In a follow-up to our findings that elevated systolic blood pressure was associated with poorer cognitive test performance on tests of confrontational naming and nonverbal memory1, we examined the relation of cognitive performance with arterial stiffness measured by pulse pressure and pulse wave velocity. In a sample of 1,749 non-demented and stroke-free participants from the Baltimore Longitudinal Study of Aging with as many as 8 repeated cognitive assessments over 14 years, we found that increasing pulse pressure was associated with poorer performance on tests of verbal learning, nonverbal memory, working memory, a cognitive screening measure. A subset of 582 participants had a single baseline measure of pulse wave velocity and as many as 6 repeated cognitive assessments over 11 years. Higher baseline pulse wave velocity was associated prospective decline on tests of verbal learning and delayed recall, nonverbal memory, and a cognitive screening measure.? ? In addition to physiological associations with age-associated cognitive changes, we also examined the association of depressive symptoms with cognition in participants of the Baltimore Longitudinal Study of Aging. This study investigated the effect of concurrent, baseline, and average depressive symptoms on cognitive functioning and decline, and examined the interactive effect of age and depressive symptoms on measures of learning and memory, attention and executive functions, verbal and language abilities, visuospatial functioning, and general cognitive status. Increased depressive symptoms were associated with poor cognitive functioning and cognitive decline in multiple domains. Concurrent, baseline, and average depressive symptoms had differential associations with cognition. Average depressive symptoms, a measure of chronic symptoms, showed the most widespread effects on cognitive abilities. Effects of depressive symptoms on some frontal functions were greater with advancing age. The results suggest that depressive symptoms are associated with poor cognitive functioning and cognitive decline, particularly with advancing age. The widespread impact of average depressive symptoms on cognition suggests that clinicians should consider depressive symptoms when evaluating cognitive functioning in older adults.? ? We performed separate analyses using concurrent, baseline, and average CES-D scores. Concurrent analyses included testing sessions in which both the CES-D and the cognitive measure of interest were administered coincidentally. These analyses estimate the extent to which cognition is affected by elevated depressive symptoms at the time of cognitive performance. Concurrent CES-D by age interactions indicate that older participants are more affected by elevated depressive symptoms at the time of cognitive performance than younger individuals. Baseline analyses included participants only if the CES-D was administered at the first administration of the neuropsychological test of interest. This approach, which replicates that used by previous studies, examines whether depressive symptoms measured at one time point (baseline) predicts subsequent cognitive decline. Baseline CES-D by age interactions suggest that at older ages, high depressive symptoms at one time point are associated with greater subsequent decrements in cognitive performance. Average CES-D measured chronic depressive symptoms based on the mean of all available CES-D scores for participants during the study interval. Interactions between average CES-D and age reflect greater effect of chronic depressive symptoms on cognition at older ages. To provide a more accurate measurement of chronic depressive symptoms, mean CES-D analyses were based only on subjects with two or more assessments.? ? Overall, the models showed expected cross-sectional effects of baseline age on cognition. We found significant interval effects that reflect longitudinal decline and interval effects for some measures that reflect accelerated decline during the follow-up period. Concurrent depressive symptoms were associated with poorer performance on measures of attention (Trails B) and language (Letter Fluency). The effect of depressive symptoms was more severe for older participants on Letter Fluency, and the effects of increasing depressive symptoms was associated with steeper and accelerating declines on cognitive status assessed by the Mini-Mental State Examination. For baseline analyses, initial depressive symptoms were associated with greater decline) in attention (Digits Forward) and cognitive status (Mini-Mental State Examination).? ? Although concurrent and baseline analyses yielded significant associations, analyses of the average depressive symptoms yielded the majority of the significant findings. Higher average depressive symptoms were associated with poorer performance on measures of attention (Trails A), attention and executive function (Trails B), memory (California Verbal Learning Test), cognitive status (Mini-Mental State Examination and Blessed Information-Memory-Concentration test), and language (Letter Fluency).? ? These results suggest that higher average depressive symptoms, which reflect chronic or persistent symptoms, were associated with executive dysfunction and decline in memory, attention, and general cognitive status. Although concurrent, baseline, and average depressive symptoms had differential associations with cognitive decline, average depressive symptoms had the most extensive effects on cognition. Together, our results show that depressive symptoms have widespread effects on cognitive function and decline and they suggest that prolonged depressive symptoms may have a greater impact on cognition than transient symptoms.
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| Waldstein, Shari R; Rice, S Carrington; Thayer, Julian F et al. (2008) Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging. Hypertension 51:99-104 |
