Reclassified cognitive leisure activity and risk of cognitive impairment in Chinese older adults aged ≥80 years: A 16‐year prospective cohort study

ABSTRACTBackground: Previous meta-analyses have suggested that antipsychotics are associated with increased mortality in dementia patients with behavioral and psychological symptoms (BPSD). Subsequent observational studies, however, have produced conflicting results. In view of this controversy and the lack of any suitable pharmacological alternative for BPSD, this study aimed to investigate the relationship between continuous use of antipsychotics and mortality as well as hospitalizations in Chinese older adults with BPSD residing in nursing homes.Methods: This was a prospective cohort study conducted in nursing homes in the Central & Western and Southern Districts of Hong Kong from July 2009 to December 2010. Older adults were stratified into the exposed group (current users of antipsychotics) and control group (non-users). Demographics, comorbidity according to the Charlson Comorbidity Index (CCI), Barthel Index (BI(20)), Abbreviated Mental Test (AMT), and vaccination status for pandemic Influenza A (H1N1) 2009, seasonal influenza and pneumococcus were collected at baseline. Subjects were followed up at 18 months. All-cause mortality and all-cause hospitalizations were recorded.Results: 599 older adults with dementia from nine nursing homes were recruited. The 18-month mortality rate for the exposed group was 24.1% while that for control group was 27.5% (P = 0.38). The exposed group also had a lower median rate of hospitalizations (56 (0–111) per 1000 person-months vs 111 (0–222) per 1000 person-months, median (interquartile range), p<0.001).Conclusions: The continuous use of antipsychotics for BPSD does not increase mortality among Chinese older adults with dementia living in nursing homes. Furthermore, our results show that the use of antipsychotics can lead to decreased hospitalizations.

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Association Between Body Mass Index, Its Change And Cognitive Impairment Among Chinese Older Adults: A Community-Based, 9-Year Prospective Cohort Study

10.21203/rs.3.rs-417270/v1 ◽

2021 ◽

Author(s):

Shanshan Wu ◽

Xiaozhen Lv ◽

Jie Shen ◽

Hui Chen ◽

Yuan Ma ◽

...

Keyword(s):

Older Adults ◽

Body Mass Index ◽

Weight Loss ◽

Cohort Study ◽

Cognitive Impairment ◽

Prospective Cohort ◽

Community Based ◽

Chinese Older Adults ◽

Large Weight Loss ◽

Increased Risk

Abstract Objective To examine the association of baseline body mass index (BMI) and BMI change with cognitive impairment among older adults in China. Methods The study included data from the Chinese Longitudinal Healthy Longevity Study, a national community-based prospective cohort study from 2002-2018. Baseline BMI and BMI change measurements were available for 12,027 adults aged older than 65 years. Cognitive impairment was defined as Chinese version of the Mini Mental State Examination score less than 18. Multivariable Cox proportional hazard model was used.Results Among 12027 participants (mean age was 81.23 years old and 47.48% were male), the proportion of underweight, normal, overweight and obese at baseline was 33.87%, 51.39%, 11.39% and 3.34%, respectively. During an average of 5.9 years’ follow-up, 3086 participants (4.35 per 100 person-years) with incident cognitive impairment were identified. Compared with normal weight group, adjusted hazard ratio (AHR) for cognitive impairment was 0.86 (95% CI 0.75-0.99) among overweight group, whereas corresponding AHR was 1.02 (95% CI 0.94-1.10) in underweight and 1.01 (95% CI 0.80-1.28) in obese. Large weight loss (<-10%) was significantly associated with an increased risk of cognitive impairment (AHR, 1.42, 95% CI 1.29-1.56), compared to stable weight status group (-5%~5%). In the restricted cubic spline models, BMI change showed a L-shaped association with cognitive impairment. Conclusions BMI-defined overweight is associated with a reduced risk of cognitive impairment among Chinese older adults, while large weight loss is associated with increased risk. More attention should be paid to older adults with significant weight loss.

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