Handbook of Psychology

Cognition and Neuropsychology 493

Figure 21.1 Change in estimated mean Adjusted Fluid V-P (Visualization-
Performance) scores over twenty years for Hypertensive (H) and Normoten-
sive (N) cohorts participating in the Maine-Syracuse Longitudinal Study of
Cognitive Function. Change scores are adjusted for age, education, occupa-
tion, gender, and treatment with antihypertensive medication. Adapted for
this chapter from tabled data presented in Elias, M. F., Robbins, M. A., Elias,
P. K., and Streeten, D. H. P. (1998). A longitudinal study of blood pressure in
relation to performance on the Wechsler Adult Intelligence Scale. Health
Psychology, 17,486...493, with permission of the authors.

0

WAIS Adjusted Change Scores

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Fluid V-P

N H

with decline in psychomotor speed (Digit Symbol Substitu-
tion). None of the BP predictors were signi“cantly related to
the crystallized-verbal composite score. Age at entry into
the study (at baseline) was signi“cantly associated with lon-
gitudinal decline and was positively correlated with blood
pressure. However, all signi“cant associations between
blood pressure predictors and cognitive performance scores
remained statistically signi“cant when adjusted for the age
at entry into the study (baseline). Most importantly, there
were consistent reductions in the strength and magnitude of
associations between age and cognitive functioning when
the various measures of blood pressure were introduced into
the model following age and the other covariates. For ex-
ample, introducing the control for systolic blood pressure
averaged over all examinations reduced associations be-
tween age and the ”uid ability composite measure by 50%.
This “nding is consistent with a cross-sectional report by
Madden and Blumenthal (1998) that age-related variance in
a measure of selective attention was reduced by approxi-
mately 58% when systolic and diastolic blood pressure were
controlled.
These “ndings have been replicated more recently with a
larger sample of men and women and are consistent with the
results of a 15-year study of neuropsychological test perfor-
mance (M. Elias et al., 1998b). The higher the blood pressure,
the greater was the rate of decline per year of longitudinal

study participation. From this work, we conclude that hyper-

tension and increments in systolic or diastolic blood pressure

are related to more accelerated rates of decline in cognitive

functioning.

Future Research

While interactions of age and hypertension, and to a lesser

extent, diabetes, insulin resistance, stroke, and coronary

bypass surgery (Newman, Stygall, & Kong, 2001; C. Ryan,

2001) have received major attention in the cognitive function

literature, there are many cardiovascular disease (CVD)

risk factors (with positive or negative effects on cognitive

function) that have not been studied suf“ciently with regard

to age. These include cigarette smoking, cholesterol, obesity,

left ventricular hypertrophy, family history of premature

coronary heart disease (CHD), low blood levels of folate and

vitamin B12, and elevated homocysteine levels. These areas

also offer excellent research opportunities: low blood pres-

sure, menopause, estrogen, estrogen replacement, and oral

contraceptive devices. A review of this literature (M. Elias

et al., 2001) indicates that each of these risk factors has been

related to lowered cognitive functioning in geriatric popula-

tions and many with AD and brain morphology, but also

with lowered cognitive performance in elderly individuals.

M. Elias et al. (2001) point out that particularly promising re-

search opportunities exist with respect to Apolipoprotein e4.

Apolipoprotein e4 (APOE-4) allele is not only a risk factor

for AD but also for cognitive decline within generally normal

limits (Riley et al., 2000) and in the absence of dementia

(Small, Basun, & Bachman, 1998). It is particularly impor-

tant to have studies that examine the impact of cardiovascu-

lar risk factors on cognitive functioning in the presence of the

APOE-4 allele and that they do so in the context of designs

that consider aging (longitudinal change in cognitive func-

tioning) or age cohort differences. Many studies have had the

opportunity to do this via a large sample of men and women

varying widely in age but have neglected to do so. It is

particularly important to undertake these studies as well as

give more attention to women•s health issues. For example,

Rosenberg et al. (1985) reported that female smokers who

use oral contraceptives are at 20 times the risk of coronary

heart disease than female nonsmokers who do not use oral

contraceptives. We are unaware of any studies relating the

cumulative risk of smoking and oral contraception to cogni-

tive functioning in the context of aging research.

It is now well-known that hard-driving aggressiveness,

hostility, depression, anxiety, anger, social isolation, low

social support, low socioeconomic status, marital stress, and