Biomedical subjects

Julia L Bienias

Publications and source records attributed to Julia L Bienias.

At least 19 recordsLinked to original sources

PubMed2007

Physical activity and motor decline in older persons.

We tested the hypothesis that physical activity modifies the course of age-related motor decline. More than 850 older participants of the Rush Memory and Aging Project underwent baseline assessment of physical activity and annual motor testing for up to 8 years. Nine strength measures and nine motor performance measures were summarized into composite measures of motor function. In generalized estimating equation models, global motor function declined during follow-up (estimate, -0.072; SE, 0.008; P < 0.001). Each additional hour of physical activity at baseline was associated with about a 5% decrease in the rate of global motor function decline (estimate, 0.004; SE, 0.001; P = 0.007). Secondary analyses suggested that the association of physical activity with motor decline was mostly due to the effect of physical activity on the rate of motor performance decline. Thus, higher levels of physical activity are associated with a slower rate of motor decline in older persons.

Activities of Daily Living↗

PubMed2007

Change in motor function and risk of mortality in older persons.

OBJECTIVES: To assess the association between change in motor function and mortality. DESIGN: Prospective, observational cohort study. SETTING: Approximately 40 retirement communities across the Chicago metropolitan area participating in the Rush Memory and Aging Project. PARTICIPANTS: Eight hundred thirty-seven community-based older persons without dementia. MEASUREMENTS: Change in composite measures of motor performance and muscle strength. RESULTS: During a mean follow-up of 2.2 years, 81 persons died. In a proportional hazards model adjusted for age, sex, education, and body mass index, each 1-unit increase in the level of baseline motor performance was associated with an approximately 10% decrease in risk of mortality (hazard ratio (HR)=0.901, 95% confidence interval (CI)=0.863-0.941), and each unit of annual increase in motor performance was associated with an approximately 11% decrease in the risk of mortality (HR=0.887, 95% CI=0.835-0.942). In a similar model, each 1-unit increase in the level of baseline strength was associated with an approximately 9% decrease in the risk of mortality (HR=0.906, 95% CI=0.859-0.957), and each 1-unit annual increase in strength was associated with an approximately 10% decrease in the risk of mortality (HR=0.898, 95% CI=0.809-0.996). These results were similar when men and women were analyzed separately and after controlling for physical activity, cognition, and chronic disorders. When motor performance and muscle strength were examined in a single model, only baseline and annual change in motor performance were associated with mortality. CONCLUSION: Level and rate of change in strength and motor performance are associated with mortality. The attenuation of the association between strength and mortality by motor performance suggests that motor function is not a unitary process and that its components may vary in their associations with adverse health consequences in older persons.

Aged, 80 and over↗

PubMed2006

Black-white differences in health-related quality of life among older adults.

Very little information exists on racial differences in quality of life among older adults. In this paper, we examine black-white differences in health-related quality of life (HRQOL) and identify factors that may account for these differences. The participants were 5,986 community-dwelling persons age 65+ (62% black at baseline) from the Chicago Health and Aging Project. Poor HRQOL was defined as having 14 or more self-reported physically or mentally unhealthy days over the past 30 days. A higher proportion of blacks (11.0%) than whites (9.7%) reported poor HRQOL. After adjusting for age and sex, blacks had increased odds of reporting poor HRQOL compared with whites (odds ratio [OR] = 1.72; 95% CI: 1.50-1.98). The black-white differences in HRQOL tended to increase with age (p < 0.05) and were greater among females (p < 0.05). Lifetime socioeconomic status, summary measures of medical conditions, and cognitive function accounted for most of the black-white difference (OR = 1.06; 95% CI: 0.89-1.27). Our results suggest that racial differences in HRQOL are associated with the combined effects of social disadvantage, poor physical health, and lower cognitive function.

Black or African American↗

PubMed2006

Association of fecal incontinence with physical disability and impaired cognitive function.

OBJECTIVES: Fecal incontinence is a common health problem for older people and is associated with significant morbidity and cost. In this study, we report on the association of fecal incontinence with physical disability and impaired cognitive function in a large bi-racial population of individuals aged 65 yr and older. METHODS: Study subjects are participants of the Chicago Health and Aging Project (CHAP), an ongoing study of older Chicago residents. A total of 6,099 participants completed the baseline in-home interview and assessments used in this analysis. Physical disability was assessed using a performance-based measure of basic physical functions and three commonly used self-report measures. Impaired cognitive function was assessed using a global measure of the averaged scores of four cognitive tests. The question used to determine the presence of fecal incontinence was: "In the past few months have you ever lost control of your bowels when you didn't want to?" RESULTS: In multiple logistic regression models adjusted for age, sex, and race, fecal incontinence was correlated with the presence of physical disability and impaired cognitive function on every measure. For example, using the performance-based measure of physical function, the odds of prevalent fecal incontinence were higher by 20% (OR 1.20, 95% CI 1.2-1.2) for each additional unit higher on the performance score, indicating a lower physical performance. The prevalence odds ratio for fecal incontinence was decreased by 51% for each one-point increase in the global cognitive score, indicating higher cognitive function. We found a statistically significant interaction between both race and physical disability and race and impaired cognitive function, such that the associations were stronger in blacks than in non-blacks. These associations remained after further adjustment for diabetes and stroke, and the intake of psychoactive medications. CONCLUSION: In urban, community-dwelling, older adults, fecal incontinence may be more common among persons with physical disability and impaired cognitive function.

Aged↗

PubMed2006

Relative weight and mobility: a longitudinal study in a biracial population of older adults.

PURPOSE: We examined the association of relative weight with mobility and changes in mobility over time and whether these associations differed by race. METHODS: Data come from a prospective, population-based, observational study of adults aged 65 years or older. Mobility outcomes were assessed at baseline and two follow-up interviews at 3-year intervals. The study included 4195 participants with a mean age of 73.8 +/- 6.3 (SD) years; 61.4% were women, and 60.9% were black. Assessment of mobility included a brief self-report instrument and a performance-based walk test. Body mass index (BMI, kilograms per square meter) was used as a measure of relative weight. We used generalized estimating equation models to examine change in mobility outcomes over time as a function of BMI. RESULTS: Average BMI was 26.6 +/- 5.7 kg/m(2), with 34.0% overweight and 23.4% obese. BMI showed a significant curvilinear association with mobility outcomes at baseline (p < 0.001), but was not associated with change in mobility during follow-up. Maximum mobility levels occurred at a significantly higher level of BMI among blacks than whites. CONCLUSIONS: Higher levels of BMI may lead to mobility impairments earlier in life, but there is little evidence that they increase the rate of decline in mobility in older age itself.

Aged↗

PubMed2006

The relation of cigarette smoking to incident Alzheimer's disease in a biracial urban community population.

The relationship between smoking status and incident Alzheimer's disease (AD) was investigated in a random stratified sample of a biracial community in Chicago. Analyses are based on 1,064 persons (of 1,134 evaluated) who had data on smoking status, disease incidence, and key covariates such as apolipoprotein allele status. During a mean of about 4 years of follow-up, 170 persons met criteria for incident AD. Current smoking was associated with increased risk of incident AD (OR = 3.4, 95% CI = 1.4-8.0) compared to persons who never smoked. There was no apparent increase in risk of AD for former smokers compared to persons who never smoked (OR = 0.9, 95% CI = 0.5-1.7). Apolipoprotein E allele status modified this association in that former smokers with a upsilon4 allele were less likely to develop AD (p = 0.04) than those who never smoked. Former smokers also appeared to have a reduced risk of developing AD as their pack-years of smoking increased (p = 0.02)such that the odds of developing AD increased by 50% for every 10 years of smoking cessation (OR = 1.3, CI = 0.9-1.7). The results suggest that older people who currently smoke are more likely to develop AD compared to those who never smoked; the relation between those who used to smoke but quit and the risk of AD is complex and requires further research.

Black or African American↗

PubMed2006

Motor dysfunction in mild cognitive impairment and the risk of incident Alzheimer disease.

BACKGROUND: Little is known about motor function in mild cognitive impairment (MCI) and its relation to the risk of Alzheimer disease (AD). OBJECTIVE: To examine motor function in persons with MCI and its relation to risk of AD. DESIGN: Longitudinal cohort study. SETTING: More than 40 Catholic religious orders across the United States. PARTICIPANTS: We studied 816 older Catholic clergy members from the Religious Orders Study. At the baseline evaluation, they were classified as having no cognitive impairment (n = 558), MCI (n = 198), or dementia (n = 60). MAIN OUTCOME MEASURES: Motor function was assessed at baseline using performance-based measures of upper and lower extremity function and a modified version of the motor section of the Unified Parkinson's Disease Rating Scale, from which previously established measures of parkinsonian signs were derived. Clinical evaluations for dementia and AD were repeated annually for up to 10 years. All analyses controlled for age, sex, educational level, and possession of at least 1 apolipoprotein E epsilon4 allele. RESULTS: At baseline, individuals with MCI had impaired motor function relative to those without cognitive impairment and superior motor function vs those with dementia. Among those with MCI, baseline levels of lower extremity motor performance, parkinsonian gait, and bradykinesia were inversely related to risk of AD, even after controlling for clinical stroke. Thus, a person with impaired lower limb performance or parkinsonian gait (10th percentile) was 2 to 3 times more likely to develop AD than a person with good lower limb function (90th percentile). CONCLUSIONS: Persons with MCI also have impaired motor function, and the degree of impairment in lower extremity function is related to the risk of AD.

Age Factors↗

PubMed2006

Dietary copper and high saturated and trans fat intakes associated with cognitive decline.

BACKGROUND: Evidence from prospective epidemiologic studies and animal models suggests that intakes of dietary fats and copper may be associated with neurodegenerative diseases. OBJECTIVE: To examine whether high dietary copper intake is associated with increased cognitive decline among persons who also consume a diet high in saturated and trans fats. DESIGN: Community-based prospective study. SETTING: Chicago, Ill. Patients Chicago residents 65 years and older. MAIN OUTCOME MEASURES: Cognitive function was assessed using 4 cognitive tests administered during in-home interviews at 3-year intervals for 6 years. Dietary assessment was performed with a food frequency questionnaire. Dietary intakes of copper and fats were related to change in global cognitive score (the mean of the 4 tests) among 3718 participants. RESULTS: Among persons whose diets were high in saturated and trans fats, higher copper intake was associated with a faster rate of cognitive decline. In multiple-adjusted mixed models, the difference in rates for persons in the highest (median, 2.75 mg/d) vs lowest (median, 0.88 mg/d) quintiles of total copper intake was -6.14 standardized units per year (P<.001) or the equivalent of 19 more years of age. There was also a marginally statistically significant association (P = .07) with the highest quintile of food intake of copper (median, 1.51 mg/d) and a strong dose-response association with higher copper dose in vitamin supplements. Copper intake was not associated with cognitive change among persons whose diets were not high in these fats. CONCLUSION: These data suggest that high dietary intake of copper in conjunction with a diet high in saturated and trans fats may be associated with accelerated cognitive decline.

Aged↗

PubMed2006

Cognitive decline and survival in Alzheimer's disease.

OBJECTIVE: To test the association of rate of cognitive decline, an indicator of the severity of the underlying disease process, with risk of death in Alzheimer's disease (AD). METHODS: A total of 472 persons with clinically diagnosed AD were recruited from a memory disorders clinic and day care centers in the Chicago area. They completed a uniform clinical evaluation at baseline and a battery of nine cognitive tests at six-month intervals for a mean of about three years. A previously established measure of global cognition was derived from the nine tests. RESULTS: During follow-up, 168 persons (36%) died. In a proportional hazards model that controlled for age, sex, race, education, and baseline level of cognition, individual rate of global cognitive decline, estimated with least squares regression, was linearly related to mortality risk. Thus, a person declining minimally (increase of 0.04 unit per year, 90th percentile) was 2.7 times less likely to die during the study period than a person declining rapidly (decrease of 0.76 unit per year, 10th percentile). Controlling for baseline disability did not substantially affect results. The association of cognitive decline with mortality was substantially stronger for white persons compared to African Americans and in those with less compared to more education. CONCLUSION: The results indicate that the rate at which cognition declines in AD is robustly related to survival.

Adult↗

PubMed2006

Cognitive decline in old age: separating retest effects from the effects of growing older.

Repeated administration of cognitive tests improves test performance, making it difficult for researchers to gauge the true extent of age-related cognitive decline. The authors examined this issue using data from the Rush Religious Orders Study and linear mixed-effects models. At annual intervals for up to 8 years, more than 800 older Catholic clergy members completed the same set of 19 cognitive tests from which previously established composite measures of cognitive domains were derived. Retest effects on some measures were substantial and continued to accumulate even after 8 annual test readministrations, but effects on other measures were minimal. Across cognitive measures, retest effects were not related to age, sex, or education. Individual differences in retest effects were substantial but not consistent across cognitive measures. The results suggest that retest-based improvement in cognitive test performance can be substantial and persistent.

Aged↗

PubMed2006

Is lower cognitive function in one spouse associated with depressive symptoms in the other spouse?

This study examines whether lower cognitive function in one spouse is associated with depressive symptoms in the other spouse. The subjects were 528 community-dwelling spouse pairs aged 65+ who participated in the Chicago Health and Aging Project (CHAP), an ongoing longitudinal, bi-racial, population-based study of risk factors for incident Alzheimer's disease and other age-related chronic conditions. CHAP participants were assessed at 3-year intervals over a period of nearly ten years. The results show a cross-sectional association of wives' lower cognitive function at baseline with depressive symptoms in husbands; however, husbands' cognitive function was not associated with wives' depressive symptoms. There was no longitudinal association of cognitive function at baseline with increased depressive symptoms over time. Furthermore, change in cognitive function over time had no effect on depressive symptoms in either spouse. The relationship between cognitive function and depressive symptoms in spouse pairs is complex. Our findings suggest that husbands may be particularly psychologically vulnerable to the negative effects of their wives' cognitive impairment. This vulnerability may have a range of long-term health and caregiving implications.

Activities of Daily Living↗

PubMed2006

Blood pressure and lower limb function in older persons.

BACKGROUND: Factors contributing to gait difficulties in elderly persons are considered to be multifactorial and are not well understood. The purpose of this study was to examine the association of blood pressure (BP) with change in lower limb function in older persons. METHODS: Eight hundred eighty-eight older Catholic clergy members without baseline dementia or Parkinson's disease were recruited from about 40 groups across the United States. At baseline, BP was measured, the presence of vascular diseases and diabetes was recorded, cognitive function was assessed, and medications were inspected. At baseline and subsequent annual visits, gait and balance were assessed using performance-based tasks from which a previously established composite measure of lower limb function was derived. RESULTS: In a general estimating equation analysis controlling for age, education, and gender, a 10 mmHg increment in systolic blood pressure (SBP) was associated with greater decline in lower limb function (estimate of interaction = -6.35 x 10(-3), standard error = 2.49 x 10(-3), p =.011). Thus, on average, lower limb function declined 28.7% faster in persons with an SBP of 160 mmHg than in persons with an SBP of 120 mmHg. This effect was unchanged after controlling for baseline vascular diseases, diabetes, or cognition. However, censoring individuals who developed stroke during the study made the relationship between SBP and change in lower limb function nonsignificant. CONCLUSIONS: SBP may be associated with decline in lower limb function in older persons.

Aged↗

PubMed2006

Childhood adversity and psychosocial adjustment in old age.

OBJECTIVE: The objective of this study was to test the hypothesis that higher level of childhood adversity is associated with lower level of psychosocial adjustment in old age. METHOD: Participants are 253 older persons (mean age: 79.8, standard deviation: 2.1; 73.9% women) from the Rush Memory and Aging Project, a clinicopathologic study of common chronic conditions of old age. Childhood adversity was assessed with a 16-item measure based on portions of the Childhood Trauma Questionnaire and other inventories. Psychosocial adjustment was assessed with multiple measures of neuroticism (i.e., proneness to negative emotions) and social engagement. RESULTS: Based in part on a factor analysis, composite measures of total adversity, emotional neglect, parental intimidation, parental violence, family turmoil, and financial need were developed. In a series of linear regression models adjusted for age, sex, own education, and parental education, the composite measure of childhood adversity was associated with all facets of neuroticism and accounted for more than 13% of the variance in the composite neuroticism measure. Emotional neglect and parental intimidation had the strongest associations with neuroticism. Childhood adversity was not related to frequency of participation in social activities, but more adversity was associated with having a smaller network (accounting for 3% of the variance) and feeling more emotionally isolated (accounting for 7% of the variance). CONCLUSION: Childhood adversity is associated with less adaptive psychosocial functioning in old age.

Aged↗

PubMed2006

Dietary folate and vitamins B-12 and B-6 not associated with incident Alzheimer's disease.

CONTEXT: It is currently not known whether dietary intakes of folate and vitamins B12 and B6, co-factors in the methylation of homocysteine, protect against Alzheimer's disease. OBJECTIVE: To examine the association between risk of incident Alzheimer's disease and dietary intakes of folate, vitamin B-12, and vitamin B-6. DESIGN: Prospective cohort study. SETTING: Geographically defined biracial Chicago community. PARTICIPANTS: 1,041 residents, aged 65 years and older, initially free of Alzheimer's disease and followed a median 3.9 years for the development of incident disease. MAIN OUTCOME MEASURE: Probable Alzheimer's disease identified through structured clinical neurological evaluation using standardized criteria. RESULTS: A total of 162 persons developed incident Alzheimer's disease during follow-up. In logistic regression models adjusted for age, sex, race, education, cognitive activities, APOE-epsilon4, and dietary intakes of vitamin E in food and total niacin, there was no association between risk of developing Alzheimer's disease and quintiles of folate intake or of vitamin B-12 intake. The adjusted odds ratio was 1.6 (95% confidence interval: 0.5, 5.2) for persons in the highest quintile of total folate intake (median of 752.7 microg/d) compared with persons in the lowest quintile of intake (median, 202.8 microg/d). Compared with persons in the first quintile of total vitamin B-12 intake (median, 3.1 microg/d) the odds ratio was 0.6 (95% confidence interval: 0.2, 1.6) for persons in the fifth quintile of intake (median, 20.6 microg/d). Intake of vitamin B-6 was not associated with incident Alzheimer's disease after control for dietary intakes of vitamin E and total niacin. CONCLUSION: Dietary intakes of folate, vitamin B-12, or vitamin B-6 do not appear to be associated with the development of Alzheimer's disease.

Aged↗

PubMed2005

Relation of blood pressure to risk of incident Alzheimer's disease and change in global cognitive function in older persons.

PURPOSE: To examine the relation of systolic and diastolic blood pressure to incident Alzheimer's disease (AD) and rate of cognitive change. METHODS: Longitudinal cohort study with annual clinical evaluations. At baseline, blood pressure was measured, apolipoprotein E (APOE) genotyping was performed, and medications were reviewed. RESULTS: 824 older Catholic clergy members without baseline dementia were recruited from across the United States. During a mean of about 6 years of observation, 151 persons developed AD. In a proportional hazards model adjusted for age, sex and education, neither systolic (relative risk = 0.995; 95% CI: 0.986, 1.004, p = 0.249) nor diastolic (relative risk = 1.000; 95% CI: 0.985, 1.015, p = 0.975) blood pressure was related to AD incidence. In mixed effects models, neither systolic nor diastolic blood pressure was related to level or to annual rate of change on a global measure of cognition. These results did not change in subsequent models that accounted for the use of medications with antihypertensive properties or for the possession of an APOE epsilon4 allele. CONCLUSIONS: In a cohort of older persons with a majority taking medications with antihypertensive properties, we did not find a relationship between blood pressure and risk of AD or cognitive decline.

Aged↗

PubMed2005

Fish consumption and cognitive decline with age in a large community study.

BACKGROUND: Dietary intake of fish and the omega-3 fatty acids have been associated with lower risk of Alzheimer disease and stroke. OBJECTIVE: To examine whether intakes of fish and the omega-3 fatty acids protect against age-related cognitive decline. DESIGN: Prospective cohort study. SETTING: Geographically defined Chicago, Ill, community. PARTICIPANTS: Residents, 65 years and older, who participated in the Chicago Health and Aging Project. MAIN OUTCOME MEASURE: Change in a global cognitive score estimated from mixed models. The global score was computed by summing scores of 4 standardized tests. In-home cognitive assessments were performed 3 times over 6 years of follow-up. RESULTS: Cognitive scores declined on average at a rate of 0.04 standardized units per year (SU/y). Fish intake was associated with a slower rate of cognitive decline in mixed models adjusted for age, sex, race, education, cognitive activity, physical activity, alcohol consumption, and total energy intake. Compared with a decline rate in score of -0.100 SU/y among persons who consumed fish less than weekly, the rate was 10% slower (-0.090 SU/y) among persons who consumed 1 fish meal per week and 13% slower (-0.088 SU/y) among persons who consumed 2 or more fish meals per week. The fish association was not accounted for by cardiovascular-related conditions or fruit and vegetable consumption but was modified after adjustment for intakes of saturated, polyunsaturated, and trans fats. There was little evidence that the omega-3 polyunsaturated fatty acids were associated with cognitive change. CONCLUSIONS: Fish consumption may be associated with slower cognitive decline with age. Further study is needed to determine whether fat composition is the relevant dietary constituent.

Age Factors↗

PubMed2005

The Rush Memory and Aging Project: study design and baseline characteristics of the study cohort.

The long-term objective of the Rush Memory and Aging Project is to identify the postmortem indices linking genetic and environmental risk factors to the development of Alzheimer's disease (AD). The overall study design involves a detailed assessment of risk factors for AD in older persons without known dementia who agree to annual clinical evaluation and organ donation at the time of death. In contrast to other clinical-pathologic studies which are conducted on special populations, the Rush Memory and Aging Project enrolled a cohort with much greater diversity in terms of educational attainment, in addition to gender, race, and ethnicity. From September of 1997 through April of 2005, more than 1,000 older persons without known dementia from more than 30 residential facilities across the Chicago metropolitan area agreed to participate. Their mean age was 81 years, about a third had 12 or fewer years of education, a third were men, and about 10% were members of a racial or ethnic minority group. More than 950 already have completed their baseline clinical evaluation.

Activities of Daily Living↗

PubMed2005

Implicit memory and Alzheimer's disease neuropathology.

Explicit memory failure is the defining cognitive feature of Alzheimer's disease and relates to the hallmark neuropathological features (plaques and tangles) of this illness. However, a pattern of preserved and impaired implicit memory has been found in Alzheimer's disease patients that may be explained by the association between the processing demands of certain implicit tests and the level of regional Alzheimer's disease neuropathology. In this study, we tested the hypothesis that these neuropathological features are related to implicit memory--measured by repetition priming--in a test that emphasized conceptual (or meaning-based) cognitive processing, and that the pathological changes are not related to implicit memory in a repetition priming test that emphasized perceptual (or sensory-based) cognitive processing. Subjects were older nuns, priests and brothers participating in the Religious Orders Study who agreed to annual neurological and neuropsychological evaluation for Alzheimer's disease and common neurological conditions of ageing, and brain autopsy at time of death. Explicit memory was measured by seven tests of episodic recall and recognition and converted to a previously established summary measure. Implicit memory was measured by four repetition priming tests. One test, category exemplar priming, emphasized conceptual, or meaning-based cognitive processing. A second test, word-identification priming, emphasized perceptual, or sensory-based cognitive processing. Two additional priming tests, picture-naming and word-stem completion, invoke both conceptual and perceptual processes. Neuritic and diffuse plaques, and neurofibrillary tangles identified by Bielschowsky silver stain, were quantified from five regions separately (frontal, parietal, temporal, entorhinal cortex and the hippocampus) and converted to a previously established summary measure. In linear regression analyses--controlling for age, sex and education--higher levels of Alzheimer's disease neuropathology were related to lower levels of explicit memory proximate to death. Higher levels of neuropathology were also related to lower levels of priming on the category-exemplar test, but were not related to levels of priming on the word-identification, picture-naming, or word-stem completion tests. The results suggest that hallmark indices of Alzheimer's disease neuropathology are associated with performance on priming tests to the extent that conceptual, but not perceptual, processing resources are required.

Aged↗