"Do it-yourself": Home blood pressure as a predictor of traditional and everyday cognition in older adults.

BACKGROUND: Hypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored. METHODS: We examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed "everyday cognition" measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks. RESULTS: Good to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures. CONCLUSION: Our findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.

Positive affect predicts everyday problem-solving ability in older adults.

OBJECTIVES: Increased symptom endorsement on the short form of the Centre for Epidemiologic Studies Depression (CES-D) Scale has been previously associated with lower everyday problem-solving (EPS) ability in older adults. However, given the multifactorial and complex nature of depressive symptoms, it remains unclear whether certain symptoms/aspects of depression account for this relationship. We examined established factor scores on the full version of the CES-D to assess their utility as predictors of EPS in an older adult cohort. METHODS: Community-dwelling older adults (n = 103; age: 51-91) were administered the CES-D along with a measure of EPS ability assessing both social and practical EPS. Regression analyses were used to determine the relationships between variables. RESULTS: Analyses revealed that increased CES-D scores predicted worse EPS ability in older adults (ß = -.17, p < .05) beyond the effects of age, gender, and education. Regression analyses examining each CES-D factor score revealed that decreased positive affect (loss of hope/enjoyment in life; ß = -.21, p < .01) remained the only significant predictor of decreased overall EPS scores beyond demographic variables, while depressed affect, interpersonal, and somatic factors were not significant predictors. Positive affect predicted both practical, as well as social EPS scores. CONCLUSIONS: Current results extend previous findings by showing that the relationship between increased depressive symptoms and decreased EPS ability in older age may be primarily driven by anhedonia as opposed to other depressive symptoms.

Age-related effects of blood pressure on everyday cognitive function in community-dwelling women.

OBJECTIVES: Blood pressure is an indicator of vascular health that has been associated with cognition and quality of life in older age. Few studies have examined blood pressure across everyday cognitive tasks, which may have superior predictive functional utility than traditional cognitive measures. We explored blood pressure as a predictor of everyday problem solving (EPS) performance in middle-aged and older women. METHOD: Community-dwelling women (age: 51-91) with low-normal blood pressure to mild hypertension underwent traditional and everyday cognitive testing. EPS was determined by the number of safe/effective solutions generated for real-world scenarios. RESULTS: Analyses revealed that lower systolic blood pressure and pulse pressure were associated with worse EPS ability after controlling for age, education, and traditional cognitive abilities. DISCUSSION: These results support that blood pressure may be an important predictor of everyday cognitive abilities in older age. Potential implications for real-world functioning are discussed.

Exploring effects of type 2 diabetes on cognitive functioning in older adults.

Type 2 diabetes may be associated with exacerbated aging-related declines in cognitive neuropsychological performance. The authors examined whether such effects are systematic (i.e., broadly distributed across domains or domain-specific) or moderated by age (i.e., varying across age within older adults). The authors assembled recent cross-sectional data from the Victoria Longitudinal Study (VLS) Sample 3 (Wave 1; initial n = 570; initial age = 53-90 years). Using a comprehensive, multidimensional spectrum of cognitive neuropsychological tests, the authors examined performance differences by diabetes status (diabetes group vs. healthy controls) and age (young-old vs. old-old). Our results showed that healthy controls significantly outperformed the diabetes group only on markers of executive functioning and speed. Notably, the diabetes-related effects were robust across the two late-life age groups. Future research examining longitudinal changes is recommended.

Short-term longitudinal trends in cognitive performance in older adults with type 2 diabetes.

Type 2 diabetes is associated with cognitive deficits, although inconsistently across neuropsychological domains. We examined 3-year longitudinal data from the Victoria Longitudinal Study, comparing diabetes (n = 28) and control (n = 272) older adults on a comprehensive neuropsychological battery. Assessing potential change and stability, we found that (a) baseline diabetes group deficits in semantic speed and speed-intensive executive function were preserved, (b) new average deficits for reaction time and nonspeeded executive function appeared, and (c) no differential short-term change was observed. It is clinically and theoretically important to examine sequential change in multiple domains over time.