bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Plasma Insulin‐Like Growth Factor‐1 Concentrations Predict Worsening of Insulin‐Mediated Glucose Uptake in Older People
Authors: Paolisso Giuseppe , Tagliamonte Maria Rosaria , Rizzo Maria Rosaria , Carella Carlo , Gambardella Antonio , Barbieri Michelangela , Varricchio Michele 
Published: April 2015

OBJECTIVE: The relationship among insulin action, advancing age, and insulin like growth factor‐1 (IGF‐1) is poorly understood. To gain further insight, the predictive role that low plasma IGF‐1 concentration may have on insulin‐ mediated glucose uptake in older persons was investigated.DESIGN: The study was designed as a longitudinal, observational trial.PARTICIPANTS: Fifty‐eight healthy aged (73.1 ± 9.4 years) subjects (31 males/27 females) were followed up for 12 months.MEASUREMENTS: At baseline and at the end of the follow‐up, insulin‐mediated glucose uptake was assessed by eugly‐cemic glucose clamp and plasma total IGF‐1 and IGF‐binding protein 3 (IGF‐BP‐3) in each subject, and concentrations were determined.RESULTS: At baseline, plasma IGF‐1 concentrations correlated with whole body glucose uptake (WBGD) (r = 0.39, P < .003), insulin‐stimulated glucose oxidation (GOX) (r = 0.35, P < .009), and non‐oxidative glucose metabolism (r = 0.37, P < .007). Such correlations were also independent of age, sex, body fat, and waist/hip ratio. Fasting plasma total IGF‐1 concentrations (84 ± 56 vs 63 ±44 fig/L, P < .040), plasma IGF‐1/IGF‐BP3 molar ratio (0.13 ±0.05 vs 0.10 ±0.03 P < .050), and WBGD (34.8 ±5.0 vs 23.1 ±4.6 /umol/kg × min, P < .010) were more elevated at baseline than at the end of the follow‐up. Low baseline fasting plasma IGF‐1 concentration (RR = 1.5, 95%CI = 1.3‐1.7) and plasma IGF‐l/IGFBP‐3 molar ratio (RR = 1.4, 95% CI = 1.3‐1.8) predicted a decline in WBGD. The predictive role of plasma IGF‐1 on age‐related decline in WBGD was independent of age, sex, body fat, waist/hip ratio, and degree of physical activity (model 1), or of fasting plasma free fatty acid and triglyceride concentrations, LDL/HDL ratio, and basal adjusted respiratory quotient (model 2). Finally, low plasma IGF‐1 concentration predicts a decline in WBGD independent of body fat, free fatty acids, waist/hip ratio, and basal adjusted respiratory quotient (model 3).CONCLUSION: Our study demonstrates that fasting plasma IGF‐1 concentration may have a modulatory role on insulin action in older people. This finding might prompt an evaluation of the direct effect of IGF‐1 administration on insulin sensitivity in older adults. J Am Geriatr Soc 47:1312–1318, 1999.
The Power of Ageism on Physical Function of Older Persons: Reversibility of Age‐Related Gait Changes
Authors: Hausdorff Jeffrey M. , Levy Becca R. , Wei Jeanne Y. 
Published: April 2015

OBJECTIVE: To test the hypothesis that age‐associated changes in physical function, particularly walking performance, are influenced by ageism and that the activation of positive stereotypes of aging can partially reverse these changes.DESIGN: Randomized intervention study.SETTING: General community.PARTICIPANTS: Forty‐seven community‐dwelling men and women (63–82 years old) who walked independently and described themselves as healthy.INTERVENTION: Thirty‐minute exposure to the subconscious reinforcement of either a positive or negative stereotype of aging while subjects played a computer game.MEASUREMENTS: Pre‐ and post intervention measures of gait speed and percent swing time (the time spent with one foot in the air during walking). Health and psychosocial status were also evaluated.RESULTS: Significant increases in walking speed (9% ± 2%; P < .001) and percent swing time (percent change: 1.1% ± 0.4%; P = .023) were observed in subjects who received reinforcement of positive stereotypes of aging. Gait speed and swing time did not change in those who received reinforcement of negative stereotypes of aging. The observed improvements in gait were related to the positive intervention, but were not related to age, gender, health status, or psychosocial status.CONCLUSIONS: Stereotypes of aging apparently have a powerful impact on the gait of older persons. Interventions designed to enhance perceptions of old age may prove beneficial in helping to improve gait and functional independence among older persons. In the future, positive changes in society's view of aging may also help to reduce and prevent age‐related declines in function and the associated deleterious consequences. J Am Geriatr Soc 47:1346–1349, 1999.
Temporal Arteritis: A Clinical Approach
Authors: Lee Andrew G. , Brazis Paul W. 
Published: April 2015

OBJECTIVE: To develop a clinical guide to the evaluation of temporal arteritis.DESIGN: A Medline English‐language search of the literature from 1966 to 1998, including more than 300 articles about temporal arteritis, was performed to develop a guide to the evaluation of temporal arteritis.RESULTS: A user‐friendly guide to the evaluation of temporal arteritis was developed based on the following criteria: (1) clinical suspicion, (2) laboratory testing, and (3) temporal artery biopsy.CONCLUSION: A clinical guide to the evaluation of temporal arteritis may assist clinicians in the care of patients with this condition. J Am Geriatr Soc 47:1364–1370,1999.
The Efficacy of Ginkgo for Elderly People with Dementia and Age‐Associated Memory Impairment: New Results of a Randomized Clinical Trial
Authors: van Dongen Martien C.J.M. , van Rossum Erik , Kessels Alphons G.H. , Sielhorst Hilde J.G. , Knipschild Paul G. 
Published: April 2015

OBJECTIVES: To evaluate the efficacy, the dose‐dependence, and the durability of the effect of the ginkgo biloba special extract EGb 761 (ginkgo) in older people with dementia or age‐associated memory impairment.DESIGN: A 24‐week, randomized, double‐blind, placebo‐controlled, parallel‐group, multicenter trial.SETTING: Homes for the elderly in the southern part of the Netherlands.PARTICIPANTS: Older persons with dementia (either Alzheimer's dementia or vascular dementia; mild to moderate degree) or age‐associated memory impairment (AAMI). 214 Participants were recruited from 39 homes for the elderly.INTERVENTION: The participants were allocated randomly to treatment with EGb 761 (2 tablets per day, total dosage either 240 (high dose) or 160 (usual dose) mg/day) or placebo (0 mg/d). The total intervention period was 24 weeks. After 12 weeks of treatment, the initial ginkgo users were randomized once again to either continued ginkgo treatment or placebo treatment. Initial placebo use was prolonged after 12 weeks.MEASUREMENTS: Outcomes were assessed after 12 and 24 weeks of intervention. Outcome measures included neuropsychological testing (trail‐making speed (NAI‐ZVT‐G), digit memory span (NAI‐ZN‐G), and verbal learning (NAI‐WL)), clinical assessment (presence and severity of geriatric symptoms (SCAG), depressive mood (GDS), self‐perceived health and memory status (report marks)), and behavioral assessment (self‐reported level of instrumental daily life activities).RESULTS: An intention‐to‐treat analysis showed no effect on each of the outcome measures for participants who were assigned to ginkgo (n = 79) compared with placebo (n = 44) for the entire 24‐week period. After 12 weeks of treatment, the combined high dose and usual dose ginkgo groups (n = 166) performed slightly better with regard to self‐reported activities of daily life but slightly worse with regard to self‐perceived health status compared with the placebo group (n = 48). No beneficial effects of a higher dose or a prolonged duration of ginkgo treatment were found. We could not detect any subgroup that benefited from ginkgo. Ginkgo use was also not associated with the occurrence of (serious) adverse events.CONCLUSIONS: The results of our trial suggest that ginkgo is not effective as a treatment for older people with mild to moderate dementia or age‐associated memory impairment. Our results contrast sharply with those of previous ginkgo trials.
Dementia Diagnostic Guidelines: Methodologies, Results, and Implementation Costs
Authors: Beck Cornelia , Cody Marisue , Souder Elaine , Zhang Mingliang , Small Gary W. 
Published: April 2015

OBJECTIVE: To facilitate the diagnostic process for dementia. Five guidelines and four consensus statements on specific diagnostic recommendations, specialist referral recommendations, and costs of recommended diagnostic procedures were compared and summarized.DATA SOURCES AND SELECTION: A MEDLINE search from 1984 to 1999 and queries to experts yielded 14 guidelines and consensus statements that addressed the diagnosis of dementia. Only nine documents which had national or international scopes were reviewed.METHODS: Comparisons were made on the specific diagnostic criteria for patient history, clinical examination, functional assessment, laboratory tests, neuroimaging, and other diagnostic tests, as well as specialist referral recommendations and costs for the recommended diagnostic procedures. The first three authors reviewed independently each document and completed a table on specific recommendations in each document. To settle disagreements about specific recommendations, they discussed them until they reached a consensus. To interpret the intent of vague statements, they used their best judgment.RESULTS: The documents differed in content, recommendations, and development methodology. They were based on either expert opinion or scientific evidence, or both. Although the nine documents were nearly unanimous in several recommendations, including assessing the presenting problem, taking a medical history, conducting physical and neurological examinations, and assessing the patient's mental and cognitive status, considerable differences in recommendations were common. Such differences led to large differentials in the estimated costs (range, $190 to $2,001) for recommended diagnostic assessments.CONCLUSIONS: A systematic approach to diagnostic recommendations for dementia may induce greater consistency among guidelines and consensus statements. The current approach leads to considerable variability in recommendations and estimated costs.
The Role of Routine Laboratory Studies and Neuroimaging in the Diagnosis of Dementia: A Clinicopathological Study
Authors: Massoud Fadi , Devi Gayatri , Moroney Joan T. , Stern Yaakov , Lawton Arlene , Bell Karen , Marder Karen , Mayeux Richard 
Published: April 2015

OBJECTIVE: To determine the neuropathological diagnoses of longitudinally followed patients with potentially reversible causes of dementia and to examine the results of the “dementia work‐up,” especially neuroimaging, by comparison with the pathological diagnosis.DESIGN: A neuropathologic series of 61 consecutive patients, with review of clinical, laboratory, neuroimaging, and pathological results.RESULTS: Of the 61 patients, forty‐eight (79%) had a clinical diagnosis of probable or possible Alzheimer's disease (AD). Compared with the pathological diagnosis, the sensitivity and specificity of the clinical diagnosis of AD were 96% and 79%, respectively. Of the 61 patients, 9 had abnormal laboratory tests, the correction of which did not improve the subsequent course. These patients were found to have AD8 and frontotemporal dementia1 on pathology. In two patients, neuroimaging was helpful in the clinical diagnoses of frontotemporal dementia and progressive supranuclear palsy (PSP). Neuroimaging revealed cerebrovascular disease in 18 patients, only two of whom were suspected clinically. Pathology confirmed AD in 17 and PSP in 1 of these patients. Sensitivity and specificity for the clinical diagnosis of cerebrovascular disease in comparison with pathology were 6% and 98%, respectively. With the added information from neuroimaging, that sensitivity increased to 59% and specificity decreased to 81%.CONCLUSIONS: All cases with abnormal laboratory or neuroimaging results had AD or some other neurodegenerative disease on pathology. The “dementia work‐up” did not reveal any reversible causes for dementia in this group of patients. Neuroimaging may have a role, especially in the diagnosis of possible AD with concomitant cerebrovascular disease.
Factors Related to Sleep Disturbance in Older Adults Experiencing Knee Pain or Knee Pain with Radiographic Evidence of Knee Osteoarthritis
Authors: Wilcox Sara , Brenes Gretchen A. , Levine Doug , Sevick Mary Ann , Shumaker Sally A. , Craven Timothy 
Published: April 2015

OBJECTIVES: To describe the types and frequencies of sleep complaints and the biopsychosocial factors associated with sleep disturbance in a large community sample of older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis (OA).DESIGN: Baseline analyses of an observational prospective study.SETTING AND PARTICIPANTS: Participants were 429 men and women aged 65 years and older experiencing knee pain or knee pain with radiographic evidence of OA enrolled in the Observational Arthritis Study in Seniors (OASIS).MEASUREMENTS: Demographic variables (age, gender, ethnicity, education), health (X‐rays of knee rated for OA severity, medical conditions, medication use, smoking status, body mass index, self‐rated health), physical functioning (self‐rated physical functioning, physical performance), knee pain, and psychosocial functioning (social support, depression) were measured.RESULTS: Problems with sleep onset, sleep maintenance, and early morning awakenings occurred at least weekly among 31%, 81%, and 51% of participants, respectively. Bivariate correlates of greater sleep disturbance in those with OA were less education, cardiovascular disease, more arthritic joints, poorer self‐rated health, poorer physical functioning, poorer physical performance, knee pain, depression, and less social support. In regression analyses, each set of variables representing the domains of health, physical functioning, pain, and psychosocial functioning contributed to the prediction of sleep disturbance beyond the demographic set. Finally, in a simultaneous model, white race (trend, P = .06), poorer self‐rated health, poorer physical functioning, and depressive symptoms were predictive of sleep disturbance.CONCLUSIONS: Sleep disturbance is common in older adults experiencing knee pain or knee pain with radiographic evidence of OA and is best understood through the consideration of demographic, physical health, physical functioning, pain, and psychosocial variables. Interventions that take into account the multidetermined nature of sleep disturbance in knee pain or knee OA are most likely to be successful.
Impact of Depressive Symptoms on Hospitalization Risk in Community‐Dwelling Older Persons
Authors: Huang Benjamin Y. , Cornoni‐Huntley Joan , Hays Judith C. , Huntley Robert R. , Galanos Anthony N. , Blazer Dan G. 
Published: April 2015

OBJECTIVE: To determine whether depressive symptoms in older adults are associated with an increased risk for hospitalization.DESIGN: A 6 month cohort study.SETTING: Five counties in the northern Piedmont of North Carolina from the Duke University site of the Established Populations for Epidemiological Studies of the Elderly project.PARTICIPANTS: The sample included 3486 community‐dwelling adults, aged 65 and older.MEASUREMENTS: Crude risk ratios for the effect of depressive symptoms on 6 month risk for hospitalization were calculated, followed by a multivariable analysis controlling for demographics and health status.RESULTS: Three hundred participants were hospitalized during the 6 month follow‐up period. The crude risk ratio for the effect of depressive symptoms on hospitalization was 1.95 (95% CI = 1.47–2.58). Subgroup analysis showed significant positive risk ratios for men aged 65 to 74 and ≥75, and women aged 65 to 74. After a multivariable analysis, however, these associations remained significant only among men ≥75 (RR = 3.43; 95% CI = 1.33–8.86).CONCLUSIONS: Depressive symptoms were independently associated with a more than threefold increased risk for hospitalization among men aged ≥75. This result reflects differences in the effects of depressive symptoms across age and gender groups, and emphasizes that symptoms of depression influence overall health and medical utilization among, at the very least, the oldest subset of men.
Relationships Between Nutritional Markers and the Mini‐Nutritional Assessment in 155 Older Persons
Authors: Vellas Bruno , Guigoz Yves , Baumgartner Marcel , Garry Philip J. , Lauque Sylvie , Albarede Jean‐Louis 
Published: April 2015

OBJECTIVE: To investigate the relationships between nutritional status measured by a comprehensive nutritional assessment including anthropometric measurements, nutritional biological markers, evaluation of dietary intake, and the Mini‐Nutritional Assessment (MNA) nutrition screening tool.DESIGN: A prospective study.PARTICIPANTS: One hundred fifty‐five older subjects (53 men and 102 women; mean age = 78 years; range = 56–97 years). These participants were hospitalized in a geriatric evaluation unit (n = 105) or free living in the community (n = 50).MEASUREMENT: Weight, height, knee height, midarm and calf circumferences, triceps and subscapular skinfolds, albumin, transthyretin (prealbumin), transferrin, ceruloplasmin, C‐reactive protein, alpha1‐acid glycoprotein, cholesterol, vitamins A, D, E, B1, B2, B6, B12, folate, copper, zinc, a 3 day food record combined with a food‐frequency questionnaire; the MNA nutritional screening.RESULTS: The MNA scores have been found to be significantly correlated to nutritional intake (P < .05 for energy, carbohydrates, fiber, calcium, vitamin D, iron, vitamin B6, and vitamin C), anthropometric and biological nutritional parameters (P < .001 for albumin, transthyretin, transferrin, cholesterol, retinol, alpha‐tocopherol, 25‐OH cholecalciferol zinc). An MNA score between 17 and 23.5 can identify those persons with mild malnutrition in which nutrition intervention may be effective.CONCLUSIONS: The MNA is a practical, noninvasive, and cost‐effective instrument allowing for rapid nutritional evaluation and effective intervention in frail older persons.
Nonspecific Presentation of Pneumonia in Hospitalized Older People: Age Effect or Dementia?
Authors: Johnson Jerry C. , Jayadevappa Ravishankar , Baccash Patricia D. , Taylor Lynne 
Published: April 2015

OBJECTIVES: Older adults, when presenting with pneumonia, are often thought to present with nonspecific symptoms instead of more suggestive symptom(s). However, studies designed to determine whether age is associated with nonspecific presentations have yielded contradictory results. Many studies have not distinguished between the effects of preexisting cognitive impairment that results from dementia and the effects of age. The aim of this study is to determine whether there are significant differences in the presentation of pneumonia in demented versus nondemented patients across two age groups. We hypothesized that the nonspecific presentation of pneumonia in older people is due to dementia rather than to chronological age.DESIGN: We compared retrospectively nonspecific (weakness, decreased appetite, urinary incontinence, falls, and delirium) and specific (cough, sputum production, dyspnea, and chest pain) symptoms of pneumonia in 148 hospitalized adult subjects from two urban, general medical teaching hospitals.RESULTS: When the subjects with dementia were included in the analysis, two (falls and delirium) of the five nonspecific symptoms were associated with older age and one other symptom (weakness) showed a trend toward statistical significance. However, when we excluded the demented subjects, nonspecific presenting symptoms were similar in old and young adults with the exception of an increased frequency of delirium on presentation. Similarly, when demented subjects were excluded, we found a stronger association of younger age with the classic specific symptoms than were seen when the demented subjects were included.CONCLUSIONS: We conclude that age differences in the presentation of pneumonia are largely due to the presence of dementia.
Nocturnal Polyuria in Older People: Pathophysiology and Clinical Implications
Authors: Miller Myron 
Published: April 2015

OBJECTIVES: To review the physiological changes of aging which affect the systems involved in urine formation and to consider how these changes interact with changes in bladder function, thereby leading to the onset of nocturnal polyuria with associated urinary frequency, nocturia, and incontinence. Based on this information, data are presented on the effectiveness of pharmacological interventions which reduce the rate of urine formation and, thus, can be of benefit in reducing symptoms, especially during the nighttime.METHODS: Peer‐reviewed journal articles were identified by MEDLINE Search and by review of the literature.CONCLUSIONS: As a consequence of age‐associated diminished renal concentrating capacity, diminished sodium conserving ability, loss of the circadian rhythm of antidiuretic hormone secretion, decreased secretion of renin‐angiotensin‐aldosterone, and increased secretion of atrial natriuretic hormone, there is an age‐related alteration in the circadian rhythm of water excretion leading to increased nighttime urine production in older people. The interaction of nocturnal polyuria with age‐related diminution in functional bladder volume and detrusor instability results in the symptoms of urinary frequency, nocturia and, in some persons, incontinence. The additional impact of Alzheimer's disease on these physiological and aging changes, as well as on a diminished perception of bladder fullness, leads to an even greater risk of urinary incontinence in these patients. Treatment of nocturnal polyuria with the antidiuretic hormone analog, DDAVP (desmopressin), can result in decreased nocturnal urine production with improvement in symptoms of frequency, nocturia, and incontinence.
The Protective Effect of Social Engagement on Mortality in Long‐Term Care
Authors: Kiely Dan K. , Simon Samuel E. , Jones Richard N. , Morris John N. 
Published: April 2015

OBJECTIVES: To examine the effect of social engagement (SE) on mortality in long‐term care.DESIGN: A retrospective cohort study.SETTING: A 725‐bed long‐term care facility.PARTICIPANTS: A total of 927 long‐term care residents who had SE measurements and did not have a serious communication problem.MEASUREMENTS: Minimum Data Set information including psychosocial items comprising an internally reliable and valid SE scale, and mortality risk factor measurements. Mortality data during the 1721‐day follow‐up period was obtained from facility records.RESULTS: Life table analyses indicate that higher levels of SE are associated with longer survival (P = .0001). Unadjusted proportional hazards analyses show that residents who did not engage socially were 2.3 times more likely to die during the follow‐up period compared with residents who were the most socially engaged. Multivariate adjusted analyses showed the protective effect of SE on mortality remained even after simultaneously adjusting for mortality risk factors. Residents who did not engage socially were 1.4 times as likely to die during the follow‐up period compared with residents who were the most socially engaged.CONCLUSIONS: Increased levels of SE were associated with longer survival independent of mortality risk factors. SE may be a modifiable risk factor for death among long‐term care residents. More research is needed to understand psychological factors that may influence residents' desire and ability to engage socially.