Glucose-Dementia Association is Consistent Over Blood Pressure/Antihypertensive Groups

2021 ◽  
pp. 1-12
Author(s):  
Jing Zhou ◽  
Rod L. Walker ◽  
Shelly L. Gray ◽  
Zachary A. Marcum ◽  
Douglas Barthold ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Antihypertensive Treatment ◽  
Clinical Care ◽  
Community Dwelling ◽  
Diabetes Treatment ◽  
Hypertension Status ◽  
Glucose Levels ◽  
Dementia Risk ◽  
Antihypertensive Treatments

Background: Higher glucose levels are associated with dementia risk in people with and without diabetes. However, little is known about how this association might vary by hypertension status and antihypertensive treatment. Most studies on modifiable dementia risk factors consider each factor in isolation. Objective: To test the hypothesis that hypertension and antihypertensive treatments may modify associations between glucose levels and dementia. Methods: Analyses of data generated from a research study and clinical care of participants from a prospective cohort of dementia-free older adults, including glucose measures, diabetes and antihypertensive treatments, and blood pressure data. We defined groups based on blood pressure (hypertensive versus not, ≥140/90 mmHg versus <140/90 mmHg) and antihypertensive treatment intensity (0, 1, or ≥2 classes of antihypertensives). We used Bayesian joint models to jointly model longitudinal exposure and time to event data. Results: A total of 3,056 participants without diabetes treatment and 480 with diabetes treatment were included (mean age at baseline, 75.1 years; mean 7.5 years of follow-up). Higher glucose levels were associated with greater dementia risk among people without and with treated diabetes. Hazard ratios for dementia were similar across all blood pressure/antihypertensive treatment groups (omnibus p = 0.82 for people without and p = 0.59 for people with treated diabetes). Conclusion: Hypertension and antihypertensive treatments do not appear to affect the association between glucose and dementia risk in this population-based longitudinal cohort study of community-dwelling older adults. Future studies are needed to examine this question in midlife and by specific antihypertensive treatments.

Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study

2019 ◽  
Vol 40 (25) ◽  
pp. 2021-2028 ◽  
Author(s):  
Antonios Douros ◽  
Markus Tölle ◽  
Natalie Ebert ◽  
Jens Gaedeke ◽  
Dörte Huscher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cardiovascular Events ◽  
Antihypertensive Treatment ◽  
Antihypertensive Drugs ◽  
Community Dwelling ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Aims To assess whether blood pressure (BP) values below 140/90 mmHg during antihypertensive treatment are associated with a decreased risk of all-cause mortality in community-dwelling older adults. Methods and results Within the Berlin Initiative Study, we assembled a cohort of patients ≥70 years treated with antihypertensive drugs at baseline (November 2009–June 2011). End of prospective follow-up was December 2016. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality associated with normalized BP [systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg] compared with non-normalized BP (SBP ≥140 mmHg or DBP ≥90 mmHg) overall and after stratification by age or previous cardiovascular events. Among 1628 patients (mean age 81 years) on antihypertensive drugs, 636 exhibited normalized BP. During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with an increased risk of all-cause mortality (incidence rates: 60.3 vs. 48.5 per 1000/year; HR 1.26; 95% CI 1.04–1.54). Increased risks were observed in patients ≥80 years (102.2 vs. 77.5 per 1000/year; HR 1.40; 95% CI 1.12–1.74) and with previous cardiovascular events (98.3 vs. 63.6 per 1000/year; HR 1.61; 95% CI 1.14–2.27) but not in patients aged 70–79 years (22.6 vs. 22.7 per 1000/year; HR 0.83; 95% CI 0.54–1.27) or without previous cardiovascular events (45.2 vs. 44.4 per 1000/year; HR 1.16, 95% CI 0.90–1.48). Conclusion Blood pressure values below 140/90 mmHg during antihypertensive treatment may be associated with an increased risk of mortality in octogenarians or elderly patients with previous cardiovascular events.

Antihypertensive Treatment Patterns and Blood Pressure Control in Older Adults: Results from the Berlin Aging Study II

Drugs & Aging ◽  
2018 ◽  
Vol 35 (11) ◽  
pp. 993-1003 ◽  
Author(s):  
Maximilian König ◽  
Maik Gollasch ◽  
Adrian Rosada ◽  
Ilja Demuth ◽  
Dominik Spira ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Blood Pressure Control ◽  
Antihypertensive Treatment ◽  
Pressure Control ◽  
Treatment Patterns ◽  
Aging Study

Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study

2021 ◽  
pp. 089826432110552
Author(s):  
Qian Lian ◽  
Tazeen H. Jafar ◽  
John C. Allen ◽  
Stefan Ma ◽  
Rahul Malhotra
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Diastolic Blood Pressure ◽  
Mortality Risk ◽  
Cox Regression ◽  
Community Dwelling ◽  
Representative Study ◽  
Hazard Ratios ◽  
Nationally Representative ◽  
Community Dwelling Older Adults

Objectives To assess the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with mortality among older adults in Singapore. Methods Association of SBP and DBP measured in 2009 for 4443 older adults (69.5±7.4 years; 60–97 years) participating in a nationally representative study with mortality risk through end-December 2015 was assessed using Cox regression. Results Higher mortality risk was observed at the lower and upper extremes of SBP and DBP. With SBP of 100–119 mmHg as the reference, multivariable mortality hazard ratios [HRs (95% confidence interval)] were SBP <100 mmHg: 2.41 (1.23–4.72); SBP 160–179 mmHg: 1.51 (1.02–2.22); and SBP ≥180 mmHg: 1.78 (1.12–2.81). With DBP of 70–79 mmHg as the reference, HRs were DBP <50 mmHg: 2.41 (1.28–4.54) and DBP ≥110 mmHg: 2.16 (1.09–4.31). Discussion Management of high blood pressure among older adults will likely reduce their mortality risk. However, the association of excessively low SBP and DBP values with mortality risk needs further evaluation.

Abstract 22: Visit-to-Visit Variability in Blood Pressure is Related to Late-Life Cognitive Decline

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Bo Qin ◽  
Anthony J Viera ◽  
Linda S Adair ◽  
Brenda L Plassman ◽  
Lloyd J Edwards ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Verbal Memory ◽  
Repeated Measures ◽  
Community Dwelling ◽  
Cognitive Testing ◽  
Cognitive Test ◽  
Nutrition Survey

Introduction: Recent studies suggest higher visit-to-visit variability of blood pressure (BP) is associated with worse cognitive function, but evidence based on longitudinal cognitive testing has not been reported. Hypothesis: We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. Methods: This prospective cohort study comprised 1213 adults who had two or more waves of BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed a cognitive screening test at two or more waves in 1997, 2000 or 2004. Mean (SD) age at first cognitive test was 64 (6) y. Outcomes were repeated measures of global cognitive scores (baseline mean ± SD: 19 ± 6 points), standardized composite cognitive and verbal memory scores (standardized units [SU]). Visit-to visit BP variability was expressed as the standard deviation [SD] or as the variation independent of mean (SD/mean^x, with x derived from curve fitting) in BP measures obtained at a mean interval of 3.6 years. Multivariable-adjusted linear mixed-effects models were used to determine the association of changes in cognitive scores with visit-to visit BP variability. Results: Higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD in variability (Figure): global score -0.23 points/y [-0.41 to -0.04], composite scores -0.029 SU/y [-0.056 to -0.002] and verbal memory -0.044 SU/y [-0.075 to -0.012]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of global cognitive function only among adults 55-64 years, independent of mean diastolic BP. Conclusion: Higher long-term BP visit-to-visit variability predicted a faster rate of cognitive decline among older adults.

Physical Performance Predictors for Incident Dementia Among Japanese Community-Dwelling Older Adults

2019 ◽  
Vol 99 (9) ◽  
pp. 1132-1140
Author(s):  
Takehiko Doi ◽  
Kota Tsutsumimoto ◽  
Sho Nakakubo ◽  
Min-Ji Kim ◽  
Satoshi Kurita ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Grip Strength ◽  
Physical Performance ◽  
Performance Level ◽  
Community Dwelling ◽  
Sit To Stand ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Community Dwelling Older Adults

Abstract Background Evaluating physical performance could facilitate dementia risk assessment. However, findings differ regarding which type of physical performance best predicts dementia. Objective The objective of this study was to examine the association between physical performance and incidence of dementia in Japanese community-dwelling older adults. Design This was a prospective study of community-dwelling older adults. Methods Of 14,313 invited individuals who were ≥ 65 years old, 5104 agreed to participate from 2011 to 2012, and 4086 (52% women; mean age = 72.0 years) met the criteria. Baseline assessments of the following physical performance indicators were obtained: grip strength, the Five-Times Sit-to-Stand Test, and the Timed “Up & Go” Test. The physical performance level in each test was categorized as C1 (highest), C2 (middle–high), C3 (middle–low), or C4 (lowest) on the basis of sex-stratified quartile values. Incident dementia status was obtained from medical records that were updated monthly. Results During follow-up (mean duration = 42.9 months), there were 243 incident cases of dementia (5.9%). Log-rank test results indicated that a lower physical performance level constituted a significant risk factor for dementia. After adjustment for covariates, Cox proportional hazards models (reference: highest physical performance level [C1]) demonstrated that the Five-Times Sit-to-Stand Test in the group with the lowest physical performance level (hazard ratio = 1.69; 95% CI = 1.10–2.59) was significantly associated with a risk of dementia. Likewise, the Timed “Up & Go” Test in the group with the lowest physical performance level (hazard ratio = 1.54; 95% CI = 1.01–2.35) was significantly associated with a risk of dementia. However, grip strength was not significantly associated with a risk of dementia. Limitations This study was limited by the use of medical record data. Conclusions A lower mobility-related physical performance level was associated with dementia risk. Dementia risk assessment should include an adequate evaluation of physical function.

scholarly journals The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Omar Yaxmehen Bello-Chavolla ◽  
Carlos Alberto Aguilar-Salinas ◽  
José Alberto Avila-Funes
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Older Adults ◽  
Community Dwelling ◽  
Related Factors ◽  
Dementia Risk ◽  
Sf 36 ◽  
Community Dwelling Older Adults

Abstract Background The type 2 diabetes (T2D) specific dementia-risk score (DSDRS) was developed to evaluate dementia risk in older adults with T2D. T2D-related factors have been shown increase the risk of age-related conditions, which might also increase dementia risk. Here, we investigate the associations of DSDRS with frailty, disability, quality of life (QoL) and cognition in community-dwelling older adults with T2D. Methods We included 257 community-dwelling older adults with T2D to evaluate the association between DSDRS and Mini-mental state examination (MMSE), Isaac’s set-test (IST), clock drawing test (CDT), quality of life (SF-36), risk of malnutrition (Mini-Nutritional Assessment or MNA), as well as frailty, Katz’ and Lawton-Brody scores. We also assessed the phenotype and correlates of high-estimated dementia risk by assessing individuals with DSDRS >75th age-specific percentiles. Results Mean age of participants was 78.0 ± 6.2 years. DSDRS showed a significant correlation with MMSE test, IST, CDT, SF-36, MNA, Lawton-Brody and Katz scores, and an increasing number of frailty components. DSDRS was higher among frail, pre-frail, and subjects with limited ADL and IADL (p < 0.001). Participants with DSDRS >75th age-specific percentiles had lower education, MMSE, IST, SF-36, MNA, Katz, Lawton-Brody, and higher frailty scores. High-estimated 10-year dementia risk was associated with ADL and IADL disability, frailty and risk of malnutrition. When assessing individual components of DSDRS, T2D-related microvascular complications were associated to all outcome measures. Conclusion The DSDRS is associated with frailty, disability, malnutrition and lower cognitive performance. These findings support that T2D-related factors have significant burden on functional status, QoL, disability and dementia risk.

scholarly journals Group Lifestyle Phone Maintenance for Weight, Health, and Physical Function in Adults Aged 65–80 Years: A Randomized Clinical Trial

2020 ◽  
Author(s):  
Elizabeth M Venditti ◽  
Marsha D Marcus ◽  
Rachel G Miller ◽  
Vincent C Arena ◽  
Susan L Greenspan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Weight Loss ◽  
Physical Function ◽  
Community Dwelling ◽  
Lipid Lowering ◽  
Additional Risk ◽  
Management Group ◽  
Registration Number ◽  
And Function

Abstract Background Group lifestyle sessions with phone maintenance could improve weight, health, and function in vulnerable older adults. Methods Community-dwelling adults (N = 322) with body mass index (BMI, kg/m2) ≥27 and additional risk factors received 12 one-hour in-person behavioral weight management group sessions then were randomized to 8 half-hour telephone sessions (n = 162) or newsletter control (n = 160) from 4 to 12 months with no treatment contact thereafter. Primary outcome was 0- to 12-month weight change. Cardiometabolic, short physical performance battery (SPPB), and self-reported activity changes were assessed at 12 and 24 months. Results At baseline, the mean (SD) age was 71.2 (4.3) and BMI was 33.8 (5.1). Participants were 77% women, 13% Black, 85% retired, averaging 4 medical conditions, and taking blood pressure (67.4%) and lipid-lowering (51.6%) medications. At 12 months, a greater proportion of the phone group (66.0%) achieved ≥5% weight loss compared with newsletter control (53.2%; p = .02). Mean (95% CI) weight loss was greater for phone (−6.6 kg [−7.5, −5.8]) than newsletter (−5.1 kg [−7.2, −3.0]); p = .01. Modest lipid, glucose, and blood pressure improvements were found, but did not differ significantly between groups. Small SPPB and activity improvements were maintained at 12 and 24 months in both groups. Conclusions Brief phone contacts compared to newsletters enhanced weight loss maintenance among older high-risk adults at 1 year, but not cardiometabolic outcomes. Modest functional improvements were observed in both. Lower-intensity maintenance contacts (phone or newsletter) for weight, health, and physical function in older adults warrant further study. Clinical Trials Registration Number NCT03192475

scholarly journals Evaluation of Clinically Meaningful Changes in Measures of Frailty

2020 ◽  
Vol 75 (6) ◽  
pp. 1143-1147 ◽  
Author(s):  
Il-Young Jang ◽  
Hee-Won Jung ◽  
Hea Yon Lee ◽  
Hyungchul Park ◽  
Eunju Lee ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trials ◽  
Clinical Care ◽  
Frailty Index ◽  
Large Change ◽  
Community Dwelling ◽  
Deficit Accumulation ◽  
Frailty Phenotype ◽  
Euroqol 5D ◽  
Community Dwelling Older Adults

Abstract Background To determine the clinically meaningful changes and responsiveness of widely used frailty measures. Methods We analyzed data from a prospective cohort study of 1,135 community-dwelling older adults who underwent assessments of frailty and health-related quality of life using the EuroQol-5D at baseline and 1 year later. Frailty measures included deficit-accumulation frailty index (FI); frailty phenotype; Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale; and the Study of Osteoporotic Fracture (SOF) index. We determined the clinically meaningful changes by the distribution-based method and the anchor-based method using the EuroQol-5D score and responsiveness indices. Results Frailty measures were available in 925 participants at 1 year (81.5%). Based on the distribution-based method, small and large clinically meaningful changes were 0.019 and 0.057 for FI, 0.249 and 0.623 for frailty phenotype, 0.235 and 0.587 for FRAIL scale, and 0.116 and 0.289 for SOF index, respectively. The anchor-based estimates of small and large changes were 0.028 and 0.076 for FI, 0.097 and 0.607 for frailty phenotype, 0.269 and 0.368 for FRAIL scale, and 0.023 and 0.287 for SOF index, respectively. Based on the responsiveness index, per-group sample sizes to achieve 80% power in clinical trials, ranged from 51 (FI) to 7,272 (SOF index) for a small change and 9 (FI) to 133 (FRAIL scale) for a large change. Conclusions The estimates of clinically meaningful change of frailty measures can inform the choice of frailty measures to track longitudinal changes of frailty in clinical trials and clinical care of community-dwelling older adults.

scholarly journals Longitudinal Engagement in Modifiable Lifestyle Behaviors and Dementia Risk

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 58-58
Author(s):  
Roger Wong
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Proportional Hazards Model ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Future Research ◽  
Lifestyle Behaviors ◽  
Sampling Weights ◽  
Social Contacts ◽  
Dementia Risk

Abstract Dementia is a major public health threat as there are currently no definitive methods to prevent, treat, and cure the disorder. Recent efforts have focused on modifiable lifestyle behaviors to reduce dementia risk. Yet, the majority of these studies have utilized cross-sectional data or are limited to specific geographic areas. The purpose of this study was to explore how longitudinal engagement in modifiable lifestyle behaviors (physical activity, smoking, and social contacts) influence dementia risk. This study analyzed eight annual waves (2011-2018) of prospective data from the National Health and Aging Trends Study, a large nationally representative U.S. sample of older adults. Each wave, physical activity was measured as engagement in vigorous physical activities; smoking was measured as current engagement in cigarette smoking; and social contacts was measured as visiting friends/family outside of their home. The dependent variable was number of years to a new dementia diagnosis. Multivariate analyses were conducted using the Cox proportional hazards model with survey sampling weights applied for a national sample of 6,800 community-dwelling older adults dementia-free at baseline. After controlling for sociodemographics (age, sex, race, etc.) and health (physical health, chronic disease, etc.), longitudinal engagement in physical activity significantly decreased dementia risk (Hazard Ratio [HR]=0.60, p&lt;.05), however, there was no significant relationship with smoking (HR=1.12, p=.58) and social contacts (1.06, p=.83). Our findings indicate physical activity is a promising modifiable lifestyle behavior for prevention. Future research should explore physical activity interventions that are most effective in reducing dementia risk, such as strength-based or aerobic-based activities.

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