Cognitive function and cardiovascular disease in relation to hypertension and adaptive behavior in the serial Color Word Test. Results from population study "Men born in 1914" in Malmö, Sweden

Detta är en avhandling från Department of Psychology, Box 213, SE-221 00 Lund, Sweden

Sammanfattning: "Men born in 1914" is a prospective cohort study on the epidemiology of cardiovascular disease. The study is run by the Department of Community Medicine, Lund University, Malmö. Five hundred men participated in the study when it started with a baseline examination in 1982/83. The men were then 68 years old. The psychological part of the study included tests of cognitive function and the serial Color Word Test. The incidence of cardiac events, strokes and deaths has continuously been monitored since baseline. In 1995/96, when the men were 81 years old, a follow-up examination took place, including both a medical and a psychological investigation. Study I showed, that blood pressure level at the age of 68 may be associated with concurrent cognitive test-performance. A negative association was found between the most severe stage of hypertension and visual memory and psychomotor speed. This suggested that these two tests are sensitive to the deleterious effects of hypertension. In Study II cognitive decline between 68 and 81 years was studied in relation to baseline blood pressure. These results suggested that a small part of the variability in cognitive decline on tests measuring spatial ability and spatial memory could be attributed to blood pressure level at the age of 68. The serial Color Word Test is a semi-experimental way to measure how individuals adapt in a conflicting and stressful encounter. This test was used in Studies III, IV, and V and was analyzed in relation to incidence of a cardiac event and incidence of a stroke in hypertensive men. In Study V it was analyzed in association with 28 days and one year survival following a myocardial infarction among all men who had experienced such an event. Study III showed that among hypertensive men, the Cumulative-dissociative pattern, of the Variability dimension in the serial Color Word Test, was associated with an almost threefold risk of suffering a cardiac event during the follow-up time. These findings showed that different ways of handling a stressful task were associated with distinct outcomes and that these adaptive patterns modified the risk of a cardiac event in association with hypertension. Study IV showed that hypertensive men whose behavior was categorized as Cumulative-dissociative in the Regression dimension were vulnerable to stress and consequently exposed to an increased risk of a future stroke. Study V showed that the Cumulative-dissociative pattern of the Regression dimension was univariately associated with mortality within 28 days. The Dissociative and the Cumulative-dissociative patterns, likewise of the Regression dimension, were independently associated with mortality within one year. The serial Color Word Test can be an aid in identifying a subgroup of individuals whose adaptive pattern in a stressful encounter makes them more vulnerable to stress and thereby at an increased risk of a future cardiovascular event.

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