Adjunctive effects of apple cider vinegar on metabolic syndrome and insulin resistance in polycystic ovary syndrome patients receiving metformin: a randomized clinical trial.

Aging is associated with decline in physical, sensory, and cognitive functions, with cardiovascular health posited as the common underlying factor. The “common cause” theory suggests that age-related changes in cardiovascular health may simultaneously influence hearing and cognitive abilities. Furthermore, sensory deficits may be prodromal for cognitive deficits with decline in hearing as one of the earliest potential markers. However, evidence on the mechanisms underlying these associations—particularly the role of physical function (PF) and its relationship to systolic blood pressure, hearing, and cognition—remains limited. A secondary analysis of a randomized trial testing the effect of hearing intervention vs. health education control in older adults aged 70–84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment, found no efficacy signal for a benefit of treatment on performance measures of physical function. Hence, improving hearing function did not improve physical function, allowing for the possibility that physical function impacts hearing. PF is the ability of an individual to perform physical activities; one method of assessment in older adults is self-reported abilities. PF is positively associated with physical activity, particularly with measures that assess the ability to carry out moderate to intensive exercise. Moreover, older adults show improvement in PF following an exercise program suggesting that PF is a clinically meaningful, potentially modifiable risk factor in aging. Previous studies have shown that physical activity can reduce the risk of cognitive impairment and dementia and that hypertension is a major risk factor for cognitive decline in older adults. The Systolic Blood Pressure Intervention Trial (SPRINT) was a large clinical trial to determine the benefit of a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) compared to a systolic blood-pressure target of less than 140 mm Hg (standard treatment) in 50 + year olds. Among patients who were at increased cardiovascular risk, targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of major adverse cardiovascular events and lower all-cause mortality than targeting a systolic blood pressure of less than 140 mm Hg, both during the randomly assigned therapy and at follow-up. The SPRINT-MIND, a sub‐study of SPRINT evaluated cognitive outcomes and found that intensive blood pressure (BP) control reduced risk of mild cognitive impairment (MCI) by 19% and reduced the risk of developing either MCI or probable dementia (PD) by 15%. There was also a statistically non‐significant reduction of 17% in PD alone. Other studies have supported the SPRINT-MIND findings and reported that lowering blood pressure with physical activity in middle-aged and older adults has a beneficial effect on cognition. A meta-analysis suggested that moderate to vigorous physical activity implemented for 12 weeks or longer had the greatest impact on BP management. Together these findings highlight the potential of physical activity and blood pressure management as modifiable intervention targets for reducing risk of cognitive decline and dementia.