Migraine Does Not Affect Cognitive Decline: Results From the Maastricht Aging Study

(Headache 2010;50:176‐184) Objective.— To investigate the effects of migraine and related pharmacotherapy on cognitive performance and cognitive change over time in a longitudinal population‐based study. Methods.— Migraineurs (n = 99) and healthy controls (n = 1724) participating in the Maastricht Aging Study were cognitively tested at baseline and after 6 years. Scores on Mini Mental State Examination, immediate and delayed recall tests, and tests for simple and complex speed were compared for both groups. Generalized Estimating Equations analyses were performed to test the longitudinal effects of migraines on cognition. Effects of migraine medication use were also tested. Results.— Migraine headaches were found to have no effect on any of the cognitive measures. Medication use also had no effect on all cognitive measures. Conclusions.— No evidence was found that migraine headaches or migraine‐related medication use are risk or protective factors for cognitive dysfunction or cognitive deterioration over time.     

Preoperative Risk Factors for Postoperative Falls in Persons Undergoing Hip or Knee Arthroplasty: A Longitudinal Study of Data From the Osteoarthritis Initiative

Objective

To identify preoperative risk factors associated with posthospitalization falls over an approximate 2-year postoperative period in patients undergoing both hip and knee arthroplasty.

Semmes-Weinstein Monofilament Examination for Predicting Physical Performance and the Risk of Falls in Older People: Results of the Pro.V.A. Longitudinal Study

Objective

To investigate whether the Semmes-Weinstein monofilament examination (SWME) was associated with, and could predict, measures of physical performance and the risk of fall in older people.

Age-Associated Changes in Motor Unit Physiology: Observations From the Baltimore Longitudinal Study of Aging

Ling SM, Conwit RA, Ferrucci L, Metter EJ. Age-associated changes in motor unit physiology: observations from the Baltimore Longitudinal Study of Aging.

Objective

To examine motor unit characteristics (size and firing rate) associated with aging.

Design

Cross-sectional, observational.

Setting

Community.

Participants

Baltimore Longitudinal Study of Aging participants (N=102), aged 22.2 to 94.1 years, were studied.

Interventions

Not applicable.

Main Outcome Measures

Surface-represented motor unit size and firing rate were collected from the vastus medialis during knee extension at 10%, 20%, 30%, and 50% of each subject's maximum isometric voluntary contraction (MVC).

Results

MVC declined with older age (P<.0001). Adjusting for differences in MVC, both firing rate and motor unit size per newton force generated began to increase in the 6th decade of life. Motor unit size increased per newton force to a greater extent than firing rate. Those over the age of 75 years also activated significantly larger motor units per unit force (P=.04). Relative to force generated, the average firing rate began increasing at 57.8±3.4 years and between 50.2 and 56.4 years (±4y) for motor unit size.

Conclusions

The size of motor units and firing rates used to achieve a given force changes with age, particularly after middle age. Whether these changes precede, follow, or occur concurrent to age-related modifications in muscle structure and contractile properties or sarcopenia is not known.     

Neuropsychological,Balance, and Mobility Risk Factors for Falls in People With Multiple Sclerosis: A Prospective Cohort Study

Objectives

To determine whether impaired performance in a range of vision, proprioception, neuropsychological, balance, and mobility tests and pain and fatigue are associated with falls in people with multiple sclerosis (PwMS).

Design

Prospective cohort study with 6-month follow-up.

Setting

A multiple sclerosis (MS) physiotherapy clinic.

Participants

Community-dwelling people (N=210; age range, 21–74y) with MS (Disease Steps 0–5).

Interventions

Not applicable.

Main Outcome Measures

Incidence of falls during 6 months' follow-up.

Results

In the 6-month follow-up period, 83 participants (39.7%) experienced no falls, 57 (27.3%) fell once or twice, and 69 (33.0%) fell 3 or more times. Frequent falling (≥3) was associated with increased postural sway (eyes open and closed), poor leaning balance (as assessed with the coordinated stability task), slow choice stepping reaction time, reduced walking speed, reduced executive functioning (as assessed with the difference between Trail Making Test Part B and Trail Making Test Part A), reduced fine motor control (performance on the 9-Hole Peg Test [9-HPT]), and reported leg pain. Increased sway with the eyes closed, poor coordinated stability, and reduced performance in the 9-HPT were identified as variables that significantly and independently discriminated between frequent fallers and nonfrequent fallers (model χ²₃=30.1, P<.001). The area under the receiver operating characteristic curve for this model was .712 (95% confidence interval, .638–.785).

Conclusions

The study reveals important balance, coordination, and cognitive determinants of falls in PwMS. These should assist the development of effective strategies for prevention of falls in this high-risk group.     

Food-Insecure Dietary Patterns Are Associated With Poor Longitudinal Glycemic Control in Diabetes: Results From the Boston Puerto Rican Health Study

OBJECTIVE

To determine whether dietary patterns associated with food insecurity are associated with poor longitudinal glycemic control.

RESEARCH DESIGN AND METHODS

In a prospective, population-based, longitudinal cohort study, we ascertained food security (Food Security Survey Module), dietary pattern (Healthy Eating Index–2005 [HEI 2005]), and hemoglobin A_1c (HbA_1c) in Puerto Rican adults aged 45–75 years with diabetes at baseline (2004–2009) and HbA_1c at ∼2 years follow-up (2006–2012). We determined associations between food insecurity and dietary pattern and assessed whether those dietary patterns were associated with poorer HbA_1c concentration over time, using multivariable-adjusted repeated subjects mixed-effects models.

RESULTS

There were 584 participants with diabetes at baseline and 516 at follow-up. Food-insecure participants reported lower overall dietary quality and lower intake of fruit and vegetables. A food insecurity*HEI 2005 interaction (P < 0.001) suggested that better diet quality was more strongly associated with lower HbA_1c in food-insecure than food-secure participants. In adjusted models, lower follow-up HbA_1c was associated with greater HEI 2005 score (β = −0.01 HbA_1c % per HEI 2005 point, per year, P = 0.003) and with subscores of total vegetables (β = −0.09, P = 0.04) and dark green and orange vegetables and legumes (β = −0.06, P = 0.048). Compared with the minimum total vegetable score, a participant with the maximum score showed relative improvements of HbA_1c of 0.5% per year.

CONCLUSIONS

Food insecurity was associated with lower overall dietary quality and lower consumption of plant-based foods, which was associated with poor longitudinal glycemic control.     

Cross-sectional and Longitudinal Associations Between Objectively Measured Sedentary Time and Metabolic Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

OBJECTIVE

Prolonged sedentary time (ST) might be contributing to the diabetes epidemic, but most studies have been cross-sectional and few have objectively measured ST. The purpose of this study was to evaluate cross-sectional and 5-year longitudinal relationships between ST and metabolic parameters and outcomes.

RESEARCH DESIGN AND METHODS

This was an analysis of 2,027 Coronary Artery Risk Development in Young Adults (CARDIA) study participants (aged 38–50 years, 57% female, and mean BMI of 29.0 ± 7.0 kg/m²) with accelerometry data (≥4 days with ≥10 h/day) measured at the year 20 follow-up exam (2005–2006). Metabolic variables (fasting glucose, fasting insulin, 2-h postchallenge glucose, HOMA of insulin resistance [HOMA-IR], and HbA_1c) and outcomes (impaired fasting glucose [IFG], impaired glucose tolerance [IGT], prediabetes by HbA_1c, and diabetes) were assessed concurrently and 5 years later.

RESULTS

Average ST was 8.1 ± 1.7 h/day or 55 ± 10% of wear time. Each additional hour per day of ST was cross-sectionally associated with a 3% higher fasting insulin and HOMA-IR (both P < 0.01) but not 5-year changes in metabolic parameters. Having ≥10 h/day vs. <6 h/day of ST was associated with an odds ratio (OR) = 2.74 (95% CI 1.13, 6.62) for IGT and an OR = 3.80 (95% CI 1.39, 10.35) for diabetes. ST was not associated with prevalent IFG, prevalent prediabetes by HbA_1c, or 5-year incidence of any metabolic outcomes (all P > 0.05).

CONCLUSIONS

ST was independently related to insulin, HOMA-IR, and prevalent diabetes and IGT but did not predict 5-year changes in metabolic parameters or incidence of metabolic outcomes. These results suggest that higher ST may not be a risk factor for future metabolic outcomes, but more research with repeated ST measurement and longer follow-up is needed.     

Individual and Combined Associations of Cognitive and Mobility Limitations on Mortality Risk in Older Adults

Objective

To evaluate the potential independent and combined associations of cognitive and mobility limitations on risk of all-cause mortality in a representative sample of the US older adult population who, at baseline, were free of cardiovascular and cerebrovascular disease.

Impact of Prevalent Fractures on Quality of Life: Baseline Results From the Global Longitudinal Study of Osteoporosis in Women

OBJECTIVE: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women who report previous fractures, and to provide perspective by comparing these findings with those in other chronic conditions (diabetes, arthritis, lung disease).PATIENTS AND METHODS: Fractures are a major cause of morbidity among older women. Few studies have examined HRQL in women who have had prior fractures and the effect of prior fracture location on HRQL. In this observational study of 57,141 postmenopausal women aged 55 years and older (enrollment from December 2007 to March 2009) from 17 study sites in 10 countries, HRQL was measured using the European Quality of Life 5 Dimensions Index (EQ-5D) and the health status, physical function, and vitality questions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36).RESULTS: Reductions in EQ-5D health-utility scores and SF-36–measured health status, physical function, and vitality were seen in association with 9 of 10 fracture locations. Spine, hip, and upper leg fractures resulted in the greatest reductions in quality of life (EQ-5D scores, 0.62, 0.64, and 0.61, respectively, vs 0.79 without prior fracture). Women with fractures at any of these 3 locations, as well as women with a history of multiple fractures (EQ-5D scores, 0.74 for 1 prior fracture, 0.68 for 2, and 0.58 for ≥3), had reductions in HRQL that were similar to or worse than those in women with other chronic diseases (0.67 for diabetes, 0.69 for arthritis, and 0.71 for lung disease).CONCLUSION: Previous fractures at a variety of bone locations, particularly spine, hip, and upper leg, or involving more than 1 location are associated with significant reductions in quality of life.EQ-5D = European Quality of Life 5 Dimensions Index; GLOW = Global Longitudinal Study of Osteoporosis in Women; HRQL = health-related quality of life; SF-36 = Medical Outcomes Study 36-Item Short Form Health SurveyFractures are a major clinical concern in older women and men. The most commonly considered sites of fracture are the hip, spine, and wrist.^1-4 About 40% of white women aged 50 years and older will experience at least 1 clinically recognized fracture at one of these skeletal sites and be subjected to increased risks of morbidity and mortality.^5,6 However, other less recognized fractures, such as those of the pelvis, ribs, shoulder, distal femur, and proximal tibia, may also lead to reductions in quality of life.^7-10 If their full health impact is to be appreciated, fractures at a range of sites need to be examined to determine their effects on health-related quality of life (HRQL).The European Quality of Life 5 Dimensions Index (EQ-5D) is a generic, preference-based instrument that provides a comprehensive framework within which to determine health status and measure HRQL.^11,12 The EQ-5D describes states of health in 5 dimensions: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) is used widely to compare the HRQL of general and specific populations, to estimate the burden of disease, and to examine the benefits of treatment interventions; we used it in the current study to measure overall health status, physical function, and vitality.The purpose of our study was to examine the impact of common fractures on quality of life. Using data from participants aged 55 years and older from the Global Longitudinal Study of Osteoporosis in Women (GLOW), we performed a cross-sectional analysis to determine whether a history of fracture after age 45 years is associated with reduced HRQL, as measured by the EQ-5D instrument and the physical function and vitality subscales of the SF-36.     

Comparison of the Risks of Opioid Abuse or Dependence Between Tapentadol and Oxycodone: Results From a Cohort Study

Tapentadol may have a lower abuse risk than other opioids because it has a relatively low affinity for the mu-opioid receptor. The aim of this retrospective cohort study was to compare the risk of opioid abuse between tapentadol immediate release (IR) and oxycodone IR using 2 claims databases (Optum and MarketScan). Subjects with no recent opioid use exposed to tapentadol IR or oxycodone IR in 2010 were followed for 1 year. The outcome was the proportion of subjects who developed opioid abuse, defined as subjects with International Classification of Diseases, 9th revision, codes for opioid abuse, addiction, or dependence. The relative odds of abuse were estimated using a logistic regression model with propensity-score stratification. The estimates from the 2 databases were pooled using a random effects model. There were 13,814 subjects in Optum (11,378 exposed to oxycodone, 2,436 exposed to tapentadol) and 25,553 in MarketScan (21,728 exposed to oxycodone, 3,825 exposed to tapentadol). The risk of abuse was higher in the oxycodone group than in the tapentadol group in each database. The pooled adjusted estimate for the odds of abuse was 65% lower with tapentadol than with oxycodone (odds ratio = .35, 95% confidence interval = .21–.58). The risk of receiving an abuse diagnosis with tapentadol was lower than the risk with oxycodone. Continued monitoring is warranted because opioid desirability can change over time.     

失能老人跌倒的危险因素及预防进展

随着老年人口数量的增长,跌倒正逐渐成为公共关注的问题。文章通过讨论失能老人跌倒的主要危险因素,包括老人生理特征、疾病状态、认知能力、心理因素、居家环境、药物因素、辅助器械使用等,提出了跌倒风险评估、治疗原发疾病、有效功能锻炼、健康教育、营造安全照护环境、合理药物干预、使用保护器具等干预措施。在此基础上,对失能老人跌倒预防的研究前景进行了展望。     

The Associations Between the Dominant and Nondominant Peak External Knee Adductor Moments During Gait in Healthy Subjects: Evidence for Symmetry

Teichtahl AJ, Wluka AE, Morris ME, Davis SR, Cicuttini FM. The associations between the dominant and nondominant peak external knee adductor moments during gait in healthy subjects: evidence for symmetry.

Objectives

There is growing interest in the role of the knee adduction moment in the pathogenesis of knee pain and osteoarthritis. It is unclear whether the knee adduction moment is similar between the dominant and nondominant legs during locomotion. This study examined whether asymmetry exists in the peak knee adductor moments during gait in healthy adults.

Design

Cross-sectional study.

Setting

Musculoskeletal Research Centre, La Trobe University, Melbourne, Victoria, Australia.

Participants

Three-dimensional Vicon gait analyses were performed for 17 healthy men and women.

Interventions

Not applicable.

Main Outcome Measures

The external dominant and nondominant peak knee adduction moments during early and late stance were analyzed to determine whether any significant differences occurred between limbs.

Results

Peak knee adductor moments for dominant and nondominant limbs were significantly correlated during early (R=0.61, P=0.009) and late (R=0.72, P=0.001) stance. After adjustment for age and sex, there was an associated 0.58 (P=0.030) and 0.98 (P=0.009) unit increase in the peak knee adduction moment in the nondominant leg, for every 1 unit increase in the dominant leg during the early and late stance phases of gait, respectively. Further evidence for symmetry was provided by the symmetry index, which was 0.04% and 0.62% for early and late stance, respectively.

Conclusions

In healthy subjects, the magnitude of the dominant limb peak external knee adduction moments during stance, and in particular late stance, appears representative of the magnitude of the moment in the nondominant limb. These findings imply symmetry between these moments and may have important implications when collecting data for limb analyses among healthy subjects. Whether gait symmetry protects against the onset of unilateral (or increases the risk for bilateral) pathological joint changes will need to be confirmed longitudinally.     

Evaluation of Risk Factors Predicting Chemotherapy-Related Nausea and Vomiting: Results From a European Prospective Observational Study

ContextDemographic, personal, clinical, and behavioral factors predicting chemotherapy-induced nausea and vomiting (CINV) have been assessed in the past, but inconsistencies exist in the literature, studies have methodological shortcomings, and many risk factors have been examined in cross-sectional studies and univariate analyses.ObjectivesTo evaluate the predictive power of personal and treatment-related characteristics in the development of CINV, using a large and prospectively evaluated sample of a heterogeneous group of cancer patients receiving routine chemotherapy.MethodsThis was a multicountry, multisite prospective study over three cycles of chemotherapy. Adult patients from eight European countries about to receive highly and moderately emetogenic chemotherapy were recruited. Clinicians completed a case report form at or before the initial chemotherapy treatment, recording patient demographic and baseline clinical characteristics. Participants completed a daily patient diary for six days per chemotherapy cycle describing their CINV experience. Baseline patient data also included a history of nausea/vomiting (yes/no), patient expectation of nausea (0–100 mm visual analogue scale [VAS]), prechemotherapy anxiety (0–100 mm VAS), and prechemotherapy nausea (0–100 mm VAS) measured during the 24-hour period before chemotherapy initiation.ResultsThere were 991 evaluable patients with complete Cycle 1 data, 888 for Cycle 2 data, and 769 for Cycle 3 data. A complex picture of predictor variables was shown, with different contribution of variables to the acute, delayed, and overall phases of CINV. Key predictor variables included the use of antiemetics inconsistent with international guidelines, younger age, prechemotherapy nausea, and no CINV complete response in an earlier cycle (all at P < 0.05). Anxiety, history of nausea/vomiting, and expectations of nausea were important predictors for some phases and cycles but not consistently across the CINV pathway.ConclusionThe results of this study provide clarity for the relative contribution of a set of characteristics in the development of CINV. Following evidence-based clinical antiemetic guidelines is of paramount importance, alongside treating patients with increased risk for CINV more aggressively, which both could lead to more optimal CINV management. These data can assist clinicians in making decisions about the antiemetic management of their patients.     

老年脑血管病跌倒患者平衡与步态的评定分析及护理对策

目的 了解并分析老年脑血管病跌倒患者的平衡能力,提出针对性的护理措施,指导临床预防跌倒,保证护理安全。方法对52例老年脑血管病患者进行跌倒情况调查,采用Tinetti平衡与步态评定量表评定其平衡与步态,寻找跌倒发生与平衡能力各因素之间的关系。结果有87．6％的老年脑血管病患者平衡及步态两者相加总分〈19分,显示有跌倒的危险,即刻站立平衡、转立平衡、胸部轻推反应、闭眼站立平衡不能很好完成者居多。其中在即刻站立平衡、转立平衡上跌倒≥3次者比跌倒1次者下降明显,有显著差异（P〈0．05）。结论老年脑血管病患者在即刻站立及转立时容易发生多次跌倒,该两方面是护理人员预防工作的重点。详细观察老人平衡功能和步态,可为采取护理措施提供良好的依据。     

Depressive Symptoms and Risk of Type 2 Diabetes in a National Sample of Middle-Aged and Older Adults: The English Longitudinal Study of Aging

OBJECTIVE

To examine the association between baseline elevated depressive symptoms and incident type 2 diabetes in a national sample of people aged ≥50 years.

RESEARCH DESIGN AND METHODS

The sample consisted of 6,111 individuals free from self-reported doctor-diagnosed diabetes at baseline in 2002–2003. The eight-item Center for Epidemiological Studies–Depression (CES-D) scale was the measurement of depressive symptoms. Cox proportional hazards regression models were used to assess whether baseline elevated (≥4) depressive symptoms were associated with a higher risk of type 2 diabetes over 45.8 months of follow-up.

RESULTS

The hazard ratio (HR) for diabetes was 1.62 (95% CI 1.15–2.29) in a model adjusted for age, sex, marital status, education, total net household wealth, cardiovascular and psychiatric and other noncardiovascular comorbidities, BMI, and health behaviors for participants with elevated CES-D symptoms compared with those without. Complementary analysis performed for a subsample (n = 5,090) showed that additional adjustment of this model for use of antidepressants did not explain the association (HR 1.58, 95% CI 1.09–2.29).

CONCLUSIONS

Elevated depressive symptoms were associated with a higher risk of developing type 2 diabetes after accounting for sociodemographic, lifestyle, and clinical factors in a national sample of people aged ≥50 years.Depression is a known comorbid condition of diabetes. Individuals with diabetes have increased odds of being depressed and consistently higher prevalence rates of depression than their counterparts without diabetes (1). An accumulating body of research shows that type 2 diabetes is a risk factor for recurrent depression (2), but longitudinal studies also suggest that depression and elevated depressive symptoms are related to subsequent incidence of diabetes (3–10). Two recent meta-analyses of longitudinal studies suggest that depression is associated with a 40–60% increased risk of developing type 2 diabetes (11,12). The etiology and pathogenic mechanism of this association is poorly understood. It has been suggested that unhealthy behaviors (i.e., physical inactivity and smoking), obesity, and use of psychotropic medication may be parts of the causal pathway linking depression to type 2 diabetes (3,11,13).The majority of previous longitudinal studies on the association between depressive symptoms and incident diabetes have not accounted adequately for socioeconomic status (SES), and therefore their results might be biased because of residual confounding. They have also generally failed to account for baseline comorbidities such as cardiovascular, noncardiovascular, and psychiatric diseases, which might explain the association between depression and diabetes. Moreover, more research is needed on the use of antidepressants and other psychotropic medication as a depression-related risk factor for diabetes in older samples, since evidence on this issue is conflicting (6,8,9,14).We used data from the English Longitudinal Study of Aging (ELSA), a national prospective cohort study of community-dwelling middle-aged and older men and women, to examine whether baseline elevated depressive symptoms measured by the Center for Epidemiological Studies–Depression (CES-D) scale were associated with a higher risk of developing type 2 diabetes. We adjusted for a wide range of potential confounders including education and wealth as markers of SES and baseline comorbidities including psychiatric diseases. We then explored whether health behaviors, BMI, and use of antidepressants or other psychotropic medication mediated the association between elevated baseline depressive symptoms and incident type 2 diabetes.