By Dr Alex Dregan
Do vascular risk factors such as high blood pressure and smoking make us forgetful?
As our bodies start to show the signs of ageing, our brain is naturally ageing too. But some older people can become forgetful and have trouble remembering common words or organising daily activities more than others. There are few proven interventions to prevent this kind of cognitive decline in older adults, although treating modifiable risk factors for vascular disease and stroke, such as cholesterol and body mass index (BMI), has been suggested as a promising approach to preventing or delaying cognitive impairment for a growing UK population of older adults. So is there a link between high blood pressure and forgetfulness?
Despite much recent interest, studies to date have reported inconsistent relationships between blood pressure and cognitive functioning. Evidence suggests that people diagnosed with high blood pressure levels tend to perform more poorly on most domains of cognitive functioning, including memory, learning, attention, and reasoning. However, clinical trials have so far failed to demonstrate that antihypertensive drugs used to lower or control high blood pressure levels are effective in preventing cognitive decline in older adults. This inconsistent evidence poses a challenge when developing recommendations for the prevention of cognitive ageing.
Cognitive ageing, such as symptoms of forgetfulness, is increasingly seen as the result of the joint effect of several vascular disease risk factors, including high blood pressure, BMI, cholesterol levels, and smoking. However, the combined influence of these on cognitive decline is less commonly explored among older adults at increased risk of both cardiovascular disease and cognitive decline.
In a recent paper, we looked at Framingham stroke and cardiovascular risk scores (a measure used to assess an individual’s probability of developing stroke or cardiovascular disease over a 10-years period) and investigated their association with cognitive decline in older adults. The study included over 8,000 adults aged 50+ living in private households in England. Participants with the highest risk of future stroke or cardiovascular events, based on their risk factors values, were found to perform more poorly on tests of memory and executive functioning after a four year period. This adds weight to the theory that the combined effects of risk factors for vascular disease and stroke may be associated with more rapid cognitive decline in older adults. In other words, those at greater risk of cardiovascular problems were likely to experience a more rapid onset of symptoms associated with cognitive decline, such as forgetfulness.
We believe that these findings support the need for a multifaceted approach when seeking to prevent cognitive decline. The main implication of this is the need for addressing the combined effect of multiple risk factors, including lowering high blood pressure and high cholesterol levels, weight loss, and stopping smoking. Thus, healthcare professionals should encourage older people to adopt healthy lifestyles that would include stopping smoking and increased exercise (as well as improved diet not investigated here) and taking prescribed medicines aimed at controlling high blood pressure and high cholesterol levels. Such recommendations could potentially prevent or delay future declining memory or reasoning capacities in older adults, particularly those in higher risk groups.
The results also suggest that a harmful effect of high blood pressure on memory or reasoning abilities may develop over a prolonged period of time. This may be one reason why short-term trials have failed to show a consistent benefit from antihypertensive treatment on cognitive decline. For instance, since the negative impact of high blood pressure on memory or reasoning abilities takes place over a prolonged period of time, short-term treatment may not be sufficient to reverse or delay its adverse influence. Therefore, we would expect that any potential cognitive benefits from lowering blood pressure may only be observed over substantial periods of time.
These new results suggest that attention to the combined effects of multiple vascular risk factors may hold some promise as a strategy to prevent cognitive decline in older adults.
Dr Alex Dregan is a Lecturer in Translational Epidemiology within the NIHR Biomedical Research Centre at the Guy’s and St Thomas’ NHS Trust and King’s College London. He trained in Public health at the Institute of Education, University of London. His research interests are in translational epidemiology research as applied to public health. He is co-author of the paper Cardiovascular risk factors and cognitive decline in adults aged 50 and over: a population-based cohort study for the Age and Ageing journal, and this has been made freely available for a limited time.
Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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Jason Rosenhouse is Associate Professor of mathematics at James Madison 
University in Virginia and the author of The Monty Hall Problem: The Remarkable Story of Math’s Most Contentious Brain Teaser, which looks at one of the most interesting mathematical brain teasers of recent times. In the excerpt below Rosenhouse explains what it is like to be a professional mathematician and introduces The Monty Hall Problem.
Like all professional mathematicians, I take it for granted that most people will be bored and intimidated by what I do for a living. Math, after all, is the sole academic subject about which people brag of their ineptitude. “Oh,” says the typical well-meaning fellow making idle chitchat at some social gathering, “I was never any good at math.” Then he smiles sheepishly, secure in the knowledge that his innumeracy in some way reflects well on him. I have my world-weary stock answers to such statements. Usually I say, “Well, maybe you just never had the right teacher.” That defuses the situation nicely.
It is the rare person who fails to see humor in assigning to me the task of dividing up a check at a restaurant. You know, because I’m a mathematician. Like the elementary arithmetic used in check division is some sort of novelty act they train you for in graduate school. I used to reply with “Dividing up a check is applied math. I’m a pure mathematician,” but this elicits puzzled looks from those who thought mathematics was divided primarily into the cources they were forced to take in order to graduate versus the ones they could mercifully ignore. I find “Better have someone else do it. I’m not good with numbers” works pretty well.
I no longer grow vexed by those who ask, with perfect sincerity, how folks continue to do mathematical research when surely everything has been figured out by now. My patience is boundless for those who assure me that their grade-school nephew is quite the little math prodigy. When a student, after absorbing a scintillating presentation of, say, the mean-value theorem, asks me with disgust what it is good for, it does not even occur to me to grow annoyed. Instead I launch into a discourse about all of the practical benefits that accrue from an understanding of calculus. (”You know how when you flip a switch the lights come on? Ever wonder why that is? It’s because some really smart scientists like James Clerk Maxwell knew lots of calculus and figured out how to apply it to the problem of taming electricity. Kind of puts your whining into perspective, wouldn’t you say?”) And upon learning that a mainstream movie has a mathematical character, I feel cheated if that character and his profession are presented with any element of realism.
(Speaking of which, do you remember that 1966 Alfred Hitchcock movie Torn Curtain, the one where physicist Paul Newman goes to Leipzig in an attempt to elicit certain German military secrets? Remember the scene where Newman starts writing equations on the chalkboard, only to have an impatient East German scientist, disgusted by the primitive state of American physics, cut him off and finish the equations for him? Well, we don’t do that. We don’t finish each other’s equations. And that scene in Good Will Hunting where emotionally troubled math genius Matt Damon and Fields Medalist Stellan Skarsgard high-five each other after successfully performing some feat of elementary algebra? We don’t do that either. And don’t even get me started on Jeff Goldblum in Jurassic Pa
Elvin Lim is Assistant Professor of Government at Wesleyan University and 
author of The Anti-intellectual Presidency, which draws on interviews with more than 40 presidential speechwriters to investigate this relentless qualitative decline, over the course of 200 years, in our presidents’ ability to communicate with the public. He also blogs at www.elvinlim.com. In the article below he looks at what happens when you judge too quickly. See his previous OUPblogs here.
In his press conference on July 22, President Obama’s knee-jerk reaction to call what the Cambridge police department did “stupid” was poor form. The president thought he was avoiding the hot spot when asked about the Gates arrest by saying that the controversy offered a “teachable moment.” But having admitted that he had imperfect knowledge of the facts, he went on and assumed that this particular incident invited a lesson about racial profiling and made the very indictment that his conversational segway was intended to avoid. In so doing, Obama confirmed conservatives’ belief that minorities love to whine about their beleaguered status (also another knee-jerk belief, incidentally) even if Obama could have made a case had he marshalled the evidence appropriately. Obama spoke like a liberal before he thought, and that was his mistake.
In so doing, he repeated the same mistake that Professor Gates made. Like Obama, Gates, too, jumped to the conclusion that Sgt Crowley was racist. I do not know if Sgt Crowley acted hastily in arresting the Professor for allegedly exhibiting “tumultous” behavior, so I won’t jump to conclusions but simply note my suspicion that there was probably a contest of egos on both sides. Those who have rushed to Crowley’s defense should ask themselves if they do not also have a knee-jerk reaction to give the benefit of the doubt to a law enforcement officer (or a soldier or a partisan affiliated with the Commander-in-Chief.)
Gates, Obama, and possibly Crowley were not the only people who have been jumping to conclusions, substituting unreflected intuition for a careful weighing of the evidence. Frank Luntz and his political students are encouraging Americans to become thoughtless automatons responding to carefully researched code words like “government takeover” and “health-care rationing.” The issue domain is different, but the error is the same.
It is very difficult to prove racial-profiling, for it demands an investigator to go inside the head of the alleged perpetrator. It is equally difficult to prove that the president’s and Democratic Congress’s plan for a “public option” is a precursor to a completely government-run health-care system. If it is not appropriate to rush to accuse someone of being racist, then it is at least premature to rush to accuse of someone of being socialist (assuming that that is a bad thing).
Those who are accusing Obama and Gates for rushing into judgment should look into the mirror to see if they too have not rushed to conclude that liberals are whiners and socialists who want a government takeover of health-care. At some level, we all have the instinct to cherry-pick the evidence to come to the conclusions we want.
Ideologies, like stereotypes, are cognitive cues or heuristics. They help us to “think” before we get the facts. They allow us to abdicate our duty to make sense of the world with our own independent judgment. They do the easy but intellectually dishonest work of guiding our reactions to the conclusions we want without us having to do the hard work of getting to know a person or a proposed policy before we came to a judgment. The people who are reinforcing such behavior in our politics are destroying our democracy and robbing us of our first freedom - the freedom of independent thought.
So the Gates controversy is a teaching moment, and the lesson is quite simple. Look before you leap; think before you conclude. It is probably the first lesson of critical thinking, but two professors forgot it last week. If Obama wants us to learn this lesson, he should have been clearer about what the nature of his lapse was. It wasn’t that the president miscallibrated his words - for the question wasn’t about the intensity of what he said, but the very fact that he said something at all. Obama should have apologized for expressing what he felt and intuited without having first perused the evidence. If he had done that, he would have claimed the moral ground to shame some of his opponents in Congress into admitting that they too are doing the same thing in their knee-jerk opposition to what they call “Obamacare.”
