Lower Risk Of Cognitive Decline Research Articles

Social interaction and cognitive decline: Results of a 7-year community intervention

IntroductionThere are few intervention studies that demonstrated linking social participation to lower risk of cognitive decline. We examined prospectively the protective effect of a community intervention program promoting social participation on the incidence of cognitive disability. MethodsThe baseline was established in a survey of community-dwelling older people aged 65 years old or more in July 2006 (2793 respondents, response rate 48.5%). The setting was Taketoyo town in Japan, where municipal authorities launched an intervention that was based on the establishment of community-based centers called “salons,” where the town's senior residents could congregate and participate in social activities, ranging from arts and crafts, games, and interactive activities with preschool children. Three salons were established in May 2010, and a total of 10 salons were in operation by 2013. We recorded the frequency of salon participation among survey respondents till 2013 and conducted two follow-up surveys (in 2010 and 2013) to collect information about health status and behaviors. The onset of cognitive disability was followed from May 2007 to January 2014. We used the marginal structural models to evaluate the effect of program. ResultsThe range of prevalence of cognitive disability was from 0.2% to 2.5% during the observation period. The proportion of respondents who participates to salons increased over time to about 11.7%. The frequency of salon participation was protectively associated with cognitive decline, even after adjusting for time-dependent covariates and attrition (odds ratio = 0.73, 95% confidence interval: 0.54–0.99). DiscussionOur study suggests that operating community salons that encourage social interactions, light physical activity, and cognitive activities among older participants may be effective for preventing cognitive decline. In future studies, we need to understand what sorts of activities (e.g., those involving light physical activity vs. purely intellectual activities) are most effective in maintaining cognitive function.

Which type of social activities may reduce cognitive decline in the elderly?: a longitudinal population-based study.

BackgroundPrevious studies have found that social activities are beneficial for the reduction of cognitive decline (CD) in the elderly. However, knowledge regarding the types of social activities that reduce CD in later life is limited. The aim of this study is to examine which type of social activities reduce CD 4 years later among young-old (Y-O) and old-old (O-O) adults.MethodsWe conducted a secondary analysis using data from cognitively intact adults 65 years of age or older who participated in the Korean Longitudinal Study of Aging (KLoSA). Cognitive function was assessed using the Korean version of the Mini-Mental State Examination (MMSE). We computed CD between 2008 and 2012 by subtracting the Wave 4 MMSE score from the Wave 2 MMSE score. Multivariate linear regression analysis was conducted regarding the effects of social activities on CD after adjusting for age, sex, education, income, marital status, activities of daily living (ADL), instrumental activities of daily living (IADL), chronic diseases, quality of life, depressive symptom, change in depressive symptom, and cognitive functioning at baseline.ResultsSubjects who participated in senior citizen clubs or senior centers at baseline had a lower risk of CD 4 years later than those who did not in Y-O adults. Frequent contact with offspring by phone or letters was associated with reduced CD in O-O adults. Frequent face-to-face contact with offspring was positively associated with CD in O-O adults. Participating in two or more formal social activities was associated with reduced CD compared with nonparticipation in O-O adults.ConclusionEncouraging older adults to participate in senior citizen clubs or to have frequent contacts with adult children by phone or letters may help reduce CD in later life among older adults. Participation in a variety of formal social activities may also have a beneficial effect on preventing CD in older adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0343-x) contains supplementary material, which is available to authorized users.

Chocolate Consumption is Associated with a Lower Risk of Cognitive Decline.

Cocoa-related products like chocolate have taken an important place in our food habits and culture. In this work, we aim to examine the relationship between chocolate consumption and cognitive decline in an elderly cognitively healthy population. In the present longitudinal prospective study, a cohort of 531 participants aged 65 and over with normal Mini-Mental State Examination (MMSE; median 28) was selected. The median follow-up was 48 months. Dietary habits were evaluated at baseline. The MMSE was used to assess global cognitive function at baseline and at follow-up. Cognitive decline was defined by a decrease ≥ 2 points in the MMSE score between evaluations. Relative risk (RR) and 95% confidence interval (95% CI) estimates were adjusted for age, education, smoking, alcohol drinking, body mass index, hypertension, and diabetes. Chocolate intake was associated with a lower risk of cognitive decline (RR = 0.59, 95% CI 0.38-0.92). This protective effect was observed only among subjects with an average daily consumption of caffeine lower than 75 mg (69% of the participants; RR = 0.50, 95% CI 0.31-0.82). To our knowledge, this is the first prospective cohort study to show an inverse association between regular long-term chocolate consumption and cognitive decline in humans.

Body Mass Index and Decline of Cognitive Function.

BackgroundThe association between body mass index (BMI) and cognitive function is a public health issue. This study investigated the relationship between obesity and cognitive impairment which was assessed by the Korean version of the Mini-mental state examination (K-MMSE) among mid- and old-aged people in South Korea.MethodsA cohort of 5,125 adults, age 45 or older with normal cognitive function (K-MMSE≥24) at baseline (2006), was derived from the Korean Longitudinal Study of Aging (KLoSA) 2006~2012. The association between baseline BMI and risk of cognitive impairment was assessed using multiple logistic regression models. We also assessed baseline BMI and change of cognitive function over the 6-year follow-up using multiple linear regressions.ResultsDuring the follow-up, 358 cases of severe cognitive impairment were identified. Those with baseline BMI≥25 kg/m2 than normal-weight (18.5≤BMI<23 kg/m2) were marginally less likely to experience the development of severe cognitive impairment (adjusted odds ratio [aOR] = 0.73, 95% CI = 0.52 to 1.03; Ptrend = 0.03). This relationship was stronger among female (aOR = 0.63, 95% CI = 0.40 to 1.00; Ptrend = 0.01) and participants with low-normal K-MMSE score (MMSE: 24–26) at baseline (aOR = 0.59, 95% CI = 0.35 to 0.98; Ptrend<0.01). In addition, a slower decline of cognitive function was observed in obese individuals than those with normal weight, especially among women and those with low-normal K-MMSE score at baseline.ConclusionIn this nationally representative study, we found that obesity was associated with lower risk of cognitive decline among mid- and old-age population.

Circulating Progenitor Cells is Linked to Cognitive Decline in Healthy Adults

ObjectiveCognitive and cardiovascular disorders share many risk factors. Higher bone-marrow derived progenitor cells (PC) in blood are associated with lower rates of cardiovascular events but the association of PC with cognitive function is unclear. The objective of this study was to assess the association between PC and cognition in a sample of healthy adults enrolled in a cohort study. Materials and MethodsA random sample of employees at Emory University and Georgia Institute of Technology were followed for 4 years and underwent yearly vascular and cognitive assessment (N = 430, mean age = 49.2 years, 70% women, and 27% African-American). Cognition was assessed using computerized versions of 15 cognitive tests and principal component analysis was used for deriving cognitive scores: executive function, memory and working memory. PC were defined as mononuclear cells with specific surface markers (7 phenotypes). Decreased cognition in a domain was defined as performing below the lowest quartile for the corresponding domain at baseline. Generalized estimating equations were used to investigate associations between PC and cognition. ResultsHigher PC levels at baseline were associated with lower risk of cognitive decline in the executive and working memory domains during the follow-up period (P < 0.002 for all PC phenotypes). Further, the degree of decline in PC over the follow-up period was correlated with a corresponding decline in performances in all 3 cognitive domains over the same period (All P < 0.002). ConclusionLower PC and greater yearly declines in PC are associated with greater cognitive decline. These findings suggest the role for PC in neurocognitive aging.

White Matter Hyperintensities in Mild Cognitive Impairment and Lower Risk of Cognitive Decline.

White matter hyperintensities (WMH) may have a different impact on cognitive decline depending on strategic localization. The goal of this study is to assess the impact of global and cholinergic WMH on cognitive decline of mild cognitive impairment (MCI) patients in the ADNI-1 dataset. This is a retrospective analysis of data from a natural history study. MRI scans (T2 and PD sequences) were assessed with two visual scales: 1) The Cholinergic Pathways HyperIntensities Scale (CHIPS) score, designed to assess WMH in the cholinergic tracts, and 2) the Age-Related White Matter Changes Scale (ARWMC), a scale to assess the global WMH burden. All subjects underwent standardized neuropsychological testing. Subjects included 310 individuals with MCI. Analysis showed no association between WMH at baseline and conversion from MCI to Alzheimer's disease (AD), either for the global WMH burden or WMH within the cholinergic pathways. However, ARWMC scores had a significant confounding effect (p = 0.03) on conversion to dementia (hazard ratio of 0.37) among MCI subjects with low executive functions. We found no association between the burden of WMH at baseline in MCI and conversion to AD over 3 years. However, a higher global WMH burden appears to reduce the risk of conversion to AD in subjects with low executive functions. These results suggest that higher WMH burden in MCI individuals may be associated with a more gradual cognitive decline or stabilization, compared to a low WMH burden.

Healthy eating and reduced risk of cognitive decline: A cohort from 40 countries.

We sought to determine the association of dietary factors and risk of cognitive decline in a population at high risk of cardiovascular disease. Baseline dietary intake and measures of the Mini-Mental State Examination were recorded in 27,860 men and women who were enrolled in 2 international parallel trials of the ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) studies. We measured diet quality using the modified Alternative Healthy Eating Index. Cox proportional hazards regression was used to determine the association between diet quality and risk of ≥3-point decline in Mini-Mental State Examination score, and reported as hazard ratio with 95% confidence intervals with adjustment for covariates. During 56 months of follow-up, 4,699 cases of cognitive decline occurred. We observed lower risk of cognitive decline among those in the healthiest dietary quintile of modified Alternative Healthy Eating Index compared with lowest quintile (hazard ratio 0.76, 95% confidence interval 0.66-0.86, Q5 vs Q1). Lower risk of cognitive decline was consistent regardless of baseline cognitive level. We found that higher diet quality was associated with a reduced risk of cognitive decline. Improved diet quality represents an important potential target for reducing the global burden of cognitive decline.

Using sulcal and gyral measures of brain structure to investigate benefits of an active lifestyle

BackgroundPhysical activity is associated with brain and cognitive health in ageing. Higher levels of physical activity are linked to larger cerebral volumes, lower rates of atrophy, better cognitive function and a lower risk of cognitive decline and dementia. Neuroimaging studies have traditionally focused on volumetric brain tissue measures to test associations between factors of interest (e.g. physical activity) and brain structure. However, cortical sulci may provide additional information to these more standard measures. MethodAssociations between physical activity, brain structure, and cognition were investigated in a large, community-based sample of cognitively healthy individuals (N=317) using both sulcal and volumetric measures. ResultsPhysical activity was associated with narrower width of the Left Superior Frontal Sulcus and the Right Central Sulcus, while volumetric measures showed no association with physical activity. In addition, Left Superior Frontal sulcal width was associated with processing speed and executive function. DiscussionThese findings suggest sulcal measures may be a sensitive index of physical activity related to cerebral health and cognitive function in healthy older individuals. Further research is required to confirm these findings and to examine how sulcal measures may be most effectively used in neuroimaging.

Religion and cognitive decline in the older U.S. population

Previous findings on the relationship between religion and cognitive decline are mixed. Some researchers have found religious attendance, but not religious identity (strength of religious feeling), is associated with lower risk of cognitive decline in older adults.1 In contrast, the results of a study of Israeli men suggested those with strong religious identity according to belief and practice were at greater risk of dementia.2 More broadly, recent research has suggested adults who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorders.3

Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals

Cognitive decline may lead to dementia whose most frequent cause is Alzheimer's disease (AD). Among the many potential risk factors of cognitive decline and AD, diet raises increasing interest. Most studies considered diet in the frame of a single nutrient approach with inconsistent results. A novel approach to examine the link between nutrition and cognitive function is the use of dietary patterns. The aim of the present review was to update and complete the body of knowledge about dietary patterns in relationship with various cognitive outcomes in the elderly. Two approaches can be used: a priori and a posteriori patterns. A priori patterns are defined by the adhesion to a pre-defined healthy diet using a score such as the Mediterranean diet (MeDi) score, the Healthy Eating Index, the Canadian Healthy Eating Index, the French National Nutrition and Health Programme (Programme National Nutrition Santé) Guideline Score (PNNS-GS), the Recommended Food Score (RFS) and Dietary Approaches to Stop Hypertension (DASH). MeDi score, RFS, PNNS-GS and DASH have been associated with lower risks of cognitive impairment, cognitive decline, and dementia or AD. Principal components analysis, reduced rank regression and clustering methods allow the identification of 'healthy' patterns associated with lower risk of cognitive decline. However, some studies did not report any associations with cognitive outcomes and results are discordant especially regarding MeDi and the risk of dementia. Several methodological challenges should be overcome to provide a higher level of evidence supporting the development of nutritional policies to prevent cognitive decline and AD.

What sleep characteristics predict cognitive decline in the elderly?

Sleep is critical for optimal cognitive function, but as we age both cognitive impairment and sleep problems increase. Longitudinal, population-based studies can be used to investigate temporal relationships between sleep and cognition. A total of 2012 cognitively unimpaired individuals 65 years and over were drawn from the MRC Cognitive Function and Ageing Study (CFAS). They answered self-reported measures including: insomnia symptoms and age of onset, night time wakings, snoring, sleep onset latency, napping, daytime sleepiness and duration of night time sleep. Cognition was measured via the Mini-Mental State Examination. It was found that daytime napping at baseline was associated with a lower risk of cognitive decline at two and 10 years, and that obtaining ≤6.5h of night-time sleep and excessive daytime sleepiness at baseline were associated with an increased risk at 10 years. Daytime napping, night-time sleep duration, and excessive daytime sleepiness may be modifiable behaviours open to intervention strategies, or, clinical indicators of future decline in older individuals.

Cholesteryl Ester Transfer Protein (CETP) genotype and cognitive function in persons aged 35 years or older

Common polymorphisms of the Cholestryl Ester Transfer Protein (CETP) gene may predict lower risk of cognitive decline. We investigated the association of cognitive function with CETP genotype in a population-based cohort of 4135 persons aged 35–82 years. Cognitive function was measured with the Ruff Figural Fluency Test (RFFT; worst score, 0 points; best score, 175 points) and CETP I405V and Taq1B genotypes were determined by polymerase chain reaction. RFFT score was not associated with I405V genotype in persons aged 35–64 years. Remarkably, beyond age 65, homozygous valine carriers had higher RFFT scores than heterozygous carriers and noncarriers: RFFT (SD), 52 (21), 49 (18), and 47 (17) points, respectively (p = 0.005). There also was a statistically significant interaction between I405V genotype and age. Beyond age 65, the difference between homozygous valine carriers and noncarriers increased by 0.11 point per year (p = 0.005). RFFT score was not associated with Taq1B genotype. In conclusion, CETP I405V valine homozygosity was associated with better cognitive function in persons aged 65 years or older.

Omega-3 polyunsaturated fatty acid supplements and cognitive decline: Singapore Longitudinal Aging Studies.

To determine the association between long chain omega-3 polyunsaturated fatty acid (n-3 PUFA) supplements intake and cognitive decline in an older Chinese population. Prospective cohort study. The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban region of Singapore. 1,475 Chinese adults aged ≥ 55 years. Omega-3 PUFA supplements intake and Mini-Mental State Examination (MMSE) were assessed at baseline. MMSE was re-assessed at a median of 1.5 years after baseline and cognitive decline was defined as at least 2-points drop in MMSE score from baseline to follow-up. Odds ratios (ORs) of association between n-3 PUFA supplements intake and cognitive decline were calculated in logistic regression models controlling for baseline confounding variables. Daily n-3 PUFA supplements intake was significantly (p=0.024) associated with lower risk of cognitive decline (OR=0.37, 95% C.I. 0.16-0.87) after controlling for age, gender, education, number of medical comorbidity, the presence of vascular risk factors/diseases, smoking, alcohol drinking, depression, APOE e4 allele carrier status, nutritional status, level of leisure activities, baseline MMSE and length of follow-up. The association remained significant (p=0.015) after excluding participants with baseline cognitive impairment (MMSE < 24), diabetes, stroke, and cardiac diseases (OR=0.23, 95% C.I. 0.07-0.75). No statistically significant association (OR=1.02, 95% C.I. 0.81-1.27) of fish consumption with cognitive decline was found. Daily n-3 PUFA supplements consumption was independently associated with less cognitive decline in elderly Chinese.

Caffeine Intake is Associated with a Lower Risk of Cognitive Decline: A Cohort Study from Portugal

Alzheimer's disease has emerged in recent decades as a major health problem and the role of lifestyles in the modulation of risk has been increasingly recognized. Recent epidemiological studies suggest a protective effect for caffeine intake in dementia. We aimed to quantify the association between caffeine dietary intake and cognitive decline, in a cohort of adults living in Porto. A cohort of 648 subjects aged > or =65 years was recruited between 1999-2003. Follow-up evaluation (2005-2008) was carried out on 58.2% of the eligible participants and 10.9% were deceased. Caffeine exposure in the year preceding baseline evaluation was assessed with a validated food frequency questionnaire. Cognitive evaluation consisted of baseline and follow-up Mini-Mental State Examination (MMSE). Cognitive decline was defined by a decrease > or =2 points in the MMSE score between evaluations. Relative risk (RR) and 95% confidence interval (95%CI) estimates adjusted for age, education, smoking, alcohol drinking, body mass index, hypertension, and diabetes were computed using Poisson regression. Caffeine intake (> 62 mg/day [3rd third] vs. < 22 mg/day [1st third]) was associated with a lower risk of cognitive decline in women (RR=0.49, 95%CI 0.24-0.97), but not significantly in men (RR=0.65, 95%CI 0.27-1.54). Our study confirms the negative association between caffeine and cognitive decline in women.

Cardiovascular and biochemical risk factors for incident dementia in the Hypertension in the Very Elderly Trial

Several cardiovascular and biochemical factors including hypertension have been associated with cognitive decline and dementia, although both epidemiological and intervention evidence is mixed with the majority of studies examining those in midlife or younger elderly and the recent Hypertension in the Very Elderly Trial showing no significant association between blood pressure lowering and incident dementia. It has also been suggested that risk factors may differ in the very elderly. The aim of these analyses was to examine the impact of baseline cardiovascular and biochemical factors upon incident dementia and cognitive decline in a very elderly hypertensive group. Participants of the Hypertension in the Very Elderly Trial were aged at least 80 years and hypertensive. Cognitive function was assessed at baseline and annually with diagnostic information collected for dementia and relationships between baseline total and high-density lipoprotein cholesterol, creatinine, glucose, haemoglobin, heart failure, atrial fibrillation, diabetes, previous stroke and later dementia/cognitive decline were examined. There were 3336 participants with longitudinal cognitive function data. In multivariate analyses higher creatinine was associated with a lower risk of incident dementia and cognitive decline. Higher total and lower high-density lipoprotein cholesterol were associated with lower risk of cognitive decline. Other variables were not significant. In very elderly hypertensive patients heart failure, diabetes, atrial fibrillation, prior stroke, glucose and haemoglobin levels did not demonstrate a relationship with cognitive decline or dementia. Higher creatinine (excluding moderate renal impairment) was associated with a lower risk of dementia and cognitive decline. The findings for total and high-density lipoprotein cholesterol add to the varied literature in this area and together these findings may add weight to the suggestion that risk factor profiles differ in the very elderly.

P4-020: Tea consumption and cognitive impairment and decline

Background: Laboratory research suggests that tea has potential neuro-cognitive protective effects, but this is not established in humans. Methods: Among community-living Chinese older adults aged 55 in the Singapore Longitudinal Aging Studies (SLAS) cohort, we measured tea consumption at baseline, and Mini Mental State Examination (MMSE) at baseline and 1 to 2 years later. Cognitive impairment was defined as MMSE 23, cognitive decline as MMSE drop 1 point. We performed cross-sectional analysis on baseline data of 2501 participants, and longitudinal analysis on 1438 cognitively intact participants. Odds ratio (OR) of association were calculated in logistic regression models that adjusted for potential confounders. Results: Total tea intake was significantly associated with lower prevalence of cognitive impairment, independent of other risk factors. Compared with those who never or rarely drink teas, the OR for low, medium and high levels of tea intake was 0.54 (95% CI: 0.39-0.76), 0.48 (95% CI: 0.30-0.78) and 0.38 (95% CI: 0.14-1.00) respectively (P for tend 0.001). For cognitive decline, the corresponding OR was 0.76 (95% CI: 0.56-1.02), 0.74 (95% CI: 0.52-1.04) and 0.64 (95% CI: 0.36-1.12), (P for tend 0.037). Both black and green teas were associated with lower prevalence of cognitive impairment in cross-sectional analysis, but only black tea was associated with lower risk of cognitive decline. In contrast, no association between coffee intake and cognitive status was found. Conclusions: Regular tea consumption was associated with lower risks of cognitive impairment and decline.

Neuropsychological Measures in Normal Individuals That Predict Subsequent Cognitive Decline

To examine neuropsychological measures among normal individuals that predict time to subsequent cognitive decline. Cognitive performance, as measured by 6 neuropsychological tests, was examined at baseline. Participants were followed up for approximately 5 years. Cox proportional hazards models were used to evaluate the neuropsychological measures at baseline that predicted time to progression from normal cognition to mild impairment. Comparable data also examined time to progression from mild impairment to a diagnosis of Alzheimer disease. Community volunteer-based sample examined at a medical institution. One hundred and seven individuals who were cognitively normal and 235 individuals with mild cognitive impairment at baseline. Time to progression from normal cognition to mild impairment and time to progression from mild impairment to a diagnosis of Alzheimer disease. The risk of progressing from normal to mild impairment was considerably greater among those with lower scores on tests of episodic memory (eg, hazard ratio for a 1-SD decrease in the California Verbal Learning Test, 0.55; P<.001). Normal individuals who carried at least 1 copy of the apolipoprotein E epsilon2 allele were less likely to develop cognitive impairments over time than individuals with no epsilon2 allele (hazard ratio for presence of allele, 0.13; P = .006). Measures of both episodic memory and executive function were significant predictors of time to progression from mild impairment to a clinical diagnosis of Alzheimer disease (eg, hazard ratio for a 1-SD decrease in California Verbal Learning Test score, 0.67; P = .005; hazard ratio for a 1-SD increase in the time to complete part B of the Trail Making test, 1.40; P = .007). Among individuals with mild impairments, the apolipoprotein E epsilon4 allele increased risk for Alzheimer disease in a dose-dependent manner; however, this effect was not significant within the context of multivariable models. Episodic memory performance among normal individuals predicts time to progression to mild impairment while apolipoprotein E epsilon2 status is associated with lower risk of cognitive decline among normal individuals. Tests of both episodic memory and executive function are predictors of time to progression from mild impairment to a clinical diagnosis of Alzheimer disease.

Cardiovascular disease and Alzheimer's disease: common links

Growing evidence supports a strong and likely causal association between cardiovascular disease (CVD), and its risk factors, with incidence of cognitive decline and Alzheimer's disease. Individuals with subclinical CVD are at higher risk for dementia and Alzheimer's. Several cardiovascular risk factors are also risk factors for dementia, including hypertension, high LDL cholesterol, low HDL cholesterol and especially diabetes. Moderate alcohol appears to be protective for both CVD and dementia. In contrast, inflammatory markers predict cardiovascular risk, but not dementia, despite biological plausibility for such a link. The substantial overlap in risk factors points to new avenues for research and prevention.

P1-188: Endogenous sex hormones and cognitive decline in elderly men

Decline in cognitive function is an early symptom of dementia. Studies conducted in elderly women and men suggested that higher levels of endogenous estradiol and testosterone are associated with better cognitive function. However, recent studies in women demonstrated adverse effects of estrogen on cognition. To determine whether low levels of endogenous sex hormones are associated with increased risk of cognitive decline in very old men. The Frail Old Men Study is a population based prospective cohort study among 403 independently living elderly men in The Netherlands to determine risk factors of health and aging in the oldest old. Participants were aged 73–94 years at baseline in 1996 and were re–examined in 2000. At baseline, serum concentrations of total and free testosterone, total and free estradiol, estrone, and relevant covariates were determined. As a measure of global cognitive functioning, participants underwent the Mini Mental State Examination (MMSE) at baseline and follow–up after 4 years. Cognitive decline was defined as a decline of 4 or more points on the MMSE at follow–up. Follow–up was complete in 244 men. Of these, the mean (SD) baseline age was 77.4 (3.2), and the mean (range) baseline MMSE was 27.5 (20–30). At follow–up, 44 men (18%) had a decline of 4 or more points on the MMSE. Using multiple logistic regression analyses, levels of total and free testosterone were not associated with cognitive decline (OR per SD increase 1.1; 95%CI 0.8–1.5 and 1.0; 95%CI 0.7–1.4, respectively). Higher levels of total and free estradiol were related to increased risk of cognitive decline (OR per SD increase 1.5; 95%CI 1.0–2.1 and 1.4; 95%CI 1.0–2.0, respectively). For estrone the OR per SD increase was 1.4 (95%CI 1.0–2.0). These associations were independent of age, education, ApoE4, BMI, waist–to–hip ratio, blood pressure, diabetes, smoking, and serum cholesterol levels. The results do not support the hypotheses that high levels of endogenous sex hormones in elderly men are associated with lower risk of cognitive decline. Further longitudinal investigations are needed to more fully understand the role of hormonal effects on cognitive decline and dementia in older men.

ALCOHOL CONSUMPTION AND THE RISK OF DEMENTIA: BIOLOGICAL AND PSYCHOLOGICAL MECHANISMS

To the Editor: We would like to comment on the results of the study of Luchsinger et al. recently published in the Journal of the American Geriatrics Society1 on the protective effect on risk of dementia of moderate wine consumption. To contribute to the debate on the possible interpretations of the phenomenon at biological, clinical, and psychosocial levels, we present results on a population of 1,201 older persons aged 70 to 75 living in the city center of Brescia, Italy. At baseline, in 1986, a questionnaire assessing demographics; social, mental, and functional status; chronic conditions; and healthcare utilization was administered to elderly subjects. Trained community researchers collected the data at the subjects' home. Response rate was 92.2%. Alcohol consumption was evaluated using an ad hoc questionnaire asking about the amount of intake computed in grams;2 all subjects were divided in abstainers, moderate drinkers, and heavy drinkers. (Men with an alcohol intake >60 g/d and women with an intake >40 g/d were classified as inadequate (n=197) and were not considered in this analysis.) Vital status and clinical and psychosocial characteristics were assessed for abstainers and moderate drinkers (n=1,004) 12 years after baseline assessment. On follow-up, 459 subjects (45.7%) had died. Incident dementia was computed as a loss of 2 or more points on the Mental Status Questionnaire3 at follow-up. A protective effect of alcohol on cognitive decline was not found in this population (no significant differences in the risk ratio (RR) for incident dementia were detected in moderate drinkers (n=669)) compared with abstainers (RR=0.9, 95% confidence interval (CI)=0.5–1.6), but it was found that moderate alcohol consumption exerted a positive effect on mortality, in comparison with abstainers, taken as reference group; the adjusted RR was 0.7 (95% CI=0.6–0.9) (Table 1). These results may be interpreted as a consequence of the peculiar psychological structure of moderate drinkers, who are less depressed (adjusted Beck's Depression Inventory Scale and Anxiety Scale and Personal Well-Being Scale scores4 were 17.2±12.1 and 21.2±14.6, P<.001, respectively, for abstainers and moderate drinkers), probably more open to social contacts, and more able to exert mastery over their own lives. From this perspective, the effect on dementia found by Luchsinger et al. may be interpreted as the consequence of the psychological attitudes of moderate drinkers, characterized by a higher level of capability in performing advanced activities of daily living, inducing at the same time a lower risk of cognitive decline and of mortality. Furthermore, wine drinkers may have a particular pattern of alcohol consumption characterized by a higher attitude for social interactions (as indicated in the Luchsinger's study also by higher education level). In conclusion, the effect of alcohol on cognitive impairment should not be interpreted only as the result of biological mechanisms, but also as a consequence of the association between moderate alcohol consumption (in particular wine) and behavior characterized by a higher level of mental performance.