Subclinical Cardiac Dysfunction and Cognitive Function: A Systematic Review

Abstract Background: Cardiovascular disease, and more recently, subclinical cardiac dysfunction have both been implicated as important risk factors for cognitive decline. Several measures have been used to detect subclinical cardiac dysfunction, with global longitudinal strain (GLS) emerging as an important and more sensitive indicator than traditional measures. Yet, the association of GLS with cognitive function remains relatively unexplored. Objective: The aim of this review is to systematically summarize the literature exploring the association between GLS and cognitive function. Methods: We conducted a systematic review of the literature following PRISMA guidelines using the following databases: PubMed, OVID Medline, Embase, Web of Science, and CINAHL. Inclusion criteria were observational studies published in English, measuring GLS and assessing cognitive function through neuropsychiatric tests or brain imaging. Quality assessment was done using the Newcastle Ottawa Scale. Results: The initial search revealed 394 studies, of which three met inclusion criteria and were included for final review. The three studies included were cross-sectional and of high quality. They all reported that lower GLS scores were associated? with worse cognitive function and more brain abnormalities in both bivariate and multivariable analysis. Conclusion: Subclinical cardiac dysfunction, identified by GLS, was associated with worse cognitive function and presence of cerebral abnormality on brain imaging. The underlying mechanism could be attributed to dysfunctional autoregulatory and microvascular processes occurring in the brain vasculature. Further longitudinal studies are needed to better delineate the relationship between GLS and cognitive function.


SOCIAL DISENGAGEMENT AND COGNITIVE FUNCTION: DOES THE ASSOCIATION VARY BY GENDER?
Bada Kang, 1 Eunhee Cho, 2 and Sarah Oh, 2 1. Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing,Seoul,Republic of Korea,2. Yonsei University College of Nursing,Seoul,Seoult'ukpyolsi,Republic of Korea Although social disengagement is considered to be a predictor of cognitive decline, and increase risk of Alzheimer's and related dementias, little is known regarding the genderspecific association between social disengagement and cognition among Korean middle-aged and older adults.Korea's Confucianism-based gender roles provide unique contexts to examine gender differences in the influence of social disengagement on cognition.This study investigated the association between social disengagement and cognitive function in a nationally representative sample of Koreans aged 45 years or older (N = 5,196 women and 2,707 men), using data from the Korean Longitudinal Study of Aging (2008Aging ( -2018)).Results from the generalized estimating equation model showed that compared to consistent social engagement, consistent non-engagement was significantly associated with lower cognitive function among both genders.Transitioning from social engagement to non-engagement was significant for males only.Of various types of social activities (religious, senior center, sport, reunion, voluntary, political), consistent non-engagement in a senior center was most associated with lower cognitive function among both genders, while consistent non-engagement in religious activities was significant for females only.While household arrangements were not associated with cognition in men, widowed women had increased risk of cognitive decline than married women, as did women living in households of three or more people.Depression was a predictor of cognitive decline among males only.In this gender-specific study, we found that consistent participation in social activities, especially via membership in a senior community center, is beneficial in preventing cognitive decline among both genders.
brain abnormalities in both bivariate and multivariable analysis.Conclusion: Subclinical cardiac dysfunction, identified by GLS, was associated with worse cognitive function and presence of cerebral abnormality on brain imaging.The underlying mechanism could be attributed to dysfunctional autoregulatory and microvascular processes occurring in the brain vasculature.Further longitudinal studies are needed to better delineate the relationship between GLS and cognitive function.Tyran Terada, 1 and Yeonjung Lee, 2 1 Stimulating leisure games have been shown to offer cognitive stimulation among older adults.This cross-sectional study examined the association between word games (crossword puzzles and scrabble) / cards and games (games such as chess) and cognitive functioning among adults aged 65 years and older (n=3271).All data were collected from the Health and Retirement Study (2016).Results from the hierarchical regression models suggest that higher levels of participation in word games (p<.01) and cards and games (p<.01) predicted higher levels of cognitive functioning.In the final model, after controlling for age, gender, ethnicity, marital status, education, and income, a total variance of 31 percent was explained.All covariates were statistically significant except marital status.Word games (β=.117, p<01) and cards and games (β=.054, p<.01) had a significantly positive association with cognitive functioning.These findings suggest that participation in word games and cards and games are associated with cognitive functioning among older adults.

THE EFFECTS OF MILD COGNITIVE IMPAIRMENT ON FALL SEVERITY IN OLDER ADULTS
Megan Jones, 1 Sally Paulson, 2 Joshua Gills, 1 Anthony Campitelli, 1 Jordan Glenn, 3 Erica Madero, 3 Jennifer Myers, 3 and Michelle Gray, 1 1.University of Arkansas at Fayetteville, Fayetteville, Arkansas, United States, 2. University of Arkansas at Fayetteville, Cincinnati, Ohio, United States,3. Neurotrack Technologies,Redwood City,California,United States Falls affect more than 30% of older adults and are one of the leading causes of injury, hospitalization, and mortality in this populations.Mild cognitive impairment (MCI) is one of the risk factors for falls in older adults.The purpose of this study is to determine if older adults with MCI have increased fall severity than older adults without MCI.Participants (n: 81: age: 79 ± 6) completed a Montreal Cognitive Assessment (MoCA) and a Hopkins Falls Grading Scale, a tool used to grade the severity of falls on a scale of 1-4 (1 = loss of balance without fall; 4 = fall requiring hospital admission).Participants were categorized as having MCI (score <26: N: 44: age: 81 ± 6.4) or non-MCI (score ≥26: n: 37: age: 77 ± 6).Groups were analyzed using a one-way ANOVA in SPSS to compare the severity of falls within the previous 12 months.There were no differences between groups for fall grade 1 (p =.22) or fall grade 2 (p =.45).There was a significant difference between groups for fall grade 3 (p =.04) and fall grade 4 (p =.05) with the MCI group having more of these falls compared to the non-MCI group.Older adults with MCI had a higher number of falls requiring medical attention than older adults without MCI.Although falls are a risk in all older adults, those with MCI may be at higher risk of more injurious falls than older adults without MCI.

VITAMIN D, INSULIN-LIKE GROWTH FACTOR, AND COGNITIVE PERFORMANCE: AGE AND SEX VARIATIONS
Magdalena Tolea, 1 Stephanie Chrisphonte, 2 and James Galvin, 2 1.University of Miami Miller School of Medicine,Boca Raton,Florida,United States,2. University of Miami Miller School of Medicine,Miami,Florida,United States Vitamin D has been consistently linked to better cognitive function in observational studies.This impact may be due in part through its influence on neurotrophins.Whether the relationships between vitamin D, neurotrophins, and cognition vary based on biological factors such as age and sex is unclear.Using data from a sample of 400 communitydwelling older (mean age=75.3±9.4;47% female) participants in a cross-sectional study of cognitive aging, we assessed relationships between plasma 25-hydroxy-Vitamin D and performance on a neuropsychological battery modeled after the UDSv3.0.Moderation by age and sex and the impact of vitamin D on the relationship between Insulin-like Growth Factor-1 and cognitive performance were assessed by linear regression stratified by sex and age (median split at 76y).We found vitamin D to be positively linked to global cognition (MoCA: β=0.095±0.025SE,p<0.001), working memory (Number Span Forward: β=0.017±0.007SE,p=0.011;Number Span Backward: β=0.016±0.007SE,p=0.028), episodic memory (Immediate Recall : β=0.089±0.027SE,p=0.001;Delayed Recall: β=0.047±0.015SE,p=0.002), attention and processing speed (Trail Making A: β=-0.365±0.163SE,p=0.026), executive function (Trail Making B: β=-0.537±0.215SE,p=0.014;Number-Symbol Coding: β=0.139±0.057SE,p=0.016), and an overall measure of cognitive function (z score: β=0.049±0.018SE,p=0.007).Most of these relationships were observed in women and younger older individuals (<76y).In addition, vitamin D increased the effect of IGF-1 on global cognition and memory by 13% and 8%, respectively.Our findings suggest that vitamin D-focused dementia prevention efforts would benefit if targeted to women and younger segments of the senior population and/ or as an adjuvant to cognitive enhancement interventions.
W.Quin Yow, 1 Jia Wen Lee, 2 and Xiaoqian Li, 3 1.Singapore University of Technology & Design, Singapore, Singapore, 2. Singapore University of Technology & Design, Singapore University of Technology & Design, Singapore, 3. Singapore University of Technology and Design, Singapore, Singapore