The Effect of Diabetes Medication on Cognitive Function: Evidence from the PATH Through Life Study

Objective. To examine the effect of diabetes treatment on change of measures of specific cognitive domains over 4 years. Research Design and Methods. The sample was drawn from a population-based cohort study in Australia (the PATH Through Life Study) and comprised 1814 individuals aged 65-69 years at first measurement, of whom 211 were diagnosed with diabetes. Cognitive function was measured using 10 neuropsychological tests. The effect of type of diabetes treatment (diet, oral hypoglycemic agents, and insulin) on measures of specific cognitive domains was assessed using Generalized Linear Models adjusted for age, sex, education, smoking, physical activity level, BMI, and hypertension. Results. Comparison of cognitive function between diabetes treatment groups showed no significant effect of type of pharmacological treatment on cognitive function compared to diet only group or no diabetes group. Of those on oral hypoglycaemic treatment only, participants who used metformin alone had better cognitive function at baseline for the domains of verbal learning, working memory, and executive function compared to participants on other forms of diabetic treatment. Conclusion. This study did not observe significant effect from type of pharmacological treatment for diabetes on cognitive function except that participants who only used metformin showed significant protective effect from metformin on domain of verbal learning, working memory, and executive function.The PATH Through Life Study was funded by National Health and Medical Research Council (NHMRC) Grants (973302, 179805, and 350833). Kaarin J. Anstey and Nicolas Cherbuin were supported by NHMRC Fellowships (002560 and 1063907, resp.). Pushpani M. Herath was supported by Australian National University International Student Scholarship and Australian Research Council Centre for Excellence in Population Ageing Research (CEPAR)

Patient initiated aggression and violence in the Australian general practice setting

This is the first national study to be conducted in Australia examining the incidence and prevalence of violence against general practitioners and general practice staff.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

A self-report risk index to predict occurrence of dementia in three independent cohorts of older adults: The ANU-ADRI

Background and Aims: The Australian National University AD Risk Index (ANU-ADRI, http://anuadri.anu.edu.au) is a self-report risk index developed using an evidence-based medicine approach to measure risk of Alzheimer's disease (AD). We aimed to evaluate the extent to which the ANU-ADRI can predict the risk of AD in older adults and to compare the ANU-ADRI to the dementia risk index developed from the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study for middle-aged cohorts. Methods: This study included three validation cohorts, i.e., the Rush Memory and Aging Study (MAP) (n = 903, age ≥53 years), the Kungsholmen Project (KP) (n = 905, age ≥75 years), and the Cardiovascular Health Cognition Study (CVHS) (n = 2496, age ≥65 years) that were each followed for dementia. Baseline data were collected on exposure to the 15 risk factors included in the ANU-ADRI of which MAP had 10, KP had 8 and CVHS had 9. Risk scores and C-statistics were computed for individual participants for the ANU-ADRI and the CAIDE index. Results: For the ANU-ADRI using available data, the MAP study c-statistic was 0.637 (95% CI 0.596-0.678), for the KP study it was 0.740 (0.712-0.768) and for the CVHS it was 0.733 (0.691-0.776) for predicting AD. When a common set of risk and protective factors were used c-statistics were 0.689 (95% CI 0.650-0.727), 0.666 (0.628-0.704) and 0.734 (0.707-0.761) for MAP, KP and CVHS respectively. Results for CAIDE ranged from c-statistics of 0.488 (0.427-0.554) to 0.595 (0.565-0.625). Conclusion: A composite risk score derived from the ANU-ADRI weights including 8-10 risk or protective factors is a valid, self-report tool to identify those at risk of AD and dementia. The accuracy can be further improved in studies including more risk factors and younger cohorts with long-term follow-up. © 2014 Anstey et al

Risk and protective factors included from each cohort.

<p>NHMRC- Australian National Health and Medical Research Council, MET- Metabolic Equivalent, FFQ- Food Frequency Questionnaire, CES-D- Centre for Epidemiology Scale for Depression. NA = Not available or data not compatible with ANU-ADRI scoring.</p

Dementia cases per quartile score on the ANU-ADRI for young-old and old-old in the CVHS study.

<p>Dementia cases per quartile score on the ANU-ADRI for young-old and old-old in the CVHS study.</p

Characteristics and accuracy of CAIDE for predicting AD and dementia in the three cohort studies.

*<p>cholesterol data were unavailable for the KP study.</p

Characteristics and accuracy of ANU-ADRI for predicting AD and dementia in the three cohort studies.

<p>Note. The results for quartiles are the mean score within each quartile, the range of scores within each quartile of the observed ANU-ADRI scores within each cohort.</p>*<p>Common variables for three studies included; age, sex, education, diabetes mellitus, smoking, and alcohol.</p

Incidence of AD (per 1000 person-years) and hazards ratios for AD by quartile of ANU-ADRI score.

*<p>There was a large amount of missing data for the CVHS on length of follow-up.</p

Descriptive statistics for the three evaluation cohorts, their measured risk and protective factors, and the points allocated to each factor on the ANU-ADRI.

<p>Note. NA = Data not available either because it was not collected or collected but not in a format compatible with the ANU-ADRI. The points are the weights given to each level of each variable in the ANU-ADRI risk score.</p