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Cognitive Scores (cognitive + score)

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Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2010
Kristine Yaffe MD
OBJECTIVES: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors. DESIGN: Cross-sectional. SETTING: Chronic Renal Insufficiency Cohort Study. PARTICIPANTS: Eight hundred twenty-five adults aged 55 and older with CKD. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m2) was estimated using the four-variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score ,1 standard deviations from the mean). RESULTS: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1,3.9), naming (AOR=1.9, 95% CI=1.0,3.3), attention (AOR=2.4, 95% CI=1.3,4.5), executive function (AOR=2.5, 95% CI=1.9,4.4), and delayed memory (AOR=1.5, 95% CI=0.9,2.6) but not on category fluency (AOR=1.1, 95% CI=0.6,2.0) than those with mild to moderate CKD (eGFR 45,59). CONCLUSION: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment. [source]

The safety and tolerability of duloxetine in depressed elderly patients with and without medical comorbidity

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007
T. N. Wise
Summary Aim and methods:, The impact of medical comorbidity on the efficacy and tolerability of duloxetine in elderly patients with major depressive disorder (MDD) was investigated in this study. Data were obtained from a multicentre, randomised, double-blind, placebo-controlled study in 311 patients with MDD aged 65,89. The primary outcome measure was a prespecified composite cognitive score based on four cognitive tests: (i) Verbal Learning and Recall Test; (ii) Symbol Digit Substitution Test; (iii) 2-Digit Cancellation Test and (iv) Letter-Number Sequencing Test. Secondary measures included the Geriatric Depression Scale (GDS), 17-Item Hamilton Depression Scale (HAMD17), Clinical Global Impression-Severity (CGI-S) Scale, Visual Analogue Scale (VAS) for pain and 36-Item Short Form Health Survey (SF-36). Tolerability measures included adverse events reported as the reason for discontinuation and treatment-emergent adverse events (TEAEs). The consistency of the effect of duloxetine vs. placebo comparing patients with and without medical comorbidity (vascular disease, diabetes, arthritis or any of these) was investigated. Results:, Overall, duloxetine 60 mg/day demonstrated significantly greater improvement compared with placebo for the composite cognitive score, GDS and HAMD17 total scores, CGI-Severity, HAMD17 response and remission rates, and some of the SF-36 and VAS measures. There were few significant treatment-by-comorbidity subgroup interactions for these efficacy variables, or for adverse events reported as the reason for discontinuation and common TEAEs. Conclusions:, The present analyses suggested that the efficacy of duloxetine on cognition and depression in elderly patients, and its tolerability, were not largely affected by the comorbidity status. These results further support the use of duloxetine in elderly patients with MDD. [source]

Validation of a memory inventory for the assessment of awareness of memory deficits in Alzheimer's disease in Chinese elderly

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2006
Victor Wing Cheong Lui
Abstract Background This paper describes the development and validation of the Memory Inventory for Chinese (MIC), for measuring the awareness of memory deficits in the Chinese population with Alzheimer's disease (AD). Methods A combination of qualitative and quantitative approaches was adopted. The MIC was developed with focus group discussion and pilot testing. It has a patient and a caregiver version. A consecutive series of 79 new out-patients with the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorder Association (NINCDS-ADRDA) criteria of probable and possible AD and 20 non-demented elderly subjects were recruited. Results A high internal consistency was found, with Cronbach alpha of 0.89 for the patient version and 0.90 for the caregiver version of MIC. The inter-rater reliability was satisfactory. For validity assessment, the caregiver score of the MIC correlated significantly with cognitive score of the subject as assessed by the Mini-Mental State Examination (rp,=,,0.37; p,<,0.01). The Memory Deficit Awareness Score, calculated by subtracting the patient score from the caregiver score, correlated significantly with clinician ratings of awareness of memory impairment (rs,=,,0.67; p,<,0.01). Conclusions The MIC appears to be a culturally appropriate and valid instrument for the measurement of awareness of memory deficits in Chinese patients with AD. Potential applications of the MIC should be further explored in other subtypes of dementia and in prospective studies. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Maternal blood glucose in diabetic pregnancies and cognitive performance in offspring in young adulthood: a Danish cohort study

DIABETIC MEDICINE, Issue 7 2010
G. L. Nielsen
Diabet. Med. 27, 786,790 (2010) Abstract Aims, Maternal diabetes is a known risk factor for perinatal complications, but there are little data on consequences for long-term intellectual outcome in offspring. We assess cognitive performance in military conscripts according to maternal blood glucose levels during pregnancy. Methods, We identified a cohort of 60 Danish male offspring of insulin-treated diabetic mothers born between 1976 and 1984 and followed this cohort to military conscription. From medical records, we extracted data on all available values of maternal blood glucose categorized as fasting and non-fasting and by day in pregnancy, together with maternal White class, smoking habits and socio-economic status. The main outcome was cognitive performance at conscription measured with a validated intelligence test. The association between maternal blood glucose level and cognitive performance was assessed by multivariate linear regression and a fitted fractional polynomial. Results, Median fasting blood glucose values in the second half of pregnancy was negatively associated with cognitive scores at conscription [adjusted coefficient ,1.7; 95% confidence interval (CI) ,3.0; ,0.4]. Restriction to only first-born sibling slightly strengthened the association (coefficient ,1.9; 95% CI ,3.3; ,0.5), but after exclusion of two pregnancies with the blood glucose > 10 mmol/l the association became insignificant (coefficient ,0.6; 95% CI ,2.6; 1.4). Conclusions, Maternal blood glucose level during diabetic pregnancy is negatively associated with cognitive performance in offspring at military conscription. In pregnancies with fasting blood glucose levels below 10 mmol/l, the association is weak and considered to be without clinical relevance. [source]

Cognitive test scores in male adolescent cigarette smokers compared to non-smokers: a population-based study

ADDICTION, Issue 2 2010
Mark Weiser
ABSTRACT Background Although previous studies indicate that people with lower intelligence quotient (IQ) scores are more likely to become cigarette smokers, IQ scores of siblings discordant for smoking and of adolescents who began smoking between ages 18,21 years have not been studied systematically. Methods Each year a random sample of Israeli military recruits complete a smoking questionnaire. Cognitive functioning is assessed by the military using standardized tests equivalent to IQ. Results Of 20 221 18-year-old males, 28.5% reported smoking at least one cigarette a day (smokers). An unadjusted comparison found that smokers scored 0.41 effect sizes (ES, P < 0.001) lower than non-smokers; adjusted analyses remained significant (adjusted ES = 0.27, P < 0.001). Adolescents smoking one to five, six to 10, 11,20 and 21+ cigarettes/day had cognitive test scores 0.14, 0.22, 0.33 and 0.5 adjusted ES poorer than those of non-smokers (P < 0.001). Adolescents who did not smoke by age 18, and then began to smoke between ages 18,21 had lower cognitive test scores compared to never-smokers (adjusted ES = 0.14, P < 0.001). An analysis of brothers discordant for smoking found that smoking brothers had lower cognitive scores than non-smoking brothers (adjusted ES = 0.27; P = 0.014). Conclusion Controlled analyses from this large population-based cohort of male adolescents indicate that IQ scores are lower in male adolescents who smoke compared to non-smokers and in brothers who smoke compared to their non-smoking brothers. The IQs of adolescents who began smoking between ages 18,21 are lower than those of non-smokers. Adolescents with poorer IQ scores might be targeted for programmes designed to prevent smoking. [source]

Validation analysis of informant's ratings of cognitive function in African Americans and Nigerians

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2006
Jianzhao Shen
Abstract Objectives To examine informant validity using the Community Screening Interview for Dementia (CSI ,D') both cross-sectionally and longitudinally in two very different cultures and to explore the effects of informants and study participants' characteristics on the validity of informants' reports. Methods Elderly African Americans age 65 years and older residing in Indianapolis, USA and elderly Yoruba Nigerians age 65 years and older residing in Ibadan, Nigeria were assessed on cognitive functioning using the CSI ,D' at baseline (1992,1993) and five-year follow-up (1997,1998). At baseline, the informant validity in both samples was evaluated against participants' cognitive tests using Pearson correlation and regular regression models. At follow-up, informants ratings on cognitive decline were assessed against participants' cognitive decline scores from baseline to follow-up using biserial correlation and logistic regressions. Results At baseline, informants' reports on cognitive functioning significantly correlated with cognitive scores in both samples (Indianapolis:r,=,,0.43, p,<,0.001; Ibadan:r,=,,0.47, p,<,0.001). The participant,informant relationships significantly affected the informants' reports in the two samples with different patterns (p,=,0.005 for Indianapolis and p,<,0.001 for Ibadan) at a given level of cognitive functioning. African Americans spouses reported more cognitive problems, while siblings reported more problems for the Yoruba Nigerians. At follow-up, informants' ratings on cognitive decline significantly correlated with the cognitive decline scores (Indianapolis r,=,0.38, p,<,0.001; Ibadan r,=,0.32, p,<,0.001). The characteristics of study participants and informants had little impact on the informants' ratings on cognitive decline. Conclusions Informant reports are valid in assessing the cognitive functioning of study participants both cross-sectionally and longitudinally in two very different cultures, languages and environments. Copyright © 2006 John Wiley & Sons, Ltd. [source]

The Cross-Sectional Relationship Between Body Mass Index, Waist,Hip Ratio, and Cognitive Performance in Postmenopausal Women Enrolled in the Women's Health Initiative

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2010
Diana R. Kerwin MD
OBJECTIVES: To determine whether body mass index (BMI) is independently associated with cognitive function in postmenopausal women and the relationship between body fat distribution as estimated by waist-hip ratio (WHR). DESIGN: Cross-sectional data analysis. SETTING: Baseline data from the Women's Health Initiative (WHI) hormone trials. PARTICIPANTS: Eight thousand seven hundred forty-five postmenopausal women aged 65 to 79 free of clinical evidence of dementia who completed the baseline evaluation in the WHI hormone trials. MEASUREMENTS: Participants completed a Modified Mini-Mental State Examination (3MSE), health and lifestyle questionnaires, and standardized measurements of height, weight, body circumference, and blood pressure. Statistical analysis was performed of associations between 3MSE score, BMI, and WHR after controlling for known confounders. RESULTS: With the exception of smoking and exercise, vascular disease risk factors, including hypertension, waist measurement, heart disease, and diabetes mellitus, were significantly associated with 3MSE score and were included as covariables in subsequent analyses. BMI was inversely related to 3MSE score; for every 1-unit increase in BMI, 3MSE score decreased 0.988 points (P<.001) after adjusting for age, education, and vascular disease risk factors. BMI had the most pronounced association with poorer cognitive functioning scores in women with smaller waist measurements. In women with the highest WHR, cognitive scores increased with BMI. CONCLUSION: Higher BMI was associated with poorer cognitive function in women with smaller WHR. Higher WHR, estimating central fat mass, was associated with higher cognitive function in this cross-sectional study. Further research is needed to clarify the mechanism for this association. [source]

Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

Metabolic Markers of Cobalamin Deficiency and Cognitive Function in Normal Older Adults

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004
Angeles A. Garcia MD, FRCPC
Objectives: To investigate the relationship between metabolic markers of cobalamin deficiency and cognitive function in normal older adults. Design: Cross-sectional study. Setting: Queen's University and St. Mary's of the Lake Hospital, Kingston, Ontario, Canada. Participants: Two hundred eighty-one cognitively normal, community-dwelling participants aged 65 and older. Measurements: Serum cobalamin, red blood cell folate, methylcitric acid, homocysteine, and methylmalonic acid were determined. Cognitive instruments included the California Verbal Learning Test, Mattis Dementia Rating Scale, and the Stroop Neuropsychological Screening Inventory (Stroop). Results: Serum levels of methylcitric acid had a significant negative correlation with recall, learning, and discriminability (factor 1) of the California Verbal Learning Test after adjusting for age and sex (,=,0.138, P=.019). Subjects with elevated methylcitric acid had significantly lower scores (factor 1) than subjects with normal methylcitric acid (P<.01). Bivariate analysis showed significant correlations between levels of homocysteine and the Stroop score and between cobalamin, methylmalonic acid, and homocysteine and some scores of the California Verbal Learning Test, but these relationships did not remain significant after multivariate analysis. Subjects with high homocysteine (tHcy) had lower Stroop scores than subjects with normal tHcy (P<.05). No biochemical parameters were associated with the Mattis Dementia Rating Scale scores. Conclusion: This study indicates that, in normal elderly subjects, some cognitive scores are related to serum methylcitric acid and possibly homocysteine. [source]

Reduced N -acetylaspartate is consistent with axonal dysfunction in cerebral small vessel disease

NMR IN BIOMEDICINE, Issue 3 2009
Arani Nitkunan
Abstract Background: Cerebral small vessel disease (SVD) is an important cause of cognitive impairment, but the pathophysiological mechanisms remain unclear. We used 1H MRS to investigate brain metabolic differences between patients with SVD and controls and correlated this with cognition. Methods: 35 patients with SVD (lacunar stroke and radiological evidence of confluent leukoaraiosis) and 35 controls underwent multi-voxel spectroscopic imaging of white matter to obtain absolute metabolite concentrations of N -acetylaspartate (NAA), total creatines, total cholines, myo -inositol, and lactate. A range of cognitive tests was performed on patients with SVD, and composite scores were calculated. Results: Scans of sufficient quality for data analysis were available in 29 cases and 35 controls. NAA was significantly reduced in patients compared with controls (lower by 7.27%, P,=,0.004). However, when lesion load within each individual voxel (mean 22% in SVD vs 5% in controls, P,<,0.001) was added as a covariate, these differences were no longer significant, suggesting that the metabolite differences arose primarily from differences in lesioned tissue. In patients with SVD, there was no correlation between cognitive scores and any brain metabolite. No lactate, an indicator of anaerobic metabolism, was detected. Conclusions: The most consistent change in SVD is a reduction in NAA, a marker of neuronal integrity. The lack of correlation with cognition does not support the use of MRS as a surrogate disease marker. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Cognitive and emotional outcome after pediatric liver transplantation

PEDIATRIC TRANSPLANTATION, Issue 5 2003
Petra Adebäck
Abstract: The aim of the study was to evaluate the cognitive and emotional development after pediatric liver transplantation. A total of 21 patients, aged 4,16.9 yr (median 9.6 yr) were tested 1,9 yr (median 4.2 yr) after the transplantation. The pretransplant diagnoses included biliary atresia (eight patients), various metabolic diseases (n = 6), acute liver failure (n = 3), and miscellaneous (n = 4). The cognitive functions were tested with Wechsler preschool and primary scale of intelligence (WPPSI)-R or Wechsler intelligence scale for children (WISC)-III according to age. The Piers,Harris self-concept scale and the evaluation of human figure drawings according to Koppitz were used to detect emotional problems. All tests in all patients were performed by the same psychologist. A significantly lower result on cognitive tests was seen when compared with the expected normal values (p < 0.01). The number of patients with results within or under the lower normal range was higher than expected. Although the mean value of the Piers,Harris self-concept scale was normal, there was a large spread within the group. Indicators of emotional problems were found in the human figure drawings of 50% of the patients. To some extent, low cognitive scores coincided with low scores on self-concept scale and indicators of emotional difficulties. We conclude that the high degree of cognitive and emotional problems after liver transplantation is an important argument for routine psychologic follow-up and support in these patients. [source]