Ruby Yu

Incremental Predictive Value of Sarcopenia for Incident Fracture in an Elderly Chinese Cohort: Results From the Osteoporotic Fractures in Men (MrOs) Study

OBJECTIVES We examined whether sarcopenia is predictive of incident fractures among older men, whether the inclusion of sarcopenia in models adds any incremental value to bone mineral density (BMD), and whether sarcopenia is associated with a higher risk of fractures in elderly with osteoporosis. METHODS A cohort of 2000 community-dwelling men aged ≥65 years were examined for which detailed information regarding demographics, socioeconomic, medical history, clinical, and lifestyle factors were documented. Body composition and BMD were measured using dual energy X-ray absorptiometry. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013, and related to sarcopenia and its component measures using Cox proportional hazard regressions. The contribution of sarcopenia for predicting fracture risk was evaluated by receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS During an average of 11.3 years of follow-up, 226 (11.3%) men sustained at least 1 incident fracture, making the incidence of fractures 1200.6/100,000 person-years. After multivariate adjustments, sarcopenia was associated with increased fracture risk (hazard ratio [HR], 1.87, 95% confidence interval [CI], 1.26-2.79) independent of BMD and other clinical risk factors. The addition of sarcopenia did not significantly increase area under curve or IDI but significantly improved the predictive ability on fracture risk over BMD and other clinical risk factors by 5.12% (P < .05) using the NRI approach. In addition, the combination of osteoporosis and sarcopenia (sarco-osteoporosis) resulted in a significantly increased risk of fractures (HR, 3.49, 95% CI, 1.76-6.90) compared with those with normal BMD and without sarcopenia. CONCLUSIONS This study confirms that sarcopenia is a predictor of fracture risk in this elderly men cohort, establishes that sarcopenia provides incremental predictive value for fractures over the integration of BMD and other clinical risk factors, and suggests that the combination of osteoporosis and sarcopenia could identify a subgroup with a particularly high fracture risk.

Incidence, reversibility, risk factors and the protective effect of high body mass index against sarcopenia in community-dwelling older Chinese adults

We examined the incidence and the reversibility of sarcopenia and their associated factors over a 4‐year period using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria.

Sarcopenia Combined With FRAX Probabilities Improves Fracture Risk Prediction in Older Chinese Men

OBJECTIVES To examine whether the inclusion of sarcopenia in prediction models adds any incremental value to fracture risk assessment tool (FRAX). DESIGN, SETTING, AND PARTICIPANTS Data from a prospective cohort of 4000 community-dwelling Chinese men and women aged 65 years and older with adjudicated fracture outcomes were analyzed. MEASUREMENTS At baseline, femoral neck bone mineral density (BMD) was assessed, as were the clinical risk factors included in FRAX, along with additional appendicular skeletal muscle mass, grip strength, and gait speed. Sarcopenia was defined according to the Asian Working Group for Sarcopenia algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013. RESULTS Of 4000 participants, 565 experienced at least 1 type of incident fracture and 132 experienced a hip fracture during a follow-up of 10.2 years. Hazard ratios (HRs) for 1-unit increase in FRAX score without BMD in men were 1.12 [95% confidence interval (CI) 1.08-1.16] for all fractures combined and 1.19 (95% CI 1.13-1.27) for hip fracture, and in women were 1.04 (95% CI 1.03-1.06) for all fractures combined and 1.08 (95% CI 1.06-1.11) for hip fracture. Similar to results of the FRAX score without BMD, HRs for 1-unit increase in FRAX score with BMD in men were 1.04 (95% CI 1.03-1.06) for all fractures combined and 1.19 (95% CI 1.13-1.25) for hip fracture, and in women were 1.04 (95% CI 1.03-1.05) for all fractures combined and 1.06 (95% CI 1.05-1.08) for hip fracture. Sarcopenia was significantly associated with all fractures combined (Adjusted HR 1.87; 95% CI 1.30-2.68) and hip fracture (Adjusted HR 2.67; 95% CI 1.46-4.90) in men but not in women. The discriminative values for fracture, as measured by the area under the receiver operating characteristic curve, were 0.60-0.73 and 0.62-0.76 for FRAX without and with BMD, respectively. Adding sarcopenia did not significantly improve the discriminatory capacity over FRAX (P > .05). Using reclassification techniques, sarcopenia significantly enhanced the integrated discrimination improvement by 0.6% to 1.2% and the net reclassification improvement by 7.2% to 20.8% in men, but it did not contribute to predictive accuracy in women. CONCLUSIONS Sarcopenia added incremental value to FRAX in predicting incident fracture in older Chinese men.

Trends in Prevalence and Mortality of Dementia in Elderly Hong Kong Population: Projections, Disease Burden, and Implications for Long-Term Care

Background. We describe the trends in prevalence and mortality of dementia among older people in Hong Kong over time. Projections of the number of older people with dementia through 2039 and estimation of the disease burden are also included. Methods. Prevalence data were extracted from previous studies in Hong Kong. Mortality data were obtained from the Department of Health of Hong Kong. Projections of the number of people with dementia were calculated by applying the prevalence rates of dementia obtained from previous studies to Hong Kong population projections. The burden of dementia was measured by Disability-Adjusted Life Years (DALYs). Results. The number of people aged 60 and above with dementia is projected to increase by 222%, from 103,433 in 2009 to 332,688 in 2039, with a large proportion of those living in institutions. The number of deaths due to dementia among people aged 60 and above has more than doubled between 2001 and 2009. Mortality rates for dementia have also risen. In 2006, about 286,313 DALYS were lost due to dementia. Conclusions. The information presented may be used to formulate a long-term care strategy for dementia of the ageing population in Hong Kong.

Association of general and abdominal obesities and metabolic syndrome with subclinical atherosclerosis in asymptomatic Chinese postmenopausal women

Objective: This study aimed to investigate the relationships between obesity, especially abdominal obesity, andmetabolic syndrome (MS) with carotid intima-media thickness (IMT) and plaque, markers of subclinical atherosclerosis, in asymptomatic Chinese postmenopausal women in Hong Kong. Design: A total of 518 postmenopausal women aged 50 to 64 years were recruited through random telephone dialing. Body mass index (BMI), waist circumference, waist-to-hip ratio, sociodemographic characteristics, blood pressures, medical, biochemical and lifestyle factors were obtained. MS was defined on the basis of the National Cholesterol and Education Program, Adult Treatment Panel III criteria. Subclinical atherosclerosis was determined by measuring IMT and plaque using high-resolution B-mode ultrasonography. Results: Women with a BMI of 25 kg/m2or greater, a waist circumference of 80 cm or greater, a waist-to-hip ratio of 0.85 or greater, or MS were observed to have higher IMT values and prevalence of plaque. Multivariate analyses revealed that waist circumference was significantly associated with IMT independent of age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas a waist-to-hip ratio of 0.85 or greater was significantly associated with plaque (odds ratio = 1.7; 95% CI: 1.0-2.8) after controlling for age, hormone therapy, lifestyle and sociodemographic factors, BMI, and the traditional cardiovascular risk factors. MS was also associated with IMT after adjustment for age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas its association with plaque was also significant (odds ratio = 1.7; 95% CI: 1.0-2.6) after controlling for age. Conclusions: Abdominal obesity and MS are independent of general obesity markers of subclinical atherosclerosis in Chinese postmenopausal women.

Use of a Therapeutic, Socially Assistive Pet Robot (PARO) in Improving Mood and Stimulating Social Interaction and Communication for People With Dementia: Study Protocol for a Randomized Controlled Trial

Background Socially assistive robotics is a growing area for geriatric research. Objective This single-blind, randomized controlled trial (RCT) aims to investigate the use of PARO, a therapeutic, socially assistive pet robot, in improving mood, and stimulating social interaction and communication for people with dementia in the community. Methods For the study, 40 community-dwelling older Chinese adults (≥60 years) with mild to moderate dementia will be recruited and randomly assigned to the PARO therapy group or the psychosocial activities control group. Both treatments consist of six, 30-minute weekly sessions, which will be conducted in a geriatric day hospital. Subjects in both groups will be assessed by a trained research assistant at baseline (pre-), during, and post-treatment. Mood (assessed with a simplified face scale), social interaction, and communication (ie, facial expressions and reactions towards each treatment, assessed with an observation table) will be the primary outcome measures. Secondary outcome measures will include assessments on cognitive function (Mini-Mental State Examination) and depressive symptoms (Cornell Scale for Depression in Dementia), as well as caregiver burden (Zarit Burden Inventory). Subjective impression towards each treatment and qualitative comments from the caregivers, facilitator, and therapists will also be obtained. Results Recruitment to the pilot study began in 2014 and the last subject is expected to complete their post-treatment assessment in 2015. Conclusions This will be the first RCT using PARO to improve mood, and stimulate social interaction and communication in the care of older people with dementia, as well as provide an evidence basis for the use of PARO in dementia care in Hong Kong. Trial Registration The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000037606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000037606 (Archived by WebCite at http://www.webcitation.org/6Xi7uXdu9).

Altered Frontal Lateralization Underlies the Category Fluency Deficits in Older Adults with Mild Cognitive Impairment: A Near-Infrared Spectroscopy Study

Individuals with mild cognitive impairment (MCI) have been consistently found to have category fluency deficits. However, little is known about the neural basis of these deficits. A diversity of neuroimaging studies has revealed left-lateralized prefrontal activations due to verbal processing and control functions during the performance of category fluency tasks. Given the reports of structural and functional abnormalities in the prefrontal cortices in individuals with MCI, it is conceivable that these individuals would also exhibit altered prefrontal activation patterns during a category fluency task. The present study aimed to investigate the prefrontal dynamics during the category fluency task in older adults with MCI by using near-infrared spectroscopy (NIRS). Twenty-six older adults with MCI were compared with 26 older adults with normal cognition (NC) who were matched in age, gender, handedness, and educational level. All participants performed a category fluency task while the prefrontal dynamics were recorded. The results showed that the MCI group generated fewer unique words, made fewer switches between subcategories, and generated fewer new subcategories than did the NC group. Importantly, the NIRS results showed that the NC group exhibited a left lateralization of frontal activations during the category fluency task, while the MCI group did not exhibit such a lateralization. Furthermore, there was a significant positive correlation between the category fluency performance and the extent of lateralization, suggesting that the category fluency deficits in the MCI group could be related to frontal dysfunction. That is, the rightward shift of frontal activations in the MCI group may reflect the presence of cortical reorganization in which the contralateral regions (i.e., the right hemisphere) are recruited to take over the function that is declining in the specialized regions (i.e., the left hemisphere). Our lateralization finding may serve as an objective neural marker for distinguishing between normal aging and MCI. Our study highlights that an alteration of neural functioning is already present at the prodromal stage of dementia.

Cardiorespiratory fitness and its association with body composition and physical activity in Hong Kong Chinese women aged from 55 to 94 years

BACKGROUND Low levels of cardiorespiratory fitness have proven to be associated with a higher risk of premature death from all causes, specifically from cardiovascular disease. However, there has been no study conducted to describe the cardiorespiratory fitness normative values in Chinese midlife and elderly. OBJECTIVES To provide normative values of cardiorespiratory fitness expressed as maximal oxygen uptake (VO(2max)) and its association with body composition and physical activity in Chinese midlife and elderly women in Hong Kong. METHODS 659 Chinese women aged from 55 to 94 years were recruited from two existing cohorts: the carotid atherosclerosis in women Hong Kong cohort study and the Osteoporotic Fractures in Women (MsOS) Hong Kong cohort study. Symptom-limited maximal exercise testing on an electrically braked bicycle ergometer was performed to assess VO(2max), where the subject was connected to a calibrated metabolic cart for gas analysis. Their body composition and physical activity data were also assessed. RESULTS The body mass index was 23.4 kg/m(2) and the mean fat mass and lean body mass were 16.6 kg and 37.3 kg, respectively. The mean VO(2max) was 20.3±4.1 ml/kg/min (range, 7.9-35.7 ml/kg/min). VO(2max) decreased with age, with the rate of decline 0.25 ml/kg/min/yr (7.1% per decade). In a subgroup of 475 women from the MsOS study, the decline in VO(2max) was found to depend on ageing (β=0.31, P<0.001), body mass index (β=-0.30, P<0.001) and levels of physical activity (β=0.02, P<0.001). Fat mass was also independently associated with VO(2max) (β=-0.20, P<0.001). CONCLUSIONS This study describes the normative values of VO(2max) in a sample of Chinese midlife and elderly women which provides a valuable reference to assess health and fitness in Chinese elderly. Results from this study also suggested that body composition and levels of physical activity were important determinants of the age-related decline in VO(2max).

Psychological factors and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong.

BACKGROUND Substantial evidence shows that psychological factors are associated with cardiovascular diseases. However, data on the association between psychological factors and subclinical atherosclerosis is lacking in postmenopausal Chinese women. OBJECTIVES To examine the associations of perceived stress and trait anxiety with subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong. Their relationships with biological and behavioral risk factors were also examined. METHODS Between 2002 and 2004, we recruited 518 postmenopausal women aged 50-64 years. Perceived stress and trait anxiety were evaluated by the perceived stress scale and the state-trait anxiety inventory, respectively. Subclinical atherosclerosis was determined by measuring carotid intima-media thickness (IMT) and plaque using B-mode ultrasonography. RESULTS Perceived stress and trait anxiety showed no significant association with IMT or plaque. Multivariate analyses showed high perceived stress scores were associated with an increased risk of elevated total cholesterol (OR=2.10; 95% CI=1.17-3.77) and elevated low-density lipoprotein cholesterol (LDL-C) (OR=2.39; 95% CI=1.36-4.21). High trait anxiety scores were associated with a 2.7-fold risk of elevated LDL-C (OR=2.74; 95% CI=1.56-4.80). Women with high perceived stress or trait anxiety scores were more likely to be physically inactive. CONCLUSIONS Perceived stress and trait anxiety were associated with atherogenic lipid levels, but not subclinical atherosclerosis. Maintaining high physical activity may help alleviate psychological stress and anxiety.

Carotid atherosclerosis and the risk factors in early postmenopausal Chinese women.

OBJECTIVES To describe the distribution of intima-media thickness (IMT) and the prevalence of plaque by carotid segments, walls and sides, and to examine their associated risk factors in asymptomatic, early postmenopausal Chinese women in Hong Kong. METHODS Between 2002 and 2004, the study recruited 518 postmenopausal women aged 50-64 years. They were examined by B-mode ultrasound to measure the IMT and the prevalence of plaque at the near and far walls of common carotid (CCA), bifurcation (bulb), and internal carotid (ICA) of both the left and right carotid arteries. Blood pressures, obesity indices, lipids and glucose levels, sociodemographic, medical and lifestyle factors were also obtained. RESULTS The mean IMT was 0.76+/-0.12 mm (range: 0.53-1.33 mm). IMT was significantly thicker on the far wall than on the near wall and differed among segments (being thickest at the bulb and the narrowest at the ICA). 21.8% had at least one plaque in the carotid artery with most of the plaque found at the bulb area. Systolic blood pressure had statistically significant relationship with IMT that were fairly homogeneous among different segments. Lipids were associated with the CCA and bulb IMT, but not the ICA IMT. Diabetes predicted only CCA IMT. Older age, higher waist-hip-ratio and low-density lipoprotein cholesterol were significant predictors of plaques at all sites combined. CONCLUSIONS We described the distribution of IMT and the prevalence of plaque in asymptomatic, early postmenopausal Chinese women. Associations of risk factors with IMT of different arterial segments were also observed.