Showing papers by "José A. Luchsinger published in 2005"

Aggregation of vascular risk factors and risk of incident Alzheimer disease.

Abstract: Background: The prevalence of Alzheimer disease (AD) is increasing in the elderly, and vascular risk factors may increase its risk. Objective: To explore the association of the aggregation of vascular risk factors with AD. Methods: The authors followed 1,138 individuals without dementia at baseline (mean age 76.2) for a mean of 5.5 years. The presence of vascular risk factors was related to incident possible and probable AD. Results: Four risk factors (diabetes, hypertension, heart disease, and current smoking) were associated with a higher risk of AD ( p p for trend Conclusions: The risk of Alzheimer disease (AD) increased with the number of vascular risk factors. Diabetes and current smoking were the strongest risk factors, but clusters including hypertension and heart disease also increased the risk of AD. These associations are unlikely to be explained by misclassification of the outcome, given strong associations when only probable AD is considered.

Relationship Between Plasma Lipids and All‐Cause Mortality in Nondemented Elderly

Abstract: Objectives: To investigate the relationship between plasma lipids and risk of death from all causes in nondemented elderly Design: Prospective cohort study Settin: Community-based sample of Medicare recipients, aged 65 years and older, residing in northern Manhattan Participants: Two thousand two hundred seventy-seven nondemented elderly, aged 65 to 98; 672 (295%) white/non-Hispanic, 699 (307%) black/non-Hispanic, 876 (385%) Hispanic, and 30 (13%) other Measurements: Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-HDL-C, body mass index, and apolipoprotein E (APOE) genotype Clinical measures: neuropsychological, neurological, medical, and functional assessments; medical history of diabetes mellitus, heart disease, hypertension, stroke, and treatment with lipid-lowering drugs Vital status measure: National Death Index date of death Survival methods were used to examine the relationship between plasma lipids and subsequent mortality in younger and older nondemented elderly, adjusting for potential confounders Results: Nondemented elderly with levels of total cholesterol, non-HDL-C, and LDL-C in the lowest quartile were approximately twice as likely to die as those in the highest quartile (rate ratio (RR)=18, 95% confidence interval (CI)=13–24) These results did not vary when analyses were adjusted for body mass index, APOE genotype, diabetes mellitus, heart disease, hypertension, stroke, diagnosis of cancer, current smoking status, or demographic variables The association between lipid levels and risk of death was attenuated when subjects with less than 1 year of follow-up were excluded (RR=14, 95% CI=10–21) The relationship between total cholesterol, non-HDL-C, HDL-C, and triglycerides and risk of death did not differ for older (≥75) and younger participants (>75), whereas the relationship between LDL-C and risk of death was stronger in younger than older participants (RR=24, 95% CI=12–49 vs RR=16, 95% CI=102–26, respectively) Overall, women had higher mean lipid levels than men and lower mortality risk, but the risk of death was comparable for men and women with comparable low lipid levels Conclusion: Low cholesterol level is a robust predictor of mortality in the nondemented elderly and may be a surrogate of frailty or subclinical disease More research is needed to understand these associations

Impact of plasma lipids and time on memory performance in healthy elderly without dementia.

Abstract: Objective: To examine the association of plasma lipid levels to changes in cognitive function in elderly subjects without dementia. Methods: The authors examined changes in performance in tests of memory, visuospatial/cognitive, and language abilities in 1,147 elderly individuals without dementia or cognitive impairment at baseline followed for 7 years using generalized estimating equations. Results: Performance in all cognitive domains declined significantly over time, while there was no association between levels of any plasma lipid or lipid lowering treatment and memory, cognitive/visuospatial, or language performance at any interval. Higher age at baseline was related to lower scores in all three domains at each interval, while higher education and white ethnicity were associated with higher scores in all domains. Analyses relating plasma lipids to performance in color trails tests using proportional hazards regression showed no association. In subsequent analyses excluding subjects with incident dementia, memory performance declined over time, while cognitive/visuospatial and language performance did not. Higher plasma high density lipoprotein and total cholesterol were associated with higher scores in language performance at baseline; this domain declined faster among individuals with higher total cholesterol, but this result was not significant after taking multiple comparisons into account. Plasma triglycerides, low density lipoprotein, or treatment with lipid lowering agents were not associated with changes in cognitive performance. Conclusions: Plasma lipid levels or treatment with lipid lowering agents in the elderly were not associated with changes in cognitive function.

Effect of smoking and time on cognitive function in the elderly without dementia.

Abstract: Objective: To examine the association between smoking and changes in cognitive function over time in elderly persons without dementia. Methods: The results of neuropsychological tests grouped into domains of memory, abstract-visuospatial, and language, from several intervals over a 5-year period in 791 elderly patients without dementia or cognitive impairment. Smoking history was categorized as never, current, or past smokers and related to the slope of performance in each cognitive domain using generalized estimating equations. Results: Performance in all cognitive domains declined over time. Memory performance declined more rapidly among current smokers aged >75 years than in nonsmokers similar in age, including those who never smoked or had quit smoking. The effect was stronger among those without an APOE -e4 allele. There was no association between smoking and performance in any cognitive domain in persons aged Conclusion: Current smokers aged >75 years perform more poorly on cognitive tests and appear to decline in memory more rapidly than their peers who do not smoke, especially if they lack the APOE -e4 allele. Smoking does not affect cognitive performance in those persons aged