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Introduction: This study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death., Methods: Analysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated., Results: Across most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies., Discussion: This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings., (Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Background: institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition., Objective: to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment., Design and Setting: a retrospective cohort study of people admitted to a single large Scottish teaching hospital., Subjects: 100 individuals admitted to the acute hospital from home and discharged to a care home., Methods: a single researcher extracted data from ward-based case notes., Results: people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14-231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital., Conclusions: care home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients., (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Background and Purpose: Lower birth weight is associated with increased risk of stroke, but little is known about the mechanism for this association or influence in addition to vascular risk factors. We investigated whether there was an association between birth parameters and imaging markers of white matter integrity in community-dwelling older people., Methods: One hundred seven volunteers, age 75 to 81 years, had birth parameters (weight, length, placental weight, gestational age) extracted from archives. Neuroimaging included assessment of white matter lesions and diffusion tensor-magnetic resonance imaging parameters in normal-appearing white matter., Results: Lower placental weight was correlated with increased white matter lesion load (P<0.05) and diffusion tensor-magnetic resonance imaging parameters (P<0.05). Birth weight and frontal white matter fractional anisotropy were significantly correlated (P<0.05). These associations were only slightly attenuated when corrected for gestational age, sex, age at scan, and vascular risk factors., Conclusions: Lower placental and possibly lower birth weight were associated with sensitive neuroimaging measures of white matter lesions in this cohort, independent of vascular risk factors later in life. Further studies are required to confirm these findings to explore life-long risk factors for age-related white matter changes.

Purpose: Although it is well established that atrial fibrillation (AF) causes ischemic stroke, the relationship between AF and cognitive impairment is unclear. The aim of this systematic review is to investigate whether AF is associated with cognitive impairment or dementia., Materials and Methods: An electronic search of Medline, Embase, Psychlit, Cinahl and the Cochrane library was performed in March 2000 to identify studies in which the primary aim was to investigate the relationship between AF and cognitive impairment or dementia. Studies with relevant data on both cognitive function and AF (even if that was not the primary aim of the study) were also identified. Further references were identified from these sources., Results: Ten studies were identified, of which 4 were cross-sectional, 5 were case-control, and 1 was a prospective cohort study. The methodology and measures of cognition varied substantially, so it was not valid to apply formal meta-analysis techniques to the results. However, the methodology in all the studies was flawed in at least 1 aspect, including the reporting of results, external validity, and internal validity. Seven studies found an association between AF and at least 1 measure of cognition whereas 3 studies did not find an association., Conclusion: The evidence that AF is associated with cognitive impairment is inconclusive. Further studies are required to establish whether there is a relationship between AF and cognitive impairment, and if so, whether the relationship is causal.