Role of functional performance in diagnosis of dementia in elderly people with low educational level living in Southern Italy

BACKGROUND AND AIMS: Diagnosis of dementia is often difficult in subjects with low educational level. Our aim was to evaluate the role of functional performance and the possibility of preferring scores of activities of daily living (ADL) and instrumental activities of daily living (IADL) in screening elderly people for diagnosis of dementia in a rural population of Southern Italy with a very high percentage of non-educated subjects. METHODS: a random sample of 300 residents, out of 1089 subjects over 60 years of age living in San Marcellino (Caserta, Campania), received door-to-door visit for information about their medical history, with clinical evaluation of general geriatric conditions, including the cumulative illness rating scale (CIRS). Dementia was diagnosed if subjects had a Clinical Dementia Rating score (CDR) > or = 1 and according to the criteria of DSMIV, but not according to scores on the Mini Mental State Examination (MMSE), ADL and IADL. Two hundred and nineteen normal subjects (NS) and 75 patients with dementia (DP) were evaluated. RESULTS: in NS, their mean age- and education-corrected MMSE score was 22.15 (lower than the normal cut-off value of 23.8) and 12.60 in DP (p<0.0001). In NS, the mean ADL score was higher than in DP (5.53 vs 2.64, p<0.0001); only age was correlated with ADL scores (coeff=-0.44, t=-4.557, p<0.0001). Assuming age as covariate, ADL scores highly differentiated DP from NS (F(1, 289)=26.083, p<0.0001). In both sexes, mean IADL scores were higher in NS than in DP (4.46 vs 1.80 in men, p<0.0001; 6.85 vs 2.31 in women, p<0.0001). Age and education did not influence IADL scores in men, but age greatly affected performance in women. IADL scores clearly differentiated NS from DP. In NS, a positive correlation was evident between ADL and IADL scores (r=0.234, p<0.0005), but neither scores correlated with the MMSE scores, even when correlation was performed separately for men and women. In DP, a strong correlation was observed between ADL and IADL scores (r=0.709, p<0.0001) and significant correlations were also evident between the scores of MMSE and both ADL (r=0.492,p<0.0001) and IADL (r=0.398, p<0.0004). CONCLUSIONS: in a rural community with a high prevalence of non-educated subjects, cognitive impairment is related to education, whereas independent functioning is limited mainly to age and not to cognition, if the latter remains (relatively) unimpaired. These results point to the importance of an "ecological" approach to the evaluation of elderly people, particularly those living in small rural communities, where education and the social environment may give rise to difficulties in diagnosis of dementia. The assessment of functional autonomy by ADL and IADL scales may be a better screening tool in diagnosing dementia than the MMSE scores.     

Resting heart rates in an ambulatory elderly population: an evaluation of age, sex, symptoms, and medication

In a cross-sectional analysis of 2,301 ambulatory elderly subjects, the mean resting heart rate for women (66.2/min) was significantly higher than for men (63.6/min), p less than 0.0001, and heart rate was positively correlated with age for both men and women. Resting heart rate was positively correlated with the number of drugs used (p less than 0.05), number of symptoms reported (p less than 0.05), systolic (p less than 0.01), and diastolic (p less than 0.0001) blood pressure. Of 975 participants who were followed longitudinally over an 8-year period there was a significant decrease in resting heart rate of approximately 2.75/min, p less than 0.0001.     

Risk factors for coronary artery disease in persons older than 62 years in a long-term health care facility

A history of smoking 5 to 60 cigarettes per day, hypercholesterolemia (fasting total serum cholesterol 200 mg/dl or more), history of systolic (160 mm Hg or more) or diastolic (90 mm Hg or more) hypertension, diabetes mellitus (fasting venous plasma glucose 140 mg/dl or more) and obesity (at least 20% above ideal body weight) were correlated with coronary artery disease (CAD) in 138 men (mean age 82 +/- 8 years) and 380 women (mean age 82 +/- 8 years) in a long-term health care facility. CAD occurred in 43 of 138 men (31%) and in 103 of 380 women (27%), difference not significant. A history of smoking 5 to 60 cigarettes per day significantly correlated with CAD in men (p less than 0.001) but not in women. Hypercholesterolemia significantly correlated with CAD in both men (p less than 0.001) and women (p less than 0.005). A history of systemic hypertension significantly correlated with CAD in women (p less than 0.001) but not in men. Diabetes mellitus did not significantly correlate with CAD in men or women but weakly correlated with CAD in men plus women (p less than 0.05). Obesity did not significantly correlate with CAD in men or women. Hypercholesterolemia, a history of smoking 5 to 60 cigarettes per day, and a history of systemic hypertension were considered major risk factors. Having 2 or 3 major risk factors correlated with CAD significantly better than having no or 1 major risk factor in both elderly men (p less than 0.001, p less than 0.01) and women (p less than 0.001).     

Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients with deconditioning

We sought to determine if admission Norton scale scores (ANSS) used for evaluating pressure ulcer risk also correlate with rehabilitation outcome and length in elderly patients with deconditioning. This was a retrospective study conducted in a geriatric department between June 2008 and June 2010. The medical charts of consecutive elderly (≥65 years) patients admitted for rehabilitation due to deconditioning were studied for the following measurements: ANSS, admission albumin serum levels, mini-mental status examination (MMSE) scores, discharge walking functional independence measure (FIM) scores, discharge transfer FIM scores, and rehabilitation length. The cohort included 152 patients: 79 (52%) females and 73 (48%) males. Mean age was 83.6±6.5 years. The three most common causes of deconditioning were pneumonia, congestive heart failure exacerbation, and falls. ANSS correlated with discharge walking FIM scores (r=0.32; p=0.003), discharge transfer FIM scores (r=0.30; p=0.005), and length of rehabilitation (r=-0.37; p<0.0001), following adjustment for age, albumin serum levels, and MMSE scores. Linear regression analysis showed that ANSS were independently associated with discharge walking FIM scores (p=0.004), discharge transfer FIM scores (p=0.006), and rehabilitation length (p<0.0001). We conclude that the Norton scoring system may be used for predicting the outcome and the length of rehabilitation in elderly patients with deconditioning.     

Correlates of Constipation in an Ambulatory Elderly Population

Constipation is a common and often perplexing problem for elderly people. The prevalence of self-reported constipation and factors associated with constipation were investigated in 3,166 people over age 65. Twenty-six percent of women and 15.8% of men reported recurrent constipation (p less than 0.0001). There was a significant increase in reported constipation with increasing age (p less than 0.0001). Multiple factors were found to correlate with self-reported constipation. A logistic regression model revealed 13 factors of significance in predicting constipation. The most important factors were age, sex, total number of drugs taken, pain in the abdomen, and hemorrhoids (p less than 0.0001). Specific drugs do not appear to be important factors in constipation in the elderly. Elderly people who report the use of multiple drugs, pain in the abdomen, and hemorrhoids are at increased risk for constipation.     

A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire.

A need was identified for a fixed-format self-complete questionnaire for measuring health in chronic airflow limitation. A 76-item questionnaire was developed, the St. George's Respiratory Questionnaire (SGRQ). Three component scores were calculated: symptoms, activity, and impacts (on daily life), and a total score. Three studies were performed. (1) Repeatability was tested over 2 wk in 40 stable asthmatic patients and 20 patients with stable COPD. The coefficient of variation for the SGRQ total score was 19%. (2) SGRQ scores were compared with spirometry, 6-min walking distance (6-MWD), MRC respiratory symptoms questionnaire, anxiety, depression, and general health measured using the Sickness Impact Profile score. A total of 141 patients were studied, mean age 63 yr (range 31 to 75) and prebronchodilator FEV1, 47% (range 11 to 114%). SGRQ scores correlated with appropriate comparison measures. For example, symptom score versus frequency of wheeze, r2 = 0.32, p less than 0.0001; activity versus 6-MWD, r2 = 0.50, p less than 0.0001; impact versus anxiety, r2 = 0.38, p less than 0.0001. Multivariate analysis demonstrated that SGRQ scores summed a number of areas of disease activity. (3) Changes in SGRQ scores and other measures were studied over 1 yr in 133 patients. Significant correlations were found between changes in SGRQ scores and the comparison measures (minimum r2 greater than 0.05, p less than 0.01). Multivariate analysis showed that change in total SGRQ score summed changes in a number of aspects of disease activity. We conclude that the SGRQ is a valid measure of impaired health in diseases of chronic airflow limitation that is repeatable and sensitive.     

Lack of association of nonsteroidal anti-inflammatory drug use and cognitive decline in the elderly.

Folstein Mini-Mental State Examination (MMSE) scores obtained in an ambulatory elderly population were used to examine the effect of nonsteroidal anti-inflammatory drug (NSAID) use on cognitive performance. There were 1,310 participants who met the inclusion criteria for the study, of whom 873 (66.6%) were women and 437 (33.3%) were men. There were no differences in mean MMSE scores or in the five dimensions of cognitive function measured by the MMSE for subjects reporting NSAIDs or aspirin use.     

Comparison of prognostic usefulness of coronary artery calcium in men versus women (results from a meta- and pooled analysis estimating all-cause mortality and coronary heart disease death or myocardial infarction)

Women with coronary heart disease (CHD) have higher mortality compared with men. Atherosclerotic imaging risk markers are associated with higher mortality and relative risk of CHD events in women compared with men. However, data on the predictive accuracy of coronary artery calcium (CAC) in women are scarce. We performed a systematic review of the published literature from 2003 to 2006 on the prognostic value of CAC in women and men. Two investigators reviewed Medline for prospective registries on annual rates of CHD death or myocardial infarction (MI) by CAC results. Three studies in 6,481 women and 13,697 men reported results by gender. We also analyzed 2 observational registries for annual all-cause death rates by CAC scores in women (n = 17,779) and men (n = 17,850). Summary relative risk ratios and 95% confidence intervals were calculated using a random effects model. For all-cause mortality, rates were 0.1% to 1.6% per year for women and 0.1% to 2.6% for men with CAC scores from 0 to 10 to > or =1,000, respectively (p <0.0001). For CHD death or MI, annual rates were 0.2% to 1.3% in women and 0.3% to 2.4% for men with low- to high-risk CAC scores. For women with a CAC score of 0, annual CHD death or MI rates were 0.16%, similar to that of men (p = 0.55). Summary relative risk ratios increased 4.9-fold (p = 0.006), 5.5-fold (p = 0.002), and 8.7-fold (p <0.0001) for mild-, moderate-, and high-risk CAC scores, respectively. A comparative analysis of gender differences showed no significant differences between women and men for mild- to high-risk CAC scores (p = 0.66), suggesting an equivalent ability to risk stratify by gender. In conclusion, this meta- and pooled analysis revealed that CAC screening is equally accurate in stratifying risk in women and men.     

Differences in the Course of Alcohol Withdrawal in Women and Men: A Polish Sample

A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in women and men hospitalized in the Nowowiejski Hospital in Warsaw from 1973 to 1987. Medical records pertaining to 1179 patients were analyzed; 13.8% of these patients were women and 86.2% were men. The study showed that women began intensive alcohol drinking later than men ( p < 0.0001), but the period between the onset of alcohol abuse and the first occurrence of alcohol withdrawal was shorter in women than in men ( p < 0.0001). In the period of heavy drinking before hospitalization, women consumed significantly less alcohol then men ( p < 0.0001); moreover, women drank nonbeverage alcohol less frequently than men ( p < 0.05). Women were hospitalized substantially longer than men ( p < 0.0001), whereas the duration of alcohol withdrawal symptoms at the time of hospitalization was comparable in both groups. Withdrawal seizures were significantly more frequent among men than among women ( p < 0.001). Significant differences in the patients'somatic conditions were not noted between the groups, with the exception of anemia and decreased potassium concentration, which were more frequently observed in women (both p < 0.0001), and of increased concentration of ALT and hypoproteinemia, which were more frequent in men (respectively, p < 0.05 and p < 0.01). Co-existing personality disorders, depressive disorders, and anxiety disorders—as well as abuse of benzodiazepines and barbiturates—were more frequently observed in women ( p < 0.0001). The period between the first hospitalization due to alcohol withdrawal and the time of death was significantly shorter in men than in women ( p < 0.05). The results point to differences in the conditions and the course of alcohol dependence and alcohol withdrawal between women and men.     

Nightmares, sleep and cardiac symptoms in the elderly

BACKGROUND: Sleep complaints and various sleep symptoms are common in elderly persons with cardiac diseases. Nightmares are associated with profound sleep disturbances. METHODS: The present questionnaire survey with questions on sleep symptoms, nightmares and cardiac symptoms comprised 6103 elderly subjects (39.5% men). RESULTS: Nightmares occurred rather often in 6.9% and very often in 2.1% of the men. The corresponding frequencies in women were 9.6 and 2.3%, respectively. Irregular heart beats were reported by 11.8% of the men and 131% of the women (NS). Spasmodic chest pain occurred in 12.9 and 10.6%, respectively (p < 0.01). Irregular heart beats increased in association with increasing nightmares in both men (p < 0.01) and women (p < 0.0001). The percentages of men and women with both irregular heart beats and spasmodic chest pain were three times and seven times higher, respectively, among those who had nightmares very often than among those who very seldom or never had nightmares. The increase in cardiac symptoms in nightmare sufferers was not attributable to an increase in medication with cardiac drugs. CONCLUSION: In this group of elderly men and women increased nightmares were associated with an increase in irregular heart beats and spasmodic chest pain.     

Epidemiology of intermittent claudication: evaluation of risk factors

Information from a geriatric health screening programme (Dunedin Program) was used to study the prevalence and risk factors predisposing to intermittent claudication (IC) in 1704 ambulatory elderly subjects. Risk factors studied included reported symptoms and diseases, mediation use, haematological and biochemical findings. The prevalence of IC reported by Dunedin participants was 14.1% for women and 14.4% for men. There was a positive relationship between IC and the number of other diseases and symptoms reported (P less than 0.0001). Serum glucose, cholesterol, and triglycerides were significantly higher in subjects reporting IC. Systolic blood pressure was higher in men and women reporting IC, but no significant relationship was observed with diastolic blood pressure.     

Risk factors for atherothrombotic brain infarction in persons over 62 years of age in a long-term health care facility

A history of systolic (greater than or equal to 160 mm Hg) or diastolic (greater than or equal to 90 mm Hg) hypertension, diabetes mellitus (fasting venous plasma glucose greater than or equal to 140 mg/dl), a history of cigarette smoking, fasting serum total cholesterol greater than or equal to 200 mg/dl and greater than or equal to 250 mg/dl, and obesity (greater than or equal to 20% above ideal body weight) were examined as risk factors for atherothrombotic brain infarction (ABI) in 144 men, mean age 81 +/- 8 years, and 391 women, mean age 82 +/- 8 years, in a long-term health care facility. ABI occurred in 33 of 144 men (23%) and in 68 of 391 women (17%), P not significant. A history of systolic or diastolic hypertension correlated with ABI in both men and women (P less than 0.001). Diabetes mellitus correlated with ABI in both men and women (P less than 0.001). A history of cigarette smoking correlated with ABI in men (P less than 0.02) but not in women. Serum total cholesterol greater than or equal to 200 mg/dl and greater than or equal to 250 mg/dl did not significantly correlate with ABI in men or in women. Obesity did not significantly correlate with ABI in men or in women. Systolic or diastolic hypertension, diabetes mellitus, and cigarette smoking are risk factors for ABI in elderly men. Systolic or diastolic hypertension and diabetes mellitus are risk factors for ABI in elderly women.     

Prevalence of conventional risk factors in Jordanians with coronary heart disease: the Jordan Hyperlipidemia and Related Targets Study (JoHARTS)

BACKGROUND: The prevalence of the major conventional cardiovascular risk factors - cigarette smoking, diabetes mellitus, hypertension, and dyslipidemia - among coronary heart disease (CHD) patients in the Middle East has not been studied extensively. METHODS AND RESULTS: The Jordan Hyperlipidemia And Related Targets Study (JoHARTS) evaluated the prevalence of the 4 conventional risk factors in 5000 individuals including 1692 (34%) women. CHD was present in 1534 (31%) individuals (1202 men and 332 women). Among CHD patients, at least one risk factor was present in the majority of men (95%) and women (96%). Compared with women who had CHD, men had significantly higher prevalence of smoking (45% vs. 11%, p < 0.0001) and low levels of high-density lipoprotein cholesterol (60% vs. 39%, p < 0.0001), and lower prevalence of diabetes (40% vs. 64%, p < 0.0001), hypertension (38% vs. 63%, p < 0.0001), and hypercholesterolemia (19% vs. 27%, p = 0.003). Diabetes was more prevalent among men and women with CHD than men and women without CHD (40% vs. 18% for men, and 64% vs. 24% for women p < 0.0001). Similarly, smoking was more prevalent in men and women with CHD than those without CHD (45% vs. 32% for men, and 11% vs. 7%, p < 0.0001). Low levels of high-density lipoprotein cholesterol were also more prevalent in men with CHD than those without CHD (60% vs. 51%, p < 0.001) and among women with CHD than those without CHD (39% vs. 24%, p = 0.0001). Prevalence rates of hypertension, hypercholesterolemia, and hypertriglyceridemia were not different among individuals with or without CHD. CONCLUSION: These results further challenge claims that patients with CHD commonly lack conventional risk factors. The great majority (>95%) of CHD patients studied have at least one risk factor. Detection, evaluation and management of these factors are essential steps to control CHD in the region.     

Rehabilitation outcome of hip fracture patients: the importance of a positive albumin gain

Low serum albumin level is associated with poor functional outcome and predicting a greater functional decline in the elderly. The aim of this study is to determine the interrelation between change of serum albumin level during rehabilitation period and functional outcome in hip fracture patients. We studied 433 consecutive elderly hip fracture patients admitted for rehabilitation. Functional outcome was assessed by the Functional Independence Measure (FIM) at admission and discharge of patients with no albumin gain (<0 g/dl) or with positive albumin gain (>or=0 g/dl). Data were analyzed by t-test, Pearson correlation, chi(2)-test and linear regression. Of patients 66.7% showed no albumin gain. These patients had a higher prevalence of previous stroke (p=0.04), lower Mini Mental State Examination (MMSE) scores (p=0.05) and were less likely to have hyperlipidemia (p=0.008) compared with patients with albumin gains. Admission and discharge FIM parameters and total and motor FIM gain/day were statistically significantly lower among patients with no albumin gain. In a linear regression analysis total FIM at discharge was inversely associated with pre-fracture function (beta=-0.148; p<0.001), Albumin gain (beta=0.047; p=0.005), high MMSE score (beta=0.143; p<0.001), and higher admission total FIM score (beta=0.69; p<0.001) emerged as significant predictors of higher total FIM scores upon discharge. The results suggest that patients with albumin gain have better admission and discharge FIM scores. Albumin gain emerged as a significant predictor for higher discharge FIM scores. We conclude that greater attention and efforts should be made regarding the dietary intervention and protein supplementation, in order to improve the rehabilitation outcome.     

天津市蓟县农村老年人尿失禁与慢性疾病及女性分娩史的关系

目的 了解天津市蓟县农村老年人尿失禁的患病情况和老年人尿失禁与慢性疾病及女性分娩史的关系. 方法 采用整群抽样的方法抽取天津市蓟县所辖的两个乡(镇)卫生院60岁及以上老年人743名,按统一设计的调查问卷,以面对面询问的方式进行入户调查,通过单因素和多因素分析,探讨农村老年人尿失禁与慢性疾病及女性分娩史的关系. 结果 天津市蓟县农村老年人尿失禁患病率为33.4%(248例),女性患病率高于男性(43.2%与22.8%,χ~2=34.70,P<0.0001).多因素Logistic回归分析结果显示,患呼吸系统、前列腺、神经系统、运动系统疾病的老年男性患者尿失禁风险比未患者高,其中患前列腺疾病和神经系统疾病的老年男性患尿失禁风险最高(OR值分别为11.47、11.76).老年女性中,便秘的老年人比无便秘者患尿失禁风险高(OR=1.46),患呼吸系统和运动系统疾病及糖尿病的老年女性患尿失禁风险比未患者高,其中患呼吸系统疾病的老年女性患尿失禁风险最高(OR=4.84);围产期孕次、产次越多患尿失禁风险越高(OR=1.03、1.02);分娩过程中会阴裂伤、伤口感染患尿失禁风险高(OR=1.72、1.65). 结论 天津市蓟县农村老年人尿失禁患病率较高,老年人尿失禁的发生与多种慢性疾病有关,同时女性分娩史也影响老年人尿失禁的发生.     

Levels of selected cardiovascular risk factors in a sample of geriatric participants--the Dunedin Program

A sample of 310 white, ambulatory elderly adults (n = 116 men, n = 194 women, ages 65 to 99 years) from the Dunedin Program in Florida were examined for serum total and lipoprotein cholesterols, weight, and blood pressure. Women had higher age-adjusted mean levels of total cholesterol (p less than .0001), low density lipoprotein cholesterol (p less than .0001), high density lipoprotein cholesterol (p less than .0005), and weight/height (p less than .0001). Systolic blood pressure increased with age in both sexes, but the trend rose more sharply in women (p less than .0001). Both systolic (p less than .05) and diastolic (p less than .025) blood pressure increased with obesity in women but were unrelated to obesity in men. Approximately 70% (218) of the sample had elevated levels of at least one risk factor. This included 12% (38) having elevated levels of two risk factors and 1% (3) with three. The distribution of risk factors for coronary heart disease in this sample indicates a homogeneous population derived through selective survival remains by age 70 years. These results emphasize the need for additional investigations of genetic and environmental variables promoting longevity.     

Cardiovascular disease and cognitive performance in middle-aged and elderly men

BACKGROUND: Decline of cognitive function with age may be due, in part, to atherosclerotic changes. The aim of the present study was to determine the relative contribution of cardiovascular disease (CVD) to cognitive functioning in middle-aged and elderly men. METHODS: In a cross-sectional study, cognitive tests were administered to 400 independently living men aged 40-80 years. Compound scores were calculated for memory function, processing capacity/speed, and executive function. The MMSE was used as a measure of global cognitive function. Carotid intima-media thickness, pulse wave velocity and ankle brachial blood pressure index were assessed as measures of sub-clinical CVD. The adjusted association of sub-clinical and prevalent CVD with neuropsychological test scores in the total group and in subgroups was assessed by linear regression analysis. RESULTS: Increased IMT was associated with lower scores on memory performance, and increased PWV was associated with lower scores on processing capacity and executive functioning. Compared with subjects with no CVD, both sub-clinical and prevalent cardiovascular diseases were related to a lower memory performance, beta's (95% CI) were -0.45 (-0.83, -0.07) and -0.45 (-0.84, 0.01), respectively. These associations were present in both middle-aged and elderly men. Furthermore, we observed that for subjects who had sub-clinical or prevalent cardiovascular disease the distribution of MMSE-scores was shifted toward lower values; the distributions were statistically different (p=0.003). CONCLUSIONS: The results of this study support a relation of sub-clinical CVD with cognitive functioning in middle-aged and elderly men. These results suggest that actions to prevent cognitive decline by preventing atherosclerosis should be taken before middle age.     

Comparison of the clinical profile and outcome of women and men in cardiac rehabilitation.

Few data are available regarding the outcome of women in cardiac rehabilitation. To determine whether women differ from men in clinical profile and outcome, 225 consecutive patients were prospectively evaluated in an urban, multidisciplinary, exercise-based cardiac rehabilitation program. Among the 51 women (age 56 +/- 10) and 174 men (age 54 +/- 10), most were: white (84%), married (64%), employed (63%), had had myocardial infarction or revascularization, or both (66%), and traveled less than 10 miles to the program (92%). Risk profiles revealed obesity in 48% (mean Metropolitan Relative Weight = 124 +/- 22%), hypertension in 47%, smoking in 23%, diabetes in 16%, and mean cholesterol of 236 +/- 45 mg/dl. Compared with men, more women were nonwhite, unemployed, unmarried, hypertensive or diabetic (p less than 0.0001) and had higher cholesterol (p less than 0.01). Compliance rates were similar for women (51%) and men (63%) (p = not significant). Univariate predictors of program noncompliance differed between women and men. Initial exercise capacity was less for women than for men, but both groups achieved a similar training effect. Women increased their exercise time by 31% and peak METs by 30%, whereas men showed a 21% increase in exercise time and 16% increase in peak METs achieved (p less than 0.001). Thus, in this cardiac rehabilitation program, women have a less favorable risk factor profile and differ from men with regard to baseline demographics and predictors of program completion. Women, however, have similar rates of compliance and achieve the same improvement in functional capacity with training.     

Screening cognition in the elderly with metabolic syndrome

Abstract Background: Metabolic syndrome reaches its highest prevalence in the elderly, and evidence suggests that metabolic syndrome could be an independent risk factor for cognitive impairment. The aims of this study were to detect whether patients with metabolic syndrome have lower cognition and to investigate whether there is a relationship with cognition and single metabolic syndrome components. Methods: We assessed fasting blood glucose (FBG), high-density lipoprotein cholesterol (HDL-C), triglycerides, high-sensitivity C-reactive protein (hsCRP), and anthropometric measurements. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. The population sample was divided into two groups according to the presence of metabolic syndrome. Cognitive function was investigated through the Mini-Mental State Examination (MMSE). Results: We enrolled 159 elderly subjects (mean age, 69.8±4.8 years). Seventy had metabolic syndrome. Metabolic syndrome subjects had higher hsCRP values (P<0.0001) and lower MMSE scores (P<0.0001) than those without metabolic syndrome. MMSE scores were significantly correlated with body mass index (BMI), hsCRP, metabolic syndrome, the number of metabolic syndrome components, and each of them. However, at multivariate regression analysis, only fasting blood glucose [FBG; B=-0.046; 95% confidence interval (CI) -0.066 to -0.028; P<0.0001] and the number of metabolic syndrome components (B=-0.317; 95% CI -0.572 to -0.010; P=0.042) were found to be independent predictors of lower MMSE scores. Conclusion: We found that subjects with metabolic syndrome have lower MMSE scores than those without, even without symptomatic cognitive impairment, and that the number of metabolic abnormalities is independently associated to lower MMSE scores. We suggest that these patients should always undergo cognitive screening to prevent more severe outcomes.     

Subject Index to Volume 25

We assessed whether subitem scores on the Mini-Mental State Examination (MMSE) associated independently with cerebral white matter hyperintensity (WMH) and lacunar infarction (LI). Magnetic resonance imaging (MRI) and neuropsychological evaluation (MMSE) were performed in 1008 elderly individuals from the Ohasama Study (348 men, 660 women [65.5%]; age 68.0 ± 6.0 [mean ± SD] years; MMSE score, 26.5 ± 2.9). The relationships between MRI findings and MMSE subitem scores were analyzed by logistic regression. Significant associations were observed between the MMSE subitems “Orientation to place” and WMH, and “Copy a figure” and LI. Pathological changes were detected by brain MRI associated with a decrease in cognitive function in healthy elderly individuals.