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An international needs assessment of caregivers for frontotemporal dementia.

https://arctichealth.org/en/permalink/ahliterature131976
Source
Can J Neurol Sci. 2011 Sep;38(5):753-7
Publication Type
Article
Date
Sep-2011
Author
Tiffany W Chow
Fabricio J Pio
Kenneth Rockwood
Author Affiliation
Rotman Research Institute, Baycrest, 3560 Bathurst Street, 8th Floor Brain Health Complex, Toronto, Ontario, M6A 2E1, Canada.
Source
Can J Neurol Sci. 2011 Sep;38(5):753-7
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Caregivers - psychology
Cognition Disorders - diagnosis - etiology
Female
Frontotemporal Dementia - complications - epidemiology - nursing
Health Surveys
Humans
Internet
Male
Middle Aged
Needs Assessment - standards
Neuropsychological Tests
United States
Abstract
To guide development of public awareness and caregiver support resources for frontotemporal dementia (FTD) syndromes.
We used an online survey to explore their needs. The survey was self-administered by self-identified, English-speaking caregivers for patients with FTD in several countries.
Of 79 caregiver respondents, approximately half were caring for patients with behavioural variant FTD or semantic dementia. The most common initial symptoms were Changes in Thinking and Judgment. Half of the respondents identified "failure to recognize the early stage of illness as a dementia" as the most troublesome aspect. Accordingly, over 40% of respondents had difficulty obtaining an accurate diagnosis for the patient. Caregivers prioritized family counseling and the public educational message that dementia can affect young people.
The largest international survey of FTD caregivers to-date showed that support is needed for all family members adapting to the shock of early-onset dementia, and this may be most readily provided online.
Notes
Comment In: Can J Neurol Sci. 2011 Sep;38(5):671-221856567
PubMed ID
21856580 View in PubMed
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An unsuitable old age: the paradoxes of elder care.

https://arctichealth.org/en/permalink/ahliterature171685
Source
CMAJ. 2005 Dec 6;173(12):1500-1
Publication Type
Article
Date
Dec-6-2005
Author
Kenneth Rockwood
Author Affiliation
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Source
CMAJ. 2005 Dec 6;173(12):1500-1
Date
Dec-6-2005
Language
English
Publication Type
Article
Keywords
Aged
Canada
Frail Elderly
Health Care Costs
Health Services for the Aged
Humans
National Health Programs
Notes
Cites: Can J Cardiol. 2004 May;20 Suppl A:7A-16A15190403
PubMed ID
16330653 View in PubMed
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APOE genotype, memory test performance, and the risk of Alzheimer's disease in the Canadian Study of Health and Aging.

https://arctichealth.org/en/permalink/ahliterature187557
Source
Dement Geriatr Cogn Disord. 2003;15(1):1-5
Publication Type
Article
Date
2003
Author
Jennifer D Klages
John D Fisk
Kenneth Rockwood
Author Affiliation
Department of Psychology, Dalhousie University, Halifax, Canada.
Source
Dement Geriatr Cogn Disord. 2003;15(1):1-5
Date
2003
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - diagnosis - genetics
Apolipoprotein E3
Apolipoprotein E4
Apolipoproteins E - genetics
Canada
Cognition Disorders - diagnosis - genetics
Female
Genetic Predisposition to Disease
Genotype
Humans
Longitudinal Studies
Male
Memory - physiology
Neuropsychological Tests
Protein Isoforms
Risk assessment
Task Performance and Analysis
Abstract
This study examined the relation between two risks for Alzheimer's disease (AD): the apolipoprotein (APOE) epsilon4 allele and poor memory test performance.
In the Canadian Study of Health and Aging (CSHA), a 5-year longitudinal population-based study that screened and followed over 10,000 participants, 2,914 had an initial clinical assessment and 1,624 had APOE genotype testing. All participants were categorized as having no cognitive impairment, cognitive impairment but no dementia, or dementia at both baseline and follow-up. We examined those (n = 209) with a complete neuropsychological assessment at baseline and no evidence of cognitive impairment who had either APOE epsilon3/epsilon3 or epsilon3/epsilon4 genotypes and who had a clinical consensus diagnosis of either no cognitive impairment or AD at follow-up. Delayed free recall memory was evaluated at CSHA-1 with the Buschke Cued Recall Test (BCRT).
The risk of AD at follow-up was increased for participants with an APOE epsilon3/epsilon4 genotype when memory test performance was not considered, but logistic regression demonstrated that a model which also considered baseline memory test performance was more predictive of AD. In the more complete model, reduced BCRT free recall scores were associated with an increased risk of AD, whereas the risk associated with the APOE epsilon3/epsilon4 genotype was no longer significant.
For those with no evidence of cognitive impairment, drawn from a population-based sample of elderly persons, the APOE epsilon3/epsilon4 genotype was only associated with an increased risk of AD after 5 years if their memory test performance was relatively poor at baseline. Regardless of the APOE genotype, and in the absence of clinical evidence of cognitive impairment, reduced scores on a test of delayed free recall at baseline was associated with an increased risk of AD after 5 years.
PubMed ID
12457072 View in PubMed
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APOE genotype, vascular risk factors, memory test performance and the five-year risk of vascular cognitive impairment or Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature172854
Source
Dement Geriatr Cogn Disord. 2005;20(5):292-7
Publication Type
Article
Date
2005
Author
Jennifer D Klages
John D Fisk
Kenneth Rockwood
Author Affiliation
Department of Psychology, Dalhousie University, Halifax, Canada.
Source
Dement Geriatr Cogn Disord. 2005;20(5):292-7
Date
2005
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - epidemiology - genetics - psychology
Apolipoproteins E - genetics
Canada - epidemiology
Cues
Dementia, Vascular - epidemiology - genetics - psychology
Female
Genotype
Humans
Logistic Models
Male
Memory - physiology
Mental Recall - physiology
Neuropsychological Tests
Risk factors
Vascular Diseases - epidemiology
Abstract
The APOE epsilon4 gene and poor memory test performance have each been associated with an increased risk of developing dementia, but the relationship between these risk factors in predicting dementia is unclear. We examined the multivariate effects of APOE genotype, memory test performance and vascular risk factors in predicting incident Alzheimer's disease (AD) and vascular cognitive impairment (VCI) in the Canadian Study of Health and Aging. Delayed free recall was measured by the Buschke Cued Recall Test (BCRT). The study sample included 223 people who were identified as having no cognitive impairment (NCI) and either APOE epsilon3/epsilon3 or epsilon3/epsilon4 genotypes at the baseline clinical assessment. After 5 years, 182 (82%) still had NCI, 21 developed VCI (9%) and 20 AD (9%). Multivariate analyses demonstrated that APOE epsilon4 increased the risk of AD (OR, 3.48; CI, 1.15-10.48) but not VCI (OR, 0.89; CI, 0.24-3.27). Vascular risk factors increased the risk of VCI (OR, 2.18; CI, 1.36-3.51) but not AD (OR, 0.68; CI, 0.38-1.20). Lower BCRT scores conferred an increased risk of both VCI (OR, 1.75; CI, 1.27-2.42) and AD (OR, 1.86; CI, 1.29-2.67) but attenuated the APOE epsilon4 effect in AD. VCI and AD have different risk profiles and outcomes, but subtle memory difficulties may be an early feature of both.
PubMed ID
16166776 View in PubMed
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Apolipoprotein E-polymorphism, frailty and mortality in older adults.

https://arctichealth.org/en/permalink/ahliterature158869
Source
J Cell Mol Med. 2008 Dec;12(6B):2754-61
Publication Type
Article
Date
Dec-2008
Author
Kenneth Rockwood
Bassam Nassar
Arnold Mitnitski
Author Affiliation
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Kenneth.Rockwood@Dal.Ca
Source
J Cell Mol Med. 2008 Dec;12(6B):2754-61
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged, 80 and over
Alleles
Apolipoproteins E - genetics
Canada - epidemiology
Cognition
Female
Frail Elderly
Genotype
Humans
Male
Mortality
Polymorphism, Genetic
Survival Analysis
Abstract
Although apolipoprotein E (ApoE) polymorphism is associated with variable risks of several illnesses, and with mortality, no persuasive relationship has been demonstrated with frailty. Here, the clinical examination cohort (n=1452 older adults, aged 70+ years at baseline) of the Canadian Study of Health and Aging was evaluated, with 5-year follow-up data. Frailty was defined using both the phenotypic definition from the Cardiovascular Health Study (Frailty-CHS) and the 'Frailty Index', from which age-specific trajectories of deficit accumulation can be estimated. In age-sex adjusted analyses, people with ApoE 4 allele had a higher risk of death (hazard ratio [HR]=1.20; 95% confidence interval: 1.01-1.45), but this relationship was not significant when adjusted for cognitive impairment (1.06; 95% confidence interval: 0.88-1.27). There was no association between frailty and ApoE polymorphism, defined in age-sex adjusted models either as Frailty-CHS (ApoE4 HR 1.17; 95% confidence interval: 0.98-1.40, frailty HR 1.37; 95% confidence interval: 1.28-1.46) or by the Frailty Index (ApoE4 HR 1.07; 95% confidence interval: 0.90-1.29, frailty HR 35.3; 95% confidence interval: 20.4-61.1). The data do not support an association between ApoE polymorphism and frailty. This result did not depend on how frailty was defined.
PubMed ID
18266965 View in PubMed
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Assessment of individual risk of death using self-report data: an artificial neural network compared with a frailty index.

https://arctichealth.org/en/permalink/ahliterature179540
Source
J Am Geriatr Soc. 2004 Jul;52(7):1180-4
Publication Type
Article
Date
Jul-2004
Author
Xiaowei Song
Arnold Mitnitski
Chris MacKnight
Kenneth Rockwood
Author Affiliation
Geriatric Medicine Research Unit, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
Source
J Am Geriatr Soc. 2004 Jul;52(7):1180-4
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Female
Frail Elderly
Geriatric Assessment
Humans
Male
Mortality - trends
Neural Networks (Computer)
Predictive value of tests
ROC Curve
Risk assessment
Self-Assessment
Abstract
To evaluate the potential of an artificial neural network (ANN) in predicting survival in elderly Canadians, using self-report data.
Cohort study with up to 72 months follow-up.
Forty self-reported characteristics were obtained from the community sample of the Canadian Study of Health and Aging. An individual frailty index score was calculated as the proportion of deficits experienced. For the ANN, randomly selected participants formed the training sample to derive relationships between the variables and survival and the validation sample to control overfitting. An ANN output was generated for each subject. A separate testing sample was used to evaluate the accuracy of prediction.
A total of 8,547 Canadians aged 65 to 99, of whom 1,865 died during 72 months of follow-up.
The output of an ANN model was compared with an unweighted frailty index in predicting survival patterns using receiver operating characteristic (ROC) curves.
The area under the ROC curve was 86% for the ANN and 62% for the frailty index. At the optimal ROC value, the accuracy of the frailty index was 70.0%. The ANN accuracy rate over 10 simulations in predicting the probability of individual survival mean+/-standard deviation was 79.2+/-0.8%.
An ANN provided more accurate survival classification than an unweighted frailty index. The data suggest that the concept of biological redundancy might be operationalized from health survey data.
PubMed ID
15209659 View in PubMed
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Attitudes to aging: a comparison of obituaries in Canada and the U.K.

https://arctichealth.org/en/permalink/ahliterature150546
Source
Int Psychogeriatr. 2009 Aug;21(4):787-92
Publication Type
Article
Date
Aug-2009
Author
Ruth E Hubbard
Eamonn M P Eeles
Sherri Fay
Kenneth Rockwood
Author Affiliation
Geriatric Medicine Research Unit, Dalhousie University and Queen Elizabeth Health Sciences Centre, Halifax, Canada. ruth.hubbard@cdha.nsheath.ca
Source
Int Psychogeriatr. 2009 Aug;21(4):787-92
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aging - psychology
Alzheimer Disease - psychology
Attitude to Death
Canada
Charities
Cross-Cultural Comparison
Data Collection
Female
Great Britain
Humans
Male
Newspapers
Population Dynamics
Public Opinion
Social Values
Writing
Abstract
Populations worldwide are aging and the overall prevalence of dementia at death is now 30%. Since the contemporary social impact of a disease is indicated by the frequency of its newspaper coverage and since obituary notices illuminate conceptions of death, we hypothesized that obituary notices placed by families would reflect societal attitudes to aging and dementia.
We undertook critical discourse analysis of obituaries in representative national and local newspapers in Canada and the U.K.
In the 799 obituaries studied, chronological age, suggested donations in memory of the deceased, and donations to dementia charities were each included in significantly more obituaries in Canadian newspapers than in U.K. ones. Military service was explicit for significantly more men aged > or = 80 years in Canada compared to the U.K. (41% versus 4%; p or = 70 years were more likely to recommend donations to children's charities (n = 12) or the Royal National Lifeboat Institution than dementia charities.
Donations to dementia charities were significantly more common in obituaries in Canada than in the U.K. In both countries, donations to medical charities did not reflect disease prevalence or impact to the individual. Societal attitudes in the U.K. may be impacted by the fragmentation of aging research and antipathy to geriatric medicine in the national medical press.
PubMed ID
19497141 View in PubMed
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Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey.

https://arctichealth.org/en/permalink/ahliterature134815
Source
CMAJ. 2011 May 17;183(8):E487-94
Publication Type
Article
Date
May-17-2011
Author
Kenneth Rockwood
Xiaowei Song
Arnold Mitnitski
Author Affiliation
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS. kenneth.rockwood@dal.ca
Source
CMAJ. 2011 May 17;183(8):E487-94
Date
May-17-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Canada - epidemiology
Chi-Square Distribution
Female
Frail Elderly - statistics & numerical data
Health status
Health Surveys
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Physical Fitness
Prevalence
Proportional Hazards Models
Sex Factors
Young Adult
Abstract
The prevalence of frailty increases with age in older adults, but frailty is largely unreported for younger adults, where its associated risk is less clear. Furthermore, less is known about how frailty changes over time among younger adults. We estimated the prevalence and outcomes of frailty, in relation to accumulation of deficits, across the adult lifespan.
We analyzed data for community-dwelling respondents (age 15-102 years at baseline) to the longitudinal component of the National Population Health Survey, with seven two-year cycles, beginning 1994-1995. The outcomes were death, use of health services and change in health status, measured in terms of a Frailty Index constructed from 42 self-reported health variables.
The sample consisted of 14,713 respondents (54.2% women). Vital status was known for more than 99% of the respondents. The prevalence of frailty increased with age, from 2.0% (95% confidence interval [CI] 1.7%-2.4%) among those younger than 30 years to 22.4% (95% CI 19.0%-25.8%) for those older than age 65, including 43.7% (95% CI 37.1%-50.8%) for those 85 and older. At all ages, the 160-month mortality rate was lower among relatively fit people than among those who were frail (e.g., 2% v. 16% at age 40; 42% v. 83% at age 75 or older). These relatively fit people tended to remain relatively fit over time. Relative to all other groups, a greater proportion of the most frail people used health services at baseline (28.3%, 95% CI 21.5%-35.5%) and at each follow-up cycle (26.7%, 95% CI 15.4%-28.0%).
Deficits accumulated with age across the adult spectrum. At all ages, a higher Frailty Index was associated with higher mortality and greater use of health care services. At younger ages, recovery to the relatively fittest state was common, but the chance of complete recovery declined with age.
Notes
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Comment In: CMAJ. 2011 May 17;183(8):889-9021540170
PubMed ID
21540166 View in PubMed
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Changes in the Lethality of Frailty Over 30 Years: Evidence From Two Cohorts of 70-Year-Olds in Gothenburg Sweden.

https://arctichealth.org/en/permalink/ahliterature285261
Source
J Gerontol A Biol Sci Med Sci. 2017 Jul 01;72(7):945-950
Publication Type
Article
Date
Jul-01-2017
Author
Kristoffer Bäckman
Erik Joas
Hanna Falk
Arnold Mitnitski
Kenneth Rockwood
Ingmar Skoog
Source
J Gerontol A Biol Sci Med Sci. 2017 Jul 01;72(7):945-950
Date
Jul-01-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Frail Elderly - statistics & numerical data
Geriatric Assessment - methods - statistics & numerical data
Health Status Disparities
Health Status Indicators
Humans
Male
Mortality - trends
Sweden - epidemiology
Abstract
With aging, health deficits accumulate: people with few deficits for their age are fit, and those with more are frail. Despite recent reports of improved health in old age, how deficit accumulation is changing is not clear. Our objectives were to evaluate changes over 30 years in the degree of deficit accumulation and in the relationship between frailty and mortality in older adults.
We analyzed data from two population based, prospective longitudinal cohorts, assembled in 1971-1972 and 2000-2001, respectively. Residents of Gothenburg Sweden, systematically drawn from the Swedish population registry. The 1901-1902 cohort (N = 973) had a response rate of 84.8%; the 1930 cohort (N = 500) had a response rate of 65.1%. A frailty index using 36 deficits was calculated using data from physical examinations, assessments of physical activity, daily, sensory and social function, and laboratory tests. We evaluated mortality over 12.5 years in relation to the frailty index.
Mean frailty levels were the same (x¯ = 0.20, p = .37) in the 1901-1902 cohort as in the 1930 cohort. Although the frailty index was linked to the risk of death in both cohorts, the hazards ratio decreased from 1.67 per 0.1 increment in the frailty index for the first cohort to 1.32 for the second cohort (interaction term p = .005).
Although frailty was as common at age 70 as before, its lethality appears to be less. Just why this is so should be explored further.
Notes
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PubMed ID
27522060 View in PubMed
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Changes with age in the distribution of a frailty index.

https://arctichealth.org/en/permalink/ahliterature179246
Source
Mech Ageing Dev. 2004 Jul;125(7):517-9
Publication Type
Article
Date
Jul-2004
Author
Kenneth Rockwood
Alexander Mogilner
Arnold Mitnitski
Author Affiliation
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, 1421-5955 Veterans Memorial Lane, Halifax, Nova Scotia B3H 1C6, Canada. Kenneth.Rockwood@dal.ca
Source
Mech Ageing Dev. 2004 Jul;125(7):517-9
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Aging
Canada
Female
Frail Elderly - statistics & numerical data
Humans
Male
Middle Aged
Sample Size
Abstract
Models of human mortality include a factor that summarises intrinsic differences in individual rates of ageing, commonly called frailty. Frailty also describes a clinical syndrome of apparent vulnerability. In a representative, cross-sectional, Canadian survey (n = 66,589) we calculated a frailty index as the mean accumulation of deficits and previously showed it to increase exponentially with age. Here, its density function exhibited a monotonic change in shape, being least skewed at the oldest ages. Although the shape gradually changed, the frailty index was well fitted by a gamma distribution. Of note, the variation coefficient, initially high, decreased from middle age on. Being able to quantify frailty means that health risks can be summarised at both the individual and group levels.
PubMed ID
15246748 View in PubMed
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57 records – page 1 of 6.