400 research outputs found
Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study
BACKGROUND:
African Americans are especially at risk of hypertension and dementia. Antihypertensive medications reduce the risk of cardiovascular events, but may also reduce the risk of dementia.
OBJECTIVE:
To assess the longitudinal effects of antihypertensive medications and blood pressure on the onset of incident dementia in a cohort of African Americans.
DESIGN:
Prospective cohort.
PARTICIPANTS:
1236 community-dwelling patients from an inner-city public health care system, aged 65 years and older, with a history of hypertension but no history of dementia, and who had at least three primary care visits and a prescription filled for any medication.
MAIN MEASURES:
Blood pressure was the average of three seated measurements. Dementia was diagnosed using a two-stage design, with a screening evaluation every 2 to 3 years followed by a comprehensive in-home clinical evaluation for those with a positive screen. Laboratory, inpatient and outpatient encounter data, coded diagnoses and procedures, and medication records were derived from a health information exchange.
KEY RESULTS:
Of the 1236 hypertensive participants without dementia at baseline, 114 (9%) developed incident dementia during follow-up. Individuals prescribed any antihypertensive medication (n = 816) were found to have a significantly reduced risk of dementia (HR = 0.57, 95% CI 0.37-0.88, p = 0.0114) compared to untreated hypertensive participants (n = 420). When this analysis was repeated including a variable indicating suboptimally treated blood pressure (> 140 mmHg systolic or >90 mmHg diastolic), the effect of antihypertensive medication was no longer statistically significant (HR = 0.65, 95% CI 0.32-1.30, p = 0.2217).
CONCLUSIONS:
Control of blood pressure in older adult African American patients with hypertension is a key intervention for preventing dementia, with similar benefits from most of the commonly available antihypertensive medications
Mild Cognitive Impairment, Incidence, Progression, and Reversion: Findings from a Community-based Cohort of Elderly African Americans
Objective
To examine the long-term outcomes of community-based elderly African Americans by following their transitions from normal cognition to mild cognitive impairment (MCI), and to dementia.
Methods
Participants were from the community-based Indianapolis Dementia Project. A total of 4104 African Americans were enrolled in 1992 or 2001 and followed until 2009 with regularly scheduled evaluation of cognitive assessment. A two-stage sampling was used at each evaluation to select individuals for extensive clinical assessment following the results of stage one cognitive testing. Age and gender specific incidence, progression and reversion rates for MCI were derived using the person-year method in a dynamic cohort and predicted probabilities from weighted multinomial logistic models of transitional probabilities among normal cognition, MCI and dementia.
Results
Annual overall incidence rate for MCI is 5.6% (95% CI: 4.6–6.6%). Annual progression rate from MCI to dementia is 5.9% (95% CI: 5.3–6.5%) and annual reversion rate from MCI to normal is 18.6% (95% CI: 16.7–20.4%). Both MCI incidence rates and MCI to dementia progression rates increase with age, while reversion rates from MCI to normal decrease with age.
Conclusion
MCI progression to dementia is much more frequent in the older age groups than in the younger participants where reversion to normal cognition is more common. Future research is needed to determine factors related to the heterogeneous outcomes in MCI individuals
“I’m in a very good frame of mind”: A qualitative exploration of the experience of standing frame use in people with progressive multiple sclerosis
This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordData sharing:
The SUMS study protocol and statistical analysis plan are publicly available at
https://www.plymouth.ac.uk/research/sums. Individual participant data that underlie
the results will be made available (after de-identification) on a controlled access
basis, subject to suitable data sharing agreements. Requests for data sharing should
be made to the Chief Investigator (CI; J Freeman) in the first instance.The study aim was to explore the experiences of people with progressive multiple
sclerosis (MS) and their standing assistants during their participation in SUMS, a
randomised controlled trial (RCT) of a home-based, self-managed standing frame
programme.
Design
A qualitative approach, using audio diary methodology was used to collect data
contemporaneously. Diary data were transcribed verbatim and analysed using
thematic analysis.
Setting
Participants were recruited from eight health-care organisations in two regions of the
United Kingdom. The intervention was home-based.
Participants
As part of the RCT, 140 participants were randomly allocated to either usual care or
usual care plus a standing frame programme. Using a sampling matrix 12 people
with progressive MS (six female, aged 35–71 years, Expanded Disability Status
Scale 6.5-8.0) and eight standing assistants (four female) kept audio diaries of their
experiences.
Intervention
The standing frame programme involved two face-to-face home-based
physiotherapy sessions to set up the standing frame programme, supplemented by
educational material designed to optimise self-efficacy. Participants were
encouraged to stand for at least 30 minutes, three times a week for the 36 week
study period.
Results
Four main themes were identified: “Feeling like the old me”; “Noticing a difference”; “I
want to do it right” and “You have a good day, you have a bad day”.
Conclusions
Supported standing helped people with progressive MS feel more like their old
selves and provided a sense of normality and enjoyment. People noticed
improvements in physical and psychological symptoms, which were often associated
with increased participation in activities they valued. Provision of support from a
physiotherapist and recognition of the variable nature of the condition were
highlighted as factors to consider when establishing a standing programme.National Institute for Health Research (NIHR
Dementia incidence declined in African-Americans but not in Yoruba
INTRODUCTION:
To compare dementia incidence of African-American and Yoruba cohorts aged ≥70 years enrolled in 1992 and 2001.
METHODS:
African-Americans residing in Indianapolis and Yoruba in Ibadan, Nigeria without dementia were enrolled in 1992 and 2001 and evaluated every 2-3 years until 2009. The cohorts consist of 1440 African-Americans, 1774 Yoruba in 1992 and 1835 African-Americans and 1895 Yoruba in the 2001 cohorts aged ≥70 years.
RESULTS:
In African-Americans, dementia and Alzheimer's disease (AD) incidence rates were significantly lower in 2001 than 1992 for all age groups except the oldest group. The overall standardized annual dementia incidence rates were 3.6% (95% confidence interval [CI], 3.2%-4.1%) in the 1992 cohort and 1.4% (95% CI, 1.2%-1.7%) in the 2001 cohort. There was no significant difference in dementia or AD incidence between the Yoruba cohorts.
DISCUSSION:
Future research is needed to explore the reasons for the differential changes in incidence rates in these two populations
Changes of glucose levels precede dementia in African Americans with diabetes but not in Caucasians
INTRODUCTION
Changes in glucose levels may represent a powerful metabolic indicator for dementia in African Americans with diabetes. It is unclear whether these changes also occur in Caucasians.
METHODS
A secondary data analysis using electronic medical records from 5228 African Americans and Caucasians 65 years and older. Mixed effects models with repeated serum glucose measurements were used to compare changes in glucose levels between African Americans and Caucasian patients with and without incident dementia.
RESULTS
African Americans and Caucasians with diabetes had significantly different changes in glucose levels by dementia status (p<0.0001). African Americans experienced a significant decline in glucose levels before the dementia diagnosis (estimated glucose decline 1.3421 mg/dL per year, p<0.0001) than those who did not develop dementia. Caucasians with and without dementia showed stable glucose levels over time (p=0.3071).
DISCUSSION
Significant changes in glucose levels precede dementia in African American patients with diabetes but not in Caucasians
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