Blood Pressure, White Matter Disease, and Cognitive Decline in the Normal Elderly Population

Age-related changes in brain morphology have been linked to memory loss, declines in executive functioning, and slower reaction time. Furthermore, hypertension is a strong risk factor for cognitive decline. However, few studies have examined longitudinal relationships between blood pressure, frontal white matter integrity, hippocampal grey matter volume, and cognition within a healthy elderly population. This study utilized structural MRI and neuropsychological tests administered two years apart to examine these relationships in a sample of healthy, community-dwelling older adults aged 75-90. Results indicated that increases in frontal white matter disease and, more strongly, declines in hippocampal volume were better predictors of cognitive change than age and education. No significant associations were observed between blood pressure and cognition. These findings suggest tracking trajectories of structural change within the brains of elderly individuals over time can facilitate identification of those at risk for cognitive decline.

Psychometrics of the AAN Caregiver Driving Safety Questionnaire and Contributors to Caregiver Concern about Driving Safety in Older Adults

The American Academy of Neurology (AAN) updated their practice parameters in the evaluation of driving risk in dementia and developed a Caregiver Driving Safety Questionnaire, detailed in their original manuscript (Iverson Gronseth, Reger, Classen, Dubinsky, & Rizzo, 2010). They described four factors associated with decreased driving ability in dementia patients: history of crashes or citations, informant-reported concerns, reduced mileage, and aggressive driving. An informant-reported AAN Caregiver Driving Safety Questionnaire was designed with these elements, and the current study was the first to explore the factor structure of this questionnaire. Additionally, we examined associations between these factors and cognitive and behavioral measures in patients with mild cognitive impairment or early Alzheimer\u27s disease and their informants. Exploratory factor analysis revealed a four-component structure, consistent with the theory behind the AAN scale composition. These four factor scores also were significantly associated with performance on cognitive screening instruments and informant reported behavioral dysfunction. Regressions revealed that behavioral dysfunction predicted caregiver concerns about driving safety beyond objective patient cognitive dysfunction. In this first known quantitative exploration of the scale, our results support continued use of this scale in office driving safety assessments. Additionally, patient behavioral changes predicted caregiver concerns about driving safety over and above cognitive status, which suggests that caregivers may benefit from psychoeducation about cognitive factors that may negatively impact driving safety