Anne B Newman

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (770)4984.86 Total impact

  • Journal of Pain and Symptom Management 02/2015; 49(2):332-333. DOI:10.1016/j.jpainsymman.2014.11.034 · 2.80 Impact Factor
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    ABSTRACT: Importance The risk of cardiovascular disease (CVD) after infection is poorly understood.Objective To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD.Design, Settings, and Participants We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, ≥65 years; enrollment period, 1989–1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15 792; enrollment age, 45-64 years; enrollment period, 1987–1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status.Exposures Hospitalization for pneumonia.Main Outcomes and Measures Incident CVD (myocardial infarction, stroke, and fatal coronary heart disease).Results Of 591 pneumonia cases in CHS, 206 had CVD events over 10 years after pneumonia hospitalization. CVD risk after pneumonia was highest in the first year. CVD occurred in 54 cases and 6 controls in the first 30 days (HR, 4.07; 95% CI, 2.86-5.27); 11 cases and 9 controls between 31 and 90 days (HR, 2.94; 95% CI, 2.18-3.70); and 22 cases and 55 controls between 91 days and 1 year (HR, 2.10; 95% CI, 1.59-2.60). Additional CVD risk remained elevated into the tenth year, when 4 cases and 12 controls developed CVD (HR, 1.86; 95% CI, 1.18-2.55). In ARIC, of 680 pneumonia cases, 112 had CVD over 10 years after hospitalization. CVD occurred in 4 cases and 3 controls in the first 30 days (HR, 2.38; 95% CI, 1.12-3.63); 4 cases and 0 controls between 31 and 90 days (HR, 2.40; 95% CI, 1.23-3.47); 11 cases and 8 controls between 91 days and 1 year (HR, 2.19; 95% CI, 1.20-3.19); and 8 cases and 7 controls during the second year (HR, 1.88; 95% CI, 1.10-2.66). After the second year, the HRs were no longer statistically significant.Conclusions and Relevance Hospitalization for pneumonia was associated with increased short-term and long-term risk of CVD, suggesting that pneumonia may be a risk factor for CVD.
    JAMA The Journal of the American Medical Association 01/2015; 313(3):264-74. DOI:10.1001/jama.2014.18229 · 35.29 Impact Factor
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    ABSTRACT: Additional information is needed about the role of dietary sodium on health outcomes in older adults. To examine the association between dietary sodium intake and mortality, incident cardiovascular disease (CVD), and incident heart failure (HF) in older adults. We analyzed 10-year follow-up data from 2642 older adults (age range, 71-80 years) participating in a community-based, prospective cohort study (inception between April 1, 1997, and July 31, 1998). Dietary sodium intake at baseline was assessed by a food frequency questionnaire. We examined sodium intake as a continuous variable and as a categorical variable at the following levels: less than 1500 mg/d (291 participants [11.0%]), 1500 to 2300 mg/d (779 participants [29.5%]), and greater than 2300 mg/d (1572 participants [59.5%]). Adjudicated death, incident CVD, and incident HF during 10 follow-up years. Analysis of incident CVD was restricted to 1981 participants without prevalent CVD at baseline. The mean (SD) age of participants was 73.6 (2.9) years, 51.2% were female, 61.7% were of white race, and 38.3% were black. After 10 years, 881 participants had died, 572 had developed CVD, and 398 had developed HF. In adjusted Cox proportional hazards regression models, sodium intake was not associated with mortality (hazard ratio [HR] per 1 g, 1.03; 95% CI, 0.98-1.09; P = .27). Ten-year mortality was nonsignificantly lower in the group receiving 1500 to 2300 mg/d (30.7%) than in the group receiving less than 1500 mg/d (33.8%) and the group receiving greater than 2300 mg/d (35.2%) (P = .07). Sodium intake of greater than 2300 mg/d was associated with nonsignificantly higher mortality in adjusted models (HR vs 1500-2300 mg/d, 1.15; 95% CI, 0.99-1.35; P = .07). Indexing sodium intake for caloric intake and body mass index did not materially affect the results. Adjusted HRs for mortality were 1.20 (95% CI, 0.93-1.54; P = .16) per milligram per kilocalorie and 1.11 (95% CI, 0.96-1.28; P = .17) per 100 mg/kg/m2 of daily sodium intake. In adjusted models accounting for the competing risk for death, sodium intake was not associated with risk for CVD (subHR per 1 g, 1.03; 95% CI, 0.95-1.11; P = .47) or HF (subHR per 1 g, 1.00; 95% CI, 0.92-1.08; P = .92). No consistent interactions with sex, race, or hypertensive status were observed for any outcome. In older adults, food frequency questionnaire-assessed sodium intake was not associated with 10-year mortality, incident CVD, or incident HF, and consuming greater than 2300 mg/d of sodium was associated with nonsignificantly higher mortality in adjusted models.
    JAMA Internal Medicine 01/2015; 175(3). DOI:10.1001/jamainternmed.2014.6278 · 13.12 Impact Factor
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    ABSTRACT: Introduction: We examined whether statins are associated with better cerebral white (WM) and gray matter (GM) indices in community-dwelling elders. Methods: In 295 older adults, we compared white matter hyperintensities (WMH) on brain magnetic resonance imaging and, total WM fractional anisotropy (FA) and GM mean diffusivity (MD) on diffusion tensor imaging, of Alzheimer's disease (AD) relevant regions in statin-exposed and statin-unexposed participants stratified by Modified Mini-Mental Status Examination (3MS) score. Results: There was no overall effect of statin exposure on cerebral structural indices. The interaction between statin exposure and 3MS was significant for total-WMH and WM FA (both P < .05) but not GM MD. In the lowest 3MS tertile (mean: 86), statin-exposed individuals had lower total-WMH and higher WM FA (P = .005 and P = .044) and FA of tracts linked to clinical AD (P-value range= .005-.04) despite statistical adjustments. These differences were not significant in the two higher 3MS tertiles. Discussion: Statins may benefit WM in older adults vulnerable to dementia.
    Alzheimer's and Dementia 01/2015; DOI:10.1016/j.jalz.2014.11.003 · 12.41 Impact Factor
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    ABSTRACT: To examine the association between multiple measures of visual impairment (VI) and incident mobility limitations in older adults. Prospective observational cohort study. Memphis, Tennessee, and Pittsburgh, Pennsylvania. Health, Aging and Body Composition study participants aged 70 to 79 without mobility limitations at the Year 3 visit (N = 1,862). Vision was measured at the Year 3 visit, and VI was defined as distance visual acuity (VA) worse than 20/40, contrast sensitivity (CS) less than 1.55 log Contrast, and stereoacuity (SA) greater than 85 arcsec. Incident persistent walking and stair climbing limitation was defined as two consecutive 6-month reports of any difficulty walking one-quarter of a mile or walking up 10 steps after 1, 3, and 5 years of follow-up. At Year 3 (baseline for these analyses), 7.4% had impaired VA, 27.2% had impaired CS, and 29.2% had impaired SA. At all follow-up times, the incidence of walking and stair climbing limitations was higher in participants with VA, CS, or SA impairment. After 5 years, impaired CS and SA were independently associated with greater risk of walking limitation (hazard ratio (HR)CS = 1.3, 95% confidence interval (CI) = 1.1-1.7; HRSA = 1.3, 95% CI = 1.1-1.6) and stair climbing limitation (HRCS = 1.4, 95% CI = 1.1-1.8; HRSA = 1.3, 95% CI=1.1-1.7). Having impaired CS and SA was associated with greater risk of mobility limitations (HRwalking limitations = 2.0, 95% CI = 1.6-2.5; HRstair limitation = 2.1, 95% CI = 1.6-2.8). Multiple aspects of VI may contribute to mobility limitations in older adults. Addressing more than one component of vision may be needed to reduce the effect of vision impairment on functional decline. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
    Journal of the American Geriatrics Society 12/2014; 63(1). DOI:10.1111/jgs.13183 · 4.57 Impact Factor
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    ABSTRACT: Sarcopenia and visceral obesity have been suggested to aggravate each other, resulting in a vicious cycle. However, evidence based on prospective study is very limited. Our purpose was to investigate whether visceral fat promotes a decrease in skeletal muscle mass and vice versa. We observed changes in anthropometric and body composition data during a follow-up period of 27.6±2.8 months in 379 Korean men and women (mean age 51.9±14.6 years) from the Korean Sarcopenic Obesity Study (KSOS). Appendicular lean soft tissue (ALST) mass was calculated using dual-energy X-ray absorptiometry, and visceral fat area (VFA) was measured using computed tomography at baseline and follow-up examination. ALST mass significantly decreased, whereas trunk and total fat mass increased in both men and women despite no significant change in weight and body mass index. In particular, women with visceral obesity at baseline had a greater decrease in ALST mass than those without visceral obesity (P = 0.001). In multiple linear regression analysis, baseline VFA was an independent negative predictor of the changes in ALST after adjusting for confounding factors including age, gender, life style and body composition parameters, insulin resistance, high sensitivity C-reactive protein and vitamin D levels (P = 0.001), whereas the association between baseline ALST mass and changes in VFA was not statistically significant (P = 0.555). This longitudinal study showed that visceral obesity was associated with future loss of skeletal muscle mass in Korean adults. These results may provide novel insight into sarcopenic obesity in an aging society.
    PLoS ONE 12/2014; 9(12):e115407. DOI:10.1371/journal.pone.0115407 · 3.23 Impact Factor
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    ABSTRACT: To assess the relationship between sensorimotor nerve function and incident mobility disability over 10 years. Prospective cohort study with longitudinal analysis. Two U.S. clinical sites. Population-based sample of community-dwelling older adults with no mobility disability at 2000/01 examination (N = 1,680; mean age ± SD 76.5 ± 2.9, body mass index 27.1 ± 4.6; 50.2% female, 36.6% black, 10.7% with diabetes mellitus). Motor nerve conduction amplitude (poor <1 mV) and velocity (poor <40 m/s) were measured on the deep peroneal nerve. Sensory nerve function was measured using 10- and 1.4-g monofilaments and vibration detection threshold at the toe. Lower extremity symptoms included numbness or tingling and aching or burning pain. Incident mobility disability assessed semiannually over 8.5 years (interquartile range 4.5-9.6 years) was defined as two consecutive self-reports of a lot of difficulty or inability to walk one-quarter of a mile or climb 10 steps. Nerve impairments were detected in 55% of participants, and 30% developed mobility disability. Worse motor amplitude (HR = 1.29 per SD, 95% CI = 1.16-1.44), vibration detection threshold (HR = 1.13 per SD, 95% CI = 1.04-1.23), symptoms (HR = 1.65, 95% CI = 1.26-2.17), two motor impairments (HR = 2.10, 95% CI = 1.43-3.09), two sensory impairments (HR = 1.91, 95% CI = 1.37-2.68), and three or more nerve impairments (HR = 2.33, 95% CI = 1.54-3.53) predicted incident mobility disability after adjustment. Quadriceps strength mediated relationships between certain nerve impairments and mobility disability, although most remained significant. Poor sensorimotor nerve function independently predicted mobility disability. Future work should investigate modifiable risk factors and interventions such as strength training for preventing disability and improving function in older adults with poor nerve function. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
    Journal of the American Geriatrics Society 12/2014; 62(12). DOI:10.1111/jgs.13152 · 4.57 Impact Factor
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    ABSTRACT: Mitochondrial function is altered with age and variants in mitochondrial DNA (mtDNA) modulate risk for several age-related disease states. However, the association of mtDNA copy number, a readily available marker which reflects mitochondrial depletion, energy reserves, and oxidative stress, on aging and mortality in the general population has not been addressed. To assess the association between mtDNA copy number and two primary outcomes-prevalent frailty and all-cause mortality-we utilize data from participants who were from two multicenter, multiethnic, community-based, prospective studies-the Cardiovascular Health Study (CHS) (1989-2006) and the Atherosclerosis Risk in Communities (ARIC) study (1987-2013). A total of 4892 participants (43.3 % men) from CHS and 11,509 participants (44.9 % men) from ARIC self-identifying as white or black were included in the analysis. mtDNA copy number, the trait of interest, was measured using a qPCR-based method in CHS and an array-based method in ARIC from DNA isolated from whole blood in participants from both cohorts. In race-stratified meta-analyses, we observe a significant inverse association of mtDNA copy number with age and higher mtDNA copy number in women relative to men. Lower mtDNA copy number was also significantly associated with prevalent frailty in white participants from CHS (OR 0.91, 95 % CI 0.85-0.97). Additionally, mtDNA copy number was a strong independent predictor of all-cause mortality in an age- and sex-adjusted, race-stratified analysis of 16,401 participants from both cohorts with a pooled hazard ratio of 1.47 (95 % CI 1.33-1.62) for the lowest quintile of mtDNA copy number relative to the highest quintile. Mitochondrial DNA (mtDNA) copy number is associated with age and sex. Lower mtDNA copy number is also associated with prevalent frailty. mtDNA copy number is a significant predictor of all-cause mortality in a multiethnic population.
    Journal of Molecular Medicine 12/2014; 93(2). DOI:10.1007/s00109-014-1233-3 · 5.11 Impact Factor
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    ABSTRACT: Objectives To describe the development of the Pittsburgh Fatigability Scale (PFS) and establish its reliability and concurrent and convergent validity against performance measures.DesignCross-sectional.SettingUniversity of Pittsburgh, Pittsburgh, Pennsylvania.ParticipantsScale development sample: 1,013 individuals aged 60 and older from two registries; validation sample: 483 adults aged 60 and older from the Baltimore Longitudinal Study of Aging (BLSA).MeasurementsThe scale development sample and BLSA participants self-administered an initial 26-item perceived fatigability scale. BLSA participants also completed measures of performance fatigability (perceived exertion from a standard treadmill task and performance deterioration from a fast-paced long-distance corridor walk), a 6-m usual-paced corridor walk, and five timed chair stands.ResultsPrincipal components analysis with varimax rotation reduced the 26-item scale to the 10-item PFS. The PFS showed strong internal consistency (Cronbach's alpha 0.88) and excellent test–retest reliability (intraclass correlation 0.86). In the validation sample, PFS scores, adjusted for age, sex, and race, were greater for those with high performance fatigability, slow gait speed, worse physical function, and lower fitness, with differences between high and low fatigability ranging from 3.2 to 5.1 points (P < .001).Conclusion The 10-item PFS physical fatigability score is a valid and reliable measure of perceived fatigability in older adults and can serve as an adjunct to performance-based fatigability measures for identifying older adults at risk of mobility limitation in clinical and research settings.
    Journal of the American Geriatrics Society 12/2014; 63(1). DOI:10.1111/jgs.13191 · 4.57 Impact Factor
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    ABSTRACT: Objectives To examine the association between statin use and objectively assessed decline in gait speed in community-dwelling older adults.DesignLongitudinal cohort study.SettingHealth, Aging and Body Composition (Health ABC) Study.ParticipantsTwo thousand five participants aged 70–79 at baseline with medication and gait speed data at 1998–99, 1999–2000, 2001–02, and 2002–03.MeasurementsThe independent variables were any statin use and their standardized daily doses (low, moderate, high) and lipophilicity. The primary outcome measure was decline in gait speed of 0.1 m/s or more in the following year of statin use. Multivariable generalized estimating equations were used, adjusting for demographic characteristics, health-related behaviors, health status, and access to health care.ResultsStatin use increased from 16.2% in 1998–99 to 25.6% in 2002–03. The overall proportions of those with decline in gait speed of 0.1 m/s or more increased from 22.2% in 1998 to 23.9% in 2003. Statin use was not associated with decline in gait speed of 0.1 m/s or more (adjusted odds ratio (AOR) = 0.90, 95% confidence interval (CI) = 0.77–1.06). Similar nonsignificant trends were also seen with the use of hydrophilic or lipophilic statins. Users of low-dose statins were found to have a 22% lower risk of decline in gait speed than nonusers (AOR = 0.78, 95% CI = 0.61–0.99), which was mainly driven by the results from 1999–2000 follow-up.Conclusion These results suggest that statin use did not increase decline in gait speed in community-dwelling older adults.
    Journal of the American Geriatrics Society 12/2014; 63(1). DOI:10.1111/jgs.13134 · 4.57 Impact Factor
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    ABSTRACT: Background: Physical activity in older adults has physical and mental health benefits. The positive effects of exercise may be even greater in those without a regular exercise routine. We examined the impact of the Arthritis Foundation Exercise Program (AFEP) in 48 community-based sites in Western Pennsylvania. Pain and energy levels were assessed in those who self-reported a pre-program routine of “never” or “sometimes” exercising vs. those who reported “regularly” exercising. Methods: The exercise program for this study was a 10-week 20-session program designed for those with arthritis or joint pain. Sixty-minute sessions include range-of-motion, endurance, strengthening, arthritis-management education, and relaxation. Data on attendance, demographics, bodily pain, and energy were compared. Bodily pain and energy were assessed using standard questionnaires. Results: The sample consisted of 378 participants (never/sometimes exercise n=244; regular exercise n=134). Attendance and demographics did not significantly differ between groups. Average age was 72.7 (± 8.0) years; 87.8% were women, 38% had high school education or less, and 80.3% were Caucasian; average attendance was 14 sessions (± 5.3). Energy level on a scale of 0-10 increased significantly within the “never/sometimes” group over the 10-week program (5.84 to 6.25, p = .0046), but not within the “regular” group. Bodily pain decreased for the “never/sometimes” group, and increased for the “regular” group; however, neither of these within-group changes was statistically significant. Conclusions: Although many exercise programs for older adults in community settings attract those who are already familiar with exercise, engaging and motivating those who rarely exercise can have important benefits, including energy level.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Cardiovascular disease (CVD) is a major health problem accounting for 30% of deaths globally. Projected increases in the population aged 60+ are greatest in developing countries, including India and will lead to increased CVD burden. Hypertension is the most common risk factor for CVD worldwide. We examined the prevalence of CVD and its relationship with hypertension and other risk factors in a cohort of rural Indians from the Mobility and Independent Living in Elders Study (MILES). Methods: MILES is an observational cohort study, which enrolled 562 community dwelling men(N=281) and women(N=281), aged 60+ in Andhra Pradesh, India. CVD was defined as a composite of self-reported history of CVD, major ECG abnormality or peripheral artery disease. Logistic regression was used to analyze the association between CVD and risk factors in cross-sectional analyses. Results: Despite low mean BMI (men=21.4, women=23.1), prevalence of hypertension (men=51.3%, women=49.1%) and CVD (men=24.6%, women=25.6%) were high. However, only 28.7% of hypertensive individuals were on treatment and 47.8 % of the treated still had uncontrolled hypertension. In multivariable analysis, hypertension was significantly associated with CVD in both men [OR=2.58(1.22-4.21)] and women [OR=1.79(1.02-3.20)]. Greater number of depressive symptoms and higher BMI were significantly associated with CVD only in men. Conclusion: The prevalence of hypertension, a major contributor to CVD is high among rural Indians, aged 60+. There is low awareness of hypertension and poor treatment optimization in this cohort. These data indicate urgent need for primary prevention measures and increasing availability of treatment to prevent further complications.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Mitochondrial dysfunction is a prominent hallmark of many sensory neuropathies. The purpose of this study was to assess the influence of mitochondrial DNA sequence variation on peripheral nerve function in the population-based Health, Aging, and Body Composition Study. Methods: We investigated the role of common mitochondrial DNA variation (n = 1,580) and complete mitochondrial DNA sequences (n = 138) on peroneal motor nerve conduction velocity and amplitude, average vibration detection threshold, and monofilament sensitivity. Results: Nominal associations among common mitochondrial DNA variants and haplogroups were identified but were not statistically significant after adjustment for multiple comparisons. Sequence-based approaches were used to identify aggregate variant associations across the 16S rRNA (weighted-sum, p = 2E-05 and variable threshold, p = 9E-06) for nerve conduction velocity. Several of these rare 16S variants occurred at or near sites with earlier disease associations and are also in close proximity to the peptidyl transferase center, which is the catalytic center of the 16S rRNA CONCLUSIONS: These results suggest that sequence variation related to mitochondrial protein synthesis/assembly is associated with peripheral nerve function and may provide insight into targets for intervention or new clinical strategies to preserve nerve function in late life.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 11/2014; 70(11). DOI:10.1093/gerona/glu175 · 5.42 Impact Factor
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    ABSTRACT: Background: The frailty syndrome is as a well-established condition of risk for disability. Aim of the study is to explore whether a physical activity (PA) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability. Methods: Exploratory analyses from the Lifestyle Interventions and Independence for Elders pilot, a randomized controlled trial enrolling 424 community-dwelling persons (mean age=76.8 years) with sedentary lifestyle and at risk of mobility disability. Participants were randomized to a 12-month PA intervention versus a successful aging education group. The frailty phenotype (ie, ≥3 of the following defining criteria: involuntary weight loss, exhaustion, sedentary behavior, slow gait speed, poor handgrip strength) was measured at baseline, 6 months, and 12 months. Repeated measures generalized linear models were conducted. Results: A significant (p = .01) difference in frailty prevalence was observed at 12 months in the PA intervention group (10.0%; 95% confidence interval = 6.5%, 15.1%), relative to the successful aging group (19.1%; 95% confidence interval = 13.9%,15.6%). Over follow-up, in comparison to successful aging participants, the mean number of frailty criteria in the PA group was notably reduced for younger subjects, blacks, participants with frailty, and those with multimorbidity. Among the frailty criteria, the sedentary behavior was the one most affected by the intervention. Conclusions: Regular PA may reduce frailty, especially in individuals at higher risk of disability. Future studies should be aimed at testing the possible benefits produced by multidomain interventions on frailty.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 11/2014; 70(2). DOI:10.1093/gerona/glu099 · 5.42 Impact Factor
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    ABSTRACT: Objective: To quantify racial differences in brain structural characteristics in white and black octogenarians, and to examine whether these characteristics contribute to cognition. Methods: Cross-sectional study of 283 adults 79-89 years old (59.4% white;42.0% women) with data on gray matter integrity via diffusion tensor imaging (mean diffusivity), gray matter atrophy (GMA), white matter hyperintensities (WMH), literacy, smoking, drinking, income, hypertension and diabetes. Participants were recruited from an ongoing epidemiological study of older adults living in the community with a range of chronic conditions, physical and cognitive function. Standardized betas (sβ) of neuroimaging markers predicting Digit Symbol Substitution Test (DSST) and Modified Mini-Mental State Examination (3MS) scores were computed in multivariable regression models stratified by race. Results: Compared to whites, blacks had lower DSST (p=0.001) and lower 3MS (p=0.006), but also lower mean diffusivity (i.e. higher gray matter microstructural integrity, p=0.032), independent of gender, income, literacy, body mass index, diabetes and drinking habits. Racial differences were not significant for WMH (p=0.062) or GMA (p=0.4). Among blacks, mean diffusivity and WMH were associated with DSST (sβ=-.209, p=0.037and -.211, p=.038, respectively) independent of each other and other covariates; among whites, mean diffusivity, but not WMH, was significantly associated with DSST and 3MS (sβ =-.277, p=.002 and -.250, p=0.029, respectively). Conclusions: In this cohort of octogenarians living in the community, blacks appeared to have higher microstructural integrity of gray matter as compared to whites. This neuroimaging marker was related to higher cognition even in the presence of WMH and other cardiovascular conditions. If confirmed, these findings suggest microstructural gray matter integrity may be a target to improve cognition, especially among blacks who survive to very old age with a range of chronic cardiovascular conditions.
    Current Alzheimer Research 11/2014; 12(7). DOI:10.2174/1567205011666141107153634 · 3.89 Impact Factor
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    ABSTRACT: Background: Slowed gait is an important health indicator in older adults but a single identifiable cause is often lacking. We assessed whether a summary index measuring impairments across multiple physiologic systems was associated with slowed gait in older individuals. Methods: Data from the Cardiovascular Health Study (n = 3,010) were used to assess associations between baseline physiologic index (measuring vasculature, brain, kidneys, lungs, and glucose metabolism; range 0-10 with 0-2 points/system and lower score indicating higher function) and annual gait speed (m/s) over 6 years. Participants with complete data on the physiologic index and at least two gait speed measures were included. Mean gait speed and 95% confidence intervals (CI) by category of index were calculated using mixed effects models. Results: Those with scores of three or higher on the index had significantly slower gait speed at baseline compared to those with scores of 0-2 (7-10: mean speed = 0.83 m/s, 95% CI: 0.80, 0.84; 0-2: mean speed = 1.01 m/s, 95% CI: 0.99, 1.03). Those with higher indices also had faster decline in gait speed compared to those with lower scores after adjustment for demographic and health characteristics (7-10: change in speed = -0.020 m/s/year, 95% CI: -0.024, -0.016; 0-2: change in speed= -0.010 m/s/year, 95% CI: -0.014, -0.006). Conclusions: Greater impairment across five organ systems was associated with slower gait speed and greater declines in gait speed over 6 years. Impairments accumulated over multiple physiologic systems may make older adults more vulnerable to slow gait speed.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 11/2014; 70(3). DOI:10.1093/gerona/glu176 · 5.42 Impact Factor
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    ABSTRACT: Background and objectives: Cross-sectional studies have found that low serum bicarbonate is associated with slower gait speed. Whether bicarbonate levels independently predict the development of functional limitation has not been previously studied. Whether bicarbonate was associated with incident persistent lower extremity functional limitation and whether the relationship differed in individuals with and without CKD were assessed in participants in the Health, Aging, and Body Composition study, a prospective study of well functioning older individuals Design, setting, participants, & measurements: Functional limitation was defined as difficulty in walking 0.25 miles or up 10 stairs on two consecutive reports 6 months apart in the same activity (stairs or walking). Kidney function was measured using eGFR by the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and CKD was defined as an eGFR<60 ml/min per 1.73 m(2). Serum bicarbonate was measured using arterialized venous blood gas. Cox proportional hazards analysis was used to assess the association of bicarbonate (<23, 23-25.9, and ≥26 mEq/L) with functional limitation. Mixed model linear regression was performed to assess the association of serum bicarbonate on change in gait speed over time. Results: Of 1544 participants, 412 participants developed incident persistent functional limitation events over a median 4.4 years (interquartile range, 3.1 to 4.5). Compared with ≥26 mEq/L, lower serum bicarbonate was associated with functional limitation. After adjustment for demographics, CKD, diabetes, body mass index, smoking, diuretic use, and gait speed, lower serum bicarbonate was significantly associated with functional limitation (hazard ratio, 1.35; 95% confidence interval, 1.08 to 1.68 and hazard ratio, 1.58; 95% confidence interval, 1.12 to 2.22 for bicarbonate levels from 23 to 25.9 and <23, respectively). There was not a significant interaction of bicarbonate with CKD. In addition, bicarbonate was not significantly associated with change in gait speed. Conclusions: Lower serum bicarbonate was associated with greater risk of incident, persistent functional limitation. This association was present in individuals with and without CKD.
    Clinical Journal of the American Society of Nephrology 11/2014; 9(12). DOI:10.2215/CJN.05480614 · 4.61 Impact Factor
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    ABSTRACT: Background and aims Fast- and usual-paced 400-m walking tests are often used to assess physical fitness or function, respectively, though it is not known how performance converges on these tests. This study aims to determine whether performance on the fast- and usual-paced 400-m walks varies based upon age and physical function. Methods Participants (26 men, 38 women aged 70–92) completed a fast- and usual-paced 400-m walk. The Short Physical Performance Battery was used to assess function (score range 0–12). Body mass index and health history were also assessed. Results Finish times for the fast- and usual-paced 400-m walks were 333.3 and 380.3 s, respectively (P
    Aging - Clinical and Experimental Research 11/2014; 27(3). DOI:10.1007/s40520-014-0287-y · 1.22 Impact Factor
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    ABSTRACT: Reduced forced expiratory volume in 1 second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC) are strong predictors of mortality and lung function is higher among individuals with exceptional longevity. However, genetic factors associated with lung function in individuals with exceptional longevity have not been identified. We conducted a genome wide association study (GWAS) to identify novel genetic variants associated with lung function in the Long Life Family Study (LLFS) (n = 3,899). Replication was performed using data from the CHARGE/SpiroMeta consortia. The association between SNPs and FEV1 and FEV1/FVC was analyzed using a linear mixed effects model adjusted for age, age2, sex, height, field center, ancestry principal components and kinship structure to adjust for family relationships separately for ever smokers and never smokers. In the linkage analysis, we used the residuals of the FEV1 and FEV1/FVC, adjusted for age, sex, height, ancestry principal components (PCs), smoking status, pack-years, and field center. We identified nine SNPs in strong linkage disequilibrium in the CYP2U1 gene to be associated with FEV1 and a novel SNP (rs889574) associated with FEV1/FVC, none of which were replicated in the CHARGE/SpiroMeta consortia. Using linkage analysis, we identified a novel linkage peak in chromosome 2 at 219 cM for FEV1/FVC (LOD: 3.29) and confirmed a previously reported linkage peak in chromosome 6 at 28 cM (LOD: 3.33) for FEV1. Future studies need to identify the rare genetic variants underlying the linkage peak in chromosome 6 for FEV1.
    Respiratory Research 11/2014; 15(1):134. DOI:10.1186/s12931-014-0134-x · 3.09 Impact Factor
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    ABSTRACT: Study Objective: Inflammation may represent a common physiological pathway linking both short and long sleep duration to mortality. We evaluated inflammatory markers as mediators of the relationship between sleep duration and mortality in community-dwelling older adults. Design: Prospective cohort with longitudinal follow-up for mortality outcomes. Setting: Pittsburgh, Pennsylvania, and Memphis, Tennessee. Participants: Participants in the Health, Aging and Body Composition (Health ABC) Study (mean age 73.6 ± 2.9 years at baseline) were sampled and recruited from Medicare listings. Measurements and Results: Baseline measures of subjective sleep duration, markers of inflammation (serum interleukin-6, tumor necrosis factor-α, and C-reactive protein) and health status were evaluated as predictors of all-cause mortality (average follow-up = 8.2 ± 2.3 years). Sleep duration was related to mortality, and age-, sex-, and race-adjusted hazard ratios (HR) were highest for those with the shortest (< 6 h HR: 1.30, CI: 1.05-1.61) and longest (> 8 h HR: 1.49, CI: 1.15-1.93) sleep durations. Adjustment for inflammatory markers and health status attenuated the HR for short (< 6 h) sleepers (HR = 1.06, 95% CI = 0.83-1.34). Age-, sex-, and race-adjusted HRs for the > 8-h sleeper group were less strongly attenuated by adjustment for inflammatory markers than by other health factors associated with poor sleep with adjusted HR = 1.23, 95% CI = 0.93-1.63. Inflammatory markers remained significantly associated with mortality. Conclusions: Inflammatory markers, lifestyle, and health status explained mortality risk associated with short sleep, while the mortality risk associated with long sleep was explained predominantly by lifestyle and health status.
    Sleep 10/2014; 38(2). DOI:10.5665/sleep.4394 · 4.59 Impact Factor

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  • 1991-2015
    • University of Pittsburgh
      • • Department of Epidemiology
      • • Department of Medicine
      • • Division of Geriatric Medicine
      Pittsburgh, Pennsylvania, United States
  • 2014
    • United States Department of Veterans Affairs
      Бедфорд, Massachusetts, United States
    • Columbia University
      New York City, New York, United States
  • 2007-2014
    • Pennsylvania Department of Health
      Harrisburg, Pennsylvania, United States
  • 2013
    • Pittsburg State University
      Питсбург, Kansas, United States
    • Bristol-Myers Squibb
      New York, New York, United States
    • University of Pennsylvania
      Philadelphia, Pennsylvania, United States
    • University of Cambridge
      • Department of Public Health and Primary Care
      Cambridge, England, United Kingdom
    • Cary Orthopaedics
      Кэри, North Carolina, United States
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
    • The University of Tennessee Health Science Center
      • Department of Medicine
      Memphis, Tennessee, United States
  • 2005-2013
    • National Institute on Aging
      • • Clinical Research Branch (CRB)
      • • Laboratory of Epidemiology, Demography and Biometry (LEDB)
      Baltimore, Maryland, United States
    • Duquesne University
      • Department of Mathematics and Computer Science
      Pittsburgh, Pennsylvania, United States
    • University of Queensland 
      • School of Human Movement Studies
      Brisbane, Queensland, Australia
    • University of Florida
      • Department of Aging and Geriatric Research
      Gainesville, FL, United States
    • Tufts Medical Center
      • Division of Nephrology
      Boston, Massachusetts, United States
    • Fletcher Allen Health Care
      Burlington, Vermont, United States
  • 2002-2013
    • Boston University
      • • Section of Cardiovascular Medicine
      • • Pulmonary Center
      Boston, Massachusetts, United States
  • 2012
    • University of Vermont
      • Department of Pathology
      Burlington, VT, United States
  • 2011
    • Beth Israel Deaconess Medical Center
      • Division of Gerontology
      Boston, MA, United States
    • Kaiser Permanente
      Oakland, California, United States
    • California Pacific Medical Center Research Institute
      • Research Institute
      San Francisco, CA, United States
  • 2010
    • The University of Memphis
      Memphis, Tennessee, United States
    • Ben-Gurion University of the Negev
      Be'er Sheva`, Southern District, Israel
  • 2005-2010
    • University of Lausanne
      • Faculté de biologie et de médecine (FBM)
      Lausanne, VD, Switzerland
  • 2009
    • University of South Carolina
      Columbia, South Carolina, United States
    • Emory University
      • School of Medicine
      Atlanta, Georgia, United States
    • Hospital of the University of Pennsylvania
      • Department of Medicine
      Philadelphia, Pennsylvania, United States
    • University of Georgia
      • Department of Foods and Nutrition
      Athens, GA, United States
    • Temple University
      • Center for Obesity Research and Education (CORE)
      Philadelphia, PA, United States
  • 2007-2009
    • VU University Medical Center
      • • Department of Epidemiology and Biostatistics
      • • Department of Psychiatry
      Amsterdam, North Holland, Netherlands
  • 2008
    • Pennington Biomedical Research Center
      Baton Rouge, Louisiana, United States
    • Vanderbilt University
      • Department of Neurology
      Nashville, MI, United States
  • 2005-2008
    • Wake Forest School of Medicine
      • • Sticht Center on Aging
      • • Section on Gerontology and Geriatric Medicine
      • • Department of Internal Medicine
      Winston-Salem, NC, United States
  • 2006
    • Magee-Womens Hospital
      Pittsburgh, Pennsylvania, United States
  • 2005-2006
    • Maastricht University
      Maestricht, Limburg, Netherlands
    • VU University Amsterdam
      • IHS-Institute of Health Sciences
      Amsterdamo, North Holland, Netherlands
  • 2004-2006
    • Kent State University
      Кент, Ohio, United States
    • University of California, San Francisco
      • • Veterans Affairs Medical Center
      • • Department of Psychiatry
      San Francisco, CA, United States
    • University of Florence
      Florens, Tuscany, Italy
  • 2003-2006
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2004-2005
    • San Francisco VA Medical Center
      San Francisco, California, United States
  • 2001
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2000
    • Georgetown University
      • Division of Cardiology
      Washington, D. C., DC, United States
  • 1998
    • University of Washington Seattle
      • Department of Biostatistics
      Seattle, WA, United States
  • 1993
    • Allegheny General Hospital
      Pittsburgh, Pennsylvania, United States