bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive Impairment and Risk of Stroke in the Older Population
Authors: Verruca Luigi , Guralnik Jack M. , Salive Marcel E. , Pahor Marco , Corti Maria‐Chiara , Baroni Alberto , Havlik Richard J. 
Published: April 2015

OBJECTIVE: Recent studies have suggested that vascular dementia in older persons is more common than previously hypothesized. A substantial proportion of dementia in old age may be an early manifestation of cerebrovascular disease (CVD), that eventually becomes clinically evident as an acute cerebrovascular accident. This study was aimed at assessing whether cognitive impairment and cognitive decline in older persons free of stroke are associated with higher risk of future stroke, independently of other risk factors.DESIGN: Population‐based prospective study.PARTICIPANTS: A total of 5024 subjects from the Established Populations for Epidemiologic Studies of the Elderly, who were alive and had no history of previous stroke at the sixth follow‐up visit. Subjects who had reported a stroke in a previous interview or with a diagnosis of cerebrovascular disease in a hospitalization record during the previous 3 years were excluded.MEASUREMENTS: Cognitive function was assessed by the Short Portable Mental Status Questionnaire (SPMSQ). Occurrence of a stroke was prospectively assessed by examining hospital discharge diagnoses and death certificates.RESULTS: During 19,533 person‐years of follow‐up, 259 strokes were recorded (13.3/1000 person‐years). Stroke incidence was lowest in those with normal SPMSQ score (12.1/1000 person‐years), intermediate in those with moderate impairment (16.3/1000 person‐years), and highest in those with severe impairment (30.9/1000 person‐years). Adjusting for age, education, smoking, history of hypertension, blood pressure, heart attack, diabetes, and disability, the relative risks of stroke for moderate and severe cognitive impairment were 1.2 (0.9–1.6) and 2.2 (1.2–3.8), respectively. The association between cognitive impairment and incident stroke was not mediated by hypertension or diabetes. Compared with subjects with stable or improved SPMSQ score in the previous 3 years, those who declined had higher risk of stroke.CONCLUSIONS: The elevated risk of subsequent strokes in older persons with cognitive impairment suggests that CVD may play a larger role in causing cognitive impairment then previously suspected. It remains to be demonstrated whether reducing modifiable risk factors for CVD decreases the burden of cognitive impairment in older persons without stroke. J Am Geriatr Soc 44:237–241, 1996.
Weight Change in Alzheimer's Disease
Authors: White Heidi , Pieper Carl , Schmader Ken , Fillenbaum Gerda 
Published: April 2015

PURPOSE: To determine the natural history of weight change and the occurrence of clinically significant weight loss in subjects with Alzheimer's disease (AD).PATIENTS AND METHODS: Subjects with AD and cognitively normal older controls were recruited from 21 U.S. university medical centers that were participating in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Annual assessments were performed. Subjects with AD (n = 362) and controls (n = 317) with two or more weight measurements taken a year or more apart were included in this analysis. The average period of follow‐up was > 2 years for both subjects with AD and controls. Four variables describing different aspects of weight change were defined: ≥ 5% weight loss, percent weight change/year, maximum percent weight loss over 1 year, and standard deviation of measurements/subject.RESULTS: Nearly twice as many subjects with AD experienced a weight loss of 5% or more when compared with controls (men P = .003, women P = .001). Surprisingly, a weight gain of 5% or more was also more common among AD cases. Overall, there was a tendency toward weight loss for both subjects with AD and controls, as measured by percent weight change/year. When other possible causes of weight loss were controlled using a multivariate model, a diagnosis of AD remained a significant predictor of ≥5% weight loss (P ≪ .001), maximum percent weight loss over 1 year (P ≪ .001), and standard deviation of measurements/subject (P ≪ .001). A trend toward significance was noted for percent weight change/year (P = .07). Other than AD, very few of the possible confounders of this association remained significant predictors of weight change. In bivariate analysis, the severity of AD at entry correlated with percent weight change/year and standard deviation of measurements/subject. Additionally, the functional status of subjects with AD correlated with all four measures of weight change.CONCLUSION: Clinically important weight loss occurs more frequently among patients with AD than among cognitively normal control subjects. Instances of weight gain, periods of acute weight loss, and greater fluctuations in weight suggest that the natural history of weight change in AD may be characterized by dysfunction in body weight regulation. Further analysis is warranted regarding the relationship of severity of dementia, functional status, and other specific aspects of AD to weight change. J Am Geriatr Soc 44:265–272, 1996.
An Assessment of Surgery for Spinal Stenosis: Time Trends, Geographic Variations, Complications, and Reoperations
Authors: Ciol Marcia A. , Deyo Richard A. , Howell Eric , Kreif Suzanne 
Published: April 2015

OBJECTIVE: To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short‐term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair.DESIGN: Cohort study based on Medicare claims.SETTING: Hospital care.SUBJECTS: All Medicare beneficiaries 65 years of age or older who received a lumbar spine operation for spinal stenosis in 1985 or 1989 were followed through 1991 (10,260 patients from the 1985 cohort and 18,655 from the 1989 cohort).MAIN OUTCOME MEASURES: Two outcomes were measured: (1) rates of operation for spinal stenosis by state and (2) on an individual level, operative complications (cardiopulmonary, vascular, or infectious), postoperative mortality, and time between first operation and any subsequent reoperation.RESULTS: Rates of surgery for spinal stenosis increased eightfold from 1979 to 1992 for patients aged 65 and older and varied almost fivefold among US states. Mortality and operative complications increased with age and comorbidity. Complications were more likely for men and for individuals receiving spinal fusions. The 1989 cohort experienced a slightly higher probability of reoperation than the 1985 cohort for the first 3 years of follow‐up.CONCLUSIONS: A rapid increase in surgery rates for spinal stenosis was identified over a 14‐year period. The wide geographic variations and substantial complication rate from this elective surgical procedure (partly related to patient age) suggest a need for more information on the relative efficacy of surgical and nonsurgical treatments for this condition. The risks and benefits of particular surgical procedures for specific clinical and demographic subgroups as well as individual patient preferences regarding surgical risks and possible outcomes should also be evaluated further. These issues are likely to become increasingly important with the aging of the US population. J Am Geriatr Soc 44:285–290, 1996.
Can a Physician Recognize an Older Driver with Increased Crash Risk Potential?
Authors: Johansson Kurt , Bronge Lena , Lundberg Catarina , Persson Anders , Seideman Marianne , Viitanen Matti 
Published: April 2015

OBJECTIVE: To identify factors in a medical examination that distinguish convicted older drivers with traffic violations from other drivers.DESIGN: Matched case‐control study.SETTING: Two counties in Sweden.SUBJECTS: Thirty‐seven drivers older than age 65, whose driving licenses have been temporarily suspended, each matched to one control subject based on age, sex, type of driving license, year of first license, living area, educational level, and annual distance driven.MEASUREMENTS: Case and control subjects were compared with respect to medical history, medication use, blood tests, drawing and memory tests, Mini‐Mental State Examination, medical status findings, visual acuity, and brain imaging procedures.MAIN RESULTS: The group of drivers with suspended driving licenses did not differ from matched controls with respect to visual acuity or presence of cardiovascular diseases. However, persons with suspended driving licenses were more likely than control subjects to have suspected or mild dementia (P < .010) and to perform less well on two easily administrated screening tests: copying a cube (P < .010) and 5‐item recall (P < .010). Case subjects with crashes had significantly more cardiovascular diseases than case subjects with other moving violations (P < .050). These case subjects with crashes also had significantly more cognitive impairments than control subjects without crashes as shown by a higher clinical dementia rating score (CDR) (P < .001), lower score on the Mini‐Mental State Examination (MMSE) (P < .050), and lower level of performance in the copying task (cube) (P < .050) and 5‐item recall test (P < .010). They also had evidence of greater cognitive impairment than those case subjects with other moving violations.CONCLUSIONS: Visual acuity and common medical examination did not distinguish convicted older drivers with crashes or other moving violations from controls. There was evidence that even mild cognitive impairment contributed to the risk of losing a driving license because of crashes.
Suicidal Ideation Among Older Primary Care Patients
Authors: Callahan Christopher M. , Hendrie Hugh C. , Nienaber Nancy A. , Tierney William M. 
Published: April 2015

OBJECTIVE: To describe the prevalence and sociodemographic and clinical correlates of suicidal ideation among older primary care patients.DESIGN: Baseline screening for depressive symptoms, functional status, and suicidal ideation, with prospective assessment of mortality.SETTING: An academic primary care group practice at an ambulatory care clinic.PARTICIPANTS: 301 patients who screened positive for depression and a random sample of 101 patients who screened negative from among 3767 patients aged 60 and older who completed screening for depression during routine office visits.MEASUREMENTS: Centers for Epidemiologic Studies Depression (CES‐D) scale, Hamilton Depression Rating (HAM‐D) scale, Sickness Impact Profile (SIP), structured psychiatric interview, sociodemographic and clinical variables, and mortality.RESULTS: Among the 301 patients with CES‐D scores ≥16, 14 (4.6%) reported suicidal ideation and received urgent evaluation by mental health professionals. The estimated prevalence of suicidal ideation in this cohort of older primary care patients was 0.7 to 1.2%. All patients with suicidal ideation had evidence of a current affective disorder, and nearly all had moderate to severe functional impairment. However, even though all 14 patients endorsed suicidal ideation, corresponding HAM‐D scores ranged from 3 to 40, and only four of 14 met diagnostic criteria for major depression. The most common suicide plan involved use of a hand gun. Depressed patients with suicidal ideation did not differ significantly from depressed non‐suicidal patients on any of the following variables: age, gender, race, education, alcohol abuse, cognitive impairment, or mean CES‐D, HAM‐D, or SIP scores. None of the suicidal patients had died within 12 months of the screening date.CONCLUSION: The prevalence of suicidal ideation was about 1% among this cohort of older primary care patients, and the prevalence approaches 5% among those older adults who report significant symptoms of depression. However, asking patients directly about the presence of active suicidal ideation appears to be the only effective means of identifying those at risk.
Physician Responses to a Hospital Policy Allowing Them to Not Offer Cardiopulmonary Resuscitation
Authors: Swig Louise , Cooke Molly , Osmond Dennis , Luce Judith A. , Brody Robert V. , Bird Carol , Luce John M. 
Published: April 2015

OBJECTIVE: To determine whether physicians followed a hospital policy permitting them to not offer cardiopulmonary resuscitation (CPR) to patients considered unlikely to benefit from this therapy.DESIGN: Prospective series.SETTING: San Francisco General Hospital, a university‐affiliated public hospital.PATIENTS: Attending physicians were interviewed about patients admitted over a period of 5 consecutive months for whom do‐not resuscitate (DNR) orders were written. Only the first patient for whom each physician wrote a DNR order was included.MAIN OUTCOME MEASURES: Responses of physicians to questions regarding their initiation of DNR orders for these patients.RESULTS: Sixty‐nine physicians responded to questions about DNR orders written for 69 patients. Fifty‐seven of these physicians said that they were aware of the hospital policy, and 49 of the 57 physicians said that they generally agreed with it. Thirty‐three physicians felt that CPR should be offered only to patients likely to benefit from it. In contrast, 36 physicians said that CPR should be offered to all patients, regardless of benefit. CPR was offered to 41 patients and 15 surrogates; 27 of these patients were considered to be unlikely to benefit from CPR.CONCLUSION: Despite a policy that allows them to do otherwise, physicians usually offered CPR to patients, regardless of benefit. Most physicians believed that CPR should be offered to all patients. These findings suggest that policies such as that of San Francisco General Hospital may not be compelling because physicians hold attitudes that are inconsistent with the policies.
Five‐Year Performance Trends for Older Exercisers: A Hierarchical Model of Endurance, Strength, and Flexibility
Authors: Morey Miriam C. , Pieper Carl F. , Sullivan Robert J , Crowley Gail M. , Cowper Patricia A. , Robbins Michael S. 
Published: April 2015

OBJECTIVE: To examine 5‐year trends in measures of physical performance, and the impact of disease upon performance, in three domains: cardiovascular fitness, musculoskeletal strength, and flexibility among older adults participating in a medically supervised exercise program.DESIGN: Longitudinal analyses of data obtained in an observational cohort study.SETTING: Department of Veterans Affairs Medical Center in Durham, North Carolina.PARTICIPANTS: Seventy‐three community‐dwelling veterans between 64 and 90 years of age.INTERVENTION: Voluntary participation in a medically supervised outpatient exercise program meeting 3 days per week for 90 minutes per session.MAIN OUTCOME MEASURES: Changes over time in cardiovascular fitness, musculoskeletal strength, and flexibility.RESULTS: Forty‐nine percent of the original study participants remained in the program for a full 5 years. They had lower baseline rates of cardiorespiratory and musculoskeletal diseases than did the dropouts. Dropouts were significantly more impaired in baseline measures of cardiovascular fitness (P = .038) and strength (P = .007). Changes over time for cardiovascular fitness and strength were similar. Only linear (P < .05) and quadratic time (P < .001) were significant. Only linear time was significant for measures of flexibility (P < .05). Baseline cardiorespiratory disease, baseline musculoskeletal disease, and interaction terms were not significant. Overall, measures of physical performance demonstrated gradual improvement for 2 to 3 years, followed by a gradual decline in performance irrespective of baseline disease status.CONCLUSION: Older adults who exercise regularly, including those with multiple chronic diseases, can achieve significant gains in measures of physical performance, and these gains can be sustained for 2 to 3 years.
Breathing Disorders During Sleep and Cognitive Performance in an Older Community Sample: The EVA Study
Authors: Dealberto Marie‐José , Pajot Nicole , Courbon Dominique , Alpérovitch Annick , Group EVA Study 
Published: April 2015

OBJECTIVES: To determine whether poor cognitive performance was associated with symptoms related to the sleep apnea syndrome, snoring, and breathing stoppage during sleep.DESIGN: Cross‐sectional analysis of data collected at baseline in the EVA Study, a 4‐year cohort study.SETTING: The city of Nantes in western France.SAMPLE: A total of 1389 persons, aged 60 to 70 years, recruited from the electoral rolls of the city of Nantes.MEASUREMENTS: Demographic characteristics and data on drug use and tobacco and alcohol consumption were collected using a standardized questionnaire. Weight and height were measured. Individuals completed a previously validated sleep questionnaire about nocturnal sleep characteristics, snoring, breathing stoppage during sleep, and day‐time sleepiness. Trained psychologists administered eight neuropsychological tests: The Mini‐Mental State Examination, Trail Making Test, Digit Symbol Substitution Test of the WAIS‐Revised, Benton Visual Retention Test, Paced Auditory Serial‐Addition Task, Auditory Verbal Learning Test, Raven Progressive Matrices, and Word Fluency Test. Depressive symptomatology was assessed by the Center for Epidemiologic Studies‐Depression scale.MAIN RESULTS: In this older sample, 49.5% of subjects reported snoring, and 10.8% reported breathing stoppage during sleep. Both respiratory disorders were associated significantly with male gender and high body mass index. In men, prevalence of snoring was increased significantly in those with alcohol consumption greater than 40 mL per day. Breathing stoppage during sleep was associated with depressive symptoms in women. Logistic regression models adjusted for age, gender, educational level, tobacco status and alcohol consumption, depressive symptomatology, and number of medications found that both snoring and breathing stoppage were associated with low scores (≤10th percentile) in tests requiring visual attention skills, the Trail Making Test (OR = 2.14, 95% CI = 1.24–3.69 and OR = 1.88, 95% CI = 1.04–3.39, respectively), and the Digit Symbol Substitution Test (OR = 1.80, 95% CI = 1.09–2.99 and OR = 1.58, 95% CI = .87–2.89, respectively). These relationships were significant only when either snoring or breathing stoppage was associated with daytime sleepiness.CONCLUSIONS: This cross‐sectional analysis suggested that in community‐dwelling individuals 60 to 70 years of age, snoring and breathing stoppage during sleep associated with daytime sleepiness were risk factors for low cognitive performance in tests requiring visual attention skills. J Am Geriatr Soc 44:1287–1294, 1996.
Sleep‐Disordered Breathing and Systemic Hypertension in the Older Male
Authors: Stoohs Riccardo A. , Gingold Jeffrey , Cohrs Stefan , Harter Richard , BA Emily Finlayson , Guilleminault Christian 
Published: April 2015

OBJECTIVE: To investigate the relationship between sleep‐disordered breathing (SDB) and essential hypertension in a population of older male hypertensives.PATIENTS: One‐hundred forty consecutive older hypertensive males.MEASUREMENTS: Monitoring of sleep‐related breathing abnormality with a portable sleep apnea monitor (level III device). Assessment of complaints related to sleep quality using a validated questionnaire. Systemic arterial blood pressure according to WHO standards and biochemical analyses. SDB was defined as more than 10 abnormal respiratory events per hour of sleep.DESIGN: Prospective investigation on a retrospective cohort.SETTING: Veterans Administrations hypertension clinic.MAIN RESULTS: SDB was diagnosed in 80% of this older, hypertensive, male population. Thirty‐four percent of all study subjects presented with severe SDB, with more than 30 abnormal respiratory events per hour of sleep. Subjects with SDB were significantly heavier (BMI = 30.0 ± 5.2 kg/m2) than subjects without SDB (BMI = 26.8 ± 5.1 kg/m2, P = .004). Furthermore, subjects with SDB slept significantly longer (by a mean of 46 minutes/night, P = .027) and complained significantly more often of daytime sleepiness than subjects without SDB (P = .018). Fifty percent of all 140 subjects snored more than 10% of the total sleep time, and 26% snored for more than one‐third of the night. No significant differences in blood pressure values were observed in subjects with compared with subjects without sleep‐disordered breathing. However, a considerable number of subjects presenting with hypertensive blood pressure values despite treatment could be identified. Subjects presenting with hypertensive blood pressure values had a significantly higher severity index of SDB than subjects with normotensive blood pressure values (P = .047).CONCLUSIONS: This investigation supports data showing that undiagnosed SDB is a common phenomenon in older male individuals, leading to impaired daytime functioning and impairment of overall quality of life. More importantly, our data suggests that untreated SDB may have an adverse effect on the efficacy of antihypertensive treatment in hypertensive individuals with sleep‐disordered breathing. J Am Geriatr Soc 44:1295–1300, 1996.
Quality of Life in Patients with Alzheimer's Disease as Reported by Patient Proxies
Authors: Albert S. M. , Del Castillo‐Castaneda C. , Sano M. , Jacobs D. M. , Marder K. , Bell K. , Bylsma F. , Lafleche G. , Brandt J. , Albert M. , Stern Y. 
Published: April 2015

OBJECTIVE: To measure behaviors indicative of quality of life (QOL) in patients with Alzheimer's disease and to examine correlates of patient QOL.DESIGN: Cross‐sectional investigation.SETTING: Multi‐center study.PARTICIPANTS: Sample of 130 diagnosed patients.PRINCIPAL OUTCOME MEASURES: Proxy ratings of (1) the frequency, opportunity, and enjoyment of 15 non‐ADL activities potentially within the capacity of a demented person, and (2) the frequency of a series of positive and negative affects, evident in clearly demarcated facial and bodily expressions.RESULTS: QOL ratings were reliably elicited. Family and institutional caregivers differed only in reports of opportunity for patient activity. Frequency of activities declined with increasing severity of dementia. The frequency of negative affects increased and positive affects declined with increasing severity of dementia, but correlations were weak. High QOL, defined by frequent activity and positive affect, was evident in a quarter of the sample. In multivariate models, functional and cognitive status independently predicted QOL among community‐resident older adults; only absence of antipsychotics was related to QOL among older people in nursing homes. Patient education, a marker of premorbid state, independently predicted some activity patterns.CONCLUSIONS: Although the subjective world of the demented patient is not directly accessible, readily observable behaviors offer a basis for assessing QOL. J Am Geriatr Soc 44:1342–1347, 1996.
Cognitive and Functional Status of the Oldest Old
Authors: Corey‐Bloom Jody , Wiederholt Wigbert C. , Edelstein Sharon , Salmon David P. , Cahn Deborah , Barrett‐Connor Elizabeth 
Published: April 2015

OBJECTIVE: To compare the cognitive performance and functional status of the normal oldest old (85+ years) with that of normal older persons aged 65 to 84 years to identify age‐associated changes in cognition in individuals considered clinically normal.BACKGROUND: Advancing age appears to be a risk factor for dementia.DESIGN/METHODS: Analysis of performance on an extensive neuropsychological battery and the Pfeffer Outpatient Disability Scale in 243 normal individuals age 65 to 99 years.RESULTS: Fifty‐two normal subjects who were 85 years of age and older (mean age 88.2 ± 3.1) and 191 normal subjects aged 65–84 years (mean age 75.8 ± 5.0) were compared. Mean education for both groups was not statistically different. No significant differences in functional disability were found between the two groups. Normal subjects aged 85 years and older performed significantly less well than their younger counterparts on verbal and nonverbal memory, psychomotor/executive tasks, and category verbal fluency.CONCLUSIONS: Advancing age in normal subjects is accompanied by a decrease in cognitive function, measured by various neuropsychological tests, but is not accompanied by functional impairment.