Cognitive Frailty is Associated With Elevated Proinflammatory Markers and a Higher Risk of Mortality.

BACKGROUND: Cognitive impairment and physical frailty are common among older adults and associated with a higher likelihood of adverse health outcomes. These two conditions frequently coexist in the same individual as cognitive frailty, yet few studies have examined the impact of such comorbidity on clinical outcomes or underlying biological mechanisms. METHODS: A total of 1,340 older adults (age ≥60 years old) from the Bambui Cohort Study of Ageing, with a total follow-up of 10 years, were included in this study. Frailty was defined by the accumulation of deficit framework and cognitive impairment based on scores on the MMSE less than 22. In addition, serum IL-6 levels were measured by cytometric bead array assay. RESULTS: Individuals classified with cognitive frailty had significantly higher serum IL-6 levels compared to the robust, cognitively unimpaired group. Those with cognitive frailty (aOR = 1.97 [1.18-3.27] and prefrailty and cognitive impairment (aOR = 1.83 [1.24-2.69]) had the highest mortality risk over 10 years of follow-up. Higher IL-6 levels were also independently associated with a higher mortality rate (aOR = 1.37 [1.23-1.54]). CONCLUSION: Our study shows that cognitive Frailty indicates a vulnerability state and of increasing mortality risk. Our findings also suggested that proinflammatory abnormalities can be viewed as a central phenomenon underlying common age-related problems (e.g., cognitive impairment and Frailty) and outcomes (e.g., mortality).

Diabetes, depressive symptoms, and mortality risk in old age: The role of inflammation.

BACKGROUND: Both diabetes and depression increase the mortality risk in the elderly. In this study, we evaluated mortality risk associated with the comorbidity between depression and diabetes. We also assessed the moderating role of inflammation in the mortality risk in this population. METHODS: We included a total of 1,183 community-dwelling older adults, divided into four groups: "neither diabetes nor depression"; "diabetes only"; "depression only," and "both diabetes and depression," and followed-up for a median of 13.5 years. We evaluated the inflammatory status by the high-sensitivity C-reactive protein (hs-CRP) levels. Date of death was computed by reviewing death certificates. We used Cox's proportional hazards models and additive interactions to evaluate the risk of mortality in the subject groups and the moderating effect of hs-CRP. RESULTS: Participants with both diabetes and depression had higher death risk (hazard ratio [HR]: 2.33; 95% confidence interval [CI]: 1.59-3.42) than those with each condition alone (HR diabetes: 2.08 95% CI: 1.56-2.76 HR depression: 1.26; 95% CI: 1.03-1.54). High level of hs-CRP, indicative of high inflammatory status, significantly moderated the risk of mortality in subjects with both diabetes and depression (Bonferroni-adjusted p = 0.0116). CONCLUSIONS: The coexistence of diabetes and depression symptoms is associated with the highest death risk in this population. This risk is moderated by inflammatory status.

APOE ε4 allele is associated with worse performance in memory dimensions of the mini-mental state examination: the Bambuí Cohort Study of Aging.

OBJECTIVE: This study aimed to investigate the correlation between apolipoprotein E (APOE) ε4 and the mini-mental state examination (MMSE) dimension in an elderly population, using baseline data from the Bambui (Brazil) Cohort Study of Aging. DESIGN: We conducted a community-based cross-sectional study. SETTING: The study took place at Bambui city, Minas Gerais State, Southeast Brazil. PARTICIPANTS: A total of 1408 (87.7%) cohort participants had complete information on the MMSE and health measures. MEASUREMENTS: The association between each of five dimensions (concentration, language/praxis, orientation, attention, and memory) underlying the MMSE and APOE ε4 allele was assessed using multivariate linear regression models. Potential confounding variables included sociodemographic factors and selected biomarkers. RESULTS: The main finding is a strong negative association between the presence of APOE ε4 allele and memory dimension in the MMSE (fully adjusted ß coefficient = -0.14; 95% confidence interval: -0.27 to -0.04; p = 0.016). No other cognitive dimensions showed significant associations with the APOE ε4 allele. CONCLUSION: This study is the first to investigate the association between dimensions of the MMSE, obtained from principal component analysis and APOE ε4 carrier status in community-dwelling older adults taking into account a range of potential confounding factors. We found a strong negative association between the presence of APOE ε4 allele and scores on memory dimension of the MMSE, but no effect on other dimensions. Our results reinforce previous data on the literature that APOE ε4 allele has a significant effect on cognitive performance that can be detected even in screening tests, such as the MMSE.

Predictors of incidence of clinically significant depressive symptoms in the elderly: 10-year follow-up study of the Bambui cohort study of aging.

OBJECTIVE: We aim to evaluate the incidence rate and predictors of clinically significant depressive symptoms (CSDS) over 10 years of follow-up from a population-based cohort study (the Bambui Cohort Study of Aging). METHODS: We calculated the predictors of incidence of CSDS over 10 years of follow-up by the Cox proportional regression analysis. Depressive symptoms were evaluated by GHQ-12 and scores of five or higher indicated CSDS. RESULTS: The annualized incidence rate of clinically significant depressive symptoms was 46 per 1000 person-year. In the multivariate analysis, the main predictors of CSDS were cognitive impairment (HR = 1,69 CI95% [1,20 - 2.37], p = 0.002), diabetes (HR = 1.59 CI95% [1.14 - 2.20], p = 0.006), use of 2 to 4 (HR = 1,95 CI95% [1.21 - 3.15], p = 0.006) and of 5 or more medications in the last 90 days (HR = 2.19 CI95% [1.31 - 3.66], p = 0.003) and higher baseline depressive symptoms (HR = 2.12 CI95% [1.61 - 2.78], p < 0.001). CONCLUSION: These results highlight the importance of higher depressive symptoms, cognitive impairment and endocrine-metabolic disorders to the development of depressive symptoms in older adults. These findings provide a framework for the development of interventions to prevent the emergence of clinically significant depressive symptoms in the elderly.

The effect of gender, age, and symptom severity in late-life depression on the risk of all-cause mortality: the Bambuí Cohort Study of Aging.

BACKGROUND: Increased mortality risk and its moderators is an important, but still under recognized, negative outcome of late-life depression (LLD). Therefore, we aimed to evaluate whether LLD is a risk factor for all-cause mortality in a population-based study with over 10 years of follow-up, and addressed the moderating effect of gender and symptom severity on mortality risk. METHODS: This analysis used data from the Bambuí Cohort Study of Aging. The study population comprised 1.508 (86.5%) of all eligible 1.742 elderly residents. Depressive symptoms were annually evaluated by the GHQ-12, with scores of five or higher indicating clinically significant depression. From 1997 to 2007, 441 participants died during 10,648 person-years of follow-up. We estimated the hazard ratio for mortality risk by Cox regression analyses. RESULTS: Depressive symptoms were a risk factor for all-cause mortality after adjusting for confounding lifestyle and clinical factors (adjusted HR = 1.24 CI95% [1.00-1.55], P = .05). Mortality risk was significantly elevated in men (adjusted HR = 1.45 CI95% [1.01-2.07], P = 0.04), but not in women (adjusted HR = 1.13 CI95% [0.84-1.48], P = 0.15). We observed a significant interaction between gender and depressive symptoms on mortality risk ((HR = 1.72 CI95% [1.18-2.49], P = 0.004). CONCLUSION: The present study provides evidence that LLD is a risk factor for all-cause mortality in the elderly, especially in men. The prevention and adequate treatment of LLD may help to reduce premature disability and death among elders with depressive symptoms.

Construct validity of the mini mental state examination across time in a sample with low-education levels: 10-year follow-up of the Bambuí Cohort Study of Ageing.

OBJECTIVE: The study aims to investigate whether longitudinal data on the structure of the mini mental state examination (MMSE) collected in an older Brazilian cohort support factorial invariance over time. DESIGN: Analysis of 10-year data from a community-based cohort study was performed. SETTING: The study took place in Bambuí, Brazil. PARTICIPANTS: The study sample comprised 1558 (89.4%) of all eligible 1742 elderly residents. MEASUREMENTS: A standard Brazilian version of the MMSE was used. RESULTS: A five-factor solution (developed on the baseline of the cohort) either with no constraints or with loadings constrained to equality across time provided a reasonable fit for the MMSE. A comparison between both models suggested that the model with no constraints was superior. However, the five absolute goodness-of-fit indices suggest that the fully constrained model was also adequate and did not differ substantively from the model without any restriction. CONCLUSION: The structure of the MMSE remained relatively unchanged across the 10 measurement times, thus providing evidence for the good construct validity of the scale across time.

Discontinuation of anti-hypertensive drugs increases 11-year cardiovascular mortality risk in community-dwelling elderly (the Bambuí Cohort Study of Ageing).

BACKGROUND: Hypertension remains a major public health problem whose management is hampered by poor persistence with pharmacological therapy. The aim of this study was to evaluate the association between discontinuing antihypertensive drugs (AHDs) and the risk of cardiovascular mortality in the elderly. METHODS: A population-based prospective cohort study of all of the ≥ 60-year-old residents in Bambuí city (Brazil) enrolled 1606 subjects (92.2%), of whom 1494 (93.0%) were included in this study. The use of AHDs was ascertained annually in a real-clinical context, and time-varying AHD exposure was categorised as non-use, current use or stopped. The predicted cardiovascular mortality rates were estimated using interval Poisson models for ungrouped person-time data, taking into account current levels of systolic blood pressure (BP). RESULTS: The overall adjusted cardiovascular mortality risk ratio of AHD stoppers vs current users was 3.12 (95% CI: 2.35-4.15). There was a significant interaction with BP levels: the association between discontinuing AHDs and the risk of cardiovascular mortality was stronger at higher systolic BP levels. The estimates of the risk of cardiovascular mortality over the follow-up period were similar in AHD users and non-users, for whom AHDs were never prescribed. CONCLUSION: Discontinuing AHDs increases the risk of cardiovascular mortality in the elderly. Misconceptions about symptoms or drug-related adverse effects could underlie a subject's decision to discontinue AHDs. Greater attention should be paid to the choice of AHDs and informative action.

Association between sleep duration and all-cause mortality in old age: 9-year follow-up of the Bambuí Cohort Study, Brazil.

This study investigates the association of sleep duration with risk of all-cause mortality among elderly Brazilians using data from a 9-year population-based cohort study and applying a multivariable longitudinal categorical and continuous analysis using Cox's proportional hazards models. This analysis used data from the Bambui Health and Ageing Study (BHAS), conducted in Bambuí city (approximately 15000 inhabitants) in southeastern Brazil. The study population comprised 1512 (86.8%) of all eligible 1742 elderly residents. In multivariable analysis, using sleep duration as categorical variable and controlling for multiple measures of sociodemographic and health status, those who slept 9h or more per night were found to be at higher risk of mortality than those who slept 7h [hazard ratio (HR): 1.53; 95% confidence interval (CI): 1.12-2.09]. Excluding those whose deaths occurred within 2years after entry, this association remained significant (HR: 1.56; 95% CI: 1.12-2.18). In analyses using sleep duration as a continuous variable, a linear correlation was found between sleep duration and mortality in all adjusted models in the whole sample (HR: 1.08; 95% CI: 1.02-1.15) and following exclusion of those whose deaths occurred within 2years after entry (HR: 1.13; 95% CI: 1.06-1.21). Both linear and quadratic terms were significant, reflecting a predicted relationship, with mortality predominantly increasing in association with long sleep duration but with the addition of a slight decrease in association with shorter sleep duration. In conclusion, long rather than short sleep duration was associated principally with all-cause mortality in this sample. It is therefore reasonable to suggest that clinicians should be aware of the potential adverse prognosis associated with prolonged sleep.

Mild and moderate cognitive impairment and mortality among Brazilian older adults in long-term follow-up: The Bambui Health Aging Study.

OBJECTIVE: To compare mortality in older adults with and without mild or moderate cognitive impairment over 15 years of follow-up in a middle-income country, where little information on this subject is available. METHODS: A total of 1,281 community-dwelling older adults were followed-up for a median of 13.3 years. We evaluated their cognitive impairment using the Mini-Mental State Examination, categorizing it as none (1.0 SD above cutoff means), mild (1.0 SD below cutoff means) or moderate (2.0 SD below cutoff means). The date of death was determined by reviewing death certificates. Cox's proportional hazards models were used to evaluate the risk of mortality in participants with cognitive impairment. RESULTS: Participants with mild or moderate cognitive impairment had a higher mortality risk than those without it in the unadjusted model, but these associations did not remain in the final model. After sex stratification, only men with moderate cognitive impairment had a higher mortality risk in the final model. CONCLUSION: The findings suggest an association between moderate cognitive impairment and all-cause mortality in men in a large Brazilian cohort of older adults.

[Influence of income on the association between cognitive impairment and polypharmacy: Bambuí Project]. / Influência da renda na associação entre disfunção cognitiva e polifarmácia: Projeto Bambuí

OBJECTIVE: To evaluate the prevalence of polypharmacy and the influence of income on the association between medication use and cognitive impairment among elderly people. METHODS: Out of the 1,606 baseline members of the Bambuí cohort of elderly people, which started in 1997, 1,554 took part in the study. The Mini-Mental State Examination was applied to all the participants. The association between cognitive impairment and polypharmacy was tested by means of multivariate ordinal regression, performed for the whole population and for each of the income strata. RESULTS: The prevalence of polypharmacy (two or more medications consumed) was 70.4% and the number of medications used presented an independent negative association with cognitive impairment (OR=0.72; 95% CI: 0.55;0.95). When this was stratified according to personal income (<2 minimum monthly salaries versus >or= 2 minimum monthly salaries), a negative association was observed between medication use and cognitive impairment among elderly people with lower income (OR=0.64; 95% CI: 0.48;0.86), but not among those with higher income (OR=1.74; 95% CI: 0.81;3.74). CONCLUSIONS: With regard to the association between cognitive impairment and number of medications consumed, the results indicate social inequality in the use of medications. It is possible that these elderly people are not consuming the medicines needed for appropriate treatment of their health problems.

A population-based study on binge drinking among elderly Brazilian men: evidence from the Belo Horizonte and Bambuí health surveys.

OBJECTIVES: To assess the prevalence and factors associated with binge drinking in two populations of older adults (> or = 60 years). METHOD: A random sample of 685 subjects in the metropolitan area of Belo Horizonte (4.4 million inhabitants) and 643 subjects (92.7% from total residents) in Bambuí City (15,000 inhabitants), both in Southeast Brazil, participated in the study. The dependent variable was binge drinking (> or = 5 drinks on a single occasion in the last 30 days), and independent variables included sociodemographic characteristics, social network, health conditions and use of health services. RESULTS: The prevalence of binge drinking was higher in the metropolitan area of Belo Horizonte (27.0%) than in Bambuí (13.7%). In the multivariate analysis, worse self-rated health was the only variable associated with binge drinking in both populations (Prevalence ratios [PR] 0.62; 95%CI 0.45-0.85 and 0.57; (0.40-0.83), respectively). On the other hand, two important differences were found: 1) in the metropolitan area of Belo Horizonte, binge drinking was associated with higher school level [8+ years] (PR = 1.55; 95%CI 1.07-2.26) and functional disability (PR = 0.12); 95%CI (0.02-0.83) 2) in Bambuí, binge drinking was associated with being divorced or separated (PR = 2.49; 95%CI 1.55-3.99). CONCLUSIONS: Among older adults, differences of prevalence and factors associated with binge drinking can be found in a same country, probably due to sociocultural influences.

Factors associated with depressive symptoms measured by the 12-item General Health Questionnaire in community-dwelling older adults (The Bambuí Health Aging Study).

OBJECTIVE: To investigate factors associated with depressive symptoms in community-dwelling older adults. METHOD: This study evaluated 1,510 participants of the Bambuí Health Aging Study baseline. The dependent variable was the presence of depressive symptoms assessed by the 12-item General Health Questionnaire and predictive variables were sociodemographic characteristics, social support network, lifestyle and health conditions. RESULTS: The prevalence of depressive symptoms was 38.5% (12-item General Health Questionnaire > or = 5). Depressive symptoms were positively and independently associated with female gender (PR = 1.15; 95%CI 1.01-1.33), aged 80 years or over (PR = 1.22; 95%CI: 1.02-1.54) compared with 60-69 years, single (PR = 1.25; 95%CI: 1.02-1.46) or separated (PR = 1.30; 95%CI: 1.03-1.65) marital status, less than 4 years of schooling (PR = 1.42; 95%CI: 1.04-2.00), self-reported global health (reasonable: PR = 1.84; 95%CI 1.45-2.34; bad or very bad: PR = 2.44; 95%CI 1.91-3.12), incapacity or great difficulty in performing daily activities (PR = 1.39; 95%CI: 1.22-1.57) and complaint of insomnia in the last month (PR = 1.77; 95%CI: 1.22-1.99). CONCLUSION: The similarities between factors associated with depressive symptoms in this population and in others do not explain the high prevalence rates previously reported in Bambuí. These findings may guide efforts to investigate others factors to elucidate the etiopathogenesis of depression in this population.

Prognostic value of disability on mortality: 15-year follow-up of the Bambuí cohort study of aging.

BACKGROUND: Disability is a concern in the context of population ageing. The extent of an individual's disability is a major determinant of whether or not they require long-term care or survival time. We investigated the effect of three disability domains as predictors of all-cause mortality over 15-year follow-up in a Brazilian socioeconomically disadvantaged and multiracial older adult population. METHODS: We estimated Cox proportional hazards models using data from 1333 community-dwelling individuals aged 60 and older from the Bambuí Cohort Study of Ageing. Disability was defined as a great difficulty or not being able to perform one and two or more activities in each domain: mobility, instrumental activities of daily living (IADL) and basic activities of daily living (BADL). RESULTS: The overall mortality rate was 46.1 per 1000 person-years at risk (pyrs) and it was higher in men. Among men, the fully adjusted Hazard Ratios (HRs) were 1.92 (95%CI: 1.43-2.58), 2.07 (95%CI: 1.53-2.79) and 1.65 (95%CI: 1.11-2.45), and among women 1.75 (95%CI: 1.38-2.21), 1.43 (95%CI: 1.11-1.84) and 1.43 (95%CI: 1.05-1.95), for two or more disability in mobility tasks, IADLs and BADLs, respectively, compared to those with no difficulty or some difficulty to perform all the tasks. CONCLUSION: A similar risk of death for mobility, IADL and BADL in both genders was found, suggesting that any of these domains can be used to identify risk of all-cause mortality among older adults. The number of activities with limitations in each domain was an important factor.

[The influence of proxy respondents on health perception among older adults: a study based on the Brazilian National Household Survey (1998, 2003) and the cohort study in Bambuí, Minas Gerais State, Brazil]. / A influência de respondente substituto na percepção da saúde de idosos: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998, 2003) e na coorte de Bambuí, Minas Gerais, Brasil.

This study was developed to examine whether the use of a proxy respondent influences the distribution and factors associated with health perception among older adults, as well as the mortality relative risk. The study included 28,943 and 35,040 participants from the Brazilian National Household Survey (PNAD) in 1998 and 2003, respectively, and 1,606 members of the cohort from Bambuí, Minas Gerais, Brazil. The results showed that use of proxy in the PNAD 1998 and 2003 did not modify the distribution of health perception or associated factors. The 5-year mortality rate ratio among cohort participants was higher in direct interviews with seniors (RR = 2.40) as compared to those answered by proxies (RR = 1.28), but the direction of the association was the same. These results indicate that health perception data from the PNAD can be used regardless of who answers the interview and that the association between worse health perception and mortality persisted even when perception was inferred from a proxy.

Components of the metabolic syndrome and depressive symptoms in community-dwelling older people: the Bambuí Cohort Aging Study.

OBJECTIVE: To investigate the moderating effect of an increasing number of clustered metabolic syndrome (MetS) components on the association between MetS and depressive symptoms in a population-based cohort of older adults in Brazil. METHODS: This analysis used data from the Bambuí Cohort Aging Study. Participants in this cross-sectional study comprised 1,469 community-dwelling older people aged ≥ 60 years. Analyses were performed to assess both the association between depressive symptoms and each individual MetS component and the association between depressive symptoms and clustering of an increasing number of MetS components. RESULTS: High triglyceride level was the individual component that showed the strongest association with depressive symptoms (odds ratio [OR]: 1.47; 95% confidence intervals [95%CI] 1.19-1.81; p < 0.0001). Only the presence of three MetS components was associated with depressive symptoms (OR = 1.53; 95%CI 1.05-2.23; p = 0.025). No graded association was detected between increasing number of clustered MetS components and depressive symptoms. CONCLUSIONS: Increasing the number of MetS components did not impact the association with depressive symptoms. The association between high triglyceride level and depressive symptoms highlights the relevance of lipid metabolism abnormalities for the emergence of depressive symptoms in older adults.

[The Bambui Health and Aging Study (BHAS): a population-based cohort study of prevalence and factors associated with the needs of caregivers for the elderly]. / Projeto Bambuí: um estudo de base populacional da prevalência e dos fatores associados à necessidade de cuidador entre idosos.

The objective of this study was to determine the prevalence and factors associated with the needs of caregivers for older adults living in the community. All residents (n = 1,742) of Bambuí, Minas Gerais State, Brazil (15,000 inhabitants) aged > or = 60 years were selected. Of these, 92% were interviewed and 86% were examined. The dependent variable "need for a caregiver" was defined as the inability to perform at least one of the basic activities of daily living and/or a Mini Mental score under 13. Some 23% of the elderly required caregivers. After adjustment for confounding, independent and positive associations with the need for a caregiver were found for: age, single marital status, history of alcohol abuse, hypertension, obesity, and use of > or = 2 prescription drugs. Independent and negative associations were found for: level of schooling, familiar income, living alone, total cholesterol > 240 mmHg, and having a private health plan. Those requiring caregivers presented evidence of worse socioeconomic and health status. The study provides evidence that care of the dependent elderly is a public health problem.

Bipolar disorder prevalence: a systematic review and meta-analysis of the literature.

OBJECTIVE: Bipolar disorder (BD) is common in clinical psychiatric practice, and several studies have estimated its prevalence to range from 0.5 to 5% in community-based samples. However, no systematic review and meta-analysis of the prevalence of BD type 1 and type 2 has been published in the literature. We carried out a systematic review and meta-analysis of the lifetime and 1-year prevalence of BD type 1 and type 2 and assessed whether the prevalence of BD changed according to the diagnostic criteria adopted (DSM-III, DSM-III-R vs. DSM-IV). METHODS: We searched MEDLINE, Scopus, Web of Science, PsycINFO, and the reference lists of identified studies. The analyses included 25 population- or community-based studies and 276,221 participants. RESULTS: The pooled lifetime prevalence of BD type 1 was 1.06% (95% confidence interval [95%CI] 0.81-1.31) and that of BD type 2 was 1.57% (95%CI 1.15-1.99). The pooled 1-year prevalence was 0.71% (95%CI 0.56-0.86) for BD type 1 and 0.50% (95%CI 0.35-0.64) for BD type 2. Subgroup analysis showed a significantly higher lifetime prevalence of BD type 1 according to the DSM-IV criteria compared to the DSM-III and DSM-IIIR criteria (p < 0.001). CONCLUSION: This meta-analysis confirms that estimates of BD type 1 and type 2 prevalence are low in the general population. The increase in prevalence from DSM-III and DSM-III-R to DSM-IV may reflect different factors, such as minor changes in diagnostic operationalization, use of different assessment instruments, or even a genuine increase in the prevalence of BD.

Physical activity and all-cause mortality among older Brazilian adults: 11-year follow-up of the Bambuí Health and Aging Study.

OBJECTIVE: To investigate the association between physical activity (eg, energy expenditure) and survival over 11 years of follow-up in a large representative community sample of older Brazilian adults with a low level of education. Furthermore, we assessed sex as a potential effect modifier of this association. MATERIALS AND METHODS: A population-based prospective cohort study was conducted on all the ≥60-year-old residents in Bambuí city (Brazil). A total of 1,606 subjects (92.2% of the population) enrolled, and 1,378 (85.8%) were included in this study. Type, frequency, and duration of physical activity were assessed in the baseline survey questionnaire, and the metabolic equivalent task tertiles were estimated. The follow-up time was 11 years (1997-2007), and the end point was mortality. Deaths were reported by next of kin during the annual follow-up interview and ascertained through the Brazilian System of Information on Mortality, Brazilian Ministry of Health. Hazard ratios (95% confidence intervals [CIs]) were estimated by Cox proportional-hazard models, and potential confounders were considered. RESULTS: A statistically significant interaction (P<0.03) was found between sex and energy expenditure. Among older men, increases in levels of physical activity were associated with reduced mortality risk. The hazard ratios were 0.59 (95% CI 0.43-0.81) and 0.47 (95% CI 0.34-0.66) for the second and third tertiles, respectively. Among older women, there was no significant association between physical activity and mortality. CONCLUSION: It was possible to observe the effect of physical activity in reducing mortality risk, and there was a significant interaction between sex and energy expenditure, which should be considered in the analysis of this association in different populations.

Mild and moderate cognitive impairment and mortality among Brazilian older adults in long-term follow-up: The bambui health aging study

Objective: To compare mortality in older adults with and without mild or moderate cognitive impairment over 15 years of follow-up in a middle-income country, where little information on this subject is available. Methods: A total of 1,281 community-dwelling older adults were followed-up for a median of 13.3 years. We evaluated their cognitive impairment using the Mini-Mental State Examination, categorizing it as none (1.0 SD above cutoff means), mild (1.0 SD below cutoff means) or moderate (2.0 SD below cutoff means). The date of death was determined by reviewing death certificates. Cox's proportional hazards models were used to evaluate the risk of mortality in participants with cognitive impairment. Results: Participants with mild or moderate cognitive impairment had a higher mortality risk than those without it in the unadjusted model, but these associations did not remain in the final model. After sex stratification, only men with moderate cognitive impairment had a higher mortality risk in the final model. Conclusion: The findings suggest an association between moderate cognitive impairment and all-cause mortality in men in a large Brazilian cohort of older adults.

Genomic Ancestry, Self-Rated Health and Its Association with Mortality in an Admixed Population: 10 Year Follow-Up of the Bambui-Epigen (Brazil) Cohort Study of Ageing.

BACKGROUND: Self-rated health (SRH) has strong predictive value for mortality in different contexts and cultures, but there is inconsistent evidence on ethnoracial disparities in SRH in Latin America, possibly due to the complexity surrounding ethnoracial self-classification. MATERIALS/METHODS: We used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual genomic proportions of African, European and Native American ancestry, and ethnoracial self-classification, with baseline and 10-year SRH trajectories in 1,311 community dwelling older Brazilians. We also examined whether genomic ancestry and ethnoracial self-classification affect the predictive value of SRH for subsequent mortality. RESULTS: European ancestry predominated among participants, followed by African and Native American (median = 84.0%, 9.6% and 5.3%, respectively); the prevalence of Non-White (Mixed and Black) was 39.8%. Persons at higher levels of African and Native American genomic ancestry, and those self-identified as Non-White, were more likely to report poor health than other groups, even after controlling for socioeconomic conditions and an array of self-reported and objective physical health measures. Increased risks for mortality associated with worse SRH trajectories were strong and remarkably similar (hazard ratio ~3) across all genomic ancestry and ethno-racial groups. CONCLUSIONS: Our results demonstrated for the first time that higher levels of African and Native American genomic ancestry--and the inverse for European ancestry--were strongly correlated with worse SRH in a Latin American admixed population. Both genomic ancestry and ethnoracial self-classification did not modify the strong association between baseline SRH or SRH trajectory, and subsequent mortality.