Search

Objectives: To determine whether transcranial Doppler ultrasound (TCD) measures of mean blood flow velocity (MBFV) in the major cerebral arteries are associated with measures of lower extremity function in community-dwelling older adults., Design: Cross-sectional study., Setting: Community sample., Participants: Individuals aged 70 and older (mean 79.5, 54% female) without dementia participating in the Einstein Aging Study (N = 200)., Measurements: All participants underwent TCD assessments and tests of lower extremity function at an annual clinic visit. Average MBFV for anterior (left and right anterior and middle cerebral arteries (MCAs)) and posterior (vertebral (VA) and basilar (BA) artery) circulation was measured using a standardized TCD protocol. Lower extremity function was characterized according to gait speed (cm/s) measured using an instrumented walkway, balance according to unipedal stance time (UPST, seconds), and lower extremity strength according to timed repeated chair rise (seconds)., Results: Multiple regression models adjusted for age, sex, race, education, and medical comorbidities showed that lower MBFV in the MCA was associated with slower gait speed and chair rise time but not with UPST. Ordinal regression models showed that lower MBFV in the VA and BA is associated with shorter UPST., Conclusion: Low MBFV in the anterior and posterior cerebral circulation was associated with worse lower extremity function and balance in older adults. This might be indicative of the importance of age-related changes in cerebral hemodynamics in the function of brain regions involved in specific aspects of physical performance., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Objectives: To examine the association between vascular pathology and rate of cognitive decline in older adults independent of Alzheimer's disease (AD) pathology., Design: Prospective cohort study., Setting: Community sample., Participants: Individuals from the Einstein Aging Study autopsy series (N = 62)., Measurements: The Blessed Information-Memory-Concentration (BIMC) test was used to assess global cognitive status. AD pathology was quantified according to Braak stage (<3 vs ≥ 3). Vascular pathology was quantified using a previously reported macrovascular lesion (MVL) score. The association between vascular pathology and antemortem rates of cognitive decline adjusted for level of AD pathology was assessed using linear mixed-effects models., Results: Mean age was 81.8 at enrollment and 89.0 at death. Participants with more than two MVLs had faster cognitive decline than those with no MVLs (difference in annual rate of change in BIMC 0.74 points/yr, P = .03). Braak stage was also associated with cognitive decline (difference 0.57 points/yr, P = .03). The difference in rate of cognitive decline between those with more than two MVLs and those free of vascular lesions persisted after adjustment for AD pathology (difference in rate of change in BIMC 0.68 points/yr, P = .04). The effect of vascular pathology on cognitive decline was not significantly different according to AD pathology., Conclusion: Vascular brain pathology is associated with rate of cognitive decline after adjusting for level of AD pathology., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Objectives: To examine the association between diet and executive function, episodic memory and global verbal cognition in the Einstein Aging Study (EAS) cohort and determine whether race modifies this relationship., Design: Cross-sectional., Setting: Community., Participants: EAS participants without dementia who completed the Rapid Eating and Activity Assessment for Patients (REAP) (N = 492)., Measurements: The previously validated REAP is based on the 2000 U.S. dietary guidelines. REAP scores were dichotomized as less-healthy (

Objectives: To investigate the independent and combined contributions to the risk of Alzheimer's disease (AD) of three important domains of cognitive assessment: neuropsychological measurement, self-reports, and informant reports., Design: Longitudinal, community-based sample., Setting: Einstein Aging Study., Participants: Six hundred twenty-seven individuals without dementia aged 70 and older systematically recruited from the Bronx, New York., Measurements: Comprehensive assessment included neurological examination, behavioral questions, and neuropsychological testing. AD diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria assigned at a multidisciplinary consensus case conference. The major statistical analyses used Cox proportional hazards models (with age as the time scale) adjusted for sex, education, and depressive symptoms., Results: Forty-eight participants developed incident AD during a median of 3.3 years of follow-up. Self- and informant reports of cognitive status and baseline scores on tests of episodic memory and psychomotor speed predicted the onset of AD, but in models examining all the variables simultaneously, only the episodic memory tests and informant reports were associated with risk of AD. A likelihood ratio test confirmed the incremental effect of informant reports in addition to the neuropsychological test scores (P = .03)., Conclusion: Informant ratings improved the prediction of AD conversion in addition to objective memory impairment in older adults without dementia. Combining these cognitive measures may provide a useful, empirical method for identifying individuals at high risk of future AD., (© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.)

Objectives: To investigate whether there are racial differences in gait velocity in elderly adults., Design: Cross-sectional analysis., Setting: Bronx, New York., Participants: Two hundred thirteen participants of the Einstein Aging Study (157 Caucasian, 56 African American), a longitudinal study of community-residing elderly adults recruited using Medicare and voter registration records., Measurements: Demographic characteristics, medical history, Geriatric Depression Scale, Blessed Information-Memory-Concentration Test, Total Pain Index, gait velocity., Results: Caucasians were older (median 79.9 vs 75.5, P = .002) and more educated (median 14 vs 12 years, P = .007) and had lower body mass index (mean 26.9 ± 4.3 vs 28.9 ± 6.4, P = .03). African Americans were more likely to be female (80.4% vs 59.9%, P = .006) and to have diabetes mellitus (28.6% vs 13.4%, P = .01). Pain levels were not significantly different between Caucasians and African Americans. African Americans had a significantly slower gait velocity (mean 90.2 ± 17.9 vs 99.1 ± 20.1 cm/s, P = .004). This difference persisted after adjusting for multiple covariates. Differences in common factors known to influence gait did not explain a 7.79-cm/s slower gait speed in African Americans than Caucasians., Conclusion: Differences in gait velocity persist between African Americans and Caucasians despite adjusting for many confounders. Increases of just 10 cm/s are associated with lower mortality. Further studies are needed to evaluate whether there are modifiable risk factors that may explain this difference and whether an intervention could reduce the discrepancy between the groups., (© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.)

Objectives: To determine whether offspring of parents with exceptional longevity (OPEL) have a lower rate of dementia than offspring of parents with usual survival (OPUS)., Design: Community-based prospective cohort study., Setting: Bronx, New York., Participants: A volunteer sample of 424 community-residing older adults without dementia aged 75 to 85 recruited from Bronx County starting in 1980 and followed for up to 23 years., Measurements: Epidemiological, clinical, and neuropsychological assessments were completed every 12 to 18 months. OPEL were defined as having at least one parent who reached the age of at least 85. OPUS were those for whom neither parent reached the age of 85. Dementia was diagnosed according to case conference consensus based on Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria without access to information on parental longevity. Alzheimer's disease was diagnosed using established criteria., Results: Of 424 subjects, 149 (35%) were OPEL, and 275 (65%) were OPUS. Mean age at entry for both groups was 79. The OPEL group had a lower incidence of Alzheimer's disease (hazard ratio=0.57, 95% confidence interval=0.35-0.93). After adjusting for sex, education, race, hypertension, myocardial infarction, diabetes mellitus, and stroke, results were essentially unchanged. OPEL also had a significantly lower rate of memory decline on the Selective Reminding Test (SRT) than OPUS (P=.03)., Conclusion: OPEL develop dementia and Alzheimer's disease at a significantly lower rate than OPUS. Demographic and medical confounders do not explain this result. Factors associated with longevity may protect against dementia and Alzheimer's disease.

Objectives: To determine the influence of homocysteine on mobility decline in older adults., Design: Prospective cohort., Setting: Einstein Aging Study, community-based aging study., Participants: Five hundred seventy-four older adults without dementia (mean age 80.2 +/- 5.4, 61% women)., Measurements: Mobility decline defined using gait velocity measurements at baseline and annual follow-up visits. Linear mixed effects models were used to adjust for age, sex, education, and other potential confounders., Results: Higher homocysteine levels were associated with slower gait velocity at baseline. Adjusted for age, sex, and education, a one-unit increase in baseline log homocysteine levels was associated with a 2.95-cm/s faster mobility decline per year (P=.01) over a median follow-up of 1.4 years. The 140 subjects in the highest quartile of homocysteine had a faster rate of mobility decline (1.75 cm/s per year faster, P=.01) than the 434 subjects in the lowest three quartiles of homocysteine (