Association between Cognitive Function and Clustered Cardiovascular Risk of Metabolic Syndrome in Older Adults at Risk of Cognitive Decline.

OBJECTIVES: Metabolic syndrome (MetS) represents a cluster of obesity and insulin resistance-related comorbidities. Abdominal obesity, hypertension, elevated triglyceride and glucose levels are components of MetS and may have a negative effect on cognitive function, but few cognitive studies have examined the combined risk severity. We sought to determine which specific cognitive abilities were associated with MetS in older adults at risk of cognitive decline. DESIGN: Cross-sectional study. PARTICIPANTS: 108 AIBL Active participants with memory complaints and at least one cardiovascular risk factor. MEASUREMENTS: Cardiovascular parameters and blood tests were obtained to assess metabolic syndrome criteria. The factors of MetS were standardized to obtain continuous z-scores. A battery of neuropsychological tests was used to evaluate cognitive function. RESULTS: Higher MetS z-scores were associated with poorer global cognition using ADAS-cog (adjusted standardized beta=0.26, SE 0.11, p<0.05) and higher Trail Making B scores (adjusted beta=0.23, SE 0.11, p<0.05). Higher MetS risk was related to lower cognitive performance. CONCLUSION: Combined risk due to multiple risk factors in MetS was related to lower global cognitive performance and executive function. A higher MetS risk burden may point to opportunities for cognitive testing in older adults as individuals may experience cognitive changes.

Hip fractures among indigenous Western Australians from 1999 to 2009.

BACKGROUND: Minimal trauma hip fractures are prevalent in Australia. The incidence rate and trend of hip fractures in Indigenous Western Australians have not been formally reported. AIMS: To evaluate incidence rates and trend of minimal trauma hip fractures in Indigenous and other Western Australians aged 40 years and over in 1999-2009 METHODS: Hip fracture data were obtained from an administrative database for all hospitalisations in Western Australia. Age-standardised incidence rates were calculated using direct standardisation, and standardised rate ratios were calculated using the indirect method. Trend in incidence rates were calculated using Poisson regression. RESULTS: In 1999-2009, 11,844 admissions for minimal trauma hip fractures were reported among Western Australians aged 40 years and over, of which 201 were recorded as indigenous. The age-standardised hip fracture rate was 273.0 (95% confidence interval (CI) 230.7-315.4) per 100,000 person-years for indigenous adults and 148.8 (95% CI 146.1-151.5) per 100,000 person-years for non-indigenous adults. The standardised morbidity ratio was 2.2 (95% CI 1.9-2.5). Over this period, age-standardised rates increased by an average of 7.2% per year among indigenous adults (P = 0.006), whereas non-indigenous rates fell by an average of 3.4% per year (P < 0.001). The relatively higher rates among indigenous adults were more evident in the younger age groups. CONCLUSION: There is a widening gap in minimal trauma hip fracture rates between indigenous and other Western Australians. This study demonstrates a need for public health review and management strategies to reduce falls and hip fracture in the indigenous community.

Intracranial cause of delirium: computed tomography yield and predictive factors.

BACKGROUND: Computed tomography (CT) of the brain in delirium investigation has a low yield of identifiable causes. We sought to identify the best clinical predictors of an intracranial cause of delirium. METHODS: We performed a case-control study of patients admitted to a delirium unit. Clinical factors of patients with positive findings on scans were compared with those without demonstrated causes. The main outcome measure was intracranial abnormalities accountable for the cause of delirium. RESULTS: During 18 months, there were 300 admissions to the unit. Mean age of patients was 86.6 years. Among 200 patients who proceeded to CT scanning, only 29 demonstrated intracranial pathology accountable for the cause of delirium, with a yield of 14.5%. There were 13 patients with ischaemic stroke, seven with subdural haemorrhage and nine with intracerebral haemorrhage. In multivariate analysis, new neurological deficits (adjusted odds ratio (OR) 18.17, 95% confidence interval (CI) 5.99-55.15), recent falls history (adjusted OR 5.58, 95% CI 1.90-16.42) and decline in conscious level (adjusted OR 4.58, 95% CI 1.33-15.79) were predictors of clinically meaningful radiological findings. Twenty-six of the 29 patients with scans had these three predictors with a sensitivity of 89.7% (95% CI 78.6-100%). CONCLUSION: We identified a history of recent fall as a new independent predictor for clinically relevant intracranial pathology in delirious patients, besides new neurological deficits and decline in conscious state. A flow chart incorporating CT head scanning as part of delirium investigation is proposed.