@article {7348, title = {Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study.}, journal = {Alzheimer Dis Assoc Disord}, year = {2017}, month = {2017 Mar 03}, abstract = {

INTRODUCTION: The association between history of coronary artery bypass graft surgery (CABG) and dementia risk remains unclear.

METHODS: We conducted a prospective cohort analysis using data on 3155 elderly adults free from prevalent dementia from the US population-based Cardiovascular Health Study (CHS) with adjudicated incident all-cause dementia, Alzheimer disease (AD), vascular dementia (VaD), and mixed dementia.

RESULTS: In the CHS, the hazard ratio (HR) for all-cause dementia was 1.93 [95\% confidence interval (CI), 1.36-2.74] for those with CABG history compared with those with no CABG history after adjustment for potential confounders. Similar HRs were observed for AD (HR=1.71; 95\% CI, 0.98-2.98), VaD (HR=1.42; 95\% CI, 0.56-3.65), and mixed dementia (HR=2.73; 95\% CI, 1.55-4.80). The same pattern of results was observed when these CHS findings were pooled with a prior prospective study, the pooled HRs were 1.96 (95\% CI, 1.42-2.69) for all-cause dementia, 1.71 (95\% CI, 1.04-2.79) for AD and 2.20 (95\% CI, 0.78-6.19) for VaD.

DISCUSSION: Our results suggest CABG history is associated with long-term dementia risk. Further investigation is warranted to examine the causal mechanisms which may explain this relationship or whether the association reflects differences in coronary artery disease severity.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000191}, author = {Ku{\'z}ma, El{\.z}bieta and Airdrie, Jac and Littlejohns, Thomas J and Lourida, Ilianna and Thompson-Coon, Jo and Lang, Iain A and Scrobotovici, Monica and Thacker, Evan L and Fitzpatrick, Annette and Kuller, Lewis H and Lopez, Oscar L and Longstreth, William T and Ukoumunne, Obioha C and Llewellyn, David J} } @article {8622, title = {Cognitive decline in older adults with epilepsy: The Cardiovascular Health Study.}, journal = {Epilepsia}, volume = {62}, year = {2021}, month = {2021 Jan}, pages = {85-97}, abstract = {

OBJECTIVE: Cognitive decline is a major concern for older adults with epilepsy. Whether and how much faster older adults with epilepsy experience cognitive decline beyond expected age-related cognitive change remain unclear. We sought to estimate and compare rates of cognitive decline in older adults with and without epilepsy.

METHODS: The Cardiovascular Health Study is a population-based longitudinal cohort study of 5888 US adults aged 65+. Cognitive function was assessed annually with Modified Mini-Mental State Exam (3MS) and Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate average rates of decline in 3MS and DSST scores by epilepsy status (prevalent, incident, or no epilepsy), adjusted for risk factors associated with cognitive decline.

RESULTS: The rate of decline in 3MS was significantly faster in prevalent epilepsy (P~<~.001) and after incident epilepsy (P~=~.002) compared with no epilepsy. Prevalent epilepsy and apolipoprotein E gene (APOE) ε4 (ApoE4) had a synergistic interaction, whereby prevalent epilepsy and ApoE4 together were associated with 1.51 points faster annual decline in 3MS than would be expected if prevalent epilepsy and ApoE4 did not interact (P~<~.001). Older adults with prevalent epilepsy had a significantly lower initial DSST score and faster rate of decline compared to those with no epilepsy (P~<~.001).

SIGNIFICANCE: Faster decline in global cognitive ability seen in this study validates concerns of patients. ApoE4 allele status was an effect modifier of the relationship between cognitive decline and prevalent epilepsy. Further research is warranted to explore biological mechanisms and possible interventions to mitigate cognitive decline.

}, issn = {1528-1167}, doi = {10.1111/epi.16748}, author = {Choi, Hyunmi and Thacker, Evan L and Longstreth, William T and Elkind, Mitchell S V and Boehme, Amelia K} } @article {9477, title = {Circulating Omega-3 and Omega-6 Fatty Acids, Cognitive Decline, and Dementia in Older Adults.}, journal = {J Alzheimers Dis}, year = {2023}, month = {2023 Aug 23}, abstract = {

BACKGROUND: Comprising nearly 35\% of brain lipids, polyunsaturated fatty acids (PUFA) are essential for optimal brain function. However, the role of PUFA on cognitive health outcomes later in life is largely unknown.

OBJECTIVE: We investigated prospective associations of plasma phospholipid omega-3 (ALA [18 : 3], EPA [20 : 5], DPA [22 : 5], DHA [22 : 6]) and omega-6 (LA [18 : 2], AA [20 : 4]) PUFA with cognitive decline, risk of cognitive impairment and dementia among adults aged>=65 years in the Cardiovascular Health Study.

METHODS: Circulating fatty acid concentrations were measured serially at baseline (1992/1993), 6 years, and 13 years later. Cognitive decline and impairment were assessed using the 100-point Modified Mini-Mental State Examination (3MSE) up to 7 times. Clinical dementia was identified using adjudicated neuropsychological tests, and ICD-9 codes.

RESULTS: Among 3,564 older adults free of stroke and dementia at baseline, cognitive function declined annually by approximately -0.5 3MSE points; 507 participants developed cognitive impairment and 499 dementia over up to 23 years of follow-up. In multivariable models, higher circulating arachidonic acid (AA) concentrations were associated with slower cognitive decline and lower dementia risk, with associations growing stronger with greater length of follow-up (hazard ratio [HR,95\% CI] of dementia per interquintile range, 0.74 [0.56-0.97] at 5 years, and 0.53 [0.37-0.77] at 15 years). Circulating docosapentaenoic (DPA) concentrations were associated with slower cognitive decline and lower risk of cognitive impairment (extreme-quintile HR, 0.72 [95\% CI: 0.55, 0.95]). Findings were generally null or inconsistent for other omega-3 or omega-6 PUFA.

CONCLUSION: Circulating AA and DPA, but not other PUFA, are associated with slower rate of cognitive decline and lower risk of dementia or cognitive impairment later in life.

}, issn = {1875-8908}, doi = {10.3233/JAD-230083}, author = {de Oliveira Otto, Marcia C and Wu, Jason H Y and Thacker, Evan L and Lai, Heidi Tsz Mung and Lemaitre, Rozenn N and Padhye, Nikhil and Song, Xiaoling and King, Irena B and Lopez, Oscar and Siscovick, David S and Mozaffarian, Dariush} }