 2 g/dL of the WHO threshold, there was no relationship between hemoglobin concentration and the odds of cognitive impairment. The associations did not differ by sex and race.
Within a large sample of community-dwelling adults, there was no significant association between hemoglobin concentration and cognitive impairment after multivariable adjustment.
Hemoglobin; Anemia; Cognitive impairment
Self and informant reports of functional abilities are weighted heavily in diagnostic decision making regarding mild cognitive impairment (MCI). However, it is unclear whether patients with MCI are fully aware and provide reliable estimates of their functional status. In this study, we used three different approaches to examine accuracy of self report of financial abilities among patients with MCI.
Cross-sectional, case-comparison group study.
University medical center.
Seventy-four patients with MCI and their informants, and 73 cognitively healthy older adults and their informants.
We compared MCI patients’ report of their financial abilities to their performance on an objective measure of financial capacity. We also compared informant reports of patients’ abilities to patients’ objective test performance, and informant reports to patients’ self report.
We found that the discrepancy between self report and objective performance was higher among MCI patients compared to the cognitively healthy older adults on the financial domains of Checkbook Management, Bank Statement Management, and Bill Payment, and on overall financial capacity. We also found that MCI patients with poorer global cognition overestimated their financial abilities whereas those with higher depressive symptoms underestimated their financial abilities. Overall, MCI patients were better at estimating their financial abilities than their informants.
Patients with MCI are not fully aware of deficits in their financial abilities. Both cognitive impairment and depression impact MCI patients’ self-reported functioning. In addition, MCI informants misestimate patients’ financial abilities. This raises concerns about the widespread use of informant report as the gold standard against which to evaluate patient self-report of functioning.
financial capacity; awareness; anosognosia; report-based measures; objective testing; MCI; AD
These secondary analyses were conducted to identify predictors of self-rated driving ability over three years in community-dwelling older adults. From the Staying Keen in Later Life (SKILL) study, baseline and 3-year follow-up data for 426 older drivers were analyzed. Health, visual, physical, psychological and cognitive abilities were examined as prospective predictors of self-rated driving ability over a 3-year period, controlling for baseline self-rated driving. Results indicated that lower baseline ratings of self-efficacy and a diagnosis of osteoporosis independently predicted lower self-rated driving ability at 3-year follow-up. Interestingly, functional performance, such as visual, physical and cognitive abilities, were not predictive of self-ratings of driving ability across three years. Older drivers’ self-ratings are more reflective of perceived self-efficacy rather than functional abilities. Self-screening tools for older drivers may be effective in improving the correspondence between perceived ability and actual ability in order to promote better informed decisions about driving regulation.
Self-rated ability; older drivers; speed-of-processing; Useful Field of View
Studies have found that adults with possible mild cognitive impairment (MCI) exhibit decrements in everyday functioning (e.g., Wadley, V. G., Crowe, M., Marsiske, M., Cook, S. E., Unverzagt, F. W., Rosenberg, A. L., et al. (2007). Changes in everyday function among individuals with psychometrically defined mild cognitive impairment. Journal of the American Geriatrics Society, 55, 1192–1198). However, it is not known whether driving mobility and life space mobility are reduced in such individuals. The current study examined 5-year trajectories of mobility change in older adults (N = 2,355) with psychometrically defined MCI from the Advanced Cognitive Training for Independent and Vital Elderly trial. Mixed effect models evaluated group differences for the following mobility outcomes: driving space, life space, driving frequency, and driving difficulty. Relative to cognitively normal participants, participants with possible MCI showed reduced baseline mobility for all outcomes as well as faster rates of decline for driving frequency and difficulty. These results suggest that mobility declines could be features of MCI, and changes in mobility may be particularly important for researchers and clinicians to monitor in this population.
Driving; Life space; Mild cognitive impairment; Mobility; Older adults
Statin use and type has been variably associated with impaired or improved cognitive performance.
To assess the association of statin use and type (lipophilic vs hydrophilic) and cognitive impairment
Cross-sectional analysis of 24595 (7191 statin users and 17404 non-users) participants (age >45), from a population-based national cohort study (REasons for Geographic And Racial Differences in Stroke) enrolled from January 2003-October 2008 with over-sampling from the southeastern Stroke Belt, and African Americans.
Statin use and type were documented in participants’ homes by a trained health professional. Cognitive performance was assessed with a prior validated instrument of global cognitive status (Six-Item Screener). Cognitive impairment was defined as a score of < 4. .
Overall, an association of cognitive impairment and statin use was observed (8.6% of users vs 7.7% or non-users had cognitive impairment p=.014) but, after adjusting for variables known to be associated with cognition (age, gender, race, income, levels of education, and cardiovascular disease) the association was attenuated (OR 0.98, CI; 0.87;1.10). No association was observed between statin type (lipophilic vs hydrophilic) and cognition (OR 1.03, CI; 0.86;1.24), and there were no regional differences in cognitive impairment in statin users (8% in the stroke belt and 7.9% other regions p=0.63).
Statin use and type was marginally associated with cognitive impairment. After adjusting for known variables that affect cognition, no association was observed. No regional differences were observed. This large study found no evidence to support an association between statins and cognitive performance.
We investigated whether factors related to health disparities – race, rural residence, education, perceived racial discrimination, vascular disease, and health care access and utilization – may moderate the association between diabetes and cognitive decline.
Participants were 624 community-dwelling older adults (49% African American, 49% rural) who completed in-home Mini-Mental State Examination at baseline and four-year follow-up.
Diabetes at baseline predicted cognitive decline over four years in regression models adjusted for a number of possible confounds. Only perceived discrimination and health utilization showed significant interaction effects with diabetes. Among African Americans who reported experiencing racial discrimination, there was a stronger relationship between diabetes and cognitive decline. Among participants who reported absence of visiting a physician within the past six months, the association between diabetes and cognitive decline was substantially larger.
Findings suggest that factors related to health disparities may influence cognitive outcomes among older adults with diabetes.
diabetes; cognitive decline; older adults; health disparities
The purpose of the study is to determine if functional status and quality of life (QoL) vary with glomerular filtration rate (GFR) among older adults.
We studied adults aged 45 years and older participating in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study. Data included demographic and health information, serum creatinine and hemoglobin, the 4-item Center for Epidemiologic Studies Depression Scale (CES-D-4), the 4-item Cohen's Perceived Stress Scale (PSS-4), reported health status and inactivity and the Medical Outcomes Study Short Form-12 (SF-12) QoL scores.
CKD (GFR <60 ml/min/1.73 m2) was present in 11.6% of the subjects. As GFR declined, the SF-12 physical component score, adjusted for other participant attributes, declined from 38.9 to 35.9 (p = 0.0001). After adjustment for other risk factors, poorer personal health scores (p < 0.0001) and decreased physical activity (p < 0.0001) were reported as GFR declined. In contrast, after adjusting for other participant characteristics, depression scores and stress scores and the mental component score of the SF-12 were not associated with kidney function.
Older individuals with CKD in the US population experience an increased prevalence of impaired QoL that cannot be fully explained by other individual characteristics.
Functional status; Quality of life; Chronic kidney disease; End-stage renal disease; Glomerular filtration rate; REGARDS cohort study; Medical Outcomes Study Short Form-12
Background and Purpose
The prevalence of stroke is increased in individuals with heart failure (HF). Stroke mechanism in HF may be cardiogenic embolism or cerebral hypoperfusion. Stroke risk increases with decreasing ejection fraction and low cardiac output is associated with hypotension and poor survival. We here examine the relationship between blood pressure level, history of stroke/TIA and HF.
We compared the prevalence of self-reported history of stroke or TIA in the REasons for Geographic And Racial Differences in Stroke (REGARDS) participants with HF (as defined by current digoxin use) and without HF. We excluded participants with atrial fibrillation or missing data. We examined the relationship between HF and history of stroke/TIA within tertiles of systolic blood pressure (SBP), adjusting for patient demographic and health characteristics.
Prevalent stroke/TIA were reported by 66 (26.3%) of 251 participants with and 1,805 (8.5%) of 21,202 participants without HF (p<0.0001). Within each tertile of SBP, the unadjusted OR (95%CI) for prior stroke/TIA among those with HF compared to those without HF (the reference group) was, 4.0 (2.8-5.8) for SBP<119.5mmHg, 2.7(1.8-3.9) for SBP≥119.5,<131.5mmHg and 2.3 (1.6-3.2) for SBP ≥131.5mmHg. After adjustment, the relationship between prior stroke/TIA and HF remained significant only within the lowest tertile of SBP (<119.5mmHg) (3.0; 1.5-6.1).
The odds of prevalent self-reported stroke/TIA are increased in participants with HF, and most markedly increased in participants with low SBP. Longitudinal data are needed to determine whether this reflects stroke/TIA secondary to thromboembolism from poor cardiac function or secondary to cerebral hypoperfusion.
Brain infarction; cardiac disease; hypertension
To examine the relationship between subjective cognitive function and subsequent cognitive decline among individuals with psychometrically defined amnestic mild cognitive impairment (MCI), and to determine whether the presence of depressive symptoms modifies this relationship.
Fifty-five individuals met psychometric criteria for amnestic mild cognitive impairment (MCI). Cognitive decline was measured using the Mini-Mental State Examination (MMSE), which was administered at baseline and at follow-up two years later. Subjective cognitive function was examined using two different one-item memory complaints, as well as a scale focused on current level of cognitive function relative to past function and a scale focused on forgetting in specific everyday situations.
In multiple regression analyses, the one-item complaint of change in memory at baseline predicted future cognitive decline. There was a significant interaction effect whereby this association was stronger in participants who endorsed fewer symptoms of depression.
Individuals showing memory deficits consistent with amnestic MCI have at least some insight regarding cognitive decline and the extent to which subjective cognitive function is useful in predicting future decline may depend on what particular questions are asked as well as presence of depressive symptoms.
subjective cognitive function; mild cognitive impairment; depression; cognitive decline
The objective of this study was to determine if older drivers with pharmacologically treated hypertension and/or heart disease demonstrate impaired performance on established driving related cognitive measures. Data regarding self-reported demographic variables (i.e., age, sex, race, income, mental and physical health diagnoses, and prescription drug use) and performance on driving-related measures of cognitive function (i.e., Trail Making Test B; and Useful Field of View (UFOV® subtest 2) were gathered from 865 licensed drivers. No group cognitive performance differences were found among the treated hypertensives and the healthy control group, thus underscoring the importance of effective hypertension management. However, older adults with pharmacologically treated heart disease demonstrated poorer performance than older adults without heart disease on Trails B and UFOV® subtest 2. Although it is generally agreed that assessment and early intervention with regard to heart disease risk factors (i.e., cholesterol, tobacco smoking, obesity, etc.) beneficially affect physical health, the current results also indicate that addressing such risk factors prior to the development of heart disease may benefit cognitive function, as well.
older drivers; heart disease; hypertension; cognition
Mild Cognitive Impairment (MCI) involves subtle functional losses that may include decrements in driving skills. We compared 46 participants with MCI to 59 cognitively normal controls on a driving evaluation conducted by a driving rehabilitation specialist who was blinded to participants’ MCI classification. Participants with MCI demonstrated significantly lower performance than controls on ratings of global and discrete driving maneuvers, but these differences were not at the level of frank impairments. Rather, performance was simply less than optimal, which to a lesser degree was also characteristic of a subset of the cognitively normal control group. The finding of significantly lower global driving ratings, coupled with the increased incidence of dementia among people with MCI and the known impact of dementia on driving safety, suggests the need for increased vigilance among clinicians, family members, and individuals with MCI for initially benign changes in driving that may become increasingly problematic over time.
Mild Cognitive Impairment; Functional Ability; Instrumental Activities of Daily Living; Driving
To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) using a clinician interview approach.
Tertiary care medical center.
Healthy older adults (N=75), patients with amnestic MCI (N=58), mild AD (N=97), and moderate AD (N=31).
The investigators and five study physicians developed a conceptually based, semi-structured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi-Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity.
Study physicians made a total of over 11,000 capacity judgments across the study sample (N=261). Very good inter-rater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95 percent of physician judgments for older controls were rated as capable, as compared to only 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD.
Financial capacity in cognitively impaired older adults can be reliably evaluated by physicians using a relatively brief, semi-structured clinical interview. Financial capacity shows mild impairment in MCI, emerging global impairment in mild AD, and advanced global impairment in moderate AD. MCI patients and their families should proactively engage in financial and legal planning given these patients’ risk of developing AD and accelerated loss of financial abilities.
financial capacity; competency; clinical assessment; mild cognitive impairment; Alzheimer’s disease