Kenneth J Rockwood

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

..Many definitions of frailty exist, but few have been directly compared. We compared the relationship between a definition of frailty based on a specific phenotype with one based on an index of deficit accumulation...

..Understanding people and their needs as deficits accumulate is an exciting challenge for clinical research on frailty and its management by geriatricians...

..By recognizing frailty and measuring it objectively, clinicians can better engage patients and their loved ones in difficult discussions about treatment plans and prognosis, and ultimately deliver better palliative care...

..Smoking is common in China, where the population is aging rapidly. This study evaluated the relationship between smoking and frailty and their joint association with health and survival in older Chinese men and women...

..Clinical research into outcomes associated with frailty in specific settings is ongoing and will be instrumental to the provision of appropriate care of older adults in the future...

..Unless we understand the complexity of the needs of frail older adults, we will neither be able to treat them effectively nor evaluate our efforts sensibly.Please see related article http://www.biomedcentral.com/1741-7015/10/120...

..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...

..This review seeks to address how frailty is recognised and managed, especially in the realm of primary care...

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

..Less is known about deficit accumulation in China, the country with the world's largest number of older adults...

..Our objective was to identify factors associated with short-term (by discharge) and long-term (by 6 month) incomplete recovery of function following delirium...

..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...

..A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index...

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

..Future studies include the application of network analyses and stochastic analytical techniques to the evaluation of the frailty index and the description of other state variables in relation to frailty...

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..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...

..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...

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

..We examined how this change compared with measures of clinical meaningfulness...

..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...

..Furthermore, less is known about how frailty changes over time among younger adults. We estimated the prevalence and outcomes of frailty, in relation to accumulation of deficits, across the adult lifespan...

..These roles will best be executed by hearing what patients and caregivers tell us about dementia, and its response to treatment...

..In keeping with the reliability theory of aging, this would be quantitated by attenuation in the slope of a Frailty Index (FI) with age. The more deficits, the less steep the slope and the less redundancy...

..The objective of this study was to evaluate whether vascular risk factor clinical practice guidelines consider cognition as an outcome or in connection with treatment compliance...

..In an investigator-initiated, clinical trial of galantamine, we investigated the extent to which a 4-point change classifies goal attainment by individual patients...

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

..07; 95% confidence interval: 0.90-1.29, frailty HR 35.3; 95% confidence interval: 20.4-61.1). The data do not support an association between ApoE polymorphism and frailty. This result did not depend on how frailty was defined...

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

..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...

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

..The need for progress on our understanding of frailty is evident, but for now, there is insufficient evidence to accept a single definition of frailty...

..The artist programme has inspired a design initiative for the improvement of the physical environment for older patients, and has created a unique art collection that is becoming a resource for scholarship...

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

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..We sought to identify and categorize clinically recognizable effects of donepezil treatment in Alzheimer's disease...

..Of note, the variation coefficient, initially high, decreased from middle age on. Being able to quantify frailty means that health risks can be summarised at both the individual and group levels...

..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...

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

..The data suggest a level of frailty beyond which, even in developed countries, further deficit accumulation is not sustainable...

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

..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...

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

..To evaluate the prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation...

..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...

..The importance of executive dysfunction is increasingly recognized in the dementia syndrome. Although executive dysfunction has been associated with subcortical ischemic lesions, it may not be unique to VCI or to its clinical subtypes...

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

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

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..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...

..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...

..We investigated whether social vulnerability, defined as an index comprising many social factors, is associated with cognitive decline...

..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...

..Verbal repetition is a common symptom and target for treatment in Alzheimer disease (AD), yet little is known of its manifestations in the daily lives of patients. Here we characterized the nature of verbal repetition and its correlates...

..We studied a symptom checklist, completed separately by caregivers and by clinicians, to identify patterns of change associated with donepezil treatment...

..The model suggests that all health transitions, including health improvement, worsening, and death, can be summarized in a unified stochastic model with a few interpretable parameters...

..The MCI criteria identify people at increased risk of AD, but the potential for improvement of a substantial proportion of those with MCI needs to be acknowledged...

..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...

..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...

..Age-related deficit accumulation is highly characteristic, and can be modeled as a stochastic process with readily interpretable parameters...

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

..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...

..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...

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

..Clinicians appear to be skeptical of cognitive changes not supported by like changes in function or behaviour...

..2-47.9), dementias other than Alzheimer disease (OR: 6.5, 95% CI: 2.1-20.8), and decreased survival (hazard ratio: 2.8, 95% CI: 1.6-4.6). CONCLUSIONS: Patients with CIAO are clinically identifiable and have distinct outcomes...

..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...

..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...

..The effect of parental age on fitness/frailty in late life is unknown. We aimed to investigate the relationships between parental age and frailty and longevity in older adults...

..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...

..Cognition and mortality are each also affected by biological sex, which might modify the effect of exercise. We investigated how sex mediates the impact of exercise on mortality and 5-year changes in cognition...

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

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

..At the individual level, KDD suggests that more precise diagnosis seems possible as well as individual life expectancy prediction. Biomedical databases appear to hold the potential for novel insights when explored by systematic modeling...

..This method consists of systematizing facts that cannot necessarily be explained by considering those facts in isolation...

..To investigate whether dementia risk can be estimated using only health deficits not known to predict dementia...