LIFESTYLES I focus hereon the chronic diseases of hypertension, cardiovascular disease, and diabetes not only due to their high prevalence in old age, but because of the related changes in lifestyles expressed through improved health behaviors (cf. also Leventhal et al., 2008; Schaie et alb Hypertension Hypertension is associated with poorer cognitive performance at all adult ages, primarily on fluid-type tests (e.g., attention, learning, memory, executive functions Elias & Robbins, 1991; Elias et al., 1987 ; P. Elias et al., 1995; Waldstein & Elias, 2001 ); crystallized abilities are less affected. Chronic hypertension is associated not only with level of cognition but also with accelerated longitudinal decline ( Elias et al., 1996; Elias et al., 1998; Knopman et al., 2000 ). Hypertension impacts cognitive decline in young adults as well as the aged (PK. Elias et al., 2004 ). Ina year longitudinal study, cognitive decline was 12.1 percent greater for hypertensives compared to nor- motensives. Prospective cohort studies reported that the higher blood ( Swan et al., 1992 ). Moreover, anti- hypertensive therapy has increased two- to threefold in recent cohorts and consideration of the impact of long-term antihypertensive therapy on the relation between hypertension and cognition is critical in longitudinal studies ( Elias et alb Cardiovascular Disease Atherosclerosis contributes to mild but consistent deficits in cognitive performance in midlife and old age ( Waldstein & Elias, 2001
). Community-based studies of dementia ( Lim et al., 1999 ) have found that cerebrovascular pathology often co-occurs with Alzheimer ’ s disease (AD) pathology ( Snowdon et al.,
1997 ). Up to 45 percent of community-based incident dementia cases with autopsy-proven AD have co-occurring cerebral infarctions ( Lim et al., 1999 ). In cases with vascular disease, less AD neuropathol- ogy is necessary for similar severity of clinical dementia Snowdon et al., 1997 ), especially at earlier stages of the disease ( Esiri et al., 1999 ). However, most of this evidence comes from cross-sectional studies with few longitudinal studies relating cognitive performance and atherosclerosis. Diabetes Case control studies of Type 2 diabetes in older adults have found cognitive impairment, most commonly for fluid-type abilities of learning and memory (Hassing et al., ab Strachan et al., 1997 ). Large-scale epidemiological studies support the findings of case control studies, but most have been cross- sectional. An exception is the Framingham Health Study, which reported evidence of a causal relationship between diabetes and cognitive dysfunction ( Elias et al., 1997 ). Duration of diabetes was related to poorer performance on verbal memory and abstract reasoning tests.
Chapter HISTORICAL INFLUENCES ON AGING AND BEHAVIOR