Depressive Symptoms and Cognitive Decline in Community‐Dwelling Older Adults

OBJECTIVES: To examine the temporal association between depressive symptoms and cognitive functioning and estimate the effect measure modification of the apolipoprotein E (APOE) ?4 allele on this relationship. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Population‐based sample of 598 cognitively intact older adults aged 60 and older, with re‐assessments after 3 (N=479) and 6 years (N=412). MEASUREMENTS: Depressive symptoms (Symptom Checklist) and neurocognitive functioning (memory, Visual Verbal Learning Test; attention, Stroop Color–Word Test; processing speed, Letter Digit Substitution Test; general cognition, Mini‐Mental State Examination). Longitudinal associations were assessed using linear mixed models. The risk for cognitive impairment, no dementia (CIND) was examined using logistic regression. RESULTS: Adjusting for age, sex, education, and baseline cognition, the rate of change in memory z‐scores was 0.00, ?0.11, ?0.20, and ?0.37 for those in the lowest (reference group), second, third, and highest depressive symptom quartiles at baseline, respectively (P<.001 for highest vs lowest quartile). The odds ratios for developing CIND with amnestic features were 1.00, 0.87, 0.69, and 2.98 for the four severity groups (P=.05 for highest vs lowest quartile). Associations were strongest for those with persistent depressive symptoms, defined as high depressive symptoms at baseline and at least one follow‐up visit. Results were similar for processing speed and global cognitive function but were not as strong for attention. No APOE interaction was observed. CONCLUSION: Depression and APOE act independently to increase the risk for cognitive decline and may provide targets for prevention and early treatment.     

Prevalence and Correlates of Nocturia in Community‐Dwelling Older Adults

OBJECTIVES: To determine the prevalence and correlates of nocturia in community‐dwelling older adults. DESIGN: Planned secondary analysis of cross‐sectional data from the University of Alabama at Birmingham Study of Aging population‐based survey. SETTING: Participants' homes. PARTICIPANTS: One thousand older adults (aged 65–106) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% each African‐American women, African‐American men, white women, and white men. MEASUREMENTS: In‐person interviews included sociodemographic information, medical history, Mini‐Mental State Examination (MMSE) score, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as rising two or more times per night to void. RESULTS: Nocturia was more common in men than women (63.2% vs 53.8%, odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15–1.91, P=.003) and more common in African Americans than whites (66.3% vs 50.9%, OR=1.89, 95% CI=1.46–2.45, P<.001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African‐American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m²). Higher MMSE score was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African‐American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). CONCLUSION: Nocturia in community‐dwelling older adults is a common symptom associated with male sex, African‐American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia.     

Serum Parathyroid Hormone Levels Predict Falls in Older Adults with Diabetes Mellitus

OBJECTIVES: To examine the association between serum parathyroid hormone (PTH) levels and incident falls in older adults with diabetes mellitus. DESIGN: Longitudinal analysis of incident falls over 1 year in a substudy of participants with diabetes mellitus in the Health, Aging and Body Composition Study. SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Well‐functioning, community‐dwelling black and white adults aged 70 to 79 with diabetes mellitus (N=472). MEASUREMENTS: Measured baseline serum PTH. Self‐report of falls over the subsequent 12 months. Baseline physical performance and self‐reported demographic, behavioral, and health status measures including kidney function, chronic conditions, and medication use. RESULTS: One‐third (30.3%) of participants reported falling over 1 year of follow‐up. Mean baseline serum PTH was 53.5±30.0 pg/mL in nonfallers and 62.6±46.2 pg/mL in fallers (P=.01). For every 1 standard deviation (36 pg/mL) increment in baseline serum PTH, there was approximately a 30% greater likelihood of reporting a fall in the subsequent year, after adjusting for age, sex, race, field center, alcohol consumption, body mass index, physical activity, and winter or spring season (adjusted odds ratio (aOR)=1.30, 95% confidence interval (CI)=1.06–1.59). Further adjustment for kidney function, chronic conditions, medication and supplement use, and physical performance attenuated the association slightly (aOR=1.26, 95% CI=1.01–1.58). A trend remained after additional adjustment for reported falls in the previous year. CONCLUSION: Higher serum PTH was associated with incident falls in older, well‐functioning men and women with diabetes mellitus. Further investigation aimed at understanding the underlying mechanism for the association between serum PTH and falls is needed.