03362nas a2200457 4500008004100000022001400041245015400055210006900209260001300278300001100291490000700302520203900309653000902348653002202357653001502379653001002394653002802404653002602432653001102458653001102469653001502480653003102495653000902526653001702535653002902552653001802581653001602599653001102615653001402626100002102640700002002661700002102681700002202702700002802724700002602752700002302778700002002801700002702821700002002848856003602868 2013 eng d a1534-779600aLong-term survival in adults 65 years and older with white matter hyperintensity: association with performance on the digit symbol substitution test.0 aLongterm survival in adults 65 years and older with white matter c2013 Sep a624-310 v753 a

OBJECTIVE: White matter hyperintensity (WMH) confers increased mortality risk in patients with cardiovascular diseases. However, little is known about differences in survival times among adults 65 years and older who have WMH and live in the community. To characterize the factors that may reduce mortality risk in the presence of WMH, measures of race, sex, apolipoprotein E4, neuroimaging, and cardiometabolic, physiological, and psychosocial characteristics were examined, with a particular focus on information processing as measured by the Digit Symbol Substitution Test (DSST).

METHODS: Cox proportional models were used to estimate mortality risks in a cohort of 3513 adults (74.8 years, 58% women, 84% white) with WMH (0-9 points), DSST (0-90 points), risk factor assessment in 1992 to 1994, and data on mortality and incident stroke in 2009 (median follow-up [range] = 14.2 [0.5-18.1] years).

RESULTS: WMH predicted a 48% greater mortality risk (age-adjusted hazard ratio [HR; 95% confidence interval {CI}] for WMH >3 points = 1.48 [1.35-1.62]). This association was attenuated after adjustment for DSST (HR [CI] = 1.38 [1.27-1.51]) or lacunar infarcts (HR [CI] = 1.37 [1.25,1.50]) but not after adjustment for other factors. The interaction between DSST and WMH was significant (p = .011). In fully adjusted models stratified by WMH of 3 or higher, participants with DSST greater than or equal to median had a 34% lower mortality risk among those with WMH of 3 or higher (n = 532/1217) and a 28% lower mortality risk among those with WMH lower than 3 (n = 1364/2296), compared with participants with DSST less than median (HR [95% CI] = 0.66 [0.55-0.81] and 0.72 [0.62-0.83], respectively).

CONCLUSIONS: WMH is associated with increased long-term mortality risk in community-dwelling adults 65 years and older. The increased risk is attenuated for those with higher DSST. Assessment of cognitive function with DSST may improve risk stratification of individuals with WMH.

10aAged10aApolipoprotein E410aBiomarkers10aBrain10aCardiovascular Diseases10aEpidemiologic Methods10aFemale10aHumans10aLife Style10aMagnetic Resonance Imaging10aMale10aNeuroimaging10aNeuropsychological Tests10aReaction Time10aSex Factors10aStroke10aSurvivors1 aRosano, Caterina1 aChang, Yue-Fang1 aKuller, Lewis, H1 aGuralnik, Jack, M1 aStudenski, Stephanie, A1 aAizenstein, Howard, J1 aGianaros, Peter, J1 aLopez, Oscar, L1 aLongstreth, William, T1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/610702328nas a2200229 4500008004100000022001400041245007500055210006900130260001600199300001200215490000800227520165300235100002101888700002001909700002501929700002001954700002101974700002101995700002302016700002302039856003602062 2016 eng d a1476-625600aNeighborhood Socioeconomic Status and Cognitive Function in Late Life.0 aNeighborhood Socioeconomic Status and Cognitive Function in Late c2016 Jun 15 a1088-970 v1833 a

Neighborhood socioeconomic status (NSES) is associated with cognitive function, independently of individual demographic, health, and socioeconomic characteristics. However, research has been largely cross-sectional, and mechanisms of the association are unknown. In 1992-1993, Cardiovascular Health Study participants (n = 3,595; mean age = 74.8 years; 15.7% black) underwent cognitive testing and magnetic resonance imaging of white matter hyperintensities (WMH), and their addresses were geocoded. NSES was calculated using 1990 US Census data (block groups; 6 measures of wealth, education, and occupation). The Modified Mini-Mental State Examination (3MS) was used to assess general cognition, and the Digit Symbol Substitution Test (DSST) was used to assess speed of processing annually for 6 years. Associations of race-specific NSES tertiles with 3MS, DSST, and WMH were estimated using linear mixed-effects models accounting for geographic clustering, stratified by race, and adjusted for demographic, health, and individual socioeconomic status (education, income, lifetime occupational status) variables. In fully adjusted models, higher NSES was associated with higher 3MS scores in blacks (mean difference between highest and lowest NSES = 2.4 points; P = 0.004) and whites (mean difference = 0.7 points; P = 0.02) at baseline but not with changes in 3MS over time. NSES was marginally associated with DSST and was not associated with WMH. Adjustment for WMH did not attenuate NSES-3MS associations. Associations of NSES with cognition in late adulthood differ by race, are not explained by WMH, and are evident only at baseline.

1 aRosso, Andrea, L1 aFlatt, Jason, D1 aCarlson, Michelle, C1 aLovasi, Gina, S1 aRosano, Caterina1 aBrown, Arleen, F1 aMatthews, Karen, A1 aGianaros, Peter, J uhttps://chs-nhlbi.org/node/7132