The Aging Mind Opportunities in Cognitive Research (2000) / Chapter Skim
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Appendix E: Health Effects on Cognitive Aging
Appendix E: Health Effects on Cognitive Aging
Pages 189-217
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From page 189... ...
Although these influences may be particularly pertinent to older adults, who experience an increased incidence and prevalence of disease, systemic diseases have been shown to affect cognitive performance in persons of all ages in both cross-sectional and longitudinal investigations. Therefore disease-cognition relations should viewed from a life-span perspective.
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From page 190... ...
Less healthful lifestyles also tend to aggregate among individuals with lower levels of education and may, in part, explain previously noted associations between low education and/or socioeconomic status and poorer cognitive function (Kilander et al., 19971. Examples of such lifestyle factors include smoking, excessive alcohol consumption, illicit drug use, dietary factors, and physical inactivity.
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From page 191... ...
have also been associated with higher levels of cognitive functioning (Dustman et al., 1994~. In addition, several investigations have revealed improvements in cognitive performance with aerobic exercise training (Emery and Blumenthal, 1991; Kramer et al., 1998~.
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From page 192... ...
Examples include cardiovascular diseases, such as hypertension and myocardial infarction (Waldstein and Elias, in press; Waldstein et al., in press) ; pulmonary diseases, such as chronic obstructive pulmonary disease and asthma (Fitzpatrick et al., 1991; Hopkins and Bigler, in press; Grant et al., 1987; Prigatano et al., 1983~; pancreatic diseases, such as diabetes mellitus (Reaven et al., 1990; Ryan, in press; Ryan et al., 1993~; hepatic diseases, such as cirrhosis (Moss et al., 1995; Tarter and Van Thiel, in press)
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From page 193... ...
. Some improvements in cognitive performance have been associated with oxygenrelated treatments for chronic obstructive pulmonary disease and obstructive sleep apnea syndrome (Hopkins and Bigler, in press)
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From page 194... ...
, black race, and numerous lifestyle and behavioral factors such as excess body weight, physical inactivity, dietary factors including high sodium and low potassium or calcium intake, excessive alcohol consumption, oral contraceptive use, various psychosocial factors, and stress-related cardiovascular reactivity (American Heart Association, 1998; Joint National Committee,1997; Kaplan, 19981. Hypertension is a major risk factor for atherosclerosis, coronary heart disease, and stroke (Stamler, 19921.
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From page 195... ...
Indeed, life-time exposure to elevated blood pressure may be a more potent predictor of poor cognitive outcome in older adults than crosssectionally measured blood pressure (Elias et al., 1993; Swan et al., 19981. Chronicity of hypertension was emphasized in several recent epidemiological studies in which persistent blood pressure elevation, measured across numerous examinations, predicted poorer cognitive functioning and/or greater rate of cognitive decline (Elias et al., 1993, 1998; Swan et al., 19981.
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From page 196... ...
In sum, when interactive effects of age and hypertension (or blood pressure) are noted, poorer performance tends to aggregate among the younger individuals in any particular investigation.
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From page 197... ...
Mediation of Age-Related Variance Continuous blood pressure levels have been found to partially mediate age-related variance in cognitive performance. In one investigation, systolic and diastolic blood pressure attenuated by almost 58 percent the age-related variance in performance of an attention-shift reaction time task (Madden and Blumenthal, 1998~.
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From page 198... ...
However, Phillips and Mate-Kole (1997) did not find hypertension to be a predictor of cognitive performance in patients with peripheral vascular disease.
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. In this regard, a significantly increased risk for poor cognitive performance, both cross-sectionally and longitudinally, is associated with hypertension or progressive increments in blood pressure (M.F.
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, lifestyle, genetic, and other biological factors are also possible, yet they remain virtually unexplored. Further study of the relation of low blood pressure to cognitive performance (and associated mechanisms)
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From page 201... ...
Both family history studies and hypertension studies could include some evaluation of the numerous candidate genes that have been implicated as determinants of interindividual variability in blood pressure (Krushkal et al., 19991. Cross-sectional and longitudinal studies should determine the impact of hypertension on cognition in the presence of other cardiovascular risk factors and both cardiovascular and noncardiovascular diseases.
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From page 202... ...
The cardiovascular diseases discussed above predispose to stroke (Kennel, 1992) and maybe associated with diminished cognitive performance via many of the same neurobiological mechanisms as hypertension (see Vingerhoets, in press)
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Nonetheless, it is generally thought to be unlikely that hypertension-related cognitive deficits are completely reversed by antihypertensive agents and, on average, any direct treatment effects on cognition are believed to be small (Muldoon et al., 19911. However, long-term blood pressure control with antihypertensive therapy is likely to be critical for preservation of cognitive functioning over time.
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From page 204... ...
In this regard, prior research has indicated that poor performance on certain cognitive tests predicts lower scores on selfreported quality of life in patients with chronic obstructive pulmonary disease (McSweeney and Labuhn, 1996) and poorer functional outcomes in peripheral vascular disease patients (Phillips, in press)
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From page 205... ...
As mentioned above, recent research has indicated that the presence of several cardiovascular risk factors (e.g., hypertension, diabetes, smoking) confers greater risk for poor cognitive performance than any single factor considered in isolation (M.F.
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From page 206... ...
. Representative tests include Logical Memory, Visual Reproductions, Verbal Paired-Associate Learning, the Benton Visual Retention Test, the Tactual Performance Test, the Symbol-Digit Learning Test, and free recall of word lists.
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Reves 1991 A preliminary study of the effects of cardiac procedures on cognitive performance. International Journal of Psychosomatics 38: 13- 16.
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.A. Wolf 1995 Neuropsychological test performance, cognitive functioning, blood pressure, and age: The Framingham Study.
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Silbershatz, and P.A. Wolf 1997 NIDDM and blood pressure as risk factors for poor cognitive performance.
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Evans 1999 Current and remote blood pressure and cognitive decline. Journal of the American Medical Association 281 :438-445.
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American Journal of Epidemiology 144:275-280. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1997 The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
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Havlik 1995 The association between midlife blood pressure levels and late-life cognitive function. Journal of the American Medical Association 274:1846-1851.
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Kong In Neuropsychological consequences of coronary artery bypass surgery. In Neuropsy press chology of Cardiovascular Disease, S.R.
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Colton 1994 Unmedicated blood pressure levels and quality of life in elderly hypertensive women. Psychosomatic Medicine 56:251-259.
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1998 Systolic blood pressure tracking over 25 to 30 years and cognitive performance in older adults. Stroke 29:2334-2340.
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In Cognitive consequences of myocardial infarction, cardiac arrhythmias, and cardiac press arrest. In Neuropsychology of Cardiovascular Disease, S.R.
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Eisdorfer 1971 Intelligence and blood pressure in the aged. Science 172:959-962.
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