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1.
Yue-Bin Lv Peng-Fei Zhu Zhao-Xue Yin Virginia Byers Kraus Diane Threapleton Choy-Lye Chei Melanie Sereny Brasher Juan Zhang Han-Zhu Qian Chen Mao David Bruce Matchar Jie-Si Luo Yi Zeng Xiao-Ming Shi 《Journal of the American Medical Directors Association》2017,18(2):193.e7-193.e13
Objectives
Higher or lower blood pressure may relate to cognitive impairment, whereas the relationship between blood pressure and cognitive impairment among the elderly is not well-studied. The study objective was to determine whether blood pressure is associated with cognitive impairment in the elderly, and, if so, to accurately describe the association.Design
Cross-sectional data from the sixth wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2011.Setting
Community-based setting in longevity areas in China.Participants
A total of 7144 Chinese elderly aged 65 years and older were included in the sample.Measures
Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured, pulse pressure (PP) was calculated as (SBP) ? (DBP) and mean arterial pressures (MAP) was calculated as 1/3(SBP) + 2/3(DBP). Cognitive function was assessed via a validated Mini-Mental State Examination (MMSE).Results
Based on the results of generalized additive models (GAMs), U-shaped associations were identified between cognitive impairment and SBP, DBP, PP, and MAP. The cutpoints at which risk for cognitive impairment (MMSE <24) was minimized were determined by quadratic models as 141 mm Hg, 85 mm Hg, 62 mm Hg, and 103 mm Hg, respectively. In the logistic models, U-shaped associations remained for SBP, DBP, and MAP but not PP. Below the identified cutpoints, each 1-mm Hg decrease in blood pressure corresponded to 0.7%, 1.1%, and 1.1% greater risk in the risk of cognitive impairment, respectively. Above the cutpoints, each 1-mm Hg increase in blood pressure corresponded to 1.2%, 1.8%, and 2.1% greater risk of cognitive impairment for SBP, DBP, and MAP, respectively.Conclusion
A U-shaped association between blood pressure and cognitive function in an elderly Chinese population was found. Recognition of these instances is important in identifying the high-risk population for cognitive impairment and to individualize blood pressure management for cognitive impairment prevention. 相似文献2.
Paul D. Loprinzi Megan M. Danzl Elizabeth Ulanowski Calli Paydo 《Disability and health journal》2018,11(1):165-168
Background
Few studies have examined the association between daily physical activity and cognitive function among older adults with Parkinson's disease (PD).Objective
Here we evaluate the association between accelerometer-assessed physical activity and cognition among older patients with PD.Methods
Cognition assessed via the Montreal Cognitive Assessment (MoCA). Moderate-to-vigorous physical activity (MVPA) was assessed via accelerometry over a 1–2 week monitoring period.Results
After adjusting for motor impairment severity, for every 1 min/day increase in MVPA, participants had a 0.09 unit increase in MoCA-determined cognitive function (β = 0.09; 95% CI: ?0.003–0.19; P = 0.05). When further adjusting for motor impairment, age and gender, results were unchanged (β = 0.09; 95% CI: 0.004–0.19; P = 0.04).Conclusion
The present study provides suggestive evidence of a favorable association between daily physical activity behavior and cognitive function among adults with PD. 相似文献3.
Kazuki Uemura Takehiko Doi Sungchul Lee Hiroyuki Shimada 《Journal of the American Medical Directors Association》2019,20(1):90-93
Objectives
This study aimed to investigate the additive effects of sarcopenia and low serum albumin level on the risk of incident disability in older adults.Design
Prospective cohort study.Setting
A Japanese community.Participants
Community-dwelling older adults aged ≥65 years, without disability at baseline (N = 4452).Measures
Sarcopenia was defined as the presence of both poor muscle function (low physical performance or muscle strength) and low muscle mass. Low serum albumin level was defined as ≤4.0 g/dL. Other potential confounding factors (demographics, medical history, depressive symptoms, and cognitive function) were also assessed. Incident disability was monitored based on Long-Term Care Insurance certification during follow-up.Results
The median follow-up duration was 30 (interquartile range, 28-32) months. Participants were classified into mutually exclusive groups based on sarcopenia status and serum albumin levels: nonsarcopenia/normal serum albumin (n = 3719), low serum albumin alone (n = 552), sarcopenia alone (n = 132), and sarcopenia/low serum albumin (n = 49). A Cox hazards regression showed that the low serum albumin alone [hazard ratios (HR) = 1.71, 95% confidence interval (CI) = 1.26-2.33], sarcopenia alone (HR = 2.74, 95% CI = 1.58-4.77), and sarcopenia/low serum albumin groups (HR = 3.73, 95% CI = 1.87-7.44) had higher risk of disability than the nonsarcopenia/normal serum albumin group after adjusting for the covariates.Conclusions/Implications
Sarcopenia and low serum albumin level synergistically increase the risk of incident disability in older adults. Sarcopenia in older adults at risk of malnutrition should be detected early, and appropriate interventions should be implemented. 相似文献4.
Geeske Peeters Siobhan Leahy Sean Kennelly Rose Anne Kenny 《Journal of the American Medical Directors Association》2018,19(3):248-254.e3
Background
Fear of falling (FoF) is present in 20% to 85% of older adults and may be an early marker of decline in global cognitive functioning (GCF). We tested the hypothesis that FoF is associated with lower levels of GCF (cross-sectional) and greater decline in GCF (prospective) in adults aged 50 and older.Design
Observational cohort study.Setting
The Irish Longitudinal Study on Ageing, a population-based study.Participants
Data were from 4931 participants (mean age 62.9 ± 9.1, range 50–98, 54.3% female).Measurements
FoF was based on self-report in 2010. GCF was measured with the Montreal Cognitive Assessment (MoCA) and Mini Mental Status Examination (MMSE) in 2010 and 2014. The cross-sectional association was examined using linear regression unadjusted and after adjustment for demographic and health factors. The prospective association between FoF and the odds of >1-SD decline in GCF were examined using logistic regression. Interaction with age and mediation by social and physical activities were examined.Results
In 2010, 21.9% of participants reported FoF. In the unadjusted cross-sectional models, those with FoF had lower scores on the MoCA (B ?1.15, 95% confidence interval [CI] ?1.40 to ?0.90) and MMSE (B ?0.52, CI ?0.67 to ?0.37). In the unadjusted prospective models, FoF was associated with a greater odds of decline in MoCA (odds ratio [OR] 1.60, CI 1.26–2.04) and MMSE (OR 1.64, CI 1.29–2.08). After adjustment for covariates, all associations attenuated and were no longer statistically significant, except the association with decline in MoCA (OR 1.32, CI 1.01–1.71). No statistically significant interaction with age was found (P > .37). Additional adjustment for social and physical activity did not change the results.Conclusions
The findings provide weak evidence for FoF as a predictor of cognitive decline. 相似文献5.
Flávia Silva Arbex Borim Tiago da Silva Alexandre Anita Liberalesso Neri Roberta de Oliveira Máximo Marcela Fernandes Silva Cesar de Oliveira 《Journal of the American Medical Directors Association》2019,20(1):47-52
Background and objective
There is little epidemiologic evidence considering the combined effect of dynapenia and low 25-hydroxyvitamin D [25 (OH) D] on incident disability. Our aim was to investigate whether the combination of dynapenia and low 25 (OH) D serum levels increases the risk of activities of daily living (ADL) incident disability.Design
Prospective cohort study.Settings
English Longitudinal Study of Aging.Participants
A total of 4630 community-dwelling adults aged 50 years and older without ADL disability at baseline.Measurements
The baseline sample was categorized into 4 groups (ie, nondynapenic/normal 25 (OH) D, low 25 (OH) D only, dynapenic only, and dynapenic/low 25 (OH) D according to their handgrip strength (<26 kg for men and <16 kg for women) and 25 (OH) D (≤50 nmol/L). The outcome was the presence of any ADL disability 2 years after baseline according to the modified Katz Index. Incidence rate ratios (IRRs) adjusted by sociodemographic, behavioral, and clinical characteristics were estimated using Poisson regression.Results
The fully adjusted model showed that older adults with dynapenia only and those with lower serum levels of 25 (OH) D combined with dynapenia had higher incident ADL disability risk compared with nondynapenic and those with normal serum levels of 25 (OH) D. The IRRs for lower 25 (OH) D serum levels combined with dynapenia were higher than for dynapenia only, however, the confidence intervals (CIs) showed similar effect for these 2 groups. The IRRs were 1.31 for low 25(OH) D only (95% CI 0.99–1.74), 1.77 for dynapenia only (95% CI 1.08–2.88), and 1.94 for combined dynapenia and low 25(OH)D (95% CI 1.28–2.94).Conclusions
Dynapenia only and dynapenia combined with low 25 (OH) D serum levels were important risk factors for ADL disability in middle-aged individuals and older adults in 2 years of follow-up. 相似文献6.
Tsukasa Kamitani Yosuke Yamamoto Shingo Fukuma Tatsuyoshi Ikenoue Miho Kimachi Sayaka Shimizu Shungo Yamamoto Koji Otani Miho Sekiguchi Yoshihiro Onishi Misa Takegami Rei Ono Shin Yamazaki Shinichi Konno Shinichi Kikuchi Shunichi Fukuhara 《Journal of the American Medical Directors Association》2019,20(2):195-200.e1
Objectives
A discrepancy in self-reported and performance-based physical functioning levels is often observed among older adults. We investigated the association of discrepancy in self-reported and performance-based physical functioning levels with risk of future falls among community-dwelling older adults.Design
Prospective cohort study.Setting
Two communities in Fukushima Prefecture, Japan.Participants
1379 older adults who took part in the yearly health checkup in both 2009 and 2010.Measures
The performance-based and self-reported physical functioning levels were evaluated by the Timed Up and Go test and the Short-Form 12 Health Survey (Japanese version) physical functioning subscale, respectively. We divided the participants into 4 groups based on the combinations of low or high performance-based and self-reported physical functioning groups, which were classified by age- and sex-specific reference values. The main outcome was the occurrence of any falls within the 1-year follow-up period, assessed using a self-reported questionnaire.Results
A total of 22% of the participants reported the occurrence of a fall during the follow-up period. In multivariable logistic regression analysis, the adjusted odds ratios of the high self-reported and low performance-based, low self-reported and high performance-based, and low self-reported and low performance-based physical functioning groups were 1.10 (95% confidence interval [CI], 0.67–1.82), 1.76 (95% CI, 1.17–2.66), and 1.80 (95% CI, 1.11–2.90), respectively, compared with the high self-reported and high performance-based physical functioning group.Conclusions
Our findings suggest that the discrepancy as high performance-based but low self-reported physical functioning level is associated with an increased risk of future falls in older adults aged 65–89 years. Clinicians should carefully assess older adults whose subjective perception of their physical functioning capacity is lower than those in similar age and sex groups, even if their actual physical functioning appears to be objectively high. 相似文献7.
Anne Michel Eric Vérin Xavier Gbaguidi Laurent Druesne Frédéric Roca Philippe Chassagne 《Journal of the American Medical Directors Association》2018,19(9):770-774
Objectives
To define the prevalence of oropharyngeal dysphagia (OD) in community-dwelling older persons with dementia, using V-VST (Volume-Viscosity Swallow Test), the reference clinical screening test for swallowing disorders, to assess the feasibility of the V-VST in an ambulatory care setting, to search for associations between geriatric parameters and OD, and to identify a relationship between severities of cognitive impairment and OD.Design
Prospective, monocentric study.Setting
Population from a geriatric outpatients clinic.Participants
Patients older than 70 with a diagnosis of dementia (NINCDS-ADRDA criteria), effective cough, and ability of voluntary swallowing for testing.Measurements
OD screening was realized using V-VST during consultation. Severity of cognitive impairment was estimated by the MMSE and severity of OD by the Dysphagia Outcome Severity Scale (DOSS). Six geriatric domains were evaluated (comorbidities, functional abilities, cognition, nutrition, mood disorders, frailty).Results
117 patients participated in the study (77 women, mean age = 84.5 ± 5.1 years). Prevalence of OD was 86.6%. Among the 97 patients with OD, 3 (3.1%) had only safety impairment, 52 (53.6%) had only efficacy impairment and 42 (43.3%) had both. The mean time necessary to realize V-VST was 8.7 ± 2.7 minutes with a rate of success of 96%. Dependency was independently associated with OD [odds ratio (OR) 4.8; 95% confidence interval (CI) 1.5-15.9; P < .05], and age and grip strength were associated with safety impairment (OR 1.1; 95% CI 1.0-1.2 and OR 1.9; 95% CI 1.2-3.2 respectively; both P < .05). No significant relationship was found between severity of OD and severity of cognitive impairment.Conclusion
OD is very frequent in community-dwelling older persons with dementia and is associated with dependency and frailty. The V-VST is an easy-to-perform and well tolerated screening test in this population and therefore should be systematically included in the geriatric assessment of older persons with dementia. The role of V-VST in therapeutic strategies of OD remains to be evaluated. 相似文献8.
Phillip J. Tully Catherine Helmer Ruth Peters Christophe Tzourio 《Journal of the American Medical Directors Association》2019,20(2):188-194.e4
Objectives
The objective was to test the hypothesis that antihypertensive drugs have a differential effect on cognition in carriers and noncarriers of the apolipoprotein ε4 (APOE4) polymorphism.Design
Prospective population-based cohort, France.Setting and participants
A total of 3359 persons using antihypertensive drugs (median age 74 years, 62% women) were serially assessed up to 10 years follow-up.Measures
Exposure to antihypertensive drug use was established in the first 2 years. Cognitive function was assessed at baseline, 2, 4, 7, and 10 years with a validated test battery covering global cognition, verbal fluency, immediate visual recognition memory, processing speed, and executive function. Clinically significant change in cognitive function was determined using reliable change indices represented as z scores and analyzed with linear mixed-models.Results
From 3359 persons exposed to antihypertensive drugs, 653 were APOE4 carriers (5.1% homozygous, 94.9% heterozygous) and median follow-up was 5.2 years (interquartile range 3.7–8.0). In APOE4 carriers, improved general cognitive function over time was associated with exposure to angiotensin converting enzyme inhibitors [β = .14; 95% confidence interval (CI) .06–.23, P = .001] and angiotensin receptor blockers (β = .11; 95% CI .02–.21, P = .019). Improved verbal fluency was associated with angiotensin converting enzyme inhibitors (β = .11; 95% CI .03–.20, P = .012).Conclusions
Renin-angiotensin-system blockade was associated with improved general cognitive function in APOE4 carriers. Findings did not support renin-angiotensin-system drugs' lipophilicity or ability to cross the blood-brain barrier as potential mechanisms. The findings have implications for selecting the optimal antihypertensive drug in older populations at risk of cognitive decline and dementia. 相似文献9.
Oscar H. Del Brutto Robertino M. Mera Mauricio Zambrano Mark J. Sedler 《Journal of the American Medical Directors Association》2019,20(2):213-216
Objective
To assess the influence of frailty on cognitive decline.Design
Population-based prospective cohort study.Settings/participants
Community-dwelling older adults living in a rural Ecuadorian village, fulfilling the following criteria: age ≥60 years at baseline Montreal Cognitive Assessment (MoCA) and frailty assessment, a baseline brain magnetic resonance imaging, and a follow-up MoCA performed at least 12 months after the baseline.Measures
Frailty was evaluated by the Edmonton Frailty Scale (EFS) and cognitive performance by MoCA. The relationship between baseline EFS and MoCA decline was assessed by longitudinal linear and fractional polynomial models, adjusted for relevant confounders. The score of the cognitive component of the EFS was subtracted, and an alternative fractional polynomial model was fitted to settle the impact of such cognitive question on the model.Results
A total of 252 individuals, contributing 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years) were included. The mean EFS score was 4.7 ± 2.5 points. The mean baseline MoCA score was 19.5 ± 4.5 points, and that of the follow-up MoCA was 18.1 ± 4.9 points (P = .001). Overall, 154 (61%) individuals had lower MoCA scores in the follow-up. The best fitted longitudinal linear model showed association between baseline EFS score and MoCA decline (P = .027). There was a continuous increase in MoCA decline in persons with an EFS ≥7 points (nonlinear relationship). Fractional polynomials explained the effect of the EFS on MoCA decline. For the complete EFS score, the β coefficient was 2.43 (95% confidence interval 1.22–3.63). For the effect of the EFS (without its cognitive component) on MoCA decline, the relationship was still significant (β 4.86; 95% confidence interval 2.6–7.13).Conclusions/implications
Over a 3.7-year period, 61% of older adults living in Atahualpa experienced cognitive decline. Such decline was significantly associated with frailty status at baseline. Region-specific risk factors influencing this relationship should be further studied to reduce its burden in rural settings. 相似文献10.
Rosanne van Seben Lucienne A. Reichardt Jesse J. Aarden Marike van der Schaaf Martin van der Esch Raoul H.H. Engelbert Jos W.R. Twisk Jos A. Bosch Bianca M. Buurman 《Journal of the American Medical Directors Association》2019,20(2):152-158.e2
Objectives
To establish the prevalence and course of geriatric syndromes from hospital admission up to 3 months postdischarge and to determine the probability to retain geriatric syndromes over the period from discharge until 3 months postdischarge, once they are present at admission.Design
Prospective multicenter cohort study conducted between October 2015 and June 2017.Setting and participants
Acutely hospitalized patients aged 70 years and older recruited from internal, cardiology, and geriatric wards of 6 Dutch hospitals.Measures
Cognitive impairment, depressive symptoms, apathy, pain, malnutrition, incontinence, dizziness, fatigue, mobility impairment, functional impairment, fall risk, and fear of falling were assessed at admission, discharge, and 1, 2, and 3 months postdischarge. Generalized estimating equations analysis were performed to analyze the course of syndromes and to determine the probability to retain syndromes.Results
A total of 401 participants [mean age (standard deviation) 79.7 (6.7)] were included. At admission, a median of 5 geriatric syndromes were present. Most prevalent were fatigue (77.2%), functional impairment (62.3%), apathy (57.5%), mobility impairment (54.6%), and fear of falling (40.6%). At 3 months postdischarge, an average of 3 syndromes were present, of which mobility impairment (52.7%), fatigue (48.1%), and functional impairment (42.5%) were most prevalent. Tracking analysis showed that geriatric syndromes that were present at admission were likely to be retained. The following 6 geriatric syndromes were most likely to stay present postdischarge: mobility impairment, incontinence, cognitive impairment, depressive symptoms, functional impairment, and fear of falling.Implications
Acutely hospitalized older adults exhibit a broad spectrum of highly prevalent geriatric syndromes. Moreover, patients are likely to retain symptoms that are present at admission postdischarge. Our study underscores the need to address a wide range of syndromes at admission, the importance of communication on syndromes to the next care provider, and the need for adequate follow-up care and syndrome management postdischarge. 相似文献11.
Susanne C. de Ruiter Jos F.M. de Jonghe Tjeerd Germans Jaap H. Ruiter René W.M.M. Jansen 《Journal of the American Medical Directors Association》2017,18(5):409-413
Objectives
To evaluate the prevalence of cognitive impairment (CI), including mild CI and dementia, in elderly patients with syncope and unexplained falls. In this population, we compared the use of the Mini-Mental State Examination (MMSE) with a cognitive screening test that assesses executive dysfunction typical of subcortical (vascular) CI, that is, the Montreal Cognitive Assessment (MoCA).Design
Observational cohort study.Setting
Outpatient fall and syncope clinic.Participants
Consecutive patients aged ≥65 years with syncope and unexplained falls without loss of consciousness.Measurements
Baseline characteristics, functional status, MMSE, MoCA, and magnetic resonance imaging scans of the brain. Main outcome: prevalence of CI, comparing the MMSE with the MoCA. CI was defined as an MMSE/MoCA score <26. Secondary outcomes: MMSE/MoCA overall and subdomain scores, Fazekas and medial temporal lobe atrophy scores.Results
We included 200 patients, mean age 79.5 (standard deviation 6.6) years (Syncope Group: n = 101; Fall Group: n = 99). Prevalence of CI was 16.8% (MMSE) versus 60.4% (MoCA) in the Syncope Group (P < .001) and 16.8% (MMSE) versus 56.6% (MoCA) in the Fall Group (P < .001). Prevalence of CI did not differ between the Syncope Group and Fall Group with either method. Executive dysfunction was present in both groups.Conclusion
CI is as common in elderly patients with syncope as it is in patients with unexplained falls, with an overall prevalence of 58%. The MMSE fails as a screening instrument for CI in these patients, because it does not assess executive function. Therefore, we recommend the MoCA for cognitive screening in older patients with syncope and unexplained falls. 相似文献12.
Teresa Gijón-Conde Auxiliadora Graciani Esther López-García Esther García-Esquinas Martin Laclaustra Luis M. Ruilope Fernando Rodríguez-Artalejo José R. Banegas 《Journal of the American Medical Directors Association》2018,19(5):433-438
Background and objective
Frailty and disability are associated with cardiovascular risk factors, including hypertension, in older people; however, little is known about their association with ambulatory blood pressure (BP). Thus, we assessed the relationship of frailty and disability with ambulatory BP in older adults.Design, setting, and participants
Cross-sectional study of 1047 community-living individuals aged ≥60 years in Spain.Measurements
BP was determined with validated devices under standardized conditions during 24 hours. Frailty was defined as having 3 or more of the following criteria: weight loss, low grip strength, low energy, slow gait speed, and low physical activity. Disability was assessed with the Lawton-Brodýs questionnaire on instrumental activities of daily living. Associations with systolic BP (SBP) and dipping (nocturnal SBP decline) were modeled and adjusted for sociodemographic variables, body mass index, lifestyles, antihypertensive drug treatment, comorbidities, 24-hour heart rate, and conventional or ambulatory SBP as appropriate.Results
Participants' mean age was 71.7 years (50.8% men); 6% were frail and 8.1% had disability. Compared with nonfrail participants, those with frailty had 3.5 mm Hg lower daytime SBP (P = .001), 3.3% less SBP dipping (P = .003), and 3.6 mmHg higher nighttime SBP (P = .016). Compared with participants who are not disabled, those who are disabled had 2.5 mmHg lower daytime SBP (P = .002), 2.5% less SBP dipping (P = .003), and 2.7 mmHg higher nighttime SBP (P = .011).Conclusions
In community-dwelling older adults, frailty and disability were independently associated with lower diurnal SBP, blunted nocturnal decline of SBP, and higher nocturnal SBP. These findings may help explain the higher mortality associated with low clinic SBP in frail older subjects observed in epidemiologic studies. 相似文献13.
Emerald G. Heiland Anna-Karin Welmer Rui Wang Giola Santoni Laura Fratiglioni Chengxuan Qiu 《Journal of the American Medical Directors Association》2019,20(2):208-212.e3
Objectives
We aimed to quantify the increased risk of disability associated with cardiovascular risk factors among older adults, and to verify whether this risk may vary by age and functional status.Design
Longitudinal population-based cohort study.Setting
Urban area of Stockholm, Sweden.Participants
Community-dwelling and institutionalized adults ≥60 years in the Swedish National study on Aging and Care in Kungsholmen free of cardiovascular diseases and disability (n = 1756) at baseline (2001-2004).Measures
Incident disability in activities of daily living (ADL) was ascertained over 9 years. Cardiovascular risk factors (physical inactivity, alcohol consumption, smoking, high blood pressure, diabetes, high body mass index, high levels of total cholesterol, and high C-reactive protein) and walking speed were assessed at baseline. Data were analyzed using Cox proportional hazards models, stratifying by younger-old (age 60-72 years) and older-old (≥78 years).Results
During the follow-up, 23 and 148 persons developed ADL-disability among the younger- and older-old, respectively. In the younger-old, the adjusted hazard ratio (HR) of developing ADL-disability was 4.10 (95% confidence interval [CI] 1.22-13.76) for physical inactivity and 5.61 (95% CI 1.17-26.82) for diabetes. In the older-old, physical inactivity was associated with incident ADL-disability (HR 1.99, 95% CI 1.36-2.93), and there was a significant interaction between physical inactivity and walking speed limitation (<0.8 m/s), showing a 6-fold higher risk of ADL-disability in those who were both physically inactive and had walking speed limitation than being active with no limitation, accounting for a population-attributable risk of 42.7%.Conclusions/Implications
Interventions targeting cardiovascular risk factors may be more important for the younger-old in decreasing the risk of disability, whereas improving physical function and maintaining physical activity may be more beneficial for the older-old. 相似文献14.
Jing-Hong Liang Jia-Yu Li Rui-Xia Jia Ying-Quan Wang Rong-Kun Wu Hong-Bo Zhang Lei Hang Yong Xu Chen-Wei Pan 《Journal of the American Medical Directors Association》2019,20(3):347-355
Objectives
We aimed to identify the best form of cognitive therapy among 3 main cognitive interventions of Alzheimer's disease (AD) including cognitive training (CT), cognitive stimulation (CS), and cognitive rehabilitation (CR).Design
Systematic review and Bayesian network meta-analysis.Setting and Participants
An exhaustive literature search was conducted based on PubMed, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, the China National Knowledge Infrastructure database, the Chinese Biomedical Literature database, the Wan Fang database, and Web of Science and other database and randomized controlled trials were identified from their inception to May 1, 2018. Older adult participants diagnosed with AD were recruited.Measures
We conducted a Bayesian network meta-analysis (NMA) to rank the included treatments. Cognitive functions were measured based on the Mini-Mental State Examination (MMSE). A series of analyses and assessments, such as the Pairwise meta-analysis and the risk of bias, were performed concurrently.Results
Only 22 studies were included in our analysis based on a series of rigorous screenings, which comprised 1368 participants. No obvious heterogeneities were found in NMA (I2 = 32.7%, P = .07) after the data were pooled. The mean difference (MD) of CT [MD = 2.1, confidence interval [CI]: 1.0, 3.2), CS (MD = 0.92, CI: ?0.20, 2.0), and CR (MD = 2.0, CI: 0.73, 3.4) showed that CT and CR could significantly improve cognitive function as measured by MMSE in the treatment group whereas the CS was less effective. CT had the highest probability among the 3 cognitive interventions [the surface under the cumulative ranking curve (SUCRA) = 84.7%], followed by CR (SUCRA = 50.0%) and CS (SUCRA = 47.4%).Conclusions/Relevance
Our study indicated that the CT might be the best method for improving the cognitive function of AD patients. The findings from our study may be useful for policy makers and service commissioners when they make choices among different alternatives. 相似文献15.
16.
Bertrand Fougère Matthieu Daumas Matthieu Lilamand Sandrine Sourdet Julien Delrieu Bruno Vellas Gabor Abellan van Kan 《Journal of the American Medical Directors Association》2017,18(11):990.e1-990.e5
Background
A consensus panel, based on epidemiologic evidence, argued that physical frailty is often associated with cognitive impairment, possibly because of common underlying pathophysiological mechanisms. The concepts of cognitive frailty and motoric cognitive risk were recently proposed in literature and may represent a prodromal stage for neurodegenerative diseases. The purpose of this study was to analyze the relationship between cognition and the components of the physical phenotype of frailty.Methods
Participants admitted to the Toulouse frailty day hospital aged 65 years or older were included in this cross-sectional study. Cognitive impairment was identified using the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Frailty was assessed using the physical phenotype as defined by Fried's criteria. We divided the participants into 2 groups: participants with normal cognition (CDR = 0) and participants who had cognitive impairment (CDR = 0.5). Participants with CDR >0.5 were excluded.Results
Data from 1620 participants, mean age 82 years and 63% of women were analyzed. Cognitive impairment was identified in 52.5% of the participants. Frailty was identified in 44.7% of the sample. There were more frail subjects in the impaired group than the normal cognitive group (51% vs 38%, P < .001). In logistic regression analyses, elevated odds for frailty were observed in patients with cognitive impairment [adjusted odds ratio (OR) 1.66, 95% confidence interval (CI) 1.12-2.46]. Subsequent analysis showed that the association between cognitive impairment and frailty was only observed considering one of the 5 frailty criteria: gait speed (adjusted OR 1.89, 95% CI 1.55-2.32).Conclusion
Physical frailty and in particular slow gait speed were associated with cognitive impairment. Future research including longitudinal studies should exploit the association between cognitive impairment and frailty. 相似文献17.
Astrid S. Doorduijn Ondine van de Rest Wiesje M. van der Flier Marjolein Visser Marian A.E. de van der Schueren 《Journal of the American Medical Directors Association》2019,20(1):14-21
Objectives
Protein and energy malnutrition and unintended weight loss are frequently reported in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Possible underlying mechanisms include increased energy expenditure, altered uptake of nutrients, a reduced nutritional intake, or a combination of these 3. We aimed at systematically reviewing the literature to examine potential differences in energy and protein intake in patients with MCI and AD compared to controls as a possible mechanism for unintended weight loss.Design
Systematic review and meta-analysis.Setting
PubMed and Cochrane Electronic databases were searched from inception to September 2017 for case control studies.Participants
Patients with MCI or AD compared to cognitive healthy controls, all adhering to a Western dietary pattern.Measurements
Energy and protein intake.Results
The search resulted in 7 articles on patients with AD versus controls, and none on patients with MCI. Four articles found no differences in energy and protein intakes, 1 found higher intakes in patients with AD, and 1 article found lower intakes in patients with AD compared to controls. One article reported on intakes, but did not test differences. A meta-analysis of the results indicated no difference between patients with AD and controls in energy [?8 kcal/d, 95% confidence interval (CI): ?97, 81; P = .85], or protein intake (2 g/d, 95% CI: ?4, 9; P = .47). However, heterogeneity was high (I2 > 70%), and study methodology was generally poor or moderate.Conclusion
Contrary to frequently reported unintended weight loss, our systematic review does not provide evidence for a lower energy or protein intake in patients with AD compared to controls. High heterogeneity of the results as well as of participant characteristics, setting, and study methods was observed. High-quality studies are needed to study energy and protein intake as a possible mechanism for unintended weight loss and malnutrition in both patients with MCI and AD. 相似文献18.
Joyce Y.C. Chan Karen K.L. Yiu Timothy C.Y. Kwok Samuel Y.S. Wong Kelvin K.F. Tsoi 《Journal of the American Medical Directors Association》2019,20(3):279-286.e1
Objective
To investigate whether depression and/or antidepressants can be a potential risk factor for the development of dementia and mild cognitive impairment (MCI).Design
Systematic review and meta-analysis of longitudinal studies.Setting and Participants
Community or clinical settings. Participants included patients with depression, antidepressant users, and the general population.Measures
Longitudinal studies evaluating the risks of dementia or MCI in patients with depression and/or antidepressant users were identified from the OVID database. The outcomes were the number of patients who developed dementia or MCI among the antidepressant users and nonusers. Relative risk (RR) with 95% confidence interval (95% CI) was used to evaluate the association between the use of antidepressants and the risk of dementia and MCI. Meta-analysis was used for combining the effect sizes of individual studies, and the heterogeneity test was performed. Risk of bias and reporting quality of included studies was assessed. Subgroup analyses were conducted for different types of antidepressants.Results
A total of 18 studies with 2,119,627 participants with mean age ranging from 55 to 81 years were included. Among patients with depression, antidepressant users showed a significantly higher risk of dementia (RR = 1.37, 95% CI = 1.11-1.70) and MCI (RR = 1.20, 95% CI = 1.02-1.42) than the nonusers. Besides, patients with depression who used antidepressants and who did not use antidepressants also showed significantly higher risk of dementia than the general population (RR = 1.50, 95% CI = 1.26-1.78, and RR = 1.31, 95% CI = 1.15-1.51, respectively).Conclusions/Implications
Patients with depression are associated with a higher risk of dementia, and the use of antidepressants is not shown to be a protective factor of dementia. Further large-scale trials are required for investigation of the benefit-risk ratio between depression relapse and dementia when prescribing antidepressants. 相似文献19.
Maheen Islam Mridul Mazumder Derek Schwabe-Warf Yannick Stephan Angelina R. Sutin Antonio Terracciano 《Journal of the American Medical Directors Association》2019,20(2):131-137
Objective
To examine changes in personality in individuals with mild cognitive impairment (MCI) or dementia as observed by family members using both new data and a meta-analysis with the published literature.Design
Current and retrospective personality assessments of individuals with dementia by family informants. PubMed was searched for studies with a similar design and a forward citation tracking was conducted using Google Scholar in June 2018. Results from a new sample and from published studies were combined in a random effect meta-analysis.Setting and participants
Family members of older adults with MCI or dementia.Measures
The 5 major dimensions (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and facets of personality were assessed with NEO Personality Inventory questionnaires.Results
The new sample (n = 50) and meta-analysis (18 samples; n = 542) found consistent shifts in personality from the premorbid to current state in patients with cognitive impairment. The largest changes (>1 standard deviation) were declines in conscientiousness (particularly for the facets of self-discipline and competence) and extraversion (decreased energy and assertiveness), as well as increases in neuroticism (increased vulnerability to stress). The new sample suggested that personality changes were larger in individuals taking cognition-enhancing medications (cholinesterase inhibitors or memantine). More recent studies and those that examined individuals with MCI found smaller effects.Conclusions and implications
Consistent with the clinical criteria for the diagnosis of dementia, the new study and meta-analysis found replicable evidence for large changes in personality among individuals with dementia. Future research should examine whether there are different patterns of personality changes across etiologies of dementia to inform differential diagnosis and treatments. Prospective, repeated assessments of personality using both self- and informant-reports are essential to clarify the temporal evolution of personality change across the preclinical, prodromal, and clinical phases of dementia. 相似文献20.
Ning Zhang Susan F. Lu Yanhua Zhou Bo Zhang Sybil Crawford Jerry H. Gurwitz 《Journal of the American Medical Directors Association》2019,20(3):312-316