by
Ioannis Karakis;
Matthew P. Pase;
Alexa Beiser;
Sarah L. Booth;
Paul F. Jacques;
Gail Rogers;
Charles DeCarli;
Ramachandran S. Vasan;
Thomas J. Wang;
Jayandra J. Himali;
Cedric Annweiler;
Sudha Seshadri
Background: Identifying nutrition- and lifestyle-based risk factors for cognitive impairment and dementia may aid future primary prevention efforts.
Objective: We aimed to examine the association of serum vitamin D levels with incident all-cause dementia, clinically characterized Alzheimer's disease (AD), MRI markers of brain aging, and neuropsychological function.
Methods: Framingham Heart Study participants had baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations measured between 1986 and 2001. Vitamin D status was considered both as a continuous variable and dichotomized as deficient (<10ng/mL), or at the cohort-specific 20th and 80th percentiles. Vitamin D was related to the 9-year risk of incident dementia (n=1663), multiple neuropsychological tests (n=1291) and MRI markers of brain volume, white matter hyperintensities and silent cerebral infarcts (n=1139).
Results: In adjusted models, participants with vitamin D deficiency (n=104, 8% of the cognitive sample) displayed poorer performance on Trail Making B-A (β=-0.03 to -0.05±0.02) and the Hooper Visual Organization Test (β=-0.09 to -0.12±0.05), indicating poorer executive function, processing speed, and visuo-perceptual skills. These associations remained when vitamin D was examined as a continuous variable or dichotomized at the cohort specific 20th percentile. Vitamin D deficiency was also associated with lower hippocampal volumes (β=-0.01±0.01) but not total brain volume, white matter hyperintensities, or silent brain infarcts. No association was found between vitamin D deficiency and incident all-cause dementia or clinically characterized AD.
Conclusions: In this large community-based sample, low 25(OH)D concentrations were associated with smaller hippocampal volume and poorer neuropsychological function.
Background: Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance.
Methods: We examined the prevalence of nocturia and examined its role in self-reported insomnia and poor sleep quality in a survey of 1,424 elderly individuals, ages 55–84. Data were derived from a 2003 National Sleep Foundation telephone poll conducted in a representative sample of the United States population who underwent a 20-minute structured telephone interview. Nocturia was not a focus of the survey, but data collected relevant to this topic allowed examination of relevant associations with sleep.
Results: When inquired about in a checklist format, nocturia was listed as a self-perceived cause of nocturnal sleep “every night or almost every night” by 53% of the sample, which was over four times as frequently as the next most often cited cause of poor sleep, pain (12%). In multivariate logistic models, nocturia was an independent predictor both of self-reported insomnia (75% increased risk) and reduced sleep quality (71% increased risk), along with female gender and other medical and psychiatric conditions.
Conclusions: Nocturia is a frequently overlooked cause of poor sleep in the elderly and may warrant targeted interventions.
African Americans are under-represented in Alzheimer's disease (AD)-related biomarker studies, and it has been speculated that mistrust plays a major factor in the recruitment of African Americans for studies involving invasive procedures such as the lumbar puncture (LP). We set out to determine factors associated with non-participation in a biomarker study aiming to explore cerebrospinal fluid (CSF) AD biomarker differences between older African Americans and Caucasians. We also surveyed participants' procedure-related perception (a standard medical procedure vs. a frightening invasive procedure) and reluctance, as well as the rate and type of post-procedure discomfort and complications. Among 288 subjects approached for study participation, 145 (50.3%) refused participation with concerns over LP being the most commonly reported reason. Relatively more African Americans than Caucasians reported concerns over LP as the main reason for non-participation (46% vs. 25%, p = 0.03), but more African Americans also did not provide a specific reason for non-participation. Among those who completed study participation (including the LP), African Americans and Caucasians were similar in pre-LP perceptions and reluctance, as well as post-LP rates of discomfort or complication. Perceiving LP as a frightening invasive procedure, not race, is associated with increased likelihood of post-LP discomfort or complication (RR 6.2, 95% confidence interval 1.1-37.0). Our results indicate that LP is a well perceived procedure in a cohort of African American and Caucasian research participants, and is associated with few serious complications. The pre-procedure perception that the LP is a frightening invasive procedure significantly increases the risk of self-reported discomfort of complications, and African Americans may be more likely to turn down study participation because of the LP. Future studies will need to address factors associated with negative LP perceptions to further assure participants and reduce complication rates.
Consistent with Western cultural values, the traditional liberal theory of autonomy, which places emphasis on self-determination, liberty of choice, and freedom from interference by others, has been a leading principle in health care discourse for several decades. In context to aging, chronic illness, disability, and long-term care, increasingly there has been a call for a relational conception of autonomy that acknowledges issues of dependency, interdependence, and care relationships. Although autonomy is a core philosophy of assisted living (AL) and a growing number of studies focus on this issue, theory development in this area is lagging and little research has considered race, class, or cultural differences, despite the growing diversity of AL. We present a conceptual model of autonomy in AL based on over a decade of research conducted in diverse facility settings. This relational model provides an important conceptual lens for understanding the dynamic linkages between varieties of factors at multiple levels of social structure that shape residents' ability to maintain a sense of autonomy in this often socially challenging care environment. Social and institutional change, which is ongoing, as well as the multiple and ever-changing cultural contexts within which residents are embedded, are important factors that shape residents' experiences over time and impact resident-facility fit and residents' ability to age in place.
Background: Little is known about progression of and risk factors for sleep disordered breathing (SDB) in old age. We prospectively examined elderly volunteers to understand how changes in body weight are related to SDB for a period of 20–30 years.
Methods: Participants were 30 surviving members of a community-based cohort (mean entry age = 57.8) studied over a median follow-up of 23.4 years. SDB was quantified as the apnea–hypopnea index (AHI) via in-lab polysomnography from 215 nights, representing 733.3 person-years of follow-up. Weights were recorded in kilograms. We used linear regression to derive individual trajectories of AHI and weight regressed on time.
Results: Individuals had relatively low AHI (X = 2.3 [SD = 3.5]) and body mass index (kg/m2; X = 24.6 [SD = 4.6]) at entry. Rates of change in AHI were characterized by positive slopes and linear increases by least squares regression. Mean rate of change was +0.43 events per hour per year, a 3.3% yearly increase relative to the maximum AHI observed for each case. Within individuals, curve fitting indicated statistically significant AHI increases associated not only with increases, but also decreases, in weight.
Conclusions: Rates of increase in AHI were larger than for aging reported for other organ systems (eg, autonomic, musculoskeletal, and respiratory), possibly reflecting complex mechanistic determination of SDB in old age. Association between decreased weight and increased SDB with advancing years represents an important “proof of concept,” perhaps compatible with failure to maintain airway patency during sleep as a component of generalized muscle weakness in old age.