Cognitive performance and functional status are the major factors predicting survival of centenarians in Poland

The association of cognitive function and its changes with all-cause mortality among community-dwelling older adults

Background

The association of cognitive function, its changes, and all-cause mortality has not reached a consensus, and the independence of the association between changes in cognitive function and mortality remains unclear. The purpose of this study was to evaluate the longitudinal association between baseline cognitive function and cognitive changes over 1 year with subsequent all-cause mortality among the older adults aged 60 and above.

Methods

A prospective cohort study utilizing the Community Older Adults Health Survey data. Initiated in 2018, the study annually assessed all individuals aged 60+ in Dalang Town, Dongguan City. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE). A total of 6,042 older adults individuals were included, and multivariate Cox proportional hazard models were used to examine cognitive function's impact on mortality.

Results

Participants' median age was 70 years, with 39% men. Over a median 3.08-year follow-up, 525 died. Mortality risk increased by 6% per MMSE score decrease (adjusted HR = 1.06, 95%CI: 1.05-1.08). Compared to those with normal cognitive function at baseline, participants with mild cognitive impairment and moderate to severe cognitive impairment had significantly higher mortality risks (adjusted HR = 1.40, 95%CI: 1.07-1.82; HR = 2.49, 95%CI: 1.91-3.24, respectively). The risk of death was 5% higher for each one-point per year decrease in cognitive function change rate (HR = 1.05, 95%CI: 1.02-1.08). Compared with participants with stable cognitive function, those with rapid cognitive decline had a 79% increased risk of death (adjusted HR = 1.79, 95% CI: 1.11-2.87), with baseline cognitive function influencing this relationship significantly (P for interaction = 0.002).

Conclusion

Baseline cognitive impairment and rapid cognitive decline are associated with higher all-cause mortality risks in Chinese older adults. Baseline function influences the mortality impact of cognitive changes.

Profiles of centenarians' functioning: linking functional and cognitive capacity with depressive symptoms

BACKGROUND

Despite most centenarians facing age-related declines in functional and cognitive capacities, the severity of these declines varies among individuals, as does the maintenance of good mental health (e.g., depressive symptoms) despite these declines. This study aims to examine this heterogeneity in centenarians from the Second Heidelberg Centenarian Study, which collected data from 112 centenarians living in Germany. In our study, we focus on a subsample of 73 centenarians who provided self-reports for our measures of interest (M age = 100.4, SD age = 0.55).

METHODS

We examined correlations between functional capacity (i.e., PADL, IADL), cognitive capacity (i.e., MMSE), and depressive symptoms (i.e., GDS), and the existence of different profiles using hierarchical clustering.

RESULTS

Higher functional capacity was related to higher cognitive capacity and to fewer depressive symptoms. Yet, higher cognitive capacity was associated with more depressive symptoms. Hierarchical clustering analysis elucidated this contradiction by identifying three profiles: low-capacity individuals (i.e., 24 individuals had low functional and cognitive capacities, with low depressive symptoms), high-capacity individuals (i.e., 33 individuals with high functional and cognitive capacities, with low depressive symptoms), and low-functional-high-cognitive-capacity individuals (i.e., 16 individuals showed low functional but high cognitive capacity, with high depressive symptoms). Our post-hoc analyses highlighted arthritis and pain as risk factors for functional dependence and depression.

CONCLUSIONS

Our findings emphasize the importance of identifying centenarian subgroups with specific resource- and risk profiles to better address their needs, and of treating pain to improve functional capacity and mental health in centenarians.

Frailty and Survivability of Polish Caucasian Nonagenarians and Centenarians

Frailty is a major geriatric problem leading to an increased risk of disability and death. Prevention, identification, and treatment of frailty are important challenges in gerontology and public health. The study aimed to estimate the prevalence of the frailty phenotype (FP) among the oldest-old Polish Caucasians and investigate the relationship between the FP and mortality. Baseline data were collected from 289 long-lived individuals, including 87 centenarians and 202 subjects aged 94-99. Mortality was obtained from population registers over the following 5 years. Sixty percent of subjects were classified as frail, 33% as prefrail, and 7% as robust. Frailty was more common in women than men and among centenarians than nonagenarians. During the 5-year observation period, 92.6% of the frail women and all frail men died, while mortality rates were lower among prefrail, 78.8% and 66.7%, and robust individuals, 60% and 54.5%, respectively. In the survival analysis, frailty was the strongest negative risk factor: HR = 0.328 (95% CI: 0.200-0.539). The inability to perform handgrip strength measurement was an additional predictor of short survival. In conclusion, the FP is prevalent in nonagenarians and centenarians and correlates with lower survivability. Future studies should address differences between unavoidable age-associated frailty and reversible disability in long-lived individuals.

Physical inability rather than depression and cognitive impairment had negative effect on centenarian prognosis: A prospective study with 5-year follow-up

AIM

Scarce study has involved the effects of physical inability, depression and cognitive impairment on the prognosis of older individuals, especially in Chinese centenarians. This prospective study was designed to investigate the effects with 5-year follow-up in Chinese centenarians.

METHODS

According to the list of centenarians provided by Department of Civil Affairs, an household survey was conducted on all centenarians residing in 18 cities and counties of Hainan province. A total of 423 centenarians were followed up, including 84 survival centenarians and 261 dead centenarians, with 78 cases lost to follow-up.

RESULTS

Dead centenarians had less females and more physical inability than survival centenarians (P < 0.05 for all). Univariable Cox regression analyses indicated that physical inability [EXP(B): 2.038, 95 % confidence interval (CI): 1.413-2.939], urea nitrogen [EXP(B): 1.116, 95 % CI: 1.039-1.199], and creatinine [EXP(B): 1.006, 95 % CI: 1.001-1.012] had negative effects on the prognosis of centenarians (all P < 0.05). Gender [EXP(B): 0.606, 95 % CI: 0.391-1.940] and albumin [EXP(B): 0.939, 95 % CI: 0.896-0.985] had positive effects on the prognosis of centenarians (all P < 0.05). Multivariable Cox regression analysis indicated that physical inability [EXP(B): 2.148, 95 % CI: 1.454-3.173] and urea nitrogen [EXP(B): 1.114, 95 % CI: 1.020-1.216] had negative effects on the prognosis of centenarians (all P < 0.05).

CONCLUSIONS

For Chinese centenarians, this prospective study demonstrated that physical inability rather than depression and cognitive impairment had negative effect on the long-term mortality rate and survival time. This result suggested that in order to improve the prognosis of older adults, it could be mainly achieved by improving physical ability.

Association of Drinking Herbal Tea with Activities of Daily Living among Elderly: A Latent Class Analysis

The aim of this study was to explore whether drinking herbal tea and tea would positively benefit activities of daily living (ADL) in the elderly. We used data from the Chinese longitudinal healthy longevity survey (CLHLS) to explore the association. Drinking herbal tea and drinking tea were divided into three groups using latent class analysis (LCA): frequently, occasionally, and rarely. ADL disability was measured by the ADL score. Multivariate COX proportional hazards models with competing risks were used to explore the impact of drinking herbal tea and tea on ADL disability, statistically adjusted for a range of potential confounders. A total of 7441 participants (mean age 81.8 years) were included in this study. The proportions of frequently and occasionally drinking herbal tea were 12.0% and 25.7%, respectively. Additionally, 29.6% and 28.2% of participants reported drinking tea, respectively. Multivariate COX regression showed that compared with rarely drinking, frequently drinking herbal tea could effectively reduce the incidence of ADL disability (HR = 0.85, 95% CI = 0.77-0.93, p = 0.005), whereas tea drinking had a relatively weaker effect (HR = 0.92, 95% CI = 0.83-0.99, p = 0.040). Subgroup analysis found that frequently drinking herbal tea was more protective for males under 80 years old (HR = 0.74 and 0.79, respectively), while frequently drinking tea was somewhat protective for women (HR = 0.92). The results indicate that drinking herbal tea and tea may be associated with a lower incidence of ADL disability. However, the risks associated with using Chinese herb plants still deserve attention.

Predictors of Mortality in 433 Nonagenarians Inside the Mugello Study: A 10 Years Follow-Up Study

OBJECTIVE

to identify the predictors of mortality in a cohort of nonagenarians inside the "Mugello study" after 10 years follow-up.

METHODS

Information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 non-selected participants aged 90-99 years, living in the Mugello area (Italy). Participants were followed over 10 years and their dates of death were retrieved from the municipal registers. Cox regression analysis was used to determine significant potential prognostic factors.

RESULTS

The mortality rate was 96.5%. Cox proportional hazards analysis showed that a lower cognitive status was significantly associated with higher mortality as well as a poorer functional status, a higher comorbidity, and a higher number of drugs consumption.

DISCUSSION

Impaired cognitive function, loss of functional independence, higher comorbidity, and higher drugs intake were the stronger predictors of mortality.

12-month survival in nonagenarians inside the Mugello study: on the way to live a century

Background

Life expectancy has increased over the last century and a growing number of people is reaching age 90 years and over. However, data on nonagenarians’ health trends are scarce due to difficulties in investigating this specific population. This study aims to identify risk factors for one-year mortality in nonagenarians using data collected within the “Mugello Study”.

Methods

Complete information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 nonagenarians, as well as information about survival after 1 year from the interview.

Results

The sample included 314 women (72.5%) and 119 men (27.5%) with a median age of 92 years (range 90-99 years). The mortality rate was 20.3% (88 deaths). After adjustment for age and sex, a significantly higher risk of dying within 12 months was observed in individuals with more severe cognitive impairment (HR = 5.011, p < 0.001), more severe disability in basic activities of daily living (HR = 4.193, p < 0.001), sedentary lifestyle (HR = 3.367, p < 0.001), higher number of drugs assumed (HR = 1.118, p = 0.031), and kidney dysfunction (HR = 2.609, p = 0.004). When all the variables were included in the analysis, only older age (HR = 1.079, p = 0.048), lower cognitive function (HR = 2.859, p = 0.015), sedentary lifestyle (HR = 2.030, p = 0.026), and kidney dysfunction (HR = 2.322, p = 0.018) remained significantly associated with reduced survival.

Conclusions

Data from the Mugello study support the hypothesis that survival at 12 months in nonagenarians is not a stochastic process and that older age, reduced cognitive function, sedentary lifestyle, and the presence of kidney dysfunction are associated with mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02908-9.

Association of Cognitive Function Trajectories in Centenarians With Postmortem Neuropathology, Physical Health, and Other Risk Factors for Cognitive Decline

IMPORTANCE

Understanding mechanisms associated with prolonged cognitive health in combination with exceptional longevity might lead to approaches to enable successful aging.

OBJECTIVE

To investigate trajectories of cognitive functioning in centenarians across domains, and to examine the association of these trajectories with factors underlying cognitive reserve, physical health, and postmortem levels of Alzheimer disease (AD)-associated neuropathology.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used neuropsychological test data and postmortem neuropathological reports from Dutch centenarians who were drawn from the 100-plus Study between January 2013 and April 2019. Eligible participants self-reported being cognitively healthy, which was confirmed by a proxy. Data analysis was performed between June 2019 and June 2020.

EXPOSURES

Age, sex, APOE ε genotype, factors of cognitive reserve, physical health, and AD-associated neuropathology (ie, amyloid-β, neurofibrillary tangles, and neuritic plaques).

MAIN OUTCOMES AND MEASURES

In annual visits (until death or until participation was no longer possible), centenarians underwent an extensive neuropsychological test battery, from which an mean z score of global cognition, memory, executive functions, verbal fluency, visuospatial functions, and attention/processing speed was calculated. Linear mixed models with a random intercept and time as independent variable were used to investigate cognitive trajectories, adjusted for sex, age, education, and vision and hearing capacities. In a second step, linear mixed models were used to associate cognitive trajectories with factors underlying cognitive reserve, physical health at baseline, and AD-associated neuropathology.

RESULTS

Of the 1023 centenarians approached, 340 were included in the study. We analyzed 330 centenarians for whom cognitive tests were available at baseline (239 [72.4%] women; median [interquartile range] age of 100.5 [100.2-101.7] years), with a mean (SD) follow-up duration of 1.6 (0.8) years. We observed no decline across investigated cognitive domains, with the exception of a slight decline in memory function (β, -0.10 SD per year; 95% CI, -0.14 to -0.05 SD; P < .001). Cognitive performance was associated with factors of physical health (eg, higher Barthel index: β, 0.37 SD per year; 95% CI, 0.24-0.49; P < .001) and cognitive reserve (eg, higher education: β, 0.41 SD per year; 95% CI, 0.29-0.53; P < .001), but none of these factors were associated with the rate of decline. Neuropathological reports were available for 44 participants. While centenarian brains revealed varying loads of postmortem neuropathological hallmarks of AD, this was not associated with cognitive performance or rate of decline.

CONCLUSIONS AND RELEVANCE

While we observed a slight vulnerability for decline in memory function, centenarians maintained high levels of performance in all other investigated cognitive domains for up to 4 years despite the presence of risk factors of cognitive decline. These findings suggest that mechanisms of resilience may underlie the prolongation of cognitive health until exceptional ages.

Endovascular abdominal aortic aneurysm repair in a centenarian

As the general population ages, there will be an increasing number of vascular patients in their 90s and older. However, geriatric patients have historically been turned down for abdominal aortic aneurysm repair despite high aneurysm-related mortality in the unrepaired. Herein, we describe the perioperative considerations and the successful, uncomplicated operative course of a 100-year-old woman who underwent an elective endovascular aortic aneurysm repair for an expanding 5.3-cm abdominal aortic aneurysm. Given a suitable patient, there is acceptable risk profile of an endovascular approach, even in centenarians.

Associations Between Complement Components and Vitamin D and the Physical Activities of Daily Living Among a Longevous Population in Hainan, China

Background: Vitamin D and complement components shared some common pathophysiological pathways in the musculoskeletal system, circulation, and metabolism, which were linked to physical function. It is hypothesized that serum complement components may interact with vitamin D in respect of the physical activities of daily living (PADLs). Objective: To investigate if serum complement components 3 (C3), complement components 4 (C4), and 25-hydroxyvitamin D [25(OH)D] associate with PADLs, and to examine whether the association between 25(OH)D levels and PADLs varies at different complement component levels among Chinese centenarians. Methods: This study was conducted in a group of population-based centenarians. PADLs were evaluated using the Barthel Index. Multiple regressions were used to analyze the associations among 25(OH)D, complements C3 and C4, and PADLs. Results: Among 943 participants, 672 (71.3%) had physical dependence (PD). After adjusting for potential confounders, serum 25(OH)D and C3 levels were positively correlated with PADLs, while C4 levels were negatively correlated with PADLs (Ps < 0.05). Serum 25(OH)D levels significantly interacted with both C3 (P for interaction = 0.033) and C4 (P for interaction = 0.006) levels on PADLs. At lower complement component levels, the multivariate odds ratios (ORs) of the upper tertile of vitamin D for PD were 0.32 (95% CI: 0.18-0.55) in the C3 group and 0.29 (95% CI: 0.16-0.50) in the C4 group. At higher complement component levels, the ORs in the C3 and C4 groups were not statistically significant. Conclusions: In a group of population-based Chinese centenarians, we observed that serum complement C3 and 25(OH)D levels were positively associated with PADLs, while C4 was negatively associated with PADLs. The associations between 25(OH)D levels and PADLs were more pronounced in groups with lower serum complement component levels.

Age-related epigenetic drift deregulates SIRT6 expression and affects its downstream genes in human peripheral blood mononuclear cells

Sirtuin 6 (SIRT6) exerts a protective effect on health and extends the lives of model organisms. We, therefore, aimed to clarify whether age-related epigenetic drift is responsible for differences in SIRT6 expression in peripheral blood mononuclear cells (PBMCs) of healthy young (n = 55, mean age 27.5 ± 4.4 years), middle-aged (n = 51, 65.4 ± 3.3 years), and long-lived (n = 51, 93.9 ± 3.6 years) humans. In silico analysis was performed using the STRING network. No age-related differences were observed in the percentage of SIRT6 CpG island methylation. However, the age affected the expression of miR-34a-5p, miR-125a-5p, miR-186-5p, miR-342-5p and miR-766-3p (all p < 0.0001), miR-181-2-3p and Let-7c (both p = 0.0003), and miR-103a-3p (p = 0.0069). A negative association was observed between SIRT6 mRNA and miR-186-5p (r_s = -0.25, p = 0.026), and a positive association was observed with miR-34a-5p (r_s = 0.31, p = 0.0055) and miR-181a-2-3p (r_s = 0.39, p = 0.0002). SIRT6 mRNA also negatively correlated with the expression of TP53 (r_s = -0.41, p = 0.0126) and MYC (r_s = -0.35, p = 0.0448). Notably, the expression of several miRNAs and genes was similar in young and long-lived groups but different from the middle-aged group. We conclude that age-related epigenetic changes can affect the expression of SIRT6 in PBMCs and, in this way, possibly influence immunosenescence. Moreover, molecular events could differentiate 'normal' ageing from that of long-lived individuals.

Longitudinal Maintenance of Cognitive Health in Centenarians in the 100-plus Study

IMPORTANCE

Some individuals who reach ages beyond 100 years in good cognitive health may be resilient against risk factors associated with cognitive decline. Exploring the processes underlying resilience may contribute to the development of therapeutic strategies that help to maintain cognitive health while aging.

OBJECTIVE

To identify individuals who escape cognitive decline until extreme ages and to investigate the prevalence of associated risk factors.

DESIGN, SETTING, AND PARTICIPANTS

The 100-plus Study is a prospective observational cohort study of community-based Dutch centenarians enrolled between 2013 and 2019 who were visited annually until death or until participation was no longer possible. The centenarians self-reported their cognitive health, as confirmed by a proxy. Of the 1023 centenarians approached for study inclusion, 340 fulfilled the study criteria and were included in analyses. Data analysis was performed from April 2019 to December 2019.

MAIN OUTCOMES AND MEASURES

Cognition was assessed using the Mini-Mental State Examination (MMSE). To identify centenarians who escape cognitive decline, this study investigated the association of baseline cognition with survivorship and cognitive trajectories for at least 2 years of follow-up using linear mixed models, adjusted for sex, age, and education. This study investigated the prevalence of apolipoprotein E (APOE) genotypes and cardiovascular disease as risk factors associated with cognitive decline.

RESULTS

At baseline, the median age of 340 centenarians was 100.5 years (range, 100.0-108.2 years); 245 participants (72.1%) were female. The maximum survival estimate plateaued at 82% per year (95% CI, 77% to 87%) across centenarians who scored 26 to 30 points on the baseline MMSE (hazard ratio, 0.56; 95% CI, 0.42 to 0.75; P < .001), suggesting that an MMSE score of 26 or higher is representative of both cognitive and physical health. Among the 79 centenarians who were followed up for 2 years or longer, those with baseline MMSE score less than 26 experienced a decline in MMSE score of 1.68 points per year (95% CI, -2.45 to -0.92 points per year; P = .02), whereas centenarians with MMSE scores of 26 or higher at baseline experienced a decline of 0.71 point per year (95% CI, -1.08 to -0.35 points per year). For 73% of the centenarians with baseline MMSE scores of 26 or higher, no cognitive changes were observed, which often extended to ensuing years or until death. It is estimated that this group is representative of less than 10% of Dutch centenarians. In this group, 18.6% carried at least 1 APOE-ε4 allele, compared with 5.6% of the centenarians with lower and/or declining cognitive performance.

CONCLUSIONS AND RELEVANCE

Most centenarians who scored 26 or higher on the MMSE at baseline maintained high levels of cognitive performance for at least 2 years, in some cases despite the presence of risk factors associated with cognitive decline. Investigation of this group might reveal the processes underlying resilience against risk factors associated with cognitive decline.

Further survival at age 100: Findings from the Oporto Centenarian study

BACKGROUND

This paper aims to identify the health-related predictors of survival in centenarians.

METHODS

A population-based study conducted in North Portugal (PT100) followed 140 individuals from the age of 100+ years. A detailed questionnaire at baseline was completed including information on sociodemographic characteristics, physical health, functional, cognitive, and nutritional status and life-style. Survival of study participants was checked every six months over the period of December 2013 until June 2019.

RESULTS

In the univariate Cox proportional hazards model, longer survival was associated with the absence of acute disease, better functional status, absence of physical fatigue and better cognition. Multivariate analysis revealed that acute disease, functional status and physical fatigue remained significant.

CONCLUSIONS

Acute disease, functional status and physical fatigue are predictors of survival in the PT100 centenarians.

Handgrip strength accuracy as discriminator of functional independence in centenarian women

Abstract The aim of this study was to verify and compare handgrip strength (HS) with activities of the daily living (ADL) and to identify the cutoff point of HGS in the prediction of independence in ADL of centenarians. Twenty-four centenarians with mean age of 101.67 ± 2.80 years participated in the study. Subjects were asked about marital status, schooling (years), diseases, hearing difficulties and activities of the daily living (Katz scale), to classify functional independence. Handgrip strength of the right hand (HSR) and left hand (HSL) (mean of the three measures of each hand) was evaluated by means of manual dynamometer. The U Mann Whitney test was applied to compare HSR and HSL with functions of ADL. To identify the cutoff point (sensitivity and specificity) of the right and left HGS of centenarians in the prediction of independence in functions of ADL, the Received Operating Characteristic (ROC) Curves were used. The following cutoff points were used: 11 Kgf for HSR (sensitivity = 66.7%, specificity = 100%, ROC curve = 0.778) and 9 Kgf for HSL (sensitivity = 66.7%, specificity = 77.8%, curve ROC = 0.730) to predict independence in performing the "bathing" function; 11 Kgf for HSR for the "continence" function (sensitivity = 83.3%, specificity = 66.7%, ROC curve = 0.712); and 9 Kgf for HSL for "transfer" function (sensitivity = 80%, specificity = 71.4%, ROC curve = 0.786). For these functions, sensitivity and specificity presented values greater than 66%. On all these functions, sensitivity showed values higher than 46% and specificity 77%. Minimum HSR is required to perform functions of ADL independently. The best HSR cutoff point to predict independence of subjects differs according to functions of activities of the daily living and hand evaluated.

Association of Anemia with Activities of Daily Living in Chinese Female Centenarian

OBJECTIVES

Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016.

MEASUREMENTS

Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60.

RESULTS

The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability.

CONCLUSION

These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.

Functional capacity assessment of long-lived older adults from Amazonas

OBJECTIVE

To evaluate the functional capacity of long-lived older adults from Amazonas.

METHOD

A cross-sectional epidemiological study was carried out with 116 older adults aged 80 years or older, registered in a primary health care unit in Belém, in the state of Pará, Brazil. The Functional Independence Measure (FIM) was used for functional capacity assessment and the Mini-Mental State Examination (MMSE) for cognitive screening. Univariate and bivariate analyses were carried out, in addition to the Pearson's chi-square test.

RESULTS

The older adults presented modified independence in the self-care, sphincter control and locomotion dimensions, and needed supervision for mobility/transfers. In mobility, men presented complete independence. Modified independence was found in the 80-89 age group. It was observed that, the lower the education level, the worse the cognitive performance.

CONCLUSION

In spite of their advanced age, long-lived older adults still present functional capacity for activities of daily living, even though they required supervision for high energy expenditure tasks, such as mobility and transfers.

Combined associations of hs-CRP and cognitive function with all-cause mortality among oldest-old adults in Chinese longevity areas: a prospective cohort study

BACKGROUND

Inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), and cognitive impairment (CI) are associated with mortality; CRP is related to the deterioration of CI. However, it is still unknown whether these two indices predict mortality independent of each other. Furthermore, their joint effect on all-cause mortality has not been well established, especially in oldest-old adults.

METHODS

Based on data from the 2012 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we included 1447 oldest-old adults (mean age 84.7 years and 58.7% were female, weighted) with information on hs-CRP (stratified by a cutoff value of 3.0 mg/L) and cognition (quantified by Mini-Mental Status Examination (MMSE) scored according to the personal educational level) at baseline. Mortality was assessed in followed 2014 and 2017 waves. Cox proportional hazards regression models were used, with adjustment for hs-CRP and cognition (mutually controlled) and several traditional mortality risk factors.

RESULTS

During a median follow-up period of 32.8 months (Q1-Q3, 9.7-59.0 months), 826 participants died. Hs-CRP [HR > 3.0 mg/L vs ≤ 3.0 mg/L: 1.64 (95% CI, 1.17, 2.30)] and cognition [HR CI vs normal: 2.30 (95% CI, 1.64, 3.21)] each was independent predictor of all-cause mortality, even after accounting for each other and other covariates. Monotonic and positive associations were observed in combined analyses, in which the highest mortality risk was obtained in elders with both high hs-CRP> 3.0 mg/L and CI [HR: 3.56 (95% CI, 2.35, 5.38)].The combined effects were stronger in male and younger oldest-old (aged 80-89 years).

CONCLUSION

High hs-CRP and CI, both individually and jointly, were associated with increased all-cause mortality risks in Chinese oldest-old. Intervention strategies for preventing inflammation and maintaining adequate cognitive function may be more important in male and younger oldest-old for reducing mortality risk.

Skeletal Muscle Mass as a Mortality Predictor among Nonagenarians and Centenarians: A Prospective Cohort Study

This study aimed to evaluate the association between skeletal muscle mass and long-term all-cause mortality among nonagenarians and centenarians in China. We used data from the Project of Longevity and Aging in Dujiangyan (PLAD). A total of 738 community-dwelling people aged ≥ 90 years (mean age of 93.5 ± 3.2 years) were analyzed in this study. The appendicular skeletal muscle mass (ASM) was estimated using a previously validated anthropometric equation. The information on the survival status was requested from the local government registries during the 4 year follow-up period following the baseline investigation. The mean muscle mass index (SMI) was 6.11 ± 0.53 kg/m² in men and 4.00 ± 0.63 kg/m² in women, respectively. Low muscle mass was associated with a higher risk of death (hazard ratio [HR] 1.54; (95% confidence interval [CI]:1.10–2.16) in women; however, no significant association was found in men. Disability in activities of daily living (ADL) (HR = 1.73; 95% CI: 1.13–2.63) in men and women and cognitive impairment (HR = 1.49; 95% CI: 1.05–2.13) in men were also associated with increased all-cause mortality. In conclusion, low muscle mass were predictors of long-term mortality in nonagenarian and centenarian women.

Exceptional human longevity is associated with a specific plasma phenotype of ether lipids

A lipid profile resistant to oxidative damage is an inherent trait associated with animal lifespan. However, there is a lack of lipidomic studies on human longevity. Here we use mass spectrometry based technologies to detect and quantify 137 ether lipids to define a phenotype of healthy humans with exceptional lifespan. Ether lipids were chosen because of their antioxidant properties and ability to modulate oxidative stress. Our results demonstrate that a specific ether lipid signature can be obtained to define the centenarian state. This profile comprises higher level of alkyl forms derived from phosphatidylcholine with shorter number of carbon atoms and double bonds; and decreased content in alkenyl forms from phosphatidylethanolamine with longer chain length and higher double bonds. This compositional pattern suggests that ether lipids from centenarians are more resistant to lipid peroxidation, and that ether lipid signature expresses an optimized feature associated with exceptional human longevity. These results are in keeping with the free radical theory of aging.

Neuropsychological Test Performance of Cognitively Healthy Centenarians: Normative Data From the Dutch 100-Plus Study

OBJECTIVES

The fraction of the population that reaches the age of 100 years is growing. At this age, dementia incidence is high and cognitive functioning is highly variable across individuals. Normative data for neuropsychological tests are lacking in centenarians, which hampers the ability to evaluate their cognitive functioning for both research and clinical practice. Here, we generated norms for neuropsychological tests in a sample of cognitively healthy centenarians while taking sensory impairments into account.

DESIGN

Cross-sectional cohort study.

SETTING

Centenarians who participate in the prospective 100-plus Study.

PARTICIPANTS

A total of 235 centenarians (71.5% female), who self-reported to be cognitively healthy, which was confirmed by an informant and a trained researcher.

MEASUREMENTS

We generated normative data for 15 cognitive tests, measuring global cognition (Mini-Mental State Examination [MMSE]), premorbid intelligence, attention, language, memory, executive function, and visuospatial function by multiple linear regressions and/or by reporting percentiles.

RESULTS

Normative data for global cognition resulted in a mean MMSE score of 25.6 ± 3.1 (range = 17-30; interquartile range = 24-28). Vision problems and fatigue often complicated the ability to complete tests, and these problems explained 41% and 22% of the missing test scores, respectively. In contrast, hearing problems (4%) and task incomprehension (6%) rarely complicated test performance. While educational level was associated with performance on the majority of the tests, sex and age were only weakly associated with test performance.

CONCLUSIONS

We generated normative data for 15 common neuropsychological tests in a large sample of cognitively healthy centenarians, while taking age-related sensory impairments into consideration. These normative data allow the detection of deficits across a wide range of cognitive domains. Our results suggest that, next to education level, vision ability and the level of fatigue should be taken into account when evaluating cognitive functioning in centenarians. J Am Geriatr Soc 67:759-767, 2019.

Cognitive functioning transitions, health expectancies, and inequalities among elderly people in China: A nationwide longitudinal study

OBJECTIVE

In China, cognitive impairment has become a huge challenge owing to the rapid aging process. We investigate cognitive health expectancy and potential factors leading to inequalities of cognitive health for Chinese older people.

METHODS

The study included 19 943 participants aged 65 to 95 at the first observation in Chinese Longitudinal Healthy Longevity Survey collected during 2002-2014. Cognitive impairment was categorized into none, mild, and severe by the score of cMMSE. Multistate models based on continuous-time Markov process were applied to calculate cognitive health expectancies and estimate hazard ratio from no impairment to impairment for potential factors.

RESULTS

Urban women and men aged 65 were expected to spend 31.18% and 19.82% of their remaining 17.46 and 15.45 years with cognitive impairment; meanwhile, rural women and men aged 65 were expected to spend 35.31% and 21.39% of their remaining 16.73 and 14.87 years with cognitive impairment. Women achieving lower educational attainment (HR_1-6 years  = 0.78, 95% CI, 0.71-0.87; HR_7+ years  = 0.59, 95% CI, 0.49-0.70) than men and rural residents having less access to medical service (HR = 0.79, 95% CI, 0.68-0.92) and doing less regular exercise (HR = 0.87, 95% CI, 0.80-0.96) than urban people caused the differences of cognitive health for genders and regions.

CONCLUSIONS

Women and rural people experience less cognitive health expectancies compared with their counterparts, respectively. Chinese government should pay more attention to rural women and make efforts to reduce the inequalities of cognitive health by increasing opportunities of education for women and improving access to medical service and healthy lifestyle for rural people.

The 100-plus Study of cognitively healthy centenarians: rationale, design and cohort description

Although the incidence of dementia increases exponentially with age, some individuals reach more than 100 years with fully retained cognitive abilities. To identify the characteristics associated with the escape or delay of cognitive decline, we initiated the 100-plus Study (www.100plus.nl). The 100-plus Study is an on-going prospective cohort study of Dutch centenarians who self-reported to be cognitively healthy, their first-degree family members and their respective partners. We collect demographics, life history, medical history, genealogy, neuropsychological data and blood samples. Centenarians are followed annually until death. PET–MRI scans and feces donation are optional. Almost 30% of the centenarians agreed to post-mortem brain donation. To date (September 2018), 332 centenarians were included in the study. We analyzed demographic statistics of the first 300 centenarians (25% males) included in the cohort. Centenarians came from higher socio-economic classes and had higher levels of education compared to their birth cohort; alcohol consumption of centenarians was similar, and most males smoked during their lifetime. At baseline, the centenarians had a median MMSE score of 25 points (IQR 22.0–27.5); most centenarians lived independently, retained hearing and vision abilities and were independently mobile. Mortality was associated with cognitive functioning: centenarians with a baseline MMSE score ≥ 26 points had a mortality percentage of 17% per annual year  in the second year after baseline, while centenarians with a baseline MMSE score < 26 points had a mortality of  42% per annual year (p = 0.003). The cohort was 2.1-fold enriched with the neuroprotective APOE-ε2 allele relative to 60–80 year-old population controls (p = 4.8 × 10⁻⁷), APOE-ε3 was unchanged and the APOE-ε4 allele was 2.3-fold depleted (p = 6.3 × 10⁻⁷). Comprehensive characterization of the 100-plus cohort of cognitively healthy centenarians might reveal protective factors that explain the physiology of long-term preserved cognitive health.

Prevalence of functional dependence in Chinese centenarians and its relationship with serum vitamin D status

BACKGROUND

Functional dependence (FD) and vitamin D deficiency are common conditions in older adults. However, little is known about the relationship between FD and serum vitamin D status in centenarians. The current study was designed to evaluate the prevalence of FD and examine its relationship with serum vitamin D status among centenarians in China.

SUBJECTS AND METHODS

A cross-sectional study of a large sample of Chinese centenarians including 180 men and 822 women was conducted from June 2014 to December 2016. Home interviews, physical examinations, and blood analyses were performed in 958 centenarians following standard procedures. FD was evaluated using the Barthel index of activities of daily living (ADL). Serum 25-hydroxyvitamin D (25OHD) concentrations were measured as a marker of vitamin D status.

RESULTS

The prevalence of centenarians with FD was 71.2%. Vitamin D deficiency, lack of tea consumption, lack of outdoor activities, visual impairment, and fracture were predictors of FD. Centenarians in the lowest quartile of serum 25OHD concentration had an approximately threefold greater likelihood of FD than those in the highest quartile in multiple logistic regression models (OR =2.88; 95% CI 1.75-4.73; P<0.001). The multivariable OR with a 1 ng/mL decrease in serum 25OHD concentration was 1.06 (95% CI 1.04-1.08; P<0.001) for FD.

CONCLUSION

Serum 25OHD levels have important associations with FD in Chinese centenarians. Future research could focus on the value of intervening in the case of low serum 25OHD levels through vitamin D supplementation and improving ADL in the older population.

Cohort profile: 'Centenari a Trieste' (CaT), a study of the health status of centenarians in a small defined area of Italy

PURPOSE

Centenarians, a segment of the population which some 50 years ago comprised only a few individuals, now count thousands in many countries, and demographic projections forecast that this growth will continue. The study of this new population will give us new information on extreme longevity and help prepare for their health and social needs. The aim of the Centenari a Trieste study is to describe the health and health service use by centenarians, with specific focus on cognitive status.

PARTICIPANTS

This is a population-based study of centenarians living in the province of Trieste (Italy), a small area with a high prevalence of centenarians and a close network of health and social services, which makes it possible to conduct a study. Consenting individuals were visited by a clinician, tested by neuropsychologists and also gave a sample of their blood. Administrative data were retrieved as well.

FINDINGS TO DATE

Of the 163 centenarians, 70 could be contacted and participated in the study. The main reasons for non-participation were impossibility to contact the subject (70) and death (20). Centenarians were mostly women (90%), tended to live in a nursing home (60%) and were generally severely functionally impaired (Barthel Index <50: 61%). Data from the administrative database showed that about one out of five needed hospitalisation in the preceding year and more than three out of four had at least one drug prescription.

FUTURE PLANS

In 2017, we started a new wave of the study enrolling people who had just become centenarian and reassessing subjects already seen; we hope to extend this recruitment in the next years. Subjects are now examined also by cardiologists and dental specialists. We are collecting further different biological specimens to investigate new hypotheses on the cognitive function of the centenarians.

Functional impairment is associated with an increased risk of mortality in patients on chronic hemodialysis

BACKGROUND

Functional impairment is associated with adverse outcomes in older people, as well as in patients on chronic hemodialysis. The aim of the present study was to determine the characteristics associated with functional impairment in chronic hemodialysis, and to evaluate if functional impairment represents a risk factor for reduced survival in chronic hemodialysis.

METHODS

All 132 chronic hemodialysis referring to the Hemodialysis Service of the Catholic University, Rome, Italy between November 2007 and May 2015 were included. All patients underwent comprehensive geriatric assessment; functional ability was estimated using two questionnaires exploring independency in bathing, dressing, toileting, transferring, continence, feeding (ADLs), and independency in using the telephone, shopping, food preparation, housekeeping, laundering, traveling, taking medications, and handling finances (IADLs). Functional impairment was diagnosed in presence of dependence in one or more ADLs/IADLs. Mood was assessed using the 30-item Geriatric Depression Scale. Logistic regression was used to evaluate factors associated with functional impairment. The association between functional impairment and survival was assessed by Cox regression.

RESULTS

ADLs impairment was present in 34 (26 %) participants, while IADLs impairment was detected in 64 (48 %) subjects. After a follow up of 90 months, 55 (42 %) patients died. In logistic regression, depressive symptoms were associated with ADLs and IADLs impairment (OR 1.12; 95 % CI = 1.02-1.23; OR 1.16; 95 % CI = 1.02-1.33; respectively). In Cox regression, ADLs impairment was associated with mortality (HR 2.47; 95 % CI-1.07-5.67) while IADLs impairment was not associated with reduced survival (HR .80; 95 % CI-.36-1.76).

CONCLUSIONS

Functional impairment is associated with depressive symptoms; also, impairment in the ADLs represents a risk factor of reduced survival in chronic hemodialysis. These associations and their potential implication should be assessed in dedicated studies.

COUNTRY-LEVEL SOCIOECONOMIC INDICATORS ASSOCIATED WITH SURVIVAL PROBABILITY OF BECOMING A CENTENARIAN AMONG OLDER EUROPEAN ADULTS: GENDER INEQUALITY, MALE LABOUR FORCE PARTICIPATION AND PROPORTIONS OF WOMEN IN PARLIAMENTS

This study confirms an association between survival probability of becoming a centenarian (SPBC) for those aged 65 to 69 and country-level socioeconomic indicators in Europe: the gender inequality index (GII), male labour force participation (MLP) rates and proportions of seats held by women in national parliaments (PWP). The analysis was based on SPBC data from 34 countries obtained from the United Nations (UN). Country-level socioeconomic indicator data were obtained from the UN and World Bank databases. The associations between socioeconomic indicators and SPBC were assessed using correlation coefficients and multivariate regression models. The findings show significant correlations between the SPBC for women and men aged 65 to 69 and country-level socioeconomic indicators: GII (r=-0.674, p=0.001), MLP (r=0.514, p=0.002) and PWP (r=0.498, p=0.003). The SPBC predictors for women and men were lower GIIs and higher MLP and PWP (R 2=0.508, p=0.001). Country-level socioeconomic indicators appear to have an important effect on the probability of becoming a centenarian in European adults aged 65 to 69. Country-level gender equality policies in European counties may decrease the risk of unhealthy old age and increase longevity in elders through greater national gender equality; disparities in GII and other country-level socioeconomic indicators impact longevity probability. National longevity strategies should target country-level gender inequality.

Effects of Mobility and Cognition on Risk of Mortality in Women in Late Life: A Prospective Study

BACKGROUND

This study examines the effects of mobility and cognition on mortality risk in women late in life.

METHODS

A prospective study was conducted among 1,495 women (mean age 87.6 years) participating in the Study of Osteoporotic Fractures Year 20 examination (2006-2008). Mobility (ascertained by Short Physical Performance Battery [SPPB]) was categorized as poor (SPPB 0-3, n = 312), intermediate (SPPB 4-9, n = 799), or good (SPPB 10-12, n = 384). Cognitive status (adjudicated based on neuropsychological tests) was classified as normal (n = 873), mild cognitive impairment (n = 354), or dementia (n = 268). Deaths (n = 749) were identified from Year 20 through July 31, 2014 (average follow-up 4.9 years).

RESULTS

There was not strong evidence of an interaction between mobility and cognition for prediction of mortality risk (p interaction term .16). Compared to women with good mobility, mortality risks were increased among women with intermediate mobility (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.02-1.57) and those with poor mobility (HR 1.64, 95% CI 1.24-2.16) after consideration of cognition and other mortality risk factors. Similarly, mortality risks were higher among women with mild cognitive impairment (HR 1.46, 95% CI 1.21-1.76) and those with dementia (HR 1.88, 95% CI 1.54-2.31) compared to women with normal cognition after consideration of mobility and other mortality risk factors.

CONCLUSIONS

Among women late in life, 5-year mortality risk was substantially increased among women with deficits in mobility even after accounting for cognition and traditional prognostic indicators. Similarly, deficits in cognition were associated with increased 5-year mortality despite consideration of mobility and conventional risk factors.

Functional measures, inflammatory markers and endothelin-1 as predictors of 360-day survival in centenarians

Centenarians represent a rapidly growing population. To better characterize this specific age group, we have performed a cross-sectional study to observe associations between functional measures and a range of biochemical markers, including inflammatory markers and their significance as predictors of 360-day survival. Medical history and physical and functional assessment (Mini-Mental State Examination (MMSE), Katz Index (activities of daily living, ADL) and Barthel Index (Barthel Index) of Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)) were conducted on 86 101.9 ± 1.2-year-old (mean ± SD) subjects (70 women, 16 men). Blood tests were performed on 84 subjects of whom 43 also had extended biomarker assessment. As a reference group 30 51.8 ± 5.0-year old healthy subjects (20 women, 10 men) were recruited. The centenarians received follow-up phone calls. Fifty-two centenarians (60 %) survived ≥360 days. Longer survival was associated with higher MMSE (hazard ratio, HR = 0.934, 95 % confidence interval (CI) 0.896-0.975, P = .002), ADL (HR = 0.840, 95 % CI 0.716-0.985, P = .032), Barthel Index (HR = 0.988, 95 % CI 0.977-0.999, P = .026), and albumin level (HR .926, 95 % CI 0.870-0.986, P .016) and with lower white blood cell (WBC) (HR = 1.161, 95 % CI 1.059-1.273, P = .001), C-reactive protein (CRP) (HR = 1.032, 95 % CI 1.014-1.050, P < .001), IL-6 (HR = 1.182, 95 % CI 1.047-1.335, P = .007), and endothelin-1 (ET-1) level (HR = 3.711, 95 % CI 1.233-11.169, P = .020). Centenarians had higher 360-day survival probability with MMSE ≥13 (P < .001), ADL ≥1 (P < .001), Barthel Index ≥15 (P < .001), Lawton IADL ≥10 points (P = .009), WBC <8.3 G/L (P = .039), CRP <10 mg/L (P < .001), IL-6 <6 pg/mL (P .002), and ET-1 <1.1 pg/mL (P .007). Our results indicate that functional measures, inflammatory markers, and endothelin-1 are predictors of 360-day survival in centenarians.

Use of serum albumin and activities of daily living to predict mortality in long-lived individuals over 95 years of age: a population-based study

Both activities of daily living (ADL) and some blood biomarkers (such as albumin) have been associated with mortality in very elderly people, but scarce data is available on the predictive performance of them in isolation or in combination, which is important for clinicians in decision making. Here, based on prospective mortality data over a 6-year follow-up period from 433 long-lived individuals (LLIs) aged 95+ years in the Rugao longevity cohort, we aimed to evaluate Cox proportional hazard ratios (HRs) and discriminative power (ROC curve) of 14 biomarkers and ADL for all-cause mortality. We found that six biomarkers (total triglyceride, albumin, low-density lipoprotein cholesterol, platelet count, lymphocyte count, and neutrophil count) were associated with mortality with a p < .10 in the univariate model. Significant associations of albumin and neutrophil count with mortality were observed when they were simultaneously included in a multivariate model, with HRs of 0.97 (95 % CI 0.94, 0.99; p = .005) and 1.09 (95 % CI 1.00, 1.18; p = .043). With respect to ADL, the corresponding HR was 1.10 (95 % CI 1.07, 1.14; p < .001). Low albumin (<40 g/L) combined with ADL dependent had a significantly increased mortality risk (HR = 2.19; 95 % CI 1.63, 2.95). Albumin and ADL separately showed good discriminative accuracies (area under the curve [AUC] = 0.68 and 0.66, respectively), and their combination had an increased predictive utility (AUC = 0.73). In conclusion, both albumin and ADL are efficient predictors of all-cause mortality in long-lived populations and their combination further increases discriminative power. The preliminary findings, if validated and translated, would help clinicians to identify the elderly people at varying mortality risk.

Mildly elevated blood pressure is a marker for better health status in Polish centenarians

The number of centenarians is projected to rise rapidly. However, knowledge of evidence-based health care in this group is still poor. Hypertension is the most common condition that leads to multiple organ complications, disability, and premature death. No guidelines for the management of high blood pressure (BP) in centenarians are available. We have performed a cross-sectional study to characterize clinical and functional state of Polish centenarians, with a special focus on BP. The study comprised 86 consecutive 100.9 ± 1.2 years old (mean ± SD) subjects (70 women and 16 men). The assessment included structured interview, physical examination, geriatric functional assessment, resting electrocardiography, and blood and urine sampling. The subjects were followed-up on the phone. Subjects who survived 180 days (83 %) as compared to non-survivors had higher systolic BP (SBP), diastolic BP (DPB), mean arterial pressure (MAP), pulse pressure (PP), higher mini-mental state examination, Barthel Index of Activities of Daily Living and Lawton Instrumental Activities of Daily Living Scale scores, higher serum albumin and calcium levels, and total iron-binding capacity, while lower serum creatinine, cystatin C, folate, and C-reactive protein levels. SBP ≥140 mm Hg, DBP ≥90 mm Hg, MAP ≥100 mm Hg, and PP ≥40 mm Hg were associated with higher 180-day survival probability. Results suggest that mildly elevated blood pressure is a marker for better health status in Polish centenarians.

Blood biomarkers and functional disability among extremely longevous individuals: a population-based study

BACKGROUND

Several blood biomarkers have been linked to functional disability, a health problem in general populations. However, there are limited data for evaluating the potential association of biomarkers with functional disability in an extremely longevous (95+) population.

METHODS

We used data from 420 extremely longevous individuals from the Rugao longevity cohort, a population-based association study conducted in Rugao, a longevity town in China. Functional disability was assessed by the Katz Index of Independence in activities of daily living. Blood biomarkers, including serum lipid, lipoprotein cholesterol, serum albumin, and lymphocyte count, were correlated with activities of daily living.

RESULTS

Among extremely longevous women, following the degree of functional disability, serum albumin and lymphocyte count decreased significantly (all p for trend < .001). In a univariate model, serum albumin (β = -0.279, p < .001), lymphocyte count (β = -0.187, p < .001), and neutrophil count (β = 0.140, p = .012) were found to be significantly associated with activities of daily living in women. After adjustment for other covariates, the significance remained. Notably, multivariate regression analysis revealed independent effects of all the three biomarkers on activities of daily living (β = -0.242, -0.185, and 0.143, all p < .05). We did not observe any association in men.

CONCLUSIONS

We found significant associations between serum albumin, lymphocyte count, and neutrophil count and physical disability even after adjustment for potential confounders in extremely longevous women, which call for further study. The findings provide preliminary but crucial clues for future studies specifically aimed at exploring the longitudinal relationships of interest before proceeding with interventions.