Irene Bruce

Low serum cholesteryl ester-docosahexaenoic acid levels in Alzheimer's disease: a case–control study

Low n-3 polyunsaturated fatty acid (PUFA) status may be associated with neuro-degenerative disorders, in particular Alzheimers disease, which has been associated with poor dietary fish or n-3 PUFA intake, and low docosahexaenoic acid (DHA) status. The present case-control study used an established biomarker of n-3 PUFA intake (serum cholesteryl ester-fatty acid composition) to determine n-3 PUFA status in patients with Alzheimers disease, who were free-living in the community. All cases fulfilled the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimers Disease and Related Disorders Association criteria for Alzheimers disease. Detailed neuropsychological testing and neuroimaging established the diagnosis in all cases. The subjects (119 females and twenty-nine males) aged 76.5 (SD 6.6) years had a clinical dementia rating (CDR) of 1 (SD 0.62) and a mini mental state examination (MMSE) score of 19.5 (SD 4.8). The control subjects (thirty-six females and nine males) aged 70 (SD 6.0) years were not cognitively impaired (defined as MMSE score <24): they had a mean MMSE score of 28.9 (SD 1.1). Serum cholesteryl ester-eicosapentaenoic acid and DHA levels were significantly lower (P<0.05 and P<0.001 respectively) in all MMSE score quartiles of patients with Alzheimers disease compared with control values. Serum cholesteryl ester-DHA levels were progressively reduced with severity of clinical dementia. DHA levels did not differ in patients with Alzheimers disease across age quartiles: all were consistently lower than in control subjects. Step-wise multiple regression analysis showed that cholesteryl ester-DHA and total saturated fatty acid levels were the important determinants of MMSE score and CDR. It remains to be determined whether low DHA status in Alzheimers disease is a casual factor in the pathogenesis and progression of Alzheimers disease.

Loneliness, social support networks, mood and wellbeing in community‐dwelling elderly

Both loneliness and social networks have been linked with mood and wellbeing. However, few studies have examined these factors simultaneously in community‐dwelling participants. The aim of this study was to examine the relationship between social network, loneliness, depression, anxiety and quality of life in community dwelling older people living in Dublin.

Benzodiazepine use among the elderly in the community

Benzodiazepines are the most commonly prescribed psychotropic drug in the elderly. Benzodiazepines with a long duration of action can produce marked sedation and psychomotor impairment in older people, and are associated with an increased risk of hip fracture and of motor vehicle crash. One thousand seven hundred and one individuals of 65 years and over, identified from General Practitioner lists, were interviewed using the Geriatric Mental State‐AGECAT package and current psychotropic drug use was recorded. Benzodiazepines were classified as having a short or long elimination half‐life. Two hundred and ninety‐five (17.3%) individuals were taking a benzodiazepine, with use in females being twice that in males. Of the 295, 152 (51.5%) were taking a long acting benzodiazepine and the use of long acting anxiolytic type benzodiazepines was particularly common. Fifty‐two (17.6%) benzodiazepine users were taking one or more other psychotropic drugs. A benzodiazepine was used by eight of 18 (44.4%) subjects with an anxiety disorder, 62 of 180 (34.4%) individuals with depression, and seven of 71 (9.9%) people with dementia. Four‐fifths of older people on a psychotropic drug were taking a benzodiazepine, highlighting the importance of this class of drug in the elderly population. The choice of a benzodiazepine with a long duration of action, which have been shown to be associated with serious adverse events in the elderly in over one half of benzodiazepine users, is of concern. The potential for adverse effects was further accentuated by polypharmacy practices. The choice of benzodiazepine for an older person has important consequences and should be addressed in greater detail with primary care. Copyright

Anxiety and behavioural disturbance as markers of prodromal Alzheimer's disease in patients with mild cognitive impairment.

Depression and anxiety have been reported to be independently predictive of conversion to Alzheimers disease (AD) in patients with mild cognitive impairment (MCI). Anxiety symptoms have been less well studied and findings in this regard have been inconsistent. The objectives of this study are to determine which symptoms among a range of neuropsychiatric symptoms known to commonly occur in patients with MCI are predictive of later conversion to AD. We also wish to determine whether these symptoms track existing measures of declining cognitive and functional status or may be considered distinct and sensitive biomarkers of evolving Alzheimers pathology.

Detecting prodromal Alzheimer's disease in mild cognitive impairment: utility of the CAMCOG and other neuropsychological predictors

The Cambridge cognitive examination (CAMCOG) is a mini neuropsychological battery which is well established and widely used. The utility of the CAMCOG in detecting prodromal Alzheimers disease (AD) in patients with mild cognitive impairment (MCI) has not been determined. The objectives of this study are: to establish which subtests of cognitive domains contained within the CAMCOG are predictive of conversion to AD, to compare these with an extended version of the delayed word recall (DWR) test and to establish optimal cut points for all measures used.

Subjective well-being amongst community-dwelling elders: what determines satisfaction with life? Findings from the Dublin Healthy Aging Study

BACKGROUND Life satisfaction is a subjective expression of well-being and successful aging. Subjective well-being is a major determinant of health outcomes in older people. The aim of this study was to determine which factors predicted well-being in older people living in the community as measured by their satisfaction with life. METHODS The relationship between life satisfaction, as measured by the Life Satisfaction Index (LSI-A) and physical, cognitive and demographic variables was examined in 466 older people living in the community using a stepwise regression model. RESULTS Depression, loneliness, neuroticism, extraversion, recent participation in physical activity, age and self-reported exhaustion, were the independent predictors of life satisfaction in our elderly cohort. CONCLUSION Subjective well-being, as measured by the Life Satisfaction Scale, is predicted by depression, loneliness, personality traits, recent participation in physical activity and self-reported exhaustion. The mental and emotional status of older individuals, as well as their engagement in physical activity, are as important as physical functionality when it comes to life satisfaction as a measure of well-being and successful aging. These areas represent key targets for intervention.

Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults

It has been reported that late onset depression is more frequently associated with acquired organic pathology and that patients are less likely to report a family history of depression. Differences in phenomenology according to age of onset have been described although these have not been consistently replicated. The majority of these studies have been in hospital populations. The aim of this study is to address this question in a sample of community dwelling older adults.

Prevalence of mental illness in an elderly community dwelling population using AGECAT

Objective: The purpose of this study was to determine the prevalence of a range of mental disorders in an elderly community dwelling population in Dublin using AGECAT, a reliable and standardised computerised diagnostic system that has been previously validated in community epidemiological surveys. Methods: A total of 451 individuals over the age of 65 in a GP group practice were interviewed using AGECAT. Results: Approximately one in five subjects had a mental illness according to AGECAT criteria. The prevalence of depression was 13.1% and did not change appreciably with age. 5.5% of subjects met organic ‘case’ criteria, and the frequency of organic cases increased with age, approximating 15% in the over 80 year age group. Neurotic disorders occurred with very low frequency, representing 1.1% of the subjects tested. Conclusions: These findings have implications for mentalhealth services planning at a local level, and underscore the utility of AGECAT as a tool for comparative crosscultural epidemiological surveys.

Vascular biomarkers of cognitive performance in a community-based elderly population: the Dublin Healthy Ageing study

BACKGROUND population studies suggest that cardiovascular risk factors may be associated with cognitive impairment. Epidemiological studies evaluating individual markers of vascular disease as risk factors for cognitive dysfunction have yielded inconsistent results. Homocysteine has emerged as a marker consistently associated with poorer outcomes. Existing studies have largely examined individual vascular risks in isolation and have tended to ignore patient psychological status. OBJECTIVE to investigate the association between markers of vascular disease and cognition in a community-dwelling non-demented elderly population while adjusting for vascular and non-vascular confounds. DESIGN cross-sectional community based assessment. PARTICIPANTS 466 subjects with mean age 75.45 (s.d., 6.06) years. 208 (44.6%) were male. RESULTS higher levels of homocysteine were consistently associated with poorer performance in tests assessing visual memory and verbal recall. No other vascular biomarker was found to be associated with cognitive performance. Factors such as alcohol use, tea intake, life satisfaction, hypertension and smoking were positively correlated with global cognitive performance. Negative correlations existed between cognitive performance and depression, past history of stroke, intake of fruit and use of psychotropic medication. CONCLUSIONS homocysteine was the only vascular biomarker associated with poorer function in a number of domains on neuropsychological testing, independent of vascular and non-vascular confounds. Other psychosocial factors may need to be taken into account as potential confounds in future studies investigating cognition.

The spectrum of worry in the community-dwelling elderly

Objectives: In this study, we examine the prevalence and distribution of worry, its content, and its associations with quality of life and depression, based on a large sample of community-dwelling elderly. We will attempt to distinguish between pathological and non-pathological worry based on these associations. Design: Community survey. Setting: Inner-city population. Participants: A total of 2136 people aged between 65 and 96, of whom 66% were women, were recruited through general practitioners and interviewed in their own homes. Measurements: The GMS-AGECAT structured psychiatric interview was used to rate symptoms which were classified into five levels of severity of worry ranging from simple, non-excessive to generalised anxiety disorder (GAD). Results: In this study, 79% of the participants reported worrying, 37% worrying excessively, while 20% reported excessive, uncontrollable worry and 6.3% met criteria for GAD. Prevalence of all types of worry declined with age and was lower in men. The prevalence of depressed mood was similar in those without worry and those with non-severe worry (Wald post hoc test, p = 0.06) but rose significantly with each level of severe worry (Wald post hoc tests, all p < 0.05). Major depressive disorder was absent in those who did not worry, and had a prevalence of only 0.2% in those with non-severe worry (p = 0.552, Fishers exact test). It has a significantly elevated prevalence at all levels of excessive worry, and a significantly higher prevalence in those with GAD. All levels of excessive worry were associated with reduced quality of life. Conclusion: Severe worry is highly prevalent in the elderly; most severe worriers do not meet criteria for GAD, but have a reduced quality of life and an increased prevalence of depression.