Objectives
To investigate the association between hearing loss, hearing aid use, and cognitive decline.
Design
Prospective population‐based study.
Setting
Data gathered from the Personnes Agées QUID ...study, a cohort study begun in 1989–90.
Participants
Individuals aged 65 and older (N = 3,670).
Measurements
At baseline, hearing loss was determined using a questionnaire assessing self‐perceived hearing loss; 137 subjects reported major hearing loss, 1,139 reported moderate problems (difficulty following the conversation when several persons talk at the same time or in a noisy background), and 2,394 reported no hearing trouble. Cognitive decline was measured using the Mini‐Mental State Examination (MMSE), administered at follow‐up visits over 25 years.
Results
Self‐reported hearing loss was significantly associated with lower baseline MMSE score (β = −0.69, P < .001) and greater decline during the 25‐year follow‐up period (β = −0.04, P = .01) independent of age, sex, and education. A difference in the rate of change in MMSE score over the 25‐year follow‐up was observed between participants with hearing loss not using hearing aids and controls (β = −0.06, P < .001). In contrast, subjects with hearing loss using a hearing aid had no difference in cognitive decline (β = 0.07, P = .08) from controls.
Conclusion
Self‐reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline.
Abstract Introduction Few recent studies have suggested declining trends in dementia frequency. French cohorts with long follow-up allowed us to explore incidence evolution trends. Methods Two ...different populations of subjects aged ≥65 years included in 1988–1989 (n = 1469) and 1999–2000 (n = 2104) were followed up over 10 years, with systematic assessment for cognition and dementia. Multistates illness-death models were used to compare dementia incidence using both clinical and algorithmic diagnoses. Results Using the algorithmic diagnosis, incidence declined significantly overall and for women (age-adjusted hazard ratio HR = 0.62; confidence interval (CI) = 0.48–0.80 for women between the two populations). Differences in education, vascular factors, and depression accounted only to some extent for this reduction (women full-adjusted HR = 0.73; CI = 0.57–0.95). No significant decreasing trends were found for men or when using the clinical diagnosis for either sex. Discussion Our study provides further support for a decrease in dementia incidence in women using algorithmic diagnosis. Changes in diagnostic boundaries mask this reduction.
While exposure to ultraviolet radiation (UVR) is a recognized risk factor for cataract, its association is more controversial with age-related macular degeneration (AMD). We report the associations ...of lifetime exposure to ambient UVR with cataract extraction and AMD.
The Alienor Study is a population-based study of 963 residents of Bordeaux (France), aged 73 years or more. Lifetime exposure to ambient UVR was estimated from residential history and Eurosun satellite-based estimations of ground UVR. It was divided in three groups (lower quartile, intermediate quartiles, upper quartile), using the intermediate quartiles as the reference. Early and late AMD was classified from retinal color photographs. Cataract extraction was defined as absence of the natural lens at slit-lamp.
After multivariate adjustment, subjects in the upper quartile of lifetime ambient UVR exposure were at increased risk for cataract extraction (odds ratio OR = 1.53; 95% confidence interval CI, 1.04-2.26; P = 0.03) and for early AMD (OR = 1.59; 95% CI, 1.04-2.44; P = 0.03), by comparison with subjects in the intermediate quartiles. Subjects in the lower quartile of UVR exposure also were at increased risk for early AMD (OR = 1.69; 95% CI, 1.06-2.69; P = 0.03), by comparison with those with medium exposure. Associations of late AMD with UVR exposure was not statistically significant.
This study further confirms the increased risk for cataract extraction in subjects exposed to high ambient UVR. Moreover, it suggests that risk for early AMD is increased in subjects exposed to high UVR, but also to low UVR, by comparison with medium exposures.
Objectives
Some factors influence the experience of the COVID‐19 pandemic (health, loneliness, digital access...), but what about the living area? The objective was to compare between rural and urban ...areas, the psychological and social experiences of the older individuals with regard to the COVID‐19 crisis during the first French lockdown.
Methods
The sample included participants of three existing population‐based cohorts on aging. Telephone interviews conducted by psychologists focused on the lockdown period. Data collected included living environment, professional assistance, social support, contacts with relatives, difficulties encountered, health, and knowledge and representations of the epidemic. The negative experience was defined by the presence of at least two of the following items: high anxiety symptomatology, depressive symptoms, worries or difficulties during the lockdown and insufficient social support.
Results
The sample included 467 participants, aged on average 87.5 years (5.2), 58.9% were female and 47.1% lived in rural areas. Persons living in rural area had better social support, greater family presence, a less frequent feeling of imprisonment (OR = 0.60, 95 CI% = 0.36‐0.99), 95% had a garden (vs. 56%), fewer depressive symptoms and lower anxiety scores, but also tended to lower comply with the health measures. Finally, they had an almost twofold lower risk of having a negative experience of the lockdown compared to their urban counterparts (OR = 0.55, 95% CI = 0.33–0.92, p = 0.0223).
Conclusions
The oldest old living in rural area experienced the first lockdown better than the urbans. Living conditions, with access to nature, a greater social support and family presence, could have contributed to these findings.
Key points
The large majority of the studies on the COVID‐19 pandemic are web‐based, which exclude de facto the numerous older adults still in digital divide, also often frail, dependent and in poor health
Based on three existing cohorts on aging and on telephone interviews, we highlighted that the oldest old living in rural area were less likely to have a negative experience of the first strict lockdown
Several specificities of this living environment could explain these findings: private outdoor spaces, easy access to nature and greater social support
However, they could less often rely on digital tools to keep in touch with their entourage and tented to have lower compliance with the barrier measures
Abstract Introduction Benzodiazepine use has been associated with increased risk of dementia. However, it remains unclear whether the risk relates to short or long half-life benzodiazepines and ...whether it extends to other psychotropic drugs. Methods Prospective cohort study among 8240 individuals ≥65, interviewed on medication use. Incident dementia confirmed by an end point committee after a multistep procedure. Results During a mean of 8 years of follow-up, 830 incident dementia cases were observed. Users of benzodiazepines at baseline had a 10% increased risk of dementia (adjusted hazard ratio HR, 1.10; 95% confidence interval, 0.90–1.34). However, long half-life (>20 hours) benzodiazepine users had a marked increased risk of dementia (HR = 1.62; 1.11–2.37) compared with short half-life users (HR = 1.05; 0.85–1.30). Users of psychotropics had an increased risk of dementia (HR = 1.47; 1.16–1.86). Discussion Results of this large, prospective study show increased risk of dementia for long half-life benzodiazepine and psychotropic use.
AbstractObjectiveTo test the hypotheses that physical activity in midlife is not associated with a reduced risk of dementia and that the preclinical phase of dementia is characterised by a decline in ...physical activity.DesignProspective cohort study with a mean follow-up of 27 years.SettingCivil service departments in London (Whitehall II study).Participants10 308 participants aged 35-55 years at study inception (1985-88). Exposures included time spent in mild, moderate to vigorous, and total physical activity assessed seven times between 1985 and 2013 and categorised as “recommended” if duration of moderate to vigorous physical activity was 2.5 hours/week or more.Main outcome measuresA battery of cognitive tests was administered up to four times from 1997 to 2013, and incident dementia cases (n=329) were identified through linkage to hospital, mental health services, and mortality registers until 2015.ResultsMixed effects models showed no association between physical activity and subsequent 15 year cognitive decline. Similarly, Cox regression showed no association between physical activity and risk of dementia over an average 27 year follow-up (hazard ratio in the “recommended” physical activity category 1.00, 95% confidence interval 0.80 to 1.24). For trajectories of hours/week of total, mild, and moderate to vigorous physical activity in people with dementia compared with those without dementia (all others), no differences were observed between 28 and 10 years before diagnosis of dementia. However, physical activity in people with dementia began to decline up to nine years before diagnosis (difference in moderate to vigorous physical activity −0.39 hours/week; P=0.05), and the difference became more pronounced (−1.03 hours/week; P=0.005) at diagnosis.ConclusionThis study found no evidence of a neuroprotective effect of physical activity. Previous findings showing a lower risk of dementia in physically active people may be attributable to reverse causation—that is, due to a decline in physical activity levels in the preclinical phase of dementia.
Objectives
Our study aimed at estimating the prevalence of neuropsychiatric symptoms and investigating associated factors among older adults living in two countries in Central Africa (Central African ...Republic CAR and Republic of Congo ROC).
Methods
The EPIDEMCA multicentre population‐based study was carried out in rural and urban areas of CAR and ROC between 2011 and 2012 among people aged 65 and over. After cognitive screening using the Community Screening Interview for Dementia, participants with low performances underwent neurological examination including the brief version of the Neuropsychiatric Inventory Questionnaire (NPI‐Q). Multivariate logistic regression analyses were performed to identify factors independently associated with neuropsychiatric symptoms in this population.
Results
NPI‐Q data were available for 532 participants. Overall, 333 elderly people (63.7%) reported at least one neuropsychiatric symptom. The prevalence of neuropsychiatric symptoms was 89.9% (95% CI, 84.6‐95.1) in participants with dementia, 73.4% (95% CI, 65.1‐81.7) in participants with mild cognitive impairment (MCI), and 48.7% (95% CI, 42.9‐54.6) in participants with no MCI nor dementia after neurological examination (P < 0.0001). The most common symptoms were depression, anxiety, and irritability. Participants living in Gamboma, with normal hearing and with friends in the community, were less likely to present neuropsychiatric symptoms. Physical disability, difficulties in eating, female sex, and dementia were significantly associated with neuropsychiatric symptoms.
Conclusion
Neuropsychiatric symptoms are common among older people with neurocognitive disorders in CAR and ROC. Our results confirm those from previous studies in Nigeria and Tanzania. Nevertheless, knowledge of these symptoms remains limited in sub‐Saharan Africa, hampering their appropriate management.
Background. To better understand the contribution of frailty to health-related outcomes in elderly persons, it seems valuable to explore data from cohort studies across the world in an attempt to ...establish a comprehensive definition. The purpose of this report is to show the characteristics of frailty and observe its prognosis in a large sample of French community-dwelling elderly persons. Methods. We used data from 6078 persons 65 years old or older participating in the Three-City Study (3C). Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low activity. Principal outcomes were incident disability, hospitalization, and death. Multiple covariates were used to test the predictive validity of frailty on these outcomes. Results. Four hundred twenty-six individuals (7%) met frailty criteria. Participants classified as frail were significantly older, more likely to be female, and less educated and reported more chronic diseases, lower income, and poorer self-reported health status in comparison to nonfrail participants. In multivariate analysis, frailty was significantly associated with 4-year incidence of disability in activities of daily living (ADL) and instrumental ADL. However, frailty was marginally associated with incident hospitalization and was not a statistically significant predictor of incident mobility disability or mortality adjusting for potential confounding factors. Conclusions. Frailty is not specific to a subgroup or region of the world. The construct proposed by Fried and colleagues confirms its predictive validity for adverse-health outcomes, particularly for certain components of disability, thus suggesting that it may be useful in population screening and predicting service needs.
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