Katarzyna Broczek

Design, recruitment, logistics, and data management of the GEHA (Genetics of Healthy Ageing) project

In 2004, the integrated European project GEHA (Genetics of Healthy Ageing) was initiated with the aim of identifying genes involved in healthy ageing and longevity. The first step in the project was the recruitment of more than 2500 pairs of siblings aged 90 years or more together with one younger control person from 15 areas in 11 European countries through a coordinated and standardised effort. A biological sample, preferably a blood sample, was collected from each participant, and basic physical and cognitive measures were obtained together with information about health, life style, and family composition. From 2004 to 2008 a total of 2535 families comprising 5319 nonagenarian siblings were identified and included in the project. In addition, 2548 younger control persons aged 50-75 years were recruited. A total of 2249 complete trios with blood samples from at least two old siblings and the younger control were formed and are available for genetic analyses (e.g. linkage studies and genome-wide association studies). Mortality follow-up improves the possibility of identifying families with the most extreme longevity phenotypes. With a mean follow-up time of 3.7 years the number of families with all participating siblings aged 95 years or more has increased by a factor of 5 to 750 families compared to when interviews were conducted. Thus, the GEHA project represents a unique source in the search for genes related to healthy ageing and longevity.

Polish Centenarians Programme. Multidisciplinary studies of successful ageing: aims, methods, and preliminary results.

Studies of centenarians as a model of successful ageing may help identify various environmental, social, psychological, and genetic factors supporting longevity. The scientific aims of the programme were to assess health status and environmental determinants of ageing of Polish centenarians, and to collect biological material for studying selected aspects of longevity, including genetic factors. The social aim of the project was to bring public attention to ageing of the population, as well as living conditions of elderly individuals. The intention of the authors of this paper is to present aims, scope, methods and preliminary results of the Polish Centenarians Programme, as well as to provide potential new partners for studying various aspects of longevity and ageing with the information about available materials collected during the programme. In this study, 346 subjects aged 100+ were visited, biological material was collected from 285 subjects, and 153 lymphocyte cell lines were immortalized.

The prevalence of chronic kidney disease and its relation to socioeconomic conditions in an elderly Polish population: results from the national population-based study PolSenior

BACKGROUND Rapidly progressing ageing of worldwide populations is likely to increase the occurrence of chronic kidney disease (CKD) in the next decades. However, until now little is known about the prevalence of CKD in the Polish elderly population. The aim of this study was to assess the prevalence of CKD and its relation to socioeconomic conditions in the Polish elderly population. METHODS A glomerular filtration rate estimated (eGFR) according to the CKD-EPI formula and urine albumin/creatinine ratio were determined in 3797 out of 4979 randomly selected elderly subjects from the national survey study PolSenior. Additionally, some socioeconomic factors related to the prevalence of CKD were also analysed. RESULTS The prevalence of CKD in the Polish elderly population was 29.4%. Only 3.2% of elderly subjects with CKD were aware of the disease. CKD was more frequent among urban dwellers, non-smokers, alcohol abstinents and those with low physical activity. Decreased eGFR was more frequent among less educated women, better educated men, blue collar female workers and white collar male workers. Increased albuminuria was associated with low physical activity. CONCLUSIONS (i) CKD affects almost one-third of the elderly Polish population. (ii) In Poland elderly subjects with CKD are usually unaware of their kidney disease. (iii) In Polish elderly population, CKD is more frequently present among urban residents, non-smokers, abstainers and less physically active people. (iv) Only in women is higher educational status related to the lower risk of CKD.

The assessment of cognitive impairment suspected of dementia in Polish elderly people: results of the population-based PolSenior Study.

The growing incidence of dementia in ageing societies is a major concern of health care organizations. Because of its detrimental influence on the mental and functional statuses of elderly people, it leads to increased economic burdens caused by the social and financial needs of patients with dementia and their caregivers. There has been no data concerning the prevalence of dementia in the elderly in the general Polish community so far. The main aim of the study was to assess the prevalence of cognitive impairment suspected of dementia among the Polish elderly and the relationships between cognitive performance and age, gender, place of residence and educational status. The presented data was the result of nationwide, multicentre PolSenior Study conducted from 2007 to 2011 in the Polish elderly population. Cognitive functions were evaluated using Mini-Mental State Examination (MMSE) performed by pre-trained nurses. The result of MMSE lower than 24 points was classified as cognitive impairment suspected of dementia and divided according to its severity into three stages: mild, moderate and severe dementia. The results were analysed in two ways: raw MMSE and MMSE scores after Mungas adjustment (MMSEadj), that is, corrected for age and educational level, and these were compared. To verify the suspicion of dementia an assessment was complemented by an interview of carers for the occurrence and course of memory disorders, treatment of dementia and by functional status assessment. In order to assess the prevalence of suspicion of dementia in the general Polish population, statistical analyses based on weighting were done. The suspicion of dementia on the basis of raw MMSE was made in 20.4% of respondents aged 65years and more, and after Mungas adjustment in 12.1% of older subjects. The prevalence of cognitive impairment grew with increasing age, as well as depending on the educational status of elderly respondents in both types of analyses; raw MMSE and MMSEadj. There was no significant difference in the prevalence of cognitive impairment according to gender in the general population (raw MMSE); however in analyses including MMSEadj results, the suspicion of dementia was made more often among men. Suspicion of dementia based on raw MMSE and MMSEadj results was made significantly more often among men than women at the age of 65-69years, and significantly more often among the oldest women, aged 90years and more. Suspicion of dementia was diagnosed more often in respondents living in rural communities (based on raw MMSE, but not on MMSEadj), which might be related to the differences in their educational status.

Cognitive Performance and Functional Status Are the Major Factors Predicting Survival of Centenarians in Poland

BACKGROUND Clinical and biochemical predictors of extreme longevity would be useful in geriatric practice but have still not been clearly defined. METHODS To identify the best nongenetic predictors of survival in centenarians, we examined 340 individuals aged 100+ years. A detailed questionnaire was completed, and comprehensive geriatric assessment and blood analyses were performed. Survival of study participants was checked annually over the period of 10 years. RESULTS In the univariate Cox proportional hazards model, a longer survival of centenarians was correlated with a higher adjusted Mini-Mental State Examination (MMSE(adj)) score (p < .000001), higher Activities of Daily Living (ADL) and adjusted Instrumental Activities of Daily Living (IADL(adj)) scores (p < .000001 and p = .00008, respectively), and younger age at the time of testing (p = .005). Blood pressure, lipid profile, and C-reactive protein and hemoglobin concentrations were not associated with survival. Multivariate analysis including age, sex, and the MMSE(adj) and ADL scores showed that both MMSE(adj) and ADL predicted survival (HR = 0.978 per each MMSE(adj) point, 95% CI: 0.964-0.993, p = .004; HR = 0.900 per each ADL point, 95% CI: 0.842-0.962, p = .002, respectively). In multivariate analysis with the ADL score substituted by the IADL(adj) score, the only predictor of survival was MMSE(adj) (HR = 0.973 per each MMSE(adj) point, 95% CI: 0.958-0.988, p = .0006). CONCLUSIONS Cognitive and functional performances are predictors of survival in centenarians.

Assessment of adiponectin and its isoforms in Polish centenarians

BACKGROUND The physiological mechanisms that promote longevity remain unclear. It has been suggested that insulin sensitivity is preserved in centenarians, whereas typical aging is accompanied by increasing insulin resistance. The oldest-old individuals display raised total adiponectin levels, despite the potential correlation between enhanced adiponectin and all-cause and cardiovascular mortality. AIM To evaluate the level of adiponectin and its isoforms in sera of centenarians and to assess associations between adiponectin and metabolic parameters. PARTICIPANTS A group of 58 Polish centenarians (50 women and 8 men, mean age 101±1.34 years) and 68 elderly persons (55 women and 13 men, mean age 70±5.69 years) as controls. MEASUREMENTS Serum samples were analyzed to evaluate the following parameters: adiponectin array (total adiponectin, HWM-, MMW- and LMW-adiponectin; all by ELISA methods), insulin (by IRMA methods), glucose and lipid profiles. HOMA-IR was calculated. Clinical data were collected. Statistical analyses were performed. RESULTS The concentrations of all adiponectin isoforms were significantly higher in the oldest-old participants. In the centenarian group, total adiponectin positively correlated with age and HDL-cholesterol, and HMW-adiponectin was negatively associated with insulin and triglycerides. The long-lived participants had a lower incidence of hypertension, type 2 diabetes, overweight and obesity, with lower concentrations of serum glucose and insulin, and reduced HOMA-IR. CONCLUSION Our findings support the thesis that centenarians possess a different adiponectin isoform pattern and have a favorable metabolic phenotype in comparison with elderly individuals. However, additional work is necessary to understand the relevance of these findings to longevity.

Temporal Information Processing and its Relation to Executive Functions in Elderly Individuals

Normal aging triggers deterioration in cognitive functions. Evidence has shown that these age-related changes concern also executive functions (EF) as well as temporal information processing (TIP) in a millisecond range. A considerable amount of literature data has indicated that each of these two functions sets a frame for our mental activity and may be considered in terms of embodied cognition due to advanced age. The present study addresses the question whether in elderly subjects the efficiency of TIP is related to individual differences in EF. The study involved 53 normal healthy participants aged from 65 to 78. In these subjects TIP was assessed by sequencing abilities measured with temporal-order threshold (TOT). It is defined as the minimum time gap separating two auditory stimuli presented in rapid succession which is necessary for a subject to report correctly their temporal order, thus the relation ‘before-after.’ The EF were assessed with regard to the efficiency of the executive planning measured with the Tower of London-Drexel University (TOLDX) which has become a well-known EF task. Using Spearman’s rank correlations we observed two main results. Firstly, the indices of the TOLDX indicated a coherent construct reflecting the effectiveness of executive planning in the elderly. Initiation time seemed dissociated from these coherent indices, which suggested a specific strategy of mental planning in the elderly based on on-line planning rather than on preplanning. Secondly, TOT was significantly correlated with the indices of TOLDX. Although some of these correlations were modified by subject’s age, the correlation between TOT and the main index of TOLDX (‘Total Move Score’) was rather age resistant. These results suggest that normal aging may be characterized by an overlapping of deteriorated TIP and deteriorated EF.

Prevalence of chronic pain in the elderly Polish population – results of the PolSenior study

Introduction Pain is the most common complaint of elderly people. In Poland, no large studies on the prevalence of chronic pain in the elderly were conducted until recently. Material and methods The study was a part of the PolSenior project, a cross-sectional multidisciplinary study on ageing of the Polish population, and included a randomly selected group of 716 people aged 55–59 years, and 4979 people over 65 years. The survey was conducted through a standardized questionnaire. An evaluation of pain occurrence, location, intensity and coexistence of pains in relation to gender, age and use of health care was performed. Results Chronic pain affected 42.0% of respondents aged 65 years and over (48.6% of women and 35.8% of men) as compared to 35.2% of the pre-elderly. The most common pain locations were the lumbar region (51.6%) and knees (41.0%). The average number of pain sites was 3.1 ±2.3. Average intensity of pain was 6.2 points on the VAS scale in people over 65 years and 6.0 points in the pre-elderly (NS). Average pain intensity increased significantly from 5.7 points in patients reporting pain in one place to 7.2 points in those reporting six pain sites. Elderly respondents with pain compared to those without pain more frequently reported physician visits performed at least once a month (54.6% vs. 48.4%, p < 0.001). Conclusions Polish elderly most frequently complained of low back and lower limb pain. In respondents reporting many sites of pain, an increase in the intensity of pain was observed. Elderly patients with chronic pain often use medical care.

Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project

Background: Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community‐dwelling older patients with a history of AF. Methods: The data were collected as part of the nationwide PolSenior project (2007–2012). Out of 4979 individuals (age range 65–104years), data on self‐reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15‐item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression. Results: Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self‐reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P<0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR=1.69; 95%CI: 1.43–2.00), stronger than heart failure, diabetes or coronary heart disease. Conclusions: In community‐dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke). HIGHLIGHTSDepression is independently associated with AF in population aged ≥65years.The results come from a study involving >4000 participants.The relationship with AF is stronger than with other cardiac diseases.

Self-rated health and its association with all-cause mortality of older adults in Poland: The PolSenior project

OBJECTIVES Predictive effect of self-rated health (SRH) on mortality in older adults has been observed. The purpose of the study was to analyze this association in Poles aged 65+. METHODS Data were obtained from the nationwide, multidisciplinary PolSenior project, conducted in a representative sample of older population. The study group comprised 4049 respondents (48.0% women) without significant cognitive deficit. SRH was measured using Visual Analog Scale. The analysis included selected socio-economic, health status and life-style factors. Mortality data were retrieved from the state registry. RESULTS During 5-year period, 414 women (21.4%) and 672 men (31.8%) have died, including 17.5% of women and 26.6% of men with good, 21.6% and 32.9% with fair, 36.2% and 55.3% with poor SRH, respectively. Kaplan-Meier survival curves for SRH revealed significant differences for both genders. Univariate Cox regression analysis revealed significant hazard ratios (HRs) for mortality among women and men with poor compared to good SRH [2.48 (1.83-3.37); 2.62 (2.04-3.36), respectively] and those with fair compared to good SRH [1.29 (1.03-1.60); 1.29 (1.10-1.52), respectively]. Age-adjusted HRs for mortality were significant between groups with poor and good SRH [women: 1.98 (1.46-2.68), men: 2.06 (1.60-2.64)]. Multivariate Cox proportional hazard regression model including revealed significant HRs for mortality between women with poor and good SRH [1.67 (1.06-2.64)]. CONCLUSIONS SRH was associated with mortality in both genders. After adjustment for age, this relationship was maintained in respondents with poor compared to good SRH. Inclusion of potential confounders demonstrated that SRH was an independent predictor of mortality only in women.