Epidemiology Of Vascular Ageing Study Research Articles

Plasma lipids and cerebral small vessel disease.

We examined the cross-sectional association between lipid fractions and 2 MRI markers of cerebral small vessel disease, white matter hyperintensity volume (WMHV) and lacunes, representing powerful predictors of stroke and dementia. The study sample comprised 2,608 participants from the 3C-Dijon Study (n = 1,842) and the Epidemiology of Vascular Aging Study (EVA) (n = 766), 2 large French population-based cohorts (72.8 ± 4.1 and 68.9 ± 3.0 years; 60.1% and 58.4% women, respectively). Analyses were performed separately in each study and combined using inverse variance meta-analysis. Lipid fractions (triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol) were studied as continuous variables. WMHV was studied both in a continuous and dichotomous manner, the latter reflecting the age-specific top quartile of WMHV (EXT-WMHV). Analyses were adjusted for age and sex. Increasing triglycerides were associated with larger WMHV in the 3C-Dijon Study (β ± SE = 0.0882 ± 0.0302, p = 0.0035), in the EVA Study (β ± SE = 0.1062 ± 0.0461, p = 0.021), and in the combined analysis (β ± SE = 0.0936 ± 0.0252, p = 0.0002) and with higher frequency of lacunes in the 3C-Dijon Study (odds ratio [OR] = 1.65 [95% confidence interval 1.10-2.48], p = 0.015), in the EVA Study (OR = 1.58 [95% confidence interval 0.93-2.70], p = 0.09), and in the combined analysis (OR = 1.63 [95% confidence interval 1.18-2.25], p = 0.003). Associations were attenuated but maintained after adjusting for other vascular risk factors or for inflammatory markers. Associations were present and in the same direction both in participants taking and those not taking lipid-lowering drugs but tended to be stronger in the former for EXT-WMHV. Increasing low-density lipoprotein cholesterol tended to be associated with a decreased frequency and severity of all MRI markers of cerebral small vessel disease in both studies. Increasing triglycerides but not other lipid fractions were associated with MRI markers of cerebral small vessel disease in older community persons.

Incidence and Characteristics of Benzodiazepine Use in an Elderly Cohort: The EVA Study

ObjectiveThe aim of this study was to estimate the incidence of benzodiazepine use in an elderly population and to identify associated factors. MethodsData were collected in four self-report questionnaires on the use of sedatives and sleeping drugs. These questionnaires were sent every 6 months, over a 2-year period, to the 1272 elderly subjects interviewed at the first follow-up examination of the EVA (Epidemiology of Vascular Aging) Study. ResultsThe incidence rate of benzodiazepine use was 4.7 per 1000 person-months (95% confidence interval [CI] 3.6, 5.8). In multivariable analyses (logistic regression model), incident use of benzodiazepines was significantly associated with depressive or anxious symptoms (odds ratio [OR] = 3.3; 95% CI 1.7, 6.4), high use of non-psychotropic drugs (≥3; OR = 1.8; 95% CI 1.1, 3.1) and female gender (OR = 1.9; 95% CI 1.1, 3.3). ConclusionSimultaneous use of benzodiazepines and other medications should be carefully assessed in elderly patients, considering the risk of adverse drug reactions and drug-drug interactions.

Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study.

Several cross-sectional studies have found cognitive impairment in subjects taking benzodiazepines for long periods. However, it is not known whether long-term use of benzodiazepines accelerates cognitive decline in the elderly. The authors addressed this issue in a follow-up study of 1,389 people aged 60 to 70 years recruited from the electoral rolls of the city of Nantes (Epidemiology of Vascular Aging study). Data on cognitive functioning (five cognitive tests), depressive symptoms (Center for Epidemiologic Studies-Depression Scale), anxiety symptoms (Spielberger Inventory Scale), use of psychotropics and other drugs, and tobacco and alcohol consumption were collected at baseline, 2-year, and 4-year examinations. People reporting to take benzodiazepines at one, two and three examinations were classified as episodic, recurrent, and chronic users, respectively. Among the 1,176 subjects (85%) who participated in the three examinations, the proportions of episodic, recurrent, and chronic users were 10%, 6%, and 7%, respectively. Chronic users of benzodiazepines had a significantly higher risk of cognitive decline in the global cognitive test (Mini Mental State Examination) and the two attention tests than nonusers (Mini Mental State Examination: odds ratio [OR] [95% confidence interval (CI)] = 1.9 [1.0-3.5]; Digit Symbol Substitution test: OR [95% CI] = 2.7 [1.6-4.7]; Trail Making test, part B: OR [95% CI] = 2.1 [1.2-3.7]). Overall, episodic and recurrent users had lower cognitive scores than nonusers, but differences were not statistically significant. These results were independent of age, sex, education, alcohol and tobacco use, anxiety and depression scores, and use of psychotropic drugs other than benzodiazepines. The findings suggest that long-term use of benzodiazepines is risk factor of increased cognitive decline in the elderly.

Concordance for psychotropic drug use in older married couples.

To the Editor: As part of the Epidemiology of Vascular Aging (EVA) Study, a large study of cognitive decline in older adults, we examined cognitive performance similarities in married couples, taking into account the potential confound-ers that might be shared by spouses. This led us to investigate concordance among couples for psychotropic drug use, a major risk factor for cognitive impairment in older adults.1 The EVA study is a longitudinal study of vascular aging and cognitive decline conducted in a community sample of 1389 subjects, born between 1922 and 1932, recruited from the electoral rolls of the city of Nantes (Western France). An extensive questionnaire was administered by a research assistant at study entry. Data regarding education, self-reported sleep disorders, and treatments were used for this analysis. Medication use during the month before the interview was recorded from both subject interview and original medical prescriptions. Drugs were classified according to the French National Prescription Dictionary (1991). Psychotropic drugs included anxiolytic, hypnotic, sedative, antidepressant, normothimic, and neuroleptic drugs. The name of the subject's general practitioner was also recorded. The study also included an assessment of depressive symptoms using the Center for Epidemiologic Study-Depression (CES-D) scale; high depressive symptomatology was defined as a CES-D score higher than 16 in men or 22 in women.2 There were 318 married couples in the EVA study. Husbands were slightly older than wives (mean ages: 65.7 years (Standard Deviation (SD) = 2.8) vs 64.2 years (SD = 2.8), P < .001). The prevalence of psychotropic drug use was 13.8% among husbands and 25.8% among wives (P < .001); these rates were similar to those found in the whole EVA population (13.9% in men and 27.0% in women). The frequency of spouses having the same general practitioner was 77.7%. Multivariate logistic regression models showed that independent of depression and sleep disorders, men whose wives take psychotropic drugs had a 3.5 times increased risk of psychotropic drug use compared with men whose wives did not. Similarly, the odds ratio associated with husbands' psychotropics drug use was equal to 2.9 in women (Table 1). All analyses were adjusted for age, education level, and concordance for general practitioner. Numbers were too small to perform separate analysis by psychotropic drug category. The effect of a spouse's use was similar in magnitude (even greater in women) than personal determinants of psychotropic use such as depressive symptoms or sleep complaints. No similarity among spouses was found for other categories of drugs (odds ratio = 1.2, P = .5 in men; odds ratio = 1.3, P = .4 in women). Psychotropic drug use may have various negative consequences in older adults, including cognitive impairment,1 falls,3 or motor vehicle accidents.4 The risk of adverse reactions as a result of pharmacological interactions between psychotropic and other drugs is particularly high in older people who take medications for treating a variety of age-related disorders.5 Thus, the rationale for prescribing psychotropic drugs to older people must be critically analyzed. Our study showed high concordance for psychotropic drug use among married couples that was not explained by potential shared confounders such as sleep disorders, depressive symptoms, or same general practitioner. Concordance might result from either common attitude toward psychotropic drugs in married couples or self-prescription of the psychotropic drug used by his/her spouse. The public health importance of psychotropic drug use in older persons suggests the need for investigating this finding further in order to define appropriate information to be given both to prescribers and to older users.