MacArthur Studies Of Successful Aging Research Articles

Social integration and pulmonary function in the elderly.

This study sought to determine whether social integration, defined as number of social roles, is associated with better pulmonary function in the elderly and which roles are associated with greatest benefit. It also examined pathways that connect social integration to better lung health. High functioning men (n = 518) and women (n = 629) ages 70-79 were recruited as part of the MacArthur Study of Successful Aging, and data were collected on social roles as well as pulmonary function as assessed by peak expiratory flow rate (PEFR). Multiple regressions predicting PEFR from the number of social roles controlled for age, sex, race, education, weight, and height. Physiological, behavioral, social, and psychological factors were tested as mediators of the association between the number of social roles and PEFR. More social roles were associated with better PEFR. Analysis of specific roles indicated that marriage was the strongest positive correlate of PEFR. However, greater numbers of roles were also associated with better PEFR independent of marriage. Being a relative or friend were each also individually associated with better PEFR. Even so, greater numbers of social roles were associated with better PEFR independent of relative and friend. The data were consistent with greater happiness, not smoking, and more physical activity acting as pathways linking the number of roles to PEFR. Number of social roles is an important correlate of healthy lung function in the elderly. This association may be driven by healthier behaviors and greater feelings of well-being.

Pulmonary Function Affects Language Performance in Aging

Pulmonary Function Affects Language Performance in Aging

Do the effects of APOE-ε4 on cognitive function and decline depend upon vitamin status? MacArthur Studies of Successful Aging.

To investigate whether gene nutrient interactions influence the risk of cognitive dysfunction among older persons. We performed a cross-sectional and longitudinal study of 499 adults aged 70-79 years from the Mac Arthur Study of Successful Aging to determine the effect of apolipoprotein E (APOE) in conjunction with plasma levels of homocysteine and of the related B vitamins on multiple domains of cognitive function and cognitive decline. The APOE-ε4 allele, high homocysteine, low folate, and low vitamin B6 levels were each associated with worse baseline cognitive function, and all but B6 and B12 were associated with seven year cognitive decline. There was no interaction between APOE-ε4, and homocysteine, folate, B6, or B12 in predicting baseline cognitive function (p-values: 0.12-0.94) or longitudinal decline (p-values: 0.52-0.91). Of five cognitive subtests, there was a significant interaction between the ε4 allele, low B6, and decline in correct naming response items (p=0.04). B vitamin status does not influence the risk of overall cognitive dysfunction in ε4 allele affected older adults.

Productive Activities and Development of Frailty in Older Adults

Our aim was to examine whether engagement in productive activities, including volunteering, paid work, and childcare, protects older adults against the development of geriatric frailty. Data from the first (1988) and second (1991) waves of the MacArthur Study of Successful Aging, a prospective cohort study of high-functioning older adults aged 70-79 years (n = 1,072), was used to examine the hypothesis that engagement in productive activities is associated with lower levels of frailty 3 years later. Engagement in productive activities at baseline was associated with a lower cumulative odds of frailty 3 years later in unadjusted models (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.58-0.96) but not after adjusting for age, disability, and cognitive function (adjusted OR = 0.78, 95% CI = 0.60-1.01). Examination of productive activity domains showed that volunteering (but neither paid work nor childcare) was associated with a lower cumulative odds of frailty after adjusting for age, disability, and cognitive function. This relationship diminished and was no longer statistically significant after adjusting for personal mastery and religious service attendance. Though high-functioning older adults who participate in productive activities are less likely to become frail, after adjusting for age, disability, and cognitive function, only volunteering is associated with a lower cumulative odds of frailty.

Increased Mortality Risk in Older Adults With Persistently Low or Declining Feelings of Usefulness to Others

This study seeks to determine if persistently low or declining feelings of usefulness to others in later life predict increased mortality hazard in older adults. Data on change in perceptions of usefulness, health, behavioral and psychosocial covariates, and mortality originate from the MacArthur Study of Successful Aging, a prospective study of 1,189 older adults (aged 70 to 79). Older adults with persistently low feelings of usefulness or who experienced a decline to low feelings of usefulness during the first 3 years of the study experienced a greater hazard of mortality (sociodemographic adjusted hazard ratio = 1.75; 95% confidence interval = 1.22, 2.51) during a subsequent 9-year follow-up as compared to older adults with persistently high feelings of usefulness. Older adults with persistently low perceived usefulness or feelings of usefulness that decline to a low level may be a vulnerable group with increased risk for poor health outcomes in later life.

Preliminary Evidence for Subdimensions of Geriatric Frailty: The MacArthur Study of Successful Aging

To identify frailty subdimensions. Longitudinal cohort (MacArthur Study). Three U.S. urban centers. One thousand one hundred eighteen high-functioning subjects aged 70 to 79 in 1988. Participants with three or more of five Cardiovascular Health Study (CHS) frailty criteria (weight loss, weak grip, exhaustion, slow gait, and low physical activity) in 1991 were classified as having the CHS frailty phenotype. To identify frailty subdimensions, factor analysis was conducted using the CHS variables and an expanded set including the CHS variables, cognitive impairment, interleukin-6 (IL-6), C-reactive protein (CRP), subjective weakness, and anorexia. Participants with four or more of 10 criteria were classified as having an expanded frailty phenotype. Predictive validity of each identified frailty subdimension was assessed using regression models for 4-year disability and 9-year mortality. Two subdimensions of the CHS phenotype and four subdimensions of the expanded frailty phenotype were identified. Cognitive function was consistently part of a subdimension including slower gait, weaker grip, and lower physical activity. The CHS subdimension of slower gait, weaker grip, and lower physical activity predicted disability (adjusted odds ratio (AOR)=1.7, 95% confidence interval (CI)=1.3-2.2) and mortality (AOR=1.5, 95% CI=1.3-1.8). Subdimensions of the expanded model with predictive validity were higher IL-6 and CRP (AOR=1.2 for mortality); slower gait, weaker grip, lower physical activity, and lower cognitive function (AOR=1.8 for disability; AOR=1.5 for mortality), and anorexia and weight loss (AOR=1.2 for disability). This study provides preliminary empirical support for subdimensions of geriatric frailty, suggesting that pathways to frailty differ and that subdimension-adapted care might enhance care of frail seniors.

Inflammation and Rate of Cognitive Change in High-Functioning Older Adults

Inflammatory proteins including interleukin-6 (IL-6) and C-reactive protein (CRP) have been associated with incident cognitive impairment, but little research has addressed their effects on the rate of cognitive change, and findings are mixed. The purpose of this study was to examine the relationship between serum levels of IL-6 and CRP and the rate of cognitive change across a range of cognitive domains in a sample of healthy older persons. Growth curve analysis was performed on data from the MacArthur Study of Successful Aging, a longitudinal cohort study of high-functioning older adults aged 70-79 years at baseline in 1988 and reinterviewed in 1991 and 1995 (N = 851). Individual growth curve parameters were derived from baseline and follow-up performance in abstraction, language, spatial ability, verbal recall, spatial recognition, and global cognitive function based on age, IL-6, CRP, and covariates. Cross-sectionally, there is a generally linear negative relationship between inflammation and cognition, such that higher levels of inflammation are associated with lower levels of baseline cognitive function. After controlling for potential confounders, there was no effect of inflammation on baseline cognitive function or the rate of longitudinal cognitive change. However, persons in the top tertile on IL-6 were at an increased risk of incident declines on the Short Portable Mental Status Questionnaire (SPMSQ). Although high levels of inflammation are associated with incident cognitive impairment, these results do not generalize to the full range of cognitive changes, where the role of inflammation appears to be marginal.

Encyclopedia of health & aging

SAGE Reference is proud to announce the Encyclopedia of Health and Aging. This one-volume encyclopedia presents state-of-the-art research and ready-to-use facts on health and aging. The 250 entries and relevant appendices cover: biological; psychological; social; and economic aspects of health and aging and impacts within health-care systems. As an ever increasing percentage of the population of western societies enters `old age', health issues grow in importance in terms of the well-being of this population, economic impact within the health-care system, impacts on families and family relationships and in so many other ways. The Encyclopedia of Health and Aging covers issues including: - acute illness; - Alzheimer's disease; - bereavement; - cataracts; - centenarians; - dementia; - economic; - dependency; - exercise; - health care costs; - health promotion; - hospice care; - long-term care; - managed care; - medications; - menopause; - nursing homes; - nutrition; - obesity; - optimal aging; - osteoporosis; - Parkinson's disease; - public policy; - `quality of life'; - religiosity; - sexual function; - sleep disturbances; - smoking; - spousal care-giving; - stroke; - widowhood; - wisdom. Also included are landmark studies: Duke Longitudinal Study of Aging; Framingham Heart Study; MacArthur Study of Successful Aging; Established Populations for the Epidemiologic Studies of the Elderly (EPESE); Health and Retirement Study (HRS); and National Long-Term Care Survey, as well as important social and health programmes including: social security, `meals on wheels' and Medicaid/Medicare. The Encyclopedia of Health and Aging is cross-disciplinary, with contributions from the fields of: gerontology; epidemiology; health psychology; biology; sociology; health and medicine; and public policy.

Depressive Symptoms as a Predictor of Cognitive Decline: MacArthur Studies of Successful Aging

The prevalence of dementia continues to rise, and yet, there are few known modifiable risk factors. Depression, as a treatable condition, may be important in the development of dementia. Our objective was to examine the association between depressive symptoms and longitudinal cognitive changes in older adults who were high-functioning at baseline. The authors analyzed data from a community-based cohort (aged 70-79 at baseline), who, at study entry, scored 7 or more (out of 9) on the Short Portable Mental Status Questionnaire (SPMSQ). Depressive symptoms were assessed at baseline using the depression subscale of the Hopkins Symptom Check List. Cognitive performance was measured at baseline and at seven-year follow up by the SPMSQ and by summary scores from standard tests of naming, construction, spatial recognition, abstraction, and delayed recall. After adjusting for potential confounders, including age, education, and chronic health conditions such as diabetes, heart attack, stroke, and hypertension, a higher number of baseline depressive symptoms were strongly associated with greater seven-year decline in cognitive performance and with higher odds of incident cognitive impairment, i.e., decline in SPMSQ score to < or = 6 (adjusted odds ratio per quartile of depressive symptoms score: 1.34, 95% confidence interval: 1.10-1.68). Depressive symptomatology independently predicts cognitive decline and incident cognitive impairment in previously high-functioning older persons.

Advances in Vascular Cognitive Impairment 2006

Vascular cognitive impairment is common and represents a spectrum of cognitive dysfunction associated with stroke and cardiovascular risk factors which may be slight, moderate or severe.1 Recently and as a major advance, the National Institute of Neurological Disorders and Stroke—Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Working Group published clinical and research standards for the description and study of vascular cognitive impairment.2 In this update we report advances in vascular cognitive impairment in the following areas: clinical trials and treatment, new risk factors, white matter disease, and genetics. Cardiovascular risk factors such as blood pressure elevation and hyperglycemia are prime targets for clinical trial study because they are believed to cause negative effects on brain structure and cognitive function and may even influence risk of Alzheimer disease (AD).3 Results of recently published observational epidemiological studies have fueled controversy in relation to the role of blood pressure on cognition because some studies such as the Honolulu Asia Aging Study4 and Cache County Study5 suggest that antihypertensive therapy may reduce risk of dementia and cognitive decline or reduce incidence of AD, respectively, whereas the Religious Orders Study6 did not find an association between blood pressure and risk of AD or cognitive decline. Meta-analysis of patients with cardiovascular and/or cerebrovascular disease who received blood pressure-lowering treatment show a trend toward prevention of dementia and/or cognitive decline;7 however, a systematic analysis of 3 studies comprising 12 091 patients with hypertension who were treated with either medication or lifestyle strategies for at least 6 months show no evidence that blood pressure-lowering prevents dementia or cognitive impairment.8 Lack of definitive results in some of these trials may be explained by insufficient power to detect treatment effects, measurement error in cognitive end points, variation in treatment effects between …

Feelings of Usefulness to Others, Disability, and Mortality in Older Adults: The MacArthur Study of Successful Aging

We examined feelings of usefulness to others as a predictor of disability and mortality risk in a sample of older adults (aged 70-79 years) from the MacArthur Study of Successful Aging. We examined participants' perceptions of their usefulness to friends and family, measured at a baseline interview, as a predictor of subsequent increases in self-reported mobility disability, the onset of difficulty in performing activities of daily living, or mortality occurrence over a 7-year follow-up period. Compared with older adults who frequently felt useful to others, those who never or rarely felt useful were more likely to experience an increase in disability or to die over the 7-year period, even when we accounted for a number of demographic, health status, behavioral, and psychosocial factors. This suggests that feelings of usefulness may shape health trajectories in older adults.

Religious service attendance and decline in pulmonary function in a high-functioning elderly cohort

Pulmonary function is an important indicator of respiratory and overall health, yet little is known about the psychosocial factors that predict pulmonary function itself. At the same time, religious activity is emerging as a potential health promoting factor, especially among the elderly. Whether there is a connection between religious activity and pulmonary function is unknown. In this study, we sought to examine the association between religious attendance and rate of decline in pulmonary function. The sample consisted of 1,174 healthy elderly persons enrolled in the MacArthur Study of Successful Aging who were followed for an average of 4.6 years. Information on frequency of religious service attendance and peak expiratory flow rate (PEFR) was collected over 3 waves. A linear mixed model with repeated measures was used to compare rate of decline in PEFR between those who attended religious services regularly and those who did not. Regular religious service attendance was associated with a slower pulmonary function decline among men (by 3.71 L/min per year, p = .02) and women (by 3.27 L/min per year, p = .02), compared to those who never attend services. The findings could not be explained by differences in smoking or physical activity. Overall findings support the hypothesis that religious activity may play a protective role in maintaining pulmonary health among the elderly.

Getting strategic about environment and health

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Cardiovascular disease and Alzheimer's disease: common links

Growing evidence supports a strong and likely causal association between cardiovascular disease (CVD), and its risk factors, with incidence of cognitive decline and Alzheimer's disease. Individuals with subclinical CVD are at higher risk for dementia and Alzheimer's. Several cardiovascular risk factors are also risk factors for dementia, including hypertension, high LDL cholesterol, low HDL cholesterol and especially diabetes. Moderate alcohol appears to be protective for both CVD and dementia. In contrast, inflammatory markers predict cardiovascular risk, but not dementia, despite biological plausibility for such a link. The substantial overlap in risk factors points to new avenues for research and prevention.

Association Between Serum Beta-Carotene Levels and Decline of Cognitive Function in High-Functioning Older Persons With or Without Apolipoprotein E 4 Alleles: MacArthur Studies of Successful Aging

Growing evidence from animal studies suggests an interaction between antioxidants and apolipoprotein E (APOE) alleles on cognitive functioning. We used data from a 7-year cohort study of high-functioning older persons to explore whether the associations between serum beta-carotene level and subsequent decline of cognitive function differed by APOE 4 genotype. Baseline information on sociodemographic characteristics, serum beta-carotene level, inflammation markers, APOE genotype, and cognitive functioning measured by a 9-item Short Portable Mental Status Questionnaire (SPMSQ) was obtained in 455 survivors. Multivariable logistic regression analyses were used to examine the relation between high serum beta-carotene level and risk of SPMSQ score decline in participants with or without APOE 4 alleles, while adjusting for age, sex, race, baseline SPMSQ score, and other covariates. Nine (2%) study participants had homozygous and 97 (21%) had heterozygous APOE 4 alleles. Two hundred forty-nine (55%) had decline of SPMSQ scores during the follow-up. The presence of an APOE 4 allele was associated with higher risk and larger magnitude of SPMSQ score decline. The adjusted odds ratio of high beta-carotene level for cognitive decline was 0.11 (95% confidence interval, 0.02-0.57) in participants with at least one APOE 4 allele and 0.89 (95% confidence interval, 0.54-1.47) among those who were APOE 4 negative. Among high-functioning older persons, antioxidants and beta-carotene in particular may offer protection from cognitive decline in persons with greater genetic susceptibility as evidenced by the presence of the APOE 4 allele.

Reduction in Allostatic Load in Older Adults Is Associated With Lower All-Cause Mortality Risk: MacArthur Studies of Successful Aging

To study the association between change in allostatic load (a risk score constructed from multiple biological markers) over a 2.5-year period and mortality in the following 4.5 years in older adults. We measured 10 physiologic parameters at baseline (1988) in a cohort of 171 high-functioning, community-dwelling, 70- to 79-year-old adults. These measurements were repeated 2.5 years later, in 1991. Summary allostatic load scores for 1988 and 1991 were created as the weighted sum of the 10 biological markers and their second-order terms. Mortality status (alive or dead) for participants was determined 4.5 years later, in 1995. The association between change in allostatic load score (1988-1991) and subsequent mortality (1991-1995) was studied using logistic regression. Compared with participants whose allostatic load score decreased between 1988 and 1991, individuals whose allostatic load score increased had higher risk of all-cause mortality between 1991 and 1995 (15% versus 5%, p = .047). Adjusted for age and baseline allostatic load, each unit increment in the allostatic load change score was associated with mortality odds ratio of 3.3 (95% confidence interval, 1.1-9.8). Our results suggest that even in older ages, change in risk scores can be followed to improve assessment of mortality risk.

Education and APOE-e4 in Longitudinal Cognitive Decline: MacArthur Studies of Successful Aging

Longitudinal data from the MacArthur Study of Successful Aging were used to test for interactions between education and apolipoprotein E (APOE) genotype with respect to time trends in cognitive performance. Interactions between education, APOE-e4 status, and time were found for overall cognitive function, and for subscales measuring memory and naming: The presence of the e4 allele was associated with steeper declines in cognition for those with a greater than eighth-grade education. For those with an eighth-grade education or less, time trends did not differ by APOE genotype. A measure of cognitive impairment (i.e., scores of < or = 7 on the Short Portable Mental Status Questionnaire) yielded parallel though weaker evidence for a similar interaction with respect to risk of cognitive impairment. These findings suggest that the presence of at least one e4 allele appears to reduce the protective effects of education for those with at least a ninth-grade education or more, resulting in steeper cognitive declines with age.

Increase in epinephrine excretion is associated with cognitive decline in elderly men: MacArthur studies of successful aging

High stress hormone levels are associated with increased risk of cognitive decline in elderly individuals. However, the effect of late-life changes in stress hormone levels on cognitive decline risk has not been examined. Our objective was to investigate whether increase over time in urinary epinephrine excretion in older adults was associated with subsequent cognitive decline. Measurements were made on 154 high-functioning men and women, 70-79 years of age, in 1988, 1991, and 1995. Twelve-hour overnight urinary excretion of epinephrine (normalized by creatinine excretion to adjust for body size) was recorded in 1988 and 1991. Cognitive functioning was assessed in 1991 and 1995 by summary scores based on standard tests of language, memory, abstraction, spatial recognition, and spatial construction. Compared to individuals whose epinephrine excretion decreased between 1988 and 1991, the individuals whose epinephrine excretion increased over the same period had greater subsequent declines in summary cognitive scores between 1991 and 1995. After adjusting for baseline epinephrine, baseline cognitive function, and relevant covariates, and stratifying by gender, increases in urine epinephrine were positively associated with cognitive decline only in men. We conclude that increase in urinary excretion of epinephrine predicts subsequent cognitive decline in older men.

Homocysteine versus the vitamins folate, B 6, and B 12 as predictors of cognitive function and decline in older high-functioning adults: MacArthur Studies of Successful Aging

Elevated plasma total homocysteine concentration may be a risk factor for cognitive decline and Alzheimer disease, but data from prospective studies are limited. Further, high homocysteine levels are associated with low vitamin status, and it is unknown whether it is homocysteine toxicity or vitamin insufficiency that is responsible for the observed cognitive dysfunction. We performed cross-sectional and longitudinal analyses of a cohort of 499 high-functioning community-dwelling persons aged 70 to 79 years to determine the effect of homocysteine and related vitamin plasma concentrations on cognitive function and cognitive decline. Nonfasting plasma concentrations of homocysteine, folate, vitamin B(6), and vitamin B(12) were measured at baseline. Summary measures of cognitive function were created from tests of multiple cognitive domains administered at baseline and again after 7 years. In cross-sectional analyses investigating each variable separately, subjects with elevated homocysteine levels, or low levels of folate or vitamin B(6), demonstrated worse baseline cognitive function. In longitudinal analyses, after adjusting for multiple covariates, including homocysteine, those in the bottom quartile of folate had a 1.6-fold increased risk (95% confidence interval: 1.01 to 2.31; P =0.04) of being in the worst quartile of 7-year cognitive decline. Low folate levels largely accounted for a trend towards greater cognitive decline with elevated homocysteine level. In high-functioning older adults, low folate levels appear to be a risk factor for cognitive decline. The risk of developing cognitive decline might be reduced through dietary folate intake.

The effects of serum beta-carotene concentration and burden of inflammation on all-cause mortality risk in high-functioning older persons: MacArthur studies of successful aging.

It remains unclear to what extent the associations between low serum beta-carotene concentration and increased risk for cardiovascular disease and cancers are attributable to inflammation. The objective of this study was to evaluate simultaneously the effects of serum beta-carotene concentration and inflammation on the subsequent all-cause mortality risk in high-functioning older persons. The authors conducted a prospective cohort study using information from 672 participants from the MacArthur Studies of Successful Aging. Baseline information was obtained for serum concentrations of beta-carotene, C-reactive protein, interleukin-6, cholesterols, and albumin; body mass index; waist:hip ratio; prevalent medical conditions; health behaviors; and medications. Sex-specific univariate and multivariate logistic regression analyses were used to study the effects of low beta-carotene, high inflammation burden, or both on 7-year all-cause mortality rates while adjusting for other confounders. The serum beta-carotene concentration was inversely associated with C-reactive protein and interleukin-6 levels. After adjustment for inflammation markers and other covariates, the relative risks for low beta-carotene for the 7-year all-cause mortality risk were 2.30 (95% confidence interval [CI], 1.23 to 4.31) in men and 0.85 (95% CI, 0.42 to 1.75) in women. Compared with men with high beta-carotene levels and low inflammation, the multiply adjusted relative risk for low beta-carotene and high inflammation burden was 3.78 (95% CI, 1.69 to 8.47) in men. Low levels of serum beta-carotene are independently associated with an increased all-cause mortality risk in older men, even after adjustment for the effects of inflammation and other risk factors. In men, but not women, a synergistic effect occurs between low beta-carotene concentration and high inflammation burden in predicting higher mortality rates.