Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.

BACKGROUND: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse. OBJECTIVE: The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality. METHODS: A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses. RESULTS: During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09). CONCLUSION: Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.

Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population.

PURPOSE: The purpose of this study was to explore whether associations between self-reported sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness differed in older community-dwelling men and women. DESIGN: Cross-sectional. METHODS: A community-dwelling sample of 675 older men and women (mean age 77.7 years, SD 3.8 years) was used. All participants underwent a clinical examination by a cardiologist. Validated questionnaires were used to investigate sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness. Subjects were divided into short sleepers (≤6 hours), n = 231; normal sleepers (7-8 hours), n = 338; and long sleepers (≥9 hours), n = 61. ancovas were used to explore sex-specific effects. RESULTS: Depressive symptoms were associated with short sleep in men, but not in women. Fatigue was associated with both short and long sleep duration in men. No sex-specific associations of sleep duration with daytime sleepiness or anxiety were found. CONCLUSION: Nurses investigating sleep duration and its correlates, or effects, in clinical practice need to take sex into account, as some associations may be sex specific. Depressive symptoms and fatigue can be used as indicators to identify older men with sleep complaints.

Genetic and Environmental Influences on Longitudinal Trajectories of Functional Biological Age: Comparisons Across Gender.

We used an alternate age variable, functional biological age (fBioAge), which was based on performance on functional body measures. The aim was to examine development of fBioAge across the adult life span, and to also examine potential gender differences and genetic and environmental influences on change with age. We used longitudinal data (n = 740; chronological age (ChronAge) range 45-85 at baseline) from the Swedish Adoption/Twin Study of Aging. The rate of increase in fBioAge was twice as fast after ChronAge 75 than before. fBioAge was higher in women than in men. fBioAge was fairly equally influenced by genetic and environmental factors. Whereas the rate of ChronAge cannot vary across time, gender, or individual, our analyses demonstrate that fBioAge does capture these within and between individual differences in aging, providing advantages for fBioAge in the study of aging effects.

Different Context but Similar Cognitive Structures: Older Adults in Rural Bangladesh.

Most research in cognitive aging is based on literate participants from high-income and Western populations. The extent to which findings generalize to low-income and illiterate populations is unknown. The main aim was to examine the structure of between-person differences in cognitive functions among elderly from rural Bangladesh. We used data from the Poverty and Health in Aging (PHA) project in Bangladesh. The participants (n = 452) were in the age range 60-92 years. Structural equation modeling was used to estimate the fit of a five-factor model (episodic recall, episodic recognition, verbal fluency, semantic knowledge, processing speed) and to examine whether the model generalized across age, sex, and literacy. This study demonstrates that an established model of cognition is valid also among older persons from rural Bangladesh. The model demonstrated strong (or scalar) invariance for age, and partial strong invariance for sex and literacy. Semantic knowledge and processing speed showed weak (or metric) sex invariance, and semantic knowledge demonstrated also sensitivity to illiteracy. In general, women performed poorer on all abilities. The structure of individual cognitive differences established in Western populations also fits a population in rural Bangladesh well. This is an important prerequisite for comparisons of cognitive functioning (e.g., declarative memory) across cultures. It is also worth noting that absolute sex differences in cognitive performance among rural elderly in Bangladesh differ from those usually found in Western samples.

Prevalence of depressive symptoms and suicidal thoughts among elderly persons in rural Bangladesh.

BACKGROUND: Depression, if broadly defined, is the commonest late-life mental disorder. We examined the distribution of depressive symptoms and suicidal thoughts, across age, sex, literacy, and marital status, among elderly individuals residing in rural Bangladesh and participating in a population-based study on health and aging. METHODS: Prevalence figures of depressive symptoms were assessed with SRQ20 (n = 625), and possible social network and economic associations were examined. Morbidity accounts of depressive symptoms and suicidal thoughts were examined for a subsample that also underwent complete medical examination (n = 471). RESULTS: We selected for analyses the items that corresponded to DSM-IV criteria and constructed a dichotomous variable. The prevalence was 45%, and most pronounced among the oldest women (70%). The overall prevalence of suicidal thoughts was 23%. Being a woman, illiterate or single were all risk factors for depressive symptoms and suicidal thoughts. These associations remained unaccounted for by the social network and economic variables. Co-residing with a child and having a high quality of contact were protective of both depressive symptoms and suicidal thoughts. The main findings were replicated in the subsample, where it was found that morbidities were also associated with the outcomes, independently of the four main predictors. CONCLUSIONS: Prevalence figures for depressive symptoms among elderly in rural Bangladesh are high. Demographic, social network, and morbidity factors are independently associated with both depressive symptoms and suicidal thoughts. This is the first study to report prevalence figures for depressive symptoms in this population.

Prevalence of dementia and factors associated with dementia in rural Bangladesh: data from a cross-sectional, population-based study.

BACKGROUND: There are currently no published reports of dementia prevalence or factors associated with dementia occurrence in Bangladesh. The aims are to report the prevalence of definite and questionable dementia in rural Bangladesh, and examine factors potentially associated with dementia occurrence, including sociodemographic, clinical, social, and nutritional factors. METHODS: We used data from a population-based, cross-sectional study from Matlab, in rural Bangladesh, on 471 persons aged 60+ years. Participants underwent a clinical examination including diagnosis of somatic disorders, and a structured interview including questions about sociodemographic and social factors. Nutritional status was measured with the Mini Nutritional Assessment, and blood tests were conducted to assess a range of nutritional and clinical aspects. Age- and sex-specific dementia prevalence was calculated. Crude and adjusted logistic regression was used to examine associations between dementia and clinical, social, and nutritional factors. Dementia was diagnosed using a two-step procedure by physicians according to DSM-IV criteria. RESULTS: The prevalence of questionable dementia was 11.5% and definite dementia was 3.6%. Dementia prevalence increased with increasing years of age (adjusted OR: 1.04; 95% CI = 1.002-1.1) and decreased with more years of education (adjusted OR: 0.8; 95% CI = 0.6-0.99). Being malnourished increased the odds of dementia almost six-fold (adjusted OR: 5.9; 95% CI = 1.3-26.3), while frequent participation in social activities was associated with a decreased odds (adjusted OR: 0.5; 95% CI = 0.2-0.9). CONCLUSIONS: The prevalence of dementia in rural Bangladesh is similar to other countries in the South Asia region, but lower than reports from other world regions. Malnutrition is strongly associated with dementia occurrence, and is a relevant area for future research within low-income countries.

Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study.

Data on multimorbidity among the elderly people in Bangladesh are lacking. This paper reports the prevalence and distribution patterns of multimorbidity among the elderly people in rural Bangladesh. This cross-sectional study was conducted among persons aged > or = 60 years in Matlab, Bangladesh. Information on their demographics and literacy was collected through interview in the home. Information about their assets was obtained from a surveillance database. Physicians conducted clinical examinations at a local health centre. Two physicians diagnosed medical conditions, and two senior geriatricians then evaluated the same separately. Multimorbidity was defined as suffering from two or more of nine chronic medical conditions, such as arthritis, stroke, obesity, signs of thyroid hypofunction, obstructive pulmonary symptoms, symptoms of heart failure, impaired vision, hearing impairment, and high blood pressure. The overall prevalence of multimorbidity among the study population was 53.8%, and it was significantly higher among women, illiterates, persons who were single, and persons in the non-poorest quintile. In multivariable logistic regression analyses, female sex and belonging to the non-poorest quintile were independently associated with an increased odds ratio of multimorbidity. The results suggest that the prevalence of multimorbidity is high among the elderly people in rural Bangladesh. Women and the non-poorest group of the elderly people are more likely than men and the poorest people to be affected by multimorbidity. The study sheds new light on the need of primary care for the elderly people with multimorbidity in rural Bangladesh.

Examination of the common cause account in a population-based longitudinal study with narrow age cohort design.

BACKGROUND: The common cause account suggests that there is a third factor causing aging effects in both sensory and cognitive functioning, hypothesized to be the integrity of the central nervous system [Lindenberger and Baltes; Psychol Aging 1994;9:339-355]. Importantly, the common cause account was developed based on cross-sectional data, which are especially biased by cohort effects. However, cohort effects can be controlled for in narrow age cohort (NAC) designs and by longitudinal examination. Findings from the few longitudinal studies that have studied the relation between age-related changes in sensory and cognitive functions are complex and give only partial support to the common cause account. OBJECTIVE: The present paper examines the common cause account within a longitudinal setting. METHOD: Our study is unique in the sense that it tests the common cause account within a longitudinal NAC design using data from the Betula project. The participants (n = 1,057) were in the age range of 45-90 years. RESULTS: The findings indicate that the relationship between sensory and memory functioning in both a longitudinal age-heterogeneous and a longitudinal NAC design are much weaker than that detected by an age-heterogeneous cross-sectional design. CONCLUSION: The demonstrated weak age-associated sensory-cognitive link raises questions regarding the explanatory value of the common cause account and related theoretical accounts for accounting for age-related cognitive changes.

Earning their keep: the productivity of older women and men in rural Bangladesh.

In Bangladesh, being active and able to participate in productive activities is often essential to ensure ongoing health and survival. This study aims to describe and explore the patterns of participation in productive activities by older people in Matlab, a rural area of Bangladesh. Data from a cross sectional survey of people over 60 years of age was utilised. Six hundred and twenty five men and women participated in home based interviews providing information about their participation in productive activities including work, domestic activities and community groups. Overall, 94.4% of subjects reported participation in at least one productive activity. Men were the main participants in paid work and community groups, with 62% reporting engagement in paid work and 44% contributing to community groups. Both men (95.4%) and women (91.9%) reported performing at least one domestic activity. Performance of higher numbers of domestic tasks was associated with being younger, female, not requiring any assistance with self care, not married, not living with any children and earning between 100-999 Bangladesh Taka in the past month. Participation in community groups was low with only 26% of the sample reporting any involvement. This study indicates a high level of productivity in the older population in Matlab which benefits the individual, the family and the wider community. The safety and suitability of typical productive activities needs further investigation, in order to inform strategies protecting the older population from the effects of over work and harmful activities.

The multidimensional background of malnutrition among rural older individuals in Bangladesh--a challenge for the Millennium Development Goal.

OBJECTIVE: To investigate the associations and relative impact of illness, socio-economic and social indicators for nutritional status among elderly persons in rural Bangladesh. DESIGN: A multidisciplinary, cross-sectional study employing home interviews to collect information on demographic, socio-economic and social status; clinical examination to classify medical diagnoses; and Mini Nutritional Assessment (MNA) to assess the nutritional status of each participant. SETTING: Matlab, Bangladesh. SUBJECTS: A total of 625 randomly selected individuals (>or=60 years of age) participated in home interviews and 473 underwent clinical examination. Complete information on nutritional status was available for 457 individuals, median age 68 years, 55 % women. RESULTS: Twenty-six per cent of the elderly participants were undernourished and 62 % were at risk of malnutrition according to MNA. More than three-quarters of the participants had acute infections, 66 % suffered from chronic illnesses, 36 % had sensory impairments and 81 % were suffering from gastrointestinal disorders. Acute infections (P < 0.001), gastrointestinal disorders (P < 0.01), depressive symptoms (P < 0.001) and impaired cognitive function (P < 0.01) were significantly and independently associated with poorer nutritional status. Moreover, female gender (P < 0.05), having no income (P < 0.01), being illiterate (P < 0.01) and not receiving regular financial support (P < 0.05) were also independently associated with poor nutritional status. CONCLUSIONS: Malnutrition among elderly people in rural Bangladesh is associated with female gender, medical, psychological, socio-economic and social indicators. A multidimensional approach is probably needed to reduce undernutrition in older populations in low-income countries like Bangladesh.

Impact of health education on health-related quality of life among elderly persons: results from a community-based intervention study in rural Bangladesh.

UNLABELLED: This study examines the change in health-related quality of life (HRQoL) among (> or =60 years) elderly persons as a result of health education intervention. A community-based intervention study was performed in eight randomly selected villages ( INTERVENTION: n = 4; CONTROL: n = 4) in rural Bangladesh. A total of 1135 elderly persons was selected for this study. The analyses include 839 participants ( INTERVENTION: n = 425; CONTROL: n = 414) who participated in both baseline and post-intervention surveys. Participants in the intervention area were further stratified into compliant (n = 315) and non-compliant (n = 110) groups based on the reported compliance to the intervention activities. The intervention includes, for example, physical activity, advice on healthy food intake and other aspects of management. To create an enabling environment, social awareness was provided by means of information about the contribution of and challenges faced by elderly persons at home and the community, including information about elderly persons' health and health care. The intervention activities were provided to the elderly persons, caregivers, household members and community people for 15 months. The HRQoL was assessed using a multi-dimensional generic instrument designed for elderly persons. Multivariate analyses revealed that in the non-compliant group the probabilities of increased scores were less likely in overall HRQoL (OR 0.52, 95% CI 0.32-0.82). Among the CONTROL group, increased scores were less likely in the physical (OR 73, 95% CI 0.54-0.99), social (OR 0.37, 95% CI 0.27-0.50), spiritual (OR 0.60, 95% CI 0.34-0.94), environment (OR 0.36, 95% CI 0.26-0.49) dimensions and overall HRQoL (OR 0.44, 95% CI 0.32-0.59) (adjusted for age, sex, literacy, marital status and economic status). This study concludes that provision of community-based health education intervention might be a potential public health initiative to enhance the HRQoL in old age.

Associations Between Functional Biological Age and Cognition Among Older Adults in Rural Bangladesh: Comparisons With Chronological Age.

OBJECTIVES: We constructed a functional biological age (fBioAge) indicator by using four functional variables: grip strength, forced expiratory lung volume, visual acuity, and hearing. Our aim was to compare how chronological age (ChronAge) and fBioAge are related to cognitive abilities in older adults. METHOD: We used data from the Poverty and Health in Aging project, Bangladesh. Participants ( N = 400) were 60+ years of age and diagnosed as nondemented. Examined cognitive abilities were four episodic memory measures (including recall and recognition), two verbal fluency indicators, two semantic knowledge, and two processing speed tasks. RESULTS: fBioAge accounted for cognitive variance beyond that explained by ChronAge also after controlling for medical diagnoses and blood markers. DISCUSSION: Compared with ChronAge, fBioAge was a stronger predictor of cognition during a broad part of the old adult span. fBioAge seems, in that respect, to have the potential to become a useful age indicator in future aging studies.

Vitamin B status and cognitive performance in preclinical and clinical Alzheimer's disease: data from the Kungsholmen Project.

BACKGROUND/AIMS: The impact of vitamin B status on cognitive functioning in Alzheimer's disease (AD) is disputed. Using a population-based sample, we examined the associations of vitamin B(12) and folate with cognitive functioning in clinical (n = 44) and preclinical (n = 39) AD. METHODS: The groups were subdivided in terms of low (<200 pmol/l) versus normal levels of B(12) and low (<13 nmol/l) versus normal folate levels. Participants were administered tests of verbal and nonverbal episodic memory, visuospatial abilities and verbal fluency. RESULTS: As expected, the preclinical AD group performed better than the AD group across most cognitive tests. More interestingly, the effects of low vitamin B(12) and folate levels were negligible across all cognitive tests in clinical and preclinical AD. CONCLUSION: These findings suggest that the influence of vitamin B deficiency on cognitive functioning is overshadowed by the neurodegenerative processes associated with AD.

Cholesterol and triglycerides moderate the effect of apolipoprotein E on memory functioning in older adults.

We used data from the Betula Study to examine associations between total cholesterol, triglycerides, and apolipoprotein E on 10-year changes in cognitive performance. Tests assessing episodic memory (recall and recognition), semantic memory (knowledge and fluency), and visuospatial ability (block design) were administered to 524 nondemented adults (initial age of 55-80 years); multilevel modeling was applied to the data. Higher triglyceride levels were associated with a decline in verbal knowledge. Lipid levels moderated the influence of apolipoprotein E on episodic memory, such that among epsilon4 allele carriers, decline in recognition was noted for individuals with higher cholesterol levels. Cholesterol and triglyceride levels are pharmacologically modifiable risk factors that account for variation in normal cognitive aging.

Cognitive and social functioning in recovery from depression: results from a population-based three-year follow-up.

BACKGROUND: This study prospectively examined cognitive and social functioning in recovery from depression using participants sampled from the general population. METHOD: Seventy-six depressed persons fulfilling (n=41) and not fulfilling (n=35) the criteria for DSM-IV depression at a three-year follow-up were compared with respect to episodic memory performance and social functioning at baseline (T1), at follow-up (T2) and change across time. RESULTS: The groups did not differ in episodic memory performance either at T1, T2 or in residual change. However, the groups differed in social functioning at T2 and in residual change indicating improved social functioning in the recovered group. LIMITATION: The absence of a healthy control group at follow-up. CONCLUSION: Despite the symptomatic improvement and improved social functioning, cognitive functioning does not follow this general recovery trend, at least not in the three-year interval examined.

How do health and biological age influence chronological age and sex differences in cognitive aging: moderating, mediating, or both?

Much research on cognitive competence in normal older adults has documented age and sex differences. The authors used new cross-sectional data from the Victoria Longitudinal Study (VLS) (n=386; age 61 to 95 years) to examine how health and biological age influence age and sex differences in cognitive aging. The authors found evidence for both moderating and mediating influences. Age differences were moderated by health status, such that the negative effects of age were most pronounced among participants of relatively better health. Sex differences were moderated by health and were more pronounced among participants reporting comparatively poorer health. Although health mediated a notable amount of age-related cognitive variation, BioAge mediated considerably more variance, even after statistical control for differences in health. A complex pattern emerged for the mediation of sex differences: Although BioAge accounted for sex-related variation in cognitive performance, health operated to suppress these differences. Overall, both health and BioAge predicted cognitive variation independently of chronological age.

Cognitive function did not improve after initiation of natalizumab treatment in relapsing-remitting multiple sclerosis. A prospective one-year dual control group study.

BACKGROUND: Cognitive impairment in multiple sclerosis (MS) is common and has severe implications. Natalizumab (NZ) has documented effects on relapse rate and radiological disease activity in relapsing-remitting MS (RRMS) but studies regarding its specific effects on cognitive functioning are few. Previous studies have reported improvement, however, often lacking relevant control groups. The objective of the present study was to evaluate the cognitive effects of NZ treatment, compared to patients on stable first-line treatment and healthy control subjects. METHODS: MS patients starting NZ (MS-NZ), MS controls with stable interferon beta therapy (MS-C) and healthy control subjects (HC) were evaluated twice with one year interval, using a cognitive test battery covering six cognitive domains. The effects of NZ on levels of self-reported depression, fatigue, daytime sleepiness and perceived health were also examined. RESULTS: MS patients (MS-NZ and MS-C) had significantly lower baseline cognitive performance compared to HC (global score, p=0.002), but there were no significant differences between MS-NZ and MS-C. At follow-up, both MS-NZ and MS-C had improved significantly in four and five cognitive domains, respectively, and in global score (p=0.013 and p<0.001, respectively). HC improved significantly in three cognitive domains but not in global score. A regression analysis including baseline cognitive z-score and z-score change showed that participants with lower baseline scores had a significantly greater improvement, compared to those with better initial performance (p=0.021). There were no significant changes in depression, fatigue, daytime sleepiness or perceived health in MS-NZ or MS-C. CONCLUSIONS: Initiation of NZ therapy did not result in true cognitive improvement over one year. Presumably, the increased test performance in both MS groups was artificial and due to retest effects that were stronger in patients with lower baseline performance. Adequate control groups are essential when evaluating cognitive functioning in intervention trials among RRMS patients.

Longitudinal evidence of the impact of normal thyroid stimulating hormone variations on cognitive functioning in very old age.

The purpose of this study was to examine longitudinal associations among thyroid stimulating hormone (TSH) levels and cognitive performance. Data collected at the first three assessment times, approximately 3 years apart, are reported for the survivors (n=45) from a previously published cross-sectional study. Participants were aged 75-93 years at baseline, and data reported were collected in the Kungsholmen Project, a longitudinal project investigating aging and dementia. Analyses revealed that although declining verbal fluency and visuospatial abilities were accompanied by simultaneously declining TSH levels, the pattern of cross-sectional and longitudinal results are interpreted such that declining TSH levels may have caused episodic memory deficits later on. These results were obtained in the examination of 6-year but not 3-year change, and after removal of the cognitive variation associated with depressive mood symptoms.

Apolipoprotein E, B vitamins, and cognitive function in older adults.

Recognition of dated and contemporary famous faces, short-term memory, and visuospatial abilities were investigated in adults aged 75 years and older as a function of apolipoprotein E (APOE) genotype, epsilon4 or not epsilon4, and whether participants recorded normal or low levels of B vitamins. No associations between B vitamins and APOE were identified in respect to short-term memory or visuospatial skills, or for contemporary famous faces. However, in respect to the recognition of dated famous faces, deficits in persons carrying the epsilon4 allele who also recorded low vitamin B(12) values were found. The results suggest that the neurological structures and processes supporting face recognition may be vulnerable to the combined influence of the APOE epsilon4 allele and low levels of vitamin B(12). This finding was unrelated to incipient dementia up to 6 years following testing. The results are discussed with reference to the neuroanatomical reserves that epsilon4 carriers may possess.