Chronic Diseases and Neurocognition

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Disease of any physiological system can negatively impact the brain and cognitive function (see Armstrong and Morrow, in press; Tarter et al, 2001; Waldstein and Elias, 2001). Cardiovascular diseases have been studied fairly extensively, and a range of conditions are associated with cognitive decrements. These include cardiac arrythmias (Mead and Keir, 2001), clinical coronary disease or myocardial infarction (Vingerhoets et al, 1997), heart failure (Vogels et al, 2007), and peripheral arterial disease (Waldstein et al, 2003). Various indices of sub-clinical vascular disease such as carotid intimal-medial thickening (Wendell et al, 2009), pulse wave velocity (Waldstein et al, 2008), brachial flow-mediated dilation (Cohen et al, 2009), and left ventricular hypertrophy (Elias et al, 2007) are similarly associated with poor cognitive outcomes.

Negative cognitive outcomes are also associated with type I and type II diabetes mellitus, pulmonary diseases such as chronic obstructive pulmonary disease and asthma, hepatic diseases such as cirrhosis, kidney diseases, autoimmune diseases such as systemic lupus erythematosus, various cancers, sleep disorders such as obstructive sleep apnea, and the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) (see Bellia et al, 2007; Biessels et al, 2008; Borson et al, 2008; Kurella et al, 2005; Tarter et al, 2001; Zhang et al, 2007).

Medical and surgical treatments for disease affect cognitive function though in inconsistent directions. For example, prospective investigations generally indicate better cognitive outcomes for those taking antihypertensive medication than untreated hypertensives (Murray et al, 2002). Yet, results of double-blind, placebo controlled trials of antihypertensive have yielded complex and conflicting findings. Statin use may also be related to lesser prospective decline in cognitive performance (Szwast et al, 2007), although results of investigations of statin administration are mixed. Treatments for asthma (e.g., corticosteroid, theophylline) have yielded similarly mixed findings. Acute improvements in cognitive function have been associated with oxygen-related treatments for chronic obstructive pulmonary disease and obstructive sleep apnea syndrome and with hemodialysis (see Tarter et al, 2001). Coronary artery bypass surgery - a major surgical intervention - has been associated with both short- and long-term cognitive difficulties, although long-term alterations in performance may be attributable to the underlying disease (Royter et al, 2005).

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