Duke Psychology & Neuroscience

Selected Publications

• • JA Blumenthal, PJ Smith, K Welsh-Bohmer, MA Babyak, J Browndyke, PH Lin, PM Doraiswamy, J Burke, W Kraus, A Hinderliter, A Sherwood.
  • 2013.
  • Can lifestyle modification improve neurocognition? Rationale and design of the ENLIGHTEN clinical trial..
  • Contemporary clinical trials
  • 34:
  • 60-9
  • .

  Publication Description

  BACKGROUND: Risk factors for cardiovascular disease (CVD) not only increase the risk for clinical CVD events, but also are associated with a cascade of neurophysiologic and neuroanatomic changes that increase the risk of cognitive impairment and dementia. Although epidemiological studies have shown that exercise and diet are associated with lower CVD risk and reduced incidence of dementia, no randomized controlled trial (RCT) has examined the independent effects of exercise and diet on neurocognitive function among individuals at risk for dementia. The ENLIGHTEN trial is a RCT of patients with CVD risk factors who also are characterized by subjective cognitive complaints and objective evidence of neurocognitive impairment without dementia (CIND) STUDY DESIGN: A 2 by 2 design will examine the independent and combined effects of diet and exercise on neurocognition. 160 participants diagnosed with CIND will be randomly assigned to 6months of aerobic exercise, the DASH diet, or a combination of both exercise and diet; a (control) group will receive health education but otherwise will maintain their usual dietary and activity habits. Participants will complete comprehensive assessments of neurocognitive functioning along with biomarkers of CVD risk including measures of blood pressure, glucose, endothelial function, and arterial stiffness. CONCLUSION: The ENLIGHTEN trial will (a) evaluate the effectiveness of aerobic exercise and the DASH diet in improving neurocognitive functioning in CIND patients with CVD risk factors; (b) examine possible mechanisms by which exercise and diet improve neurocognition; and (c) consider potential moderators of treatment, including subclinical CVD.

• • BM Hoffman, JA Blumenthal, RC Carney, CV O'Hayer, K Freedland, PJ Smith, MA Babyak, RD Davis, JP Mathew, T Martinu, S Palmer.
  • 2012.
  • Changes in neurocognitive functioning following lung transplantation..
  • American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
  • 12:
  • 2519-25
  • .

  Publication Description

  Although neurocognitive impairment is relatively common among patients with advanced lung disease, little is known regarding changes in neurocognition following lung transplantation. We therefore administered 10 tests of neurocognitive functioning before and 6 months following lung transplantation and sought to identify predictors of change. Among the 49 study participants, native diseases included chronic obstructive pulmonary disease (n = 22), cystic fibrosis (n = 12), nonfibrotic diseases (n = 11) and other (n = 4). Although composite measures of executive function and verbal memory scores were generally within normal limits both before and after lung transplantation, verbal memory performance was slightly better posttransplant compared to baseline (p 1 standard deviations on at least 20% of tests) from baseline to posttransplant. Patients who declined were older (p

• • PJ Smith.
  • 2012.
  • Physical activity, vascular health, and cognitive impairment..
  • Archives of internal medicine
  • 172:
  • 83; author reply 84
  • .
• • PJ Smith, JA Blumenthal.
  • 2011.
  • [Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment]..
  • Revista española de cardiología
  • 64:
  • 924-33
  • .

  Publication Description

  Psychosocial and behavioral factors, including mood (depression, anxiety, anger, and stress), personality (Type A, Type D, and hostility), and social support, are associated with both the development and progression of cardiovascular disease. "Negative" emotions have been associated with increased rates of cardiovascular death and recurrent cardiac events, although the mechanisms responsible for this association remain unclear. A number of pathophysiological mechanisms have been proposed to explain these relationships, including hypothalamic-pituitary-adrenal axis dysregulation, platelet activation, and inflammation. Behavioral factors also have been implicated, such as nonadherence to prescribed medical therapies and physical inactivity. Several randomized trials of patients with cardiovascular disease have examined the impact of pharmacologic and behavioral treatments on hard cardiovascular disease events as well as on cardiovascular disease biomarkers of risk. Although psychological treatments generally have been shown to improve quality of life and psychological functioning among cardiac patients, the benefit of psychological interventions with respect to improving clinical outcomes has not been conclusively demonstrated.

• • ET Cirulli, DK Attix, PJ Smith, O Chiba-Falek, TO Pennuto, KN Linney, DB Goldstein.
  • 2011.
  • Contribution of pastimes and testing strategies to the performance of healthy volunteers on cognitive tests..
  • The Clinical neuropsychologist
  • 25:
  • 778-98
  • .

  Publication Description

  Clinicians routinely query factors known to impact cognitive test scores, including age and education. However, without data delineating the impact of less-frequently tracked variables, clinicians are limited to educated inferences about their effect. We explored the relationship of demographics, pastimes, and strategies with cognitive scores in a sample of 499 healthy young volunteers. As expected, age, education, ethnicity, and native language were strongly associated with most tests, while gender and dysphoria were associated with only some. Interestingly, pastimes such as playing number games and word games, and doing activities similar to the tests, were strongly associated with many measures, and testing strategies with almost all. Importantly, at least an additional 50% of the variation in Digit Span Backward and Animals scores was explained by adding covariates about pastimes and strategies to demographic covariates. These results support the utility of querying these elements.

• • PJ Smith, JA Blumenthal, MA Babyak, LL Watkins, A Hinderliter, BM Hoffman, DC Steffens, A Sherwood, PM Doraiswamy.
  • 2010.
  • Cerebrovascular risk factors and cerebral hyperintensities among middle-aged and older adults with major depression..
  • The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
  • 18:
  • 848-52
  • .

  Publication Description

  OBJECTIVE: To examine the association between cerebral hyperintensities and cerebrovascular risk factors (CVRF) among middle-aged and older adults with major depressive disorder (MDD). METHODS: Thirty patients (aged 55-77 years) with MDD and no history of stroke participated in a magnetic resonance imaging assessment to assess for the presence of cerebral hyperintensities and underwent a physical examination to assess stroke risk as indexed by the Framingham Stroke Risk Profile (FSRP). In addition, intima medial thickness (IMT) was measured in the left and right carotid arteries. RESULTS: Higher FSRP levels were associated with total greater cerebral hyperintensities (r = 0.64), as well as greater subependymal hyperintensities (r = 0.47), confluent periventricular changes (r = 0.46), and tended to be associated with subcortical gray matter hyperintensities (r = 0.34). A quadratic relationship was observed between IMT and total cerebral hyperintensities (b = 4.84), and higher IMT levels were associated with greater subependymal hyperintensities (r = 0.40). CONCLUSIONS: Higher levels of CVRF are associated with graded increases in cerebral hyperintensities among middle-aged and older adults with MDD.

• • PJ Smith, JA Blumenthal, MA Babyak, L Craighead, KA Welsh-Bohmer, JN Browndyke, TA Strauman, A Sherwood.
  • 2010.
  • Effects of the dietary approaches to stop hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure..
  • Hypertension
  • 55:
  • 1331-8
  • .

  Publication Description

  High blood pressure increases the risks of stroke, dementia, and neurocognitive dysfunction. Although aerobic exercise and dietary modifications have been shown to reduce blood pressure, no randomized trials have examined the effects of aerobic exercise combined with dietary modification on neurocognitive functioning in individuals with high blood pressure (ie, prehypertension and stage 1 hypertension). As part of a larger investigation, 124 participants with elevated blood pressure (systolic blood pressure 130 to 159 mm Hg or diastolic blood pressure 85 to 99 mm Hg) who were sedentary and overweight or obese (body mass index: 25 to 40 kg/m(2)) were randomized to the Dietary Approaches to Stop Hypertension (DASH) diet alone, DASH combined with a behavioral weight management program including exercise and caloric restriction, or a usual diet control group. Participants completed a battery of neurocognitive tests of executive function-memory-learning and psychomotor speed at baseline and again after the 4-month intervention. Participants on the DASH diet combined with a behavioral weight management program exhibited greater improvements in executive function-memory-learning (Cohen's D=0.562; P=0.008) and psychomotor speed (Cohen's D=0.480; P=0.023), and DASH diet alone participants exhibited better psychomotor speed (Cohen's D=0.440; P=0.036) compared with the usual diet control. Neurocognitive improvements appeared to be mediated by increased aerobic fitness and weight loss. Also, participants with greater intima-medial thickness and higher systolic blood pressure showed greater improvements in executive function-memory-learning in the group on the DASH diet combined with a behavioral weight management program. In conclusion, combining aerobic exercise with the DASH diet and caloric restriction improves neurocognitive function among sedentary and overweight/obese individuals with prehypertension and hypertension.

• • PJ Smith, JA Blumenthal, BM Hoffman, H Cooper, TA Strauman, K Welsh-Bohmer, JN Browndyke, A Sherwood.
  • 2010.
  • Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials..
  • Psychosomatic medicine
  • 72:
  • 239-52
  • .

  Publication Description

  OBJECTIVE: To assess the effects of aerobic exercise training on neurocognitive performance. Although the effects of exercise on neurocognition have been the subject of several previous reviews and meta-analyses, they have been hampered by methodological shortcomings and are now outdated as a result of the recent publication of several large-scale, randomized, controlled trials (RCTs). METHODS: We conducted a systematic literature review of RCTs examining the association between aerobic exercise training on neurocognitive performance between January 1966 and July 2009. Suitable studies were selected for inclusion according to the following criteria: randomized treatment allocation; mean age > or =18 years of age; duration of treatment >1 month; incorporated aerobic exercise components; supervised exercise training; the presence of a nonaerobic-exercise control group; and sufficient information to derive effect size data. RESULTS: Twenty-nine studies met inclusion criteria and were included in our analyses, representing data from 2049 participants and 234 effect sizes. Individuals randomly assigned to receive aerobic exercise training demonstrated modest improvements in attention and processing speed (g = 0.158; 95% confidence interval [CI]; 0.055-0.260; p = .003), executive function (g = 0.123; 95% CI, 0.021-0.225; p = .018), and memory (g = 0.128; 95% CI, 0.015-0.241; p = .026). CONCLUSIONS: Aerobic exercise training is associated with modest improvements in attention and processing speed, executive function, and memory, although the effects of exercise on working memory are less consistent. Rigorous RCTs are needed with larger samples, appropriate controls, and longer follow-up periods.

• • PJ Smith, JA Blumenthal, MA Babyak, A Georgiades, A Sherwood, MH Sketch Jr, LL Watkins.
  • 2009.
  • Association between n-3 fatty acid consumption and ventricular ectopy after myocardial infarction..
  • The American journal of clinical nutrition
  • 89:
  • 1315-20
  • .

  Publication Description

  BACKGROUND: n-3 (omega-3) Fatty acids are associated with a reduced risk of cardiovascular disease; however, the relation between dietary intake of n-3 fatty acids and ventricular arrhythmias has not been investigated among acute post-myocardial infarction (AMI) patients-a group at elevated risk of malignant arrhythmias. OBJECTIVE: The objective was to examine the association between n-3 fatty acid consumption and ventricular ectopy among AMI patients. METHODS: In 260 AMI patients, dietary intake of n-3 fatty acids was assessed by using the Harvard food-frequency questionnaire, and ventricular ectopy was estimated from 24-h electrocardiograph recordings. RESULTS: A greater intake of n-3 fatty acids (eicosapentaenoic acid + docosahexaenoic acid + docosapentaenoic acid + alpha-linolenic acid) was associated with lower ventricular ectopy (beta = -0.35, P = 0.011), and this effect remained after cardiovascular comorbidities were controlled for (beta = -0.47, P = 0.003). Higher concentrations of both marine-based (eicosapentaenoic acid + docosahexaenoic acid) (beta = -0.21, P = 0.060) and plant-based (alpha-linolenic acid) (beta = -0.33, P = 0.024) fatty acids remained associated with lower ventricular ectopy after cardiovascular comorbidities were controlled for. CONCLUSIONS: These findings extend existing evidence linking n-3 fatty acid consumption to a reduced risk of ventricular arrhythmias by showing that a greater intake of n-3 fatty acids may be associated with low ventricular ectopy among AMI patients.

• • NH Greene, DK Attix, BC Weldon, PJ Smith, DL McDonagh, TG Monk.
  • 2009.
  • Measures of executive function and depression identify patients at risk for postoperative delirium..
  • Anesthesiology
  • 110:
  • 788-95
  • .

  Publication Description

  BACKGROUND: Postoperative delirium is associated with increased morbidity and mortality. Preexisting cognitive impairment and depression have been frequently cited as important risk factors for this complication. This prospective cohort study was designed to determine whether individuals who perform poorly on preoperative cognitive tests and/or exhibited depressive symptoms would be at high risk for the development of postoperative delirium. METHODS: One hundred nondemented patients, aged 50 yr and older, scheduled to undergo major, elective noncardiac surgery completed a preoperative test battery that included measures of global cognition, executive function, and symptoms of depression. Known preoperative risk factors for delirium were collected and examined with the results of the preoperative test battery to determine the independent predictors of delirium. RESULTS: The overall incidence of delirium was 16% and was associated with increased hospital duration of stay (P

• • JL Taylor, PJ Smith, MA Babyak, KA Barbour, BM Hoffman, DL Sebring, RD Davis, SM Palmer, FJ Keefe, RM Carney, I Csik, KE Freedland, JA Blumenthal.
  • 2008.
  • Coping and quality of life in patients awaiting lung transplantation..
  • Journal of psychosomatic research
  • 65:
  • 71-9
  • .

  Publication Description

  OBJECTIVE: Patients with end-stage lung disease (ESLD) experience significant decrements in quality of life (QOL). Although coping strategies are related to QOL in patients with ESLD, the extent to which specific native lung disease moderates this relationship is unknown. METHODS: We investigated the relationship between coping, native lung disease, and QOL among 187 patients awaiting lung transplantation, including 139 patients with chronic obstructive pulmonary disease (COPD) and 48 with cystic fibrosis (CF). Participants completed a psychosocial battery assessing psychological QOL, physical QOL, and coping strategies. RESULTS: For both COPD and CF patients, higher levels of Active Coping (P

• • PJ Smith, JA Blumenthal, MA Babyak, A Georgiades, A Hinderliter, A Sherwood.
  • 2007.
  • Effects of exercise and weight loss on depressive symptoms among men and women with hypertension..
  • Journal of psychosomatic research
  • 63:
  • 463-9
  • .

  Publication Description

  OBJECTIVE: This study aimed to investigate changes in depressive symptoms in hypertensive individuals participating in an exercise and weight loss intervention. METHODS: This study involved 133 sedentary men and women with high blood pressure (BP; 130-180 mmHg systolic BP and/or 85-110 mmHg diastolic BP) who participated in a 6-month intervention consisting of three groups: aerobic exercise, aerobic exercise and weight loss, and a waiting list control. RESULTS: Participants in both treatment groups demonstrated significant improvements in aerobic capacity and lower BP compared with participants in the control group. Participants in the active treatment groups who had mild to moderate depressive symptoms at baseline also exhibited greater reductions in depressive symptoms compared with participants in the control group. CONCLUSIONS: Results from the present study suggest that exercise, alone or combined with weight management, may reduce self-reported depressive symptoms among patients with hypertension.

• • PJ Smith, JA Blumenthal, MA Babyak, BM Hoffman, PM Doraiswamy, R Waugh, A Hinderliter, A Sherwood.
  • 2007.
  • Cerebrovascular risk factors, vascular disease, and neuropsychological outcomes in adults with major depression..
  • Psychosomatic medicine
  • 69:
  • 578-86
  • .

  Publication Description

  OBJECTIVE: To investigate the relationship of cerebrovascular risk factors (CVRFs), endothelial function, carotid artery intima medial thickness (IMT), and neuropsychological performance in a sample of 198 middle-aged and older individuals with major depressive disorder (MDD). Neuropsychological deficits are common among adults with MDD, particularly among those with CVRFs and potentially persons with subclinical vascular disease. METHODS: CVRFs were indexed by the Framingham Stroke Risk Profile (FSRP) and serum cholesterol levels obtained by medical history and physical examination. Patients completed a neuropsychological test battery including measures of executive functioning, working memory, and verbal recall. Vascular function was indexed by carotid artery IMT and brachial artery flow mediated dilation (FMD). Hierarchical multiple regression analyses were used to investigate the association between CVRFs, vascular disease, and neurocognitive performance. RESULTS: Greater FSRP scores were associated with poorer executive functioning (b = -0.86; p = .041) and working memory (b = -0.90; p = .024). Lower high-density lipoprotein levels also were associated with poorer executive functioning (b = 1.03; p = .035). Higher IMT (b = -0.83; p = .028) and lower FMD (b = 1.29; p = .032) were associated with poorer executive functioning after controlling for CVRFs. Lower FMD was also associated with poorer working memory (b = 1.58; p = .015). CONCLUSIONS: Greater CVRFs were associated with poorer neuropsychological performance. Vascular dysfunction also was associated with neuropsychological decrements independent of traditional CVRFs.

• • PJ Smith, JA Blumenthal, MA Babyak, A Georgiades, A Sherwood, MH Sketch Jr, LL Watkins.
  • 2007.
  • Ventricular ectopy: impact of self-reported stress after myocardial infarction..
  • American heart journal
  • 153:
  • 133-9
  • .

  Publication Description

  BACKGROUND: Although psychologic stress has been implicated in the pathogenesis of ventricular arrhythmias, the relationship between self-reported stress and ventricular ectopy has not been evaluated under naturalistic conditions in acute post-myocardial infarction (MI) patients, a group at elevated risk for arrhythmias. METHODS: Diary-reported stress was measured during 24-hour Holter monitoring in 80 patients (52 men and 28 women) approximately 12 weeks after their MI. In addition, state and trait anxiety were measured using the Spielberger State and Trait Anxiety Inventory, which was administered at the beginning of the 24-hour Holter monitoring session. The relationships between diary-reported stress, anxiety, and ventricular ectopy were evaluated. RESULTS: Mean diary-reported stress was associated with total ventricular ectopy (beta = .29, P = .01). State anxiety was also associated with 24-hour ectopy (beta = .24, P = .04); however, trait anxiety was not significantly associated with ectopy. Temporal analyses of the relationship between stress and ectopy showed that diary-reported stress was associated with an increase in the number of ventricular premature beats occurring in the following hour (beta = .74, P