Abstract-This investigation examined cross-sectional and longitudinal relations, both linear and nonlinear, of blood pressure (BP) and its interaction with demographic and lifestyle variables to a broad spectrum of cognitive functions. Eight hundred forty-seven participants (503 men and 344 women) from the Baltimore Longitudinal Study of Aging completed tests of verbal and nonverbal memory, attention, perceptuo-motor speed, executive functions, and confrontation naming, and clinical assessment of BP on 1 to 7 occasions over 11 years. Key Words: blood pressure Ⅲ hypertension Ⅲ cognitive function Ⅲ neuropsychology H ypertension is a major risk factor for stroke, vascular dementia, and possibly Alzheimer's disease. 1,2 Even among stroke-free and dementia-free persons, hypertension or higher blood pressure (BP) levels have been related to lowered levels of cognitive function in numerous cross-sectional and longitudinal investigations. 3-5 However, not only high BP but also low BP levels have negative effects on cognitive function. Low BP has been related to risk for Alzheimer's disease and diminished cognitive function. 6 Furthermore, U-shaped relations between BP and cognitive function have been noted such that individuals with high or low BP perform more poorly on cognitive tests and/or display more pronounced cognitive decline than persons with mid-range BP. 7-9 With one exception, 5 these studies are limited by the assessment of BP, cognitive function, or both on a single occasion.The purpose of the present investigation was to examine both cross-sectional and longitudinal relations of concurrently measured BP and cognitive function across 1 to 7 testing sessions in a single stroke and dementia-free sample while evaluating potential nonlinear associations, effect modifiers, and a broad spectrum of cognitive functions. To our knowledge, only 1 previous investigation has assessed concurrently measured BP and cognitive function on Ͼ2 testing occasions in a small sample (nϭ140). 5 Although several previous studies have examined nonlinear relations of BP to cognition, 7-9 few domains of cognitive function were measured (ie, global mental status, verbal memory, perceptuomotor speed), there was limited assessment of effect modification, and persons with stroke or dementia were included (which may lead to overestimation of BP-cognition relations). Here, we examined measures of verbal and nonverbal memory, attention, perceptuo-motor speed, executive functions, and confrontation naming, and potential interactions of BP with several demographic and lifestyle variables.

Overall, MMSE scores exhibited ceiling effects, poor test-retest reliability, limited sensitivity to subtle brain abnormalities, and a high rate of intrusion elsewhere in the neuropsychological battery. Individual MMSE items demonstrated poor construct validity. These qualities illustrate the serious limitations of the MMSE in detecting individual differences in cognitive function among healthy older adults.

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The Judgment of Line Orientation (JLO) test is a commonly used measure of visuospatial perception. Because of its length, several short forms have appeared in the literature. We examined the internal consistency of the JLO and eight of its published short forms among 128 undergraduates, 203 healthy older adults, and 55 chronic kidney disease patients. The full test demonstrated good reliability for traditional neuropsychological assessment, but the majority of short forms were adequate only for screening purposes, where greater measurement error is typically permitted in exchange for brevity. In contrast, a recently developed short form based upon item response theory (Calamia, Markon, Denburg, & Tranel, 2011) demonstrated promise as a stand-alone measure.