Factors associated with symptoms of anxiety and depression in five cohorts of community-based older people: the HALCyon (Healthy Ageing across the Life Course) Programme.

BACKGROUND: Symptoms of anxiety and depression are common in older people, but the relative importance of factors operating in early and later life in influencing risk is unclear, particularly in the case of anxiety. METHOD: We used data from five cohorts in the Healthy Ageing across the Life Course (HALCyon) collaborative research programme: the Aberdeen Birth Cohort 1936, the Caerphilly Prospective Study, the Hertfordshire Ageing Study, the Hertfordshire Cohort Study and the Lothian Birth Cohort 1921. We used logistic regression to examine the relationship between factors from early and later life and risk of anxiety or depression, defined as scores of 8 or more on the subscales of the Hospital Anxiety and Depression Scale, and meta-analysis to obtain an overall estimate of the effect of each. RESULTS: Greater neuroticism, poorer cognitive or physical function, greater disability and taking more medications were associated in cross-sectional analyses with an increased overall likelihood of anxiety or depression. Associations between lower social class, either in childhood or currently, history of heart disease, stroke or diabetes and increased risk of anxiety or depression were attenuated and no longer statistically significant after adjustment for potential confounding or mediating variables. There was no association between birth weight and anxiety or depression in later life. CONCLUSIONS: Anxiety and depression in later life are both strongly linked to personality, cognitive and physical function, disability and state of health, measured concurrently. Possible mechanisms that might underlie these associations are discussed.

Prevalence and pattern of cognitive impairment in a community cohort of men in South Wales: methodology and findings from the Caerphilly Prospective Study.

BACKGROUND/AIMS: The prevalence of dementia and cognitive impairment not dementia was investigated in the Caerphilly Prospective Study cohort (men currently aged 65-84 years). METHODS: Of 1,633 men eligible for cognitive screening, 1,225 (75%) were seen, with those failing the screening criteria (CAMCOG <83 or decline in CAMCOG >9) being neurologically examined. RESULTS: For dementia, diagnosed by DSM-IV criteria, the population prevalence was 5.2% rising to 6.1% in the screened population. For cognitive impairment not dementia, the prevalence in the screened population was 15.6% giving an overall prevalence of cognitive impairment of 21.8%. Prevalence rose fivefold between ages of 65 and 84 years to reach over 50%. CONCLUSION: These figures are likely to underestimate actual prevalence in this population, and developing effective interventions should be a public health priority.

Long term effect of breast feeding: cognitive function in the Caerphilly cohort.

STUDY OBJECTIVE: There is evidence suggesting that artificial feeding is associated with a reduction in cognitive function in infants and children, in contrast with breast feeding, but the available evidence suffers from confounding by social and educational factors. An opportunity arose in the Caerphilly cohort study to examine relations between cognitive function in older men and their feeding as infants, when breast feeding was usual. DESIGN: A prospective cohort study. SETTING: Caerphilly, South Wales, UK, was a deprived coal mining community when the men had been born in 1920-35. Most had been breast fed as infants. PARTICIPANTS: 779 men aged 60-74 years when tested. The men had earlier been asked to obtain from their mothers their birth weight, and how they had been fed as infants. RESULTS: Complete data were obtained for 779 men. In those whose birth weight had been at or above the median, the adjusted mean cognitive function was only slightly and non-significantly lower in those who had been artificially fed. In the men whose birth weight had been below the median, having been artificially fed was associated with significantly lower results in both a test of reasoning (the AH4) and word power (the national adult reading test (NART)). Two standard deviations below the median birth weight, artificial feeding was associated with a reduction of six points (70% of a SD) on word power (the NART). CONCLUSIONS: In men whose birth weight had been low, having been artificially fed is associated with poorer cognitive function in late adult life.

Health status as a potential effect modifier of the relation between noise annoyance and incidence of ischaemic heart disease.

AIMS: Traffic noise is a psychosocial stressor. Epidemiological studies suggest chronic noise stress to be a risk factor for cardiovascular disorders. METHODS: In a prospective cohort study, the association between annoyance and disturbances due to road traffic noise and the incidence of ischaemic heart disease (IHD) was studied in 3950 middle aged men. RESULTS: Depending on the questionnaire item, non-significant odds ratios for IHD incidence ranging from 0.9 to 1.4 were found for the highly noise annoyed/disturbed subjects when compared with the less annoyed/disturbed subjects, over the six year follow up period. However, this relation was strongly modified by the prevalence of pre-existing chronic diseases. In subjects free of any chronic disease at the beginning of the follow up, significant odds ratios between 1.7 and 3.0 were seen. In the subgroup with chronic diseases no such noise effects were seen. This surprising result of no effect in the group of people with a potential risk, due to pre-existing health problems, may be because of the dilution of the true effect due to recall bias. CONCLUSIONS: Annoyance and disturbance due to road traffic noise is associated with a higher incidence of IHD. Prevalence of disease can be an important effect modifier of the relation between noise annoyance and health outcomes.

Cognitive function and blood rheology: results from the Caerphilly cohort of older men.

OBJECTIVES: Vascular lesions are important contributors to cerebral disease, yet relatively little work has been done on relationships between haematological factors and cognitive function. We have explored these relationships in the Caerphilly cohort of older men. DESIGN: The development of vascular disease and the decline in cognitive function are being studied in a cohort of older men in Caerphilly, South Wales, UK. We have recorded a range of life-style, dietary, lipid, haematological and rheological factors which are, or may be, predictive of vascular disease. We have examined the relationships between these and both incident myocardial infarction and stroke, and identified factors relevant to cognitive function. SETTING: A community-based study based upon a representative population sample of older men. We collected data for the study from around 90% of the survivors of the original cohort. SUBJECTS: 2154 men who were aged 55-69 years at the time blood was taken for the haematological tests and cognitive function was tested. MAIN OUTCOME MEASURES: We present data from the AH4 test of general cognitive performance and from choice reaction time, a test of vigilance. RESULTS: There is a U-shaped relationship between haematocrit and cognitive function, the best cognitive function scores occurring at a mean haematocrit of 0.46. The relationship is significant for the choice reaction time (P < 0.05). The relationship between haematocrit and the AH4 test score is also curvilinear, but it is not significant. Plasma viscosity showed strong and robust relationships, with significantly better cognitive performance and faster reaction times at lower levels of viscosity (both relationships P < 0.001). Plasma fibrinogen concentration did not show any significant relationships with cognitive function. All these relationships are present, but are much weaker, with rheological tests that had been carried out 5 years before the cognitive testing. CONCLUSIONS: Blood rheology, as estimated by both haematocrit and plasma viscosity, is a significant determinant of cognitive function in older men. On the other hand, the thrombotic potential of blood, as indicated by fibrinogen level, shows no significant relationships. The relationships with rheology seem to be direct, presumably through blood flow at the time of testing, rather than through underlying long-term disease processes.

Anger and incident heart disease in the caerphilly study.

OBJECTIVE: The idea that anger may predict ischemic heart disease (IHD) is more than 30 years old. Some, but not all, prospective studies have supported this suggestion. Attention has focused on hostility as the critical component of anger for IHD risk. This idea is explored using prospective data from the Caerphilly study. METHODS: A sample of 2890 men aged 49 to 65 years living in and around Caerphilly, South Wales, was identified. Anger was assessed using the Framingham scales comprising "anger symptoms," "anger in," "anger out," and "anger discuss." A new "suppressed anger" scale was also constructed. Cardiovascular risk factors assessed included baseline blood pressure, total and high-density lipoprotein cholesterol, fibrinogen, white cell count, psychiatric caseness as assessed by the General Health Questionnaire, social support, smoking habit, alcohol consumption, leisure exercise, body mass index, and calorie intake. Prediction of IHD, measured as the occurrence of a major event over a follow-up period of 9 years, was assessed using multiple logistic regression analysis. RESULTS: A low anger out score predicted increased risk of a major IHD event (relative odds (RO) = 1.70; 95% confidence interval = 1.26-2.29 for all RO). This association was unchanged on controlling for physiological risk factors (RO = 1.74), psychosocial risk factors (RO = 1.72), and behavioral risk factors (RO = 1.69). Suppressed anger showed associations with incident IHD similar to those of anger out but identified the population at risk more closely. CONCLUSIONS: Anger out and suppressed anger were predictive of incident IHD. Neither of these constructs are overtly similar to hostility. These findings suggest there may be mechanisms other than hostility by which anger predicts IHD risk and that a conceptually varied approach to anger is currently appropriate.

Traffic noise and cardiovascular risk: the Caerphilly and Speedwell studies, third phase--10-year follow up.

The authors tested the hypothesis that prolonged exposure to road traffic noise causes ischemic heart disease in a 10-y follow-up cohort study of middle-aged men. In the Caerphilly and Speedwell studies, 2512 and 2348 men, respectively, who were 45-59 y of age were seen in the initial cross-sectional phase and at follow-up intervals of 10 y. Adjusted odds ratios of 1.1 (95% confidence interval = 0.6, 1.9) and 0.9 (95% confidence interval = 0.6, 1.4) were found in the total cohorts. However, the relative risk was 1.3 (95% confidence interval = 0.8, 2.2) in the pooled reconstructed cohort of men who were followed for 6 y (i.e., from phase 2 to phase 3) and for whom room orientation and window-opening habits could be considered. Furthermore, the relative risk increased to 1.6 (95% confidence interval = 0.9, 3.0) in the subsample of men who had lived at least 15 y in their present homes at the time of recruitment. Living adjacent to streets with high traffic noise levels was associated with an adjusted (for covariates) increase in relative risk of 1.01-1.02/y in residence--a result that was only borderline significant (p < .10).

Smoking, drinking, and other life style factors and cognitive function in men in the Caerphilly cohort.

STUDY OBJECTIVES: To examine the cognitive function in a large, ongoing cohort study of older men, and to identify associations with social and lifestyle factors. DESIGN: A cross sectional study of cognitive function was conducted within the Caerphilly Prospective Study of Heart Disease and stroke. SETTING: The Caerphilly Study was originally set up in 1979-83 when the men were 45-59 years of age. Extensive data are available on a wide range of lifestyle and other factors of possible relevance to cognitive decline. Associations between some of these and cognitive function are reported. PARTICIPANTS: A representative sample of 1870 men aged 55-69 years. MAIN RESULTS: Age, social class, medication, and mood were found to be powerful determinants of performance. Self report data on the involvement of the men in leisure pursuits were examined by factor analysis. This indicated that the more intellectual leisure pursuits are the most strongly linked with performance. A measure of social contact showed a weak positive association with the test scores. Current cigarette smokers gave lower test cognitive function scores than either men who had never smoked, or ex-smokers. There was however no evidence of any gradient in function with the total lifetime consumption of tobacco. The disparity between these two data sets suggests that there had been prior selection of men who had originally started to smoke, but more particularly selection of those who later quit smoking. There was no significant association between alcohol consumption and cognitive function, though ex-drinkers had markedly lower test scores than either current drinkers or men who had never drunk alcohol. This seemed probably to be a consequence of an high prevalence of illness among the ex-drinkers. CONCLUSIONS: Age and social class show strong associations with cognitive function. Leisure persuits and social contact are also both positively associated. Neither tobacco smoking nor the drinking of alcohol seem to be associated with cognitive function, though there is evidence suggestive of self selection of both men who had never smoked and ex-smokers.

Cognitive function in the Caerphilly study: associations with age social class, education and mood.

Baseline cognitive function was established for a study of pre-symptomatic cognitive decline in 1870 men from the general population aged 55-69 years as part of the third examination of the Caerphilly Study. Cognitive assessment included the AH4, a four choice serial reaction time task, a modified CAMCOG, MMSE, NART and various memory tests. Distributions and relationships with age, social class, education and mood at time of testing are presented for a younger population than has previously been available. Multiple linear regression showed cognitive function to be independently associated with all four factors. The age effect was equivalent to one half of a standard deviation (SD) in CRT and AH4 scores. Only the NART score was not associated with age, supporting the use of NART score as an estimate of pre-morbid IQ. The largest age adjusted differences between men with low and normal mood were for the AH4 (3 points, t = 5.6, p < 0.0001) and the CAMCOG (2 points, t = 5.8, p < 0.0001). The smallest age adjusted effect of mood was for the CRT (33 ms, t = 2.14, p = 0.32) and the MMSE (0.4 points, t = 2.97, p = 0.003). Age, mood and education adjusted social class effects were very large ranging between around 0.5 SD for the CRT, and 1.0 SD for the AH4 and NART, respectively. For educational status age, mood and social class adjusted differences were also substantial with tests for trend showing the largest differences for the NART (t = 12, p < 0.0001) and modified CAMCOG (t = 10.6, p < 0.0001) with the smallest differences for the CRT (t = 2.73, p = 0.006).

Blood pressure reactions to the cold pressor test and the prediction of future blood pressure status: data from the Caerphilly study.

The prognostic significance of the cold pressor test in hypertension remains a matter of controversy. Following determination at an initial screening session, blood pressure (BP) was recorded at baseline rest and in reaction to a cold pressor test. Follow-up screening BP was determined 5 years later. The effective sample was 1039 men, with an average age of 56.6 years at initial screening. Step-wise multiple regression indicated that BP reactions to the cold pressor test provided minimal independent prediction of follow-up BP over and above that afforded by BP at initial screening. In the case of follow-up systolic pressure, a model including only age and initial screening systolic BP (SBP) accounted for 38% of the variance; SBP reactions to the cold pressor did not enter the regression equation. In the case of follow-up diastolic BP (DBP), diastolic pressure at initial screening accounted for 21% of the variance, and while DBP reaction to the cold pressor test entered the equation, it accounted for only an additional 1% of the variance. These results suggest that the cold pressor test may be of limited clinical use in older populations.

Attitudes and ischaemic heart disease in the Caerphilly Study: the Health Attitude Inventory.

BACKGROUND: The Health Attitude Inventory (HAI) is developed to assess attitudes, beliefs and values towards coronary-related behaviour in epidemiological studies. It comprises a 76-item self-administered questionnaire which can be completed in under 10 minutes by most adults. METHODS: The HAI was administered to 2100 men aged 50-64 years along with measures of ischaemic heart disease risk factors, including the following coronary-related behaviours: smoking, exercise, type A behaviour and the consumption of fried food, dairy produce, wholemeal bread and vegetables. RESULTS: Cross-sectional analyses using linear regression showed attitudes, beliefs and values to explain between 8% and 27% of the variance in the dietary coronary-related behaviour. For exercise 13% of the variance was explained, and for type A behaviour 18%. Similar analysis for smoking using logistic regression (non-smoker versus current smoker) showed a predictive concordance of 95%. CONCLUSIONS: The HAI has demonstrated the assessment of attitudes, beliefs and values in an epidemiological setting to show associations with a range of coronary risk behaviours. This finding has potential public health as well as aetiological application in that influential attitudes, values and beliefs can be identified to aid increasing healthy as well as reducing risky coronary-related behaviour.

Traffic noise and cardiovascular risk: the Speedwell study, first phase. Outdoor noise levels and risk factors.

As part of the Speedwell study, traffic noise exposure and risk factors for ischemic heart disease were studied in a sample of 2,348 men whose ages ranged from 45 to 63 y. The road traffic noise emission level, Leq, ranged between 51 and 70 dB(A) (6-22 h, 10-m distance). Significant associations were found between noise and potential ischemic heart disease risk factors, including total triglycerides, platelet count, plasma viscosity, glucose (increases), and systolic and diastolic blood pressure (decreases). Not all results support the hypothesis that traffic noise increases ischemic heart disease risk. The results were controlled for a number of potential confounding factors.

A population survey of ischaemic heart disease and minor psychiatric disorder in men.

Associations between ischaemic heart disease and psychiatric morbidity in hospital recruited samples may be confounded by differential referral of patients with co-morbidity. Associations of angina, past history of myocardial infarction, blood pressure, and electrocardiographic evidence of ischaemia with psychiatric disorder can best be examined in community samples as reported here in 2204 middle-aged men from the Caerphilly Collaborative Study. There was a strong association between past history of myocardial infarction, non-specific chest pain, Angina Grade II and psychiatric disorder measured by the 30-item General Health Questionnaire. Electrocardiographic evidence of ischaemia alone was not significantly associated with psychiatric disorder. It is suggested that non-specific chest pain is a symptom of psychiatric disorder; conversely in severe angina psychiatric disorder is secondary to the pain, restricted activity and threat to life which angina implies.

Social factors and minor psychiatric disorder in middle-aged men: a validation study and a population survey.

A cross-sectional survey of minor psychiatric disorder is reported in a representative community sample of 2204 men between the ages of 45 years and 64 years living in Caerphilly, South Wales. Minor psychiatric disorder was measured by the 30-item General Health Questionnaire and validated by the Clinical Interview Schedule in a consecutive sample of 97 men, weighted to provide one-third cases, two-thirds non-cases. A case threshold of 4/5 on the General Health Questionnaire was chosen on the basis of 'ROC' analysis. An overall estimated 'true' prevalence rate for minor psychiatric disorder of 22.0% was found, with 22.3% of men scoring 5 or more on the General Health Questionnaire. Rates of minor psychiatric disorder were higher in widowed and divorced men than in married men but were also, unexpectedly, lower in single as opposed to married men. There was no social-class gradient in minor psychiatric morbidity but a lower rate in Social Class III NM may be largely explained by lower unemployment rates. There were markedly higher rates of minor psychiatric morbidity in unemployed men and those who retired ill. Men with no available social contacts had higher rates of morbidity than men with some or high social contacts.

Blood viscosity and hearing levels in the Caerphilly Collaborative Heart Disease Study.

Data from 342 men who are participants in the Caerphilly Collaborative Heart Disease Study were used to replicate a previous report of a significant relationship between measures of whole-blood viscosity and hearing levels in persons with sensorineural hearing impairment. In the unselected data, there were significant relationships between measures of whole-blood viscosity at high shear rates and hearing threshold levels at 2000 and 4000 Hz, even after accounting for the effects of age and socioeconomic group. In a subset of the data containing 124 persons selected on the basis of likely sensorineural hearing impairment, there were significant relationships between whole-blood viscosity and hearing level at all frequencies, with stronger effects at the higher frequencies. The data support the contention of a potentially important relationship between whole-blood viscosity and sensorineural hearing impairment.

A framework for the adaptation of psychological questionnaires for epidemiological use: an example of the Bortner Type A scale.

A model for the systematic adaptation of psychological questionnaires for epidemiological use is presented. Application of the model is illustrated using variants of the Bortner Type A scale in a representative age/sex stratified sample of 256 persons. Through the application of the model the Bortner scale was adapted to compare the effects of scale direction, scale format and example position. Overall the Bortner scale was shown to provide robust measurement which was little affected by response rate, age, sex or by the adaptations of the scale. An association was found of sex with response rate. Interaction effects of sex and scale direction on mean Type A scores, and of example position and scale format on both response rate and Type A score variability were also found. In identifying critical aspects of questionnaire performance, and in providing a coherent framework for their interrelationship, the model acts as a guide to the systematic assessment of questionnaire performance. The use of this model will, therefore, facilitate greater confidence in the interpretation of questionnaire data in epidemiological studies.

Coffee, blood pressure and plasma lipids: a randomized controlled trial.

A randomized controlled trial was conducted to examine the effects of coffee (as commonly drunk in Britain) on blood pressure and plasma lipids in healthy subjects. Fifty-four subjects followed three regimens successively, the order being randomized according to a Latin square design: five or more cups of coffee daily for 4 weeks; five or more cups of decaffeinated coffee daily for 4 weeks but no ordinary coffee; no coffee for 4 weeks. Coffee appeared to cause a small rise (of 3 mm Hg) in recumbent systolic blood pressure; this effect was less than, and obscured by, changes induced by posture and mild stress. No consistent changes attributable to coffee were found in diastolic blood pressure or pulse rate. Small changes in the expected directions occurred in plasma high density lipoprotein (HDL) cholesterol and apolipoprotein AI (decrease), and in total cholesterol, non-HDL cholesterol and apolipoprotein B (increase), but none of these were statistically significant. The effect of coffee on risk of heart disease in Britain is probably small.