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  • Cross-sectional survey of Parkinson's disease and parkinsonism in a rural area of the United Kingdom.

    3 November 2018

    The objective of this study was to estimate the crude and standardized age/sex-adjusted prevalence rates of parkinsonism and Parkinson's disease (PD) in a rural area of North Wales. Cases of PD and parkinsonism in a geographically defined rural area of North Wales were ascertained from the prescription of antiparkinsonian medication in primary care, hospital records, attendance at general medical outpatient clinics and at a specialist movement disorder clinic. In this population, the crude prevalence of clinically probable/possible PD was 144 per 1000,000 (95% confidence interval [CI], 120-173) and for parkinsonism 169 per 100,000 (95% CI, 143-201). When adjusted to the UK population, the prevalence for clinically probable PD was 105 per 100,000 (95% CI, 85-124) and for parkinsonism 122 per 100,000 (95% CI, 102-143). Age- and sex-adjusted standardized rates indicate that regional variations in PD and parkinsonism may exist in the United Kingdom. There are several possible reasons for this, although methodological differences between studies may be the most likely explanations for the present findings.

  • A framework for the adaptation of psychological questionnaires for epidemiological use: an example of the Bortner Type A scale.

    3 November 2018

    A model for the systematic adaptation of psychological questionnaires for epidemiological use is presented. Application of the model is illustrated using variants of the Bortner Type A scale in a representative age/sex stratified sample of 256 persons. Through the application of the model the Bortner scale was adapted to compare the effects of scale direction, scale format and example position. Overall the Bortner scale was shown to provide robust measurement which was little affected by response rate, age, sex or by the adaptations of the scale. An association was found of sex with response rate. Interaction effects of sex and scale direction on mean Type A scores, and of example position and scale format on both response rate and Type A score variability were also found. In identifying critical aspects of questionnaire performance, and in providing a coherent framework for their interrelationship, the model acts as a guide to the systematic assessment of questionnaire performance. The use of this model will, therefore, facilitate greater confidence in the interpretation of questionnaire data in epidemiological studies.

  • Generating large-scale longitudinal data resources for aging research.

    3 November 2018

    OBJECTIVES: The need for large studies and the types of large-scale data resources (LSDRs) are discussed along with their general scientific utility, role in aging research, and affordability. The diversification of approaches to large-scale data resourcing is described in order to facilitate their use in aging research. METHODS: The need for LSDRs is discussed in terms of (a) large sample size; (b) longitudinal design; (c) as platforms for additional investigator-initiated research projects; and (d) broad-based access to core genetic, biological, and phenotypic data. DISCUSSION: It is concluded that a "lite-touch, lo-tech, lo-cost" approach to LSDRs is a viable strategy for the development of LSDRs and would enhance the likelihood of LSDRs being established which are dedicated to the wide range of important aging-related issues.

  • An analysis of prospective risk factors for aortic stiffness in men: 20-year follow-up from the Caerphilly prospective study.

    3 November 2018

    Arterial stiffness is an important determinant of cardiovascular risk. The precise risk factors for arterial stiffening remain unclear. We aimed to identify potential risk factors using prospective exposure data from the Caerphilly Prospective Study. Aortic pulse wave velocity and augmentation index were measured in 825 men and related to current (2004) and baseline (1979-1988) anthropometric, hemodynamic, and biochemical factors. The mean age of the men was 74 years, with an average follow-up of 20 years. The only independent baseline predictors of current velocity were pulse pressure (standardized beta-coefficient: 0.58), C-reactive protein (0.35), glucose (0.25), and waist circumference (0.23). The sole baseline predictor of current augmentation index was fibrinogen (0.78). After additional adjustment for the corresponding current risk factor, pulse wave velocity was best related to cumulative exposure to C-reactive protein, whereas augmentation index was most strongly related to current levels. Velocity was also more strongly correlated with baseline levels of triglycerides and smoking but with current waist circumference. The pulse pressure heart rate product assessed over the whole of 20 years was independently correlated with aortic pulse wave velocity but not augmentation index. Other than blood pressure, established cardiovascular risk factors have only a modest effect on aortic stiffness and wave reflection. Inflammation and the level of repetitive cyclic stress are important predictors of aortic stiffness, whereas wave reflection is predicted by acute inflammation only. Adequate control of pulse pressure and heart rate, as well as reducing inflammation, may, in the long-term, retard aortic stiffening, although this remains to be tested directly.

  • Does anxiety affect risk of dementia? Findings from the Caerphilly Prospective Study.

    3 November 2018

    OBJECTIVE: To examine the association of anxiety with incident dementia and cognitive impairment not dementia (CIND). METHODS: We conducted a prospective study of men aged 48 to 67 years at baseline anxiety assessment; we measured cognition 17 years later. We studied 1481 men who were either eligible for examination or were known to have dementia. Trait Anxiety was assessed using the Spielberger State Trait Anxiety Inventory. Psychological distress was assessed using the 30-item general health questionnaire. Cognitive screening was followed by a clinical examination. Medical notes and death certificates of those not seen were also examined. Outcomes were CIND and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) dementia. RESULTS: Of 1160 men who were cognitively screened, 174 cases of CIND and 69 cases of dementia were identified. A further 21 cases of dementia were identified from medical records. After adjustment for age, vascular risk factors and premorbid cognitive function associations with higher anxiety (31st-95th centile) were for CIND odds ratio (OR) 2.31 (95% Confidence Interval (CI) = 1.20-4.44) and for dementia OR 2.37 (95% CI = 0.98-5.71). These associations were slightly stronger for nonvascular (OR = 2.45; 95% CI = 1.28-4.68) than for vascular impairment (OR = 1.94; 95% CI = 0.77-4.89). Analyses of change in cognitive performance, assessed by the Cambridge Cognitive Examination of the Elderly subscales found some evidence for decline in learning memory with higher anxiety score (b(age adj) = -0.291 (-0.551, -0.032), but not for any other subscale. CONCLUSIONS: Anxiety is a risk factor for CIND and dementia. The extent to which the association is independent of depression and whether or not it is causal requires further study.

  • Anger and incident heart disease in the caerphilly study.

    3 November 2018

    OBJECTIVE: The idea that anger may predict ischemic heart disease (IHD) is more than 30 years old. Some, but not all, prospective studies have supported this suggestion. Attention has focused on hostility as the critical component of anger for IHD risk. This idea is explored using prospective data from the Caerphilly study. METHODS: A sample of 2890 men aged 49 to 65 years living in and around Caerphilly, South Wales, was identified. Anger was assessed using the Framingham scales comprising "anger symptoms," "anger in," "anger out," and "anger discuss." A new "suppressed anger" scale was also constructed. Cardiovascular risk factors assessed included baseline blood pressure, total and high-density lipoprotein cholesterol, fibrinogen, white cell count, psychiatric caseness as assessed by the General Health Questionnaire, social support, smoking habit, alcohol consumption, leisure exercise, body mass index, and calorie intake. Prediction of IHD, measured as the occurrence of a major event over a follow-up period of 9 years, was assessed using multiple logistic regression analysis. RESULTS: A low anger out score predicted increased risk of a major IHD event (relative odds (RO) = 1.70; 95% confidence interval = 1.26-2.29 for all RO). This association was unchanged on controlling for physiological risk factors (RO = 1.74), psychosocial risk factors (RO = 1.72), and behavioral risk factors (RO = 1.69). Suppressed anger showed associations with incident IHD similar to those of anger out but identified the population at risk more closely. CONCLUSIONS: Anger out and suppressed anger were predictive of incident IHD. Neither of these constructs are overtly similar to hostility. These findings suggest there may be mechanisms other than hostility by which anger predicts IHD risk and that a conceptually varied approach to anger is currently appropriate.

  • Coffee, blood pressure and plasma lipids: a randomized controlled trial.

    3 November 2018

    A randomized controlled trial was conducted to examine the effects of coffee (as commonly drunk in Britain) on blood pressure and plasma lipids in healthy subjects. Fifty-four subjects followed three regimens successively, the order being randomized according to a Latin square design: five or more cups of coffee daily for 4 weeks; five or more cups of decaffeinated coffee daily for 4 weeks but no ordinary coffee; no coffee for 4 weeks. Coffee appeared to cause a small rise (of 3 mm Hg) in recumbent systolic blood pressure; this effect was less than, and obscured by, changes induced by posture and mild stress. No consistent changes attributable to coffee were found in diastolic blood pressure or pulse rate. Small changes in the expected directions occurred in plasma high density lipoprotein (HDL) cholesterol and apolipoprotein AI (decrease), and in total cholesterol, non-HDL cholesterol and apolipoprotein B (increase), but none of these were statistically significant. The effect of coffee on risk of heart disease in Britain is probably small.