The Cretan Aging Cohort: Cohort Description and Burden of Dementia and Mild Cognitive Impairment.

Our aim was to explore the burden of dementia in the Cretan Aging Cohort, comprised of 3140 persons aged ≥60 years (56.8% women, 5.8 ± 3.3 years formal education, 86.2% living in rural areas) who attended selected primary health-care facilities on the island of Crete, Greece. In the first study phase, a formal diagnosis of dementia had been reached in 4.0% of the participants. However, when selected 505 participants underwent thorough neuropsychiatric evaluation in the second phase of this study (344 with Mini-Mental State Examination [MMSE] <24 and 161 with MMSE ≥24), and results were extrapolated to the entire cohort, the prevalence of dementia and mild cognitive impairment was estimated at 10.8% (9.7%-11.9%) and 32.4% (30.8%-34.0%), respectively. Using both the field diagnostic data and the extrapolated data, the highest dementia prevalence (27.2%) was found in the 80- to 84-year-old group, who also showed the lowest educational level, apparently due to lack of schooling during World War II.

Self-reported fatigue as a risk index for dementia diagnosis.

INTRODUCTION: Cognitive impairment and frailty are major problems of older age. This study aims to explore the association between frailty and cognitive impairment in a rural cohort of older subjects in southern Europe (Cretan Aging Cohort). METHODS: Community-based, primary care, cross-sectional, study in the Heraklion Prefecture, Crete, Greece. Four hundred and two persons aged 60-100 years from the Cretan Aging Cohort [100 with dementia, 175 with mild cognitive impairment (MCI) and 127 cognitively non-impaired] were enrolled, mostly rural dwellers (86.2%). Frailty was assessed with the Simple "Frail" Questionnaire Screening Tool. Demographic data, BMI, Mini-Mental State Examination scores (MMSE), severity of dementia according to the Clinical Dementia Rating Scale, and depressive symptoms according to the Geriatric Depression Scale (GDS) were recorded. RESULTS: Frailty was present in 17% of persons with dementia (73.8% of mild severity), in 6.3% of persons with MCI and in 8.7% of cognitively non-impaired persons (P < 0.05). Among the various frailty variables, fatigue and difficulty walking were significantly more frequently reported by persons with dementia. Each frailty variable and the frailty score correlated negatively with MMSE score and positively with GDS score and polypharmacy. Multivariate analysis revealed that reported fatigue improved the identification of dementia in addition to MMSE, significantly and independently of symptoms of depression (P = 0.04). CONCLUSION: Frailty rates are significantly higher in persons with dementia. In this predominantly rural cohort of older subjects, reported fatigue could serve as a marker of physical decline and a complementary index for referral for further neuropsychological and neuropsychiatric evaluation.