Alzheimer disease and mortality: a 15-year epidemiological study.

BACKGROUND: Alzheimer disease (AD) is considered a leading cause of death, but few studies have examined the contribution of AD to mortality based on follow-up of representative US cohorts. OBJECTIVE: To examine mortality rates, duration of survival, causes of death, and the contribution of AD to the risk of mortality in an aging community-based cohort, controlling for other predictors. DESIGN: Fifteen-year prospective epidemiological study. Mortality rates per 1000 person-years and the population-attributable risk of mortality were determined. Cox proportional hazards models were used to estimate relative risk of mortality due to AD, adjusting for relevant covariates. Death certificates were abstracted for listed causes of death. SETTING: A largely blue-collar rural community in southwestern Pennsylvania. PARTICIPANTS: A community-based cohort of 1670 adults 65 years and older at study enrollment. MAIN OUTCOME MEASURE: Mortality. RESULTS: In the overall cohort, AD was a significant predictor of mortality, with a hazard ratio of 1.4 after adjusting for covariates. The population-attributable risk of mortality from AD was 4.9% based on the same model. Examining the sexes separately, AD increased mortality risk only among women. Death certificates of AD subjects were more likely to list dementia/AD, other brain disorders, pneumonia, and dehydration, and less likely to include cancer. CONCLUSIONS: Alzheimer disease was responsible for 4.9% of the deaths in this elderly cohort. Alzheimer disease increased the risk of mortality 40% in the cohort as a whole and separately in women but not in men. The mean (SD) duration of survival with AD was 5.9 (3.7) years, and longer with earlier age at onset.

Medical and cognitive correlates of denture wearing in older community-dwelling adults.

OBJECTIVES: To examine the association between denture wearing and use of dental services, oral function limitations, and medical and cognitive status in a community-based cohort of rural older adults enrolled in an epidemiological study. DESIGN: This cross-sectional study was part of a larger cohort study, the Monongahela Valley Independent Elders Survey. Dental data were collected during the fifth wave of assessments (10 years after the start of the study in 1987). SETTING: Monongahela Valley, a rural western Pennsylvania community. PARTICIPANTS: The 805 participants were English-speaking community-dwelling (noninstitutionalized) persons, aged 73 and older, with at least a sixth grade education. MEASUREMENTS: A questionnaire was used to collect data on denture-wearing status, oral function limitations, and recency of the last dental visit. Other data collected included demographics, self-rated health, medication usage, depression, cognitive status using the Mini-Mental State Examination, and self-reports of weight loss and appetite. RESULTS: There were 44.7% of participants who had full dentures. Those with complete dentures were more likely to complain of oral function limitation, report poor health status, and take prescription medications. Additionally, 93.6% of those with complete dentures had not seen a dentist in more than 1 year. CONCLUSION: Denture wearing and edentulism are common in older patients and can be related to poor quality of life and risk for undiagnosed oral disease and may be a marker for other medical comorbidities. Geriatricians need to include oral health status evaluations and understand that attention to the oral cavity should be part of an older adult's care.

Hemoglobin levels and Alzheimer disease: an epidemiologic study in India.

OBJECTIVE: Anemia is common in developing countries, where populations are aging rapidly. The authors explored the cross-sectional relationship between hemoglobin concentration and Alzheimer disease (AD) in a rural elderly sample in Ballabgarh, India. METHODS: A clinical diagnostic evaluation for dementia and a hemoglobin estimation were performed in 605 persons selected by screening a larger community-based sample age 55+ years. Twenty-six participants met criteria for AD. RESULTS: Hemoglobin was inversely associated with AD after adjustment for age, sex, and literacy. CONCLUSION: Low hemoglobin is associated with AD and should be investigated further as a modifiable risk factor.

Exercise level and cognitive decline: the MoVIES project.

Growing evidence suggests that physical exercise may be protective against cognitive impairment and decline. A prospective study of a representative rural community sample (N = 1,146) aged 65+ years examined self-reported exercise habits and measured global cognitive function using the Mini-Mental State Examination (MMSE). A composite variable "exercise level" combining type, frequency, and duration of exercise was created with three levels: "high exercise" (aerobic exercise of > or = 30 minute duration > or = 3 times a week), "low exercise" (all other exercise groups), and "no exercise." Cognitive decline was defined as being in the 90 percentile of decline in this cohort, ie, declining by 3 or more MMSE points during the 2-year interval between two assessments. In a multiple regression model, high exercise level at the baseline assessment was negatively associated with, ie, was protective against, being in the group with the greatest amount of decline at the follow-up assessment, after adjusting for likely confounders (odds ratio = 0.39; 95% confidence interval, 0.19, 0.78). When high exercise was redefined using frequency as > or = 5 days per week as the threshold, as per the Surgeon General's guidelines, both low exercise and high exercise were negatively associated with cognitive decline. Exercise may have implications for prevention of cognitive decline.