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Merrick R, Brayne C. Sex Differences in Dementia, Cognition, and Health in the Cognitive Function and Ageing Studies (CFAS). J Alzheimers Dis 2024; 100:S3-S12. [PMID: 39121118 DOI: 10.3233/jad-240358] [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: 08/11/2024]
Abstract
Background There is renewed interest in whether sex differences in dementia risk exist, and what influence social and biological factors have. Objective To review evidence from the Cognitive Function and Ageing Studies (CFAS), a multi-center population-representative cohort study in the UK; focusing on dementia and cognition, incorporating findings on participants' health and social circumstances. Methods After identifying all CFAS publications, the results of all sex-stratified primary analyses of CFAS data were narratively reviewed. Results Of 337 publications, 94 report results by sex (including null findings), which are summarized by theme: dementia epidemiology, cognition, mental health, health expectancy, social context and biological resource (including neuropathology). Conclusions Where differences are found they most commonly favor men; however, greater mortality in men may confound associations with age-related outcomes. This 'survival bias' may explain findings of greater risk of dementia and faster cognitive decline in women. Age-specific dementia incidence was similar between sexes, although reduced incidence across study generations was more pronounced in men. Mood disorders were more prevalent in women, but adjusting for disability and deprivation attenuated the association. Prominent findings from other cohorts that women have more Alzheimer's disease pathology and greater risk of dementia from the Apolipoprotein E ɛ4 allele were not observed, warranting further investigation. The 'male-female health-survival paradox' is demonstrated whereby women live longer but with more comorbidity and disability. Examining why health expectancies changed differently over two decades for each sex (interacting with deprivation) may inform population interventions to improve cognitive, mental and physical health in later life.
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Affiliation(s)
- Richard Merrick
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Capoglu R, Alemdar M, Bayhan Z, Gonullu E, Akın E, Altintoprak F, Harmantepe AT, Kucuk F, Demir H, Aka BU. Effects of cognitive status on outcomes of groin hernia repair using various anesthesia techniques. Hernia 2023; 27:1315-1323. [PMID: 36449177 DOI: 10.1007/s10029-022-02725-4] [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] [Received: 09/06/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND AIM Because of increasing life expectancy, there is an increasing number of cognitively impaired older individuals undergoing surgeries such as groin hernia repair. Here, we evaluated the effects of cognitive status on postoperative complication rates in patients undergoing groin hernia repair using various anesthesia techniques. We also analyzed the rate of same-day hernia surgery in patients with cognitive decline. METHODS Patients who presented to our general surgery clinic for unilateral or bilateral inguinal or femoral hernia were prospectively classified into general (group 1), local (group 2), and spinal (group 3) anesthesia groups. The Mini-Mental State Examination (MMSE) was used for preoperative evaluation of each patient's cognitive status. The Visual Analog Scale (VAS) was used to evaluate postoperative pain. Groups were compared in terms of age, MMSE and VAS scores, cognitive decline and complication rates, and surgery duration. RESULTS In total, 33 (35.1%), 30 (31.9%), and 31 (33.0%) of 94 patients underwent surgery using general, local, and spinal anesthesia, respectively. The mean MMSE score did not differ among groups (p = 0.518). Cognitive decline was present in 18 (19.2%) patients, and the proportion did not significantly differ among groups. The complication rate did not differ between patients with and without cognitive decline. The mean surgery duration was similar among the three groups (p = 0.127). Group 2 had a lower mean postoperative VAS score, compared with the other groups (p < 0.001). Complications because of anesthesia and surgery were significantly more common in group 3 than in the other groups (p = 0.025). In the local anesthesia group, 7 patients had cognitive decline and 22 patients had normal cognition. There were no significant differences between patients with and without cognitive decline in terms of mean surgery duration (50.3 ± 15.4 min vs. 45.2 ± 10.7 min; p = 0.338) or mean VAS score (3.14 ± 0.90 vs. 3.13 ± 0.77; p = 0.985). Among the 22 and 7 patients without and with cognitive decline, 11 (50%) and 0 patients were discharged on the same day (p = 0.025). In the local anesthesia group, the respective median ages were 70, 52, and 59 years for patients with cognitive decline, patients with normal cognition discharged on the same day, and patients with normal cognition who were not discharged on the same day (p = 0.001). CONCLUSION Groin hernia repair was successfully performed under local anesthesia in all patients, including older patients with cognitive decline. Patients with cognitive decline were not discharged on the day of surgery, although the mean surgery duration and postoperative VAS score did not differ between patients with and without cognitive decline. Prolonged hospitalization in patients with cognitive decline may be related to their advanced age. Further studies are needed to determine the safety of same-day surgery in patients with cognitive decline.
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Affiliation(s)
- Recayi Capoglu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Murat Alemdar
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey.
| | - Emre Gonullu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
- Department of Gastrointestinal Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Emrah Akın
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Furkan Kucuk
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Hakan Demir
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Bahaeddin Umur Aka
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Brayne C, Wu YT. Population-Based Studies in Dementia and Ageing Research: A Local and National Experience in Cambridgeshire and the UK. Am J Alzheimers Dis Other Demen 2022; 37:15333175221104347. [PMID: 36000966 PMCID: PMC10581148 DOI: 10.1177/15333175221104347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dementia has been recognised as a key challenge in many ageing societies across the world. Several population-based studies have been developed to investigate dementia and cognitive ageing from perspectives of biology, health, psychology and social sciences. However, there is a need to provide a better understanding of 'contexts', the circumstance where these ageing populations existed, and heterogeneity within and across the populations in different time and places. In this article, we summarise some examples of earlier population-based studies undertaken by our research groups in England and Wales and their contribution to the epidemiology of dementia, neuropathology, cognitive and mental health in older age. We also describe how these studies illustrated variation among ageing populations and changes in their health conditions across time and place. These findings highlight the contribution that population-based studies can make, along with the vital to incorporate contexts in ageing research. A lifecourse approach within social context is needed to integrate life experiences, social circumstances, and multiple dimensions of cognition, functioning, physical health and wellbeing over the ageing process. We also discuss how evidence from population-based studies can support various international initiatives on dementia, healthy ageing and Sustainable Development Goals and facilitate tailored approaches for diverse populations across global societies.
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Affiliation(s)
- Carol Brayne
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yu-Tzu Wu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Dos Santos M, Licaj I, Bellera C, Cany L, Binarelli G, Soubeyran P, Joly F. Cognitive Impairment in Older Cancer Patients Treated with First-Line Chemotherapy. Cancers (Basel) 2021; 13:cancers13246171. [PMID: 34944791 PMCID: PMC8699230 DOI: 10.3390/cancers13246171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Chemotherapy-related cognitive impairment is frequently reported by patients and can have a negative impact on their quality of life. Elderly patients appear to be particularly at risk for cognitive decline but they are rarely included in studies. Our study investigated cognitive impairment during chemotherapy and its predictive factors among a large elderly population (≥70 years) treated with first-line chemotherapy. The aim was to identify risk factors before starting chemotherapy in order to manage and help elderly patients with decision making. Abstract Older cancer patients are vulnerable to chemotherapy-related cognitive impairment. We prospectively evaluated cognitive impairment and its predictive factors during first-line chemotherapy in elderly cancer patients (≥70 years). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) with adjusted scores for age and sociocultural level. Multidimensional geriatric assessment was performed at baseline and during chemotherapy including the MMSE, Instrumental Activities in Daily Living (IADL), Mini-Nutritional Assessment (MNA), and the Geriatric Depression Scale (GDS15). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ-C30). Of 364 patients included, 310 had two MMSE evaluations including one at baseline and were assessed. Among these patients, 86 (27.7%) had abnormal MMSE, 195 (62.9%) abnormal MNA, 223 (71.9%) abnormal IADL, and 137 (43.1%) had depressive symptoms at baseline. MMSE impairment during chemotherapy was observed in 58 (18.7%) patients. Abnormal baseline MNA (odds ratio (OR) = 1.87, p = 0.021) and MMSE (OR = 2.58, p = 0.022) were independent predictive factors of MMSE impairment. These results suggest that pre-existing cognitive impairment and malnutrition are predictive factors for cognitive decline during chemotherapy in elderly cancer patients. Detection and management of these risk factors should be systematically considered in this population before starting chemotherapy.
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Affiliation(s)
- Mélanie Dos Santos
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (I.L.); (G.B.); (F.J.)
- Department of Medical Oncology, Centre François Baclesse, 14000 Caen, France
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), 14000 Caen, France
- Correspondence: ; Tel.: +33-2-3145-5002; Fax: +33-2-3145-5158
| | - Idlir Licaj
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (I.L.); (G.B.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), 14000 Caen, France
- Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, 9010 Tromsø, Norway
| | - Carine Bellera
- Clinical and Epidemiological Research Unit, Institut Bergonié, 33076 Bordeaux, France;
| | - Laurent Cany
- Department of Medical Oncology, Clinique Francheville, 24000 Périgueux, France;
| | - Giulia Binarelli
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (I.L.); (G.B.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), 14000 Caen, France
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonie, 33076 Bordeaux, France;
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (I.L.); (G.B.); (F.J.)
- Department of Medical Oncology, Centre François Baclesse, 14000 Caen, France
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), 14000 Caen, France
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
- University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France
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Engelheart S, Andrén D, Repsilber D, Bertéus Forslund H, Brummer RJ. Nutritional status in older people - An explorative analysis. Clin Nutr ESPEN 2021; 46:424-433. [PMID: 34857230 DOI: 10.1016/j.clnesp.2021.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/23/2021] [Accepted: 08/30/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS The nutritional status is seldom defined in general, but is considered to be important throughout life span, especially in times of diseases and disabilities. We previously proposed a theoretical model of the nutritional status from a functional perspective [1], however without proposing a definition of the nutritional status. The model comprises four domains that might affect the nutritional and functional status in a bidirectional way. These four domains are: Food and nutrition; Health and somatic disorders; Physical function and capacity; and Cognitive, affective, and sensory function. This study contributes to the existing literature and knowledge by empirically analysing patterns and relationships of possible nutritional status indicators within and between the four domains. METHODS This study is based on a sample of 69 men and women; older than 65 years, receiving home health care. They were followed up for three years. A broad set of nutritional status indicators in the participants were assessed in their home yearly. Given the small sample size and large number of variables, we used both correlation and factor analysis to explore patterns of nutritional status indicators within the four domains and relationships between the four domains suggested by the theoretical model of nutritional status which we proposed earlier. RESULTS At baseline, between 4 and 18 components were extracted from the four domains, separately, using factor analysis. The first three components of each domain (called main components) were correlated (p < 0.05) with at least one of the main components of each of the other three domains (r = -0.34-0.79 at baseline, 0.38-0.74 at year 1, 0.40-0.77 at year 2 and 0.47-0.71 at year 3). At baseline, these main components explained, respectively, 31%, 52%, 57% and 63% of the sample variation in the four domains. This remained stable throughout all three years of follow up. In all four domains, there were statistically significant differences in prevalence of malnutrition, frailty, sarcopenia, and dehydration (all different inadequate nutritional status) between individuals' individual component scores. CONCLUSIONS This study provides empirical evidence for the relationship between nutritional status indicators within and between the four domains suggested by our theoretical model of nutritional status. Components in all four domains were associated with inadequate nutritional status, highlighting that a wide perspective of the nutritional status assessment is necessary to be applied in clinical practice.
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Affiliation(s)
| | | | - Dirk Repsilber
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Heléne Bertéus Forslund
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cognitive function, daily function and physical and mental health in older adults: A comparison of venue and home-visit community surveys in Metropolitan Tokyo. Arch Gerontol Geriatr 2021; 100:104617. [DOI: 10.1016/j.archger.2021.104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
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Karartı C, Özüdoğru A, Basat HÇ, Özsoy İ, Özsoy G, Kodak Mİ, Sezgin H, Uçar İ. Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther 2020; 44:85-94. [PMID: 33248744 DOI: 10.1016/j.jmpt.2020.07.006] [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: 01/14/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine cutoff scores for the Biodex Balance System (BBS) and verify if they could be used to discriminate older people with nonspecific low back pain (NSLBP) with poor postural performance from those with good postural performance. METHODS This cross-sectional study included 52 participants with NSLBP older than 65 years. One level of stability (level 5; intraclass correlation ≥0.70) and 2 conditions (eyes open and eyes closed) were selected for the testing procedure. Anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and overall stability index (OSI) scores were calculated. The participants were classified into 2 groups: high risk of falling and low risk of falling. Both the receiver operating characteristic and the area under the curve were used to determine the best BBS cutoff values. Binary logistic regression analysis was used to investigate the ability of BBS scores to predict risk of falling. RESULTS BBS cutoff scores in the eyes-open condition (APSI = 2.60, MLSI = 1.95, OSI = 2.95) and eyes-closed condition (APSI = 3.05, MLSI = 2.17, OSI = 3.25) were found to be sensitive and specific in determining postural performance. Participants with index values lower than the cutoff scores had, respectively, 6.42, 4.20, and 3.72 times lower risk of falling in the eyes-open condition and 3.33, 5.50, and 3.00 times lower risk of falling in the eyes-closed condition. The predictive characteristics of the models for risk analysis were excellent and good to excellent. CONCLUSION Our study shows that BBS cutoff scores are sensitive and specific in distinguishing between poor and good postural performance in older people with NSLBP.
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Affiliation(s)
- Caner Karartı
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey.
| | - Anıl Özüdoğru
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Gülşah Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Muhammed İhsan Kodak
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hicabi Sezgin
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İlyas Uçar
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Büyükturan Ö, Demirci S, Büyükturan B, Yakut Y. Effects of Using Insoles of Different Thicknesses in Older Adults: Which Thickness Has the Best Effect on Postural Stability and Risk of Falling? J Am Podiatr Med Assoc 2020; 110:9862. [PMID: 29668299 DOI: 10.7547/17-085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Postural stability (PS) problems arise as individuals grow older, and as a result, risk of falling (RoF) increases in older adults. We sought to examine the effects of insoles of various thicknesses on PS and RoF in older adults. METHODS Fifty-six study participants had PS and RoF evaluated statically and dynamically under five different conditions: barefoot, only-shoes, with 5-mm insoles, with 10-mm insoles, and with 15-mm insoles. Standard shoes with identical features were used. To avoid time-dependent problems, these assessments were performed under the same conditions in 3 consecutive weeks. The average of these three values was recorded. RESULTS Insoles of different thicknesses significantly affected static PS (overall: P =.003; mediolateral [ML]: P =.021; anteroposterior [AP]: P =.006), static RoF (overall, ML, and AP: P < .001), dynamic RoF (overall: P = .003; ML: P = .042; AP: P = .050), and dynamic PS (overall: P = .034; AP: P = .041) but not dynamic PS ML (P = .071). For static PS overall, dynamic PS AP, static RoF overall and ML, and dynamic RoF overall and ML, the highest PS scores and the lowest RoF were recorded when using 10-mm insoles (P < .05). CONCLUSIONS The use of insoles of different thicknesses has been shown to be effective on all RoF and PS measurements except dynamic PS ML. The 10-mm-thick insole was a better option for elderly individuals to increase PS and reduce RoF compared. For older adults, 10-mm-thick insoles made of medium-density Plastozote may be recommended to help improve PS and reduce RoF.
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Bernier PJ, Gourdeau C, Carmichael PH, Beauchemin JP, Verreault R, Bouchard RW, Kröger E, Laforce R. Validation and diagnostic accuracy of predictive curves for age-associated longitudinal cognitive decline in older adults. CMAJ 2017; 189:E1472-E1480. [PMID: 29203616 DOI: 10.1503/cmaj.160792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Mini-Mental State Examination continues to be used frequently to screen for cognitive impairment in older adults, but it remains unclear how to interpret changes in its score over time to distinguish age-associated cognitive decline from an early degenerative process. We aimed to generate cognitive charts for use in clinical practice for longitudinal evaluation of age-associated cognitive decline. METHODS We used data from the Canadian Study of Health and Aging from 7569 participants aged 65 years or older who completed a Mini-Mental State Examination at baseline, and at 5 and 10 years later to develop a linear regression model for the Mini-Mental State Examination score as a function of age and education. Based on this model, we generated cognitive charts designed to optimize accuracy for distinguishing participants with dementia from healthy controls. We validated our model using a separate data set of 6501 participants from the National Alzheimer's Coordinating Center's Uniform Data Set. RESULTS For baseline measurement, the cognitive charts had a sensitivity of 80% (95% confidence interval [CI] 75% to 84%) and a specificity of 89% (95% CI 88% to 90%) for distinguishing healthy controls from participants with dementia. Similar sensitivities and specificities were observed for a decline over time greater than 1 percentile zone from the first measurement. Results in the validation sample were comparable, albeit with lower sensitivities. Negative predictive value was 99%. INTERPRETATION Our innovative model, which factors in age and education, showed validity and diagnostic accuracy for determining whether older patients show abnormal performance on serial Mini-Mental State Examination measurements. Similar to growth curves used in pediatrics, cognitive charts allow longitudinal cognitive evaluation and enable prompt initiation of investigation and treatment when appropriate.
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Affiliation(s)
- Patrick J Bernier
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Christian Gourdeau
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Pierre-Hugues Carmichael
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Jean-Pierre Beauchemin
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - René Verreault
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Rémi W Bouchard
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Edeltraut Kröger
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Robert Laforce
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que.
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Ekdahl AW, Odzakovic E, Hellström I. Living Unnoticed: Cognitive Impairment in Older People with Multimorbidity. J Nutr Health Aging 2016; 20:275-9. [PMID: 26892576 DOI: 10.1007/s12603-015-0580-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the correlation between MMSE ≤ 23 and the presence of a diagnosis of dementia in the medical record in a population with multimorbidity. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was part of the Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT; N = 382). Participants were community dwelling, aged ≥ 75 years, had received inpatient hospital care at least three times during the past 12 months, and had three or more concomitant diagnoses according to the International Classification of Diseases, 10th revision. MEASUREMENTS The Mini Mental State Examination (MMSE) was administered at baseline. Medical records of participants with MMSE scores < 24 were examined for the presence of dementia diagnoses and two years ahead. RESULTS Fifty-three (16%) of 337 participants with a measure of MMSE had a MMSE scores < 24. Six of these 53 (11%) participants had diagnoses of dementia (vascular dementia, n = 4; unspecified dementia, n = 1; Alzheimers disease, n = 1) according to medical records; 89% did not. CONCLUSIONS A MMSE-score < 24 is not well correlated to a diagnosis of dementia in the medical record in a population of elderly with multimorbidity. This could imply that cognitive decline and the diagnosis of dementia remain undetected in older people with multimorbidity. Proactive care of older people with multimorbidity should focus on cognitive decline to detect cognitive impairment and to provide necessary help and support to this very vulnerable group.
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Affiliation(s)
- A W Ekdahl
- Anne W. Ekdahl, Department of Geriatric Medicine, Norrköping and Karolinska Institutet, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Sweden. E-mail:
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Abstract
OBJECTIVE To analyse the relationship between serum folate (SF), vitamin B12 and impaired cognitive function in the Chilean elderly. DESIGN We analysed the relationships between impaired cognitive function and age, SF (µg/l) and vitamin B12 (pg/ml) with Student's t test, as well as between impaired cognitive function and gender, educational level, residence area, diabetes and hypertension with the χ 2 test. Multiple logistic regressions with interactions were estimated to assess the impact of SF on impaired cognitive function according to these methods. SETTING Chile. SUBJECTS Older adults (>65 years, n 1051), drawn from representative households of a national prevalence study, assessed using the Modified Mini Mental Status Examination (MMMSE). Individuals with altered MMMSE scores (≤13 points) were sequentially assessed using the Pfeffer Functional Activities Questionnaire (PFAQ). RESULTS Multivariate models using the MMMSE demonstrated an increased risk of impaired cognitive function for seniors who had hypertension, diabetes and higher vitamin B12 levels. SF and its square (SF2) were statistically significant, indicating that this predictor of impaired cognitive function displays a U-shaped distribution. The interaction between SF and vitamin B12 was not statistically significant. Models using the MMMSE plus PFAQ suggested that urban residence decreased the risk of impaired cognitive function, whereas male gender, older age, vitamin B12 levels and hypertension increased this risk. The variables SF and SF2 and the SF × vitamin B12 interaction were statistically significant (P<0.05). The risk of impaired cognitive function depended on different combinations of SF and vitamin B12 levels. When SF was low, a one-unit increase in SF (1 µg/l) diminished the risk. When SF was elevated, a further increase in SF raised the risk, especially at low vitamin B12 levels. CONCLUSIONS The relationship between folate, vitamin B12 and impaired cognitive function warrants further study.
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Webster SJ, Bachstetter AD, Nelson PT, Schmitt FA, Van Eldik LJ. Using mice to model Alzheimer's dementia: an overview of the clinical disease and the preclinical behavioral changes in 10 mouse models. Front Genet 2014; 5:88. [PMID: 24795750 PMCID: PMC4005958 DOI: 10.3389/fgene.2014.00088] [Citation(s) in RCA: 492] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/01/2014] [Indexed: 01/17/2023] Open
Abstract
The goal of this review is to discuss how behavioral tests in mice relate to the pathological and neuropsychological features seen in human Alzheimer's disease (AD), and present a comprehensive analysis of the temporal progression of behavioral impairments in commonly used AD mouse models that contain mutations in amyloid precursor protein (APP). We begin with a brief overview of the neuropathological changes seen in the AD brain and an outline of some of the clinical neuropsychological assessments used to measure cognitive deficits associated with the disease. This is followed by a critical assessment of behavioral tasks that are used in AD mice to model the cognitive changes seen in the human disease. Behavioral tests discussed include spatial memory tests [Morris water maze (MWM), radial arm water maze (RAWM), Barnes maze], associative learning tasks (passive avoidance, fear conditioning), alternation tasks (Y-Maze/T-Maze), recognition memory tasks (Novel Object Recognition), attentional tasks (3 and 5 choice serial reaction time), set-shifting tasks, and reversal learning tasks. We discuss the strengths and weaknesses of each of these behavioral tasks, and how they may correlate with clinical assessments in humans. Finally, the temporal progression of both cognitive and non-cognitive deficits in 10 AD mouse models (PDAPP, TG2576, APP23, TgCRND8, J20, APP/PS1, TG2576 + PS1 (M146L), APP/PS1 KI, 5×FAD, and 3×Tg-AD) are discussed in detail. Mouse models of AD and the behavioral tasks used in conjunction with those models are immensely important in contributing to our knowledge of disease progression and are a useful tool to study AD pathophysiology and the resulting cognitive deficits. However, investigators need to be aware of the potential weaknesses of the available preclinical models in terms of their ability to model cognitive changes observed in human AD. It is our hope that this review will assist investigators in selecting an appropriate mouse model, and accompanying behavioral paradigms to investigate different aspects of AD pathology and disease progression.
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Affiliation(s)
- Scott J Webster
- Sanders-Brown Center on Aging, University of Kentucky Lexington, KY, USA
| | - Adam D Bachstetter
- Sanders-Brown Center on Aging, University of Kentucky Lexington, KY, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky Lexington, KY, USA ; Division of Neuropathology, Department of Pathology and Laboratory Medicine, University of Kentucky Lexington, KY, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky Lexington, KY, USA ; Department of Neurology, University of Kentucky Lexington, KY, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky Lexington, KY, USA ; Department of Anatomy and Neurobiology, University of Kentucky Lexington, KY, USA
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Kenny RA, Coen RF, Frewen J, Donoghue OA, Cronin H, Savva GM. Normative values of cognitive and physical function in older adults: findings from the Irish Longitudinal Study on Ageing. J Am Geriatr Soc 2013; 61 Suppl 2:S279-90. [PMID: 23662720 DOI: 10.1111/jgs.12195] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To provide normative values of tests of cognitive and physical function based on a large sample representative of the population of Ireland aged 50 and older. DESIGN Data were used from the first wave of The Irish Longitudinal Study on Ageing (TILDA), a prospective cohort study that includes a comprehensive health assessment. SETTING Health assessment was undertaken at one of two dedicated health assessment centers or in the study participant's home if travel was not practicable. PARTICIPANTS Five thousand eight hundred ninety-seven members of a nationally representative sample of the community-living population of Ireland aged 50 and older. Those with severe cognitive impairment, dementia, or Parkinson's disease were excluded. MEASUREMENTS Measurements included height and weight, normal walking speed, Timed Up-and-Go, handgrip strength, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Color Trails Test, and bone mineral density. Normative values were estimated using generalized additive models for location shape and scale (GAMLSS) and are presented as percentiles, means, and standard deviations. RESULTS Generalized additive models for location shape and scale fit the observed data well for each measure, leading to reliable estimates of normative values. Performance on all tasks decreased with age. Educational attainment was a strong determinant of performance on all cognitive tests. Tests of walking speed were dependent on height. Distribution of body mass index did not change with age, owing to simultaneous declines in weight and height. CONCLUSION Normative values were found for tests of many aspects of cognitive and physical function based on a representative sample of the general older Irish population.
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Affiliation(s)
- Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
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Matthews F, Marioni R, Brayne C. Examining the influence of gender, education, social class and birth cohort on MMSE tracking over time: a population-based prospective cohort study. BMC Geriatr 2012; 12:45. [PMID: 22889350 PMCID: PMC3542122 DOI: 10.1186/1471-2318-12-45] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/26/2012] [Indexed: 11/19/2022] Open
Abstract
Background Whilst many studies have analysed predictors of longitudinal cognitive decline, few have described their impact on population distributions of cognition by age cohort. The aim of this paper was to examine whether gender, education, social class and birth cohort affect how mean population cognition changes with age. Methods The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) is a multi-centre population based longitudinal study of 13,004 individuals in England and Wales. Using ten years of follow-up data, mean Mini-mental State Examination (MMSE) scores were modelled by age and birth cohort adjusting for non-random drop-out. The model included terms to estimate cohort effects. Results are presented for five year age bands between 65–95 years. Results At a population level, women show greater change in MMSE scores with age than men. Populations with lower education level and manual work also show similar effects. More recent birth cohorts have slightly higher scores. Conclusion Longitudinal data can allow examination of population patterns by gender, educational level, social class and cohort. Each of these major socio-demographic factors shows some effect on whole population change in MMSE with age.
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Hatton AL, Dixon J, Rome K, Martin D. Standing on textured surfaces: effects on standing balance in healthy older adults. Age Ageing 2011; 40:363-8. [PMID: 21450692 DOI: 10.1093/ageing/afr026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND standing on textured surfaces or wearing textured shoe insoles can alter balance performance. This evidence, although inconclusive, offers a potential intervention for improving balance in older adults. This study explored the effect of standing on textured surfaces on double-limb balance in older adults and changes in muscle activity as a possible mechanism of effect. METHODS 50 healthy older adults (29 female, age mean [1SD] 75.1 [5.0]) stood quietly in six conditions-eyes open and closed on two different textured surfaces and a smooth surface control. Mediolateral sway, anterior-posterior sway and centre of pressure velocity were extracted from a force platform and lower limb muscle activity collected using surface electromyography (EMG) over 30 s. RESULTS for mediolateral range with eyes closed, there was a statistically significant effect of texture (F [2, 47] = 3.840, P = 0.033). This was attributed to a 9.2% decrease with Texture 1 compared with Control. No such effects were seen in any other balance variable or lower limb EMG activity for either visual condition. CONCLUSION the results suggest an effect of standing on textured surfaces on mediolateral sway in older adults, supporting further work to develop the therapeutic benefits of textured surfaces as an intervention to improve balance.
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Affiliation(s)
- Anna Lucy Hatton
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Manchester, UK.
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Abstract
BACKGROUND Approximately 25% of individuals with dementia live alone, yet little is known about the cognitive and functional factors that impact detection of impairment. METHODS Subjects with dementia (n = 349) from a community study of dementia management were administered the Mini-mental State Examination (MMSE) and were asked to rate their cognitive status. Each participant's knowledgeable informant (KI) was interviewed to provide information about the subject's mental health and levels of cognitive and functional impairment. Subjects with dementia living alone (n = 97, 27.8%) were compared to subjects living with others (n = 252, 72.2%) regarding functional impairment, psychiatric symptoms, cognitive functioning, and dementia recognition. RESULTS While subjects with dementia living alone had significantly fewer ADL impairments (p < 0.0001) and less cognitive impairment (p < 0.0001) than subjects with dementia who were living with others, nearly half of subjects living alone had two or more IADL impairments. Both knowledgeable informants (p < 0.001) and primary care physicians (p < 0.009) were less likely to detect dementia in subjects living alone, while 77.3% of subjects with dementia living alone rated their cognitive abilities as "good" or "a little worse". Subjects with dementia living alone and those living with others had similar rates of psychosis (p = 0.2792) and depressive symptoms (p = 0.2076). CONCLUSIONS Lack of awareness of cognitive impairment by individuals with dementia living alone as well as their knowledgeable informants and physicians, combined with frequent functional impairment and psychiatric symptoms, heightens risk for adverse outcomes. These findings underscore the need for increased targeted screening for dementia and functional impairment among older persons living alone.
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Telephone-administered cognitive tests as tools for the identification of eligible study participants for population-based research in aging. Can J Aging 2010; 28:251-9. [PMID: 19860980 DOI: 10.1017/s0714980809990092] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTAs part of its recruitment process, the Canadian Longitudinal Study on Aging (CLSA) will face the challenge of screening out individuals who are sufficiently impaired in their ability to provide informed consent. In the process of developing the design of the CLSA, a review of the literature was performed with the goal of identifying currently existing telephone cognitive screening tools that can be used to identify eligible study participants for population-based research on aging. We identified 12 telephone screening tools, four of which were based on the Mini-Mental State Exam (MMSE) and eight that were based on other face-to-face screening tools. Characteristics - including the constructs measured, the length of time for administration, the scoring/classification scheme, and any information regarding the validation of each tool - were extracted and summarized.
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Kochhann R, Varela JS, Lisboa CSDM, Chaves MLF. The Mini Mental State Examination: Review of cutoff points adjusted for schooling in a large Southern Brazilian sample. Dement Neuropsychol 2010; 4:35-41. [PMID: 29213658 PMCID: PMC5619528 DOI: 10.1590/s1980-57642010dn40100006] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The increase in life expectancy can influence the prevalence of dementias in the population. Instruments that evaluate cognitive functions such as the Mini Mental State Examination (MMSE) are necessary for the investigation of dementia. The supposition that patient score on the MMSE can be influenced by academic level points to the need for establishing cut-off values that take into account educational level. The aim of this study was to review MMSE cut-off values adjusted for schooling in a large southern Brazilian sample. Method Demographic data and MMSE scores of 968 subjects, of which 162 were dementia patients and 806 healthy participants, were analyzed. The sample was grouped according to education. The cut-off values were established by ROC Curve analysis. Results The total sample mean age was 70.6±7.3 years, and the mean years of education was 7.2±5.3. The cut-off score of 23 points (sensitivity=86%, specificity=83%) was observed as the optimal level to detect dementia on the MMSE instrument for the overall sample. Regarding level of schooling, the cut-off values were: 21 for the illiterate group (sensitivity=93%, specificity=82%), 22 for the low education group (sensitivity=87%, specificity=82%), 23 for the middle education group (sensitivity=86%, specificity=87%) and 24 for the high education group (sensitivity=81%, specificity=87%). Conclusions The cut-off values revealed by this analysis, and adjusted for level of schooling, can improve the clinical evaluation of cognitive deficits.
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Affiliation(s)
- Renata Kochhann
- Medical Sciences Post-Graduate Course, UFRGS School of Medicine.,Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
| | | | | | - Márcia Lorena Fagundes Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre.,Internal Medicine Department, UFRGS School of Medicine
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Evaluation of the validity and reliability of the Alzheimer Disease-related Quality of Life Assessment Instrument. Alzheimer Dis Assoc Disord 2010; 23:275-84. [PMID: 19812471 DOI: 10.1097/wad.0b013e31819b02bc] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Alzheimer Disease-related Quality of Life (ADRQL) instrument was developed to assess health-related quality of life in people with AD using assessments from family caregivers or professional staff. Validity and reliability of the ADRQL in its original form and a revised version are assessed in a sample consisting of persons in 3 residential settings (community, assisted living, nursing home). The ADRQL exhibits good item-internal consistency (67.5% of items met 0.40 standard); high correlation of items to hypothesized scales (85% of items met criteria for 4 of 5 subscales and the overall instrument); a good range of scores (21.6 to 100 for total sample revised instrument); very low missing data; and internal-consistency reliability coefficients exceeding the minimum reliability standard for group comparisons (0.86 for total scores; range of 0.56 to 0.83 for subscales). In a community sample, the ADRQL discriminates between groups and is responsive over time in hypothesized directions. Characteristics of caregiver raters (community sample) including demographics and self-rated health were largely unrelated to scores. The results support the use of the ADRQL to evaluate health-related quality of life in persons with AD across various care settings and various stages of the disease. Modest correlations with cognitive and functional disability levels suggest that the ADRQL provides insight into other important dimensions of life experience in persons with dementia. The revised version has improved measurement properties and is recommended for use over the original.
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van den Hout A, Jagger C, Matthews FE. Estimating life expectancy in health and ill health by using a hidden Markov model. J R Stat Soc Ser C Appl Stat 2009. [DOI: 10.1111/j.1467-9876.2008.00659.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Matthews FE, Jagger C, Miller LL, Brayne C. Education differences in life expectancy with cognitive impairment. J Gerontol A Biol Sci Med Sci 2009; 64:125-31. [PMID: 19182231 PMCID: PMC2691183 DOI: 10.1093/gerona/gln003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Low education has an impact on life expectancy and level of cognition, but little is known on its effect on life expectancy with cognitive impairment. Methods The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) collected population-based longitudinal data on people aged 65 years and older including measures of education and cognitive impairment, using the Mini-Mental State Examination (MMSE), for five geographically diverse areas around England and Wales interviewed between 1991 and 2003. Transitions between health states were calculated using Markov chain methods. Life expectancy in different states of cognitive function as measured by MMSE were further explored for different education groups. The effect of fixed and educationally based cut points for cognitive impairment are investigated. Results Life expectancy spent with cognitive impairment is fairly constant with increasing age at around 1.4 years in men and 2.5 years in women, though this reflects a large increase in the proportion of life spent with cognitive impairment. The differences seen between education groups for the proportion of total life with cognitive impairment (men 13% and women 22% of life lived for low education vs men 7% and women 12% in high education group) disappear when education-adjusted cut points are used (10% in men and 17% in women at age 65 for all education groups). Conclusions The results show that there is a substantial amount of life expectancy with cognitive impairment in both men and women. The impairment burden is just as great for those with high education as the lowest educated group.
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The influence of multiple lifestyle behaviors on cognitive function in older persons living in the community. Prev Med 2009; 48:86-90. [PMID: 19026677 DOI: 10.1016/j.ypmed.2008.10.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/15/2008] [Accepted: 10/16/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aimed to examine the influence of multiple lifestyle behaviors on cognitive function in older persons living in an urban community. METHOD A representative sample of 977 persons aged 65 and older in Suwon, Korea were interviewed in 2001, with follow-up interviews completed on 645 (2002) and 537 (2003). Lifestyle behaviors included physical activity, non-smoking, vegetable consumption, and social activity. Individual, as well as, the number and combination of health behavioral profiles were considered. Cognitive function was assessed by the Korean version of the Mini-Mental State Examination. Linear regression with generalized estimating equations was used in the analysis, controlling for sociodemographics and chronic conditions. RESULTS All lifestyle behaviors showed independent association with cognitive ability, even after adjusting for the covariates. An incremental benefit of multiple lifestyle behaviors was evident, with those engaging in more positive behaviors exhibiting a tendency to have a higher cognitive score. A two- or three-factor combination of non-smoking, vegetable consumption, and social activity showed the strongest association with cognitive function. CONCLUSION Participation in healthy lifestyles may contribute to the maintenance of cognitive function in later life. It underlines the potential benefit of multiple behaviors in promoting cognitive health of older persons.
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Nazem S, Siderowf AD, Duda JE, Have TT, Colcher A, Horn SS, Moberg PJ, Wilkinson JR, Hurtig HI, Stern MB, Weintraub D. Montreal cognitive assessment performance in patients with Parkinson's disease with "normal" global cognition according to mini-mental state examination score. J Am Geriatr Soc 2008; 57:304-8. [PMID: 19170786 DOI: 10.1111/j.1532-5415.2008.02096.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine Montreal Cognitive Assessment (MoCA) performance in patients with Parkinson's disease (PD) with "normal" global cognition according to Mini-Mental State Examination (MMSE) score. DESIGN A cross-sectional comparison of the MoCA and the MMSE. SETTING Two movement disorders centers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center. PARTICIPANTS A convenience sample of 131 patients with idiopathic PD who were screened for cognitive and psychiatric complications. MEASUREMENTS Subjects were administered the MoCA and MMSE, and only subjects defined as having a normal age- and education-adjusted MMSE score were included in the analyses (N=100). As previously recommended in patients without PD, a MoCA score less than 26 was used to indicate the presence of at least mild cognitive impairment (MCI). RESULTS Mean MMSE and MoCA scores+/-standard deviation were 28.8+/-1.1 and 24.9+/-3.1, respectively. More than half (52.0%) of subjects with normal MMSE scores had cognitive impairment according to their MoCA score. Impairments were seen in numerous cognitive domains, including memory, visuospatial and executive abilities, attention, and language. Predictors of cognitive impairment on the MoCA using univariate analyses were male sex, older age, lower educational level, and greater disease severity; older age was the only predictor in a multivariate model. CONCLUSION Approximately half of patients with PD with a normal MMSE score have cognitive impairment based on the recommended MoCA cutoff score. These results suggest that MCI is common in PD and that the MoCA is a more sensitive instrument than the MMSE for its detection.
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Affiliation(s)
- Sarra Nazem
- Department of Psychiatry, University of Pennsyvania, Philadelphia, USA
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Engberg H, Christensen K, Andersen-Ranberg K, Jeune B. Cohort changes in cognitive function among Danish centenarians. A comparative study of 2 birth cohorts born in 1895 and 1905. Dement Geriatr Cogn Disord 2008; 26:153-60. [PMID: 18679030 PMCID: PMC2731155 DOI: 10.1159/000149819] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM The objective was to examine cohort changes in cognitive function in 2 cohorts of centenarians born 10 years apart. METHODS The Longitudinal Study of Danish Centenarians comprises all Danes reaching the age of 100 in the period April 1, 1995 through May 31, 1996. A total of 207 out of 276 persons participated (75%). The Danish 1905 Cohort Survey includes all individuals born in 1905. In total, 225 out of 364 persons who reached the age of 100 in the cohort participated in the most recent 2005 follow-up (62%). In both cohorts, cognitive function was assessed using the Mini-Mental State Examination. RESULTS There were no significant differences in cognitive score between the two centenarian birth cohorts. However, modest tendencies were seen towards better cognitive functioning for the centenarians in the 1905 cohort living at home compared to the home-dwelling ones in the 1895 cohort and worse cognitive performance for the centenarians in the 1905 group living in nursing homes compared to the nursing home dwellers in the 1895 cohort. CONCLUSION The increasing number of centenarians may not entail larger proportions of cognitively impaired individuals in this extreme age group.
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Affiliation(s)
- Henriette Engberg
- Danish Aging Research Center, Epidemiology Unit, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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