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Bai W, Ma R, Yang Y, Xu J, Qin L. Enhancing predictive validity of motoric cognitive risk syndrome for incident dementia and all-cause mortality with handgrip strength: insights from a prospective cohort study. Front Aging Neurosci 2024; 16:1421656. [PMID: 38974906 PMCID: PMC11224449 DOI: 10.3389/fnagi.2024.1421656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Background This study aimed to assess whether integrating handgrip strength (HGS) into the concept of motoric cognitive risk (MCR) would enhance its predictive validity for incident dementia and all-cause mortality. Methods A cohort of 5, 899 adults from the Health and Retirement Study underwent assessments of gait speed, subjective cognitive complaints, and HGS were involved. Over a 10-year follow-up, biennial cognitive tests and mortality data were collected. Cox proportional hazard analyses assessed the predictive power of MCR alone and MCR plus HGS for incident dementia and all-cause mortality. Results Patients with MCR and impaired HGS (MCR-HGS) showed the highest adjusted hazard ratios (AHR) for dementia (2.33; 95% CI, 1.49-3.65) and mortality (1.52; 95% CI, 1.07-2.17). Even patients with MCR and normal HGS (MCR-non-HGS) experienced a 1.77-fold increased risk of incident dementia; however, this association was not significant when adjusted for socioeconomic status, lifestyle factors, and medical conditions. Nevertheless, all MCR groups demonstrated increased risks of all-cause mortality. The inclusion of HGS in the MCR models significantly improved predictive discrimination for both incident dementia and all-cause mortality, as indicated by improvements in the C-statistic, integrated discrimination improvement (IDI) and net reclassification indices (NRI). Conclusion Our study underscores the incremental predictive value of adding HGS to the MCR concept for estimating risks of adverse health outcomes among older adults. A modified MCR, incorporating HGS, could serve as an effective screening tool during national health examinations for identifying individuals at risk of dementia and mortality.
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Affiliation(s)
- Weimin Bai
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
| | - Ruizhu Ma
- Department of Endocrinology, The People’s Hospital of Danyang, Danyang Hospital of Nantong University, Danyang, Jiangsu, China
| | - Yanhui Yang
- Department of Cardiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Juan Xu
- Department of General Surgery, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Lijie Qin
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
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Li Z, Gong X, Wang S, Liu M, Liu S, Wang Y, Wu D, Yang M, Li R, Li H, Li X, Chen S, Zhang X, Jia R, Guo J, He Y, Wang Y. Cognitive impairment assessed by Mini-Mental State Examination predicts all-cause and CVD mortality in Chinese older adults: A 10-year follow-up study. Front Public Health 2022; 10:908120. [PMID: 36518570 PMCID: PMC9744251 DOI: 10.3389/fpubh.2022.908120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Cognitive impairment (CI) has been demonstrated as a useful proxy measure of mortality in Western populations. However, the predictive value of CI in Chinese populations is unknown. We aimed to explore whether CI is independently associated with increased long-term all-cause and cardiovascular disease (CVD) mortality in Chinese older adults and the association of performance in specific MMSE sub-domains to subsequent mortality. Methods and results A total of 4,499 older adults [mean (SD) age, 70.3(6.7) years] who received a sample investigation from 2011 to 2014 were followed up till 2021 for mortality. The Mini-Mental State Examination was used to assess cognitive function, and Cox's proportional hazard models were used to evaluate the effects of cognitive function on the risk of all-cause and CVD mortality. Demographic characteristics, lifestyle, and health status were included as covariates. During a 10-year follow-up, a total of 667 (14.8%) died. In the fully adjusted model, compared with cognitively normal participants with CI had a 1.33-fold [HR, 1.33; (95% CI, 1.10-1.61)] greater risk of all-cause mortality and a 1.45-fold [HR, 1.45; (95% CIs, 1.11-1.92)] greater risk of CVD mortality. After a similar multivariable adjustment, a per-SD increase in MMSE scores was associated with a reduced risk of all-cause mortality [HR, 0.85; (95% CI, 0.78-0.93)] and CVD mortality [HR, 0.74; (95% CI, 0.65-0.84)]. In the unadjusted model, MMSE sub-domains (apart from immediate recall) were associated with mortality. But only orientation and calculation and attention were still independently associated with all-cause and CVD mortality in a multivariable model. Conclusion These findings confirmed that CI is a marker of all-cause and CVD mortality risk in Chinese older adults, independently of other commonly assessed risk factors, and some sub-domains of the MMSE may have stronger associations with mortality. Further research is needed to identify the mechanisms underlying the observed associations.
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Affiliation(s)
- Zhiqiang Li
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Xinran Gong
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Shengshu Wang
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China,Department of Healthcare, Agency for Offices Administration, Central Military Commission, Beijing, China
| | - Miao Liu
- Department of Epidemiology and Statistics, Graduate School of Chinese PLA General Hospital, Beijing, China
| | - Shaohua Liu
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanding Wang
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Di Wu
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Meitao Yang
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Rongrong Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Haowei Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xuehang Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shimin Chen
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiushan Zhang
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Ruizhong Jia
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Jinpeng Guo
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Yao He
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China,State Key Laboratory of Kidney Diseases, Department of Epidemiology, Chinese People's Liberation Army General Hospital, Beijing, China,Yao He
| | - Yong Wang
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China,*Correspondence: Yong Wang
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Lu K, Xiong X, Horras A, Jiang B, Li M. Impact of financial barriers on health status, healthcare utilisation and economic burden among individuals with cognitive impairment: a national cross-sectional survey. BMJ Open 2022; 12:e056466. [PMID: 35508339 PMCID: PMC9073389 DOI: 10.1136/bmjopen-2021-056466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To study the impact of financial barriers to healthcare on health status, healthcare utilisation and costs among patients with cognitive impairment. DESIGN Cross-sectional. SETTING National Health Interview Survey (NHIS), 2011-2017. PARTICIPANTS Patients with cognitive impairment aged 18 years or older. INTERVENTIONS Financial barriers to healthcare were identified using a series of NHIS prompts asking about the affordability of healthcare services. PRIMARY OUTCOME MEASURES Health status was based on a survey prompt about respondents' general health. Healthcare utilisation included office visits, home healthcare visits, hospital stays and emergency department (ED) visits. Economic burden was based on the family spending on medical care. Logistic regression models were used to examine the impact of financial barriers to healthcare access on health status, home healthcare visits, office visits, hospital stays and ED visits, respectively. RESULTS Compared with cognitively impaired respondents without financial barriers to healthcare access, those with financial barriers were more likely to be unhealthy (OR 0.64, 95% CI 0.57 to 0.72). Cognitively impaired respondents with financial barriers were less likely to have home healthcare (OR 0.69, 95% CI 0.48 to 0.99) and more likely to have hospital stays (OR 1.33, 95% CI 1.19 to 1.48) and ED visits (OR 1.50, 95% CI 1.35 to 1.67). In addition, compared with cognitively impaired respondents without financial barriers to healthcare access, those with the barriers were more likely to have an increased economic burden (OR=1.85, 95% CI 1.65 to 2.07). CONCLUSION Financial barriers to healthcare worsened health status and increased use of ED, hospitalisation and economic burden. Policy decision-makers, providers and individuals with cognitive impairment should be aware of the impact of financial barriers and take corresponding actions to reduce the impact.
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Affiliation(s)
- Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Ashley Horras
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Bin Jiang
- Department of Administrative and Clinical Pharmacy, Peking University, Beijing, China
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Xiang K, Liu Y, Sun L. Motoric Cognitive Risk Syndrome: Symptoms, Pathology, Diagnosis, and Recovery. Front Aging Neurosci 2022; 13:728799. [PMID: 35185512 PMCID: PMC8847709 DOI: 10.3389/fnagi.2021.728799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
The motoric cognitive risk (MCR) syndrome is a pre-dementia condition, marked by the enhanced risk for Alzheimer's disease (AD) and vascular dementia, together with falls, disability, and abnormal movements. The research studies revealed the distinct neurological and non-neurological clinical gait irregularities during dementia and accelerated functional decline, such as postural and balance impairments, memory loss, cognitive failure, and metabolic dysfunctions. The disabling characteristics of MCR comprise altered afferent sensory and efferent motor responses, together with disrupted visual, vestibular, and proprioceptive components. The pathological basis of MCR relates with the frontal lacunar infarcts, white matter hyperintensity (WMH), gray matter atrophy in the pre-motor and pre-frontal cortex, abnormal cholinergic functioning, inflammatory responses, and genetic factors. Further, cerebrovascular lesions and cardiovascular disorders exacerbate the disease pathology. The diagnosis of MCR is carried out through neuropsychological tests, biomarker assays, imaging studies, questionnaire-based evaluation, and motor function tests, including walking speed, dual-task gait tests, and ambulation ability. Recovery from MCR may include cognitive, physical, and social activities, exercise, diet, nutritional supplements, symptomatic drug treatment, and lifestyle habits that restrict the disease progression. Psychotherapeutic counseling, anti-depressants, and vitamins may support motor and cognitive improvement, primarily through the restorative pathways. However, an in-depth understanding of the association of immobility, dementia, and cognitive stress with MCR requires additional clinical and pre-clinical studies. They may have a significant contribution in reducing MCR syndrome and the risk for dementia. Overall, the current review informs the vital connection between gait performance and cognition in MCR and highlights the usefulness of future research in the discernment and treatment of dementiating illness.
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Predictive ability of the G8 screening test to determine probable sarcopenia and abnormal comprehensive geriatric assessment in older patients with solid malignancies. BMC Geriatr 2021; 21:574. [PMID: 34666690 PMCID: PMC8524815 DOI: 10.1186/s12877-021-02544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Pre-treatment evaluation for sarcopenia is recommended in cancer patients. New screening tests that are less time-consuming and can identify patients who will potentially benefit from geriatric assessment are being developed; the G8 geriatric screening test is one such example. We aimed to investigate whether the G8 screening test can detect probable sarcopenia and is valid and reliable compared to a comprehensive geriatric assessment (CGA) in Turkish older adults with solid cancers. Methods We included solid cancer patients referred to a single center. Probable sarcopenia and abnormal CGA were defined as low handgrip strength. Cut-offs for handgrip strength in the Turkish population have been previously determined to be 32 kg for males and 22 kg for females and impairment in at least one of the CGA tests, respectively. The CGA tests comprised KATZ Basic Activities of Daily Living Scale Lawton–Brody Instrumental Activities of Daily Living Scale, Mini-Mental-State Examination Scale, Geriatric Depression Scale-15, and Mini-Nutritional Assessment Short Form. Receiver operating characteristic curve analyses evaluated the test’s predictive ability. Intra-rater and inter-rater reliabilities were assessed. Results The median age of the 76 patients included was 72 (65–91) years. There was a moderate correlation between handgrip strength and the G8 test total score. The sensitivity and specificity of the G8 test to detect probable sarcopenia alone (cut off score = 12.5) were 50 and 92%, respectively (AUC: 0.747; p < 0.001); to determine abnormal CGA plus probable sarcopenia (cut off score = 13) were 93.33 and 86.89%, respectively (AUC: 0.939; p < 0.001); and to detect abnormal CGA alone (cut off score = 14) were 79.63 and 95.45%, respectively (AUC: 0.893; p < 0.001). The G8 test results agreed with those of CGA (κ = 0.638; p < 0.001). Both inter- and intra-rater assessments of G8 scores revealed a strong agreement (Interclass correlation coefficient = 0.979, p < 0.001 and ρ = 0.994, p < 0.001, respectively). Conclusions The Turkish version of the G8 test is a good screening tool to detect probable sarcopenia alone and in conjunction with abnormal CGA in older patients with solid malignancies. The G8 screening tool may thus be useful in detecting probable sarcopenia in Turkish older adults with solid cancers.
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Shaked O, Cohen G, Goshen A, Shimony T, Shohat T, Gerber Y. Physical Activity and Long-Term Mortality Risk in Older Adults with and without Cardiovascular Disease: A Nationwide Cohort Study. Gerontology 2021; 68:529-537. [PMID: 34515134 DOI: 10.1159/000518169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS To evaluate the association between physical activity (PA) levels and mortality among older adults, to determine whether it differs according to cardiovascular disease (CVD) status, and to assess the optimal weekly duration of PA associated with subsequent survival. METHODS Participants (n = 1,799) were drawn from a national survey conducted from 2005 to 2006, constituting Israeli adults aged ≥65 years. Sociodemographic, clinical, behavioral, and psychosocial data were collected via interview at study entry. Based on a detailed PA questionnaire and according to published guidelines, participants were classified as sufficiently active, insufficiently active, and inactive. CVD status was self-reported. Mortality data (last follow-up, December 2016) were obtained from the Israeli Ministry of Health. Using Cox models, inverse probability weighted hazard ratios (HRs) for mortality, based on propensity score, were estimated for PA categories. RESULTS Among the participants at baseline (mean age, 74.6 years), 559 (31.1%) were sufficiently active, 506 (28.1%) were insufficiently active, and 734 (40.8%) were inactive. During follow-up (mean, 9.0 years), 684 participants (38.0%) died. PA was inversely associated with mortality, with propensity score-adjusted HRs (95% confidence intervals) of 0.84 (0.71-1.01) in insufficiently and 0.73 (0.61-0.88) in sufficiently active participants (ptrend < 0.001). No PA-by-CVD interaction was detected on multiplicative scale (p = 0.36) or additive scale (p = 0.58). A monotonic survival benefit was observed until ∼150 min of PA per week, beyond which no further gain was apparent. CONCLUSIONS In a nationwide cohort of older adults, nearly 70% did not meet the guideline for PA. PA engagement was inversely associated with long-term mortality risk, similarly in individuals with and without CVD. A maximum survival advantage was achieved at around 150 min of exercise per week.
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Affiliation(s)
- Or Shaked
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abigail Goshen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Shimony
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Tamar Shohat
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Zhao X, Jin L, Sun SB. The Bidirectional Association Between Physical and Cognitive Function Among Chinese Older Adults: A Mediation Analysis. Int J Aging Hum Dev 2020; 92:240-263. [PMID: 32677441 DOI: 10.1177/0091415020940214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study investigated the bidirectional association between physical and cognitive function in later life and examined the mechanisms underlying the interrelationship. We employed cross-lagged panel models to analyze a sample of 4232 unique participants aged 65 years and older from three waves of the Chinese Longitudinal Healthy Longevity Survey. Physical activity and social participation were tested as potential mediators between physical and cognitive function. Our findings revealed a reciprocal relationship between physical and cognitive function and a reciprocal relationship between physical and cognitive decline. Moreover, physical activity was confirmed to mediate the bidirectional association between physical and cognitive function, whereas social participation did not seem to be a mediator. A vicious cycle linking physical and cognitive decline may exist in Chinese older adults. However, leading a physically active lifestyle could be an effective intervention to slow physical and cognitive aging, thereby toning down the vicious cycle.
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Affiliation(s)
- Xiaohang Zhao
- 26451 Department of Sociology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lei Jin
- 26451 Department of Sociology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Skylar Biyang Sun
- 26451 Department of Sociology, The Chinese University of Hong Kong, Hong Kong SAR, China
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9
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Liao H, Zhu Z, Wang H, Rong X, Young CA, Peng Y. Cognitive Performance Concomitant With Vision Acuity Predicts 13-Year Risk for Mortality. Front Aging Neurosci 2019; 11:65. [PMID: 30967772 PMCID: PMC6439522 DOI: 10.3389/fnagi.2019.00065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/06/2019] [Indexed: 01/04/2023] Open
Abstract
Objective: To assess the joint impact of cognitive performance and visual acuity on mortality over 13-year follow-up in a representative US sample. Methods: Data from National Health and Nutrition Examination Survey (NHANES) participants (≥18 years old) were linked with the death record data of the National Death Index (NDI) with mortality follow-up through December 31, 2011. Cognitive performance was evaluated by the Digit Symbol Substitution Test (DSST) and cognitive performance impairment was defined as the DSST score equal to or less than the median value in the study population. Visual impairment (VI) was defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Risks of all-cause and specific-cause mortality were estimated with Cox proportional hazards models after adjusting for confounders. Results: A total of 2,550 participants 60 years and older from two waves of (NHANES, 1999–2000, 2001–2002) were included in the current analysis. Over a median follow-up period of 9.92 years, 952 (35.2%) died of all causes, of whom 239 (23.1%), 224 (24.0%), and 489 (52.9%) died from cardiovascular disease (CVD), cancer, and non-CVD/non-cancer mortality, respectively. Cognitive performance impairment and VI increased the odds for mortality. Co-presence of VI among cognitive impaired elderly persons predicted nearly a threefold increased risk of all-cause mortality [hazard ratios (HRs), 2.74; 95% confidence interval (CI), 2.02–3.70; P < 0.001) and almost a fourfold higher risk of non-CVD/non-cancer mortality (HR, 3.72; 95% CI, 2.30–6.00; P < 0.001) compared to having neither impairment. Conclusion: People aged 60 years and over with poorer cognitive performance were at higher risk of long-term mortality, and were especially vulnerable to further mortality when concomitant with VI. It is informative for clinical implication in terms of early preventive interventions.
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Affiliation(s)
- Huan Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongxuan Wang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
| | - Ying Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Hayat SA, Luben R, Dalzell N, Moore S, Hogervorst E, Matthews FE, Wareham N, Brayne C, Khaw KT. Understanding the relationship between cognition and death: a within cohort examination of cognitive measures and mortality. Eur J Epidemiol 2018; 33:1049-1062. [PMID: 30203336 PMCID: PMC6208995 DOI: 10.1007/s10654-018-0439-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Abstract
Despite several studies demonstrating an independent and inverse association between cognition and mortality, the nature of this association still remains unclear. To examine the association of cognition and mortality after accounting for sociodemographic, health and lifestyle factors and to explore both test and population characteristics influencing this relationship. In a population based cohort of 8585 men and women aged 48-92 years, who had cognitive assessments in 2006-2011 and were followed up till 2016 for mortality, we examined the relationship between individual cognitive tests as well as a global cognition score to compare their ability in predicting mortality and whether these differed by population characteristics. Risk of death was estimated using Cox proportional hazard regression models including sociodemographic, lifestyle and health variables, and self-reported comorbidities, as covariates in the models. Poor cognitive performance (bottom quartile of combined cognition score) was associated with higher risk of mortality, Hazard Ratio = 1.32 (95% Confidence Interval 1.09, 1.60); individual cognitive tests varied in their mortality associations and also performed differently in middle-age and older age groups. Poor cognitive performance is independently associated with higher mortality. This association is observed for global cognition and for specific cognitive abilities. Associations vary depending on the cognitive test (and domain) as well as population characteristics, namely age and education.
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Affiliation(s)
- Shabina A Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nichola Dalzell
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Stephanie Moore
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Eef Hogervorst
- Applied Cognitive Research Group, Loughborough University, National Centre for Sports and Exercise Medicine, Loughborough, UK
| | - Fiona E Matthews
- Faculty of Medicine, Institute of Health and Society, Newcastle University, Newcastle, UK
- MRC Biostatistics Unit, Cambridge Biomedical Campus, Cambridge Institute of Public Health, Cambridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
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Palsetia D, Rao GP, Tiwari SC, Lodha P, De Sousa A. The Clock Drawing Test versus Mini-mental Status Examination as a Screening Tool for Dementia: A Clinical Comparison. Indian J Psychol Med 2018; 40:1-10. [PMID: 29403122 PMCID: PMC5795671 DOI: 10.4103/ijpsym.ijpsym_244_17] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a growing incidence of dementia patients in the community, and with this growth, there is need for rapid, valid, and easily administrable tests for the screening of dementia and mild cognitive impairment in the community. This review looks at the two most commonly used tests in dementia screening, namely, the clock drawing test (CDT) and the mini-mental status examination (MMSE). Both these tests have been used in dementia screening over the past three decades and have been the subject of scrutiny of various studies, reviews, and meta-analysis. Both these tests are analyzed on their ability to assess dementia and screen for it in the community, general practice and general hospital settings. The methods of administration and scoring of each test are discussed, and their advantages and disadvantages are explained. There is also a direct comparison made between the MMSE and CDT in dementia screening. Future research needs with these tests are also elucidated.
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Affiliation(s)
- Delnaz Palsetia
- Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India
| | - G. Prasad Rao
- Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India
| | - Sarvada C. Tiwari
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pragya Lodha
- Department of Research Assistant, Desousa Foundation, Mumbai, Maharashtra, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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12
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Watanabe S, Fukatsu T, Kanemoto K. Risk of hospitalization associated with anticholinergic medication for patients with dementia. Psychogeriatrics 2018; 18:57-63. [PMID: 29372598 DOI: 10.1111/psyg.12291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND With the ageing of the general population, demand has grown for measures to prevent hospitalization for dementia, which can exacerbate problems associated with activities of daily living in elderly individuals. Anticholinergic medication has been shown to cause falls, delirium, and cognitive impairment in aged patients. However, the risk of hospitalization associated with the administration of anticholinergics is unclear. METHODS We analyzed the records of 61 outpatients (26 men, 35 women; mean age: 78 ± 7 years; mean follow-up period: 420 days) diagnosed with dementia (Alzheimer's disease: n = 45; dementia with Lewy bodies: n = 3; undifferentiated n = 13) and prescribed anti-dementia drugs between May 2013 and December 2014. Medication history was noted, and the patients were divided into two groups according to the Anticholinergic Risk Scale: with risk (n = 13) and without risk (n = 48). Outcome was judged based on an end-point of hospitalization or death. Kaplan-Meier survival and Cox proportional hazard analyses were performed. RESULTS Eight patients with anticholinergic risk and 12 without anticholinergic risk reached the end-point (P < 0.005). Analysis with a proportional hazard model showed that anticholinergic medication administration was related to a higher risk for reaching the end-point (crude hazard ratio: 3.62, 95% confidence interval: 1.45-9.04, P < 0.01; adjusted hazard ratio: 4.54, 95% confidence interval: 1.03-20.0, P < 0.05). In contrast, Mini-Mental State Examination score, Charlson Comorbidity Index, and the number of drugs were not major risk factors for hospitalization in patients with dementia. CONCLUSION The Anticholinergic Risk Scale findings were shown to be a strong predictor of hospitalization for patients with dementia. We should evaluate the anticholinergic burden before initiating anti-dementia therapy.
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Affiliation(s)
- Shuichi Watanabe
- Department of Neuropsychiatry, Aichi Medical University, Nagakute, Japan
| | - Takahide Fukatsu
- Department of Neuropsychiatry, Aichi Medical University, Nagakute, Japan
| | - Kosuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagakute, Japan
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13
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Kim JH, Chon D. Association between Cognitive Impairment, Vascular Disease and All-Cause Mortality. J Nutr Health Aging 2018; 22:790-795. [PMID: 30080221 DOI: 10.1007/s12603-018-1011-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the association between elder's cognitive impairment and mortality. Additionally, interaction between cognitive impairment and cardio- and cerebrovascular diseases was considered. METHODS Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2014 was assessed using 10,026 participants at baseline with no missing information. Chi-square test, log-rank test, and Cox proportional hazards models were used to investigate the association between cognitive impairment and mortality. RESULTS Cognitive impairment was significantly associated with mortality. With normal cognitive functioning group as reference: HR=2.329 (p<.0001) for severe cognitive impairment, HR=1.238 (p.009) for mild cognitive impairment. The association remained significant even after considering for cardio- and cerebrovascular diseases. CONCLUSION This study provided additional support to previous findings in regards to the relationship between cognitive impairment and mortality. Worse cognitive functioning increased the risk of mortality and the presence of cardio- and cerebrovascular diseases exacerbated this relationship.
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Affiliation(s)
- J-H Kim
- Doukyoung Chon, Ph.D candidate, Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea, Phone: +82 41-550-1471, Fax: +82 41-559-7934, E-mail:
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14
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Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, Espaulella J, Villanueva A, Oller R, Martori JC, Constante C. Utility of the NECPAL CCOMS-ICO © tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study. Palliat Med 2017; 31:754-763. [PMID: 27815556 DOI: 10.1177/0269216316676647] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. AIM To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. DESIGN Longitudinal, prospective and observational cohort study. SETTING/PARTICIPANTS Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. RESULTS Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. CONCLUSION SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.
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Affiliation(s)
- Xavier Gómez-Batiste
- 1 The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC), Catalan Institute of Oncology (CIO), Department of Health (DoH), Barcelona, Spain.,2 Chair of Palliative Care, University of Vic, Barcelona, Spain
| | - Marisa Martínez-Muñoz
- 1 The Qualy Observatory/WHO Collaborating Centre for Public Health Palliative Care Programs (WHOCC), Catalan Institute of Oncology (CIO), Department of Health (DoH), Barcelona, Spain.,2 Chair of Palliative Care, University of Vic, Barcelona, Spain
| | - Carles Blay
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,3 Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health (DoH), Government of Catalonia, Barcelona, Spain
| | - Jordi Amblàs
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,4 Hospital de la Santa Creu, Hospital General de Vic, Barcelona, Spain
| | - Laura Vila
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,5 Institut Català de la Salut - SAP Osona, Barcelona, Spain
| | - Xavier Costa
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,5 Institut Català de la Salut - SAP Osona, Barcelona, Spain
| | - Joan Espaulella
- 2 Chair of Palliative Care, University of Vic, Barcelona, Spain.,4 Hospital de la Santa Creu, Hospital General de Vic, Barcelona, Spain
| | | | - Ramon Oller
- 7 Department of Economics and Business, University of Vic, Barcelona, Spain
| | | | - Carles Constante
- 8 Department of Health (DoH), Government of Catalonia, Barcelona, Spain
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Evaluation of an Outpatient Rehabilitative Program to Address Mobility Limitations Among Older Adults. Am J Phys Med Rehabil 2017; 96:600-606. [PMID: 28079616 PMCID: PMC5510704 DOI: 10.1097/phm.0000000000000682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. Live Long Walk Strong is a clinical demonstration program for community-dwelling older patients. It was designed to be consistent with current fall prevention guidelines and reimbursed under the Medicare model. Patients were screened within primary care and referred to a physiatrist followed by systematic assessment and treatment within an outpatient rehabilitative care setting. The treatment included behavioral modification, fall prevention education, community/home exercise integration, and exercise targeting strength, power, flexibility, balance, and endurance. Treatment duration and frequency varied with each patient based on baseline presentation, clinical judgment, and patient preference. Program feasibility and preliminary effectiveness were evaluated by assessing participation and changes in physical performance, respectively. There were 266 patients referred to the program, and 147 were willing to participate. Of these, 116 patients completed all scheduled visits (10.8 ± 3.9 visits). The noncompleters (n = 31) had a higher rate of falls in the previous 6 months and lower baseline Short Physical Performance Battery composite score. At the completion of care, the adjusted mean change in Short Physical Performance Battery was 1.66 units, surpassing a large clinically meaningful threshold (1 unit). The Live Long Walk Strong program appears to be feasible to implement and demonstrates preliminary effectiveness in enhancing mobility among older adults.
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Gómez-Batiste X, Murray SA, Thomas K, Blay C, Boyd K, Moine S, Gignon M, Van den Eynden B, Leysen B, Wens J, Engels Y, Dees M, Costantini M. Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy. J Pain Symptom Manage 2017; 53:509-517. [PMID: 28042069 DOI: 10.1016/j.jpainsymman.2016.10.361] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/21/2016] [Accepted: 10/07/2016] [Indexed: 11/21/2022]
Abstract
The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system.
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Affiliation(s)
- Xavier Gómez-Batiste
- The "Qualy" Observatory/WHO Collaborating Center for Palliative Care Public Health Programs, Catalan Institute of Oncology, Barcelona, Spain; Chair in Palliative Care, University of Vic, Barcelona, Spain.
| | - Scott A Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Keri Thomas
- End of Life Care, University of Birmingham, Birmingham, UK
| | - Carles Blay
- Chair in Palliative Care, University of Vic, Barcelona, Spain; Chronic Care Program, Catalan Department of Health, Government of Catalonia, Barcelona, Spain
| | - Kirsty Boyd
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Sebastien Moine
- Education and Health Practices Laboratory, University Paris 13, Sorbonne Paris Cité, Bobigny, France; Health Simulation CenterSimUSanté®, Amiens University Hospital, Amiens, France
| | - Maxime Gignon
- Education and Health Practices Laboratory, University Paris 13, Sorbonne Paris Cité, Bobigny, France; Health Simulation CenterSimUSanté®, Amiens University Hospital, Amiens, France
| | - Bart Van den Eynden
- Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium
| | - Bert Leysen
- Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium
| | - Johan Wens
- Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium
| | - Yvonne Engels
- Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne Dees
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Massimo Costantini
- Palliative Care Unit, IRCCS Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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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: 96] [Impact Index Per Article: 12.0] [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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Santabárbara J, Gracia-García P, Pírez G, López-Antón R, De La Cámara C, Ventura T, Pérez-Sastre M, Lobo E, Saz P, Marcos G, Lobo A. Mortality in Mild Cognitive Impairment Diagnosed with DSM-5 Criteria and with Petersen's Criteria: A 17-Year Follow-Up in a Community Study. Am J Geriatr Psychiatry 2016; 24:977-986. [PMID: 27639289 DOI: 10.1016/j.jagp.2016.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/27/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the possibility that the mortality risk of mild cognitive impairment (MCI) as diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (DSM-5-MCI) will be higher than using Petersen's criteria (P-MCI) and to report the population-attributable fraction (PAF) of mortality due to MCI. METHODS A representative community sample of 4,803 individuals aged 55 or more years was interviewed and then followed for 17 years. Standardized instruments were used in the assessment, including the Geriatric Mental State-AGECAT, and research psychiatrists diagnosed P-MCI and DSM-5-MCI cases following operationalized criteria. Mortality information was obtained from the official population registry. Kaplan-Meier age-adjusted survival curves were built for the MCI diagnostic groups, and Cox proportional hazards regression models were used to calculate the hazard ratio of death in participants with MCI relative to those without. We also estimated the PAF of mortality due to specific MCI diagnostic groups. RESULTS Compared with noncases, the mortality rate ratio was approximately double in DSM-5-MCI individuals (2.3) than in P-MCI individuals (1.2). In the multivariate statistical analysis, a significant association between each diagnostic category and mortality was observed but was only maintained in the final model in DSM-5-MCI cases (hazard ratio: 1.24). The PAF of mortality due to MCI was approximately 1% in both MCI categories. CONCLUSION The mortality risk in comparison with noncases was higher in DSM-5-MCI than in P-MCI. The PAF of mortality in DSM-5-MCI individuals was ~ 1% over a 17-year period.
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Affiliation(s)
- Javier Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - Patricia Gracia-García
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain; Psychiatry Service, Universidad de Zaragoza, Zaragoza, Spain
| | - Guillermo Pírez
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain; Centre Assistencial Sant Joan de Déu d'Almacelles, Lérida, Spain
| | - Raúl López-Antón
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Concepcion De La Cámara
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain; Psychiatry Service, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Tirso Ventura
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain; Psychiatry Service, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Marina Pérez-Sastre
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - Elena Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - Pedro Saz
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - Guillermo Marcos
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain; Medical Records Service, Hospital Clínico Universitario, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain; 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.
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19
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Santabárbara J, Lopez-Anton R, Marcos G, De-la-Cámara C, Lobo E, Saz P, Gracia-García P, Ventura T, Campayo A, Rodríguez-Mañas L, Olaya B, Haro JM, Salvador-Carulla L, Sartorius N, Lobo A. Degree of cognitive impairment and mortality: a 17-year follow-up in a community study. Epidemiol Psychiatr Sci 2015; 24:503-11. [PMID: 24905936 PMCID: PMC8367364 DOI: 10.1017/s2045796014000390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment. METHOD A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages. RESULTS Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the 'mild' degree of impairment; HR: 1.29 in the 'moderate' degree; and HR: 2.08 in the 'severe' degree). The PAF of mortality due to severe cognitive impairment was 3.49%. CONCLUSIONS A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.
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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
| | - 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
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Medical Records 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
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, 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
| | - P. Saz
- 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
| | - P. Gracia-García
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - T. Ventura
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A. Campayo
- 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
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - L. Rodríguez-Mañas
- Hospital Universitario de Getafe and Red Tematica de Investigacion Cooperativa en Envejecimiento y Fragilidad (RETICEF), Madrid, Spain
| | - B. Olaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - J. M. Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - L. Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - 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
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
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Motoric cognitive risk syndrome and risk of mortality in older adults. Alzheimers Dement 2015; 12:556-64. [DOI: 10.1016/j.jalz.2015.08.167] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/19/2015] [Accepted: 08/29/2015] [Indexed: 12/21/2022]
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Krall JR, Carlson MC, Fried LP, Xue QL. Examining the dynamic, bidirectional associations between cognitive and physical functioning in older adults. Am J Epidemiol 2014; 180:838-46. [PMID: 25205829 DOI: 10.1093/aje/kwu198] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The delineation of the interrelationships between cognitive and physical functioning in older adults is critical to determining pathways to disability. By using longitudinal data from 395 initially high-functioning, community-dwelling older women in Baltimore, Maryland, from the Women's Health and Aging Study II (from 1994 to 2006), we simultaneously assessed associations of cognition with later physical functioning and associations of physical functioning with later cognition. The analysis included measures of global cognition and 2 cognitive domains (executive functioning and memory), as well as 2 measures of physical functioning (a Short Physical Performance Battery and a 4-meter test of usual walking speed). We found the strongest bidirectional associations of memory with physical functioning and less evidence of associations of physical functioning with executive functioning and global cognition. For a 1-standard deviation increase in walking speed, subsequent memory increased by 0.08 standard deviations (95% confidence interval: (0.03, 0.13)). For a 1-standard deviation increase in memory, subsequent walking speed increased by 0.07 standard deviations (95% confidence interval: 0.03, 0.10). Associations were similar in magnitude for models using a Short Physical Performance Battery. We did not find evidence that associations between cognitive and physical functioning varied over time. Our results suggest that cognition, and particularly memory, is associated with subsequent physical functioning and vice versa.
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Mini-mental state examination as a predictor of mortality among older people referred to secondary mental healthcare. PLoS One 2014; 9:e105312. [PMID: 25184819 PMCID: PMC4153564 DOI: 10.1371/journal.pone.0105312] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/21/2014] [Indexed: 11/19/2022] Open
Abstract
Background Lower levels of cognitive function have been found to be associated with higher mortality in older people, particularly in dementia, but the association in people with other mental disorders is still inconclusive. Methods and Findings Data were analysed from a large mental health case register serving a geographic catchment of 1.23 million residents, and associations were investigated between cognitive function measured by the Mini-Mental State Examination (MMSE) and survival in patients aged 65 years old and over. Cox regressions were carried out, adjusting for age, gender, psychiatric diagnosis, ethnicity, marital status, and area-level socioeconomic index. A total of 6,704 subjects were involved, including 3,368 of them having a dementia diagnosis and 3,336 of them with depression or other diagnoses. Descriptive outcomes by Kaplan-Meier curves showed significant differences between those with normal and impaired cognitive function (MMSE score<25), regardless of a dementia diagnosis. As a whole, the group with lower cognitive function had an adjusted hazard ratio (HR) of 1.42 (95% CI: 1.28, 1.58) regardless of diagnosis. An HR of 1.23 (95% CI: 1.18, 1.28) per quintile increment of MMSE was also estimated after confounding control. A linear trend of MMSE in quintiles was observed for the subgroups of dementia and other non-dementia diagnoses (both p-values<0.001). However, a threshold effect of MMSE score under 20 was found for the specific diagnosis subgroups of depression. Conclusion Current study identified an association between cognitive impairment and increased mortality in older people using secondary mental health services regardless of a dementia diagnosis. Causal pathways between this exposure and outcome (for example, suboptimal healthcare) need further investigation.
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Dong X, Simon M, Beck T, Evans D. Decline in cognitive function and elder mistreatment: findings from the Chicago Health and Aging Project. Am J Geriatr Psychiatry 2014; 22:598-605. [PMID: 24821287 PMCID: PMC9942679 DOI: 10.1016/j.jagp.2012.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 10/29/2012] [Accepted: 11/07/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study aimed to examine the longitudinal association between decline in cognitive function and elder mistreatment (EM). METHODS Chicago Health and Aging Project (CHAP) is an epidemiologic study conducted in a geographically defined community (N = 6,159). We identified 143 CHAP participants who had longitudinal cognitive data and EM reported to social services agency. The primary predictor was cognitive function, which was assessed using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test (Perceptual Speed), and both immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z scores of all tests. Logistic regression models were used to assess the association of cognitive function domains and risk for EM. RESULTS After adjusting for potential confounders, every one-point decline in global cognitive function (odds ratio [OR]: 1.57 [1.21-2.03]), MMSE (OR: 1.07 [1.03-1.10]), Episodic Memory (OR: 1.46 [1.14-1.86]), and Perceptual Speed (OR: 1.05 [1.02-1.07]) scores were associated with increased risk for EM. Lowest tertiles in global cognitive function (OR: 2.71 [1.49-4.88]), MMSE (OR: 2.02 [1.07-3.80]), Episodic Memory (OR: 2.70 [1.41-5.16]), and Perceptual Speed (OR: 4.41 [2.22-8.76]) scores were associated with increased risk for EM. CONCLUSION Decline in global cognitive function, MMSE, and Perceptual Speed scores were associated with increased risk for EM.
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Affiliation(s)
- XinQi Dong
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
| | - Melissa Simon
- Department of Preventive Medicine and OB/GYN, Northwestern University Medical Center, Chicago, IL
| | - Todd Beck
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
| | - Denis Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
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Iwasa H, Kai I, Yoshida Y, Suzuki T, Kim H, Yoshida H. Global cognition and 8-year survival among Japanese community-dwelling older adults. Int J Geriatr Psychiatry 2013; 28:841-9. [PMID: 23008014 DOI: 10.1002/gps.3890] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/07/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We sought to examine the longitudinal relationship between cognitive function and all-cause mortality among Japanese community-dwelling older adults, using an 8-year prospective cohort study design with mortality surveillance. METHODS A total of 454 men and 386 women, aged 70 years and older, participated in the study. The Mini Mental State Examination (MMSE) was administered to assess global cognition. The total MMSE score and subscale scores were used as independent variables, and age, gender, education level, chronic disease, sensory deficit, depressive symptoms, and instrumental activities of daily living were used as covariates. RESULTS During the follow-up period, 191 subjects (139 men and 52 women) died, and 64 subjects (31 men and 33 women) moved to a different region of Japan and were lost to follow-up. Use of the multivariate Cox proportional hazards model, adjusted for potential confounders, showed that global cognition was significantly and independently associated with mortality (hazard ratio [HR] = 1.59, 95% confidence interval [CI]: 1.14-2.23 and HR = 2.81, 95% CI: 1.77-4.36 for the middle [24-27 points] and lowest [0-23 points] categories, respectively). Among the MMSE subscales, place orientation (HR = 1.57, 95% CI: 1.09-2.25), calculation (HR = 1.67, 95% CI: 1.18-2.35), and delayed recall (HR = 1.42, 95% CI: 1.03-1.96), were also significantly and independently associated with mortality. CONCLUSIONS Our study suggests that among older individuals, those with lower levels of cognitive function are more likely to have a shorter lifespan compared with those with higher cognitive functioning.
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Affiliation(s)
- Hajime Iwasa
- School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Cosentino S, Schupf N, Christensen K, Andersen SL, Newman A, Mayeux R. Reduced prevalence of cognitive impairment in families with exceptional longevity. JAMA Neurol 2013; 70:867-74. [PMID: 23649824 PMCID: PMC4151346 DOI: 10.1001/jamaneurol.2013.1959] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Family studies of centenarians and long-lived persons have found substantial familial aggregation of survival to extreme ages; however, the extent to which such familial longevity is characterized by cognitively intact survival is not established. OBJECTIVE To determine whether families with exceptional longevity are protected against cognitive impairment consistent with Alzheimer disease. DESIGN Cross-sectional analysis. SETTING Multisite study in New York, Massachusetts, Pennsylvania, and Denmark. PARTICIPANTS A total of 1870 individuals (1510 family members and 360 spouse controls) recruited through the Long Life Family Study. MAIN OUTCOME AND MEASURE Prevalence of cognitive impairment based on a diagnostic algorithm validated using the National Alzheimer's Coordinating Center data set. RESULTS The cognitive algorithm classified 546 individuals (38.5%) as having cognitive impairment consistent with Alzheimer disease. Long Life Family Study probands had a slightly but not statistically significant reduced risk of cognitive impairment compared with spouse controls (121 of 232 for probands vs 45 of 103 for spouse controls; odds ratio = 0.7; 95% CI, 0.4-1.4), whereas Long Life Family Study sons and daughters had a clearly reduced risk of cognitive impairment (11 of 213 for sons and daughters vs 28 of 216 for spouse controls; odds ratio = 0.4; 95% CI, 0.2-0.9). Restriction to nieces and nephews in the offspring generation attenuated this effect (37 of 328 for nieces and nephews vs 28 of 216 for spouse controls; odds ratio = 0.8; 95% CI, 0.4-1.4). CONCLUSIONS AND RELEVANCE Rates of cognitive impairment characteristic of Alzheimer disease were relatively high. In the proband generation, rates were comparable across family members and spouse controls, whereas sons and daughters of probands had significantly lower rates than spouse controls. Results suggest a delayed onset of cognitive impairment in families with exceptional longevity, but assessment of age-specific incidence rates is required to confirm this hypothesis.
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Affiliation(s)
- Stephanie Cosentino
- Gertrude H. Sergievsky Center, Columbia University, New York, NY
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Nicole Schupf
- Gertrude H. Sergievsky Center, Columbia University, New York, NY
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Kaare Christensen
- The Danish Aging Research Center, University of Southern Denmark and the Department of Clinical Genetics, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Stacy L. Andersen
- Geriatrics Section, School of Medicine, Boston University and Boston Medical Center, Boston, MA
| | - Anne Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Richard Mayeux
- Gertrude H. Sergievsky Center, Columbia University, New York, NY
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Park MH, Kwon DY, Jung JM, Han C, Jo I, Jo SA. Mini-Mental Status Examination as predictors of mortality in the elderly. Acta Psychiatr Scand 2013; 127:298-304. [PMID: 22901036 DOI: 10.1111/j.1600-0447.2012.01918.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Because the number of elderly is increasing worldwide, cognitive dysfunction becomes important health care issue. This study investigated the association between cognitive dysfunction and mortality in the elderly. METHOD Data were analyzed from a longitudinal mortality follow-up study of 2712 Korean elderly aged 60 and over, examined in 2002 with complete data followed an average 6.03 years. Measurements included socio-demographic and clinical factors and Mini-Mental State Examination (MMSE). MMSE was categorized into groups with no, mild, or moderate cognitive dysfunction, and the subscores of MMSE domains were categorized into no dysfunction or dysfunction. The Cox proportional hazards models were conducted to examine the association between MMSE score and mortality, after adjusting for age, gender, education and other socio-demographic factors. RESULTS Death during follow-up occurred in 318 subjects. The mortality risk was significantly associated with the elderly with mild cognitive dysfunction [hazard ratio (HR) = 1.93] and with moderate cognitive dysfunction (HR = 2.66). 'Orientation-to-time' (HR = 1.39) and 'Attention' (HR = 1.48) domains of MMSE were independently associated with mortality. CONCLUSION This study showed that cognitive dysfunction independently predicted mortality in the elderly. Cognitive dysfunction should be considered part of identifying the elderly at high risk for mortality.
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Affiliation(s)
- M H Park
- Department of Neurology, Korea University Medical College and Korea University Ansan Hospital, Ansan, Korea.
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The impact of inflammation on cognitive function in older adults: implications for healthcare practice and research. J Neurosci Nurs 2012; 44:206-17. [PMID: 22743812 DOI: 10.1097/jnn.0b013e3182527690] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accumulating evidence suggests that levels of inflammation, an immune response, increase with age throughout the body and the brain. The effects of inflammation on the brain, both acute and chronic, have been associated with cognitive decline and risk of dementia in older adults. Factors believed to increase inflammation include certain health-related behaviors, such as smoking, poor diet, and inactivity as well as health conditions like diabetes, hypertension, and chronic obstructive pulmonary disease, most of which require medical intervention and monitoring. As such, nurses and healthcare professionals are likely to encounter patients who are at a high risk for future development of inflammation-related cognitive decline. A review of inflammatory processes and their relation to cognitive function in older adults is provided, along with factors that may increase or reduce inflammation. Implications for practice and research are discussed.
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Kane RL, Shamliyan T, Talley K, Pacala J. The Association Between Geriatric Syndromes and Survival. J Am Geriatr Soc 2012; 60:896-904. [DOI: 10.1111/j.1532-5415.2012.03942.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Kristine Talley
- School of Nursing, University of Minnesota; Minneapolis; Minnesota
| | - James Pacala
- Medical School, University of Minnesota; Minneapolis; Minnesota
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Inverted mitral inflow pattern in echocardiography among the elderly ? A marker of non-cardiovascular mortality and cognitive dysfunction. Int J Cardiol 2012; 155:70-4. [DOI: 10.1016/j.ijcard.2011.01.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/01/2011] [Indexed: 11/20/2022]
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Kerola T, Hiltunen M, Kettunen R, Hartikainen S, Sulkava R, Vuolteenaho O, Nieminen T. Mini-Mental State Examination score and B-type natriuretic peptide as predictors of cardiovascular and total mortality in an elderly general population. Ann Med 2011; 43:650-9. [PMID: 20961273 DOI: 10.3109/07853890.2010.526137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION. The aim of the present study was to examine the power of B-type natriuretic peptide (BNP) and mild cognitive impairment as independent predictors of total and cardiovascular mortality in combination with established cardiovascular risk markers in an elderly general population without severe cognitive impairment. METHODS. A total of 499 individuals, aged more than 75 years, were examined and followed up for a median of 7.9 years in a prospective population-based stratified cohort study carried out in eastern Finland. The Cox proportional hazards regression model was used to determine the impact of multiple factors on total and cardiovascular mortality. RESULTS. In a multivariable model including established cardiovascular risk factors and conditions, both continuous BNP (adjusted hazard ratio (HR) 1.44 for a 1-SD change; 95% confidence interval (CI) 1.22-1.77; P < 0.001) and continuous MMSE score (HR 0.81 for a 1-SD change; 95% CI 0.70-0.94; P = 0.007) were independently associated with all-cause mortality. In a multivariable model, BNP remained a significant predictor of cardiovascular mortality, while MMSE score lost its significance. CONCLUSIONS. BNP, a measure of cardiovascular burden, and MMSE score 18-23, an indicator of mild cognitive impairment, are both independent predictors of total mortality. BNP and MMSE score may potentially be useful in screening elderly patients for elevated risk of mortality.
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Affiliation(s)
- Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
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Sartori AC, Wadley VG, Clay OJ, Parisi JM, Rebok GW, Crowe M. The relationship between cognitive function and life space: the potential role of personal control beliefs. Psychol Aging 2011; 27:364-74. [PMID: 21875217 DOI: 10.1037/a0025212] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined the relationship of cognitive and functional measures with life space (a measure of spatial mobility examining extent of movement within a person's environment) in older adults, and investigated the potential moderating role of personal control beliefs. Internal control beliefs reflect feelings of competence and personal agency, while attributions of external control imply a more dependent or passive point of view. Participants were 2,737 adults from the ACTIVE study, with a mean age of 74 years. Females comprised 76% of the sample, with good minority representation (27% African American). In multiple regression models controlling for demographic factors, cognitive domains of memory, reasoning, and processing speed were significantly associated with life space (p < .001 for each), and reasoning ability appeared most predictive (B = .117). Measures of everyday function also showed significant associations with life space, independent from the traditional cognitive measures. Interactions between cognitive function and control beliefs were tested, and external control beliefs moderated the relationship between memory and life space, with the combination of high objective memory and low external control beliefs yielding the highest life space (t = -2.07; p = .039). In conclusion, older adults with better cognitive function have a larger overall life space. Performance-based measures of everyday function may also be useful in assessing the functional outcome of life space. Additionally, subjective external control beliefs may moderate the relationship between objective cognitive function and life space. Future studies examining the relationships between these factors longitudinally appear worthwhile to further elucidate the interrelationships of cognitive function, control beliefs, and life space.
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Affiliation(s)
- Andrea C Sartori
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Uusvaara J, Pitkala KH, Kautiainen H, Tilvis RS, Strandberg TE. Association of anticholinergic drugs with hospitalization and mortality among older cardiovascular patients: A prospective study. Drugs Aging 2011; 28:131-8. [PMID: 21275438 DOI: 10.2165/11585060-000000000-00000] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Many potentially inappropriate drugs prescribed to older people have anticholinergic properties as adverse effects and are therefore potentially harmful. These effects typically include constipation, dry mouth, blurred vision, dizziness and slowing of urination. It has been shown that drugs with anticholinergic properties (DAPs) are associated with cognitive decline and dementia, may contribute to events such as falls, delirium and impulsive behaviour, are associated with self-reported adverse effects and physical impairment, and may even be associated with mortality. However, studies of the prognostic implications of DAPs remain scarce. OBJECTIVE To evaluate the impact of DAPs on hospitalization and mortality in older patients with stable cardiovascular disease (CVD). METHODS This was a prospective study with a mean follow-up of 3.3 years involving two study groups: users (n = 295) and non-users (n = 105) of DAPs. The participants were 400 community-dwelling older people (aged 75-90 years) with stable CVD participating in a secondary prevention study of CVD (DEBATE) in Helsinki, Finland. The use of DAPs was estimated using definitions from the previous scientific literature. The Charlson Comorbidity Index (CCI) was used to estimate the burden of co-morbidity and the Mini-Mental State Examination test was used to assess cognitive function. The risks in the two study groups for hospital visits, number of days spent in hospital care and mortality were measured from 2000 to the end of 2003. RESULTS The unadjusted follow-up mortality was 20.7% and 9.5% among the users and non-users of DAPs, respectively (p = 0.010). However, the use of DAPs was not a significant predictor of mortality in multivariate analysis after adjustment for age, sex and CCI score (hazard ratio 1.57; 95% CI 0.78, 3.15). The mean ± SD number of hospital days per person-year was higher in the DAP user group (14.9 ± 32.5) than in the non-user group (5.2 ± 12.3) [p < 0.001]. In a bootstrap-type analysis of covariance adjusted for age, sex and CCI score, the use of DAPs predicted the number of days spent in hospital (p = 0.011). CONCLUSIONS The use of DAPs in older patients with stable CVD was associated with an increased number of hospital days but not with mortality.
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Barral S, Cosentino S, Costa R, Matteini A, Christensen K, Andersen SL, Glynn NW, Newman AB, Mayeux R. Cognitive function in families with exceptional survival. Neurobiol Aging 2011; 33:619.e1-7. [PMID: 21439683 DOI: 10.1016/j.neurobiolaging.2011.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 01/24/2011] [Accepted: 02/03/2011] [Indexed: 11/16/2022]
Abstract
The authors investigated whether cognitive function may be used as an endophenotype for longevity by assessing the cognitive performance of a family-based cohort consisting of 1380 individuals from 283 families recruited for exceptional survival in field centers in Boston, New York, Pittsburgh, and Denmark. Cognitive performance was assessed in the combined offspring of the Long Life Family Study (LLFS) probands and their LLFS siblings as compared with their spouses' cognitive performance. Our results indicate that the combined offspring of the LLFS probands and their siblings achieve significantly higher scores on both digit forward and backward tasks (p = 5 10(-5) and p = 8 10(-4) respectively) as well as on a verbal fluency task (p = 0.008) when compared with their spouse controls. No differences between groups were found for the other cognitive tests assessed. We conclude that LLFS family members in the offspring generation demonstrate significantly better performance on multiple tasks requiring attention, working memory, and semantic processing when compared with individuals without a family history of exceptional survival, suggesting that cognitive performance may serve as an important endophenotype for longevity.
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Affiliation(s)
- Sandra Barral
- The Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
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Dong X, Simon MA, Wilson RS, Mendes de Leon CF, Rajan KB, Evans DA. Decline in cognitive function and risk of elder self-neglect: finding from the Chicago Health Aging Project. J Am Geriatr Soc 2011; 58:2292-9. [PMID: 21143438 DOI: 10.1111/j.1532-5415.2010.03156.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the longitudinal association between decline in cognitive function and risk of elder self-neglect in a community-dwelling population. DESIGN Prospective population-based study. SETTING Geographically defined community in Chicago. PARTICIPANTS Community-dwelling subjects reported to the social services agency from 1993 to 2005 for self-neglect who also participated in the Chicago Health Aging Project (CHAP). Of the 5,519 participants in CHAP, 1,017 were reported to social services agency for suspected elder self-neglect from 1993 to 2005. MEASUREMENTS Social services agency identified reported elder self-neglect. The primary predictor was decline in cognitive function assessed using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test (Executive Function), and immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z-scores of all tests. Outcome of interest was elder self-neglect. Logistic and linear regression models were used to assess these longitudinal associations. RESULTS After adjusting for potential confounding factors, decline in global cognitive function, MMSE score, and episodic memory were not independently associated with greater risk of reported and confirmed elder self-neglect. Decline in executive function was associated with greater risk of reported and confirmed elder self-neglect. Decline in global cognitive function was associated with greater risk of greater self-neglect severity (parameter estimate=0.76, standard error=0.31, P=.01). CONCLUSION Decline in executive function was associated with risk of reported and confirmed elder self-neglect. Decline in global cognitive function was associated with risk of greater self-neglect severity.
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Affiliation(s)
- XinQi Dong
- Rush University Medical Center, Chicago, Illinois, USA.
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Dong X, Wilson RS, Mendes de Leon CF, Evans DA. Self-neglect and cognitive function among community-dwelling older persons. Int J Geriatr Psychiatry 2010; 25:798-806. [PMID: 19946866 DOI: 10.1002/gps.2420] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Elder self-neglect is a common public health issue, but it is unclear to what degree it is associated with cognitive function. This study aimed to examine the cross-sectional association between self-neglect and cognitive function. METHODS Chicago Health and Aging Project (CHAP) is a population-based epidemiological study conducted in a geographically defined community in Chicago (N = 8698): we identified 1094 CHAP participants who had self-neglect reported to social services agency, which assessed the self-neglect severity. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test (Perceptual Speed), and both immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z-scores of all tests. Linear regression models were used to assess the association of self-neglect severity and cognitive function. RESULTS Self-neglect was associated with poorer cognitive function. After adjusting for confounders, self-neglect was associated with lower global cognitive function (parameter estimate[PE] = -0.367, standard error[SE] = 0.026, p < 0.001), lower MMSE (PE = -2.592, SE = 0.182, p < 0.001), episodic memory (PE = -0.288, SE = 0.032, p < 0.001), and perceptual speed (PE = -5.428, SE = 0.444, p < 0.001). In addition, higher self-neglect severity scores were associated with lower global cognitive function (PE = -0.008, SE = 0.003, p = 0.014). Greater self-neglect severity was not correlated with worse performance on MMSE, but was correlated with worse performance on episodic memory (PE = -0.008,=SE = 0.003, p = 0.010), and perceptual speed (PE = -0.131, SE = 0.042, p = 0.002). CONCLUSION Self-neglect is associated with lower global cognitive function, episodic memory and perceptual speed. Future studies are needed to examine the temporality of these associations.
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Affiliation(s)
- Xinqi Dong
- Rush University Medical Center, Chicago, Illinois, USA.
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Vazzana R, Bandinelli S, Lauretani F, Volpato S, Lauretani F, Di Iorio A, Abate M, Corsi AM, Milaneschi Y, Guralnik JM, Ferrucci L. Trail Making Test predicts physical impairment and mortality in older persons. J Am Geriatr Soc 2010; 58:719-23. [PMID: 20398153 DOI: 10.1111/j.1532-5415.2010.02780.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine whether performance in the Trail Making Test (TMT) predicts mobility impairment and mortality in older persons. DESIGN Prospective cohort study. SETTING Community-dwelling older persons enrolled in the Invecchiare in Chianti (InCHIANTI) Study. PARTICIPANTS Five hundred eighty-three participants aged 65 and older and free of major cognitive impairment (Mini-Mental State Examination score >21) with baseline data on TMT performance. Of these, 427 performed the Short Physical Performance Battery (SPPB) for the assessment of lower extremity function at baseline and after 6 years. Of the initial 583 participants, 106 died during a 9-year follow-up. MEASUREMENTS The TMT Parts A and B (TMT-A and TMT-B) and SPPB were administered at baseline and 6-year follow-up. Impaired mobility was defined as an SPPB score less than 10. Vital status was ascertained over a 9-year follow-up. RESULTS InCHIANTI participants in the fourth quartile of the time to complete TMT-B minus time to complete TMT-A (TMT (B-A)) were significantly more likely to develop an SPPB score less than 10 during the 6-year follow-up than those in the first quartile (relative risk (RR)=2.4, 95% confidence interval (CI)=1.4-3.9, P=.001). After adjusting for potential confounders, these findings were substantially unchanged (RR=2.2, 95% CI=1.4-3.6, P=.001). Worse performance on the TMT was associated with significantly greater decline in SPPB score over the 6-year follow-up, after adjusting for age, sex, and baseline SPPB scores (beta=-0.01, standard error=0.003, P=.004). During the 9-year follow-up, 18.2% of the participants died. After adjustment for age and sex, the proportion of participants who died was higher in participants in the worst than the best performance quartile of TMT (B-A) scores (hazard ratio (HR)=1.7, 95% CI=1.0-2.9, P=.048). Results were similar in a parsimonious adjusted model (HR=1.8, 95% CI=1.0-3.2, P=.04). CONCLUSION Performance on the TMT is a strong, independent predictor of mobility impairment, accelerated decline in lower extremity function, and death in older adults living in the community. The TMT could be a useful addition to geriatric assessment.
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Affiliation(s)
- Rosamaria Vazzana
- Department of Medicine and Sciences of Aging, Laboratory of Clinical Epidemiology, University G. D'Annunzio, Chieti, Italy
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Amirian E, Baxter J, Grigsby J, Curran-Everett D, Hokanson JE, Bryant LL. Executive function (capacity for behavioral self-regulation) and decline predicted mortality in a longitudinal study in Southern Colorado. J Clin Epidemiol 2009; 63:307-14. [PMID: 19716261 DOI: 10.1016/j.jclinepi.2009.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 05/29/2009] [Accepted: 06/09/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the relationship between mortality and impairment and decline in a specific executive cognitive function, the capacity for behavioral self-regulation. STUDY DESIGN AND SETTING This study examined the association between mortality and baseline and 22-month decline in the capacity for behavioral self-regulation, as measured by the Behavioral Dyscontrol Scale, among 1,293 participants of the San Luis Valley Health and Aging Study (SLVHAS), a population-based longitudinal study. The Behavioral Dyscontrol Scale and a measure of overall mental status, the Mini-Mental State Examination, were administered at baseline and follow-up interviews. Cox regression was used to examine baseline and decline in capacity for behavioral self-regulation as possible predictors of mortality. RESULTS Baseline Behavioral Dyscontrol Scale score was predictive of mortality, independent of demographics and comorbidity count (hazard ratio [HR]=1.07; 95% confidence interval [CI]: 1.04, 1.09). It remained a significant predictor with further adjustment for Mini-Mental State Examination score. Decline in this specific executive cognitive function was associated with mortality after adjustment for covariates and baseline cognitive scores (HR=1.09; 95% CI: 1.04, 1.13). CONCLUSION Thus, both baseline capacity for behavioral self-regulation and its decline over time predicted mortality in the SLVHAS cohort. These associations may partly be attributed to maintaining the ability for self-care. Understanding how specific forms of impairment contribute to mortality may help identify patients who could benefit from early intervention.
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Affiliation(s)
- E Amirian
- Department of Epidemiology, UT-MD Anderson Cancer Center, Houston, TX, USA
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Sachs-Ericsson N, Corsentino E, Cougle JR. Problems meeting basic needs predict cognitive decline in community-dwelling Hispanic older adults. J Aging Health 2009; 21:848-63. [PMID: 19571183 DOI: 10.1177/0898264309340689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. Indices of low socioeconomic status (SES) have been found to predict negative health outcomes. However, problems meeting basic needs (e.g., not having enough money for health care, adequate food, etc.) may be a more potent measure of negative health outcomes than other more typically assessed indices of SES, such as income. This article examined the association between problems meeting basic needs and cognitive decline in a sample of community-dwelling Hispanic older adults (N = 1,964). Method. The authors used a prospective design to study the influence of problems meeting basic needs on cognitive functioning. Analyses controlled for demographics, health problems, and depressive symptoms. Results. The authors found problems meeting basic needs to be a more potent predictor of cognitive decline than income. Discussion. Interventions focused on providing older adults with resources for meeting basic needs, such as adequate food and health care, may substantially reduce the subsequent level of stress and health problems in this population.
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Does executive function explain the IQ-mortality association? Evidence from the Canadian study on health and aging. Psychosom Med 2009; 71:196-204. [PMID: 19073749 DOI: 10.1097/psy.0b013e318190d7f0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the robustness of the association between intelligence quotient (IQ) and mortality in older adults and to examine whether or not the association can be explained by more specific cognitive processes, including individual differences in executive functioning. METHODS We examined the associations among Full Scale IQ, individual IQ subtest scores, and 10-year mortality among older community-dwelling, adult participants in the Canadian Study of Health and Aging, who were verified as disease and cognitive-impairment free at baseline via comprehensive medical and neurological evaluation (n = 516). Survival analysis including Cox proportional hazards regression models were used to examine mortality risk as a function of Full Scale IQ and its specific subcomponents. RESULTS An inverse association was found between IQ and mortality, but this did not survive adjustment for demographics and education. The association between IQ and mortality seemed to be predominantly accounted for by performance on one specific IQ subtest that taps executive processes (i.e., Digit Symbol (DS)). Performance on this subtest uniquely and robustly predicted mortality in both unadjusted and adjusted models, such that a 1-standard deviation difference in performance was associated with a 28% change in risk of mortality over the 10-year follow-up interval in adjusted models. CONCLUSIONS The association between IQ and mortality in older adults may be predominantly attributable to individual differences in DS performance.
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Strandberg TE, Pitkala KH, Tilvis RS. Predictors of Mortality in Home-Dwelling Patients with Cardiovascular Disease Aged 75 and Older. J Am Geriatr Soc 2009; 57:279-84. [DOI: 10.1111/j.1532-5415.2008.02112.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Association of childhood intelligence with risk of coronary heart disease and stroke: findings from the Aberdeen Children of the 1950s cohort study. Eur J Epidemiol 2008; 23:695-706. [DOI: 10.1007/s10654-008-9281-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 07/29/2008] [Indexed: 10/21/2022]
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Ayalon L. Subjective cognitive functioning as a predictor of all cause mortality in an Israeli national sample of community dwelling older adults. Int J Geriatr Psychiatry 2008; 23:830-6. [PMID: 18314928 DOI: 10.1002/gps.1991] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive functioning has been identified as a predictor of all cause mortality in several epidemiological studies. As a result, researchers have suggested the use of short cognitive screens as prognostic indicators in older adults. Little is known, however, about subjective complaints of cognitive functioning as predictors of all cause mortality. METHODS A 7-year follow-up of a national sample of 4,921 Israelis over the age of 60. Main predictors were subjective complaints of memory problems, confusion, and recognition problems. Outcome was time to death. RESULTS As expected, in the fully adjusted model, age, gender, subjective health, baseline health, and ADL and IADL impairments were significant predictors of all cause mortality. In addition, complaints about difficulties recognizing familiar people also were associated with a greater risk for mortality. CONCLUSIONS Subjective complaints about recognition problems serve as a risk for all cause mortality above and beyond well-known risk factors. Health care professionals can use this information about subjective cognitive functioning in conjunction with other measures in order to identify older adults at risk for an earlier death.
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Affiliation(s)
- Liat Ayalon
- School of Social Work, Bar Ilan University, Ramat Gan, Israel.
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Does cognition predict mortality in midlife? Results from the Whitehall II cohort study. Neurobiol Aging 2008; 31:688-95. [PMID: 18541343 DOI: 10.1016/j.neurobiolaging.2008.05.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 04/10/2008] [Accepted: 05/01/2008] [Indexed: 11/20/2022]
Abstract
The authors examined the association of 'g' (general intelligence) factor and five specific cognitive measures assessed in 1997-1999 with mortality till 2006 (mean follow-up of 8 years) in the middle-aged Whitehall II cohort study. In age- and sex-adjusted analysis, a decrease in 1 S.D. in memory (hazard ratio (HR), 1.19; 95% confidence interval (CI): 1.02, 1.39) and in Alice Heim 4-I (AH4-I) (HR, 1.16; 95% CI: 1.01, 1.35) was found to be associated with higher mortality. The association with 'g' factor, phonemic and semantic fluency did not reach significance at p<0.05. No association was found with vocabulary. Out of education, health behaviours and health measures, it was health behaviours that explained the greater part of the association between cognition and mortality, ranging from 21% for memory to 70% for semantic fluency. All the covariates taken together explained only 26% of the association with memory and between 33 and 90% for the other cognitive measures. This study suggests that 'g' type composite measure of cognition might not be enough to understand the associations between cognition and health.
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Cerveira MO, Franz AP, Camozzato AL, Chaves MLF. General psychiatric or depressive symptoms were not predictive for mortality in a healthy elderly cohort in Southern Brazil. Dement Neuropsychol 2008; 2:119-124. [PMID: 29213554 PMCID: PMC5619581 DOI: 10.1590/s1980-57642009dn20200008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
General psychiatric symptoms may interfere with the ability of individuals to
take care of their health, to get involved with activities and develop social
abilities, thereby increasing risk of death.
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Affiliation(s)
- Maria Otilia Cerveira
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre. Medical Sciences Post-Graduation Course, UFRGS School of Medicine. Internal Medicine Department, UFRGS School of Medicine
| | - Adelar Pedro Franz
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre. Medical Sciences Post-Graduation Course, UFRGS School of Medicine. Internal Medicine Department, UFRGS School of Medicine
| | - Ana Luiza Camozzato
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre. Medical Sciences Post-Graduation Course, UFRGS School of Medicine. Internal Medicine Department, UFRGS School of Medicine
| | - Márcia Lorena Fagundes Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre. Medical Sciences Post-Graduation Course, UFRGS School of Medicine. Internal Medicine Department, UFRGS School of Medicine
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Suárez García FM, Pérez Martín A, Peiró Moreno S, García García FJ. [Risk factors for 4-year mortality in older adults. Toledo Study]. Rev Esp Geriatr Gerontol 2008; 43:76-84. [PMID: 18682117 DOI: 10.1016/s0211-139x(08)71159-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION multiple factors contribute to mortality in older adults. Measures of physical and cognitive function are strong predictors of mortality, but the extent to which function, health-related quality of life and other factors contribute independently to mortality risk is not known. MATERIAL AND METHODS we performed a prospective study of a representative sample of people aged 65 years and older (n=3,214) followed-up for 4 years. Individuals from the sample were interviewed to obtain information about sociodemographic characteristics, comorbidity, functional status, health-related quality of life, and healthcare utilization. The main outcome measure was 4-year mortality. To assess the independent impact of each risk factor on mortality, several multivariate survival models were built using the Cox proportional hazard model. RESULTS in the 4 years of monitoring, 478 people died (14.9%). The variables independently associated with mortality risk were age 75 years or older (HR = 1.93), male gender (HR = 1.73), heart disease (HR = 1.32), chronic respiratory disease (HR = 1.78), activities of daily living disability (HR = 1.55), instrumental activities of daily living disability (HR = 2.19), cognitive impairment (HR = 1.39), poor health-related quality of life (HR = 1.85) and hospital admission in the year prior to the interview (HR = 1.51). CONCLUSIONS objective measures of physical and cognitive function are independent predictors of 4-year mortality in the elderly. Poor health-related quality of life is associated with mortality. The magnitude of this association is comparable to that of other well-know predictors of mortality. Instruments to measure health-related quality of life can be useful to evaluate health requirements in the elderly.
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Johnson JK, Lui LY, Yaffe K. Executive function, more than global cognition, predicts functional decline and mortality in elderly women. J Gerontol A Biol Sci Med Sci 2007; 62:1134-41. [PMID: 17921427 PMCID: PMC2049089 DOI: 10.1093/gerona/62.10.1134] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Functional impairment in community-dwelling older adults is common and is associated with poor outcomes. Our goal was to compare the contribution of impairment in executive function or global cognitive function to predicting functional decline and mortality. METHODS We studied 7717 elderly women enrolled in a prospective study (mean age 73.3 years) and identified women with poor baseline executive function (score > 1 standard deviation [SD] below the mean on the Trail Making Test B (Trails B; n = 957, 12.4%), poor global cognitive function (score > 1 SD below the mean on a modified Mini-Mental State Examination [mMMSE], n = 387, 5.0%), impairment in both (n = 249, 3.2%), or no impairment (n = 6124, 79.4%). We compared level of functional difficulty (Activities of Daily Living [ADLs] and Instrumental ADLs [IADLs]) at baseline and at 6-year follow-up and survival at follow-up. We also determined if the association was independent of age, education, depression, medical comorbidities, and baseline functional ability. RESULTS At baseline, women with Trails B impairment only or impairment on both tests reported the highest proportion of ADL and IADL dependence compared to the other groups. At the 6-year follow-up after adjusting for age, education, medical comorbidities, depression, and baseline ADL or IADL, women with only Trails B impairment were 1.3 times more likely to develop an incident ADL dependence (adjusted odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.07-1.69) and 1.5 times more likely to develop a worsening of ADL dependence (adjusted OR = 1.48; 95% CI, 1.16-1.89) when compared to women with no impairment on either test. In addition, women with only Trails B impairment had a 1.5-fold increased risk of mortality (adjusted hazard ratio [HR] = 1.48; 95% CI, 1.21-1.81). In contrast, women with impairment on only mMMSE were not at increased risk to develop incident ADL or IADL dependence, a worsening of ADL or IADL dependence, or mortality. CONCLUSION Compared to women with no impairment, women with executive function impairment had significantly worse ADL and IADL function cross-sectionally and over 6 years. Individuals with executive dysfunction also had increased risk of mortality. These results suggest that screening of executive function can help to identify women who are at risk for functional decline and decreased survival.
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Affiliation(s)
- Julene K Johnson
- UCSF Department of Neurology, Memory and Aging Center, 350 Parnassus, Suite 706, San Francisco, CA 94117, USA.
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Schupf N, Patel B, Pang D, Zigman WB, Silverman W, Mehta PD, Mayeux R. Elevated plasma beta-amyloid peptide Abeta(42) levels, incident dementia, and mortality in Down syndrome. ACTA ACUST UNITED AC 2007; 64:1007-13. [PMID: 17620492 PMCID: PMC2587094 DOI: 10.1001/archneur.64.7.1007] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Deposition of the beta-amyloid peptide Abeta(42) is thought to be an important initial step in the pathogenesis of Alzheimer disease (AD). Individuals with Down syndrome have increased levels of beta-amyloid peptides and an increased risk for AD. OBJECTIVE To examine the relation of plasma levels of Abeta(42) and Abeta(40) to the risk of dementia in nondemented participants and all-cause mortality in adults with Down syndrome. DESIGN Prospective, community-based longitudinal cohort study. SETTING State and voluntary service providers in New York State. PARTICIPANTS Adults with Down syndrome (N = 204). MAIN OUTCOME MEASURE Plasma Abeta(42) and Abeta(40) levels were measured at initial examination. Participants were assessed for cognitive and functional abilities, behavioral/psychiatric conditions, and health and vital status at 14- to 18-month intervals for 4 cycles of data collection. RESULTS Among participants who were nondemented at baseline, those in the middle and highest tertiles of plasma Abeta(42) levels were more than 2 times as likely to develop AD as those in the lowest tertile. Compared with participants without AD, participants with prevalent AD had higher levels of plasma Abeta(42) but not Abeta(40). Among all participants, those in the highest tertile of plasma Abeta(42) level at baseline were more than twice as likely to die during the study period as those in the lowest tertile, whereas there was no difference in risk of death between those in the middle and lowest tertiles of plasma Abeta(42) level. CONCLUSION Elevations in plasma Abeta(42) peptide levels are associated with earlier onset of AD and increased risk of death.
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Affiliation(s)
- Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, PO Box 16, 630 W 168th St, New York, NY 10032, USA.
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Batty GD, Deary IJ, Gottfredson LS. Premorbid (early life) IQ and later mortality risk: systematic review. Ann Epidemiol 2006; 17:278-88. [PMID: 17174570 DOI: 10.1016/j.annepidem.2006.07.010] [Citation(s) in RCA: 301] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/19/2006] [Accepted: 07/26/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Studies of middle-aged and particularly older-aged adults found that those with higher scores on tests of IQ (cognitive function) had lower rates of later mortality. Interpretation of such findings potentially is hampered by the problem of reverse causality: such somatic diseases as diabetes or hypertension, common in older adults, can decrease cognitive function. Studies that provide extended follow-up of the health experience of individuals who had their (premorbid) IQ assessed in childhood and/or early adulthood minimize this concern. The purpose of the present report is to systematically locate, evaluate, and interpret the findings of all such studies. METHODS We systematically identified individual-level studies linking premorbid IQ with later mortality by using four approaches: search of electronic databases (MEDLINE, EMBASE, and PSYCHINFO); scrutiny of the reference sections of identified reports; search of our own files; and contact with researchers in the field. Study quality was assessed by using predefined criteria. RESULTS Nine cohort studies met the inclusion criteria. Overall, study quality was moderate. All reports showed an inverse IQ-mortality relation; i.e., higher IQ scores were associated with decreased mortality risk. The nature of this relation (i.e., dose-response or threshold) and whether it differs by sex was unclear. The IQ-mortality association did not appear to be explained by reverse causality or selection bias. Confounding by other early-life factors also did not seem to explain the association, although some studies were not well characterized in this regard. Adult socioeconomic position appeared to mediate the IQ-mortality association in some studies, but this was not a universal finding. CONCLUSIONS In all studies, higher IQ in the first two decades of life was related to lower rates of total mortality in middle to late adulthood. Some plausible mechanistic pathways exist, but further examination is required. The precise nature of the IQ-mortality relation (particularly in ethnic minorities and women) and the link between IQ and disease-specific outcomes also warrants further research.
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Affiliation(s)
- G David Batty
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
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Regal-Ramos R, Salinero Fort M, Cruz-Jentoft A. [Mortality predictive factors of a clinical cohort of elderly patients]. Aten Primaria 2006; 36:480-6. [PMID: 16324504 PMCID: PMC7676102 DOI: 10.1016/s0212-6567(05)70548-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study the association between the main variables collected in the comprehensive geriatric assessment (CGA) and mortality, in a clinical cohort of elderly people referred from primary care, following standardised criteria, to a geriatric unit. Design. Retrospective cohort study. SETTING Outpatient department of a geriatric unit of a hospital in Madrid, Spain. PARTICIPANTS A total of 140 patients older than 65 years were followed up for 70 months. MAIN MEASUREMENTS We collected demographic, clinical, functional, and social variables during the CGA carried out by a multidisciplinary team. After 70 months we measured this cohort survival and we analysed the predictive factors for mortality using Cox hazard ratio analysis. RESULTS. Sixty three patients died after the 70 months of the study, and the survival median was 37 months. In the univariate analysis, age, male gender, diagnosed cancer, COPD, the Katz and Lawton indices, and the Mini-Mental State Examination (MMSE) score of 35 items, were significantly associated with mortality. In the multivariate analysis we found, as predictive factors for mortality: MMSE-35 (HR=0.965; 95% CI, 0.934-0.998; P=.037); male gender (HR=2.75; 95% CI, 1.6-4.74; P=.001); Katz score (HR=1.22; 95% CI, 1.04-1.43; P=.017); Lawton score (HR=0.93; 95% CI, 0.82-1.07; P=.30). CONCLUSION Cognitive impairment is a mortality predictive factor (HR=0.65), for each point less in the MMSE-35, we observed an increase in mortality risk of 3.5% (1-HR) at 70 months, after adjustment for Katz and Lawton index and gender.
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Affiliation(s)
| | - M.A. Salinero Fort
- Unidad de Formación e Investigación de Atención Primaria. Área 4. Servicio Madrileño de Salud. Madrid. España
- Correspondencia: M.A. Salinero Fort. Unidad de Formación e Investigación de Atención Primaria. Área 4. Servicio Madrileño de Salud. José Arcones Gil, 11. 28017 Madrid. España.
| | - A.J. Cruz-Jentoft
- Hospital Ramón y Cajal.Unidad de Geriatría. Servicio Madrileño de Salud. Madrid. España
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