Antioxidant vitamin supplement use and risk of dementia or Alzheimer's disease in older adults

OBJECTIVES: To examine whether use of vitamins C or E alone or in combination was associated with lower incidence of dementia or Alzheimer's disease (AD).
DESIGN: Prospective cohort study.
SETTING: Group Health Cooperative, Seattle, Washington.
PARTICIPANTS: Two thousand nine hundred sixty-nine participants aged 65 and older without cognitive impairment at baseline in the Adult Changes in Thought study.
MEASUREMENTS: Participants were followed biennially to identify incident dementia and AD diagnosed according to standard criteria. Participants were considered to be users of vitamins C or E if they self-reported use for at least 1 week during the month before baseline.
RESULTS: Over a mean follow-up±standard deviation of 5.5±2.7 years, 405 subjects developed dementia (289 developed AD). The use of vitamin E was not associated with dementia (adjusted hazard ratio (HR)=0.98, 95% confidence interval (CI)=0.77–1.25) or with AD (HR=1.04; 95% CI=0.78–1.39). No association was found between vitamin C alone (dementia: HR=0.90, 95% CI=0.71–1.13; AD: HR=0.95, 95% CI=0.72–1.25) or concurrent use of vitamin C and E (dementia: HR=0.93, 95% CI=0.72–1.20; AD: HR=1.00, 95% CI=0.73–1.35) and either outcome.
CONCLUSION: In this study, the use of supplemental vitamin E and C, alone or in combination, did not reduce risk of AD or overall dementia over 5.5 years of follow-up.     

Incidence of dementia,Alzheimer's disease,and vascular dementia in Italy. The ILSA Study

OBJECTIVES: To estimate the incidence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship of age, gender, and education to developing dementia. DESIGN: Cohort incidence study in the context of the Italian Longitudinal Study on Aging. SETTING: Population sample from eight Italian municipalities. PARTICIPANTS: A dementia-free cohort of 3,208 individuals (aged 65-84), individuated after a baseline evaluation performed in 1992 / 93, aimed at detecting prevalent cases. MEASUREMENTS: The dementia-free cohort was reexamined in 1995 to identify incident cases. The Mini-Mental State Examination (cutoff 23 / 24) was employed to screen for dementia. Trained neurologists evaluated the individuals who screened positive. Final diagnoses had to meet Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria for dementia, National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD, and International Classification of Diseases, Tenth Revision criteria for VaD. RESULTS: Before the follow-up examination, 382 individuals had died (232 had reliable information). Of the 2,826 survivors, 2,266 completed the study. Overall, 127 new dementia cases were identified. Average incidence rates per 1,000 person-years were 12.47 (95% confidence interval (CI)=10.23-14.72) for dementia, 6.55 (95% CI=4.92-8.17) for AD, and 3.30 (95% CI=2.14-4.45) for VaD. Both AD and VaD showed age-dependent patterns. Education was protective against dementia and AD. Women carried a significantly higher risk of developing AD (hazard ratio=1.67, 95% CI=1.02-2.75), and men of developing VaD (hazard ratio=2.23, 95% CI=1.06-4.71). CONCLUSIONS: Incidence of dementia in Italy paralleled that in most industrialized countries. About 150,000 new cases per year are expected. A significant gender effect was evidenced for major dementia subtypes. The burden of VaD, especially in men, offers opportunities for prevention.     

Metabolic Syndrome and Risk of Dementia in Older Adults

OBJECTIVES: To investigate the association between metabolic syndrome (MetS; a clustering of cardiovascular risk factors including abdominal obesity, hypertension, dyslipidemia, and hyperglycemia, each of which has been individually associated with dementia) and incident dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older adults before and after the age of 75. DESIGN: Prospective population‐based cohort. SETTING: An Italian municipality. PARTICIPANTS: A community‐based sample of 749 subjects aged 65 and older who, in 1999/2000, were free of cognitive impairment and, in 2003/04, underwent follow‐up for incident dementia. MEASUREMENTS: The relationship between incident overall dementia, AD, and VaD and MetS. Dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. MetS was defined according to the National Cholesterol Education Program criteria. RESULTS: Risk of overall dementia and its subtypes was not associated with MetS or any MetS component in participants younger than 75. In participants aged 75 and older, MetS was associated with a lower risk of AD (hazard ratio (HR)=0.33, 95% confidence interval (CI)=0.12–0.94) but not of VaD, and abdominal obesity was associated with a lower risk of overall dementia (HR=0.53, 95% CI=0.28–0.98). CONCLUSION: MetS measured in late life is not associated with risk of dementia. After age 75, persons with MetS may even be at lower risk for AD.     

Angiotensin-converting enzyme inhibitors and incidence of mild cognitive impairment. The Italian Longitudinal Study on Aging

Midlife elevated blood pressure and hypertension contribute to the development of Alzheimer's disease (AD) and overall dementia. We sought to estimate whether angiotensin-converting enzyme inhibitors (ACE-Is) reduced the risk of developing mild cognitive impairment (MCI) in cognitively normal individuals. In the Italian Longitudinal Study on Aging, we evaluated 1,445 cognitively normal individuals treated for hypertension but without congestive heart failure from a population-based sample from eight Italian municipalities with a 3.5-year follow-up. MCI was diagnosed with current clinical criteria. Dementia, AD, and vascular dementia were diagnosed based on DSM-IIIR criteria, NINCDS–ADRDA criteria, and ICD-10 codes. Among 873 hypertension-treated cognitively normal subjects, there was no significant association between continuous exposure to all ACE-Is and risk of incident MCI compared with other antihypertensive drugs [hazard ratio (HR), 0.45, 95% confidence interval (CI), 0.16–1.28]. Captopril exposure alone did not significantly modify the risk of incident MCI (HR, 1.80, 95% CI, 0.39–8.37). However, the enalapril sub-group alone (HR, 0.17, 95% CI, 0.04 –0.84) or combined with the lisinopril sub-group (HR, 0.27, 95% CI, 0.08–0.96), another ACE-I structurally related to enalapril and with similar potency, were associated with a reduced risk of incident MCI. Study duration exposure to ACE-Is as a “class” was not associated with incident MCI in older hypertensive adults. However, within-class differences linked to different chemical structures and/or drug potencies may exist, with a possible effect of the enalapril and lisinopril sub-groups in reducing the risk of incident MCI.     

Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies

This study examined the association of diabetes with the onset of dementia (including Alzheimer's disease (AD), vascular dementia (VD) and any dementia) and mild cognitive impairment (MCI) by using a quantitative meta-analysis of longitudinal studies. EMBASE and MEDLINE were searched for articles published up to December 2010. All studies that examined the relationship between diabetes and the onset of dementia or MCI were included. Pooled relative risks were calculated using fixed and random effects models. Nineteen studies met our inclusion criteria for this meta-analysis, and 6184 subjects with diabetes and 38 530 subjects without diabetes were included respectively. All subjects were without dementia or MCI at baseline. The quantitative meta-analysis showed that subjects with diabetes had higher risk for AD (relative risk (RR):1.46, 95% confidence interval (CI): 1.20-1.77), VD (RR: 2.48, 95% CI: 2.08-2.96), any dementia (RR: 1.51, 95% CI: 1.31-1.74) and MCI (RR: 1.21, 95% CI: 1.02-1.45) than those without. The quantitative meta-analysis showed that diabetes was a risk factor for incident dementia (including AD, VD and any dementia) and MCI.     

Mild Cognitive Impairment: Incidence and Risk Factors: Results of the Leipzig Longitudinal Study of the Aged

OBECTIVES: To provide information on age‐ and sex‐specific incidence rates of mild cognitive impairment (MCI) and risk factors for incident MCI. DESIGN: Prospective longitudinal cohort. SETTING: Leipzig Longitudinal Study of the Aged, a population‐based German study of the epidemiology of dementia and mild cognitive impairment. PARTICIPANTS: At baseline, 1,692 subjects aged 75 and older were included in the sample. MEASUREMENTS: Trained psychologists and physicians conducted structured clinical interviews including neuropsychological assessment and questions about sociodemographics, familial history of dementia, activities of daily living, subjective memory impairment, and lifestyle (alcohol consumption, smoking) at participants' homes. Structured third‐party interviews were conducted with proxies. Incidence was calculated according to the person‐years‐at‐risk method. Cox proportional hazards models were used to examine the association between risk factors and incident MCI. RESULTS: During an 8‐year follow‐up period, 26.4% (n=137) of the 519 study participants (population at risk) were identified as incident MCI cases (person‐years=1,791.1). The overall incidence rate of MCI was 76.5 (95% confidence interval=64.7–90.4) per 1,000 person‐years. Older age, subjective memory impairment, impairment in instrumental activities of daily living, and antecedent lower cognitive performance were found to be significantly associated with the development of future MCI. CONCLUSION: MCI is highly incident in the elderly population. For the purpose of early detection of dementia, subjective memory impairment should be taken seriously as a possible prestage of MCI.     

Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints

OBJECTIVE: To evaluate the relationship between antihypertensive treatments and cognitive function in elderly hypertensive patients with memory complaints. METHODS: The association between cognitive function and antihypertensive drug therapy was studied in 1241 hypertensive elderly patients with memory complaints attending a geriatric outpatient clinic. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and validated neuropsychological tests (Cognitive Efficiency Profile; CEP). Patients were classified into four categories according to their cognitive status: normal cognitive function, mild cognitive impairment (MCI), Alzheimer's disease (AD) or vascular dementia (VaD). RESULTS: In this population aged 78 +/- 8 years, with a mean blood pressure of 152 +/- 19/86 +/- 12 mmHg, antihypertensive treatment was prescribed for 57% of patients. After adjustment for age, sex and education, treated hypertensive patients had better cognitive function than untreated patients (MMSE score 23.9 +/- 5.6/30 versus 22.7 +/- 6.4/30, P < 0.001, CEP score 49.1 +/- 24.9/100 versus 45.4 +/- 23.7/100, P < 0.001). This association was observed independently of the cognitive status, both in normal, MCI, AD and VaD hypertensive patients. The odds ratio (OR) for AD was 0.58 [95% confidence interval (CI) 0.42-0.81] in treated compared with untreated hypertensive patients. In patients on antihypertensive therapy, higher cognitive function was observed in patients using calcium antagonists compared with those without calcium antagonists (CEP 52.9 +/- 24.6/100 versus 46.4 +/- 23.4/100, P < 0.001; OR for AD 0.67; 95% CI 0.45-0.99), independently of blood pressure level. CONCLUSIONS: Antihypertensive therapy was associated with a lower risk of cognitive impairment and AD. In particular, the use of calcium antagonists was associated with a decreased risk of cognitive impairment and AD independently of the blood pressure level, suggesting a specific neuroprotective effect of these antihypertensive agents.     

Risk Factors for Preoperative and Postoperative Delirium in Elderly Patients with Hip Fracture

OBJECTIVES: To evaluate risk factors for preoperative and postoperative delirium.
DESIGN: Prospective cohort study.
SETTING: Departments of orthopedic surgery in two Norwegian hospitals.
PARTICIPANTS: Three hundred sixty-four patients with and without cognitive impairment, aged 65 and older.
MEASUREMENTS: Patients were screened daily for delirium using the Confusion Assessment Method. Established risk factors and risk factors regarded as clinically important according to expert opinion were explored in univariate analyses. Variables associated with the outcomes ( P <.05) were entered into multivariate logistic regression models.
RESULTS: Delirium was present in 50 of 237 (21.1%) assessable patients preoperatively, whereas 68 of 187 (36.4%) patients developed delirium postoperatively (incident delirium). Multivariate logistic regression identified four risk factors for preoperative delirium: cognitive impairment (adjusted odds ratio (AOR)=4.7, 95% confidence interval (CI)=1.9–11.3), indoor injury (AOR=3.6, 95% CI=1.1–12.2), fever (AOR=3.4, 95% CI=1.5–7.7), and preoperative waiting time (AOR=1.05, 95% CI=1.0–1.1 per hour). Cognitive impairment (AOR=2.9, 95% CI=1.4–6.2), indoor injury (AOR=2.9, 95% CI=1.1–6.3), and body mass index (BMI) less than 20.0 (AOR=2.9, 95% CI=1.3–6.7) were independent and statistically significant risk factors for postoperative delirium.
CONCLUSION: Time from admission to operation is a risk factor for preoperative delirium, whereas low BMI is an important risk factor for postoperative delirium in hip fracture patients. Cognitive impairment and indoor injury are independent risk factors for preoperative and postoperative delirium.     

Awareness of memory deficits in patients with dementias: a study with the Everyday Memory Checklist

AIM: We examined the level of awareness of memory deficits in 63 patients with Alzheimer's disease (AD), 17 patients with dementia with Lewy bodies (DLB), 14 patients with vascular dementia (VaD), and 56 patients with amnestic mild cognitive impairment (MCI). METHODS: The unawareness of memory impairment was evaluated with a standardized memory questionnaire system based on the Everyday Memory Checklist (EMC). The EMC scores for the patient's own rating, the caregivers' rating and the unawareness score, defined as the discrepancy between these (caregiver rating-patient rating), were analyzed. RESULTS: Although the EMC self-rating scores were comparable among the four groups, the EMC scores in caregivers were significantly higher in the AD group than in the DLB, VaD, and MCI groups. Therefore, the unawareness scores were significantly higher in the AD groups than in other groups. When an unawareness score of 9 or more was defined as significant, impaired awareness was found in 41 (65%) patients with AD, 1 (6%) patient with DLB, 5 (36%) patients with VaD, and in 19 (34%) patients with MCI. CONCLUSION: We found that impaired awareness was found in two-thirds of patients with mild AD and even in one-third of patients with MCI. However, other dementias, in particular DLB, had less severe and less frequent unawareness of memory deficits than AD, suggesting the difference in the pathophysiology between them.     

Depressive symptoms and incidence of mild cognitive impairment and probable dementia in elderly women: the Women's Health Initiative Memory Study

OBJECTIVES: To examine whether significant depressive symptoms in postmenopausal women increases the risk of subsequent mild cognitive impairment (MCI) and dementia. DESIGN: Prospective cohort study. SETTING: Thirty nine of the 40 Women's Health Initiative (WHI) clinical centers that participated in a randomized clinical trial of hormone therapy. PARTICIPANTS: Six thousand three hundred seventy‐six postmenopausal women without cognitive impairment aged 65 to 79 at baseline. MEASUREMENTS: Depressive disorders were assessed using an eight‐item Burnam algorithm and followed annually for a mean period of 5.4 years. A central adjudication committee classified the presence of MCI and probable dementia based on an extensive neuropsychiatric examination. RESULTS: Eight percent of postmenopausal women in this sample reported depressive symptoms above a 0.06 cut point on the Burnam algorithm. Depressive disorder at baseline was associated with greater risk of incident MCI (hazard ratio (HR)=1.98, 95% confidence interval (CI)=1.33–2.94), probable dementia (HR=2.03, 95% CI=1.15–3.60), and MCI or probable dementia (HR=1.92, 95% CI=1.35–2.73) after controlling for sociodemographic characteristics, lifestyle and vascular risk factors, cardiovascular and cerebrovascular disease, antidepressant use, and current and past hormone therapy status. Assignment to hormone therapy and baseline cognitive function did not affect these relationships. Women without depression who endorsed a remote history of depression had a higher risk of developing dementia. CONCLUSION: Clinically significant depressive symptoms in women aged 65 and older are independently associated with greater incidence of MCI and probable dementia.     

Cerebrovascular disease in the elderly: lipoprotein metabolism and cognitive decline

Data concerning the treatment of lipoprotein disturbances in patients with cerebrovascular disease (CVD) are less robust than those for coronary heart disease (CHD), raising clinical questions as to which is the appropriate therapeutic approach to stroke patients. Although observational cohort studies have failed to demonstrate an association between lipoprotein disorders and stroke incidence, recently completed trials of subjects at risk for CHD have shown that statins reduce not only the risk of myocardial infarction and death, but also that of brain infarction and transient ischemic attacks. At present, it seems reasonable to conclude that stroke patients with undesirable lipid profiles who have a history of CHD should receive specific treatment for the lipid disorder. Recommendations are more problematic for stroke patients with lipid disorder but no history of CHD. Furthermore, many of the risk factors for CVD and vascular dementia (VaD), including serum total cholesterol (TC), lipoprotein(a), diabetes, atrial fibrillation, hypertension, apolipoprotein E levels, and atherosclerosis, have also been shown to increase the risk of Alzheimer's disease (AD). In a recent study, we estimated the prevalence, incidence and rate of progression of Mild Cognitive Impairment (MCI) to dementia, and correlated vascular risk factors with incident MCI and its progression to dementia. We evaluated 2963 individuals from the population-based sample of 5632 subjects 65-84 years old of the Italian Longitudinal Study on Aging, with a 3.5-year follow-up. We found a progression rate to dementia (all causes) of 3.8/100 person-years. Furthermore, age was a risk factor for incident MCI, while education was protective, and serum TC evidenced a non-significant borderline trend for a protective effect. There was a non-significant trend for stroke as a risk factor of progression of MCI to dementia. In conclusion, in our population, among MCI patients who progressed to dementia, 60% progressed to AD and 33% to VaD. Vascular risk factors and CVD may influence the development of MCI and the rate of progression to dementia.     

Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project

OBJECTIVES: To describe the association between late-life body mass index (BMI) and dementia development with a time perspective and to investigate the effect of weight changes on dementia incidence.
DESIGN: Three-, 6-, and 9-year follow-up study.
SETTING: The Kungsholmen Project.
PARTICIPANTS: One thousand two hundred fifty-five subjects aged 75 and older with baseline BMI data available.
MEASUREMENTS: Cox-regression models were used to estimate hazard ratios (HRs) for dementia detected at different risk periods in relation to baseline BMI. The association between BMI changes and development of dementia after 3 and 6 years was also analyzed.
RESULTS: Subjects with a BMI of 25.0 kg/m² or higher had a lower risk of developing dementia than subjects with a BMI of 20.0 to 24.9 (HR=0.75, 95% confidence interval (CI)=0.59–0.96), even when cases occurring only during the last follow-up period (6–9 years after BMI assessment) were included (HR=0.66. 95% CI=0.40–1.07). Severe BMI loss (>10%) was related to a greater risk of dementia, but this association was present only for dementia cases detected in the subsequent 3 years (HR=2.18, 95% CI=1.27–3.74).
CONCLUSION: This study does not confirm that being overweight in late life is a risk factor for dementia, although a protective effect for a BMI greater than 25.0 is suggested. In addition, BMI loss is confirmed as a marker of incipient dementia. The findings suggest that, from a clinical perspective, the cognitive profile of elderly persons with unexplained weight loss should be considered and that being moderately overweight at older ages might be indicative of good health status.     

Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study

OBJECTIVES: To study the subtle changes in instrumental activities of daily living (IADLs) over the 10 years preceding the clinical diagnosis of dementia.
DESIGN: Prospective cohort designed in 1988 to study cerebral and functional aging.
SETTING: Community-based study in southwestern France.
PARTICIPANTS: The sample included 104 incident cases of dementia at the 10-year follow-up (T10) and 882 subjects free of dementia at the same visit, all forming part of the PAQUID Study.
MEASUREMENTS: Restriction in four IADLs was studied (telephone, transportation, medication, and finances) 2, 5, 7, and 10 years before the T10 visit.
RESULTS: The future dementia cases had greater IADL restrictions 10 years before the clinical diagnosis of dementia and more-rapid functional deterioration over time. Controlled for age, sex, and education, subjects restricted in at least two IADLs at baseline had a higher risk of dementia 10 years later (odds ratio (OR)=2.59, 95% confidence interval (CI)=1.24–5.38). In finances, difficulty at baseline was a predictor of dementia 10 years later (OR=2.15, 95% CI=1.13–4.08).
CONCLUSION: This study is the first to show that, 10 years before the clinical diagnosis of dementia, subjects who later developed dementia performed worse in complex activities of daily living, which may constitute an early marker of the disease. In practice, restriction in IADLs may be a simple and useful tool for screening subjects at risk of developing dementia in the long term.     

Endogenous sex hormones as risk factors for dementia in elderly men and women

BACKGROUND: The associations of endogenous sex hormones with risk of dementia in the elderly population are not well known. METHODS: The relationship of baseline serum total estradiol (E2) and free testosterone (FT) to 4-year risk of all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD) was examined in a dementia-free, population-based cohort of 433 women (mean age 74 years) and 376 men (mean age 73 years). Multivariable proportional hazards regression was used to adjust for sociodemographic and lifestyle variables, body mass index, apolipoprotein E genotype, cardiovascular conditions, and homocysteinemia. RESULTS: Dementia developed in 71 women (46 AD, 21 VaD) and 39 men (23 AD, 12 VaD). In women with high E2 (serum E2 >or= 10 pg/mL), the multivariable-adjusted hazard ratio (HR) for dementia was 1.75 (95% confidence interval [CI], 1.06-2.89). The corresponding multivariable-adjusted HR for AD was 1.94 (95% CI, 1.04-3.61), whereas no association was found for VaD. No association with dementia was found for serum FT in women and for either serum E2 or FT in men. CONCLUSION: High serum E2 is an independent predictor for dementia and AD in elderly women.     

Effect of Central Nervous System Medication Use on Decline in Cognition in Community-Dwelling Older Adults: Findings from the Health, Aging and Body Composition Study

OBJECTIVES: To evaluate whether combined use of multiple central nervous system (CNS) medications over time is associated with cognitive change.
DESIGN: Longitudinal cohort study.
SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee.
PARTICIPANTS: Two thousand seven hundred thirty-seven healthy adults (aged ≥65) enrolled in the Health, Aging and Body Composition study without baseline cognitive impairment (modified Mini-Mental State Examination (3MS) score ≥80).
MEASUREMENTS: CNS medication (benzodiazepine- and opioid-receptor agonists, antipsychotics, antidepressants) use, duration, and dose were determined at baseline (Year 1) and Years 3 and 5. Cognitive function was measured using the 3MS at baseline and Years 3 and 5. The outcome variables were incident cognitive impairment (3MS score <80) and cognitive decline (≥5-point decline on 3MS). Multivariable interval-censored survival analyses were conducted.
RESULTS: By Year 5, 7.7% of subjects had incident cognitive impairment; 25.2% demonstrated cognitive decline. CNS medication use increased from 13.9% at baseline to 15.3% and 17.1% at Years 3 and 5, respectively. It was not associated with incident cognitive impairment (adjusted hazard ratio (adj HR)=1.11, 95% confidence interval (CI)=0.73–1.69) but was associated with cognitive decline (adj HR 1.37, 95% CI=1.11–1.70). Longer duration (adj HR=1.39, CI=1.08–1.79) and higher doses (>3 standardized daily doses) (adj HR=1.87, 95% CI=1.25–2.79) of CNS medications suggested greater risk of cognitive decline than with nonuse.
CONCLUSION: Combined use of CNS medications, especially at higher doses, appears to be associated with cognitive decline in older adults. Future studies must explore the effect of combined CNS medication use on vulnerable older adults.     

Mild Cognitive Impairment and Objective Instrumental Everyday Functioning: The Everyday Cognition Battery Memory Test

OBJECTIVES: To examine the performance subjects with and without mild cognitive impairment (MCI) on an objective measure of everyday or real-world memory and subjective items assessing competency within the same instrumental domains; to determine whether the Everyday Cognition Battery (ECB) can uniquely predict MCI status.
DESIGN: Cross-sectional.
SETTING: Independent-living sample of urban dwelling elders in Baltimore Maryland.
PARTICIPANTS: The sample consisted of 555 subjects ranging in age from 50 to 95 (mean 68.8 ± 9.6).
MEASUREMENTS: Objective performance in three instrumental domains (medication use, financial management, nutrition and food preparation) was assessed using the ECB Memory Test. Subjective performance within the same instrumental domains was also assessed.
RESULTS: No difference was found between elderly subjects with and without MCI on the subjective items of instrumental activity of daily living (IADL) competency. A significant multivariate effect for cognitive status group (F_{3, 507}=21.88, P <.05, η²=.12) was observed for the objective measure, with participants with MCI performing, on average, significantly worse than those without on all thee instrumental domain subscales. The medicine use (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94–0.99) and financial management (OR=0.93, 95% CI=0.91–0.96) subscales of the ECB Memory Test were unique and significant predictors of MCI.
CONCLUSION: This study adds to the growing body of literature suggesting that cognitively complex IADLs might be compromised in elderly people with MCI. Moreover, the ECB Memory Test might be a clinically useful tool in evaluating real-world competency.     

High Levels of Serum C-Reactive Protein Are Associated with Greater Risk of All-Cause Mortality, but Not Dementia, in the Oldest-Old: Results from The 90+ Study

OBJECTIVES: To evaluate whether high levels of C-reactive protein (CRP) in serum are associated with greater risk of all-cause dementia or mortality in the oldest-old.
DESIGN: Prospective.
SETTING: Research clinic and in-home visits.
PARTICIPANTS: Population-based sample of adults (N=227; aged 93.9±2.8) from The 90+ Study, a longitudinal cohort study of people aged 90 and older.
MEASUREMENTS: CRP levels were divided into three groups according to the assay detection limit: undetectable (<0.5 mg/dL), detectable (0.5–0.7 mg/dL), and elevated (≥0.8 mg/dL). Neurological examination was used to determine dementia diagnosis ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , criteria). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox regression, and results were stratified according to and apolipoprotein E4 (APOE4) genotype.
RESULTS: Subjects with detectable CRP levels had significantly greater risk of mortality (HR=1.7, 95% CI=1.0–2.9), but not dementia (HR=1.2, 95% CI=0.6–2.1), 0.4 to 4.5 years later than subjects with undetectable CRP. The highest relative risk for dementia and mortality was in APOE4 carriers with detectable CRP (dementia HR=4.5, 95% CI=0.9–23.3; mortality HR=5.6, 95% CI=1.0–30.7).
CONCLUSION: High levels of CRP are associated with greater risk of mortality in people aged 90 and older, particularly in APOE4 carriers. There was a trend toward greater risk of dementia in APOE4 carriers with high CRP levels, although this relationship did not reach significance. High levels of CRP in the oldest-old represent a risk factor for negative outcomes.     

Is Dementia Special Care Really Special? A New Look at an Old Question

OBJECTIVES: To quantify differences in care provided to nursing home (NH) residents with dementia living on and off dementia special care units (SCUs).
DESIGN: Cross-sectional study using propensity score adjustment for resident and NH characteristics.
SETTING: Free-standing NHs in nonrural U.S. counties that had an SCU in 2004 (N=1,896).
PARTICIPANTS: Long-stay (≥90 days) NH residents with a diagnosis of Alzheimer's disease or dementia and at least moderate cognitive impairment (N=69,131).
MEASUREMENTS: Resident-level NH care processes such as physical restraints, bed rails, feeding tubes, psychotropic medications, and incontinence care.
RESULTS: There was no difference in the use of physical restraints (adjusted odds ratio (AOR)=0.94, 95% confidence interval (CI)=0.79–1.11), but SCU residents were less likely to have had bed rails (AOR=0.55, 95% CI=0.46–0.64) and to have been tube fed (AOR=0.36, 95% CI=0.30–0.43). SCU residents were more likely to be on toileting plans (AOR=1.23, 95% CI=1.08–1.39) and less likely to use pads or briefs in the absence of a toileting plan (AOR=0.73, 95% CI=0.61–0.88). SCU residents were more likely to have received psychotropic medications (AOR=1.23, 95% CI=1.05–1.44), primarily antipsychotics (SCU=44.9% vs non-SCU=30.0%).
CONCLUSION: SCU residents received different care than comparable non-SCU residents. Most strikingly, SCU residents had greater use of antipsychotic medications.     

Incidence and risk factors of dementia and the primary subtypes in northern rural China

This study was carried out to estimate the incidence and to determine socio-demographic risk factors for dementia among individuals residing in rural northern China.The current prospective, population-based study was conducted between 2011 and 2016. Follow-up interviews were conducted annually from 2014 to 2016. The study involved 1511 dementia-free individuals aged 60 years or above from rural China. Standard criteria were used to make diagnoses for dementia and Alzheimer disease (AD).At least one follow up survey was completed with 1181 study participants. At the 5-year follow-up, 127 individuals had developed dementia, 75 had developed AD, and 32 had developed vascular dementia (VaD). With a total of 5649.2 risk years for the sample, the estimated incidence rates per 1000 person-years were 22.48 (95% CI: 18.62, 26.35) for dementia and 13.28 (95% CI: 10.29, 16.26) for AD. Incidence rates for dementia and AD increased with age across the 10-year age groups. Poor education (illiteracy) was an independent risk factor for both AD and VaD. Being engaged in social activities was an independent protective factor for VaD.The incidence of dementia in rural China was found to be higher than previously reported. Incidence of dementia increased with age, and AD was the most frequent type of dementia. Poor education was associated with a higher risk of VaD and AD. Engagement in social activities was an independent protective factor for VaD.     

Chewing problems and mortality in older adults in home care: results from the Aged in Home Care study

OBJECTIVES: To assess the association between chewing problems and risk of mortality in an older population receiving home care in Europe.
DESIGN: Retrospective cohort study.
SETTING: Eleven European countries.
PARTICIPANTS: Two thousand seven hundred fifty-five older adults (mean age±standard deviation 82.2±7.2) in home care.
MEASUREMENTS: Data were collected using the Minimum Data Set for Home Care. Study personnel recorded chewing problems (inability to chew food easily and without pain or difficulties, regardless of cause) that presented in the last 3 days before baseline assessment. Data on mortality were collected over a 1-year period.
RESULTS: Three hundred ninety-five participants (14.3%) presented with chewing problems. One-year mortality differed significantly according to presence of chewing problems; 303 of 2,361 (12.8%) without chewing problems (crude incident rate per person-year (p-y)=0.15) and 80 of 394 (20.3%) participants with chewing problems (crude incident rate per p-y=0.24) died during follow-up. After adjusting for potential confounders, the risk of death was significantly higher for participants with chewing problems (adjusted hazard ratio (HR)=1.45, 95% confidence intervals (CI)=1.05–1.99). This association remained after exclusion of participants with cognitive impairment (adjusted HR=1.50, 95% CI=1.03–2.20) and those with unintended weight loss (adjusted HR=1.62, 95% CI=1.12–2.34).
CONCLUSION: In older adults in home care in Europe, chewing problems are associated with greater risk of mortality.