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1.
Geroscience ; 2024 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-39192005

RESUMO

Gait Speed Reserve (GSR) expresses a difference between fast and comfortable gait speed and may have an impact on everyday functioning. It was also hypothesized as a useful proxy measure of physiological reserve. However, height-normalizing values of GSR and its associated factors have not been evaluated in a general population of older adults. Therefore, we aimed to investigate the distribution of height-normalized GSR (HN-GSR) in an elderly population-based cohort from urban and rural areas (n = 4342) aged 60-93 years and evaluate associated physiological and lifestyle factors. Using linear mixed models, we identified gender and nine modifiable factors as significantly associated with HN-GSR across four age groups. Better handgrip strength, cognition and standing balance, higher physical activity level, larger calf circumference, and less smoking had positive associations with HN-GSR, while female gender, more leg pain, higher weight and, alcohol consumption had opposite effects. The Marginal R2 imply that this model explained 26% of the variance in HN-GSR. Physical activity and handgrip strength varied across age groups in impact on HN-GSR. The differences were however comparatively minor. In this large cohort study of older adults, we proposed for the first time that factors associated with HN-GSR represented multi-domain features that are in line with previous findings reported for GSR. Measuring HN-GSR/GSR may help clinicians identify early physiological impairments or unhealthy lifestyle habits, especially among older women, and may also have safety implications in daily life. Further work is needed to find out if measuring HN-GSR/GSR may be useful in identifying adverse health outcomes and overall physiological reserve.

2.
J Neurol ; 271(9): 5997-6003, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39026021

RESUMO

BACKGROUND AND OBJECTIVES: Cerebral small vessel disease (CSVD) is associated to cognitive decline and dementia. Neuroimaging changes of CSVD are highly prevalent above 80 years. Only few studies report on incidence of CSVD in high age. We have investigated the incidence and prevalence of magnetic resonance imaging (MRI) markers of CSVD and risk factors in the general older population. METHODS: As part of the general population Good Aging in Skåne cohort study (GÅS), 241 persons (mean age 76.3 years) underwent two brain MRI, 3-T scanner with a mean interval of 5.9 years. The incidence of white matter hyperintensities (WMH), lacunar infarction, cerebral atrophies and cerebral microbleeds (CMB) were calculated and the relationship to risk factors analysed by a multivariate regression analysis. Medial temporal lobe atrophy (MTA) was graded according to Scheltens'18 scale and CMB were defined as having > 1 small (0.2-0.5 cm) hypointense lesion. RESULTS: The 6-year incidence of CMB, WMH and MTA were, 19%, 17% and 13% respectively, corresponding to 170/1,000 py., 172/1,000 py., and respectively 167/1,000 py. The incidence of CSVD according to the modified STRIVE score was 33%, 169/1,000 py and the prevalence at baseline was 73%. Moderate to high intake of alcohol was related to increased incidence of MTA and higher STRIVE score. Exposure to smoking was related to higher incidence of CMB and higher STRIVE score, adjusted for other known risk factors. CONCLUSION: CSVD is highly prevalent in the general older population and the 6-year incidence of WMH, CMB and MTA ranges from 13 to 19 percent. The modifiable lifestyle factors: smoking, and moderate alcohol intake are related to incident CSVD.


Assuntos
Doenças de Pequenos Vasos Cerebrais , Imageamento por Ressonância Magnética , Humanos , Idoso , Masculino , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Feminino , Incidência , Suécia/epidemiologia , Idoso de 80 Anos ou mais , Fatores de Risco , Envelhecimento/patologia , Estudos de Coortes , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Atrofia/patologia
3.
Cereb Circ Cogn Behav ; 6: 100220, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38523604

RESUMO

Aims: Cognitive and perfusion changes have been previously observed in older men with Mini Mental State Examination scores>24 points. We aimed to investigate time change in cognitive domains in a cohort of non-demented men between age 68 and 82, and how they are expressed in regional defects estimated by Cerebral Blood Flow (rCBF). Methods: 103 men at age 81 with MMSE scores >24 (mean 28.4 ± 1.7), no dementia or stroke, were examined with the same cognitive test battery at age 68 and age 81: Synonyms (SRB-1), Block design (SRB-3), Paired Associates, Digit Symbol Substitution and Benton Visual Retention test. rCBF was estimated using 99mTc-HMPAO SPECT at age 82. Results: Between ages 68 and 82 we observed a relative decline (Δ%) of cognitive test scores: SRB-3 and Benton tests, -33.7 % (SD 16,8) and -25.8 % (SD 23.9) respectively, followed by Digit Symbol test: -22,6 % (SD 15,6). The cluster of men (46 %) could be detected, grouped on the largest test score decline and highest overall test predictors' importance in decreasing order: Δ% SRB-3, Δ% Paired Associates, Δ% Digit Symbol, Δ% Benton VR and Δ% SRB-1. Compared to the cluster with stable cognitive functions, it expressed lower rCBF in frontal and parietal lobes, and in subcortical areas. Conclusion: Nearly half of the studied, community-dwelling cohort of non-demented, octogenarian men with MMSE > 24, had a combination of decreasing visuospatial ability and episodic memory during preceding years, expressed by widespread rCBF changes in fronto-subcortical areas.

4.
Gerontology ; 70(3): 257-268, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38043521

RESUMO

INTRODUCTION: Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60-97, and their impact on physical and autonomic function. METHODS: Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1-Q4). RESULTS: Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4-Q1: male 10.8-9.6 s; female 11.7-10.2 s), 15 m Walk test (Q4-Q1: male 11.1-9.9 s; female 11.2-10.4 s), and fewer repetitions in Step test (Q4-Q1: male 15.2-17.0 steps; female 14.5-15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7-3.8); female 2.1 (1.1-3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2-6.7]; female 1.8 [1.3-2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation. CONCLUSIONS: In a general population, 20-25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms.


Assuntos
Doenças do Sistema Nervoso Periférico , Equilíbrio Postural , Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Qualidade de Vida , Medo , Estudos de Tempo e Movimento , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/epidemiologia , Dor/epidemiologia
6.
Parkinsonism Relat Disord ; 111: 105416, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37130449

RESUMO

INTRODUCTION: Mild parkinsonian signs (MPS) have been characterized by several definitions, using the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). We aimed to investigate the prevalence of MPS and their association with functional level and comorbidities in the oldest old. METHOD: Community-dwelling older adults (n = 559, median age 85, range 80-102 years) were examined regarding MPS, possible parkinsonism (PP) and subthreshold parkinsonism (SP) according to four previously used definitions and concerning the impact of parkinsonian signs on cognitive, physical, and autonomic function. MPS, PP and SP are different terms describing a very similar phenomenon and there is no gradation between these. In two of the four definitions more advanced symptoms were categorized as parkinsonism. RESULTS: Median UPDRS score in the whole study group was 10 points (range: 0-58) and was predominated by bradykinesia. MPS/PP/SP were present in 17-85%, and parkinsonism in 33-71% of the cohort. Independently of age and gender, MPS/PP/SP and especially parkinsonism, were associated with a higher risk of fear of falling and accomplished falls, with lower: cognition, ADL, physical activity and quality of life, and with urinary incontinence, obstipation and orthostatic intolerance. CONCLUSIONS: In a population of older adults above 80 years, MPS are highly prevalent as well as more advanced symptoms defined as parkinsonism, and only 9-17% of the cohort is symptom-free. Predominance of bradykinesia in the oldest old might indicate a need for revision of MPS definitions to improve their sensibility.


Assuntos
Hipocinesia , Transtornos Parkinsonianos , Idoso de 80 Anos ou mais , Humanos , Idoso , Prevalência , Acidentes por Quedas , Qualidade de Vida , Medo , Transtornos Parkinsonianos/diagnóstico , Envelhecimento
7.
J Stroke Cerebrovasc Dis ; 32(3): 106981, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36657270

RESUMO

OBJECTIVES: A growing body of evidence links age related brain pathologies to systemic vascular processes. We aimed to study the prevalence and interrelations between magnetic resonance imaging (MRI) markers of cerebral small vessel disease and patterns of brain atrophy, and their association to carotid duplex ultrasound flow parameters. MATERIALS AND METHODS: We investigated a population based randomised cohort of older adults (n=391) aged 70-87, part of the Swedish Good Aging in Skåne Study. Peak systolic and end diastolic velocities of the carotid arteries were measured by ultrasound, and resistivity- and pulsatility indexes were calculated. Subjects with increased peak systolic velocity indicating carotid stenosis were excluded from analysis. Nine MRI findings were rated by visual scales: white matter changes, pontine white matter changes, microbleeds, lacunar infarctions, medial temporal lobe atrophy, global cortical atrophy, parietal atrophy, precuneus atrophy and central atrophy. RESULTS: MRI pathologies were found in 80% of subjects. Mean end diastolic velocity in common carotid arteries was inversely associated with white matter hyperintensities (OR=0.92; p=0.004), parietal lobe atrophy (OR=0.94; p=0.039), global cortical atrophy (OR=0.90; p=0.013), precuneus atrophy (OR=0.94; p=0.022), "number of CSV pathologies" (ß=-0.07; p<0.001) and "MRI-burden score" (ß=-0.11; p<0.001), after adjustment for age and sex. The latter three were also associated with pulsatility and resistivity indexes. CONCLUSIONS: Low carotid end diastolic velocity, as well as increased carotid resistivity and pulsatility, were associated with signs of cerebral small vessel disease and patterns of brain atrophy, indicating a vascular component in the process of brain aging.


Assuntos
Doenças de Pequenos Vasos Cerebrais , Doenças Neurodegenerativas , Idoso , Humanos , Atrofia/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Artérias Carótidas/patologia , Artéria Carótida Primitiva , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Imageamento por Ressonância Magnética , Doenças Neurodegenerativas/patologia
8.
Aging Ment Health ; 24(8): 1246-1253, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-30945552

RESUMO

Objectives: Depressive symptoms in the elderly have been shown to be associated with increased mortality. The purpose of this study was to examine symptoms of depression in octogenarian men and their association with all-cause mortality, and whether physical, cognitive and social factors influence this association.Methods: Out of the 703 initially included 55-years-old men, from the prospective cohort study "Men born in 1914", we studied 163 survivors who could take a part in a survey at age 81, and followed them until their death.Results: Those men who had at least mild depressive symptoms, defined with Zung Self-rating Depression Scale, were found to have an increased mortality risk (HR = 1.52; CI =1.10-2.08; p = 0.01). This association persisted significantly after adjusting for: education, global cognition at age 81, cognitive abilities at age 68, vascular risk factors and comorbidities. Instead, it was attenuated after adjustments for Activities of Daily Life (ADL) - dependency and for a grade of Satisfaction with Participation in daily life.Conclusion: In octogenarian men with survival above the average, mild depressive symptoms predict all-cause mortality. Neither cognitive capacity nor vascular comorbidity explained this association, but lower Satisfaction with Participation in daily life, especially in combination with moderate ADL-dependency.


Assuntos
Depressão , Participação Social , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos de Coortes , Depressão/epidemiologia , Humanos , Masculino , Estudos Prospectivos
9.
J Clin Hypertens (Greenwich) ; 21(8): 1099-1107, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31274244

RESUMO

Cerebral microbleeds (CMB) on MRI are frequent in healthy aging individuals but precede ischemic and hemorrhagic stroke and dementia. Different etiologies have been suggested for nonlobar CMB, which have a stronger connection to hypertension (HT) than do lobar CMB. This study aimed to investigate the prevalence of CMB and the association between nonlobar/lobar CMB and different blood pressure (BP) and HT treatment conditions in a longitudinal, population-based cohort of the Good Aging in Skåne (GÅS) study. White matter hyperintensities (WMH), CMB, atrophies, and infarctions were identified with brain 3T MRI, and BP parameters were examined in 344 randomly selected subjects between 70 and 87 years old. CMB were observed in 26% of the whole cohort, increasing from 19% of subjects in their 70s to 30% of those over 80 years of age. Of these subjects, 38% had multiple CMB, and 59% had a lobar localization. CMB were associated with severe confluent WMH (odds ratio = 7.02; 2.16-18.84). Increasing age, being male, and having HT, impaired cognition, or a history of angina pectoris were associated with CMB. Both lobar and nonlobar CMB were associated with HT. Nonlobar CMB were particularly associated with increased BP, pulse pressure, controlled HT, and uncontrolled HT. After controlling for sex and HT, age was no longer a risk factor for CMB In conclusion, sex and HT are the major risk factors for CMB, especially nonlobar CMB, which suggests stricter implementation of recommended guidelines for HT treatment in the elderly.


Assuntos
Isquemia Encefálica/patologia , Encéfalo/patologia , Hemorragia Cerebral/fisiopatologia , Hipertensão/complicações , Substância Branca/patologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Angina Pectoris/epidemiologia , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Encéfalo/irrigação sanguínea , Isquemia Encefálica/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Demência/etiologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Estudos Longitudinais , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Suécia/epidemiologia , Substância Branca/diagnóstico por imagem
10.
Artigo em Inglês | MEDLINE | ID: mdl-28068866

RESUMO

OBJECTIVES: Mini Mental State Examination's (MMSE's) sensitivity in its upper level is questioned, hence we investigated cognitive abnormalities and defects in regional cerebral blood flow (rCBF) in elderly with MMSE scores ≥24. METHODS: One hundred and four men at age 81 with MMSE scores ≥24 (mean 28.4 ± 1.7), no dementia or stroke, were examined with neuropsychological test battery, and their rCBF was estimated using 99mTc-HMPAO SPECT. RESULTS: MMSE was very sparsely correlated with rCBF. Instead, visuo-spatial tests were correlated with rCBF in parietal and occipital lobe, verbal tests with rCBF in frontal and temporal-parietal lobes, and most of all between Digit Symbol and all rCBF regions, especially in subcortical gray and white matter. In a cluster of low achievers, test of Synonyms, followed by Digit Symbol and Benton test, had highest discriminatory importance. Low achievers had generalized rCBF changes especially in subcortical areas. Only lower scores on two MMSE items, figure drawing and calculation, could discriminate the clusters. CONCLUSION: A substantial number of octogenarian men with MMSE ≥ 24p have widespread rCBF changes corresponding to a decreased speeded performance and verbal capacity.


Assuntos
Encéfalo/fisiopatologia , Circulação Cerebrovascular , Disfunção Cognitiva/fisiopatologia , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Cognição/fisiologia , Disfunção Cognitiva/diagnóstico por imagem , Estudos de Coortes , Humanos , Vida Independente , Masculino , Testes Neuropsicológicos , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Exametazima , Tomografia Computadorizada de Emissão de Fóton Único
11.
BMC Geriatr ; 16: 23, 2016 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-26791263

RESUMO

BACKGROUND: One of the primary reasons for hospitalisation among elderly individuals with heart failure (HF) is poor self-care. Self-awareness of having HF may be a key-element in successful self-care. The prevalence of self-awareness of HF, and how it is affected by age-and HF-related factors, remains poorly understood. The aims of the present study were to determine the prevalence of self-awareness of HF in participants, ≥ 80 years of age, and to investigate the association between this self-awareness and age-related and HF-related factors. METHODS: A single-centre observational study was conducted in which non-hospitalised participants (80+) with objectively verified HF were identified (n = 90). The statement of having HF or not having HF was used to divide the participants into two groups for comparisons: aware or unaware of one's own HF. Logistic regression models were completed to determine the impact of age-and HF-related factors on self-awareness. RESULTS: Twenty-six percent (23/90) were aware of their own HF diagnosis. No significant differences were found between the participants who were aware of their own HF diagnosis and the participants who were not. Neither age-nor HF-related factors had influence on the prevalence of self-awareness. CONCLUSIONS: Prevalence of self-awareness of own HF in the oldest old is insufficient, and this self-awareness may be influenced by external factors. One such factor is likely the manner in which the HF diagnosis is relayed to the patient by health care professionals.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Insuficiência Cardíaca , Autocuidado , Idoso de 80 Anos ou mais , Conscientização , Autoavaliação Diagnóstica , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Modelos Logísticos , Masculino , Percepção , Prevalência , Autocuidado/métodos , Autocuidado/normas , Suécia/epidemiologia
12.
BMC Psychiatry ; 13: 347, 2013 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-24369109

RESUMO

BACKGROUND: The aim of this study was to examine in elderly men a relationship between depressive symptoms, peripheral vascular disease and cerebral blood flow (CBF). METHODS: Population-based cohort study started with an examination of 809 men at age 55, followed by the first (age 68ys) and second follow up (age 82ys). 128 survivors were examined at age 82 with 99mTc-HMPAO-SPECT to estimate CBF, Zung-Self-Rating-Depression Scale (ZSDS), and Ankle-Brachial Index (ABI). Analysis was performed on men free from stroke and dementia which defined the final study population to 120 subjects. RESULTS: ZSDS in the whole cohort ranged from 0.26 to 0.71 (reference 0.25-1.0). As the frequency of depressive symptoms was low, the case group (n = 31) was defined by ZSDS index above 75th percentile (≥0.48), comprising 9 subjects with mild depression (ZSDS 0.55-0.71) and 22 subjects at 88th percentile and above of the normal range (ZSDS index 0.48-0.54). Cases were more often current smokers at age 68 (44% vs. 24%; p = .02) and had lower systolic blood presure (SBP), lower social and physical activity, and suffered from fatigue, nausea, freezing and leg edema at age 82. Within the case group, ZSDS-index correlated negatively with CBF in subcortical area (r = -.42*), left and right thalamus (r = -.40*, r = -.46**), and right basal nuclei (r = -.35*). ZSDS-index correlated also with ABI at age 82 (right leg r = -.40*; left leg r = -.37*), and with Δ between ABI at age 82 and 68 (right r = -.36*; left r = -.46**). Despite decreasing SBP from age 68 to 82, adjusted multiple regression analysis showed in the case group that higher SBP determined CBF changes in the frontal and parietal areas, independently of ZSDS index, Δ ABI, and smoking. CONCLUSION: In this population-based cohort of octogenarian men free from stroke or dementia, a proportion of subjects with depressive symptoms was low. Still, men with borderline or mild depression scores had lower social and physical activity, persistent smoking habit, worse peripheral circulation in legs, and cerebral perfusion changes in basal nuclei, thalamus and subcortical white matter. Regional CBF decline could be partly mediated by higher SBP.


Assuntos
Aterosclerose/complicações , Transtornos Cerebrovasculares/complicações , Depressão/complicações , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico por imagem , Aterosclerose/fisiopatologia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/fisiopatologia , Depressão/diagnóstico por imagem , Depressão/fisiopatologia , Exercício Físico , Seguimentos , Humanos , Masculino , Cintilografia , Fumar , Comportamento Social
13.
BMC Geriatr ; 13: 45, 2013 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-23672300

RESUMO

BACKGROUND: The aims of this study are to examine possible associations between left cardiac ventricular measures in sixth decade and cognitive performance, both cross sectionally and longitudinally, and to examine if left cardiac ventricular measures could predict future changes in cerebral blood flow (CBF). METHODS: 211 elderly men from a cohort of the population study "Men born in 1914" completed M-mode echocardiography and a cognitive test battery at age 68. The cognitive test battery was repeated at age 81. CBF was estimated with 99mTc-HMPAO SPECT in 72 survivors at age 83. Cognitive performance at baseline and at 1st follow up and CBF at 1st follow up were analysed in relation to left ventricular internal dimension in diastole (LVIDd mm/m2) and fractional shortening (FS). RESULTS: Subjects with enlarged LVIDd at age 68 had poorer results on verbal and speed-performance tests at baseline and on verbal and visuo-spatial tests 14 years later on. Low FS was associated with decreased results on visuo-spatial tests at baseline. There was an inverse relationship between LVIDd and both verbal and spatial ability at the baseline and after 14 years of follow-up. Normotensive men with lower FS had also decreased CBF in a majority of brain areas 14 years later. CONCLUSIONS: Mild echocardiographic abnormalities in 68 ys.-old men, as increased LVIDd and lower FS, are associated with lower cognitive test results and may predict cognitive decline and silent cerebral perfusion abnormalities 14 years later.


Assuntos
Envelhecimento/fisiologia , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Transtornos Cognitivos/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Transtornos Cognitivos/psicologia , Estudos de Coortes , Seguimentos , Humanos , Masculino , Testes Neuropsicológicos , Vigilância da População/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Tomografia Computadorizada de Emissão de Fóton Único
14.
Am J Geriatr Psychiatry ; 21(9): 863-71, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23567417

RESUMO

OBJECTIVE: The aim of this study was to examine the longitudinal impact of blood pressure variations and vascular risk factors on depressive symptoms in the elderly. DESIGN: Longitudinal and cross-sectional cohort study. SETTING: Urban population of elderly men, city of Malmö, Sweden. PARTICIPANTS: A total of 809 randomly included men took part in a prospective cohort study, "Men born in 1914", and 171 survivors reached the age of 81 years. MEASUREMENTS: Depressive symptoms were estimated at the age of 81 using the Zung Self-Rating Depression Scale (ZSDS). Vascular risk factors were identified at both 68 and 81 years of age. RESULTS: At the age of 68, diagnosis of hypertension and on-going antihypertensive therapy were more frequent in subjects with high than low ZSDS scores. In contrast, at age 81, the highest ZSDS scores correlated with low systolic blood pressure (SBP). Declining SBP between the ages of 68 and 81 was more frequent in high-scoring than in low-scoring groups. Subjects with high ZSDS scores took more drugs and had more clinical diagnoses at age 81. Those taking hypnotics and sedatives had higher ZSDS scores, lower SBP at 81, and showed more frequent decrease in SBP during the observation period. CONCLUSION: Depressive symptoms in octogenarian men could be predicted by hypertension earlier in life, and were strongly associated with decreasing SBP during the last decade.


Assuntos
Pressão Sanguínea , Doenças das Artérias Carótidas/epidemiologia , Depressão/epidemiologia , Hipertensão/epidemiologia , Doença Arterial Periférica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Doenças das Artérias Carótidas/diagnóstico por imagem , Estudos de Coortes , Estudos Transversais , Humanos , Hipertensão/tratamento farmacológico , Hipnóticos e Sedativos/uso terapêutico , Estudos Longitudinais , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Estudos Prospectivos , Fatores de Risco , Suécia , Sístole , Ultrassonografia , Doenças Vasculares/epidemiologia
15.
Int J Vasc Med ; 2012: 579531, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22778963

RESUMO

To examine if mild carotid stenosis correlates with silent vascular brain changes, we studied a prospective population-based cohort "Men born in 1914." Data from followups at ages 68 and 81, have been used. Carotid ultrasound was performed at age 81, and cerebral blood flow (CBF) was measured with SPECT at age 82. Out of 123 stroke-free patients, carotid stenosis <50% was observed in 94% in the right and 89% in the left internal carotid arteries (ICAs). In these subjects, Peak Systolic Velocities in ICA correlated negatively with CBF in a majority of several brain areas, especially in mesial temporal area. Results were limited to normotensive until their seventies, who developed late-onset hypertension with a subsequent blood pressure, pulse pressure, and ankle-brachial index growth. Elderly with asymptomatic carotid stenosis <50% and peak systolic velocities in ICA 0.7-1.3 m/s, should be offered an intensified pharmacotherapy to prevent stroke or silent cerebrovascular events.

16.
Int J Hypertens ; 2012: 417291, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22216405

RESUMO

To assess an impact of vascular risk factors on ambulatory blood pressure measurement (ABPM) in the elderly, we followed up a population-based cohort of men from 68 until 82 years, when 104 survivors underwent ABPM. Results. At age 68, hypertension and high clinic blood pressure (CBP) did not predict ABPM level. Smoking and low ankle-brachial index (ABI) predicted higher ABPM variability and pulse pressure (PP), but not absolute ABPM values. At age 82, hypertension, high or increasing CBP, strongly positively correlated with all variables of ABPM. Carotid stenosis, low or declining ABI during followup, correlated with higher nocturnal ABPM and PP. Concluding. Hypertension and vascular risk factors in a cohort of 68-year-old men do not result in higher ABPM at age 82, possibly due to inflection point in their pressure development. Higher ABPM reflects instead an increasing CBP and aggravating atherosclerosis during the preceding decade in that part of the cohort with previously favorable risk factor status.

17.
BMC Geriatr ; 11: 57, 2011 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-21967408

RESUMO

BACKGROUND: Systolic blood pressure (SBP) decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP) and Strain-Gauge-Finger-Plethysmography (SG-BP), and which of them were more reliable in expressing vascular burden. METHODS: A cohort of 703 men from a population of Malmö, Sweden, were included in "Men born in 1914-study" and followed-up at ages: 68 and 81 years. 176 survivors were examined with K-BP and SG-BP at both ages, and 104 of them with Ambulatory Blood Pressure at age 81/82. Ankle Brachial Index (ABI) was measured on both occasions, and Carotid Ultrasound at age 81. RESULTS: From age 68 to 81, mean K-BP decreased in the cohort with mean 8.3 mmHg, while SG-BP increased with 13.4 mmHg. K-BP decreased in 55% and SG-BP in 31% of the subjects. At age 81, K-BP was lower than SG-BP in 72% of subjects, and correlated to high K-BP at age 68 (r = --.22; p < .05). SG-BP at age 81 was correlated with mean ambulatory 24-h SBP (r = .480; p < .0001), daytime SBP (r = .416; p < .0001), nighttime SBP (r = .395; p < .0001), and daytime and nighttime Pulse Pressure (r = .452; p < .0001 and r = .386; p < .0001). KB-BP correlated moderately only with nighttime SBP (r = .198; p = .044), and daytime and nightime pulse pressure (r = .225; p = .021 and r = .264; p = .007). Increasing SG-BP from age 68 to 81, but not K-BP, correlated with: 24-h, daytime and nighttime SBP, and mean daytime and nighttime Pulse Pressure. Increasing SG-BP was also predicted by high B-glucose and low ABI at age 68, and correlated with carotid stenosis and low ABI age 81, and the grade of ABI decrease over 13 years. CONCLUSION: In contrast to K-BP, values of SG-BP in octogenarians strongly correlated with Ambulatory Blood Pressure. The SG-BP decline in the last decade was rare, and increasing SG-BP better than K-BP reflected advanced atherosclerosis. It should be aware, that K-BP underdetected 46% of subjects with SG-BP equal/higher than 140 mmHg at age 81, which may lead to biased associations with risk factors due to differential misclassification by age.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/normas , Pressão Sanguínea/fisiologia , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Sístole/fisiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Monitorização Ambulatorial da Pressão Arterial/métodos , Estudos de Coortes , Estudos Transversais , Seguimentos , Humanos , Masculino , Estudos Prospectivos
18.
Atherosclerosis ; 214(1): 231-6, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21111419

RESUMO

OBJECTIVE: Knowledge about the impact of cardiovascular disease on cerebral autoregulation and cognition in aging is sparse. The aim of our study is to examine the association between cerebral blood flow (CBF), silent ST segment depression (STDE) on ambulatory ECG (LTER) and nocturnal blood pressure variations in elderly men. METHODS: In a cross-sectional cohort study "Men born in 1914", eighty 83-year-old men were examined by CBF, LTER and ambulatory blood pressure monitoring (ABPM). The presence and the degree of STDE were analyzed in relation to regional CBF in nocturnal blood pressure dippers/non-dippers. RESULTS: Fourty-five (56%) study subjects had STDE, 25 at both day and night and 20 only daytime. Subjects with STDE expressed lower CBF in left frontal, temporal, inferior parietal regions and bilateral superior parietal regions compared to men without STDE. Low regional CBF was most frequent in subjects with daytime STDE. Subjects with nocturnal diastolic blood pressure dip and STDE (22 subjects; 35%) had lower mean CBF in the parietal lobe and also correlation between STDE and CBF (r=0.31-0.44, p=0.056-0.006) compared to non-dippers with STDE. The lowest CBF in nocturnal dippers was observed in subjects with maximal STDE daytime. CONCLUSION: Silent myocardial ischemia may contribute to cerebrovascular disease in non-demented elderly men. Cerebral perfusion seems to be most vulnerable to myocardial ischemia in elderly with nocturnal blood pressure dipping.


Assuntos
Pressão Sanguínea , Isquemia Miocárdica/patologia , Idoso , Idoso de 80 Anos ou mais , Monitorização Ambulatorial da Pressão Arterial/métodos , Encéfalo/patologia , Circulação Cerebrovascular , Ritmo Circadiano , Estudos de Coortes , Estudos Transversais , Eletrocardiografia/métodos , Humanos , Masculino , Monitorização Ambulatorial/métodos , Isquemia Miocárdica/diagnóstico , Perfusão , Tomografia Computadorizada de Emissão de Fóton Único/métodos
19.
Blood Press Monit ; 13(5): 269-75, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18799952

RESUMO

INTRODUCTION: Low blood pressure (BP) has been found to be associated with cerebrovascular damage in the elderly. Studies of the relation of ambulatory BP to cognitive function in elderly persons aged 80 years or above is lacking, however. METHODS: Ninety-seven 81-year-old men from the population study 'Men born in 1914' underwent ambulatory BP monitoring and were given a cognitive test battery, 79 subjects completing all six tests. Low ambulatory systolic blood pressure (SBP) was defined as <130 mmHg and low ambulatory diastolic blood pressure (DBP) as <80 mmHg (corresponding in terms of office BP to approximately <140 and <90 mmHg, respectively). Odds ratios (OR) for lower cognitive function were calculated using a forward stepwise logistic regression model, controlling for confounding factors. RESULTS: Subjects with ambulatory SBP <130 mmHg had higher OR values for daytime (OR 2.6; P=0.037), nighttime (OR 3.6; P=0.032) and 24h (OR 2.6; P=0.038) BP measurements. A lower cognitive function was associated with lower nighttime SBP and DBP levels and lower 24-h mean SBP compared to subjects with higher cognitive function. OR values connected to low nocturnal SBP, had a tendency to be particularly high among subjects on anti-hypertensive drugs (OR 9.1; P=0.067, n.s.). CONCLUSION: Ambulatory SBP levels <130 mmHg and lower nighttime SBP and DBP were associated with lower cognitive function in healthy elderly men. Further investigation is needed to ascertain the effects of the presently recommended treatment goal of <140 mmHg for office SBP also on elderly over 80 years of age.


Assuntos
Pressão Sanguínea/fisiologia , Transtornos Cognitivos/fisiopatologia , Hipotensão/fisiopatologia , Idoso de 80 Anos ou mais , Monitorização Ambulatorial da Pressão Arterial , Transtornos Cognitivos/complicações , Estudos de Coortes , Humanos , Hipotensão/complicações , Masculino , Razão de Chances
20.
Neuroepidemiology ; 30(2): 84-92, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18311087

RESUMO

AIM: Smoking and hypertension are known causes of stroke and dementia. This study was designed to test the longitudinal effect of lifestyle factors and hypertension on cerebral blood flow (CBF) in old age. METHOD: A study of an unselected population cohort of 703 men, born in 1914, has been in progress since 1968 and the last clinical examination occurred at age 69. CBF was examined in 129 survivors who reached 82 years, using SPECT. RESULTS: At the age of 69, the study subjects consisted of 36 smokers, 37 nonsmokers and 56 former smokers who had quit. Fourteen years later, there were no differences in CBF among them. The cohort was stratified into 69 hypertensive and 60 normotensive men. CBF in normotensives was lowest in smokers and highest in nonsmokers. No CBF differences were observed in hypertensive men regarding smoking, but their CBF was as low as in normotensive smokers. Hypertensives had a higher BMI, and higher blood glucose and triglyceride levels, but lower alcohol consumption at 69 and a lower ankle-brachial pressure index at 82 years. Alcohol consumption was highest in normotensive smokers. CONCLUSION: Smoking and high alcohol consumption in normotensive men are correlated to low CBF in senescence. Low CBF in hypertensive men regardless of smoking may be due to a high vascular risk profile.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Fumar/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/epidemiologia , Colesterol/sangue , Estudos de Coortes , Seguimentos , Humanos , Hipertensão/sangue , Hipertensão/complicações , Estudos Longitudinais , Masculino , Vigilância da População/métodos , Estudos Prospectivos , Fatores de Risco , Fumar/epidemiologia , Suécia/epidemiologia , Tomografia Computadorizada de Emissão de Fóton Único , Triglicerídeos/sangue , Ultrassonografia
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