Helen Creasey

A case‐control study of Alzheimer's disease in Australia

We conducted a case-control study of clinically diagnosed Alzheimers disease (AD) on 170 cases aged 52 to 96 years, and 170 controls matched for age, sex and, where possible, the general practice of origin. Trained lay interviewers naive to the hypotheses and to the clinical status of the elderly person carried out risk-factor interviews with informants. Significant odds ratios were found for 4 variables: a history of either dementia, probable AD, or Downs syndrome in a 1st-degree relative, and underactivity as a behavioral trait in both the recent and more distant past. Previously reported or suggested associations not confirmed by this study include head injury, starvation, thyroid disease, analgesic abuse, antacid use (aluminum exposure), alcohol abuse, smoking, and being left-handed.

Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the Concord Health and Ageing in Men Project.

OBJECTIVES: To determine the association between loss of muscle strength, mass, and quality and functional limitation and physical disability in older men.

Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study

Current definitions for the preclinical phase of dementia focus predominantly on cognitive measures, with particular emphasis on memory and the prediction of Alzheimers disease. Incorporation of non-cognitive, clinical markers into preclinical definitions may improve their predictive power. The Sydney Older Persons Study examined 6-year outcomes of 630 community-dwelling participants aged 75 or over at recruitment. At baseline, participants were defined as demented, cognitively intact or having a syndrome possibly representing the preclinical phase of Alzheimers disease, vascular dementia, an extrapyramidal dementia or various combinations of the three. Those with cognitive impairment in combination with gait and motor slowing were the most likely to dement over the 6-year period (OR 5.6; 95% CI 2.5-12.6). This group was also the most likely to die (OR 3.3; 95% CI 1.6-6.9). White matter indices on MRI scanning were not consistently correlated with gait abnormalities. Simple measures of gait may provide useful clinical tools, assisting in the prediction of dementia. However, the underlying nature of these deficits is not yet known.

Health habits and risk of cognitive impairment and dementia in old age: a prospective study on the effects of exercise, smoking and alcohol consumption.

Previous research has yielded inconsistent results on the effects of exercise, smoking and alcohol use on cognitive impairment and dementia in old age. We analysed data from the Sydney Older Persons Study to see if these health habits were associated with cognitive functioning, dementia or Alzheimers disease. Health habits were assessed in Wave 1 of the study, when the subjects were aged 75 years or over. Three years later, the subjects were tested for cognitive functioning and clinically examined for dementia and Alzheimers disease. The analysis was restricted to the 327 subjects examined in Wave 2 who were non‐demented in Wave 1. There were few significant associations between health habits and cognitive performance and these were not found consistently across cognitive measures. No associations were found with dementia or Alzheimers disease. While these health habits do not affect risk for dementia and cognitive impairment in the very elderly, who are at highest risk for these disorders, we cannot discount a role at younger ages.

Topography of brain atrophy during normal aging and alzheimer's disease

The present study investigated the effect of age on total and regional brain volumes and compared age-associated changes in 20 healthy controls with those observed in 12 patients with Alzheimers disease (AD). Weights and volumes of the whole brain and cerebrum, as well as the fractional volumes of the frontal, temporal, and parieto-occipital cortices, medial temporal structures, deep brain structures, and white matter were measured. Males had larger and heavier brains than females of comparable age. A small decline in brain volume with age was found (approximately 2 ml per year), but only within the white matter. In comparison, no further loss of white matter occurred in AD; however, the cerebral cortex was significantly reduced in volume, with the greatest loss from the medial temporal structures. This loss was related to disease progression; greater proportional loss was associated with more rapid decline in older patients. This study suggests that significant brain atrophy is not a consequence of advancing age. In addition, it suggests a regional specificity of damage in AD.

Political drive to screen for pre-dementia: Not evidence based and ignores the harms of diagnosis

#### Summary box Current policy in many countries is aimed at increasing the rates of diagnosis of dementia and cognitive impairment.1 2 …

Gastric Emptying Rate in the Elderly: Implications for Drug Therapy

ABSTRACT: The effect of the aging process on gastric emptying was studied in 11 elderly subjects (mean age, 77) and in 7 young healthy volunteers (mean age, 26). Gastric emptying rates were assessed by a modified sequential scintiscanning technique after administration of the nonabsorbable chelated radiopharmaceutical 99mTc‐DTPA. The rate of emptying, expressed as half‐time (T1/2e) in minutes, was significantly longer (p < 0.001) in the elderly subjects (mean apparent T1/2e = 123.23 min) compared to the young healthy volunteers (mean apparent T1/2e = 49.69 min). Clinical implications of these findings are discussed, particularly with respect to the rate and extent of drug absorption in elderly persons.

Cohort Profile: The Concord Health and Ageing in Men Project (CHAMP)

Epidemiological studies on ageing have tended to focus on women, a phenomenon recognized by sociologists as the feminization of ageing. However, a large percentage of older people are men. For example, in Australia, 44% of those aged 65 and over are male, as are 39% of those aged 75 years and over. Furthermore, the 5–7 year shorter life expectancy for men than women and higher death rates at all ages, including older ages, suggest that more detailed study of the health of older men is essential. Probably the best known study of the health of ageing in men is the Massachusetts Male Aging Study. However, at baseline, men in the Massachusetts Male Aging Study were relatively young, with a mean age of 58 years (range: 40–70 years). The recently established European Male Ageing Study also involves mostly younger men (range: 45–79 years). The Concord Health and Ageing in Men Project (CHAMP) was established to investigate health in old men, defined as age 70 years and over. There is no upper age limit for recruitment into CHAMP. CHAMP is funded by the National Health and Medical Research Council of Australia. Current funding is for baseline assessments and a two-year followup assessment. Additional funding will be sought to allow biennial assessments for at least 10 years. Recruitment of study subjects mainly occurred during 2005 and 2006, with the first follow-up assessments in early 2007. What does it cover?

Long-term benzodiazepine use by elderly people living in the community.

Objective : To investigate the prevalence of long‐term benzodiazepine use in an elderly community sample, and factors associated with such use.

Vascular risk factors, cognition and dementia incidence over 6 years in the Sydney Older Persons Study.

The specific contributions of factors associated with an increased risk of stroke to cognitive decline and vascular dementia in elderly people remain somewhat unclear. We investigated the prevalence of vascular risk factors (RFs) and their role on the incidence of dementia, cognitive decline and death over a 6-year period in a sample of 377 non-demented community dwellers aged 75 years and over at the time of study entry. Presence and history of vascular RFs and cognitive decline over 6 years were ascertained using direct interviews, medical and cognitive examinations. Hypertension and history of heart disease were very common affecting about 50% of the participants. At 6 years, 114 (30%) participants had died, and 63 (16.7%) met diagnostic criteria for dementia. Hypertension was significantly associated with a greater cognitive decline but not with dementia. Smoking and stroke diagnosis showed a significant positive association with death. Reported hypercholesterolaemia was found to be associated with a protective effect for the development of dementia, for cognitive decline and for death over the 6-year period. All other associations were non-significant. Figures of dementia incidence are similar to previous studies in contrast to the lack of anticipated effects of the vascular RFs. The results indicate that in very old participants, the impact of vascular RFs changes with time and may no longer contribute to the development of dementia and cognitive decline.