Optimal cognitive functioning is necessary to successfully negotiate one's environment, yet medical conditions can interfere with brain health, thus negatively impacting cognitive functioning. Such comorbidities include hypertension, heart disease, diabetes, depression, and HIV, as well as others. The physiological properties of these comorbidities can reduce one's cognitive reserve and limit one's cognitive efficiency. This article provides an overview of a few common comorbidities known to affect cognitive functioning and addresses ways in which cognitive functioning may be ameliorated and protected or mitigated in lieu of cognitive declines in such clinical populations. Implications for nursing practice and research are posited.

Bone resorption is glucose concentration dependent. Mechanisms regulating glucose-dependent increases in bone resorption have not been identified. Glucose activates p38 MAP-kinase in other cells and since MAP kinases activate transcription factors, we hypothesized that glucose-stimulated bone resorption may be modulated by increased expression of the vacuolar H(+)-ATPase. Glucose activates osteoclast p38 MAP-kinase in a time and concentration-dependent manner as determined by Western analysis with phospho-specific p38 antibody while total p38 levels are unchanged. The K0.5 for glucose-dependent activation of p38 MAP-kinase is approximately 7 mM, activation is maximal at 30 min and is elevated but returning to basal levels by 60 min. The concentration-dependent increase in H(+)-ATPase expression was confirmed by Northern analysis. The specific inhibitor of p38 MAP-kinase, SB203580, inhibited glucose transport in osteoclasts, as well as glucose concentration-dependent increases in bone resorption and expression of H(+)-ATPase A and B subunits. Glucose had no effect on calmodulin expression levels that are regulated in response to other environmental changes. The glucose-stimulated increase in H(+)-ATPase mRNA expression is a specific response to glucose since glucose has little effect on G3PDH mRNA levels. We conclude that glucose regulates osteoclast H(+)-ATPase expression by a mechanism likely to involve p38 MAP-kinase.

Glucose-stimulated increases in osteoclast activity are mediated, at least in part, by transcriptional regulation of H+-ATPase expression through a mechanism involving p38 mitogen-activated protein kinase. We hypothesized that early events in the glucose-dependent signaling pathway would be similar to those identified in other glucose-sensitive cells, such as islet beta-cells, including rapid changes in the cellular ATP/ADP ratio and mobilization of intracellular Ca2+. We demonstrate that glucose stimulates a prolonged 50% increase in the ATP/ADP ratio that was maximal 30 s after glucose concentrations were increased. Glucose stimulated a transient 30% increase in calcium/calmodulin-dependent kinase II (CaMK II) activity that was maximal 3 min after the glucose concentration was increased. CaMK II was activated maximally by 3 mmol D-glucose/L in 3-min assays. Activation of CaMK II in the presence of the nonmetabolizable glucose analog 2-deoxyglucose was 2-fold greater than with D-glucose but was unchanged by glucosamine. Pretreatment of osteoclasts with the intracellular Ca2+ chelator BAPTA-AM inhibited glucose transport by 75%. BAPTA-AM treatment also prevented glucose-dependent stimulation of CaMK II. The data indicate that osteoclasts utilize a glucose-sensing mechanism similar to that of beta-cells and that glucose-stimulated signaling in osteoclasts involves changes in the ATP/ADP ratio and mobilization of intracellular Ca2+, resulting in activation of CaMK II.