K Rockwood

..More must be done to encourage all physicians to use these techniques in caring for frail elderly people who are ill...

..This association could be due to indication bias, i.e., people who elect to take lipid-lowering agents (LLAs) may be healthier than those who do not, so that it may be these other health factors that explain their lower risk of dementia...

..to estimate the age-specific prevalence of diabetes mellitus in elderly people in Canada, and to examine the effect of method of ascertainment on the estimation of prevalence...

..The purpose of defining the new concept of VCI is to identify preventable risk factors. Importantly, not only physical health but also mental health should be monitored and treated...

..Large, systematic clinical studies of treated patients remain necessary to define reliable guides to successful treatment...

..Goal Attainment Scaling (GAS) measures multiple, individualized goals, but its responsiveness in comparative clinical trials has not been established...

..Future models of frailty should incorporate more precise operationalisation of the probability of frailty and better explain the relationship between disease, disability and frailty...

..The concept of mixed dementia should be extended to include vascular dementia in combination with dementias, other than Alzheimer's disease...

..The purpose of this study was to estimate the incidence of diabetes mellitus among elderly people in Canada and the relative risks of death and admission to an institution among elderly diabetic patients...

..Estimates of the feasibility, reliability, and construct validity of these measures in large, heterogeneous samples are necessary to establish their importance relative to traditional measures of function...

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..delirium is common and is associated with many adverse short-term consequences...

..The strength of educational interventions needs to be assessed carefully. Interventions which are time-sensitive, less complex, directed to observable, patient-focused endpoints are more likely to be successful...

..To better understand and treat ischaemic causes of cognitive impairment, the concept of VaD should be expanded to include patients who do not meet traditional dementia criteria...

..The RetroBCRS used by an expert physician with a reliable informant is a valid method of detecting dementia and determining whether AD was present...

..With a 45- to 90-minute time investment, physicians can obtain an inventory of the factors that threaten an elderly patient's independence and gain a fuller understanding of the patient's complex needs...

..To assess the efficacy and safety of galantamine in Alzheimer's disease at 3 months using flexible dose escalation...

..CONCLUSION: Daytime sleepiness itself is not associated with an increased risk of death when other factors are taken into account. Daytime sleepiness may be a proxy for other morbid conditions and therefore for overall tiredness...

..Here, we compared 3 frailty measures in relation to cognitive changes and mortality in the Canadian Study of Health and Aging (CSHA)...

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..Smoking has adverse effects on a variety of organ systems but little is known about the relationship between smoking and frailty. We aimed to investigate differences in health status between smoking and non smoking older adults...

..1, 1.0 to 4.5). Of 32 participants alive without dementia, cognition had deteriorated in seven and improved in four. Half of those with vascular CIND developed dementia within 5 years, suggesting a target for preventive interventions...

..quot; Limitations of the six items used to assess the physical environment and ways in which to improve the sensitivity of the items, consequently avoiding measurement bias, are discussed...

..In hindsight, several important features of the study would be repeated. Future studies might profitably consider a longer funding period for analysis, and a more strategic approach to in-depth, supplementary studies...

..2, GDS 4.8, FRS 27.5, DAD 16.9). CONCLUSION: Living situation is related to the severity of dementia at diagnosis. Primary care providers should have a low threshold for case-finding in older adults who live with family or friends...

..The SARF questions incorporating high blood pressure and treatment appear preferable to assess the risks associated with hypertension...

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..The calculation of the CDS from data contained in the Canadian Study of Health and Aging (CSHA) is described. This measure can be used to estimate comorbidity within the CSHA database...

..There is insufficient evidence for carrying out routine recommendations for frail elderly people. Treatment of comorbid illnesses dictates choice of therapeutic agent...

..Factors associated with recovery and non-progression in MCI require elucidation...

..Patient and carer descriptions of misplacing in clinical interviews are reported here...

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..To compare the relative prognostic importance in older people of diagnosed diabetes, the number and severity of co-morbidities and frailty...

..In conclusion, motor impairment and frailty are common in older people and are associated with an increased risk of cognitive decline and dementia. GPI is common in CIND, while GPI and parkinsonism are both common in dementia...

..Six cholinesterase inhibitors (ChEIs) have been tested in people with Alzheimer's disease, using methods currently required for regulatory approval. The clinical importance of their treatment effects is controversial...

..On this basis, an improved version of the HABAM was developed, suitable in its graphical form for everyday clinical use and for research, using the interval numbers that were generated...

..Two CX3CR1 mutations, V249I and T280M, reportedly decrease coronary artery disease (CAD) risk independent of established risk factors. An I249 protective effect is attributed to reducing CX3CR1 binding to fractalkine, its ligand...

..A secondary objective was to isolate the effect of the AED phenytoin on the development of dementia and AD...

..This variability further complicates the difficulty of dementia's high dimensionality--Alzheimer's disease affects many aspects of cognition, function, and behavior...

..We suggest that, because neurons expressing BuChE may be involved in cognition, there is merit to further evaluation of selective BuChE inhibitors in treating cognitive dysfunction...

..Still, the first reports appear to have overestimated the extent of protection, so that unless there are important effects achievable with specific statins, a more than a modest role for statins in preventing AD seems unlikely...

..Less is known about the relationship between falls and frailty defined as deficit accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation...

..The model is valuable for estimating how changes in health can influence mortality across the life course from late middle age...

..This may be because of death being a competing risk for incident late-onset dementia...

..Mutations in the presenilin-1 gene (PS1) account for a majority of patients with early-onset familial AD. However, the clinical indications and algorithms for genetic testing in dementia are still evolving...

..23 (95% CI 1.18-1.29) and institutionalization (HR 1.20; 1.10-1.32). CONCLUSIONS: In a population survey, the FI-CGA is a valid means of quantifying frailty from routinely collected data...

..In samples (e.g., clinical/institutional) in which most people are frail, there is no relationship with age, suggesting that there are maximal values of deficit accumulation beyond which survival is unlikely...

..There is a need for empirical studies to define criteria for vascular cognitive impairment (VCI) subtypes. In this paper, we report the predictive validity of a subtype classification scheme based on clinical and radiographic features...

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..CONCLUSION: CIND consists of a heterogeneous group of disorders that can be classified syndromically. Many subclassess - not just those with pre-AD CIND - are at high risk of progression to dementia, usually to Alzheimer's disease...

..We compared cognitive, functional, and behavioural outcomes in patients with VCI to patients with no cognitive impairment (NCI), and Alzheimer's disease (AD)...

..We compared the neuropsychological performances of people with incident VCI, incident AD, and no cognitive impairment (NCI) 5 years before their clinical diagnoses...

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..To compare 3 methods of describing the frailty of older adults in nursing homes...

..Adjusting for apolipoprotein E4 status did not change the point estimates of the ORs. The greatest impact of LLAs was seen in the CIND subtype circumscribed memory impairment...

..Given that cognition also changes with age, we wondered whether the same model might also describe the accumulation of errors in cognitive test scores in community-dwelling older adults...

..The issues to be resolved prior to the use of a survival design for conversion from vascular MCI to dementia will be discussed...

..CONCLUSIONS: From a public health viewpoint, recognition of VCI before the development of dementia and correction of vascular burden on the brain may lead to a global decrease of incident dementia...

..We investigated the relationship between diabetes and incident dementia (including Alzheimer's disease and vascular cognitive impairment) in a 5-year longitudinal study...

..CONCLUSIONS: Neuropsychological measures can indicate risk of dementia in patients with vascular CIND. This study did not suggest a prediction-to-progression profile distinct from that seen in Alzheimer disease...

..Even for patients who do, the proportion identified with VaD varies widely. Criteria based on empirical analyses need to be developed and validated...

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..VCI might be preventable, although the evidence for this is not as complete as it is for the prevention of stroke. Future studies into specific therapies for VCI will need to consider the clinical features and outcomes carefully...

..While greater physical activity is generally associated with a lower odds of both dementia and CIND, whether this effect applies across subgroups is not known...

..Dedicated clinical trials are now under way, and their results are awaited with great interest...

..To understand how there can be treatment success short of cure, without knowing at the outset what form that success may take, will require systematic observation and careful description of patients' experiences...

..Epidemiologic reports indicate that lipid-lowering agents (LLAs) protect against dementia. We hypothesized that LLAs might affect cholinergic systems. The effects of LLAs on the activity of cholinesterases were examined...

..From late middle age, transitions in health states occur with a regularity that is easily modeled. Improvements in health can occur at any age. At all ages, there is a limit to deficit accumulation...

..Decreased initiation of activities is a common symptom in Alzheimer's disease (AD) and creates significant burden for carers, yet little is known about how patients, carers and treating physicians describe this problem...

..We evaluated whether impairments on the Disability Assessment for Dementia (DAD) and Functional Rating Scale (FRS) can predict progression to AD...

..To recommend how the description of clinically detectable treatment effects might be improved for antidementia drug trials...

..This study examined the relation between two risks for Alzheimer's disease (AD): the apolipoprotein (APOE) epsilon4 allele and poor memory test performance...

..Attempts to treat VaD had varying degrees of success, but it now appears that many forms of VCI might be preventable, especially with good control of vascular risk factors in middle age...

..To date, there is limited information from large-scale studies regarding outcomes of persons specifically identified with cognitive impairment but no dementia (CIND)...

..The case definition of NPDementia identified individuals with cognitive impairment that is unlikely to resolve and likely to progress to dementia...

..To study the test-retest and interrater reliability of the Hierarchical Assessment of Balance and Mobility (HABAM) in frail older adults...

..The aims of the present study were to operationalize social vulnerability according to a deficit accumulation approach, to compare social vulnerability and frailty, and to study social vulnerability in relation to mortality...

..To determine what change in the Modified Mini-Mental State Examination (3MS), a validated and widely used cognitive screening tool for which meaningful change scores have not been clearly characterized, should be considered meaningful...

..The construct of vascular cognitive impairment (VCI) includes many whose care is or will be costly. Nevertheless, estimates of these costs are not well described. We therefore set out to estimate the societal costs of VCI in elderly people...

..We aimed to: 1) understand changes in cognition and function in people taking galantamine; (2) identify treatment subgroups...

..To investigate whether exercise confounds the relationship between folate and cerebrovascular events, all-cause dementia, and Alzheimer's disease...

..We examined delirium prevalence and outcomes in a large cohort of older Canadians living outside of acute care...

..To measure relative fitness and frailty in older people without specific frailty instruments and to relate that measurement to long-term health outcomes...

..Responders generally also show improved cognition and function, perhaps as an aspect of improved executive function...

..An important aspect of clinical meaningfulness is the extent to which an intervention meets the goals of treatment...

..77 for 18-month and 0.70 for 70-month mortality). INTERPRETATION: Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information...

..SRT use may be an independent measure of potential treatment responsiveness...

..75; CI, 1.27-2.42) and AD (OR, 1.86; CI, 1.29-2.67) but attenuated the APOE epsilon4 effect in AD. VCI and AD have different risk profiles and outcomes, but subtle memory difficulties may be an early feature of both...

..Frailty and fitness are important attributes of older persons, but population samples of their prevalence, attributes, and outcomes are limited...

..Intrarater reliability was 0.95. CONCLUSION: The FI-CGA is a valid, reliable, and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes...

..The phenomenon of slowing or non-progression itself should be investigated, and such investigations likely should extend to people now classified as having mild dementia...

..Steps should be taken to improve the specificity of treatment effect description and to incorporate patient/caregiver preferences in global measures about disease treatment in dementia...

..Present functional performance measures may not be sufficiently responsive for use as the primary endpoint of small intervention studies; alternatively, stimulation of GH may not result in significant functional improvement...

..How best to improve sensitivity to change of functional measurements is controversial, but it is necessary to do so in order to evaluate the full effects of treatment...

..2+/-0.8%. CONCLUSION: An ANN provided more accurate survival classification than an unweighted frailty index. The data suggest that the concept of biological redundancy might be operationalized from health survey data...

..992 for women and.955 for men) with survival. CONCLUSIONS: A frailty index, based on self-report data, can be used as a tool for capturing heterogeneity in the health status of older adults...