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.     

血压昼夜变化与动脉硬化指数的关系

目的 探讨血压昼夜节律改变与动脉硬化的关系.方法 收集2004～2008年行24 h动态血压监测的住院患者的动态血压数据及相关资料,并进行统计分析.结果 在调整性别、年龄、降压治疗、24 h脉率及平均动脉压前后,242例患者中非杓型(n=103)、反杓型(n=42)和超杓型(n=12)与杓型患者(n=85)相比,动态动脉硬化指数和24 h脉压均显著升高,而年龄、血糖、尿酸、总胆固醇及甘油三酯等差异无显著性(P>0.05).结论 血压昼夜节律的改变与动脉硬化相关.