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NIA Bedside-to-Bench Conference

NIA Bedside-to-Bench Conference. “Cognition, mood and movement disorders in older Mexican Americans” Mukaila A. Raji, MD, MSc Associate Professor, Internal Medicine-Geriatrics Director, Memory Loss Clinics University of Texas Medical Branch Galveston, Texas, USA. Objectives.

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NIA Bedside-to-Bench Conference

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  1. NIA Bedside-to-Bench Conference “Cognition, mood and movement disorders in older Mexican Americans” Mukaila A. Raji, MD, MSc Associate Professor, Internal Medicine-Geriatrics Director, Memory Loss Clinics University of Texas Medical Branch Galveston, Texas, USA

  2. Objectives • Recognize high rates of cardiovascular risk factors (metabolic syndrome, diabetes, physical inactivity) in older Mexican Americans • Recognize the association of vascular risk factors with cognitive, depressive and gait disorders in this population

  3. Hispanics as % of U.S. Population Source: U.S. Bureau of the Census

  4. POPULATION PROJECTIONS TO 2050 Non-Hispanic Whites 210 million Hispanics 103 million (25%) African Americans (Blacks) 61 million Asian Origin 33 million Source: U.S. Bureau of the Census (2004)

  5. FIGURE 1. Hispanics by Origin: 2002 (In percent) Mexican American 66.9 Central and South American 14.3 Puerto Rican 8.6 Cuban3.7 Other Hispanic 6.5 Source: U.S. Census Bureau, Annual Demographic Supplement to the March 2002 Current Population Survey. (Adapted from U.S. Bureau of the Census, 2003)

  6. Older Mexican Americans: Risk factor profiles Markides & Coreil, 1986; Ford, 2002; Dergance, 2005; Ostir, 2000; Barcelo, 2007; Blaum, 2007; Martins, 2007; Crespo, 1996; Kirali, 2006; Kivipelto, 2005

  7. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey.Ford ES, Giles WH, Dietz WH Metabolic syndrome defined as ≥3 of: ↑ waist circumference serum trig ≥150 mg/dL BP ≥ 130/85 mm Hg serum glucose level ≥ 110 mg/dL low HDL Mexican Americans had highest age-adjusted prevalence of metabolic syndrome (32%) JAMA, 2002

  8. Leisure-time physical activity among U.S. adults: Results from the Third National Health and Nutrition Examination Survey highest rates of physical inactivity Mexican-American men (33%) Mexican-American women (46%) non-Hispanic black women (40%) Crespo CJ, Keteyian SJ, Heath GW, Sempos CT Arch Intern Med. 1996

  9. Changes in Blood Pressure and Risk Factors for Cardiovascular Disease among Older Mexican Americans from 1982-1984 to 1993-1994 Prevalence of obesity and diabetes rose significantly Mean diastolic pressure increased significantly Stroup-Benham, C.A., Markides, K.S., Espino, D.V. & Goodwin, J. S. Journal of the American Geriatric Society, 1999

  10. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Prevalence of 25-hydroxyvitamin D levels <30 ng/mL highest in the elderly, non-Hispanic blacks and Mexican Americans Increased risk of hypertension, diabetes & obesity in persons with lowest serum 25(OH)D levels Martins D, Wolf M, Pan D et al. Arch Intern Med. 2007

  11. Epidemiological evidence linking vascular risk factors to cognition, mood & movement disorders

  12. Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, & body composition study Maraldi C, Volpato S, Penninx BW. et al. 6-year prospective cohort study of ~ 2500 community-residing elders Uncontrolled diabetes predicts new onset depression over the 6-year period Obesity also predicts incident depression Arch Intern Med. 2007

  13. Metabolic syndrome and cognitive decline in elderly Latinos: findings from the Sacramento Area Latino Study of Aging study. Yaffe K, Haan M, Blackwell T et al. Metabolic syndrome in elderly Latinos is associated with greater 3-year decline on Modified Mini-Mental State Examination (3MS) & the Delayed Word-List Recall tests J Am Geriatr Soc. 2007

  14. Predictors of decline in MMSE scores among older Mexican Americans: Findings from Hispanic EPESENguyen HT, Black SA, Ray LA et al. Physician diagnosed diabetes is an independent predictor of increased risk of MMSE decline over 5 years in older Mexican Americans J Gerontol: Medical Sciences, 2002

  15. Diabetes mellitus and incidence of lower body disability among older Mexican Americans.Al Snih S, Fisher M, Raji MA et al. Diabetes is independently associated with increased risk of developing new limitations in mobility tasks and lower body disability over a 7-year follow-up J. of Gerontology: Medical Sciences, 2005

  16. Is the metabolic syndrome, with or without diabetes, associated with progressive disability in older mexican americans?Blaum CS, West NA, Haan MN. Baseline metabolic syndrome is associated with high risk of developing limitation of mobility & strength over 3-year follow-up, regardless of presence of diabetes J. of Gerontology: Medical Sciences, 2007

  17. The microvascular frontal-subcortical syndrome of aging.Pugh KG, Lipsitz LA Frontal-sub-cortical regions modulate cognition, affect & motor control Ischemic lesions in these regions may lead to cognitive, mood and movement disorders Interventions to reduce midlife cardiovascular risk factors Neurobiol Aging. 2002

  18. Implication of shared risk factors: One disorder may be a risk factor for others Shared risk factors may cause disorders in cognition, mood and mobility Any of the disorders (e.g., depression) could be initial presentation in a patient Over time & with persistence of risk factors, other disorders (e.g., cognitive decline) may emerge

  19. Evidence linking cognition, mood & movement disordersRaji MA Ostir GV, Markides KS, Goodwin JS, J Gerontol 2002

  20. Cognitive Function, Gait Speed Decline, & Comorbidities: The Health ABC studyH. Atkinson, C. Rosano, E. Simonsick et al. Global & executive cognition tests are strong independent predictors of declines in gait speed over 3-yr period Depression attenuates association of executive cognition with gait-speed decline J. of Gerontology: Medical Sciences, 2007

  21. Depression, Gait Speed and Cognitive Decline in Older Mexican Americans *Eight foot walk time **high depressive symptoms Independent predictors of dev of cognitive decline over 7 yrs among initially cognitively-intact elders **Raji et al. J Geriatric Psychiatr Neurol 2007 *Alfaro-Acha et al. J Am Geriatr Soc. 2007

  22. Data from Health, Aging, and Body Composition StudyMaraldi C, Volpato S, Penninx BW. et al. Slow walking speed cognitive impairment independent predictors of risk of new onset depression in elderly over 6-year period Arch Intern Med. 2007

  23. Mechanisms & Implications • Vascular e.g. frontal & cortical regions ischemia • Inflammation • Nutrition • Metabolic • Endocrine • Genetics • Treatment implications: new ways to treat cognitive, mood and mobility disorders • Diagnostic implications: proteomics, genomics, metabolomics, etc.

  24. CONCLUSIONS • Obesity, diabetes, metabolic syndrome, low physical activity, & low serum vitamin D are common conditions in older Mexican Americans • These conditions predict co-occurrence of cognitive, mood and movement disorders • Understanding the underlying mechanisms is key to developing culturally appropriate tests to prevent mental and mobility disorders in Mexican American elders, a rapidly growing segment of US population

  25. ACKNOWLEDGEMENTS • P30 – AG-024832-01. UTMB Claude Pepper Older American Independence Center, from the National Institute of Health. (James Goodwin, Principal Investigator) • R01-AG -10939-11. A Longitudinal Study of Mexican-American Elderly Health, from the National Institute on Aging (Kyriakos Markides, Principal Investigator) • R01-AG-017638-04. Disablement Process in Mexican American Older Adults, from the National Institute on Aging (Kenneth Ottenbacher, Principal Investigator)

  26. References Raji, MA, Ostir GV, Markides KS, Goodwin JS. The interaction of cognitive and emotional status on subsequent physical functioning in older Mexican Americans: Findings from the Hispanic-EPESE. J Gerontol Med Sci. 2002;57A:M1-M5. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third NHANES. JAMA. 2002;287:356-359 Dergance JM, Mouton CP, Lichtenstein MJ et al. Potential mediators of ethnic differences in physical activity in older Mexican Americans and European Americans: results from the San Antonio Longitudinal Study of Aging. J Am Geriatr Soc. 2005 ;53:1240-7. Barcelo A, Gregg EW, Pastor-Valero M, et al Waist circumference, BMI and the prevalence of self-reported diabetes among the elderly of the United States and six cities of Latin America and the Caribbean. Diabetes Res Clin Pract. 2007 Jul 30; [Epub ahead of print] :17669541 Blaum CS, West NA, Haan MN. Is the metabolic syndrome, with or without diabetes, associated with progressive disability in older mexican americans? J Gerontol A Biol Sci Med Sci. 2007;62:766-73. Martins D, Wolf M, Pan D, Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007;167:1159-65.

  27. References Nguyen HT, Black SA, Ray LA et al Predictors of decline in MMSE scores among older Mexican Americans. J Gerontol Biol Sci Med Sci. 2002;57:M181-5. Yaffe K, Haan M, Blackwell T et al. Metabolic syndrome and cognitive decline in elderly Latinos: findings from the Sacramento Area Latino Study of Aging study. J Am Geriatr Soc. 2007;55:758-62 Alfaro-Acha A, Al Snih S, Raji MA et al.. Does 8-foot walk time predict cognitive decline in older Mexicans Americans? J Am Geriatr Soc. 55:245-251, 2007 Rotkiewicz-Piorun, AM, Al Snih S, Kuo YF, Raji MA et al.. Cognitive decline in older Mexican Americans with diabetes. J Natl Med Assoc, 2006;98(11):1840-7. Arvanitakis Z, Wilson RS, Bienias JL, Bennett DA. Diabetes and parkinsonian signs in older persons. Alzheimer Dis Assoc Disord. 2007;21:144-9. Al Snih S, Fisher M, Raji MA, Markides KS et al. Diabetes mellitus and incidence of lower body disability among older Mexican Americans. J Gerontol A Biol Sci Med Sci. 2005;60:1152-6.

  28. References Pugh KG, Lipsitz LA The microvascular frontal-subcortical syndrome of aging. Neurobiol Aging. 2002;23:421-31 Maraldi C, Volpato S, Penninx BW. et al. Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. Arch Intern Med. 2007;167:1137-44. Raji MA, Reyes-Ortiz CA, Kuo YF et al. Depressive symptoms and cognitive change in older Mexican Americans. J Geriatric Psychiatry and Neurol 2007;20:145-152. Raji MA, Kuo YF, Al Snih S, Markides KS, Peek MK, Ottenbacher KJ. Cognitive status, muscle strength and subsequent disability in older Mexican Americans. J Am Geriatr Soc. 2005;53:1462-8. Ostir GV, Markides KS, Freeman DH Jr, Goodwin JS. Obesity and health conditions in elderly Mexican Americans: the Hispanic EPESE. Established Population for Epidemiologic Studies of the Elderly. Ethn Dis. 2000;10:31-8. Crespo CJ, Keteyian SJ, Heath GW . Leisure-time physical activity among U.S. adults: Results from the Third National Health and Nutrition Examination Survey. Arch Intern Med 1996;: 93–98.

  29. References Kivipelto M, Ngandu T, Fratiglioni L, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005 ;62(:1556-60. Kiraly SJ, Kiraly MA, Hawe RD, Makhani N. Vitamin D as a neuroactive substance: review. ScientificWorldJournal. 2006 Jan 26;6:125-39. Wu JH, Haan MN, Liang J, et al. Impact of diabetes on cognitive function among older Latinos. A population-based cohort study. J Clin Epidemiol. 2003;56:686-693. United States Bureau of the Census.  The Hispanic population in the United States: March 2002. Current Population Reports, p 20-545, U.S.  Bureau of the Census, Washington, D.C. 2003. Markides & Coreil. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101:253-65. Atkinson HH, Rosano C, Simonsick EM et al. Cognitive function, gait speed decline, and comorbidities: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2007 ;62:844-50.

  30. NIA Bedside-to-Bench Conference “Cognition, mood and movement disorders in older Mexican Americans” Mukaila A. Raji, MD, MSc Associate Professor, Internal Medicine-Geriatrics Director, Memory Loss Clinics University of Texas Medical Branch Galveston, Texas, USA

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