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PubMed1996

Barium enema: detection of colonic lesions in a community population.

OBJECTIVE: The purposes of this study were to assess the prevalence of colonic lesions detected at barium enema in a community practice, to compare the findings at barium enema between patients who are asymptomatic and have no known risk factors for colorectal cancer (screening group) and patients who have symptoms of colonic disease or have known risk factors, and to determine if a questionnaire about symptoms and risk factors is an appropriate screening tool. SUBJECTS AND METHODS: A self-administered questionnaire about colorectal symptoms and risk factors was given to 1779 patients scheduled for barium enema examination. On the basis of their responses, patients were divided into three groups: screening group (asymptomatic, without risk factors), symptomatic, and asymptomatic with risk factors. Each patient underwent a fluoroscopic barium enema. We then compared the results (number, histologic type, size of lesion(s), location in the colon, and Patient's age) and risk factors among the three groups. RESULTS: At least one lesion within the colorectum was found in 166 (9%) of 1779 patients at combined proctosigmoidoscopy and barium enema. The prevalence of lesions in the 111 patients with at least one lesion above the rectum at barium enema was 4% (32 of 738) for the screening group, 8% (38 of 476) for asymptomatic patients with risk factors, and 7% (41 of 565) for symptomatic patients (p = .015 when comparing the prevalence in the screening group with the prevalences in the other two groups). Twenty-nine percent of all colonic lesions were found in the screening group. Among the asymptomatic patients, risk factors that included a history of colorectal polyps and advanced age were associated with a significantly higher prevalence of colonic polyps found at barium enema. In the symptomatic group, if patients with histories of polyps were excluded, we were unable to identify other risk factors that led to a significantly higher prevalence of polyps. CONCLUSION: Asymptomatic patients without known risk factors have a significantly lower prevalence of colonic polyps than either symptomatic patients or patients with risk factors alone. Despite this lower prevalence, 29% of all lesions in our series were in the screening group. Assessment of risk factors through a patient questionnaire was not helpful in identifying a group of patients with a higher prevalence of lesions--except for a history of polyps. Management decisions based on a patient questionnaire should be approached with caution. When low-risk patients are denied screening examinations, a significant number of lesions will be missed.

Aged↗

PubMed1988

Correlates of cognitive function in an elderly community population.

In 1982 and 1983, brief, structured performance tests of selected areas of cognitive function were administered to 3,682 (82.1 per cent) of the residents aged 65 years and older of the geographically defined community of East Boston, Massachusetts, a center of the Established Populations for Epidemiologic Studies of the Elderly program. There was a strong inverse relation between age and performance on all four cognitive tests in analyses adjusted for sex only as well as in those adjusted for the effects of other variables. Similarly, fewer years of formal education, increasing level of disability on the modified Katz Activities of Daily Living Scale, and less prestigious occupations, as measured by the modified Duncan Socioeconomic Index, were each independently related to lower performance on all four tests.

Activities of Daily Living↗

PubMed1991

The progression of mild idiopathic dementia in a community population.

Thirty-one subjects aged 75 years and over who were identified as suffering from mild, idiopathic dementia in a large community survey were reviewed at annual intervals for 2 years. Diagnoses and severity ratings were based on defined criteria following a mental state examination, a medical and psychiatric history, detailed cognitive testing, and an interview with relatives or other key informants. Fourteen subjects became more severely demented within 2 years. The initial cognitive test battery failed to reveal any differences between respondents whose dementia advanced and those whose condition remained unchanged, but, in the former group, subjects' symptoms had been present for longer, and a greater proportion had been recognised as demented, or possibly demented, by their general practitioners. We suggest that subjects whose dementia progressed had actually been more severely disabled at the time of identification.

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↗

PubMed1986

Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity. Cultural and linguistic artifacts.

The Mini-Mental State Evaluation (MMSE) was used in an epidemiological survey of a community of mixed ethnicity (Hispanic, white non-Hispanic) as part of the Los Angeles Epidemiologic Catchment Area Program. Results of the study showed that age, educational level, ethnicity, and language of the interview influenced the number of MMSE errors. Items on which the effects of ethnicity and language were most pronounced were identified, and suggestions on ways to minimize such sociocultural artifacts are provided in efforts to improve the epidemiological significance of the instrument, particularly as it concerns cross-cultural research.

Age Factors↗

PubMed2000

Ten-year incidence of dementia in a rural elderly US community population: the MoVIES Project.

OBJECTIVE: To determine incidence rates by age, sex, and education of overall dementia and probable/ possible AD in a largely rural community. METHODS: Ten-year prospective study of a randomly selected community sample aged 65+; biennial cognitive screening followed by standardized clinical evaluation. Incidence rates were estimated for overall dementia (Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised, criteria and Clinical Dementia Rating [CDR]) and for probable/possible AD (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). RESULTS: The cohort consisted of 1,298 individuals free of dementia at study entry. Among these, 199 incident (new) cases of overall (all-cause) dementia with CDR stage > or = 0.5, including 110 with CDR > or = 1, were detected during follow-up. Among the incident cases, 153 (76.9%) had probable/ possible AD. Age-specific incidence rates are reported for all dementia and for probable/possible AD, by sex and CDR stage. Among all-cause dementias with CDR = 0.5, controlling for age and education, men had a higher incidence rate than women. In the same group, those with less than high school education had significantly higher incidence rates than those with more education. Rates did not vary significantly by sex or education for probable/possible AD or for dementia with CDR > or = 1. CONCLUSIONS: Incidence rates of all dementias and of AD increased with age; men and those with lesser education had higher rates of possible/incipient dementia (CDR = 0.5) in this community. Potential explanations for these sex and education effects are discussed.

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PubMed1990

Anthropometric measurements as predictors of mortality in a community population aged 70 years and over.

Corrected arm muscle area (CAMA), triceps skin-fold thickness (TSF) and body mass index (BMI) were measured in a community sample of 758 people who were then followed for 40-46 months. Percentile values were calculated for each sex in 5-year age groups. The relative risk of death of those in the upper and lower percentiles was compared with those between the 10th and 90th percentiles, controlling for age and sex. Subjects below the 5th percentile for CAMA, TSF and BMI and between the 5th and 10th percentile for CAMA had a significantly increased risk of death. There was no increased risk of death in those subjects above the 90th percentile in any measurement. In the logistic regression model, both low CAMA and low TSF were associated with a significantly increased risk of subsequent mortality. Poor nutritional state shown by low muscle bulk and fat stores was an important predictor of mortality, but obesity had no adverse effect on survival.

Aged↗

PubMedDate not supplied

Association between blood pressure and cognitive function in a biracial community population of older persons.

We examined whether or not blood pressure is related to cognitive function in a cross-sectional study of a biracial community of 5,816 persons aged 65 years and older. Blood pressure had a curvilinear association with cognitive performance in linear regression models adjusted for age, sex, race and education. Scores were lower by 2-5 percentiles at 100 mm Hg systolic pressure compared to scores at the mean of 140 mm Hg and lower by <1 percentile at 180 mm Hg. For diastolic pressure, scores were lower by 2-3 percentiles at 60 mm Hg and by 1-2 percentiles at 100 mm Hg compared to scores at the mean (77 mm Hg). The differences in the scores with low blood pressure were reduced with further adjustment for body mass index, self-perceived health status, depressive symptoms, alcohol use and smoking. The curvilinear associations were stronger among persons with histories of stroke, myocardial infarction and hypertension. The cross-sectional association between blood pressure and cognitive functions is small and curvilinear and more apparent in persons with cardiovascular conditions.

Black or African American↗

PubMed1997

Violence and severe mental disorder in clinical and community populations: the effects of psychotic symptoms, comorbidity, and lack of treatment.

This paper examines links between violent behavior, type and severity of psychopathology, substance abuse comorbidity, and community mental health treatment, using matched data from two surveys: the National Institute of Mental Health Epidemiologic Catchment Area project and the Triangle Mental Health Survey (a North Carolina study of adults with severe and persistent mental illness). Multivariate logistic regression analysis was used to model the risk of violent acts attributable to three domains of independent variables: sociodemographic characteristics, clinical diagnoses and symptomatology, and mental health services utilization. Findings include: (1) Symptom severity was significantly greater in the clinically-selected sample than in the community survey of respondents with comparable diagnoses who self-reported using mental health services; (2) Violence risk was related to psychoticism/agitation in a curvilinear form; (3) In a multivariable model, violence was significantly associated with substance abuse comorbidity, particular psychotic symptoms (perceived threat and loss of internal cognitive controls), and absence of recent contact with a community mental health provider; (4) The relationship between lack of treatment and higher odds of violence was less pronounced among respondents with substance abuse comorbidity; (5) When clinical and services-use variables were taken into account, sociodemographic predictors were not significantly related to violence.

Adult↗

PubMed2004

Predictors of beginning and ending caregiving during a 3-year period in a biracial community population of older adults.

OBJECTIVES: We sought to identify predictors of beginning and ending caregiving. METHODS: At baseline and 3-year follow-up, we interviewed 4245 community residents (61.4% Black, 38.4% White, 0.20% other) aged 65 years or older. We used logistic regression to test predictors of beginning caregiving among baseline noncaregivers and of continuing caregiving among baseline caregivers. RESULTS: After control for demographic variables, physically healthier individuals were significantly more likely to become caregivers and to continue caregiving. Mental health had little influence on beginning caregiving, but declining mental heath was associated with continuing caregiving. CONCLUSIONS: Maintenance of physical health and function is essential to the ability of older adults to begin and to continue caregiving. Studies that compare the health of current caregivers with that of noncaregivers may substantially underestimate the impact of caregiving on health.

Black or African American↗

PubMed1996

Prevalence of parkinsonian signs and associated mortality in a community population of older people.

BACKGROUND: Older people frequently have signs of parkinsonism, but information about the prevalence of parkinsonism and mortality among those with the condition in the community is limited. METHODS: A stratified random sample of 467 residents of East Boston, Massachusetts, 65 years of age or older, were given structured neurologic examinations. Using uniform, specified combinations of parkinsonian signs, we estimated the prevalence of four categories of signs--bradykinesia, gait disturbance, rigidity, and tremor--and of parkinsonism, defined as the presence of two or more categories. We did not study Parkinson's disease because it could not be distinguished from other conditions that can cause parkinsonism. Proportional-hazards models were used to compare the risk of death among people with and those without parkinsonism. RESULTS: One hundred fifty-nine persons had parkinsonism, 301 did not, and 7 could not be classified. The overall prevalence estimates were 14.9 percent for people 65 to 74 years of age, 29.5 percent for those 75 to 84, and 52.4 percent for those 85 and older. With a mean follow-up period of 9.2 years, 124 persons with parkinsonism (78 percent) and 146 persons without (49 percent) died. Adjusted for age and sex, the overall risk of death among people with parkinsonism was 2.0 (95 percent confidence interval, 1.6 to 2.6) times that among people without. Among people with parkinsonism, the presence of gait disturbance was associated with an increased risk of death. CONCLUSIONS: Parkinsonism is very common among people over the age of 65, and its prevalence increases markedly with age. Parkinsonism is associated with a twofold increase in the risk of death, which is strongly related to the presence of a gait disturbance.

Age Distribution↗

PubMed1999

The detection of dementia and cognitive impairment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test.

AIM: To assess cognitive function in elderly subjects with clinically probable Parkinson's disease (PD). METHODS: A community sample of 126 patients with probable PD completed the CAMCOG, which is the cognitive section of the Cambridge Examination for Mental Disorders, and the Mini-Mental State Examination (MMSE). The performance of the CAMCOG and the MMSE in detecting dementia in this subject group was compared with the results of applying the DSM-IV criteria for dementia to this population. RESULTS: A total of 44% of the group met DSM-IV criteria for dementia, which is higher than most previous prevalence figures for dementia in PD. The CAMCOG was more sensitive than the MMSE in detecting cognitive impairment and more specific than the MMSE in detecting dementia as defined by DSM-IV criteria. Poorer performance on the CAMCOG was related to gender, social class and age (P<0.05). Among subjects with PD, those with dementia, as defined by DSM-IV criteria, were significantly older, had greater depressive symptomatology and had greater motor deficits. A greater proportion of the group with dementia were living in residential care (P<0.05). CONCLUSION: The CAMCOG appears to be a useful screening instrument for dementia and cognitive impairment in PD. Furthermore, it may prove helpful in detecting those with PD who may be at risk of developing dementia and in longitudinal studies of cognitive function in PD.

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PubMed1998

Response to a mail nutritional survey in an older bi-racial community population.

PURPOSE: We conducted a pilot study of a mail food frequency questionnaire among a bi-racial sample of 200 persons 65 years and older, selected from participants of an ongoing community study. METHODS: Up to three successive mailings were followed by personal contact with nonresponders. Response to the mail survey was higher in whites (81%) than in blacks (53%). Personal contact was important to achieving high and uniform response (94%) in both racial groups. RESULTS: Those responding to the mailed questionnaires were also more likely to be older and higher educated. The vast majority of questionnaires returned by mail were complete; 85% had fewer than 15 missing items out of 152 questions. CONCLUSIONS: A mail nutritional survey is a feasible method of dietary assessment in older, white populations, but personal contact with nonresponders may be required for comparable participation among blacks.

Black or African American↗

PubMed1999

Occurrence and progression of dementia in a community population aged 75 years and older: relationship of antihypertensive medication use.

OBJECTIVE: To examine whether antihypertensive medication use can affect the occurrence and progression of dementia. SUBJECTS AND METHODS: In a community cohort of 1810 persons aged 75 years and older, 225 prevalent cases of dementia were detected. Among the 1301 persons without dementia, 224 incident cases of dementia were identified during an average period of 3 years. Among the 225 prevalent cases of dementia, 79 were suitable for the analysis of cognitive decline. Information on drug use was collected for the 2 weeks preceding the baseline interview. RESULTS: Subjects taking antihypertensive medication (n = 651, 83.9% of whom took diuretics) had a lower prevalence of dementia than those not taking antihypertensive medication (P<.001). Subjects without dementia who were taking antihypertensive medication at baseline (n = 584) had a reduced incidence of dementia (adjusted relative risk, 0.7; 95% confidence interval, 0.6-1.0; P = .03). Furthermore, subjects taking diuretics (n = 484) had an adjusted relative risk of 0.7 (95% confidence interval, 0.5-1.0; P = .02) for all dementia, and subjects taking diuretic monotherapy (n = 345) had an adjusted relative risk of 0.6 (95% confidence interval, 0.4-0.9; P = .006). The use of other antihypertensive medication (calcium antagonists or beta-blockers), however, was related to a reduced risk of Alzheimer disease (adjusted relative risk, 0.6; 95% confidence interval, 0.3-1.2) only in the subpopulation with a higher baseline blood pressure (n = 458). Patients with dementia at baseline who were not taking diuretics had a 2-fold faster rate of decline in the score on the Mini-Mental State Examination than those taking diuretics. CONCLUSION: The use of diuretics may protect against dementia in elderly persons.

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PubMed2004

Depressive symptoms and cognitive decline in a community population of older persons.

BACKGROUND: An association between depressive symptoms and cognitive decline has been observed in selected cohorts of older people, but studies of defined populations have had conflicting results. OBJECTIVE: To test whether the level of depressive symptoms predicted the rate of cognitive decline in a biracial community of older persons. METHODS: 4392 older people (88% of those eligible) from a defined community in Chicago completed two or three structured interviews at approximately three year intervals for an average of 5.3 years. At the baseline interview, the number of depressive symptoms was assessed with a 10 item version of the Center for Epidemiologic Studies Depression scale. Cognitive function was assessed at each interview with four performance tests, from which a previously established measure of global cognition was derived. Random effects models were used to assess change in cognition and its relation to depressive symptoms, controlling for age, sex, race, education, and baseline cognitive function. RESULTS: Participants reported a median of one depressive symptom at baseline (interquartile range, 0 to 2). For each depressive symptom, the rate of cognitive decline increased by a mean of about 5%. Results were not substantially changed when persons with cognitive impairment at baseline were excluded, or when chronic illness or participation in cognitively stimulating activities was controlled, and the association was not modified by age, sex, race, or education. CONCLUSIONS: The results suggest that depressive symptoms predict cognitive decline in old age.

Aged↗

PubMed2005

The presence and clinical implications of depression in a community population of adults with epilepsy.

Depression is the most common psychiatric comorbidity in epilepsy, but clinical and other factors associated with this observation and their impact on detection and management of depression in people with epilepsy are poorly understood. This study used a community-based postal questionnaire of primary care-identified people with epilepsy. We were therefore able to explore depression in a nonspecialist care-identified population. Clinical and demographic associative factors were examined. The dependent variable was depression, as defined by a score of 11 or greater on the Hospital Anxiety and Depression Scale (HADS). The prevalence of depression in our sample (n = 499) was found to be 11.2% (95% CI: 8.3-13.7%). Depression was most strongly associated with unemployment. It was also associated with having had a recent seizure and complaints of side effects of antiepileptic medications. Depression was not associated with gender, marital status, or monotherapy or polytherapy antiepileptic medication. The prevalence of depression in epilepsy is greater than in the general population, with no associated female preponderance. Our findings underline important variations in the associative features between depression in the general population and in people with epilepsy, with particular implications for management of this comorbidity.

Adult↗

PubMedDate not supplied

[Analysis of the frequency, types and justification for radiographic examination based on a sample of a community population].

According to the patient's general practitioner files of the Health centre "Josip Adamić" Ivanić-Grad, all x-ray diagnostic examinations carried out in health insured persons of the Ivanić-Grad community were analyzed between 1983 and 1987. During the period, a total of 22,615 x-ray examinations were done. An average number of 0.761 radiographs was performed and the average x-ray dose to which patients were exposed was 126.62 mrads (1.26 mGy). The site of most usual examination was the thorax (44.1%). Males underwent more x-ray examinations than females (53.2% versus 46.8%). X-rays of thorax, head and neck, arms and legs were more frequent in males, while abdomen and pelvis x-ray examinations and diascopies were more usual in females. The greatest number of x-ray examinations was performed between the ages of 0 to 20 years of age, and patients were exposed to the highest x-ray dose between the ages of 41 to 60 years of age. The average gonadal dose was 58.78 mrads (0.58 mGy) per year. Clinical examinations preceded radiologic examinations in 81.3% of cases, laboratory investigations in 9.7% and other non-radiologic examinations in 1.4% of cases. The working diagnosis existed before x-ray examination in 77% of cases and pathological findings were discovered in 32.7% of cases.

Adult↗

PubMed1998

Screening for thyroid dysfunction in a community population of diabetic patients.

In a general practice population of 11,300 patients, 223 were known to have diabetes mellitus. Thirteen diabetic patients (5.8%) had a previous diagnosis of thyroid disease. The study excluded 17 patients who received sole diabetes care at a secondary referral centre (of whom 5 had a previous diagnosis of thyroid disease), 8 with a previous diagnosis of thyroid disease receiving community care, and 1 patient who declined screening. New thyroid disease was diagnosed in 11 patients (8 female, 3 male): 5 with primary hypothyroidism, 4 with subclinical hypothyroidism, 1 with hyperthyroidism and 1 with subclinical hyperthyroidism. Thus the prevalence of undiagnosed thyroid disease in diabetic patients receiving community diabetes care was 5.5% (9.5% of female patients), and the prevalence of thyroid disease (previously known and diagnosed as a result of screening) in the entire population of diabetic patients registered in the general practice was 10.8%. These findings suggest that screening for thyroid disease should be considered in patients receiving diabetes care in the community.

Adolescent↗