Objectives
To systematically review longitudinal studies examining the association between oral health and cognitive decline.
Design
Studies published between January 1993 and March 2013 were ...identified by search of English language publications in PubMed/Medline using relevant Medical Subject Heading terms and title and keywords and from CINAHL using relevant subject headings. After applying eligibility criteria and adding four studies identified from article references, 56 of the 1,412 articles identified remained; 40 were cross‐sectional, and 16 were longitudinal; 11 of the latter examined the effect of oral health on change in cognitive health or dementia incidence, five examined the reverse.
Setting
Sources of information included administrative data, subject evaluations in parent studies, medical and dental records, self‐reports, and in‐person evaluations.
Participants
Older adults.
Measurements
Most studies used subjects whose oral or cognitive status was known, using standard approaches to impute for missing information. The oral health information most frequently studied included number of teeth, periodontal and caries problems, and denture use. Cognition was most frequently evaluated using the Mini‐Mental State Examination or according to a diagnosis of dementia.
Results
Some studies found that oral health measures such as number of teeth and periodontal disease were associated with risk of cognitive decline or incident dementia, whereas others did not find an association. Similarly, cognitive decline was not consistently associated with greater loss of teeth or number of decayed teeth. It is likely that methodological limitations play a major role in explaining the inconsistent findings.
Conclusion
It is unclear how or whether oral health and cognitive status are related. Additional research is needed in which there is greater agreement on how oral health and cognitive states are assessed to better examine the linkages between these two health outcomes.
Kuchibhatla MN, Fillenbaum GG, Hybels CF, Blazer DG. Trajectory classes of depressive symptoms in a community sample of older adults.
Objective: To identify trajectories of depressive symptoms in ...older community residents.
Method: Depressive symptomatology, based on a modified Center for Epidemiological Studies–Depression scale, was obtained at years 0, 3, 6, and 10, in the Duke Established Populations for Epidemiologic Studies of the Elderly (n = 4162). Generalized growth mixture models identified the latent class trajectories present. Baseline demographic, health, and social characteristics distinguishing the classes were identified using multinomial logistic regression.
Results: Four latent class trajectories were identified. Class 1 – stable low depressive symptomatology (76.6% of the sample); class 2 – initially low depressive symptomatology, increasing to the subsyndromal level (10.0%); class 3 – stable high depressive symptomatology (5.4%); class 4 – high depressive symptomatology improving over 6 years before reverting somewhat (8.0%). Class 1 was younger, male gender, with better education, health, and social resources, in contrast to class 3. Class 2 had poorer cognitive functioning and higher death rate. Class 4 had better health and social resources.
Conclusion: Reduction in high depressive symptomatology is associated with more education, better health, fewer stressful events, and a larger social network. Increasing depressive symptomatology is accompanied by poorer physical and cognitive health, more stressful life events, and greater risk of death.
In 1986, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was mandated to develop a brief neuropsychological assessment battery (CERAD-NAB) for AD, for uniform ...neuropsychological assessment, and information aggregation. Initially used across the National Institutes of Aging-funded Alzheimer's Disease Research Centers, it has become widely adopted wherever information is desired on cognitive status and change therein, particularly in older populations.
Our purpose is to provide information on the multiple uses of the CERAD-NAB since its inception, and possible further developments.
Since searching on "CERAD neuropsychological assessment battery" or similar terms missed important information, "CERAD" alone was entered into PubMed and SCOPUS, and CERAD-NAB use identified from the resulting studies. Use was sorted into major categories, e.g., psychometric information, norms, dementia/differential dementia diagnosis, epidemiology, intervention evaluation, genetics, etc., also translations, country of use, and alternative data gathering approaches.
CERAD-NAB is available in ∼20 languages. In addition to its initial purpose assessing AD severity, CERAD-NAB can identify mild cognitive impairment, facilitate differential dementia diagnosis, determine cognitive effects of naturally occurring and experimental interventions (e.g., air pollution, selenium in soil, exercise), has helped to clarify cognition/brain physiology-neuroanatomy, and assess cognitive status in dementia-risk conditions. Surveys of primary and tertiary care patients, and of population-based samples in multiple countries have provided information on prevalent and incident dementia, and cross-sectional and longitudinal norms for ages 35-100 years.
CERAD-NAB has fulfilled its original mandate, while its uses have expanded, keeping up with advances in the area of dementia.
Current information on the epidemiology of physical inactivity among older adults is lacking, making it difficult to target the inactive and to plan for interventions to ameliorate adverse effects.
...To present statewide representative findings on the prevalence of physical inactivity among older community residents, its correlates and associated health service use.
A representative non-institutionalized random sample of 6963 individuals in Rio Grande do Sul, Brazil, aged ≥60 years, was interviewed face-to-face. Information was obtained on demographic characteristics, social resources, health conditions and behaviors, health service use, and physical inactivity. Controlled logistic regression was used to determine the association of physical inactivity with these characteristics.
Overall, 62% reported no regular physical activity. Physical inactivity was significantly more prevalent among women, older persons, those with lower education and income, Afro-Brazilians (73%; White: 61%; "other": 64%), those no longer married, and was associated with multiple individual health conditions and impaired activities of daily living (ADL). In adjusted analyses, associations remained for sociodemographic characteristics, social participation, impaired self-rated health, ADL, vision, and depression (odds ratios (OR) 1.2-1.7). Physically inactive respondents were less likely to report outpatient visits (OR 0.81), but more likely to be hospitalized (OR 1.41).
Physical inactivity is highly prevalent, particularly among Afro -Brazilians. It is associated with adverse sociodemographic characteristics; lack of social interaction; and poor self-rated health, ADL, vision, and depression; although not with other health conditions. Self-care may be neglected, resulting in hospitalization.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Identifying a National Death Index Match Fillenbaum, Gerda G.; Burchett, Bruce M.; Blazer, Dan G.
American journal of epidemiology,
08/2009, Letnik:
170, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Data from the National Death Index (NDI) are frequently used to determine survival status in epidemiologic or clinical studies. On the basis of selected information submitted by the investigator, NDI ...returns a file containing a set of candidate matches. Although NDI deems some matches as perfect, multiple candidate matches may be available for other cases. Working across data from the Duke University site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), NDI, and the Social Security Death Index (SSDI), the authors found that, for this Established Populations for Epidemiologic Studies of the Elderly cohort of 1,896 cases born before 1922 and alive as of January 1, 1999, a match on Social Security number plus additional personal information (specific combinations of last name, first name, month of birth, day of birth) resulted in agreement between NDI and Social Security Death Index dates of death 94.7% of the time, while comparable agreement was found for only 12.3% of candidate decedents who did not have the required combination of information. Thus, an easy to apply algorithm facilitates accurate identification of NDI matches.
Objectives: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10‐year trajectories of ...incident disability for cognitively intact participants and subgroups with MCI.
Design: Prospective cohort; 10 years of follow‐up.
Setting: Community‐based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa).
Participants: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged ≥65; N=3,673; 61.3% female; 99.9% white).
Measurements: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20‐item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions.
Results: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (≤1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median=0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range=0.12–0.36).
Conclusion: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability—a prerequisite for a diagnosis of dementia.
OBJECTIVES: To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether ...single‐item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6‐month mortality.
DESIGN: Observational cohort study.
SETTING: Inpatient hospital cardiology ward.
PARTICIPANTS: Three hundred nine consecutive inpatients aged 70 and older admitted to a cardiology service (n=309; 70% male, 84% white) with minimum two‐vessel CAD determined using cardiac catheterization.
MEASUREMENTS: Two standard frailty phenotypes (Composite A and Composite B), usual gait speed, grip strength, chair stands, cardiology clinical variables, and 6‐month mortality.
RESULTS: Prevalence of frailty was 27% for Composite A versus 63% for Composite B. Utility of single‐item measures for identifying frailty was greatest for gait speed (receiver operating characteristic curve c statistic=0.89 for Composite A, 0.70 for Composite B) followed by chair‐stands (c=0.83, 0.66) and grip strength (c=0.78, 0.57). After adjustment, composite scores and single‐item measures were individually associated with higher mortality at 6 months. Slow gait speed (≤0.65 m/s) and poor grip strength (≤25 kg) were stronger predictors of 6‐month mortality than either composite score (gait speed odds ratio (OR)=3.8, 95% confidence interval (CI)=1.1–13.1; grip strength OR=2.7, 95% CI=0.7–10.0; Composite A OR=1.9, 95% CI=0.60–6.1; chair‐stand OR=1.5, 95% CI=0.5–5.1; Composite B OR=1.3, 95% CI=0.3–5.2).
CONCLUSION: Gait speed frailty was the strongest predictor of mortality in a population with CAD and may add to traditional risk assessments when predicting outcomes in this population.
Objectives
To explore the association between a newly developed cumulative laboratory‐based frailty index (FI) and intrinsic (personal) and extrinsic (social, environmental) characteristics.
Design
...Cross‐sectional longitudinal study.
Setting
The third and fourth waves of the community‐representative, five‐county, 10‐year Duke Established Populations for Epidemiologic Studies of the Elderly study, carried out in a health service‐rich area.
Participants
Cognitively intact survivors of the third wave (N = 1,740), who provided blood samples for standard laboratory work.
Measurements
Biomarkers (n = 28) were measured to develop a cumulative deficit laboratory test–based FI (Duke FI) derived from standard laboratory tests: SMAC‐24 chemistry panel, high‐density lipoprotein cholesterol panel, and complete blood count. Information was gathered on scales assessing intrinsic characteristics (personal locus of control, life satisfaction, self‐esteem, depressive symptomatology) and extrinsic characteristics (support received from and provided to family and friends, stressful life events, neighborhood disadvantage).
Results
The newly developed Duke FI had content, construct, concurrent, and predictive validity. In addition to sex, race, and income, the Duke FI was associated at the intrinsic level with locus of control, self‐esteem, life satisfaction, and depressive symptomatology (each P < .01) and at the extrinsic level with provision (P < .01) and with receipt of instrumental help (P < .10), social stressors (P < .03), and neighborhood disadvantage (P < .01) in unadjusted analysis; race fully explained neighborhood disadvantage.
Conclusion
Intrinsic (personality) characteristics and personally close extrinsic characteristics (contacts with family and friends, personal stressors) are associated with laboratory test–based frailty, as is neighborhood disadvantage, although in this accessible, health service–rich environment, race fully explained association with neighborhood disadvantage, suggesting that interventions to reduce frailty in residents in such an environment should pay particular attention to characteristics that immediately affect the individual.
OBJECTIVES: To evaluate the prevalence and utility of memory complaint in a geographically representative cohort and, in cases with mild cognitive impairment (MCI), to determine whether memory ...complaint alters 10‐year trajectories of disability in activities of daily living (ADLs), Short Portable Mental Status Questionnaire (SPMSQ) score, and 20‐item word recall.
DESIGN: Prospective cohort study.
SETTING: Washington and Iowa counties, Iowa.
PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (N=3,673; aged ≥65; 61.3% female; 99.9% white).
MEASUREMENTS: Age, sex, education, SPMSQ score, 20‐item word recall, ADL or instrumental ADL disability, and chronic medical conditions.
RESULTS: The prevalence of memory complaint was 34%. Although proportionally more cognitively impaired individuals were in the memory complaint group (34% vs 27%), the pattern of subclassification into cognitively intact and MCI Stage 1 and 2 subgroups was similar for people with and without memory complaint. Median SPMSQ score and number of words recalled at baseline were comparable across memory complaint categories in each subgroup. MCI participants without subjective memory complaint constituted a larger proportion of the overall sample than individuals with subjective memory complaint (460 (14%) vs 295 (8.9%)) and of persons objectively classified as having MCI (61% vs 39%). The distribution of individual 10‐year change in ADL disability, SPMSQ score, and word recall were similar for those with and without memory complaint across all subgroups of cognitive impairment.
CONCLUSION: Memory complaint is not necessary for MCI diagnosis and does not distinguish cases with different progression rates in disability or cognitive impairment. 2006.
A number of large-scale population studies have provided valuable information about physical performance in aged individuals; however, there is little information about trajectories of function and ...associations with age across the adult life span. We developed a mobility-focused physical performance screener designed to be appropriate for the adult life span.
The physical performance battery includes measures of mobility, strength, endurance, and balance. Physical activity (PA) was assessed with accelerometry. We examined age-related trends in physical performance and PA, and the relationship between physical performance and PA across the age range (30-90+), by decade, in 775 participants enrolled in the study 2012-2014.
Physical performance was worse with increasing age decade. Although men performed better than women across all ages, the decrement by age group was similar between genders. Worsening physical performance was observed as early as the fifth decade for chair stands and balance and in the sixth decade for gait speed and aerobic endurance. The number and strength of significant associations between physical performance and PA increased with greater age: the greatest number of significant associations was seen in the 60-79 age groups, with fewer reported in the 30-59 and 80-90+ age groups. More PA was associated with better physical function.
These results emphasize the importance of a life span approach to studies of function and aging. This work points to the need for a physical performance screener that spans across adulthood as a clinical tool for identifying functional decline.
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