Showing papers by "Linda Fried published in 2008"

Cystatin C as a marker of cognitive function in elders: findings from the health ABC study.

Abstract: We determined if serum cystatin-C, a novel measure of kidney function that also co-localizes with brain β-amyloid, is associated with cognitive function among 3030 Black and White elders (mean age, 74 years). Elders with high cystatin-C (N=445, 15%) had worse baseline cognitive scores on 3MS (p=0.01) or DSST (p=0.02) compared to those with intermediate (N=1008, 33%) or low level (N=1577, 52%) and more pronounced decline over 7 years (p=0.002 and p=0.04). Multivariate adjustment led to similar results. Incident cognitive impairment (decline of ≥1.0 SD) was greatest among those with high cystatin-C (3MS: 38% vs. 25%, adjusted OR=1.92; 95%CI 1.37-2.69; DSST: 38% vs 26%, OR= 1.54; 95% CI 1.10-2.15).

At the Tipping Point: Predicting Severe Mobility Difficulty in Vulnerable Older Women

Abstract: More than 46% of Medicare beneficiaries in 2004 reported difficulty walking one-quarter of a mile,1 placing them at risk of progression to mobility disability, dependency, and greater health services requirements.2 Several screening tests and prognostic indices have been constructed that predict incident mobility limitations or mild mobility disability in relatively high-functioning older persons. These tests and indices primarily use performance measures that reflect impairments and functional limitations3–5 or self-report indicators of preclinical disability.6 Much less is known about how to identify persons on the verge of developing severe mobility difficulty from among the many older adults with functional limitations or mild mobility difficulty. Severe mobility difficulty—great difficulty walking or inability to ambulate without assistance over a short distance, such as a small room—threatens the ability to live independently and negatively affects quality of life. In functionally limited older persons, an initially broad clinical assessment may be particularly appropriate in light of the diverse and complex health issues that may underlie their functional difficulties. Clinical practice and emerging evidence suggest that factors difficult to categorize as impairments or limitations, such as fatigue or pain, can have critical effects on the development of difficulty.7–10 Although severe mobility difficulty may be evident when a patient can no longer walk unaided from the waiting to the examination room, features that distinguish the state immediately preceding severe difficulty, or that predict its development, are less obvious. The objective of this study was to identify easily ascertainable clinical measures that distinguish persons at risk of developing severe mobility difficulty over the short term. To accomplish this, an observational cohort study with in-depth clinical information on factors hypothesized to influence mobility difficulty was utilized. As a first step, measures readily obtainable in a clinical setting and highly correlated with severe mobility difficulty were identified. Initial selection of measures was based on a conceptual model that delineates physiological domains necessary for walking.11 The degree to which measures identified in the first step predicted incident severe mobility difficulty within the next 12 months was then determined.