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Pre-Dementia Stages and Incident Dementia in the NuAge Study.
Beauchet, O, Sekhon, H, Launay, CP, Gaudreau, P, Morais, JA, Allali, G
Journal of Alzheimer's disease : JAD. 2021;(4):1465-1470
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) and mild cognitive impairment (MCI) are two pre-dementia stages with an overlap, which may influence the risk for dementia. OBJECTIVE The study aims to examine the association of MCR, MCI, and their combination with incident dementia in Quebec community-dwelling older adults. METHODS 1,063 older adults (i.e., ≥65) were selected from a population-based observational cohort study known as the "Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge). Participants were separated into four groups at the baseline assessment: those without MCR and MCI (i.e., cognitively healthy individual; CHI), those with MCR alone, those with MCI alone, and those with MCR plus MCI. Incident dementia was recorded at each annual visit during a 3-year follow-up. RESULTS The prevalence of CHI was 87.2%, MCR 3.0%, MCI 8.8%, and MCR plus MCI 0.9%. The overall incidence of dementia was 2.4% and was significantly associated with MCR alone (Odd Ratio (OR) = 5.00 with 95% Confidence interval (CI) = [1.01;24.59] and p = 0.049), MCI alone (OR = 6.04 with 95% CI = [2.36;15.47] and p≤0.001), and the combination of MCR and MCI (OR = 25.75 with 95% CI = [5.32;124.66] and p≤0.001). CONCLUSION Combining MCR and MCI increased the risk for incident dementia. These results also demonstrated that this combination is a better predictor of dementia than MCI or MCR alone.
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Adherence to Mediterranean diet and subjective cognitive function in men.
Bhushan, A, Fondell, E, Ascherio, A, Yuan, C, Grodstein, F, Willett, W
European journal of epidemiology. 2018;(2):223-234
Abstract
Benefits of a Mediterranean diet for cognition have been suggested, but epidemiologic studies have been relatively small and of limited duration. To prospectively assess the association between long-term adherence to a Mediterranean dietary pattern and self-reported subjective cognitive function (SCF). Prospective observational study. The Health Professionals' Follow-up Study, a prospective cohort of 51,529 men, 40-75 years of age when enrolled in 1986, of whom 27,842 were included in the primary analysis. Mediterranean diet (MD) score, computed from the mean of five food frequency questionnaires, assessed every 4 years from 1986 to 2002. Self-reported SCF assessed by a 6-item questionnaire in 2008 and 2012, and validated by association with genetic variants in apolipoprotein-4. Using the average of 2008 and 2012 SCF scores, 38.0% of men were considered to have moderate memory scores and 7.3% were considered to have poor scores. In a multivariate model, compared with men having a MD score in the lowest quintile, those in the highest quintile had a 36% lower odds of a poor SCF score (odds ratio 0.64, 95% CI 0.55-0.75; P, trend < 0.001) and a 24% lower odds of a moderate SCF score (OR 0.76, 95% CI 0.70-0.83; P, trend < 0.001). Both remote and more recent diet contributed to this relation. Associations were only slightly weaker using baseline dietary data and a lag of 22 years. Long-term adherence to the Mediterranean diet pattern was strongly related to lower subjective cognitive function. These findings provide further evidence that a healthy dietary pattern may prevent or delay cognitive decline.
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Mediterranean Diet and Cognitive Status in Free-Living Elderly: A Cross-Sectional Study in Northern Italy.
De Amicis, R, Leone, A, Foppiani, A, Osio, D, Lewandowski, L, Giustizieri, V, Cornelio, P, Cornelio, F, Fusari Imperatori, S, Cappa, SF, et al
Journal of the American College of Nutrition. 2018;(6):494-500
Abstract
OBJECTIVE Few data are available on the Italian elderly population with regard to adherence to the Mediterranean diet (MD) and cognitive impairment. Our aim was to investigate adherence to the MD and its association with cognitive function in an Italian urban sample. METHODS A cross-sectional study of 279 participants aged ≥ 65 years (80 men, 199 women) was carried out at a nutritional center. Adherence to the MD was evaluated using a 14-item questionnaire. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). RESULTS The clinical and nutritional assessments performed revealed 30.1% to have a dietary pattern in accordance with the MD; 13.6% had suspected or mild cognitive impairment (MMSE score ≤ 23). The MD pattern was associated with a lower risk of cognitive impairment (odds ratio [OR] = 0.39; 95% confidence interval [CI], 0.15-0.99; p = 0.045), as was the consumption of wine (OR = 0.37; 95% CI, 0.16-0.84; p = 0.018) and nuts (OR = 0.30; 95% CI, 0.13-0.69, p = 0.005). No association was found with other food groups. CONCLUSION A closer adherence to the MD was associated with a better cognitive status. Further cohort studies and randomized controlled trials are warranted.
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Effect of ninjin'yoeito, a Kampo (traditional Japanese) medicine, on cognitive impairment and depression in patients with Alzheimer's disease: 2 years of observation.
Kudoh, C, Arita, R, Honda, M, Kishi, T, Komatsu, Y, Asou, H, Mimura, M
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society. 2016;(2):85-92
Abstract
BACKGROUND Only a few approved drugs are capable of alleviating the cognitive and behavioural symptoms of people living with Alzheimer's disease (AD). In recent years, however, the number of studies examining the clinical effects of herbal medicines on cognitive function in patients with AD has increased considerably. This study evaluated the long-term effects of a traditional Japanese medicine (Kampo medicine) known as ninjin'yoeito (NYT) on cognitive impairment and mood status in patients with AD over a 2-year period. METHODS Twenty-three patients with mild-to-moderate probable AD according to the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria were included. Each participant had exhibited an insufficient response to treatment with donepezil alone before the start of the trial. Eleven patients received treatment with donepezil alone, and the remaining patients received a combined treatment of donepezil and NYT for 2 years. Patients were assessed by the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale-cognitive component-Japanese version for cognitive function, and the Neuropsychiatric Inventory was used to evaluate the patients' mood status at baseline and every 6 months for 2 years. RESULTS The Mini-Mental State Examination results showed no significant differences between the two groups. Significant improvements were observed on the Alzheimer's Disease Assessment Scale-cognitive component-Japanese version and the Neuropsychiatric Inventory depression scores of patients who received the combined therapy with donepezil and NYT (Alzheimer's Disease Assessment Scale-cognitive component-Japanese version, 12 months: P < 0.01, 18 months: P = 0.04, 24 months: P < 0.01; Neuropsychiatric Inventory depression, 6 months: P < 0.05, 24 months: P < 0.05). CONCLUSIONS A 2-year follow-up of patients receiving donepezil and NYT treatment showed an improved cognitive outcome and alleviation of AD-related depression.
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COMT Val 158 Met polymorphism is associated with nonverbal cognition following mild traumatic brain injury.
Winkler, EA, Yue, JK, McAllister, TW, Temkin, NR, Oh, SS, Burchard, EG, Hu, D, Ferguson, AR, Lingsma, HF, Burke, JF, et al
Neurogenetics. 2016;(1):31-41
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Abstract
Mild traumatic brain injury (mTBI) results in variable clinical outcomes, which may be influenced by genetic variation. A single-nucleotide polymorphism in catechol-o-methyltransferase (COMT), an enzyme which degrades catecholamine neurotransmitters, may influence cognitive deficits following moderate and/or severe head trauma. However, this has been disputed, and its role in mTBI has not been studied. Here, we utilize the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study to investigate whether the COMT Val (158) Met polymorphism influences outcome on a cognitive battery 6 months following mTBI--Wechsler Adult Intelligence Test Processing Speed Index Composite Score (WAIS-PSI), Trail Making Test (TMT) Trail B minus Trail A time, and California Verbal Learning Test, Second Edition Trial 1-5 Standard Score (CVLT-II). All patients had an emergency department Glasgow Coma Scale (GCS) of 13-15, no acute intracranial pathology on head CT, and no polytrauma as defined by an Abbreviated Injury Scale (AIS) score of ≥3 in any extracranial region. Results in 100 subjects aged 40.9 (SD 15.2) years (COMT Met (158) /Met (158) 29 %, Met (158) /Val (158) 47 %, Val (158) /Val (158) 24 %) show that the COMT Met (158) allele (mean 101.6 ± SE 2.1) associates with higher nonverbal processing speed on the WAIS-PSI when compared to Val (158) /Val (158) homozygotes (93.8 ± SE 3.0) after controlling for demographics and injury severity (mean increase 7.9 points, 95 % CI [1.4 to 14.3], p = 0.017). The COMT Val (158) Met polymorphism did not associate with mental flexibility on the TMT or with verbal learning on the CVLT-II. Hence, COMT Val (158) Met may preferentially modulate nonverbal cognition following uncomplicated mTBI.Registry: ClinicalTrials.gov Identifier NCT01565551.
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Chorioamnionitis and Neurocognitive Development at Age 2 Years.
Vander Haar, E, Gyamfi-Bannerman, C
Obstetrics and gynecology. 2016;(3):437-441
Abstract
OBJECTIVE To evaluate whether chorioamnionitis is associated with decreased Bayley II scores at age 2 years. METHODS We conducted an observational cohort study of women and their offspring enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Development's Maternal-Fetal Medicine Units Network multicenter, randomized controlled trial of magnesium for cerebral palsy prevention in pregnancies at high risk for early preterm delivery. We included nonanomalous singleton gestations and excluded pregnancies missing outcome or exposure data. Our primary exposure was chorioamnionitis, defined by the clinical diagnosis of chorioamnionitis and a maternal fever greater than 100°F. Our primary outcome was a Bayley II Mental Developmental Index score less than 70 or Psychomotor Developmental Index score less than 70 assessed at age 2 years. We also assessed Mental Developmental Index or Psychomotor Developmental Index score less than 85. We conducted bivariate analyses and fit a log-linear regression model, adjusting for related to Mental Developmental Index or Psychomotor Developmental Index score less than 70 or less than 85 with a detectable effect size estimated at a relative risk of 1.5 or greater. RESULTS Of 1,574 patients in our analysis, 194 (12%) had chorioamnionitis and 1,366 (87%) had preterm premature rupture of membranes. The mean gestational age at delivery was 29 3/7 weeks. There were no significant differences in Mental Developmental Index score less than 70 (37 [19.1%] compared with 233 [17%], P=.45) or Psychomotor Developmental Index score less than 70 (29 [15%] compared with 195 [14%] P=.76) for children born to mothers with or without chorioamnionitis, respectively. After adjusting for confounders, there remained no difference in the proportion of abnormal scores in either group. However, neonates diagnosed with sepsis were found to have significantly decreased Mental Developmental Index scores. CONCLUSION Exposure to chorioamnionitis was not associated with neurocognitive defects as measured by abnormal Bayley II scores.
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Effects of CO2 Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy.
Liu, LL, Bao, N, Lu, HW
Gynecologic and obstetric investigation. 2016;(1):90-5
Abstract
AIM: To evaluate the effects of CO2 pneumoperitoneum during gynecologic laparoscopy on patients' postoperative cognitive function. METHODS This prospective clinical study included 225 adult female patients with American Society of Anesthesiologists physical status I or II. Patients underwent conventional open surgery (group I, n = 115) or gynecologic laparoscopy using abdominal insufflation with CO2 to an intra-abdominal pressure of 15 mm Hg (group II, n = 110). Serum S100β and neuron-specific enolase (NSE) concentrations were measured, both immediately before surgery and before the patient awoke after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery as well as 1, 6, 12, 24 and 72 h after surgery and before discharge. RESULTS MMSE scores were significantly lower relative to baseline at 1, 6 and 12 h post surgery, but returned to baseline by 48 h (group I) or 72 h (group II) post surgery. One hour after surgery, S100β serum levels were higher in group II than in group I (p < 0.05). NSE levels did not differ between the groups. In group II, the MMSE score significantly correlated with serum S100β or NSE concentrations. CONCLUSION CO2 pneumoperitoneum influences postoperative cognitive function in patients undergoing gynecologic laparoscopy.
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Cognition in school-age children exposed to levetiracetam, topiramate, or sodium valproate.
Bromley, RL, Calderbank, R, Cheyne, CP, Rooney, C, Trayner, P, Clayton-Smith, J, García-Fiñana, M, Irwin, B, Morrow, JI, Shallcross, R, et al
Neurology. 2016;(18):1943-1953
Abstract
OBJECTIVE To investigate the effects of prenatal exposure to monotherapy levetiracetam, topiramate, and valproate on child cognitive functioning. METHODS This was a cross-sectional observational study. Children exposed to monotherapy levetiracetam (n = 42), topiramate (n = 27), or valproate (n = 47) and a group of children born to women who had untreated epilepsy (n = 55) were enrolled retrospectively from the UK Epilepsy and Pregnancy Register. Assessor-blinded neuropsychological assessments were conducted between 5 and 9 years of age. Information was collected on demographic and health variables and adjusted for in multiple regression analyses. RESULTS In the adjusted analyses, prenatal exposure to levetiracetam and topiramate were not found to be associated with reductions in child cognitive abilities, and adverse outcomes were not associated with increasing dose. Increasing dose of valproate, however, was associated with poorer full-scale IQ (-10.6, 95% confidence interval [CI] -16.3 to -5.0, p < 0.001), verbal abilities (-11.2, 95% CI -16.8 to -5.5, p < 0.001), nonverbal abilities (-11.1, 95% CI -17.3 to -4.9, p < 0.001), and expressive language ability (-2.3, 95% CI -3.4 to -1.6, p < 0.001). Comparisons across medications revealed poorer performance for children exposed to higher doses of valproate in comparison to children exposed to higher doses of levetiracetam or topiramate. CONCLUSIONS Preconception counseling should include discussion of neurodevelopmental outcomes for specific treatments and their doses and women should be made aware of the limited nature of the evidence base for newer antiepileptic drugs.
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Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years.
Kuban, KC, Joseph, RM, O'Shea, TM, Allred, EN, Heeren, T, Douglass, L, Stafstrom, CE, Jara, H, Frazier, JA, Hirtz, D, et al
The Journal of pediatrics. 2016;:69-75.e1
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Abstract
OBJECTIVES To compare the prevalence of cognitive, neurologic, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm. STUDY DESIGN A total of 889 of 966 eligible children previously enrolled in the multicenter Extremely Low Gestational Age Newborns Study from 2002-2004 were evaluated at 10 years of age. Children underwent a neuropsychological battery and testing for autism spectrum disorder (ASD), and parents reported on their child's behavior, development, and seizures. RESULTS Of the children, 28% of boys and 21% of girls exhibited moderate to severe impairment on summary measures of cognitive abilities. Boys had a higher prevalence of impairment than girls in nearly all measures of cognition, were more than twice as likely to have microcephaly (15% in boys, 8% in girls), and require more often assistive devices to ambulate (6% in boys, 4% in girls). In contrast, boys and girls had comparable risk for a history of seizure (identified in 10% of the cohort) or epilepsy (identified in 7% of the cohort). The boy-to-girl ratio of ASD (9% in boys, 5% in girls) was lower than expected compared with the overall US autism population. CONCLUSIONS In this contemporary cohort of children born extremely premature and evaluated at school age, boys had higher prevalence of cognitive, neurologic, and behavioral deficits than girls. The ratio of boys to girls among those with ASD deserves further study as does the perinatal environmental-genetic interactions that might contribute to male preponderance of deficits in this high-risk sample.
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Antihypertensive drug use and risk of cognitive decline in the very old: an observational study - the Newcastle 85+ Study.
Peters, R, Collerton, J, Granic, A, Davies, K, Kirkwood, T, Jagger, C
Journal of hypertension. 2015;(10):2156-64
Abstract
OBJECTIVES Older adults are a fast growing group in society and are at high risk of hypertension, cognitive decline and dementia. Antihypertensive drugs, particularly calcium channel blockers (CCB), have been associated with a decreased risk of cognitive decline and dementia. We used observational data to examine the association between antihypertensive drug class and change in cognitive function. METHODS The Newcastle 85+ Study is a population-based cohort study recruiting individuals aged 85 (born in 1921) via general/family practices in Newcastle/North Tyneside, United Kingdom. Data, including blood pressure, antihypertensive drug use and cognitive function [assessed using the Standardized Mini-Mental State Exam (SMMSE)], were collected at baseline and 3-year follow-up. RESULTS The study population comprised 238 participants with a diagnosis of hypertension, prescribed antihypertensive drug treatment and with baseline and follow-up SMMSE assessment. There was an association between CCB use and less cognitive decline over 3 years (rate of decline was lower by 1.29 SMMSE points (95% confidence interval 0.16-2.42; P = 0.03) compared with those taking other antihypertensive classes after adjustment for age, sex, years of education, baseline SMMSE score, smoking, BMI, baseline blood pressure, and incident cerebrovascular event. This finding was even stronger in the cognitively intact (SMMSE >24), wherein rate of cognitive decline was lower by 1.33 SMMSE points (95% confidence interval 0.30-2.37; P = 0.01), but was not seen for other antihypertensive classes. CONCLUSION Findings provide support for an association between CCB use and a lower rate of cognitive decline in very old adults with hypertension.