Prevalence and Patterns of Multimorbidity among Elderly People in Rural Bangladesh: A Cross-sectional Study

Data on multimorbidity among the elderly people in Bangladesh are lacking. This paper reports the prevalence and distribution patterns of multimorbidity among the elderly people in rural Bangladesh. This cross-sectional study was conducted among persons aged ≥60 years in Matlab, Bangladesh. Information on their demographics and literacy was collected through interview in the home. Information about their assets was obtained from a surveillance database. Physicians conducted clinical examinations at a local health centre. Two physicians diagnosed medical conditions, and two senior geriatricians then evaluated the same separately. Multimorbidity was defined as suffering from two or more of nine chronic medical conditions, such as arthritis, stroke, obesity, signs of thyroid hypofunction, obstructive pulmonary symptoms, symptoms of heart failure, impaired vision, hearing impairment, and high blood pressure. The overall prevalence of multimorbidity among the study population was 53.8%, and it was significantly higher among women, illiterates, persons who were single, and persons in the non-poorest quintile. In multivariable logistic regression analyses, female sex and belonging to the non-poorest quintile were independently associated with an increased odds ratio of multimorbidity. The results suggest that the prevalence of multimorbidity is high among the elderly people in rural Bangladesh. Women and the non-poorest group of the elderly people are more likely than men and the poorest people to be affected by multimorbidity. The study sheds new light on the need of primary care for the elderly people with multimorbidity in rural Bangladesh

Episodic memory functioning in very old age : Individual differences and utilization of cognitive support

Wahlin, Å. Episodic memory functioning in very old age: Individual differences and utilization ofcognitive support. Doctoral Dissertation, Department of Clinical Neuroscience and Family Medicine,Division of Geriatric Medicine, Karolinska Institute; and Stockholm Gerontology Research Center,Section of Psychology. Correspondence: Stockholm Gerontology Research Center, Box 6401, S- 11382 Stockholm, Sweden. 1996; ISBN 91-628-1860-0The general aim of the present doctoral thesis was to examine potential age-related differences inepisodic memory performance and utilization of cognitive support in very old age. An additionalobjective was to investigate the influence of individual difference variables within demographic (e.g.,education, gender), psychometric (e.g., general cognitive status; MMSE, fluid intelligence), lifestyle(e .g ., social activity), and biological (e.g., serum vitamin B 12) domains on episodic memory functioningin late life. A population-based sample of normal adults between 75 and 96 years served as subjects.Across all five studies, participants were carefully screened for health, using a variety of exclusioncriteria (e.g., depression, dementia, sensory loss). In Study I, II, and III the aims were addressedemploying several episodic memory tasks, including verbal and non-verbal materials, and examiningutilization of cognitive support in the form of task-relevant prior knowledge, extended study time, copycues at retrieval (recognition), organizability of the to-be-remembered materials as well as categorycuing at retrieval. In these studies, the age-related deterioration of episodic memory performance wasfound to be slight, albeit reliable. Furthermore, the ability to utilize cognitive support appeared to remainunaffected by advancing age. Several individual difference variables including age, MMSE score, fluidintelligence, and level of formal education, were generally and positively related to memory performance.Study IV examined the impact of demographic and lifestyle factors on episodic memory andperformance benefits due to the provision of cognitive support. Results indicated that age wasnegatively related to performance, whereas education and participation in social activities exerted apositive influence. Exercise was also positively related to performance, but only in the least supportedtasks. With regard to performance benefits due to cognitive support, education was positively relatedto benefits from more study time and item organizability, age was negatively related to the effect of itemorganizability, and social activity was positively associated with the ability to benefit from retrievalcues. Study V explored the impact of low serum vitamin B12 and folic acid on episodic memoryperformance and utilization of cognitive support. It was found that participants with low levels of serumfolic acid performed significantly worse than controls in both free recall and recognition of verbalmaterials, and that this deterioration was most pronounced in participants with low levels of both folicacid and vitamin B 12. However, vitamin status did not affect utilization of more study time or copy cues(recognition). Overall, the five studies indicated that the well-known age-related deficit in episodicmemory performance continues into very old age, although the ability to utilize the studied forms ofcognitive support is less affected by advancing age. In addition to age, several individual-differencefactors contributed to the amount of explained variance in both episodic memory performance andutilization of cognitive support, such that advantaged older persons (e.g., in terms of education andsocial activity) remembered more and benefited more from cognitive support. The results also indicatethe relevance of including serum vitamin status as a health screening factor in research concerning age-related differences in episodic memory performance.Key words: Episodic memory, aging, cognitive support, individual differences. Åke Wahlin, 1996 Number of pages 60: ISBN 91-628-1860-

Episodic Learning and Memory in Prodromal Huntington’s Disease : The Role of Multimodal Encoding and Selective Reminding

This study investigated episodic memory in prodromal HD. Three groups were compared (N=70): mutation carriers with less than 12.5 years to disease onset (n=16), mutation carriers with 12.5 or more years to disease onset (n=16), and noncarriers (n=38). Episodic memory was assessed using the Fuld Object Memory Evaluation, which includes multimodal presentation and selective reminding, and the Claeson-Dahl Learning Test which includes verbal repeated presentation and recall trials. Both carrier groups demonstrated deficient episodic memory compared to noncarriers. The results suggest deficient episodic memory in prodromal HD, and that inconsistent retrieval contributes to these deficits. Multimodal presentation attenuates the deficits

Genetic and environmental influences on longitudinal trajectories of functional biological age : Comparisons across gender

We used an alternate age variable, functional biological age (fBioAge), which was based on performance on functional body measures. The aim was to examine development of fBioAge across the adult life span, and to also examine potential gender differences and genetic and environmental influences on change with age. We used longitudinal data (n = 740; chronological age (ChronAge) range 45-85 at baseline) from the Swedish Adoption/Twin Study of Aging. The rate of increase in fBioAge was twice as fast after ChronAge 75 than before. fBioAge was higher in women than in men. fBioAge was fairly equally influenced by genetic and environmental factors. Whereas the rate of ChronAge cannot vary across time, gender, or individual, our analyses demonstrate that fBioAge does capture these within and between individual differences in aging, providing advantages for fBioAge in the study of aging effects

Non-verbal and verbal fluency in prodromal Huntington’s disease

Background: This study examines nonverbal (design) and verbal (phonemic and semantic) fluency in prodromal Huntington’s disease (HD). An accumulating body of research indicates subtle deficits in cognitive functioning among prodromal mutation carriers for HD. Methods: Performance was compared between 32 mutation carriers and 38 noncarriers in order to examine the magnitude of impairment across fluency tasks. The Predicted Years To Onset (PYTO) in mutation carriers was calculated by a regression equation and used to divide the group according to whether onset was predicted less than 12.75 years (HD+CLOSE; n=16) or greater than 12.75 years (HD+DISTANT; n=16). Results: The results indicate that both nonverbal and verbal fluency are sensitive to subtle impairment in prodromal HD. HD+CLOSE group produced fewer items in all assessed fluency tasks compared to noncarriers. HD+DISTANT produced fewer drawings than noncarriers in the nonverbal task. PYTO correlated significantly with all measures of nonverbal and verbal fluency. Conclusion: The pattern of results indicates that subtle cognitive deficits exist in prodromal HD, and that less structured tasks with high executive demands are the most sensitive in detecting divergence from the normal range of functioning. These selective impairments can be attributed to the early involvement of frontostriatal circuitry and frontal lobes