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Background. The precise relationship between depression and cognitive decline in older adults is unclear. We investigated the influence of apolipoprotein E (APOE)-[epsilon]4 genotype in modulating the effect of depressive symptoms on cognitive decline. Methods. Prospective cohort study of 1,487 cognitively high-functioning Chinese older adults. Depressive symptoms (Geriatric Depression Scale score [greater than or equal to] 5) and Mini-Mental State Examination (MMSE) were assessed at baseline, and cognitive decline (at least l-point drop in MMSE) at 1-2 years after baseline. Results. There was no significant difference in cognitive decline between depressed (32.9%) and nondepressed (31.5%) participants in the whole sample or among non-APOE-[epsilon]4 carriers. Among APOE-[epsilon]4 carriers, depressed participants showed more cognitive decline (40.0%) than their nondepressed counterparts (28.6%), odds ratio = 2.89, 95% confidence interval: 1.03-8.12; p = .04, after controlling for age, gender, education, vascular risk factors/events, smoking, alcohol drinking, physical functioning, subjective memory complaint, length of follow-up, and baseline MMSE scores (p for interaction = .03). Conclusions. Our study suggests that the presence of the APOE-[epsilon]4 allele significantly enhanced the risk of cognitive decline associated with depressive symptoms. This finding should be independently replicated in future studies. Key Words: Depression--Cognition--Dementia--Apolipoprotein E.

Background. We sought to assess the validity of the physical and cognitive domains of Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale and its cross-cultural applicability across ethnic groups in an Asian population of community-living older adults. Methods. Using data from a random population sample of noninstitutionalized Chinese, Malay, and Indian older adults 60 years old and older in Singapore (N = 1072), we modeled the dimensional structure of the 8-item IADL Scale using exploratory and confirmatory factor analyses, and assessed its convergent and divergent validity using known group differences and strengths of association. Results. Factor analyses yielded two strong and reliable factors representing underlying physical and cognitive dimensions of IADL. The validity of the model was supported by the pattern of associations of the IADL with age, gender, education, self-reported health status, hospitalization, physical comorbidities, dementia and depression, and Mini-Mental State Examination (MMSE) scores. Notably, cognitive IADL showed a greater total effect on MMSE cognitive performance score than did physical IADL, with the effect of physical IADL on MMSE score mostly explained by cognitive IADL. Reasonably good cross-cultural validity was demonstrated among Chinese, Malays, and Indians, with strongest validity for Indians. Conclusion. The eight-item IADL Scale has physical and cognitive domains and is cross-culturally applicable. The cognitive IADL domain taps a set of activities directly related to cognitive functioning.

Background: Cognitive, physical, and nutritional interventions may produce different cognitive effects for different groups of older persons. We investigated simultaneously the cognitive outcomes of cognitive, physical, and nutritional interventions singly and in combinations in older persons with the physical frailty phenotype at particular risk of cognitive decline.Method: Pre-frail and frail participants were randomly allocated to 24 weeks nutritional supplementation (N = 49), physical training (N = 48), cognitive training (N = 50), combination intervention (N = 49), or usual care control (N = 50). Cognitive domain and global functions were assessed at baseline (0M), 6 month (6M), and 12 month (12M).Results: The control group showed declines in z-scores (from -0.100 to -0.244) of all domains. The cognitive training compared to control group showed the greatest increase in global cognition at 6M (0.094 vs -0.174, p = .006) and 12M (0.099 vs -0.142, p = .002), immediate memory at 6M (0.164 vs -0.211, p = .010) and 12M (0.182 vs -0.142, p = .040), delayed memory at 6M (p = .010), and attention at 6M (p = .025). Nutritional intervention showed benefits at 6M for immediate memory (p = .028) and delayed memory (p = .024), but physical training showed no positive effects. The combination group showed the greatest increase for visuospatial construction at 6M (0.215 vs -0.141, p = .010) and 12M (0.166 vs -0.180, p = .016), and for global cognition at 12M (p = .016) and language at 12M (p = .023).Conclusion: Among frail older persons, cognitive training conferred the greatest cognitive benefits. Nutritional and physical interventions singly were associated with modest short-term or no cognitive benefits, but their combined effects on visuospatial construction should be further investigated. [ABSTRACT FROM AUTHOR]

ObjectiveA limited but growing body of evidence supports a significant role of antioxidant and anti-inflammatory micronutrients in pulmonary health. We investigated the associations of dietary and supplemental intakes of vitamins A, C, E and D, Se and n-3 PUFA with pulmonary function in a population-based study.DesignPopulation-based, cross-sectional study and data analysis of fruits and vegetables, dairy products and fish, vitamins A, C, E and D, Se and n-3 PUFA supplemental intakes, pulmonary risk factors and spirometry.SubjectsChinese older adults (n 2478) aged 55 years and above in the Singapore Longitudinal Ageing Studies.ResultsIn multiple regression models that controlled simultaneously for gender, age, height, smoking, occupational exposure and history of asthma/chronic obstructive pulmonary disease, BMI, physical activity, and in the presence of other nutrient variables, daily supplementary vitamins A/C/E (b = 0·044, se = 0·022, P = 0·04), dietary fish intake at least thrice weekly (b = 0·058, se = 0·016, P < 0·0001) and daily supplementary n-3 PUFA (b = 0·068, se = 0·032, P = 0·034) were individually associated with forced expiratory volume in the first second. Supplemental n-3 PUFA was also positively associated with forced vital capacity (b = 0·091, se = 0·045, P = 0·045). No significant association with daily dairy product intake, vitamin D or Se supplements was observed.ConclusionsThe findings support the roles of antioxidant vitamins and n-3 PUFA in the pulmonary health of older persons. [ABSTRACT FROM AUTHOR]

Background: Research on the effects of dietary nutrients on respiratory health in human populations have not investigated curcumin, a potent anti-oxidant and anti-inflammatory compound present principally in turmeric used in large amounts in Asian curry meals. Objectives: To examine the association of curry intake with pulmonary function among smokers and non-smokers. Design: The frequency of curry intake, respiratory risk factors and spirometry were measured in a population-based study of 2,478 Chinese older adults aged 55 and above in the Singapore Longitudinal Ageing Studies. Results: Curry intake (at least once monthly) was significantly associated with better FEV1 (b = 0.045±0.018, p = 0.011) and FEV1/FVC (b = 1.14±0.52, p = 0.029) in multivariate analyses that controlled simultaneously for gender, age, height, heightsquared, smoking, occupational exposure and asthma/COPD history and other dietary or supplementary intakes. Increasing levels of curry intake ('never or rarely', 'occasional', 'often', 'very often') were associated with higher mean adjusted FEV1 (p for linear trend = 0.001) and FEV1/FVC% (p for linear trend = 0.048). Significant effect modifications were observed for FEV1 (curry" smoking interaction, p = 0.028) and FEV1/FVC% (curry"smoking interaction, p = 0.05). There were significantly larger differences in FEV1 and FEV1/FVC% between curry intake and non-curry intake especially among current and past smokers. The mean adjusted FEV1 associated with curry intake was 9.2% higher among current smokers, 10.3% higher among past smokers, and 1.5% higher among non-smokers. Conclusion: The possible role of curcumins in protecting the pulmonary function of smokers should be investigated in further clinical studies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the association between serum albumin and cognitive impairment and decline in community-living older adults. DESIGNS: Population-based cohort study, followed up to 2 years; serum albumin, apolipoprotein E (APOE)-ℇ4, and cognitive impairment measured at baseline and cognitive decline (≥2-point drop in Mini-Mental State Examination (MMSE) score). Odds ratios were controlled for age, sex, education, medical comorbidity, hypertension, diabetes mellitus, cardiac disease, stroke, smoking, alcohol drinking, depression, APOE-ℇ4, nutritional status, body mass index, anemia, glomerular filtration rate, and baseline MMSE. SETTINGS: Local area whole population. PARTICIPANTS: One thousand six hundred sixty-four Chinese older adults aged 55 and older. RESULTS: The mean age of the cohort was 66.0±7.3, 65% were women, mean serum albumin was 42.3±3.1 g/L, and mean MMSE score was 27.2±3.2. Lower albumin tertile was associated with greater risk of cognitive impairment in cross-sectional analysis (low, odds ratio (OR)=2.30, 95% confidence interval (CI)=1.31–4.03); medium, OR=1.59, 95% CI=0.88–2.88) versus high ( P for trend=.002); and with cognitive decline in longitudinal analyses: low, OR=1.73, 95% CI=1.18–2.55; medium, OR=1.32, 95% CI=0.89–1.95, vs high ( P for trend=.004). In cognitively unimpaired respondents at baseline (MMSE≥24), similar associations with cognitive decline were observed ( P for trends <.002). APOE-ℇ4 appeared to modify the association, due mainly to low rates of cognitive decline in subjects with the APOE-ℇ4 allele and high albumin. CONCLUSION: Low albumin was an independent risk marker for cognitive decline in community-living older adults. [ABSTRACT FROM AUTHOR]

Objective: Few studies have explored the relationship between orthostatic hypotension (OH) and cognition. The aim of this study was to examine the association of OH with cognitive impairment and decline in a cohort of Chinese elderly, and its effect modification by blood pressure (BP) status at baseline. Method: Among 2,321 community-living older adults, free of cardiovascular disease and stroke, baseline BP measurements were used to determine the presence of OH and categorize participants as hypotensives, normotensives or hypertensives. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment (MMSE score <24). Cognitive decline (decrease in MMSE score by ≥1) was assessed from 1 to 2 years of follow-up for 1,347 participants without baseline cognitive impairment. Results: Mean age of the subjects was 65.5 years and 381 (16.6%) showed OH. OH was not associated with cognitive impairment overall. However, among hypotensives, OH increased the odds of cognitive impairment (OR = 4.1, 95% CI = 1.11–15.1), while hypertensives with OH showed reduced odds of cognitive impairment (OR = 0.48, 95% CI = 0.26–0.90). Among cognitively intact participants, OH was not associated with cognitive decline overall or in BP subgroups. Conclusion: The increased risk of cognitive impairment in hypotensives with OH suggests that hypotension with OH may be an early comorbid marker of a primary incipient dementia. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: to examine the relationships between serum albumin, haemoglobin and body mass index (BMI) with cognitive performance among community-living older adults. Method: design-population-based cross-sectional study; setting-local community in Southeast Region of Singapore; subjects-Chinese older adults aged 55 and above (N = 2,550); measurements-serum albumin, haemoglobin, BMI and Mini-Mental State Examination (MMSE). Results: in multivariable analyses controlling for gender, age, education and vascular risk factors, low albumin in the bottom quintile (OR 2.04; 95% CI 1.22-3.41) and low haemoglobin in the bottom quintile (OR 1.56; 95% CI 1.00-2.47) and low BMI with chronic comorbidity (OR 1.73; 95%CT 1.02-2.95) were independently associated with poor cognitive performance (MMSE ≥ 23). Among cognitively intact respondents (MMSE ≤ 24), albumin concentration showed a significant inverse linear relationship with MMSE scores (P for trend =0.002). Conclusion: low albumin, low haemoglobin and low BMI (in the presence of chronic comorbidity) are independently associated with poor cognitive performance in community-living older adults. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of the metabolic syndrome (MS) with cognitive decline in a Chinese older population. Methods: In a prospective cohort study of 1,352 community-living Chinese older adults without cognitive impairment (Mini Mental State Examination, MMSE <24) and without cardiovascular disease and stroke, the authors assessed baseline MS (defined according to International Diabetic Federation Criteria). Cognitive decline was predefined as at least 2-point drop in MMSE score at follow-up 1-2 years after baseline assessment. Results: MS was present in 263% of the participants at baseline and was significantly associated with the risk of cognitive decline (odds ratio, 1.42: confidence interval, 1.01-1.98), after controlling for potential confounding by age, gender, education, smoking, alcohol drinking, depressive symptoms, APOE-e4 status, level of leisure activities, baseline MMSE, and length of follow-up. Conclusion: The MS was associated with increased risk of cognitive decline in Chinese older adults. [ABSTRACT FROM AUTHOR]

Background. We sought to assess the validity of the physical and cognitive domains of Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale and its cross-cultural applicability across ethnic groups in an Asian population of community-living older adults. Methods. Using data from a random population sample of noninstitutionalized Chinese, Malay, and Indian older adults 60 years old and older in Singapore (N = 1072), we modeled the dimensional structure of the 8-item IADL Scale using exploratory and confirmatory factor analyses, and assessed its convergent and divergent validity using known group differences and strengths of association. Results. Factor analyses yielded two strong and reliable factors representing underlying physical and cognitive dimensions of IADL. The validity of the model was supported by the pattern of associations of the IADL with age, gender, education, self-reported health status, hospitalization, physical comorbidities, dementia and depression, and Mini-Mental Stale Examination (MMSE) scores. Notably, cognitive IADL showed a greater total effect on MMSE cognitive performance score than did physical IADL, with the effect of physical IADL on MMSE score mostly explained by cognitive IADL. Reasonably good cross-cultural validity was demonstrated among Chinese, Malays, and Indians, with strongest validity for Indians. Conclusion. The eight-item IADL Scale has physical and cognitive domains and is cross-culturally applicable. The cognitive IADL domain taps a set of activities directly related to cognitive functioning. [ABSTRACT FROM AUTHOR]

Objectives: To make comparative estimates of prevalence of late-life functional disability, examine sociodemographic and health correlates, investigate sex and ethnic differences, and estimate population attributable risk of modifiable risk factors. Design: Population-based survey. Setting: Multiethnic population of Singapore (3 million residents). Participants: Noninstitutionalized Chinese, Malay, and Indian people aged 60 and older (N=1,079) Measurements: Functional disability was defined as needing help in at least one basic activity of daily living (ADL) task in the 10 items of the Barthel Index. Five basic ADLs (eating, bathing, dressing, transferring, toileting) were used to compare prevalence with those reported from other national surveys and with reported past prevalence within the country. Results: The prevalence of disability in at least one of five ADL items (6.6% in those aged≥65) appeared lower than elsewhere, including China, but higher than reported past prevalence within the country. Functional disability on at least one of the 10 ADL items was independently associated with female sex, Indian ethnicity, older age, poor self-rated health, specific chronic diseases, cognitive impairment, sensory impairment, and living with others. The population attributable risks for leading modifiable factors were arthritis (12%) and cognitive impairment (14%). Conclusion: Lower prevalence of functional disability accompanies rapid aging and health transition in Singapore than in other countries but higher prevalence than reported past prevalence within the country. Associations with sociodemographic and health-related factors were consistent with Western studies, including unexplained sex and ethnic differences. [ABSTRACT FROM AUTHOR]

Background: Cognitive, physical, and nutritional interventions may produce different cognitive effects for different groups of older persons. We investigated simultaneously the cognitive outcomes of cognitive, physical, and nutritional interventions singly and in combinations in older persons with the physical frailty phenotype at particular risk of cognitive decline., Method: Pre-frail and frail participants were randomly allocated to 24 weeks nutritional supplementation (N = 49), physical training (N = 48), cognitive training (N = 50), combination intervention (N = 49), or usual care control (N = 50). Cognitive domain and global functions were assessed at baseline (0M), 6 month (6M), and 12 month (12M)., Results: The control group showed declines in z-scores (from -0.100 to -0.244) of all domains. The cognitive training compared to control group showed the greatest increase in global cognition at 6M (0.094 vs -0.174, p = .006) and 12M (0.099 vs -0.142, p = .002), immediate memory at 6M (0.164 vs -0.211, p = .010) and 12M (0.182 vs -0.142, p = .040), delayed memory at 6M (p = .010), and attention at 6M (p = .025). Nutritional intervention showed benefits at 6M for immediate memory (p = .028) and delayed memory (p = .024), but physical training showed no positive effects. The combination group showed the greatest increase for visuospatial construction at 6M (0.215 vs -0.141, p = .010) and 12M (0.166 vs -0.180, p = .016), and for global cognition at 12M (p = .016) and language at 12M (p = .023)., Conclusion: Among frail older persons, cognitive training conferred the greatest cognitive benefits. Nutritional and physical interventions singly were associated with modest short-term or no cognitive benefits, but their combined effects on visuospatial construction should be further investigated.