Slower Rate Of Cognitive Decline Research Articles

Religious Involvement and Healthy Cognitive Aging: Patterns, Explanations, and Future Directions

Van Ness and Kasl (1) were among the first to emphasizethe association between religious involvement and cognitivefunctioning. They use data from the New Haven EstablishedPopulations for the Epidemiologic Studies of the Elderlysurvey to examine the effects of religious attendance andreligious identity on cognitive functioning over 6 years. Thestudy uses Pfeiffer’s Short Portable Mental Status Ques-tionnaire to assess cognitive functioning and includescontrols for age, sex, race/ethnicity, education, income,marital status, other secular forms of social engagement,drinking and smoking, depression, chronic disease, physicalactivity, disability, and baseline cognitive functioning. Theirresults show that religious attendance, not religious identity,is associated with a reduction in the odds of cognitivedysfunction over time. Compared with those who attendreligious services less than once per week, those who attendservices once per week or more exhibit a 36% reduction inthe odds of cognitive dysfunction over 3 years.Following the work of Van Ness and Kasl, Hill andcolleagues (2) use data from the Hispanic EstablishedPopulations for the Epidemiologic Studies of the Elderly(H-EPESE) survey to test whether religious attendance isassociated with slower rates of cognitive decline amongolder Mexican Americans. This study uses the Mini-MentalState Examination (MMSE) to assess cognitive decline over8 years and includes controls for age, sex, education,English proficiency, secular forms of social engagement,drinking and smoking, depression, chronic disease, sensoryimpairments, disability, and baseline cognitive functioning.The results of this investigation demonstrate that religiousattendance is associated with slower rates of cognitivedecline among older Mexican Americans. Specifically,respondents who attend religious services monthly, weekly,and more than weekly tend to exhibit slower rates ofcognitive decline than those who do not attend services.Reyes-Ortiz and colleagues (3), in this issue of theJournal, also use H-EPESE data to examine the associationbetween religious attendance and cognitive functioning.Prior research on religious involvement and healthycognitive aging has emphasized the main effects of religiousattendance. Reyes-Ortiz and colleagues build on priorresearch by testing whether religious attendance moderatesor buffers the association between chronic depressivesymptoms and cognitive decline among older MexicanAmericans. This study uses the MMSE to assess cognitivedecline over 12 years and includes controls for age, sex,marital status, living arrangements, depression, chronicdisease, sensory impairments, and disability. Their resultscorroborate prior research, showing that respondents whoattend religious services infrequently (less than weekly) tendto exhibit faster rates of cognitive decline than respondentswho attend more frequently (weekly or more). They alsofind that the rate of cognitive decline associated with chronicdepressive symptoms is faster for respondents who attendreligious services infrequently.E

Low vitamin B-12 status and risk of cognitive decline in older adults

Background: Elevated total homocysteine (tHcy) concentrations have been associated with cognitive impairment, but it is unclear whether low vitamin B-12 or folate status is responsible for cognitive decline.Objective: We examined the associations of cognitive decline with vitamin B-12 and folate status in a longitudinal cohort study performed from 1993 to 2003 in Oxford, United Kingdom.Design: Cognitive function was assessed with the Mini-Mental State Examination on ≥3 occasions during 10 y and related to serum concentrations of vitamin B-12, holotranscobalamin (holoTC), tHcy, methylmalonic acid (MMA), and folate with the use of linear mixed models in 1648 participants who provided blood in 1995.Results: Cognitive function declined abruptly at younger ages in some participants but remained intact in others until very old age. In multivariate regression analyses after adjustment for established risk factors, concentrations of holoTC (a marker of reduced vitamin B-12 status), tHcy, and MMA predicted cognitive decline, but folate did not. A doubling in holoTC concentrations (from 50 to 100 pmol/L) was associated with a 30% slower rate of cognitive decline (−0.137 to −0.083), whereas a doubling in tHcy (from 10 to 20 μmol/L) or MMA (from 0.25 to 0.50 μmol/L) was associated with >50% more rapid cognitive decline (−0.090 to −0.169) and (−0.104 to −0.169), respectively. After adjustment for all vitamin markers simultaneously, the associations of cognitive decline with holoTC and MMA remained significant.Conclusions: Low vitamin B-12 status was associated with more rapid cognitive decline. Randomized trials are required to determine the relevance of vitamin B-12 supplementation for prevention of dementia.

Cognitive decline in Alzheimer disease

To assess effects of quality of life (QOL), spirituality, and religiosity on rate of progression of cognitive decline in Alzheimer disease (AD). In this longitudinal study, we recruited 70 patients with probable AD. The Mini-Mental State Examination was used to monitor the rate of cognitive decline. Religiosity and spirituality were measured using standardized scales that assess spirituality, religiosity, and organizational and private religious practices. We conducted a simultaneous multiple linear regression analysis for factors contributing to rate of cognitive decline. After controlling for baseline level of cognition, age, sex, and education, a slower rate of cognitive decline was associated with higher levels of spirituality (p < 0.05) and private religious practices (p < 0.005). These variables accounted for 17% of the total variance [F(11,58) = 2.24, p < 0.05]. There was no correlation between rate of cognitive decline and QOL. Higher levels of spirituality and private religious practices, but not quality of life, are associated with slower progression of Alzheimer disease.

Associations of vegetable and fruit consumption with age-related cognitive change

To examine the association between rates of cognitive change and dietary consumption of fruits and vegetables among older persons. The authors conducted a prospective cohort study of 3,718 participants, aged 65 years and older of the Chicago Health and Aging Project. Participants completed a food frequency questionnaire and were administered at least two of three cognitive assessments at baseline, 3-year, and 6-year follow-ups. Cognitive function was measured using the average z-score of four tests: the East Boston Tests of immediate memory and delayed recall, the Mini-Mental State Examination, and the Symbol Digit Modalities Test. The mean cognitive score at baseline for the analyzed cohort was 0.18 (range: -3.5 to 1.6), and the overall mean change in score per year was a decline of 0.04 standardized units. In mixed effects models adjusted for age, sex, race, and education, compared with the rate of cognitive decline among persons in the lowest quintile of vegetable intake (median of 0.9 servings/day), the rate for persons in the fourth quintile (median, 2.8 servings/day) was slower by 0.019 standardized units per year (p = 0.01), a 40% decrease, and by 0.018 standardized units per year (p = 0.02) for the fifth quintile (median, 4.1 servings/day), or a 38% decrease in rates. The association remained significant (p for linear trend = 0.02) with further control of cardiovascular-related conditions and risk factors. Fruit consumption was not associated with cognitive change. High vegetable but not fruit consumption may be associated with slower rate of cognitive decline with older age.

Immunotherapy for Alzheimer's disease

A primary goal of research on Alzheimer's disease is to develop disease modifying therapeutics. The amyloid cascade hypothesis has focused the initial efforts on methods to reduce amyloid. One surprising approach that has shown considerable success in mouse models and has hinted at benefits in human trials is anti-Abeta immunotherapy. Schenk first showed the amyloid reducing potential of active immunization in 1999. This prompted our group and that of St. George-Hyslop to investigate whether active immunization would similarly retard the memory deficits that develop in amyloid depositing transgenic mice. Contrary to our initial predictions of premature memory dysfunction due to inflammation, vaccination protected amyloid depositing mice from developing memory deficits. Subsequent studies found that passive immunization could reverse memory deficits, even when administered for short periods. These encouraging findings led to a trial of an Abeta vaccination in Alzheimer patients. The trial was cut short due to meningoencephalitic symptoms in 6% of patients, yet, in a subset of patients, those developing brain reactive antibodies benefited from slower rates of cognitive decline. These observations have accelerated the development of passive immunization protocols and safer vaccines. At this time, anti-amyloid immunotherapy stands poised to be the first test of the amyloid hypothesis in the treatment of Alzheimer disease.

Cognitive leisure activities, but not watching TV, for future brain benefits

Loss of cognition is a common and feared neurologic problem of old age. Up to 10% of older persons have dementia,1 and at least 10% more have mild cognitive impairment (MCI).2 This number with impaired cognition will increase markedly in the coming decades.1 The large and growing public health burden of cognitive impairment would best be ameliorated by the identification of modifiable risk factors for dementia and MCI.3 Engagement in cognitively stimulating leisure activities has recently been reported to reduce the risk of Alzheimer disease (AD) and to be associated with a slower rate of cognitive decline.4–9 These studies have been conducted primarily in the United States and Western Europe. In this issue of Neurology , the association between engagement in cognitively stimulating leisure activities and cognitive impairment has been extended to include risk of incident MCI, and risk of cognitive impairment in a population-based study in China.10,11 Verghese et al.10 examined risk of incident amnestic MCI in the Bronx Aging Study. The Bronx Aging Study is a prospective cohort of 437 community-residing individuals older than 75 years who were initially free of dementia or amnestic MCI. In this study, subjects were interviewed about frequency of participation in 6 cognitive activities and 10 physical activities from which composite scores were derived. Over more than 5 years of follow-up, more than 50 persons developed …

Religious Attendance and Cognitive Functioning Among Older Mexican Americans

Research shows that social engagement reduces the probability of cognitive decline in late life. The purpose of this study was to test whether religious attendance, a major source of social engagement for many older individuals, is associated with slower rates of cognitive decline among older Mexican Americans. Using four waves of data collected from a sample of 3,050 older Mexican-origin individuals, we estimated a series of linear growth curve models to assess the effects of religious attendance on cognitive functioning trajectories. We used the Mini-Mental State Examination to measure cognitive functioning. Our central finding is that religious attendance is associated with slower rates of cognitive decline among older Mexican Americans. Specifically, respondents who attend church monthly, weekly, and more than weekly tend to exhibit slower rates of cognitive decline than those who do not attend church.

Fish Consumption and Cognitive Decline With Age in a Large Community Study

Dietary intake of fish and the omega-3 fatty acids have been associated with lower risk of Alzheimer disease and stroke. To examine whether intakes of fish and the omega-3 fatty acids protect against age-related cognitive decline. Prospective cohort study. Geographically defined Chicago, Ill, community. Residents, 65 years and older, who participated in the Chicago Health and Aging Project. Change in a global cognitive score estimated from mixed models. The global score was computed by summing scores of 4 standardized tests. In-home cognitive assessments were performed 3 times over 6 years of follow-up. Cognitive scores declined on average at a rate of 0.04 standardized units per year (SU/y). Fish intake was associated with a slower rate of cognitive decline in mixed models adjusted for age, sex, race, education, cognitive activity, physical activity, alcohol consumption, and total energy intake. Compared with a decline rate in score of -0.100 SU/y among persons who consumed fish less than weekly, the rate was 10% slower (-0.090 SU/y) among persons who consumed 1 fish meal per week and 13% slower (-0.088 SU/y) among persons who consumed 2 or more fish meals per week. The fish association was not accounted for by cardiovascular-related conditions or fruit and vegetable consumption but was modified after adjustment for intakes of saturated, polyunsaturated, and trans fats. There was little evidence that the omega-3 polyunsaturated fatty acids were associated with cognitive change. Fish consumption may be associated with slower cognitive decline with age. Further study is needed to determine whether fat composition is the relevant dietary constituent.

Rate of progression of cognitive decline in Alzheimer’s disease: effect of butyrylcholinesterase K gene variation

Objective: To determine whether individuals with Alzheimer’s disease (AD) and the K variant allele of butyrylcholinesterase have a slower rate of cognitive decline than those without the K variant allele...

Relation of the tocopherol forms to incident Alzheimer disease and to cognitive change

High intake of vitamin E from food (tocopherol), but not from supplements (which usually contain alpha-tocopherol), is inversely associated with Alzheimer disease. We examined whether food intakes of vitamin E, alpha-tocopherol equivalents (a measure of the relative biologic activity of tocopherols and tocotrienols), or individual tocopherols would protect against incident Alzheimer disease and cognitive decline over 6 y in participants of the Chicago Health and Aging Project. The 1993-2002 study of community residents aged >or=65 y included the administration of 4 cognitive tests and clinical evaluations for Alzheimer disease. Dietary assessment was by food-frequency questionnaire. Tocopherol intake from food was related to the 4-y incidence of Alzheimer disease determined by logistic regression in 1041 participants who were clinically evaluated (n=162 incident cases) and to change in a global cognitive score determined by mixed models in 3718 participants. Higher intakes of vitamin E (relative risk: 0.74 per 5 mg/d increase; 95% CI: 0.62, 0.88) and alpha-tocopherol equivalents (relative risk: 0.56 per 5 mg/d increase; 95% CI: 0.32, 0.98) were associated with a reduced incidence of Alzheimer disease in separate multiple-adjusted models that included intakes of saturated and trans fats and docosahexaenoic acid. alpha- and gamma-Tocopherol had independent associations. In separate mixed models, a slower rate of cognitive decline was associated with intakes of vitamin E, alpha-tocopherol equivalents, and alpha- and gamma-tocopherols. The results suggest that various tocopherol forms rather than alpha- tocopherol alone may be important in the vitamin E protective association with Alzheimer disease.

Brain perfusion abnormalities in Alzheimer's disease: comparison between patients with focal temporal lobe dysfunction and patients with diffuse cognitive impairment

OBJECTIVESPatients with Alzheimer's disease (AD) showing a selective impairment of episodic and semantic memory have recently been classified as affected by focal temporal lobe dysfunction (FTLD) and considered as a...

Neuropsychology and Vascular Dementia

Neuropsychological impairments associated with vascular dementia (VaD) remain a challenge to diagnose and treat. Available diagnostic tests and screening by competent, knowledgeable, and experienced neuropsychologists are useful clinically in delineating individual VaD cases. Pharmaceutical treatment remains equivocal, and may not be responsive to individual needs and family issues. Neuropsychological Rehabilitation, an integrative approach to treating both cognitive impairments and personality changes, offers hope and potential improvement by incorporating a variety of techniques. Neuropsychological Rehabilitation improves self-esteem and outlook and provides professional communication with families to allow the development of an understanding of the disorder, to fulfill needs, and to furnish appropriate guidance in the care of their relatives. Gains may be short-lived if the disease progresses rapidly, but they prevail with a slower rate of cognitive decline. The benefits of Neuropsychological Rehabilitation prove invaluable both to patients and families. Although such treatments do not provide permanent solutions, patients and their families usually desire even a temporary improvement in quality of life.

Is age kinder to the initially more able? A study of eminent scientists and academics

Elderly eminent academics and blue-collar workers were compared with Doctor of Philosophy students and trade apprentices to investigate whether intelligence and memory deteriorate at a slower rate in persons with high ability. The elderly groups showed decline on tests of perceptual-motor speed, visuospatial reasoning, inferential thinking and memory relative to the young subjects. Initial ability determined the level of intellectual performance, such that elderly academics maintained their initial advantage over the elderly blue-collar workers. However, with the exception of the Similarities subtest of the Wechsler Adult Intelligence Scale, the rate of change on tests of memory and intelligence did not differ for the high- and low-ability groups. The hypothesis that high ability is associated with a slower rate of cognitive decline was not supported.