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Shang Y, Wang S, Wei C, Xie H. Associations of Cognitive Impairment with All-Cause and Cardiovascular Mortality Among Individuals with Diabetes: A Prospective Cohort Study. J Appl Gerontol 2024; 43:1449-1460. [PMID: 38652679 DOI: 10.1177/07334648241241392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
This study explored the association between diabetes, cognitive imFpairment (CI), and mortality in a cohort of 2931 individuals aged 60 and above from the 2011 to 2014 NHANES. Mortality data was gathered through 2019, and multivariable Cox proportional hazards models were used to determine the association between diabetes, CI, and mortality adjusting for sociodemographic characteristics, lifestyle factors, and comorbidity conditions. The study spanned up to 9.17 years, observing 579 deaths, with individuals having both diabetes and CI showing the highest all-cause mortality (23.6 events per 100 patient-years). Adjusted analysis revealed a 2.34-fold higher risk of all-cause mortality for this group, surpassing those with diabetes or CI alone. These results held after a series of stratified and sensitivity analyses. In conclusion, CI was linked to higher all-cause mortality in individuals with diabetes, emphasizing the need to address cognitive dysfunction in diabetic patients.
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Affiliation(s)
- Yanchang Shang
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Shuhui Wang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chao Wei
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hengge Xie
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Exposure to indoor air pollution and the cognitive functioning of elderly rural women: a cross-sectional study using LASI data, India. BMC Public Health 2022; 22:2272. [PMID: 36471286 PMCID: PMC9724350 DOI: 10.1186/s12889-022-14749-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The majority of people in rural developing counties still rely on unclean and solid fuels for cooking, putting their health at risk. Adult and elderly women are most vulnerable due to prolonged exposure in cooking areas, and Indoor Air Pollution (IAP) may negatively impact their health and cognitive function. This study examines the effect of IAP on the cognitive function of middle-aged and elderly rural women in India. METHODS The study utilized the data from the Longitudinal Ageing Study in India (LASI 2017-18, Wave-1). Bivariate analysis and multilevel linear regression models were applied to show the association between IAP and the cognitive abilities of rural women and results from regression were presented by beta coefficient (β) with 95% confidence interval (CI). Confounding factors such as age, education, health risk behaviours, marital status, monthly per capita consumption expenditure (MPCE), religion etc. were adjusted in the final model. RESULTS The study found that 18.71 percent of the rural women (n = 3,740) lived in Indoor Air Pollution exposed households. IAP was significantly found to be associated with the cognitive functional abilities among the middle and older aged rural women. Middle and older aged rural women exposed to IAP had lower cognitive functional abilities than non-exposed women. Comparing to the non-exposed group, the cognitive score was worse for those exposed to IAP in both the unadjusted (β = -1.96; 95%CI: -2.22 to -1.71) and the adjusted (β = -0.72; 95%CI: -0.92 to -0.51) models. Elderly rural women from lower socioeconomic backgrounds were more likely to have cognitive impairment as a result of IAP. CONCLUSION Findings revealed that IAP from solid fuels could significantly affect the cognitive health of elderly rural women in India, indicating the need for immediate intervention efforts to reduce the use of solid fuels, IAP and associated health problems.
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Li Y, Jiang H, Jin X, Wang H, Ji JS, Yan LL. Cognitive impairment and all-cause mortality among Chinese adults aged 80 years or older. Brain Behav 2021; 11:e2325. [PMID: 34492738 PMCID: PMC8553308 DOI: 10.1002/brb3.2325] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/30/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The oldest-old (aged ≥80 years) are the fastest growing population segment and age is related to cognitive impairment. We aimed to estimate the association between cognitive impairment and all-cause mortality, in addition to the relationship with different cognitive subdomains among the oldest-old in China. METHODS We analyzed 25,285 participants recruited from 22 out of 30 provinces in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2008, with mortality follow-up until 2014. Cognitive function was measured by the Chinese-version 30-item Mini-Mental State Examination (MMSE), classified as no (MMSE score: 25-30), mild (18-24), moderate (10-17), and severe (0-9) impairment. We used time-dependent Cox model to evaluate the relationship between time-varying cognition and mortality. RESULTS The relationship between cognition and mortality showed a dose-response pattern among the overall population. Compared to those with no impairment, participants with moderate (HR = 1.41, 95% CI 1.28-1.56) and severe (HR = 1.77, 95% CI 1.59-1.96) cognitive impairment showed increased mortality risk. Impairment in the subdomain of orientation was independently associated with increased mortality risk (HR = 1.20, 95% CI 1.05-1.36) among participants without overall cognitive impairment. Urban and rural residents had similar mortality risk. CONCLUSIONS A consistent dose-response pattern existed between cognitive impairment and all-cause mortality. Orientation was associated with mortality in the population without cognitive impairment. Similar mortality regardless of residence areas indicated scarce health care and treatment for cognitive impairment in China from 1998 to 2014.
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Affiliation(s)
- Yaxi Li
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Heng Jiang
- EHESP French School of Public Health, Rennes, France
| | - Xurui Jin
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health, Beijing, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China.,Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Institute for Global Health and Management, Peking University, Beijing, China.,School of Health Sciences, Wuhan University, Wuhan, China
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4
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Lin X, Banaszak-Holl J, Xie J, Ward SA, Brodaty H, Storey E, Shah RC, Murray A, Ryan J, Orchard SG, Fitzgerald SM, McNeil JJ. Similar mortality risk in incident cognitive impairment and dementia: Evidence from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. J Am Geriatr Soc 2021; 69:3568-3575. [PMID: 34533211 DOI: 10.1111/jgs.17435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study examined the risk of mortality in older adults with newly detected cognitive impairment or dementia. METHODS Data from the Australian cohort of the ASPirin in Reducing Events in the Elderly (ASPREE) trial were examined. The ASPREE clinical trial compared daily low-dose aspirin to a placebo and involved 16,703 individuals aged 70 years and over, who were without major cognitive impairment, physical disability, or cardiovascular disease at recruitment. During the trial, evidence of cognitive impairment, based on cognitive testing and medical record information, triggered dementia adjudication of participants using DSM-IV criteria. Cox proportional hazard models were used to compare mortality rates across the dementia, trigger-only, and no-trigger groups. RESULTS Over a median 4.7-year follow-up period, 806 participants triggered dementia adjudication, with 485 (60.2%) judged to have dementia. Following recruitment, mortality risks were 32.9, 33.6, and 10.8 events per 1000 person-years in the dementia, trigger-no-dementia, and no-trigger groups, respectively. In the fully adjusted model, mortality risks remained higher in the dementia and trigger-no-dementia groups, with hazard ratios of 1.7 (95% CI: 1.3-2.1) and 1.9 (95% CI: 1.5-2.6), respectively. There was no discernible difference between the dementia and trigger-no-dementia groups in mortality rates following recruitment, or following a dementia trigger. These two groups were more likely to die from sepsis, respiratory disease, and dementia, but less likely to die from cancer than the no-trigger group, χ2 = 161.5, p < 0.001. CONCLUSION ASPREE participants who triggered for a dementia evaluation experienced a substantially higher mortality rate than those who remained cognitively intact. The increase was indistinguishable among persons who met DSM-IV criteria for dementia vs. those who triggered for a dementia evaluation but failed to meet DSM-IV criteria. Future work should investigate whether earlier detection of cognitive decline can be used to identify and prevent early mortality.
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Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Banaszak-Holl
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jing Xie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raj C Shah
- Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Health Research Institute, Minneapolis, Minnesota, USA.,Division of Geriatrics, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Perez-Lasierra JL, Casajús JA, Casasnovas JA, Arbones-Mainar JM, Lobo A, Lobo E, Moreno-Franco B, Gonzalez-Agüero A. Can Physical Activity Reduce the Risk of Cognitive Decline in Apolipoprotein e4 Carriers? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7238. [PMID: 34299687 PMCID: PMC8303365 DOI: 10.3390/ijerph18147238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
Physical activity (PA) reduces the risk of cognitive decline (CD) in the general population. However, little is known about whether the presence of the apolipoprotein E epsilon 4 allele (APOE e4) could modify this beneficial effect. The aim of this systematic review was to analyze and synthetize the scientific evidence related to PA levels and CD risk in cognitively healthy APOE e4 carriers. Four electronic databases were analyzed. Only original articles with longitudinal study design were selected to analyze the relationship between PA and CD in APOE e4 carriers. Five studies were included in the systematic review. All studies except one stated that PA is a protective factor against CD in APOE e4 carriers. Moreover, partial support was found for the hypothesis that a greater amount and intensity of PA are more beneficial in CD prevention. The results support the idea that PA is a protective factor against CD in APOE e4 carriers. Nevertheless, it would be necessary to carry out further studies that would allow these findings to be contrasted.
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Affiliation(s)
- Jose Luis Perez-Lasierra
- Department of Physiatry and Nursing, Universidad de Zaragoza, 50009 Zaragoza, Spain; (J.L.P.-L.); (J.A.C.)
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
| | - Jose Antonio Casajús
- Department of Physiatry and Nursing, Universidad de Zaragoza, 50009 Zaragoza, Spain; (J.L.P.-L.); (J.A.C.)
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- CIBEROBN Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - José Antonio Casasnovas
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (J.A.C.); (A.L.); (E.L.); (B.M.-F.)
- CIBERCV Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jose Miguel Arbones-Mainar
- CIBEROBN Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (J.A.C.); (A.L.); (E.L.); (B.M.-F.)
- Adipocyte and Fat Biology Laboratory (AdipoFat), 50009 Zaragoza, Spain
| | - Antonio Lobo
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (J.A.C.); (A.L.); (E.L.); (B.M.-F.)
- CIBERSAM Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Elena Lobo
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (J.A.C.); (A.L.); (E.L.); (B.M.-F.)
- CIBERSAM Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Microbiology, Pediatrics, Radiology and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Belén Moreno-Franco
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (J.A.C.); (A.L.); (E.L.); (B.M.-F.)
- CIBERCV Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Microbiology, Pediatrics, Radiology and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Alejandro Gonzalez-Agüero
- Department of Physiatry and Nursing, Universidad de Zaragoza, 50009 Zaragoza, Spain; (J.L.P.-L.); (J.A.C.)
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- CIBEROBN Instituto de Salud Carlos III, 28029 Madrid, Spain;
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Cognitive Function and Mortality: Results from Kaunas HAPIEE Study 2006-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072397. [PMID: 32244660 PMCID: PMC7178058 DOI: 10.3390/ijerph17072397] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022]
Abstract
Background: The purpose of the study is to evaluate the association between cognitive function and risk of all-cause and cardiovascular disease mortality during 10 years of the follow-up. Methods: 7087 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008. During 10 years of follow-up, all-cause and CVD mortality risk were evaluated. Results: During 10 years of follow-up, 768 (23%) men and 403 (11%) women died (239 and 107 from CVD). After adjustment for sociodemographic, biological, lifestyle factors, and illnesses, a decrease per 1 standard deviation in different cognitive function scores increased risk for all-cause mortality (by 13%–24% in men, and 17%–33% in women) and CVD mortality (by 19%–32% in men, and 69%–91% in women). Kaplan-Meier survival curves for all-cause and CVD mortality, according to tertiles of cognitive function, revealed that the lowest cognitive function (1st tertile) predicts shorter survival compared to second and third tertiles (p < 0.001). Conclusions: The findings of this follow-up study suggest that older participants with lower cognitive functions have an increased risk for all-cause and CVD mortality compared to older participants with a higher level of cognitive function.
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7
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Kumar H, Arokiasamy P, Selvamani Y. Socioeconomic Disadvantage, Chronic Diseases and their Association with Cognitive Functioning of Adults in India: A Multilevel Analysis. JOURNAL OF POPULATION AGEING 2019. [DOI: 10.1007/s12062-019-09243-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Sillanpää M, Saarinen MM, Karrasch M, Schmidt D, Hermann BP. Neurocognition in childhood epilepsy: Impact on mortality and complete seizure remission 50 years later. Epilepsia 2018; 60:131-138. [PMID: 30565654 DOI: 10.1111/epi.14606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study associations of the severity of impairment in childhood neurocognition (NC) with long-term mortality and complete seizure remission. METHODS A population-based cohort of 245 subjects with childhood onset epilepsy was followed up for 50 years (median = 45, range = 2-50). Childhood NC before age 18 years was assessed as a combination of formal intelligence quotient scores and functional criteria (school achievement, working history, and psychoneurological development). Impaired NC was categorized with respect to definitions of intellectual functioning in International Classification of Diseases, 10th revision (R41.83, F70-F73). The outcome variables, defined as all-cause mortality and 10-year terminal remission with the 5 past years off medication (10YTR), were analyzed with Cox regression models. RESULTS Of the 245 subjects, 119 (49%) had normal childhood NC, whereas 126 (51%) had various degrees of neurocognitive impairment. During the 50-year observation period, 71 (29%) of the subjects died, 13% of those with normal and 44% of those with impaired NC. The hazard of death increased gradually in line with more impaired cognition, reaching significance in moderate, severe, and profound impairment versus normal NC (hazard ratio [Bonferroni corrected 95% confidence interval] = 3.3 [1.2-9.2], 4.2 [1.2-14.2], and 5.5 [2.4-12.3], respectively). The chance for 10YTR was highest among subjects with normal NC (61%), whereas none of those with profound impairment reached 10YTR. In the intermediate categories, the chance was, however, not directly related to the increasing severity of impairment. SIGNIFICANCE The severity of neurocognitive impairment during childhood shows a parallel increase in the risk of death. In comparison with normal NC, subjects with lower childhood NC are less likely to enter seizure remission. However, normal NC does not guarantee complete remission or prevent premature death in some individuals with childhood onset epilepsy.
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Affiliation(s)
- Matti Sillanpää
- Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Maiju M Saarinen
- Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | | | - Bruce P Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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López-Antón R, Barrada JR, Santabárbara J, Posadas-de Miguel M, Agüera L, Burillo C, Franco M, López-Álvarez J, Mesa P, Petidier R, Quintanilla MÁ, Robles-Del Olmo B, Ventura T, Semrau M, Sartorius N, Lobo A. Reliability and validity of the Spanish version of the IDEAL Schedule for assessing care needs in dementia: Cross-sectional, multicenter study. Int J Geriatr Psychiatry 2018; 33:482-488. [PMID: 28857260 DOI: 10.1002/gps.4781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/25/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The IDEAL Schedule was developed for staging "care needs" in patients with dementia. We here aim to validate the Spanish version, further test its psychometric properties and explore a latent construct for "care needs". METHODS A multicenter study was done in 8 dementia care facilities across Spain. Patients referred with a reliable ICD-10 diagnosis of dementia (n = 151) were assessed with the IDEAL Schedule by pairs of raters. Inter-rater reliability (intra-class correlation [ICC] coefficients), internal consistency (Cronbach's alpha), and factor analysis were calculated. Convergent validity for individual items was tested against validated Spanish versions of international instruments. RESULTS Pilot testing with numerical scales supported the feasibility, face, and content validity of the schedule. The psychometric coefficients were good/clinically acceptable: inter-rater reliability (mean ICC = 0.861; 85% of the ICCs > 0.8), internal consistency (global alpha coefficient = 0.74 in 5 nuclear items), and concurrent validity (global score against the Clinical Dementia Rating schedule, r = 0.63; coefficients for individual items ranging from 0.40 to 0.84, all statistically significant, p < 0.05). Internal consistency was low for the "nonprofessional care" and "social support" dimensions. Factor analysis supported a unidimensional solution, suggesting a latent "care needs" construct. CONCLUSION The Spanish version of the IDEAL Schedule confirms the main psychometric properties of the original version and documents for the first time the convergent validity of individual items. Factor analysis identified a latent construct consistent with the concept "care needs" although 2 dimensions need further psychometric research.
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Affiliation(s)
- Raúl López-Antón
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Juan Ramón Barrada
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Santabárbara
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Luís Agüera
- Department of Psychiatry and Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - Carmen Burillo
- Asociación de Familiares de Enfermos de Alzheimer (AFEDAZ), Zaragoza, Spain
| | - Manuel Franco
- Servicio de Psiquiatría y Salud Mental, Complejo Asistencial de Zamora, Zamora, Spain
| | - Jorge López-Álvarez
- Department of Psychiatry and Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pilar Mesa
- Geriatric Service, Hospital Nuestra Señora de Gracia, Zaragoza, Spain
| | - Roberto Petidier
- Geriatric Service, Hospital Universitario de Getafe, Madrid, Spain
| | | | | | - Tirso Ventura
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - Maya Semrau
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Antonio Lobo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
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10
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Koroukian SM, Schiltz NK, Warner DF, Stange KC, Smyth KA. Increasing Burden of Complex Multimorbidity Across Gradients of Cognitive Impairment. Am J Alzheimers Dis Other Demen 2017; 32:408-417. [PMID: 28871795 PMCID: PMC10852662 DOI: 10.1177/1533317517726388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study evaluates the burden of multimorbidity (MM) across gradients of cognitive impairment (CI). METHODS Using data from the 2010 Health and Retirement Study, we identified individuals with no CI, mild CI, and moderate/severe CI. In addition, we adopted an expansive definition of complex MM by accounting for the occurrence and co-occurrence of chronic conditions, functional limitations, and geriatric syndromes. RESULTS In a sample of 18 913 participants (weighted n = 87.5 million), 1.93% and 1.84% presented with mild and moderate/severe CI, respectively. The prevalence of most conditions constituting complex MM increased markedly across the spectrum of CI. Further, the percentage of individuals presenting with 10 or more conditions was 19.9%, 39.3%, and 71.3% among those with no CI, mild CI, and moderate/severe CI, respectively. DISCUSSION Greater CI is strongly associated with increased burden of complex MM. Detailed characterization of MM across CI gradients will help identify opportunities for health care improvement.
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Affiliation(s)
- Siran M. Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - Nicholas K. Schiltz
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - David F. Warner
- Department of Sociology, University of Nebraska–Lincoln, Lincoln, NE, USA
| | - Kurt C. Stange
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kathleen A. Smyth
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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11
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An R, Liu GG. Cognitive impairment and mortality among the oldest-old Chinese. Int J Geriatr Psychiatry 2016; 31:1345-1353. [PMID: 26891153 DOI: 10.1002/gps.4442] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the relationship between cognitive impairment status and all-cause mortality among the oldest-old Chinese. METHODS A total of 7474 survey participants 80 years of age and above came from the Chinese Longitudinal Healthy Longevity Survey 1998-2012 waves. Baseline cognitive impairment status was assessed using the Chinese version of the mini-mental state examination (MMSE), with total score ranging from 0 to 30. Cox proportional hazards regressions were performed to examine the relationship between baseline cognitive impairment status in 1998 and subsequent all-cause mortality during 1998-2012, adjusting for various individual characteristics at baseline. RESULTS Compared with those with no or mild cognitive impairment (18 ≤ MMSE score ≤ 30) at baseline, participants with moderate-to-severe cognitive impairment (0 ≤ MMSE score ≤ 17) were 28% (95% confidence interval = 20%, 37%) more likely to die during the follow-up period from 1998 to 2012. A dose-response relationship between baseline severity level of cognitive impairment and mortality was evident. Compared with those without cognitive impairment (25 ≤ MMSE score ≤ 30) at baseline, those having mild cognitive impairment (18 ≤ MMSE score ≤ 24), moderate cognitive impairment (10 ≤ MMSE score ≤ 17), and severe cognitive impairment (0 ≤ MMSE score ≤ 9), were 20% (13%, 28%), 38% (27%, 51%), and 47% (33%, 62%) more likely to die during the follow-up period. No statistically significant gender differences in the relationship between cognitive impairment status and mortality were found. CONCLUSION Baseline cognitive impairment was inversely associated with longevity among the oldest-old Chinese. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Gordon G Liu
- China Center for Health Economic Research, National School of Development, Peking University, Beijing, China
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12
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Santabárbara J, Lopez-Anton R, Gracia-García P, De-la-Cámara C, Vaquero-Puyuelo D, Lobo E, Marcos G, Salvador-Carulla L, Palomo T, Sartorius N, Lobo A. Staging cognitive impairment and incidence of dementia. Epidemiol Psychiatr Sci 2016; 25:562-572. [PMID: 26467185 PMCID: PMC7137660 DOI: 10.1017/s2045796015000918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/25/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS In a background of interest in staging models in psychiatry, we tested the validity of a simple staging model of cognitive impairment to predict incident dementia. METHOD A large community sample of adults aged ≥55 years (N = 4803) was assessed in the baseline of a longitudinal, four-wave epidemiological enquiry. A two-phase assessment was implemented in each wave, and the instruments used included the Mini-Mental Status Examination (MMSE); the History and Aetiology Schedule and the Geriatric Mental State-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. A panel of psychiatrists diagnosed cases of dementia according to DSM-IV criteria, and cases and sub-cases of dementia were excluded for the follow-up waves. Competing risk regression models, adjusted by potential confounders, were used to test the hypothesised association between MMSE levels and dementia risk. RESULTS Out of the 4057 participants followed up, 607 (14.9%) were classified as 'normal' (no cognitive impairment), 2672 (65.8%) as 'questionable' cognitive impairment, 732 (18.0%) had 'mild' cognitive impairment, 38 (0.9%) had 'moderate' cognitive impairment and eight (0.2%) had 'severe' impairment. Cognitive impairment was associated with risk of dementia, the risk increasing in parallel with the level of impairment (hazard ratio: 2.72, 4.78 and 8.38 in the 'questionable', 'mild' and 'moderate' level of cognitive impairment, respectively). CONCLUSIONS The documented gradient of increased risk of dementia associated with the severity level of cognitive impairment supports the validity of the simple staging model based on the MMSE assessment.
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Affiliation(s)
- J. Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
| | - R. Lopez-Anton
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - P. Gracia-García
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - C. De-la-Cámara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - D. Vaquero-Puyuelo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - E. Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
| | - G. Marcos
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Medical Records Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - L. Salvador-Carulla
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Australia
| | - T. Palomo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Psychiatry, Universidad Complutense, Madrid, Spain
| | - N. Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - A. Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
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13
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Gupta VK, Winter M, Cabral H, Henault L, Waite K, Hanchate A, Bickmore TW, Wolf MS, Paasche-Orlow MK. Disparities in Age-Associated Cognitive Decline Between African-American and Caucasian Populations: The Roles of Health Literacy and Education. J Am Geriatr Soc 2016; 64:1716-23. [DOI: 10.1111/jgs.14257] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Michael Winter
- School of Public Health; Boston University; Boston Massachusetts
| | - Howard Cabral
- School of Public Health; Boston University; Boston Massachusetts
| | - Lori Henault
- General Medicine; Boston Medical Center; Boston Massachusetts
| | - Katherine Waite
- General Medicine; Boston Medical Center; Boston Massachusetts
| | - Amresh Hanchate
- General Internal Medicine; Boston University; Boston Massachusetts
- Veterans Affairs Boston Healthcare System; Boston Massachusetts
| | - Timothy W. Bickmore
- College of Computer and Information Science; Northeastern University; Boston Massachusetts
| | - Michael S. Wolf
- Health Literacy and Learning Program; Institute for Healthcare Studies; Boston Massachusetts
- Division of General Internal Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illinois
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14
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Szewieczek J, Francuz T, Dulawa J, Legierska K, Hornik B, Włodarczyk I, Janusz-Jenczeń M, Batko-Szwaczka A. Functional measures, inflammatory markers and endothelin-1 as predictors of 360-day survival in centenarians. AGE (DORDRECHT, NETHERLANDS) 2015; 37:85. [PMID: 26289439 PMCID: PMC5005827 DOI: 10.1007/s11357-015-9822-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/28/2015] [Indexed: 05/16/2023]
Abstract
Centenarians represent a rapidly growing population. To better characterize this specific age group, we have performed a cross-sectional study to observe associations between functional measures and a range of biochemical markers, including inflammatory markers and their significance as predictors of 360-day survival. Medical history and physical and functional assessment (Mini-Mental State Examination (MMSE), Katz Index (activities of daily living, ADL) and Barthel Index (Barthel Index) of Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)) were conducted on 86 101.9 ± 1.2-year-old (mean ± SD) subjects (70 women, 16 men). Blood tests were performed on 84 subjects of whom 43 also had extended biomarker assessment. As a reference group 30 51.8 ± 5.0-year old healthy subjects (20 women, 10 men) were recruited. The centenarians received follow-up phone calls. Fifty-two centenarians (60 %) survived ≥360 days. Longer survival was associated with higher MMSE (hazard ratio, HR = 0.934, 95 % confidence interval (CI) 0.896-0.975, P = .002), ADL (HR = 0.840, 95 % CI 0.716-0.985, P = .032), Barthel Index (HR = 0.988, 95 % CI 0.977-0.999, P = .026), and albumin level (HR .926, 95 % CI 0.870-0.986, P .016) and with lower white blood cell (WBC) (HR = 1.161, 95 % CI 1.059-1.273, P = .001), C-reactive protein (CRP) (HR = 1.032, 95 % CI 1.014-1.050, P < .001), IL-6 (HR = 1.182, 95 % CI 1.047-1.335, P = .007), and endothelin-1 (ET-1) level (HR = 3.711, 95 % CI 1.233-11.169, P = .020). Centenarians had higher 360-day survival probability with MMSE ≥13 (P < .001), ADL ≥1 (P < .001), Barthel Index ≥15 (P < .001), Lawton IADL ≥10 points (P = .009), WBC <8.3 G/L (P = .039), CRP <10 mg/L (P < .001), IL-6 <6 pg/mL (P .002), and ET-1 <1.1 pg/mL (P .007). Our results indicate that functional measures, inflammatory markers, and endothelin-1 are predictors of 360-day survival in centenarians.
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Affiliation(s)
- Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, SUM, SPSK NR 7 SUM GCM, ul. Ziolowa 45/47, 40-635, Katowice, Poland,
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15
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Alexopoulos P, Kurz A. The New Conceptualization of Alzheimer's Disease under the Microscope of Influential Definitions of Disease. Psychopathology 2015; 48:359-67. [PMID: 26610315 DOI: 10.1159/000441327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND According to its new conceptualization, Alzheimer's disease (AD) has preclinical and symptomatic phases, and biomarker abnormality justifies the diagnosis of the disease. METHODS The conceptual validity of AD is assessed on the basis of the disease definitions of T. Szasz, R.E. Kendell and J.G. Scadding, C. Boorse, K.W.M. Fulford and J.C. Wakefield, as well as of the DSM-5 classification system. RESULTS The new AD conceptualization could fit the Szaszian disease definition, provided that AD biomarkers reflected the pathological hallmarks of a singular disease, but it seems that they do not. Moreover, preclinical AD does not yield a biological disadvantage, being a central criterion for justifying the presence of a disease according to the disease definition of Scadding and Kendell. In addition, it remains unclear whether abnormality of biomarkers in elderly people embodies a statistical deviation from normal ageing and a pathological characteristic. Furthermore, not all stages of AD are related to experiences of failure of intentional doing, which is the criterion of the disease definition of Fulford, whilst the Wakefieldian harmful dysfunction and the DSM-5 mental disorder criteria are fulfilled only in the symptomatic phases of the disease course. DISCUSSION Our analytical endeavours unveiled weak sides and the fuzzy boundaries of the new conceptualization of AD. Future refinements of the criteria should address them so that the validity of the AD concept is increased.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universitx00E4;t Mx00FC;nchen, Munich, Germany
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