Cigarette smoking and cognitive decline in midlife: evidence from a prospective birth cohort study

The association between adult-life smoking and age-related cognitive decline in Danish men

BACKGROUND

Most previous studies of effects of smoking on age-related cognitive decline have compared cognitive decline in current smokers, former smokers, and never smokers rather than investigating the effects of pack-years. The aim of the present study was to analyze the association between smoking and age-related cognitive decline in a sample of men administered the same intelligence test in young adulthood and late midlife, using pack-years between the two assessments as the primary measure of exposure to smoking.

METHODS

In 5052 men, scores on a military intelligence test (BPP, Børge Priens Prøve) were available from young adulthood and a late midlife follow-up assessment including the same intelligence test and a comprehensive questionnaire on socio-demographic factors, lifestyle, and health. Information on smoking was self-reported at follow up for eight age periods, and pack-years were calculated from age 19 based on information on daily smoking and the duration of each age period. The differences in cognitive decline between adult-life smokers and non-smokers and the differences between light, moderate, and heavy smokers defined by pack-years were analyzed in linear regression models.

RESULTS

All smoking variables were only weakly associated with cognitive decline. Comparison of adult-life smokers and non-smokers showed less cognitive decline among smokers (1.12 IQ points, p <  0.001). Among smokers, analyses of pack-years suggested a weak dose-response relationship with more decline in heavy smokers than in light smokers (1.33 IQ points, p =  0.001). Independent of pack-years, current smoking was associated with larger cognitive decline than former smoking (1.73 IQ points, p <  0.001).

CONCLUSION

Smoking explained negligible fractions of the variance in cognitive decline, and thus our results did not indicate that smoking is a strong predictor of cognitive decline. The effects of pack-years suggest a relatively weak, possibly cumulative effect of smoking across the adult lifespan. The difference in decline between smokers and non-smokers may reflect participation bias and selective attrition at follow-up while the effects of current smoking may reflect either temporary effects of smoking or individual and life-style characteristics associated with continuation of smoking into late midlife.

APOE Polymorphism, Obstructive Sleep Apnea, and Cognitive Function

Objective  Obstructive sleep apnea (OSA) is associated with the apolipoprotein E ε4 polymorphic allele ( APOE ε4 ) and with worse cognitive function. However, the influence of APOE ε4 on cognitive function in patients with moderate-to-severe OSA is controversial. The present study evaluated the influence of APOE ε4 polymorphism and cognitive function in sedentary OSA patients with no other major comorbidities. Materials and Methods  In total, 55 middle-aged patients underwent conventional nocturnal polysomnography, APOE ε4 polymorphism genotyping, cognitive evaluation (attention, inhibitory control, frontal functions, processing speed, and episodic memory), and they filled out the International Physical Activity Questionnaire. Results  Overall, 13 patients had no or mild OSA, and 42 had moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events/h of sleep) and APOE ε4 was present in 7.7% and 21.4% of the patients in each group respectively. Among patients with moderate-to-severe OSA, the sleep parameters were similar in the groups of APOE ε4 carriers and noncarriers. Compared with patients with no or mild OSA, the cognitive parameters were worse for processing speed (Digit Symbol Test) and attention (Stroop Color Word Test, SCWT-Part 2) among the patients with moderate-to-severe OSA. The difference was present even after the exclusion of APOE ε4 carriers. Among patients with moderate-to-severe OSA, APOE ε4 carriers presented worse episodic memory, evaluated through the Rey Auditory Verbal Learning Test, than APOE ε4 noncarriers. Conclusion  Moderate-to-severe OSA is associated with poor cognitive function that is further impaired by the presence of APOE ε4 polymorphism.

Alterations in cerebral artery flow velocity acceleration pattern correlate with cognitive impairment in diabetes mellitus

INTRODUCTION

Flow velocity acceleration pattern is related to shear stress, pressure changes, cardiovascular risk factors, diabetes mellitus, hypertension, endothelial dysfunction and arterial stiffness. Considering the hemodynamic alterations in cognitive impairment, perturbations in cerebral artery flow acceleration pattern may correlate with cognitive impairment, which could enhance our understanding of how cardiovascular risk factors drive cognitive decline from a mechanistic point of view.

METHOD

The first derivative of middle cerebral artery flow velocity waveforms obtained via transcranial Doppler were computed to visualize acceleration/deceleration waves (a,b,c,d,e) in ensemble-averaged signals. Vascular Aging Index was calculated per its definition (VAI:(b-c-d-e)/a). Relationship between multiple cognitive domains and VAI was evaluated with standard statistical tests.

RESULTS

VAI was significantly correlated with HVLT total recall (Hopkins Verbal Learning Test-revised) (r: -0.310 p: 0.046, n: 42), delayed recall (r: -0.396 p: 0.009), % Retention (r: -0.305 p: 0.050) and components of RCFT(Rey-Osterrieth Complex Figure Test), namely raw copy score (r: -0.524 p < 0.001), immediate recall (r: -0.323 p: 0.037). Controlling for age, body mass index, gray matter volume and diabetes duration yielded stronger correlations but lower group numbers due to missing data. Correlation coefficients for VAI with HVLT delayed recall and % Retention were -0.439 (p: 0.012) and -0.444(p: 0.011 n: 36) respectively. Likewise the adjusted correlations of VAI with RCFT components were improved (Raw Copy r: -0.557 p < 0.001, Immediate Recall r: -0.440 p: 0.012, Delayed Recall (r: -0.358 p: 0.044).

CONCLUSION

In patients with diabetes, cerebral artery flow velocity acceleration pattern correlates with cognitive performance in visuo-constructional and verbal cognitive domains. Computational fluid dynamics may aid developing a better mechanistic understanding of arterial hemodynamics-cortical function coupling.

The role of sweet/fruit-flavored disposable electronic cigarettes on early nicotine initiation - a systematic review

BACKGROUND

Sweet/fruit disposable e-cigarettes (ECs) are cheap, easy to use, and look like inconspicuous colored markers, which encourages young people and young adults to use them. This work attempts to summarize current knowledge about the effect of sweet/fruit-flavor disposable ECs on early nicotine initiation.

METHODS

The literature search was performed in June 2024 in Pub Med, Scopus, Web of Science and Science Direct databases by the terms 'ends', 'electronic nicotine delivery system', 'disposable electronic cigarette', 'disposable e-cigarette', 'cig-a-like e-cigarette', 'cig-a-like electronic cigarette', 'nicotine initiation'.

RESULTS

This systematic review analyzes findings from four heterogenous US studies. All analyzed studies highlighted that sweet/fruit-flavored ECs, compared to mint/menthol- or tobacco-flavors, were the most commonly chosen by youths and young adults during initiation and progression of vaping, regardless of the device type. Furthermore, two studies determined that never-smokers mostly start vaping by using modifiable ECs compared to disposable EC devices. Moreover, all studies showed that initiation by using disposable ECs was lower in people who had never previously vaped or smoked compared to current/former ECs users and former tobacco cigarettes (TCs) smokers or dual users.

CONCLUSIONS

Due to limited number of studies, their limited location, scope (mostly ever users aged ≥ 18), and moderate quality of the studies, it is difficult to clearly determine the effect of sweet/fruit-flavored disposable ECs on early nicotine initiation. Moreover, it is difficult to determine if sweet/fruit-flavored disposable EC have a role in the avoiding the initiation of tobacco cigarettes or delaying the initiation by the effect of competition. The findings from this systematic review are preliminary and require validation through high-quality, global studies among youth and young adult never-smokers/never-vapers who initiated using tobacco products with sweet/fruit-flavored disposable ECs and continue vaping and/or smoking any tobacco products (and any flavors).

TRIAL REGISTRATION

The study protocol of this systematic review was registered in International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42024585153.

HIV, smoking, and the brain: a convergence of neurotoxicities

PURPOSE OF REVIEW

The purpose of this review is to characterize the combined effects of tobacco smoking and human immunodeficiency virus (HIV) infection in people with HIV (PWH) and identify possible therapeutic targets through shared mechanisms for neurotoxicity.

RECENT FINDINGS

HIV and tobacco smoke can exert neurotoxicity through shared mechanisms such as brain volume changes, microglial dysregulation, and dysregulation of the cholinergic anti-inflammatory pathway (CAP) through the alpha7-nicotinic acetylcholine receptor (nAChR). Evidence also suggests the potential for synergistic effects of HIV and tobacco smoking on neurotoxicity. People with HIV (PWH) are disproportionately affected by both neurocognitive impairment (NCI) and tobacco smoking compared to the general population. Both HIV and tobacco smoking are known to have neurotoxic effects and have the potential for clinically significant impacts on brain health and cognitive functioning. Less, however, is known about how PWH may be uniquely affected by the interactive neurotoxic effects of both HIV and tobacco smoking. Evidence suggests that smoking and HIV can have synergistic effects on neurotoxicity and NCI in PWH. Some mechanisms for neurotoxicity include increased oxidative stress from microglial activation and dysfunction in the alpha7- nAChR cholinergic anti-inflammatory pathway leading to increased neuroinflammation and neuronal apoptosis. Mechanisms may vary by cell type and brain region, however, and there is a need for more human-facing, longitudinal studies on smoking in PWH.

Association between adolescent alcohol use and cognitive function in young adulthood: A co-twin comparison study

BACKGROUND AND AIMS

Studies on adolescent alcohol use and cognition are often unable to separate the potential causal effects of alcohol use on cognition from shared etiological influences, including genetic influences or other substance use comorbidities also known to be associated with cognition, such as nicotine use. The present study aimed to fill this gap and clarify the relationship between adolescent alcohol use and young adult cognition by accounting for both measured and unmeasured confounders.

DESIGN

A random effects model accounting for nesting in families was used to control for measured confounders. Next, co-twin comparisons were conducted within the full sample and in monozygotic twin pairs (MZ) to control for unmeasured genetic and environmental confounders shared by co-twins.

PARTICIPANTS/SETTING

Participants were 812 individuals (58.6% female, 361 complete pairs, 146 MZ pairs) from the longitudinal FinnTwin12 study in Finland.

MEASUREMENTS

Adolescent alcohol use was indexed with measures of frequency of use and intoxication averaged across ages 14 and 17. Cognitive outcomes were measured at average age 22 and included Trail Making Test, California Stroop test, Wechsler Adult Intelligence subtests (Vocabulary, Block Design, Digit Symbol), Digit Span subtest of Wechsler Memory Scale, Mental Rotation Test and Object Location Memory test. Covariates included sex, parental education, general cognitive ability, current alcohol use and nicotine use.

FINDINGS

Greater frequency of alcohol use and frequency of intoxication across adolescence was associated with decreased vocabulary scores in the co-twin control [freq: stnd beta = -0.12, 95% confidence interval (CI) = -0.234, -0.013] and MZ only co-twin control models (freq: stnd beta = -0.305, 95% CI = -0.523, -0.087; intox: stnd beta = -0.301, 95% CI = -0.528, -0.074).

CONCLUSIONS

In Finland, there appears to be little evidence that adolescent alcohol use causes cognitive deficits in young adulthood, except modest evidence for association of higher adolescent alcohol use with lower young adult vocabulary scores.

What have observational studies taught us about brain health? An exploration of select cardiovascular risks and cognitive function

Observational research studies serve as the cornerstone for gathering evidence on risk factors and contributors to cognitive decline and impairment. The evidence can then be combined with data from preclinical studies and randomized controlled trials to ultimately inform the development of effective interventions and the content of guidance statements. Observational cohort designs on modifiable risk factors and brain health can be particularly beneficial for studying questions that are unethical or impractical for a clinical trial setting, associations with dementia which may develop over decades, and underrepresented populations typically not included in clinical trials. This chapter will review the major observational, epidemiologic studies pertaining to the traditional vascular risk factors - hypertension, diabetes mellitus, hypercholesterolemia, smoking, and physical inactivity - and how they may impact brain health.

Characterising and differentiating cognitive and motor speed in older adults: structural equation modelling on a UK longitudinal birth cohort

OBJECTIVES

Information processing speed (IPS) has been proposed to be a key component in healthy ageing and cognitive functioning. Yet, current studies lack a consistent definition and specific influential characteristics. This study aimed to investigate IPS as a multifaceted concept by differentiating cognitive and motor IPS.

DESIGN, SETTING AND PARTICIPANTS

A retrospective data analysis using data from the Medical Research Council National Survey of Health and Development (a population-based cohort of UK adults born in 1946) at childhood (ages 8, 11 and 15) and adulthood (ages 60-64 and 68-70). Using structural equation modelling, we constructed two models of IPS with 2124 and 1776 participants, respectively.

OUTCOME MEASURES

Measures of interest included IPS (ie, letter cancellation, simple and choice reaction time), intelligence (ie, childhood intelligence and National Adult Reading Test), verbal memory, socioeconomic status (SES) and cognitive functions measured by the Addenbrooke's Cognitive Examination III, as well as a variety of health indexes.

RESULTS

We found distinct predictors for cognitive and motor IPS and how they relate to other cognitive functions in old age. In our first model, SES and antipsychotic medication usage emerged as significant predictors for cognitive IPS, intelligence and smoking as predictors for motor IPS while both share sex, memory and antiepileptic medication usage as common predictors. Notably, all differences between both IPS types ran in the same direction except for sex differences, with women performing better than men in cognitive IPS and vice versa in motor IPS. The second model showed that both IPS measures, as well as intelligence, memory, antipsychotic and sedative medication usage, explain cognitive functions later in life.

CONCLUSION

Taken together, these results shed further light on IPS as a whole by showing there are distinct types and that these measures directly relate to other cognitive functions.

The effect of e-cigarettes on cognitive function: a scoping review

AIM

Much research has been conducted on the acute effects of nicotine on human cognitive performance, demonstrating both enhancing and impairing cognitive effects. With the relatively recent introduction of electronic cigarettes ('e-cigarettes') as a smoking cessation device, little is known about the cognitive effects of e-cigarettes specifically, either as a nicotine replacement device or in the absence of nicotine. The purpose of this review was to present an overview of evidence from empirical studies on the effect of e-cigarettes on cognitive function.

APPROACH

Guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines (PRISMA-ScR), SCOPUS, PubMed, and EBSCOhost were searched from 2006, the year e-cigarettes were introduced, to June 2023 for relevant papers, along with reference lists checked for additional papers.

KEY FINDINGS

Seven experimental and four cross-sectional survey studies were identified and included. The majority of the studies only include regular and current cigarette smokers and primarily assessed the acute cognitive effect of e-cigarettes relative to nicotine. While the findings primarily suggest either no or positive effect of e-cigarettes on cognition in cigarette smokers, associations between e-cigarettes and cognitive impairments in memory, concentration and decision making were reported in both cigarette smokers and never-smokers.

IMPLICATIONS AND CONCLUSIONS

The acute cognitive effect of e-cigarettes on regular cigarette smokers appears minimal. However, long-term cognitive effect and their effects on never-smokers are unclear. Given that the increased numbers of e-cigarette users are non-smokers and/or adolescents, research with those naïve to nicotine and a developmentally vulnerable adolescent population on its long-term effect is needed.

Association between alcohol use and frailty among elder adults in three Chinese cities

BACKGROUND

Frailty is often described as a condition of the elderly and alcohol use is associated with frailty. The aim of this study is to examine the associations between alcohol use and frailty in three cities in elder adults.

METHODS

A cross-sectional study was conducted in three cities in China from June 2017 to October 2018. In total, 2888 residents aged ≥65 years old were selected by using a multi-level stage sampling procedure. Alcohol use was assessed by Focusing on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers (CAGE) four-item questionnaire. Frailty was measured by a validated Chinese version of the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. Multinomial logistic regressions were used to examine the association of alcohol use with pre-frailty and frailty after controlling for varied covariates.

RESULTS

In general, the prevalence of pre-frailty and frailty was 38.64 and 20.26%, respectively. After controlling for covariates and interaction of age and problematic drinking, non-problematic drinkers neither had association with pre-frailty (OR: 1.15, 95%CI:0.86-1.52) nor with frailty (OR:0.90, 95%CI:0.60-1.36), and problematic drinkers neither had association with frailty (OR: 1.21, 95%CI:0.83-1.76), while problematic drinkers had high odd ratios of frailty (OR:3.28, 95%CI:2.02-5.33) compared with zero-drinker.

CONCLUSIONS

Our study found a positive association between problematic drinking and frailty, no relationship between non-problematic drinking and (pre-)frailty compared with zero-drinking among Chinese elder adults. Based on previous findings and ours, we conclude it is important for the prevention of frailty to advocate no problematic drinking among elder adults.

The association between shift work exposure and cognitive impairment among middle-aged and older adults: Results from the Canadian Longitudinal Study on Aging (CLSA)

BACKGROUND

Shift work, especially rotating and night shift work, has been linked to a wide range of detrimental health outcomes. Occupational factors like shift work and their potential impact on cognitive functions have received little attention, and the evidence is inconclusive. The objective of our study is to explore associations between shift work exposure and cognitive impairment indicators based on comparisons with the normative standards from the Canadian population.

METHODS

Cross-sectional analyses were performed using baseline Canadian Longitudinal Study on Aging database, including 47,811 middle-aged and older adults (45-85 years). Three derived shift work variables were utilized: ever exposed to shift work, shift work exposure in longest job, and shift work exposure in current job. Four cognitive function tests were utilized, Rey Auditory Verbal Learning Tests (immediate and delayed) representing memory domain, and Animal Fluency, and Mental Alteration, representing the executive function domain. All cognitive test scores included in study were normalized and adjusted for the participant's age, sex, education and language of test administration (English and French), which were then compared to normative data to create "cognitive impairment' variables. Unadjusted and adjusted multivariable logistic regression models were used to determine associations between shift work variables and cognitive impairment individually (memory and executive function domains), and also for overall cognitive impairment.

RESULT

Overall, one in every five individuals (21%) reported having been exposed to some kind of shift work during their jobs. Exposure to night shift work (both current and longest job) was associated with overall cognitive impairment. In terms of domain-based measures, night shift work (longest job) was associated with memory function impairment, and those exposed to rotating shift work (both current and longest job) showed impairment on executive function measures, when compared to daytime workers.

CONCLUSION

This study suggests disruption to the circadian rhythm, due to shift work has negative impact on cognitive function in middle-aged and older adults and this warrants further investigation.

Lifestyle Adjustment: Influential Risk Factors in Cognitive Aging

Cognitive aging is inevitable. However, researchers have demonstrated that lifestyle adjustments can reduce the risk of cognitive impairment. A healthy diet style, the Mediterranean diet, has been proven to benefit the elderly. Oil, salt, sugar, and fat are, on the contrary, risk factors for cognitive dysfunction because of the resultant high caloric intake. Physical and mental exercises, especially cognitive training, are also beneficial for aging. At the same time, several risk factors need to be noted, such as smoking, alcohol consumption, insomnia, and excessive daytime sleeping, which are highly relative to cognitive impairment, cardiovascular diseases, and dementia.

Tobacco smoke exposure and mitochondrial DNA copy number on neurobehavioural performance: A community study

The influence of tobacco smoke has been a controversial and very questionable subject within the field of neurological behaviours. To examine the dose-response relationships between tobacco smoke and neurological performance, we investigated whether mitochondrial DNA copy number (mtDNAcn) mediates these relationships. We used restricted cubic spline models to estimate the dose-response relationships. A mediation model was also used to detect the mediating effect. Increased cotinine was negatively associated with auditory memory scores and a 0.51 decrease in mtDNAcn. MtDNAcn acts as a mediator between cotinine and auditory memory. Tobacco smoke levels were inversely associated with mtDNAcn and neurobehavioural changes, and there was a mediation effect between cotinine levels and auditory memory by mtDNAcn.

Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson’s Disease under General Anesthesia

Introduction. Postoperative delirium can increase cognitive impairment and mortality in patients with Parkinson’s disease. The purpose of this study was to develop and internally validate a clinical prediction model of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease under general anesthesia. Methods. We conducted a retrospective observational cohort study on the data of 240 patients with Parkinson’s disease who underwent deep brain stimulation of the subthalamic nucleus under general anesthesia. Demographic characteristics, clinical evaluation, imaging data, laboratory data, and surgical anesthesia information were collected. Multivariate logistic regression was used to develop the prediction model for postoperative delirium. Results. A total of 159 patients were included in the cohort, of which 38 (23.90%) had postoperative delirium. Smoking (OR 4.51, 95% CI 1.56–13.02, $p<0.01$ ) was the most important risk factor; other independent predictors were orthostatic hypotension (OR 3.42, 95% CI 0.90–13.06, $p=0.07$ ), inhibitors of type-B monoamine oxidase (OR 3.07, 95% CI 1.17–8.04, $p=0.02$ ), preoperative MRI with silent brain ischemia or infarction (OR 2.36, 95% CI 0.90–6.14, $p=0.08$ ), Hamilton anxiety scale score (OR 2.12, 95% CI 1.28–3.50, $p<0.01$ ), and apolipoprotein E level in plasma (OR 1.48, 95% CI 0.95–2.29, $p=0.08$ ). The area under the receiver operating characteristic curve (AUC) was 0.76 (95% CI 0.66–0.86). A nomogram was established and showed good calibration and clinical predictive capacity. After bootstrap for internal verification, the AUC was 0.74 (95% CI 0.66–0.83). Conclusion. This study provides evidence for the independent inducing factors of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease under general anesthesia. By predicting the development of delirium, our model may identify high-risk groups that can benefit from early or preventive intervention.

Association of adverse childhood experiences with subjective cognitive decline in adulthood: Findings from a population-based study

OBJECTIVE

Adverse childhood experiences have been found to be associated with negative outcomes during adulthood. Emerging research indicates that adverse childhood experiences may elevate the risk for Alzheimer's disease. Yet, few studies have investigated the association between adverse childhood experiences and subjective cognitive decline among middle-aged and older adults in the United States. The objective of this study was to investigate the association between adverse childhood experiences and subjective cognitive decline among middle-aged and older adults in the United States.

METHODS

Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance Survey. An analytic sample of 50,277 adults aged 45 to 79 years (53.3% female) from 15 states was analyzed using binary logistic regression. The outcome variable investigated in this study was subjective cognitive decline, and the main explanatory variable was adverse childhood experiences.

RESULTS

Of the 50,277 respondents, 10.3% reported experiencing subjective cognitive decline during the past year, and 14.5% had four or more adverse childhood experiences. We found a dose-response association between adverse childhood experiences and subjective cognitive decline. Respondents who had four or more adverse childhood experiences had 2.98 times higher odds of having subjective cognitive decline when compared to respondents with no adverse childhood experiences (aOR = 2.98, 95% CI = 2.56-3.48). Other factors associated with subjective cognitive decline have been identified and discussed.

CONCLUSION

The findings of this study provide evidence indicating that early life factors may be linked with cognitive decline in later adulthood. The findings of this study are discussed with implications for practice and research.

Relationship between urinary dichlorophenols and cognitive function among people over 60 years old from NHANES

Studies have shown that exposure to dichlorophenols (DCPs) and their precursors might have potential neurotoxicity, which may be related to low cognitive function, but there are few large-scale, representative population data to explore the association between DCP exposure and cognitive function. We aimed to examine the relationship between urinary DCPs and cognitive function in the US older people. A total of 952 participants ≥ 60 years old from the National Health and Nutrition Examination Survey (NHANES) in two cycles (2011-2014) were enrolled. The Consortium to Establish a Registry for Alzheimer's disease Word Learning subtest (CERAD W-L), the Animal Fluency test (AFT), and the Digit Symbol Substitution test (DSST) were used to assess cognition. Multivariate logistic regression and restricted cubic spline (RCS) were used to evaluate the relationship between DCP exposure and cognitive function. A positive association between 2,5-DCP and the risk of bad performance of DSST was observed (P for trend = 0.024) after adjusting for the covariates. Compared to the lowest quartile, OR of DSST for the highest quartile of 2,5-DCP was 1.72 (95%CI:1.03-2.87, P = 0.039). There were no significant associations between DCPs and the other tests. The RCS plot showed an inverted J-shaped relationship between 2,5-DCP, 2,4-DCP, and the DSST score. The inflection points for the curves were found at 1.531 μg/L and 0.230 μg/L, respectively. On the right side of the inflection points, the DSST score dropped sharply. In subgroup analysis, those under 70 years old, smokers, and alcohol drinkers had a higher risk of bad performance in DSST when exposed to 2,5-DCP. The higher concentration of urinary DCPs is associated with a lower score of DSST in the US older people.

Early to Midlife Smoking Trajectories and Cognitive Function in Middle-Aged US Adults: the CARDIA Study

BACKGROUND

Smoking starts in early adulthood and persists throughout the life course, but the association between these trajectories and midlife cognition remains unclear.

OBJECTIVE

Determine the association between early to midlife smoking trajectories and midlife cognition.

DESIGN

Prospective cohort study.

PARTICIPANTS

Participants were 3364 adults (mean age = 50.1 ± 3.6, 56% female, 46% Black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study: 1638 ever smokers and 1726 never smokers.

MAIN MEASURES

Smoking trajectories were identified in latent class analysis among 1638 ever smokers using smoking measures every 2-5 years from baseline (age 18-30 in 1985-1986) through year 25 (2010-2011). Poor cognition was based on cognitive domain scores ≥ 1 SD below the mean on tests of processing speed (Digit Symbol Substitution Test), executive function (Stroop), and memory (Rey Auditory Verbal Learning Test) at year 25.

RESULTS

Five smoking trajectories emerged over 25 years: quitters (19%), and minimal stable (40%), moderate stable (20%), heavy stable (15%), and heavy declining smokers (5%). Heavy stable smokers showed poor cognition on all 3 domains compared to never smoking (processing speed AOR = 2.22 95% CI 1.53-3.22; executive function AOR = 1.58 95% CI 1.05-2.36; memory AOR = 1.48 95% CI 1.05-2.10). Compared to never smoking, both heavy declining (AOR = 1.95 95% CI 1.06-3.68) and moderate stable smokers (AOR = 1.56 95% CI 1.11-2.19) exhibited slower processing speed, and heavy declining smokers additionally had poor executive function. For minimal stable smokers (processing speed AOR = 1.12 95% CI 0.85-1.51; executive function AOR = 0.97 95% CI 0.71-1.31; memory AOR = 1.21 95% CI 0.94-1.55) and quitters (processing speed AOR = 0.96 95% CI 0.63-1.48; executive function AOR = 0.98 95% CI 0.63-1.52; memory AOR = 0.97 95% CI 0.67-1.39), no association was observed.

CONCLUSIONS

The association between early to midlife smoking trajectories and midlife cognition was dose-dependent. Results underscore the cognitive health risk of moderate and heavy smoking and the potential benefits of quitting on cognition, even in midlife.

The Effect of Prenatal Exposure to Climate Anomaly on Adulthood Cognitive Function and Job Reputation

Background: The long-term effect of abnormal climate on cognitive function and socioeconomic status remains elusive. We explored the association between prenatal exposure to climate anomaly and adulthood cognitive function and job reputation. Methods: We obtained repeated cognitive and job reputation measurements from 17,105 subjects for the years 2010, 2014, and 2018, and ascertained their birth date and other covariates. We used sea surface temperature (SST) anomalies in the Southern Pacific Ocean as the indicator for global climate anomaly in the main analyses. We calculated its averaged values for different gestational periods and analyzed its possible nonlinear associations with adulthood cognitive function and job reputation. We also calculated associated economic loss due to prenatal exposure to abnormal climate. Results: We found an inverted U-shaped curve between climate anomaly and adulthood cognition. During the entire pregnancy, for SST anomalies increasing/decreasing 1 °C from 0 °C, newborn individuals will have adulthood cognition (measured by math test) changed by −2.09% (95% confidence interval (CI): −2.31%, −1.88%) and −3.98% (95% CI: −4.32%, −3.65%), respectively. We observed a similar inverted U-shaped pattern for cognitive function measured by word test and job reputation. Such an association is likely to be mediated by regional meteorological conditions, not local ones. Subgroup analyses identified females and people from less-developed regions as even more vulnerable to prenatal abnormal climate, finding an interactive effect with other social factors. The economic loss was assessed as the salary reduction due to declined cognition among all newborn individuals in China. For SST anomalies increasing/decreasing by 1 °C from 0 °C, individuals born each year in China would earn 0.33 (95% CI: 0.40, 0.25) and 1.09 (95% CI: 1.23, 0.94) billion U.S. dollars equivalent less in their annual salary at adulthood because of lowered cognitive function, respectively. Conclusion: Prenatal exposure to abnormal global climate patterns can result in declined adulthood cognitive function, lowered job reputation, and subsequent economic loss.

Paradoxical cognitive trajectories in men from earlier to later adulthood

Because longitudinal studies of aging typically lack cognitive data from earlier ages, it is unclear how general cognitive ability (GCA) changes throughout the life course. In 1173 Vietnam Era Twin Study of Aging (VETSA) participants, we assessed young adult GCA at average age 20 and current GCA at 3 VETSA assessments beginning at average age 56. The same GCA index was used throughout. Higher young adult GCA and better GCA maintenance were associated with stronger specific cognitive abilities from age 51 to 73. Given equivalent GCA at age 56, individuals who had higher age 20 GCA outperformed those whose GCA remained stable in terms of memory, executive function, and working memory abilities from age 51 to 73. Thus, paradoxically, despite poorer maintenance of GCA, high young adult GCA still conferred benefits. Advanced predicted brain age and the combination of elevated vascular burden and APOE-ε4 status were associated with poorer maintenance of GCA. These findings highlight the importance of distinguishing between peak and current GCA for greater understanding of cognitive aging.

Conservation of mechanisms regulating emotional-like responses on spontaneous nicotine withdrawal in zebrafish and mammals

BACKGROUND

Nicotine withdrawal syndrome is a major clinical problem. Animal models with sufficient predictive validity to support translation of pre-clinical findings to clinical research are lacking.

AIMS

We evaluated the behavioural and neurochemical alterations in zebrafish induced by short- and long-term nicotine withdrawal.

METHODS

Zebrafish were exposed to 1 mg/L nicotine for 2 weeks. Dependence was determined using behavioural analysis following mecamylamine-induced withdrawal, and brain nicotinic receptor binding studies. Separate groups of nicotine-exposed and control fish were assessed for anxiety-like behaviours, anhedonia and memory deficits following 2-60 days spontaneous withdrawal. Gene expression analysis using whole brain samples from nicotine-treated and control fish was performed at 7 and 60 days after the last drug exposure. Tyrosine hydroxylase (TH) immunoreactivity in pretectum was also analysed.

RESULTS

Mecamylamine-precipitated withdrawal nicotine-exposed fish showed increased anxiety-like behaviour as evidenced by increased freezing and decreased exploration. ³H-Epibatidine labeled heteromeric nicotinic acethylcholine receptors (nAChR) significantly increased after 2 weeks of nicotine exposure while ¹²⁵I-αBungarotoxin labeled homomeric nAChR remained unchanged. Spontaneous nicotine withdrawal elicited anxiety-like behaviour (increased bottom dwelling), reduced motivation in terms of no preference for the enriched side in a place preference test starting from Day 7 after withdrawal and a progressive decrease of memory attention (lowering discrimination index). Behavioural differences were associated with brain gene expression changes: nicotine withdrawn animals showed decreased expression of chrna 4 and chrna7 after 60 days, and of htr2a from 7 to 60 days.The expression of c-Fos was significantly increased at 7 days. Finally, Tyrosine hydroxylase (TH) immunoreactivity increased in dorsal parvocellular pretectal nucleus, but not in periventricular nucleus of posterior tuberculum nor in optic tectum, at 60 days after withdrawal.

CONCLUSIONS

Our findings show that nicotine withdrawal induced anxiety-like behaviour, cognitive alterations, gene expression changes and increase in pretectal TH expression, similar to those observed in humans and rodent models.

Contribution of vascular risk factors to the relationship between ADHD symptoms and cognition in adults and seniors

Symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood have been found to be predictive of compromised cognitive function, and possibly even dementia, in later adulthood. This study aimed to test vascular risk as a hypothesized moderator or mediator of this association, because individuals with elevated ADHD symptoms frequently have comorbid vascular disease or risk factors which are recognized to contribute to later-life cognitive decline. Data from 1,092 adults aged 18–85 were drawn from the Enhanced Nathan Kline Institute Rockland Sample. Childhood ADHD symptoms (assessed using the Adult ADHD Clinical Diagnostic Scale) were assessed as predictors of cognitive functioning in adulthood (assessed using subtests from the University of Pennsylvania Computerized Neurocognitive Battery, the Delis-Kaplan Executive Functioning System, and the Wechsler Memory Scale). Vascular risk factors (including diabetes, tobacco use, obesity, hypertension, and hypercholesterolemia) were tested as both a moderator and mediator of this relationship. Childhood ADHD symptoms and vascular risk factors were both independently associated with later-life cognition, but vascular risk was not a significant moderator or mediator of relationships between ADHD symptoms and cognition in statistical models. Results from this large community sample suggest that the relationship between ADHD symptoms and cognition is not accounted for by vascular risk. This question should also be investigated in clinical samples.

Nanonaringenin and Vitamin E Ameliorate Some Behavioral, Biochemical, and Brain Tissue Alterations Induced by Nicotine in Rats

Nicotine is the major alkaloid present in cigarettes that induces various biochemical and behavioral changes. Nanonaringenin (NNG) and vitamin E are antioxidants that are reported to mitigate serious impairments caused by some toxins and oxidants. Thus, we aimed to investigate the efficacy of NNG, vitamin E, and their combinations to ameliorate behavioral, biochemical, and histological alterations induced by nicotine in rats. Adult male albino rats were randomly grouped into six equal groups (10 rats/group): control, N (nicotine 1 mg/kg b.w./day S/C from 15^th to 45^th day, 5 days a week), NNG (25 mg/kg b.w./day orally for 45 days), N + NNG, N + E (nicotine + vitamin E 200 mg/kg b.w./day orally), and N + NNG + E (nicotine + NNG + vitamin E at the aforementioned doses). Behavioral tests were conducted on day 15 and 30 postnicotine injection, while memory tests, brain neurotransmitters, antioxidants, and histopathological examination were examined at day 30 only. As a result, nicotine impaired rats' activity (hypoactivity and hyperactivity) and memory, induced anxiolytic and anxiogenic effects on rats, and altered neurotransmitters (acetylcholinesterase, serotonin, and dopamine), and redox markers (MDA, H₂O₂, GSH, and catalase) levels in brain homogenates. Thickening and congestion of the meninges and degeneration of the cerebral neurons and glia cells were observed. Cosupplementation with NNG, vitamin E, and their combination with nicotine was beneficial in the alleviation of activity impairments and improved short memory and cognition defects and exploratory behaviors. Our results indicate the antioxidant potential of NNG and vitamin E by modulating redox markers and neurotransmitters in the brain. Thus, data suggest that the prophylactic use of NNG, vitamin E, and/or their combination for (45 days) may have a successful amelioration of the disrupted behavior and cognition and biochemical and histopathological alterations induced by nicotine.

The negative impact of chronic tobacco smoking on adult neuropsychological function: a cross-sectional study

Background

The evidence on the effects of chronic tobacco smoking on neuropsychological functions is conflicting. The literature remains limited by inconsistent accounting for potentially confounding biomedical and psychiatric conditions. This study aimed to assess the neuropsychological functions of adult chronic tobacco smokers in comparison to group-matched non-smokers.

Method

The study included 73 smokers and 84 group-matched non-smokers. The data was collected during the year 2019. After an initial interview to collect demographics and smoking profile, the subjects undertook neuropsychological assessments that targeted a wide range of cognitive domains.

Results

The performance of smokers was poorer on almost all neuropsychological domains, namely selective attention (p ≤ .001, p = .044), alternating attention (p = .002) working memory (p ≤ .001), Short-term memory (p = .006 and .003), Long-term memory (p ≤ .001), processing accuracy (p ≤ .001), and executive function (p = .011 and .026). Smokers were intact on processing speed. Smoking accumulation and lower age onset of regular smoking were correlated with lower neuropsychological function.

Conclusion

Our findings add to the growing body of evidence suggesting that chronic tobacco smoking impacts cognition negatively.

Do Financial Literacy and Financial Education Influence Smoking Behavior in the United States?

Smoking is still a serious economic, health, and social problem despite various efforts to curb its prevalence. We examined the influence of financial literacy and financial education on the smoking behavior in the United States in terms of the use of rational decision-making abilities to reduce irrational behavior. We hypothesized that financial literacy and financial education, as proxies for rational decision making, would reduce the likelihood of smoking. We used data from the Preference Parameters Study (PPS) of Osaka University conducted in the United States in 2010 and applied probit regression models to test our hypothesis on a sample of 3831 individuals. We found that financially literate people are less likely to be smokers, though we found no clear role of financial education in reducing the likelihood of smoking. Further, respondents' gender, age, unemployment status, and risky health behaviors such as drinking and gambling, have a significantly positive association with smoking, while marital status, university degree, family size, household income, household assets, physical exercise, and level of happiness have a significantly negative association. Our findings suggest that financial literacy, as an instrument encouraging rational decision making, could be a tool to help reduce smoking in the United States.

Persistent Symptoms in Patients Recovering From COVID-19 in Denmark

Background

Although persistent symptoms after coronavirus disease 2019 (COVID-19) are emerging as a major complication to the infection, data on the diversity and duration of symptoms are needed.

Methods

Patients aged ≥18 years with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 who were hospitalized at the Department of Infectious Diseases, Aarhus University Hospital, Denmark, in the period from March 11 to May 15 were offered follow-up after hospitalization. On admission, a comprehensive symptom and medical history was collected, including demographic characteristics, duration of symptoms, comorbidities, and concomitant medications. At discharge, patients were offered follow-up consultations—either by telephone or at an in-person visit—at 6 and 12 weeks at our post-COVID-19 outpatient clinic to assess whether symptoms present at admission had resolved.

Results

During the inclusion period, 71 patients were admitted with COVID-19. Of these, 10 patients died, 3 were transferred to another region, 4 declined to participate, and 5 were lost to follow-up before the 12-week evaluation. Thus, 49 patients were included. Overall, 96% reported 1 or more persisting symptoms at 12-week follow-up. The main symptoms were fatigue, dyspnea, cough, chemosensory dysfunction, and headache.

Conclusions

A wide range of persistent symptoms in patients recovering from COVID-19 were present 12 weeks after hospitalization, calling for larger descriptive studies and interdisciplinary research collaborations.

The Relationship Between Cardiovascular Health and Rate of Cognitive Decline in Young-Old and Old-Old Adults: A Population-Based Study

BACKGROUND

Modifiable vascular risk factors have been associated with late-life cognitive impairment. The Life Simple 7 (LS7) score comprises seven cardiovascular health metrics: smoking, diet, physical activity, body mass index, plasma glucose, total serum cholesterol, and blood pressure.

OBJECTIVE

To investigate the association between individual and composite LS7 metrics and rate of cognitive decline, and potential differences in these associations between young-old and old-old individuals.

METHODS

This cohort study included 1,950 participants aged≥60 years (M = 70.7 years) from the Swedish National Study on Aging and Care-Kungsholmen (SNAC-K), who underwent repeated neuropsychological testing (episodic and semantic memory, verbal fluency, processing speed, global cognition) across 12 years. The LS7 score was assessed at baseline and categorized as poor, intermediate, or optimal. Level and change in cognitive performance as a function of LS7 categories were estimated using linear mixed-effects models.

RESULTS

Having an optimal LS7 total score was associated with better performance (expressed in standard deviation units) at baseline for perceptual speed (β= 0.21, 95%CI 0.12-0.29), verbal fluency (β= 0.08, 0.00-0.16), and global cognition (β= 0.06, 0.00-0.12) compared to the poor group. Age-stratified analyses revealed associations for cognitive level and change only in the young-old (< 78 years) group. For the specific metrics, diverging patterns were observed for young-old and old-old individuals.

CONCLUSION

Meeting the LS7 criteria for ideal cardiovascular health in younger old age is associated with slower rate of cognitive decline. However, the LS7 criteria may have a different meaning for cognitive function in very old adults.

Cigarette smoking and cognitive function among older adults living in the community

Background. The present study aimed to examine the long-term impact of CS on Executive Function (EF) and memory among older adults living in the community. Methods. Clock Drawing Test (CDT) and Delayed Word Recall Test (DWRT) were used to examine EF and memory, respectively, using four waves of National Health and Aging Trend Study. The respondents were asked whether they have ever smoked, length of smoking, and age of start and quit smoking. Results. CS can have a long-term impact on both EF and memory. However, current smoking can increase the risk of EF impairment compared to former smokers. Lung disease and current smoking can have a synergic effect of impairment in EF. Conclusion. In the long-term, smoking can negatively affect cognitive. Lung diseases and smoking can synergize their impacts on EF. The impact of smoking on cognition varies across ethnic groups; hence, educational programs targeting minorities can reduce discrepancies.

Measures of nicotine dependence enhance interpretation of number of cigarettes smoked in youth smoking surveillance

BACKGROUND

Nicotine dependence (ND) symptoms can occur soon after first puff, so that stopping smoking becomes difficult well before 100 cigarettes lifetime is attained. Yet some surveillance systems do not monitor ND symptoms and 100-cigarettes lifetime is used in at least one surveillance system to define current smokers. To assess whether these features limit interpretation of grade-specific data in surveillance, we described smoking and ND symptoms across grade in incident vs. prevalent smokers, and in smokers according to 100-cigarettes lifetime.

METHODS

Data were available in an investigation of 1294 grade 7 students from 10 Montreal-area high schools followed every 3 months from grade 7 to 11. Analyses described cigarette consumption, 100-cigarette lifetime consumption, cravings, withdrawal symptoms, mFTQ nicotine dependence and ICD-10 tobacco dependence by grade among past 3-month smokers.

RESULTS

Despite low cigarette consumption, 21-30% of grade 7 smokers reported ND symptoms. This increased to 27-44% in grade 8 and remained stable thereafter despite increased cigarette consumption. In grade 7, 10% of all smokers had not attained the 100-cigarette milestone but were already dependent. In grade 8, 9, 10 and 11, these proportions were 12%, 8%, 6% and 6%, respectively.

CONCLUSIONS

ND symptoms should be monitored in youth surveillance systems since they tell a different "story" than cigarettes and their appearance may represent a critical "point-of-no-return." Interventions for incident smokers are needed across grades to stop smoking before ND manifests. Without a shift in focus toward incident rather than established smokers, many children who try cigarettes will become addicted.

The development of cognitive and emotional impairment after a minor stroke: A longitudinal study

OBJECTIVES

To study the development of cognitive and emotional symptoms between 3 and 12 months after a minor stroke.

MATERIAL AND METHODS

We included patients from stroke units at hospitals in the Central Norway Health Authority and from Haukeland University Hospital. We administered a selection of cognitive tests, and the patients completed a questionnaire 3 and 12 months post-stroke. Cognitive impairment was defined as impairment of ≥2 cognitive tests.

RESULTS

A total of 324 patients completed the 3-month testing, whereas 37 patients were lost to follow-up at 12 months. The results showed significant improvement of cognitive function defined as impairment of ≥2 cognitive tests (P = .03) from months 3 to 12. However, most patients still showed cognitive impairment at 12 months with a prevalence of 35.4%. There is significant association between several of the cognitive tests and hypertension and smoking (P = .002 and .05). The prevalence of depression, but not anxiety, increased from 3 to 12 months (P = .04). The prevalence of fatigue did not change and was thus still high with 29.5% after 12 months.

CONCLUSIONS

This study shows that an improvement of cognitive function still occurs between 3 and 12 months. Despite this, the prevalence of mostly minor cognitive impairment still remains high 12 months after the stroke. The increasing prevalence of depressive symptoms highlights the importance of being vigilant of depressive symptoms throughout the rehabilitation period. Furthermore, high prevalence of fatigue persisted.

Cerebellar Gray Matter Reductions Associate With Decreased Functional Connectivity in Nicotine-Dependent Individuals

Introduction

Nicotine dependence (ND) is a chronic, relapsing mental disorder characterized by compulsive cigarette seeking and smoking. Although the cerebellum plays an increasingly implicated role in ND, the exact cerebellar alterations in ND remain unclear. Identifying the localization of these cerebellar abnormalities in ND may help to further understand the role of the cerebellum in ND. Thus, we investigated the structural and functional alterations in the cerebellum in a large sample of smokers using the spatially unbiased infratentorial template (SUIT).

Methods

High-resolution structural magnetic resonance imaging (MRI) data were acquired from 85 smokers and 41 nonsmokers. We applied voxel-based morphometry (VBM) and the SUIT cerebellar atlas to compare the cerebellar gray matter (GM) volume between smokers and nonsmokers. Using resting-state functional MRI data, we also performed seed-based functional connectivity (FC) analysis to examine the functional correlates of the GM volume changes.

Results

Both VBM and lobular analyses revealed smaller GM volume in the bilateral Crus I in smokers. The GM volume of the left Crus I was inversely correlated with the severity of nicotine dependence as assessed by Fagerström Test for Nicotine Dependence (r = -.268, p = .013). We also found reduced FC between the bilateral Crus I and brain regions involved in the default mode network and motor system, as well as the frontal and temporal cortex in smokers.

Conclusions

Our results indicate that decreased cerebellar GM volume and corticocerebellar FC are associated with ND, and these may underlie the core ND phenotypes, including automatized smoking behavior, cognitive, and emotional deficits.

Implications

As smoking remains a worldwide public health problem, identifying the related neural alterations may help to understand the pathophysiology of ND. Based on previous findings in the cerebellum, we investigated the localization of the GM differences and related FC changes in ND subjects. Our findings highlight altered corticocerebellar circuits in ND, suggesting an association between the cerebellum and the phenotypes of ND.

Novel serum metabolites associate with cognition phenotypes among Bogalusa Heart Study participants

BACKGROUND

Metabolomics study provides an opportunity to identify novel molecular determinants of altered cognitive function.

METHODS

During 2013 to 2016 Bogalusa Heart Study (BHS) visit, 1,177 participants underwent untargeted, ultrahigh performance liquid chromatography-tandem mass spectroscopy metabolomics profiling. Global cognition and five cognition domains were also assessed. The cross-sectional associations of single metabolites with cognition were tested using multiple linear regression models. Weighted correlation network analysis was used to examine the covariable-adjusted correlations of modules of co-abundant metabolites with cognition. Analyses were conducted in the overall sample and according to both ethnicity and sex.

RESULTS

Five known metabolites and two metabolite modules robustly associated with cognition across overall and stratified analyses. Two metabolites were from lipid sub-pathways including fatty acid metabolism [9-hydroxystearate; minimum P-value (min-P)=1.11×10-5], and primary bile acid metabolism (glyco-alpha-muricholate; min-P=4.10×10-5). One metabolite from the glycogen metabolism sub-pathway (maltose; min-P=9.77×10-6), one from the polyamine metabolism sub-pathway (N-acetyl-isoputreanine; min-P=1.03×10-5), and one from the purine metabolism sub-pathway (7-methylguanine; min-P=1.19×10-5) were also identified. Two metabolite modules reflecting bile acid metabolism and androgenic steroids correlated with cognition (min-P=5.00×10-4 and 3.00×10-3, respectively).

CONCLUSION

The novel associations of 5 known metabolites and 2 metabolite modules with cognition provide insights into the physiological mechanisms regulating cognitive function.

Genetic Contributions to Health Literacy

Higher health literacy is associated with higher cognitive function and better health. Despite its wide use in medical research, no study has investigated the genetic contributions to health literacy. Using 5783 English Longitudinal Study of Ageing (ELSA) participants (mean age = 65.49, SD = 9.55) who had genotyping data and had completed a health literacy test at wave 2 (2004-2005), we carried out a genome-wide association study (GWAS) of health literacy. We estimated the proportion of variance in health literacy explained by all common single nucleotide polymorphisms (SNPs). Polygenic profile scores were calculated using summary statistics from GWAS of 21 cognitive and health measures. Logistic regression was used to test whether polygenic scores for cognitive and health-related traits were associated with having adequate, compared to limited, health literacy. No SNPs achieved genome-wide significance for association with health literacy. The proportion of variance in health literacy accounted for by common SNPs was 8.5% (SE = 7.2%). Greater odds of having adequate health literacy were associated with a 1 standard deviation higher polygenic score for general cognitive ability [OR = 1.34, 95% CI (1.26, 1.42)], verbal-numerical reasoning [OR = 1.30, 95% CI (1.23, 1.39)], and years of schooling [OR = 1.29, 95% CI (1.21, 1.36)]. Reduced odds of having adequate health literacy were associated with higher polygenic profiles for poorer self-rated health [OR = 0.92, 95% CI (0.87, 0.98)] and schizophrenia [OR = 0.91, 95% CI (0.85, 0.96)). The well-documented associations between health literacy, cognitive function and health may partly be due to shared genetic etiology. Larger studies are required to obtain accurate estimates of SNP-based heritability and to discover specific health literacy-associated genetic variants.

Childhood Lead Exposure and Adult Neurodegenerative Disease

Millions of Americans now entering midlife and old age were exposed to high levels of lead, a neurotoxin, as children. Evidence from animal-model and human observational studies suggest that childhood lead exposure may raise the risk of adult neurodegenerative disease, particularly dementia, through a variety of possible mechanisms including epigenetic modification, delayed cardiovascular and kidney disease, direct degenerative CNS injury from lead remobilized from bone, and lowered neural and cognitive reserve. Within the next ten years, the generation of children with the highest historical lead exposures, those born in the 1960s, 1970s, and 1980s, will begin to enter the age at which dementia symptoms tend to emerge. Many will also enter the age in which lead stored in the skeleton may be remobilized at greater rates, particularly for women entering menopause and men and women experiencing osteoporosis. Should childhood lead exposure prove pro-degenerative, the next twenty years will provide the last opportunities for possible early intervention to forestall greater degenerative disease burden across the aging lead-exposed population. More evidence is needed now to characterize the nature and magnitude of the degenerative risks facing adults exposed to lead as children and to identify interventions to limit long-term harm.

G, Calderon O, Moreno-Gonzalez I. Modifiable Risk Factors for Alzheimer's Disease

Since first described in the early 1900s, Alzheimer's disease (AD) has risen exponentially in prevalence and concern. Research still drives to understand the etiology and pathogenesis of this disease and what risk factors can attribute to AD. With a majority of AD cases being of sporadic origin, the increasing exponential growth of an aged population and a lack of treatment, it is imperative to discover an easy accessible preventative method for AD. Some risk factors can increase the propensity of AD such as aging, sex, and genetics. Moreover, there are also modifiable risk factors-in terms of treatable medical conditions and lifestyle choices-that play a role in developing AD. These risk factors have their own biological mechanisms that may contribute to AD etiology and pathological consequences. In this review article, we will discuss modifiable risk factors and discuss the current literature of how each of these factors interplay into AD development and progression and if strategically analyzed and treated, could aid in protection against this neurodegenerative disease.

Tobacco Use and Cognitive Functioning in Veterans of the Conflicts in Iraq and Afghanistan

Tobacco use is a prevalent problem in the general population as well as among military veterans. Despite the fact that tobacco users are at an increased risk of many medical and psychiatric comorbidities, the risk of cognitive impairment in younger active tobacco users is less studied. Military veterans from the conflicts in Iraq and Afghanistan (n = 113) were administered a neuropsychological protocol. Even after controlling for the severity of PTSD symptoms, tobacco use was negatively related to performance on measures of processing speed, memory, and executive functioning. The current findings have implications for the neuropsychological evaluation of tobacco users.

Profiles of visuospatial memory dysfunction in opioid-exposed and dependent populations

BACKGROUND

Chronic opioid exposure is common world-wide, but behavioural performance remains under-investigated. This study aimed to investigate visuospatial memory performance in opioid-exposed and dependent clinical populations and its associations with measures of intelligence and cognitive impulsivity.

METHODS

We recruited 109 participants: (i) patients with a history of opioid dependence due to chronic heroin use (n = 24), (ii) heroin users stabilised on methadone maintenance treatment (n = 29), (iii) participants with a history of chronic pain and prescribed tramadol and codeine (n = 28) and (iv) healthy controls (n = 28). The neuropsychological tasks from the Cambridge Neuropsychological Test Automated Battery included the Delayed Matching to Sample (DMS), Pattern Recognition Memory, Spatial Recognition Memory, Paired Associate Learning, Spatial Span Task, Spatial Working Memory and Cambridge Gambling Task. Pre-morbid general intelligence was assessed using the National Adult Reading Test.

RESULTS

As hypothesised, this study identified the differential effects of chronic heroin and methadone exposures on neuropsychological measures of visuospatial memory (p &lt; 0.01) that were independent of injecting behaviour and dependence status. The study also identified an improvement in DMS performance (specifically at longer delays) when the methadone group was compared with the heroin group and also when the heroin group was stabilised onto methadone. Results identified differential effects of chronic heroin and methadone exposures on various neuropsychological measures of visuospatial memory independently from addiction severity measures, such as injecting behaviour and dependence status.

Geriatric assessment and 1-year mortality in older patients with cancer in the head and neck region: A cohort study

Background

The aim is to describe the association of functional capacity and cognitive functioning with 1‐year mortality in older patients with cancer in the head and neck region.

Methods

We performed a cohort study in which all patients aged 70 years and older received a geriatric screening before treatment. Main outcome was 1‐year mortality.

Results

A total of 102 patients were included. Median age was 78.7 years (interquartile range [IQR], 72.3‐84.5), 25% were cognitive impaired, 40% were malnourished, and 28.4% used a walking device. Overall, 1‐year mortality was 42.3%. Male sex (hazard ratio [HR], 4.30; 95% confidence interval [CI], 1.35‐13.67), malnutrition (HR, 2.55; 95% CI, 1.19‐5.16), and using a walking device (HR, 2.80; 95% CI 1.13‐6.93) were associated with higher mortality risk, independent of stage and comorbidities.

Conclusion

In older patients with head and neck cancer, the mortality rates are high. Nutritional status and mobility are determinants of 1‐year mortality, independent of tumor stage, age, and comorbidity.

Health literacy, cognitive ability and smoking: a cross-sectional analysis of the English Longitudinal Study of Ageing

OBJECTIVES

We used logistic regression to investigate whether health literacy and cognitive ability independently predicted whether participants have ever smoked and, in ever smokers, whether participants still smoked nowadays.

DESIGN

Cross-sectional study.

SETTING

This study used data from Wave 2 (2004-05) of the English Longitudinal Study of Ageing, which is a cohort study of adults who live in England and who, at baseline, were aged 50 years and older.

PARTICIPANTS

8734 (mean age=65.31 years, SD=10.18) English Longitudinal Study of Ageing participants who answered questions about their current and past smoking status, and completed cognitive ability and health literacy tests at Wave 2.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were whether participants reported ever smoking at Wave 2 and whether ever smokers reported still smoking at Wave 2.

RESULTS

In models adjusting for age, sex, age left full-time education and occupational social class, limited health literacy (OR=1.096, 95% CI 0.988 to 1.216) and higher general cognitive ability (OR=1.000, 95% CI 0.945 to 1.057) were not associated with reporting ever smoking. In ever smokers, limited compared with adequate health literacy was associated with greater odds of being a current smoker (OR=1.194, 95% CI 1.034 to 1.378) and a 1 SD higher general cognitive ability score was associated with reduced odds of being a current smoker (OR=0.878, 95% CI 0.810 to 0.951), when adjusting for age, sex, age left full-time education and occupational social class.

CONCLUSIONS

When adjusting for education and occupation variables, this study found that health literacy and cognitive ability were independently associated with whether ever smokers continued to smoke nowadays, but not with whether participants had ever smoked.

Middle Cerebral Artery Pulsatility Index as Predictor of Cognitive Impairment in Hypertensive Patients

Background: Cognitive impairment is a manifestation of cerebrovascular disease regarding hypertension and other degenerative diseases which has become a global health issue due to increased life expectancy. Recently, the gold standard used for diagnosing vascular cognitive impairment (VCI) has required a combination of the neurophysiological approach and magnetic resonance imaging (MRI). The Neurosonological approach, involving measuring the pulsatility index (PI) of the middle cerebral artery (MCA) using Trans Cranial Doppler (TCD), can hopefully be used as an affordable alternative predictor of VCI in patients with hypertension.

Methods: A cross-sectional study was conducted at the Outpatient Clinic of the Department of Neurology in Ciptomangunkusumo Hospital, Jakarta. Sixty-six hypertensive subjects with no macrovascular complication were selected and screened using the Montreal Cognitive Assesment-Indonesia version (MoCA-Ina) to determine their cognitive status. Subjects were categorized into two groups; subjects with scores ≥26 were classified as the normal cognitive group, while subjects with scores <26 were classified as the cognitive impairment group. Both groups then underwent TCD examination to determine bilateral MCA PI.

Results: There was a significant difference between MCA PI in both groups; it was higher in the cognitive impairment group than normal group (p < 0.001). Subjects with an increased left MCA PI were more likely to suffer cognitive impairment than those with an increased right MCA PI.

Conclusion: MCA PI can be used as a predictor for cognitive impairment in hypertensive subjects.

Age at menopause and lifetime cognition: Findings from a British birth cohort study

OBJECTIVE

We investigated whether cognitive performance between ages 43 and 69 years was associated with timing of menopause, controlling for hormone replacement therapy, childhood cognitive ability, and sociobehavioral factors.

METHODS

We used data from 1,315 women participating in the Medical Research Council National Survey of Health and Development (a British birth cohort study) with known age at period cessation and up to 4 assessments of verbal memory (word-learning task) and processing speed (letter-cancellation task) at ages 43, 53, 60-64, and 69. We fitted multilevel models with linear and quadratic age terms, stratified by natural or surgical menopause, and adjusted for hormone replacement therapy, body mass index, smoking, occupational class, education, and childhood cognitive ability.

RESULTS

Verbal memory increased with later age at natural menopause (0.17 words per year, 95% confidence interval [CI]: 0.07-0.27, p = 0.001); an association remained, albeit attenuated, after full adjustment (0.09, 95% CI: 0.02-0.17, p = 0.013). Verbal memory also increased with later age at surgical menopause (0.16, 95% CI: 0.06-0.27, p = 0.002), but this association was fully attenuated after adjustment. Search speed was not associated with age at menopause.

CONCLUSION

Our findings suggest lifelong hormonal processes, not just short-term fluctuations during the menopause transition, may be associated with verbal memory, consistent with evidence from a variety of neurobiological studies; mechanisms are likely to involve estrogen receptor β function. Further follow-up is required to assess fully the clinical significance of these associations.

Delirium symptoms are associated with decline in cognitive function between ages 53 and 69 years: Findings from a British birth cohort study

INTRODUCTION

Few population studies have investigated whether longitudinal decline after delirium in mid-to-late life might affect specific cognitive domains.

METHODS

Participants from a birth cohort completing assessments of search speed, verbal memory, and the Addenbrooke's Cognitive Examination at age 69 were asked about delirium symptoms between ages 60 and 69 years. Linear regression models estimated associations between delirium symptoms and cognitive outcomes.

RESULTS

Period prevalence of delirium between 60 and 69 years was 4% (95% confidence interval 3.2%-4.9%). Self-reported symptoms of delirium over the seventh decade were associated with worse scores in the Addenbrooke's Cognitive Examination (-1.7 points; 95% confidence interval -3.2, -0.1; P = .04). In association with delirium symptoms, verbal memory scores were initially lower, with subsequent decline in search speed by the age of 69 years. These effects were independent of other Alzheimer's risk factors.

DISCUSSION

Delirium symptoms may be common even at relatively younger ages, and their presence may herald cognitive decline, particularly in search speed, over this time period.

Putative mechanisms of cognitive decline with implications for clinical research and practice

Multiple intrinsic and extrinsic mechanisms contribute to vulnerability of cognitive decline and nurses play a significant role in assisting individuals and families to use strategies for healthy cognitive aging. The objective of this narrative review is to provide a synthesis of the intrinsic and extrinsic mechanisms of cognitive decline and conditions that are associated with cognitive decline. Well-established intrinsic mechanisms of cognitive decline include aging, apolipoprotein E (APOE) ε4 carrier status, SORL1 mutations, neuroinflammation, mitochondrial dysfunction, amyloid deposition, and demyelination. Extrinsic risk factors include obesity, diabetes, hypertension, elevated lipid panel, metabolic syndrome, depression, traumatic brain injury, substance use, heart failure, and stroke. The various definitions of cognitive decline as well as the intrinsic and extrinsic factors that impact cognition as humans age should be incorporated in future clinical research studies. Nurses may use this information to help patients make lifestyle choices regarding cognitive health.

Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort

BACKGROUND

Cognitive capabilities change in later life, although their onset and rate of decline, and how they are shaped by lifetime socioeconomic position, childhood cognition and adult health status are all unclear.

METHODS

From the Medical Research Council National Survey of Health and Development, we analysed 3,192 participants undergoing one or more cognitive assessments at ages 43, 53, 60-64 and 69. Linear mixed models described cognitive trajectories, adjusting for factors across the life course.

RESULTS

For both search speed and verbal memory, better performance at age 43 (the intercept) was associated with higher paternal and own education, childhood cognition, and adult occupational class. For search speed, the trajectory was best described as a quadratic function (decline of 45.6 letters/5-years + 4.6 letters). Verbal memory showed a linear decline of 0.20 words/5-years between ages 43 and 60 and a steeper linear decline of 0.95 words/5-years between ages 60 and 69. Decline in verbal memory in the latter period was steeper in those with higher educational achievements at age 26 (additional 0.28 words/5-years for highest attainment).

CONCLUSIONS

Decline in verbal memory and search speed across midlife is evident, though with different non-linear trajectories. By implication, pathways to cognitive impairment and dementia in older age may have their origins in this period.

Determinants of Nicotine Dependence in Chronic Obstructive Pulmonary Disease

Background

Smoking cessation is the most powerful intervention to modify progress of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. We evaluated nicotine dependence status and investigated factors associated with moderate to high nicotine dependence in patients with COPD.

Methods

We included 53 current smokers with COPD in the Korean Obstructive Lung Disease II cohort enrolled between January 2014 and March 2016. Nicotine dependence was measured by using Fagerstrom test for nicotine dependence (FTND). Cognitive function was assessed by Korean version of Montreal Cognitive Assessment.

Results

The median FTND score was 3, and 32 patients (60%) had moderate to high nicotine dependence. The median smoking amount was 44 pack-years, which was not related to nicotine dependence. Multiple logistic regression analysis revealed that high education status (odds ratio, 1.286; 95% confidence interval, 1.036–1.596; p=0.023), age <70 (odds ratio, 6.407; 95% confidence interval, 1.376–29.830; p=0.018), and mild to moderate airflow obstruction (odds ratio, 6.969; 95% confidence interval, 1.388–34.998; p=0.018) were related to moderate to high nicotine dependence.

Conclusion

Nicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.

Identifying demographic and psychosocial factors related to the escalation of smoking behavior among Mexican American adolescents

Cigarette smoking is the leading preventable cause of death in the United States; smoking in Mexican American adolescents, a rapidly growing population, remains a major concern. Factors associated with escalation or progression along the smoking trajectory have not been studied in adolescent Mexican Americans. A better understanding of escalation is needed for cancer prevention and overall health. N=1,328 Mexican American adolescents joined a cohort in 2005-06. At baseline participants provided demographic, acculturation and psychosocial data, and reported their smoking status using the Minnesota Smoking Index. Those that never tried a cigarette or only had a few puffs in their life were included in this study. The primary outcome of interest, escalation in smoking status, was defined as moving up the Minnesota Smoking Index by 2010-2011. The current analysis is based on 973 participants of whom 48.2% were male, mean age=11.8 (SD=0.8), and 26.0% were born in Mexico. By 2010-2011, 283 (29%) escalated their smoking status and 690 (71%) remained the same. Being older (OR=1.30; CI=1.07-1.57), male (OR=1.88, CI=1.40-2.53), having higher levels of anxiety (OR=1.03, CI=1.02-1.05), intending to smoke (OR=1.70, CI=1.18-2.46), having friends who smoke (OR=1.73, CI=1.12-2.70) and having parents' friends who smoke (OR=1.38, CI=1.02-1.88) increased risk for smoking escalation. Higher levels of subjective social status (OR=0.91, CI=0.83-0.99) were protective against smoking escalation. Contrasting previous work in smoking experimentation, parents' friends influence was a stronger predictor than the family household influence. Preventative interventions for Mexican American youth could address this risk factor to reduce smoking escalation.

Compromised neuroplasticity in cigarette smokers under nicotine withdrawal is restituted by the nicotinic α4β2-receptor partial agonist varenicline

Nicotine modulates neuroplasticity and improves cognitive functions in animals and humans. In the brain of smoking individuals, calcium-dependent plasticity induced by non-invasive brain stimulation methods such as transcranial direct current stimulation (tDCS) and paired associative stimulation (PAS) is impaired by nicotine withdrawal, but partially re-established after nicotine re-administration. In order to investigate the underlying mechanism further, we tested the impact of the α₄β₂-nicotinic receptor partial agonist varenicline on focal and non-focal plasticity in smokers during nicotine withdrawal, induced by PAS and tDCS, respectively. We administered low (0.3 mg) and high (1.0 mg) single doses of varenicline or placebo medication before stimulation over the left motor cortex of 20 healthy smokers under nicotine withdrawal. Motor cortex excitability was monitored by single-pulse transcranial magnetic stimulation-induced motor evoked potential amplitudes for 36 hours after plasticity induction. Stimulation-induced plasticity was absent under placebo medication, whereas it was present in all conditions under high dose. Low dose restituted only tDCS-induced non-focal plasticity, producing no significant impact on focal plasticity. High dose varenicline also prolonged inhibitory plasticity. These results are comparable to the impact of nicotine on withdrawal-related impaired plasticity in smokers and suggest that α₄β₂ nicotinic receptors are relevantly involved in plasticity deficits and restitution in smokers.