Impairment In Older Women Research Articles

P3‐119: Potentially inappropriate medications and cognitive impairment in older women

P3‐119: Potentially inappropriate medications and cognitive impairment in older women

O4‐08‐05: 20‐year alcohol consumption patterns and cognitive impairment in older women

O4‐08‐05: 20‐year alcohol consumption patterns and cognitive impairment in older women

Serum oxidized low-density lipoprotein level and risk of cognitive impairment in older women

We investigated the association between serum level of oxidized low-density lipoprotein (oxLDL) and risk of cognitive impairment (dementia or mild cognitive impairment) among 572 nondemented community-dwelling women from a prospective cohort study of aging. After 5 years of follow-up, 228 (39.9%) developed cognitive impairment; and this did not differ by tertile of baseline oxLDL level (highest compared with lowest tertile 38.2% vs. 39.5%; odds ratio, 0.90; 95% confidence interval, 0.63–1.43). Multivariate adjustment produced similar results (odds ratio, 0.91; 95% confidence interval, 0.60–1.39). These findings suggest that increased levels of serum oxLDL are not associated with a greater risk of incident cognitive impairment in older women.

Sleep-Disordered Breathing and Cognitive Impairment in Older Women--Reply

Sleep-Disordered Breathing and Cognitive Impairment in Older Women--Reply

Sleep-Disordered Breathing and Cognitive Impairment in Older Women

Sleep-Disordered Breathing and Cognitive Impairment in Older Women

Circadian activity rhythms and risk of incident dementia and mild cognitive impairment in older women

Previous cross-sectional studies have observed alterations in activity rhythms in dementia patients but the direction of causation is unclear. We determined whether circadian activity rhythms measured in community-dwelling older women are prospectively associated with incident dementia or mild cognitive impairment (MCI). Activity rhythm data were collected from 1,282 healthy community-dwelling women from the Study of Osteoporotic Fractures (SOF) cohort (mean age 83 years) with wrist actigraphy for a minimum of three 24-hour periods. Each participant completed a neuropsychological test battery and had clinical cognitive status (dementia, MCI, normal) adjudicated by an expert panel approximately 5 years later. All analyses were adjusted for demographics, body mass index (BMI), functional status, depression, medications, alcohol, caffeine, smoking, health status, and comorbidities. After 4.9 years of follow-up, 195 (15%) women had developed dementia and 302 (24%) had developed MCI. Older women with decreased activity rhythms had a higher likelihood of developing dementia or MCI when comparing those in the lowest quartiles of amplitude (odds ratio [OR] = 1.57; 95% CI, 1.09-2.25) or rhythm robustness (OR = 1.57; 95% CI, 1.10-2.26) to women in the highest quartiles. An increased risk of dementia or MCI (OR = 1.83; 95% CI, 1.29-2.61) was found for women whose timing of peak activity occurred later in the day (after 3:51 PM) when compared to those with average timing (1:34 PM-3:51 PM). Older, healthy women with decreased circadian activity rhythm amplitude and robustness, and delayed rhythms have increased odds of developing dementia and MCI. If confirmed, future studies should examine whether interventions (physical activity, bright light exposure) that influence activity rhythms will reduce the risk of cognitive deterioration in the elderly.

Circadian activity rhythms and risk of incident dementia and mild cognitive impairment in older women

Circadian activity rhythms and risk of incident dementia and mild cognitive impairment in older women

Combined Impact of Geriatric Syndromes and Cardiometabolic Diseases on Measures of Functional Impairment

Examine the independent and joint effects of geriatric syndromes (GS) and cardiometabolic diseases (CMDs) on functional impairment. Cross-sectional analysis of baseline data from the Women's Health Initiative, including 62,829 women aged 65 years or older. GS (urinary incontinence, falls, and depression measured by the shortened Center for Epidemiological Studies-Depression scale/Diagnostic Interview Schedule screening instrument) and CMD (coronary artery disease, coronary heart failure, and diabetes) were self-reported. Physical and social functioning and general health subscales of the Short Form-36 dichotomized at the median for the study sample were used to assess functional impairment. Additive interaction between burden of GS and CMD was assessed using logistic regression models. Forty-three percent of women had at least one GS; 14.1% had at least one CMD; and 6.9% had at least one of each. Compared with women with no GS or CMD, women with one or more GS but no CMD were as likely to have physical functioning impairments (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.73, 1.86) as those with CMD alone (OR = 1.97; CI = 1.84, 2.10). The association with social functioning was stronger for GS alone (OR = 2.10; CI = 2.02, 2.18) compared with CMD (OR = 1.60; CI = 1.50, 1.71). The association with general health was stronger for CMD alone (OR = 2.15; CI = 2.01, 2.29) compared with GS (OR = 1.68; CI = 1.62, 1.74). Significant interactions between GS and CMD were observed for all functional measures with 20%-30% of observed ORs attributable to additive interaction. GSs alone are associated with functional impairment in older women; the association is stronger in the presence of even one CMD.

Vitamin D and older adults

This issue of Neurology ® features 3 studies on the possible link between vitamin D and cognition (or thinking) in older adults. The first study looked at the possible link between vitamin D levels and cognition in older women. Dr. Annweiler and coauthors1 studied 752 women aged 75 years and older who lived in France. Levels of 25(OH)D, the form of vitamin D found in the blood, were measured. Patients took a cognitive test called Pfeiffer's Short Portable Mental State Questionnaire (SPMSQ). In this study, low levels (or deficiency) of vitamin D were defined as a 25(OH)D blood level less than 10 (ng/mL). Cognitive impairment was defined as a score of less than 8 (out of 10 points) on the SPMSQ. Seventeen percent had vitamin D deficiency. Women with vitamin D deficiency had lower scores on the SPMSQ and were more likely to have cognitive impairment than those without vitamin D deficiency. The authors found that vitamin D deficiency was associated with cognitive impairment in older women. The second study looked for links between vitamin D levels, cognition, and strokes in older men and women. Dr. Buell and coauthors2 studied 318 men and women between 65 and 99 years old in the Boston area. These patients had low income levels, lower functional status, and need for food or personal care. The researchers checked 25(OH)D blood levels and did cognitive testing. Patients had pictures taken of the brain …

Association of vitamin D deficiency with cognitive impairment in older women

The association between low serum 25-hydroxyvitamin D [25(OH)D] concentration and cognitive decline has been investigated by only a few studies, with mixed results. The objective of this cross-sectional population-based study was to examine the association between serum 25(OH)D deficiency and cognitive impairment while taking confounders into account. The subjects, 752 women aged > or =75 years from the Epidémiologie de l'Ostéoporose (EPIDOS) cohort, were divided into 2 groups according to serum 25(OH)D concentrations (either deficient, <10 ng/mL, or nondeficient, > or =10 ng/mL). Cognitive impairment was defined as a Pfeiffer Short Portable Mental State Questionnaire (SPMSQ) score <8. Age, body mass index, number of chronic diseases, hypertension, depression, use of psychoactive drugs, education level, regular physical activity, and serum intact parathyroid hormone and calcium were used as potential confounders. Compared with women with serum 25(OH)D concentrations > or =10 ng/mL (n = 623), the women with 25(OH)D deficiency (n = 129) had a lower mean SPMSQ score (p < 0.001) and more often had an SPMSQ score <8 (p = 0.006). There was no significant linear association between serum 25(OH)D concentration and SPMSQ score (beta = -0.003, 95% confidence interval -0.012 to 0.006, p = 0.512). However, serum 25(OH)D deficiency was associated with cognitive impairment (crude odds ratio [OR] = 2.08 with p = 0.007; adjusted OR = 1.99 with p = 0.017 for full model; and adjusted OR = 2.03 with p = 0.012 for stepwise backward model). 25-Hydroxyvitamin D deficiency was associated with cognitive impairment in this cohort of community-dwelling older women.

The Metabolic Syndrome and Development of Cognitive Impairment Among Older Women

Several studies support a role for cardiovascular risk factors in cognitive aging. The metabolic syndrome, a constellation of cardiovascular risk factors, is common in elderly people. A growing but conflicting body of literature suggests that the metabolic syndrome may be associated with cognitive impairment. To investigate the association between the metabolic syndrome and its components and incident cognitive impairment in older women. We prospectively determined if the metabolic syndrome and its components were associated with a 4-year risk of developing cognitive impairment (dementia, mild cognitive impairment, or low global cognitive test score). The study was conducted at 180 clinical centers in 25 countries. A total of 4895 older women (mean age, 66.2 years) with osteoporosis who were part of an ancillary study to determine clinically relevant cognitive impairment were included in this study. These women were free of baseline cognitive impairment and had metabolic syndrome component measures. Clinically significant cognitive impairment was defined to include women with clinically adjudicated dementia or MCI and women who had a Short Blessed test score greater than 6 (consistent with impairment), but whose cases were not clinically adjudicated. Logistic regression analysis was used to examine the association between presence of the metabolic syndrome and development of clinically significant cognitive impairment. A total of 497 women (10.2%) had the metabolic syndrome and, of these, 36 (7.2%) developed cognitive impairment compared with 181 (of 4398 or 4.1%) without the syndrome (age-adjusted odds ratio, 1.66; 95% confidence interval, 1.14-2.41). The mean (SD) number of metabolic syndrome components for all women was 1.0 (1.1); 518 women (10.6%) were obese, 895 (18.3%) had hypertriglyceridemia, 1200 (24.5%) had low high-density lipoprotein cholesterol levels, 1944 (39.7%) had high blood pressure, and 381 (7.8%) had high fasting blood glucose levels. There was a 23.0% age-adjusted increase in the risk of developing cognitive impairment (odds ratio, 1.23; 95% confidence interval, 1.09-1.39) per unit increase in the number of components. Further multivariable adjustment somewhat reduced the effect. We found an association between the metabolic syndrome and the number of components and risk of developing cognitive impairment in older women. Additional studies are needed to determine if screening and close management of these at-risk elderly women would diminish the incidence of cognitive impairment.

Sleep‐Disordered Breathing and Cognition in Older Women

To investigate the association between objectively measured sleep-disordered breathing (SDB) and cognitive impairment in community-dwelling older women and to determine whether the apolipoprotein E (APOE) epsilon4 allele modifies this association. Cross-sectional. Participants' homes and two sites of the Study of Osteoporotic Fractures (SOF). Four hundred forty-eight women with a mean age+/-standard deviation (SD) of 82.8+/-3.4. Participants completed the Mini-Mental State Examination (MMSE), Trail Making Test Part B (Trails B), and polysomnography (PSG). SDB indices were the apnea-hypopnea index (AHI), the central apnea index (CAI), and oxygen saturation (SaO2) nadir less than 80%. APOE epsilon4 was determined for a subset of 242 women. Cognitive impairment was defined as 1.5 SDs or more from the sample mean on either cognitive test (MMSE or Trails B). All SDB indices were associated with cognitive impairment according to the MMSE (AHI (per SD, odds ratio (OR)=1.4, 95% confidence interval (CI)=1.03-1.9), AHI of > or = 30 (OR=3.4, 95% CI=1.4-8.1), SaO2 nadir < 80% (OR=2.7, 95% CI=1.1-6.6), and CAI (per SD, OR=1.4, 95% CI=1.1-1.7)). Weaker, nonsignificant associations emerged between SDB and Trails B. In women who completed genotyping, each SD increase in AHI was associated with 70% greater odds of cognitive impairment according to the MMSE (OR=1.7, 95% CI=1.2-2.6). Women with the epsilon4 allele had a nearly five times greater odds of impairment (per SD, OR=4.6, 95% CI-1.0-20.7); the association was smaller and nonsignificant in women without the epsilon4 allele (per SD, OR=1.5, 95% CI-0.9-2.4; P for interaction=.08). SDB is an important risk factor for cognitive impairment in older women, especially those with the APOE epsilon4 allele. Mechanisms linking these disorders need to be identified.

Serum α-tocopherol, concurrent and past vitamin E intake, and mild cognitive impairment

Associations of past dietary vitamin E intake, past and current vitamin E supplement use, and current serum alpha-tocopherol levels, with memory (amnestic) and mixed-domain cognitive impairment in older women, ascertained from an in-depth neuropsychological assessment, were explored. This analysis used baseline data from 526 participants in a single-site ancillary study to the Women's Health Initiative, the Cognitive Change in Women study. In bivariate analyses, neither past dietary vitamin E intake (<8 mg/day vs more) nor current vitamin E supplement use was associated with impairment. Women who did not use vitamin E supplements at Women's Health Initiative baseline had an increased risk of mixed-domain impairment (odds ratio [OR] 1.88; 95% CI 1.09 to 3.23). This association lost significance when adjusting for age, education, American National Adult Reading Test (ANART) score, and time between measurement of past vitamin E use and cognitive testing. Concurrent serum alpha-tocopherol had significant cross-sectional associations with both memory and mixed impairments, with women in the lowest quartile of serum alpha-tocopherol nearly twice as likely to show signs of memory (1.92; 1.24 to 2.97) and mixed-domain (2.01; 1.13 to 3.57) impairments. In multivariable models adjusting for age, education, and ANART score, the lowest quartile of serum alpha-tocopherol was associated with increased odds of memory impairment (OR 2.02; 1.27 to 3.20) and mixed impairments (OR 2.00; 1.04 to 3.85). Additional adjustment for APOE e4 did not affect these results. There was weak or no evidence of a protective effect of previous vitamin E intake on cognitive function. However, the association of low concurrent serum alpha-tocopherol with memory and mixed impairment merits further exploration.

Previous vitamin E supplement intake and memory impairment: A women’s health initiative ancillary study

Background: There are plausible mechanisms by which Vitamin E could protect against dementia or cognitive loss, but studies of such associations have been inconsistent. A previous interim cross-sectional analysis of our data found serum alpha tocopherol ( -toc) , but not current Vitamin E supplement use, to be associated with memory impairment in older women. Objective: We examine the association of past supplemental and dietary Vitamin E intake with cognitive impairment in 544 women age 60 and over, who are participants in a Women’s Health Initiative (WHI) Ancillary Study. Methods: Vitamin E supplement intake was ascertained by interview, and dietary intake by food frequency questionnaire, at WHI baseline. Women were enrolled in the cognitive function ancillary study an average of 5.6 (SD 2.2) years later, at which time an extensive cognitive test battery was administered and supplement use practices updated. Cognitive tests were classified by predominant functional domain: Memory, Executive Function, Language, Attention, and Visual Function. Women scoring 2 standard deviations or more below established ageand education-specific norms on one or more tests in a given domain were considered to have signs of impairment in that domain. Results: In bivariate analyses, mean previous supplemental -toc intake was 24-60 mg/day lower in women with memory, executive function, or language impairment compared to those without, but the difference was statistically significant only for memory impairment (mean intake 84 vs 157 mg/day; p .02). In logistic regression models adjusting for age, education, race, and time between -toc and cognitive function measurements, previous supplemental -toc was inversely associated with risk of memory impairment (p .045) such that an additional 100mg/day -toc would be associated with a relative odds of memory impairment of 0.9. In similar models, neither previous dietary, nor current supplemental -toc, were associated with memory impairment. Conclusions: Previous, but not current supplemental -toc intake is associated with a modestly reduced risk of memory impairment in older women. Possible reasons could include: previous intake acting as a surrogate for duration; latency period between -toc exposure and effects on memory or need for exposure to occur at a particular time (e.g. midlife) for maximum benefit.

L6: Influences of Past and Current Vitamin E Intake on Serum α-Tocopherol and Its Association with Cognitive Impairment in Older Women: A WHI Ancillary Study

L6: Influences of Past and Current Vitamin E Intake on Serum α-Tocopherol and Its Association with Cognitive Impairment in Older Women: A WHI Ancillary Study

Effect of Raloxifene on Prevention of Dementia and Cognitive Impairment in Older Women: The Multiple Outcomes of Raloxifene Evaluation (MORE) Randomized Trial

This investigation examined whether raloxifene, a selective estrogen receptor modulator, affects the risk for Alzheimer's disease. The Multiple Outcomes of Raloxifene Evaluation was a randomized, placebo-controlled trial among postmenopausal women with osteoporosis. The effect of raloxifene (60 or 120 mg/day) on vertebral fractures was the primary outcome. Development of mild cognitive impairment and dementia was a secondary outcome. Women were given clinical and cognitive evaluations at baseline and annually. After 3 years, among the 5,386 women enrolled at participating sites, those who had clinical symptoms of dementia or scored in the lowest 10th percentile on cognitive screening were evaluated by a blinded dementia specialist and had brain scans and laboratory tests to evaluate dementia etiology. Dementia was diagnosed by a blinded adjudication committee. Of the 5,386 women, 5,153 (95.7%) were classified as cognitively normal, 181 (3.4%) had mild cognitive impairment, and 52 (1.0%) had dementia, 36 with Alzheimer's disease. Compared to those taking placebo, women receiving 120 mg/day of raloxifene had a 33% lower risk of mild cognitive impairment (relative risk, 0.67; 95% confidence interval [CI], 0.46-0.98) and somewhat lower risks of Alzheimer's disease (relative risk=0.52, 95% CI=0.22-1.21) and any cognitive impairment (relative risk=0.73, 95% CI=0.53-1.01). Risks of mild cognitive impairment, Alzheimer's disease, and any impairment were not significantly different in the group taking 60 mg/day of raloxifene. Raloxifene at a dose of 120 mg/day, but not 60 mg/day, resulted in reduced risk of cognitive impairment in postmenopausal women.

Diabetes, impaired fasting glucose, and development of cognitive impairment in older women.

To investigate the association between diabetes and impaired fasting glucose (IFG) and cognition and risk of developing both dementia and mild cognitive impairment (MCI) in older women. The authors analyzed data from a 4-year randomized trial of raloxifene among 7,027 osteoporotic postmenopausal women (mean age, 66.3 years) at 178 sites. Diabetes was defined by history, fasting blood glucose > or =7.0 mmol/L (> or =126 mg/dL), or use of hypoglycemic agents; IFG was defined as fasting glucose <7.0 mmol/L but >6.11 mmol/L (110 mg/dL); all others were considered to have normal glucose (NG). The main outcome was baseline and 4-year change on five standardized cognitive tests (z scores with lower scores indicating worse performance) and risk of developing clinically significant impairment (dementia, mild cognitive impairment, or very low cognitive score). A total of 267 (3.8%) women had diabetes and 297 (4.2%) had IFG. Women with IFG had worse baseline cognitive scores compared to women with NG but better scores than diabetics (age-adjusted composite z score based on five tests: NG 0.40, 95% CI 0.30 to 0.49; IFG 0.14, 95% CI -0.36 to 0.64; diabetics -0.78, 95% CI -1.23 to -0.33; p < 0.001). There was greater 4-year decline among diabetics (age and treatment-adjusted composite z score: NG -0.05, 95% CI -0.16 to 0.05; IFG 0.11, 95% CI -0.53 to 0.75; diabetics -1.00, 95% CI -1.50 to -0.50; p = 0.001). Further adjustment for education, race, and depression led to similar results. Risk of developing cognitive impairment among women with IFG or diabetes was increased by almost twofold (age and treatment-adjusted OR = 1.64; 95% CI 1.03 to 2.61 for IFG; OR = 1.79; 95% CI 1.14 to 2.81 for diabetics). Diabetic as well as pre-diabetic women have impaired cognitive performance and greater risk of developing cognitive impairment.

O3-01-01 Glycosylated hemoglobin level and development of cognitive impairment in older women

O3-01-01 Glycosylated hemoglobin level and development of cognitive impairment in older women

Is there a relationship between fat-free soft tissue mass and low cognitive function? Results from a study of 7,105 women.

To test the hypothesis that low fat-free soft tissue mass and cognitive impairment are independently associated. Cross-sectional study. Five geographic areas of France. Seven thousand one hundred five community-dwelling women aged 75 and older recruited from electoral rolls between 1992 and 1994. Fat-free soft tissue mass, body fat mass, and bone mineral density were measured using dual-energy x-ray absorptiometry. Study participants were assessed for cognitive impairment using the Short Portable Mental Status Questionnaire and divided into two groups according to their scores. Logistic regression models were used to calculate multivariate-adjusted differences in body composition between two groups of subjects according to their cognitive function. After adjustment for confounders, compared with women in the highest quartile of fat-free soft tissue mass, women in the lowest quartile had an odds ratio of 1.43 (95% confidence interval (CI) = 1.07-1.91) for cognitive impairment. Low fat mass was also associated with lower cognitive function, with an odds ratio of 1.35 (95% CI = 1.01-1.79) for the lower quartile of fat mass compared with the highest quartile. There was no association between cognitive impairment and bone mineral density. This finding supports the hypothesis that low muscle mass is associated with cognitive impairment in older women. These two components represent major causes of frailty and functional decline in older people and could have some common mechanisms. Nevertheless, these results do not predict the causal variable.

Estrogen receptor 1 polymorphisms and risk of cognitive impairment in older women

Background: Several genes associated with sporadic Alzheimer’s disease have been identified; however, approximately 50% of genetic factors remain unidentified. We investigated whether estrogen receptor 1 (ESR1) polymorphisms are associated with risk of developing cognitive impairment in older women. Methods: A total of 2625 women ≥ 65 years of age completed a modified Mini-Mental Status Exam (mMMSE) at baseline and at 6–8 years of follow-up. We defined cognitive impairment as a mMMSE decline of ≥ 3 points, follow-up score ≤ 20, or a history of physician-diagnosed dementia. The ESR1 polymorphisms, PvuII (P or p) and XbaI (X or x), were coded so that the capital letter signifies the absence of the restriction site. Results: Women with a p allele had a greater age, education, and baseline-score adjusted decline in mMMSE (for PP, Pp, and pp, respectively: .6 ± .1, .8 ± .1, and .9 ± .1 points, p for trend = .01); women with at least one x allele also had greater score decline (XX, Xx, and xx: .7 ± .1, .7 ± .1, and .9 ± .1 points, p for trend = .02). Six percent ( n = 166) of the women developed cognitive impairment. Compared to those who did not develop impairment, more women who developed cognitive impairment had a p allele (62% vs. 56%, p = .03; adjusted odds ration (OR) = 1.33; 95% confidence interval [CI], 1.03-1.72) or an x allele (70% vs. 64%, p = .03; adjusted OR = 1.38; 95% CI, 1.06-1.81). There was no interaction with current estrogen use, or with serum estradiol level and ESR1 polymorphisms ( p > .10). Conclusions: Estrogen receptor 1 polymorphisms are associated with risk of developing cognitive impairment. More research is needed to determine the mechanism whereby ESR1 polymorphisms or linked genes influence cognitive function in older women.