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Baseline neuropsychological function was assessed in 2,123 Framingham Heart Study participants and was related to mortality over an 8- to 10-year follow-up period. During that time, 573 persons died. Using Cox proportional hazards models, the authors showed poor cognitive function to be consistently associated with an increased risk of death. This association persisted after adjustment for the confounding effects of age, education, and illness. Subjects scoring below the 26th percentile of performance were at increased risk of mortality compared with high scorers (the relative risk was 1.3 for the 11th percentile-25th percentile and 1.7 for the 1st percentile-10th percentile).

The associations between cigarette smoking history and later cognitive performance were examined among 3, 429 Japanese-American participants of the Honolulu Heart Program (HHP) and its extension, the Honolulu-Asia Aging Study (HAAS). Cognitive performance was measured by the Cognitive Abilities Screening Instrument (CASI), administered as part of HAAS (mean age at HAAS exam (standard deviation (SD)): 77.7 (4.6) years). Information on smoking history was collected during the first and third HHP exams (mean age (SD) at Exam III: 58.6 (4.7) years). Compared with never-smokers, those who had smoked continuously between Exams I–III and those who had quit smoking during that period had significantly lower CASI scores, after adjustment for age, education, Japanese acculturation, and Exam III alcohol intake. In multiple logistic regression controlling for the above covariates, a significantly higher risk of cognitive impairment (CASI score <82) was associated with continuous smoking (odds ratio (OR) = 1.36, 95% confidence interval (CI) 1.10–1.69) and quitting between Exams I–III (OR = 1.36, 95% CI 1.03–1.80) compared with never smoking. This excess risk of cognitive impairment among continuous smokers and Exam I–III quitters was slightly diminished by further adjustment for body mass index and several vascular covariates. Additional analyses suggested a reduced risk of cognitive impairment among the longer-term quitters. This study suggests a positive association between smoking during middle age and later risk of cognitive impairment. Am J Epidemiol 1997;145:507–15. [ABSTRACT FROM AUTHOR]

To investigate the association between idiopathic Parkinson disease (IPD) and reduced frequency of prior cigarette smoking, the authors compared the 29-year follow-up mortality rates and IPD incidence rates of men who were either cigarette smokers or nonsmokers at the time of enrollment in the Honolulu Heart Study (1965–1968). Based on IPD cases detected up to June 30, 1994, the age-adjusted incidence rate in smokers was less than half that in nonsmokers: 34.4 versus 94.2 cases per 100, 000 person-years of pre-illness follow-up, respectively. When data were stratified by 5-year age group, lower IPD incidence in smokers was observed at all ages between 50 and 90 years. Age-specific mortality trends for smokers and nonsmokers with and without IPD suggested that increased mortality in IPD patients was mostly associated with IPD itself and not with smoking. The slight excess mortality in smokers without IPD, versus nonsmokers without IPD, appeared insufficient to account for the “missing” incident IPD cases in smokers. These IPD incidence and mortality data are not highly consistent with the “selective mortality” hypothesis, which attributes reduced prior smoking frequency, typically reported by persons with IPD, to accelerated mortality in undiagnosed IPD-affected persons who smoke. The “protective” association of cigarette smoking with IPD occurrence may thus be real, suggesting the need for further study of biologic mechanisms of protection. Am J Epidemiol 1996; 144: 400–4. [ABSTRACT FROM AUTHOR]

The relation between pulmonary function and cognitive functioning was investigated in a cohort of 3,036 Japanese-American men living in Hawaii. Pulmonary function, as indicated by forced expiratory volume in 1 second (FEV1), was measured at the baseline examination from 1965 to 1968. Cognitive function was assessed by the Cognitive Abilities Screening Instrument (CASI) test at least 23 years later (1991–1993).Baseline FEV1 was significantly correlated with follow-up CASI score (r= 0.22, p = 0.0001). Although the strength of the association was reduced by controlling for the effects of other factors, stepwise multiple linear regression showed that FEV1 during middle age was a significant predictor of CASI in later life, after taking into account the effects of age, education, stroke, sedentary job activity, nonmanual occupation, height, generation, and Japanese speaking ability. The mean CASI value was significantly greater for men whose FEV1 exceeded 2.8 liter compared with those whose FEV1 levels were in the lowest (<2.5 liters) quartile. Furthermore, the test on the effect of interaction between FEV1 and age was statistically significant (p = 0.0024), with subjects less than 55 years of age at the baseline examination showing a stronger direct association of FEV1 with CASI than the men aged 55 or older. These findings suggest that pulmonary function impairment may be associated with cognitive function impairment in later life.Am J Epidemiol 1996; 143: 750–6. [ABSTRACT FROM AUTHOR]

A response by the authors to a letter to the editor about their article "Midlife Dietary Intake of Antioxidants and Risk of Late-Life Incident Dementia: The Honolulu-Asia Aging Study" is presented.

A letter to the editor is presented in response to the article "The frequency of idiopathic Parkinson's disease by age, ethnic group, and sex in northern Manhattan, 1988-1993" by R. Maryeux, K. Marder, and L. J. Cote in the 1996 issue. .