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  • 1
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 75, No. 1 ( 2017-05-01), p. 45-51
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 75, No. 1 ( 2017-05-01), p. 45-51
    Abstract: Proximal tubular dysfunction (PTD) is common in HIV-positive persons and has been associated with tenofovir disoproxil fumarate (TDF). However, few studies have assessed the natural history PTD in HIV-positive and -negative individuals, or the association of PTD with the subsequent trajectory of directly measured glomerular filtration rate (mGFR). Methods: We followed 192 HIV-positive and 100 HIV-negative, nondiabetic participants for 3 years. We measured 3 PTD markers (normoglycemic glycosuria, fractional excretion of phosphorus, and tubular proteinuria) and mGFR (by iohexol disappearance from serum) annually. We used univariate and multivariate generalized estimating equation logistic regression to identify factors associated with PTD across all visits and linear mixed effects models to assess the association between baseline PTD and mGFR slope. Results: Compared with HIV-negative participants, HIV-positive persons that were not taking antiretroviral therapy were at increased risk of PTD (adjusted odds ratio 3.33; 95% confidence interval: 1.65 to 6.71), whereas those taking a TDF-based or a TDF-sparing regimen were not at significantly increased risk of PTD. Among HIV-positive participants, uncontrolled viremia was a strong correlate of PTD. Forty-nine of 55 (89%) participants with PTD at baseline had at least 1 subsequent visit without PTD. There was no association between baseline PTD and rate of decline in mGFR over time. Conclusions: Poorly controlled HIV may be a stronger risk factor for PTD than TDF use. The individual-level variability of the PTD markers over time was high, potentially limiting their usefulness for routine screening in unselected patients. Baseline PTD was not associated with subsequent mGFR slope.
    Type of Medium: Online Resource
    ISSN: 1525-4135
    RVK:
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2038673-4
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  • 2
    In: Frontiers in Medicine, Frontiers Media SA, Vol. 9 ( 2022-6-27)
    Abstract: The inter-individual variability in cognitive changes may be early indicators of major health events. We aimed to determine whether late-life cognitive trajectories were associated with incident dementia, persistent physical disability and all-cause mortality. Methods Data came from a cohort of older community-dwelling individuals aged 70 years or above in Australia and the United States. Global cognition, verbal fluency, episodic memory and psychomotor speed were assessed regularly at up to seven waves between 2010 and 2017. Dementia, disability in activities of daily living, and death were adjudicated between 2017 and 2020. Latent classes of cognitive trajectories over seven years were determined using group-based trajectory modeling. Multivariable logistic regression was used for the prospective associations between cognitive trajectories and these outcomes. Results Cognitive trajectories were defined for 16,174 participants (mean age: 78.9 years; 56.7% female) who were alive and without incident dementia or disability by 2017, among which 14,655 participants were included in the association analysis. Between three and five trajectory classes were identified depending on the cognitive test. Cognitive trajectories were strongly associated with the risk of dementia. For example, compared to those in the highest-functioning trajectory, the worst performers of episodic memory had a 37-fold increased risk of dementia (95% CI: 17.23–82.64). The lowest trajectories of both global cognition and episodic memory also predicted increased mortality risk (OR: 1.80, 95% CI: 1.28–2.52; OR: 1.61, 95% CI: 1.09–2.36, respectively), while only slow psychomotor speed was marginally associated with physical disability (OR: 2.39, 95% CI: 0.99–5.77). Conclusions In older individuals, cognitive trajectories appear to be early indicators of clinically relevant health outcomes. Systematic cognitive assessments as part of routine geriatric evaluation may facilitate early identification and interventions for those individuals at highest risk.
    Type of Medium: Online Resource
    ISSN: 2296-858X
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2775999-4
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  • 3
    In: Annals of Internal Medicine, American College of Physicians, Vol. 172, No. 10 ( 2020-05-19), p. 656-668
    Type of Medium: Online Resource
    ISSN: 0003-4819 , 1539-3704
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    Language: English
    Publisher: American College of Physicians
    Publication Date: 2020
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  • 4
    In: JAMA Network Open, American Medical Association (AMA), Vol. 6, No. 7 ( 2023-07-14), p. e2323690-
    Abstract: Lifestyles enriched with socially and mentally stimulating activities in older age may help build cognitive reserve and reduce dementia risk. Objective To investigate the association of leisure activities and social networks with dementia risk among older individuals. Design, Setting, and Participants This longitudinal prospective cohort study used population-based data from the ASPREE Longitudinal Study of Older Persons (ALSOP) for March 1, 2010, to November 30, 2020. Community-dwelling individuals in Australia aged 70 years or older who were generally healthy and without major cognitive impairment at enrollment were recruited to the ALSOP study between March 1, 2010, and December 31, 2014. Data were analyzed from December 1, 2022, to March 31, 2023. Exposures A total of 19 measures of leisure activities and social networks assessed at baseline were classified using exploratory factor analysis. Main Outcomes and Measures Dementia was adjudicated by an international expert panel according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Cox proportional hazards regression examined dementia risk over 10 years, adjusting for education, socioeconomic status, and a range of health-related factors. Results This study included 10 318 participants. Their median age was 73.8 (IQR, 71.6-77.2) years at baseline, more than half (52.6%) were women, and most self-identified as White (98.0%). In adusted analyses, more frequent engagement in adult literacy activities (eg, writing letters or journaling, using a computer, and taking education classes) and in active mental activities (eg, playing games, cards, or chess and doing crosswords or puzzles) was associated with an 11.0% (adjusted hazard ratio [AHR], 0.89 [95% CI, 0.85-0.93] ) and a 9.0% (AHR, 0.91 [95% CI, 0.87-0.95]) lower risk of dementia, respectively. To a lesser extent, engagement in creative artistic activities (craftwork, woodwork, or metalwork and painting or drawing) (AHR, 0.93 [95% CI, 0.88-0.99] ) and in passive mental activities (reading books, newspapers, or magazines; watching television; and listening to music or the radio) (AHR, 0.93 [95% CI, 0.86-0.99]) was also associated with reduced dementia risk. In contrast, interpersonal networks, social activities, and external outings were not associated with dementia risk in this sample. Conclusions and Relevance These results suggest that engagement in adult literacy, creative art, and active and passive mental activities may help reduce dementia risk in late life. In addition, these findings may guide policies for geriatric care and interventions targeting dementia prevention for older adults.
    Type of Medium: Online Resource
    ISSN: 2574-3805
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2931249-8
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  • 5
    In: Journal of the American Geriatrics Society, Wiley, Vol. 69, No. 8 ( 2021-08), p. 2262-2272
    Abstract: To determine the association of life‐space score with subsequent healthcare costs and utilization. Design Prospective cohort study (Osteoporotic Fracture in Men [MrOS]). Setting Six U.S. sites. Participants A total of 1555 community‐dwelling men (mean age 79.3 years; 91.5% white, non‐Hispanic) participating in the MrOS Year 7 (Y7) examination linked with their Medicare claims data. Measurements Life‐space during the past month was assessed as 0 (daily restriction to one's bedroom) to 120 (daily trips outside one's town without assistance) and categorized (0–40, 41–60, 61–80, 81–100, 101–120). Total annualized direct healthcare costs and utilization were ascertained during 36 months after the Y7 examination. Results Mean total annualized costs (2020 U.S. dollars) steadily increased across category of life‐space score, from $7954 (standard deviation [SD] 16,576) among men with life‐space scores of 101–120 to $26,430 (SD 28,433) among men with life‐space scores of 0–40 ( p   〈  0.001). After adjustment for demographics, men with a life‐space score of 0–40 versus men with a life‐space score of 101–120 had greater mean total costs (cost ratio [CR] = 2.52; 95% confidence interval [CI]  = 1.84–3.45) and greater risk of subsequent hospitalization (odds ratio [OR] 4.72, 95% CI 2.61–8.53) and skilled nursing facility (SNF) stay (OR 7.32, 95% CI 3.65–14.66). Life‐space score was no longer significantly associated with total healthcare costs (CR for 0–40 vs 101–120 1.29; 95% CI 0.91–1.84) and hospitalization (OR 1.76, 95% CI 0.89–3.51) after simultaneous consideration of demographics, medical factors, self‐reported health and function, and the frailty phenotype; the association of life‐space with SNF stay remained significant (OR 2.86, 95% CI 1.26–6.49). Conclusion Our results highlight the importance of function and mobility in predicting future healthcare costs and suggest the simple and convenient life‐space score may in part capture risks from major geriatric domains and improve identification of older, community‐dwelling men likely to require costly care.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2040494-3
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  • 6
    In: Osteoporosis International, Springer Science and Business Media LLC, Vol. 34, No. 1 ( 2023-01), p. 91-99
    Type of Medium: Online Resource
    ISSN: 0937-941X , 1433-2965
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1480645-9
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  • 7
    In: Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, Wiley, Vol. 15, No. 1 ( 2023-01)
    Abstract: This study investigated whether grip strength and gait speed predict cognitive aging trajectories and examined potential sex‐specific associations. Methods Community‐dwelling older adults ( n  = 19,114) were followed for up to 7 years, with regular assessment of global function, episodic memory, psychomotor speed, and executive function. Group‐based multi‐trajectory modeling identified joint cognitive trajectories. Multinomial logistic regression examined the association of grip strength and gait speed at baseline with cognitive trajectories. Results High performers (14.3%, n  = 2298) and low performers (4.0%, n  = 642) were compared to the average performers (21.8%, n  = 3492). Grip strength and gait speed were positively associated with high performance and negatively with low performance ( P ‐values  〈  0.01). The association between grip strength and high performance was stronger in women (interaction P   〈  0.001), while gait speed was a stronger predictor of low performance in men (interaction P   〈  0.05). Discussion Grip strength and gait speed are associated with cognitive trajectories in older age, but with sex differences. Highlights There is inter‐individual variability in late‐life cognitive trajectories. Grip strength and gait speed predicted cognitive trajectories in older age. However, sex‐specific associations were identified. In women, grip strength strongly predicted high, compared to average, trajectory. In men, gait speed was a stronger predictor of low cognitive performance trajectory.
    Type of Medium: Online Resource
    ISSN: 2352-8729 , 2352-8729
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2832898-X
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  • 8
    In: Journal of the American Geriatrics Society, Wiley
    Abstract: This study examined the associations of body mass index (BMI) and waist circumference (WC), as well as their short‐ and long‐term changes over time, with incident dementia in older individuals. Methods Data came from 18,837 community‐dwelling individuals aged 65+ years from Australia and the United States, who were relatively healthy without major cognitive impairment at enrolment. Anthropometric measures were prospectively assessed at baseline, as well as change and variability from baseline to year two (three time‐points). In a subgroup ( n = 11,176), self‐reported weight at age 18 and 70+ years was investigated. Dementia cases satisfied DSM‐IV criteria. Cox regression was used to examine the associations between anthropometric measures and incident risk of dementia. Results Compared to normal weight, an overweight (HR: 0.67, 95%CI: 0.57–0.79, p 〈 0.001) or obese BMI (HR: 0.73, 95%CI: 0.60–0.89, p = 0.002), or a larger WC (elevated, HR: 0.71, 95%CI: 0.58–0.86, p 〈 0.001; highly elevated, HR: 0.65, 95%CI: 0.55–0.78, p 〈 0.001; relative to low) at baseline was associated with lower dementia risk. In contrast, substantial increases in BMI ( 〉 5%) over 2 years after baseline were associated with higher dementia risk (HR: 1.49, 95% CI: 1.17–1.91, p = 0.001). Increased dementia risk was also seen with an underweight BMI at baseline and a 2‐year BMI decrease ( 〉 5%), but these associations appeared only in the first 4 years of follow‐up. Compared to normal weight at both age 18 and 70+ years, being obese at both times was associated with increased dementia risk (HR: 2.27, 95%CI: 1.22–4.24, p = 0.01), while obesity only at age 70+ years was associated with decreased risk (HR: 0.70, 95%CI: 0.51–0.95, p = 0.02). Conclusions Our findings suggest that long‐term obesity and weight gain in later life may be risk factors for dementia. Being underweight or having substantial weight loss in old age may be early markers of pre‐clinical dementia.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2040494-3
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  • 9
    In: Health Science Reports, Wiley, Vol. 5, No. 4 ( 2022-07)
    Abstract: Reduced estimated glomerular filtration rate (eGFR  〈  60 ml/min/1.73 m 2 ) is a risk factor for cognitive impairment (CI) and medication nonadherence. However, the association between CI and medication adherence in adults with reduced eGFR has not been adequately examined. Our pragmatic objectives were to assess the cross‐sectional relationship between CI and self‐reported medication adherence, medication number, and use of potentially high‐risk medications among adults with reduced eGFR. Methods An observational cohort study of the epidemiology of CI in community‐dwelling adults aged 45 years or older with reduced eGFR. Results Our analytic cohort consisted of 420 participants (202 with CI; mean age: 69.7 years) with reduced eGFR, at least one prescription medication, and nonmissing medication adherence data. Participants with CI had four times greater unadjusted odds of reporting good medication adherence than participants without CI (self‐report of missing medications 〈 4 days/month; odds ratio [OR]: 4.04, 95% confidence interval [CI] :​​​​​ 1.62–10.10). This difference persisted following adjustment for demographic factors and comorbidities (OR: 5.50, 95% CI: 1.86–16.28). Participants with CI were no more likely than participants without CI to report forgetfulness as a reason for missing medication doses. Participants with CI were, on average, taking more total (mean: 13.3 vs. 11.5, median: 12 vs. 11) and more high‐risk (mean: 5.0 vs. 4.2, median: 5 vs. 4) medications than those without CI; these differences were attenuated and no longer significant following adjustment for demographics and comorbidities. Conclusion Given the well‐documented association between CI and medication nonadherence, better self‐reported medication adherence among those with CI may represent perceptions of adherence rather than actual adherence. Participants with CI were, on average, taking more total and more high‐risk medications than those without CI, suggesting a possible increased risk for adverse drug events. Our results highlight the potential risks of relying on self‐reported medication adherence in reduced eGFR patients with CI.
    Type of Medium: Online Resource
    ISSN: 2398-8835 , 2398-8835
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2927182-4
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