Community-dwelling Elderly Subjects Research Articles

Cognitive and Behavioral Correlates of Low Vitamin B12 Levels in Elderly Patients With Progressive Dementia

Vitamin B12 deficiency is common in elderly persons, yet its role in dementia and psychiatric illness is unclear. The authors examined the relationship between vitamin B12 serum levels and cognitive and neuropsychiatric symptoms in dementia. Community-dwelling elderly subjects (N=643) meeting NINCDS-ADRDA criteria for probable or possible Alzheimer disease (AD) underwent comprehensive neuropsychiatric evaluation and measurement of vitamin B12 serum levels. Thirty-seven subjects (5.7%) had low B12 serum levels (200 pcg/ml or less). Subjects with low B12 levels were significantly older and had significantly lower scores on the Mini-Mental State Exam and higher scores on the Blessed Dementia Scale, but not a different pattern of cognitive or behavior disturbances compared with the normal-B12 subjects. In AD, the prevalence of low vitamin B12 serum levels is consistent with that found in community-dwelling elderly persons in general but is associated with greater overall cognitive impairment.

Nocturnal Blood Pressure Predicts Left Ventricular Mass Index in Normotensive Elderly

Blood pressure (BP) predictors of left ventricular mass index (LVMI) were studied in 40 healthy normotensive (71.4 - 4.4 years) and 31 hypertensive (73.5 - 4.8 years) elderly community-dwelling subjects using short-axis cardiac cine magnetic resonance imaging and 24-h ambulatory BP monitoring. Mean night-time BPs were calculated from the average of readings during sleep and mean daytime BPs were calculated from the remaining recordings. The hypertensive subjects were all receiving anti-hypertensive therapy with angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers, beta-blockers or diuretics. Nocturnal systolic BP was a strong predictor of LVMI in both normotensive ( g = 0.38, p = 0.02) and treated hypertensive ( g = 0.39, p = 0.03) subjects. By contrast, daytime systolic BP was a weaker predictor of LVMI in the treated hypertensives ( g = 0.36, p = 0.04) and did not predict LVMI in the normal subjects ( g = 0.27, NS). Nocturnal BP may partly explain the increase in LVMI with ageing in subjects thought to be normotensive on the basis of daytime clinic BP recordings.

ＭＲＩで検出される深部白質病変・虚血性病変：地域在住高齢者の頭部ＭＲＩ所見から

To obtain relevant data on "silent" lesions found in health screening of the brain, we analyzed findigns on magnetic resonance imaging in 539 community dwelling elderly subjects with a mean age of 66 years. The prevalence of silent brain infarction and deep white matter lesions were 12.4% and 32.1%, respectively. Multivariate analysis with a logistic regression model revealed that silent brain infarction was significantly associated with age, male gender, and hypertension. Recently, elevated plasma homocysteine levels were suggested to be an independent risk factor for silent brain infarction. Particular attention should be payed to such potentially treatable or modifiable factors for ischemic lesions in the setting of health screening of the brain. With regard to deep white matter lesions, data on prevalence or pathogenetic factors are often controversial. One source of conflicting results in white matter hyperintensities on magnetic resonance imaging would be the differences in visual rating scale. In our experience, multivariate analysis revealed that deep white matter lesions were significantly associated with age, hypertension, total cholesterol, and decreased plasma tryptophan concentrations. A further important point in health screening of the brain is an early detection of cognitive decline at its mild stage to prevent the future development of dementia. Based on the clinical evidence accumulated in health screening of the brain, we need to work out a better strategy of preventing subsequent symptomatic stroke or vascular cognitive impairment.

A Preliminary Investigation to Explore the Effects of Daytime Physical Activity Patterns on Health-Related QOL in Healthy Community-Dwelling Elderly Subjects

A Preliminary Investigation to Explore the Effects of Daytime Physical Activity Patterns on Health-Related QOL in Healthy Community-Dwelling Elderly Subjects

A Preliminary Investigation to Explore the Effects of Daytime Physical Activity Patterns on Health-Related QOL in Healthy Community-Dwelling Elderly Subjects

The purpose of this study was to determine if different lifestyles of healthy elderly subjects would exert some influence on their daytime physical activity patterns and health-related QOL. Sixty-nine elders were categorized into age-gender, marital status, and body mass index (BMI)-matched groups by lifestyle; 12 males living alone (MA), 20 males living with spouse (MS), 16 females living alone (FA), and 21 females living with spouse (FS). Daytime physical activity (DPA) was recorded with the actigraph: a wrist-worn device. Health-related QOL scales consisted of Zung Self-Rating Depression Scale (SDS), Life Satisfaction Index-Z (LSI), and Visual Analogue Scale of Happiness.Among the four lifestyles, statistical analysis revealed a significant difference in SDS and LSI (both, p < 0.05), and DPA (p < 0.01). Trends in these parameters characteristically indicated that (1) the greatest SDS and the lowest others were observed in MA, compared with FA and (2) greater SDS and DPA, and lower LSI, were shown in FS than MS. The current findings demonstrate that lifestyle of the elderly subjects residing in urban wards might appreciably exercise influences on QOL and physical activity. The preliminary study suggests that more attention to daily physical activity and lifestyle of healthy community-dwelling elderly subjects may not be less efficacious than conventional care in rehabilitative intervention, but the characteristics of elderly handicapped subjects remain unclear.

Blood pressure variability over year and gene polymorphism of the renin-angiotensin system in community-dwelling elderly subjects

Blood pressure variability over year and gene polymorphism of the renin-angiotensin system in community-dwelling elderly subjects

Clock drawing test: correlation with linear measurements of CT studies in demented patients

To investigate a presumed correlation between clock drawing ratings and linear measurements of computerized tomography (CT) studies in demented patients. Blinded evaluations of clock drawing tests and CT studies of elderly dementia patients were conducted by a geriatric psychiatrist and a neuroradiologist. Fifty-one community-dwelling elderly subjects meeting the criteria for DSM-IV diagnosis of dementia (Alzheimer's type dementia: N=31; vascular dementia: N=15; "mixed" type dementia: N=5). Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clinical Dementia Rating (CDR). CAMCOG derived scored clock drawings were evaluated using adaptations of Shulman et al.'s and Freedman et al.'s methods. CT studies were evaluated using six different linear measurements of brain atrophy described in the literature. Of the CT linear measurements, only the Cerebro-Ventricular Index-2 (CVI-2; bicaudate index) significantly correlated with clock drawing ratings (CAMCOG's clock r=-0.407, p=0.003; Shulman's method r=0.357, p=0.01, Freedman's method r=-0.413, p=0.003) in the dementia group. There was no significant correlation between CVI-2 with demographic (age), cognitive (MMSE, CAMCOG) and clinical (duration of illness, CDR) ratings. Alzheimer's patients generally maintained a significant correlation between CVI-2 and clock drawings, but vascular dementia patients did not; CVI-2 also correlated significantly with the Praxis subtest of the CAMCOG in dementia and Alzheimer's patients but not in the vascular dementia group. Similarly, multiple stepwise regression analysis showed that only CVI-2 but not the other radiological measures studied, was selected as the significant variable to correlated with clock drawing test ratings in the dementia group and Alzheimer's patients. Partial correlation analysis controlling for demographic and clinical variables shows that controlled variables had no significant effect on the relationship between clock drawing ratings and CVI-2. A single and easy to perform measure of caudate atrophy correlates specifically and consistently with impairments revealed in the clock drawing test and with a Praxis subtest, suggesting possible caudate involvement with clock drawings in dementia in general and of the Alzheimer's type in particular.

Leg extensor power and dehydroepiandrosterone sulfate, insulin-like growth factor-I and testosterone in healthy active elderly people.

We examined the association between quadriceps muscle function and serum levels of dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor I (IGF-I) and testosterone in a group of healthy elderly people. Fifty-three independent, community-dwelling elderly subjects (26 men and 27 women) aged from 66 to 84 years volunteered to participate in the study. Physical activity (PA) was evaluated by a questionnaire. Quadriceps maximal muscle power (Wmax) and optimal shortening velocity (v(opt)) were measured on a friction-loaded non-isokinetic cycle ergometer. The Wmax is expressed in relation to body mass (W(max/kg), W x kg(-1)), and in relation to the mass of the two quadriceps muscles (W(max/Quadr), W x kg(Quadr(-1))). In women, when adjusted for age, anthropometric measurements and PA indices, IGF-I correlated significantly with W(max/kg) (partial correlation: r = 0.59; P = 0.001), W(max/Quadr) (r = 0.58; P = 0.002) and v(opt) (r = 0.53; P = 0.004), whereas DHEAS was correlated significantly with W(max/kg) (r = 0.54; P = 0.003) and W(max/Quadr) (r = 0.58; P = 0.002). No such correlation was found in men. These findings indicate that in healthy elderly women lower values for quadriceps muscle Wmax and v(opt) are related, independently of age, anthropometric measurements and PA indices, to lower circulating levels of DHEAS and IGF-I.

Three-year prognosis of depression in the community-dwelling elderly

Depression is the most common mental disorder in the community-dwelling elderly. To determine the three-year prognosis of depression in a cohort of 127 community-dwelling elderly subjects and identify factors relevant to outcome. The subjects, diagnosed depressed at year 0 using the GMS-AGECAT package, were followed up three years later. A number of factors were investigated for an association with recovery from, or persistence of, depression. At follow-up, 30.2% of the depressed subjects had died, 34.9% had persistent or relapsed case-level depression, 24.5% had other case- or sub-case-level mental illness and 10.4% had recovered completely. Physical ill-health, bereavement and positive family history of depression were associated with poor outcome, whereas treatment with antidepressant medication significantly improved prognosis. Late-life depression in community-dwelling subjects is a chronic condition. However, the positive response to antidepressant medication suggests that it should be vigorously treated.

Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women?

To determine whether baseline lower extremity muscle weakness is a risk factor for incident radiographic osteoarthritis (OA) of the knee. This prospective study involved 342 elderly community-dwelling subjects (178 women, 164 men) from central Indiana, for whom baseline and followup (mean interval 31.3 months) knee radiographs were available. Lower extremity muscle strength was measured by isokinetic dynamometry and lean tissue (i.e., muscle) mass in the lower extremities by dual x-ray absorptiometry. Knee OA was associated with an increase in body weight in women (P = 0.0014), but not in men. In both sexes, lower extremity muscle mass exhibited a strong positive correlation with body weight. In women, after adjustment for body weight, knee extensor strength was 18% lower at baseline among subjects who developed incident knee OA than among the controls (P = 0.053), whereas after adjustment for lower extremity muscle mass, knee extensor strength was 15% lower than in the controls (P not significant). In men, in contrast, adjusted knee extensor strength at baseline was comparable to that in the controls. Among the 13 women who developed incident OA, there was a strong, highly significant negative correlation between body weight and extensor strength (r = -0.740, P = 0.003), that is, the more obese the subject, the greater the reduction of quadriceps strength. In contrast, among the 14 men who developed incident OA, a modest positive correlation existed between weight and quadriceps strength (r = 0.455, P = 0.058). No correlation between knee flexor (hamstring) strength and knee OA was seen in either sex. Reduced quadriceps strength relative to body weight may be a risk factor for knee OA in women.

Physical activity and dehydroepiandrosterone sulphate, insulin-like growth factor I and testosterone in healthy active elderly people.

to examine the association of physical activity and cardio-respiratory fitness with dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor I (IGF-I) and testosterone in healthy elderly people. cross-sectional study. university research department and department of geriatric medicine. 60 independent, community-dwelling elderly subjects (26 men and 34 women) aged 66-84 who volunteered to participate. physical activity was evaluated by the Questionnaire d'Activité Physique Saint-Etienne and expressed by three indices: mean habitual daily energy expenditure (MHDEE), daily energy expenditure (DEE) [comprising activities with intensities corresponding to at least three metabolic equivalents (MET; 3.5 ml.kg1 x min1 of oxygen consumption)] and sport activity. Cardio-respiratory fitness was expressed by maximal oxygen consumption (VO2max). In women, DHEAS correlated with VO2max (partial correlation: r=0.33; P=0.05), MHDEE (r=0.50; P=0.002), DEE > 3 METs (r=0.49; P=0.003) and sport activity (r=0.35; P=0.04) whereas IGF-I correlated with MHDEE (r=0.48; P=0.004). DHEAS was correlated with IGF-I (r=0.43; P < 0.02) and with testosterone (r=0.41; P < 0.02). No such correlation was found in men. lower habitual physical activity is related to lower levels of circulating DHEAS and IGF-I independently of age and anthropometric measures. Lower maximal aerobic capacity is associated with lower DHEAS concentrations, in healthy elderly women.

The association of plasma IL-6 levels with functional disability in community-dwelling elderly.

IL-6 is a multifunctional cytokine that has been shown to increase with age. Plasma IL-6 was measured by ELISA in 1,727 community-dwelling elderly subjects whose blood was drawn during the third in-person survey of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). Demographics, functional status (disability), and disease states were determined. Correlations of these factors with IL-6 were analyzed with Spearman's Rho while differences between groups were assessed by Wilcoxon test. IL-6 levels were higher with age (p = .0001) even in this older population (> 70 years). There was a positive correlation between IL-6 and functional disability for each of the functional status measures (p = .0001), as well as a correlation between self-rated health and IL-6. Significantly higher median levels of IL-6 were found in subjects reporting prevalent cancer, heart attack, and high blood pressure, but not diabetes or arthritis. The association between age and functional status with high IL-6 remained when all other variables were controlled, in multivariable analysis. This association between increased plasma IL-6 levels and functional status suggests that dysregulation of IL-6 may be related to the functional disability seen with aging, and that IL-6 may be useful as a component of an overall marker of health.

Mental health and health care utilization in geriatric primary care patients.

This study examines the effect of mental health factors on health care utilization in a group of community dwelling elderly subjects followed in a primary care setting. Data on utilization was obtained prospectively from computerized billing records for a one-year period following completion of a structured survey. Relationships between variables were characterized by Spearman's rank correlation. Multivariate linear regression modeling was employed to relate health care utilization, as measured by total cost, to the baseline variables. No significant relationship was found between mental health measures and health care utilization as measured by total costs in this elderly population. However, total costs were found to be related to medical comorbidity and total daily medication use. The present study did not find the relationship of psychiatric distress and increased use of health care services to apply to a group of community dwelling elderly. Future research will need to focus on larger data sets and improvement of models that attempt to examine the relationships between mental health and health care utilization in the elderly.

Increased gait unsteadiness in community-dwelling elderly fallers

Objective: To test the hypothesis that quantitative measures of gait unsteadiness are increased in community-dwelling elderly fallers. Study Design: Retrospective, case-control study. Setting: General community. Participants: Thirty-five community-dwelling elderly subjects older than 70 years of age who were capable of ambulating independently for 6 minutes were categorized as fallers (age, 82.2 ± 4.9yrs [mean ± SD]; n = 18) and nonfallers (age, 76.5 ± 4.Oyrs; n = 17) based on history; 22 young (age, 24.6 ± 1.9yrs), healthy subjects also participated as a second reference group. Main Outcome Measures: Stride-to-stride variability (standard deviation and coefficient of variation) of stride time, stance time, swing time, and percent stance time measured during a 6-minute walk. Results: All measures of gait variability were significantly greater in the elderly fallers compared with both the elderly nonfallers and the young subjects ( p < .0002). In contrast, walking speed of the elderly fallers was similar to that of the nonfallers. There were little or no differences in the variability measures of the elderly nonfallers compared with the young subjects. Conclusions: Stride-to-stride temporal variations of gait are relatively unchanged in community-dwelling elderly nonfallers, but are significantly increased in elderly fallers. Quantitative measurement of gait unsteadiness may be useful in assessing fall risk in the elderly.

Influence of dental status on dietary intake and survival in community-dwelling elderly subjects.

to evaluate the relationships between a functional measure of dental status (FDS), the nutrients intake profile (NIP) and mortality in a community elderly population. cross-sectional analysis for FDS and NIP and a prospective study for mortality. the central district of Brescia, northern Italy. of the entire cohort of 70-75-year-old elderly subjects living in the district (n = 1303), 1189 subjects were interviewed and examined at baseline. Fifty-two of these were lost to follow-up; data are presented for the remaining 1137 subjects. baseline data were collected by a door-to-door interview using a standardized questionnaire which included a section about the dietary intake in the 24 h preceding the interview. The 24-h NIP was calculated and compared with the US Food and Drug Administration's 1980 Recommended Dietary Allowances to obtain a percentage value of each nutrient for each respondent. The dental examination considered the direct assessment of the number and position of residual teeth as well as the use of dentures; subjects were classified into three groups: naturally adequate or naturally inadequate dentition and denture wearers. Association of NIP with FDS was computed using ANCOVA and multiple logistic regression models. Mortality data were collected over a 78-month follow-up period. Association of survival with FDS was estimated by Kaplan-Meier analysis and multivariate Cox proportional hazard models. multiple logistic regression showed a significant and independent association between the dental status and the intake of micronutrients, but not of macronutrients. Moreover, denture wearers had a dietary intake very similar to adequate dentition and substantially better than inadequate dentition. Inadequate dentition in women was associated with higher mortality than adequate dentition. In elderly women, both inadequate dental status and folate intake were significant and independent predictors of mortality in a multivariate analysis based on nutritional parameters. However, inadequate dentition did not remain an independent predictor of mortality in a general multivariate model. in this cohort of urban elderly people, FDS is significantly associated with the NIP and indirectly with mortality.

Napping in the elderly and its association with night sleep and psychological status.

The aim of this study was to assess the prevalence of daytime napping and its psychic, night sleep, and functional correlates in Italian community-dwelling elderly persons. A cross-sectional survey of community-dwelling elderly subjects was conducted with a multidimensional quality-of-life questionnaire administered by interviewers at the subjects' own homes. Participants were 223 community-dwelling elderly subjects, aged 75 and over, with a Mini-Mental State Examination score of 18 or more, living in Brescia, Italy. Statistical analysis was performed with logistic regression for estimates of the bivariate and multivariate associations of continuous independent variables with a dichotomous dependent variable (napping). Beta coefficients with 95% and 99% confidence interval (CI), and p values at Wald statistics, were computed. Napping once or more per week was reported by 23.8% of the sample. Napping was found to be independently and positively associated with obsessive-compulsive symptoms (beta = .86, 95% CI 0.25 to 1.47, p = .005) and with the night sleep symptom of not feeling rested in the morning (beta = .17, 95% CI 0.00 to 0.35, p = .048). No association was found with instrumental activities of daily living (beta = .18, 95% CI -0.04 to 0.40, p = .113). It is concluded that napping in the elderly is partly related to personality characteristics and partly a consequence of night sleep disturbance.

Activity Levels and Cognitive Functioning in an Elderly Community Sample

The influence of self-reported and informant-reported activity levels on Crystallized Intelligence, Fluid Intelligence, Memory and the Mini-Mental State Examination was investigated in a sample of 858 community-dwelling elderly subjects. Both self-reported and informant-reported activity levels explained variance beyond that accounted for by sex, sensory functioning, activities of daily living, medical conditions, current health problems and education. Age accounted for additional variance once activity and the other contextual variables were entered. Interaction effects indicated that inactivity was associated with poorer performance on fluid intelligence in older rather than younger elderly subjects and that inactivity was predictive of poor crystallized intelligence at younger ages. Higher informant-rated activity levels moderated the effects of education, so that higher activity offset effects associated with low education on memory tasks. The mount of variance explained by activity levels was modest.

Variability of plasma IL-6 and crosslinked fibrin dimers over time in community dwelling elderly subjects.

Because obtaining multiple blood samples from individuals involved in epidemiologic studies is difficult, conclusions must be drawn on the basis of one or two samples. In this study, the authors attempted to determine the variability of two plasma markers over time, namely IL-6 levels and crosslinked fibrin degradation products (D-Dimers), in 16 elderly community-dwelling individuals. The study group included both men and women and black and white subjects (four in each group). Eight blood samples were obtained from each subject over a period of 36 days. Blood was separated within 1 hour after collection and aliquots of plasma were stored at -70 degrees C until all samples were collected. All samples from an individual were analyzed at one time. IL-6 and D-Dimers were measured by commercially available ELISA kits. The variability in the levels of plasma IL-6 and D-Dimers was assessed by means of intra-class correlation coefficient (ICC). The estimates of the ICCs for one measurement of IL-6 and D-Dimers were .87 and .86, respectively. Reliability values of this magnitude indicate excellent reproducibility in the measurement. These values indicate that obtaining a single sample from a subject is fairly representative of that individual's IL-6 and D-Dimer levels over an extended period of time.

The oral hygiene performance test: development and validation of dental dexterity scale for the elderly.

This paper describes a test which was developed for use in assessing the functional oral hygiene status of an elderly population. The instrument was tested among 80 community-dwelling elderly subjects 65 or more years old. The instrument, the Oral Hygiene Performance Test [OHPT], is a direct-observation measure which objectively quantifies the individual's ability to perform oral hygiene and thus reduces subjective evaluation. The test utilized several items from other already-validated instruments currently in use in geriatric medicine to assess functional abilities in a geriatric population. Additional items were developed by the research team and were included in this 17-item test. The OHPT was validated with common measures of physical function and direct-observation measures. Construct validity was assessed by comparison of the OHPT scores with other commonly used measures of other dimensions. The instrument proved to be reliable and demonstrated construct as well as concurrent validity. It appears that the OHPT can prove useful to clinicians in assessing the oral physical function of elderly patients with regard to their maintenance of oral hygiene. Because the OHPT is a direct-observation instrument, it can even elicit higher functions in elderly patients. While effective among the studied population, the instrument may still need to be validated among more diverse populations, such as various ethnic groups and demented or severely impaired populations.

The relationship between health and cognitive functioning in a sample of elderly people in the community.

The association between health status and cognitive performance was examined in a sample of 708 community dwelling elderly people aged 70 years or over. Cognitive performance declined significantly across the age groups 70-74, 75-79, 80-84, and 85-89 years on the Mini-Mental State Examination and on measures of fluid intelligence and memory, but not on measures of crystallized intelligence. Health status declined significantly across age for five of 49 past and current medical conditions, for measures of Activities of Daily Living (ADL) and for systolic blood pressure, but did not decline significantly for global self-ratings of health, diastolic blood pressure or reports of smoking. Weak but significant correlations between health and cognitive performance were found for self-reported global ratings of health and for self-reports of some physical symptoms but not for diastolic or systolic blood pressure, or for many other physical conditions. Both self- and informant-based ratings of ADL correlated with cognitive performance. Age differences remained after cognitive performance was adjusted for health variables such as ADL, self-ratings of health and current health problems. It is concluded that, at the population level, lower levels of cognitive performance in community-dwelling elderly subjects are not strongly mediated by ill health.