ABSTRACT
Alterations in the hypothalamic-pituitary-adrenal axis have been noted in people with Alzheimer disease (AD) and in the people caring for them. In a case-control study, we assessed whether the cortisol response at awakening and diurnal cortisol would reflect these changes. AD patients, their caregivers, and healthy senior noncaregivers collected saliva within 5 minutes of waking, 30 minutes after waking, before lunch, 1 hour after lunch, and at 11 pm or when getting ready for bed. They also completed a Perceived Stress Scale. Total cortisol for the day after adjusting for antidepressant use revealed a group effect [F(2,39)=12.49, P<0.0001], with mild AD patients and caregivers having higher cortisol values. Unlike the noncaregivers (t=-1.15, df=14, P>0.27), both cortisol values of the AD caregivers (t=-2.96, df=16, P<0.03) and the AD patients' (t=-2.5, df=14, P<0.01) increased between awakening and 30 minutes afterward. There were also group differences at awakening [F(2,48)=4.6, P=0.012] adjusting for antidepressant use and 30 minutes after waking adjusting for antidepressant use and awakening cortisol [F(2,46)=4.7, P=0.014<0.02). AD patients (r=0.45, P=0.08) and caregivers (r=0.44, P=0.10) with higher cortisol values 30 minutes after waking also showed a trend toward higher perceived stress scores. Salivary cortisol and cortisol response on awakening may enhance future studies relating free cortisol to subjective psychologic and physiologic markers.
Subject(s)
Alzheimer Disease/metabolism , Hydrocortisone/metabolism , Saliva/chemistry , Wakefulness/physiology , Aged , Aged, 80 and over , Alzheimer Disease/nursing , Caregivers/psychology , Case-Control Studies , Female , Humans , Hydrocortisone/analysis , Hypothalamo-Hypophyseal System/physiopathology , Male , Pituitary-Adrenal System/physiopathology , Saliva/metabolism , Stress, PsychologicalABSTRACT
To evaluate the potential effects of medications with central nervous system (CNS) activity on cognitive function and fatigue in multiple sclerosis (MS), we performed a retrospective analysis of medication use among 70 subjects with MS who were participating in a clinical trial for evaluation of the effects of yoga and exercise programs on cognition and fatigue. Among these MS subjects, 74% were taking at least one potentially CNS-active medication. These 70 subjects were divided into two groups: those taking at least one CNS-active medication (n = 52) and those not on any medications with potential CNS activity (n = 18). We compared assessments of cognitive function and fatigue using an analysis of covariance. MS subjects on CNS-active medication had greater impairment on measures of processing speed, sustained attention, and fatigue than those not on these medications. While these findings do not establish a causal relationship between medication use and cognitive impairment and fatigue, the data indicate that researchers need to control for use of CNS-active medications when conducting studies of cognitive impairment and fatigue in MS subjects.
Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/epidemiology , Fatigue Syndrome, Chronic/epidemiology , Multiple Sclerosis/drug therapy , Multiple Sclerosis/epidemiology , Adult , Age Distribution , Drug Therapy, Combination , Fatigue Syndrome, Chronic/diagnosis , Female , Humans , Incidence , Male , Mental Processes/drug effects , Middle Aged , Multiple Sclerosis/psychology , Multivariate Analysis , Neuropsychological Tests , Probability , Prognosis , Quality of Life , Risk Assessment , Sex Distribution , Treatment OutcomeABSTRACT
OBJECTIVE: To analyze dietary supplement usage data from 494 older adults, aged 65 to 101 years. SETTING: Community dwellers living independently of institutionalized care. DESIGN: All dietary supplements, including botanicals, were recorded to aid in assessing the health status of older adults. PARTICIPANTS: 1) 224 individuals enrolled in a study that follows the health of persons 85 years and older (oldest-old) in Klamath County, a non-metropolitan area in southern Oregon; 2) 134 participants of oldest-old age living in the metropolitan Portland area, enrolled in a randomized clinical trial of GBE biloba extract (GBE) for dementia prevention; and 3) 136 participants, ages 65-85 years (young-old), also of the Portland area, enrolled in a study of the effects of yoga and exercise on cognition. MEASUREMENTS: Data verified from labels, not from self-report. RESULTS: Of the participants, 70.6% used dietary supplements. Women took supplements more often than men, and usage decreased with age. A greater percentage, 67.4%, of the non-metropolitan oldest-old took supplements, compared to 56.7% of the metropolitan oldest-old. The greatest usage, 89.7%, was in the metropolitan young-olds. All of these percentages exceed those for comparable age groups in national representative surveys. CONCLUSIONS: Dietary supplement usage by older adults in these studies in Oregon exceeded that in other reports and may reflect high interest in complementary and alternative medicine. This report confirms the results of other studies showing that elderly adults, particularly women, use dietary supplements more than other segments of the US population. Researchers and clinicians should be aware of this pattern and potential conflicts with research design or treatment regimen intended for older people.
