Background
Abnormalities in brain structure and function can occur several decades prior to the
onset of cognitive decline. It is in the preceding decades that an intervention is
most likely to be effective, when informed by an understanding of factors contributing
to the disease prodrome. Few studies, however, have sufficient longitudinal data on
relevant risks to determine the optimum targets for interventions to improve cognition
in aging. In this article we examine the timing and exposure of factors contributing
to verbal memory performance in later life.
Methods
387 participants from the population-based Women's Healthy Ageing Project, mean age
at baseline of 49.6 years (range: 45–55 years), had complete neuropsychiatric assessments,
clinical information, physical measures, and biomarkers collected at baseline, with
at least three follow-up visits that included at least one cognitive reassessment.
Mixed linear models were conducted to assess the significance of risk factors on later-life
verbal memory. We explored the influence of early, contemporaneous, and cumulative
exposures.
Results
Younger age and better education were associated with baseline memory test performance
(CERAD). Over the 20 years of study follow-up, cumulative mid- to late-life physical
activity had the strongest effect on better later life verbal memory (0.136 [0.058,
0.214]). The next most likely contributors to verbal memory in late life were the
negative effect of cumulative hypertension (−0.033 [−0.047, −0.0.18] and the beneficial
effect of HDL cholesterol (0.818 [0.042, 1.593]).
Conclusions
Findings suggest that midlife interventions focused on physical activity, hypertension
control, and achieving optimal levels of HDL cholesterol will help maintain later-life
verbal memory skills.
Key Words
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References
- Amyloid beta deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer's disease: a prospective cohort study.Lancet Neurol. 2013; 12: 357-367
- Physical exercise and cognitive performance in the elderly: current perspectives.Clin Interv Aging. 2014; 9: 51-62
- Vascular risk profiles for dementia and Alzheimer's disease in very old people: a population-based longitudinal study.J Alzheimers Dis. 2010; 20: 293-300
- Vascular and psychosocial factors in Alzheimer's disease: epidemiological evidence toward intervention.J Alzheimers Dis. 2010; 20: 689-697
- The Alzheimer's Disease Neuroimaging Initiative (ADNI): MRI methods.J Magn Reson Imaging. 2008; 27: 685-691
- The Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging: methodology and baseline characteristics of 1112 individuals recruited for a longitudinal study of Alzheimer's disease.Int Psychogeriatr. 2009; 21: 672-687
- Cardiovascular disease and cognitive decline in postmenopausal women: results from the Women's Health Initiative Memory Study.J Am Heart Assoc. 2013; 2: e000369
- Mild cognitive impairment: a concept in evolution.J Intern Med. 2014; 275: 214-228
- Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease.Arch Neurol. 2005; 62: 1556-1560
- Midlife risk score for the prediction of dementia four decades later.Alzheimers Dement. 2014; 10: 562-570
- Contributions of the Framingham Heart Study to stroke and dementia epidemiologic research at 60 years.Arch Neurol. 2012; 69: 567-571
- Cardiovascular risk factors and cognitive decline in middle-aged adults.Neurology. 2001; 56: 42-48
- Predictors of maintaining cognitive function in older adults: the Health ABC study.Neurology. 2009; 72: 2029-2035
- BioAge: toward a multi-determined, mechanistic account of cognitive aging.Ageing Res Rev. 2014; 18C: 95-105
- Cognitive impairment in neurological diseases: lessons from apolipoprotein E.J Alzheimers Dis. 2014; 38: 1-9
- Apolipoprotein E in Alzheimer's disease and other neurological disorders.Lancet Neurol. 2011; 10: 241-252
- Hypertension, brain damage and cognitive decline.Curr Hypertens Rep. 2013; 15: 547-558
- Vascular risk factors and cognitive disorders.Rev Neurol (Paris). 2013; 169: 757-764
- Reserve, brain changes, and decline.Neuroimaging Clin N Am. 2012; 22 (viii-iv): 99-105
- Physical activity and cognitive function in individuals over 60 years of age: a systematic review.Clin Interv Aging. 2014; 9: 661-682
- Social disengagement and incident cognitive decline in community-dwelling elderly persons.Ann Intern Med. 1999; 131: 165-173
- Depression in the elderly: brain correlates, neuropsychological findings, and role of vascular lesion load.Curr Opin Neurol. 2013; 26: 656-661
- Lifestyle change and the prevention of cognitive decline and dementia: what is the evidence?.Curr Opin Psychiatry. 2013; 26: 239-243
- The projected effect of risk factor reduction on Alzheimer's disease prevalence.Lancet Neurol. 2011; 10: 819-828
- Capitalising on modifiable risk factors for Alzheimer's disease.Lancet Neurol. 2014; 13: 752-753
- Alzheimer's disease prevention: a reality check.Lancet Neurol. 2010; 9: 643
- Methodological challenges in designing dementia prevention trials—the European Dementia Prevention Initiative (EDPI).J Neurol Sci. 2012; 322: 64-70
- NIH state-of-the-science conference statement: preventing Alzheimer's disease and cognitive decline.NIH Consens State Sci Statements. 2010; 27: 1-30
- Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis.BMC Public Health. 2014; 14: 643
- Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging.Mayo Clin Proc. 2011; 86: 876-884
- Leisure activities, cognition and dementia.Biochim Biophys Acta. 2012; 1822: 482-491
- The Women's Healthy Ageing Project: fertile ground for investigation of healthy participants “at risk” for dementia.Int Rev Psychiatry. 2013; 25: 726-737
- Menopausal symptoms in Australian women.Med J Aust. 1993; 159: 232-236
- Well-being and the menopausal transition.J Psychosom Obstet Gynaecol. 1997; 18: 95-101
- The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease.Neurology. 1989; 39: 1159-1165
- A prospective population-based study of menopausal symptoms.Obstet Gynecol. 2000; 96: 351-358
- Risk factors and preventive interventions for Alzheimer disease: state of the science.Arch Neurol. 2011; 68: 1185-1190
- Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Münster (PROCAM) study.Circulation. 2002; 105: 310-315
- Affectometer 2: a scale to measure current level of general happiness.Aust J Psychol. 1983; 35: 259-265
- The CES-D scale.Appl Psychol Meas. 1977; 1: 385-401
- Norms and the effects of demographic variables on a neuropsychological battery for use in healthy ageing Australian populations.Aust N Z J Psychiatry. 1999; 33: 568-575
- Current concepts in mild cognitive impairment.Arch Neurol. 2001; 58: 1985-1992
- Mild cognitive impairment: clinical characterization and outcome.Arch Neurol. 1999; 56: 303-308
- Normative verbal and non-verbal memory test scores for Australian women aged 56–67.Aust N Z J Psychiatry. 2004; 38: 532-540
- Californian Verbal Learning Test.2nd ed. Psychological Corporation, San Antonio, TX2000
- Rubin: Statistical Analysis with Missing Data.J Wiley & Sons, New York1987
- Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in Men.Hypertension. 2000; 36: 801-807
- Midlife hypertension and 20-year cognitive change: the atherosclerosis risk in communities neurocognitive study.JAMA Neurol. 2014; 71: 1218-1227
- Association between mid- to late life physical fitness and dementia: evidence from the CAIDE study.J Intern Med. 2014; 276: 296-307
- Physical activity and amyloid-beta plasma and brain levels: results from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing.Mol Psychiatry. 2013; 18: 875-881
- Metabolic syndrome and cognitive decline in French elders: the Three-City Study.Neurology. 2011; 76: 518-525
- Serum lipid levels and cognitive change in late life.J Am Geriatr Soc. 2010; 58: 501-509
- The association between midlife cardiorespiratory fitness levels and later-life dementia: a cohort study.Ann Intern Med. 2013; 158: 162-168
- Cholesterol and neuropathologic markers of AD: a population-based autopsy study.Neurology. 2001; 57: 1447-1452
- Cholesterol level and statin use in Alzheimer disease: II. Review of human trials and recommendations.Arch Neurol. 2011; 68: 1385-1392
- Estrogen exposures and memory at midlife: a population-based study of women.Neurology. 2003; 60: 1369-1371
- Critical window hypothesis of hormone therapy and cognition: a scientific update on clinical studies.Menopause. 2013; 20: 695-709
- Hormone therapy, dementia, and cognition: the Women's Health Initiative 10 years on.Climacteric. 2012; 15: 256-262
- Estrogen therapy: is time of initiation critical for neuroprotection?.Nat Rev Endocrinol. 2009; 5: 620-627
- Australian Health Survey: Physical Activity, 2011–12.2014
- Early adult to midlife cardiovascular risk factors and cognitive function.Circulation. 2014; 129: 1560-1567
- Age-specific population frequencies of cerebral beta-amyloidosis and neurodegeneration among people with normal cognitive function aged 50–89 years: a cross-sectional study.Lancet Neurol. 2014; 13: 997-1005
Article info
Publication history
Published online: May 18, 2016
Accepted:
May 11,
2016
Received in revised form:
April 25,
2016
Received:
May 15,
2015
Identification
Copyright
© 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
