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      Different associations of premorbid intelligence vs. current cognition with BMI, insulin and diabetes in the homebound elderly

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          Abstract

          Premorbid intelligence does not decline through life even at the early stages of Alzheimer’s disease (AD). However, other cognitive measures such as Mini Mental State Examination (MMSE) decline with aging and severely with dementia. In this study, we examine the associations of premorbid intelligence vs. current cognition with body mass index (BMI), insulin and diabetes in elderly adults. Using a cross-sectional, population-based study, we assessed BMI, plasma insulin and the evidence of diabetes in homebound elders. The North American Adult Reading Test (NAART) and MMSE were conducted. Associations were assessed by T-test, linear correlation and multivariate regression analysis. Subjects were divided into four subgroups: 1) BMI <25; 2) 25 < BMI <30; 3) 30 < BMI <35 and 4) BMI >35. Lower verbal IQ, assessed by NAART, was associated with higher BMI (β=−0.28; P<0.01), elevated insulin (β= −0.02, P=0.02), and diabetes (β=− 3.18, P<0.01). Multivariate regression analyses showed that all three clinical conditions – obesity, hyperinsulinaemia and diabetes – were associated with lower premorbid intelligence assessed by verbal IQ, but only diabetes was associated with current cognitive impairment assessed by MMSE. These relationships persisted after adjustment for education. Premorbid intelligence is associated with diabetes precursors – obesity and high insulin – and diabetes itself, but cognitive impairment is related to diabetes only. Understanding the mechanisms that link verbal IQ to diabetes precursors might suggest targeted interventions for the prevention of diabetes and cognitive decline caused by diabetes.

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          Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition.

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            The National Adult Reading Test as a measure of premorbid intelligence: a comparison with estimates derived from demographic variables.

            Since its publication in 1982, the National Adult Reading Test (NART; Revised Version, NART-R) has become a widely accepted method for estimating premorbid levels of intelligence in neuropsychological research. However, the assumption that NART/NART-R performance is relatively independent of brain damage has been increasingly challenged in recent years. In a number of conditions, including Alzheimer dementia and Korsakoff's syndrome, studies have indicated a deterioration in reading ability, leading to an underestimated premorbid IQ. In a reaction to these studies, some researchers have advocated the use of demographic variables as a more suitable foundation for accurately predicting premorbid intelligence. We addressed this issue by calculating IQ estimates on the basis of NART/NART-R, demographic variables, and a combination of the two approaches and by comparing these with current WAIS/WAIS-R IQ in patients with Korsakoff's syndrome, Alzheimer dementia, frontal or temporal lobe lesions, and in healthy controls. Estimated premorbid IQs did not differ across groups, whether derived from NART/NART-R or demographic variables. Those based on NART/NART-R demonstrated higher correlations with current WAIS/WAIS-R IQ in controls and patients than those derived from demographic variables. An equation combining NART scores with demographic variables did not significantly increase the amount of variance in IQ explained by NART only, either in patients or controls. The data offer reassurance regarding the continued use of NART as a valid estimate of premorbid intelligence in a number of conditions.
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              NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham Study.

              To determine if NIDDM and blood pressure are risk factors for poor cognitive performance and if history and duration of NIDDM and blood pressure interact such that the risk of poor performance is greater for subjects with both NIDDM and hypertension. We used a large prospective cohort sample with 187 NIDDM subjects and 1,624 nondiabetic subjects who were followed for 28-30 years. Cognitive function was assessed using eight tests of learning, memory, visual organization, verbal fluency attention, concept formation, and abstract reasoning. A composite score was also calculated. Odds ratios were used to estimate the relative risk of performing below the lower 25th percentile of z scores on these tests. NIDDM and blood pressure interacted such that diagnosis and duration of NIDDM were associated with greater risk of poor performance on tests of visual memory and on the composite score for hypertensive subjects. Duration of NIDDM was associated with increased risk for poor performance on tests of verbal memory and concept formation. Insulin-treated NIDDM subjects were at higher risk for poor cognitive performance than those NIDDM subjects treated with oral agents or diet. Blood pressure level was associated independently with a measure of verbal fluency. History and duration of NIDDM and high blood pressure are significant risk factors for poor cognitive performance. Hypertensive people with NIDDM are at greatest risk for poor performance on tests measuring visual organization and memory.
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                Author and article information

                Journal
                101660036
                43956
                Integr Mol Med
                Integr Mol Med
                Integrative molecular medicine
                2056-6360
                5 May 2016
                19 February 2016
                2016
                16 September 2016
                : 3
                : 3
                : 547-552
                Affiliations
                [1 ]Department of Public Health and Family Medicine, Tufts University, Boston, USA
                [2 ]Departments of Psychiatry, Boston University School of Medicine, Boston, US A
                [3 ]Pharmacology, Boston University School of Medicine, Boston, USA
                [4 ]Alzheimer’s Disease Center, Boston University School of Medicine, Boston, USA
                Author notes
                Correspondence to: Wendy Wei Qiao Qiu, Boston University School of Medicine, 72 East Concord Street, R-623D, Boston, MA 02118, Tel: 617-638-4336; Fax: 617-638-5254; wqiu67@ 123456bu.edu
                Article
                NIHMS783513
                10.15761/IMM.1000202
                5026314
                a95cf9f5-409a-475e-bb18-bb15669c906c

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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                diabetes,homebound elderly,verbal iq,cognitive impairment

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