Effect of leisure activities on inflammation and cognitive function in an aging sample

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Abstract

Cardiovascular disease risk factors (CVDRFs) increase the risk of dementia. The purpose of this study was to examine whether leisure activities (mental, physical, and social activities) modified the effect of CVDRFs on inflammatory markers and cognitive function in middle and old age. A secondary-data analysis study was conducted using data from 405 middle-age participants (40–59 years) and 342 old-age participants (60–84 years) who participated in the Survey of Midlife Development in the United States (MIDUS). CVDRFs were obtained from a combination of self-report medical history and blood-based biomarkers. Three CVDRF groups (≤1, 2, and ≥3 CVDRFs) were identified. More CVDRFs were significantly associated with higher levels of inflammatory markers in both age groups, and associated with lower levels of executive function (EF) in the old age group. CVDRFs were not related to the frequency of leisure activities in either age group. After controlling for covariates, higher levels of physical activities were significantly associated with lower levels of inflammatory markers, and higher levels of mental activities were associated with higher levels of cognitive function. In the old age group, physical activities also moderated the effect of CVDRFs on episodic memory (EM), and mental activities moderated the effect of CVDRFs on interleukin-6 (IL-6). Multiple CVDRFs may be associated with poorer cognitive function and higher inflammatory markers, but middle-age and older adults with CVDRFs may not engage in frequent physical and cognitive activities that may be protective. It is important to develop strategies to facilitate engagement in these activities from midlife.

Introduction

Dementia is the sixth leading cause of mortality in the United States (Alzheimer's Association, 2010). Alzheimer's disease (AD) and vascular dementia (VaD) are the two most prevalent types of dementia, together accounting for 80% of all cases of dementia (Alzheimer's Association, 2010). Recent converging evidence points to several CVDRFs associated with development of AD and VaD (Yaffe et al., 2009, Profenno et al., 2011). Over 40 million Americans aged 60 years or older have one or more types of cardiovascular disease (Roger et al., 2011). While it is important to control those known CVDRFs, it is also important to maintain cognitive function, an important indicator of functional independence and high quality of life, when individual are unable to maintain cardiovascular health. However, it is unclear whether older adults with CVDRFs are making efforts to prevent cognitive decline.

High levels of inflammatory markers, especially IL-6 and C-reactive protein (CRP), are common in individuals with CVDRFs. Inflammation further increases the risk of later cardiovascular events and cognitive decline (Kuo et al., 2005, Swardfager et al., 2011). An observational prospective study of older adults with metabolic syndrome found that higher levels of inflammatory markers were associated with cognitive decline (Yaffe et al., 2004). In contrast, in a study of middle- and old-age adults with diabetes, CRP was not associated with the severity and progression of white matter lesions (Umemura et al., 2011), suggesting a further clarification of the association between different CVDRFs and inflammatory markers in a wider age range is needed. If inflammation is one of the potential mechanisms linking CVDRFs and cognitive deficits in old age, it is possible that effectively managing inflammation in persons with CVDRFs may indirectly modify cognitive decline.

One way to potentially delay cognitive decline and prevent dementia is to engage in physical, social, and mental activities that may facilitate positive physiological changes in the central nervous system and brain (Stern, 2009). Recent studies have shown that physical activities, including walking, may help preserve cognition in older women with CVDRFs (Vercambre et al., 2011); and increased physical activities are also associated with decreased IL-6 in older adults with impaired glucose tolerance (Yates et al., 2011). Less is known about the protective effect of social or mental activities on cognitive function and inflammatory process in individuals with CVDRFs. There is evidence to suggest that only those activities which challenge established neuronal connections may act to reduce risk for dementia, possibly through increased neural plasticity. For example, in one study, reading and internet use stimulated brain regions important for memory and other higher order cognitive abilities (Small et al., 2009), while passive or less cognitively demanding activities which accommodate with existing cognitive abilities may not have a protective effect. For example, watching TV was found to have a negative association with cognitive performance in old age (Akbaraly et al., 2009).

The purpose of this study was to examine whether leisure activities (mental, physical, and social activities) modified the effect of number of CVDRFs on inflammatory markers (IL-6, and CRP) and cognitive function in middle and old age. While we cannot determine directionality of any putative association with a cross-sectional design, the comparison of two age groups will allow us to affirm such an association exists across adulthood. We attempted to address three specific aims: (1) to compare inflammatory markers, cognitive function, and leisure activities in middle- and old-age individuals with various CVDRFs, (2) to examine whether inflammatory markers would mediate the association between CVDRFs and cognitive function, and (3) to examine whether leisure activities would moderate the effect of number of CVDRFs on inflammatory markers and cognitive function.

Section snippets

Participants

The dataset used in this secondary-data analysis study was from the MIDUS, an on-going nationally representative longitudinal survey of 7108 non-institutionalized respondents, including twins (Brim et al., 2004). The baseline data (MIDUS I) collected between 1995 and 1996 focused on socio-demographic and psychosocial assessments. These assessments were repeated between 2004 and 2006 as MIDUS II Projects 1 and 2 from 4963 participants (adjusted retention rate for mortality was 75% from MIDUS I

Results

According to the cut-off scores of measurements for CVDRFs, in middle-age participants, there were 20.5% with 1 CVDRF (n = 83), 29.9% with 2 CVDRFs (n = 121), 25.7% with 3 CVDRFs (n = 104), 17.5% with 4 CVDRFs (n = 71), 5.9% with 5 CVDRFs (n = 24), and 0.5% with 6 CVDRFs (n = 2). In old-age participants, there were 5.0% without any CVDRFs (n = 17), 27.2% with 1 CVDRF (n = 93), 32.7% with 2 CVDRFs (n = 112), 19.9% with 3 CVDRFs (n = 68), 10.5% with 4 CVDRFs (n = 36), and 4.7% with 5 CVDRFs (n = 16). Given the small

Discussion

Our cross-sectional study included 747 middle-age and older adults participating in a national longitudinal community study, 97.8% of whom had at least one CVDRF based on a combination of laboratory biomarkers and self-reported medical history. Older but not middle-age participants with various CVDRFs significantly differed in levels of EF. Both age groups with various CVDRFs significantly differed in levels of inflammatory markers, but they were similar in their engagement in three types of

Conflict of interest statement

None of the authors has any financial or personal relationships with other people or organizations that could inappropriately influence their work.

Acknowledgement

MIDUS II was supported by from the National Institute on Aging (P01-AG020166) to conduct a longitudinal follow-up of the MIDUS (Midlife in the U.S.) investigation.

The authors report no personal or financial disclosures.

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