Poorer Cognitive Scores Research Articles

Abstract 3332: Common Carotid Intima Media Thickness, Carotid Plaque and Cognitive Performance in Patients with Atherosclerotic Disease

Background - Patients with atherothrombotic disease are prone to cognitive impairment. We tested whether high common carotid intima-media thickness (CC-IMT) and bilateral carotid plaques among patients with long lasting CHD are associated with poorer cognitive scores. Methods - Patients with CHD previously included in a secondary prevention trial were assessed after a period of 15±3 years for cognitive performance (Mindstream Computerized Cognitive Battery), for CC-IMT (M’Ath®-Std, Metris) and for carotid plaque using ultrasound (HDI 5000 SonoCT, Philips). We compared cognitive scores in patients with and without high CC-IMT values (top quartile of CC- IMT; >1.06 mm) and in patients with and without high CC-IMT and bilateral carotid plaques. Results - Among 448 non-demented patients (mean age 71.8±6.1 yrs, 96% men) mean±SD CC-IMT was 0.97±0.17 and 54.7% had bilateral carotid plaques. Linear regression models ( Table ) adjusted for age, sex, education, BMI, smoking, diabetes and hypertension (Model 1) demonstrated that high CC-IMT and presence of high CC-IMT and carotid plaques were associated with lower cognitive scores. Additional adjustment for history of stroke and impaired cerebrovascular reactivity (Model 2) resulted in similar effects. Associations were only slightly altered after exclusion of patients with history of stroke. Conclusion - Among non-demented patients with long lasting CHD, high CC- IMT and presence of high CC-IMT and carotid plaques are associated with lower cognitive performance particularly in the executive function domain.

Parental Characteristics Associated With Childcare Use During the First 4 Years of Life: Results From a Representative Cohort of Québec Families

Studies have shown that children growing up in socio-economically disadvantaged families have poorer cognitive scores than children growing up in more advantaged families, and that high-quality childcare services can reduce this gap. This effect may be attenuated, however, if disadvantaged families are less likely than better-off families to use childcare and if they use childcare of lower quality. The aim of this study was to identify factors related to parental decisions to use formal and informal childcare. Data were obtained from the Quebec Longitudinal Study of Child Development, a birth cohort of children born in 1997/1998 in the Canadian province of Quebec (n=1,504). Children receiving formal (e.g., family and centre) and informal (e.g., grandparents, aunt, nanny) childcare from 5 months to 4 years of age were compared to those receiving exclusively parental care on key psycho-socio-economic family factors. Maternal unemployment during pregnancy, younger maternal age (at initiation of childbearing) and higher number of siblings (e.g., > or = 2) were related to a lower probability of a child receiving either formal or informal childcare (compared to parental care). In addition, low levels of maternal education, higher levels of overprotection, and lower levels of home stimulation were related to a lower probability of a child receiving formal childcare, but not informal childcare. Insufficient income was not associated with childcare use. Maternal education and maternal employment were the main socio-economic barriers to childcare participation in a province offering low-cost childcare services. Future initiatives may consider prioritizing childcare access to underserved children and other (e.g., literacy-based) interventions to facilitate access.

Plasma epidermal growth factor levels predict cognitive decline in Parkinson disease

Most people with Parkinson disease (PD) eventually develop cognitive impairment (CI). However, neither the timing of onset nor the severity of cognitive symptoms can be accurately predicted. We sought plasma-based biomarkers for CI in PD. A discovery cohort of 70 PD patients was recruited. Cognitive status was evaluated with the Mattis Dementia Rating Scale-2 (DRS) at baseline and on annual follow-up visits, and baseline plasma levels of 102 proteins were determined with a bead-based immunoassay. Using linear regression, we identified biomarkers of CI in PD, that is, proteins whose levels correlated with cognitive performance at baseline and/or cognitive decline at follow-up. We then replicated the association between cognitive performance and levels of the top biomarker, using a different technical platform, with a separate cohort of 113 PD patients. Eleven proteins exhibited plasma levels correlating with baseline cognitive performance in the discovery cohort. The best candidate was epidermal growth factor (EGF, p < 0.001); many of the other 10 analytes covaried with EGF across samples. Low levels of EGF not only correlated with poor cognitive test scores at baseline, but also predicted an 8-fold greater risk of cognitive decline to dementia-range DRS scores at follow-up for those with intact baseline cognition. A weaker, but still significant, relationship between plasma EGF levels and cognitive performance was found in an independent replication cohort of 113 PD patients. Our data suggest that plasma EGF may be a biomarker for progression to CI in PD.

Predictors of quality of life after resective extratemporal epilepsy surgery in adults in long-term follow-up

Purpose To present long-term outcome and predictors of the health related quality of life (HRQOL) in a large group of patients operated for refractory extratemporal epilepsy. Methods A German QOLIE-31 questionnaire and additional questions has been mailed for all adult patients operated for extratemporal epilepsy in the Bethel Epilepsy Centre, between 1992 and 2003, 87 patients were eligible for this study. Results Seizure freedom, intake of antiepileptic drugs (AEDs), presence of AEDs side effect medical comorbidities and driving a car were significantly correlated to HRQOL in all subscales of QOLIE-31. Gender, age at epilepsy onset, the presence of a partner, psychiatric disease, the presence of auras and tumour pathology have a correlation to QOL in some subscales. Stepwise regression for all patients revealed that seizure freedom and medical comorbidities were highly predictive for most of the subscales of QOLIE-31. Intake of anti-epileptic drugs and AED side effects had a modest effect on QOL. The need for psychiatric treatment predicted poor cognitive function scores. Epilepsy onset at an older age predicted a minimal increase in the overall health scores. An aura at the last follow-up predicted poor medication scores. Regarding the importance of the predictors, seizure freedom and medical comorbidities were the most important predictors of QOL after surgery. AED intake and side effects had an intermediate effect on QOL; however, the gender of the patient and age at epilepsy onset had a minimal effect on QOL. Conclusions HRQOL after extratemporal epilepsy surgery has multiple determinants. Medical comorbidities should be considered a negative risk factor for QOL during preoperative and postoperative evaluation process.

Victoria Symptom Validity Test Performance in Non-Litigating Epilepsy Surgery Candidates

We report Victoria Symptom Validity Test (VSVT) performance in 120 epilepsy patients undergoing neuropsychological assessment as part of their evaluation as epilepsy surgery candidates. Patients were grouped according to their performance on hard VSVT stimuli. Scores of at least 21/24 on the hard VSVT items were classified as valid (n=86), scores of 18/24–20/24 were considered questionably valid (n=20), and scores of 17/24 and below were designated as invalid (n=14). Significant group effects were observed for WAIS-III Full Scale IQ, Verbal IQ, Performance IQ, Digit Span, Rey 3x5 Memory, Selective Reminding Recognition, and Complex Figure Immediate Recall; poorer cognitive scores were associated with lower VSVT scores. Age was also related to VSVT performance, with patients older that 40 years of age (16/42) more likely to fail the VSVT (i.e., hard scores ≤ 20/24) than their younger counterparts (8/78) (p=.0006, Fisher's Exact Test). These results indicate that VSVT may identify cases of incomplete effort in patients being evaluated for strictly clinical purposes in which no external incentive to perform poorly has been identified, although the potential confound of low IQ on VSVT cannot be determined from this sample. Older patients also appear to be at increased risk for suboptimal performance, and may need additional encouragement or education regarding the need to perform to the best of their ability, and thereby maximize the likelihood of obtaining valid neuropsychological test results.

Employment Status and Financial Repercussions in 60 Patients with Chronic Fatigue Syndrome in Spain

AbstractChronic fatigue syndrome (CFS) is a disabling disorder with implications in employment status. We enrolled 60 patients who fulfilled the CDC diagnostic criteria of Holmes and those of Fukuda. All patients underwent a protocol involving a structured questionnaire to record diagnostic criteria items, clinical features of fatigue, social features and associated symptoms; application of the Fatigue Impact Scale (FIS); an employment repercussion questionnaire; and information on evolution of the symptoms. Statistical comparisons were performed with the Mann-Whitney U test and correlations with the Spearman test. A close correlation was found between work inactivity and higher scores in the FIS cognitive dimension. Patient age and duration of symptoms also correlated with high cognitive scores. Chronic fatigue syndrome patients report a considerable decrease in quality of life, and most of them have work limitations, particularly those with poor overall FIS scores and cognitive function scores.

Brain Aging and Midlife Tofu Consumption

Objective: To examine associations of midlife tofu consumption with brain function and structural changes in late life.Methods: The design utilized surviving participants of a longitudinal study established in 1965 for research on heart disease, stroke, and cancer. Information on consumption of selected foods was available from standardized interviews conducted 1965–1967 and 1971–1974. A 4-level composite intake index defined “low-low” consumption as fewer than two servings of tofu per week in 1965 and no tofu in the prior week in 1971. Men who reported two or more servings per week at both interviews were defined as “high-high” consumers. Intermediate or less consistent “low” and “high” consumption levels were also defined. Cognitive functioning was tested at the 1991–1993 examination, when participants were aged 71 to 93 years (n=3734). Brain atrophy was assessed using neuroimage (n=574) and autopsy (n=290) information. Cognitive function data were also analyzed for wives of a sample of study participants (n=502) who had been living with the participants at the time of their dietary interviews.Results: Poor cognitive test performance, enlargement of ventricles and low brain weight were each significantly and independently associated with higher midlife tofu consumption. A similar association of midlife tofu intake with poor late life cognitive test scores was also observed among wives of cohort members, using the husband’s answers to food frequency questions as proxy for the wife’s consumption. Statistically significant associations were consistently demonstrated in linear and logistic multivariate regression models. Odds ratios comparing endpoints among “high-high” with “low-low” consumers were mostly in the range of 1.6 to 2.0.Conclusions: In this population, higher midlife tofu consumption was independently associated with indicators of cognitive impairment and brain atrophy in late life.

Ultrasonographic assessment of carotid wall characteristics and cognitive functions in a community sample of 59- to 71-year-olds. The EVA Study Group.

This study was aimed at analyzing cross-sectional relationships between cognitive performance and ultrasonographic assessment of carotid wall characteristics. A cohort of 1279 subjects (men, 41%) aged 59 to 71 years was recruited from the electoral rolls of the city of Nantes (western France). Cognitive performances were evaluated with the Mini-Mental State Examination (MMSE) and seven neuropsychological tests assessing attention, psychomotor rapidity, verbal abilities, memory, and visuospatial perception. For each test, subjects were classified into three performance levels with a quartile distribution: 25% highest, 25% lowest, and 50% middle. The intima-media thickness of common carotid arteries and the presence of plaques in the carotid arteries were assessed with B-mode ultrasound examination. Only 28% of men and 17% of women had carotid plaques inducing moderate stenosis of the lumen ( < 40%). After adjustment for possible confounders, odds ratios for poor cognitive performance associated with plaques were above 1 for all cognitive tests in men. This association was statistically significant for the MMSE and another test assessing attention skills. There was a slight association between increase of the common carotid intima-media thickness and poor cognitive scores in men with plaques. In women, no association was found between cognitive functions and presence of plaques or intima-media thickness. This study indicated a moderate association between atherosclerosis of the carotid arteries and poor cognitive functioning in men aged 59 to 71 years. In view of these moderate cross-sectional results, further studies are required to better assess the relationship between carotid atherosclerosis and cognitive impairment.

Physical restraint use and cognitive decline among nursing home residents.

This study investigated the association between physical restraint use and decline in cognition. Cohort analytic study describing changes in resident characteristics. Eight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area. 437 nursing home admissions, with 201 remaining at 1 year. Cognitive status was measured by geropsychiatrists, using the Folstein Mini-Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year. Restraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non-ambulatory but without dementia and having strong social support. These findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.