New Norms for a New Generation: Cognitive Performance in the Framingham Offspring Cohort

Au, Rhoda; Seshadri, Sudha; Wolf, Philip A.; Elias, Merrill F.; Elias, Penelope K.; Sullivan, Lisa M.; Beiser, Alexa; D’Agostino, Ralph B.

doi:10.1080/03610730490484380

Cited by 112 publications

(143 citation statements)

References 31 publications

(30 reference statements)

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“…Details of neurocognitive testing in the FHS Offspring Cohort have been reported elsewhere. 18 A battery of neurocognitive tests targeting a range of domainspecific outcomes were conducted, from which we prespecified to study 2 in the realm of executive function and abstract reasoning. The difference score of Trail Making Test Part B minus Part A (Trails B-A) performance is a hallmark of vascular brain aging.…”

Section: Methods Study Participants the Framingham Heartmentioning

confidence: 99%

Association of arterial stiffness with progression of subclinical brain and cognitive disease

et al. 2016

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Objective: We tested whether abnormal arterial stiffness and blood pressure would be associated with progression of brain aging measured by brain MRI and neurocognitive testing.Methods: Framingham Offspring Cohort participants (n 5 1,223, 61 6 9 years, 56% women) without previous stroke or dementia underwent applanation tonometry, brain MRI, and neurocognitive testing at examination 7 (1998-2001). Follow-up brain MRI and neurocognitive testing was performed at examination 8 (2005-2008, mean interval 6.4 6 1.3 years). We related examination 7 inverse-transformed carotid-femoral pulse wave velocity (iCFPWV), central pulse pressure (CPP), and mean arterial pressure to changes in the following variables between examinations 7 and 8: total cerebral brain volume, white matter hyperintensity volume, and performance on executive function and abstraction tasks, the Trail Making Test, Parts B and A (DTrails B-A), and Similarities tests.

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Section: Methods Study Participants the Framingham Heartmentioning

confidence: 99%

Association of arterial stiffness with progression of subclinical brain and cognitive disease

et al. 2016

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“…The analyses described here include dementia-free FHS participants who underwent neuropsychological testing between 1999 and 2005 and the initial dementia-free MCSA cohort who underwent neuropsychological testing between 2004 and 2006. The neuropsychological test batteries of the MCSA 19 and the FHS 20 were similar but not identical, and are shown in table 1. To match the MCSA, the FHS cohort was limited to those between the ages of 70 and 89 years at baseline.…”

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Spectrum of cognition short of dementia

et al. 2015

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Objective: To understand the neuropsychological basis of dementia risk among persons in the spectrum including cognitive normality and mild cognitive impairment. Methods:We quantitated risk of progression to dementia in elderly persons without dementia from 2 population-based studies, the Framingham Heart Study (FHS) and Mayo Clinic Study of Aging (MCSA), aged 70 to 89 years at enrollment. Baseline cognitive status was defined by performance in 4 domains derived from batteries of neuropsychological tests (that were similar but not identical for FHS and MCSA) at cut scores corresponding to SDs of #20.5, 21, 21.5, and 22 from normative means. Participants were characterized as having no cognitive impairment (reference group), or single or multiple amnestic or nonamnestic profiles at each cut score. Incident dementia over the following 6 years was determined by consensus committee at each study separately.Results: The pattern of hazard ratios for incident dementia, rates of incident dementia and positive predictive values across cognitive test cut scores, and number of affected domains was similar although not identical across the FHS and MCSA. Dementia risks were higher for amnestic profiles than for nonamnestic profiles, and for multidomain compared with single-domain profiles.Conclusions: Cognitive domain subtypes, defined by neuropsychologically derived cut scores and number of low-performing domains, differ substantially in prognosis in a conceptually logical manner that was consistent between FHS and MCSA. Neuropsychological characterization of elderly persons without dementia provides valuable information about prognosis. The heterogeneity of risk of dementia cannot be captured concisely with one test or a single definition or cutpoint. The wide variation in cognitive function in aging, both in levels of performance and rates of change over time, forces clinicians and lay people to focus on categorical descriptions. Labels such as cognitively normal, mild cognitive impairment (MCI), and dementia are applied as if they were discrete entities, but it is accepted that these terms represent demarcations of convenience along the continuum of cognition. MCI occupies a central location in the spectrum of cognitive aging, and its use as a diagnostic term has been criticized because of the heterogeneity of its prognosis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] There are many reasons for the wide range of dementia risk in persons designated as MCI, but perhaps the most important one is that cognitive functioning that falls between the designations of "typical cognitive aging" and "definitely demented" is remarkably diverse. Changes in memory, attention, executive, language, and visuospatial domains, as well as the magnitude of those changes, have distinct implications for prognosis. The existing studies suggested to us that the diversity of affected domains and cutpoints, rather than a weakness, had

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“…The NP battery has been previously described. 17 From this battery we selected 3 tests that represent cognitive domains previously associated with an increased risk of developing AD in the original cohort 18 : the delayed recall components of the Logical Memory test (LM-d) assessing verbal memory, the delayed recall component of the Visual Reproductions test (VR-d) assessing visuospatial memory, and the Similarities test (SIM) which measures abstract reasoning skills, and a fourth test (Trails B) which is a marker of attention and executive function and has been associated with vascular brain injury. Poorer performance on VR-d and SIM tests has also been associated with presence of vascular risk factors.…”

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Red blood cell omega-3 fatty acid levels and markers of accelerated brain aging

et al. 2012

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Objective: Higher dietary intake and circulating levels of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been related to a reduced risk for dementia, but the pathways underlying this association remain unclear. We examined the cross-sectional relation of red blood cell (RBC) fatty acid levels to subclinical imaging and cognitive markers of dementia risk in a middleaged to elderly community-based cohort. Methods:We related RBC DHA and EPA levels in dementia-free Framingham Study participants (n ϭ 1,575; 854 women, age 67 Ϯ 9 years) to performance on cognitive tests and to volumetric brain MRI, with serial adjustments for age, sex, and education (model A, primary model), additionally for APOE ⑀4 and plasma homocysteine (model B), and also for physical activity and body mass index (model C), or for traditional vascular risk factors (model D). Results:Participants with RBC DHA levels in the lowest quartile (Q1) when compared to others (Q2-4) had lower total brain and greater white matter hyperintensity volumes (for model A: ␤ Ϯ SE ϭ Ϫ0.49 Ϯ 0.19; p ϭ 0.009, and 0.12 Ϯ 0.06; p ϭ 0.049, respectively) with persistence of the association with total brain volume in multivariable analyses. Participants with lower DHA and -3 index (RBC DHAϩEPA) levels (Q1 vs Q2-4) also had lower scores on tests of visual memory (␤ Ϯ SE ϭ Ϫ0.47 Ϯ 0.18; p ϭ 0.008), executive function (␤ Ϯ SE ϭ Ϫ0.07 Ϯ 0.03; p ϭ 0.004), and abstract thinking (␤ Ϯ SE ϭ Ϫ0.52 Ϯ 0.18; p ϭ 0.004) in model A, the results remaining significant in all models. Conclusion:Lower RBC DHA levels are associated with smaller brain volumes and a "vascular" pattern of cognitive impairment even in persons free of clinical dementia. Neurology ® 2012;78:658-664 GLOSSARY AD ϭ Alzheimer disease; BMI ϭ body mass index; DHA ϭ docosahexaenoic acid; DM ϭ diabetes mellitus; EPA ϭ eicosapentaenoic acid; LM-d ϭ delayed recall components of the Logical Memory test; NP ϭ neuropsychological; PAI ϭ physical activity index; PUFA ϭ polyunsaturated fatty acid; RBC ϭ red blood cell; SBP ϭ systolic blood pressure; SCI ϭ silent cerebral infarct; SIM ϭ Similarities test; TCBV ϭ total cerebral brain volume; THV ϭ temporal horn volume; VR-d ϭ delayed recall component of the Visual Reproductions test; WMHV ϭ white matter hyperintensity volume.Higher fish intake has been associated with a reduced risk of cardiovascular mortality 1,2 and stroke.3 While several large epidemiologic studies 4,5 have shown an association between the estimated intake of fatty fish and a lower risk for dementia, some other investigations have failed to confirm such a protective association. 6 One possible reason for these inconsistent results is the limited ability of dietary recall surveys and food frequency questionnaires to quantify blood levels of fatty acids. 7,8 In the Framingham original cohort, participants in the top quartile of plasma phosphatidylcholine docosahexaenoic acid (DHA) levels had 37% and 47% lower risks of Alzheimer disease (AD) and all-cause dementia, respectively.9 Red blood ...

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New Norms for a New Generation: Cognitive Performance in the Framingham Offspring Cohort

Cited by 112 publications

References 31 publications

Association of arterial stiffness with progression of subclinical brain and cognitive disease

Association of arterial stiffness with progression of subclinical brain and cognitive disease

Spectrum of cognition short of dementia

Red blood cell omega-3 fatty acid levels and markers of accelerated brain aging

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