Background. Research identifies isolation (being alone) as a risk factor for cognitive decline— yet it is possible that subjective dimensions of isolation are more critical. Potential risk factors are loneliness (the distress stemming from feeling alone) and cynical hostility (an attitude of distrust and cynicism). The present study examined the relationship between these factors and cognitive functioning and decline. Methods. Data came from the Health and Retirement Study, a nationally representative longitudinal study of US adults over 50. Loneliness was measured using the Hughes Loneliness Scale; cynical hostility was measured using items from the Cook-Medley Hostility Inventory. Cognitive functioning was indexed by the Telephone Interview for Cognitive Status. Regressions were conducted to examine loneliness and cynical hostility as predictors of cognitive function at baseline as well as cognitive decline over four and six-year periods. Models were adjusted for demographic characteristics, health behaviors, and isolation. Results. Loneliness, [f2=.003, t(52)=-3.75; p<.001] and cynical hostility, [f2=.002, t(52)=-2.98, p=.004] predicted cognitive function at baseline. Loneliness and cynical hostility each predicted cognitive decline over four [f2=.001, t(52)=-2.29; p=.026 f2=.003, t(52)=-3.98; p<.001 respectively] but not six years [t(52)= -.78; p=.439; t(52)= -1.29; p=.203 respectively]. Discussion. Loneliness and cynical hostility are correlates of lower cognitive function and risk factors for cognitive decline over four years. The absence of significant effects of loneliness and cynical hostility over six years could be attributed to low statistical power in these analyses. The effect sizes in this study are small, yet meaningful in the context of the personal and social costs associated with cognitive decline.

Introdução O envelhecimento populacional é uma realidade no Equador e este fato resulta em maior prevalência dos problemas mais frequentes em idosos, dentre eles, a deterioração das funções cognitivas. Objetivo Avaliar a função cognitiva, prevalência e fatores de risco associados ao declínio cognitivo e demência em pessoas com mais de 65 anos em Cumbayá-Quito, Equador. Métodos Este é um estudo de observação transversal que foi realizado em adultos com mais de 65 anos de idade. O Mini Exame do Estado Mental (MMSE), o Dementia Screening Interview (AD8) e a Mini Avaliação Nutricional (MNA) foram utilizados para avaliar o estado cognitivo e os hábitos nutricionais dessa população. Resultados Um total de 144 pacientes (idade média 75,3; 77,1% mulheres) fizeram parte deste estudo; 40% dos pacientes apresentaram testes positivos (AD8 e MMSE) consistentes com comprometimento cognitivo, possível demência. A idade (p<0,01), a escolaridade inferior (p <0,01), acidente vascular cerebral (p <0,01), hemorragia intracerebral (p<0,01), diabetes mellitus (p<0,01) e desnutrição (p<0,01) foram riscos significativos para o comprometimento cognitivo. O exercício (p <0,03) e o consumo de álcool (p=0,02) foram fatores de risco protetores para o declínio cognitivo nessa população. Gênero, etnia, localização, traumatismo craniano, doença de Parkinson, colesterol alto, diabetes, infarto do miocárdio, doença da tireóide, depressão, ansiedade, história familiar de demência não foram associados ao declínio cognitivo nessa população. Conclusões A prevalência de comprometimento cognitivo e possível demência aos 65 anos é de 18-21% e aos 85 anos é de 54-60% em Cumbayá, Quito, Equador. Os principais fatores de risco para deficiência cognitiva nesta população são idade, educação, desnutrição, acidente vascular cerebral e diabetes mellitus. Os fatores protetores para o declínio cognitivo foram o exercício e possivelmente o consumo moderado de álcool. / Introduction Population aging is a reality in Ecuador and this fact results in a higher prevalence of the most frequent problems in the elderly, among them, the deterioration of cognitive functions. Objective To assess the cognitive function, prevalence, and risk factors associated with cognitive decline and dementia in people over 65 years of age in Cumbayá-Quito, Ecuador. Methods This is a cross-sectional observational study that was carried out in adults over 65 years of age. The Mini Mental Scale Examination (MMSE), Dementia Screening Interview (AD8) and Mini Nutritional Assessment (MNA) were used to assess the cognition status and nutritional habits of this population. Results A total 144 patients (mean age 75.3; 77.1% females) were part of this study; 40% of patients had positive tests (AD8 & MMSE) consistent with cognitive impairment, possible dementia. The age (p<0.01), lower school education (p<0.01), stroke (p<0.01), intracerebral hemorrhage (p<0.01), diabetes (p<0.01) and malnutrition (p<0.01), were significant risk factors for cognitive impairment. Exercise (p<0.03) and consumption of alcohol were a protective risk factor for cognitive decline in this population. Gender, ethnicity, location, head trauma, Parkinson disease, high cholesterol, diabetes, myocardial infarction, thyroid disease, depression, anxiety, family history of dementia were not associated with cognitive decline in this population. Conclusions The prevalence of cognitive impairment and possible dementia at the age of 65 years is 18-21% and at age 85 years is 54-60% in Cumbayá, Quito, Ecuador. The main risk factors for cognitive impairment in this population were age, education, malnutrition, stroke, and diabetes. Protective factors for cognitive decline were exercise and possibly modest consumption of alcohol.

Delirium, or “acute confusion” is a common and serious acute neuropsychiatric syndrome mainly affecting older people. It is associated with multiple adverse outcomes, including an increased risk of developing dementia and increased mortality. The underlying mechanisms of delirium are poorly understood, and there are currently no specific treatments. This thesis investigated the roles of the hypothalamic-pituitary adrenal axis and inflammation in the pathophysiology of delirium, persistent delirium and cognitive decline following delirium. It investigated whether levels of cortisol in blood and cerebrospinal fluid (CSF) are elevated in delirium, with elevated pro-inflammatory and reduced anti-inflammatory cytokines. It also investigated whether there is loss of cortisol diurnal rhythm (in saliva) with elevated afternoon cortisol levels. The thesis investigated whether any hypercortisolaemia was sustained during the year after delirium, and whether this was associated with deterioration in cognition during the year after hip fracture. Finally, it also tested whether there are high levels of a marker of central nervous system damage (S100B) and of a dementia marker (tau) in CSF in delirium. A prospective observational cohort study was conducted in N=108 patients aged over 60 who had sustained a hip fracture, in whom 40% developed delirium. Participants gave informed consent or if they lacked capacity to give informed consent, this was given by their next of kin. Participants were assessed regularly for delirium, according to DSM IV criteria, during the two weeks after hip fracture. A sample of CSF was collected during the spinal anaesthetic performed for the operation to repair their fracture. Samples of blood and saliva were collected during the two weeks after the hip fracture operation. Participants were visited three, six and twelve months after their hip fracture for further delirium assessment, and a cognitive test battery was completed. Further samples of blood and saliva were collected at these visits. The study found evidence of high levels of cortisol and of S100B in CSF in those with active delirium, but there were no differences in levels of tau or cytokines in CSF. Those with delirium had elevated serum cortisol during the perioperative period, and elevated afternoon salivary cortisol, suggesting flattening of cortisol diurnal rhythm with failure to reach the normal diurnal nadir. After adjusting for confounders in a multivariate logistic regression analysis, serum cortisol was still predictive of delirium, but salivary cortisol AM:PM ratio had a trend towards significance. Those who had persistent delirium features in the months after hip fracture had significantly higher serum cortisol three months after hip fracture. There was a change in serum inflammatory profile in those with delirium, with a shift towards a pro-inflammatory state. Testing the study hypotheses surrounding cognition after delirium was very challenging, due to patient attrition and other factors. Some participants showed a trajectory of cognitive improvement, which was probably due to resolution of delirium during the year after hip fracture. Those with resolved delirium had deficits in verbal and visual memory. This study has improved understanding of the mechanisms of delirium, suggested further avenues for research and identified possible new therapeutic targets.

Down’s Syndrome (DS) is a genetic disorder associated with intellectual disability, accelerated aging and a propensity for early-onset Alzheimer’s disease (AD). Beta-amyloid plaques are one of the pathological hallmarks of AD, and also a common characteristic of the older DS brain. AD treatment trials are now moving towards administration of the intervention at preclinical stages, with the goal of preventing cognitive decline in the first place, rather than trying to halt or reverse existing pathology. Consequently, it has become essential to develop biomarkers of AD, which can: 1. Predict clinical changes and 2. Track the effectiveness of putative preventative treatments. The strong association between DS and AD means that this research is particularly important for people with DS and it presents a high-risk group for exploring predictive biomarkers. Electroencephalography (EEG) is a non-invasive and inexpensive measure of cortical activity, which is being evaluated with the typically developing (TD) population as a potential biomarker of AD. This thesis aims to evaluate EEG as a potential predictor of cognitive decline associated with DS-AD. There are several potential EEG measures that could be explored. Following a review of the literature, the predictive potential of the following event-related potentials (ERPs): mismatch negativity (MMN) and P300 (P3a and P3b), were chosen for exploration with cross-sectional and longitudinal investigations. The thesis begins by exploring how the ERPs differ for a cross-section of 36 adults with DS and 39 age- and gender-matched TD controls. As expected, the MMN waveform was smaller for adults with DS than TD controls. However, the P3b waveform was predominantly absent for adults with DS, whilst the P3a response was significantly enlarged. The P3a response was also enlarged for the adults with DS who scored lower on a neuropsychological measure. The neuropsychological measure indexes frontal functions, which are compromised early in DS-AD. This experiment also provided evidence that MMN was related to age in DS, with increasing latencies and decreasing amplitudes for older participants. The differences in MMN amplitude between the groups (DS, TD) were isolated to the older adults. These findings lend support to the premature aging hypothesis of DS. The thesis also included a longitudinal follow-up in which 34 adults with DS underwent a repeated cognitive examination one year after their EEG and initial cognitive assessment. The analyses found that adults with DS who had lower MMN amplitudes at the initial assessment were more likely to decline at the cognitive follow-up. This finding suggests that MMN may be a potentially useful clinical tool for predicting the cognitive decline associated with DS-AD.

Alzheimer's disease (AD) has multiple factors that contribute to the disease process. Among these is a state of chronic inflammation that is endured by the brain during the aging process. The use of non-steroidal anti-inflammatory drugs (NSAIDs) decreases the amount of neuroinflammation sustained by the brain, and greater levels of NSAID use have been demonstrated to be associated with decreased probability of developing AD. This study looked at whether greater rates of NSAID use were also associated with decreased rates of cognitive and funtional decline and survival in a population-based sample of persons with AD.

Les profils de comportement alimentaire ou de consommation de nutriments sont des stratégies prometteuses pour étudier le lien entre nutrition et fonctions cognitives chez les personnes âgées, car ils permettent de prendre en compte la complexité des apports alimentaires. Des profils dits « sains », définis a priori pour évaluer l’adhérence à une alimentation spécifique, ou construits a posteriori à partir des données observées, ont été associés à de meilleures fonctions cognitives. Jusqu’à présent, aucune étude n’avait estimé l’association longitudinale entre profils a posteriori et déclin cognitif. L’objectif principal de cette thèse en cotutelle entre l’Université Bordeaux Segalen et l’Université Laval était d’investiguer l’association entre des profils de nutriments a posteriori et le déclin cognitif par une analyse longitudinale dans deux cohortes de personnes âgées en France et au Canada. Parmi les participants français de l’étude Trois-Cités (3C) et ceux de l’étude longitudinale québécoise NuAge, respectivement 1388 et 1454 sujets avaient des mesures répétées de cognition et des données nutritionnelles à l’inclusion. Une méthode similaire d’analyse en composantes principales a été utilisée, permettant d’identifier trois profils de nutriments dans chaque cohorte. La qualité de l’alimentation et les caractéristiques du mode de vie et socioéconomiques associées à chaque profil de nutriments ont été décrites dans une première étude. Ensuite, des analyses longitudinales ont été menées pour estimer l’association entre la fonction cognitive, son déclin et les profils de nutriments identifiés. Dans les deux cohortes, un premier profil a été observé associé à une meilleure qualité nutritionnelle en opposition à un second profil de moins bonne qualité nutritionnelle. Dans l’étude 3C, le profil « sain » était associé à de meilleures fonctions cognitives à l’inclusion alors que le profil « occidental » était associé à de moins bonnes fonctions cognitives. Aucune association entre profils de nutriments et déclin cognitif dans le temps n’a été observée dans les deux cohortes. Le niveau de preuve concernant des profils de consommation d’aliments ou de nutriments chez l’aîné n’est pas suffisant pour le développement de politiques publiques nutritionnelles de prévention du déclin cognitif. / Dietary or nutrient patterns may be promising strategies to investigate the association between nutrition and cognitive function in older persons, because they capture the complexity of food intake. Both a priori defined, measuring adherence to specific diets, and a posteriori data driven dietary patterns have been reported to be associated with better cognitive function in older persons. To date, no study has investigated the link between a posteriori derived nutrient patterns and cognitive decline. The main objective of this thesis, co-directed between University Bordeaux Segalen and University Laval, was to assess the relationship of nutrient patterns with cognitive impairment and decline in two cohorts of older persons from France and Canada in a longitudinal analysis. Among the subjects from the Three-City (3C, France) study and Quebec Longitudinal Study NuAge (Quebec, Canada), respectively 1,388 and 1,454 had nutritional data at baseline and repeated measures of global cognitive function over 5 years. A similar principal component analysis was used in the two samples to derive nutrient patterns and allow the identification of three nutrient patterns in each study. The diet quality, lifestyle and socio-economic characteristics associated with each nutrient pattern were described in a first study. Then, longitudinal analyses were performed in both cohorts to estimate the association between nutrient patterns and cognitive function or decline. In both cohorts, we observed an opposition in diet quality between the first two nutrient patterns. In 3C, the healthy nutrient pattern was associated with better cognitive function at baseline, whereas the western nutrient pattern was associated with cognitive impairment at baseline. No association between any of the nutrient patterns and cognitive decline was reported in both cohorts. To date, the evidence concerning dietary or nutrient patterns and cognitive function in older persons does not yet allow the development of nutritional policies and programs to prevent cognitive decline.

The purpose of this study was to describe the relationships among common signs/symptoms (depression, fatigue, declines in cognitive function) in women with multiple sclerosis (MS) using a modified version of Braden's Self Help Theoretical Model and evaluate whether depression, fatigue, declines in cognitive function and uncertainty, enabling skills (self-control in this study) and self-management (coping in this study) influence quality of life outcomes in women with MS. MS is one of the most common causes of disability among young adults and is the most prevalent neurological disease among young and middle-aged adults in certain parts of the world. Although research had previously been undertaken with regards to the common symptoms of MS, uncertainty, enabling skills, self-management and quality of life, there had been no studies undertaken that involved all of them. This descriptive study was the first to explore relationships among common symptoms of MS, uncertainty, enabling skills, self-management and quality of life in an MS population using Braden's Learned Response Chronic Illness Self Help Model. A cross-sectional descriptive study was conducted with 106 participants. Measurement tools utilized in the study included: 1) Demographic and Illness Characteristics, 2) The Modified Fatigue Impact Scale, 3) Perceived Deficits Questionnaire, 4) Patient Health Questionnaire-9, 5) Mishel's Uncertainty in Illness Scale- Adult, 6) Rosenbaum's Self-Control Scale- Modified, 7) COPE Inventory-Brief, and 8) SF-36 Health Status Questionnaire. Data analysis involved descriptive statistics, correlations and linear regression to answer the specific aims. The study findings indicate that relationships exist among depression, fatigue, declines in cognitive function, uncertainty, enabling skills and self-management in women with MS. The study findings also indicate that depression, fatigue, declines in cognitive function, uncertainty, enabling skills and self-management influence quality of life outcomes in women with MS. Finally, while only a first study, the research findings indicate using a modified version of Braden's Learned Response Chronic Illness Self Help Model (LRCISHM) is appropriate in a population of women with MS. Future research involving women with MS who meet the inclusion criteria across the contiguous United States as well as male military veterans with MS is recommended. Research involving this modified version of Braden's LRCISHM as well as research incorporating disability levels is recommended. Research to develop interventions to improve quality of life outcomes and minimize distress is also recommended.

Myelin damage is known to increase in the normal aging brain and to correlate with age-related cognitive decline. While the causes of increased myelin damage are unknown, here we consider whether the brain’s innate capacity for remyelination diminishes with age and hence could contribute to myelin damage through slow accumulation of myelin defects. Maintenance and repair of myelin depends upon oligodendroglia precursor cells (OPCs), which must differentiate into a sufficient number of healthy mature oligodendroglia (oligos), the myelinating cell of the brain. The extracellular matrix molecule hyaluronic acid (HA) has been shown to inhibit maturation of OPCs into mature myelinating oligos. The present study examined aging changes in myelination using four markers: the damaged myelin basic protein (dMBP) antibody, a histochemical reaction to stain HA, and immunohistochemistry for OPCs and mature oligos. These markers were quantified using cell density (oligos and OPCs), percent area stained (HA and dMBP), and fluorescence intensity (HA and dMBP). Relationships between these markers, age, and behavioral measures of cognitive function were investigated using single and multiple regression analyses. Results showed that in the corpus callosum and cingulum bundle of the rhesus monkey, staining for dMBP as a marker of myelin damage strongly correlated with increases in HA. The increase in HA in the cingulum bundle correlated positively with age. OPC density increased with age in both the cingulum bundle and corpus callosum. Mature oligo density did not change significantly with age, but approached a significant increase in the cingulum and approached a significant decrease in the corpus callosum. The increase in OPC density correlated positively with both HA and dMBP in the cingulum bundle. These data are consistent with the hypothesis that HA accumulation contributes to myelin damage by inhibiting the differentiation of OPCs into mature oligodendrocytes, diminishing the brain’s innate capacity for remyelination with age.

Made available in DSpace on 2014-06-11T19:22:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-10-25Bitstream added on 2014-06-13T18:08:43Z : No. of bitstreams: 1 quadrosjunior_ac_me_rcla.pdf: 352146 bytes, checksum: c3d8dd4a171b920e5f714d014ac267d4 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O envelhecimento provoca declínios físico e/ou cognitivo. Ainda, algumas conseqüências da institucionalização do idoso parecem influenciar negativamente suas esferas física e cognitiva, geralmente já prejudicadas. Porém, o exercício aeróbio pode beneficiar ambas as esferas. Assim, esta pesquisa divide-se em Estudo #1 (transversal) e Estudo #2 (longitudinal) OBJETIVO: realizar o perfil de nível de atividade física, independência funcional básica, funções executivas, memória e estado cognitivo geral de idosos moradores de instituições de longa permanência para idosos de Rio Claro-SP (Estudo #1), e analisar possíveis efeitos de um programa de Dança de Salão nestas variáveis (Estudo #2). MATERIAIS E MÉTODOS: para o Estudo #1, a amostra foi aleatória e abrangeu 89,8% da população institucionalizada. Para o Estudo #2, a amostra foi de 14 idosos no Grupo Controle e de 13 idosos no Grupo Treinamento; o treinamento foi de três sessões de Dança de Salão por semana, durante seis meses. Em ambos os estudos foi aplicada a mesma bateria de testes e questionários. Os dados foram analisados com p<0,05. No Estudo #1, foi calculada média, desvio-padrão e quartis, além do coeficiente de correlação de Pearson para nível de atividade física e independência funcional básica com as outras variáveis. No Estudo #2, utilizou-se o teste de Shapiro-Wilk para analisar a normalidade da distribuição dos dados, teste t de Student para análise de similaridade inicial entre ambos os grupos. Assim, utilizou-se ANOVA two-way, three-way e four-way, dependendo do teste, além do coeficiente de correlação de ix Pearson. RESULTADOS: Em ambos os estudos, o desempenho dos idosos foi muito abaixo do esperado. No Estudo #1, obteve-se: idade=75,3 anos; Mini- Exame do Estado Mental=11,5 pontos; Escala Geriátrica de Depressão=12,8 pontos; Questionário Baecke Modificado... / Aging causes physical and/or cognitive decline. Moreover, some consequences of older adult’s institutionalization seem to exert a negative influence on their physical and cognitive spheres, which are generally are impaired. Anyhow, aerobic exercise can benefit both spheres. So, this research is divided into Study #1 (transversal) and Study #2 (longitudinal). OBJECTIVE: accomplish the profile of physical activity level, basic functional independence, executive functions, memory and general cognitive state of older adults living in the long-care homes at Rio Claro-SP (Study #1), and to analyze the possible effects of a Ballroom Dancing program in those variables (Study #2). MATERIAL AND METHODS: the sample selected in the framework of the Study#1 was randomized and achieved 89,8% of institutionalized population. With regard to Study #2, the sample included 14 older adults in the control group and 13 older adults in the training group. The training consisted by three sessions of Ballroom Dancing a week, during six months. The same battery of tests and questionnaires was applied to both studies. The data were analyzed with p<0,05. Along the Study #1, the mean and the standard-desviation e quarters were calculated, as well as the Pearson correlation coefficient concerning the physical activity level and the basic functional independence with other variables. Along the Study #2, ANOVA two-way, three-way e fourway was used, according with the test, in addition to the Pearson correlation coefficient. RESULTS: in both studies, older adult’s engagement was lower than expected. Study #1 shows that: age=75.3 years old; Mini Exam of Mental State=11.5 points; Geriatric Depression Scale=12.8 points; Modified Baecke 100 Questionnaire for Older Adults=1.0 point, and Katz Scale of Basic Functional Independence=4.5 points, in addition... (Complete abstract click electronic access below)

Introdução O envelhecimento populacional é uma realidade no Equador e este fato resulta em maior prevalência dos problemas mais frequentes em idosos, dentre eles, a deterioração das funções cognitivas. Objetivo Avaliar a função cognitiva, prevalência e fatores de risco associados ao declínio cognitivo e demência em pessoas com mais de 65 anos em Cumbayá-Quito, Equador. Métodos Este é um estudo de observação transversal que foi realizado em adultos com mais de 65 anos de idade. O Mini Exame do Estado Mental (MMSE), o Dementia Screening Interview (AD8) e a Mini Avaliação Nutricional (MNA) foram utilizados para avaliar o estado cognitivo e os hábitos nutricionais dessa população. Resultados Um total de 144 pacientes (idade média 75,3; 77,1% mulheres) fizeram parte deste estudo; 40% dos pacientes apresentaram testes positivos (AD8 e MMSE) consistentes com comprometimento cognitivo, possível demência. A idade (p<0,01), a escolaridade inferior (p <0,01), acidente vascular cerebral (p <0,01), hemorragia intracerebral (p<0,01), diabetes mellitus (p<0,01) e desnutrição (p<0,01) foram riscos significativos para o comprometimento cognitivo. O exercício (p <0,03) e o consumo de álcool (p=0,02) foram fatores de risco protetores para o declínio cognitivo nessa população. Gênero, etnia, localização, traumatismo craniano, doença de Parkinson, colesterol alto, diabetes, infarto do miocárdio, doença da tireóide, depressão, ansiedade, história familiar de demência não foram associados ao declínio cognitivo nessa população. Conclusões A prevalência de comprometimento cognitivo e possível demência aos 65 anos é de 18-21% e aos 85 anos é de 54-60% em Cumbayá, Quito, Equador. Os principais fatores de risco para deficiência cognitiva nesta população são idade, educação, desnutrição, acidente vascular cerebral e diabetes mellitus. Os fatores protetores para o declínio cognitivo foram o exercício e possivelmente o consumo moderado de álcool. / Introduction Population aging is a reality in Ecuador and this fact results in a higher prevalence of the most frequent problems in the elderly, among them, the deterioration of cognitive functions. Objective To assess the cognitive function, prevalence, and risk factors associated with cognitive decline and dementia in people over 65 years of age in Cumbayá-Quito, Ecuador. Methods This is a cross-sectional observational study that was carried out in adults over 65 years of age. The Mini Mental Scale Examination (MMSE), Dementia Screening Interview (AD8) and Mini Nutritional Assessment (MNA) were used to assess the cognition status and nutritional habits of this population. Results A total 144 patients (mean age 75.3; 77.1% females) were part of this study; 40% of patients had positive tests (AD8 & MMSE) consistent with cognitive impairment, possible dementia. The age (p<0.01), lower school education (p<0.01), stroke (p<0.01), intracerebral hemorrhage (p<0.01), diabetes (p<0.01) and malnutrition (p<0.01), were significant risk factors for cognitive impairment. Exercise (p<0.03) and consumption of alcohol were a protective risk factor for cognitive decline in this population. Gender, ethnicity, location, head trauma, Parkinson disease, high cholesterol, diabetes, myocardial infarction, thyroid disease, depression, anxiety, family history of dementia were not associated with cognitive decline in this population. Conclusions The prevalence of cognitive impairment and possible dementia at the age of 65 years is 18-21% and at age 85 years is 54-60% in Cumbayá, Quito, Ecuador. The main risk factors for cognitive impairment in this population were age, education, malnutrition, stroke, and diabetes. Protective factors for cognitive decline were exercise and possibly modest consumption of alcohol.