Biomedical subjects

R Tilvis

Publications and source records attributed to R Tilvis.

At least 37 records · Page 2Linked to original sources

PubMed1997

Mibefradil, a novel calcium antagonist, in elderly patients with hypertension: favorable hemodynamics and pharmacokinetics.

A multicenter, double-blind, placebo-controlled study of 310 elderly patients with mild-to-moderate essential hypertension was conducted in 20 sites throughout Europe, Brazil, and Israel to assess the antihypertensive efficacy, tolerability, safety, and dose-response characteristics of the novel calcium antagonist mibefradil in the elderly. Patients were randomly assigned to receive once-daily doses of 6.25, 12.5, 25, 50, or 100 mg of mibefradil or placebo for 4 weeks. Statistically significant and clinically relevant reductions in sitting diastolic blood pressure (SDBP) and sitting systolic blood pressure (SSBP) were observed with the 50 and 100 mg doses. Therapeutic responses reached 88.5% for SDBP and 76.5% for SSBP in the 100 mg group. Trough/peak ratios were > 75% in SDBP and SSBP with the 50 mg and 100 mg doses. At doses of 50 to 100 mg once daily, mibefradil was well tolerated and effective with a high antihypertensive response rate and consistent 24-hour blood pressure control in elderly patients.

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PubMed1997

Resorption of mandibular canal wall in the edentulous aged population.

STATEMENT OF PROBLEM: The mandibular canal wall may be affected by the progress of residual ridge resorption after tooth extraction. Little knowledge is available regarding the relationship of specific systemic factors and the resorption of the mandibular canal wall. PURPOSE: The purpose of this study was to assess the status of the mandibular canal in the edentulous mandible and to determine whether there is any relationship between the resorption of the mandibular canal wall and selected health indices in the elderly. MATERIAL AND METHODS: The status of the mandibular canal was assessed from panoramic radiographs of 128 edentulous elderly subjects (32 men and 96 women). RESULTS: The superior border of the mandibular canal was more frequently resorbed in women (32.6%) than in men (9.8%). Resorption in the mandibular canal wall was significantly more prevalent in subjects with asthma (odds ratio: 6.0), with thyroid disease (odds ratio: 3.04), and with a cortical thickness at the mandibular angle less than 1 mm thick (odds ratio 2.74). CONCLUSION: The findings suggest that gender, asthma, and thyroid disease play important roles in resorption of the mandibular canal wall.

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PubMed1997

Expression and therapeutic response related to apolipoprotein E polymorphism in primary biliary cirrhosis.

BACKGROUND/AIMS/METHODS: Apolipoprotein E polymorphism, affecting intestinal absorption and biliary secretion of bile acids, might also contribute to the variable course and response to drug treatment of primary biliary cirrhosis. To test this possibility, we studied the apo E gene frequency, and the expression and response to drug therapy in different apo E isoforms of 88 patients with primary biliary cirrhosis, randomized to ursodeoxycholic acid, colchicine or placebo treatments for 2 years. RESULTS: The frequency of the epsilon2 allele was 2.4 times higher (p<0.01) in the patients with primary biliary cirrhosis compared with the Finnish population. At entry the patients with the epsilon4 allele were significantly younger (p<0.01) than those with other epsilon alleles, while the severity of primary biliary cirrhosis was similar in the three apolipoprotein E phenotypes. Liver enzymes, acute hepatic inflammation, serum total and low density lipoprotein cholesterol were decreased by ursodeoxycholic acid only in the patients with the epsilon4 and homozygous epsilon3 alleles, but not in those with the epsilon2 allele. Improvements of liver enzyme tests by ursodeoxycholic acid were more marked in the patients with the epsilon4 than other epsilon alleles. CONCLUSIONS: The present data show that in primary biliary cirrhosis the epsilon2 allele is overrepresented, and suggest that the expression of primary biliary cirrhosis and response of the disease to ursodeoxycholic acid treatment are closely related to the apo E polymorphism.

Adult↗

PubMed1997

Associations between atrial natriuretic peptides, echocardiographic findings and mortality in an elderly population sample.

OBJECTIVES: To examine associations of N-terminal and C-terminal components of the proatrial natriuretic peptide [ANP (1-98) and ANP (99-126), respectively], with echocardiographic measurements of left ventricular structure and performance and with the function of the aortic and mitral valves in old age. To compare the predictive value of the atrial peptides and echocardiographic data for short-term mortality. DESIGN: A population based survey with 1.5-year mortality follow-up. SETTING: University hospital. SUBJECTS: Three-hundred and thirty-three people aged 78-88 years. MAIN OUTCOME MEASURES: (i) Plasma ANP (1-98) and ANP (99-126); (ii) M-mode and Doppler echocardiographic measurements of left atrial diameter; left ventricular diameters, mass and fractional shortening; peak transmitral velocities; aortic valve area, aortic regurgitation jet length and mitral regurgitant jet area; (iii) total and cardiovascular 1.5-year mortality. RESULTS: ANP (1-98) correlated with left atrial diameter (r = 0.33; P < 0.001), left ventricular mass (r = 0.19; P < 0.001), fractional shortening (r = -0.16; P < 0.01) and the early-to-atrial peak transmitral velocity ratio (r = 0.23; P < 0.001). Also, ANP (1-98) predicted the degree of aortic valve obstruction and the severity of aortic and mitral regurgitation. Associations of ANP (99-126) with echocardiographic data were much weaker. Aortic valve stenosis and ANP (1-98) were independent predictors of age- and sex-adjusted total and cardiovascular mortality at 1.5 years of entry. CONCLUSIONS: Circulating ANP (1-98) correlates with left atrial size, with left ventricular mass and performance and with the severity of aortic and mitral valve dysfunction in persons representing the general elderly population. ANP (1-98) also predicts both total and cardiovascular mortality.

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PubMed1997

Congestive heart failure in old age: prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study.

OBJECTIVE: To examine the prevalence, underlying diseases, abnormalities of left ventricular function and prognosis in congestive heart failure (CHF) of old age. DESIGN: A population-based clinical and echocardiographic study with a 4-year mortality follow-up. SETTING: University hospital. SUBJECTS: Five hundred and one individuals born in 1904. 1909 and 1914 (367 women). MAIN OUTCOME MEASURES: Presence of CHF by clinical and chest radiograph criteria: left ventricular size and systolic function by echocardiography; grade of aortic and mitral valve lesion by Doppler echocardiography; 4-year total and cardiovascular mortality. RESULTS: Forty-one of 501 participants (8.2%) had CHF. Ischaemic heart disease (54%), hypertension (54%) and moderate-to-severe mitral or aortic valve disease (51%) were the main underlying conditions; 90% of patients had one or more of these diseases. Most individuals with CHF (28 of 39 patients, 72%) had normal left ventricular contractions at echocardiography. 'Diastolic CHF', defined as CHF with normal systolic left ventricular function and no regurgitant valve disease, was found in 51% (20 of 39 patients). The relative 4-year risk for death associated with CHF, adjusted for age and sex, was 2.1 (95% confidence interval 1.3-3.4) for all-cause mortality and 4.2 (CI 1.9-5.6) for cardiovascular mortality. CONCLUSIONS: The prevalence of CHF in a population aged 75-86 years is approximately 8%. Ischaemic or valvular heart disease and hypertension are the main underlying conditions. At echocardiography, about 50% of the elderly with CHF have normal left ventricular systolic contractions in the absence of valve disease and an additional 20% have normal systolic function with mitral regurgitation. The presence of CHF doubles the age- and sex-adjusted risk of death from all causes, and quadruples the risk of cardiovascular death during 4-year follow-up.

Age Distribution↗

PubMed1997

Functional assessment scales in detecting dementia.

AIM: to evaluate the use of different functional scales in detecting dementia in a population study. METHODS: the study is part of the Helsinki Ageing Study. A random sample of 795 subjects aged 75 (n = 274), 80 (n = 266) and 85 years (n = 255) was taken. The prevalences of dementia (DSM-III-R criteria) in these age groups were 4.6, 13.1 and 26.7% respectively. The functional scale scores were known for 71% of the non-demented and 66% of the demented subjects. A structured questionnaire completed by a close informant included four functional scales: the index of activities of daily living (ADL), the modified Blessed dementia scale (DS), the instrumental activities of daily living scale (IADL) and the Functional Assessment Questionnaire (FAQ). RESULTS: all the functional scales discriminated demented from non-demented subjects. Based on receiver operating characteristics analysis, the area under the curve (95% confidence interval) was 0.90 (0.80-0.94) for the ADL, 0.94 (0.87-0.97) for the DS, 0.95 (0.90-0.98) for the IADL and 0.96 (0.92-0.98) for the FAQ. The effects of age, sex and education in detecting dementia were minor or non-existent in the ADL, DS and FAQ scales, but age had an effect on the performance of the IADL scale. All the scales detected even mild dementia adequately. CONCLUSIONS: functional scales can be used in detecting dementia when functional assessment is already used for other purposes, such as among elderly primary care patients.

Activities of Daily Living↗

PubMed1997

Outcome of aged patients in Finnish supervised home care.

The purpose of this study was to identify predictors of mortality and institutionalization in aged patients receiving Finnish supervised home care. The study was carried out in Central Finland, whose area and population is 5% of the total of the country. The subjects consisted of a sample of 312 patients (65 years or more). They were originally assembled to assess the effectiveness of a geriatric inpatient unit, the results of which have been published previously. Deaths were ascertained over at least three years and long-term care institutionalization over two years. The most powerful predictor of mortality was impaired ADL functioning. Predictors of long-term institutional care were impaired ADL functioning, impaired cognition and depression. These data may be helpful in resource allocation and targeting patients for the supervised home care programmes.

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PubMed1997

Association of residual ridge resorption with systemic factors in home-living elderly subjects.

Residual ridge resorption after loss of teeth is a multifactorial oral problem. To examine the association of residual ridge resorption with systemic factors, a cross-sectional study was made of 177 edentulous subjects (43 men and 134 women) aged 76, 81, and 86 years. Resorption in the mandibular and maxillary residual ridges was assessed from panoramic radiographs. The effects on residual ridge resorption of the age, gender, smoking, alcohol intake, body mass index, functioning in daily living, and certain systemic diseases of the subjects were investigated. After adjustment for age and duration of edentulousness, the elderly women had a greater amount of reduction in the mandibular residual ridge than the men (P < 0.001). When the resorption was classified into slight or moderate and severe resorptions, the elderly with asthma were at high risk of severe reduction in the edentulous mandible (odds ratio, 6.0; 95% confidence interval (CI), 1.3-28.2); the elderly women were at high risk of severe resorption in the edentulous mandible, with an odds ratio of 4.5 (95% CI, 1.2-17.1); an inverse association was found between alcohol intake and severe resorption in the edentulous maxilla (odds ratio, 0.4; 95% CI, 0.2-0.9). This study suggests that asthma due to corticosteroid treatment is to be considered a risk indicator for severe resorption of the edentulous mandible, alcohol intake in the elderly may be related to a lesser degree of resorption of the edentulous maxilla. Female gender is confirmed as a major factor resulting in mandibular atrophy.

Activities of Daily Living↗

PubMed1996

Natural history of aortic valve stenosis of varying severity in the elderly.

In a population sample of 501 persons aged 75 to 86 years, Doppler echocardiography uncovered moderate or severe aortic valve stenosis in 8.8% of women and 3.6% of men. Severe aortic valve stenosis predicted a four-fold-age- and sex-adjusted risk of death within 4 years of diagnosis, and mortality tended to be increased also with moderate lesions; mild aortic valve stenosis had a favorable outcome.

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PubMed1996

Major depression in the elderly: a population study in Helsinki.

The aim of the study was to estimate the prevalence of major depression and to evaluate associated features in random age cohorts of 75, 80, and 85 years (N = 651). A clinical examination was made by experienced health center physicians, and major depression was diagnosed according to DSM-III criteria. The prevalence increased with age and was 1% to 4% in the age groups of 75 and 80 years, but 13% at the age of 85 years. No sex difference was found. The frequency of major depression was fourfold among institutionalized patients (16%) as compared to those living at home (4%). Major depression was strongly associated with objective health, intellectual functioning, and functional capacity. Depression was most common in subjects suffering from poor vision, urinary incontinence, or Parkinson's disease (odd ratios 4.2 to 4.9). Depression was also correlated with musculoskeletal disorders, coronary heart disease, and cerebrovascular diseases (odd ratios 2.5 to 3.4). The survey suggests that major depression is quite rare in healthy elderly people but common in disabled institutionalized patients.

Activities of Daily Living↗

PubMed1996

Calcific degeneration of the aortic valve in old age: is the development of flow obstruction predictable?

OBJECTIVE: Aortic valve calcification and stenosis become increasingly common with advancing age. This work aimed at assessing whether a time-dependent reduction of aortic valve area is detectable in an unselected elderly population and whether the rate of reduction can be predicted from clinical or biochemical characteristics. DESIGN: A population-based prospective echocardiographic follow-up study. SETTING: A university hospital. SUBJECTS: In 1990, randomly selected persons born in 1904, 1909 and 1914 (total n = 501) underwent a Doppler echocardiographic study of aortic valve and biochemical tests of glucose, lipid and calcium metabolism. In 1993, echocardiography was repeated in 333 survivors of the original cohorts. These individuals constitute the present study population. MAIN OUTCOME MEASURES: Three-year changes in the aortic valve area and velocity ratio (peak outflow tract velocity/peak aortic jet velocity) determined by Doppler echocardiography. RESULTS: Aortic valve area decreased from a mean of 1.95 cm2 (95% confidence interval of mean, 1.88-2.03 cm2) to 1.78 cm2 (1.71-1.85 cm2) within 3 years (P < 0.001). Concomitantly, the velocity ratio decreased from 0.75 (0.73-0.77) to 0.68 (0.67-0.70) (P < 0.001). The changes in aortic valve area and velocity ratio were unrelated to age, sex, presence of hypertension, coronary artery disease or diabetes, and to all assessed biochemical characteristics. A weak positive statistical association was found between the decrease in aortic valve area and the body mass index at entry (r = 0.16, P < 0.01). CONCLUSIONS: A time-dependent reduction of the aortic valve flow orifice can be demonstrated in persons representing the general elderly population. The deterioration of aortic valve function within a span of 3 years is neither clinically nor biochemically predictable. A longer follow-up may be necessary to identify the risk factors of aortic valve stenosis in old age.

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PubMed1996

Factors related to the non-attendance in a clinical oral health study on the home-dwelling old elderly.

OBJECTIVE: To evaluate how elderly home-dwelling subjects' background factors, state of health, functional capacity and edentulousness related to their attendance in a comprehensive clinical dental study. DESIGN: Cross-sectional population study; interview and clinical dental data. SETTING: The City of Helsinki; clinical dental examinations at the Institute of Dentistry, University of Helsinki. SUBJECTS: 600 elderly aged 76, 81 and 86 years, participants in the medical examinations in the Helsinki Ageing Study one year earlier, 81% being home-dwelling. MEASURES: Age, gender, marital status, family structure, educational level, former line of work, self-perceived general health, dentulousness, ability to move, sense of hearing, state of memory, clinical findings of dementia, other medical diagnoses, and intake of drugs. OUTCOME MEASURE: Participation in clinical dental examinations. RESULTS: The overall participation was 63% being reduced by high age and female gender, 75% of the 76-year-olds, but only 53% of those aged 81 or 86 years were clinically examined, figures were for men 72% and for women 60%. As shown by a multifactorial logit model, the strongest factors related to non-participation were the home-dwelling subjects' old age (OR = 3.6), deteriorated ability to move (OR = 5.3), clinically diagnosed symptoms of dementia (OR = 4.1), or edentulousness (OR = 2.5). CONCLUSION: Non-participation selectively by those edentulous will lead to prevalence figures on numbers of teeth being too optimistic for the entire elderly population.

Age Distribution↗

PubMed1996

Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment.

A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help for the clinician concerned with hospital based geriatric medicine. It may also be useful for quality control and teaching. Not least, it may be useful for health professionals other than geriatricians. To some extent, the position of geriatric medicine in the Nordic countries varies between the countries. However, the background for developing a Nordic version of geriatric work-up is shared attitudes and principally the same organization of the health care system, and collaboration within geriatrics for many years. Several trials on comprehensive geriatric assessment and management performed in different settings have shown favourable outcomes. Results from controlled Nordic trials are compiled and summaries of meta-analyses are presented. The concept of Nordic geriatric work-up is based on a model defining health and disease in old age as dimensions of pathology, impairments, functional limitations, and disability, all being modified by extra- and intraindividual factors. Handicap is defined as the disability gap. Different health professionals have varying responsibilities in the geriatric team-work, but all should be dedicated to establish common goals. The geriatric work-up is presented with success factors and barriers, stating important differences between multidisciplinary and interdisciplinary processes. Checklists and assessment scales may be very useful when performing a geriatric work-up, but they should be used with caution. Specific scales covering different functional areas of the geriatric patient are recommended for clinical practice. Such scales must be valid, reliable, acceptable to the patient, responsive to change, and should be in an appropriate format, as well as easy to administer. Prior to the use among geriatric teams in the Nordic countries the scales should be translated into all the Nordic languages, and the translated versions should ideally have been subjected to validity and reliability testing. However, so far no scale meets these demands regarding all the five Nordic languages.

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PubMed1996

Associations of orthostatic blood pressure fall in older patients with isolated systolic hypertension. Syst-Eur Investigators.

OBJECTIVES: To investigate the associations of the orthostatic blood pressure changes in older patients with isolated systolic hypertension. METHODS: A total of 2716 patients, 917 men and 1799 women, aged > or = 60 years, were examined at three separate outpatient visits whilst receiving placebo during the single-blind run-in phase of the Syst-Eur trial. The orthostatic blood pressure changes were calculated by subtracting the average of two blood pressure readings with the patient in the supine position from the mean of two readings obtained after the patient had stood for 2 min. An orthostatic blood pressure drop by at least 20 mmHg systolic or 10 mmHg diastolic was considered exaggerated. RESULTS: For the three run-in visits combined, the supine blood pressure was 175 +/- 13 mmHg systolic and 86 +/- 6 mmHg diastolic (means +/- SD). With the patients standing the systolic blood pressure was 5 +/- 12 mmHg lower, whereas the diastolic blood pressure was 2 +/- 7 mmHg higher. An exaggerated fall in systolic blood pressure was observed on at least 1 visit in 21.0% of the patients and on all three visits in 2.5%. The corresponding values for diastolic blood pressure were 9.7 and 0.4%. The orthostatic fall in systolic blood pressure increased with previous antihypertensive treatment, age and smoking, but decreased with a higher sitting pulse rate and usual alcohol consumption versus none. The rise in diastolic blood pressure upon standing was higher in women than in men, was curvilinearly associated with age and increased with the sitting diastolic blood pressure. By multiple logistic regression analysis, the odds of having a persistent or occasional exaggerated orthostatic fall in systolic blood pressure were 22% higher in women than in men. The odds increased with previous antihypertensive treatment (by 42%), age (by 1.4%/year), electrocardiographic left ventricular mass (by 15%/mV) and sitting systolic blood pressure (by 0.9%/mmHg), but decreased with sitting pulse rate (by 1.9%/beat per min). An exaggerated orthostatic fall in diastolic blood pressure was 30% more likely in men; the likelihood increased with age (by 6.4%/year) and decreased with sitting diastolic blood pressure (by 6.6%/mmHg). CONCLUSION: An exaggerated orthostatic blood pressure fall in older patients with isolated systolic hypertension is associated mainly with gender, age and blood pressure level. Previous antihypertensive treatment, a lower pulse rate and a lower electrocardiographic left ventricular mass were also associated with an exaggerated orthostatic fall in systolic blood pressure.

Age Factors↗

PubMed1996

Prevalence and persistency of orthostatic blood pressure fall in older patients with isolated systolic hypertension. Syst-Eur Investigators.

Postural hypotension in older people has been the subject of many studies, but there remains some doubt as to its true prevalence. This study investigated the prevalence and persistency of an exaggerated orthostatic blood pressure (BP) fall in a large group of older patients with isolated systolic hypertension. A total of 2716 patients, 917 men and 1799 women, whose age ranged from 60-100 years, were examined at three separate outpatient visits on a placebo in the single-blind run-in phase of the Syst-Eur Trial. The supine and standing BPs at each visit were the averages of two readings. An exaggerated BP fall was defined as a drop in systolic pressure by at least 20 mm Hg 2 min after assuming the standing from the supine position, or as a drop in the diastolic pressure by at least 10 mm Hg. The reproducibility of orthostatic BP changes was evaluated by the Bland and Altman technique. With the three run-in visits combined, the sitting pressure averaged ( +/- standard deviation) 174 +/- 11 mm Hg systolic and 86 +/- 6 mm Hg diastolic. Systolic pressure fell on average by 5 +/- 12 mm Hg from the supine to the standing position, whereas diastolic pressure increased by 2 +/- 7 mm Hg. The percentage of patients showing an exaggerated orthostatic BP fall was constant at each of the three run-in visits, ie 11-12% for systolic pressure and 4% for diastolic pressure. An exaggerated BP fall at each of the three run-in visits was only present in 3% of the patients for systolic pressure and in 0.4% for diastolic pressure. An exaggerated BP fall at the run-in visits was not associated with dizziness and syncope, which occurred in only 1% of the patients. The orthostatic fall in systolic, but not diastolic pressure, was greater (0.6 mm Hg; P < 0.05) at the second than at the first visit. The repeatability coefficients tended to be higher (60-65%), signifying lower reproducibility, than those for the BP levels (45-55%). An exaggerated fall in systolic or diastolic pressure may occasionally occur in nearly 10% of older patients with isolated systolic hypertension even without antihypertensive drug therapy, but a persistent orthostatic response in only rarely observed.

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PubMed1995

Usefulness of the Clinical Dementia Rating scale in screening for dementia.

The Clinical Dementia Rating (CDR) scale is a qualitative staging instrument that has traditionally been used for assessing the severity of dementia. We used it for screening dementia in a population study of 75-, 80-, and 85-year-old people. The modified CDR scale was easy to establish and it proved to be useful in screening dementia. A more thorough examination is needed in the second phase to identify the false positives. The sensitivity of the CDR scale was 95% and the specificity 94%.

Activities of Daily Living↗

PubMed1995

White matter hyperintensities on MRI in the neurologically nondiseased elderly. Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home.

BACKGROUND AND PURPOSE: We undertook this study to evaluate the frequency and risk factors of white matter hyperintensities seen on T2-weighted MR imaging. We examined cohorts of neurologically nondiseased elderly subjects participating in a general-community study, the Helsinki (Finland) Aging Brain Study. Cohorts of consecutive subjects aged 55, 60, 65, 70, 75, 80, and 85 years (n = 20, 18, 20, 18, 19, 18, and 15, respectively; total, n = 128) were divided into a young-old (age < 75 years, n = 76) group and an old-old (age > or = 75 years, n = 52) group. METHODS: Frequency of hyperintensities seen on T2-weighted axial and coronal MR images (0.02 T) was rated using a four-point scale in periventricular and centrum semiovale areas. RESULTS: The majority of the subjects showed only mild white matter hyperintensities, which were more frequent in the periventricular areas. Age was the most important factor to explain the presence of hyperintensities. A logistic regression analysis related periventricular hyperintensities in the entire group to central atrophy (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.7 to 12.9) and silent infarcts (OR, 5.6; 95% CI, 1.0 to 19.8); among the young-old, hyperintensities related to diabetes (OR, 17.0; 95% CI, 1.9 to 154.2) and central atrophy (OR, 14.7; 95% CI, 3.5 to 61.8). Centrum semiovale hyperintensities related in the entire group to cardiac arrhythmia (OR, 4.0; 95% CI, 1.0 to 15.5), central atrophy (OR, 3.9; 95% CI, 1.2 to 12.4), and silent infarcts (OR, 3.6; 95% CI, 1.0 to 12.5). CONCLUSIONS: These mild white matter hyperintensities in the neurologically nondiseased elderly related especially to age and also to concomitant silent infarcts, atrophy, and some vascular risk factors. The known factors, however, explained only part of the variation. The young-old and old-old groups showed different associations. In contrast to former assumptions, the presence of white matter hyperintensities among the aged is likely to be linked to other as yet unidentified age-related factors.

Aged↗

PubMed1995

Lack of association of apolipoprotein E allele epsilon 4 with late-onset Alzheimer's disease among Finnish centenarians.

No association between Alzheimer's disease (AD) and apolipoprotein E type epsilon 4 (ApoE epsilon 4) phenotype was found among centenarians in Finland (N = 179). The data are based on ascertainment of all centenarians in Finland in 1991. All examinations were conducted during 1991. The diagnoses of dementia and AD were based on clinical grounds, conforming to DSM-III-R and NINCDS-ADRDA criteria. The percentage of ApoE epsilon 4 alleles among the centenarians was 8.7% (31 of 358 alleles). This is significantly lower than percentages found in younger Finnish populations. Thirty (16.8%) of the 179 centenarians were epsilon 4 allele carriers. One hundred fifty-one (84.4%) of the centenarians were women. Twenty-eight (18.5%) of the women had at least one epsilon 4 allele, as did two (7.1%) of the men. The prevalence of clinically diagnosed AD was 26.8%; 44% of the subjects were cognitively normal, 23% had signs of cognitive decline or at most mild dementia (with no differential diagnosis), and 6% had a dementia clinically diagnosed as being due to some cause other than AD. For AD cases versus cognitively normal subjects, the odds ratio associated with being a carrier of the epsilon 4 allele was 1.34 (p = 0.64; 95% CI = [0.5, 3.3]). Among women, the odds ratio was 0.99 (p = 1.0; 95% CI = [0.4, 2.6]). There were fewer, but not significantly so, epsilon 4 carriers among subjects with cognitive decline or at most mild dementia (12.2%) than there were among the cognitively normal subjects (16.5%). The AD patients had no evidence of difficulty standing on a flat stationary surface unless the surface suddenly moved.(ABSTRACT TRUNCATED AT 250 WORDS)

Age of Onset↗