Ethnic Differences in Singapore's Dementia Prevalence: The Stroke,Parkinson's Disease,Epilepsy, and Dementia in Singapore Study

OBJECTIVES: To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians. DESIGN: A two‐phase, cross‐sectional study of randomly selected population from central Singapore with disproportionate race stratification. SETTING: Community‐based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers. PARTICIPANTS: Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate). MEASUREMENTS: The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders—Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke—Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively. RESULTS: The overall age‐ and race‐standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10–1.45). Prevalence (in 5‐year age bands) was 0.08% (50–54), 0.08% (55–59), 0.44% (60–64), 1.16% (65–69), 1.84% (70–74), 3.26% (75–79), 8.35% (80–84), and 16.42% (≥85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese. CONCLUSION: Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.     

Primary Care Providers' Views of Challenges and Rewards of Dementia Care Relative to Other Conditions

OBJECTIVES: To compare primary care providers' (PCPs') perceptions about dementia and its care within their healthcare organization with perceptions of other common chronic conditions and to explore factors associated with differences. DESIGN: Cross‐sectional survey. SETTING: Three California healthcare organizations. PARTICIPANTS: One hundred sixty‐four PCPs. MEASUREMENTS: PCPs' views about primary care for dementia were analyzed and compared with views about care for heart disease, diabetes mellitus, and selected other conditions. Differences in views about conditions according to PCP type (internists, family physicians) were assessed. Multivariate analysis examined relationships between provider and practice characteristics and views about dementia care. RESULTS: More PCPs strongly agreed that older patients with dementia are difficult to manage (23.8%) than for heart disease (5.0%) or diabetes mellitus (6.3%); PCPs can improve quality of life for heart disease (58.9%) and diabetes mellitus (61.6%) than for dementia (30.9%); older patients should be routinely screened for heart disease (63.8%) and diabetes mellitus (67.7%) than dementia (55.5%); and their organizations have expertise/referral resources to manage diabetes mellitus (49.4%) and heart disease (51.8%) than dementia (21.1%). More PCPs reported almost effortless organizational care coordination for heart disease (13.0%) or diabetes mellitus (13.7%) than for dementia (5.6%), and a great deal or many opportunities for improvement in their ability to manage dementia (50.6%) than incontinence, depression, or hypertension (7.4–34.0%; all P<.05). Internists' views regarding dementia care were less optimistic than those of family physicians, but PCP type was unrelated to views on diabetes mellitus or heart disease. CONCLUSION: Improving primary care management of dementia should directly address PCP concerns about expertise and referral resources, difficulty of care provision, and PCP views about prospects for patient improvement.     

Neurofibrillary degeneration and neuronal loss in alzheimer's disease

Neuronal loss in Alzheimer's disease, especially in cerebral cortex and hippocampus, appears closely associated with the process of neurofibrillary degeneration. In certain noncortical nuclei neuronal loss appears not to depend upon the formation of neurofibrillary tangles. Neurofibrillary tangles and neurons were counted in the same populations of neurons in five brain regions. In the locus ceruleus and nucleus basalis, where tangles have a loose or globose structure, correlations with neuronal counts were not significant. In cerebral cortex and hippocampus, tangles have a more dense and often a flame-like appearance and their correlations with neuronal counts were significant. The relationships between tangles and noncortical neurons reported here suggest that the appearance of tangles does not necessarily herald the demise of a neuron in Alzheimer's disease. It can be reasonably anticipated that these relationships depend upon the clinical heterogeneity of Alzheimer's disease, regional differences in the brain and/or the macromolecular composition of neurofibrillary tangles.     

Exercise Training and Plasma C‐Reactive Protein and Interleukin‐6 in Elderly People

OBJECTIVES: To determine the effects of a long‐term exercise intervention on two prominent biomarkers of inflammation (C‐reactive protein (CRP) and interleukin‐6 (IL‐6)) in elderly men and women. DESIGN: Single‐blind, randomized, controlled trial: The Lifestyle Interventions and Independence for Elders (LIFE) Trial. SETTING: The Cooper Institute, Dallas, Texas; Stanford University, Stanford, California; University of Pittsburgh, Pittsburgh, Pennsylvania; and Wake Forest University, Winston‐Salem, North Carolina. PARTICIPANTS: Four hundred twenty‐four elderly (aged 70–89), nondisabled, community‐dwelling men and women at risk for physical disability. INTERVENTION: A 12‐month moderate‐intensity physical activity (PA) intervention and a successful aging (SA) health education intervention. MEASUREMENTS: CRP and IL‐6. RESULTS: After adjustment for baseline IL‐6, sex, clinic site, diabetes mellitus, treatment group, visit, and group‐by‐visit interaction, the PA intervention resulted in a lower (P=.02) IL‐6 concentration than the SA intervention. Adjusted mean IL‐6 at month 12 was 8.5% (0.21 pg/mL) higher in the SA than the PA group. There were no significant differences in CRP between the groups at 12 months (P=.09). Marginally significant interaction effects of the PA intervention according to baseline functional status (P=.05) and IL‐6 (above vs below the median; P=.06) were observed. There was a greater effect of the PA intervention on participants with lower functional status and those with a higher baseline IL‐6. CONCLUSION: Greater PA results in lower systemic concentrations of IL‐6 in elderly individuals, and this benefit is most pronounced in individuals at the greatest risk for disability and subsequent loss of independence.     

Serum ionized calcium, intact PTH and novel markers of bone turnover in bedridden elderly patients

Abstract. Chronic immobilization could markedly affect calcium and bone metabolism in elderly people. To investigate this, and to test the theory of ‘type II’ osteoporosis in bedridden elderly patients with low vitamin D status, 55 such subjects were examined. Serum concentrations of ionized calcium (Ca⁺⁺), intact parathyrin (PTH) and two novel markers of bone collagen formation (carboxyterminal propeptide of type I procollagen; PICP) and resorption (carboxyterminal crosslinked telopeptide of type I collagen; ICTP) were measured. The effects on these parameters after 40 weeks of supplementation with vitamin D (1000 IU d^-1) and/or calcium (1g d^-1) were subsequently prospectively evaluated. Despite low (mean 11·6 nmol l^-1) serum 25-hydroxyvitamin D levels (25-OHD), those of 1,25-dihydroxy-vitamin D (1,25-(OH)₂D) were mostly normal. Neither correlated with Ca⁺⁺ or PTH. PTH correlated negatively not only with Ca⁺⁺ (r=–0·328, P < 0·05) but also with ICTP (r=–0·306, P < 0·05). Mean PICP was normal but ICTP was elevated and tended to correlate positively with Ca⁺⁺ (r=–0·268, P= 0·06). Vitamin D supplementation did not change PICP or ICTP considerably, despite slightly increased 1,25-(OH)₂D and slightly decreased PTH. Ca⁺⁺ values were normal and remained stable. In conclusion, Ca⁺⁺ and PTH are poor indicators of vitamin D status in chronically immobilized elderly subjects. Furthermore, the results suggest that the increased bone resorption is not due to ‘type II’ secondary hyperparathyroidism; rather the resorption is primarily increased. Correction of vitamin D deficiency does not seem to benefit ageing bones unless adequate mechanical loading is provided.     

阿尔茨海默病的康复治疗

目的　探讨康复治疗对阿尔茨海默病 (AD)患者的有效性。方法　将 63例轻、中度AD患者分成 2组进行为期 8周的临床治疗 ,即康复组 (2 9例 )进行康复治疗 ,药物组 (3 4例 )应用盐酸多奈哌齐进行药物治疗。应用简易智能精神状态检查量表 (MMSE)、AD评定量表 (ADAS)及Blessed Roth痴呆量表判定疗效。结果　康复组患者的日常生活自理能力改善 (P <0 .0 5) ;药物组的认知功能 :MMSE较治疗前提高 3 .9分 (P <0 .0 5) ,ADAS认知部分 (ADAS cog)改善 4.8分 (P <0 .0 5) ,日常生活自理能力无明显变化 ,其中 2例(5.88% )出现轻度副作用 ;2组经治疗后的MMSE、ADAS认知部分和Blessed Roth评分进行比较 ,差异均有显著性意义 (P <0 .0 5)。结论　康复治疗能改善AD患者的日常生活自理能力 ;盐酸多奈哌齐可改善AD患者的认知功能 ,减轻痴呆的病情 ;整个治疗过程安全性好 ;康复干预应采取综合措施     

Nutrition of old people in sheltered housing

Two hundred and thirty-five sheltered housing tenants (59 men and 176 women) were investigated by using the 24-h dietary recall and checklist devised by the Nutrition Advisory Group on the Elderly (NAGE) to estimate their energy and nutrient intakes, and by measuring their body weight and demi-span to calculate ratios of weight to demi-span. Sixty seven per cent had energy intakes below the mean previously recorded in a national survey of old people living at home, but most had an adequate intake of protein, while, in 44%, the proportion of energy consumed as fat exceeded 35%. For most nutrients, few tenants had intakes below the lower recommended nutrient intake (LRNI). Exceptions were that there were 64% with pyridoxine intakes and 63% with vitamin D intakes below this level. Only 18% of men but 74% of women had weight to demi-span ratios below the means recorded in elderly people living at home in another recent survey. There was no correlation between these anthropometric ratios and energy intakes.