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ABSTRACT: OBJECTIVE: Among patients with chronic kidney disease (CKD), we investigated the prevalence of depressive symptoms, their impact on mortality and quality of life, and correlates of depressive symptoms. DESIGN: Prospective cohort study, followed up to 4 years. SETTING: General community. PARTICIPANTS: A total of 362 older adults with CKD (Stages 3 and 4 assessed from estimated glomerular filtration rate [eGFR]) drawn from the Singapore Longitudinal Aging Study cohort. MEASUREMENTS: Scores on the Geriatric Depression Scale (GDS) and the prevalence of depressive symptoms (GDS ≥5) and other variables were assessed at baseline, and SF-12 quality of life (QOL) (at 2 years) and mortality determined from 4 years of follow-up. RESULTS: Depressive symptoms were present in 13% of the participants at baseline, and were associated with poorer SF-12 QOL scores (up to 30 percentage point differences). There was a significant association between depressive symptoms and increased mortality risk (odds ratio: 3.17; 95% confidence interval: 1.17-8.61; χ(2) = 5.11; df = 1; p = 0.023), which was statistically significant in unadjusted analysis, but not in multivariate analysis that accounted for covariates (odds ratio: 2.62; 95% confidence interval: 0.77-8.89; χ(2) = 2.37; df = 1; p = 0.13). Baseline cognitive impairment, functional disability, and other chronic illness were significantly associated with both increasing GDS scores and depressive symptoms. No relationship between eGFR and depressive symptoms was observed. CONCLUSION: Depression among individuals with CKD was significantly associated with poorer quality of life, but not with increased mortality in predialysis CKD patients. More prospective studies are needed to establish the effects of depression on adverse CKD outcomes in predialysis CKD patients.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 01/2013; · 3.35 Impact Factor
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Journal of the American Geriatrics Society 12/2012; 60(12):2358-60. · 3.74 Impact Factor
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ABSTRACT: BACKGROUND: There is a paucity of studies, as well as inconsistent findings, on the associations of homocysteine, folate, and vitamin B-12 with physical function and decline in older persons. OBJECTIVE: We investigated the independent associations of homocysteine, folate, and vitamin B-12 with gait and balance performance and Instrumental Activities of Daily Living (IADL) in community-living older persons. DESIGN: We performed cross-sectional analyses on baseline data of 796 respondents in the Singapore Longitudinal Ageing Study who had laboratory measurements of fasting homocysteine folate and vitamin B-12 and completed Performance Oriented Mobility Assessment (POMA) of gait and balance and self-reports of IADLs. RESULTS: In multivariate analyses in which sex, age, education, housing type, comorbidities, hospitalization, depression and global cognitive scores, BMI, creatinine, arthritis and hip fracture, serum albumin and hemoglobin, and physical activities were controlled for, we showed that homocysteine, independently of folate and vitamin B-12, showed significant negative associations with POMA balance (P = 0.02), POMA gait scores (P < 0.01), and IADL (P < 0.01). Serum folate showed a significant positive association only with POMA balance scores (P < 0.045). No significant independent associations for vitamin B-12 were observed. CONCLUSIONS: The independent association of elevated homocysteine and low folate, but not vitamin B-12, on physical and functional decline was supported in this study. Interventional studies of the physical functional effects of folate and vitamin B-12 status in different populations are needed.
American Journal of Clinical Nutrition 11/2012; · 6.67 Impact Factor
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ABSTRACT: To investigate whether lower estimated glomerular filtration rate (eGFR) or chronic kidney disease (CKD) was associated with subsequent cognitive and instrumental activity of daily living (IADL) decline in a prospective cohort study.
Prospective cohort study, followed for up to 4 years.
General community.
One thousand three hundred fifteen adults aged 55 and older from the Singapore Longitudinal Aging Study.
Baseline data included eGFR levels, presence of CKD (eGFR < 60 mL/min per 1.73 m(2) ), and known confounders. Cognitive decline was defined as a drop of 2 or more points on the Mini-Mental State Examination (MMSE) and functional decline as a drop of 2 or more points in IADL score.
Decreasing levels of eGFR and the presence of CKD were associated with greater odds of cognitive decline at follow-up independent of confounding risk factors in multivariate analyses: estimated 14% increment in odds of cognitive decline per 10 mL/min/1.73 m(2) decrease in eGFR (odds ratio = 1.94, 95% confidence interval = 1.23-3.05; P = .004 for CKD vs non-CKD). Similar associations were found in a cognitively normal subgroup (MMSE > 23) at baseline. In the whole sample, CKD, but not eGFR, was found to be significantly associated with higher risk of IADL decline.
CKD in older persons was significantly associated with cognitive and functional decline. Future research should target the development and evaluation of strategies to delay or prevent cognitive decline and physical disability in elderly adults with impaired kidney function.
Journal of the American Geriatrics Society 06/2012; 60(7):1208-14. · 3.74 Impact Factor
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ABSTRACT: Previous studies have shown that the presence of depressive symptoms among older persons was evidently associated with subsequent physical and functional decline. However, few studies have directly examined the impact of changes in depressive symptoms or depressed mood on changes in functional ability. The present prospective study examined whether changes in the levels and remission of depressive symptoms were associated with changes in functional ability among community-living older persons who were treated for depressive symptoms in a primary care setting.
Older persons aged 60 and above with depressive symptoms (N = 267) were followed up in a primary care treatment program over 12 months. Geriatric Depression Scale (GDS-15), and instrumental and basic activities of daily living (IADL and ADL) were measured at baseline and at 12-month follow-up. The associations of GDS change scores and conversion to non-depressed status with ADL and IADL change scores, controlling for baseline covariates including chronic medical comorbidity and Mini-Mental State Examination (MMSE), were examined in multiple regression analyses.
An improvement in GDS scores (baseline score minus 12-month score) was significantly associated with improvement (12-month score minus baseline score) in ADL (β = 0.355, p < 0.001) and IADL scores (β = 0.165, p = 0.018) after adjusting for baseline functional status, MMSE, chronic medical comorbidities, and other variables. In particular, conversion in GDS status to "non-depressive" state (GDS ≤4) was associated with an improvement in ADL change scores (β = 0.281, p = 0.019).
In depressed older persons, an improvement in depressive symptoms was associated with improved functional ability.
International Psychogeriatrics 05/2012; 24(10):1633-41. · 2.24 Impact Factor
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ABSTRACT: Research on the effects of dietary nutrients on respiratory health in human populations have not investigated curcumin, a potent anti-oxidant and anti-inflammatory compound present principally in turmeric used in large amounts in Asian curry meals.
To examine the association of curry intake with pulmonary function among smokers and non-smokers.
The frequency of curry intake, respiratory risk factors and spirometry were measured in a population-based study of 2,478 Chinese older adults aged 55 and above in the Singapore Longitudinal Ageing Studies.
Curry intake (at least once monthly) was significantly associated with better FEV(1) (b = 0.045±0.018, p = 0.011) and FEV(1)/FVC (b = 1.14±0.52, p = 0.029) in multivariate analyses that controlled simultaneously for gender, age, height, height-squared, smoking, occupational exposure and asthma/COPD history and other dietary or supplementary intakes. Increasing levels of curry intake ('never or rarely', 'occasional', 'often', 'very often') were associated with higher mean adjusted FEV(1) (p for linear trend = 0.001) and FEV(1)/FVC% (p for linear trend = 0.048). Significant effect modifications were observed for FEV(1) (curry* smoking interaction, p = 0.028) and FEV(1)/FVC% (curry*smoking interaction, p = 0.05). There were significantly larger differences in FEV(1) and FEV(1)/FVC% between curry intake and non-curry intake especially among current and past smokers. The mean adjusted FEV(1) associated with curry intake was 9.2% higher among current smokers, 10.3% higher among past smokers, and 1.5% higher among non-smokers.
The possible role of curcumins in protecting the pulmonary function of smokers should be investigated in further clinical studies.
PLoS ONE 01/2012; 7(12):e51753. · 4.09 Impact Factor
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Journal of the American Geriatrics Society 09/2010; 58(9):1815-6. · 3.74 Impact Factor
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ABSTRACT: The association between statin use and depression is complex, and research findings have been mixed. The present study aimed to investigate the association of statin use with depressive symptoms among community-living older persons, and its effect modifications by gender and medical co-morbidity.
Prospective observational study of 1803 participants aged 55 and above in the Singapore Longitudinal Ageing Studies cohort, with data of statin use and other risk factors for depression at baseline, and Geriatric Depression Scale (GDS) symptom scores at follow-up (1.5 years).
Controlling for baseline demographics, cholesterol level and medical co-morbidities, statin use was not associated with depressive symptom scores in the whole sample overall (regression coefficient = -0.12 (SE 0.10), F([1,1782]) = 1.44, p = 0.23). Post hoc analyses suggested that statin use may be associated with fewer depressive symptoms in women (p = 0.02), and more depressive symptoms in men, particularly those with more medical co-morbidities (p = 0.04) and multiple drug use (p = 0.02).
This study provided no strong evidence that support an overall association of statin use and depressive symptoms. The post hoc findings in this study are suggestive but may also be spurious and should be replicated in other studies.
Pharmacoepidemiology and Drug Safety 09/2010; 19(9):942-8. · 2.53 Impact Factor
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ABSTRACT: The relationships between blood pressure and depression are unclear. There are inconsistent reports of an association between low blood pressure and depressive symptoms.
In a population-based sample of 2611 Chinese older adults aged 55 years and above, including participants with treated (n=1088), untreated (n=545), or no hypertension (n=978), depressive symptoms were determined by the 15-item Geriatric Depression Scale (> or =5), and current systolic blood pressure and diastolic blood pressure measurements were used to classify participants into high, normal, and low blood pressure groups. Estimates of association were adjusted for confounding by use of antihypertensive and depressogenic drugs and other covariables in hierarchical regression analyses.
Systolic blood pressure and diastolic blood pressure were negatively associated with Geriatric Depression Scale scores, independent of other variables. Low systolic blood pressure (odds ratio [OR] 1.54; 95% confidence interval [CI], 1.07-2.22), low diastolic blood pressure (OR 1.67; 95% CI, 0.98-2.85), and low systolic blood pressure or diastolic blood pressure (or both) (OR 1.55; 95% CI, 1.10-2.19) were independently associated with depressive symptoms. The associations with depressive symptoms were particularly observed for low systolic blood pressure (OR 2.13; 95% CI, 1.13-4.03) among treated hypertensive participants, and low diastolic blood pressure (OR 2.42; 95% CI, 1.26-4.68) among untreated or nonhypertensive participants.
Low blood pressure was independently associated with depressive symptoms in both older subjects who were treated for hypertension and those who were not.
The American journal of medicine 04/2010; 123(4):342-9. · 4.47 Impact Factor
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ABSTRACT: To investigate the independent associations between folate, B12, and homocysteine levels and depressive symptoms in older adults.
Cross-sectional study.
Resident population in southeast Singapore.
Six hundred sixty-nine community-living noninstitutionalized Chinese adults aged 55 and older.
Laboratory values of folate, vitamin B12, and homocysteine were examined for their independent relationships with depressive symptoms (Geriatric Depression Scale (GDS) score > or =5).
Respondents with depression (n=178) had lower mean serum folate concentrations (21.5 nmol/L) than those without (n=491, 24.0 nmol/L, P=.04). There was a linear relationship between descending quartiles of folate concentrations and increasing odds of association with depressive symptoms, independent of other risk factors (demographic, psychosocial, alcohol and smoking, chronic morbidity, functional status, nutritional risk, albumin, anemia, depression-inducing medications, use of antidepressants and vitamin supplements), including B12 and homocysteine (P for trend=.02). The odds ratio (OR) of association between low folate (lowest quartile: <14.6 nmol/L) and depressive symptoms independent of other risk factors, including homocysteine and B12, was 1.72 (95% confidence interval (CI)=1.11-2.66). Vitamin B12 across a range of values did not show a linear association, but B12 deficiency (<180 pmol/L) appeared to be significantly associated with depressive symptoms (OR=2.68, 95% CI=1.20-6.00), independent of folate and homocysteine.
Decreasing and low levels of serum folate and deficient levels of B12 were associated with greater risk of depressive symptoms in older Chinese adults.
Journal of the American Geriatrics Society 05/2009; 57(5):871-6. · 3.74 Impact Factor
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ABSTRACT: The relationship between depressive symptoms and health service use among older people is not well understood. In this study we examined the two-way relationships between depressive symptoms and hospitalization and/or physician visits by older adults.
In a one-year follow-up study of 973 community-dwelling older adults in the Singapore Longitudinal Aging Studies (SLAS), depressive symptoms (15-item Geriatric Depression Scale score > or =5) were assessed at baseline and one year later. Information on self-reported physician visits and hospitalization were collected bimonthly over one year.
When demographic characteristics, medical comorbidities, functional status and other covariates were controlled for, baseline depressive symptoms were associated with increased episodes of subsequent physician visits during the one-year follow-up (RR,1.34; 95% CI, 1.05-1.70), but not with subsequent hospitalization(s) during the same period. Conversely, participants with five or more physician visits (versus less than 5) over one year were more likely to be depressed at one year (OR, 10.2; 95% CI, 3.36-31.1); hospitalization during this period was also significantly associated with depressive symptoms at one year (OR = 6.43, 95% CI, 2.48-16.6).
Depressive symptoms and health service use have reciprocal relationships. Health service use for non-mental illnesses may be optimized by efforts at post-hospitalization interventions to recognize and treat depression in older persons.
International Psychogeriatrics 04/2009; 21(3):568-75. · 2.24 Impact Factor
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ABSTRACT: Depression occurs commonly among patients with COPD, but the independent association of depression and COPD and the effect of depression on COPD outcomes are not well established.
A population sample of 2402 Chinese aged >or=55 with and without COPD (characteristic symptoms of chronic cough, sputum or breathlessness and airflow obstruction and FEV(1)/FVC<0.70) was assessed on Geriatric Depression Scale (score>or=5), dependence on basic activities of daily living (ADL), SF-12 health status, smoking and medication behaviour.
The 189 respondents with COPD showed higher depressive symptoms prevalence (22.8%) than 2213 respondents without COPD (12.4%); multivariate odd ratio (OR) was 1.86; 95% CI, 1.25-2.75 after controlling for confounding risk factors. In multivariate analyses of respondents with COPD, those who were depressed (N=43), compared to those who were not (N=146), were more likely to report ADL disability (OR=2.89, p=0.049) poor or fair self-reported health (OR=3.35, p=0.004), poor SF-12 PCS scores (OR=2.35, p=0.041) and SF-12 MCS scores (OR=4.17, p<0.001).
Depressive symptoms were associated with COPD independent of known risk factors. In COPD participants, depressive symptoms were associated with worse health and functional status and self-management.
Respiratory medicine 02/2009; 103(6):895-901. · 2.33 Impact Factor
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ABSTRACT: The relation between vitamin B-12 and cognitive function in older adults is unclear. Limited evidence suggests that the relation is modulated by apolipoprotein E epsilon4. Hence, it is important to further examine this gene-nutrient interaction.
The aim was to investigate the role of apolipoprotein E (APOE) epsilon4 as a genetic predisposing factor modulating the effect of vitamin B-12 on cognitive function.
A battery of neuropsychological tests, including the Mini-Mental State Examination (MMSE) for global cognition, was administered at the baseline assessment to 539 Chinese adults aged > or =55 y. The MMSE was repeated at a median 18 mo (n = 376) and a median of 38 mo (n = 247) after baseline. The interaction of vitamin B-12 and APOE epsilon4 on cognitive function was examined in a linear mixed-effects model for MMSE and in a multiple linear regression model for neuropsychological test scores.
APOE epsilon4 was associated with a lower MMSE score. Vitamin B-12 (natural log transformed) was positively related to MMSE score, and this association was much stronger in APOE epsilon4 carriers than in APOE epsilon4 noncarriers (P for interaction = 0.016). Significant interactions between natural log-transformed vitamin B-12 and APOE epsilon4 were also found for the Digit Span Backward Longest Sequence (P for interaction = 0.013) and Rey Auditory Verbal Learning Test immediate recall (P for interaction = 0.005). Better performance in these 2 tests was associated with vitamin B-12 in APOE epsilon4 carriers but not in APOE epsilon4 noncarriers.
The association between vitamin B-12 and cognitive function was moderated by APOE epsilon4 status.
American Journal of Clinical Nutrition 02/2009; 89(4):1263-8. · 6.67 Impact Factor
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ABSTRACT: The precise relationship between depression and cognitive decline in older adults is unclear. We investigated the influence of apolipoprotein E (APOE)-epsilon4 genotype in modulating the effect of depressive symptoms on cognitive decline.
Prospective cohort study of 1,487 cognitively high-functioning Chinese older adults. Depressive symptoms (Geriatric Depression Scale score >/=5) and Mini-Mental State Examination (MMSE) were assessed at baseline, and cognitive decline (at least 1-point drop in MMSE) at 1-2 years after baseline.
There was no significant difference in cognitive decline between depressed (32.9%) and nondepressed (31.5%) participants in the whole sample or among non-APOE-epsilon4 carriers. Among APOE-epsilon4 carriers, depressed participants showed more cognitive decline (40.0%) than their nondepressed counterparts (28.6%), odds ratio = 2.89, 95% confidence interval: 1.03-8.12; p = .04, after controlling for age, gender, education, vascular risk factors/events, smoking, alcohol drinking, physical functioning, subjective memory complaint, length of follow-up, and baseline MMSE scores (p for interaction = .03).
Our study suggests that the presence of the APOE-epsilon4 allele significantly enhanced the risk of cognitive decline associated with depressive symptoms. This finding should be independently replicated in future studies.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 01/2009; 64(2):306-11. · 4.60 Impact Factor
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ABSTRACT: To examine the association between serum albumin and cognitive impairment and decline in community-living older adults.
Population-based cohort study, followed up to 2 years; serum albumin, apolipoprotein E (APOE)-epsilon4, and cognitive impairment measured at baseline and cognitive decline (> or =2-point drop in Mini-Mental State Examination (MMSE) score). Odds ratios were controlled for age, sex, education, medical comorbidity, hypertension, diabetes mellitus, cardiac disease, stroke, smoking, alcohol drinking, depression, APOE-epsilon4, nutritional status, body mass index, anemia, glomerular filtration rate, and baseline MMSE.
Local area whole population.
One thousand six hundred sixty-four Chinese older adults aged 55 and older.
The mean age of the cohort was 66.0+/-7.3, 65% were women, mean serum albumin was 42.3+/-3.1 g/L, and mean MMSE score was 27.2+/-3.2. Lower albumin tertile was associated with greater risk of cognitive impairment in cross-sectional analysis (low, odds ratio (OR)=2.30, 95% confidence interval (CI)=1.31-4.03); medium, OR=1.59, 95% CI=0.88-2.88) versus high (P for trend=.002); and with cognitive decline in longitudinal analyses: low, OR=1.73, 95% CI=1.18-2.55; medium, OR=1.32, 95% CI=0.89-1.95, vs high (P for trend=.004). In cognitively unimpaired respondents at baseline (MMSE> or =24), similar associations with cognitive decline were observed (P for trends <.002). APOE-epsilon4 appeared to modify the association, due mainly to low rates of cognitive decline in subjects with the APOE-epsilon4 allele and high albumin.
Low albumin was an independent risk marker for cognitive decline in community-living older adults.
Journal of the American Geriatrics Society 12/2008; 57(1):101-6. · 3.74 Impact Factor
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Age and Ageing 12/2008; 38(1):105-8. · 3.09 Impact Factor
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ABSTRACT: Few studies have explored the relationship between orthostatic hypotension (OH) and cognition. The aim of this study was to examine the association of OH with cognitive impairment and decline in a cohort of Chinese elderly, and its effect modification by blood pressure (BP) status at baseline.
Among 2,321 community-living older adults, free of cardiovascular disease and stroke, baseline BP measurements were used to determine the presence of OH and categorize participants as hypotensives, normotensives or hypertensives. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment (MMSE score <24). Cognitive decline (decrease in MMSE score by > or =1) was assessed from 1 to 2 years of follow-up for 1,347 participants without baseline cognitive impairment.
Mean age of the subjects was 65.5 years and 381 (16.6%) showed OH. OH was not associated with cognitive impairment overall. However, among hypotensives, OH increased the odds of cognitive impairment (OR = 4.1, 95% CI = 1.11-15.1), while hypertensives with OH showed reduced odds of cognitive impairment (OR = 0.48, 95% CI = 0.26-0.90). Among cognitively intact participants, OH was not associated with cognitive decline overall or in BP subgroups.
The increased risk of cognitive impairment in hypotensives with OH suggests that hypotension with OH may be an early comorbid marker of a primary incipient dementia.
Dementia and Geriatric Cognitive Disorders 10/2008; 26(3):239-46. · 2.14 Impact Factor
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ABSTRACT: to examine the relationships between serum albumin, haemoglobin and body mass index (BMI) with cognitive performance among community-living older adults.
design--population-based cross-sectional study; setting--local community in Southeast Region of Singapore; subjects--Chinese older adults aged 55 and above (N = 2, 550); measurements--serum albumin, haemoglobin, BMI and Mini-Mental State Examination (MMSE).
in multivariable analyses controlling for gender, age, education and vascular risk factors, low albumin in the bottom quintile (OR 2.04; 95% CI 1.22-3.41) and low haemoglobin in the bottom quintile (OR 1.56; 95% CI 1.00-2.47) and low BMI with chronic comorbidity (OR 1.73; 95%CI 1.02-2.95) were independently associated with poor cognitive performance (MMSE < or = 23). Among cognitively intact respondents (MMSE > or = 24), albumin concentration showed a significant inverse linear relationship with MMSE scores (P for trend =0.002).
low albumin, low haemoglobin and low BMI (in the presence of chronic comorbidity) are independently associated with poor cognitive performance in community-living older adults.
Age and Ageing 07/2008; 37(4):423-9. · 3.09 Impact Factor
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ABSTRACT: Laboratory research suggests that tea has potential neurocognitive protective effects, but this is not established in humans.
We aimed to examine the relation between tea intake and cognitive impairment and decline.
Among community-living Chinese adults aged > or = 55 y in the Singapore Longitudinal Ageing Studies cohort, we measured tea consumption at baseline and administered the Mini-Mental State Examination (MMSE) at baseline and 1-2 y later. Cognitive impairment was defined as an MMSE score < or = 23 and cognitive decline as a drop in MMSE score of > or = 1 point. We performed cross-sectional analysis of baseline data from 2501 participants and longitudinal analysis of data from 1438 cognitively intact participants. Odds ratios (ORs) of association were calculated in logistic regression models that adjusted for potential confounders.
Total tea intake was significantly associated with a lower prevalence of cognitive impairment, independent of other risk factors. Compared with the ORs for rare or no tea intake, the ORs for low, medium, and high levels of tea intake were 0.56 (95% CI: 0.40, 0.78), 0.45 (95% CI: 0.27, 0.72), and 0.37 (95% CI: 0.14, 0.98), respectively (P for trend < 0.001). For cognitive decline, the corresponding ORs were 0.74 (95% CI: 0.54, 1.00), 0.78 (95% CI: 0.55, 1.11), and 0.57 (95% CI: 0.32, 1.03), respectively (P for trend = 0.042). These effects were most evident for black (fermented) and oolong (semi-fermented) teas, the predominant types consumed by this population. In contrast, no association between coffee intake and cognitive status was found.
Regular tea consumption was associated with lower risks of cognitive impairment and decline.
American Journal of Clinical Nutrition 07/2008; 88(1):224-31. · 6.67 Impact Factor
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ABSTRACT: To determine the association of the metabolic syndrome (MS) with cognitive decline in a Chinese older population.
In a prospective cohort study of 1,352 community-living Chinese older adults without cognitive impairment (Mini Mental State Examination, MMSE <24) and without cardiovascular disease and stroke, the authors assessed baseline MS (defined according to International Diabetic Federation Criteria). Cognitive decline was predefined as at least 2-point drop in MMSE score at follow-up 1-2 years after baseline assessment.
MS was present in 26.3% of the participants at baseline and was significantly associated with the risk of cognitive decline (odds ratio, 1.42: confidence interval, 1.01-1.98), after controlling for potential confounding by age, gender, education, smoking, alcohol drinking, depressive symptoms, APOE-e4 status, level of leisure activities, baseline MMSE, and length of follow-up.
The MS was associated with increased risk of cognitive decline in Chinese older adults.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 06/2008; 16(6):519-22. · 3.35 Impact Factor
