Metabolic syndrome and risk of dementia in older adults.

OBJECTIVES: To investigate the association between metabolic syndrome (MetS; a clustering of cardiovascular risk factors including abdominal obesity, hypertension, dyslipidemia, and hyperglycemia, each of which has been individually associated with dementia) and incident dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older adults before and after the age of 75. DESIGN: Prospective population-based cohort. SETTING: An Italian municipality. PARTICIPANTS: A community-based sample of 749 subjects aged 65 and older who, in 1999/2000, were free of cognitive impairment and, in 2003/04, underwent follow-up for incident dementia. MEASUREMENTS: The relationship between incident overall dementia, AD, and VaD and MetS. Dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. MetS was defined according to the National Cholesterol Education Program criteria. RESULTS: Risk of overall dementia and its subtypes was not associated with MetS or any MetS component in participants younger than 75. In participants aged 75 and older, MetS was associated with a lower risk of AD (hazard ratio (HR)=0.33, 95% confidence interval (CI)=0.12-0.94) but not of VaD, and abdominal obesity was associated with a lower risk of overall dementia (HR=0.53, 95% CI=0.28-0.98). CONCLUSION: MetS measured in late life is not associated with risk of dementia. After age 75, persons with MetS may even be at lower risk for AD.

An index of self-rated health deficits in relation to frailty and adverse outcomes in older adults.

BACKGROUND AND AIMS: Poor self-rated health is associated with adverse outcomes but its relationship with frailty is not completely understood. We examined how self-rated health (SRH) is related to health outcomes and how this relationship might differ by individual level of fitness or frailty in older people. METHODS: In the Atlantic Canada sample of the Canadian Study of Health and Aging, individuals aged > or =65 (n=1318) completed a self-administered questionnaire, from which we constructed an index of self-rated health deficits (SRHDI). Heterogeneity in health status was evaluated (n=1260) by determining their Frailty Index (FI). Higher values on the FI indicate worse health status. We evaluated health attitudes in relation to other health markers and to mortality. RESULTS: Comparing those with the lowest vs highest SRHDI, significant differences (p<0.001) were seen in the mean hospital admissions in the past year (0.2 (+/-0.02) vs 0.8 (+/-0.08)), 3MS cognitive score (85.0 (+/-0.5) vs 78.4 (+/-1.2)) and (p=0.003) for age (75.3 (+/-0.3) vs 77.1 (+/-0.6)). The SRHDI and FI were moderately correlated (r=0.49) and both predicted mortality. In the fittest older people, those with poor SRHDI had a significantly increased risk of death (OR=18, 95% CI 6.0-53.6); SRHDI did not affect mortality in those who were frail. CONCLUSIONS: Measuring SRH by an index of deficits is a valid construct and is associated with adverse health outcomes. The SRHDI may facilitate exploration of the complex relationships between illness burden and health outcomes in older people.When people are frail, worse health attitude does not seem to increase mortality, but in contrast, appears to increase mortality risk in fit older people.

Prevalent depressive symptoms as a risk factor for conversion to mild cognitive impairment in an elderly Italian cohort.

OBJECTIVE: To examine the association between depressive symptoms and prevalent and incident mild cognitive impairment (MCI) in elderly individuals; to verify whether it is affected by MCI subtype. DESIGN: Prospective, population-based, longitudinal cohort study. SETTING: Adults >or=65 years resident in an Italian municipality. PARTICIPANTS: Baseline data are for 595 subjects with no cognitive impairment (NCI) and 72 subjects with prevalent MCI. NCI subjects underwent a 4-year follow-up for incident MCI. MEASUREMENTS: MCI was diagnosed according to international criteria and classified as with (m + MCI) or without memory impairment (m - MCI). Baseline depressive symptoms were measured using the 30-item Geriatric Depression Scale (GDS). Baseline use of antidepressants was also recorded. RESULTS: Baseline depressive symptoms (GDS >or=10) were more frequent in prevalent MCI cases (44.4%) than in NCI participants (18.3%). The association was independent of MCI subtype, antidepressant use, and sociodemographic and vascular risk factors. In NCI subjects, baseline depressive symptoms were also associated with increased risk of MCI at follow-up, but only for subjects on antidepressant drugs at baseline (incident cases = 72.7%) compared with those without depressive symptoms and not on antidepressant therapy (incident cases = 24.0%). The association was independent of other confounders and stronger for m - MCI (incident cases = 45.4%) with respect to m + MCI (incident cases = 27.3%). CONCLUSIONS: Depressive symptoms are highly prevalent among elderly MCI subjects and, in cognitively normal elderly individuals, are associated with an increased risk of developing MCI. The association is stronger for the MCI subtype without memory impairment.

Plasma tocopherols and risk of cognitive impairment in an elderly Italian cohort.

BACKGROUND: Evidence that vitamin E may preserve cognitive function in elderly subjects is conflicting. The most abundant and most investigated form of vitamin E in humans is alpha-tocopherol, but other antioxidant tocopherols (beta, gamma, and delta) exist in nature. OBJECTIVE: We aimed to investigate plasma concentrations of the natural tocopherols and the tocopherol oxidation markers alpha-tocopherylquinone (alphaTQ) and 5-nitro-gamma-tocopherol (5NGT) in relation to cognitive function in the elderly. DESIGN: Baseline plasma tocopherols and their oxidation markers were measured in 761 elderly Italian subjects from a population-based cohort assessed in 1999-2000 for mild cognitive impairment (MCI) and dementia. In 2003-2004, information about cognitive status was collected for 615 of the 666 subjects without baseline cognitive impairment. Tocopherols and oxidation markers were analyzed as plasma absolute values divided by serum total cholesterol because lipids affect their blood availability. Analyses were adjusted for sociodemographic, genetic, lifestyle, and medical confounders. RESULTS: Compared with the corresponding lowest tertile, the risk of prevalent dementia was higher for the highest tertile of delta-tocopherol/cholesterol [odds ratio (OR): 3.87; 95% CI: 1.46, 10.27] and alphaTQ/cholesterol (4.02; 1.45, 11.14), but the risk of incident dementia was not directly associated with plasma vitamin E metabolites. A U-shaped association, with lower risk for intermediate tertiles, was found for prevalent MCI with 5NGT/cholesterol (0.39; 0.17, 0.91) and for incident dementia with gamma-tocopherol/cholesterol (hazard ratio: 0.42; 95% CI: 0.22, 0.84). CONCLUSIONS: Plasma concentrations of some non-alpha-tocopherol forms of vitamin E are associated with cognitive impairment in elderly people. However, the associations depend on concurrent cholesterol concentration and need further investigation.

Development of an easy prognostic score for frailty outcomes in the aged.

BACKGROUND: identification of frailty is recommended in geriatric practice. However, there is a lack of frailty scores combining easy-to-collect predictors from multiple domains. OBJECTIVE: to develop a frailty score including only self-reported information and easy-to-perform standardised measurements recommended in routine geriatric practice. DESIGN: prospective population-based study. SETTING/PARTICIPANTS: included 1,007 Italian subjects aged 65 and over. MEASUREMENTS: seventeen baseline possible mortality predictors from several domains, 4-year risk of mortality and other adverse health outcomes associated with frailty [fractures, hospitalisation, and new and worsening activities of daily living (ADL) disability]. METHODS: a multivariate Cox model was used to identify the best sub-group of independent predictors and to develop a mortality prognostic score, defined as the number of adverse predictors present. Logistic regression was used to verify whether the score also predicted risk of other frailty outcomes in the cohort survivors. RESULTS: nine independent mortality predictors were identified. Among subjects with score > or =3, each one point increase in the score was associated with a doubling in mortality risk and, among survivors, with an increased risk of all the other adverse health outcomes. CONCLUSIONS: nine easy-to-collect predictors may identify aged people at increased risk of adverse health outcomes associated with frailty.

Mild cognitive impairment: epidemiology and dementia risk in an elderly Italian population.

OBJECTIVES: To investigate prevalence and incidence of mild cognitive impairment (MCI) and its risk of progression to dementia in an elderly Italian population. DESIGN: Longitudinal. SETTING: Population-based cohort aged 65 and older resident in an Italian municipality. PARTICIPANTS: A total of 1,016 subjects underwent baseline evaluation in 1999/2000. In 2003/04, information about cognitive outcome was collected for 745 participants who were free of dementia at baseline. MEASUREMENTS: MCI (classified as with or without impairment of the memory domain), dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) diagnosed according to current international criteria. RESULTS: Overall prevalence of MCI was 7.7% (95% confidence interval (CI)=6.1-9.7 %) and was greater with older age and poor education. During 4 years of follow-up, 155 incident MCI cases were diagnosed, with an incidence rate of 76.8 (95% CI=66.8-88.4) per 1,000 person-years. Approximately half of prevalent and incident MCI cases had memory impairment. Compared with normal cognition, multivariable-adjusted risk for progression from MCI with memory impairment to dementia was 4.78 (95% CI=2.78-8.07) for any dementia, 5.92 (95% CI=3.20-10.91) for AD, and 1.61 (95% CI=0.37-7.00) for VaD. No association with dementia risk was found for MCI without memory impairment. Approximately one-third of MCI cases with memory impairment did not progress to dementia. CONCLUSION: MCI occurs often in this elderly Italian cohort and is associated with greater risk of AD, but only when the impairment involves the memory domain. However, a substantial proportion of MCI cases with memory impairment do not progress to dementia.