However, litle is known about its associaoon with different ageing groups include: mild cogniove impairment (MCI), usual ageing (UA) and successful ageing.
Huijin Lau1, Arimi Fitri Mat Ludin1, Nor Fadilah Rajab1, Suzana Shahar2 & Asheila Meramat1 1 Biomedical Science Programme, School of DiagnosDc and Applied Health Sciences, Faculty of Health Sciences, UniversiD Kebangsaan Malaysia. 2 DieteDcs Programme, School of Healthcare Sciences, Faculty of Health Sciences, UniversiD Kebangsaan Malaysia.
INTRODUCTION ² Ageing is associated with an increase prevalence of vascular demen6a and Alzheimer’s disease1. ² Vascular risk factors such as hypertension and diabetes have been found to be significant associated with cogni6ve decline2&3. ² However, liEle is known about its associa6on with different ageing groups include: mild cogni6ve impairment (MCI), usual ageing (UA) and successful ageing (SA). ² Thus, this study was aimed to determine the prevalence of three ageing categories and its associa6on with vascular risk factors among Malaysian elderly. ² This study is part of a larger longitudinal study inves6ga6ng the neuroprotec6ve model for healthy longevity (UKM-‐AP-‐2011-‐27).
METHODOLOGY Ø A total of 2322 community-‐dwelling elderly aged ≥60 were par6cipated in this cross-‐sec6onal study through a mul6stage random sampling approach involving 4 states (ie. Johor, Klang Valley, Kelantan, Perak). Ø Ageing groups were classified based on criteria through face-‐to-‐face interview using Instrumental Ac6vi6es of Daily Living (IADL)4, Mini Mental State Examina6on (MMSE), Rey Auditory Verbal Learning Test (RAVLT)5 and Geriatric Depression Scale (GDS)6 ques6onnaires. Ø Par6cipants were measured for blood pressure and blood samples were collected by trained phlebotomist to determine fas6ng blood glucose level and lipid profile. Ø One sample ANOVA test was employed to compare the difference of vascular risk factors among MCI, UA and SA groups; the associa6ons between vascular risk factors and ageing groups were analyzed using mul6nomial logis6c regression model.
AGEING GROUP
CRITERIA
MCI7
1. Not having any clinical judgment on demen6a 2. Preserved independence in func6onal abili6es, scored ≥ 8 in IADL 3. Essen6ally preserved general cogni6ve func6oning, scored ≥ 19 in MMSE 4. Self-‐ or informant-‐reported memory complaint 5. Objec6ve memory impairment, scored ≤ 64.0 standard score in RAVLT firh trial
USUAL AGEING8 Do not meet all the criteria for successful aging and MCI
SUCCESSFUL AGEING9&10
RESULTS
DISCUSSION
Prevalence of MCI, UA and SA among Malaysian Elderly
10.8% 13.1%
The prevalence of MCI, usual and successful ageing among Malaysian elders are 13.1%, 76.1% and 10.8% respec6vely.
MCI UA SA
76.1%
Comparison of Vascular Risk Factors Between MCI, UA and SA a
95% Confidence Intervals (Tukey)
95% Confidence Intervals (Tukey)
Column means diff.
**
UA - SA
**
MCI - SA
MCI - UA -5
0
5
10
MCI - SA
MCI - UA
MCI - UA -4
15
-2
0
2
4
6
-0.5
Column means diff.
MCI - UA
MCI - UA 0.00
0.05
-0.8
Difference between group means
-0.6
-0.4
-0.2
1.0
1.5
2.0
-0.8
-0.6
0.0
0.2
Difference between group means
High Density Lipoportein Low DensityLipoprotein (HDL) (LDL)
0.2
Column means diff. UA - SA
MCI - SA
MCI - SA
MCI - UA
MCI - UA 0.0
0.0
95% Confidence Intervals (Tukey)
UA - SA
-0.1
-0.2
Cholesterol
95% Confidence Intervals (Tukey)
-0.2
-0.4
Difference between group means
Column means diff.
**
MCI - SA
0.5
Glucose
**
UA - SA
*
-0.25 -0.20 -0.15 -0.10 -0.05
0.0
Difference between group means
95% Confidence Intervals (Tukey)
*
*
MCI - SA
0.1
0.2
0.3
0.4
-0.4
Difference between group means
Column means diff.
CONCLUSION -0.2
0.0
0.2
0.4
Difference between group means
Triglyceride
Total CH:HDL Ratio
a One-‐way ANOVA test
b * p < 0.05,** p < 0.001
Higher systolic blood pressure and glucose level with lower HDL level increase risk of MCI and UA as compared with SA a
Ageing groups b
MCI
Usual Ageing
Independent Variables
Regression Coefficient (B)
p Value
Odd RaDo
95% C.I
Systolic BP
0.015
< 0.05
1.015
1.001 -‐ 1.029
Glucose
0.431
< 0.001
1.539
1.282 -‐ 1.847
HDL
-‐1.050
< 0.05
0.350
0.160 -‐ 0.764
Systolic BP
0.022
< 0.001
1.022
1.010 -‐ 1.034
Glucose
0.377
< 0.001
1.458
1.224 -‐ 1.737
HDL
-‐0.794
< 0.05
0.452
0.239 -‐ 0.854
a Mul6nomial Logis6c Regression test controlled for gender, age and educa6on years b The reference category is Successful Ageing.
Ø The prevalence of successful ageing among Malaysian elderly is 10.8% which is lower than 13.8% reported in previous study9. Ø Unsuccessful ageing groups which includes usual ageing and MCI carried the same vascular risk factors when compared with successful ageing group. Both cogni6ve impairment and chronic diseases develop in parallel with the ageing process and as such share a number of risk factors. Ø Maintenance of physical and cogni6ve func6oning are two important characteris6cs of successful ageing11. It has been reported that isolated systolic hypertension may cause blood brain barrier dysfunc6on and increase risk of stroke, which have adverse impacts on cogni6ve func6on12. Besides, diabetes may also increased the risk of func6onal disability and mobility limita6ons13, and therefore reduced the likelihood of subsequent successful ageing. Ø HDL cholesterol was stated to have cardiovascular as well as neurological protec6ve effect during ageing14. Maintain a high HDL level may reduce risk of MCI and promote successful ageing. Ø Further inves6ga6on on the causal rela6onship between vascular risk factors and ageing groups and its associa6ons with different domains in ageing groups categoriza6on can provide opportuni6es for improved understanding the underlying mechanisms.
Column means diff.
*
UA - SA
MCI - UA
Diastolic BP
95% Confidence Intervals (Tukey)
95% Confidence Intervals (Tukey) Column means diff.
**
**
Difference between group means
Systolic BP
MCI - SA
Column means diff. UA - SA
MCI - SA
Difference between group means
UA - SA
95% Confidence Intervals (Tukey)
*
UA - SA
1. Free from six major diseases: high blood pressure, diabetes, cancer, chronic lung disease, conges6ve heart failure and stroke through self reported medical history Preserved independence in func6onal abili6es, scored 14 in IADL 2. No depression, scored ≤ 4 in GDS 3. Scored ≥ 22 in MMSE Answering “ Sa6sfied” or “ Very sa6sfied” in a single item ‘Quality of Life’ and “ I am well some of the 6me” or “ I am well most of the 6me” in item ‘Your health status of the last two weeks’
Par6cipants with lower HDL level, higher blood glucose level and systolic blood pressured had higher risk in undergoing unsuccessful ageing. Therefore, reducing the development of vascular risk factors is a key strategy to prevent MCI or demen6a and also promote successful ageing.
ACKNOWLEDGEMENT The study was funded by UKM GUP 2011-‐130, UKM AP 2011-‐27, and LRGS/ BU/2012/UKM-‐UKM/K/01. The authors thank the par6cipants, field workers and co-‐researchers involved in this study.
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