scholarly journals Predictors of incident epilepsy in older adults

Neurology ◽  
2017 ◽  
Vol 88 (9) ◽  
pp. 870-877 ◽  
Author(s):  
Hyunmi Choi ◽  
Alison Pack ◽  
Mitchell S.V. Elkind ◽  
W.T. Longstreth ◽  
Thanh G.N. Ton ◽  
...  

Objective:To determine the prevalence, incidence, and predictors of epilepsy among older adults in the Cardiovascular Health Study (CHS).Methods:We analyzed data prospectively collected in CHS and merged with data from outpatient Medicare administrative claims. We identified cases with epilepsy using self-report, antiepileptic medication, hospitalization discharge ICD-9 codes, and outpatient Medicare ICD-9 codes. We used Cox proportional hazards regression to identify factors independently associated with incident epilepsy.Results:At baseline, 42% of the 5,888 participants were men and 84% were white. At enrollment, 3.7% (215 of 5,888) met the criteria for prevalent epilepsy. During 14 years of follow-up totaling 48,651 person-years, 120 participants met the criteria for incident epilepsy, yielding an incidence rate of 2.47 per 1,000 person-years. The period prevalence of epilepsy by the end of follow-up was 5.7% (335 of 5,888). Epilepsy incidence rates were significantly higher among blacks than nonblacks: 4.44 vs 2.17 per 1,000 person-years (p < 0.001). In multivariable analyses, risk of incident epilepsy was significantly higher among blacks compared to nonblacks (hazard ratio [HR] 4.04, 95% confidence interval [CI] 1.99–8.17), those 75 to 79 compared to those 65 to 69 years of age (HR 2.07, 95% CI 1.21–3.55), and those with history of stroke (HR 3.49, 95% CI 1.37–8.88).Conclusions:Epilepsy in older adults in the United States was common. Blacks, the very old, and those with history of stroke have a higher risk of incident epilepsy. The association with race remains unexplained.

2018 ◽  
Vol 09 (04) ◽  
pp. 551-555
Author(s):  
Oscar H. Del Brutto ◽  
Robertino M. Mera ◽  
Victor J. Del Brutto

ABSTRACT Background: Stroke is a leading cause of disability in developing countries. However, there are no studies assessing the impact of nonfatal strokes on mortality in rural areas of Latin America. Using a population-based, prospective cohort study, we aimed to assess the influence of nonfatal strokes on all-cause mortality in older adults living in an underserved rural setting. Methods: Deaths occurring during a 5-year period in Atahualpa residents aged ≥60 years were identified from overlapping sources. Tests for equality of survivor functions were used to estimate differences between observed and expected deaths for each covariate investigated. Cox proportional hazards models were used to estimate Kaplan–Meier survival curves of variables reaching significance in univariate analyses. Results: Of 437 individuals enrolled over 5 years, follow-up was achieved in 417 (95%), contributing 1776 years of follow-up (average 4.3 ± 1.3 years). Fifty-one deaths were detected, for an overall cumulative 5-year mortality rate of 12.2% (8.9%–15.6%). Being older than 70 years of age, having poor physical activity, edentulism, and history of a nonfatal stroke were related to mortality in univariate analyses. A fully adjusted Cox proportional hazards model showed that having history of a nonfatal stroke (P = 0.024) and being older than 70 years of age (P = 0.031) independently predicted mortality. In contrast, obesity was inversely correlated with mortality (P = 0.047). Conclusions: A nonfatal stroke and increasing age increase the risk of all-cause mortality in inhabitants of a remote rural village. The body mass index is inversely related to death (obesity paradox).


Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Christa Schank ◽  
Natalie J Blades ◽  
Sarwat I Chaudhry ◽  
John A Dodson ◽  
W T Longstreth ◽  
...  

OBJECTIVE: To determine whether older adults who develop incident heart failure (HF) experience faster cognitive decline than those without HF. METHODS: We analyzed longitudinal cognitive test data from the Cardiovascular Health Study, a community-based study of adults aged 65 years and older. Participants in this analysis did not have HF or history of stroke at baseline and were censored when they experienced incident clinical stroke. Incident HF was identified by self-report of physician-diagnosed HF and confirmed by adjudicated review of inpatient and outpatient medical records and medication use. Outcomes were mean score and rate of decline in mean score on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to nine times from 1990 to 1998. A linear mixed effects model was used to model the relationship of cognitive decline with HF and age, adjusted for demographics, health behaviors, and comorbid conditions including hypertension and diabetes. RESULTS: Analyses included 5,211 participants with mean age 74 years at baseline, of whom 545 (10.5%) developed incident HF over a median follow-up of 7.8 years. Mean 3MSE score was lower at the time of HF diagnosis compared with no HF, and declined faster after incident HF compared with no HF. For example, at age 80, covariate-adjusted predicted mean 3MSE score was 88.6 points (95% CI: 88.3, 89.0) in participants without HF, but 87.6 points (95% CI: 87.3, 87.9) in those with newly diagnosed HF. Predicted five-year decline in mean 3MSE score from age 80 to age 85 was 5.9 points (95% CI: 5.7, 6.0) in participants without HF, but 10.0 points (95% CI: 8.6, 11.3) in those diagnosed with incident HF at age 80. Faster decline in 3MSE score after HF diagnosis was seen at all ages studied. The figure shows predicted mean 3MSE score trajectories without HF (solid line) and after HF diagnosed at ages 70, 75, 80, and 85 (dashed lines), with 95% CI shaded. CONCLUSIONS: Older adults diagnosed with incident HF experience faster average cognitive decline than those without HF.


2016 ◽  
Vol 6 (3) ◽  
pp. 129-139 ◽  
Author(s):  
Parveen K. Garg ◽  
Willam J.H. Koh ◽  
Joseph A. Delaney ◽  
Ethan A. Halm ◽  
Calvin H. Hirsch ◽  
...  

Background: Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults. Methods: Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), 5,107 participants without a prior history of carotid endarterectomy (CEA) or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization. Results: Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23), peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93), and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46). Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77) and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86). Conclusions: Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.


Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Luc Djousse ◽  
Mary L. Biggs ◽  
Nirupa R. Matthan ◽  
Joachim H. Ix ◽  
Annette L. Fitzpatrick ◽  
...  

Background: Heart failure (HF) is highly prevalent among older adults and is associated with high costs. Although serum total nonesterified fatty acids (NEFAs) have been positively associated with HF risk, the contribution of each individual NEFA to HF risk has not been examined. Objective: The aim of this study was to examine the association of individual fasting NEFAs with HF risk in older adults. Methods: In this prospective cohort study of older adults, we measured 35 individual NEFAs in 2,140 participants of the Cardiovascular Health Study using gas chromatography. HF was ascertained using review of medical records by an endpoint committee. Results: The mean age was 77.7 ± 4.4 years, and 38.8% were male. During a median follow-up of 9.7 (maximum 19.0) years, 655 new cases of HF occurred. In a multivariable Cox regression model controlling for demographic and anthropometric variables, field center, education, serum albumin, glomerular filtration rate, physical activity, alcohol consumption, smoking, hormone replacement therapy, unintentional weight loss, and all other measured NEFAs, we observed inverse associations (HR [95% CI] per standard deviation) of nonesterified pentadecanoic (15:0) (0.73 [0.57–0.94]), γ-linolenic acid (GLA) (0.87 [0.75–1.00]), and docosahexaenoic acid (DHA) (0.73 [0.61–0.88]) acids with HF, and positive associations of nonesterified stearic (18:0) (1.30 [1.04–1.63]) and nervonic (24:1n-9) (1.17 [1.06–1.29]) acids with HF. Conclusion: Our data are consistent with a higher risk of HF with nonesterified stearic and nervonic acids and a lower risk with nonesterified 15:0, GLA, and DHA in older adults. If confirmed in other studies, specific NEFAs may provide new targets for HF prevention.


Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 363-363
Author(s):  
Megan C Leary ◽  
Jeffrey L Saver

P134 Background: Recent estimates of stroke incidence in the US range from 715,000–750,000 annually. These estimates, however, do not reflect silent infarcts and hemorrhages. Since population-based studies have found that prevalence of silent stroke is 10–20 times that of symptomatic, estimates of stroke incidence based solely on symptomatic events may substantially underestimate the annual burden of stroke. Silent strokes contribute to vascular dementia, gait impairment, and other major adverse patient outcomes. Methods: Incidence of silent infarcts for different age strata were derived from two US population-based studies of the prevalence of silent infarct-like lesions on MRI, Atherosclerosis Risk In Communities and Cardiovascular Health Study. Prevalence observations in these studies and age-specific death rates from the US Census Bureau were inputted to calculate silent infarct incidence (method of Leske et al). Similarly, incidence rates of silent hemorrhage at differing ages were extrapolated from population-based prevalence observations employing MR GRE imaging in the Austrian Stroke Prevention Study. Age-specific incidence rates were projected onto age cohorts in the 1998 US population to calculate annual burden of silent stroke. Results: Derived incidence rates per 100,000 of silent infarct ranged from 6400 in the age 50–59 strata to 16400 at ages 75–79. Extrapolated incidence rates of silent hemorrhage ranged from 230 in the age 30–39 strata to 7360 at ages > 80. Incidence rates of both subclinical infarcts and hemorrhage increased exponentially with age. Overall estimated annual US occurrence of silent infarct was 9,039,000, and of silent hemorrhage 2,130,000. Conclusion: In 1998, nearly 12 million strokes occurred in the United States, of which ∼750,000 were symptomatic and over 11 million were subclinical. Among the silent strokes, ∼81% were infarcts and ∼19% hemorrhages. These findings demonstrate that the annual burden of stroke is substantially higher than suggested by estimates based solely on clinically manifest events, and suggest that greater research and clinical resources should be allocated to stroke prevention and treatment.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S719-S719
Author(s):  
Yi-Han Hu ◽  
Hsien-Chang Lin

Abstract Chronic non-cancer pain (CNCP) is an emerging health issue among the older population. Not only did the CNCP prevalence increase gradually in past decades, but also it may cause difficulties in cognitive processing and social and emotional functioning. However, evidence for the associations between CNCP and incident mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRDs) is inconsistent and insufficient. Using the administrative claims data from health insurance companies from January 2007 to December 2017, this prospective cohort study investigated the impact of CNCP on the risks of developing MCI and ADRDs among adults aged 50 and older. To reduce potential selection bias, the propensity-score matched cohort design was applied for selecting comparable CNCP and non-CNCP patients at the beginning of the follow-up. Time-dependent Cox proportional-hazards regression models were conducted to estimate the hazard ratios (HRs) of incident MCI/ADRDs, adjusting for baseline sociodemographics and time-dependent medical conditions. Of 236,782 patients with/without CNCP, 342 individuals (0.14%) developed MCI and 1,183 patients (5.0%) had been diagnosed with one type of ADRDs during the follow-up. After adjusting confounders, CNCP patients had a 42% increased MCI risk (HR=1.42; 95% CI=1.14-1.76) and a 20% increased ADRDs risk (HR=1.20; 95% CI=1.07-1.34) relative to non-CNCP patients. Our findings indicate that CNCP is associated with incidences of MCI and ADRDs. Early diagnosis of CNCP and CNCP management may prevent cognitive impairment among middle-aged and older adults. Future studies are warranted to explore the potential effects of pain treatments on restoring cognitive function of CNCP patients.


Author(s):  
Peter D Ahiawodzi ◽  
Petra Buzkova ◽  
Luc Djousse ◽  
Joachim H Ix ◽  
Jorge R Kizer ◽  
...  

Abstract Background We sought to determine associations between total serum concentrations of nonesterified fatty acids (NEFAs) and incident total and cause-specific hospitalizations in a community-living cohort of older adults. Methods We included 4715 participants in the Cardiovascular Health Study who had fasting total serum NEFA measured at the 1992/1993 clinic visit and were followed for a median of 12 years. We identified all inpatient admissions requiring at least an overnight hospitalization and used primary diagnostic codes to categorize cause-specific hospitalizations. We used Cox proportional hazards regression models to determine associations with time-to-first hospitalization and Poisson regression for the rate ratios (RRs) of hospitalizations and days hospitalized. Results We identified 21 339 hospitalizations during follow-up. In fully adjusted models, higher total NEFAs were significantly associated with higher risk of incident hospitalization (hazard ratio [HR] per SD [0.2 mEq/L] = 1.07, 95% confidence interval [CI] = 1.03–1.10, p &lt; .001), number of hospitalizations (RR per SD = 1.04, 95% CI = 1.01–1.07, p = .01), and total number of days hospitalized (RR per SD = 1.06, 95% CI = 1.01–1.10, p = .01). Among hospitalization subtypes, higher NEFA was associated with higher likelihood of mental, neurologic, respiratory, and musculoskeletal causes of hospitalization. Among specific causes of hospitalization, higher NEFA was associated with diabetes, pneumonia, and gastrointestinal hemorrhage. Conclusions Higher fasting total serum NEFAs are associated with a broad array of causes of hospitalization among older adults. While some of these were expected, our results illustrate a possible utility of NEFAs as biomarkers for risk of hospitalization, and total days hospitalized, in older adults. Further research is needed to determine whether interventions based on NEFAs might be feasible.


2013 ◽  
Vol 31 (35) ◽  
pp. 4394-4399 ◽  
Author(s):  
Wen-Qing Li ◽  
Abrar A. Qureshi ◽  
Jing Ma ◽  
Alisa M. Goldstein ◽  
Edward L. Giovannucci ◽  
...  

Purpose Steroid hormones, particularly androgens, play a major role in prostatic carcinogenesis. Personal history of severe acne, a surrogate for higher androgen activity, has been associated with an increased risk of prostate cancer (PCa), and one recent study indicated that severe teenage acne was a novel risk factor for melanoma. These findings suggest a possible relationship between PCa and risk of melanoma. We prospectively evaluated this association among US men. Methods A total of 42,372 participants in the Health Professionals' Follow-Up Study (HPFS; 1986 to 2010) were included. Biennially self-reported PCa diagnosis was confirmed using pathology reports. Diagnosis of melanoma and nonmelanoma skin cancer (NMSC) was self-reported biennially, and diagnosis of melanoma was pathologically confirmed. We sought to confirm the association in 18,603 participants from the Physicians' Health Study (PHS; 1982 to 1998). Results We identified 539 melanomas in the HPFS. Personal history of PCa was associated with an increased risk of melanoma (multivariate-adjusted hazard ratio [HR], 1.83; 95% CI, 1.32 to 2.54). Although we also detected a marginally increased risk of NMSC associated with PCa (HR, 1.08; 95% CI, 0.995 to 1.16), the difference in the magnitude of the association between melanoma and NMSC was significant (P for heterogeneity = .002). We did not find an altered risk of melanoma associated with personal history of other cancers. The association between PCa and risk of incident melanoma was confirmed in the PHS (HR, 2.17; 95% CI, 1.12 to 4.21). Conclusion Personal history of PCa is associated with an increased risk of melanoma, which may not be entirely a result of greater medical scrutiny.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Erika Brutsaert ◽  
Sanyog Shitole ◽  
Mary Lou Biggs ◽  
Kenneth Mukamal ◽  
Ian De Boer ◽  
...  

Introduction: Elders have a high prevalence of post-load hyperglycemia, which may go undetected with standard screening. Post-load glucose has shown more robust associations with cardiovascular disease (CVD) and death than fasting glucose, but data in advanced old age are sparse. Whether post-load glucose improves risk prediction for CVD and death after accounting for fasting glucose has not been examined. Methods: Fasting and 2-hour post-load glucose were measured at baseline (1989) and follow-up (1996) visits in a prospective study of community-dwelling adults initially ≥65 years old (Cardiovascular Health Study). To evaluate if previously reported associations of fasting and post-load glucose with incident CVD from the baseline visit persist later in life, and apply to mortality, we focused on the 1996 visit (n=2394). To determine the incremental value of post-load glucose for risk prediction, we examined whether it could significantly reclassify baseline (1989) participants (≤75 years) into cholesterol treatment categories based on recent guidelines (n=2542). Results: Among participants in the 1996 visit (mean age 77), there were 543 incident CVD events and 1698 deaths during median follow-up of 11.2 years. In fully adjusted models, both fasting and 2-hour glucose were associated with CVD (HR per SD, 1.13 [1.03-1.25] and 1.17 [1.07-1.28], respectively) and mortality (HR per SD, 1.12 [1.07-1.18] and 1.14 [1.08-1.20]). After mutual adjustment, however, the associations for fasting glucose with either outcome were abolished, but those for post-load glucose remained unchanged. Among subjects ≤75 years old in 1989, there were 416 CVD events and 740 deaths at 10-year follow-up. Post-load glucose did not enhance reclassification using the 7.5% 10-year risk threshold, nor did it improve the C-statistic. Conclusion: In adults surviving to advanced old age, post-load glucose was associated with CVD and mortality independently of fasting glucose, but not vice versa, although there was no associated improvement in risk prediction. These findings affirm the robust association of post-load glucose with CVD and death late in life, but do not support the value of routine oral glucose tolerance testing for prediction of these outcomes in older adults.


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