Cognitive impairment from severe COVID-19 equivalent to 20 years of aging, study finds

by Craig Brierley, University of Cambridge

Credit: Pixabay/CC0 Public Domain

Cognitive impairment as a result of severe COVID-19 is similar to that sustained between 50 and 70 years of age and is the equivalent to losing 10 IQ points, say a team of scientists from the University of Cambridge and Imperial College London.

31 may 2022--The findings, published in the journal eClinicalMedicine, emerge from the NIHR COVID-19 BioResource. The results of the study suggest the effects are still detectable more than six months after the acute illness, and that any recovery is at best gradual.

There is growing evidence that COVID-19 can cause lasting cognitive and mental health problems, with recovered patients reporting symptoms including fatigue, 'brain fog', problems recalling words, sleep disturbances, anxiety and even post-traumatic stress disorder (PTSD) months after infection. In the UK, a study found that around one in seven individuals surveyed reported having symptoms that included cognitive difficulties 12 weeks after a positive COVID-19 test.

While even mild cases can lead to persistent cognitive symptoms, between a third and three-quarters of hospitalized patients report still suffering cognitive symptoms three to six months later.

To explore this link in greater detail, researchers analyzed data from 46 individuals who received in-hospital care, on the ward or intensive care unit, for COVID-19 at Addenbrooke's Hospital, part of Cambridge University Hospitals NHS Foundation Trust. 16 patients were put on mechanical ventilation during their stay in hospital. All the patients were admitted between March and July 2020 and were recruited to the NIHR COVID-19 BioResource.

The individuals underwent detailed computerized cognitive tests an average of six months after their acute illness using the Cognitron platform, which measures different aspects of mental faculties such as memory, attention and reasoning. Scales measuring anxiety, depression and post-traumatic stress disorder were also assessed. Their data were compared against matched controls.

This is the first time that such rigorous assessment and comparison has been carried out in relation to the after effects of severe COVID-19.

COVID-19 survivors were less accurate and with slower response times than the matched control population—and these deficits were still detectable when the patients were following up six months later. The effects were strongest for those who required mechanical ventilation. By comparing the patients to 66,008 members of the general public, the researchers estimate that the magnitude of cognitive loss is similar on average to that sustained with 20 years aging, between 50 and 70 years of age, and that this is equivalent to losing 10 IQ points.

Survivors scored particularly poorly on tasks such as verbal analogical reasoning, a finding that supports the commonly-reported problem of difficulty finding words. They also showed slower processing speeds, which aligns with previous observations post COVID-19 of decreased brain glucose consumption within the frontoparietal network of the brain, responsible for attention, complex problem-solving and working memory, among other functions.

Professor David Menon from the Division of Anaesthesia at the University of Cambridge, the study's senior author, said: "Cognitive impairment is common to a wide range of neurological disorders, including dementia, and even routine aging, but the patterns we saw—the cognitive 'fingerprint' of COVID-19—was distinct from all of these."

While it is now well established that people who have recovered from severe COVID-19 illness can have a broad spectrum of symptoms of poor mental health—depression, anxiety, post-traumatic stress, low motivation, fatigue, low mood, and disturbed sleep—the team found that acute illness severity was better at predicting the cognitive deficits.

The patients' scores and reaction times began to improve over time, but the researchers say that any recovery in cognitive faculties was at best gradual and likely to be influenced by a number of factors including illness severity and its neurological or psychological impacts.

Professor Menon added: "We followed some patients up as late as ten months after their acute infection, so were able to see a very slow improvement. While this was not statistically significant, it is at least heading in the right direction, but it is very possible that some of these individuals will never fully recover."

There are several factors that could cause the cognitive deficits, say the researchers. Direct viral infection is possible, but unlikely to be a major cause; instead, it is more likely that a combination of factors contribute, including inadequate oxygen or blood supply to the brain, blockage of large or small blood vessels due to clotting, and microscopic bleeds. However, emerging evidence suggests that the most important mechanism may be damage caused by the body's own inflammatory response and immune system.

While this study looked at hospitalized cases, the team say that even those patients not sick enough to be admitted may also have tell-tale signs of mild impairment.

Professor Adam Hampshire from the Department of Brain Sciences at Imperial College London, the study's first author, said: "Around 40,000 people have been through intensive care with COVID-19 in England alone and many more will have been very sick, but not admitted to hospital. This means there is a large number of people out there still experiencing problems with cognition many months later. We urgently need to look at what can be done to help these people."

Professor Menon and Professor Ed Bullmore from Cambridge's Department of Psychiatry are co-leading working groups as part of the COVID-19 Clinical Neuroscience Study (COVID-CNS) that aim to identify biomarkers that relate to neurological impairments as a result of COVID-19, and the neuroimaging changes that are associated with these.

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More information: Adam Hampshire et al, Multivariate profile and acute-phase correlates of cognitive deficits in a COVID-19 hospitalised cohort, eClinicalMedicine (2022). DOI: 10.1016/j.eclinm.2022.101417

Provided by University of Cambridge 

 

Study finds higher death rates in older adults with cognitive impairment during the pandemic

by The Geisel School of Medicine at Dartmouth

Credit: CC0 Public Domain

Findings from a new study, led by researchers at Dartmouth's Geisel School of Medicine and published in JAMA Neurology, show that higher death rates have been associated with the COVID-19 pandemic among older adults with cognitive impairment—especially in racial and ethnic minority populations and those living in nursing homes.

09 mar 2022--In 2020, COVID-19 abruptly altered the delivery of healthcare and the daily operations of nursing facilities across the U.S. These changes included a decrease in inpatient care and a transition of outpatient care to telehealth platforms. In nursing facilities, operational changes included lockdowns and strict visitation procedures, resulting in social isolation for many residents.

But the associations between those changes related to the pandemic and patient outcomes, especially in vulnerable populations, are not yet well understood.

"When you think about adult populations that are potentially most at risk for bad outcomes when things change dramatically and abruptly in healthcare, older adults with cognitive issues—like Alzheimer's disease and related dementias (ADRD)—are at or near the top of the list," says Lauren Gilstrap, MD, MPH, an assistant professor of The Dartmouth Institute for Health Policy and Clinical Practice and of medicine at Dartmouth's Geisel School of Medicine, who served as lead author on the study.

"During the pandemic, mortality rates increased across most if not all segments of society—we knew that going into the study," she continues. "Our main question was whether the increase in mortality among these more vulnerable populations was proportional or disproportional."

To find out, the researchers conducted a cross-sectional analysis using fee-for-service data on Medicare enrollees aged 65 and older. They compared mortality rates from 26.7 million enrollees in 2020 with those of 26.9 million enrollees in 2019 in four predetermined groups: people with ADRD; people without ADRD, those with ADRD living in nursing homes, and those without ADRD in nursing homes.

The investigators found that mortality was 24 percent higher among individuals with ADRD in 2020 compared to 2019, and 14 percent higher for people without ADRD. Among nursing home residents with ADRD, mortality was 36 percent higher in 2020 compared to 2019, versus 25 percent higher for those without ADRD.

The largest increases in mortality were observed among Asian, Black, and Hispanic ADRD populations.

When the researchers measured monthly COVID-19 infection rates across the country's 306 hospital referral regions (or service areas), they found that the areas with the lowest COVID-19 prevalence had no excess mortality among enrollees without ADRD.

But they found eight percent higher mortality among community-dwelling enrollees with ADRD and 14 percent higher mortality among enrollees with ADRD living in nursing homes in those same areas where there was very low COVID-19.

"That was the most interesting finding in the study," says Gilstrap. "I think what that tells us is that those deaths were probably related less to COVID and more to abrupt changes in the healthcare system and how those changes altered access to both acute and chronic care as well as community support services.

"Overall, I think our findings also highlight that as a healthcare system we really do have to think about people with cognitive limitations differently, and that more creative solutions are needed to better serve this highly vulnerable segment of society."

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More information: Lauren Gilstrap et al, Trends in Mortality Rates Among Medicare Enrollees With Alzheimer Disease and Related Dementias Before and During the Early Phase of the COVID-19 Pandemic, JAMA Neurology (2022). DOI: 10.1001/jamaneurol.2022.0010

Provided by The Geisel School of Medicine at Dartmouth 

Low grip strength linked to impaired cognition, memory loss in older Americans

by Laura Bailey, University of Michigan

Credit: University of Michigan

For older Americans, poor handgrip may be a sign of impaired cognition and memory, a new study suggests.

25 aug 2019--Researchers from the University of Michigan and North Dakota State University followed nearly 14,000 participants from the 2006 Health and Retirement Study, age 50 and older, for eight years.

They found that every 5-kg reduction in handgrip strength was associated with 10% greater odds for any cognitive impairment 18% greater odds for severe cognitive impairment.

They assessed handgrip with a hand-held dynamometer, and cognitive function with a modified Mini-Mental State Examination, a widely used test among the elderly that includes tests of orientation, attention, memory, language and visual-spatial skills.

Study co-author Sheria Robinson-Lane, assistant professor at the U-M School of Nursing, said the findings are important for providers and individuals seeking ways to retain physical and mental function.

The findings, published in the Journal of Alzheimer's Disease, contribute to mounting evidence that providers should include grip strength––not currently used––in routine health assessments for older adults, said first author Ryan McGrath, assistant professor at North Dakota State University.

More importantly, the researchers interpreted the findings to mean that a reduction in grip strength is associated with neural degeneration, which underscores the importance of muscle-building exercise.

"These findings suggest that this is another instance where you're seeing that staying physically active affects your overall health and your cognitive health," Robinson-Lane said.

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More information: Ryan McGrath et al. Handgrip Strength Is Associated with Poorer Cognitive Functioning in Aging Americans, Journal of Alzheimer's Disease (2019). DOI: 10.3233/JAD-190042

Journal information: Journal of Alzheimer's Disease 

Provided by University of Michigan 

Elderly home care goes digital

Credit: DECI

For the elderly with cognitive impairment, living alone can prove detrimental to their health. Assistance services can provide appropriate discreet support for independent living and a high life quality.

21 oct 2018--The DECI project has successfully defined an innovative environment for independent living of the elderly with cognitive impairment. "The project revolved around a business model to supply assistance services in-house with a remote-based approach, allowing independent living for elderly people affected by mild cognitive impairment (MCI) and mild dementia (MD)," outlines project coordinator Prof. Paolo Locatelli.
Including an up-to-date modular, flexible and scalable organisational model, and the support of an IT platform based on innovative and easy-to-replicate technologies, the system enables a high level of independence with good quality of life.

Three solutions for supported independence at home

The technological solution includes an integrated care platform and a web-based interface. This enables professionals to share information about the patients as well as patients-to-professional communication (patients interact with the case manager and gain access to educational material). A smartwatch activity monitor records the number of steps and intensity of patient physical activity. There is also a coaching app where patients follow a computer-based cognitive simulation and physical activity programme.
The service and organisational model includes remote monitoring of patients' physical activities for adherence to cognitive and physical exercises and continuous communication among clinicians and patients/caregivers. The case manager follows the patient during his/her overall care path and accesses the DECI system. In Sweden, there is an additional innovation with a DECI mobile and multidisciplinary team that visit patients at home.
Support for an EU country or region in defining its own business model according to its specific needs is available within the general business model with the coherence matrix. The tool also underlines the common needs and technological functionalities among the different areas.
Four pilot sites and three groups for a wide range of test circumstances
Four very different sites were selected in Spain, Italy, Sweden and Israel. The goal was to provide individual, local instances for design and application of the business and organisational models, ICT tools and evaluate their impacts.
More than 500 patients took part in the trial for 6 months. At each site, a control group received care according to local guidelines and routines (standard care). There were two different intervention groups – one that used the organisational approach and the DECI medical staff. The other (complete) accessed both the service and organisational model, and the overall technological solution (including the activity monitoring system and the coaching and training system).

Significant results

Patients who received the full intervention presented more stability in basic activities of daily living (BADL), as demonstrated by the statistically significant difference of the BADL scales. Moreover, in the two intervention groups, a reduction in caregiver burden was observed, in particular in the Spanish pilot site.
Testament to the success of the system, the enrolled patients and the involved professionals expressed their willingness to use DECI in the future.
Delays in patients' enrolment translated into hold-ups in the implementation of the DECI solution in the pilot sites. "However, to guarantee a full six months intervention for each patient involved in the project, we at DECI decided to go on with the experimentation after the project end until August 2018," explains Prof. Locatelli.

The DECI legacy

After completion of work at the pilot sites, full analysis and data will be published in peer-reviewed journals. Significantly, the DECI organisational models in Italy and in Sweden are already part of the offered home care services. The Fondazione Don Gnocchi (Italy) is going to integrate the DECI functionalities in the ICT tools of their institute to support the new service and organisational model.
The project coordinator sums up the success of the DECI initiative: "Each country has a different way to treat MCI and MD patients. This fact was crucial to the strength of the methodological approach of the project and a critical point in the application of the DECI models and services. For this reason the change in management processes in applying the DECI models and tools was a critical success factor in the project."


Provided by CORDIS

Study finds that yoga and meditation can help minimize cognitive impairment

Inner peace and a flexible body may not be the most valuable benefits that yoga and meditation have to offer, suggests new research by a UCLA-led team of neuroscientists.

22 may 2016--The team found that a three-month course of yoga and meditation practice helped minimize the cognitive and emotional problems that often precede Alzheimer's disease and other forms of dementia—and that it was even more effective than the memory enhancement exercises that have been considered the gold standard for managing mild cognitive impairment.
"Memory training was comparable to yoga with meditation in terms of improving memory, but yoga provided a broader benefit than memory training because it also helped with mood, anxiety and coping skills," said Helen Lavretsky, the study's senior author and a professor in residence in UCLA's department of psychiatry.
People with mild cognitive impairment are two-and-a-half times more likely to develop Alzheimer's disease and other forms of dementia.
The study, which appears May 10 in the Journal of Alzheimer's Disease, is the first to compare outcomes from yoga and meditation with those from memory training, which incorporates activities ranging from crossword puzzles to commercially available computer programs. The study of 25 participants, all over the age of 55, measured changes not just in behavior but also in brain activity.
"Historically and anecdotally, yoga has been thought to be beneficial in aging well, but this is the scientific demonstration of that benefit," said Harris Eyre, the study's lead author, a doctoral candidate at Australia's University of Adelaide and a former Fulbright scholar at UCLA's Semel Institute for Neuroscience and Human Behavior. "We're converting historical wisdom into the high level of evidence required for doctors to recommend therapy to their patients."
Lavretsky and Eyre studied participants who had reported issues with their memory, such as tendencies to forget names, faces or appointments or to misplace things. Subjects underwent memory tests and brain scans at the beginning and end of the study.
Eleven participants received one hour a week of memory enhancement training and spent 20 minutes a day performing memory exercises—verbal and visual association and other practical strategies for improving memory, based on research-backed techniques.
The other 14 participants took a one-hour class once a week in Kundalini yoga and practiced 20 Kirtan Kriya meditation at home for 20 minutes each day. Kirtan Kriya, which involves chanting, hand movements and visualization of light, has been practiced for hundreds of years in India as a way to prevent cognitive decline in older adults, Lavretsky said.
After 12 weeks, the researchers saw similar improvements among participants in both groups in verbal memory skills—which come into play for remembering names and lists of words. But those who had practiced yoga and meditation had better improvements than the other subjects in visual-spatial memory skills, which come into play for recalling locations and navigating while walking or driving.
The yoga-meditation group also had better results in terms of reducing depression and anxiety and improving coping skills and resilience to stress. That's important because coming to terms with cognitive impairment can be emotionally difficult.
"When you have memory loss, you can get quite anxious about that and it can lead to depression," said Lavretsky, who is also a researcher at the Semel Institute.
The researchers report that the participants' outward improvements in memory corresponded with perceptible changes in their brain activity. Using functional magnetic resonance imaging, they showed that subjects in both groups had changes in their brain connectivity, but the changes among the yoga group were statistically significant, whereas the changes in the memory group were not.
The researchers attribute the positive "brain fitness" effects of mindful exercise to several factors, including its abilities to reduce stress and inflammation, improve mood and resilience, and enhance production of brain-derived neurotrophic growth factor, a protein the stimulates connections between neurons and kick-start telomerase activity, a process that replaces lost or damaged genetic material.
"If you or your relatives are trying to improve your memory or offset the risk for developing memory loss or dementia, a regular practice of yoga and meditation could be a simple, safe and low-cost solution to improving your brain fitness," Lavretsky said.


Provided by University of California, Los Angeles

Four signs that a geriatric ER patient should be admitted to the hospital

Four reasons to admit a senior from the ER to the hospital (Annals of Emergency Medicine). Credit: American College of Emergency Physicians

Older adults who go to the emergency department with cognitive impairment, a change in disposition plan from admit to discharge, low blood pressure and elevated heart rate were more likely to be admitted to the intensive care unit (ICU) or to die within 7 days. The results of a matched case-control study of patients age 65 or older who died or were admitted to the ICU within 7 days of being evaluated in the emergency department were published online Wednesday in Annals of Emergency Medicine ("Poor Outcomes Following Emergency Department Discharge of the Elderly: A Case-Control Study").

11 mar 2016--"Emergency physicians must exercise extra caution when making the decision to admit or discharge a geriatric patient," said Gelareh Gabayan, MD, MSHS of the Department of Medicine at the University of California at Los Angeles. "These patients tend to be more delicate than their younger counterparts. Even abnormal vital signs, like blood pressure and heart rate, are associated with potentially catastrophic events for patients who are discharged from the ER rather than admitted."
Patients age 65 or older with a change in disposition plan (from admit to discharge), acute or chronic cognitive impairment or mental status changes, and abnormal vital signs (a systolic blood pressure below 120 and heart rate above 90) had a greater likelihood of experiencing death or an ICU admission within 7 days of being discharged from the emergency department. (The change in disposition could be directed by a physician or by the patient leaving the hospital against medical advice.)
"Both patient families and hospital administrators can pressure emergency physicians to discharge seniors from the emergency department, but our study supports caution in these decisions," said Dr. Gabayan. "Our study identifies the patients at risk and the findings show that even seemingly small indicators can add up to something dangerous in these vulnerable patients. It is important to note, however, that this study does not encourage that all older adults be admitted. The findings should act as a tool for emergency department providers."

More information: Gelareh Z. Gabayan et al. Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study, Annals of Emergency Medicine (2016). DOI: 10.1016/j.annemergmed.2016.01.007


Provided by American College of Emergency Physicians

Living longer and healthier in mind but not in body

Credit: George Hodan/public domain

Women are now spending fewer years with cognitive impairment but more years with disability compared to 20 years ago, new research has revealed.

09 dec 2015--Experts have shown that between 1991 and 2011 women's life expectancy at age 65 increased by 3.6 years but they identified that the female body doesn't age as well as its mind.
A study by Newcastle University, UK, and the University of Cambridge, UK, published in The Lancet, has revealed that women lived approximately 2.5 months less with moderate or severe cognitive impairment and six months fewer with mild cognitive impairment, such as problems with memory and thinking.
However, this is balanced by the fact that at age 65 females now spend around seven months more with moderate or severe disability and 2.5 years more with mild disability.
Meanwhile, overall men's life expectancy increased by 4.5 years but they had only 1.3 years more with mild disability and there was no increase in the years spent with moderate or severe disability, or mild or worse cognitive impairment.
Professor Carol Jagger, from Newcastle University's Institute for Ageing, led the analysis of the research.
She said: "The big unanswered question is whether our extra years of life are healthy ones and the aim of our research was to investigate how health expectancies at age 65 years and over changed between 1991 and 2011.
"One possibility for the increased years women are living with mild disability might be the rise in obesity levels over the decades, but there may also be particular conditions, or just more multiple diseases, which are a feature of very old age."
The research team compared two rounds of the Cognitive Function and Ageing Study, done in England in 1991 and 2011.
Health expectancy was measured in three ways: self-perceived health, life without disability, and time free from cognitive impairment. For the study a total of 7,635 people aged 65 and over were analysed in Newcastle, Cambridge and Nottingham.
Analysis of the Health Survey for England for those aged 65+ over a similar time period showed problems with vision and hearing did not account for increases in disability.
Nevertheless, stability in self-care activities, like cooking, and increases in mobility limitations, such as walking 200 yards and climbing stairs, may contribute to gains in mild disability.
Professor Carol Brayne, from the University of Cambridge, was overall lead for the study.
She said: "The findings suggest a compression of cognitive morbidity when comparing older people now compared to 20 years ago in England. This is very good news and consistent with our earlier reporting of a reduction in age specific prevalence of dementia across two decades."
Health expectancies are important indicators to monitor population health trends and inequalities internationally, nationally and regionally.
It is necessary for Government to get a clear indication if people are living longer, healthier lives as it can have an impact on the economy, housing and employment opportunities.
Future work will examine the reasons for the increase in years with disability. The researchers will look at which diseases and conditions are responsible for the rise in mild disability and whether patterns prevail across all the regions studied.
Professor Jagger added: "Our findings have important implications for Government, employees and individuals with respect to raising the state pension age and extending working life.
"It is also necessary for community care services and family carers who predominantly support those with mild to moderate disability to enable them to continue living independently."
In most developed countries worldwide life expectancy is increasing at the rate of at least two years every decade, and, for life expectancy at age 60, shows no sign of slowing down.
Newcastle University's Institute for Ageing held a conference today (Tuesday, December 8), which focused on 'The economic and social impact of ageing' - Professor Jagger opened the event.

More information: A comparison of health expectancies over two decades in England: results of the Cognitive Function and Ageing Study I and II, dx.doi.org/10.1016/S0140-6736(15)00947-2

Provided by Newcastle University

Canadian Task Force on Preventive Health Care releases updated guideline

For adults aged 65 years or older living in the community, there is no benefit to screening for cognitive impairment if they are asymptomatic, according to a new Canadian guideline published in CMAJ(Canadian Medical Association Journal).

30 nov 2015--"While the task force recommends against screening older community-living adults for cognitive impairment, physicians should investigate if patients or their family members express concern about possible memory loss," states Dr. Kevin Pottie, chair of the Canadian Task Force on Preventive Health Care working group for the cognitive impairment guideline. "This recommendation is for adults without symptoms, not for people with concerns."
The recommendation updates the task force's previous recommendation that found insufficient evidence to recommend for or against screening, which was published in 2001. The current recommendation is based on a lack of evidence that screening is effective, a high rate of false-positive results for screening and the ineffectiveness of treatment for mild cognitive impairment. The task force found no clinical trials that evaluated the benefits or harms of screening for cognitive impairment, and instead looked at the effectiveness of treatment for mild cognitive impairment as indirect evidence to inform its recommendations on screening.
Cognitive impairment begins with normal age-related memory loss and may progress to mild cognitive impairment and possibly dementia. Although mild cognitive impairment is noticeable, it does not substantially affect daily living, unlike dementia. However, mild cognitive impairment can be a risk factor for later dementia, but it may not progress to that stage.
"Our assumptions were that, if clinicians are able to identify individuals with mild cognitive impairment early through screening and either slow down or stop its progression through effective treatment, the incidence of cognitive impairment (measured through cognition, function, behaviour and global status) may decline," the authors state.
Key findings:

• Cholinesterase inhibitors, a common treatment for Alzheimer disease, do not improve cognition in people with mild cognitive impairment.
• Dietary supplements and vitamins did not improve cognitive function in people with mild cognitive impairment.
• Nonpharmacologic interventions such as exercise and cognitive training may have some minor benefit, although the effect was not clinically significant.

The recommendation not to screen aligns with other national and international guidelines such as the United Kingdom's National Institute for Health and Care Excellence (NICE) 2011 guidelines and the US Preventive Services Task Force 2014 guidelines.
"The task force's findings have identified multiple opportunities for research," states Dr. Pottie. "It is clear that we need more precise screening tools and treatments, including preventive approaches that improve outcomes for people with cognitive impairment."
The guideline, as well as materials for physicians, is available at http://www.canadiantaskforce.ca.
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the task force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.

More information: CMAJ, www.cmaj.ca/lookup/doi/10.1503/cmaj.141165


Provided by Canadian Medical Association Journal

The size of your hippocampi could indicate your risk of cognitive impairment

Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.

17 oct 201--A larger brain volume could indicate a reduced risk of memory decline according to research published in the open access journal Alzheimer's Research and Therapy.
The preliminary study of 226 people indicates that an association between brain volume, in particular the size of one's hippocampi, and one's memory, could predict one's likelihood of cognitive impairment, such as dementia. Further research is needed to confirm what exact role the hippocampi play in the onset of cognitive impairment.
Our hippocampi, a pair of seahorse looking structures located in the left and right sides of the brain, are responsible for forming new memories. When these are impaired, as in Alzheimer's disease, it becomes difficult to remember recent acts or events. Previous studies have suggested that their size could be used as a standard assessment, indicating those at increased risk for the development of Alzheimer's disease.
The left hippocampus is associated with verbal retention, while the right is associated with spatial memory, for example, the geographical layout of your hometown.
The researchers examined a total of 226 memory clinic patients to see if there was any indication of those who may be at higher risk of developing dementia. This was a large group of patients, for this type of study, with various forms of neurodegenerative disorders; 34 were diagnosed with Alzheimer's disease and 82 have amnestic Mild Cognitive Impairment, which can be a precursor to Alzheimer's disease.
The patients performed memory tests. The first test assessed their verbal memory by analyzing their ability to recall lists of words read out to them. The subjects then performed spatial tests to see how well they could remember geometric shapes and patterns. Following on from this, the researchers analyzed brain scans recorded from magnetic resonance imaging. Individuals with 'normal memory' had larger hippocampi and performed better in memory tasks than those with cognitive impairment.
Aaron Bonner-Jackson, the lead author of the study, from Center for Brain Health at the Cleveland Clinic, USA, says, "We found that a large left or right hippocampus could indicate a better verbal or spatial memory. We suggest that performance on the spatial memory task is a more sensitive measure of hippocampal volumes than performance on the verbal memory task. This challenges earlier studies and clinical trials which focused on verbal memory alone, as we're now finding that spatial memory is a bigger player in assessment of those at risk for Alzheimer's disease."
Bonner-Jackson adds: "We want to detect the earliest signs of dementia and this link between the performance on standard clinical measures of memory and changes in the hippocampus could be another hallmark sign of Alzheimer's disease."
"We restricted our analysis only to the hippocampus, but the relationship between other brain structures, such as thalamus and amygdala, and Alzheimer's disease should also be examined. Although this is one of the largest studies looking at the role hippocampi play in the onset of dementia, further investigation is needed to confirm the relationship. Clinical trials of Alzheimer's disease therapies should then consider these findings in designing new medications."
This study was observational, so it can increase our understanding of possible links between hippocampal volume and memory decline, but it cannot show cause and effect because other factors may play a role.
More information: Aaron Bonner-Jackson et al. Verbal and non-verbal memory and hippocampal volumes in a memory clinic population, Alzheimer's Research & Therapy (2015). DOI: 10.1186/s13195-015-0147-9

Provided by BioMed Central

Tool can help assess cognitive impairment in multicultural populations

Credit: Karen Arnold/Public Domain

20 feb 2015--The ability to assess cognitive impairment in multicultural older populations will become more important as demographics change worldwide. A new study published in CMAJ (Canadian Medical Association Journal) reports that the Rowland Universal Dementia Assessment Scale (RUDAS) is particularly effective in multicultural populations where English is not a patient's first language.

Dementia is on the rise worldwide, with numbers projected to triple by 2050 to over 100 million. More than half the patients (58%) are in low- and middle-income countries, many of which are sources of immigrants to countries like Canada and Australia.

"Given our aging immigrant population in Canada and the anticipated increase in dementia prevalence worldwide in coming decades, earlier and more accurate detection of dementia in these populations will become increasingly important," writes Dr. Raza Naqvi, a geriatrician with the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada, with coauthors.

Current tools to assess cognitive health, such as the Mini-Mental State Examination and the Montreal Cognitive Assessment, are widely used but are challenging to use in patients with low education levels and those whose first language is not English.

Researchers undertook a systematic review and meta-analysis to determine whether the RUDAS, developed in Australia in 2004, is effective in a variety of settings. They also wanted to understand how it compares to other tools. The study included 1236 people from 11 previous studies conducted in 6 countries. The mean age of participants was 73.5 years, and almost two-thirds (61%) were female.

The RUDAS includes questions such as recall of four grocery items, what safety precautions should one take when crossing the street, and naming of animals in 1 minute; it also assesses coordinated movements. The test appeared to be effective in identifying cognitive impairment and ruling it out across various cultures because language and education had less effect on results than with the other assessment tools.

The authors noted that all studies included in the analysis used trained interpreters; this may be a limitation since interpreters will not always be available for tests in all settings.

"The RUDAS is a freely available, effective brief cognitive assessment tool that has shown strong psychometric properties in several countries. It shows particular advantage in culturally and linguistically diverse populations," the authors conclude.

More information: Canadian Medical Association Journal, www.cmaj.ca/lookup/doi/10.1503/cmaj.140802

Provided by Canadian Medical Association Journal

USPSTF: Evidence lacking for cognitive impairment screening

08 nov 2013—The U.S. Preventive Services Task Force (USPSTF) has found that the evidence is insufficient to assess the balance of benefits and harms of cognitive impairment screening for older adults without signs or symptoms of cognitive impairment. This draft recommendation statement is based on an evidence review published in the Nov. 5 issue of the Annals of Internal Medicine.

Noting that some screening tools have sufficiently high sensitivity and specificity to be clinically useful in identifying dementia, researchers from the USPSTF reviewed the literature to assess the benefits and harms of routine screening of all older adults for cognitive impairment. The draft recommendation statement is applicable to adults older than 65 years without signs or symptoms of cognitive impairment.

The researchers found that the evidence was insufficient to evaluate the balance of benefits and harms of cognitive impairment screening. The draft recommendation statement is available for comment from Nov. 5 to Dec. 2, 2013.

"Although the benefits and harms of what we can offer patients through routine screening are unclear right now, clinicians should remain alert to early signs or symptoms of cognitive impairment and evaluate their patients as appropriate," Task Force co-vice chair Albert Siu, M.D., M.S.P.H., said in a statement.

More information: Draft Recommendation Statement
Comment on Recommendations
Background Review

Study examines cognitive impairment in families with exceptional longevity

A study by Stephanie Cosentino, Ph.D., of Columbia University, New York, and colleagues examines the relationship between families with exceptional longevity and cognitive impairment consistent with Alzheimer disease.

13 may 2013--The cross-sectional study included a total of 1,870 individuals (1,510 family members and 360 spouse controls) recruited through the Long Life Family Study. The main outcome measure was the prevalence of cognitive impairment based on a diagnostic algorithm validated using the National Alzheimer's Coordinating Center data set.

According to study results, the cognitive algorithm classified 546 individuals (38.5 percent) as having cognitive impairment consistent with Alzheimer disease. Long Life Family Study probands had a slightly but not statistically significant reduced risk of cognitive impairment compared with spouse controls (121 of 232 for probands versus 45 of 103 for spouse controls), whereas Long Life Family Study sons and daughters had a reduced risk of cognitive impairment (11 of 213 for sons and daughters versus 28 of 216 for spouse controls). Restriction to nieces and nephews in the offspring generation attenuated this association (37 of 328 for nieces and nephews versus 28 of 216 for spouse controls).

"Overall, our results appear to be consistent with a delayed onset of disease in long-lived families, such that individuals who are part of exceptionally long-lived families are protected but not later in life," the study concludes.

More information: JAMA Neurol. Published online May 6, 2013. doi:10.1001/.jamaneurol.2013.1959

Provided by The JAMA Network Journals

Cognitive problems common among non-demented elderly

Both subjective and objective cognitive impairment are highly common among non-demented elderly Swedes, with an overall prevalence of 39 percent and 25 percent respectively, according to a nationwide twin study by researchers at the Aging Research Center of Karolinska Institutet, Sweden. The study confirms higher education as a major protective factor and stresses the importance of environmental aspects over genes in mild cognitive disorders in old age.

12 feb 2012--In the current study, which is published in the Journal of Alzheimer's Disease, the researchers investigated the distribution and heritability of subjective and objective cognitive impairment in the population by using data from 11,926 twins aged 65 and above in the Swedish Twin Registry. Objective cognitive impairment involves a reduced performance on tests measuring different cognitive abilities, such as memory and attention, while subjective cognitive impairment involves the same type of problems but experienced only at the subjective level. The researchers then found, that together subjective and objective cognitive impairment affect the majority of non-demented Swedish elderly (joint prevalence 64 percent), suggesting that mild cognitive disorders may represent a major public health concern even in the absence of dementia.

The study also highlights that subjective and objective cognitive impairment has distinct socio-demographic profiles. Specifically, when compared with people with objective cognitive impairment, elderly with subjective complaints only were more educated, more likely to be married, and to have higher socio-economic status – pointing to a possible protective effect of this favorable life conditions. Co-twin control analysis showed that the detrimental effect of lower educational level on cognitive functioning is largely independent by genetic background and early life environment.

"This underlies the relevance of adult life educational achievements for preserved cognitive functioning in older life", says Dr Barbara Caracciolo, who led the study at the Aging Research Center in Stockholm.

Regarding the heritability of subjective and objective cognitive impairment, the researchers observed concordance rates of 63 percent and 52 percent in monozygotic twins, 63 percent and 50 percent in dizygotic same-sex twins, and 42 percent and 29 percent in dizygotic unlike-sex twins. The lack of substantial differences in concordance rates between genetically identical (monozygotic) and or non-identical (dizygotic) twins suggests that environmental influences rather than genetic background play the major role in the occurrence of mild cognitive disorders in non-demented elderly.

More information: 'Differential Distribution of Subjective and Objective Cognitive Impairment in the Population: A Nation-Wide Twin-Study', Caracciolo B, Gatz M, Xu W, Pedersen NL, Fratiglioni L., Journal of Alzheimer's Disease, epub ahead of print 10 January 2012, doi:10.3233/JAD-2011-111904

Provided by Karolinska Institutet

Even mild cognitive impairment appears to substantially increase risk for death

Cognitive impairment, even when detected at an early, mild stage, is a significant predictor of decreased life expectancy.

06 sept 2011--According to a new, long-term study from Regenstrief Institute and Indiana University researchers, cognitive impairment, especially at the moderate to severe stages has an impact on life expectancy similar to chronic conditions such as diabetes or chronic heart failure. Their findings, "Cognitive Impairment: An Independent Predictor of Excess Mortality. A Cohort Study" appears in the Sept. 6, 2011 issue of Annals of Internal Medicine.

Nearly 4,000 people between the ages of 60 to 102 years, initially seen from 1991 to 1993 by primary care physicians at Wishard Health Services, a large public hospital with community health centers in Indianapolis, participated in the study. The patients were followed for 13 years.

"Previous studies have associated cognitive impairment with an increased risk for death, but most of this work focused on patients with Alzheimer disease and subjects in research centers. The patients in our study better reflect the general public, displaying no indications of disease or mild, moderate or severe cognitive impairment," said Regenstrief investigator Greg A. Sachs, M.D., professor of medicine at the Indiana University School of Medicine, where he is the division chief of general internal medicine and geriatrics. "We found that even mild cognitive impairment, as determined by a simple screening tool in a primary care physician's office, has a strong impact on how long individuals survive on the same order as other chronic diseases."

The study followed 3,957 patients. At screening, 3,157 had no cognitive impairment, 533 had mild impairment, and 267 had moderate to severe impairment. During follow-up, 57 percent of patients with no impairment died, compared with 68 percent of those with mild impairment and 79 percent of those with moderate to severe impairment. Median survival time was 138 months for patients with no impairment, 106 months for those with mild impairment, and 63 months for those with moderate to severe impairment.

Study participants were screened for cognitive impairment using an easy-to-administer 10-question mental status questionnaire. On the basis of the number of errors patients made on this test, they were categorized as having no, mild, or moderate to severe cognitive impairment. The Regenstrief Medical Record System was used to obtain data on the patients' medical conditions, results of lab tests and other relevant information.

Cognitive impairment affects memory and thinking. Approximately 4 million to 5 million people in the United States have dementia, and the number of individuals affected is significantly higher if individuals with milder forms of cognitive impairment are included. The prevalence of cognitive impairment at all stages is expected to increase as the population ages.

The study findings have important clinical and prognostic implications beyond dementia detection, treatment and support for affected patients and their families. Reduced life expectancy in patients with cognitive impairment should be factored into medical decisions, such as advance care planning, cancer screening and prescribing of medications, especially in patients with severe impairment, the authors state.

Given that the magnitude of the risk of mild and moderate to severe cognitive impairment is similar to that of many life-limiting diseases, as well as the ease of indentifying cognitive impairment by using a short screening tool, recognition of cognitive impairment in primary care practices should be given a higher priority, the study concludes.

Provided by Indiana University School of Medicine

Studies evaluate the association between physical activity and lower rates of cognitive impairment

Engaging in regular physical activity is associated with less decline in cognitive function in older adults, according to two studies published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals. The articles are being released on July 19 to coincide with the International Conference on Alzheimer's Disease in Paris and will be included in the July 25 print edition.

25 july 2011--According to background information provided in the articles, previous research has suggested that physical activity is associated with reduced rates of cognitive impairment in older adults. However, much of this research has apparently been conducted among individuals who are generally in good health. Further, many of these studies rely on self-reports of physical activity, which are not always accurate; and focus on moderate or vigorous exercise, instead of low-intensity physical activity. The two articles being presented today seek to fill in these gaps in the research.

In one article, Marie-Noël Vercambre, Ph.D., from the Foundation of Public Health, Mutuelle Generale de l'Education Nationale, Paris, and colleagues examined data from the Women's Antioxidant Cardiovascular Study, which included women who had either prevalent vascular disease or three or more coronary risk factors. The researchers determined patients' physical activity levels at baseline (1995 to 1996) and every two years thereafter. Between 1998 and 2000, they conducted telephone interviews with 2,809 women; the calls included tests of cognition, memory and category fluency, and followed up the tests three more times over the succeeding 5.4 years.

The researchers analyzed data to correlate cognitive score changes with total physical activity and energy expenditure from walking. As participants' energy expenditure increased, the rate of cognitive decline decreased. The amount of exercise equivalent to a brisk, 30-minute walk every day was associated with lower risk of cognitive impairment.

In another report, Laura E. Middleton, Ph.D., from the Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, and colleagues utilized data from the Health, Aging, and Body Composition study, an ongoing prospective cohort study. The researchers measured participants' total energy expenditure by using doubly labeled water, a technique that provides evidence of how much water a person loses and thus serves as an objective measure of metabolic activity. The authors calculated participants' activity energy expenditure (AEE), defined as 90 percent of total energy expenditure minus resting metabolic rate. The 197 participants, with an average age of 74.8 years, had no mobility or cognitive problems when the research began in 1998 to 1999. At that time, researchers assessed participants' cognitive function, and followed up two to five years later with the Modified Mini-Mental State Examination (MMMSE).

The authors adjusted the data for baseline MMMSE scores, demographics, fat-free mass, sleep duration, self-reported health and diabetes mellitus. When these variables were accounted for, participants who had the highest AEE scores tended to have lower odds of incident cognitive impairment. The authors also noticed a significant dose response between AEE and incidence of cognitive impairment.

The authors of both articles suggest that there is more to be learned about the relationship between physical activity and cognitive function. "Various biologic mechanisms may explain the positive relation between physical activity and cognitive health," write Vercambre and colleagues. Middleton and co-authors state, "The mechanisms by which physical activity is related to late-life cognition are likely to be multifactorial." Both groups of researchers note that studies such as theirs point toward some possible answers. As Vercambre and co-authors comment, "If confirmed in future studies, physical activity recommendations could yield substantial public health benefits given the growing number of older persons with vascular conditions and their high risk of cognitive impairment." And Middleton and colleagues conclude, "We are optimistic that even low-intensity activity of daily living may be protective against incident cognitive impairment."

Commentary: Brains and Aging

In a commentary accompanying the articles, Eric B. Larson, M.D., M.P.H., from Group Health Research Institute, Seattle, notes that these studies serve to "buttress growing evidence that habitual physical activity and fitness are associated with age-related changes in cognition and risk of dementia." The key finding of the Vercambre and colleagues study, he writes, "is that older women with high levels of vascular risk constitute a major risk group and that vascular risk is linked to cognitive decline." Of the work published by Middleton and colleagues, Larson observes, "The fact that the study used a validated measurement of energy expenditure, not just self-report, makes the results of further importance." Such research, he states, is increasingly needed as the population ages and the health care field attempts to cope with higher rates of cognitive decline.

In this context, Larson suggests that articles such as the ones presented here "highlight a gradual but steady change in current thinking about risk factors for late-life dementias." Vascular risk factors such as limited physical activity may be modifiable and represent a way to reduce the incidence of cognitive impairment among older adults. Physical activity, growing scientific evidence suggests, could be one such avenue.

"I believe that these findings can inform practice and the advice that we give our aging patients," comments Larson. "We can tell them that ongoing maintenance of physical activity is definitely worthwhile and likely of increasing benefit as they advance into old age." In addition, Larson stresses the need for research into "programs that promote ongoing physical activity, especially in late life."

More information: Arch Intern Med. Published July 19, 2011. doi:10.1001/archinternmed.2011.282 ; doi:10.1001/archinternmed.2011.277

Commentary: Arch Intern Med. Published online July 19, 2011. doi:10.1001/archinternmed.2011.273

Provided by JAMA and Archives Journals

Patients who survive sepsis are more than 3 times as likely to have cognitive problems


Older adults who survive severe sepsis are at higher risk for long-term cognitive impairment and physical limitations than those hospitalized for other reasons, according to researchers from the University of Michigan Health System.

02 nov 2010--Research to be published Oct. 27 in the Journal of the American Medical Association showed that 60 percent of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults. The odds of acquiring moderate to severe cognitive impairment were 3.3 times higher following an episode of sepsis than for other hospitalizations.

Severe sepsis also was associated with greater risk for the development of new functional limitations following hospitalization, says lead author, Theodore (Jack) Iwashyna, M.D., Ph.D., assistant professor of internal medicine at U-M.

Among patients who had no limitations before sepsis, more than 40% developed trouble with walking. Nearly 1 in 5 developed new problems with shopping or preparing a meal. Patients often developed new problems with such basic things as bathing and toileting themselves.

"We used to think of sepsis as just a medical emergency, an infection that you get sick with and then recover," said Iwashyna, "But we discovered a significant number of people face years of problems afterwards.

"Those problems are bigger and more common than we expected. Most older Americans suffer real brain and body problems. We need new treatments, not just for the sepsis infection, but to prevent these new disabilities afterwards."

Sepsis is an overwhelming infection that can result in failure of multiple organ systems. The initial infections are often common problems, such as pneumonia or a urinary tract infection. About 40 percent of those with severe sepsis die from the infection.

Anyone can get sepsis, but older people and those with weakened immune systems are most vulnerable. Sepsis is probably the most common cause of critical illness in the United States.

The best data available are from the 1990s, when it was estimated that 750,000 people each year were diagnosed with sepsis. Researchers believe that number has doubled each decade.

"These new data show a majority of older patients suffer with real life-changing burdens after beating sepsis. This is an underrecognized public health problem with major implications for patients, families and the health care system," Iwashyna says.

"We need to make sure families have the resources they need to care for survivors of sepsis when they go home. It's not enough just to get them through the acute episode. We need to start preparing them for the years of problems they may have afterwards."

"This research underscores the need for physicians who care for older adults to focus early on preventing infections that can lead to sepsis," says study co-author Kenneth M. Langa, M.D., Ph.D., a core investigator for the Ann Arbor Veterans Administration Health Services Research and Development Service's Center of Excellence and professor of internal medicine at U-M.

Older patients need to get their flu and pneumonia vaccines in order to decrease their risk for infections, and physicians need to be aware of the long-term risk for cognitive and physical disabilities that many patients may face, Langa said.

"In contrast to Alzheimer's disease and other forms of dementia, the cognitive impairment associated with sepsis is likely at least partially preventable through better acute care of the sepsis episode and better rehabilitation efforts afterwards," Langa says.

"We need to start working early – from the beginning of the hospitalization – to make sure patients do not develop new disability. There are innovative new ways to care for people that might help prevent this disability," Iwashyna says.

The research was supported primarily by the National Institute on Aging and the National Heart, Lung and Blood Institute.

The researchers used data from the NIA-supported Health and Retirement Study , a long-term study that collects information on the health, economic, and social factors influencing the health and well-being of a nationally representative sample Americans over age 50.

"This research makes clearer how acute medical problems in older adults may have an important lasting impact and contribute to a downward trajectory in both cognitive and physical function," says Richard Suzman, Ph.D., director of the NIA's Division of Behavioral and Social Research, which supports the HRS.

"The unique nature of the rich HRS dataset that links both survey data and Medicare administrative data made this innovative study possible and will also facilitate future studies of the long-term impact of critical illness on older adults and the family members that care for them."

More information: Journal of the American Medical Association, 2010; 304(16): 1787-1794.

White Matter Changes May Predict Cognition Issues

Progression in white matter hypersensitivity may better predict cognitive impairment

15 july 2009 -- The progression of white matter hypersensitivity is a better predictor of persistent cognitive impairment than baseline white matter hypersensitivity volume, according to a study published in the July 14 issue of Neurology.

Lisa C. Silbert, M.D., of Oregon Health & Science University in Portland, and colleagues conducted a study of 98 elderly subjects with intact cognition, of whom 49 underwent at least three brain magnetic resonance imaging tests, as well as annual assessments of cognitive and neurological function, until they were diagnosed with persistent cognitive impairment.

There was a higher risk of persistent cognitive impairment with increased progression of total white matter hypersensitivity and periventricular white matter hypersensitivity volume, but there was no association with baseline white matter hypersensitivity volume, the investigators discovered.

"Total and periventricular white matter hypersensitivity progression in cognitively intact elderly individuals confers increased risk of eventual cognitive impairment in relatively healthy elderly individuals," the authors write. "Specifically, every 1 mL/year increase in periventricular white matter hypersensitivity increases risk of persistent cognitive impairment by 94 percent. Identifying those vulnerable to such progression may be important so that those at risk for cognitive decline can be targeted for early intervention and treatment trials."

Authors of the study reported financial relationships with Medicare, commercial insurance companies, Alzheimer's associations and the pharmaceutical industry.

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Cognitive Impairment Spikes Death Risk for Seniors

Alzheimer disease raises death risk nearly three-fold over those with no cognitive impairment

13 june 2009-- Mild cognitive impairment (MCI) and Alzheimer disease (AD) increase the risk of death, and the risk increases as the severity of the impairment increases, according to a study in the June Archives of Neurology.

Robert S. Wilson, Ph.D., of Rush University Medical Center in Chicago, and colleagues studied a group of older blacks and whites from four neighborhoods in Chicago who were considered dementia-free in an earlier data collection initiative of 1,715 subjects. Upon clinical evaluation, the cohort was found to include 802 people with no cognitive impairment, 597 with MCI, 296 with AD, and 20 with other forms of dementia. The group was followed for up to 10 years (mean, 4.7 years) for all-cause death.

During follow-up, the researchers report that 634 people died. Compared to subjects without cognitive impairment, the risk of death was approximately 50 percent higher for those with MCI (hazard ratio, 1.48) and was nearly three times higher for those with AD (hazard ratio, 2.84). For subjects with MCI or AD, the risk of death increased as cognitive impairment increased, and was more pronounced for perceptual speed than for other cognitive factors. The relationship between cognitive impairment and risk of death was similar in blacks and whites, except for a slightly elevated risk of death for blacks with AD.

"The presence and severity of MCI and AD are associated with reduced survival among African Americans, and these effects are comparable to those seen among whites," the authors write.

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Commonly used medications may produce cognitive impairment in older adults

INDIANAPOLIS, 02 june 2009 - Many drugs commonly prescribed to older adults for a variety of common medical conditions including allergies, hypertension, asthma, and cardiovascular disease appear to negatively affect the aging brain causing immediate but possibly reversible cognitive impairment, including delirium, in older adults according to a clinical review now available online in the Journal of Clinical Interventions in Aging, a peer reviewed, open access publication.

Drugs, such as diphenhydramine, which have an anticholinergic effect, are important medical therapies available by prescription and also are sold over the counter under various brand names such as Benadryl®, Dramamine®, Excederin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®. Older adults most commonly use drugs with anticholinergic effects as sleep aids.

While it is known that these medications do have an effect on the brain and in the case of sleeping pills, are prescribed to act on the brain, the study authors suggest the amount of cognitive impairment caused by the drugs in older adults is not well recognized.

"The public, physicians, and even the Food and Drug Administration, need to be made aware of the role of these common medications, and others with anticholinergic effects, in causing cognitive impairment. Patients should write down and tell their doctor which over-the-counter drugs they are taking. Doctors, who often think of these medications simply as antihistamines, antidepressants, antihypertensives, sleep aids or even itching remedies, need to recognize their systemic anticholinergic properties and the fact that they appear to impact brain health negatively. Doing so, and prescribing alternative medications, should improve both the health and quality of life of older adults," said senior study author Malaz Boustani, M.D., Indiana University School of Medicine associate professor of medicine, Regenstrief Institute investigator, and research scientist with the IU Center for Aging Research.

Dr. Boustani and colleagues conducted a systematic evidence-based analysis of 27 peer reviewed studies of the relationship of anticholinergic effect and brain function as well as investigating anecdotal information. They found a strong link between anticholinergic effect and cognitive impairment in older adults.

"One of the goals of our work is to encourage the Food and Drug Administration to expand its safety evaluation process from looking only at the heart, kidney and liver effects of these drugs to include effects of a drug on the most precious organ in human beings, our brain," Dr. Boustani said.

"Many medications used for several common disease states have anticholinergic effects that are often unrecognized by prescribers" said Wishard Health Services pharmacist, Noll Campbell, Pharm.D., first author of the study, noting that these drugs are among the most frequently purchased over the counter products. "In fact, 50 percent of the older adult population use a medication with some degree of anticholinergic effect each day."

"Our main message is that older adults and their physicians should have conversations about the benefits and harms of these drugs in relation to brain health. As the number of older adults suffering from both cognitive impairment and multiple chronic conditions increases, it is very important to recognize the negative impact of certain medications on the aging brain," said Dr. Boustani.

The brain pharmacoepidemiology group of the IU Center for Aging Research currently is conducting a study of 4,000 older adults to determine if the long term use of medications with anticholinergic effects is linked to the irreversible development of cognitive impairment such as Alzheimer disease.

Age-Related Eye Disease May Be Associated With Cognitive Impairment

25 may 2009--Older adults with low scores on tests of cognitive function, including thinking, learning and memory appear more likely to have the early stages of the eye disease age-related macular degeneration, according to a report in the May issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Age-related macular degeneration (AMD)-the leading cause of visual impairment in industrialized nations-has long been thought to share a common pathway with Alzheimer's disease, according to background information in the article. First, both conditions involve similar changes in the brain and eye, including the buildup of protein fragments known as beta-amyloid. "Second, clinical studies suggest that AMD and Alzheimer's disease share similar vascular risk factors, such as hypertension [high blood pressure] and cigarette smoking," the authors write. "Both AMD and Alzheimer's disease have been linked to an increased risk of stroke."

Michelle L. Baker, M.D., of the University of Melbourne, Victoria, Australia, and colleagues assessed 2,088 individuals age 69 to 97. Participants underwent cognitive testing, retinal photography for the detection of AMD and an extensive assessment of artery disease and its risk factors (including blood pressure, smoking status and body mass index).

After controlling for age, sex, race and the center at which they participated in the study, the one-fourth of individuals with the lowest scores on one cognitive test were twice as likely to have early-stage AMD as were individuals with higher scores. However, there was no association between AMD and scores on a second cognitive test, dementia or Alzheimer's disease.

"In conclusion, we found an association between low cognitive function and early AMD in this older population," the authors write. "These data, along with others, provide further support that AMD and cognitive impairment may share similar complex pathogenesis [development] and risk factors."

Arch Opthalmol. 2009;127[5]:667-673.