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Background: Risk factors for dementia, such as Alzheimer’s disease, are complex and span a lifetime. Exploring novel factors, such as characteristics of writing, may provide insight into dementia risk. Objective: To investigate the association between emotional expressivity and risk of dementia in the context of a previously identified risk factor, written language skills. Methods: The Nun Study recruited 678 religious sisters aged 75 + years. Of these, 149 U.S.-born participants had archived autobiographies handwritten at a mean age of 22 years. The autobiographies were scored for frequency of emotion word usage and language skills (e.g., idea density). The association of emotional expressivity and a four-level composite variable (combining high/low emotional expressivity and high/low idea density) with dementia was assessed using logistic regression models adjusted for age, education, and apolipoprotein E. Results: Within the composite variable, odds of dementia increased incrementally, with opposing effects of emotional expressivity across the two idea density levels. Compared to the referent category (low emotional expressivity/high idea density), the risk of dementia increased in those with high emotional expressivity/high idea density (OR = 2.73, 95% CI = 1.05–7.08), while those with low emotional expressivity/low idea density had the highest risk (OR = 18.58, 95% CI = 4.01–86.09). Conclusion: Dementia risk is better captured by inclusion of multiple measures relating to characteristics of writing. Emotional expressivity may be protective when individuals are at increased risk due to poor written language skills (i.e., low idea density), but detrimental when not at risk (i.e., high idea density). Our findings indicate that emotional expressivity is a contextually-dependent novel risk factor for dementia.

Background Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults. Methods Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle–Ottawa Scale (NOS). Results Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support—particularly overall and emotional support—was associated with higher cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes. Conclusions Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life. Systematic review registration Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. https://doi.org/10.1136/bmjopen-2020-037301

OBJECTIVE Severe hypoglycemia is associated with an increased risk of dementia. We examined if the association is consistently present in mid- and late-life hypoglycemia. RESEARCH DESIGN AND METHODS Using health care data from Population Data BC, we created a base cohort of patients age ≥40 years with incident type 2 diabetes. Exposure was the first occurrence of severe hypoglycemia (hospitalization or physician visit). We assessed exposure versus no exposure in mid- (age 45–64 years) and late-life (age 65–84 years) cohorts. Index date was the later of the 45th birthday (midlife cohort), 65th birthday (late-life cohort), or diabetes diagnosis. Those with hypoglycemia or dementia before the index date were excluded. Patients were followed from index date until dementia diagnosis, death, emigration, or 31 December 2018. Exposure was modeled as time dependent. We adjusted for confounding using propensity score weighting. Dementia risk was estimated using cause-specific hazards models with death as a competing risk. RESULTS Of 221,683 patients in the midlife cohort, 1,793 experienced their first severe hypoglycemic event. Over a median of 9.14 years, 3,117 dementia outcomes occurred (32 among exposed). Of 223,940 patients in the late-life cohort, 2,466 experienced their first severe hypoglycemic event. Over a median of 6.7 years, 15,997 dementia outcomes occurred (158 among exposed). The rate of dementia was higher for those with (vs. without) hypoglycemia in both the mid- (hazard ratio 2.85; 95% CI 1.72–4.72) and late-life (2.38; 1.83–3.11) cohorts. CONCLUSIONS Both mid- and late-life hypoglycemia were associated with approximately double the risk of dementia, indicating the need for prevention throughout the life course of those with diabetes.

Time-to-event data are often subject to left-truncation. Lack of consideration of the sampling condition will introduce bias and loss in efficiency of the estimation. While auxiliary information from the same or similar cohorts may be available, challenges arise due to the practical issue of accessibility of individual-level data and taking account of various sampling conditions for different cohorts. In this paper, we introduce a likelihood-based method to incorporate information from auxiliary data to eliminate the left-truncation problem and improve efficiency. A one-step Monte-Carlo Expectation-Maximization algorithm is developed to calculate an augmented likelihood through creating pseudo-data sets which extend the form and conditions of the observed sample. The method is illustrated by both a real dataset and simulation studies.

IntroductionComplex surveys use stratified or cluster sampling to recruit participants. Researchers analyzing these surveys often wish to make inferences about the source populations from which the participants are drawn. In such cases, methodologists recommend employing sample weights in regression analyses; however, the utilization of weights in studies of associations are not without dispute.Materials and methodsTo help guide analyses of complex surveys, we utilized baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging (CLSA) (n = 30,097) and compared unweighted and weighted regression analyses of the association between social support availability (SSA) and cognitive function. We also conducted simulation studies to validate our findings in the CLSA.ResultsThe regression coefficients for SSA were similar across the unweighted and weighted regression models; the standard errors of the were lower in the unweighted models. The simulation studies mimicking CLSA confirmed these findings. Overall, our findings demonstrated a small advantage for the unweighted analysis of CLSA data due to the smaller standard errors.DiscussionAlthough we cannot guarantee that this would be the case for all association analyses with CLSA data, the current study showed the use of analytical weights was not necessary for our associations of interest.

Background Previous studies have shown hypoglycaemia to be associated with an increased risk of dementia; however, there are several design challenges to consider. The objective of this study is to assess the association between hypoglycaemia and dementia while addressing these challenges using a lag period, exposure density sampling (EDS) and inverse probability of treatment weighting (IPTW). Methods This was a population-based cohort using data (1996–2018) from British Columbia, Canada. From a cohort of incident type 2 diabetes patients aged 40–70 years, we created a dynamic sub-cohort of hypoglycaemia-exposed (≥1 episode requiring hospitalization or a physician visit) and unexposed individuals using EDS, in which four unexposed individuals per one exposed were randomly selected into risk sets based on diabetes duration and age. Follow-up was until dementia diagnosis, death, emigration or 31 December 2018. Those diagnosed with dementia within 2 years of follow-up were censored. We adjusted for confounding using IPTW and estimated the hazard ratio (HR, 95% CI) of dementia using weighted conditional cause-specific hazards risk models with death as a competing risk. Results Among 13 970 patients with incident type 2 diabetes, 2794 experienced hypoglycaemia. There were 329 dementia events over a median (interquartile range: IQR) follow-up of 5.03 (5.7) years. IPTW resulted in well-balanced groups with weighted incidence rates (95% CI) of 4.59 (3.52, 5.98)/1000 person-years among exposed and 3.33 (2.58, 3.88)/1000 person-years among unexposed participants. The risk of dementia was higher among those with hypoglycaemia (HR, 1.83; 95% CI 1.31, 2.57). Conclusions After addressing several methodological challenges, we showed that hypoglycaemia contributes to an increased risk of all-cause dementia among patients with type 2 diabetes.

This study investigated the association between subtypes of social support availability (SSA) and memory in persons aged 45 to 85 years (n = 24,719). We examined two memory outcomes using a modified Rey Auditory Verbal Learning Test (RAVLT)-immediate recall (RAVLT I) and delayed recall (RAVLT II)-and five subtypes of SSA: affectionate, emotional/informational, positive interactions, tangible, overall. We found statistically significant and adjusted positive associations between all SSA subtypes and memory, except for positive interactions and delayed recall memory. For RAVLT I, the regression coefficients (

Vascular aging is associated with markers of cerebrovascular impairment. Whether discrete characteristics of arterial structure and function have independent and/or additive effects on cerebral hemodynamics, however, is not completely understood. We examined the association of cerebral hemodynamics with common carotid artery intima-media thickness (IMT) and pulse pressure (PP) in 61 older adults with prevalent cardiometabolic risk but no history of cerebrovascular disease. We calculated pulsatility index (PI) and hypercapnic reactivity of the middle cerebral artery, as well as global blood flow through the extracranial arteries. The dominant effects were related to hemodynamic pulsatility. In adults with metabolic syndrome, PI was related to IMT (r = 0.48, P = 0.003) after adjustment for age and sex. Without metabolic syndrome, PI was directly related to PP (r = 0.63, P = 0.003). Across the whole cohort, PP [β (95%CI) = 0.42 (0.18, 0.67), P = 0.001] and IMT [0.42 (0.18, 0.67), P

Objectives Dementia is the most common neurological disease in older adults; headaches, including migraines, are the most common neurological disorder across all ages. The objective of this study was to explore the relationship between migraines and dementia, including Alzheimer's disease (AD) and vascular dementia (VaD). Methods Analyses were based on 679 community-dwelling participants 65+ years from the Manitoba Study of Health and Aging, a population-based, prospective cohort study. Participants screened as cognitively intact at baseline had complete data on migraine history and all covariates at baseline and were assessed for cognitive outcomes (all-cause dementia, AD, and VaD) 5 years later. The association of exposure (lifetime history of migraines), confounding (age, gender, education, and depression), and intervening variables (hypertension, myocardial infarction, other heart conditions, stroke, and diabetes) with all-cause dementia and dementia subtypes (AD and VaD) was assessed using multiple logistic regression models. Results A history of migraines was significantly associated with both all-cause dementia (odds ratio [OR]=2.97; 95% confidence interval [CI]=1.25-6.61) and AD (OR=4.22; 95% CI=1.59-10.42), even after adjustment for confounding and intervening variables. Migraines were not significantly associated with VaD either before (OR=1.83; 95% CI=0.39-8.52) or after (OR=1.52; 95% CI=0.20-7.23) such adjustment. Conclusions Migraines were a significant risk factor for AD and all-cause dementia. Despite the vascular mechanisms involved in migraine physiology, migraines were not significantly associated with VaD in this study. Recognition of the long-term detrimental consequences of migraines for AD and dementia has implications for migraine management, as well as for our understanding of AD etiology.

The purpose of this study was to investigate if and how the associations between social support availability (SSA) and cognitive function varied across urban, rural, and geographical regions in Canada. Data from a population-level sample of community-dwelling adults aged 45-85 years were obtained from the baseline Tracking Cohort of the Canadian Longitudinal Study on Aging. The associations between SSA and two domains of cognitive function, memory and executive function, were analyzed using multilevel regression models. SSA was positively and significantly associated with both executive function and memory. We found SSA had stronger positive associations with executive function among participants living in rural areas compared to urban areas in all geographical regions; however, geographical variation in the associations between SSA and memory were not supported by model results. Understanding how the associations between cognitive function and modifiable risk factors, including SSA, vary across geographical contexts is important for developing policies and programs to support healthy aging.

OBJECTIVE: To determine the mean number of chronic diseases in Canadians aged 45 to 85 years who are living in the community, and to characterize the association of multimorbidity with age, sex, and social position. DESIGN: An analysis of data from the Canadian Longitudinal Study on Aging. The number of self-reported chronic diseases was summed, and then the mean number of chronic health problems was standardized to the 2011 Canadian population. Analyses were conducted stratified on sex, age, individual income, household income, and education level. SETTING: Canada. PARTICIPANTS: A total of 21 241 community-living Canadians aged 45 to 85 years. MAIN OUTCOME MEASURES: Overall, 31 chronic diseases (self-reported from a list) were considered, as were risk factors that were not mental health conditions or acute in nature. Age, sex, education, and household and individual incomes were also self-reported. RESULTS: Multimorbidity was common, and the mean number of chronic illnesses was 3.1. Women had a higher number of chronic illnesses than men. Those with lower income and less education had more chronic conditions. The number of chronic conditions was strongly associated with age. The mean number of conditions was 2.1 in those aged 45 to 54; 2.9 in those 55 to 64; 3.8 in those aged 65 to 74, and 4.8 in those aged 75 and older (P < .05, ANOVA [analysis of variance]). CONCLUSION: Multimorbidity is common in the Canadian population and is strongly related to age.

Background and ObjectivesLittle is known about the effect of education or other indicators of cognitive reserve on the rate of reversion from mild cognitive impairment (MCI) to normal cognition (NC) or the relative rate (RR) of reversion from MCI to NC vs progression from MCI to dementia. Our objectives were to (1) estimate transition rates from MCI to NC and dementia and (2) determine the effect of age,APOE, and indicators of cognitive reserve on the RR of reversion vs progression using multistate Markov modeling.MethodsWe estimated instantaneous transition rates between NC, MCI, and dementia after accounting for transition to death across up to 12 assessments in the Nun Study, a cohort study of religious sisters aged 75+ years. We estimated RRs of reversion vs progression for age,APOE, and potential cognitive reserve indicators: education, academic performance (high school grades), and written language skills (idea density, grammatical complexity).ResultsOf the 619 participants, 472 were assessed with MCI during the study period. Of these 472, 143 (30.3%) experienced at least one reverse transition to NC, and 120 of the 143 (83.9%) never developed dementia (mean follow-up = 8.6 years). In models adjusted for age group andAPOE, higher levels of education more than doubled the RR ratio of reversion vs progression. Novel cognitive reserve indicators were significantly associated with a higher adjusted RR of reversion vs progression (higher vs lower levels for English grades: RR ratio = 1.83; idea density: RR ratio = 3.93; and grammatical complexity: RR ratio = 5.78).DiscussionKnowledge of frequent reversion from MCI to NC may alleviate concerns of inevitable cognitive decline in those with MCI. Identification of characteristics predicting the rate of reversion from MCI to NC vs progression from MCI to dementia may guide population-level interventions targeting these characteristics to prevent or postpone MCI and dementia. Research on cognitive trajectories would benefit from incorporating predictors of reverse transitions and competing events, such as death, into statistical modeling. These results may inform the design and interpretation of MCI clinical trials, given that a substantial proportion of participants may experience improvement without intervention.

IntroductionMaintenance of cognitive function into old age is important for ageing populations. Researchers seek to identify modifiable risk and protective factors for cognitive function. One such modifiable factor is functional social support, that is, one’s perception of whether their social network can provide resources such as material help, companionship, information and emotional contact, if needed. While the literature generally reports positive associations between functional social support and cognitive function, results vary according to study methods such as the tool used to measure functional social support or the specific cognitive domain under investigation. Our review will summarise the association between functional social support and cognitive function in middle-aged and older-aged adults who reside in any setting (eg, community dwelling, long-term care facilities). We will also identify sources of discrepant findings between studies.Methods and analysisThis protocol was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. PubMed, PsycINFO, Sociological Abstracts, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus will be searched from inception to the present using a search strategy developed with a medical librarian’s help. We will supplement the database searches with a grey literature search. English-language or French-language studies with a comparison group will be subject to inclusion, regardless of the measures used to assess functional social support or cognitive function. We will assess risk of bias with the Cochrane Risk of Bias Tool-Version 2 or the Newcastle-Ottawa Scale, narratively synthesise the extracted data and conduct a meta-analysis of studies with similar characteristics (eg, sample age and sex, cognitive function outcomes). Two independent raters will screen articles and assess risk of bias.Ethics and disseminationThis review is timely given the push toward early diagnosis and treatment of dementia/major neurocognitive disorder and other types of cognitive impairment. This protocol does not require a formal ethics review. We will publish our findings in a peer-reviewed journal.

Centenarians (persons aged 100years and older) are one of the fastest growing cohorts in countries across the world. With the increasing prevalence of centenarians and growing amount of clinical information in large administrative health databases, it is now possible to more fully characterize the health of this unique and heterogeneous population. This study described patterns of health deficits in the centenarian population receiving care from community-based home care services and long-term care facilities (LTCFs) in Ontario, Canada. All centenarians who received home care and were assessed using the interRAI-Home Care Assessment instrument between 2007 and 2011 (n=1163) and all centenarians who resided in LTCFs between 2005 and 2011 who were assessed using the interRAI Minimum Data Set (MDS 2.0) (n=2228) were included in this study. Bivariate analyses described the centenarian population while K-means clustering analyses were utilized to identify relatively homogeneous subgroups within this heterogeneous population. The 3391 centenarians were aged 100 to 114 (mean age 101.5years ±1.9 SD) and the majority were women (84.7%). Commonly reported deficits included cognitive impairment, physical impairment, and bladder problems. Centenarians residing in LTCFs were significantly more likely than centenarians receiving home care services to report cognitive or functional impairment, or to exhibit symptoms of depression. The commonalities and uniqueness of four clusters of centenarians are described. Although there is great variability, there is also commonality within the centenarian population. Recognizing patterns within the heterogeneity of centenarians is key to providing high-quality person-centered care and to targeting health promotion and intervention strategies.

Objective To examine associations between baseline frailty measures, antipsychotic use, and hospitalization over 1 year and whether hospitalization risk associated with antipsychotic use varies by frailty level. Methods In this prospective cohort study of 1,066 residents (mean age: 85 years; 77% women) from the Alberta Continuing Care Epidemiological Studies, trained research nurses conducted comprehensive resident assessments at baseline (2006–2007) for sociodemographic characteristics, health conditions, frailty status, behavioral problems, and all medications consumed during the past 3 days. Two separate measures of frailty were assessed, the Cardiovascular Health Study (CHS) phenotype and an 86-item Frailty Index (FI). Time to first hospitalization during follow-up was determined via linkage with the Alberta Inpatient Discharge Abstract Database. Results Baseline frailty status (both measures), but not antipsychotic use, was significantly associated with hospitalization over 1 year. When stratified by frailty, FI-defined frail residents using antipsychotics showed a significantly increased risk for hospitalization (adjusted HR: 1.54; 95% CI: 1.01–2.36) compared with frail nonusers. CHS-defined frail antipsychotic users versus frail nonusers also showed an elevated risk (adjusted HR: 1.67; 95% CI: 0.96–2.88). Nonfrail residents using antipsychotics were significantly less likely to be hospitalized compared with nonfrail nonusers whether defined by the FI (adjusted HR: 0.62; 95% CI: 0.39–0.99) or CHS criteria (adjusted HR: 0.62; 95% CI: 0.40–0.96). Conclusion Frailty measures may be helpful in identifying those who are particularly vulnerable to adverse effects and those who may experience benefit with treatment.

Time-to-event data are often subject to left-truncation. Lack of consideration of the sampling condition will introduce bias and loss in efficiency of the estimation. While auxiliary information from the same or similar cohorts may be available, challenges arise due to the practical issue of accessibility of individual-level data and taking account of various sampling conditions for different cohorts. In this paper, we introduce a likelihood-based method to incorporate information from auxiliary data to eliminate the left-truncation problem and improve efficiency. A one-step Monte-Carlo Expectation-Maximization algorithm is developed to calculate an augmented likelihood through creating pseudo-data sets which extend the form and conditions of the observed sample. The method is illustrated by both a real dataset and simulation studies.

BACKGROUND Multilingualism is associated with enhanced executive function and may thus prevent cognitive decline and reduce the risk of dementia. OBJECTIVE To determine whether multilingualism is associated with delayed onset or reduced risk of dementia. METHODS Dementia was diagnosed in the Nun Study, a longitudinal study of religious sisters aged 75+ years. Multilingualism was self-reported. Dementia likelihood was determined in 325 participants using discrete-time survival analysis; sensitivity analyses (n = 106) incorporated additional linguistic measures (idea density and grammatical complexity). RESULTS Multilingualism did not delay the onset of dementia. However, participants speaking four or more languages (but not two or three) were significantly less likely to develop dementia than monolinguals (OR = 0.13; 95% CI = 0.01, 0.65, adjusted for age, apolipoprotein E, and transition period). This significant protective effect of speaking four or more languages weakened (OR = 0.53; 95% CI = 0.06, 4.91) in the presence of idea density in models adjusted for education and apolipoprotein E. CONCLUSION Linguistic ability broadly was a significant predictor of dementia, although it was written linguistic ability (specifically idea density) rather than multilingualism that was the strongest predictor. The impact of language on dementia may extend beyond number of languages spoken to encompass other indicators of linguistic ability. Further research to identify the characteristics of multilingualism most salient for risk of dementia could clarify the value, target audience, and design of interventions to promote multilingualism and other linguistic training as a strategy to reduce the risk of dementia and its individual and societal impacts.

Vascular aging is associated with markers of cerebrovascular impairment. Whether discrete characteristics of arterial structure and function have independent and/or additive effects on cerebral hemodynamics, however, is not completely understood. We examined the association of cerebral hemodynamics with common carotid artery intima-media thickness (IMT) and pulse pressure (PP) in 61 older adults with prevalent cardiometabolic risk but no history of cerebrovascular disease. We calculated pulsatility index (PI) and hypercapnic reactivity of the middle cerebral artery, as well as global blood flow through the extracranial arteries. The dominant effects were related to hemodynamic pulsatility. In adults with metabolic syndrome, PI was related to IMT (r = 0.48, P = 0.003) after adjustment for age and sex. Without metabolic syndrome, PI was directly related to PP (r = 0.63, P = 0.003). Across the whole cohort, PP [β (95%CI) = 0.42 (0.18, 0.67), P = 0.001] and IMT [0.42 (0.18, 0.67), P 0.001] remained significant predictors of PI, after accounting for individual cardiometabolic risk factors. The independent and combined effects of IMT and PP were tested by binarizing PP and IMT at the sample median. Participants with both IMT and PP above their respective medians had elevated PI compared with those with both vascular markers below the median [median (interquartile range) = 1.06 (0.22) vs. 0.84 (0.14), P = 0.003)]. PI was not different from the low risk group if only one of IMT or PP were above the median. Although overall vascular burden was low, moderate associations with PI persisted, suggesting pulsatile characteristics represent one of the earliest markers linking vascular aging to changes in brain health.

Background Cognitive function is important for healthy aging. Social support availability (SSA) may modify cognitive function. We descriptively examined the association between SSA and cognitive function in a population-level sample of middle- and older-aged adults. Methods We analyzed the tracking dataset of the Canadian Longitudinal Study on Aging. Participants aged between 45 and 85 years answered questions about SSA and performed three cognitive tests (Rey Auditory Verbal Learning Test, Animal Fluency Test and Mental Alternation Test) via telephone. We divided global SSA and global cognitive function scores into tertiles and generated contingency tables for comparisons across strata defined by sex, age group, region of residence, urban vs. rural residence and education. Results The proportion of participants with low global cognitive function was often greater among persons who reported low global SSA. The proportion of persons with high cognitive function was greater in participants with high SSA. The findings were most pronounced for females, 45- to 54-year olds, all regions (especially Québec) except Atlantic Canada, urban dwellers and persons with less than high school education. Conclusions Our results can help public health officials focus on providing social supports to subgroups of the population who would benefit the most from policy interventions.

Background:Both physical frailty and cognitive impairment predict death, but the joint effect of these two factors is uncertain. The objectives are to determine if the Mini-mental state examination (MMSE) and the Frailty Index (FI) predict death over a five-year interval after accounting for the effect of the other; and if there is an interaction in this effect.Methods:An analysis of an existing prospective cohort study of 1,751 community living older adults followed over a five-year time frame. Age, gender, and education were self-reported. The predictor variables were the FI – a measure of frailty based on the “Accumulation of Deficits” model of frailty; and the MMSE. Cox proportional hazards models were constructed for the outcome of time to death.Results:The unadjusted Hazard Ratio (HR) (95% CI) for mortality was 2.17 (1.69, 2.80) for those who were only cognitively impaired, 2.02 (1.53, 2.68) for those who were only frail, and 3.57 (2.75, 4.62) for those who were both frail and cognitively impaired with the reference group of those who were neither frail nor cognitively impaired. Adjusted for age, gender, and education, the HR (95% CI) was 1.49 (1.13. 1.95) for those who were only cognitively impaired, 1.81 (1.35, 2.41) for those who were only frail, and 2.28 (1.69, 3.09) for those who were both frail and cognitively impaired.Conclusions:Both frailty and cognitive impairment are predictors of mortality and the effect is cumulative. There was no interaction in this effect.

Background:Low life satisfaction predicts adverse outcomes, and may predict dementia. The objectives were: (1) to determine if life satisfaction predicts dementia over a five year period in those with normal cognition at baseline; and (2) to determine if different aspects of life satisfaction differentially predict dementia.Methods:Secondary analysis of an existing population-based cohort study with initial assessment in 1991 and follow-up five years later. Initially, 1,751 adults age 65+ living in the community were sampled from a representative sampling frame. Of these, 1,024 were alive and had complete data at time 2, of whom 96 were diagnosed with dementia. Life satisfaction was measured using the Terrible-Delightful scale, which measures overall life satisfaction on a 7-point scale, as well as various aspects of life satisfaction (e.g. friendships, finances, etc.) Dementia was diagnosed by clinical examination using DSM-IIIR criteria. Logistic regression models were constructed for the outcome of dementia at time 2, and adjusted for age, gender, education, and comorbidities.Results:Overall life satisfaction predicted dementia five years later, at time 2. The unadjusted Odds Ratio (OR; 95% confidence interval) for dementia at time 2 was 0.72 (0.55, 0.95) per point. The adjusted OR for dementia was 0.70 (0.51, 0.96). No individual item on the life satisfaction scale predicted dementia. However, the competing risk of mortality was very high for some items.Conclusion:A global single-item measure of life satisfaction predicts dementia over a five year period in older adults without cognitive impairment.

Introduction The relationship of diabetes to specific neuropathologic causes of dementia is incompletely understood. Methods We used logistic regression to evaluate the association between diabetes and infarcts, Braak neurofibrillary tangle stage, and neuritic plaque score in 2365 autopsied persons. In a subset of >1300 persons with available cognitive data, we examined the association between diabetes and cognition using Poisson regression. Results Diabetes increased odds of brain infarcts (odds ratio [OR] = 1.57, P P Discussion This study supports the conclusions that diabetes increases the risk of cerebrovascular but not Alzheimer's disease pathology, and at least some of diabetes' relationship to cognitive impairment may be modified by neuropathology.

Objective: Identify predictors of long-term care (LTC) facility residents’ self-reported quality of life (QoL). Method: QoL of a convenience sample of 928 residents from 48 volunteer LTC facilities across six Canadian provinces was assessed using the inter–Resident Assessment Instrument (interRAI) Self-Report Nursing Home Quality of Life Survey. Multivariate regression models were used to identify predictors. Results: In logistic regression modeling, residents who were religious and socially engaged, had a positive global disposition, or resided in rural, private, or municipal facilities were less likely to report low QoL. Those with post-secondary education and who were dependent on activities of daily living were more likely to report low QoL. These factors, except for religiosity and residence in municipal facilities, were significant in generalized estimating equation (GEE) modeling. Discussion: QoL is significantly associated with select resident and LTC facility characteristics with implications for improving residents’ QoL and LTC facility programming, and guiding future research and social policy development.

Objective To determine if the modified mini–mental state examination (3MS) predicts functional status and if any effect on function is observed within the normal range of cognition. Design Cohort study. Setting Community-dwelling older adults in the Canadian province of Manitoba sampled in 1991 and followed in 1996. Participants Baseline sample of 1751 adults aged 65+ from a representative registry. Five years later, 1028 participants remained in the community and had no missing data. Measurements The 3MS, age, gender, education, living arrangements, self-rated health, and depressive symptoms were self-reported. Functional status was assessed using the Older Americans Resource Survey, which was dichotomized into no/mild disability versus moderate/severe disability. Results Baseline 3MS score predicted baseline functional status. This effect was a gradient across the entire 3MS score, extending into the normal range with no apparent threshold. In logistic regression models, the unadjusted odds ratio (OR, 95% confidence interval) for the association of 3MS score with disability was 0.94 (0.93, 0.95); the adjusted OR was 0.96 (0.95, 0.98) in models including age, gender, education, and other covariates. Baseline 3MS score also predicted functional status 5 years later: The unadjusted OR for disability was 0.94 (0.92, 0.95); the adjusted OR was 0.97 (0.95, 0.99). Again, the risk of functional impairment at time 2 was a gradient effect, extending into the normal range of baseline 3MS score. Conclusions The 3MS predicts functional decline, and this effect is a gradient effect. These results support the hypothesis that cognition is a continuum in risk. Copyright © 2014 John Wiley & Sons, Ltd.

Longitudinal cognitive trajectories and other factors associated with mixed neuropathologies (such as Alzheimer’s disease with co-occurring cerebrovascular disease) remain incompletely understood, despite being the rule and not the exception in older populations. The Statistical Modeling of Aging and Risk of Transition study (SMART) is a consortium of 11 different high-quality longitudinal studies of aging and cognition (N=11,541 participants) established for the purpose of characterizing risk and protective factors associated with subtypes of age-associated mixed neuropathologies (N=3,001 autopsies). While brain donation was not required for participation in all SMART cohorts, most achieved substantial autopsy rates (i.e., > 50%). Moreover, the studies comprising SMART have large numbers of participants who were followed from intact cognition and transitioned to cognitive impairment and dementia, as well as participants who remained cognitively intact until death. These data provide an exciting opportunity to apply sophisticated statistical methods, like Markov processes, that require large, well-characterized samples. Thus, SMART will serve as an important resource for the field of mixed dementia epidemiology and neuropathology.

Objectives This study examines the association between a modifiable psychosocial factor, social support availability (SSA), and the memory domain of cognitive function in persons aged 45–85 years. Methods We used baseline data from the Canadian Longitudinal Study on Aging (CLSA) (n = 21,241) to conduct multiple linear regression analyses of the association between SSA (overall and four subscales) and memory. The CLSA assessed immediate and delayed recall memory using the Rey Auditory Verbal Learning Test (RAVLT). Results Higher levels of each type of SSA were positively associated with better performance on both immediate and delayed recall memory. The largest associations (β coefficients [95% confidence intervals]) for z-score differences on the RAVLT were observed for overall SSA (immediate: 0.07 [0.04–0.10]; delayed recall: 0.06 [0.02–0.09]) and the emotional/informational subscale (immediate: 0.06 [0.03–0.09]; delayed recall: 0.05 [0.02–0.08]). Conclusion SSA is modifiable and positively associated with memory. Public health initiatives to provide support resources such as material aid, emotional support, or companionship may entail positive benefits for memory. Promotion of SSA is also important for policies encouraging early diagnosis and intervention in dementia.

Objective The aim of this study was to determine whether bilingualism is associated with dementia in cross-sectional or prospective analyses of older adults. Methods In 1991, 1616 community-living older adults were assessed and were followed 5 years later. Measures included age, sex, education, subjective memory loss (SML), and the modified Mini-mental State Examination (3MS). Dementia was determined by clinical examination in those who scored below the cut point on the 3MS. Language status was categorized based upon self-report into 3 groups: English as a first language (monolingual English, bilingual English) and English as a Second Language (ESL). Results The ESL category had lower education, lower 3MS scores, more SML, and were more likely to be diagnosed with cognitive impairment, no dementia at both time 1 and time 2 compared with those speaking English as a first language. There was no association between being bilingual (ESL and bilingual English vs. monolingual) and having dementia at time 1 in bivariate or multivariate analyses. In those who were cognitively intact at time 1, there was no association between being bilingual and having dementia at time 2 in bivariate or multivariate analyses. Conclusions We did not find any association between speaking >1 language and dementia.

RÉSUMÉCette étude visait à déterminer (1) si des mesures de position sociale sont associées à la fragilité, (2) si une association observée entre la position sociale et la fragilité est un effet de seuil ou de gradient, et (3) si une relation observée est indépendante des facteurs de confusion possibles. Les données ont été tirées d’un échantillon de 1 751 adultes, habitants des communautés, âgés de 65 ans et plus, habitant la province canadienne de Manitoba en 1991. On a utilisé, comme mesures de la position sociale l’éducation, et la suffisance et la satisfaction du revenu selon auto-évaluation personnelle. La précarité a été classée selon la perte fontionnelle, la cognition et l’incontinence urinaire. Des analyses de régressions multiples ont révelés, après ajustement pour les facteurs possibles de confusion, que toutes les mesures de la position sociale étaient fortement associées à la fragilité par gradient d’effet, plutôt que d’effet de seuil. Nous concluons que les gradients sociaux de la fragilité sont présents chez les adultes âgés, même si un mécanisme causatif n’est pas encore clair.

We sought to determine whether residence in a rural region is associated with a higher risk of dementia and a higher risk of developing dementia over a 5-year period than residence in an urban region.This was a secondary analysis of a prospective cohort study. In 1991 and 1992, 1751 adults aged 65 years and older and residing in the community were sampled from a representative population-based registry, which included the entire province (time 1). Follow-up occurred 5 years later (time 2). Age, sex and education were selfreported. Rurality was determined by the population of the Census subdivision, with a population greater than 19 999 considered urban. Cognition was assessed using the Modified Mini-Mental State Examination, with those scoring below 78 invited to undergo a clinical examination to determine the presence of dementia. Cross-sectional analyses were conducted for participants with complete data at time 1. Prospective analyses were conducted for participants with normal cognition at time 1, who had complete data and survived until time 2. Logistic regression models were constructed for the outcome of dementia at times 1 and 2.Residence in a rural region was not associated with dementia in the cross-sectional analyses (adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 0.61-1.91) and did not predict dementia 5 years later (adjusted OR 1.05, 95% CI 0.66-1.68).We found no difference in the risk of dementia among older adults living in urban and rural regions of Manitoba.Nous avons voulu déterminer si le fait de vivre en milieu rural est associé à un risque plus élevé de démence et à un risque plus élevé de développer une démence sur une période de 5 ans, comparativement au fait de vivre en milieu urbain.Il s’agit de l’analyse secondaire d’une étude de cohorte prospective. En 1991 et 1992, 1751 adultes de 65 ans ou plus vivant dans la communauté ont été échantillonnés à partir d’un registre représentatif de la population de toute la province (période 1). Un suivi a été effectué 5 ans plus tard (période 2). L’âge, le sexe et la scolarité étaient autodéclarés, et la ruralité était déterminée à partir des subdivisions utilisées aux fins de recensement : une population de 19 999 personnes ou plus était réputée urbaine. La cognition a été évaluée au moyen d’une version modifiée du mini-examen de l’état mental, et les sujets qui obtenaient un score inférieur à 78 étaient invités à subir un examen clinique pour déterminer la présence de démence. Des analyses transversales ont été réalisées pour les participants au sujet desquels on disposait de données complètes lors de la période 1. Des analyses prospectives ont été réalisées pour les participants dont la cognition était normale à la période 1, au sujet desquels on disposait de données complètes et qui avaient survécu jusqu’à la période 2. Des modèles de régression logistique ont été élaborés pour le paramètre de démence aux périodes 1 et 2.Le fait de vivre en région rurale n’a pas été associé à la démence selon les analyses transversales (rapport des cotes [RC] ajusté 1,08, intervalle de confiance [IC] de 95 % 0,61–1,91) et ne s’est pas révélé prédicteur de la démence 5 ans plus tard (RC ajusté 1,05, IC de 95 % 0,66–1,68).Nous n’avons observé aucune différence pour ce qui est du risque de démence chez les adultes âgés du Manitoba, qu’ils vivent en milieu rural ou urbain.

Background Frailty and depressive symptoms are common issues facing older adults and may be associated. Objectives To determine if: (i) depressive symptoms are associated with frailty; (ii) there is a gradient in this effect across the range of depressive symptoms; and (iii) the association between depressive symptoms and frailty is specific to particular types of depressive symptoms (positive affect, negative affect, somatic complaints, and interpersonal relations). Method Secondary analysis of an existing population-based study was conducted. Population In 1991, 1751 community-living adults aged 65+ years were interviewed. Measures Depressive symptoms were measured using the Center for Epidemiologic Studies—Depression (CES-D) scale. Frailty was graded from 0 (no frailty) to 3 (moderate/severe frailty). Age, gender, education, marital status, self-rated health, and the number of comorbid conditions were self-reported. Analyses Logistic regression models were constructed with the outcome of no frailty/urinary incontinence only versus frailty. Results Depressive symptoms were strongly associated with frailty, and there was a gradient effect across the entire range of the CES-D scale. The odds ratio and 95% confidence interval was 1.08 (1.06, 1.09) per point of the CES-D in unadjusted models. After potential confounding factors were adjusted, the adjusted odds ratio (95% confidence interval) was 1.03 (1.01, 1.05). Positive affect, negative affect, and somatic complaints were all associated with frailty, whereas interpersonal relations were not associated with frailty. Conclusions Depressive symptoms are associated with frailty. Clinicians should consider assessing frail older adults for the presence of depression. Copyright © 2012 John Wiley & Sons, Ltd.

No nationwide study has ever measured polychlorinated biphenyl (PCB) and organochlorine pesticide (OCP) body burden in Canadians aged 65 years and over. The objective of this study was to determine plasma concentrations of PCB congeners and OCPs in participants from a sub-cohort of the Canadian Study of Health and Aging and to examine the effects of socio-demographic, anthropometric and lifestyle characteristics on selected organochlorine concentrations. Archived plasma samples collected from 2023 subjects were analyzed by gas chromatography-mass spectrometry using negative chemical ionization for 15 PCB congeners and 11 OCPs. Descriptive statistics were used to report PCB congeners and OCP plasma concentrations. Multivariate models were used to study whether age at blood collection, sex, education, body mass index, rural residence, geographic region, smoking status and alcohol intake influences PCB 153, the most abundant congener, and the major OCP (beta-hexachlorocyclohexane, hexachlorobenzene, trans-nonachlor, p,p'-DDE) plasma concentrations. Statistical analyses were restricted to 1979 subjects and 17 organochlorine compounds for which at least 50% of the samples had concentrations above the limit of detection. Of these, 775 were men (mean age: 82.2 years) and 1204 were women (mean age: 84.6 years). The median concentrations (ng/g lipid) of PCB 153 in the plasma of men and women were 70.9 and 75.4, respectively. The levels of the sum of PCBs and the sum of dioxin-like PCBs were 276 and 31.3 for men, and 300 and 45.5 for women, respectively. The median concentrations (ng/g lipid) of p,p'-DDE, the most abundant OCP, were 565 for men and 828 for women. All compounds were positively and significantly intercorrelated (rs=0.39-0.99; p

Individuals with antemortem preservation of cognition who show autopsy evidence of at least moderate Alzheimer disease (AD) pathology suggest the possibility of brain reserve, that is, functional resistance to structural brain damage. This reserve would, however, only be relevant if the pathologic markers correlate well with dementia. Using data from the Nun Study (n = 498) and the Adult Changes in Thought (ACT) Study (n = 323), we show that Braak staging correlates strongly with dementia status. Moreover, participants with severe (Braak stage V–VI) AD pathology who remained not demented represent only 12% (Nun Study) and 8% (ACT study) of nondemented subjects. Comparison of these subjects to those who were demented revealed that the former group was often significantly memory impaired despite not being classified as demented. Most of these nondemented participants showed only stage V neurofibrillary pathology and frontal tangle counts that were slightly lower than a comparable (Braak stage V) dementia group. In summary, these data indicate that, in individuals with AD-type pathology who do not meet criteria for dementia, neocortical neurofibrillary tangles are somewhat reduced and incipient cognitive decline is present. Our data provide a foundation for helping to define additional factors that may impair, or be protective of, cognition in older adults.

Background: Use of combination pharmacotherapy, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and β-adrenoceptor antagonists (β-blockers) in the management of heart failure (HF) can reduce mortality, prevent functional decline and reduce health service use. However, these first-line therapies are underused in older populations. This article describes the use and predictors of use of first-line HF therapies in a population-based cohort of older home care clients in Ontario, Canada. Objectives: To examine the use and correlates of first-line pharmacotherapy in older home care clients with HF. Methods: This was a retrospective, cross-sectional study of Resident Assessment Instrument — Home Care (RAI-HC) data in individuals aged ≥65 years receiving home care services in the province of Ontario, Canada. Data collected were from all 14 health regions in Ontario. Home care clients with HF were identified from among those aged ≥65 years whose first RAI-HC assessment occurred between January 2004 and December 2007 (n = 176 866). Potential correlates of pharmacotherapy for HF were identified from the RAI-HC and examined using multivariable logistic regression. Results: HF prevalence was 12.4%. Among clients with HF, 28.6% received no first-line pharmacotherapy; this proportion declined by 6% over the 4 years studied. Only 28.0% were receiving recommended combination therapy. First-line pharmacotherapy use was dependent on hypertension and diabetes mellitus status. Use of pharmacotherapy was less likely among older clients and those with functional impairment, airway disease or behavioural symptoms. Conclusions: Approximately 29% of older home care clients with HF received no first-line HF pharmacotherapy, while another 28% received optimal first-line HF pharmacotherapy. In addition to the expected clinical correlates, the increased likelihood of non-use associated with clients’ demographic and functional characteristics raises concerns about quality of care. A better understanding of how these factors affect prescribing practices, particularly for combination therapy, would help to optimize HF disease management. For clinicians, this work also serves as a potential reminder to follow guideline recommendations for HF management in older, vulnerable adults.

Background Multiple lines of evidence suggest that cardiovascular co-morbidities hasten the onset of Alzheimer’s disease (AD) or accelerate its course. Methods To evaluate the utility of cerebral vascular physical function and/or condition parameters as potential systemic indicators of AD, transcranial Doppler (TCD) ultrasound was used to assess cerebral blood flow and vascular resistance of the 16 arterial segments comprising the circle of Willis and its major tributaries. Results Our study showed that decreased arterial mean flow velocity and increased pulsatility index are associated with a clinical diagnosis of presumptive AD. Cerebral blood flow impairment shown by these parameters reflects the global hemodynamic and structural consequences of a multifaceted disease process yielding diffuse congestive microvascular pathology, increased arterial rigidity, and decreased arterial compliance, combined with putative age-associated cardiovascular output declines. Conclusions TCD evaluation offers direct physical confirmation of brain perfusion impairment and might ultimately provide a convenient and a noninvasive means to assess the efficacy of medical interventions on cerebral blood flow or reveal incipient AD. In the near term, TCD-based direct assessments of brain perfusion might offer the prospect of preventing or mitigating AD simply by revealing patients who would benefit from interventions to improve circulatory system function.

Background A substantial body of evidence collected from epidemiologic, correlative, and experimental studies strongly associates atherosclerotic vascular disease (AVD) with Alzheimer's disease (AD). Depending on the precise interrelationship between AVD and AD, systematic application of interventions used to maintain vascular health and function as a component of standard AD therapy offers the prospect of mitigating the presently inexorable course of dementia. To assess this hypothesis, it is vital to rigorously establish the measures of AVD that are most strongly associated with an AD diagnosis. Methods A precise neuropathological diagnosis was established for all subjects, using a battery of genetic, clinical, and histological methods. The severity of atherosclerosis in the circle of Willis was quantified by direct digitized measurement of arterial occlusion in postmortem specimens and was compared between AD and nondemented control groups by calculating a corresponding index of occlusion. Results Atherosclerotic occlusion of the circle of Willis arteries was more extensive in the AD group than in the nondemented control group. Statistically significant differences were also observed between control and AD groups with regard to Braak stage, total plaque score, total neurofibrillary tangle score, total white matter rarefaction score, brain weight, Mini-Mental State Examination scores, and apolipoprotein E allelic frequencies. Conclusions Our results, combined with a consideration of the multifaceted effects of impaired cerebral circulation, suggest an immediate need for prospective clinical trials to assess the efficacy of AD prevention using antiatherosclerotic agents.

Introduction The aging of the Canadian population is associated with a rising burden of heart failure (HF), a condition associated with significant morbidity, mortality and health service use. Methods We used data from the Ontario Resident Assessment Instrument-Home Care database for all long-stay home care clients aged 65 years or older to (1) describe the demographic and clinical characteristics of home care clients with HF and (2) examine service use among home care clients with HF to promote management at home with appropriate services. Results Compared with other home care clients, HF clients exhibit more health instability, take more medications, experience more comorbid conditions and receive significantly more nursing, homemaking and meal services. They are hospitalized more frequently, have significantly more emergency department visits and use more emergent care. Discussion HF clients are a more complex group than home care clients in general. Patient self-care must be tailored to the clinical characteristics, patterns of service use and barriers to self-care of the client. This is particularly true for older, frail and medically complex HF patients, many of whom require home care services. This work provides a background upon which to base initiatives to help these higher-needs clients manage their HF at home with appropriate support and services.

Introduction Le vieillissement de la population canadienne s’accompagne d’un accroissement du fardeau que représente l’insuffisance cardiaque (IC), affection associée à un taux de morbidité et de mortalité important ainsi qu’à un recours fréquent aux services de santé. Méthodologie Nous avons extrait les données de la base de données du Resident Assessment Instrument-Home Care (RAI-HC) de l’Ontario pour tous les clients bénéficiant de soins à domicile de longue durée et âgés de 65 ans et plus, afin 1) de décrire les caractéristiques démographiques et cliniques des clients de soins à domicile souffrant d’insuffisance cardiaque et 2) d’examiner le recours aux services de santé par les clients de soins à domicile souffrant d’insuffisance cardiaque. Résultats Par rapport aux autres clients de soins à domicile, ceux qui souffrent d’insuffisance cardiaque présentent un état de santé plus instable, consomment davantage de médicaments, affichent un taux plus élevé de comorbidité et ont besoin d’un volume significativement plus élevé de soins infirmiers, ainsi que de services ménagers et culinaires. Ils sont hospitalisés plus fréquemment et font un usage significativement plus élevé des services d’urgence et des soins de première urgence. Analyse Les clients souffrant d’insuffisance cardiaque constituent un groupe plus complexe que les clients des soins à domicile en général. La manière dont les patients prennent en main leur santé doit être adaptée à leurs caractéristiques cliniques, à leurs schémas habituels d’utilisation des services et aux obstacles auxquels ils doivent faire face. Ce constat est particulièrement vrai chez les patients plus âgés, frêles et au profil médical complexe qui souffrent d’insuffisance cardiaque, et ils sont nombreux parmi ceux qui requièrent des services à domicile. Cette étude peut servir d’assise à des initiatives de base permettant d’aider ces clients aux besoins particulièrement grands à gérer leur insuffisance cardiaque à domicile grâce à de l’aide et à des services adaptés.

SummaryAlcohol use is common in older adults and is associated with numerous health and social problems. Recent evidence suggests that in addition to level of alcohol consumption, drinking pattern may also be important. Moderate alcohol intake may confer some cardiac benefits, while heavy episodic drinking seems particularly problematic. Detecting alcohol misuse in older adults is difficult since clinical acumen is often poor, screening questionnaires have serious limitations and laboratory tests are not diagnostic. Brief alcohol interventions to reduce alcohol consumption appear useful in younger populations, but are less studied in older adults. While there is increasing research into the issue of alcohol use among older adults, clinicians and policy-makers must rely on limited evidence when making clinical decisions.

Objectives Alcohol misuse in seniors has been studied in clinical samples and in small communities, but relatively few studies are population-based. Objectives are: (1) to describe the characteristics of seniors who score 1 or more on the CAGE (Cut down; Annoyed; Guilty; Eye-opener) questionnaire of alcohol problems; (2) to determine if depressive symptoms are associated with alcohol misuse after accounting for other factors. Methods Cross-sectional study of community-dwelling older people (65+ years) sampled from a representative population registry in Manitoba, Canada. Participants were initially interviewed in 1991–1992 and reinterviewed in 1996–1997. Data from Time 2 were used; 1,028 persons were included in the analyses. Sociodemographic characteristics, the CAGE questionnaire, Activities of Daily Living (ADLs) and instrumental ADLs (IADLs), the Center for Epidemiologic Studies—Depression (CES-D) scale and the Mini-Mental State Examination (MMSE) were assessed by trained interviewers. Results Males were more likely to score positive on the CAGE questionnaire. After adjusting for gender, age, and education, there was a strong association between depressive symptoms and alcohol misuse. Poor self-rated health and impairments in IADLs were also associated with alcohol misuse. Conclusions Male gender, depressive symptoms, and poor functional status were associated with alcohol misuse in this population-based study. Attention to depressive symptoms and functional status may be important in the care of seniors with alcohol misuse. Alternatively, physicians should enquire about alcohol use in seniors with functional impairment or depressive symptoms. Copyright © 2008 John Wiley & Sons, Ltd.

Background: research has reliably demonstrated cardioprotection from regular alcohol use. Heavy episodic drinking (HED), however, negates these beneficial effects and increases the risk of cardiovascular disease (CVD). The impact of age on the health effects of episodic drinking has not been evaluated. Objective: to examine the association between alcohol volume and pattern of consumption on the risk of cardiovascular morbidity and mortality across the lifespan. Design and Setting: prospective, community-based cohort study of adults in Winnipeg, Manitoba, Canada. Subjects: a total of 1,154 participants (580 men and 574 women) aged 18‐64 surveyed at baseline (1990‐91) on alcohol consumption levels and pattern of use. Methods: usual alcohol consumption was measured using a quantity‐frequency approach. HED was estimated by asking participants how often they consumed eight or more drinks in one sitting in the past year. Questions were asked separately for wine, beer and spirits. Surveillance for cardiovascular events was conducted for 10 years (i.e. up to age 74 years). Diagnoses of CVD were obtained via health utilization records. Cox proportional hazard models were derived for both genders and for ‘young adults’ (baseline age 18‐34), ‘middle-aged adults’ (baseline age 35‐49) and ‘older adults’ (baseline 50‐64). Models were adjusted for marital status, cigarette smoking status and educational level. Results: Reduced risk of CVD was associated with usual consumption, whereas an increased risk was associated with HED. Among male usual drinkers, cardioprotection was afforded only to middle and older age groups. The benefits of regular consumption were seen only in the youngest age group among women. The heaviest usual consumption category was associated with a decreased risk of CVD in men. Heavy episodic drinking increased the risk of coronary heart disease in middle-aged men and was marginally significant in middle-aged women. Risk of hypertension was elevated in older men with heavy episodic drinking. Conclusions: The well-established relationship between regular alcohol consumption and decreased risk of CVD may not become evident until middle age or older in men. Women may benefit from usual consumption at a much younger age. In both sexes, however, these beneficial effects of alcohol use are negated when alcohol is consumed in a heavy episodic drinking pattern, particularly for middle-aged and older men.