02886nas a2200445 4500008004100000022001400041245008300055210006900138260001300207300001100220490000700231520166800238653001601906653000901922653002201931653001001953653004301963653001902006653001102025653000902036653002502045653001202070653002902082653001102111653001102122653000902133653000902142653003202151653001702183100002102200700002202221700002102243700002402264700002202288700002502310700002102335700002802356700002002384856003602404 2015 eng d a1758-535X00aMultisystem physiologic impairments and changes in gait speed of older adults.0 aMultisystem physiologic impairments and changes in gait speed of c2015 Mar a319-240 v703 a

BACKGROUND: Slowed gait is an important health indicator in older adults but a single identifiable cause is often lacking. We assessed whether a summary index measuring impairments across multiple physiologic systems was associated with slowed gait in older individuals.

METHODS: Data from the Cardiovascular Health Study (n = 3,010) were used to assess associations between baseline physiologic index (measuring vasculature, brain, kidneys, lungs, and glucose metabolism; range 0-10 with 0-2 points/system and lower score indicating higher function) and annual gait speed (m/s) over 6 years. Participants with complete data on the physiologic index and at least two gait speed measures were included. Mean gait speed and 95% confidence intervals (CI) by category of index were calculated using mixed effects models.

RESULTS: Those with scores of three or higher on the index had significantly slower gait speed at baseline compared to those with scores of 0-2 (7-10: mean speed = 0.83 m/s, 95% CI: 0.80, 0.84; 0-2: mean speed = 1.01 m/s, 95% CI: 0.99, 1.03). Those with higher indices also had faster decline in gait speed compared to those with lower scores after adjustment for demographic and health characteristics (7-10: change in speed = -0.020 m/s/year, 95% CI: -0.024, -0.016; 0-2: change in speed= -0.010 m/s/year, 95% CI: -0.014, -0.006).

CONCLUSIONS: Greater impairment across five organ systems was associated with slower gait speed and greater declines in gait speed over 6 years. Impairments accumulated over multiple physiologic systems may make older adults more vulnerable to slow gait speed.

10aAge Factors10aAged10aAged, 80 and over10aBrain10aCardiovascular Physiological Phenomena10aCohort Studies10aFemale10aGait10aGeriatric Assessment10aGlucose10aHealth Status Indicators10aHumans10aKidney10aLung10aMale10aSensitivity and Specificity10aTime Factors1 aRosso, Andrea, L1 aSanders, Jason, L1 aArnold, Alice, M1 aBoudreau, Robert, M1 aHirsch, Calvin, H1 aCarlson, Michelle, C1 aRosano, Caterina1 aKritchevsky, Stephen, B1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/659601068nas a2200361 4500008004100000022001400041245012200055210006900177260001300246300001100259490000700270653000900277653001000286653002800296653002800324653001100352653002500363653001100388653003100399653000900430653001700439653002500456653001900481100002000500700002100520700002600541700002000567700002000587700002000607700002200627700002100649856003600670 2015 eng d a1532-541500aSocial Network Size and Cranial Magnetic Resonance Imaging Findings in Older Adults: The Cardiovascular Health Study.0 aSocial Network Size and Cranial Magnetic Resonance Imaging Findi c2015 Nov a2430-20 v6310aAged10aBrain10aCardiovascular Diseases10aCross-Sectional Studies10aFemale10aGeriatric Assessment10aHumans10aMagnetic Resonance Imaging10aMale10aNeuroimaging10aSocial Participation10aSocial Support1 aFlatt, Jason, D1 aRosso, Andrea, L1 aAizenstein, Howard, J1 aSchulz, Richard1 aLongstreth, W T1 aNewman, Anne, B1 aFowler, Nicole, R1 aRosano, Caterina uhttps://chs-nhlbi.org/node/692802328nas 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/713202518nas a2200169 4500008004100000022001400041245010800055210006900163260001600232520196200248100002402210700001702234700002102251700002002272700002002292856003602312 2017 eng d a1545-721400aBrain Structural Markers and Caregiving Characteristics as Interacting Correlates of Caregiving Strain.0 aBrain Structural Markers and Caregiving Characteristics as Inter c2017 Feb 213 a

OBJECTIVE: To evaluate the association between brain structural markers and caregiving strain among older informal caregivers.

DESIGN: A secondary data analysis combining data from the Caregiver Health Effects Study (1993-1994) and the Cardiovascular Health Study MRI examination (1992-1994).

SETTING: Four United States communities.

PARTICIPANTS: Co-residing spousal caregivers (N = 237; mean age: 76.2 years, SD: 2.2 years).

MEASUREMENTS: Visually rated ventricular and white matter (WM) grades from magnetic resonance imaging, caregiving strain defined as "emotional or physical strain associated with providing care" for any of 12 activities of daily living (ADLs) and instrumental activities of daily living (IADLs), plus measures of caregiving characteristics and caregiver's health.

RESULTS: Overall, 56% of caregivers reported strain. We detected an interaction where strain was very common (>82%) among caregivers who helped with four or more IADLs, regardless of WM grades, and among caregivers with the worst WM grades (WM grades ≥4), regardless of the number of IADLs they helped with. Among caregivers helping with fewer than four IADLs, having WM grade 4 or greater was associated with a 55% higher prevalence ratio for reporting strain. This association remained statistically significant but was most markedly attenuated by adjustments for: care recipient's memory and behavioral problems, caregiver's depression symptoms, and caregiver's ADL impairment.

CONCLUSIONS: Caregiving strain is very common among older informal caregivers who provide help with many IADLs, and among caregivers who help with fewer IADLs, but have manifest signs of white matter pathology. Modern quantitative-neuroimaging studies are needed to evaluate whether more subtle variability in brain structure confers caregiving strain and the related health consequences.

1 aSmagula, Stephen, F1 aBeach, Scott1 aRosso, Andrea, L1 aNewman, Anne, B1 aSchulz, Richard uhttps://chs-nhlbi.org/node/736102505nas a2200277 4500008004100000022001400041245007600055210006900131260001600200300001100216490000700227520169000234100002001924700002101944700002001965700002101985700002002006700002502026700002102051700002302072700002802095700002002123700002502143700002302168856003602191 2023 eng d a1873-205400aNeighborhood greenspace and cognition: The cardiovascular health study.0 aNeighborhood greenspace and cognition The cardiovascular health  c2023 Jan 03 a1029600 v793 a

OBJECTIVES: We examined whether greenspace measures (overall percent greenspace and forest, and number of greenspace types) were associated with clinically adjudicated dementia status.

METHODS: In a sample of non-demented older adults (n = 2141, average age = 75.3 years) from the Cardiovascular Health and Cognition Study, Cox proportional hazard and logistic regression analyses were used to estimate associations of baseline greenspace with risks of incident dementia and MCI, respectively, while adjusting for demographics, co-morbidities, and other neighborhood factors. We derived quartiles of percent greenness (greenspace), forest (percent tree canopy cover), and tertiles of greenspace diversity (number of greenspace types) for 5-km radial buffers around participant's residences at study entry (1989-1990) from the 1992 National Land Cover Dataset. Dementia status and mild cognitive impairment (MCI) over 10 years was clinically adjudicated.

RESULTS: We observed no significant association between overall percent greenspace and risk of mild cognitive impairment or dementia and mostly null results for forest and greenspace diversity. Forest greenspace was associated with lower odds of MCI (OR quartile 4 versus 1: 0.54, 95% CI: 0.29-0.98) and greenspace diversity was associated with lower hazard of incident dementia (HR tertile 2 versus 1: 0.70, 95% CI = 0.50-0.99).

DISCUSSION: We found divergent results for different types of greenspace and mild cognitive impairment or dementia. Improved greenspace type and diversity measurement could better characterize the association between greenspace and cognition.

1 aGodina, Sara, L1 aRosso, Andrea, L1 aHirsch, Jana, A1 aBesser, Lilah, M1 aLovasi, Gina, S1 aDonovan, Geoffrey, H1 aGarg, Parveen, K1 aPlatt, Jonathan, M1 aFitzpatrick, Annette, L1 aLopez, Oscar, L1 aCarlson, Michelle, C1 aMichael, Yvonne, L uhttps://chs-nhlbi.org/node/923802568nas a2200241 4500008004100000022001400041245010600055210006900161260001600230520182300246100002202069700002402091700001702115700002102132700002302153700001602176700002002192700001802212700002102230700001802251700002102269856003602290 2024 eng d a1758-535X00aAssociations of Neurological Biomarkers in Serum with Gait Measures: The Cardiovascular Health Study.0 aAssociations of Neurological Biomarkers in Serum with Gait Measu c2024 Feb 093 a

BACKGROUND: Gait impairment leads to increased mobility decline and may have neurological contributions. This study explores how neurological biomarkers are related to gait in older adults.

METHODS: We studied participants in the Cardiovascular Health Study, a population-based cohort of older Americans, who underwent a serum biomarker assessment from samples collected in 1996-97 for neurofilament light-chain (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and total tau (n=1959, mean age=78.0 years, 60.8% female). In a subsample (n=380), cross-sectional associations with quantitative gait measures were explored. This subsample was assessed on a mat for gait speed, step length, double support time, step time, step length variability and step time variability. Gait speed was also measured over a 15-ft walkway annually from 1996-97 to 1998-99, for longitudinal analyses. Linear regression models assessed cross-sectional associations of biomarkers with gait measures, while mixed effects models assessed longitudinal gait speed change from baseline to 1998-99.

RESULTS: NfL was significantly associated with annual gait speed decline (standardized β = -0.64 m/s, 95% CI: [-1.23, -0.06]) after adjustment for demographic and health factors. Among gait mat-assessed phenotypes, NfL was also cross-sectionally associated with gait speed (β = 0.001 m/s [0.0003, 0.002]) but not with other gait measures. None of the remaining biomarkers were significantly related to gait in either longitudinal or cross-sectional analyses.

CONCLUSION: Higher NfL levels were related to greater annual gait speed decline. Gait speed decline may be related to axonal degeneration. The clinical utility of NfL should be explored.

1 aNadkarni, Abhijay1 aMukamal, Kenneth, J1 aZhu, Xiaonan1 aSiscovick, David1 aBrach, Jennifer, S1 aJacob, Mini1 aSeshadri, Sudha1 aAbe, Temidayo1 aRosano, Caterina1 aDjoussé, Luc1 aRosso, Andrea, L uhttps://chs-nhlbi.org/node/9614