Journal of American Geriatrics Society

doi: 10.1111/j.1532-5415.1996.tb02965.xpmid: N/A

doi: 10.1111/j.1532-5415.1996.tb02966.xpmid: N/A

Rozzini, Renzo; Ferrucci, Luigi; Losonczy, Kathy; Havlik, Richard J.; Guralnik, Jack M.

doi: 10.1111/j.1532-5415.1996.tb02932.xpmid: 8790225

OBJECTIVE To verify whether chronic use of nonsteroidal anti‐inflammatory drugs (NSAIDs) has a protective effect against cognitive decline in older persons. DESIGN Prospective study with a 3‐year observation period. SETTING Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). SUBJECTS A population‐based sample of 7671 subjects who received an in‐person interview at the sixth annual follow‐up. Persons with documented NSAID use at the time of the interview and 3 years before were considered chronic users (21%), while all other persons were considered as nonusers. MAIN OUTCOME MEASURE Change over time in cognitive function assessed as the number of correct answers to a 9‐item version of the Short Portable Mental Status Questionnaire (SPMSQ). RESULTS For every level of SPMSQ score measured at the beginning of the observation period, the mean SPMSQ score after 3 years was higher in chronic NSAID users than in nonusers. Cognitive function at the end of the observation period was significantly higher in chronic NSAID users than in controls, adjusting for initial SPMSQ score and potential confounders. Older age, female gender, education, and history of cerebrovascular disease were also independent predictors of lower SPMSQ score. In the multivariate analysis, the magnitude of the protective effect estimated for NSAID use was comparable to a difference in age of 3.5 years. The percentage of persons who started above a specific SPMSQ score cut‐point and deteriorated below that cut‐point over a 3‐year period was significantly lower in chronic NSAID users than in nonusers (30.2% vs 34.3%, P = .03, for decline below SPMSQ score of 8 and 12.3% vs 14.4% for decline below SPMSQ score of 6, P = .04). After controlling for potential confounders, the relative risk of cognitive declining in chronic NSAID users compared with nonusers was 0.82 (95% Confidence Interval: 0.69–0.98) for a decline below a score of 8, and 0.80 (95% CI: 0.66–0.98) for a decline below a score of 6. CONCLUSIONS These results support the association between NSAID use and reduction in cognitive decline in older persons. Ultimately, randomized controlled trials must be done to prove a beneficial effect definitively.

Pahor, Marco; Guralnik, Jack M.; Havlik, Richard J.; Carbonin, Pierugo; Salive, Marcel E.; Ferrucci, Luigi; Corti, Maria‐Chiara; Hennekens, Charles H.

doi: 10.1111/j.1532-5415.1996.tb02933.xpmid: 8790226

OBJECTIVES To assess whether low to moderate alcohol consumption decreases the risk of deep venous thrombosis and pulmonary embolism. DESIGN Prospective cohort study. SETTING Three communities of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS A total of 7959 persons aged 68 years or older. MEASUREMENTS The incidence of deep venous thrombosis and pulmonary embolism was assessed by surveying hospital discharge diagnoses and deaths from 1985 through 1992. Those participants who estimated they used alcohol less than 1 time, on average, in the past month, less than 1 ounce per day, and 1 ounce or more per day were compared with those who reported no alcohol intake in the past year. Age, gender, race, body mass index, smoking, education, income, disability, cognitive function, arterial pressure, medication use, baseline chronic conditions, number of hospital admissions in past year, and occurrence of disease during follow‐up were examined as possible confounders. RESULTS During 48,038 person‐years of follow‐up, 155 events were observed (35 deep venous thromboses and 123 pulmonary emboli). Compared with non‐drinkers, after adjusting for potential confounding variables, the relative risks (95% confidence interval) for deep venous thrombosis and pulmonary embolism associated with increasing alcohol consumption levels were 0.7 (0.4–1.1), 0.6 (0.4–0.9), and 0.5 (0.2–1.1), respectively (P for trend = .004). The results were unchanged after stratifying on health status and disability. CONCLUSIONS Low to moderate alcohol consumption is associated with a decreased risk of deep venous thrombosis and pulmonary embolism in older persons.

Bonello, Robert S.; Marcus, Robert; Bloch, Daniel; Strober, Samuel

doi: 10.1111/j.1532-5415.1996.tb02934.xpmid: 8790227

OBJECTIVE To assess the effect on peripheral blood T lymphocytes of recombinant human growth hormone administered to healthy older women. DESIGN Prospective, open study. SETTING Veterans Administration clinical research unit and community surrounding Palo Alto, California. PARTICIPANTS Thirty‐three women were recruited in two age groups: 20 to 40 years (n = 13) and 70 years or older (n = 24). Subjects were healthy, community‐dwelling volunteers. INTERVENTIONS Recombinant human growth hormone at a dose of 0.025 mg/kg body weight/day was administered to the older subjects by daily subcutaneous injection over a 6‐month study period. MAIN OUTCOME MEASURES Mean percentage and number of peripheral blood CD45RA+ (“naive”) T cells, mean counts per minute (CPM) of (3H)‐thymidine incorporation following stimulation of peripheral blood mononuclear cells with phytohemaglutinin (T cell proliferation). RESULTS Before therapy, mean percentage and number of peripheral blood CD45RA+ T cells and T cell proliferative responses were significantly reduced in older compared with younger women. The fraction of older women with CD45RA+ T cell levels or T cell proliferative responses in the young range was significantly decreased in those who were receiving estrogen (1/10) compared with those who were not (9/14). After treatment with growth hormone, there were no significant changes in the mean CD45RA+ T cell levels or proliferative responses of the older women. CONCLUSIONS The results suggest that T cell changes associated with the age‐related decline in secretion of growth hormone cannot be reversed by growth hormone therapy during the eighth decade.

Hamel, Mary Beth; Phillips, Russell S.; Teno, Joan M.; Lynn, Joanne; Galanos, Anthony N.; Davis, Roger B.; Connors, Alfred F.; Oye, Robert K.; Desbiens, Norman; Reding, Douglas J.; Goldman, Lee; Goldman, Lee

doi:

Nygaard, Ingrid E.; Lemke, Jon H.

doi: 10.1111/j.1532-5415.1996.tb02936.xpmid: 8790229

OBJECTIVES To determine the prevalence, incidence, and remission rates of urinary incontinence in a large group of older women over a 6‐year time span and to assess factors associated with incontinence incidence and remission. DESIGN Longitudinal cohort study SETTING Two rural counties in Iowa PARTICIPANTS 2025 women aged 65 years or older residing in rural Iowa, enrolled in the Iowa 65+ Rural Health Study of EPESE (Establishment of Populations for Epidemiologic Studies of the Elderly) were interviewed in person annually for 6 years; specific responses to queries about urinary incontinence were given at baseline, 3‐, and 6‐year intervals. MEASUREMENTS Conditional multivariate logistic regression analysis was done to assess the relationship between incontinence symptoms and various factors previously found to be related to incontinence. RESULTS The baseline prevalence of urge incontinence was 36.3%, and of stress incontinence it was 40.3%. For urge incontinence, the 3‐year incidence and remission rates between the third and sixth years were 28.5% and 22.1%, respectively. For stress incontinence, the 3‐year incidence and remission rates between years 3 and 6 were 28.6% and 25.1%, respectively. Seventy‐six percent and 84% of women who reported no urge or stress incontinence, respectively, at the baseline interview were continent at both follow‐up interviews. The only significant factors related to changes in incontinence status were age, which was associated with an increased incidence of urge incontinence (OR 1.11, P = .017, 95% CI 1.019–1.203), and improvement in activities of daily living, which was associated with a increased remission of urge incontinence (OR 0.50, P = .015, 95% CI 0.28–0.9) CONCLUSION In some older women, urinary incontinence is a dynamic state, with women moving back and forth along a continuum between continence and incontinence. These results are tempered by limitations of the study, which include its questionnaire design and lack of ability to detect potential treatment effect.

Pliskin, Neil H.; Kiolbasa, Theresa A.; Towle, Vernon L.; Pankow, Laura; Ernest, J. Terry; Noronha, Avertano; Luchins, Daniel J.

doi: 10.1111/j.1532-5415.1996.tb02937.xpmid: 8790230

OBJECTIVE To clarify the neuropsychological function in patients with Charles Bonnet Syndrome. DESIGN Control group comparison study. SETTING University of Chicago Hospitals. PARTICIPANTS The neuropsychological function of 15 older adults with presenting complaints of visual hallucinations who met criteria for Charles Bonnet Syndrome (CBS) were compared with 11 demographically matched controls to determine if there was any evidence of functional brain impairment. CBS patients were screened for focal brain lesions and epileptic disturbance via MRI and EEG and also received pattern visual evoked potentials and ophthalmological examinations. MEASUREMENTS Scores from the Wechsler Adult Intelligence Scale‐Revised, Mattis Dementia Rating Scale, Wechsler Memory Scale, and the Auditory Verbal Learning Test were compared. RESULTS Significant differences were found between the two groups on the neuropsychological measures. Moreover, 14 of 14 subjects had ocular abnormalities and six of eight had abnormal age‐corrected pattern visual evoked potentials indicative of dysfunction in the visual system. CONCLUSIONS The results of the study indicate that patients diagnosed with Charles Bonnet Syndrome evidence neuropsychological changes commonly associated with the early stages of dementia. Therefore, in patients with impaired vision, the appearance of cognitive deficits, albeit subtle, occur with the onset of visual hallucinations. We propose that isolated visual hallucinations in the older adult may be an indication of the early stages of dementia.

Kunik, Mark E.; Ponce, Hernando; Molinari, Victor; Orengo, Claudia; Emenaha, Ify; Workman, Richard

doi: 10.1111/j.1532-5415.1996.tb02938.xpmid: 8790231

OBJECTIVE To examine the demographic characteristics and treatment outcomes of nursing home residents admitted to a geropsychiatric inpatient unit. DESIGN A retrospective cohort design based on an ongoing data base effort. SETTING The geropsychiatric inpatient unit of the Houston Veterans Affairs Medical Center Hospital. PARTICIPANTS All admissions to the unit from nursing homes during an 18‐month period. MEASUREMENTS Mini‐Mental State Examination, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Cohen‐Mansfield Agitation Inventory, Rating Scale for Side Effects, and Global Assessment of Functioning were administered on admission and discharge. RESULTS Paired t tests comparing change scores revealed significant decreases in general psychiatric symptoms (P < .001), depression (P < .001), and agitation (P < .001); significant improvement in global functioning (P < .001); with no significant changes in cognitive status (P = .485) or side effects (P = .120). When the patients were subgrouped according to reasons for admission, paired t tests revealed decreases in violence (CMAI Factor 1; P = .000), psychosis (BPRS thought disorder scale; P = .000 and hostility subscale; P < .008), and depression (HAM‐D; P = .002). Four patients were discharged to less restrictive environments, all with chronic mental illnesses. CONCLUSION Inpatient psychiatric hospitalization significantly benefits nursing home residents with and without dementia who are admitted for severe behavior problems.

Bungener, Catherine; Jouvent, Roland; Derouesné, Christian

doi: 10.1111/j.1532-5415.1996.tb02939.xpmid: 8790232

OBJECTIVE To evaluate the emotional disturbances in patients with Alzheimer's disease (AD) using both a categorical and a dimensional approach. DESIGN Prospective study. SETTING Outpatient clinic in a neurological department from a general University Teaching Hospital. MEASURES A semi‐structured interview was used to fill in the Hamilton Depression Rating Scale, the Retardation Rating Scale for depression, the Tyrer and Covi scales for anxiety, and the Depressive Mood Scale for emotional disturbances. The cognitive status was assessed by the Mini‐Mental State Examination and the Mattis Dementia Rating Scale. PATIENTS One hundred eighteen consecutive AD outpatients fitting the criteria for probable or possible AD, according to the National Institute of Neurological and Communication Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, were compared with 34 community‐dwelling healthy older controls and with 20 inpatients meeting the diagnostic criteria for depression according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition‐Revised. RESULTS No AD patient met the criteria for Major Depressive Episode or Generalized Anxiety Disorder, but 10 (8%) met the criteria for Dysthymic Disorder. AD patients scored significantly higher than the control group but lower than the depressed group for depressive and anxious symptomatology. Depressive symptomatology was correlated negatively to the cognitive status and positively to anxious symptomatology. Two main dimensions in emotional disturbances were described using the Depressive Mood Scale: Emotional Deficit (anhedonia, hypoexpressiveness) and Loss of Control (felt irritability, hyperexpressiveness). Emotional Deficit was correlated positively to the depressive symptomatology and correlated negatively to the cognitive status and the Loss of Control dimension. Loss of Control was correlated positively to the severity of the depressive and anxious symptomatology and weakly to cognitive performance. CONCLUSION Affective changes were found frequently in AD patients, but no major affective disorder was found. The dimensional approach seems to be more appropriate than the categorical approach to describe the emotional disturbances in these patients.