A Prospective Study of Diurnal Cortisol and Incident Dementia in Community-Dwelling Older Adults

2021 ◽  
pp. 1-6
Author(s):  
Marie-Laure Ancelin ◽  
Joanna Norton ◽  
Jacqueline Scali ◽  
Karen Ritchie ◽  
Isabelle Chaudieu ◽  
...  
Keyword(s):  
Older Adults ◽  
Community Dwelling ◽  
Diurnal Cortisol ◽  
Cox Proportional Hazard ◽  
Incident Dementia ◽  
Unit Increase ◽  
Cox Proportional Hazard Models ◽  
Response To Stress ◽  
A Prospective Study ◽  
Community Dwelling Older Adults

Diurnal salivary cortisol was measured in 334 older adults without dementia, at four times on two separate days, under quiet and stressful conditions. In multivariate Cox proportional hazard models, higher global diurnal cortisol secretion was associated with incident dementia (HR = 1.09 [1.02–1.15] per one-unit increase in cortisol measure, p = 0.007) and Alzheimer’s disease (HR = 1.12 [1.04–1.21], p = 0.003) over a mean(SD) of 8.1(4.0) years, independent of potential confounders and stressful conditions. Individuals with incident dementia had a slower rate of cortisol elimination under non-stressful conditions, reflected by higher cortisol levels in the evening, and an abnormal response to stress (blunted evening stress response).

Prospective Associations between Plasma Amyloid-Beta 42/40 and Frailty in Community-Dwelling Older Adults

2020 ◽  
pp. 1-7
Author(s):  
W.-H. Lu ◽  
K.V. Giudici ◽  
Y. Rolland ◽  
S. Guyonnet ◽  
Y. Li ◽  
...  
Keyword(s):  
Older Adults ◽  
Amyloid Beta ◽  
Community Dwelling ◽  
Lower Quartile ◽  
Frailty Phenotype ◽  
Mixed Effect ◽  
Apoe Ε4 ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Community Dwelling Older Adults

Background: Brain amyloid-beta (Aβ) plaques, a hallmark of the pathophysiology of Alzheimer’s disease, have been associated with frailty. Whether the plasma Aβ markers show similar relationship with frailty is unknown. OBJECTIVES: To investigate the prospective associations between plasma Aβ42/40 ratio and overtime frailty in community-dwelling older adults. METHODS: From the 5-year Multidomain Alzheimer Preventive Trial (MAPT), we included 477 adults ≥70 years with available data on plasma Aβ42/40 ratio (lower is worse). Fried frailty phenotype (robust, pre-frail and frail) was assessed at the same time-point of plasma Aβ measures and after until the end of follow-up. The outcomes of interest were the change in the frailty phenotype over time (examined by mixed-effect ordinal logistic regressions) and incident frailty (examined by Cox proportional hazard models). RESULTS: Plasma Aβ42/40 did not show significant associations with incident frailty; however, after adjusting for Apolipoprotein E (APOE) ε4 genotype, people in the lower quartile of plasma Aβ42/40 (≤0.103) had higher risk of incident frailty (HR=2.63; 95% CI, 1.00 to 6.89), compared to those in the upper quartile (>0.123). Exploratory analysis found a significant association between the lower quartile of plasma Aβ42/40 and incident frailty among APOE ε4 non-carriers (HR=3.48; 95% CI, 1.19 to 10.16), but not among carriers. No associations between plasma Aβ42/40 and evolution of frailty were observed. CONCLUSION: No significant associations between plasma Aβ42/40 and frailty were found when APOE ε4 status was not accounted into the model. Nevertheless, APOE ε4 non-carriers with high Aβ burden might be more susceptible to develop frailty.

scholarly journals Dual Decline in Gait and Cognition Is Associated With Future Dementia: Evidence for a Phenotype

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 264-264
Author(s):  
Manuel Montero Odasso ◽  
Mark Speechley ◽  
Richard Camicioli ◽  
Nellie Kamkar ◽  
Qu Tian ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Regression Models ◽  
Community Dwelling ◽  
Hierarchical Regression ◽  
Chi Square ◽  
Cox Models ◽  
Incident Dementia ◽  
Risk Of Progression ◽  
Community Dwelling Older Adults

Abstract BACKGROUND: The concurrent decline in gait speed and cognition are associated with future dementia. However, the clinical profile of those who present with dual-decline has not yet been described. We aimed to describe the phenotype and risk for incident dementia of individuals who present a dual-decline in comparison with non dual-decliners. METHODS: Prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants’ gait speed, cognition, medical status, functionality, incidence of adverse events, and dementia biannually over 7 years. Gait speed was assessed with a 6-meter electronic-walkway, and global cognition was assessed using the MoCA test. We compared characteristics between dual-decliners and non dual-decliners using t-test, Chi-square, and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS: Among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual-decliners had a three-fold risk (HR: 3.12, 95%CI:1.23-7.93, p=0.017) of progression to dementia compared with non dual-decliners. Dual-decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (p=0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual-decliners group, while adding hypertension and dyslipidemia increased the explained variation to 8% and 10 %, respectively. The risk of becoming a dual-decliner was 4-fold if hypertension was present. CONCLUSION: Older adults with concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. These dual-decliners have a distinct phenotype with a higher prevalence of hypertension, a potentially treatable condition.

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 Assessing Older Adults’ Frequency of Going Outside and Physical Performance: NHATS 2017

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 793-794
Author(s):  
Justine Sefcik ◽  
Janeway Granche ◽  
Martha Coates ◽  
Zachary Hathaway ◽  
Rose Ann DiMaria-Ghalili
Keyword(s):  
Older Adults ◽  
Physical Performance ◽  
Logistic Model ◽  
Interdisciplinary Teams ◽  
Community Dwelling ◽  
Outdoor Activity ◽  
Mobility Devices ◽  
Unit Increase ◽  
Community Dwelling Older Adults ◽  
The Relationship

Abstract Little is known about community-dwelling older adults’ outdoor activity and the relationship between physical function and frequency of going outside. Using the 2017 NHATS (N = 4,465), we looked at self-reported outdoor frequency (Likert scale: every day to once a week or less) and the Short Physical Performance Battery (SPPB; participants completed five different physical activities to measure physical performance; total scores ranged from 0, not attempted, to 12, the best). A logistic model comparing community-dwelling older adults going out most days (18.3%), some days (10.3%), or rarely/never (3.4%) to those going out every day found ORs of 0.85, 0.70, and 0.58 respectively (all p<0.0001) for a one-unit increase in SPPB score. Interdisciplinary teams can use findings to assess disabled community-dwelling older adults’ frequency of going outdoors. Implications for interventions to assist with increasing times leaving the home (e.g. mobility devices, caregiver assistance) will be discussed.

scholarly journals Housing conditions and risk of physical function limitations: a prospective study of community-dwelling older adults

2018 ◽  
Vol 40 (3) ◽  
pp. e252-e259 ◽  
Author(s):  
Bibiana Pérez-Hernández ◽  
Esther Lopez-García ◽  
Auxiliadora Graciani ◽  
José Luis Ayuso-Mateos ◽  
Fernando Rodríguez-Artalejo ◽  
...  
Keyword(s):  
Older Adults ◽  
Prospective Study ◽  
Physical Function ◽  
Community Dwelling ◽  
Housing Conditions ◽  
A Prospective Study ◽  
Community Dwelling Older Adults

scholarly journals Apathy and risk of probable incident dementia among community-dwelling older adults

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3280-e3287 ◽  
Author(s):  
Meredith A. Bock ◽  
Amber Bahorik ◽  
Willa D. Brenowitz ◽  
Kristine Yaffe
Keyword(s):  
Older Adults ◽  
Proportional Hazards Model ◽  
Cognitive Change ◽  
Community Dwelling ◽  
Rate Of Change ◽  
Cox Proportional Hazards Model ◽  
Digit Symbol Substitution Test ◽  
Incident Dementia ◽  
Increased Risk ◽  
Community Dwelling Older Adults

ObjectiveTo evaluate the association between baseline apathy and probable incident dementia in a population-based sample of community-dwelling older adults.MethodsWe studied 2,018 white and black community-dwelling older adults from the Health, Aging, and Body Composition (Health ABC) study. We measured apathy at year 6 (our study baseline) with the modified Apathy Evaluation Scale and divided participants into tertiles based on low, moderate, or severe apathy symptoms. Incident dementia was ascertained over 9 years by dementia medication use, hospital records, or clinically relevant cognitive decline on global cognition. We examined the association between apathy and probable incident dementia using a Cox proportional hazards model adjusting for demographics, cardiovascular risk factors, APOE4 status, and depressed mood. We also evaluated the association between the apathy group and cognitive change (as measured by the modified Mini-Mental State Examination and Digit Symbol Substitution Test over 5 years) using linear mixed effects models.ResultsOver 9 years of follow-up, 381 participants developed probable dementia. Severe apathy was associated with an increased risk of dementia compared to low apathy (25% vs 14%) in unadjusted (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.5–2.5) and adjusted models (HR 1.7, 95% CI 1.3–2.2). Greater apathy was associated with worse cognitive score at baseline, but not rate of change over time.ConclusionIn a diverse cohort of community-dwelling adults, apathy was associated with increased risk of developing probable dementia. This study provides novel evidence for apathy as a prodrome of dementia.

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