Predictors of cognitive decline and mortality of aged people over a 10-year period
Reijo S. Tilvis,Mervi H Kähönen-Väre,Juha Jolkkonen,Jaakko Valvanne,Kaisu H. Pitkälä,Timo E. Strandberg +5 more
TLDR
The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes, and the role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.Abstract:
Background. The search for preventable and remediable risk conditions of cognitive decline is ongoing, but results have thus far been inconsistent. According to the hypothesis of our 10-year prospective study, the predictive values of different risk indicators change over time in a general 75þ population. Methods. A population-based sample of 75-, 80-, and 85-year-old individuals (n ¼ 650) underwent comprehensive clinical examinations in 1990 in Helsinki, Finland. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and/or Clinical Dementia Rating (CDR) at baseline and after 1, 5, and 10 years. Results. At baseline, a low MMSE score was associated with age, history of stroke, apolipoprotein E allele e4 (APOE4), and intermittent claudication. After 1 year, cognitive decline was typical of participants suffering from vascular diseases, e.g., heart failure and intermittent claudication. Five-year decline was predicted by the presence of atrial fibrillation (RR [relative risk] 2.8), APOE4 (RR 2.4), elevated C-reactive protein (CRP) (RR 2.3), diabetes mellitus (RR 2.2), and heart failure (RR 1.8). They also tended to increase 5-year all-cause mortality. At 10 years, the decline associated with APOE4 (RR 3.3), slightly elevated serum ionized calcium (RR 3.3), and feelings of loneliness (RR 3.0). Conclusions. Long follow-up of a general aged population explains several inconsistencies of earlier reports. In 75þ individuals, general ill health is a strong associate of cognitive deficits. The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes. The role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.read more
Citations
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TL;DR: Loneliness is associated with an increased risk of late-life dementia but not with its leading causes, and was robustly associated with cognitive decline and development of AD.
References
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“Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician
Marshal F. Folstein,Marshal F. Folstein,Susan E B Folstein,Susan E B Folstein,Paul R. McHugh,Paul R. McHugh +5 more
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
A practical method for grading the cognitive state of patients for the clinician
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
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TL;DR: The Clinical Dementia Rating (CRD) was developed for a prospective study of mild senile dementia—Alzheimer type (SDAT), and was found to distinguish unambiguously among older subjects with a wide range of cognitive function.
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Diabetes mellitus and the risk of dementia The Rotterdam Study
Alewijn Ott,Ronald P. Stolk,F. van Harskamp,H. A. P. Pols,Albert Hofman,Monique M.B. Breteler +5 more
TL;DR: The diabetes attributable risk for dementia of 8.8% suggests that diabetes may have contributed to the clinical syndrome in a substantial proportion of all dementia patients.
Journal ArticleDOI
15-year longitudinal study of blood pressure and dementia
Ingmar Skoog,Lars Nilsson,G. Persson,Bodil Lernfelt,Sten Landahl,Bo Palmertz,L-A Andreasson,Anders Odén,Alvar Svanborg +8 more
TL;DR: Previously increased blood pressure may increase the risk for dementia by inducing small-vessel disease and white-matter lesions, but to what extent the decline in blood pressure before dementia onset is a consequence or a cause of the brain disease remains to be elucidated.