Cognition In Older Women Research Articles

The MindMoves Trial: Cross-Sectional Analyses of Baseline Vascular Risk and Cognition in Older Women with Cardiovascular Disease.

Vascular diseases, including atherosclerotic cardiovascular disease (ASCVD) and stroke, increase the risk of Alzheimer's disease and cognitive impairment. Serum biomarkers, such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor 1 (IGF-1), may be indicators of cognitive health. We examined whether vascular risk was associated with levels of cognition and serum biomarkers in older women with cardiovascular disease (CVD). Baseline data from a lifestyle trial in older women (n = 253) with CVD (NCT04556305) were analyzed. Vascular risk scores were calculated for ASCVD (ASCVD risk estimator) and stroke (CHA2DS2-VASc) based on published criteria. Cognition-related serum biomarkers included BDNF, VEGF, and IGF-1. Cognition was based on a battery of neuropsychological tests that assessed episodic memory, semantic memory, working memory, and executive function. A series of separate linear regression models were used to evaluate associations of vascular risk scores with outcomes of cognition and serum biomarkers. All models were adjusted for age, education level, and racial and ethnic background. In separate linear regression models, both ASCVD and CHA2DS2-VASc scores were inversely associated with semantic memory (β= -0.22, p = 0.007 and β= -0.15, p = 0.022, respectively), with no significant findings for the other cognitive domains. There were no significant associations between vascular risk scores and serum biomarkers. Future studies should prospectively examine associations between vascular risk and cognition in other populations and additionally consider other serum biomarkers that may be related to vascular risk and cognition.

Polypharmacy and cognition in older women: less is more?

At present, two-thirds of all community-dwelling adults develop multiple non-communicable diseases in their lifetime, with women at nearly double the risk of multimorbidity involving psychiatric conditions than men. This high burden of somatic-psychiatric multimorbidity among women necessitates frequent and simultaneous use of drugs according to various disease-specific guidelines. This do not necessarily imply overtreatment as co-occurring diseases may warrant treatment by multiple drugs, yet when inappropriate, polypharmacy turns to be particularly detrimental to cognitive health among older women.

Effect of resistance training on cognition in older women with differing levels of resistance training experience: Active Aging Longitudinal Study

BACKGROUND: We aimed to analyze the impact of previous resistance training (RT) experience on cognitive function in older women.METHODS: Sixty-one physically independent women (>60 years) were assigned to one of the three groups: novice (N.=21, untrained individuals with no RT experience or who had not trained for several months), intermediate (N.=22, active individuals with 24 weeks of standardized RT experience), and a non-exercise control group (N.=18, untrained individuals). Novice and intermediate groups underwent a 12-week RT program for the whole-body (eight exercises, three sets, 8-12 repetitions, three alternate days per week). Measurements of cognitive performance (Stroop Test, Trail making Test A and B, letter and category verbal fluency test, Montreal Cognitive Assessment Test) were performed before and after the experimental period. ANCOVA was used for the comparison between groups over time.RESULTS: Improvement in the scores of almost all tests was observed in both novice and intermediate groups after RT (P<0.05), while the control group presented worse MoCA and Stroop Test scores after intervention (P<0.05). Thus, both exercise groups showed significantly different scores from the control group (P<0.05). Interestingly, a larger effect size was found for the intermediate group (ES=0.25-0.66) than for the novice group (ES = 0.16-0.35).CONCLUSIONS: Our results suggest that cumulative effect seems to exist, with more experienced individuals presenting more significant improvements.

Association between endocrine therapy and cognitive decline in older women with early breast cancer: Findings from the prospective CLIMB study

IntroductionStudies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by the older population. Specifically, concerns have been raised regarding the detrimental effects of endocrine therapy (ET) on cognition. Therefore, we investigated cognitive functioning over time and predictors for cognitive decline in older women treated for early breast cancer. MethodsWe prospectively enrolled Dutch women aged ≥70 years with stage I-III breast cancer in the observational CLIMB study. The Mini-Mental State Examination (MMSE) was performed before ET initiation and after 9, 15 and 27 months. Longitudinal MMSE scores were analysed and stratified for ET. Linear mixed models were used to identify possible predictors of cognitive decline. ResultsAmong the 273 participants, the mean age was 76 years (standard deviation 5), and 48% received ET. The mean baseline MMSE score was 28.2 (standard deviation 1.9). Cognition did not decline to clinically meaningful differences, irrespective of ET. MMSE scores of women with pre-treatment cognitive impairments slightly improved over time (significant interaction terms) in the entire cohort and in women receiving ET. High age, low educational level and impaired mobility were independently associated with declining MMSE scores over time, although the declines were not clinically meaningful. ConclusionCognition of older women with early breast cancer did not decline in the first two years after treatment initiation, irrespective of ET. Our findings suggest that the fear of declining cognition does not justify the de-escalation of breast cancer treatment in older women.

Degree of Polypharmacy and Cognitive Function in Older Women with HIV.

The number of people with HIV (PWH) experiencing age-associated comorbidities including those treated with medications and cognitive impairment is increasing. We examined associations between polypharmacy and cognition in older women with HIV (WWH) given their vulnerability to this comorbidity. Cross-sectional analysis capitalizing on Women's Interagency HIV Study data collected between 2014 and 2017. WWH meeting the following criteria were analyzed: age ≥50 years; availability of self-reported non-antiretroviral therapy (ART) medications data; and neuropsychological data. The number of non-ART medications used regularly in the prior 6 months was summed. Polypharmacy was categorized as none/low (0-4), moderate (5-9), or severe (≥10). Multivariable linear regression analyses examined polypharmacy-cognition (T-score) associations in the total sample and among virally suppressed (VS; < 20 copies/mL)-WWH after covariate adjustment for enrollment site, income, depressive symptoms, substance use (smoking, heavy alcohol, marijuana, crack, cocaine, and/or heroin), the Veterans Aging Cohort Study index (indicators of HIV disease and organ system function, hepatitis C virus serostatus), ART use, nadir CD4 count, and specific ART drugs (efavirenz, integrase inhibitors). We included 637 women (median age = 55 years; 72% Black). Ninety-four percent reported ART use in the past 6 months and 75% had HIV RNA <20 copies/mL. Comorbidity prevalence was high (61% hypertension; 26% diabetes). Moderate and severe polypharmacy in WWH were 34% and 24%. In WWH, severe polypharmacy was associated with poorer executive function (p = .007) and processing speed (p = .01). The same pattern of findings remained among VS-WWH. Moderate polypharmacy was not associated with cognition. Moderate and severe polypharmacy were common and associated with poorer executive function and processing speed in WWH. Severe polypharmacy may be a major contributor to the persistence of domain-specific cognitive complications in older WWH above and beyond the conditions that these medications are used to treat.

The Effect of Cumulative Lifetime Estrogen Exposure on Cognition in Depressed Versus Non-Depressed Older Women.

Two-thirds of individuals living with Alzheimer's disease are women. Declining estrogen levels influence mood and cognition. Cumulative lifetime estrogen exposure (CLEE) correlates with cognition later in life. We examined the relationship of CLEE to depression and cognition in older women with major depression compared to non-depressed women. Older women (age ≥60years) with depression were compared to non-depressed women using a lifetime estrogen exposure questionnaire. CLEE was defined as combined durations of reproductive span (age of menopause minus age of menarche) and any post-menopausal hormone replacement therapy use. Higher vs lower CLEE groups were based on a median of 474 months of estrogen exposure. University hospital outpatient research program. 135 women ≥60 years; 64 depressed and 71 non-depressed. Participants completed a comprehensive cognitive test battery. General linear models were used to examine the association between cognitive domain scores and CLEE in depressed and non-depressed women, controlling for age, education, and ethnicity. Depressed and non-depressed groups had significantly different levels of CLEE, measured in months: mean 495.7 (SD 108.6) vs 456.4 (SD 66.0) months, F(1,130) = 5.01, p = .03. Within the non-depressed participants, higher CLEE was associated with improved delayed recall (F(1,59) = 5.94, p = .02, effect size = .61), while no such relationship was observed in the depressed group. Higher CLEE was associated with improvement in delayed recall among non-depressed, but not among depressed participants. This suggests a protective role of estrogen on memory in non-depressed older postmenopausal women. Further research should examine the role of the CLEE in antidepressant response and cognitive decline.

Effects of Resistance Training Program on Muscle Mass and Muscle Strength and the Relationship with Cognition in Older Women

The aim of this study was to study the effects of a resistance training programme on Maximal Dynamic Strength (MDS) and muscle morphology of the upper limbs (UL) and lower limbs (LL), as well as to analyse their association with cognition, in a population of older women. The study had a duration of 24 months and a total of 93 Chilean older women participated. The participants were divided into two groups: the Physical Activity Group (PAG, n = 45, age (X ± SD) 77.93 ± 3.54 years), and the Sedentary Group (SG, n = 48, age (X ± SD) 77.71 ± 3.41 years). The PAG carried out a muscle strength training routine twice per week. The following variables were evaluated: muscle function through maximal dynamic strength (1RM), muscle morphology through arm and calf circumference (AC and CC, respectively), and cognition (Mini Mental State Examination: MMSE). The results show that the SG recorded significant decreases (percent changes; p &lt; 0.05) in the analysed variables: MMSE (−3.5%), MDS in UL (−3.3%), MDS in LL (−4.1%), AC (−4.5%), CC (−4.1%), and BMI (−3.1%). However, the PAG improved significantly in all the analysed variables except in BMI: MMSE (3.9%), MDS in UL (3.6%), MDS in LL (3.5%), AC (1.8%), and CC (2.5%). Moreover, there was a significant association (p &lt; 0.05) between the changes in the muscle strength variables and the changes in cognition level. Therefore, it can be concluded that a two-year muscle strength training programme (load intensity between 30–55% 1RM) in older women improves Maximal Dynamic Strength in UL and LL, as well as muscle mass in arms and calves. Furthermore, it can be asserted that the changes in muscle strength levels could predict the changes in the levels of cognition in older women.

Different glycaemia-related risk factors for incident Alzheimer's disease in men and women with type 2 diabetes-A sex-specific analysis of the Hong Kong diabetes database.

Sexual dimorphism has been reported in the epidemiology, neurobiologic susceptibility and clinical presentation of Alzheimer's disease (AD). As poor glycaemic control is associated with increased risks of AD, we aimed to investigate whether glycaemia-related risk factors also differ between men and women, using a retrospective, sex-specific analysis of a large Chinese cohort with diabetes. A total of 85,514 Chinese individuals with type 2 diabetes (T2D; 46,783 women and 38,731 men), aged ≥60 years, were identified from electronic health records and observed for incident AD. Multivariable Cox regression analysis was used to evaluate the associations with incident AD of several glycaemia-related risk factors, including severe hypoglycaemia, mean HbA1c and indices of HbA1c variability, in men and women separately. Over a median follow-up of 6 years, women had a higher incidence of AD than men (2.3% vs. 1.2%, p < 0.001). Both men and women shared the same independent non-glycaemic clinical predictors, which included older age, lower body mass index and longer duration of diabetes. However, for glycaemia-related risk factors, we observed that severe hypoglycaemia and indices of HbA1c variability were independent predictors of incident AD in women but not in men, and the associations were irrespective of their baseline glycaemic control and duration of diabetes. Our findings highlighted that glycaemia-related risk factors for incident AD differ between men and women with T2D. Strategies to maintain glycaemic stability and avoid severe hypoglycaemia might be especially important to preserve healthy cognition in older women with diabetes.

Effects of a high-DHA multi-nutrient supplement and exercise on mobility and cognition in older women (MOBILE): a randomised semi-blinded placebo-controlled study.

There is a complex interplay between mobility and cognition in older adults. We have previously shown that a high-DHA multi-nutrient supplement improves habitual walking speed, verbal memory and psychomotor response latency in older women. Exercise also improves mobility and cognition in older adults, and n-3 fatty acids and exercise share a range of overlapping biological effects. This study examined for the first time the effects of the high-DHA multi-nutrient supplement and aerobic exercise on mobility and cognition in older women. Women (mean age 67 (sd 8) years) were assigned to the following groups: multi-nutrient (1 g DHA, 160 mg EPA, 240 mg Ginkgo biloba, 60 mg phosphatidylserine, 20 mg d-α tocopherol, 1 mg folic acid and 20 µg vitamin B12 per d, n 13), multi-nutrient and exercise (spin class twice per week, n 14), exercise and placebo (n 12) or placebo (n 12). The multi-nutrient was given for 24 weeks and exercise for 12 weeks. No treatment effects were observed for the primary outcome, habitual walking speed. Improvements in verbal memory and executive function were seen for all treatments groups v. placebo (all, P < 0·05). Significant improvements in self-reported emotional well-being were seen with multi-nutrient and exercise groups v. placebo (P = 0·03). The results suggest that the high-DHA multi-nutrient supplement produces similar improvements in cognitive function to aerobic exercise, offering the intriguing prospect that supplementation may be able to mitigate some of the effects of low physical activity on cognitive function in the elderly.

Effects of Cardiorespiratory Exercise on Cognition in Older Women Exposed to Air Pollution.

The aim was to analyze the effects of cardiorespiratory exercise and air pollution on cognition and cardiovascular markers in four groups of older women: the active/clean air group (AC), the active/polluted air group (AP), the sedentary/clean air group (SC), and the sedentary/polluted air group (SP). Active groups performed a training task based on progressive walking. Prior to and after the experiment, the following parameters were assessed: cognition, by Mini Mental State Examination (MMSE); maximum oxygen uptake (VO2max), estimated by the Six-Minute Walk Test (6mWT); heart rate (HR); and oxygen saturation (SpO2). There were significant differences (p < 0.05) between the AC and the SP in all the MMSE dimensions except “Registration”, and in all the physiological variables (VO2max, SpO2, HR). Aerobic exercise may be a protective factor against the effects that pollution have on cognition and on the mechanisms of oxygen transport.

Assessing brain volume changes in older women with breast cancer receiving adjuvant chemotherapy: a brain magnetic resonance imaging pilot study

BackgroundCognitive decline is among the most feared treatment-related outcomes of older adults with cancer. The majority of older patients with breast cancer self-report cognitive problems during and after chemotherapy. Prior neuroimaging research has been performed mostly in younger patients with cancer. The purpose of this study was to evaluate longitudinal changes in brain volumes and cognition in older women with breast cancer receiving adjuvant chemotherapy.MethodsWomen aged ≥ 60 years with stage I–III breast cancer receiving adjuvant chemotherapy and age-matched and sex-matched healthy controls were enrolled. All participants underwent neuropsychological testing with the US National Institutes of Health (NIH) Toolbox for Cognition and brain magnetic resonance imaging (MRI) prior to chemotherapy, and again around one month after the last infusion of chemotherapy. Brain volumes were measured using Neuroreader™ software. Longitudinal changes in brain volumes and neuropsychological scores were analyzed utilizing linear mixed models.ResultsA total of 16 patients with breast cancer (mean age 67.0, SD 5.39 years) and 14 age-matched and sex-matched healthy controls (mean age 67.8, SD 5.24 years) were included: 7 patients received docetaxel and cyclophosphamide (TC) and 9 received chemotherapy regimens other than TC (non-TC). There were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group pre-chemotherapy (p > 0.05). Exploratory hypothesis generating analyses focusing on the effect of the chemotherapy regimen demonstrated that the TC group had greater volume reduction in the temporal lobe (change = − 0.26) compared to the non-TC group (change = 0.04, p for interaction = 0.02) and healthy controls (change = 0.08, p for interaction = 0.004). Similarly, the TC group had a decrease in oral reading recognition scores (change = − 6.94) compared to the non-TC group (change = − 1.21, p for interaction = 0.07) and healthy controls (change = 0.09, p for interaction = 0.02).ConclusionsThere were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group; however, exploratory analyses demonstrated a reduction in both temporal lobe volume and oral reading recognition scores among patients on the TC regimen. These results suggest that different chemotherapy regimens may have differential effects on brain volume and cognition. Future, larger studies focusing on older adults with cancer on different treatment regimens are needed to confirm these findings.Trial registrationClinicalTrials.gov, NCT01992432. Registered on 25 November 2013. Retrospectively registered.

Socially Housed Female Macaques: a Translational Model for the Interaction of Chronic Stress and Estrogen in Aging.

Estrogen's role in cognitive aging remains unclear. Despite evidence implicating stress in pathological aging, the interaction of stress with estrogen on cognition in older women has received little attention, and few animal models exist with which to examine this interaction. We present evidence that aging socially subordinate female macaques that experience chronic psychosocial stress constitute a suitable model to investigate this. First, we review studies showing that estrogen modulates cognition in animal models, as well as studies demonstrating that estrogen's action on certain types of cognition is impaired by stress. Next, we discuss data showing that middle-aged socially subordinate female macaques exhibit distinct stress-induced phenotypes, and review our investigations indicating that estrogen modulates behavior and physiology differently in subordinate female monkeys. We conclude that socially housed female macaques represent a translational animal model for investigating the interplay of chronic stress and estrogen on cognitive aging in women.

Strategies for Preventing Cognitive Decline in Healthy Older Adults

Many advances have been made in the understanding of age-related changes in cognition. As research details the cognitive and neurobiological changes that occur in aging, there is increased interest in developing and understanding methods to prevent, slow, or reverse the cognitive decline that may occur in normal healthy older adults. The Institute of Medicine has recently recognized cognitive aging as having important financial and public health implications for society with the increasing older adult population worldwide. Cognitive aging is not dementia and does not result in the loss of neurons but rather changes in neurotransmission that affect brain functioning. The fact that neurons are structurally intact but may be functionally affected by increased age implies that there is potential for remediation. This review article presents recent work using medication-based strategies for slowing cognitive changes in aging. The primary method presented is a hormonal approach for affecting cognition in older women. In addition, a summary of the work examining modifiable lifestyle factors that have shown promise in benefiting cognition in both older men and women is described. Much work remains to be done so that evidence-based recommendations can be made for slowing cognitive decline in healthy older adults. The success of some of these methods thus far indicates that the brains of healthy older adults are plastic enough to be able to respond to these cognitive decline prevention strategies, and further work is needed to define the most beneficial methods.

Multimodal physical activity increases brain-derived neurotrophic factor levels and improves cognition in institutionalized older women.

Physical activity has been proposed as a promising intervention to improve cognition and decrease the risk of dementia in older adults. Brain-derived neurotrophic factor (BDNF) appears to mediate, at least partially, these effects of exercise. However, intervention studies of the effects of multimodal exercises on cognition and BDNF levels are scarce and composed by small samples. Thus, the generalization of the conclusions of these studies depends on the reproducibility of the results. In order to contribute to the knowledge on the field, the present study evaluated the effects of a physical activity intervention composed by muscle strengthening and aerobic conditioning on BDNF levels and cognition in older women. Independent and non-demented subjects (≥75years) were assigned to a 3-month physical activity intervention (n=22, 60min exercise sessions three times a week) or to a control condition (n=10, no exercise). Clinical (anxiety and depression symptoms), neuropsychological (Digit Span, Stroop, Trail Making, and Contextual Memory tests), physical (upper and lower limb strength, aerobic conditioning), and physiological (serum BDNF) parameters were evaluated immediately before, 1month, and 3months after starting intervention. Results indicated that controls had stable levels for all measured variables, whereas the intervention group improved on physical fitness, depressive symptoms, cognitive performance, and BDNF levels. Moreover, a linear regression identified an association between aerobic conditioning and BDNF levels. In conclusion, combined muscle strengthening and aerobic conditioning was able to improve cognitive performance and increase BDNF levels. Aerobic conditioning seems to be an important mediator of these outcomes.

Chronic condition as a mediator between metabolic syndrome and cognition among community-dwelling older adults: The moderating role of sex.

Metabolic syndrome and chronic conditions are significant predictors of cognition; however, few studies have examined how they work together in predicting cognition in old age. Therefore, the present study examines whether a chronic condition mediates the association between metabolic syndrome and cognition. In addition, it discusses the moderating role of sex in the relationships between metabolic syndrome, chronic conditions and cognition. Secondary analysis was carried out of data from the Malaysian national survey that involved 2322 community residents aged 60 years or older in Peninsular Malaysia. Cognition was measured by the digit symbol substitution test. Metabolic syndrome was assessed by five biomarkers: triglyceride, fasting blood sugar, systolic blood pressure, cholesterol ratio and body mass index. Chronic conditions were assessed by self-reported medical history. The structural equation modeling technique was used to analyze the mediation and moderation tests. The number of chronic conditions partially mediated the association between metabolic syndrome and cognition. Men and women did not differ in the relationship between metabolic syndrome and cognition; however, the number of chronic conditions was found to be negatively associated with cognition in older women, but not in men. Metabolic syndrome might increase the likelihood of older adults to suffer from more chronic conditions; these responses might reduce their cognition. To prevent cognitive decline in old age, specific intervention to minimize the number of chronic conditions by reducing their vascular risk factors is warranted, especially among older women. Geriatr Gerontol Int 2017; 17: 1914-1920.

Sarcopenia Is Associated with High Pulse Pressure in Older Women.

Introduction. Sarcopenia is a geriatric syndrome associated with impairment of muscle function, metabolism, and cognition in older women. Recent studies have shown a relationship between changes in muscle mass and the cardiovascular system. However, this relationship has not been fully elucidated. Methods. One hundred and thirty community-dwelling Brazilian older women (65.4 ± 6.3 years) were recruited to participate in this study. Data on body composition (via bioelectrical impedance measurements), cardiovascular parameters (using an automatic and noninvasive monitor), and muscle function (using a 3-meter gait speed test) were measured. Results. Sarcopenic older women (n = 43) presented higher levels of pulse pressure (PP) (60.3 ± 2.6 mmHg) and lower muscle function (0.5 ± 0.0 m/s) compared with nonsarcopenic subjects (n = 87) (53.7 ± 1.5 mmHg; 0.9 ± 0.0 m/s) (P < 0.05). Linear regression analysis demonstrated a significantly negative association between skeletal muscle index (SMI) and PP levels (β = −226, P < 0.05). Furthermore, sarcopenic older women showed a 3.1-fold increased risk of having higher PP levels compared with nonsarcopenic women (IC = 1.323–7.506) (P < 0.05). Conclusion. Sarcopenic older women showed lower muscle function and higher cardiovascular risk due to increased PP levels compared with nonsarcopenic subjects.

Sleep duration in midlife and later life in relation to cognition.

To evaluate associations between sleep duration at midlife and later life and change in sleep duration over time and cognition in older women. Participants reported sleep duration in 1986 and 2000, and a subgroup of older participants began cognitive testing in 1995 to 2001; follow-up testing was conducted three times, at 2-year intervals. Prospective Nurses' Health Study cohort. Female nurses aged 70 and older free of stroke and depression at the initial cognitive assessment (N = 15,385). Validated, telephone-based cognitive battery to measure cognitive function; four repeated assessments over 6 years were averaged to estimate overall cognition at older ages, and trajectories of cognitive change were evaluated over follow up. Extreme sleep durations in later life were associated with worse average cognition (P < .001 for the quadratic term for a global score averaging all six cognitive tests). For example, women sleeping 5 h/d or less had worse global cognition than those sleeping 7 h/d, as did women sleeping 9 h/d or more; differences were equivalent to nearly 2 additional years of age. Associations were similar, although slightly attenuated, for sleep duration in midlife. Women whose sleep duration changed by 2 h/d or more over time had worse cognition than women with no change in sleep duration (e.g., for the global score, P < .001 for the quadratic term). Sleep duration was not associated with trajectories of cognitive function over 6 years, which might be attributable to short follow-up for detecting cognitive decline. Extreme sleep durations at midlife and later life and extreme changes in sleep duration over time appear to be associated with poor cognition in older women.

Long-term intake of nuts in relation to cognitive function in older women.

Nuts contain nutrients that may benefit brain health; thus, we examined long-term intake of nuts in relation to cognition in older women. Population-based prospective cohort study. Academic research using data from the Nurses' Health Study. Nut intake was assessed in a food-frequency questionnaire beginning in1980, and approximately every four years thereafter. Between 1995-2001, 16,010 women age 70 or older (mean age = 74 years) without a history of stroke were administered 4 repeated telephone-based cognitive interviews over 6 years. Our final sample included 15,467 women who completed an initial cognitive interview and had complete information on nut intake. The Telephone Interview for Cognitive Status (TICS), a global score averaging the results of all tests (TICS, immediate and delayed verbal recall, category fluency, and attention), and a verbal memory score averaging the results of tests of verbal recall. In multivariable-adjusted linear regression models, higher long-term total nut intake was associated with better average cognitive status for all cognitive outcomes. For the global composite score combining all tests, women consuming at least 5 servings of nuts/week had higher scores than non-consumers (mean difference=0.08 standard units, 95% confidence interval 0.00-0.15; p-trend=0.003). This mean difference of 0.08 is equivalent to the mean difference we find between women 2 years apart in age. Long-term intake of nuts was not associated with rates of cognitive decline. Higher nut intake may be related to better overall cognition at older ages, and could be an easily-modifiable public health intervention.

Dietary intake of vitamin D and cognition in older women

Serum vitamin D concentrations are associated with global cognitive function among older adults. The benefits of vitamin D intake to treat or prevent cognitive impairment remain unknown. The objective of this cross-sectional study was to determine whether weekly dietary intake of vitamin D could be associated with global cognitive performance among older adults. A total of 5,596 community-dwelling women (mean age 80.5 ± 0.1 years) free of vitamin D drug supplements from the Epidémiologie de l'Ostéoporose (EPIDOS) study were divided into 2 groups according to baseline weekly vitamin D dietary intake (either inadequate <35 μg/wk or recommended ≥35μg/wk). Weekly vitamin D dietary intakes were estimated from a self-administered food frequency questionnaire. Cognitive impairment was defined as a Pfeiffer Short Portable Mental State Questionnaire (SPMSQ) score <8. Age, body mass index, sun exposure at midday, season, disability, number of chronic diseases, hypertension, depression, use of psychoactive drugs, and education level were considered as potential confounders. Compared to women with recommended weekly vitamin D dietary intakes (n = 4,802; mean age 80.4 ± 3.8 years), women with inadequate intakes (n = 794; mean age 81.0 ± 3.8 years) had a lower mean SPMSQ score (p < 0.001) and more often had an SPMSQ score <8 (p = 0.002). We found an association between weekly vitamin D dietary intake and SPMSQ score (β = 0.002, p < 0.001). Inadequate weekly vitamin D dietary intakes were also associated with cognitive impairment (unadjusted odds ratio = 1.42 with p = 0.002; full adjusted odds ratio = 1.30 with p = 0.024). Weekly dietary intake of vitamin D was associated with cognitive performance in older women.

Total antioxidant capacity of diet in relation to cognitive function and decline

Epidemiologic evidence on the association of individual antioxidant vitamins and cognition is inconsistent. We evaluated the total antioxidant capacity of diets on the basis of the ferric-reducing antioxidant power (FRAP) assay in relation to cognition in older women. Starting in 1995, we used a telephone-based cognitive assessment to evaluate cognitive function on 3 occasions at 2-y intervals in 16,010 participants aged ≥70 y in the Nurses' Health Study. In 1980, and every 4 y thereafter, we collected dietary information by using a semiquantitative food-frequency questionnaire (FFQ). For each participant, we combined FFQ data with food- and supplement-specific FRAP values to obtain FRAP scores; these data were averaged from 1980 until the initial cognitive interview to reflect long-term diets. We used multivariable-adjusted linear regression to estimate mean differences in initial cognitive function and slopes of decline across quintiles of FRAP scores. In multivariable-adjusted models, there was an association between higher total FRAP scores and better cognitive function at the first interview (P for trend = 0.003 for global scores with all cognitive tests combined; mean difference = 0.04 standard units; 95% CI: 0.01, 0.08 standard units, comparing the highest and lowest quintiles). A weaker association was observed for dietary FRAP scores (excluding supplements) and initial global scores (P for trend = 0.05). However, prospective analyses of cognitive decline indicated no associations with total or dietary FRAP scores in models adjusted for multiple potential confounders (P for trend = 0.3 and 0.5 for global scores, respectively). We observed no clear evidence of a consistent association between the total antioxidant capacity of diets and cognition in this cohort of older women.