Apolipoprotein epsilon4 allele and problems with orientation are associated with a persistent decline in cognition in community-dwelling elderly persons.

BACKGROUND: A decline in cognitive test scores in elderly persons can signal the beginning of a descent into dementia or may indicate only a short-term cognitive disturbance. It would be clinically useful to distinguish between the two outcomes and to identify characteristics of each. METHODS: Four hundred thirty-seven community-dwelling elderly persons were given the Mini-Mental State Examination (MMSE) annually for an average of 7 years. A low score between baseline and final MMSE was identified. A low score 3 or more points lower than baseline score indicated cognitive decline. This decline was called persistent if the final MMSE score was also at least 3 points lower than baseline MMSE score; otherwise, the decline was considered transient. RESULTS: Twenty participants (4.6%) experienced a persistent cognitive decline, 67 participants (15.3%) experienced a transient cognitive decline. Presence of the apolipoprotein epsilon4 allele was significantly associated with persistent cognitive decline (age-adjusted odd ratio [OR] = 11.46, p < .0001) but not with transient cognitive decline (age-adjusted OR = 1.53, p = .219). Incorrect answers on the orientation part of the MMSE at the time of cognitive decline was associated with persistent decline compared to transient decline (age-adjusted OR = 3.58, p = .058). CONCLUSIONS: Persistent cognitive decline is an infrequent occurrence in community-dwelling elderly persons. Presence of the epsilon4 allele and errors made by the subject on questions of orientation may be useful in determining whether a cognitive decline is likely to be persistent.

Cognitive function in drinkers compared to abstainers in the New Mexico elder health survey.

BACKGROUND: Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a higher level of cognitive function and are less likely to develop dementia than those who abstain. The purpose of this study was to compare nine measures of cognitive function in drinkers compared to abstainers. METHODS: A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, age >or=65 years of age, undergoing a paid home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included questions on frequency and quantity of alcohol ingested. RESULTS: Participants who consumed alcohol had significantly better mean scores on 7 of 9 cognitive function tests and less frequently had scores below selected "cut points" compared to those who abstained from all alcohol intake. Scoring used multivariate linear and logistic regression models adjusted for sex, ethnicity, age, level of education, and evidence of depression. CONCLUSIONS: Participants in the New Mexico Elder Health Survey (nearly equal numbers of Hispanic and non-Hispanic white men and women) who consumed alcohol had better scores on their cognitive tests than did those participants who abstained.

Increasing trends in elderly persons' use of nonvitamin, nonmineral dietary supplements and concurrent use of medications.

OBJECTIVE: Use of nonvitamin, nonmineral dietary supplements among an elderly cohort was surveyed to determine which were the most frequently used, and to report potential medication/supplement interactions observed. DESIGN: A retrospective review of the use of 22 supplements and prescription/over-the-counter medications was collected annually from 1994 to 1999. SUBJECTS/SETTING: Supplement and medication records for an average of 359 male (36%) and female (64%) participants aged 60 to 99 years were reviewed annually. Ethnic distribution was 91% non-Hispanic white, 7% Hispanic, 1% Asian, and 1% African American. STATISTICAL ANALYSES PERFORMED: Descriptive statistics generated included mean, standard deviation, and frequency by percentage. To compare supplement user and nonsupplement user percentages across age groups, the chi 2 test was used. Linear regression was performed to test for longitudinal usage trends of each individual supplement. RESULTS: By 1999, glucosamine emerged as the most frequently used nonvitamin, nonmineral supplement followed by ginkgo biloba, chondroitin, and garlic. For women, there was a significant linear trend ( P < .05) over time for these 12 supplements: black cohosh, borage, evening primrose, flaxseed oil, chondroitin, dehydroepiandrosterone, garlic, ginkgo biloba, glucosamine, grapeseed extract, hawthorn, and St John's wort. For men, three supplements (alpha lipoic acid, ginkgo biloba, and grape-seed extract) showed a significant linear trend ( P <.05). Potential interactions between supplements and medications were seen for 10 of the 22 supplements surveyed, with a total of 142 potential interactions observed over the 6-year period. CONCLUSIONS: Examining nonvitamin, nonmineral supplement use in combination with prescription/over-the-counter medications in elderly persons is important to identify the potential risks of interactions.

Serum leptin levels, bone mineral density and osteoblast alkaline phosphatase activity in elderly men and women.

Although primarily secreted by adipose cells, leptin, a polypeptide hormone that influences body weight, satiety and lipid metabolism, and its receptor are also expressed in human osteoblasts. Leptin plays a role in the central, hypothalamic modulation of bone formation, as well as locally within the skeleton by enhancing differentiation of bone marrow stroma into osteoblasts and inhibiting its differentiation into osteoclasts and adipocytes. The purpose of this investigation was to compare serum leptin values in 100 postmenopausal women (age 62-97) and 31 men (age 72-92) to bone mineral density (BMD) measurements made by dual X-ray absorptiometry and additionally to biochemical markers of bone resorption and formation, including crosslinked collagen N-telopeptides (NTx), aminoterminal extension procollagen propeptides (PINP) and bone-specific alkaline phosphatase (bAP). The circulating level of leptin directly correlated with body mass index (BMI) (r=0.61-0.78, P<0.001) and was modestly, but significantly and positively associated with bAP activity (r=0.24-0.33, P<0.01) in the sera of men and women after adjustment for BMD, age and BMI. The association of circulating leptin levels with bAP, a specific marker of osteoblast activity suggests that leptin levels influence osteoblast activity in vivo in elderly women and men.

Serum insulin concentrations in daily drinkers compared with abstainers in the New Mexico elder health survey.

BACKGROUND: Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a lower prevalence of diabetes mellitus than those who abstain. The purpose of this study was to compare serum glucose and insulin concentrations between daily drinkers and abstainers stratified by diabetic status (participants with diabetes, impaired glucose tolerance, and normal glucose tolerance) to determine if there was a difference in glucose sensitivity (resistance) that might explain the lower prevalence of diabetes in drinkers. METHODS: A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, aged >or=65 years, undergoing a home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included a history of frequency, type, and quantity of alcohol ingested. Serum samples were obtained after an overnight fast and 2 hours after ingestion of 75 grams of glucose for determination of glucose and insulin levels. Height and weight was measured for determination of body mass index. RESULTS: Participants who consumed alcohol daily had significantly lower fasting and 2-hour postglucose serum insulin concentrations compared with those who abstained from alcohol intake, when adjusted using linear logistic regression models for serum glucose concentration, gender, ethnicity, age, and body mass index. CONCLUSIONS: Abstainers with their relative hyperinsulinemia appear to be more insulin resistant than daily moderate drinkers. This difference in insulin sensitivity may explain the lower prevalence of diabetes in drinkers compared with abstainers observed in various epidemiological studies.

Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey.

The serum/plasma total homocysteine (tHcy) concentration, now recognized as an independent risk factor for accelerated atherosclerotic disease, is increased in overtly hypothyroid patients, and it decreases with thyroid replacement therapy. Whether or not individuals with subclinical hypothyroidism also increase their tHcy concentrations, and whether this elevation might help to explain the increased prevalence of the atherosclerotic diseases observed in this condition, remains unclear. If individuals with subclinical hypothyroidism have higher tHcy concentrations than euthyroid subjects, there would be added incentive to treat this condition earlier. In this cross-sectional study (New Mexico Elder Health Survey) of a randomly selected sample of Medicare recipients (age > or =65 years), no significant difference in serum tHcy concentrations could be detected between the 112 participants with subclinical hypothyroidism (Groups 2 and 3) and the 643 participants with thyrotropin (TSH) values < or =4.6 microU/mL (Group 1) after adjusting for differences in gender, ethnicity, age, and serum concentrations of folate, vitamin B(12), and creatinine. Only those participants with the highest TSH levels (>10 microU/mL) (Group 3) had a significantly higher prevalence of coronary heart disease (CHD) when compared against Group 1 participants (p = 0.007). No consistent significant differences in the prevalences of CHD or in the CHD risk factors examined were observed when all participants with subclinical hypothyroidism (Groups 2 and 3 combined) were compared against Group 1 participants.

Changes in anthropometric indices of body composition with age in a healthy elderly population.

Changes in body composition are known to occur with old age, but there is limited knowledge of the normal values rates of change in anthropometric indices of body composition or the distribution of these changes in the elderly. In the present study, 98 elderly white men and 122 elderly white women were followed prospectively for 6 years. These participants were divided into 5-years cohorts on the basis of age at the start of the study in 1980. Separate linear regressions of triceps skinfold thickness, midarm circumference, midarm muscle area, and weight divided by stature squared on age were computed for each participant. The mean annual changes or slopes for these indices were small for each sex. A loss of subcutaneous adipose tissue was indicated with age, but the effects of compression or measurement error may hamper the detection of changes in indices of body composition in the elderly.

Serum homocysteine concentrations and their relation to serum folate and vitamin B12 concentrations and coronary artery disease prevalence in an urban, bi-ethnic community.

OBJECTIVE: To compare fasting serum total homocysteine (tHcy) concentrations in a randomly selected sample of elderly (> or = 65 years of age) Hispanic and non-Hispanic White (NHW) men and women, to examine associations of tHcy with folate and vitamin B12, and then to correlate these with the prevalence of coronary heart disease (CHD) in these 4 ethnic/ gender groups. DESIGN AND PARTICIPANTS: Equal numbers of Hispanic and NHW men and women were randomly selected from the Healthcare Financing Administration (Medicare) registrant list for Bernalillo County (Albuquerque), New Mexico, and asked to volunteer for a paid home interview, to be followed by a paid, comprehensive interview/examination covering health and health-related issues. INTERVENTIONS AND MAIN OUTCOME MEASURES: Serum concentrations of tHcy, folate, and vitamin B12 were determined and correlated with the prevalence of CHD, after adjusting for other CHD risk factors (age, diabetes, hypertension, smoking, dyslipidemia, adiposity). RESULTS: Men and Hispanics had higher serum tHcy concentrations compared to women and non-Hispanic Whites (NHWs), respectively. After adjusting for lower concentrations of serum folate and vitamin B12 in Hispanics, the differences between Hispanics and NHWs were no longer significant. There was a direct association between serum tHcy concentrations and the prevalence of CHD after adjusting for other known risk factors that was most significant in Hispanic women. CONCLUSIONS: The higher serum tHcy concentrations observed in Hispanics compared to NHWs can be explained by lower levels of serum folate and vitamin B12. A direct association between serum tHcy concentrations and prevalence of CHD was observed primarily in women, and was most significant in Hispanic women.

Emotional responses to APO E genotype disclosure for Alzheimer disease.

The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.