Changes In Cognitive Function Research Articles

Association Between Oral Hygiene Behaviours and Cognitive Decline in Adults: A Systematic Review and Meta-Analysis.

To evaluate the association between oral hygiene behaviour and cognitive decline in adults. The outcomes include changes in global cognitive function, visual attention, task switching and the risk of dementia. We conducted a systematic review following the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search of 11 databases and grey literature sources was conducted from inception to January 2024. We included interventional trials or cohort studies that investigated the effect of oral hygiene behaviours (e.g., toothbrushing, mouth washing, flossing, using toothpicks and cleaning dentures) on cognitive decline in adults. Data extraction and risk of bias assessment were performed by two independent reviewers with expertise in conducting systematic reviews. Meta-analyses were conducted using random-effects models, and heterogeneity was assessed with the I2 statistic and χ2 test. A total of eight studies (six intervention studies and two cohort studies) met inclusion criteria, including 261,772 participants. Follow-up periods ranged from 30 days to 48 months for interventions and 9 to 18 years for cohorts. Toothbrushing was associated with a significantly slower decline in global cognitive overtime. Toothbrushing in older adults with moderate/severe dementia could achieve significant changes in cognitive decline. There was no significant difference between the effectiveness of toothbrushing performed by professionals and caregivers. Other oral hygiene behaviours, including dental flossing, using mouthwash, using toothpicks and cleaning dentures, were not associated with the risk of dementia. Toothbrushing is linked to a decreased risk of dementia and improved global cognitive function. Promoting toothbrushing at least twice daily may significantly reduce the risk of cognitive decline and dementia. These findings highlight the urgent need for programmes that encourage daily toothbrushing, particularly in nursing home settings and among older adults with moderate-to-severe dementia.

Brain endurance training improves sedentary older adults’ cognitive and physical performance when fresh and fatigued

ObjectivesCognitive and physical performance is impaired by aging and fatigue. Cognitive and exercise training may mitigate such impairments. Accordingly, we investigated the effect of Brain Endurance Training (BET) – combined cognitive and exercise training – on cognitive and physical performance when fresh and fatigued in older adults. DesignTwenty-four healthy sedentary women (65–78 years) were randomly allocated to one of three training groups: BET, exercise training, and control (no training). The BET and exercise training groups completed the same physical training protocol comprising three 45-min exercise sessions (20-min resistance exercise plus 25-min endurance exercise) per week for eight weeks. The BET group completed a 20-min cognitive task prior to exercise tasks. Cognitive (tasks: psychomotor vigilance, Stroop) and physical (tests: walk, chair-stand, arm curl) performance was tested when fresh and fatigued (before and after a 30-min cognitive task) at weeks 0 (pre-test), 4 (mid-test), 8 (post-test), and 12 (follow-up test). ResultsCognitive and physical and performance was generally superior when fresh and fatigued at mid-test and post-test for both BET and exercise training groups compared to the control group. The BET group outperformed the exercise group when fatigued at mid-test and post-test both cognitively (always) and physically (sometimes). The pre-to-post changes in cognitive performance when fresh and fatigued averaged 3.7 % and 7.8 % for BET, 3.6 % and 4.5 % for exercise, and −0.4 % and 0.3 % for control groups. The corresponding changes in physical performance averaged 16.5 % and 29.9 % for BET, 13.8 % and 22.4 % for exercise, and 10.8 % and 7.1 % for control groups. ConclusionThese findings show that BET can improve cognitive and physical performance in older adults.

Effect of childhood trauma on cognitive function in individuals with major depressive disorder and healthy controls

BackgroundIndividuals with major depressive disorder (MDD) exhibit cognitive impairment, while childhood trauma (CT) is associated with an elevated risk of both MDD and cognitive dysfunction. The effect of CT on cognitive function in MDD patients and healthy controls (HCs) is unclear. MethodsMDD patients and HCs were enrolled between December 2013 and December 2016. The Childhood Trauma Questionnaire (CTQ) was used to assess CT. Depressive symptoms and cognitive function were assessed at baseline and after 8-week acute-phase treatment with selective serotonin reuptake inhibitors (SSRIs) in MDD patients. ResultsA total of 909 people were included in the analysis. The interaction between MDD and CT had a main effect on Digit Symbol-Coding Test (DSCT), Stroop Color Test (SCT), and Stroop Color-Word Test (SCWT) scores. The effect of CT on cognitive function disappeared after adjusting for MDD diagnosis and years of education. Neglect could predict poor performance on SCT and SCWT in the HC group. After acute-phase treatment with SSRIs, CT did not significantly predict changes in cognitive function or depressive symptoms. LimitationsThe CTQ assessment might cause recall bias, and the cross-sectional design could not establish the causal link between CT and cognitive function. ConclusionThe effect of CT on cognitive function was modulated by MDD diagnosis and years of education. CT did not predict changes in depressive symptoms or cognitive function after acute-phase treatment with SSRIs. The direct influence of CT on cognitive function in MDD patients may be over-estimated. Trial registrationClinicalTrials.gov: NCT02023567; registration date: December 2013.

Telomere length and 4-year changes in cognitive function in an older Mediterranean population at high risk of cardiovascular disease.

Cognitive decline, a common process of brain ageing, has been associated with telomere length (TL). Delving into the identification of reliable biomarkers of brain ageing is essential to prevent accelerated cognitive impairment. We selected 317 non-smoking 'Prevención con Dieta Mediterránea-Plus' (PREDIMED-Plus) participants (mean age, 65.8 ± 5.0years) with metabolic syndrome from two trial centres who were following a lifestyle intervention. We measured TL and cognitive function at baseline and after 3 and 4years of follow-up, respectively. Associations between baseline or 3-year changes in TL and baseline or 4-year changes in cognitive function were analysed using multivariable regression models. Baseline TL was not associated with baseline cognitive performance. Nevertheless, longer baseline TL was associated with improved 4-year changes in the Executive Function domain (β: 0.29; 95%CI: 0.12 to 0.44; P < 0.001) and the Global Cognitive Function domain (β: 0.19; 95%CI: 0.05 to 0.34; P =0.010). Besides, a positive association was found between longer baseline TL and improved 4-year changes in the animal version of the Verbal Fluency Test (β: 0.33; 95%CI: 0.12 to 0.52; P =0.002). By contrast, 3-year changes in TL were not associated with changes in cognitive function after 4years. Longer baseline TL could protect from cognitive decline and be used as a useful biomarker of brain ageing function in an older Mediterranean population at risk of cardiovascular disease and cognitive impairment.

The Effect Of Collaboration On Exercise-induced Change In Cognitive Performance

The Effect Of Collaboration On Exercise-induced Change In Cognitive Performance

Both Exercise And Socialization Influence Acute Changes In Cognitive Performance

Both Exercise And Socialization Influence Acute Changes In Cognitive Performance

Immune response and cognitive impairment in Post-COVID Syndrome: A systematic review

BackgroundAltered immune response and cognitive difficulties have been demonstrated in studies of post-COVID syndrome, including differences in immune status and cognitive functioning in the months following infection. This review aimed to examine immune status and cognitive differences in post-COVID Syndrome twelve or more weeks after COVID-19 infection. A further aim of this review was to explore a link between immune response and the cognitive deficits observed in this group. MethodsA systematic review was carried out of PubMed, PsychInfo, EMBASE and Web of Science electronic databases of observational studies 12+ weeks after COVID-19 infection, with assessment of immune status and cognitive function in post-COVID Syndrome samples. This review protocol was recorded on PROSPERO with registration number CRD42022366920. ResultsFollowing eligibility screening, eleven studies met inclusion criteria and were selected for our review. Six of eight studies which examined between group differences in specific domains suggested impaired cognition in the Post COVID Syndrome population, with the domains of executive function particularly affected. Of the eleven studies with immune data, nine studies reported increased markers of inflammation in the Post COVID Syndrome group, when compared to an age and gender matched “healthy control” sample, or population norms. Finally, when immune function and cognition are examined together, six studies presented results indicating a significant association between elevated immune response and cognitive function. ConclusionThis review highlights the frequency of cognitive difficulties months after COVID-19 infection and explores heighted immune response as a predictor of this change. Six studies suggest that immune status is a predictor of cognitive function, examining a marker of immune function and objective cognitive performance at 12 or more weeks following infection. Future studies of cognitive function in Post COVID Syndrome are needed to explore this relationship, and underlying mechanisms leading to changes in cognitive performance.

Backyard running: Pushing the boundaries of human performance.

Ultrarunning is gaining in popularity but no information is available on the physiological and psychological responses during backyard ultrarunning events. The aim of this study was to determine changes in cognitive function, markers of physiological resilience, and running performance during a backyard-running event. Twelve male ultrarunners (38±8years old, BMI: 23.5±1.6kg/m2, and VO2max: 60.8±4.7mL/min/kg) were monitored before, during, and after the event. Cognitive performance was determined using a cognitive test battery before, during, and after the event. During the event, the rating of perceived exertion (RPE), blood lactate concentration, and heart rate (HR) were assessed. Physical performance was investigated using the total number of completed laps and running speed per lap. Athletes completed 34±17 laps equaling 227.8±113.9km with average speeds starting at 9.0km/h and slowing down to 7.5km/h at the end of the event. Physiological resilience (estimated using HR/speed) varied between athletes, with significantly lower values in the more proficient backyard runners at the end of the event (p<0.05). HR and lactate levels remained constant, whereas a progressive increase in RPE was noticed (p≤0.001). A significantly worsened reaction time was observed for several cognitive tasks after the event compared to baseline measures (p≤0.05). These observations show that physiological resilience differs depending on the level of endurance performance of the athletes. Furthermore, the backyard ultrarunning event negatively impacted psychomotor speed. Therefore, the results suggest that implementing strategies that enhance physiological resilience and/or psychomotor speed could potentially have a positive effect on performance in ultraendurance activities.

Associations Between Cognitive Performance and Self-Efficacy for Pain Management in Older Adults With Chronic Pain

BackgroundSelf-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain. MethodsThe analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests—the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test—were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis. ResultsAfter adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened. ConclusionGreater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.

The effects of moderate alcohol and THC co-use during male and female rat adolescence on AKT-GSK3ß signaling in adulthood

Alcohol and cannabis are often taken in combination, and extensive co-use has been linked to enduring changes in cognitive and metabolic functioning. The underlying mechanisms for these effects are unclear, but we recently demonstrated that co-administration of ethanol and delta-9-tetrahydrocannbinol (THC) to adolescent rats caused lasting adaptations in GABA and glycogen synthase kinase 3ß (GSK3ß) signaling in the medial prefrontal cortex (mPFC). As a ubiquitous protein kinase, GSK3ß is downstream to the protein kinase B (also known as AKT) pathway that is activated by insulin receptor signaling in a main control center for metabolism and energy homeostasis, the mediobasal hypothalamus (MBH). Our goal here was to investigate if volitional co-use of low to moderate levels of ethanol and THC would impact the total and phosphorylated levels (p) of AKT and GSK3ß in the mPFC and MBH. Peri-adolescent Long Evans rats [postnatal day (P) 30–47] consumed 10 % ethanol, cookies laced with THC (3–10 mg/kg/day), both drugs, or vehicle controls. On P114, we modeled re-exposure to a behaviorally relevant dose of THC by challenging rats (i.p.) with 5 mg/kg THC (or vehicle) and sacrificed them 30 min later. Western blot analysis revealed that THC challenge increased pAKT and pGSK3ß compared to control similarly across all treatment groups, sexes, and brain regions; no effects on total levels of AKT or GSK3ß were found. Previously reported behavioral results from these rats showed no differences in working memory assessed in adulthood. Although future studies will be necessary to determine the role of exposure dose on drug-induced adaptations in AKT and GSK3ß signaling, the current findings suggest that moderate volitional co-use of alcohol and THC may not produce long-term deficits that persist into adulthood.

Continuous theta burst stimulation ameliorates cognitive deficits in microinfarcts mice via inhibiting glial activation and promoting paravascular CSF-ISF exchange

Microinfarcts are widespread in the elderly, accompanied by varying degrees of cognitive decline. Continuous theta burst stimulation (cTBS) has been demonstrated to be neuroprotective on cognitive dysfunction, but the underlying cellular mechanism has been still not clear. In the present study, we evaluated the effects of cTBS on cognitive function and brain pathological changes in mice model of microinfarcts. The spatial learning and memory was assessed by Morris water maze (MWM), Glymphatic clearance efficiency was evaluated using in vivo two-photon imaging. The loss of neurons, activation of astrocytes and microglia, the expression and polarity distribution of the astrocytic aquaporin-4 (AQP4) were assessed by immunofluorescence staining. Our results showed that cTBS treatment significantly improved the spatial learning and memory, accelerated the efficiency of glymphatic clearance, up-regulated the AQP4 expression and improved the polarity distribution of AQP4 in microinfarcts mice. Besides, cTBS treatment increased the number of surviving neurons, whereas decreased the activated astrocytes and microglia. Our study suggested that cTBS accelerated glymphatic clearance and inhibited the excessive gliogenesis, which ultimately exerted neuroprotective effects on microinfarcts mice.

Respiratory Function is Associated with Cognitive Function Change in Japanese Community-Dwelling Older People: A 1-Year, Longitudinal, Observational Study

Respiratory Function is Associated with Cognitive Function Change in Japanese Community-Dwelling Older People: A 1-Year, Longitudinal, Observational Study

An Exploration Of Delirium Awareness Amongst Clinical Staff Working On The Acute Floor Of A Level Three Hospital

Abstract Background Delirium is an acute change in cognitive function that has an organic cause and is likely to be reversible or preventable (HSE Delirium Algorithm, 2021). The Frailty Intervention Team (FIT) based in the Emergency Department (ED) &amp; Acute Medical Assessment Unit (AMAU) comprises of Physiotherapy, Occupational Therapy and Dietetics and is supported by an Older Persons Advanced Nurse Practitioner. The 4AT delirium screen is routinely completed by FIT as part of Comprehensive Geriatric Assessment. FIT observed limited use of delirium screening in ED/AMAU therefore we proposed to explore delirium awareness amongst all clinical staff on the acute floor. Methods All clinical staff in ED/AMAU were invited to complete an anonymised paper questionnaire to explore their awareness of delirium. Basic statistical analysis of data was completed using Excel. Results Over one week twenty-four questionnaires were completed by medical, nursing, allied health and health care assistants. Six questions explored delirium awareness and a seventh question explored the willingness to engage in delirium information sessions if made available to staff locally. On assessment of delirium awareness an average score of 79.3% (range 16.7%-100%) was achieved. Participants scored strongly on potential causes of and screening for delirium. Questions relating to delirium symptoms and potential outcomes of unrecognised delirium had the least correct response rates. 100% of respondents expressed interest in attending delirium information sessions if made accessible to them within ED/AMAU. Conclusion This study identified overall satisfactory delirium awareness amongst clinical staff on the acute floor and all participants expressed interest in expanding their knowledge in this area. Compliance with use of delirium screening tools in clinical practice was not assessed and we also acknowledge the limited number of participants. Future plans include audit of the use of delirium screening tools, delivery of delirium information sessions and provision of accessible delirium resources in ED/AMAU.

Pet Attachment and Maintenance of Physical and Cognitive Function in Community-Residing Older Adults: Evidence From the Baltimore Longitudinal Study of Aging (BLSA)

ABSTRACT Pet ownership is associated with reduced deterioration in physical and cognitive function as older adults age. To date, little research focuses on whether the degree of attachment to the pet is related to the rate of deterioration in these functions. We examined the relationship of pet, dog, and cat attachment to changes in physical and cognitive function among 214 pet-owning, generally healthy, community-dwelling adults aged 50–100 years (M = 68.0, SD = 7.8) from the Baltimore Longitudinal Study of Aging (BLSA). Pet attachment was assessed using the pet ownership module administered during a regularly scheduled BLSA visit. Physical and cognitive assessments were administered every 1–4 years over 1–13 years (M = 7.5, SD = 3.6), including 400-meter walk time, usual and rapid-gait speed, Health ABC Physical Performance Battery, SF-12 Physical Component Score, California Verbal Learning (Immediate, Short, Long recall), Benton Visual Retention, Trail-Making (Trails A, B, B-A), Digit Span, Boston Naming (Naming), and Digit Symbol Substitution (Digit Symbol) Tests. In linear mixed models, controlling for age and comorbidities, greater pet attachment was associated with slower deterioration in physical performance (p = 0.009), usual-gait speed (p < 0.001), rapid-gait speed (p = 0.002), and executive function (Trails B: p = 0.005 and Trails B-A: p < 0.001), and faster deterioration in long-term recall (p < 0.001). Among dog owners (n = 121), a higher attachment was associated with slower deterioration in attention (Trails A: p = 0.046) and faster deterioration in short- (p = 0.025) and long-term (p = 0.019) recall. Among cat owners (n = 100), higher attachment was associated with a slower decline in physical wellbeing (p = 0.035). We provide important longitudinal evidence that pet attachment is differentially associated with the rate of decline in function older adults experience as they age and that attachment to different types of pets may have a different relationship to rates of decline. Potential explanations for these differences are proposed.

Monitoring cognitive functions during deep brain stimulation (DBS) interventions by Real Time Neuropsychological Testing (DBS-RTNT).

We monitored cognition during Deep brain stimulation (DBS) surgery, when the electrode is positioned at the target subthalamic nucleus (i.e., STN motor area) in 14 PD patients. We present the Real Time Neuropsychological Testing (DBS-RTNT) protocol, our preliminary experience, along with patients' performance comparing intraoperative results with baseline data. Compared to baseline, DBS-RTNT in the target area showed a significantly decreased performance at some tasks belonging to memory and executive functions domains. Significantly decreased short-term memory and sequencing scores were found for right (vs. left) hemisphere DBS-RTNT. PD patients' performance should be monitored during DBS surgery as STN-DBS may induce changes in cognitive performance. These preliminary data contribute to improve, during DBS-surgery the anatomo-functional topography of the STN in order to identify, in future approaches, in the individual patient the best site producing positive motor effects, without causing negative cognitive and/or emotional changes. Medications (i.e., the patients underwent surgery in a levodopa off state) could in principle have influenced our results therefore future studies are needed to address possible confounding effect of levodopa use.

Screening for early Alzheimer's disease: enhancing diagnosis with linguistic features and biomarkers.

Research has shown that speech analysis demonstrates sensitivity in detecting early Alzheimer's disease (AD), but the relation between linguistic features and cognitive tests or biomarkers remains unclear. This study aimed to investigate how linguistic features help identify cognitive impairments in patients in the early stages of AD. This study analyzed connected speech from 80 participants and categorized the participants into early-AD and normal control (NC) groups. The participants underwent amyloid-β positron emission tomography scans, brain magnetic resonance imaging, and comprehensive neuropsychological testing. Participants' speech data from a picture description task were examined. A total of 15 linguistic features were analyzed to classify groups and predict cognitive performance. We found notable linguistic differences between the early-AD and NC groups in lexical diversity, syntactic complexity, and language disfluency. Using machine learning classifiers (SVM, KNN, and RF), we achieved up to 88% accuracy in distinguishing early-AD patients from normal controls, with mean length of utterance (MLU) and long pauses ratio (LPR) serving as core linguistic indicators. Moreover, the integration of linguistic indicators with biomarkers significantly improved predictive accuracy for AD. Regression analysis also highlighted crucial linguistic features, such as MLU, LPR, Type-to-Token ratio (TTR), and passive construction ratio (PCR), which were sensitive to changes in cognitive function. Findings support the efficacy of linguistic analysis as a screening tool for the early detection of AD and the assessment of subtle cognitive decline. Integrating linguistic features with biomarkers significantly improved diagnostic accuracy.

Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents

Antihypertensive medication deprescribing is common among nursing home residents, yet its association with cognitive decline remains uncertain. To investigate the association of deprescribing antihypertensive medication with changes in cognitive function in nursing home residents. This cohort study using a target trial emulation approach included VA long-term care residents aged 65 years or older with stays of at least 12 weeks from 2006 to 2019. Residents who were not prescribed antihypertensive medication, with blood pressure greater than 160/90 mm Hg, or with heart failure were excluded. Eligible residents with stable medication use for 4 weeks were classified into deprescribing or stable user groups and followed for 2 years or until death or discharge for intention-to-treat (ITT) analysis. Participants switching treatment groups were censored in the per-protocol analysis. Cognitive function measurements during follow-up were analyzed using an ordinal generalized linear mixed model, adjusting for confounders with inverse probability of treatment weighting. Per-protocol analysis included inverse probability of censoring weighting. Data analyses were performed from May 1, 2023, and July 1, 2024. Deprescribing was defined as a reduction in the total number of antihypertensive medications or a decrease in medication dosage by 30%, sustained for a minimum of 2 weeks. Cognitive Function Scale (CFS) was classified as cognitively intact (CFS = 1), mildly impaired (CFS = 2), moderately impaired (CFS = 3), and severely impaired (CFS = 4). Of 45 183 long-term care residents, 12 644 residents (mean [SD] age 77.7 [8.3] years; 329 [2.6%] females and 12 315 [97.4%] males) and 12 053 residents (mean [SD] age 77.7 [8.3] years; 314 [2.6%] females and 11 739 [97.4%] males) met eligibility for ITT and per-protocol analyses, respectively. At the end of the follow-up, 12.0% of residents had a worsened CFS (higher score) and 7.7% had an improved CFS (lower score) with 10.8% of the deprescribing group and 12.1% of the stable user group showing a worsened CFS score. In the per-protocol analysis, the deprescribing group had a 12% reduction in the odds of progressing to a worse CFS category per 12-week period (odds ratio, 0.88; 95% CI, 0.78-0.99) compared to the stable user group. Among residents with dementia, deprescribing was associated with 16% reduced odds of cognitive decline (odds ratio, 0.84; 95% CI, 0.72-0.98). These patterns remained consistent in the ITT analysis. This cohort study indicates that deprescribing is associated with less cognitive decline in nursing home residents, particularly those with dementia. More data are needed to understand the benefits and harms of antihypertensive deprescribing to inform patient-centered medication management in nursing homes.

Mediation analysis of cognitive function in the relationship between pulmonary function and depression among middle-aged and older adults.

This study aims to explore the association between declining lung function and depression in middle-aged and older adults, with a special focus on the mediating role of cognitive function. This study utilizes self-reported and physical examination data from 5345 individuals participating in the 2015 cycle of the China Health and Retirement Longitudinal Study (CHARLS) to explore the role of cognitive function changes in mediating the effects of diminished lung function on depression among middle-aged and older adults. Multivariate linear regression analysis revealed a positive correlation between pulmonary and cognitive functions (β = 0.003, 95% CI: 0.002∼0.003, P < 0.01) and a negative correlation between cognitive function and depression (β = -0.279, 95% CI: -0.330-0.228, P < 0.01). Cognitive function plays a mediating role in linking pulmonary function with depression, exhibiting a mediation effect of -0.0007 and a total effect of -0.0046, wherein the mediation effect contributes to 15.22% of the total effect. For females, the mediating effect of cognitive function was stronger (β = -0.0013, 95% CI: -0.0018∼-0.0008, P < 0.01) than it was for males (β = -0.0006, 95% CI: -0.0009∼-0.0003, P < 0.01). The study underscores the importance of monitoring lung and cognitive functions as interconnected factors contributing to the mental health of middle-aged and older adults. It suggests that interventions aimed at improving pulmonary health and cognitive function may help mitigate depressive symptoms among middle-aged and older adults. Further research is warranted to validate these findings across diverse cultural and demographic settings. Geriatr Gerontol Int 2024; ••: ••-••.

Long‐term cognitive function changes with non‐vitamin K oral anticoagulants in older patients with atrial fibrillation. A multicenter cohort study

AbstractBackgroundAtrial fibrillation is associated with several comorbidities, particularly cognitive impairment and dementia, especially in older patients. Non‐vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) were used to prevent thromboembolic events. However, data on the real benefit of these drugs on cognitive function decline remains controversial. In this study we evaluated the effect of NOACs compared to VKAs on the absolute and relative decline in cognitive function over time.MethodsNine hundred and eighty‐three older patients with nonvalvular AF were enrolled (76 ± 6 years; 291 on VKAs and 692 on NOACs). The cognitive function was assessed with Mini Mental State examination (MMSE) score. The between‐arms difference of cognitive evolution over time was investigated by Linear Mixed Models and group‐based trajectory model analyses.ResultsIn the whole multicenter observational study, after a long follow‐up of 7.2 ± 3.4 years, the patients of the NOACs versus VKAs group had lowest absolute reduction of the MMSE score between baseline and follow‐up (−0.3 ± 0.03 vs.−1.7 ± 0.1, p &lt; 0.001). After stratification into five subgroups according to trajectories of MMSE score over time, the probability to belong to trajectories with lower decline in cognitive functions was higher in patients on NOACs than in those on VKAs (3.93–13.88 times).ConclusionIn older patients with atrial fibrillation, the use of NOACs was associated with a smaller decline of cognitive function over time compared to the VKAs, regardless that patients in the NOACs group were older and with a higher burden of comorbidities.

Cognitive performance from childhood to old age and intergenerational correlations in the multigenerational Young Finns Study

Abstract Background Cognitive performance changes during the lifespan, but the information is gathered from studies on separate age cohorts. Computerized neurocognitive testing enables efficient and similar assessments for all ages. We investigated (i) the effect of age at different stages of life and (ii) intergenerational correlations across cognitive domains in the multigenerational Young Finns Study. Methods Participants in three familiarly related generations (n = 6486, aged 7–92 years) performed the Cambridge Neuropsychological Test Automated Battery (CANTAB). Overall cognitive performance and domains representing learning and memory, working memory, information processing, and reaction time were extracted by common principal component analysis from the cognitive data with several age groups. Linear models were used to study the association of age, sex, and education with overall cognitive performance and in the cognitive domains. Age-adjusted intergenerational correlations were calculated. Results Learning and memory peaked earlier during the lifespan compared to working memory and information processing, and the rate of decline toward old age differed by domain. Weak intergenerational correlations existed between two consecutive generations but were nonsignificant between grandparents and grandchildren. There was no systematic sex-specific transmission in any cognitive domain. Conclusion This study describes the natural course of cognitive performance across the lifespan and proves that cognitive performance changes differently across cognitive domains with weak intergenerational transmission.