Dementia In Older Men Research Articles

Balance and strength measures are associated with incident dementia in older men

BackgroundAs people age the risk of dementia increases. Balance and strength deteriorate with ageing, but their associations with dementia are not clear. We aimed to determine relationships of balance and strength performance with incident dementia in the Health in Men Study (HIMS) cohort. MethodsWe used wave 4 of the HIMS as baseline for analyses (2011–2013), following 1261 men until December 2017 via data linkage to determine incident dementia. Balance was measured using a modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) Score and strength with the knee extension test. Cox proportional hazards regression was used, adjusting for sociodemographic and health data. Strength and balance scores were analysed non-linearly using restricted cubic splines. Results13.7% of men were diagnosed with dementia over a mean period of 4.7 (SD 1.5) years. Higher baseline mBOOMER scores were associated with a reduced risk of incident dementia, with greater changes in risk at higher mBOOMER scores (9 vs 8: HR 0.80, 95% CI 0.73–0.88; 12 vs 11: 0.49, 95% HR 0.36–0.68). Higher baseline lower limb strength was associated with a reduced risk of incident dementia, with greater changes occurring at lower scores, plateauing at around 25 kg (5 vs 4: HR 0.93, 95% CI 0.89–0.98; 25 vs 24: HR 0.99, 95% CI 0.95–1.03). ConclusionsThis study demonstrated a non-linear association of better performance in both strength and balance with reduced likelihood of incident dementia. These results raise the hypothesis that strategies to improve strength and balance could reduce the incidence of dementia in older men.

Associations between balance, strength and incident dementia in older men: the Health in Men Study

AbstractBackgroundIncreased amount of physical activity has been associated with reduced incidence of dementia. It is less clear whether the discrete physical performance measures of balance and strength are associated with dementia incidence. We investigated whether baseline measures of balance and strength were associated with incident dementia.MethodA cohort of 1,314 men with no recorded history of dementia, aged 79‐97 underwent physical performance assessments between 2011 and 2013. These assessments were performed during wave 4 of the Health in Men Study, initially recruiting participants 1996‐9 in Perth, Australia. Balance was assessed with a modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) score: a combination of three tests, the Timed Up and Go, Step and Functional Reach Tests. Strength was tested using knee extension with a spring dynamometer, measured in kilograms. Incident dementia was identified up to December 2017 from the Western Australian Data Linkage System and the national Aged Care Assessment Program. Data were analysed using Cox proportional hazards models. Balance and strength measures were entered as restricted cubic splines to allow for non‐linear relationships. Models were adjusted for sociodemographic, lifestyle and health variables, including hours of physical activity.ResultA total of 187 (14.2%) incident cases of dementia were identified. Higher (better) mBOOMER scores were associated with decreased risk of incident dementia, with greater changes in risk occurring at higher scores (1 vs 0: HR 0.91, 95% CI 0.81‐1.01, 6 vs 5: HR 0.91, 95% CI 0.81‐1.01, 9 vs 8: HR 0.77, 95% CI 0.70‐0.84, 12 vs 11: HR 0.51, 95% CI 0.37‐0.69). Higher knee extension strength was associated with a decreased risk of incident dementia, with greater changes occurring at lower levels then plateauing at around 25 kilograms (5kg vs 4kg: HR 0.93, 95% CI 0.89‐0.97, 15kg vs 14kg: HR 0.93, 95% CI 0.89‐0.97, 25kg vs 24kg: HR 0.99, 95% CI 0.95‐1.02, 35kg to 34kg: HR 1.00, 95% CI 0.95‐1.06). Relationships remained after excluding those with a dementia diagnosis within two years of baseline physical performance assessment.ConclusionBetter balance and strength are both associated with decreased risk of developing dementia, thus representing potentially modifiable risk factors.

Cardiovascular Disease Risk Scores and Risk of Cognitive Decline and Dementia in Older Men and Women

AbstractBackgroundRisk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia in older adults who do not have a history of CVD remains unclear. The aim of this study was to determine whether CVD risk scores are associated with subsequent cognitive decline and dementia in initially healthy older men and women.MethodParticipants were from a prospective cohort of 19,114 individuals aged 65+ years without prior CVD event or major cognitive impairment. The Atherosclerotic Cardiovascular Disease risk score (ASCVDRS) and the Framingham risk score (FRS) were calculated at baseline, with women and men analysed separately due to large differences in overall level of CVD risk. Dementia was adjudicated by clinical experts according to DSM‐IV criteria. Cognitive decline was defined as a >1.5 SD decline in cognitive score from their own baseline value on any of the four cognitive tests looking at global cognition, episodic memory, psychomotor speed or verbal fluency.ResultOver a median follow‐up of 6.4 years, 4,325 individuals had cognitive decline and 850 individuals developed dementia. ASCVDRS, was associated with dementia and cognitive decline, in men and women, whether considered as a continuous measure and as tertiles. For example, men and women in the highest ASCVDRS tertile had a 41% and 45% increased risk of dementia compared to the lowest tertile respectively (HR [95%CI] men: 1.41 [1.08,1.85], women: 1.45 [1.11,1.89]). However, higher FRS was not associated with incident dementia and only associated with an increased risk of cognitive decline among women (FRS continuous: 1.08 [1.01,1.26]; highest vs. lowest tertiles: 1.13 [1.01‐1.26]).ConclusionThese results provide some evidence for ASCVDRS as a measure of shared CVD risk factors for identifying/predicting risk of dementia and cognitive decline in healthy older adults regardless of sex. Further research is needed to confirm the findings and to validate these results in more heterogeneous populations.

Ambient air pollution and risk of incident dementia in older men living in a region with relatively low concentrations of pollutants: The Health in Men Study

BackgroundIn areas with moderate to severe air pollution, pollutant concentrations are associated with dementia risk. It is unclear whether the same relationship is present in regions with lower ambient air pollution. ObjectiveTo determine whether exposure to air pollution is associated with risk of incident dementia in general, and Alzheimer's disease and vascular dementia in particular, in older men living in a relatively low ambient air pollution region. MethodsThe cohort comprised 11,243 men residing in Perth, Australia. Participants were aged ≥65 years and free of a dementia diagnosis at time of recruitment in 1996–1999. Incident dementia was identified from recruitment to 2018 via ICD diagnosis codes and subsequent study waves. Concentrations for three air pollutants, nitrogen dioxide (NO2), fine particulate matter less than 2.5 μm in diameter (PM2.5), and black carbon (BC) were estimated at participants’ home addresses using land-use regression models. We used Cox proportional hazards regression models adjusting for smoking status, physical activity, BMI, education, and socio-economic status. ResultsOf 3053 (27.2%) incident cases of dementia, 1670 (54.7%) and 355 (11.6%) had documented Alzheimer's disease and vascular dementia. The average concentration of NO2 was 13.5 (SD 4.4) μg/m3, of PM2.5 was 4.54 (SD 1.6) μg/m3 and of BC was 0.97 (SD 0.29) ×10−5 m−1. None of the air pollutants were associated with incident dementia or Alzheimer's disease. In the unadjusted model, increased exposure to PM2.5 was associated with an increased risk of vascular dementia (for a 5 μg/m3 increase: HR 1.62, 95% CI 1.13, 2.31). However, this association was attenuated following adjustment for confounders (HR 1.39, 95% CI 0.93, 2.08). NO2 and BC were not associated with vascular dementia incidence. DiscussionExposure to air pollution is not associated with increased risk of incident dementia in older men living in a region with relatively low ambient air pollution.

Age-Related Changes in the Association Between Traumatic Brain Injury and Dementia in Older Men and Women.

To investigate age-related changes in the association between traumatic brain injury (TBI) and dementia in older men and women separately. A total of 243 general practices in the UK. This study included 4760 patients who received a first TBI diagnosis between 1995 and 2010 (index date), and 4760 patients without TBI who were matched to those with TBI by age, sex, index year, Charlson Comorbidity Index, alcohol dependence, and physician (index date: a randomly selected visit date). Retrospective cohort study. Incidence of dementia in the decade following index date. Within 10 years of index date, 8.8% of men with TBI and 4.8% of those without TBI were diagnosed with dementia, while the respective figures were 9.0% and 6.7% in women (P values < .01). There was a significant association between TBI and dementia in men (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.64-3.19) and in women (HR = 1.33, 95% CI: 1.07-1.64). Furthermore, the association between TBI and dementia was significant in men aged 60 to 70 (HR = 2.51, 95% CI: 1.27-4.96) and 71 to 80 years (HR = 3.00, 95% CI: 1.82-4.93), whereas the relationship was only significant and potentially unreliable in women aged 81 to 90 years (HR = 1.49, 95% CI: 1.03-2.14). The age-related relationship between TBI and dementia differed between men and women. More research of a prospective nature and including behavioral data is needed to better understand these differences.

Re: Tamsulosin and the Risk of Dementia in Older Men with Benign Prostatic Hyperplasia.

Re: Tamsulosin and the Risk of Dementia in Older Men with Benign Prostatic Hyperplasia.

Re: Tamsulosin and the Risk of Dementia in Older Men with Benign Prostatic Hyperplasia.

Re: Tamsulosin and the Risk of Dementia in Older Men with Benign Prostatic Hyperplasia.

Sex hormones and incident dementia in older men: The health in men study

BackgroundLow circulating testosterone has been associated with dementia in older men but existing evidence from prospective studies is inconsistent. MethodsWe conducted a prospective longitudinal study of 4069 community-dwelling older men free of dementia aged 71–88 years at baseline. The main objective of the study was to determine if men with low circulating sex hormones were more likely to develop dementia over time. The main biochemical exposures of interest were collected at baseline between 2001 and 2004 and men were assessed for incident dementia via an electronic health records database to the 31 st of December 2013. ResultsDementia developed in 499 men over a median of 10.5 years (range 9.4–12.2 years). The risk of developing dementia increased with decreasing total (hazard ratio [HR] 1.14, 95% confidence interval [95%CI] 1.03–1.26 per standard deviation decrease) and calculated free testosterone (HR 1.18, 95%CI 1.06–1.31 per standard deviation decrease) after adjustment for age, baseline cognitive function, depression, body mass, hypertension, cardiovascular disease and total plasma homocysteine. Men in the lowest quartiles of total (adjusted HR 1.39, 95%CI 1.04–1.85) and calculated free testosterone (adjusted HR 1.43, 95%CI 1.08–1.90) had increased risk of developing dementia compared to those in the highest quartiles. ConclusionsLower plasma total and calculated free testosterone were associated with increased risk of developing dementia independent of relevant measured clinical and biochemical factors and was not explained due to differential mortality in those with lower testosterone levels. The association between low testosterone and dementia is biologically plausible but data on the role of testosterone treatment in preventing dementia is lacking and adequately powered trials in men at risk would be welcome.

Re: Tamsulosin and the Risk of Dementia in Older Men with Benign Prostatic Hyperplasia

Re: Tamsulosin and the Risk of Dementia in Older Men with Benign Prostatic Hyperplasia

1010 Objectively Measured Napping And 12-year Risk Of Developing Dementia In Older Men

1010 Objectively Measured Napping And 12-year Risk Of Developing Dementia In Older Men

Longevity Klotho gene polymorphism and the risk of dementia in older men

IntroductionKlotho variants (KL-VS) have been associated with increased longevity and better cognitive function. It is unclear whether they modulate dementia risk. MethodsWe recruited 527 men aged 71–87 years who were free of cognitive impairment. We used data linkage to track the onset of dementia over 10 years. KL-VS genotyping (rs9536314 T/G) followed standard procedures. ResultsThe annual rate of dementia was 17.2‰ (95%CI=14.0–21.1; total=5053 person-years), and 14.0‰ (95%CI=10.6–18.4; 3582 person-years), 23.5‰ (95%CI=16.6–33.2; 1363 person-years) and 46.4‰ (95%CI=19.3–111.5; 108 person-years) for men with the TT, TG and GG genotypes. Compared with the TT genotype, the sub-hazard ratios of dementia associated with the TG and GG genotypes were 1.6 (95%CI=1.0, 2.5; p=0.030) and 3.5 (95%CI=1.3, 9.1; p=0.011). DiscussionThe Klotho KL-VS variant is associated with an increase in the incidence of dementia in older men, in a dose-dependent fashion (intermediate for heterozygosis and highest for homozygosis).

Higher Free Thyroxine Levels Predict Increased Incidence of Dementia in Older Men: The Health In Men Study

Both hypothyroidism and subclinical hyperthyroidism hinder cognitive function. We aimed to determine whether more subtle alterations of thyroid hormone levels predict increased incidence of dementia in aging men. Community-dwelling men aged 70-89 yr participated in this prospective longitudinal study. The Standardized Mini-Mental State Examination was performed at baseline (2001-2004), and circulating TSH and free T(4) (FT(4)) were assayed. Men with known thyroid disease or dementia, or Standardized Mini-Mental State Examination scores below 24 were excluded from follow-up. New-onset dementia, defined by International Classification of Disease (ICD) codes, was ascertained using data linkage (2001-2009). During follow-up, 145 of 3401 men (4.3%) were diagnosed for the first time with dementia. Men who developed dementia had higher baseline FT(4) (16.5 ± 2.2 vs. 15.9 ± 2.2 pmol/liter, P = 0.004) but similar TSH (2.2 ± 1.4 vs. 2.3 ± 1.6 mU/liter, P = 0.23) compared with men who did not receive this diagnosis. After adjusting for covariates, higher FT(4) predicted new-onset dementia (11% increased risk per 1 pmol/liter increase in FT(4), P = 0.005; quartiles Q2-4 vs. Q1: adjusted hazard ratio = 1.76, 95% confidence interval = 1.03-3.00, P = 0.04). There was no association between TSH quartiles and incident dementia. When the analysis was restricted to euthyroid men (excluding those with subclinical hyper- or hypothyroidism), higher FT(4) remained associated with incident dementia (11% increase per unit increment, P = 0.03; Q2-4 vs. Q1: adjusted hazard ratio = 2.02, 95% confidence interval = 1.10-3.71, P = 0.024). Higher FT(4) levels predict new-onset dementia in older men, independently of conventional risk factors for cognitive decline. Additional studies are needed to explore potential underlying mechanisms and to clarify the utility of thyroid function testing in older men at risk of dementia.

Angiotensin Receptor Blocker Use May Decrease the Incidence and Progression of Alzheimer’s Disease and Dementia in Older Men but the Strength of the Evidence Is Questionable

ANGIOTENSIN RECEPTOR BLOCKER USE MAY DECREASE THE INCIDENCE AND PROGRESSION OF ALZHEIMER’S DISEASE AND DEMENTIA IN OLDER MEN BUT THE STRENGTH OF THE EVIDENCE IS QUESTIONABLE Multiple longitudinal studies suggest that elevated blood pressure (BP) in midlife is associated with deterioration of cognitive function later in life, and prospective, randomized, placebo-controlled studies have suggested that treatment of hypertension may reduce the incidence and severity of dementia. Whether certain antihypertensive agents provide additional benefits independent of their BP-lowering ability in reducing the incidence and progression of dementia in general, and Alzheimer’s disease (AD) in particular, has been the subject of considerable debate. A few studies in both humans and animals have suggested that angiotensin receptor blockers (ARBs) may preserve cognitive function independent of and in addition to their effects on BP. The current prospective, observational study analyzed information from the Veteran’s Administration (VA) healthcare system decision support database in a large population with uniform healthcare coverage. It asked whether, as compared to the angiotensin converting enzyme inhibitor (ACEI) lisinopril or other cardiovascular (CV) disease medications, use of ARBs is associated with a decrease in the incidence and progression of dementia and AD. Investigators identified patients who as of October 2002 were 65 years of age or older from a database of over 7.3 million people. Patients were divided into those who did (progression analysis) or did not yet (incidence analysis) have a diagnosis of AD or dementia as of October 2002. In each of these groups, 3 different cohorts were analyzed and compared: (1) those taking ARBs (overall sample size of more than 11,500 patients), (2) those taking the ACEI lisinopril (overall sample size of more than 91,000 patients), and (3) those taking other CV drugs (excluding ARBs, ACEIs, and statins) as defined by VA formulary classification (more than 696,000 patients). Drug use from any of those 3 classes was determined based on a ‘‘drug possession ratio’’ of at least 80% and no exposure to other study drug classes during an index period of 6 months from October 2002. Drug use after entry into the study was in no way restricted by the investigators and was completely at the discretion of the treating physicians. For patients with a known history of dementia or AD at study entry (progression analysis), the primary endpoints evaluated were time to admission to a nursing home and death. For patients without a known history of dementia or AD at study entry (incidence analysis), time to diagnosis of either condition were the primary endpoints. Data on endpoints were collected over a 5-year time span (fiscal year 2002–2006). Since raw BP data were not in the VA decision support database at the time of this study, the investigators determined mean BP for each cohort on the basis of a subsample from the VA health systems vertically integrated service network. To account for potential confounding variables, multiple statistical models including various CV From the Division of General Internal Medicine ⁄ Division of Cardiology, University of Nevada School of Medicine; the Risk Reduction Center, Saint Mary’s Regional Medical Center, Reno, NV; the Primary Care Service Line, Ralph H. Johnson VA Medical Center; and the Division of General Internal Medicine ⁄Geriatrics, Medical University of South Carolina, Charleston, SC Address for correspondence: Michael J. Bloch, MD, Risk Reduction Center, Saint Mary’s Regional Medical Center, 645 North Arlington Street, Suite 460, Reno, NV 89503 E-mail: mbloch@aol.com

P1-188: Endogenous sex hormones and cognitive decline in elderly men

Decline in cognitive function is an early symptom of dementia. Studies conducted in elderly women and men suggested that higher levels of endogenous estradiol and testosterone are associated with better cognitive function. However, recent studies in women demonstrated adverse effects of estrogen on cognition. To determine whether low levels of endogenous sex hormones are associated with increased risk of cognitive decline in very old men. The Frail Old Men Study is a population based prospective cohort study among 403 independently living elderly men in The Netherlands to determine risk factors of health and aging in the oldest old. Participants were aged 73–94 years at baseline in 1996 and were re–examined in 2000. At baseline, serum concentrations of total and free testosterone, total and free estradiol, estrone, and relevant covariates were determined. As a measure of global cognitive functioning, participants underwent the Mini Mental State Examination (MMSE) at baseline and follow–up after 4 years. Cognitive decline was defined as a decline of 4 or more points on the MMSE at follow–up. Follow–up was complete in 244 men. Of these, the mean (SD) baseline age was 77.4 (3.2), and the mean (range) baseline MMSE was 27.5 (20–30). At follow–up, 44 men (18%) had a decline of 4 or more points on the MMSE. Using multiple logistic regression analyses, levels of total and free testosterone were not associated with cognitive decline (OR per SD increase 1.1; 95%CI 0.8–1.5 and 1.0; 95%CI 0.7–1.4, respectively). Higher levels of total and free estradiol were related to increased risk of cognitive decline (OR per SD increase 1.5; 95%CI 1.0–2.1 and 1.4; 95%CI 1.0–2.0, respectively). For estrone the OR per SD increase was 1.4 (95%CI 1.0–2.0). These associations were independent of age, education, ApoE4, BMI, waist–to–hip ratio, blood pressure, diabetes, smoking, and serum cholesterol levels. The results do not support the hypotheses that high levels of endogenous sex hormones in elderly men are associated with lower risk of cognitive decline. Further longitudinal investigations are needed to more fully understand the role of hormonal effects on cognitive decline and dementia in older men.

Endogenous sex hormones and incidence of dementia in older men: The Honolulu-Asia Aging Study

Endogenous sex hormones and incidence of dementia in older men: The Honolulu-Asia Aging Study

Tremor, ataxia and dementia in older men may indicate a carrier of the fragile X syndrome.

Recently it has been reported that late-onset tremor, gait unsteadiness and dementia can be associated with brain atrophy in males of normal intelligence and the pre-mutation carrier state of the fragile X syndrome. We have shown, by means of a telephone survey, that this association is probably causal rather than coincidental. These findings have uncovered another testable cause of late-onset neurological symptoms in males, which also has serious genetic implications for their daughters who are at risk of having sons with full mutations causing mental handicap - the fragile X syndrome.

Physical Activity and Risk of Cognitive Decline and Dementia in Older Men and Women

Physical Activity and Risk of Cognitive Decline and Dementia in Older Men and Women

Aggression of dementia in older men

Problematic behaviours are often observed in patients with probable Alzheimer's disease or other dementias. Many pharmacological agents have been used to treat this behaviour, but have shown only moderate efficacy and have been associated with a number of adverse effects. An alternative approach is the use of estrogen. This idea was put into practice by Dr Helen Kyomen, who provided data on her clinical experience at the 49th Annual Scientific Meeting of the American Geriatrics Society held in Washington DC, USA, in November 1992.