Abstract
Background
It is well established that individual medications that affect the central nervous system (CNS) increase falls risk in older adults. However, less is known about risks associated ...with taking multiple CNS-active medications.
Methods
Employing a new user design, we used data from the Adult Changes in Thought study, a prospective cohort of community-dwelling people aged 65 and older without dementia. We created a time-varying composite measure of CNS-active medication exposure from electronic pharmacy fill data and categorized into mutually exclusive categories: current (within prior 30 days), recent (31–90 days), past (91–365 days), or nonuse (no exposure in prior year). We calculated standardized daily dose and identified new initiation. Cox proportional hazards models examined the associations between exposures and the outcome of fall-related injury identified from health plan electronic databases.
Results
Two thousand five hundred ninety-five people had 624 fall-related injuries over 15,531 person-years of follow-up. Relative to nonuse, fall-related injury risk was significantly greater for current use of CNS-active medication (hazard ratio HR = 1.95; 95% CI = 1.57–2.42), but not for recent or past use. Among current users, increased risk was noted with all doses. Risk was increased for new initiation compared with no current use (HR = 2.81; 95% CI = 2.09–3.78). Post hoc analyses revealed that risk was especially elevated with new initiation of opioids.
Conclusions
We found that current use, especially new initiation, of CNS-active medications was associated with fall-related injury in community-dwelling older adults. Increased risk was noted with all dose categories. Risk was particularly increased with new initiation of opioids.
Sleep disturbance plays a significant role in cognitive impairment following traumatic brain injury (TBI).
To summarize recent findings that examine sleep disturbance and cognition in TBI.
...Epidemiological information on sleep disorders in people with TBI is presented. A simple introduction to the role of sleep in normal cognition provides context for the literature on clinical populations. Current theory on the mechanisms underlying cognitive problems in people with sleep disorder is briefly described. Findings on the relationship between sleep disorder and cognitive problems in TBI is examined in more detail.
Consistent reports of an association between sleep duration and cognition include several studies noting positive associations (shorter sleep duration accompanies cognitive impairment) and others observing negative associations (longer sleep duration accompanies cognitive problems). Both insomnia and hypersomnolence are forms of sleep disturbance that disrupt key mental processes such as memory consolidation. Obstructive sleep apnea, cerebral structural abnormalities, neurochemical changes and psychiatric pathology are implicated.
Additional information is needed on how severity of injury impacts sleep and cognition. Hypothesized mechanisms underlying the effects of sleep on cognition in TBI should be empirically tested. Further, discrepancies between objective and subjective measures of sleep and cognition must be explored.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective
Previously published community‐ or population‐based studies of brain aging and dementia with autopsy were restricted to a single sex, a single ethnic group, Roman Catholic clergy, or ...focused pathological assessments. Our goal was to determine the independent pathological correlates associated with dementia in a typical US population.
Methods
We evaluated autopsy data from the Adult Changes in Thought study, an ongoing longitudinal, population‐based study of brain aging and dementia. Analyses were based on data collected from about 3,400 people 65 years or older who were cognitively intact at the time of enrollment in the Group Health Cooperative in King County, Washington. All consecutive autopsies (n = 221; 20% of deaths) from this cohort were evaluated and analyzed by weighted multivariate analysis to account for potential participation bias.
Results
After adjusting for age, sex, education, and APOE, independent correlates of dementia (relative risk, 95% confidence interval; overall p value) included Braak stage (V/VI vs 0/I/II: 5.89, 1.62–17.60; p < 0.05), number of cerebral microinfarcts in standardized sections (>2 vs none: 4.80, 1.91–10.26; p < 0.001), and neocortical Lewy bodies (any vs none: 5.08, 1.37–18.96; p < 0.05). Estimates of adjusted population attributable risk for these three processes were 45% for Braak stage, 33% for microinfarcts, and 10% for neocortical Lewy bodies.
Interpretation
Our results underscore the therapeutic imperative for Alzheimer's and Lewy body diseases, and provide evidence to support the immediate use of strategies that target cerebral microinfarcts as a means to partially prevent or delay the onset of dementia. Ann Neurol 2007
Cognitive Decline and Older Driver Crash Risk Fraade‐Blanar, Laura A.; Ebel, Beth E.; Larson, Eric B. ...
Journal of the American Geriatrics Society (JAGS),
June 2018, Letnik:
66, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objectives
To examine automobile crash risk associated with cognition in older drivers without dementia.
Design
Retrospective secondary analysis of longitudinal cohort study.
Setting
Our study used ...data from the Adult Changes in Thought (ACT) Study merged with Washington State crash reports and licensure records. Data were available from 2002 to 2015.
Participants
Group Health enrollees from Washington State aged 65 and older with active driver's licenses (N=2,615).
Measurements
Cognitive function was assessed using the Cognitive Abilities Screening Instrument scored using item response theory (CASI‐IRT). The study outcome was police‐reported motor vehicle crash. We used a negative binomial mixed‐effects model with robust standard errors clustered on the individual and considered associations between crash risk, level of cognition, and amount of decline since the previous study visit. Covariates included age, sex, education, alcohol, depression, medical comorbidities, eyesight, hearing, and physical function. Individuals were censored at dementia diagnosis, death, or failure to renew their license.
Results
Over an average of 7 years of follow‐up, 350 (13%) people had at least one crash. A 1‐unit lower CASI‐IRT score was associated with a higher adjusted incidence rate ratio of crash of 1.26 (95% confidence interval=1.08–1.51). Beyond level of cognition, amount of cognitive decline between study visits was not associated with crash risk.
Conclusion
This study suggests that, in older drivers, poorer performance on the CASI‐IRT may be a risk factor for motor vehicle crashes, even in individuals without diagnosed dementia. Further research is needed to understand driving behavior and inform driving decisions for older adults with poor cognitive function.
We evaluated dementia and Alzheimer's disease (AD) risks after a cancer diagnosis in a population-based prospective cohort, the Adult Changes in Thought (ACT) study.
We followed community-dwelling ...people aged ≥65 years without dementia at study entry for incident dementia and AD from 1994-2015. We linked study data with cancer registry data and categorized cancer diagnoses as prevalent (diagnosed before ACT study enrollment) or incident (diagnosed during follow-up). We used Cox regression to estimate cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) for dementia or AD risk comparing people with a cancer diagnosis to people without cancer. We conducted sensitivity analyses restricted to people surviving beyond age 80, and stratified by cancer stage, type, and whether the cancer was smoking-related.
Among 4,357 people, 756 (17.4%) had prevalent cancer; 583 (13.4%) developed incident cancer, 1,091 (25.0%) developed dementia, and 877 (20.1%) developed AD over a median 6.4 years (34,482 total person-years) of follow-up. Among complete cases (no missing covariates) with at least one follow-up assessment, adjusted HRs for dementia following prevalent and incident cancer diagnoses were 0.92 (95%CI: 0.76, 1.11) and 0.87 (95%CI: 0.64, 1.04), compared to no cancer history. HRs for AD were 0.95 (95%CI: 0.77, 1.17) for prevalent cancer and 0.73 (95%CI: 0.55, 0.96) for incident cancer. In sensitivity analyses, prevalent late-stage cancers were associated with reduced risks of dementia (HR = 0.51, 95%CI: 0.30, 0.89) and AD (HR = 0.50, 95%CI: 0.27, 0.94). When limited to people who survived beyond age 80, incident cancers were still associated with reduced AD risk (HR = 0.69, 95%CI: 0.51, 0.92).
Our results do not support an inverse association between prevalent cancer diagnoses, which were primarily early-stage, less aggressive cancers, and risk of dementia or AD. A reduced risk of AD following an incident cancer diagnosis is biologically plausible but may reflect selective mortality.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Approximately 34 million family and friends provided unpaid care to individuals aged 50 and older in 2015. It is difficult to place a value on that time, because no payment is made to the caregiver, ...and multiplying caregiving hours by a wage does not account for the value of lost leisure time, implications for future employability and wages, or any intrinsic benefits accrued to the care provider. This study used a dynamic discrete choice model to estimate the costs of informal care provided by a daughter to her mother, including these other costs and benefits not typically accounted for, and compared these cost estimates for 4 categories of the mother's functional status: doctor‐diagnosed memory‐related disease, limitations in activities of daily living (ADLs), combination of both, cannot be left alone for 1 hour or more. We studied women aged 40 to 70 with a living mother at the start of the sample period (N=3,427 adult daughters) using data from the Health and Retirement Study (1998–2012). The primary outcome was the monetized change in well‐being due to caregiving, what economists call “welfare costs.” We estimate that the median cost to the daughter's well‐being of providing care to an elderly mother ranged from $144,302 to $201,896 over 2 years, depending on the mother's functional status. These estimates suggest that informal care cost $277 billion in 2011, 20% more than estimates that account only for current foregone wages.
Sharing study data within the research community generates tension between two important goods: promoting scientific goals and protecting the privacy interests of study participants. This study was ...designed to explore the perceptions, beliefs, and attitudes of research participants and possible future participants regarding genome-wide association studies and repository-based research.
Focus group sessions with (1) current research participants, (2) surrogate decision-makers, and (3) three age-defined cohorts (18–34 years, 35–50, >50).
Participants expressed a variety of opinions about the acceptability of wide sharing of genetic and phenotypic information for research purposes through large, publicly accessible data repositories. Most believed that making de-identified study data available to the research community is a social good that should be pursued. Privacy and confidentiality concerns were common, although they would not necessarily preclude participation. Many participants voiced reservations about sharing data with for-profit organizations.
Trust is central in participants' views regarding data sharing. Further research is needed to develop governance models that enact the values of stewardship.
Categorizing people with late-onset Alzheimer's disease into biologically coherent subgroups is important for personalized medicine. We evaluated data from five studies (total n = 4050, of whom 2431 ...had genome-wide single-nucleotide polymorphism (SNP) data). We assigned people to cognitively defined subgroups on the basis of relative performance in memory, executive functioning, visuospatial functioning, and language at the time of Alzheimer's disease diagnosis. We compared genotype frequencies for each subgroup to those from cognitively normal elderly controls. We focused on APOE and on SNPs with p < 10
and odds ratios more extreme than those previously reported for Alzheimer's disease (<0.77 or >1.30). There was substantial variation across studies in the proportions of people in each subgroup. In each study, higher proportions of people with isolated substantial relative memory impairment had ≥1 APOE ε4 allele than any other subgroup (overall p = 1.5 × 10
). Across subgroups, there were 33 novel suggestive loci across the genome with p < 10
and an extreme OR compared to controls, of which none had statistical evidence of heterogeneity and 30 had ORs in the same direction across all datasets. These data support the biological coherence of cognitively defined subgroups and nominate novel genetic loci.
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