Pedro Saz

This study examined hypothesized differences across males and females in the relationship between cognitive trajectories and mortality in older adults. Data were drawn from the ZARADEMP study on dementia and depression in adults aged 55 and older in Zaragoza, Spain. A total of 2403 cognitively healthy individuals who completed at least three of four waves over a 12-year follow-up were included. Cognitive trajectories were derived from Mini-Mental State Examination (MMSE) scores. Using growth mixture modeling (GMM), four trajectories in men and three in women were previously identified. Mortality data, obtained from official records, covered up to 6 years after the final wave. Cox proportional hazards models assessed mortality risk across trajectories, adjusting for sociodemographic, medical, and lifestyle factors. Mortality was higher among participants with steeper cognitive decline in both sexes. In men, those in the declining-low and stable-medium trajectories had 133% and 36% higher mortality risk, respectively, compared to the stable-high group. In women, declining-low and stable-medium classes had 133% and 30% increased risk, respectively. The association in women followed a clear gradient; in men, this pattern was absent. Differences in mortality predictors were identified: medical conditions (e.g., hypertension, diabetes, alcohol use) were significant only in men, whereas psychosocial and functional variables (e.g., anxiety, ADL dependency, marital status) were significant only in women. This is the first report showing differences across males and females in the association between cognitive decline trajectories and mortality. Sex-specific strategies may be needed to mitigate mortality associated with trajectories of cognitive decline.

Purpose: To test the hypotheses that declining cognitive aging trajectories would increase mortality risk and that predictors of mortality would differ between trajectory groups. Methods: This is a sub-study of the ZARADEMP project studying dementia and depression in older adults aged 55 years or more, conducted in Zaragoza, Spain, including 2403 cognitively healthy individuals who had completed at least three of the four waves in a 12-year follow-up. The three cognitive trajectories previously identified were based on the Mini-Mental State Examination (MMSE). Mortality information obtained from the city’s official population registry was registered up to 6 years after the end of the fourth wave of the study. Cox proportional hazard regression analyses for analyzing the risk of death were performed globally and for each cognitive trajectory. Results: At follow-up, 42.4% of the participants had died. Individuals in class 2-moderate-stable and in class 3-low-and-declining had a 24% and 96%, respectively, higher risk of mortality than those in class 1-high-to-moderate. Those younger and women showed significant lower risks of death in all the classes. Being single, with diabetes, dependency in basic Activities of Daily Living, ex-drinkers, smokers, and ex-smokers increased the risk in class 2. Hypertension showed a higher risk of death in the high-to-moderate group. In the low-and-declining trajectory, anxiety nearly tripled the risk of death. Conclusion: Trajectories with cognitive decline are associated with higher mortality, with the risk of death showing a gradient. Predictors of mortality differ by cognitive trajectory; the differences being observed even among the cognitively healthier groups.

Great inter-individual variability has been reported in the maintenance of cognitive function in aging. We examined this heterogeneity by modeling cognitive trajectories in a population-based longitudinal study of adults aged 55+ years. We hypothesized that (1) distinct classes of cognitive trajectories would be found, and (2) between-class differences in associated factors would be observed. The sample comprised 2403 cognitively healthy individuals from the Zaragoza Dementia and Depression (ZARADEMP) project, who had at least three measurements of the Mini-Mental State Examination (MMSE) in a 12-year follow-up. Longitudinal changes in cognitive functioning were modeled using growth mixture models (GMM) in the data. The best-fitting age-adjusted model showed 3 distinct trajectories, with 1-high-to-moderate (21.2% of participants), 2-moderate-stable (67.5%) and, 3-low-and-declining (9.9%) cognitive function over time, respectively. Compared with the reference 2-trajectory, the association of education and depression was significantly different in trajectories 1 and 3. Instrumental activities of daily living (iADLs) were only associated with the declining trajectory. This suggests that intervention strategies should be tailored specifically to individuals with different trajectories of cognitive aging, and intervention strategies designed to maintain cognitive function might be different from those to prevent decline. A stable cognitive performance (‘successful cognitive aging’) rather than a mild decline, might be more ‘normal’ than generally expected.

Sense of Coherence (SOC) is defined as a tendency to perceive life experiences as comprehensible, manageable and meaningful. The construct is split in three major domains: Comprehensibility, Manageability, and Meaningfulness. SOC has been associated with successful coping strategies in the face of illness and traumatic events and is a predictor of self-reported and objective health in a variety of contexts. In the present study we aim to evaluate the association of SOC with disability and dependence in Spanish elders. A total of 377 participants aged 75 years or over from nine locations across Spain participated in the study (Mean age: 80.9 years; 65.3% women). SOC levels were considered independent variables in two ordinal logistic models on disability and dependence, respectively. Disability was established with the World health Organization-Disability Assessment Schedule 2.0 (36-item version), while dependence was measured with the Extended Katz Index on personal and instrumental activities of daily living. The models included personal (sex, age, social contacts, availability of an intimate confidant), environmental (municipality size, access to social resources) and health-related covariates (morbidity). High Meaningfulness was a strong protective factor against both disability (Odds Ratio [OR] = 0.50; 95% Confidence Interval [CI] = 0.29–0.87) and dependence (OR = 0.33; 95% CI = 0.19–0.58) while moderate and high Comprehensibility was protective for disability (OR = 0.40; 95% CI = 0.22–0.70 and OR = 0.39; 95%CI = 0.21–0.74), but not for dependence. Easy access to social and health resources was also highly protective against both disability and dependence. Our results are consistent with the view that high levels of SOC are protective against disability and dependence in the elderly. Elderly individuals with limited access to social and health resources and with low SOC may be a group at risk for dependence and disability in Spain.

The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF.

This study describes the prevalence of dementia and major dementia subtypes in Spanish elderly. We identified screening surveys, both published and unpublished, in Spanish populations, which fulfilled specific quality criteria and targeted prevalence of dementia in populations aged 70 years and above. Surveys covering 13 geographically different populations were selected (prevalence period: 1990-2008). Authors of original surveys provided methodological details of their studies through a systematic questionnaire and also raw age-specific data. Prevalence data were compared using direct adjustment and logistic regression. The reanalyzed study population (aged 70 year and above) was composed of Central and North-Eastern Spanish sub-populations obtained from 9 surveys and totaled 12,232 persons and 1,194 cases of dementia (707 of Alzheimer's disease, 238 of vascular dementia). Results showed high variation in age- and sex-specific prevalence across studies. The reanalyzed prevalence of dementia was significantly higher in women; increased with age, particularly for Alzheimer's disease; and displayed a significant geographical variation among men. Prevalence was lowest in surveys reporting participation below 85%, studies referred to urban-mixed populations and populations diagnosed by psychiatrists. Prevalence of dementia and Alzheimer's disease in Central and North-Eastern Spain is higher in females, increases with age, and displays considerable geographic variation that may be method-related. People suffering from dementia and Alzheimer's disease in Spain may approach 600,000 and 400,000 respectively. However, existing studies may not be completely appropriate to infer prevalence of dementia and its subtypes in Spain until surveys in Southern Spain are conducted.

Objective:  Clinical experience and recent population studies suggest that psychopathological, non‐cognitive symptoms are both frequent and relevant in dementia.Method:  A representative community sample (n = 4,803 individuals, 55 + years) was interviewed in a two‐phase design. The Geriatric Mental Sate (GMS) was used for assessment and cases were diagnosed according to DSM‐IV‐TR criteria.Results:  The prevalence of non‐cognitive symptoms (1 + symptoms) in cases of dementia (n = 223) was 90.1%, and negative‐type symptoms were most frequently found. A GMS ‘apathy‐related symptom cluster’ (anergia, restriction of activities and anhedonia) was significantly more frequent in the demented (55.6%) than in non‐cases (0.7%; specificity = 99.2%). In both dementia of Alzheimer’s type and vascular dementia, number of symptoms tended to be inversely related to severity of dementia, but psychopathological profiles differed.Conclusion:  Non‐cognitive, negative‐type symptoms are very frequent in cases of dementia living in the community. They have powerful specificity in the distinction with non‐cases, and might change current concepts of dementia.