Relation between dairy food intake and cognitive function: The Maine-Syracuse Longitudinal Study.

Diet modification to alter the course of age-related cognitive decline is becoming increasingly important. Few observational findings suggest that dairy food intake may be positively related to cognitive function, but research in this novel area is limited. The aim of this study was to investigate whether dairy food intake is associated with cognitive function, before and after adjustment for cardiovascular, lifestyle and dietary factors. To do this, a cross-sectional analyses of a subset of the community-based Maine-Syracuse Longitudinal Study (MSLS) sample (N = 972) was undertaken. It was determined that participants who consumed dairy products at least once per day had significantly higher scores on multiple domains of cognitive function compared with those who never or rarely consumed dairy foods, adjusting for cardiovascular risk factors, lifestyle and dietary factors. Frequent dairy food intake is associated with better cognitive performance but underlying causal mechanisms are still to be determined.

Presence of the APOE epsilon4 allele modifies the relationship between type 2 diabetes and cognitive performance: the Maine-Syracuse Study.

AIMS/HYPOTHESIS: The primary aim of this study was to determine whether the presence of one or more APOE epsilon4 alleles modifies the association between diabetes (defined by glucose > or =7 mmol/l or treatment) and cognitive function. METHODS: Diabetic status and APOE genotype interactions were assessed cross-sectionally for 826 community-dwelling, stroke-free, non-demented individuals (526 non-diabetic non-APOE epsilon4 carriers, 174 non-diabetic APOE epsilon4 carriers, 87 diabetic APOE epsilon4 non-carriers, 39 diabetic APOE epsilon4 carriers) ranging in age from 50 to 98 years. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), the similarities subtest from the Wechsler Adult Intelligence Scale, and four composite scores derived from 17 additional neuropsychological tests. Multiple linear regression analyses were employed to relate diabetes and APOE genotype to cognitive performance and to examine the interaction between these two risk factors as they relate to cognitive performance. Multiple cardiovascular disease risk factors were statistically controlled. RESULTS: With adjustment for age, education, sex, race/ethnicity and APOE genotype, performance level was lower for the diabetic than for the non-diabetic group for the MMSE, the similarities subtest and each of the cognitive composites with the exception of the verbal memory composite. Interactions (p < 0.05) between diabetes and APOE genotype were found for all but the visual-spatial memory/organisation composite. The negative association between diabetes and cognitive performance was of a higher magnitude for individuals who carry one or more APOE epsilon4 alleles. Results were similar with additional adjustment for cardiovascular disease and associated risk factors. CONCLUSIONS/INTERPRETATION: The presence of one or more APOE epsilon4 alleles modifies the association between diabetes and cognitive function.

NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham Study.

OBJECTIVE: To determine if NIDDM and blood pressure are risk factors for poor cognitive performance and if history and duration of NIDDM and blood pressure interact such that the risk of poor performance is greater for subjects with both NIDDM and hypertension. RESEARCH DESIGN AND METHODS: We used a large prospective cohort sample with 187 NIDDM subjects and 1,624 nondiabetic subjects who were followed for 28-30 years. Cognitive function was assessed using eight tests of learning, memory, visual organization, verbal fluency attention, concept formation, and abstract reasoning. A composite score was also calculated. Odds ratios were used to estimate the relative risk of performing below the lower 25th percentile of z scores on these tests. RESULTS: NIDDM and blood pressure interacted such that diagnosis and duration of NIDDM were associated with greater risk of poor performance on tests of visual memory and on the composite score for hypertensive subjects. Duration of NIDDM was associated with increased risk for poor performance on tests of verbal memory and concept formation. Insulin-treated NIDDM subjects were at higher risk for poor cognitive performance than those NIDDM subjects treated with oral agents or diet. Blood pressure level was associated independently with a measure of verbal fluency. CONCLUSIONS: History and duration of NIDDM and high blood pressure are significant risk factors for poor cognitive performance. Hypertensive people with NIDDM are at greatest risk for poor performance on tests measuring visual organization and memory.

Interactions between plasma homocysteine and arterial stiffness in chronic kidney disease in community-dwelling individuals: The Maine-Syracuse Study.

Plasma homocysteine (tHcy) is associated with kidney disease. However, few, if any, studies have examined homocysteine in relation to arterial stiffness, with stratification by the presence or absence of early-stage chronic kidney disease (CKD). The aim of this study was to examine prospective associations between tHcy and carotid-femoral pulse wave velocity (PWV) in persons with and without early-stage CKD in a sample of community-living individuals free from end-stage renal disease, dialysis, stroke and dementia. We conducted a prospective study with 498 participants of the Maine-Syracuse Longitudinal Study (mean age 61 years). Levels of tHcy were positively related to PWV measured 4-5 years later for participants with early-stage CKD (estimated glomerular filtration rate <60 ml min(-1) per 1.73 m(2)). Statistical adjustment was made for multiple confounders, including demographic factors, PWV-related variables and cardiovascular risk factors (b=4.27, 95% confidence interval: 0.23-8.31, P=0.04). These associations were not observed in persons free from CKD. Plasma tHcy is an important predictor of arterial stiffness, as indexed by PWV, in community-living individuals with modest CKD.

Higher Cognitive Performance Is Prospectively Associated with Healthy Dietary Choices: The Maine Syracuse Longitudinal Study.

OBJECTIVES: Few studies have examined whether cognitive function predicts dietary intake. The majority of research has focused on how diet can influence cognitive performance or risk for cognitive impairment in later life. The aim of this study was to examine prospective relationships between cognitive performance and dietary intake in participants of the Maine-Syracuse Longitudinal Study. DESIGN: A prospective study with neuropsychological testing at baseline and nutritional assessments measured a mean of 18 years later. SETTING: Community-dwelling individuals residing in central New York state. PARTICIPANTS: 333 participants free of dementia and stroke. MEASUREMENTS: The Wechsler Adult Intelligence Scale (WAIS) was assessed at baseline and dietary intake was measured using the Nutrition and Health Questionnaire. RESULTS: Higher WAIS Scores at baseline were prospectively associated with higher intakes of vegetables, meats, nuts and legumes, and fish, but inversely associated with consumption of total grains and carbonated soft drinks. After adjustment for sample selection, socioeconomic indicators, lifestyle factors (smoking and physical activity), and cardiovascular risk factors, the relations between higher cognitive performance and greater consumption of vegetables, meat, and fish, and lower consumption of grains remained significant. CONCLUSION: These data suggest that cognition early in life may influence dietary choices later in life.

Clinical significance of cognitive performance by hypertensive patients.

Fifty-four subjects with uncomplicated essential hypertension and 54 normotensive subjects were compared with regard to a widely employed clinical index of cognitive dysfunction (the Average Impairment Rating) calculated from neuropsychological tests that discriminate between brain-damaged and neurologically normal persons. Hypertensive subjects exhibited lower mean scores on this index when education was ignored, but results were not the same for highly educated and less well educated groups. There were no differences between exceptionally well educated hypertensive and normotensive subjects, but in the less well educated group, hypertensive subjects performed more poorly than normotensive subjects. The percentages of hypertensive and normotensive subjects scoring in a cognitively impaired range on the Average Impairment Rating were low and did not differ for either education group. These data indicate the important role of subtle differences in education level with respect to positive or negative findings for studies comparing hypertensive and normotensive subjects and illustrate the important role of clinical neuropsychological indices of cognitive dysfunction when one wishes to make meaningful inferences regarding cerebral cortical function in hypertensive subjects.

Protein and calorie malnutrition in infant cebus monkeys: growth and behavioral development during deprivation and rehabilitation.

The growth and development of 32 cebus monkeys were studied during a period of insult in nutritional or rearing conditions and after rehabilitation. Eight experimental groups of four animals each were subjected to one of four diets--control, protein restricted, calorie restricted, and protein-calorie restricted, and one of two rearing conditions-partial isolation or a comparatively enriched condition-in a 4 x 2 factorial design. The period of insult from 2 to 6 months of age was followed by 6 months of rehabilitation in both diet and rearing conditions. It was found that only diet affected physical growth, but both diet and rearing affected behavioral development and exploratory behavior. Whereas calorie deficiency produced a direct effect on behavior independent of rearing conditions, protein deficiency produced an effect only in combination with rearing restriction. The effect of protein-calorie deficiency had some characteristics in common with each of the other deficiencies. Retardation in rate of behavioral development was less severe than retardation in growth, most notably in the protein-restricted, enriched-rearing group, producing animals who were behaviorally mature for their size. All groups caught up in physical growth during rehabilitation but the protein-calorie restricted groups failed to recuperate completely in exploratory behavior.

The preclinical phase of alzheimer disease: A 22-year prospective study of the Framingham Cohort.

OBJECTIVES: To relate performance on tests of cognitive ability to the subsequent development of probable Alzheimer disease (pAD) and to identify the pattern of earliest changes in cognitive functioning associated with a diagnosis of pAD. DESIGN: From May 1975 to November 1979, a screening neuropsychological battery was administered to Framingham Study participants. They were followed up prospectively for 22 years and examined at least every 2 years for the development of pAD. SETTING: A community-based center for epidemiological research. PARTICIPANTS: Subjects were 1076 participants of the Framingham Study aged 65 to 94 years who were free of dementia and stroke at baseline (initial) neuropsychological testing. MAIN OUTCOME MEASURE: Presence or absence of pAD during a 22-year surveillance period was related to test performance at initial neuropsychological testing. RESULTS: Lower scores for measures of new learning, recall, retention, and abstract reasoning obtained during a dementia-free period were associated with the development of pAD. Lower scores for measures of abstract reasoning and retention predicted pAD after a dementia-free period of 10 years. CONCLUSIONS: The "preclinical phase" of detectable lowering of cognitive functioning precedes the appearance of pAD by many years. Measures of retention of information and abstract reasoning are among the strongest predictors of pAD when the interval between initial assessment and the development of pAD is long. Arch Neurol. 2000.

Nursing interval and maternal responsivity: effect on early infant crying.

In industrialized societies, the unique pattern of crying in the first three months is "unexplained" but thought to be due to different biobehavioral factors from later crying behavior. To increase the range of the feeding and caretaking behaviors hypothesized to be relevant determinants of early crying, home observations and diary records were analyzed from samples of two subcultures of American middle-class women (La Leche League and "standard care" mothers; each n = 16) differing primarily in such practices. Both during and after the early crying stage, frequently fed infants cried or fretted less often (8.1 v 15.8 episodes per hour at 2 months of age; 10.7 v 16.6 episodes per hour at 4 months of age), and fewer of them exhibited rhythmic crying behavior (four v 11 at 2 months; eight v 13 at 4 months) during observations. However, only during the early crying period at 2 months were interval between feedings and maternal response latency shown to be independent determinants of cry/fret frequency (overall r2 = .35, P = .01), each factor accounting for approximately half of the explained individual variance. Furthermore, feeding interval was the only variable associated with rhythmic crying behavior at 2 months of age (r2 = .20;P = .01). In similar analyses at 4 months, there were no significant relationships with later crying or fretting. The results suggest that, in the presence of variation in feeding practice greater than that which is typical for our society, feeding interval may be a significant factor in early (but not later) crying behavior; furthermore, this effect is independent of and additive to the soothing effect of short response latency.

Sleep/wake patterns of breast-fed infants in the first 2 years of life.

Published norms for infant sleep/wake patterns during the first 2 years of life include an increase in length of maximum sleep bout from four to five to eight to ten hours by 4 months but little decrease in total sleep in 24 hours from 13 to 15 hours. Thirty-two breast-fed infants were followed for 2 years and data collected on 24-hour patterns of nursing and sleep. Infants who were breast-fed into the second year did not develop sleep/wake patterns in conformance with the norms. Instead of having long unbroken night sleep, they continued to sleep in short bouts with frequent wakings. Their total sleep in 24 hours was less than that of weaned infants. This pattern was most pronounced in infants who both nursed and shared a bed with the mother, common practices in many nonwestern cultures. The sleep/wake development accepted as the physiologic norm may be attributable to the early weaning and separated sleeping practiced in western culture. As prolonged breast-feeding becomes more popular in our society, the norms of sleep/wake patterns in infancy will have to be revised.

Effects of antihypertensive medications on quality of life in elderly hypertensive women.

The impact of antihypertensive medications on the quality of life of elderly hypertensive women has rarely been systematically evaluated in large clinical trials using drugs from the new generations of pharmaceutic preparations. We carried out a multicenter, randomized double-blind clinical trial with 309 hypertensive women aged 60 to 80 years to assess effects of atenolol, enalapril, and isradipine on measures of quality of life over a 22-week period. The patients had mild to moderate hypertension. Hydrochlorothiazide was added to treatment if monotherapy was inadequate in lowering blood pressure. At the conclusion of the trial the three drug groups did not differ in degree of reduction of diastolic blood pressure or in supplementation with hydrochlorothiazide. Over the 22-week trial, linear trend analysis showed no differences between the treatment groups in change from baseline on quality of life measures of well-being, physical status, emotional status, cognitive functioning, and social role participation. Regarding each of 33 physical side effects over the 22 weeks, we found no general difference between atenolol, enalapril, and isradipine groups on measures of change in distress over symptoms except for enalapril patients who worsened in distress over cough (P = .001) and atenolol patients who worsened in distress over dry mouth (P = .014). Centering on three medications that are relatively new additions to the armamentarium for blood pressure control, the findings underline the increasing opportunities for the physician to select drugs that can control blood pressure while maintaining the quality of life of elderly hypertensive women.

A longitudinal study of blood pressure in relation to performance on the Wechsler Adult Intelligence Scale.

A growth curve analysis was used to examine estimated longitudinal decline (over 19 years) on the Wechsler Adult Intelligence Scale (WAIS; D. Wechsler, 1955) in relation to arterial hypertension and blood pressure (BP) for 55 men and 85 women (40 to 70 years old) who were free from overt major coexisting diseases. BP was associated with longitudinal decline for Visualization-Performance (VP) ability and Speed. Hypertension was a weaker predictor of VP and was unrelated to Speed. Age effects on VP were overestimated when averaged BP level, particularly systolic BP, was not controlled statistically. It was concluded that initial BP level and hypertension predict age-related longitudinal decline in specific major abilities assessed by the WAIS but that BP averaged over examinations is a stronger predictor.

Genetic analysis of water maze discrimination learning for Mus musculus: polygenes and albinism.

Recombinant inbred strains, their progenitor strains and reciprocal F1 hybrids were given thirty spatial discrimination learning trials in the water maze. The pattern of RI strains in relation to the reciprocal F1 hybrids and the progenitor strains, and differences among strains, suggested that different sets of genes affect the various components of water maze discrimination learning. There was no evidence that the albino gene influenced either inferior or superior performance. Pigmented strains performed as well as, or better than, some albino strains, and albino strain BALB/cBy differed significantly from albino strains CXBG and CXBI. The two reciprocal F1 hybrids differed from blocks 2 and 3 of discrimination trials when swimming time was used a dependent variable. Thus, it appears that performance of the F1 hybrids was influenced by paternal effects, maternal effects, or paternal maternal interactions.

Acquisition of word-processing skills by younger, middle-age, and older adults.

A total of 45 subjects in three age groups (younger, middle-age, older) were trained to word process on microcomputers using a commercial training program and an experimenter-designed test and evaluation protocol. Although all of the subjects mastered the essentials of word processing, the older group took significantly longer to complete the training and evaluation procedures and performed more poorly on a review examination that tested their knowledge of the word-processing commands and techniques. The results are discussed in relation to requirements for trainer assistance, motivational factors, and the need to design training protocols that meet the needs of older adults.

A longitudinal study of the performance of hypertensive and normotensive subjects on the Wechsler Adult Intelligence Scale.

Performance on the Wechsler Adult Intelligence Scale was followed over two 5- to 6-year intervals for essential hypertensive Ss (EH; n = 22) free from medical complications and for normotensive Ss (N; n = 20). EH were treated with adrenergic beta-blocking drugs, diuretics, or both. Mean age was 46 years (SD = 12.6 years), initially (Time 1). Results were unaltered by adjustment for initial age. N improved modestly on the Verbal scale, from Time 1 to Time 2 only. EH neither improved nor declined on the Verbal scale. Scores remained unchanged for both EH and N Ss for the Performance scale. Overall, and at Times 2 and 3, Verbal scores were lower for the EH group. It was concluded that neither decline nor improvement in cognitive function over time are necessary outcomes of modest, carefully treated, uncomplicated hypertension in the middle years.

A 15-year longitudinal study of Halstead-Reitan neuropsychological test performance.

Using a two-stage growth curve analysis, change over time in performance on tests in the Halstead-Reitan Battery and Average Impairment Rating (AIR) was assessed for 53 individuals who varied in age and health status. In the first stage of the analysis, estimated slope and intercept values were calculated for each individual by regressing longitudinal data points on time. In the second stage, estimated slope and intercept values obtained in the first-stage analysis were regressed on age at entry into the study with statistical control for health status, education, occupation, and gender. Control for health status had an insignificant influence on magnitude of associations between age and test performance. Age-at-entry into the study was associated with statistically significant increasing change over time (poorer performance) for tests placing relatively heavy demands on speed of psychomotor performance and for AIR.

Ethanol consumption in genetically selected hypertensive and hypotensive mice.

Hypertensive mice drank more alcohol than did hypotensive animals over a wide range of concentrations. The intake was not related to blood pressure phenotype in a causal manner, nor was age a factor in the results.

Effects of chronic hypertension on cognitive functioning.

Arterial hypertension and blood pressure level are associated with modestly accelerated cognitive decline over the adult life span and with moderately increased risk of poor cognitive performance at all ages. Correlations between white matter lesions in brain and elevated blood pressure provide indirect evidence that structural and functional changes in brain over time may lead to lowered of cognitive functioning when blood pressure control is poor or lacking. Preventive methods designed to lower population blood pressure, early detection, and aggressive treatment of hypertension are important to prevent accelerated cognitive decline in the individual and to preserve cognitive ability in the population. Some evidence suggests that poorly controlled hypertension may predispose to the dementias, but more work is needed to ascertain this.

Seizures in east-bound visitors to Hawaii.

Anecdotal observations by emergency physicians at Straub Clinic and Hospital suggest that first-time seizures are common in Japanese tourists visiting Hawaii. Because such patients seemed to present in the evening of their day of arrival, some physicians have attributed these seizures to sleep deprivation based primarily upon clinical impressions. However, there has been no previous review of these cases to confirm the impression that these seizures have a relatively benign cause. This retrospective study aims to identify the role of sleep deprivation as a potential factor in seizures within this population.