Estrogen receptor 1 polymorphisms and risk of cognitive impairment in older women.

BACKGROUND: Several genes associated with sporadic Alzheimer's disease have been identified; however, approximately 50% of genetic factors remain unidentified. We investigated whether estrogen receptor 1 (ESR1) polymorphisms are associated with risk of developing cognitive impairment in older women. METHODS: A total of 2625 women > or = 65 years of age completed a modified Mini-Mental Status Exam (mMMSE) at baseline and at 6-8 years of follow-up. We defined cognitive impairment as a mMMSE decline of > or = 3 points, follow-up score < or = 20, or a history of physician-diagnosed dementia. The ESR1 polymorphisms, PvuII (P or p) and XbaI (X or x), were coded so that the capital letter signifies the absence of the restriction site. RESULTS: Women with a p allele had a greater age, education, and baseline-score adjusted decline in mMMSE (for PP, Pp, and pp, respectively:.6 +/-.1,.8 +/-.1, and.9 +/-.1 points, p for trend =.01); women with at least one x allele also had greater score decline (XX, Xx, and xx:.7 +/-.1,.7 +/-.1, and.9 +/-.1 points, p for trend =.02). Six percent (n = 166) of the women developed cognitive impairment. Compared to those who did not develop impairment, more women who developed cognitive impairment had a p allele (62% vs. 56%, p =.03; adjusted odds ration (OR) = 1.33; 95% confidence interval [CI], 1.03-1.72) or an x allele (70% vs. 64%, p =.03; adjusted OR = 1.38; 95% CI, 1.06-1.81). There was no interaction with current estrogen use, or with serum estradiol level and ESR1 polymorphisms (p >.10). CONCLUSIONS: Estrogen receptor 1 polymorphisms are associated with risk of developing cognitive impairment. More research is needed to determine the mechanism whereby ESR1 polymorphisms or linked genes influence cognitive function in older women.     

Mild cognitive impairment and everyday functioning in older adults

The relations between mild cognitive impairment without dementia (MCI/CIND) and everyday functional abilities were examined using data from the Canadian Study of Health and Aging (CSHA). Individuals were identified with MCI/CIND if both caregiver report and clinician judgment agreed on the presence of cognitive impairment in the absence of dementia. Cross-sectional and longitudinal comparisons indicated that individuals with MCI/CIND demonstrated a broad range of impairment in instrumental activities of daily living (IADL) compared to individuals with no cognitive impairment (NCI). In cross-sectional analyses, neuropsychological measures of memory and psychomotor speed were significantly related to impairment in eight areas of functioning. In addition, poorer memory performance was significantly predictive of future impairment in money management.     

Alcoholism in older Korean men: prevalence,aetiology, and comorbidity with cognitive impairment and dementia in urban and rural communities

BACKGROUND: Alcoholism in the elderly has received little research, particularly outside 'Western' cultures. OBJECTIVES: This study aimed to investigate the prevalence and aetiology of alcoholism, and its comorbidity with cognitive impairment and dementia in an older Korean population. METHODS: 1134 urban and rural community residents aged 65 or over were surveyed in Kwangju, South Korea. Alcoholism was identified by a culturally validated screening scale. RESULTS: Alcoholism was present in 16% of men and 2% of women. In men (n = 457), alcoholism was positively associated with manual occupation and negatively with religions encouraging temperance. In the urban sample, alcoholism was associated with higher education and with dementia. In the rural sample, it was associated with lower education and less strongly with dementia. CONCLUSIONS: The prevalence of alcoholism was high in this population. Associated factors and urban/rural differences reflect traditional attitudes toward drinking.     

Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients

OBJECTIVE: To investigate the criterion validity of the four-item Geriatric Depression Scale (GDS4) and the six-item Orientation-Memory-Concentration-test (OMC) against longer widely used screening instruments. METHOD: Participants were 153 patients (aged 65 or over) admitted to four acute medical wards of a northern UK town. The validity of the GDS4 was determined using the 30-item geriatric depression scale (GDS30) as the comparator; the validity of the OMC was determined using the standardised mini-mental state examination (MMSE) as the comparator. For both screens, the area under receiver operating characteristic (ROC) curve was calculated in addition to the number of true and false positives and the sensitivity and specificity for various cut-off points. RESULTS: The area under ROC curve was 0.80 for the GDS4 and 0.90 for the OMC. Using a cut-off of 0/1, the GDS4 correctly classified 78.2% of participants, using the GDS30 as the standard. This cut-off gave a sensitivity of 90.1% and specificity of 55.3%. With a cut-off of 1/2 the GDS4 correctly classified 76.8% of participants and had sensitivity and specificity of 78% and 74.5% respectively. The GDS4 and GDS30 were highly correlated (rho=0.63, p < 0.0005). A cut-off of 10/11 on the OMC gave optimum performance. With this cut-off, it correctly classified 85.9% of participants, and had 85.6% sensitivity and 86.8% specificity. There was a significant correlation between the OMC and the SMMSE (rho = -0.827, p < 0.0005). CONCLUSION: The GDS4 and OMC appear to be useful instruments for screening for depression and cognitive impairment among older medical inpatients.     

Yield of a new method to detect cognitive impairment in general practice

OBJECTIVE: To examine whether a new screening method that identified patients with cognitive impairment who needed further examination on the presence of dementia yielded patients who were not detected by their general practitioner (GP), and to identify factors associated with GPs' awareness of patients identified by the screening. METHODS: Cross-sectional comparison between two methods used to identify dementia symptoms: (1) usual identification of dementia by GPs; (2) a two-stage screening to identify cognitive impairment. The two methods were implemented on the same older general practice population. The study was set in primary care practices in the Netherlands. The participants were 44 GPs and 2,101 general practice patients aged 75+ who lived at home. The following measurements were used: (1) yield of the screening; (2) determinants of GPs' awareness of patients identified by the screening. RESULTS: The two-stage screening yielded 117 patients with cognitive impairment who needed further examination; in most cases (n = 82, 70.1%) their GP was unaware of the symptoms. Among patients identified by the screening, GPs' awareness was associated with co-morbidity of chronic diseases [odds ratio (OR) = 3.19; 95% Confidence Interval (CI) = 1.25 to 8.15], depressive symptoms (OR = 0.41; 95% CI = 0.17 to 0.99), and cognitive functioning (per point on the MMSE, OR = 0.88; 95% CI = 0.79 to 0.98). CONCLUSION: A two-stage screening method and increased alertness for cognitive impairment and dementia among patients with depressive symptoms may improve detection rate of dementia in general practice.     

Consistency of traumatic brain injury reporting in older adults with and without cognitive impairment

Objective: Medical history information regarding prior traumatic brain injury (TBI) usually relies on self-report, although little is known about the reliability of this information with regard to injuries sustained years or decades earlier. Even less is known about the reliability of self-reported medical history information in older individuals with cognitive impairment. To this end, we assessed the test-retest reliability of self-reported TBI history in a large, national sample. Methods: Participants (n = 4309) were older adults with intact cognition, mild cognitive impairment (MCI) and Alzheimer’s disease (AD) from the National Alzheimer’s Coordinating Center. Subjects provided TBI history information at baseline and one annual follow-up visit. Consistency of self-reported history of TBI with <5 minutes loss of consciousness (mLOC) and TBI with ≥5 mLOC reported at time 1 and 2 was analyzed across diagnostic groups. Results: Overall, subjects provided reports of TBI history at follow-up that were highly consistent with baseline reports (97.8–99.6% agreement), and Cohen’s kappa coefficients were all larger than .80 and statistically significant, maximum p < .001. Furthermore, level of cognitive impairment was not a significant predictor of consistency in reporting. Conclusions: These data are some of the first to suggest that self-report may be a consistent method of obtaining remote TBI history in the absence of medical records for older individuals, regardless of cognitive impairment.     

Patterns of functioning in older adults with mild cognitive impairment: a two-year study focusing on everyday technology use

Objectives: Early detection is vital for persons with mild cognitive impairment (MCI) who are at risk of activity and participation limitations, and crosssectional studies suggest the ability to use everyday technology (ET) to be a sensible tool. However, group level analyses fail to inform us about how functioning can vary over time for individuals. This study aimed at exploring and describing patterns of functioning over two years in a sample newly classified with MCI, with a special focus on perceived difficulty in ET use and involvement in everyday activities. In addition, cognitive functioning and conversion to dementia were studied.

Method: 37 older adults (aged ≥ 55) with MCI were assessed at inclusion, and at 6, 12, and 24 months. Longitudinal case plots for the variables under study were analyzed based on strict criteria using a person-oriented approach. Paired t-tests from baseline and 24 months were also conducted to analyze change.

Results: The 32 participants who remained in the study after two years showed three distinct patterns of functioning over time: stable/ascending (n = 10), fluctuating (n = 10), and descending (n = 12), with the highest conversion to dementia in the descending pattern (58%). The perceived ability to use ET decreased or fluctuated in 50% of the sample. However, on a group level, a significant difference between baseline and 24 months was found only regarding cognitive function.

Conclusion: As the need for support is individual and likely to alter over time, repeated evaluations of activity involvement and difficulty in ET use are suggested to target timely interventions for persons with MCI.     

Gait and posture impairment,parkinsonism and cognitive decline in older people

Summary Our objective was to examine the frequency of gait and posture impairment and parkinsonism in 3 waves of the Canadians Study of Health and Aging (CSHA) and to determine their relationship to the development of cognitive impairment-not dementia (CIND) and dementia. A secondary analysis of a Canadian population-based cohort study was performed. People 65 years of age and older without cognitive impairment or dementia underwent examination for the presence of gait or posture impairment (GPI) or parkinsonism (based on the presence of 2/3 signs among resting tremor, rigidity or bradykinesia), both defined by a clinical examination. Risk for development of cognitive impairment or dementia was examined at 5 and 10 year follow up in pre-specified logistic regression models adjusted for age, sex, education and in separate models, frailty. The frequency of GPI ranged from 25 to 30% in cognitively unimpaired to 46–53% in CIND and demented subjects. Parkinsonism was more common with increasing cognitive impairment at each wave of the CSHA. Both GPI and parkinsonism predicted cognitive decline. Frailty reduced, but did not eliminate the impact of these motor measures and was itself a significant predictor of cognitive decline. In conclusion, motor impairment and frailty are common in older people and are associated with an increased risk of cognitive decline and dementia. GPI is common in CIND, while GPI and parkinsonism are both common in dementia.     

Depression, cognitive impairment and function in Alzheimer's disease.

Depression is very common in patients with dementia but the relationship is very complex. Depression is regarded as a cause of excess disability in persons with dementia and contributes to their functional decline. The assessment of depression in dementia patients, however, has been difficult in that the validity of self-reported depression in patients with dementia has been questioned. This study was done to investigate whether self-reported depression by persons with dementia (using the GDS) is related to their functional abilities as rated by a family caregiver (using the IADL scale) above and beyond demographic variables. This study was conducted at the Detroit Satellite of the Michigan Alzheimer's Disease Research Center. There were 141 participants, 67% were African American and 33% were European American. Statistical analyses included a correlational and multiple regression approach to determine the predictive relationships of cognitive and depressive symptoms above and beyond the influence of demographic variables and cognition. The results of the study further support the notion that depression in dementia is significantly related to functional decline but, more importantly, that self-reported depression in patients with dementia can be valuable information in understanding patients' functioning.     

Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan

BACKGROUND: Cognitive impairment and depressive symptoms impose a heavy burden on the care of the elderly in Japan and Korea, two of the fastest aging nations in Asia. The purpose of this study was to examine and compare factors associated with cognitive impairment and depressive symptoms among older persons in the two countries. METHODS: In 2002, representative samples of community-dwelling people aged 65 and older were selected among residents in Anyang, Korea and Yoita, Japan. Mini-Mental State Examination and Geriatric Depression Scale were used to assess the elderly's mental status. Sociodemographics, physical function, chronic conditions, social support, and health behaviors were examined to identify significant associations. RESULTS: The prevalence of cognitive impairment in older adults was 17.0% in Anyang and 14.6% in Yoita. The rates for depressive symptoms were 15.2% and 19.8%, respectively. Overall, functional capacity was the universal factor significantly associated with mental conditions. Self-rated health and social support were also found to be independently associated with depressive symptoms in the study subjects. Differences in the patterns of association by community, however, were notable for other characteristics. For example, in factors associated with cognitive impairment, sociodemographic factors such as age, gender, and education were significant among Koreans, whereas socio-behavioral factors such as obesity, social support and hospitalization experience were found to be significant for older Japanese residents. CONCLUSIONS: Similarities in the patterns of association indicate the need for joint explorations into the role these factors play in affecting the mental health of older persons. Socioeconomic and regional differentials, however, may account for the disparity in the associations observed, suggesting the importance of developing mental health programs sensitive to the older individual's culture.