Biomedical subjects
Publications and source records attributed to Anne F Ambrose.
Balance dysfunction remains a significant contributing factor for disability in the elderly. A wide variety of surgical, pharmaceutical, medical, and rehabilitation treatment options exists for these patients. The complexity of the balance system, however, often requires a thorough, multidisciplinary approach to the evaluation and successful treatment of balance impairment.
OBJECTIVES: To study the epidemiology of gait disorders in community-residing older adults and their association with death and institutionalization. DESIGN: Community-based cohort study. SETTING: Bronx County and the research center at Albert Einstein College of Medicine. PARTICIPANTS: The Einstein Aging study recruited 488 adults aged 70 to 99 between 1999 and 2001. At entry and during annual visits over 5 years, subjects received clinical evaluations to determine presence of neurological or nonneurological gait abnormalities. MEASUREMENTS: Prevalence and incidence of gait disorders based on clinical evaluations and time to institutionalization and death. RESULTS: Of 468 subjects (95.9%) with baseline gait evaluations, 168 had abnormal gaits: 70 neurological, 81 nonneurological, and 17 both. Prevalence of abnormal gait was 35.0% (95% confidence interval (CI) = 28.6-42.1). Incidence of abnormal gait was 168.6 per 1,000 person-years (95% CI = 117.4-242.0) and increased with age. Men had a higher incidence of neurological gait abnormalities, whereas women had a higher incidence of nonneurological gaits. Abnormal gaits were associated with greater risk of institutionalization and death (hazard ratio (HR) = 2.2, 95% CI =1.5-3.2). The risk was strongly related to severity of impairment; subjects with moderate to severe gait abnormalities (HR = 3.2, 95% CI = 1.9-5.2) were at higher risk than those with mild gait abnormalities (HR = 1.8, 95% CI = 1.0-2.8). CONCLUSION: The incidence and prevalence of gait disorders are high in community-residing older adults and are associated with greater risk of institutionalization and death.
BACKGROUND: Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia. METHODS: We examined the relation between leisure activities and the risk of dementia in a prospective cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line. We examined the frequency of participation in leisure activities at enrollment and derived cognitive-activity and physical-activity scales in which the units of measure were activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities, with adjustment for age, sex, educational level, presence or absence of chronic medical illnesses, and base-line cognitive status. RESULTS: Over a median follow-up period of 5.1 years, dementia developed in 124 subjects (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). Among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia. A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia (hazard ratio, 0.93 [95 percent confidence interval, 0.90 to 0.97]), but a one-point increment in the physical-activity score was not (hazard ratio, 1.00). The association with the cognitive-activity score persisted after the exclusion of the subjects with possible preclinical dementia at base line. Results were similar for Alzheimer's disease and vascular dementia. In linear mixed models, increased participation in cognitive activities at base line was associated with reduced rates of decline in memory. CONCLUSIONS: Participation in leisure activities is associated with a reduced risk of dementia, even after adjustment for base-line cognitive status and after the exclusion of subjects with possible preclinical dementia. Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia.