The veterans affairs Saint Louis University mental status exam (slums exam) and the mini-mental status exam as predictors of mortality and institutionalization

Objective: To evaluate predictive validity of cognitive dysfunction of the Saint Louis University Mental Status (SLUMS) exam or Mini-Mental State Exam (MMSE) for institutionalization and mortality after 7.5-years. Design: Longitudinal study. Setting: Geriatric Research, Education and Clinical Center Veterans Affairs Hospital St. Louis, MO. Participants: Patients (N=705) were screened for cognitive dysfunction in 2003 using the SLUMS exam and MMSE, and mortality and institutionalization up to 7.5-years later were evaluated as outcome measures. Measurement: The associations between outcome measures and MMSE and SLUMS exam total scores, and cognitive status were examined using Kaplan-Meier curves and Cox proportional-hazards regression. Results: Five hundred thirty-three charts were reviewed, 176/533(33%) patients had died and 31/526 (6%) were institutionalized during 7.5-year follow-up period. All subjects were male with a mean age of 75 years and most had high school education or greater (71%). MMSE dementia, SLUMS dementia (ps<.001) and MCI (p<.05) groups had significantly lower survival rates than normal cognition group in the Kaplan-Meier curves. Scores classified as dementia on SLUMS (HR=2.4, 95% CI 1.6-3.7; p <.001) or MMSE (HR=2.3, 95% CI 1.5-3.6; p <.001) both predicted mortality and, also, institutionalization (SLUMS: HR=3.5, 95% CI 1.3-9.1; p <.01; MMSE: HR=3.8, 95% CI 1.6-9.0; p <.001) after adjustment for covariates. Unadjusted SLUMS exam MCI predicted morality (HR=1.5, 95% CI 1.1-2.2; p <.019) but not institutionalization. Conclusion: The SLUMS exam and MMSE both predict mortality and institutionalization for male patients screened as positive for dementia.     

Inflammation biomarkers and near-term death in older men

Associations of C-reactive protein (CRP) and fibrinogen with death may weaken over time. Combining both markers may improve prediction of death in older adults. In 5,828 Cardiovascular Health Study participants (United States, 1989-2000), 383 deaths (183 cardiovascular disease (CVD)) in years 1-3 (early) and 914 deaths (396 CVD) in years 4-8 (late) occurred. For men, when comparing highest to lowest quartiles, hazard ratios for early death were 4.1 (95% confidence interval (CI): 2.7, 6.3) for CRP and 4.1 (95% CI: 2.7, 6.4) for fibrinogen in models adjusted for CVD risk. For early CVD death, hazard ratios were 4.3 (95% CI: 2.2, 8.4) and 3.4 (95% CI: 1.8, 6.3), respectively. When comparing men in the highest quartiles of both biomarkers with those in the lowest, hazard ratios were 9.6 (95% CI: 4.3, 21.1) for early death and 13.5 (95% CI: 3.2, 56.5) for early CVD death. Associations were weaker for late deaths. For women, CRP (hazard ratio = 2.3, 95% CI: 1.4, 3.9), but not fibrinogen (hazard ratio = 1.3, 95% CI: 0.8, 2.2), was associated with early death. Results were similar for CVD death. Neither was associated with late deaths. CRP and fibrinogen were more strongly associated with death in older men than women and more strongly associated with early than late death. Combining both markers may identify older men at greatest risk of near-term death.     

Correlates of mini-mental status examination scores among elderly demented patients: The influence of race-ethnicity

Data on 1888 patients seen at Alzheimer's Disease Diagnostic and Treatment Centers in California were used to examine possible differences in Mini-Mental State Examination (MMSE) results for different racial-ethnic groups. White patients had scores less indicative of dementia than Black and Hispanic patients using the standard 23 cutting point on the MMSE. However, there were no differences among these groups in the percentages clinically diagnosed as demented. The difference in the percentage of Whites vs Blacks and Hispanics categorized as demented by the MMSE was not accounted for by education, occupation, age, sex, or other variables tested, even though these variables were correlated with MMSE scores. Our data suggest that clinicians should consider MMSE scores for Black and Hispanic patients an underestimate of their cognitive capabilities relative to that of White patients.     

Study of mini-mental state exam evolution in community-dwelling subjects aged over 60 years without dementia

Objective  

In recent years, the Mini-Mental State Examination (MMSE) has been widely used and has been proposed for cognitive decline screening in the framework of a systematic geriatric evaluation in health centers. The aim of the present longitudinal study was to identify the potential determinants of MMSE score and its evolution over a 4-year period in a population aged over sixty years with good general health without dementia and consulting for a health check-up.     

Lead exposure in ironworkers

In adults, lead toxicity is most commonly caused by occupation in a lead industry. Whereas lead toxicity has been described in workers who are involved in bridge rehabilitation, as of this date there has been no systematic evaluation published regarding the conditions responsible for lead toxicity in ironworkers. This is a report of a study designed to identify risk factors for elevated blood-lead levels in ironworkers. One hundred fifty members of a 2,400-member local ironworkers union volunteered to have their blood drawn for lead and zinc protoporphyrin analysis and to complete a questionnaire regarding demographics, health, and occupation. The relationships between these variables and blood-lead level were analyzed using student's t-test, chi-square, and logistic regression. Current work on a lead job, rivet busting as the predominant job task, and cigarette smoking were all found to be significantly associated with elevated blood-lead level. Whereas cigarette smoking and current work with lead have been previously identified as risk factors for toxicity, interventions to prevent lead toxicity in ironworkers should also focus on work practices during rivet busting. Am. J. Ind. Med. 32:540–543, 1997. © 1997 Wiley-Liss, Inc.     

儿童铅暴露相关危险因素Logistic逐步回归分析

目的:了解珠江三角洲中心地区儿童铅暴露水平及相关因素。方法:对1 866例1-3岁入托体检儿童进行静脉血铅、锌、钙、铁、铜、锰测定,并做铅暴露危险因素问卷调查。结果:儿童血铅水平均数为116.72 μg／L,≥100 μg／L者占48.77％,年龄、喜饮罐装饮料、母亲职业、居住的楼龄及楼层、居住环境是儿童铅暴露的危险因素,血锌是保护因素。结论:环境铅污染是儿童铅暴露的主要来源,环境污染对儿童已构成严重的威胁,应引起社会的关注。     

儿童铅暴露相关危险因素Logistic逐步回归分析

目的了解珠江三角洲中心地区儿童铅暴露水平及相关因素.方法对1 866例1～3岁入托体检儿童进行静脉血铅、锌、钙、铁、铜、锰测定,并做铅暴露危险因素问卷调查.结果儿童血铅水平均数为116.72μg/L,≥100 μg/L者占48.77%,年龄、喜饮罐装饮料、母亲职业、居住的楼龄及楼层、居住环境是儿童铅暴露的危险因素,血锌是保护因素.结论环境铅污染是儿童铅暴露的主要来源,环境污染对儿童已构成严重的威胁,应引起社会的关注.     

Correlates of urinary symptom scores in men.

OBJECTIVES: This study determined the prevalence of urinary symptoms and their relationship to characteristics of a cohort of men in Beaver Dam, Wis, from 1993 to 1995. METHODS: A standardized questionnaire concerning urinary symptoms (the American Urological Association Urinary Symptom Questionnaire) was administered. RESULTS: All outcomes were associated with age and history of enlarged prostate. Urinary frequency (57%) and nocturia (65%) were the most common individual symptoms. Diuretic usage, diabetes, history of cardiovascular disease, and smoking were related to specific symptoms. CONCLUSIONS: While urinary symptoms are associated with age and history of enlarged prostate, symptoms may also be attributable to other diseases and exposures.     

Effect of nutritional status and ozone exposure on some biomarkers of oxidative stress in rat brain regions

The aim of this study was to analyze the effect of nutritional condition and simulated exposure to ozone on Glutathione (GSH), the activity of Na+/K+ ATPase and lipid peroxidation in rat brain. Male Wistar rats were fed with 7% and 23% protein diets. Two groups were formed for each nutritional condition: one group was exposed for 15 successive days to 0.75 ppm of ozone and the other to air. Subsequently, the brain was dissected in cortex, hemispheres, cerebellum, and brainstem to measure the activity of thiobarbituric acid reactive substances (TBARS), ATPase, and levels of GSH. The activity of Na+/K+ ATPase increased in cerebellum of well-nourished rats exposed to ozone, while total ATPase and TBARS decreased in all studied areas in the malnourished groups. The levels of GSH decreased significantly (P < 0.05) in the brain of rats fed with 7% of protein diet and exposed to ozone but increased in rats fed with normal diet and exposed to ozone. These results suggest that malnutrition causes alterations in the values of Na+/K+ ATPase, total ATPase, GSH, and lipid peroxidation, while ozone contributes to these modifications. As a consequence, both variables are involved in oxidative stress in the rat brain.     

A survey on exposure level, health status, and biomarkers in workers exposed to 1-bromopropane

BACKGROUND: The aim of this study was to evaluate the health effects of exposure mainly to 1-bromopropane, which is an alternative to ozone-depleting solvents, and to establish biomarkers for assessing 1-bromopropane exposure. METHODS: Twenty-four female and 13 male workers of a 1-bromopropane-factory were interviewed, and their urine and blood samples were collected. Measured parameters included 1-bromopropane levels in the factory, as well as individual exposure levels, urinary 1-bromopropane levels, enzymatic activity and M subunit's concentration of serum creatine kinase (CK). RESULTS: Frequent symptoms reported by workers exposed to 1-bromopropane were nose, throat, and eyes irritation or malaise and/or headache. Urinary 1-bromopropane levels correlated significantly with individual exposure levels, but enzymatic activity or CK-M subunit did not. CONCLUSIONS: The symptoms suggested irritation of the mucous membrane and possible adverse effects on the central nervous system. There were no severe chronic symptoms suggestive of neurological damage in workers exposed to less than 170 ppm. Urinary 1-bromopropane level may be a good indicator of exposure. Am. J. Ind. Med. 45:63-75, 2004.     

Antioxidant nutrients and chronic disease: use of biomarkers of exposure and oxidative stress status in epidemiologic research

Oxidation of lipid, nucleic acids or protein has been suggested to be involved in the etiology of several chronic diseases including cancer, cardiovascular disease, cataract, age-related macular degeneration and aging in general. A large body of research has investigated the potential role of antioxidant nutrients in the prevention of these and other chronic diseases. This review concentrates on the following antioxidant nutrients: beta-carotene and other carotenoids, vitamin E, vitamin C and selenium. The first part of the review emphasizes the utility of biological markers of exposure for these nutrients and the relationship to dietary intake data. The second part considers functional assays of oxidative stress status in humans including the strengths and limitations of various assays available for use in epidemiologic research. A wide variety of functional assays both in vivo and ex vivo, are covered, including various measures of lipid oxidation (thiobarbituric acid reactive substances, exhaled pentane/ethane, low-density lipoprotein resistance to oxidation, isoprostanes), DNA oxidation (oxidized DNA bases such as 8-OHdG, autoantibodies to oxidized DNA, modified Comet assay) and protein oxidation (protein carbonyls). Studies that have examined the effects of antioxidant nutrients on these functional markers are included for illustrative purposes. The review concludes with a discussion of methodologic issues and challenges for studies involving biomarkers of exposure to antioxidant nutrients and of oxidative stress status.     

Polychlorinated biphenyl exposure and neuropsychological status among older residents of upper Hudson River communities

BACKGROUND: Polychlorinated biphenyls (PCBs) may accelerate the cognitive and motor dysfunction found in normal aging, but few studies have examined these outcomes and PCB exposure among older adults. OBJECTIVE: We evaluated neuropsychological status and low-level PCB exposure among older adults living along contaminated portions of the upper Hudson River in New York. METHODS: A total of 253 persons between 55 and 74 years of age were recruited and interviewed, and provided blood samples for congener-specific PCB analysis. Participants also underwent a neuropsychological battery consisting of 34 tests capable of detecting subtle deficits in cognition, motor function, affective state, and olfactory function. RESULTS: After adjustment for potential confounders, the results indicated that an increase in serum total PCB concentration from 250 to 500 ppb (lipid basis) was associated with a 6.2% decrease in verbal learning, as measured by California Verbal Learning Test trial 1 score (p = 0.035), and with a 19.2% increase in depressive symptoms, as measured by the Beck Depression Inventory (p = 0.007). CONCLUSIONS: The results suggest that exposure to PCBs may be associated with some measures of memory and learning and depression among adults 55-74 years of age whose current body burdens are similar to those of the general population. Although the results are useful in delineating the neuropsychological effects of low-level exposure to PCBs, further studies of whether older men and women are a sensitive subpopulation are needed.     

Lead exposure in highway toll-booth workers

Biomarkers of lead exposure (blood lead, BPb) and effect (erythrocyte protoporhyrin, EP, and activity of delta-aminolevulinic acid dehydratase, ALAD) were measured in 68 male toll-booth operators (aged 22-60 years) on the Zagreb-Karlovac motorway. Average values (arithmetic mean +/- standard deviation) were: 61.8 +/- 29.3 micrograms/L for BPb, 0.70 +/- 0.20 mumol/L erythrocytes for EP, and 50.6 +/- 9.8 U/L erythrocytes for ALAD. All were within the normal range determined for general population (BPb < 150 micrograms/L, EP < 1.62 mumol/L erythrocytes, and ALAD > 35 U/L erythrocytes). A significant positive correlation was found between BPb and EP (r = 0.367, P < 0.01) and an inverse correlation between BPb and ALAD (r = -0.271, P < 0.05) and for EP and ALAD (r = -0.381, P < 0.01). Significant correlations were found between BPb or ALAD and smoking index (r = 0.486, P < 0.01, and r = -0.322, P < 0.01, respectively), whereas BPb also significantly correlated with blood gamma-glutamyl transferase (GGT) activity, which may indicate hepatotoxic effect of alcohol consumption (r = 0.334, P < 0.01). Among standard spirometric tests, BPb inversely correlated with FEV1 (r = -0.251, P < 0.05) and Tiffenau index (r = -0.280, P < 0.05), whereas ALAD positively correlated with FEF75-85 (r = 0.261, P < 0.05) and Tiffenau index (r = 0.314, P < 0.01). Among standard hematologic tests, BPb positively correlated with MCV (r = 0.282, P < 0.05), EP inversely correlated with erythrocyte count (r = -0.253, P < 0.05), and ALAD positively correlated with MCHC (r = 0.306, P < 0.05) and inversely with MCV (r = -0.250, P < 0.05). Although PbB values in these workers are within occupational exposure limits, they are higher than in corresponding occupations in developed countries. This may be explained by greater exposure to lead in ambient air, tobacco (through mainstream and sidestream smoking) and alcohol in this population.