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Kenneth Rockwood

Publications and source records attributed to Kenneth Rockwood.

79 records · Page 5Linked to original sources
PubMed2002

Diabetes mellitus and the risk of dementia, Alzheimer's disease and vascular cognitive impairment in the Canadian Study of Health and Aging.

BACKGROUND: Conflicting results have been reported about the status of diabetes mellitus as a risk for Alzheimer's disease. We investigated the relationship between diabetes and incident dementia (including Alzheimer's disease and vascular cognitive impairment) in a 5-year longitudinal study. METHODS: Secondary analysis of the Canadian Study of Health and Aging, a representative cohort study of dementia in older Canadians. RESULTS: 5,574 subjects without cognitive impairment at baseline participated in 5-year follow-up. Diabetes mellitus at baseline was associated with incident vascular cognitive impairment (RR: 1.62; 95% CI: 1.12-2.33) and its subtypes, vascular dementia (RR: 2.03; 95% CI: 1.15-3.57), and vascular cognitive impairment not dementia (RR: 1.68; 95% CI: 1.01-2.78). Diabetes was not associated with mixed Alzheimer's/vascular dementia (RR: 0.87; 95% CI: 0.34-2.21), incident Alzheimer's disease (RR: 1.30; 95% CI: 0.83-2.03) or all dementias (RR: 1.26; 95% CI: 0.90-1.76). CONCLUSIONS: Despite increased recognition of the role of vascular factors in Alzheimer's disease, we did not find an association between diabetes and incident Alzheimer's disease, even though diabetes was associated with incident vascular cognitive impairment.

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PubMed2002

Societal costs of vascular cognitive impairment in older adults.

BACKGROUND AND PURPOSE: The construct of vascular cognitive impairment (VCI) includes many whose care is or will be costly. Nevertheless, estimates of these costs are not well described. We therefore set out to estimate the societal costs of VCI in elderly people. METHODS: In a secondary analysis of the Canadian Study of Health and Aging, a representative cohort study, Canadian dollar costs using a societal perspective were estimated by standard methods. RESULTS: The total annual per-patient societal costs for VCI by severity were $15 022 for those with mild disease, $14 468 for those with mild to moderate disease, $20 063 for those with moderate disease, and $34 515 for those with severe disease. The most expensive component per individual was the cost of institutional long-term care. Although severe impairment was associated with higher costs, the extent of institutionalization at all levels of severity and less drug use among those more severely impaired mitigated a severity-cost gradient. CONCLUSIONS: The societal costs of VCI are not inconsiderable. In contrast to Alzheimer disease, there is no clear gradient relating cost to severity. Unpaid caregiver costs are an important aspect of societal costs, even in those with only mild impairment.

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PubMed2002

Neuropsychological predictors of incident dementia in patients with vascular cognitive impairment, without dementia.

BACKGROUND: Vascular cognitive impairment that does not fulfill dementia criteria (ie, vascular cognitive impairment, no dementia [CIND]) is common. Although progression to dementia is frequent, little is known about factors that predict progression. We examined whether performance on neuropsychological tests administered at baseline could predict incident cases of dementia in patients with vascular CIND after 5 years. Summary of Report- The Canadian Study of Health and Aging is a prospective, cohort study of 10 263 randomly selected persons aged > or =65 years. Of 149 people diagnosed with vascular CIND, 125 completed a battery of neuropsychological tests at baseline. Follow-up cognitive diagnoses were available for 102 individuals. After 5 years, 45 patients (44%) developed dementia. Low baseline scores on tests of memory and category fluency were associated with incident dementia. CONCLUSIONS: Neuropsychological measures can indicate risk of dementia in patients with vascular CIND. This study did not suggest a prediction-to-progression profile distinct from that seen in Alzheimer disease.

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PubMedDate not supplied

Prognostic factors for functional independence in older adults with mild dementia: results from the canadian study of health and aging.

We investigated the prevalence of and prognostic factors for functional independence in personal activities of daily living in a population-based sample of 90 seniors with mild dementia from the Canadian Study of Health and Aging. Personal activities of daily living were assessed from the report of proxy respondents at baseline and at the 5-year follow-up (or retrospectively if death had occurred). Sixteen (17.8% of the total group of 90) subjects maintained their personal activities of daily living independence over the full 5-year period or up to 3 months before death (15.1% if the four subjects reclassified as not demented at the second wave are excluded). An age of 75-84 years (vs. those 65-74 years of age and 85+ years of age; odds ratio 12.9, 95% confidence interval 2.7, 112.7), the absence of gait-balance-movement problems (odds ratio 5.2, 95% confidence interval 1.3, 25.8), the presence of extrapyramidal signs (odds ratio 9.5), and fewer years of formal education (odds ratio 3.6) were favorable prognostic factors in our multivariate modeling. An absence of sensory problems was a statistically significant favorable prognostic factor in bivariate analysis. Prior studies on the time required for patients with dementia to progress to functional milestones used clinic-based samples. Our findings, which have potential public health implications, need to be confirmed and expanded upon.

Activities of Daily Living↗
PubMedDate not supplied

Inhibition of human cholinesterases by drugs used to treat Alzheimer disease.

Current approaches to the treatment of cognitive and behavioral symptoms of Alzheimer disease emphasize the use of cholinesterase inhibitors. The kinetic effects of the cholinesterase inhibitors donepezil, galantamine, metrifonate, physostigmine, rivastigmine, and tetrahydroaminoacridine were examined with respect to their action on the esterase and aryl acylamidase activities of human acetylcholinesterase (AChE) and human butyrylcholinesterase (BuChE). Each of these drugs inhibited both AChE and BuChE, but to different degrees. Inhibition of BuChE by these compounds was approximately the same, or better, when acetylthiocholine, the analog of the neurotransmitter acetylcholine, was used as the substrate, instead of butyrylthiocholine. In addition, for these drugs, the inhibition of aryl acylamidase activity paralleled that observed for inhibition of esterase activity of AChE and BuChE. Given that drugs that are currently in use for the treatment of Alzheimer disease inhibit both AChE and BuChE, the development of drugs targeted toward the exclusive inhibition of one or the other cholinesterase may be important for understanding the relative importance of inhibition of BuChE and AChE in the treatment of this disease.

Acetylcholinesterase↗
PubMedDate not supplied

Five-year outcomes for dementia defined solely by neuropsychological test performance.

Cognitive impairment that does not meet criteria for dementia is common and progresses to dementia at a high rate. It is not clear how best to define this type of cognitive impairment. We assessed the predictive validity of different case definitions for cognitive impairment and dementia by comparing rates of adverse outcomes for individuals who did not meet dementia criteria but had neuropsychological test results indicating dementia (NPDementia), those who had traditional dementia diagnoses (mild and moderate-severe severity), those who had other cognitive impairment but no dementia (CIND), and those with no cognitive impairment (NCI). Our sample comprised 1,659 participants who had completed a neuropsychological assessment in the Canadian Study of Health and Aging, a prospective, cohort study of 10,263 randomly selected persons aged 65 years or older. Outcomes were determined after 5 years. Institutionalization and death rates for the NPDementia and CIND groups were higher than for the NCI group. Both groups had lower institutionalization rates than the two Dementia groups and lower death rates than the Moderate-Severe Dementia group. Rates of progression to dementia were increased in NPDementia and CIND groups, relative to the NCI group, and the NPDementia group was less likely than the CIND group to revert to a diagnosis of NCI at the 5-year follow-up. Thus, individuals with NPDementia and CIND have substantially worse outcomes over 5 years than those with NCI. The case definition of NPDementia identified individuals with cognitive impairment that is unlikely to resolve and likely to progress to dementia.

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