Pamela M Rist1, Jessica R Marden2, Benjamin D Capistrant3, Qiong Wu4, M Maria Glymour5. 1. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. 2. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA. 3. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA. 4. Institute of Social Science Survey, Peking University, Peking, China. 5. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
Abstract
BACKGROUND: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. OBJECTIVES: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. METHODS: Health and Retirement Study participants aged 65+ without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. RESULTS: Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95% CI: 0.28-0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95% CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. CONCLUSION: Physical activity may protect against IADL limitations while not smoking, alcohol consumption, and not being depressed do not afford substantial protection among the cognitively impaired. RESULTS highlight the need for extra support for IADLs among individuals with cognitive losses.
BACKGROUND: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. OBJECTIVES: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. METHODS:Health and Retirement Studyparticipants aged 65+ without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. RESULTS:Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95% CI: 0.28-0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95% CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. CONCLUSION: Physical activity may protect against IADL limitations while not smoking, alcohol consumption, and not being depressed do not afford substantial protection among the cognitively impaired. RESULTS highlight the need for extra support for IADLs among individuals with cognitive losses.
Authors: Christiaan G Blankevoort; Marieke J G van Heuvelen; Froukje Boersma; Helga Luning; Jeltsje de Jong; Erik J A Scherder Journal: Dement Geriatr Cogn Disord Date: 2010-10-28 Impact factor: 2.959
Authors: B L Plassman; K M Langa; G G Fisher; S G Heeringa; D R Weir; M B Ofstedal; J R Burke; M D Hurd; G G Potter; W L Rodgers; D C Steffens; R J Willis; R B Wallace Journal: Neuroepidemiology Date: 2007-10-29 Impact factor: 3.282
Authors: Pamela M Rist; Benjamin D Capistrant; Elizabeth Rose Mayeda; Sze Y Liu; M Maria Glymour Journal: Neurology Date: 2017-04-05 Impact factor: 9.910
Authors: Astrid Etman; Carlijn B M Kamphuis; Frank H Pierik; Alex Burdorf; Frank J Van Lenthe Journal: Int J Health Geogr Date: 2016-11-15 Impact factor: 3.918