Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy.

BACKGROUND: During the Covid-19 pandemic fake news has been circulating impacting on the general population's opinion about a vaccine against the SARS-CoV-2. Health literacy measures the capacity of navigating health information. METHODS: We used data from a prospective national online cohort of 1647 participants. Descriptive statistics, Chi2 and ANOVA independence tests and two multivariable multinomial regression models were performed. Interactions between each variable were tested. RESULTS: Detection of fake news and health literacy scores were associated with intention to get vaccinated against SARS-CoV-2 (p < 0.01). The risk of being "anti-vaccination" or "hesitant", rather than "pro-vaccination", was higher among individuals reporting bad detection of fake news, respectively OR = 1.93 (95%CI = [1.30;2.87]) and OR = 1.80 (95%CI = [1.29;2.52]). The risk of being in "hesitant", rather than "pro-vaccination" was higher among individuals having a bad health literacy score (OR = 1.44; 95%CI = [1.04;2.00]). No interaction was found between detection of fake news and health literacy. CONCLUSIONS: To promote acceptance of a vaccine against SARS-CoV-2, it is recommended to increase individuals' ability to detect fake news and health literacy through education and communication programs.

Epidemiology of neurological diseases in older adults.

Neurological diseases refer to the diseases that target the nervous system (brain, spine or nerves). They are the second leading cause of death, and the first cause of severe long-term disability in the world. The prevalence of most neurological diseases increases sharply with age, and age also modulates the impact of risk factors, clinical presentation and the natural course of these diseases. Longitudinal population-based studies provide useful insights for a better understanding of the specificities of neurological diseases in older adults by assessment of a wide range of risk factors. Rapid population aging, especially in low-income countries, presents challenges in terms of health and social care. A multidisciplinary approach is necessary to find solutions to tackle the burden of neurological diseases in older adults.

Sensory loss and suicide ideation in older adults: findings from the Three-City cohort study.

ABSTRACTObjectives:To examine the longitudinal risk of vision loss (VL) or hearing loss (HL) for experiencing suicidal ideation in older adults. DESIGN: The Three-City study, examining data from three waves of follow-up (2006-2008, 2008-2010, and 2010-2012). SETTING: Community-dwelling older French adults. PARTICIPANTS: N = 5,438 adults aged 73 years and over. MEASUREMENTS: Suicidality was assessed by the Mini-International Neuropsychiatric Interview, Major Depressive Disorder module. Mild VL was defined as Parinaud of 3 or 4 and severe VL as Parinaud >4. Mild HL was self-reported as difficulty understanding a conversation and severe HL as inability to understand a conversation. RESULTS: Severe VL was associated with an increased risk of suicidal ideation at baseline (OR = 1.59, 95% CIs = 1.06-2.38) and over five years (OR = 1.65, 95% CIs = 1.05-2.59). Mild and severe HL were associated with an increased risk of suicidal ideation, both at baseline (OR = 1.29, 95% CIs = 1.03-1.63; OR = 1.78, 95% CIs = 1.32-2.40) and over five years (OR = 1.47, 95% CIs = 1.17-1.85; OR = 1.97, 95% CIs = 1.44-2.70). CONCLUSION: Sensory losses in late life pose a risk for suicidal ideation. Suicidality requires better assessment and intervention in this population.

The association of vision loss and dimensions of depression over 12 years in older adults: Findings from the Three City study.

BACKGROUND: The established relationship between vision impairment and depression is limited by the examination of depression only as a unidimensional construct. The present study explores the vision-depression relationship using a dimensional approach. METHODS: 9036 participants aged 65 years and above enrolled in the Three-City study were included. Relationships between baseline near Vision Impairment (VI) or self-reported distance Visual Function (VF) loss with trajectory of four dimensions of depression - depressed affect, positive affect, somatic symptoms and interpersonal problems - over 12 years were examined using mixed-effects models. Depression dimensions were determined using the four-factor structure of the Centre for Epidemiology Studies-Depression Scale (CESD). RESULTS: In the fully adjustment models, mild near VI predicted poorer depressed affect (b = 0.04, p = .002) and positive affect (b = -0.06, p < 0.001) over time, with evidence of longer term adjustment. Distance VF loss was associated with poorer depressed affect (b = 0.27, p ≤ .001), positive affect (b = -0.15, p = .002), and somatic symptoms (b = 0.18, p ≤ .001) at baseline, although only the association with depressed affect was significant longitudinally (b = 0.01, p = .001). Neither near VI nor distance VF loss was associated with interpersonal problems. LIMITATIONS: This paper uses a well-supported model of depression dimensions, however, there remains no definite depression dimension model. Distance VF loss was self-reported, which can be influenced by depression symptoms. CONCLUSIONS: Vision impairment in older adults is primarily associated with affective dimensions of depression. A reduction in social connectedness and ability to engage in pleasurable activities may underlie the depression-vision relationship. Older adults with vision impairment may benefit from targeted treatment of affective symptoms, and pleasant event scheduling.

The association between systolic blood pressure variability with depression, cognitive decline and white matter hyperintensities: the 3C Dijon MRI study.

BACKGROUND: Accumulating evidence links blood pressure variability (BPV) with white matter hyperintensities (WMH) and stroke. The longitudinal association between BPV with late onset depression (LOD) and cognitive decline remains unexplored. METHODS: Prospective cohort study of 2812 participant's age ⩾65 years (median age 72 years, 63.6% female) without dementia or stroke. Serial clinic visits assessed blood pressure, cognitive function, depression disorder, and depressive symptoms. A brain magnetic resonance imaging (MRI) substudy was performed in 1275 persons to examine possible associations with WMH. RESULTS: The interaction between symptomatic LOD and systolic BPV was associated with cognitive decline on the Isaac Set Test [slope -4.45; 95% confidence interval (CI) -8.92 to -0.16, p = 0.04], Benton Visual Retention Test (slope -0.89; 95% CI -1.77 to -0.01, p = 0.049), Mini Mental State Examination (slope -1.08; 95% CI -1.86 to -0.30, p = 0.007) and Finger Tapping Test (slope -7.53; 95% CI -13.71 to -1.34, p = 0.017) but not Trail Making Test-A or -B/A. The MRI substudy demonstrated that systolic BPV was associated with cognitive decline via interactions with depression and total WMH volume, but this was not dependent on either deep or periventricular WMH volumes. CONCLUSIONS: The findings show that the interaction between systolic BPV with symptomatic depression and WMH increases cognitive decline in persons ⩾65 years of age. Future work could extend these findings by examining systolic BPV in relation to cognitive decline and WMH in older populations with depression.

Stress, attention deficit hyperactivity disorder (ADHD) symptoms and tobacco smoking: The i-Share study.

BACKGROUND: The contribution of mental health to the risk of smoking is increasingly acknowledged but still insufficiently studied during the key period of student life. In particular, the simultaneous action of stress and Attention Deficit Hyperactivity Disorder (ADHD) symptoms on the risk of smoking remains poorly understood. AIMS: To assess the effects of stress and ADHD symptoms on tobacco smoking. METHOD: Multivariate modeling was conducted on the French i-Share study (n=8110, median age 20.3 years, 74.8% females, 32.9% regular/occasional smokers) to evaluate the associations between stress, ADHD symptoms and tobacco smoking, adjusting for potential family/socio-demographic confounders. RESULTS: Students with high levels of stress were more likely to smoke>10 cigarettes/day (adjusted odds ratio (aOR): 1.48, 95% CI: 1.12-1.96) than those with low levels of stress. Students with high levels of ADHD symptoms were more likely to smoke>10 cigarettes/day (aOR: 2.08, 95% CI: 1.58-2.75) than those with low levels of ADHD symptoms. CONCLUSIONS: Stress and ADHD contribute independently to the risk of smoking. Interventions targeting each condition are likely to reduce the burden of tobacco use in students.

Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort.

In this population-based elderly cohort, participants using selective serotonin reuptake inhibitor (SSRI) antidepressants have an increased risk of falls and fractures notably when the treatment was continued over 4 years. Among the various SSRI types, citalopram only was at significant risk for falls and fluoxetine for fractures. INTRODUCTION: Increased risk of falls and fractures has been reported in elderly users of SSRIs. However, biases were insufficiently addressed notably temporality between exposure and outcome and confounding by residual depression. Our objective was to examine the associations between SSRIs and fall or fracture incidence focusing on their chronic use and different types of SSRIs. METHODS: The population-based cohort included participants aged 65 years and above, who had not fallen before inclusion (n = 6599) or were free of recent fracture (n = 6823) and were followed up twice over 4 years. New fall and fracture events were self-reported and defined as at least two falls and one fracture, respectively, during the previous 2 years. SSRI users were compared with those taking no antidepressants. Hazard ratios (HRs) were estimated using Cox models with delayed entry and adjusted for many confounders including residual depressive symptoms. RESULTS: Incidence of falls was 19.3 % over 4 years and that of fractures 9.5 %. After multi-adjustment, SSRI intake was significantly associated with a higher risk of falls (HR, 95 % CI = 1.58, 1.23-2.03) and fractures (HR, 95 % CI = 1.61, 1.16-2.24). The risks were significantly increased by 80 % in those continuing the treatment over 4 years. Citalopram intake only was at significant risk for falls and fluoxetine for fractures. CONCLUSIONS: In this large community-dwelling elderly sample, SSRI users were at higher risk of falls and fractures. This association was not due to reverse causality or residual depressive symptoms. Different SSRI drugs may have specific adverse effects on falls and fractures.

Association of Alzheimer's related genotypes with cognitive decline in multiple domains: results from the Three-City Dijon study.

Several genetic polymorphisms have been associated with Late Onset Alzheimer's Disease (LOAD), but there has been limited evidence on whether these polymorphisms predict intermediary stage outcomes such as cognitive changes in prospective community-based studies. Our aim was to evaluate whether polymorphisms previously established as predictors of LOAD also predict worse cognitive function and accelerated decline across multiple cognitive domains. We analyzed data from the 3C-Dijon study, in which 4931 respondents aged 65+ were examined up to 5 times over 10 years with a neuropsychological assessment. We evaluated the associations of polymorphisms in APOE, CR1, BIN1, CLU, PICALM, ABCA7, MS4A6A, CD33, MS4A4E and CD2AP with level and change in 5 neuropsychological tests, assuming a dominant effect model. To optimize measurement, we used a mixed regression model with a latent process for each cognitive domain: global cognition (Mini Mental State Examination); verbal fluency (Isaac's Set Test); visual memory (Benton Visual Retention Test); information processing (Trail Making Test B) and literacy (National Adult Reading Test). APOE was associated with accelerated decline in global cognition and verbal fluency. Only two non-APOE genetic polymorphisms were associated with cognitive decline: CR1 was associated with rate of change in verbal fluency and BIN1 was associated with rate of change in global cognition. In a large prospective population-based study of dementia-free individuals, only a few cognitive domains were associated with established LOAD risk alleles. The most consistent associations were for global cognition and verbal fluency.

Depression, depressive symptoms, and rate of hippocampal atrophy in a longitudinal cohort of older men and women.

BACKGROUND: Several studies have reported smaller hippocampal volume (HcV) in depression patients; however, the temporality of the association remains unknown. One proposed hypothesis is that depression may cause HcV loss. This study evaluates whether previous depression and recent depressive symptoms are associated with HcV and HcV loss. METHOD: We used a prospective cohort of older adults (n = 1328; age = 65-80 years) with two cerebral magnetic resonance imaging examinations at baseline and 4-year follow-up. Using multivariable linear regression models, we estimated, in stratified analyses by gender, the association between indicators of history of depression and its severity (age at onset, recurrence, hospitalization for depression), proximal depressive symptoms [Center for Epidemiologic Studies-Depression (CES-D) scale], baseline antidepressant use, and the outcomes: baseline HcV and annual percentage change in HcV. RESULTS: At baseline, women with more depressive symptoms had smaller HcV [-0.05 cm3, 95% confidence interval (CI) -0.1 to -0.01 cm3 per 10-unit increase in CES-D scores]. History of depression was associated with a 0.2% faster annual HcV loss in women (95% CI 0.01-0.36%). More baseline depressive symptoms and worsening of these symptoms were also associated with accelerated HcV loss in women. No associations were observed in men. Treatment for depression was associated with slower HcV loss in women and men. CONCLUSIONS: While only concomitant depressive symptoms were associated with HcV, both previous depression and more proximal depressive symptoms were associated with faster HcV loss in women.

A genome-wide association meta-analysis of plasma Aß peptides concentrations in the elderly.

Amyloid beta (Aß) peptides are the major components of senile plaques, one of the main pathological hallmarks of Alzheimer disease (AD). However, Aß peptides' functions are not fully understood and seem to be highly pleiotropic. We hypothesized that plasma Aß peptides concentrations could be a suitable endophenotype for a genome-wide association study (GWAS) designed to (i) identify novel genetic factors involved in amyloid precursor protein metabolism and (ii) highlight relevant Aß-related physiological and pathophysiological processes. Hence, we performed a genome-wide association meta-analysis of four studies totaling 3 528 healthy individuals of European descent and for whom plasma Aß1-40 and Aß1-42 peptides levels had been quantified. Although we did not observe any genome-wide significant locus, we identified 18 suggestive loci (P<1 × 10(-)(5)). Enrichment-pathway analyses revealed canonical pathways mainly involved in neuronal functions, for example, axonal guidance signaling. We also assessed the biological impact of the gene most strongly associated with plasma Aß1-42 levels (cortexin 3, CTXN3) on APP metabolism in vitro and found that the gene protein was able to modulate Aß1-42 secretion. In conclusion, our study results suggest that plasma Aß peptides levels are valid endophenotypes in GWASs and can be used to characterize the metabolism and functions of APP and its metabolites.

A simple score to predict survival with dementia in the general population.

BACKGROUND/AIMS: This study was designed to develop a practical risk score for predicting 5-year survival after the diagnosis of dementia. METHODS: Using the Paquid Study (prospective, population-based, long-term cohort study), we created a prognosis score with incident cases of dementia and validated it in another prospective, population-based, long-term cohort study, the Three City Study. - RESULTS: Among the 3,777 subjects enrolled in the Paquid Study, 454 incident cases of dementia were included in this study. After a 5-year follow-up period, 319 (70.3%) were deceased. The score was constructed from three independent prognostic variables (gender, age at diagnosis and number of ADL restricted). The discriminant ability of the score was good with a c index of 0.754. Sensitivity was 64.7% and specificity 76.3%. In the validation cohort, the discriminant ability of the prognostic score with c statistics was 0.700. Sensitivity was 26.3% and specificity 95.4%. CONCLUSIONS: The prognostic factors selected in the predictive model are easily assessable, so this simple score could provide helpful information for the management of dementia, particularly to identify patients with duration of the disease greater than 5 years.

Genome-wide haplotype association study identifies the FRMD4A gene as a risk locus for Alzheimer's disease.

Recently, several genome-wide association studies (GWASs) have led to the discovery of nine new loci of genetic susceptibility in Alzheimer's disease (AD). However, the landscape of the AD genetic susceptibility is far away to be complete and in addition to single-SNP (single-nucleotide polymorphism) analyses as performed in conventional GWAS, complementary strategies need to be applied to overcome limitations inherent to this type of approaches. We performed a genome-wide haplotype association (GWHA) study in the EADI1 study (n=2025 AD cases and 5328 controls) by applying a sliding-windows approach. After exclusion of loci already known to be involved in AD (APOE, BIN1 and CR1), 91 regions with suggestive haplotype effects were identified. In a second step, we attempted to replicate the best suggestive haplotype associations in the GERAD1 consortium (2820 AD cases and 6356 controls) and observed that 9 of them showed nominal association. In a third step, we tested relevant haplotype associations in a combined analysis of five additional case-control studies (5093 AD cases and 4061 controls). We consistently replicated the association of a haplotype within FRMD4A on Chr.10p13 in all the data set analyzed (OR: 1.68; 95% CI: (1.43-1.96); P=1.1 × 10(-10)). We finally searched for association between SNPs within the FRMD4A locus and Aß plasma concentrations in three independent non-demented populations (n=2579). We reported that polymorphisms were associated with plasma Aß42/Aß40 ratio (best signal, P=5.4 × 10(-7)). In conclusion, combining both GWHA study and a conservative three-stage replication approach, we characterised FRMD4A as a new genetic risk factor of AD.

Circulating IL-6 and CRP are associated with MRI findings in the elderly: the 3C-Dijon Study.

OBJECTIVE: The relation between inflammation and brain MRI findings in the elderly remains poorly known. We investigated the association of circulating interleukin-6 (IL-6) and C-reactive protein (CRP) levels with baseline and longitudinal white matter hyperintensities (WMH), silent brain infarction, and brain volumes in community-dwelling elderly free of dementia. METHODS: We included 1,841 participants aged 65 to 80 years from the Three City-Dijon cohort. Participants followed an MRI examination at baseline and after a 4-year follow-up (n = 1,316). IL-6 and CRP concentrations were measured at baseline from fasting blood samples. WMH were detected with an automatic imaging processing method and gray matter, hippocampal, white matter, and CSF volumes were estimated with voxel-based morphometry. Silent brain infarctions were assessed visually and defined as focal lesions of ≥3 mm in the absence of stroke. We used analysis of covariance and logistic regression to model the associations between inflammatory biomarkers and brain MRI findings adjusting for potential confounders. RESULTS: In cross-sectional analyses, higher IL-6 levels were associated with higher WMH volumes (p < 0.01), lower gray matter (p = 0.001) and hippocampal (p = 0.01) volumes, and increasing CSF volumes (p = 0.002) in a dose-relationship pattern. Similar but weaker relations were observed for CRP. We observed no associations between baseline inflammatory biomarker levels and the evolution of MRI findings over 4 years. CONCLUSIONS: IL-6, and, to a lesser degree, CRP levels were associated with WMH severity as well as global markers of brain atrophy. These results suggest that an inflammatory process may be involved in both age-associated brain alterations.

[The second (main) phase of an open, randomised, multicentre study to investigate the effectiveness of an INTEnsive blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT2): protocol and baseline characteristics of patients included in France]. / La seconde phase d'une étude randomisée, multicentrique évaluant en ouvert l'effet de la réduction intensive de la pression artérielle dans l'hémorragie cérébrale (INTERACT2) : protocole et caractéristiques des patients inclus en France.

RATIONALE AND AIM: The INTERACT pilot study demonstrated the feasibility of the protocol, safety of early intensive blood pressure (BP) lowering, and effects on hematoma expansion within 6hours of onset of intracerebral hemorrhage (ICH). This article describes the design of the second, main phase, INTERACT2. INTERACT2 aims to compare the effects of a management strategy of early intensive BP lowering with a more conservative guideline-based BP management policy in patients with acute ICH. This article also compares the baseline characteristics of the patients included in France with the baseline characteristics of the patients included in the pilot study INTERACT1. DESIGN OF THE STUDY: INTERACT2 is an international, prospective, multicentre, open, assessor-blinded outcome (PROBE), randomised, controlled trial. Patients with a systolic BP greater than 150mmHg are centrally randomised to either to an intensive BP lowering treatment (Systolic BP≤140mmHg within 1hour) or to a conservative treatment strategy (target systolic BP of 180mmHg). A projected 2800 subjects are to be enrolled from approximately 140 centres worldwide to provide 90% power (α 0.05) to detect a beneficial effect of early treatment on the primary outcome. STUDY OUTCOMES: The primary outcome is the combined endpoint of death and dependency according to the modified Rankin Scale (mRS) at 90 days. The key secondary outcome is the primary endpoint in those patients treated within 4hours of ICH. Other predefined secondary outcomes are the separate components of the primary endpoint, grades of physical function on the mRS, health-related quality of life on the EuroQoL, recurrent stroke and other vascular events, days of hospitalisation, requirement for permanent residential care, and unexpected serious adverse events. The study is registered under NCT00716079, ISRCTN73916115, and ACTRN12608000362392. POPULATION: As of early July, 152 patients have been included in France. When compared with the patients randomised in the INTERACT1 pilot study, these patients are older, less likely to have had a previous ICH, more often on antiplatelet or warfarin therapy, have a lower diastolic BP, arere more severe clinically (higher NIHSS) and experience their first ICH.

Chronic kidney disease, cognitive decline, and incident dementia: the 3C Study.

OBJECTIVE: To evaluate the longitudinal relationship between moderate chronic kidney disease (CKD), decline in kidney function, and microalbuminuria with subsequent cognitive decline and incident dementia. METHODS: This study is based on a population-based cohort of 7,839 subjects over 65 years with 7 years of follow-up. Glomerular filtration rate was estimated (eGFR) using the CKD-EPI equation. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE) and dementia was actively screened and diagnosed. RESULTS: At baseline, 12% of the participants had an eGFR <60 mL/min/1.73 m(2). A total of 564 incident dementia cases were diagnosed during the follow-up. Low baseline eGFR values were not associated with an increased risk of incident dementia or cognitive decline over the 7-year follow-up, except a borderline significant association with dementia with vascular component. However, eGFR decline over the first 4-year period was associated with higher risk of dementia with vascular component (relative risk = 5.35 [1.76-16.3] in those with eGFR decline >4 mL/min/1.73 m(2)/y compared with those <4) and with higher cognitive decline on the MMSE (-0.12 points, p < 0.01 in those with eGFR >4 mL/min/1.73 m(2)/y compared with those <4) in the 3 subsequent years. Proteinuria tended to be associated with an increased risk of subsequent dementia with vascular component. CONCLUSIONS: Despite a large sample and a long follow-up, we found no increased risk of cognitive decline or dementia associated with low eGFR level. However, faster eGFR decline was associated with global cognitive decline and incident dementia with vascular component, suggesting that this association may be mediated by vascular mechanisms.

Self-rated health and risk of incident dementia: a community-based elderly cohort, the 3C study.

OBJECTIVES: We examined the relationship between self-rated health and incident dementia, and investigated the impact of cognitive complaints, depressive symptoms, and functional status on this relationship. METHODS: Participants of the 3C Study, a prospective cohort study composed of 8,169 community-dwelling persons aged ≥65 years, were asked to rate their health at the baseline examination in 1999-2001. They were followed for a median of 6.7 years during which dementia was screened and diagnosed. Hazard ratios (HR) of dementia according to baseline self-rated health (good, fair, or poor) were estimated with a Cox model adjusted for potential confounders. RESULTS: During the 46,990 person-years of follow-up, 618 participants developed dementia. Risk of dementia was increased in participants with poor (adjusted HR 1.70, 95% confidence interval [CI] 1.22-2.37) or fair (adjusted HR 1.34, 95% CI 1.13-1.59) self-rated health compared to those with good self-rated health. Poor self-rated health was associated with both AD (1.48, 1.00-2.24) and vascular dementia (3.38, 1.25-9.17). Self-rated health was a stronger predictor of dementia in participants without cognitive complaints (risk of dementia in subjects without cognitive complaints rating their health as poor: 1.96 [1.24-3.09], p = 0.004) and in those without functional disability. CONCLUSIONS: Participants rating their health as poor or fair at baseline were at increased risk of incident dementia during follow-up. Self-rated health could help raise awareness of medical doctors about a patient's risk of dementia, especially in those without conditions indicative of potential cognitive impairment.

Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study.

OBJECTIVE: To determine whether high olive oil consumption, and high plasma oleic acid as an indirect biological marker of olive oil intake, are associated with lower incidence of stroke in older subjects. METHODS: Among participants from the Three-City Study with no history of stroke at baseline, we examined the association between olive oil consumption (main sample, n = 7,625) or plasma oleic acid (secondary sample, n = 1,245) and incidence of stroke (median follow-up 5.25 years), ascertained according to a diagnosis validated by an expert committee. RESULTS: In the main sample, 148 incident strokes occurred. After adjustment for sociodemographic and dietary variables, physical activity, body mass index, and risk factors for stroke, a lower incidence for stroke with higher olive oil use was observed (p for trend = 0.02). Compared to those who never used olive oil, those with intensive use had a 41%(95% confidence interval 6%-63%, p = 0.03) lower risk of stroke. In the secondary sample, 27 incident strokes occurred. After full adjustment, higher plasma oleic acid was associated with lower stroke incidence (p for trend = 0.03). Compared to those in the first tertile, participants in the third tertile of plasma oleic acid had a 73% (95% confidence interval 10%-92%, p = 0.03) reduction of stroke risk. CONCLUSIONS: These results suggest a protective role for high olive oil consumption on the risk of stroke in older subjects.

Resting heart rate, mortality and future coronary heart disease in the elderly: the 3C Study.

OBJECTIVES: To investigate the association between resting heart rate (RHR) and mortality and incident coronary heart disease (CHD) in the elderly. METHODS: Data derived from the Three-City Study, a French multicentre prospective study including 9294 community-dwelling elderly subjects aged ≥65 years at baseline examination between 1999 and 2001. The study population comprised 7147 participants (61% women) who were free of a pacemaker or any cardiac arrhythmias at baseline. RHR was measured twice at baseline in a seated position using an electronic tensiometer. Participants were then followed up bi-annually for vascular morbidity and mortality over 6 years. CHD events and cardiovascular death were adjudicated by an independent expert committee. RESULTS: After 6 years of follow-up, 615 subjects died including 17.9% from cardiovascular causes. Subjects from the top quintile of RHR (>79 bpm) had respectively a 74% (95% CI, 1.3-2.3), a 87% (95% CI: 0.98-3.6, p = 0.06) and a 72% (95% CI, 1.3-2.3) increased risk of total, cardiovascular and non-cardiovascular mortality compared to those from the lowest quintile (<62 bpm), after adjustment for cardiovascular risk factors and beta-blocker (BB) use in a Cox regression analysis. Associations with total mortality were consistent according to age, gender, BB use, diabetes and hypertension status (all p values for interaction >0.10). Conversely, RHR was not predictive of incident CHD (n = 228 events; top vs lowest quintile: HR: 1.0; 95% CI: 0.6-1.5). CONCLUSIONS: RHR is an independent risk marker of mortality but not of incident CHD events in community-dwelling elderly. Its routine measurement may help identify those who are at increased risk of mortality in the short term.

Metabolic syndrome and cognitive decline in French elders: the Three-City Study.

OBJECTIVE: To examine associations between metabolic syndrome (MetS) and its individual components with risk of cognitive decline on specific cognitive functions. METHODS: Participants were 4,323 women and 2,764 men aged 65 and over enrolled in the longitudinal Three-City Study. Cognitive decline, defined as being in the worst quintile of the distribution of the difference between baseline score and either 2- or 4-year follow-up, was assessed by the Mini-Mental State Examination (MMSE, global cognitive function), the Isaacs Set Test (IST, verbal fluency), and the Benton Visual Retention Test (BVRT, visual working memory). MetS was defined by National Cholesterol Education Program-Adult Treatment Panel III criteria (at least 3 of 5 cardio-metabolic abnormalities: hypertension, high waist circumference, hypertriglyceridemia, low high-density lipoprotein [HDL] cholesterol, hyperglycemia). Proportional hazards models were adjusted for age, gender, educational level, center, baseline cognitive score, APOE4 genotype, and other potential confounders. RESULTS: MetS at baseline was associated with an increased risk of cognitive decline on MMSE (hazard ratio [HR] = 1.22 [1.08-1.37]; p = 0.001) and BVRT (HR = 1.13 [1.01-1.26]; p = 0.03) but not on IST (HR = 1.11 [0.95-1.29]; p = 0.18). Among MetS components, hypertriglyceridemia and low HDL cholesterol were significantly associated with higher decline on MMSE; diabetes, but not elevated fasting glycemia, was significantly associated with higher decline on BVRT and IST. CONCLUSIONS: MetS as a whole and several of its components had a negative impact on global cognitive decline and specific cognitive functions in older persons.

Frequency and location of dilated Virchow-Robin spaces in elderly people: a population-based 3D MR imaging study.

BACKGROUND AND PURPOSE: dVRS have been previously associated with aging and cerebrovascular diseases. However, little is known about their prevalence and topographic distribution in the general elderly population. MATERIALS AND METHODS: dVRS were evaluated by using high-resolution 3D MR imaging in 1826 subjects enrolled in the 3C-Dijon MR imaging study. On T1-weighted MR imaging, dVRS were detected according to 3D imaging criteria and rated by using 4-level severity scores based in the BG or in the WM. The number and anatomic location of large dVRS (≥3 mm) were recorded. RESULTS: dVRS were observed in the BG or WM in every subject. The severity of dVRS was significantly associated with higher age in both the BG and WM, whereas sex was related to the severity of dVRS only in the BG. Large dVRS were detected in 33.2% of participants. Status cribrosum was found in 1.3% of participants. dVRS were also highly prevalent within the hippocampus (44.5%) and hypothalamus (11.6%). CONCLUSIONS: dVRS are always detected in the BG or WM in elderly people, and large dVRS are also prevalent. The topographic distribution of dVRS is not uniform within the brain and may depend on anatomic or pathologic characteristics interacting with aging and sex.