Multiple Influences on Cognitive Function Among Urban-Dwelling African Americans.

This study examined multiple influences on cognitive function among African Americans, including education, literacy, poverty status, substance use, depressive symptoms, and cardiovascular disease (CVD) risk factors. Baseline data were analyzed from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Participants were 987 African Americans (mean age 48.5 years, SD = 9.17) who completed cognitive measures assessing verbal learning and memory, nonverbal memory, working memory, verbal fluency, perceptuo-motor speed, attention, and cognitive flexibility. Using preplanned hierarchical regression, cognitive performance was regressed on the following: (1) age, sex, education, poverty status; (2) literacy; (3) cigarette smoking, illicit substance use; (4) depressive symptoms; and (5) number of CVD risk factors. Results indicated that literacy eliminated the influence of education and poverty status in select instances, but added predictive utility in others. In fully adjusted models, results showed that literacy was the most important influence on cognitive performance across all cognitive domains (p < .001); however, education and poverty status were related to attention and cognitive flexibility. Depressive symptoms and substance use were significant predictors of multiple cognitive outcomes, and CVD risk factors were not associated with cognitive performance. Overall, findings underscore the need to develop cognitive supports for individuals with low literacy, educational attainment, and income, and the importance of treating depressive symptoms and thoroughly examining the role of substance use in this population.

Changes in bone mineral density over time by body mass index in the health ABC study.

UNLABELLED: Obesity appears protective against osteoporosis in cross-sectional studies. However, results from this longitudinal study found that obesity was associated with bone loss over time. Findings underscore the importance of looking at the longitudinal relationship, particularly given the increasing prevalence and duration of obesity among older adults. INTRODUCTION: Cross-sectional studies have found a positive association between body mass index (BMI) and bone mineral density (BMD), but little is known about the longitudinal relationship in US older adults. METHODS: We examined average annual rate of change in BMD by baseline BMI in the Health, Aging, and Body Composition Study. Repeated measurement of BMD was performed with dual-energy X-ray absorptiometry (DXA) at baseline and years 3, 5, 6, 8, and 10. Multivariate generalized estimating equations were used to predict mean BMD (femoral neck, total hip, and whole body) by baseline BMI (excluding underweight), adjusting for covariates. RESULTS: In the sample (n = 2570), 43 % were overweight and 24 % were obese with a mean baseline femoral neck BMD of 0.743 g/cm(2), hip BMD of 0.888 g/cm(2), and whole-body BMD of 1.09 g/cm(2). Change in total hip or whole-body BMD over time did not vary by BMI groups. However, obese older adults lost 0.003 g/cm(2) of femoral neck BMD per year more compared with normal weight older adults (p < 0.001). Femoral neck BMD change over time did not differ between the overweight and normal weight BMI groups (p = 0.74). In year 10, adjusted femoral neck BMD ranged from 0.696 g/cm(2) among obese, 0.709 g/cm(2) among normal weight, and 0.719 g/cm(2) among overweight older adults. CONCLUSIONS: Findings underscore the importance of looking at the longitudinal relationship between body composition and bone mineral density among older adults, indicating that high body mass may not be protective for bone loss over time.

Association of fasting glucose with subclinical cerebrovascular disease in older adults without Type 2 diabetes.

AIMS: To examine how fasting glucose and glucose tolerance are related to magnetic resonance imaging-assessed indicators of subclinical cerebrovascular disease and brain atrophy and their variation according to age, sex and education. METHODS: Participants in the present study were 172 healthy, community-dwelling older adults. An oral glucose tolerance test was administered and magnetic resonance imaging performed. Fasting, 2-h, and 2-h area-under-the-curve glucose levels, their associations with subclinical cerebrovascular disease and brain atrophy, and their respective interactions with age, sex and education were examined. RESULTS: A positive association between fasting glucose and subclinical cerebrovascular disease (but not brain atrophy) emerged; this association was more pronounced for participants with < 12 years of education; however, glucose tolerance was not related to subclinical cerebrovascular disease or brain atrophy. CONCLUSIONS: Findings revealed a potential link between fasting glucose levels and the presence of subclinical cerebrovascular disease indicators - white matter hyperintensities and silent brain infarction - in older adults without diabetes and with an education level below high school. Additional research is needed to confirm these associations and to determine the need for interventions aimed at closely monitoring and preventing elevated glucose levels in this population to reduce the prevalence of subclinical cerebrovascular disease.

Interactive relations of central versus total obesity and blood pressure to cognitive function.

OBJECTIVE: To examine the potential interactive relations of central versus total obesity and blood pressure (BP) to cognitive function. METHOD: In all, 90 healthy, stroke, and dementia-free middle-aged and older adults (ages 54-81 years; 63% male; 93% White) underwent biomedical and neuropsychological assessment. Relations of central obesity (assessed by waist circumference (WC)) and systolic or diastolic BP to cognitive function were examined in multiple regression models. Next, body mass index (BMI) was substituted for WC in the models. RESULTS: After statistical adjustment for age, education, gender, and other potential confounders including components of the metabolic syndrome (depending on the model), significant interactions of WC and systolic (or diastolic) BP were noted for the Grooved Pegboard - Dominant Hand and Stroop Interference scores, with marginally significant results for Grooved Pegboard - Nondominant Hand. In general, individuals with greater WC and higher BP performed most poorly on these measures. Similar results were obtained for BMI. CONCLUSION: Independent of other confounders including facets of the metabolic syndrome, the combination of greater WC (or BMI) and higher (systolic or diastolic) BP was associated with diminished performance on tests of motor speed and manual dexterity, and executive function (i.e. response inhibition) accounting for 3-13% of the variance in these measures. In healthy older adults, there are similar, negative relations of central and total obesity to cognitive function that are potentiated by higher BP levels.

Similar patterns of cardiovascular response during emotional activation as a function of affective valence and arousal and gender.

OBJECTIVE: Laboratory studies of emotion-induced cardiovascular responses have been conducted predominantly with a specific affects approach rather than a dimensional approach. The purpose of this study was to apply the principles of the Circumplex Model of Affect (i.e., valence and arousal) to investigate cardiovascular reactivity during emotional activation in men and women. METHODS: Forty-two healthy university students (mean age = 19.45, 52% women, 58% Caucasian) engaged in personally relevant recall tasks that varied as a function of valence and arousal. Self-reported valence and arousal, systolic and diastolic blood pressure (SBP and DBP, respectively), heart rate (HR), preejection period (PEP), stroke index (SI), cardiac index (CI), and total peripheral resistance (TPR) were measured during baseline and task periods. RESULTS: Cardiovascular responses were found to be largely comparable across the recall tasks and were characterized by significant increases in blood pressure, HR, and TPR, and decreases in SI (Ps < .001). In addition, SBP during negative valence tasks was significantly higher than during positive valence tasks (P < .03), and PEP lengthened more during low as compared to high arousal tasks (P < .03). CONCLUSIONS: These results highlight the similarity of hemodynamic adjustments during the verbal expression of emotion across gender and the dimensions of valence and arousal. The overall response pattern suggests alpha-adrenergically mediated sympathetic activation and vagal withdrawal.

Teaching psychosomatic (biopsychosocial) medicine in United States medical schools: survey findings.

OBJECTIVE: A survey of US medical schools regarding the incorporation of psychosomatic (biopsychosocial) medicine topics into medical school curriculum was conducted. The perceived importance and success of this curriculum, barriers to teaching psychosomatic medicine, and curricular needs were also assessed. METHODS: From August 1997 to August 1999, representatives of US medical schools were contacted to complete a survey instrument either by telephone interview or by written questionnaire. RESULTS: Survey responses were received from 54 of the 118 US medical schools contacted (46%). Responses were obtained from representatives of both public (57%) and private (43%) institutions. Only 20% of respondents indicated that their schools used the term "psychosomatic medicine"; the terms "behavioral medicine" (63%) and "biopsychosocial medicine" (41%) were used more frequently. Coverage of various health habits (eg, substance use and exercise) ranged from 52% to 96%. The conceptualization and/or measurement of psychosocial factors (eg, stress and social support) was taught by 80% to 93% of schools. Teaching about the role of psychosocial factors in specific disease states or syndromes ranged from 33% (renal disease) to 83% (cardiovascular disease). Coverage of treatment-related issues ranged from 44% (relaxation/biofeedback) to 98% (doctor-patient communication). Topics in psychosomatic medicine were estimated to comprise approximately 10% (median response) of the medical school curriculum. On a scale of 1 (lowest) to 10 (highest), ratings of the relative importance of this curriculum averaged 7 (SD = 2.5; range = 2-10). Student response to the curriculum varied from positive to mixed to negative. Perceived barriers to teaching psychosomatic medicine included limited resources (eg, time, money, and faculty), student and faculty resistance, and a lack of continuity among courses. Sixty-three percent of respondents expressed an interest in receiving information about further incorporation of topics in psychosomatic medicine into their school's curriculum. CONCLUSIONS: Results of this survey reveal variable coverage of specific psychosomatic medicine topics in the medical school curriculum and differential use of nomenclature to refer to this field. There is a need for further curricular development in psychosomatic medicine in US medical schools.

Frontal electrocortical and cardiovascular reactivity during happiness and anger.

The present study investigated electrocortical and cardiovascular reactivity during positive and negative emotion, and examined the relation of asymmetric frontal lobe activation to cardiovascular responses. Participants were 30 healthy, right-handed university students (mean age, 23.9; 60% female; 76% Caucasian). Electroencephalographic (EEG), blood pressure (BP), and heart rate (HR) responses were assessed while subjects engaged in laboratory tasks (personally-relevant recall tasks and film clips) designed to elicit happiness or anger. Happiness-inducing tasks evoked more prominent left than right frontal EEG activation, and greater left frontal EEG activation than anger-inducing tasks. However, anger-inducing tasks were, on average, associated with comparable left and right frontal EEG activation. Irrespective of emotional valence, cardiovascular activation was more pronounced during personally-relevant recall tasks than during the viewing of film clips. During anger recall, both greater left frontal EEG response (r=-0.46, P<0.02) and greater right frontal EEG response (r=-0.45, P<0.02) were correlated significantly with increased HR reactivity during the task. In addition, a right lateralized frontal EEG response during anger-inducing tasks was associated with greater concomitant systolic BP (P<0.03) and diastolic BP (P<0.008) reactivity. Exploratory analyses also indicated that men who displayed a left lateralized frontal EEG response during happiness-inducing tasks showed the greatest concomitant systolic BP and HR reactivity (P's<0.03). These findings suggest that asymmetric frontal EEG responses to emotional arousal may elicit different patterns of cardiovascular reactivity in healthy adults.

Cardiovascular reactivity and central adiposity in older African Americans.

This study examined central adiposity, as measured by waist circumference (WC), in relation to mental-stress induced systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) responses, body composition, the metabolic syndrome, and health practices in 22 older, African American men and women (ages 52-79 years). The high WC (> 100 cm) group showed significantly greater SBP, DBP, and HR reactivity, greater fasting insulin levels, lower high density lipoprotein cholesterol levels, greater fat mass in both truncal and peripheral regions, and greater body mass index as compared to the low WC (< 100 cm) group. Groups were comparable with respect to fat-free mass, peak oxygen consumption (VO2), leisure time activity, dietary intake, resting blood pressure, and other metabolic variables. The findings support a clustering of metabolic and mental stress risk factors that may predispose older African Americans to increased cardiovascular and metabolic disease.

Postural effects on hemodynamic response to interpersonal interaction.

Laboratory studies of stress-induced cardiovascular reactivity have been conducted predominantly with participants in a seated posture. This procedure may contribute to limited laboratory-field generalization of cardiovascular response. The present study examined hemodynamic adjustments underlying pressor responses, in addition to heart rate and systolic time intervals, during seated and standing role-played, interpersonal interaction in 60 young adults. Irrespective of gender or race, blood pressure responses to the seated and standing interactions were comparable. However, seated interactions yielded a significantly greater increase in heart rate, shortened preejection period and decreased stroke index as compared to standing. Alternatively, interacting while standing yielded a significantly increased left ventricular ejection time and total peripheral resistance in comparison to sitting. These results suggest that hemodynamic adjustments during stressful interpersonal interaction vary as a function of posture, with somewhat greater cardiac influences apparent while seated and a more pronounced vascular response while standing.

Role-played interpersonal interaction: ecological validity and cardiovascular reactivity.

Conflictual role-play scenarios have been used to model brief interpersonal interaction and to elicit cardiovascular reactivity in the laboratory. Here we discuss data suggesting that role-played interactions constitute an ecologically valid laboratory task that may improve laboratory-to-field generalization of cardiovascular response. Specifically, our research indicates that young adults perceive the stress associated with role-play scenarios as similar to that encountered in everyday life. Furthermore, these stress appraisals moderate cardiovascular response to role-play in men. We also find that a social stressor (i.e. speech task) is perceived as significantly more similar to a real-life stressor as compared to other standard laboratory tasks. We propose that particular constellations of cognitive, affective, and behavioral responses to laboratory-based social stressors, such as role-played interaction, may elicit different patterns of hemodynamic response. Further understanding of interrelations among cognitive, affective, behavioral, and physiological response patterns may assist in the study of cardiovascular reactivity as a potential mechanism linking personality factors and the development of cardiovascular disease.

Self-reported levels of anxiety do not predict neuropsychological performance in healthy men.

It is widely believed that even mild to moderately severe levels of anxiety have a negative impact on neuropsychological performance. To test that possibility, we used scores from Spielberger's State and Trait Anxiety scales to predict performance on measures of attention, learning, memory, mental flexibility, and eye-hand coordination. Two samples of healthy young and middle-aged men were studied. Sample 1 consisted of 125 university students (M age = 20.37); Sample 2 consisted of 50 men recruited from the community (M age = 40.64). Results of multiple regression analyses revealed no significant associations in either sample, after controlling for age, education, and average alcohol consumption. These findings suggest an absence of relationship between self-reported symptoms of anxiety and neuropsychological function in healthy men.

Active coping and cardiovascular reactivity: a multiplicity of influences.

OBJECTIVE: Active coping enhances cardiovascular response presumably by beta-adrenergically mediated myocardial activation. This study examined impedance-derived hemodynamic parameters underlying blood pressure response to two laboratory tasks requiring active coping, performed either with or without an appetitive (i.e., monetary) incentive. METHOD: Forty-eight healthy, young men completed the Stroop Color-Word Test and Mirror Tracing. Half received no incentive, whereas half were provided with a monetary incentive as an active coping manipulation. Task-related changes in blood pressure, heart rate, systolic time intervals, and hemodynamic parameters were monitored. Psychological responses to the tasks were also obtained. RESULTS: On average, incentive virtually doubled blood pressure response to both Stroop and Mirror Tracing. The change in blood pressure was explained predominantly by a concomitant increase in total peripheral resistance. Heart rate response was also enhanced substantially with incentive. Individuals in the incentive condition reported greater interest in the task, but less perceived control, than persons in the no-incentive condition. CONCLUSIONS: The incentive-related increase in total peripheral resistance, combined with an absence of enhanced stroke volume, cardiac output, or preejection period response, indicates that active coping may, under certain conditions, elevate blood pressure via increased systemic resistance, presumably reflecting alpha-adrenergic activation. Furthermore, the enhanced heart rate associated with incentive may reflect a withdrawal of parasympathetic influence.

Hypertension and neuropsychological performance in men: interactive effects of age.

Potentially interactive effects of hypertension and age on the performance of neuropsychological and information processing tests were examined in 123 untreated hypertensive and 50 normotensive men. After covarying education, average alcohol consumption, trait anxiety, and depression scores, results indicated an interaction of age and hypertension. Young hypertensive men (23-40 years) scored significantly worse than young normotensive men on tests of attention/executive function and working memory; middle-aged hypertensive (41-56 years) and normotensive participants were not distinguished by any measures. Hypertensive men performed significantly more poorly than normotensive men on tests of manual dexterity. Results suggest that neuropsychological sequelae of hypertension are more pronounced in young than in middle-aged hypertensive individuals and are independent of various demographic, psychosocial, and alcohol-related factors.

Absence of enhanced sympathoadrenal activity and behaviorally evoked cardiovascular reactivity among offspring of hypertensives.

To determine whether offspring of hypertensives show enhanced sympathetic nervous system activity, we evaluated several indices of sympathoadrenal activation and cardiovascular responsiveness to behavioral stimuli among 90 normotensive, young adult men having either one or two hypertensive parents (PH+(-), PH++) or normotensive parents only (PH--) (n = 30/group). Measurements included heart rate (HR) and blood pressure (BP) reactions to three mental stressors (the Stroop test, mental arithmetic, mirror tracing), a cold pressor test, postural adjustment (60 degrees upright tilt), isometric exercise and bicycle ergometry, as well as the 24-h excretion of catecholamines (epinephrine [E], norepinephrine [NE]) and venous plasma catecholamine concentrations, both at rest (seated and supine) and in response to the Stroop test and upright tilt. The three groups did not differ in age, education, body mass index (BMI), estimated aerobic fitness, resting HR, cardiac preejection period (PEP) and PEP:LVET (left ventricular ejection time) ratio, 24-h Na or K excretion, or fasting lipids, insulin or plasma renin activity. Resting systolic and diastolic BP varied as a function of parental hypertension, and were significantly higher in PH++ than among PH-- subjects (P < .05). No significant group difference was observed on any measure of plasma or urinary catecholamines, nor did offspring of hypertensives (PH++ or PH+-) showed greater HR or BP reactions than PH-- subjects to any of the several laboratory challenges. In sum, we find no evidence of enhanced sympathetic activity or heightened cardiovascular responsiveness among normotensive young adults who are familially predisposed to essential hypertension.

Predictors of neuropsychological impairment in alcoholics: antisocial versus nonantisocial subtypes.

The role of demographic, perinatal/developmental, and acquired subject characteristics in determining neuropsychological (NP) performance was investigated in 22 alcoholics with Antisocial Personality Disorder (ASPD) and 84 non-ASPD alcoholics. Results of stepwise multiple regression analyses revealed that in ASPD subjects, poor NP performance was predicted by less education, childhood symptoms of Conduct Disorder, drinks per drinking day, and history of head injury, accounting for 80% of the explained variance (p < .0001). In non-ASPD subjects, NP performance was predicted by self-reported history of diagnosed Attention Deficit Disorder, Verbal Learning Disability, and symptoms of Nonverbal Learning Disability, accounting for 24% of the explained variance (p < .0001). These results suggest the presence of potentially different lifelong paths to NP impairment among ASPD and non-ASPD alcoholics. Further exploration of the multivariate predictors of neuropsychological performance in subgroups of alcoholics is warranted.

Neuropsychological consequences of antihypertensive medication use.

A growing proportion of the general population is being prescribed antihypertensive medications for the long-term treatment of essential hypertension. Untreated hypertensive individuals exhibit some neuropsychological performance decrements, and numerous researchers have sought to determine whether drug therapy for hypertension worsens, improves, or leaves unaltered objectively measured cognitive skills. These issues may be especially important in the elderly, among whom both high blood pressure and compromised cognitive function are common. In this review, we collate the findings of more than 50 clinical studies according to class of antihypertensive medication studied and domains of neuropsychological performance assessed. Special attention is given to investigations of elderly subjects, and a critical summary is provided.

Hypertension and neuropsychological function: a lifespan perspective.

This article explores the relationship of hypertension to neuropsychological performance from a lifespan perspective. First, I examine cross-sectional and longitudinal studies of neuropsychological performance in cohorts of young to middle-aged hypertensive patients (ages 20-60); older hypertensive patients (ages 60-80+); and the young, normotensive offspring of hypertensive parents (ages 18-25). The pattern of performance deficits associated with hypertension is generally found to differ from that related to hypertension risk. Next, I discuss potential mechanisms underlying hypertension-performance relationships in the aforementioned cohorts. I suggest that lowered levels of performance in the offspring of hypertensives reflect genetic risk for hypertension. Compromised neuropsychological function in young and middle-aged hypertensives may occur secondary to alterations in neurophysiological function that result from elevated blood pressure. Such neurophysiological changes may predispose to neuroanatomical changes in older hypertensive patients.

Neuropsychological performance of young men who vary in familial risk for hypertension.

Neuropsychological performance was examined as a function of parental history of hypertension. Thirty-five normotensive offspring of two hypertensive parents (PH+/+) were compared to 35 offspring of two normotensive parents (PH-/-) and 35 offspring of one hypertensive and one normotensive parent (PH+/-) on tests of abstract reasoning, attention/mental flexibility, memory, perception, psychomotor skills, and visuospatial/constructional abilities. Results indicated that PH+/+ offspring performed more poorly than PH-/- offspring on tests of visuospatial/constructional and visuoperceptual ability; PH+/- offspring tended to score lower than PH-/- offspring on these tests. These findings were independent of age, education, diastolic blood pressure levels, average alcohol consumption, trait anxiety, and depression. Results of this study may indicate subtle central nervous system involvement associated with familial risk for hypertension.

Relationship of cardiovascular reactivity and anger expression to serum lipid concentrations in healthy young men.

The relationship between behaviorally evoked cardiovascular reactivity, preferred mode of anger expression, and serum lipid concentrations was examined in 63 healthy, young adult males. Subjects derived from three studies, each evaluating cardiovascular response to laboratory stressors. All participants completed the Spielberger Anger Expression Scale and provided fasting blood samples for lipid determinations. A significant negative correlation, calculated by meta-analytic procedures, was noted between a baseline-free measure of heart rate reactivity and high density lipoprotein-cholesterol (HDL-C) concentrations (r = -0.26, p = 0.05). However, the previously reported relationship between cardiovascular reactivity and elevated total serum cholesterol (TSC) was not found. Additionally, men scoring high on a self-report measure of the tendency to express anger outwardly had significantly higher HDL-C concentrations than men scoring low on this measure (r = 0.30, p = 0.02); when subjects were stratified by level of cardiovascular reactivity, this relationship was apparent only among those showing the greatest magnitude of heart rate and blood pressure responses to acute mental stress.

Acute cholesterol responses to mental stress and change in posture.

BACKGROUND: Serum lipid levels vary widely within individuals, but the causes of these fluctuations are poorly understood. One area of research concerns elevations in cholesterol concentration in response to emotional stress. In a laboratory-based experiment, we compared the effects of acute mental stress and postural change (standing) on serum cholesterol concentration. In addition, plasma volume was indirectly monitored to determine whether cholesterol changes with mental stress, if present, were a function of hemoconcentration. METHODS: Twenty-six men attended two laboratory sessions, each consisting of baseline (30 minutes), task (20 minutes), and recovery (30 minutes) periods. Subjects rested in the supine position during the baseline and recovery periods. During the task period of one session, subjects performed a mental task (Stroop test and mental arithmetic); during the other session, the subjects stood for the task period. RESULTS: Both mental stress and standing elicited significant elevations in heart rate, blood pressure, and plasma catecholamine concentrations, relative to the baseline and recovery periods. Both the mental and orthostatic tasks also significantly increased serum cholesterol concentration (by 0.10 and 0.57 mmol/L [3.7 and 21.9 mg/dL], respectively), as well as hemoglobin level and hematocrit. Cholesterol elevations with standing were reversible, while those resulting from mental stress persisted through the recovery period. When values were corrected for concomitant hemoconcentration, no net change in serum cholesterol level occurred during either task. CONCLUSIONS: Acute mental stress can produce rapid elevations in serum cholesterol concentration. It can also increase hemoglobin concentration and hematocrit (ie, reduce plasma volume). Therefore, increases in serum cholesterol level after acute mental stress are analogous to those with standing and may reflect hemoconcentration rather than altered lipoprotein metabolism.