Teratogenic effects of radiofrequency electromagnetic radiation on the embryonic development of chick: A study on morphology and hatchability

The present study was aimed at studying the effects of RF-EMR in causing teratogenic changes in the embryonic development of organisms using chick embryo as a model. The fertilized eggs of the hen were incubated in a digital humidified incubator and exposed to RF-EMR from 2G and 4G mobile phones by ringing at regular time intervals. The dose of RF-EMR was varied by increasing the call duration and number of calls per day, with the lower dose being a call duration of 50 min/day and the higher dose being 90 min/day. The phone kept had a range of radiofrequency between 900 and 1800 MHz and SAR (Specific Absorption Rate) 1.355 (2G) and 1.12 (4G) watts/ kg respectively. The batch of eggs incubated without any exposure to RF-EMR was taken as control. The hatchability of 2G and 4G experimental groups were respectively, 65% and 75% at lower radiation exposure and 40% and 55% at higher radiation exposure. The teratogenic effects of RF-EMR on the morphology of chick embryos manifested as the cross beak, non-retracted yolk sac, macrocephaly, malformed legs and toes, disability in standing and balancing the body and variations in body weight, body length and beak length. The results indicate that the RF-EMR poses potential threats to the developing stages of organisms.

Antixenosis by a resistant Musa cultivar to stem borer Odoiporus longicollis attack and expression of microsomal α-amylase by the pest

Banana pseudo-stem weevil (BPW) Odoiporus longicollis Olivier is a serious pest of Musa cultivars which completes its lifecycle as an internal parasite in the pseudo-stem of susceptible host plants. The larval stage of BPW is destructive and difficult to control as larvae are endophytic. Plantains (bananas), resistant to infestation by BPW, exhibited antixenosis against the larvae. Experimental maintenance of the larvae for 4 days in the live pseudo-stem of the resistant plantain resulted in the disruption of carbohydrate metabolism and imbalance of protein-free amino acid turnover. The pseudo-stem possesses three larvicides: stigmasterol-3-O-glucoside (SOG), sulfoquinovosyl diacylglycerol (SQDG), and betulinic acid (BA). Larvicides cause significant elevation in hemolymph protein and reduction in total free amino acids. Larvae treated with larvicides showed elevated activities of hexokinase, trehalase, and lactic acid dehydrogenase, which resulted in significant decrease of glucose and trehalose but sharp increase of lactic acid. Also, inhibition in the activity of glycogen phosphorylase caused significant increase of fat body glycogen in affected larvae. At LD₂₀ concentration, toxicities by SOG, SQDG, and BA were similar but antixenosis by the resistant host plant was more severe due to the simultaneous action of three larvicides present in the resistant, live pseudo-stem. Disruption of carbohydrate metabolism and imbalance of protein-amino acid turnover due to toxicity by larvicides resulted in slow death of the larvae. The larval body responded against toxicity through the induction of the amy gene, which resulted in increased synthesis of α-amylase. The protein was sequenced as ID AHN 92452.2 with 496 amino acids, and the gene has 1491 nucleotides. Defense mechanisms by the larvae are not sufficient to resist antixenosis by the host plant. SOG, SQDG, and BA can be used synergistically as a larvicide for the control of BPW.

Monitoring Postmatch Fatigue During a Competitive Season in Elite Youth Soccer Players

CONTEXT

Countermovement jump (CMJ) and perceived wellness measures are useful for monitoring fatigue. Fatigue indicators should simultaneously show sensitivity to previous load and demonstrate influence on subsequent physical output; however, these factors have not been examined.

OBJECTIVE

To explore the efficacy of CMJ and wellness measures to both detect postmatch fatigue and predict subsequent physical match output in elite youth soccer players.

DESIGN

Cross-sectional study.

PATIENTS OR OTHER PARTICIPANTS

Sixteen soccer players (18 ± 1 years) from 36 English Football League Youth Alliance League fixtures.

MAIN OUTCOME MEASURE(S)

Physical match outputs (total distance, high-speed running, very high-speed running, and accelerations and decelerations [AD]) were recorded using a 10-Hz global positioning system and 200-Hz accelerometer device during competitive match play. The CMJ height and perceived wellness were assessed weekly and daily, respectively, as indirect indicators of fatigue. Four subunits of wellness (perceived soreness, energy, general stress, and sleep) were measured using customized psychometric questionnaires.

RESULTS

Simple linear regression showed that match AD predicted energy (R2 = 0.08, P = .001), stress (R2 = 0.09, P < .001), and total wellness (R2 = 0.06, P = .002) at 2 days postmatch. The CMJ (R2 = 0.05, P = .002), stress (R2 = 0.08, P < .001), sleep (R2 = 0.03, P = .034), and total wellness (R2 = 0.05, P = .006) measures at 5 days prematch predicted AD during the subsequent match.

CONCLUSIONS

The CMJ and wellness measures may be useful for detecting postmatch fatigue. Wellness scores, but not CMJ, at 5 days prematch influenced subsequent match output and therefore may be used to plan and periodize training for the upcoming microcycle.

Consensus exercise identifying priorities for research in the field of general surgery of childhood in the UK

BACKGROUND

The evidence base underlying clinical practice in children's general surgery is poor and high-quality collaborative clinical research is required to address current treatment uncertainties. The aim of this study was, through a consensus process, to identify research priorities for clinical research in this field amongst surgeons who treat children.

METHODS

Questions were invited in a scoping survey amongst general surgeons and specialist paediatric surgeons. These were refined by the study team and subsequently prioritized in a two-stage modified Delphi process.

RESULTS

In the scoping survey, a total of 226 questions covering a broad scope of children's elective and emergency general surgery were submitted by 76 different clinicians. These were refined to 71 research questions for prioritization. A total of 168 clinicians took part in stage one of the prioritization process, and 157 in stage two. A 'top 10' list of priority research questions was generated for both elective and emergency general surgery of childhood. These cover a range of conditions and concepts, including inguinal hernia, undescended testis, appendicitis, abdominal trauma and enhanced recovery pathways.

CONCLUSION

Through consensus amongst surgeons who treat children, 10 priority research questions for each of the elective and emergency fields have been identified. These should provide a basis for the development of high-quality multicentre research projects to address these questions, and ultimately improve outcomes for children requiring surgical care.

End-tidal CO2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey

Introduction

Procedural sedation and analgesia (PSA) provides safe and effective relief for pain, anxiety and discomfort during procedures performed in the emergency department (ED). Our objective was to identify hospital-level factors associated with routine PSA capnography use in the ED.

Methods

This study was a cross-sectional telephone survey of ED nurse managers and designees in a Midwestern state. Respondents identified information about hospital infrastructure, physician staffing, family practice (FP) physicians only, board-certified emergency physicians (EPs) only (or both), and critical intervention capabilities. Additional characteristics including ED volume and hospital designation (i.e., rural-urban classification) were obtained from the Centers for Medicare and Medicaid Services and the state hospital association database, respectively. The primary outcome was reported use of PSA capnography. We conducted univariate analyses (relative risks, 95% confidence interval [CI]) to identify associations between hospital-level characteristics and PSA capnography use.

Results

We had an overall response rate of 98% (n=118 participating hospitals). The majority of EDs were in rural settings (78%), with a median of 5,057 visits per year (interquartile range 2,823-14,322). Nearly half of the EDs were staffed by FP physicians only, while 16% had board-certified EPs only. Nearly all hospitals (n=114, 97%), reported using continuous capnography for ventilated patients, and 74% reported use of capnography during PSA. Urban hospitals were more likely to use PSA capnography than critical access hospitals (relative risk 1.45; 95% CI, 1.22-1.73), and PSA capnography use increased with each ED volume quartile. Facilities with only EPs were 1.46 (95% CI, 1.15-1.87) times more likely to use PSA capnography than facilities with FP physicians only.

Conclusion

Continuous capnography was available in nearly all EDs, independent of size, location or patient volume. The implementation of capnography during PSA was less penetrant. Smaller, rural departments were less likely than their larger, urban counterparts to implement these national guidelines. Rurality and hospital size may be potential institutional barriers to capnography implementation.

Isolation, characterization and mode of action of a larvicidal compound, 22-hydroxyhopane from Adiantum latifolium Lam. against Oryctes rhinoceros Linn

Oryctes rhinoceros Linn. is one of the most serious pests of coconuts and other palms. Following bioassay guided method, a larvicidal compound, 22-hydroxyhopane has been isolated for the first time from methanol extract of leaves of Adiantum latifolium Lam. against the pest (LC₅₀ value 20.81 μg/g). It is a hopanoid triterpene with molecular mass of 442.42 g/mol. The compound exhibited antibacterial activity against symbiotic gut bacteria, caused histolysis of midgut tissues and inhibited secretion of digestive enzymes such as protease, amylase and trehalase resulting in weight loss of larvae. Enzyme immunoassay showed an elevation of 20-hydroxyecdysone level in haemolymph causing disruption of metamorphosis of larvae.

Perineal closure following extralevator abdominoperineal excision for cancer of the rectum

AIM

Extralevator abdominoperineal resection (ELAPE) may be complicated by perineal wound healing problems and herniation. We report a consecutive series of 38 such patients with selective use of a fasciocutaneous V-Y buttock advancement flap (BAF).

METHOD

Data were collected on a series of patients undergoing ELAPE for rectal malignancy between August 2011 and July 2017. Demographics, management and outcomes were recorded prospectively. Perineal wound problems were considered as 'major' if they required packing; otherwise, they were classed as 'minor'.

RESULTS

Thirty-eight patients [eight female and 30 male; median age 63 (range: 35-89) years] underwent ELAPE. Thirty-seven had an adenocarcinoma of the rectum and one had a malignant melanoma. The median tumour height (from the anal verge) was 30 (range: 0-80) mm. Sixteen patients had a BAF. The median length of stay was 10 (range: 6-25) days. Primary perineal healing occurred in 18 (47%) patients. Major wound breakdown occurred in three (10%) patients and minor wound breakdown in 17 (45%). Two of the 16 patients having a BAF had major wound breakdown: one wound took 9 weeks to heal completely and the other took 9 months. Of the 22 patients who did not have a BAF, one had a major wound breakdown which closed by 3 months. There were no perineal fistulae or chronic sinuses. There were two perineal herniae that were successfully repaired by perineal insertion of biological mesh (Permacol™; Covidien, Dublin, Ireland).

CONCLUSIONS

Selective use of a BAF for perineal closure can give good results in terms of healing and an acceptably low early perineal herniation rate.

Retention of laryngoscopy skills in medical students: a randomised, cross-over study of the Macintosh, A.P. Advance(™) , C-MAC(®) and Airtraq(®) laryngoscopes

In addition to being effective and easy to learn how to use, the ideal laryngoscope should be associated with minimal reduction in skill performance during gaps in practice over time. We compared the time taken to intubate the trachea of a manikin by novice medical students immediately after training, and then after 1 month, with no intervening practice. We designed a two-period, four-group, randomised, cross-over trial to compare the Macintosh, Venner(™) A.P. Advance(™) with difficult airway blade, C-MAC(®) with D-Blade and Airtraq(®) with wireless video-viewer. A bougie was used to aid intubation with the Macintosh and the C-MAC. After training, there was no significant difference in median (IQR [range]) intubation time using the videolaryngoscopes compared with the Macintosh, which took 30 (26.5-35 [12-118])s. One month later, the intubation time was longer using the C-MAC (41 (29.5-52 [20-119])s; p = 0.002) and A.P. Advance (40 (28.5-57.5 [21-107])s; p = 0.0003)m compared with the Macintosh (27 (21-29 [16-90])s); there was no difference using the Airtraq (27 (20.5-32.5 [15-94])s; p = 0.258) compared with the Macintosh. While skill acquisition after a brief period of learning and practice was equal for each laryngoscope, performance levels differed after 1 month without practice. In particular, the consistency of performance using the C-MAC and A.P. Advance was worse compared with the Macintosh and the Airtraq. While the clinical significance of this is doubtful, we believe that reliable and consistent performance at laryngoscopy is desirable; for the devices that we tested, this requires regular practice.

BIAN N-Heterocyclic Gold Carbene Complexes induced cytotoxicity in human cancer cells via upregulating oxidative stress

BACKGROUND

Nanoparticles of gold and silver are offering revolutionary changes in the field of cancer therapy. N-heterocyclic carbene (NHC) metal complexes possess diverse biological activities and are being investigated as potential chemotherapeutic agents. The purpose of this study was to examine the cytotoxicity and possible mechanisms of action of two types of newly synthesized nanofiber composites containing BIAN N-heterocyclic gold carbene complexes in two types of human cancer cells, namely breast cancer (MCF7) and liver cancer (HepG2) cells and also in normal human embryonic kidney cells (HEK 293).

MATERIALS AND METHODS

Cytotoxicity was assessed by MTT cell viability assay and oxidative stress by checking the total glutathione level.

RESULTS

Both compounds affected the cell survival of the tested cell lines at very low concentrations (IC50 values in the micro molar range) as compared to a well-known anti-cancer drug, 5 fluorouracil. A 60-80% depletion in total glutathione level was detected in treated cells.

CONCLUSIONS

Reduction in total glutathione level is one of the biochemical pathways for the induction of oxidative stress which in turn could be a possible mechanism of action by which these compounds induce cytotoxicity in cancer cell lines. The in vitro toxicity towards cancer cells found here means that these molecules could be potential anticancer candidates.

Photophysical tuning of the aggregation-induced emission of a series of para-substituted aryl bis(imino)acenaphthene zinc complexes

Bis(imino)acenaphthene (BIAN) zinc complexes with para-substituted aryl groups have been synthesized and investigated from the standpoint of their photophysical properties. Each complex was found to be nonemissive in solution. However, complexes 1-6 turned out to be emissive in the solid state, while complexes 7 and 8 remained nonemissive. The emissions for complexes 1-8 displayed color tunability ranging from red-yellow. A detailed crystallographic study of the "as-synthesized" structures revealed a distinct difference in the crystal packing environments of the emissive and nonemissive complexes. Furthermore, a solvatomorphic study provided further emission tunability via changes in the crystal packing environments of each solvatomorph. Lastly, TD-DFT calculations were performed in order to investigate the effect of different para-substituents on the flanking aryl rings of the BIAN ligand.

Cadaveric study of movement of an unstable atlanto-axial (C1/C2) cervical segment during laryngoscopy and intubation using the Airtraq(®) , Macintosh and McCoy laryngoscopes

Concern that laryngoscopy and intubation might create or exacerbate a spinal cord injury has generated extensive research into cervical spinal movement during laryngoscopy. We performed a randomised trial on six cadavers, using three different laryngoscopes, before and after creating a type-2 odontoid peg fracture. Our primary outcome measure was the change in the space available for the spinal cord at the C1/2 segment measured by cinefluoroscopy. Tracheal intubation was performed using a minimal view of the glottis, a bougie, and manual in-line stabilisation. In a cadaveric model of type-2 odontoid fracture, the space available for the cord was preserved in maximum flexion and extension, and changed little on laryngoscopy and intubation.

A Census of X-ray gas in NGC 1068: Results from 450ks of Chandra HETG Observations

We present models for the X-ray spectrum of the Seyfert 2 galaxy NGC 1068. These are fitted to data obtained using the High Energy Transmission Grating (HETG) on the Chandra X-ray observatory. The data show line and radiative recombination continuum (RRC) emission from a broad range of ions and elements. The models explore the importance of excitation processes for these lines including photoionization followed by recombination, radiative excitation by absorption of continuum radiation and inner shell fluorescence. The models show that the relative importance of these processes depends on the conditions in the emitting gas, and that no single emitting component can fit the entire spectrum. In particular, the relative importance of radiative excitation and photoionization/recombination differs according to the element and ion stage emitting the line. This in turn implies a diversity of values for the ionization parameter of the various components of gas responsible for the emission, ranging from log(ξ)=1 - 3. Using this, we obtain an estimate for the total amount of gas responsible for the observed emission. The mass flux through the region included in the HETG extraction region is approximately 0.3 M_⊙ yr^-1 assuming ordered flow at the speed characterizing the line widths. This can be compared with what is known about this object from other techniques.

Syntheses of sterically shielded stable carbenes of the 1,2,4-triazole series and their corresponding palladium complexes: efficient catalysts for chloroarene hydrodechlorination

Sterically shielded 1,2,4-triazol-5-ylidenes and their palladium complexes: catalysts for hydrodechlorination.

Exceptionally efficient catalytic hydrodechlorination of persistent organic pollutants: application of new sterically shielded palladium carbene complexes

Exceptionally efficient catalysis of haloarene hydrodehalogenation by palladium carbene complexes.

Sterically directed functionalization of the redox-active bis(imino)acenaphthene ligand class: an experimental and theoretical investigation

The synthesis, characterization, and theoretical study of the sterically directed functionalization of the redox-active bis(imino)acenaphthene (BIAN) ligand class has been explored. With dependence on the steric congestion encompassing the N-C-C-N fragment of the Ar-BIAN ligand, functionalization can be directed to proceed either via a radical backbone dearomatization or a nucleophilic imine C-alkylation pathway. The structures of the Ar-BIAN derivatives 14-19 were determined by means of single-crystal X-ray diffraction. The reaction pathways involved in Ar-BIAN functionalization were monitored by means of EPR spectroscopy. The experimental results and observations were examined in conjunction with DFT-D calculations in order to explain the driving forces that direct the pathways leading to Ar-BIAN functionalization.

Mediterranean diet and depressive symptoms among older adults over time

OBJECTIVE

To examine whether adherence to a Mediterranean-based dietary pattern is predictive of depressive symptoms among older adults.

DESIGN

Generalized estimating equation models were used to test the association between a Mediterranean-based dietary pattern and depressive symptoms over time. Models were adjusted for age, sex, race, education, income, widowhood, antidepressant use, total calorie intake, body mass index, smoking, alcohol consumption, number of self-reported medical conditions, cognitive function, and physical disability.

SETTING

Chicago, Illinois.

PARTICIPANTS

Community-dwelling participants (n=3502) of the Chicago Health and Aging Project aged 65+ years (59% African American) who had no evidence of depression at the baseline.

MEASUREMENTS

Adherence to a Mediterranean-based dietary pattern was assessed by the MedDietScore. Dietary evaluation was performed with a food frequency questionnaire at baseline and related to incident depression as measured by the presence of four or more depressive symptoms from the 10-item version of the Center for Epidemiologic Studies Depression scale.

RESULTS

Over an average follow-up of 7.2 years, greater adherence to a Mediterranean-based diet was associated with a reduced number of newly occurring depressive symptoms (parameter estimate = -0.002, standard error = 0.001; p = 0.04). The annual rate of developing depressive symptoms was 98.6% lower among persons in the highest tertile of a Mediterranean-based dietary pattern compared with persons in the lowest tertile group.

CONCLUSION

Our results support the hypothesis that adherence to a diet comprised of vegetables, fruits, whole grains, fish, and legumes may protect against the development of depressive symptoms in older age.

Unique radical dearomatization and two-electron reduction of a redox-active ligand

The syntheses and characterizations of [Li(4)][(1,2-di-(tert-butyl)-dpp-BIAN)(2)] (7), (1,2-di-(tert-butyl)-dpp-BIAN) (8), and (1-(tert-butyl)-2-OH-dpp-BIAN) (9) are described. Compound 7 was formed via a radical dearomatization, two-electron reduction pathway that was accompanied by vicinal di-tert-butylation of the BIAN ligand backbone. Oxidation of 7 afforded a dearomatized vicinal di-tert-butyl substituted BIAN ligand (8). An analogous dearomatized vicinal tert-butyl-hydroxy substituted BIAN ligand (9) was also isolated in the course of mechanistic studies related to the formation of 7.

Cognitive decline after hospitalization in a community population of older persons

OBJECTIVE

To test the hypothesis that hospitalization in old age is associated with subsequent cognitive decline.

METHODS

As part of a longitudinal population-based cohort study, 1,870 older residents of an urban community were interviewed at 3-year intervals for up to 12 years. The interview included a set of brief cognitive tests from which measures of global cognition, episodic memory, and executive function were derived. Information about hospitalization during the observation period was obtained from Medicare records.

RESULTS

During a mean of 9.3 years, 1,335 of 1,870 persons (71.4%) were hospitalized at least once. In a mixed-effects model adjusted for age, sex, race, and education, the global cognitive score declined a mean of 0.031 unit per year before the first hospitalization compared with 0.075 unit per year thereafter, a more than 2.4-fold increase. The posthospital acceleration in cognitive decline was also evident on measures of episodic memory (3.3-fold increase) and executive function (1.7-fold increase). The rate of cognitive decline after hospitalization was not related to the level of cognitive function at study entry (r = 0.01, p = 0.88) but was moderately correlated with rate of cognitive decline before hospitalization (r = 0.55, p = 0.021). More severe illness, longer hospital stay, and older age were each associated with faster cognitive decline after hospitalization but did not eliminate the effect of hospitalization.

CONCLUSION

In old age, cognitive functioning tends to decline substantially after hospitalization even after controlling for illness severity and prehospital cognitive decline.

Vitamin B12, cognition, and brain MRI measures: a cross-sectional examination

OBJECTIVE

To investigate the interrelations of serum vitamin B12 markers with brain volumes, cerebral infarcts, and performance in different cognitive domains in a biracial population sample cross-sectionally.

METHODS

In 121 community-dwelling participants of the Chicago Health and Aging Project, serum markers of vitamin B12 status were related to summary measures of neuropsychological tests of 5 cognitive domains and brain MRI measures obtained on average 4.6 years later among 121 older adults.

RESULTS

Concentrations of all vitamin B12-related markers, but not serum vitamin B12 itself, were associated with global cognitive function and with total brain volume. Methylmalonate levels were associated with poorer episodic memory and perceptual speed, and cystathionine and 2-methylcitrate with poorer episodic and semantic memory. Homocysteine concentrations were associated with decreased total brain volume. The homocysteine-global cognition effect was modified and no longer statistically significant with adjustment for white matter volume or cerebral infarcts. The methylmalonate-global cognition effect was modified and no longer significant with adjustment for total brain volume.

CONCLUSIONS

Methylmalonate, a specific marker of B12 deficiency, may affect cognition by reducing total brain volume whereas the effect of homocysteine (nonspecific to vitamin B12 deficiency) on cognitive performance may be mediated through increased white matter hyperintensity and cerebral infarcts. Vitamin B12 status may affect the brain through multiple mechanisms.

Elder abuse and mortality: the role of psychological and social wellbeing

BACKGROUND

Elder abuse is a pervasive human right and public health issue.

OBJECTIVES

We aimed to examine the mortality associated with elder abuse across levels of psychological and social factors.

METHODS

The Chicago Health and Aging Project (CHAP) is a prospective population-based cohort study that began in 1993. A subset of these participants enrolled between 1993 and 2005 had elder abuse reported to social services agencies (n = 113). Mortality was ascertained during follow-up and with the National Death Index. Psychosocial factors (depression, social network and social engagement) were assessed during the CHAP interview. Cox proportional hazard models were used to assess the mortality of elder abuse across levels of psychosocial factors using time-varying covariate analyses.

RESULTS

The median follow-up time for the cohort (n = 7,841) was 7.6 years (interquartile range 3.8-12.4 years). In multivariate analyses, those with highest (hazard ratio (HR) 2.60, 95% CI 1.58-4.28) and middle levels (HR 2.18, 95% CI 1.19-3.99) of depressive symptoms had an increased mortality risk associated with elder abuse. For social network, those with lowest (HR 2.50, 95% CI 1.62-3.87) and middle levels (HR 2.65, 95% CI 1.52-4.60) of social network had increased mortality risk associated with elder abuse. For social engagement, those with lowest (HR 2.32, 95% CI 1.47-3.68) and middle levels (HR 2.59, 95% CI 1.65-5.45) of social engagement had increased mortality risk associated with elder abuse. Among those with lowest levels of depressive symptoms, highest levels of social network and social engagement, there was no significant effect of reported or confirmed elder abuse on mortality risk.

CONCLUSION

Mortality risk associated with elder abuse was most prominent among those with higher levels of depressive symptoms and lower levels of social network and social engagement.

Change in risk of Alzheimer disease over time

OBJECTIVE

To assess whether the risk of incidence of Alzheimer disease (AD) varies over time. The increase in numbers of people at the oldest ages in the population will bring an increase in the number of people with AD. Projections of the size of the increase assume the risk of AD is constant.

METHODS

All persons age 65 or older in a biracial, geographically defined area were invited to participate in a home interview every 3 years. From the approximately 10,000 participants, stratified random samples were selected for detailed clinical evaluation. At each cycle, individuals determined free of AD in a previous cycle, either by examination or by high score on cognitive function tests, were sampled in the subsequent cycle for evaluation for incident AD. The evaluations for disease were structured and uniform across time. These analyses include 1,695 subjects evaluated for incident disease from 1997 through 2008.

RESULTS

AD developed in 360 participants. Change over time in risk of incident disease was assessed in logistic regression analyses including evaluation date and controlling for age, gender, education, race, interval from disease-free designation to evaluation for incident disease, and sample design. The time variable (in years) was not significant (odds ratio = 0.970, 95% confidence interval = 0.902 to 1.044).

CONCLUSIONS

The null relation of evaluation date to disease incidence suggests no recent change in risk of AD over time, and supports this assumption for projections of AD.

Cognitive activity and the cognitive morbidity of Alzheimer disease

OBJECTIVE

To test the hypothesis that frequent cognitive activity predicts slower cognitive decline before dementia onset in Alzheimer disease (AD) and faster decline thereafter.

METHODS

As part of a longitudinal cohort study, older residents of a geographically defined population were assessed at 3-year intervals with brief cognitive performance tests from which a composite measure of global cognition was derived. After each wave of testing, a subset was sampled for clinical evaluation. The present analyses are based on 1,157 participants. They were free of dementia at study enrollment at which time they rated frequency of participation in common cognitively stimulating activities from which a previously validated summary measure was derived. They were sampled for clinical evaluation a mean of 5.6 years after enrollment and subsequently followed a mean of 5.7 years with brief cognitive performance testing at 3-year intervals.

RESULTS

On clinical evaluation, 614 people had no cognitive impairment, 395 had mild cognitive impairment, and 148 had AD. During follow-up, the annual rate of global cognitive decline in persons without cognitive impairment was reduced by 52% (estimate = 0.029, SE = 0.010, p = 0.003) for each additional point on the cognitive activity scale. In the mild cognitive impairment group, cognitive decline rate was unrelated to cognitive activity (estimate = -0.019, SE = 0.018, p = 0.300). In AD, the mean rate of decline per year increased by 42% (estimate = 0.075, SE = 0.021, p < 0.001) for each point on the cognitive activity scale.

CONCLUSION

Mentally stimulating activity in old age appears to compress the cognitive morbidity associated with AD by slowing cognitive decline before dementia onset and hastening it thereafter.

Temporal course of depressive symptoms during the development of Alzheimer disease

OBJECTIVE

To characterize change in depressive symptoms before and after the onset of dementia in Alzheimer disease (AD).

METHOD

We used data from the Chicago Health and Aging Project, a longitudinal cohort study of risk factors for AD in a geographically defined population of old people. Two subsets were analyzed. In 357 individuals who developed incident AD during the study, self-report of depressive symptoms (Center for Epidemiologic Studies Depression Scale) was obtained at 3-year intervals for a mean of 8 to 9 years. In 340 individuals who agreed to annual data collection, informant report of depressive symptoms (Hamilton Depression Rating Scale) was obtained for a mean of 3 years after a diagnosis of AD (n = 107), mild cognitive impairment (n = 81), or no cognitive impairment (n = 152).

RESULTS

The incident AD group reported a barely perceptible increase in depressive symptoms during 6 to 7 years of observation before the diagnosis (0.04 symptoms per year) and no change during 2 to 3 years of observation after the diagnosis except for a slight decrease in positive affect. In those with annual follow-up, neither AD nor its precursor, mild cognitive impairment, was associated with change in informant report of depressive symptoms during a mean of 3 years of observation.

CONCLUSION

Depressive symptoms show little change during the development and progression of AD to a moderate level of dementia severity.

Cognitive decline in incident Alzheimer disease in a community population

OBJECTIVE

To measure the cognitive consequences of incident Alzheimer disease (AD) in older African American and white subjects.

METHODS

Data are from the Chicago Health and Aging Project, a longitudinal cohort study of older white and black persons residing in a geographically defined community. At 3-year intervals, the entire study population completed 4 brief cognitive tests, from which a previously established composite measure of global cognition was derived, and a subset underwent detailed clinical evaluation that supported clinical classification of mild cognitive impairment, dementia, and AD. We used mixed-effects models to examine change in cognitive function following the diagnostic evaluation.

RESULTS

On clinical evaluation, 614 persons were found to have no cognitive impairment, 395 had mild cognitive impairment, and 149 had AD (88.5% mild); 10 persons with other dementias were excluded from analyses. During up to 11 years of observation following the clinical evaluation (mean = 5.5, SD = 2.5), the composite measure of global cognition declined a mean of 0.042 unit per year (SE = 0.008, p < 0.001) in those with no cognitive impairment. In comparison to the no cognitive impairment group, the annual rate of decline was increased more than twofold in mild cognitive impairment (estimate = 0.086, SE = 0.011, p < 0.001) and more than fourfold in AD (estimate = 0.173, SE = 0.020, p < 0.001). Results did not reliably vary by race, sex, or age.

CONCLUSIONS

Alzheimer disease has a devastating impact on cognition, even in its prodromal stages, with comparable effects in African American and white persons.

Diamond-metal contacts: interface barriers and real-time characterization

A review of diamond-metal contacts is presented with reference to reported values of interfacial potential (Schottky) barriers and their dependence on macroscopic and microscopic properties of the diamond surface, the interface and the metal. No simple model can account for the overall spread of p-diamond barriers, although there are, for certain metals, correlations with metal electronegativity, interface chemistry and diamond surface preparation. Detailed studies are presented for a selected contact (Al-p-diamond) using real-time monitoring during metal growth from sub-nanometre to bulk films and subsequent in situ heating to 1000 °C. This contact, prepared in a clean vacuum environment on characterized single-crystal substrates, provides a case study for a combined in situ electrical and spectroscopic investigation using IV measurements for macroscopic diodes and real-time photoelectron spectroscopy for nanoscale metal films. Band bending during growth leads to a rectifying contact with a measured IV barrier height of 1.05 V and an ideality factor of 1.4. A transition from layered to clustered growth of the metal film is revealed in the real-time measurements and this is confirmed by AFM. For the annealed contact, a direct correlation is revealed by real-time photoemission between the onset of interfacial carbide formation and the change from a rectifying to an ohmic contact at 482 °C.

Educational attainment and cognitive decline in old age

BACKGROUND

Level of education is a well-established risk factor for Alzheimer disease but its relation to cognitive decline, the principal clinical manifestation of the disease, is uncertain.

METHODS

More than 6,000 older residents of a community on the south side of Chicago were interviewed at approximately 3-year intervals for up to 14 years. The interview included administration of four brief tests of cognitive function from which a previously established composite measure of global cognition was derived. We estimated the associations of education with baseline level of cognition and rate of cognitive change in a series of mixed-effects models.

RESULTS

In an initial analysis, higher level of education was related to higher level of cognition at baseline, but there was no linear association between education and rate of change in cognitive function. In a subsequent analysis with terms to allow for nonlinearity in education and its relation to cognitive decline, rate of cognitive decline at average or high levels of education was slightly increased during earlier years of follow-up but slightly decreased in later years in comparison to low levels of education. Findings were similar among black and white participants. Cognitive performance improved with repeated test administration, but there was no evidence that retest effects were related to education or attenuated education's association with cognitive change.

CONCLUSIONS

The results suggest that education is robustly associated with level of cognitive function but not with rate of cognitive decline and that the former association primarily accounts for education's correlation with risk of dementia in old age.

Relation of NSAIDs to incident AD, change in cognitive function, and AD pathology

OBJECTIVE

To examine the relation of nonsteroidal anti-inflammatory drugs (NSAIDs) to incident Alzheimer disease (AD), change in cognition, and AD pathology.

METHODS

Participants were 1,019 older Catholic clergy followed up annually for up to 12 years (mean baseline age = 75.0 years, education = 18.1 years, Mini-Mental State Examination score = 28.5), enrolled in the Religious Orders Study, a longitudinal clinical-pathologic study of aging and AD. Clinical evaluations allowed for AD classification and assessment of global cognition and five cognitive domains. NSAIDs were identified by direct medication inspection at baseline and follow-up evaluations. Neuropathologic data were available on 328 deceased participants. AD pathology was summarized as a global measure and as measures of neuritic plaques, diffuse plaques, and neurofibrillary tangles. We used Cox proportional hazards models and mixed models for incident AD and cognitive decline, respectively, and logistic and linear regression for pathologic outcomes, adjusted for age, sex, and education.

RESULTS

Overall, we found no apparent relation of NSAIDs to incident AD (n = 209 cases), change in cognition, or AD pathology. The hazard ratio of incident AD was 1.19 (95% CI 0.87-1.62) comparing those using NSAIDs with those not using NSAIDs at baseline, and 0.84 (95% CI 0.63-1.11) for specific use of aspirin. Findings were similar in analyses in which we considered NSAID use during follow-up. NSAIDs were not related to change in cognition (all p values > 0.14). There was no relation of NSAIDs to global AD pathology or plaques or tangles.

CONCLUSION

These data do not support a strong relation between nonsteroidal anti-inflammatory drugs and Alzheimer disease or cognition. Consistent findings across clinical and pathologic outcomes provide additional confidence in these results.

Statins, incident Alzheimer disease, change in cognitive function, and neuropathology

OBJECTIVE

To examine the relation of statins to incident Alzheimer disease (AD) and change in cognition and neuropathology.

METHODS

Participants were 929 older Catholic clergy (68.7% women, mean baseline age 74.9 years, education 18.2 years, Mini-Mental State Examination 28.5) free of dementia, enrolled in the Religious Orders Study, a longitudinal clinical-pathologic study of AD. All agreed to brain autopsy at time of death and underwent annual structured clinical evaluations, allowing for classification of AD and assessment of cognition (based on 19 neuropsychological tests). Statins were identified by direct medication inspection. Neuropathologic data were available on 262 participants. All macroscopic chronic cerebral infarctions were recorded. A measure of global AD pathology was derived from silver stain, and separate measures of amyloid and tangles were based on immunohistochemistry. We examined the relation of statins to incident AD using Cox proportional hazards, change in cognition using mixed effects models, and pathologic indices using logistic and linear regression.

RESULTS

Statin use at baseline (12.8%) was not associated with incident AD (191 persons, up to 12 follow-up years), change in global cognition, or five separate cognitive domains (all p values > 0.20). Statin use any time prior to death (17.9%) was not related to global AD pathology. Persons taking statins were less likely to have amyloid (p = 0.02). However, among those with amyloid, there was no relation of statins to amyloid load. Statins were not related to tangles or infarction.

CONCLUSIONS

Overall, statins were not related to incident Alzheimer disease (AD) or change in cognition, or continuous measures of AD pathology or infarction.

Body mass index and cognitive decline in a biracial community population

OBJECTIVE

To examine whether a higher body mass index (BMI) in older adults is associated with greater cognitive decline.

METHODS

A longitudinal study was conducted from 1993 to 2003 with an average follow-up of 6.4 years of a biracial community population on the south side of Chicago. Participants were 3,885 community-dwelling adults aged 65 and older who participated in at least two assessments. A composite measure of global cognitive function was used which was derived from the average of standardized scores from four cognitive tests.

RESULTS

There was a significant curvilinear association between BMI and cognitive function scores at baseline for both black (= -0.0014, p = 0.001) and non-black subjects (= -0.0011, p = 0.002). In a mixed model adjusted for age, sex, race, and education, higher BMI was associated with less cognitive decline in both black (= 0.0013, p = 0.009) and non-black subjects (= 0.0021, p = 0.006). Adjusting for comorbid illnesses did not change these findings substantially. However, the associations were much smaller and no longer significant among participants with no cognitive decline at baseline as measured by a Mini-Mental State Examination score of greater than 24.

CONCLUSIONS

The findings suggest that greater body mass index in old age is not predictive of cognitive decline in a cognitively unimpaired community population.

Associations of vegetable and fruit consumption with age-related cognitive change

OBJECTIVE

To examine the association between rates of cognitive change and dietary consumption of fruits and vegetables among older persons.

METHODS

The authors conducted a prospective cohort study of 3,718 participants, aged 65 years and older of the Chicago Health and Aging Project. Participants completed a food frequency questionnaire and were administered at least two of three cognitive assessments at baseline, 3-year, and 6-year follow-ups. Cognitive function was measured using the average z-score of four tests: the East Boston Tests of immediate memory and delayed recall, the Mini-Mental State Examination, and the Symbol Digit Modalities Test.

RESULTS

The mean cognitive score at baseline for the analyzed cohort was 0.18 (range: -3.5 to 1.6), and the overall mean change in score per year was a decline of 0.04 standardized units. In mixed effects models adjusted for age, sex, race, and education, compared with the rate of cognitive decline among persons in the lowest quintile of vegetable intake (median of 0.9 servings/day), the rate for persons in the fourth quintile (median, 2.8 servings/day) was slower by 0.019 standardized units per year (p = 0.01), a 40% decrease, and by 0.018 standardized units per year (p = 0.02) for the fifth quintile (median, 4.1 servings/day), or a 38% decrease in rates. The association remained significant (p for linear trend = 0.02) with further control of cardiovascular-related conditions and risk factors. Fruit consumption was not associated with cognitive change.

CONCLUSION

High vegetable but not fruit consumption may be associated with slower rate of cognitive decline with older age.

Mild cognitive impairment is related to Alzheimer disease pathology and cerebral infarctions

OBJECTIVES

To examine the extent to which persons with mild cognitive impairment have intermediate levels of Alzheimer disease (AD) pathology, cerebral infarcts, and Lewy body disease.

METHODS

A total of 180 Catholic clergy participating in the Religious Orders Study underwent annual detailed evaluation and brain autopsy. Blocks of midfrontal, superior temporal, medial temporal lobe, inferior parietal, entorhinal cortex, hippocampus, and substantia nigra were paraffin embedded, and sectioned at 6 mum. Cortical neuritic plaques, diffuse plaques, and neurofibrillary tangles were visualized with Bielschowsky silver stain, and counted and summarized to yield a Braak stage, Consortium to Establish a Registry for Alzheimer's Disease (CERAD) diagnosis, National Institute on Aging (NIA)-Reagan diagnosis, and composite measure of AD pathology. The authors recorded the number and location of all gross chronic cerebral infarctions. Lewy bodies were identified with antibodies to alpha-synuclein. Multiple regression analyses were used to examine the relation of AD pathology and cerebral infarctions to clinical diagnosis proximate to death, controlling for age, sex, and education.

RESULTS

A total of 37 had mild cognitive impairment, 60 did not have cognitive impairment, and 83 had dementia proximate to death. Nearly all persons had at least some AD pathology. Cerebral infarctions were present in 35.2%, and 15.6% had Lewy body disease. Persons with mild cognitive impairment were intermediate in terms of Braak stage and CERAD and NIA-Reagan neuropathologic criteria for AD compared to the other two groups. In multiple regression analyses, persons with mild cognitive impairment had intermediate levels of AD pathology from those without cognitive impairment and those with dementia (test for trend, F = 45.2, p < 0.001). Further, the relation between cognition and AD pathology in persons with mild cognitive impairment did not differ significantly from the relation between cognition and AD pathology in persons with dementia or those without cognitive impairment. Persons with mild cognitive impairment also had intermediate levels of cerebral infarctions (test for trend, p = 0.04). Only 3 (8.1%) persons with mild cognitive impairment had Lewy body disease.

CONCLUSION

These data suggest that mild cognitive impairment may be the earliest clinical manifestation of common age-related neurologic diseases.

Hallucinations, cognitive decline, and death in Alzheimer's disease

The relation of psychotic symptoms to cognitive decline and mortality in Alzheimer's disease (AD) was examined during a mean of 2.2 years in 478 persons selected from clinical settings. Psychotic symptoms were ascertained at baseline and cognition was assessed semiannually with nine tests from which a global measure was formed. In analyses that controlled for age, sex, race, and education, hallucinations (29.6%), especially visual ones, were associated with more rapid global cognitive decline and increased mortality, even after controlling for baseline level of cognition and use of antipsychotic medication, and the association with mortality increased with higher level of education. Delusions and misperceptions were not strongly related to cognitive decline or mortality. The results suggest that hallucinations in Alzheimer's disease, particularly visual ones, are associated with more rapid progression.

Socioeconomic Characteristics of the Community in Childhood and Cognition in Old Age

We examined the relation of early life socioeconomic circumstances to cognition in older residents of a biracial urban community. Participants had brief cognitive testing three times at approximately 3-year intervals. At baseline, information about early life household and county socioeconomic level was collected. In mixed-effects models adjusted for age, sex, race, and education, both early life household and county socioeconomic levels were positively associated with baseline level of cognition but unrelated to cognitive decline. The results suggest that socioeconomic conditions in early life are associated with level of cognitive function in old age but not with rate of cognitive decline.

Change in body mass index and risk of incident Alzheimer disease

OBJECTIVE

To examine the association of change in body mass index (BMI) with risk of Alzheimer disease (AD).

METHODS

Nine hundred eighteen older Catholic clergy participating in the Religious Orders Study without dementia at baseline were studied. Outcome measures were the clinical diagnosis of AD and change in cognitive function.

RESULTS

During a mean follow-up of 5.5 years, 151 persons developed AD. BMI averaged 27.4 at baseline and declined in about half the participants. In a proportional hazards model adjusted for age, sex, and education, each 1-unit less of BMI at baseline was associated with about a 5% increase in the risk of AD (hazard ratio = 0.944; 95% CI = 0.908 to 0.981), and each 1-unit annual decline in BMI (about the 10th percentile) was associated with about a 35% increase in the risk of AD compared with a person experiencing no change in BMI (about the 50th percentile) (hazard ratio = 0.730; 95% CI = 0.625 to 0.852). The results were similar after controlling for chronic diseases and excluding persons who developed AD during the first 4 years of observation. Random effects models showed that the rate of cognitive decline increased by about 8% for each 1-unit less of BMI at baseline and declined an additional 40%/year in persons losing 1 unit of BMI/year compared with those with no change in BMI.

CONCLUSION

Declining body mass index (BMI) is associated with increased risk of incident Alzheimer disease (AD). Loss of BMI may reflect pathologic processes that contribute to the subsequent development of AD.

Social resources and cognitive decline in a population of older African Americans and whites

OBJECTIVE

To examine the relation of social resources and cognitive decline in older adults.

METHODS

Data are from the Chicago Health and Aging Project, an epidemiologic study of risk factors for Alzheimer disease (AD) and other common conditions in a geographically defined population of older persons. The sample consisted of 6,102 non-Hispanic African Americans (61.2%) and whites, aged > or = 65, who underwent up to three interviews during an average of 5.3 years of follow-up. Each interview included administration of four cognitive function tests from which a composite measure of cognition was formed. Social networks were based on the number of children, relatives, and friends seen at least once a month. Social engagement was measured with four items related to social and productive activity.

RESULTS

Higher number of social networks and level of social engagement were positively correlated with initial level of cognitive function (networks estimate = 0.003, engagement estimate = 0.060, both p < 0.001). Both resources were also associated with a reduced rate of cognitive decline. A high (90th percentile) number of networks reduced the rate of decline by 39% compared to a low level (10th percentile), and high social engagement reduced decline by 91%. These relations remained after controlling for socioeconomic status, cognitive activity, physical activity, depressive symptoms, and chronic medical conditions.

CONCLUSIONS

Greater social resources, as defined by social networks and social engagement, are associated with reduced cognitive decline in old age.

The apolipoprotein E epsilon4 allele increases the odds of chronic cerebral infarction [corrected] detected at autopsy in older persons

BACKGROUND AND PURPOSE

Studies investigating the relation of the apolipoprotein E (apoE) epsilon4 allele to clinical stroke and to vascular changes on magnetic resonance imaging have been conflicting. Little data are available regarding the relation of apoE epsilon4 to cerebral infarctions documented on postmortem examination.

METHODS

We studied the apoE epsilon4 allele in 214 deceased members of the Religious Orders Study, a longitudinal clinical-pathologic study of aging and Alzheimer disease. The apoE genotype was determined using DNA from lymphocytes. Brains were removed a median of 5 hours (interquartile range, 5.5) after death. At postmortem examination, age, location, and size of macroscopic chronic cerebral infarctions were recorded from 1-cm coronal slabs after paraformaldehyde fixation. We also examined 20-microm paraffin-embedded sections of midfrontal and calcarine cortex for amyloid angiopathy on a scale of 1 to 4.

RESULTS

Subjects included 96 males and 118 females with a mean age at death of 86 years (SD, 7). Sixty-five subjects (30.4%) had at least 1 apoE epsilon4 allele and 76 (35.5%) exhibited cerebral infarctions. More than 74% of the subjects exhibited amyloid angiopathy with a mean score of 1.4+/-1.2. After controlling for age and sex, apoE epsilon4 increased the odds of cerebral infarction by 2.3-fold (95% CI, 1.2 to 4.2). apoE epsilon4 increased the odds of cortical 3.2-fold (95% CI, 1.3 to 7.7) and subcortical infarctions 2.3-fold (95% CI, 1.2 to 4.5). The effect was unchanged after accounting for amyloid angiopathy.

CONCLUSIONS

apoE epsilon4 increases the odds of chronic cerebral infarction detected at autopsy in older persons.

Proneness to psychological distress and risk of Alzheimer disease in a biracial community

Persons without dementia residing in a biracial community completed a brief scale of proneness to psychological distress, and 1,064 were subsequently examined for incident Alzheimer disease (AD) 3 to 6 years later. In analyses controlling for selected demographic and clinical variables, persons prone to distress were 2.4 times more likely to develop AD than persons not distress prone. This effect was substantially stronger in white persons compared to African Americans.

Education and the course of cognitive decline in Alzheimer disease

OBJECTIVE

To test the hypothesis that higher level of education is related to more rapid cognitive decline in Alzheimer disease (AD).

METHODS

Participants are older persons with clinically diagnosed AD recruited from health care facilities in the Chicago area. At 6-month intervals for up to 4 years, they underwent uniform structured clinical evaluations that included administration of nine cognitive performance tests from which a composite measure of global cognition was derived. Analyses are based on 494 persons with follow-up data (89.3% of those eligible). In mixed models that allowed for linear and nonlinear decline, the authors first accounted for the effects of age on cognition and then tested the relation of education to rate of cognitive decline.

RESULTS

Global cognitive decline had linear and nonlinear components, resulting in a gradually accelerating course of decline. Age was related to linear but not nonlinear decline, with more rapid decline observed in younger compared with older persons. Higher educational level was related to more rapid global cognitive decline, as hypothesized, with education related to the nonlinear but not the linear component of decline.

CONCLUSION

Higher educational attainment is associated with a slightly accelerated rate of cognitive decline in Alzheimer disease.

Diabetes mellitus and progression of rigidity and gait disturbance in older persons

BACKGROUND

Parkinsonian-like signs, including rigidity, gait disturbance, and bradykinesia, are common and progressive in old age and are associated with morbidity and mortality. Few risk factors for these signs have been identified. Diabetes mellitus, also a common chronic condition in old age and known to be associated with physical and neurologic disability, may be associated with parkinsonian-like signs.

OBJECTIVE

To examine the relation of diabetes to four parkinsonian-like signs.

METHODS

Participants were 822 older Catholic clergymen and women who were without clinically diagnosed Parkinson disease or dementia at baseline. For up to 9 years, they had uniform annual evaluations, which included a modified version of the motor portion of the Unified Parkinson's Disease Rating Scale, from which previously established measures of four specific parkinsonian-like signs were derived. Participants were evaluated for the presence of diabetes, based on direct medication inspection and history.

RESULTS

Diabetes was present in 128 (15.6%) participants. In random effects models controlling for age, sex, and education, diabetes was associated with worsening rigidity (p < 0.01) and gait (p < 0.05), over an average of 5.6 years of follow-up, but not with change in bradykinesia or tremor. The presence of stroke did not substantially affect the association of diabetes with rigidity but reduced the association of diabetes with gait to a trend (p = 0.08).

CONCLUSION

Diabetes may be a previously unrecognized risk factor for progression of parkinsonian-like signs in older persons.

Depressive symptoms, clinical AD, and cortical plaques and tangles in older persons

BACKGROUND

Depressive symptoms in old age have been associated with risk of Alzheimer disease (AD), but it is uncertain whether they are an independent risk factor for disease or an early clinical sign of its underlying pathology.

METHODS

A group of 130 older Catholic nuns, priests, and brothers underwent detailed annual clinical evaluations and brain autopsy at death. The evaluations included administration of a modified 10-item Center for Epidemiologic Studies Depression Scale (CES-D) and 19 cognitive performance tests and clinical classification of dementia and AD. On postmortem examination, neuritic plaques, diffuse plaques, and neurofibrillary tangles in tissue samples from four cortical regions were counted, and a previously established composite measure of cortical plaque and tangle density (range 0 to 2.98) was derived. All analyses were adjusted for age, sex, and education.

RESULTS

Participants reported a mean 1.5 depressive symptoms (SD 1.6) on the CES-D scale averaged across evaluations. In a logistic regression model, the odds of clinically diagnosed AD proximate to death increased by 1.33 (95% CI 1.01 to 1.76) for each depressive symptom and by 8.41 (95% CI 3.49 to 20.26) for each unit on the composite measure of pathology. In subsequent analyses, depressive symptoms were not related to level of pathology and did not modify the relation of pathology to clinical AD. In a series of linear regression models that controlled for pathology, depressive symptoms were related to level of cognitive function proximate to death and did not modify the association of pathology with cognition.

CONCLUSION

The association of depressive symptoms with clinical AD and cognitive impairment appears to be independent of cortical plaques and tangles.

Dietary fat intake and 6-year cognitive change in an older biracial community population

OBJECTIVE

To examine whether consumption of different types of fat is associated with age-related change in cognition.

METHODS

The authors related fat consumption to 6-year change in cognitive function among 2,560 participants of the Chicago Health and Aging Project, ages 65 and older, with no history of heart attack, stroke, or diabetes at baseline. Fat intake was measured by food frequency questionnaire. Cognitive function was measured at baseline and 3-year and 6-year follow-ups, using the average z score of four cognitive tests: the East Boston Tests of Immediate and Delayed Recall, the Mini-Mental State Examination, and the Symbol Digit Modalities Test.

RESULTS

In separate mixed models adjusted for demographic and cardiovascular risk factors and intakes of antioxidant nutrients and other dietary fats, higher intakes of saturated fat (p for trend = 0.04) and trans-unsaturated fat (p for trend = 0.07) were linearly associated with greater decline in cognitive score over 6 years. These associations became stronger in analyses that eliminated persons whose fat intake changed in recent years or whose baseline cognitive scores were in the lowest 15%. Inverse associations with cognitive decline were observed in these latter restricted analyses for high intake of monounsaturated fat and a high ratio of polyunsaturated to saturated fat intake. Intakes of total fat, vegetable and animal fats, and cholesterol were not associated with cognitive change.

CONCLUSION

A diet high in saturated or trans-unsaturated fat or low in nonhydrogenated unsaturated fats may be associated with cognitive decline among older persons.

Enhancement in the absorption of water and electrolytes from rat intestine byHemidesmus indicus R. Br. root(water extract)

Hemidesmus indicus root in the form of suspension in water (10 mg/ml) containing 15.5 mM NaCl, 3 mM KCl and 12 mM glucose, when injected into the ligated jejunal sac (1 ml/sac) of rat, increased the absorption of water, Na(+) and K(+) (but not glucose) from the sac. This bioactivity was present in the water extract (5 or 10 mg/sac) of the root and not in the hexane extract. In contrast, the ethanol extract decreased the absorption of water and electrolytes from the jejunal sac. The effect of water extract was not affected by heat at 100 degrees C for 30 min. Intraperitoneal administration of the water extract (50 to 200 mg/kg) was devoid of any significant effect on the jejunal absorption. Neither the root suspension nor the water extract (125-500 mg/kg) showed any significant anti-ulcer and diuretic activities in rats. The intestinal motility was also not influenced by the root (water extract) when tested in mice. The present study indicates that H. indicus root powder or its water extract can be incorporated in oral rehydrating salt solution (ORS) for increasing its anti-diarrhoeal efficacy.

Influence of behavioral symptoms on rates of institutionalization for persons with Alzheimer's disease

BACKGROUND

Recent studies indicate that behavioral symptoms may play a key role in decisions to institutionalize persons with Alzheimer's disease (AD), but the specific types of behavior that contribute to this increased risk have not been reliably identified. The relationship between behavioral symptoms and time to institutionalization was evaluated in a 4-year longitudinal study.

METHOD

A total of 410 persons with the clinical diagnosis of AD completed annual clinical evaluations to assess cognitive impairment, functional limitations, delusions, hallucinations, depressive symptoms and physical aggression. Participation rates among survivors exceeded 90% for four follow-up evaluations with complete ascertainment of mortality and institutionalization. Time to institutionalization was evaluated using proportional hazards regression models in relation to time-varying clinical features.

RESULTS

In multivariate models, adjusted for demographic and social variables, four clinical features emerged as the predominant predictors of institutionalization: cognitive impairment level, physical aggression, hallucinations and depressive symptoms. These associations were virtually unchanged in analyses controlling for mortality.

CONCLUSIONS

Specific behavioral symptoms are important independent risk factors for institutionalization in persons with AD. Because behavioral symptoms are susceptible to therapy, efforts to modify or prevent these symptoms deserve careful consideration as a means to delay institutionalization for persons with this disease.

Dietary niacin and the risk of incident Alzheimer's disease and of cognitive decline

BACKGROUND

Dementia can be caused by severe niacin insufficiency, but it is unknown whether variation in intake of niacin in the usual diet is linked to neurodegenerative decline. We examined whether dietary intake of niacin was associated with incident Alzheimer's disease (AD) and cognitive decline in a large, prospective study.

METHODS

This study was conducted in 1993-2002 in a geographically defined Chicago community of 6158 residents aged 65 years and older. Nutrient intake was determined by food frequency questionnaire. Four cognitive tests were administered to all study participants at 3 year intervals in a 6 year follow up. A total of 3718 participants had dietary data and at least two cognitive assessments for analyses of cognitive change over a median 5.5 years. Clinical evaluations were performed on a stratified random sample of 815 participants initially unaffected by AD, and 131 participants were diagnosed with 4 year incident AD by standardised criteria.

RESULTS

Energy adjusted niacin intake had a protective effect on development of AD and cognitive decline. In a logistic regression model, relative risks (95% confidence intervals) for incident AD from lowest to highest quintiles of total niacin intake were: 1.0 (referent) 0.3 (0.1 to 0.6), 0.3 (0.1 to 0.7), 0.6 (0.3 to 1.3), and 0.3 (0.1 to 0.7) adjusted for age, sex, race, education, and ApoE e4 status. Niacin intake from foods was also inversely associated with AD (p for linear trend = 0.002 in the adjusted model). In an adjusted random effects model, higher food intake of niacin was associated with a slower annual rate of cognitive decline, by 0.019 standardised units (SU) per natural log increase in intake (mg) (p = 0.05). Stronger associations were observed in analyses that excluded participants with a history of cardiovascular disease (beta = 0.028 SU/year; p = 0.008), those with low baseline cognitive scores (beta = 0.023 SU/year; p = 0.02), or those with fewer than 12 years' education (beta = 0.035 SU/year; p = 0.002)

CONCLUSION

Dietary niacin may protect against AD and age related cognitive decline.

Blood pressure and late-life cognitive function change: A biracial longitudinal population study

OBJECTIVE

To examine the relation of blood pressure (BP) to subsequent decline in cognitive function among persons age 65 or over.

METHODS

All persons age 65 or over in a geographically defined community were invited to participate in a longitudinal study of problems of the elderly. Interviews were conducted in the participants' homes and included two BP measures and four tests of cognitive function. Follow-up interviews 3 and 6 years after baseline repeated the cognitive function tests. These analyses included 4,284 individuals who had baseline and at least one follow-up measure of cognitive function. The average of z scores of the individual cognitive function tests was used as a global measure of cognitive function.

RESULTS

In random effects analyses controlling for age, sex, education, and race, there was no significant linear association of either systolic or diastolic BP with 6-year change in global cognitive function score. There was no significant curvilinear association with systolic BP. In tests for a curvilinear association with diastolic BP, there was a suggestion of increased decline among those with low or high diastolic BP (p = 0.03 for the quadratic diastolic term). At baseline, 50% of participants took some type of medication affecting BP.

CONCLUSION

In this community population where BP treatment was common, there was no association of either high systolic or high diastolic BP at the beginning of the observation interval with 6-year cognitive decline.