@article {723, title = {Evaluation of dementia in the cardiovascular health cognition study.}, journal = {Neuroepidemiology}, volume = {22}, year = {2003}, month = {2003 Jan-Feb}, pages = {1-12}, abstract = {

OBJECTIVE: To describe a methodology to evaluate dementia and frequency of different types of dementia and prevalence of the Cardiovascular Health Study (CHS).

METHODS: The CHS is a longitudinal study of cardiovascular disease among community-dwelling individuals over the age of 65. Of the 5,888 participants in the original study, 3,608 had a magnetic resonance imaging (MRI) of the brain in 1991, and formed the cohort for the dementia study. The CHS included yearly measures of cognitive function and, from 1998 to 2000, participants were evaluated for dementia by detailed neurological, and neuropsychological examinations. The possible cases of dementia and mild cognitive impairment (MCI) were adjudicated by a review committee of neurologists and psychiatrists.

RESULTS: There were 480 cases of (13.3\%) incident dementia in the total sample, 227 (6.3\%) prevalent dementia, 577 (16.0\%) MCI, and 2,318 (64.4\%) normal. The adjudication committee classified 69\% of the incident dementia as Alzheimer{\textquoteright}s disease (AD), 11\% as vascular dementia (VaD), 16\% as both, and 4\% as other types. There was a substantial agreement between pre- and postMRI diagnosis of types of dementia. The frequency of dementia within the CHS cohort which survived to the end of the study in 1998-1999, was 13.5\% for white men, 14.5\% for white women, 22.2\% for black men and 23.4\% for black women.

CONCLUSION: The CHS has developed a methodology for longitudinal studies of dementia in large cohorts and represents the largest study of dementia including cognitive testing, MRI and genetic markers.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Cardiovascular Diseases, Cognition Disorders, Cohort Studies, Cross-Sectional Studies, Dementia, Female, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Prevalence, Risk Factors, Sex Distribution}, issn = {0251-5350}, doi = {10.1159/000067110}, author = {Lopez, Oscar L and Kuller, Lewis H and Fitzpatrick, Annette and Ives, Diane and Becker, James T and Beauchamp, Norman} } @article {1241, title = {Diastolic blood pressure levels and ischemic stroke incidence in older adults with white matter lesions.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {66}, year = {2011}, month = {2011 Jan}, pages = {74-81}, abstract = {

BACKGROUND: The optimal blood pressure level to minimize the risk of ischemic stroke (IS) in older adults is undetermined. Cerebral white matter lesions (WML), prevalent in older adults, may be a marker for vulnerability to IS. We aimed at determining the relationship between diastolic blood pressure (DBP) levels and IS in the presence of WML.

METHODS: The Cardiovascular Health Study population (N = 3,345, age >= 65 years, N = 3,345) was followed between 1989 and 2002 for IS incidence. Survival analysis included quintiles of DBP analyzed within WML levels controlling for age and cardiovascular disease.

RESULTS: DBP had no effect on IS incidence in low WML levels but had a marginally significant J-curve relationship with IS in high WML levels: the adjusted hazard ratio for IS in the lowest (<63 mmHg) and highest (>= 80) DBP quintiles compared with the third (nadir, 69-73 mmHg) was 1.64 (95\% confidence interval: 0.93-2.9) and 1.83 (95\% confidence interval: 1.06-3.15), respectively.

CONCLUSIONS: In older adults with low-grade WML, low DBP may not pose a risk for IS. However, in high-grade WML, IS risk may increase in DBP less than 69 mmHg but is highest more than 80 mmHg. People with high-grade WML may be at risk of IS in high and low DBP.

}, keywords = {Aged, Aged, 80 and over, Brain, Brain Ischemia, Cerebrovascular Circulation, Diastole, Female, Humans, Incidence, Male, Multivariate Analysis, Stroke}, issn = {1758-535X}, doi = {10.1093/gerona/glq166}, author = {Reshef, Shoshana and Fried, Linda and Beauchamp, Norman and Scharfstein, Daniel and Reshef, Daniel and Goodman, Steven} }