Background: muscle wasting is associated with a detrimental outcome in older people. Muscle strength measurements could be useful as part of a clinical evaluation of oldest old patients to determine ...who are most at risk of accelerated decline in the near future. Objective: this study aimed to assess if handgrip strength predicts changes in functional, psychological and social health among oldest old. Design: the Leiden 85-plus Study is a prospective population-based follow-up study. Subjects: five-hundred fifty-five, all aged 85 years at baseline, participated in the study. Methods: handgrip strength was measured with a handgrip strength dynamometer. Functional, psychological and social health were assessed annually. Baseline data on chronic diseases were obtained from the treating physician, pharmacist, electrocardiogram and blood sample analysis. Results: at age 85, lower handgrip strength was correlated with poorer scores in functional, psychological and social health domains (all, P < 0.001). Lower baseline handgrip strength predicted an accelerated decline in activities of daily living (ADL) and cognition (both, P ≤ 0.001), but not in social health (P > 0.30). Conclusion: poor handgrip strength predicts accelerated dependency in ADL and cognitive decline in oldest old. Measuring handgrip strength could be a useful instrument in geriatric practice to identify those oldest old patients at risk for this accelerated decline.
Observational studies have given conflicting results about the effect of statins in preventing dementia and cognitive decline. Moreover, observational studies are subject to prescription bias, making ...it hard to draw definite conclusions from them. Randomized controlled trials are therefore the preferred study design to investigate the association between statins and cognition. Here we present detailed cognitive outcomes from the randomized placebo-controlled PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Cognitive function was assessed repeatedly in all 5,804 PROSPER participants at six different time points during the study using four neuropsychological performance tests. After a mean follow-up period of 42 months, no difference in cognitive decline at any of the cognitive domains was found in subjects treated with pravastatin compared to placebo (all
p
> 0.05). Pravastatin treatment in old age did not affect cognitive decline during a 3 year follow-up period. Employing statin therapy in the elderly in an attempt to prevent cognitive decline therefore seems to be futile.
White matter hyperintensities are frequent on neuroimaging of older people and are a key feature of cerebral small vessel disease. They are commonly attributed to chronic hypoperfusion, although ...whether low cerebral blood flow is cause or effect is unclear. We systematically reviewed studies that assessed cerebral blood flow in small vessel disease patients, performed meta-analysis and sensitivity analysis of potential confounders. Thirty-eight studies (n = 4006) met the inclusion criteria, including four longitudinal and 34 cross-sectional studies. Most cerebral blood flow data were from grey matter. Twenty-four cross-sectional studies (n = 1161) were meta-analysed, showing that cerebral blood flow was lower in subjects with more white matter hyperintensity, globally and in most grey and white matter regions (e.g. mean global cerebral blood flow: standardised mean difference−0.71, 95% CI −1.12, −0.30). These cerebral blood flow differences were attenuated by excluding studies in dementia or that lacked age-matching. Four longitudinal studies (n = 1079) gave differing results, e.g., more baseline white matter hyperintensity predated falling cerebral blood flow (3.9 years, n = 575); cerebral blood flow was low in regions that developed white matter hyperintensity (1.5 years, n = 40). Cerebral blood flow is lower in subjects with more white matter hyperintensity cross-sectionally, but evidence for falling cerebral blood flow predating increasing white matter hyperintensity is conflicting. Future studies should be longitudinal, obtain more white matter data, use better age-correction and stratify by clinical diagnosis.
Summary
Aging is associated with cognitive decline, diminished brain function, regional brain atrophy, and disrupted structural and functional brain connectivity. Understanding brain networks in ...aging is essential, as brain function depends on large‐scale distributed networks. Little is known of structural covariance networks to study inter‐regional gray matter anatomical associations in aging. Here, we investigate anatomical brain networks based on structural covariance of gray matter volume among 370 middle‐aged to older adults of 45–85 years. For each of 370 subjects, we acquired a T1‐weighted anatomical MRI scan. After segmentation of structural MRI scans, nine anatomical networks were defined based on structural covariance of gray matter volume among subjects. We analyzed associations between age and gray matter volume in anatomical networks using linear regression analyses. Age was negatively associated with gray matter volume in four anatomical networks (P < 0.001, corrected): a subcortical network, sensorimotor network, posterior cingulate network, and an anterior cingulate network. Age was not significantly associated with gray matter volume in five networks: temporal network, auditory network, and three cerebellar networks. These results were independent of gender and white matter hyperintensities. Gray matter volume decreases with age in networks containing subcortical structures, sensorimotor structures, posterior, and anterior cingulate cortices. Gray matter volume in temporal, auditory, and cerebellar networks remains relatively unaffected with advancing age.
Summary Background & aims Body composition measurement is a valuable tool for assessing nutritional status and physical fitness in a variety of clinical settings. Although bioimpedance analysis (BIA) ...can easily assess body composition, its accuracy remains unclear. We examined the accuracy of direct segmental multi-frequency BIA technique (DSM-BIA) in assessing different body composition parameters, using dual energy X-ray absorptiometry (DEXA) as a reference standard. Methods A total of 484 middle-aged participants from the Leiden Longevity Study were recruited. Agreements between DSM-BIA and DEXA for total and segmental body composition quantification were assessed using intraclass correlation coefficients and Bland–Altman plots. Results Excellent agreements were observed between both techniques in whole body lean mass (ICC female = 0.95, ICC men = 0.96), fat mass (ICC female = 0.97, ICC male = 0.93) and percentage body fat (ICC female = 0.93, ICC male = 0.88) measurements. Similarly, Bland–Altman plots revealed narrow limits of agreements with small biases noted for the whole body lean mass quantification but relatively wider limits for fat mass and percentage body fat quantifications. In segmental lean muscle mass quantification, excellent agreements between methods were demonstrated for the upper limbs (ICC female≥0.91, ICC men≥0.87) and lower limbs (ICC female≥0.83, ICC male≥0.85), with good agreements shown for the trunk measurements (ICC female = 0.73, ICC male = 0.70). Conclusions DSM-BIA is a valid tool for the assessments of total body and segmental body composition in the general middle-aged population, particularly for the quantification of body lean mass.
Objectives
To evaluate the association between various blood pressure (BP) measures at age 85 and future decline in physical and cognitive function the oldest old.
Design
Longitudinal study.
Setting
...The population‐based Leiden 85‐plus Study.
Participants
Five hundred seventy‐two 85‐year‐old community‐dwelling individuals.
Measurements
BP was measured at age 85 during home visits. Activities of daily living (ADLs) and Mini‐Mental State Examination (MMSE) were assessed at age 85 and annually thereafter up to age 90. On average, participants were followed for 3.2 years. Cross‐sectional and longitudinal analyses were performed using linear regression models using systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) as the determinants. All analyses were adjusted for sociodemographic and cardiovascular factors.
Results
At age 85, higher SBP and PP were associated with lower ADL disability scores (both P = .01). Similarly, higher SBP, DBP, and MAP were associated with higher MMSE scores (all P < .05). From age 85 onward, higher SBP (P < .001), MAP (P = .01), and PP (P = .003) at age 85 were associated with lower annual increases in ADL disability scores. Likewise, higher SBP (P = .03) and PP (P = .008) at age 85 were associated with lower annual declines in MMSE scores. Additional analyses showed that the association between high BP and lower annual decline in MMSE score was most pronounced in participants with high ADL disability.
Conclusion
In the oldest old, higher SBP and PP are associated with resilience to physical and cognitive decline, especially in individuals with pre‐existing physical disability.
OBJECTIVES: To investigate whether higher circulating levels of C‐reactive protein (CRP), interleukin‐6 (IL‐6), and α1‐antichymotrypsin (ACT) are associated with worse cognitive function and decline ...in old age.
DESIGN: Two independent population‐based cohort studies.
SETTING: The Rotterdam Study (mean follow‐up 4.6 years) and the Leiden 85‐plus Study (maximal follow‐up 5 years).
PARTICIPANTS: Three thousand eight hundred seventy‐four individuals, mean age 72, from the Rotterdam Study, and 491 individuals, all aged 85, from the Leiden 85‐plus Study.
MEASUREMENTS: Both studies assessed global cognition, executive function, and memory. Linear regression analyses were used in the current study to investigate the associations between inflammatory markers and cognitive function and decline.
RESULTS: In the Rotterdam Study, higher levels of CRP and IL‐6 were cross‐sectionally associated with worse global cognition and executive function (P<.05). ACT was not associated with cognitive function. In the Leiden 85‐plus Study, estimates were similar for CRP, although not statistically significant. Higher IL‐6 levels were related to a steeper annual decline in memory function in the longitudinal analysis in the Leiden 85‐plus Study (P<.05). The effect of higher IL‐6 levels on global and memory function decline was stronger in apolipoprotein E (APOE) ɛ4 carriers (P‐interaction=.01) than in those who were not (P‐interaction=.05). In the Rotterdam Study, higher IL‐6 levels were related to a steeper annual decline in global cognition in APOE ɛ4 carriers only.
CONCLUSION: Systemic markers of inflammation are only moderately associated with cognitive function and decline and tend to be stronger in carriers of the APOE ɛ4 allele. Systemic markers of inflammation are not suitable for risk stratification.
Old age is associated with comorbidity and decreased functioning which influences treatment decisions in elderly breast cancer patients. The purpose of this study was to identify risk factors for ...complications after breast cancer surgery in elderly patients, and to assess mortality in patients with postoperative complications. The FOCUS cohort is a detailed retrospective cohort of all breast cancer patients aged 65 years and older who were diagnosed between 1997 and 2004 in the South-West of the Netherlands. Risk factors for postoperative complications were assessed using univariable and multivariable logistic regression models. One-year survival and overall survival were calculated using univariable and multivariable Cox Regression models, and relative survival was calculated according to the Ederer II method. 3179 patients received surgery, of whom 19 % (
n
= 618) developed 1 or more postoperative complication(s). The odds ratio of having postoperative complications increased with age OR 1.85 (95 % confidence interval (CI) 1.37–2.50,
p
= 0.001) in patients >85 years and number of concomitant diseases OR 1.71 (95 % CI 1.30–2.24,
p
≤ 0.001) for 4 or more concomitant diseases. One-year overall survival, overall survival, and relative survival were worse in patients with postoperative complications multivariable HR 1.49 (95 % CI 1.05–2.11),
p
= 0.025. HR 1.21, (95 % CI 1.07–1.36),
p
= 0.002 and RER 1.19 (95 % CI 1.05–1.34),
p
= 0.006 respectively. Stratified for comorbidity, relative survival was lower in patients without comorbidity only. Increasing number of concomitant disease increased the risk of postoperative complications. Although elderly patients with comorbidity did have a higher risk of postoperative complications, relative mortality was not higher in this group. This suggests that postoperative complications in itself did not lead to higher relative mortality, but that the high relative mortality was most likely due to geriatric parameters such as comorbidity or poor physical function.
Context:
Subclinical thyroid dysfunction is common in older people. However, its clinical importance is uncertain.
Objective:
Our objective was to determine the extent to which subclinical ...hyperthyroidism and hypothyroidism influence the risk of heart failure and cardiovascular diseases in older people.
Setting and Design:
The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) is an prospective cohort study.
Patients:
Patients included men and women aged 70–82 yr (n = 5316) with known cardiovascular risk factors or previous cardiovascular disease.
Main Outcome Measures:
Incidence rate of heart failure hospitalization, atrial fibrillation, and cardiovascular events and mortality according to baseline thyroid status were evaluated. Euthyroid participants (TSH =0.45–4.5 mIU/liter) were compared with those with subclinical hyperthyroidism (TSH <0.45 mIU/liter) and those with subclinical hypothyroidism (TSH ≥4.5 mIU/liter, both with normal free T4).
Results:
Subclinical hyperthyroidism was present in 71 participants and subclinical hypothyroidism in 199 participants. Over 3.2 yr follow-up, the rate of heart failure was higher for subclinical hyperthyroidism compared with euthyroidism age- and sex-adjusted hazard ratio (HR) = 2.93, 95% confidence interval (CI) = 1.37–6.24, P = 0.005; multivariate-adjusted HR = 3.27, 95% CI = 1.52–7.02, P = 0.002). Subclinical hypothyroidism (only at threshold >10 mIU/liter) was associated with heart failure (age- and sex-adjusted HR = 3.01, 95% CI = 1.12–8.11, P = 0.029; multivariate HR = 2.28, 95% CI = 0.84–6.23). There were no strong evidence of an association between subclinical thyroid dysfunction and cardiovascular events or mortality, except in those with TSH below 0.1 or over 10 mIU/liter and not taking pravastatin.
Conclusion:
Older people at high cardiovascular risk with low or very high TSH along with normal free T4 appear at increased risk of incident heart failure.
Objectives To investigate whether statins reduce all cause mortality and major coronary and cerebrovascular events in people without established cardiovascular disease but with cardiovascular risk ...factors, and whether these effects are similar in men and women, in young and older (>65 years) people, and in people with diabetes mellitus.Design Meta-analysis of randomised trials.Data sources Cochrane controlled trials register, Embase, and Medline.Data abstraction Two independent investigators identified studies on the clinical effects of statins compared with a placebo or control group and with follow-up of at least one year, at least 80% or more participants without established cardiovascular disease, and outcome data on mortality and major cardiovascular disease events. Heterogeneity was assessed using the Q and I2 statistics. Publication bias was assessed by visual examination of funnel plots and the Egger regression test.Results 10 trials enrolled a total of 70 388 people, of whom 23 681 (34%) were women and 16 078 (23%) had diabetes mellitus. Mean follow-up was 4.1 years. Treatment with statins significantly reduced the risk of all cause mortality (odds ratio 0.88, 95% confidence interval 0.81 to 0.96), major coronary events (0.70, 0.61 to0.81), and major cerebrovascular events (0.81, 0.71 to 0.93). No evidence of an increased risk of cancer was observed. There was no significant heterogeneity of the treatment effect in clinical subgroups.Conclusion In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.
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