Cerebrovascular function and its association with systemic artery function and stiffness in older adults with and without mild cognitive impairment.

PURPOSE: Our aim was to compare cerebrovascular and systemic vascular function between older adults with and without mild cognitive impairment (MCI), and to determine which measures of vascular function best predict the presence of MCI. METHODS: In 41 adults with MCI and 33 adults without MCI (control) we compared middle cerebral artery velocity (MCAv) and cerebrovascular pulsatility index (PI) at rest, cerebrovascular reactivity to CO2, and responsiveness to changes in blood pressure (%∆MCAv/%∆MAP). Systemic vascular function was assessed by flow-mediated dilation (FMD) and stiffness by pulse wave velocity (PWV). RESULTS: Cerebrovascular PI was higher in MCI compared with control (mean ± SD: 1.17 ± 0.27 vs. 1.04 ± 0.21), and MCI exhibited a lower %∆MCAv/%∆MAP (1.26 ± 0.44 vs. 1.50 ± 0.55%). Absolute (p = 0.76) and relative cerebrovascular reactivity to CO2 (p = 0.34) was similar between MCI and control. When age was included as a covariate the significant difference in cerebral PI between groups was lost. PWV was higher (13.2 ± 2.2 vs. 11.3 ± 2.5 m s-1) and FMD% (4.41 ± 1.70 vs. 5.43 ± 2.15%) was lower in MCI compared with control. FMD% was positively associated with PI across the cohort. Logistic regression analysis indicated that FMD and PWV significantly discriminated between MCI and controls, independent of age, whereas the inclusion of cerebrovascular measures did not improve the predictive accuracy of the model. CONCLUSION: These findings raise the possibility that early changes in systemic vascular stiffness and endothelial function may contribute to altered cerebrovascular haemodynamics and impaired cognitive function, and present potential targets for prevention and treatment strategies in people with MCI.

The Effect of Non-Stroke Cardiovascular Disease States on Risk for Cognitive Decline and Dementia: A Systematic and Meta-Analytic Review.

Cardiovascular disease is associated with increased risk for cognitive decline and dementia, but it is unclear whether this risk varies across disease states or occurs in the absence of symptomatic stroke. To examine the evidence of increased risk for cognitive decline and dementia following non-stroke cardiovascular disease we conducted two independent meta-analyses in accordance with PRISMA guidelines. The first review examined cardiovascular diagnoses (atrial fibrillation, congestive heart failure, periphery artery disease and myocardial infarction) while the second review assessed the impact of atherosclerotic burden (as indicated by degree of stenosis, calcification score, plaque morphology or number of plaques). Studies eligible for review longitudinally assessed risk for clinically significant cognitive decline and/or dementia and excluded stroke and cognitive impairment at baseline. Summary statistics were computed via the inverse variance weighted method, utilising Cox Proportional Hazards data (Hazard Ratios, HR). Both atrial fibrillation (n = 5, HR = 1.26, 95% CI [1.12, 1.43]) and severe atherosclerosis (n = 4, HR = 1.59, 95% CI [1.12, 2.26]) emerged as significant risk factors for cognitive decline and/or dementia. A small set of studies reviewed, insufficient for meta-analysis, examining congestive heart failure, peripheral artery disease and myocardial infarction suggested that these conditions may also be associated with an increased risk of cognitive decline/dementia. In the absence of stroke, patients with atrial fibrillation or generalised atherosclerosis are at heightened risk for cognitive deterioration. Nonetheless, this paper highlights the need for methodologically rigorous and prospective investigation of the relationship between CVD and dementia.

Diagnostic Accuracy of Memory Measures in Alzheimer's Dementia and Mild Cognitive Impairment: a Systematic Review and Meta-Analysis.

With an increasing focus on biomarkers in dementia research, illustrating the role of neuropsychological assessment in detecting mild cognitive impairment (MCI) and Alzheimer's dementia (AD) is important. This systematic review and meta-analysis, conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) standards, summarizes the sensitivity and specificity of memory measures in individuals with MCI and AD. Both meta-analytic and qualitative examination of AD versus healthy control (HC) studies (n = 47) revealed generally high sensitivity and specificity (≥ 80% for AD comparisons) for measures of immediate (sensitivity = 87%, specificity = 88%) and delayed memory (sensitivity = 89%, specificity = 89%), especially those involving word-list recall. Examination of MCI versus HC studies (n = 38) revealed generally lower diagnostic accuracy for both immediate (sensitivity = 72%, specificity = 81%) and delayed memory (sensitivity = 75%, specificity = 81%). Measures that differentiated AD from other conditions (n = 10 studies) yielded mixed results, with generally high sensitivity in the context of low or variable specificity. Results confirm that memory measures have high diagnostic accuracy for identification of AD, are promising but require further refinement for identification of MCI, and provide support for ongoing investigation of neuropsychological assessment as a cognitive biomarker of preclinical AD. Emphasizing diagnostic test accuracy statistics over null hypothesis testing in future studies will promote the ongoing use of neuropsychological tests as Alzheimer's disease research and clinical criteria increasingly rely upon cerebrospinal fluid (CSF) and neuroimaging biomarkers.

Exploring the utility of a social norm approach in reducing younger drivers' engagement in hand-held phone use while driving: A qualitative study.

INTRODUCTION: Engagement in hand-held phone use while driving among young drivers is a prevalent concern in society, despite countermeasures to deter the behavior. The social norm approach has been effective in reducing negative behaviors in young adults (e.g., binge drinking, drink driving). However, whether this approach can reduce hand-held phone use while driving in this population has not been thoroughly investigated. METHOD: The qualitative study explored young drivers' attitudes and opinions on social norm messages designed to reduce hand-held phone use while driving. In addition, young drivers' opinions on current campaigns were explored to provide further insight into the effectiveness of these messages. Thirty young drivers were interviewed and shown six social norm messages. RESULTS: The data were analyzed using reflexive thematic analysis, resulting in five themes and one sub-theme: (1) Road safety messages with minimal impact on hand-held phone use while driving; (2) What constitutes an effective road safety message for hand-held phone use while driving; (3) Comparisons between social norm messages and road safety messages; (4) The potential benefits of combined social norms, (4a) Improving and optimizing the message; and (5) "It's kinda just numbers on a screen": Negative views on social norm messages. Results highlight the diverse opinions towards road safety campaigns and the need to increase exposure to these messages. Further, a combined social norm message was perceived as most effective in reducing engagement in hand-held phone use while driving. CONCLUSIONS: The current study provides preliminary evidence that the social norm approach may be effective in reducing hand-held phone use among young drivers. Further, this study highlights the need to maximize exposure to phone use while driving campaigns in this high-risk cohort. PRACTICAL APPLICATIONS: Results support the development of a social norm messaging intervention to reduce young drivers hand-held phone use while driving.

Road rule enforcement and where to find it: An investigation of applications used to avoid detection when violating traffic rules.

INTRODUCTION: One of the primary countermeasures in place to prevent road rule violations is legal enforcement, yet there are numerous applications that can undermine such efforts by notifying drivers of enforcement locations. However, the capabilities of these applications and how they can impact offending behavior is currently unknown. METHOD: Two studies were conducted to understand which of these applications are being used by drivers and how these applications are impacting road rule violations. Study 1 consisted of a content analysis that involved searching the Google Play Store and Apple iTunes Store for applications that could be used to avoid road rule violations using pre-determined keywords. Meanwhile, Study 2 consisted of 468 licensed Australian drivers (54.5% males) over the age of 17 years (Mage = 35 years) who completed a survey. RESULTS: A total of 73 applications were identified for Study 1, with most of the applications displaying speed camera locations. It was found that applications that notify drivers of traffic enforcement locations are widely prevalent, can be used on a variety of interfaces and include numerous additional features. Study 2 found that those who use the applications were more willing to speed than those who do not use the applications, while there was no difference in phone use while driving between those who do and do not use the applications. PRACTICAL APPLICATIONS: The findings have important implications for stakeholders, policy, and future research. For example, it is suggested that specific functions of these applications need to be regulated to reduce road rule violations and crash risk. Meanwhile, enforcement initiatives need to evolve at a faster rate to keep up to date with the changing technology that can undermine them.

The impact of descriptive and injunctive norms on engagement in mobile phone use while driving in young drivers: A systematic review.

BACKGROUND/OBJECTIVES: Prior research indicates that younger adults overestimate their peers' engagement in risk-taking behaviours, with these estimates being directly associated with engagement in such behaviours. However, the extent to which younger adults perceive their peers' approval of, and engagement in, road traffic violations (such as mobile phone use while driving) is yet to be clearly identified. Further, the influence of such perceptions on subsequent mobile phone use while driving behaviours remains unclear. Accordingly, the aim of this systematic review was to (a) examine young drivers' perceptions regarding their peers' approval of (injunctive norms), and engagement in (descriptive norms) mobile phone use while driving and (b) to identify whether such perceptions increase young drivers own engagement in the behaviour. METHODS: Studies were eligible for review if they measured (a) perceived social norms (descriptive/injunctive) and (b) the relationship between such norms and mobile phone use while driving in younger adults aged 16-25 years. Searches were conducted in December 2021, using Pubmed, Scopus, Web of Science, and TRID. Five articles were included in the review. RESULTS: Overall, the results indicate that young drivers perceive their peers to engage in mobile phone use while driving on a frequent basis, however they typically believe that their peers disapprove of the behaviour. The majority of studies indicated that descriptive norms were significantly associated with increasing engagement in mobile phone use while driving (including distracted driving behaviours). Finally, the few studies that investigated injunctive norms on mobile phone use while driving indicated positive correlations between perceived peer approval and increasing distracted driving behaviour. DISCUSSION: The findings highlight the importance of social norms in influencing behaviour, indicating that both descriptive and injunctive norms warrant further investigation when examining the impact of peer influences on mobile phone use while driving.

Does exposure to social media content influence attitudes towards, and engagement in, road rule violations? A systematic review.

BACKGROUND/OBJECTIVES: With the increasing popularity and saliency of social media, there is a pressing need to identify whether exposure to such content can affect road rule compliance, especially given that social media has been found to influence other risky behaviours. This systematic review (conducted in accordance with the PRISMA guidelines) summarised existing evidence concerning: (a) the nature of driving-related content on social media and (b) whether such content can influence attitudes and subsequent driving behaviour. METHODS: Peer-reviewed articles written in English, that explored social media content in relation to road safety or driving behaviours (e.g., speeding, tailgating, distraction, impaired driving, and seatbelt use), were eligible for review. Searches were conducted via SCOPUS, PUBMED, ProQuest and TRID in June 2021. RESULTS/DISCUSSION: A total of 8 studies met the requirements for this study, resulting in three key findings. First, it was found that very few studies have explored the type and extent of driving-related content on social media, and the small collection of existing research has focused solely on YouTube and Twitter. Second, whilst the nature of driving-related content on social media varies substantially across studies, a body of content exists that promotes or encourages risky driving behaviour or road rule violations. Third, and despite the array of available online content, there is a paucity of research illuminating the impact of social media messages on attitudes towards, and behaviours linked to road safety. This review highlights the need for research to keep pace with the rapidly changing nature of social media (not least the impacts upon human behaviour) and outlines pathways to increase current scientific understanding.

Reduced cerebral pressure-flow responses are associated with electrophysiological markers of attention in healthy older adults.

The aim of this study was to determine the effect of age on the relationship between cerebrovascular function and the neural bases of sustained attention. Twenty-seven healthy young adults (aged 18-30 years) and 24 older adults (60-75 years) underwent assessments of cerebrovascular function and sustained attention. Blood flow velocity of the middle cerebral artery was assessed via Transcranial Doppler Ultrasound, during seated rest, in response to hypocapnic breathing (cerebrovascular reactivity) and during a repeated sit-to-stand procedure (pressure-flow response). Attentional processing was assessed using the N2 and P3 components of the event-related potential during a two-tone auditory oddball task. Poorer pressure-flow responses were significantly associated with reductions in N2 and P3 amplitude in the old group (b = -0.50, p = .029 and b = -0.46, p = .045), but not the young group. These results suggest that alterations in the brain's capacity to combat reductions in perfusion pressure are associated with age-related differences in attentional processing, supporting the hypothesis that cerebrovascular hemodynamic disturbances play a role in age-related cognitive decline.

Healthy aging affects cerebrovascular reactivity and pressure-flow responses, but not neurovascular coupling: A cross-sectional study.

BACKGROUND AND PURPOSE: Aging leads to alterations in cerebrovascular function, and these are thought to contribute to cognitive decline/dementia. Disturbances to cerebral blood flow regulation have been reported, but the findings are inconsistent and to date no study has comprehensively tested the collective and independent contribution of these parameters in the same age range. Such lines of enquiry are vital since aging is a heterogeneous and complex process, with cerebrovascular parameters being differentially affected depending on the individual. A multicomponent comprehensive measure of cerebrovascular function, which accounts for such diversity, is needed to differentiate between healthy young and old adults. METHODS: We tested the effect of aging on cerebrovascular function by comparing healthy young adults aged 18-30 and older adults aged 60-75, without cognitive impairments. Cerebrovascular blood flow velocity was assessed using transcranial Doppler ultrasound. Parameters included resting middle cerebral artery velocity (MCAv), neurovascular coupling, cerebrovascular reactivity to CO2 (hypercapnia and hypocapnia), and the pressure-flow response during a sit-to-stand procedure. RESULTS: MANOVA revealed that collectively, the parameters discriminated the groups (p < .001). MCAv and pressure-flow responses were lower in the older group (p < .001). While there were no differences in hypercapnic responses (p = .908) and neurovascular coupling (p = .517), hypocapnic responses were elevated in the old (p = .002). CONCLUSIONS: Collectively, cerebrovascular parameters can distinguish between healthy young and older adults, with aging leading to reductions in MCAv, and altering cerebrovascular reactivity and pressure-flow responses under hypotensive conditions.

Cerebrovascular Correlates of Subclinical Attentional Disturbances in Non-stroke Cardiovascular Disease.

Evidence suggests that cerebrovascular hemodynamic disturbances underlie cognitive deterioration secondary to cardiovascular disease (CVD), including manifestations other than stroke, but the mechanisms remain unclear. To date, the majority of studies have used neuropsychological measures validated for the detection of clinically significant cognitive decline but lack the sensitivity to accurately detect subclinical or subtle cognitive changes. The N2 and P3 components of the event-related potential are sensitive markers of attention and cognitive processing, and are valuable in the assessment of age-related cognitive changes and neurodegenerative disease. The aims of this study were to test (a) the sensitivity of N2 and P3 components in differentiating older adults with CVD from healthy controls, and (b) whether cerebrovascular hemodynamics are associated with alterations in attention in persons with non-stroke CVD. Older adults with CVD (n = 20) and healthy older adults (n = 20) without cognitive impairment or history of stroke and matched for age, were recruited. Cerebral blood flow velocity of the middle cerebral artery (MCAv) and Gosling's Pulsatility Index (PI) were assessed using Transcranial Doppler ultrasound (TCD). ERPs were elicited using a two-tone auditory oddball task. N2 amplitude was significantly reduced in the CVD group at midline frontal, central and parietal sites (p < .05, d > 0.6). No significant group differences were observed in N2 latency, P3 amplitude, or P3 latency. Further, MCAv and PI were strongly associated with N2 amplitude in the CVD group, such that greater MCAv was associated with reductions in N2 amplitude (b = -0.58, p = .018), whilst PI was associated with increases in N2 amplitude (b = 0.66, p = .006). No relationships between MCAv or PI with N2 or P3 ERP components were observed in the healthy control group. The data reported here suggest that a reduction in N2 amplitude may be an important objective indicator of subclinical cognitive and attentional alterations in non-stroke CVD, and support the notion that cerebrovascular hemodynamic disturbances play a role in the pathogenesis of cognitive deterioration secondary to non-stroke CVD.