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- Predictors of metabolic syndrome in adults and older adults from Amazonas, BrazilPublication . Gouveia, Élvio Rúbio; Gouveia, Bruna R.; Marques, Adilson; Peralta, Miguel; França, Cíntia; Lima, Alex; Campos, Alderlane; Jurema, Jefferson; Kliegel, Matthias; Ihle, Andreas: Metabolic syndrome has been considered a factor of vulnerability and a major public health problem because it increases the risk of cardiovascular disease and type 2 diabetes. The present study from Amazonas, Brazil aimed to estimate the prevalence of the individual and general components of metabolic syndrome in adults and older adults and identify the independent predictors of metabolic syndrome. The sample of the present cross-sectional study comprised 942 participants (590 women), with a mean age of 59.8 ± 19.7 (range: 17.5 to 91.8). Blood pressure in men (62.5%), abdominal obesity in women (67.3%), and lower high-density lipoprotein cholesterol (HDL-C) in both (52.2% in men and 65.0% in women) were the most prevalent individual risk factors for metabolic syndrome. Women had a higher prevalence of abdominal obesity (p < 0.001), low HDL-C (p < 0.001), and metabolic syndrome (p < 0.001) than men; however, opposite results were seen in men for blood pressure (p < 0.001). The overall prevalence of metabolic syndrome was 47.5%. Advanced age, being female, having a higher body mass index, and a having lower educational level independently increased the odds of metabolic syndrome. Due to the association of metabolic syndrome with deterioration of health status and increased vulnerability, this study sustains the need for early public health interventions in the Amazonas region.
- Sarcopenia and Physical Activity Predict Falls in Older Adults from Amazonas, BrazilPublication . Ihle, Andreas; Kliegel, Matthias; Jurema, Jefferson; Tinôco, Antonieta; Campos, Pedro; Marques, Adilson; Gouveia, Bruna; Gouveia, Élvio Rúbio; Miranda, Kessketlen Alvest. Introduction: Sarcopenia is a progressive and widespread skeletal muscle disorder involving loss of muscle mass and function, and is associated with several outcomes, including falls, functional decline, frailty, and mortality. Therefore, this study aimed: (1) to estimate the prevalence of sarcopenia, falls, and the risk of falls considering age, sex, and the level of physical activity (PA), and (2) to identify which of these predictors better explained the likelihood that participants present risk of fall. A total of 701 participants (433 women) with a mean age of 70.4±6.9. Sarcopenia was determined according to the most recent guidelines from the European Working Group (EWGSOP2). The prevalence of falls and the level of physical activity were assessed by questionnaires. The risk of falls was assessed using the Fullerton Advance Balance (FAB) scale. This study provides evidence that women (OR: 2.5, p<0.001), the oldest people (OR: 1.1 p<0.001), and people who had identified sarcopenia (OR: 2.9 p<0.001), and lower level of physical activity (OR: 2.9 p<0.001), were more likely to present the risk of falls. Implications for vulnerable aging are discussed.
- The Relation of Having Experienced a Fall in the Past to Lower Cognitive Functioning in Old Age Is Mediated via Less Physical Activity Engagement as Cognitive Reserve ContributorPublication . Ihle, Andreas; Gouveia, Élvio R.; Gouveia, Bruna R.; Marques, Adilson; Marconcin, Priscila; Nascimento, Marcelo de Maio; Haas, Maximilian; Jurema, Jefferson; Tinôco, Maria A.; Kliegel, MatthiasSimple Summary: Experiencing a fall in old age represents a critical life event affecting physical and cognitive health and the ability to engage in physical activities and exercise. This is crucial since physical activity engagement contributes to the accumulation of the so-called cognitive reserve relevant for maintaining cognitive health at old age. The goal of our study was to investigate whether the relationship between having experienced a fall and lower cognitive functioning can be explained by hampered physical activity engagement. Confirming this idea, our findings demonstrated that experiencing a fall at an older age hinders sufficient physical activity engagement and thereby impedes cognitive reserve accumulation, resulting in lower cognitive functioning outcomes. Consequently, our study suggests that at old age, the prevention of falls and related accidents is not only crucial to avoid injuries and preserve physical health, but it is also essential for maintaining one’s ability to engage in physical activities and exercises and, consequently, for preserving cognitive health in later life. Abstract: Physical activity and exercise contribute to the accumulation of cognitive reserve, which is instrumental for preserving cognitive health in old age. In a large sample of 701 older adults (mean age = 70.36 years), we investigated whether the relationship between having experienced a fall in the past and lower performance in cognitive functioning was mediated via less physical activity engagement as a cognitive reserve contributor. General cognition was assessed using the mini-mental state examination (MMSE), long-term memory using a word-pair delayed recall test and working memory using a backward digit-span test. In face-to-face interviews, individuals reported information on falls during the past 12 months and their habitual physical activity engagement. Our analyses demonstrated that the relationship between having experienced a fall in the past and lower performance in the cognitive functioning measures was partly mediated (by 16.3% for general cognition, 30.6% for ong-term memory, and 33.1% for working memory, respectively) via less physical activity engagement. In conclusion, we suggest as a core bio-psychological mechanism that experiencing a fall at an older age is a critical life event that hinders sufficient physical activity engagement and thereby impedes cognitive reserve build-up, resulting in lower cognitive functioning outcomes.
- The relation of education, occupation, and cognitive activity to cognitive status in old age: the role of physical frailtyPublication . Ihle, Andreas; Gouveia, Élvio R.; Gouveia, Bruna R.; Freitas, Duarte; Jurema, Jefferson; Odim, Angeany P.; Kliegel, MatthiasBackground: It remains unclear so far whether the role of cognitive reserve may differ between physically frail compared to less frail individuals. Therefore, the present study set out to investigate the relation of key markers of cognitive reserve to cognitive status in old age and its interplay with physical frailty in a large sample of older adults. Methods: We assessed Mini-Mental State Examination (MMSE) in 701 older adults. We measured grip strength as indicator of physical frailty and interviewed individuals on their education, past occupation, and cognitive leisure activity. Results: Greatergripstrength,longereducation,highercognitivelevelofjob,andgreaterengagingincognitive leisure activity were significantly related to higher MMSE scores. Moderation analyses showed that the relations of education, cognitive level of job, and cognitive leisure activity to MMSE scores were significantly larger in individuals with lower, compared to those with greater grip strength. Conclusions: Cognitive status in old age may more strongly depend on cognitive reserve accumulated during the life course in physically frail (compared to less frail) older adults. These findings may be explained by cross-domain compensation effects in vulnerable individuals.
- High-density lipoprotein cholesterol level relates to working memory, immediate and delayed cued recall in brazilian older adults: the role of cognitive reservePublication . Ihle, Andreas; Gouveia, Élvio R.; Gouveia, Bruna R.; Freitas, Duarte L.; Jurema, Jefferson; Tinôco, Maria A.; Kliegel, MatthiasAims: The present study set out to investigate the relation of the high-density lipoprotein cholesterol (HDL-C) level to cognitive performance and its interplay with key markers of cognitive reserve in a large sample of older adults. Methods: We assessed tests of working memory, immediate and delayed cued recall in 701 older adults from Amazonas, Brazil. The HDL-C level was derived from fasting blood samples. In addition, we interviewed individuals on their education, past occupation, and cognitive leisure activity. Results: A critically low HDL-C level (<40 mg/dL) was significantly related to lower performance in working memory, immediate and delayed cued recall. Moderation analyses suggested that the relations of the HDL-C level to working memory and delayed cued recall were negligible in individuals with longer education, a higher cognitive level of the job, and greater engagement in cognitive leisure activity. Conclusion: Cognitive reserve accumulated during the life course may reduce the detrimental influences of a critically low HDL-C level on cognitive functioning in old age.
- The relation of hypertension to performance in immediate and delayed cued recall and working memory in old age: the role of cognitive reservePublication . Ihle, Andreas; Gouveia, Élvio R.; Gouveia, Bruna R.; Freitas, Duarte L.; Jurema, Jefferson; Machado, Floramara T.; Kliegel, MatthiasWe investigated the relation of hypertension to cognitive performance and its interplay with key markers of cognitive reserve in a large sample of older adults. Method: We assessed tests of immediate and delayed cued recall and working memory in 701 older adults. We measured systolic blood pressure and interviewed individuals on their education, past occupation, and cognitive leisure activity. Results: Hypertension (≥140 mmHg) was related to lower performance in all three cognitive measures. Moderation analyses suggested that these relations were reduced in individuals with greater engaging in cognitive leisure activity. Hierarchical regression analyses showed that hypertension was not related to any of the three investigated cognitive performance measures when education, cognitive level of job, and cognitive leisure activity were simultaneously taken into account. Discussion: The detrimental influences of hypertension on cognitive functioning in old age may be reduced in individuals with greater cognitive reserve accumulated during the life course.
- The relation of education and cognitive activity to mini‑mental state in old age: the role of functional fitness statusPublication . Ihle, Andreas; Gouveia, Élvio R.; Gouveia, Bruna R.; Freitas, Duarte L.; Jurema, Jefferson; Ornelas, Rui T.; Antunes, António M.; Muniz, Bárbara R.; Kliegel, MatthiasIt remains unclear so far whether the role of cognitive reserve for cognitive functioning in old age may differ between individuals with low, compared to those with high functional fitness status. Therefore, the present study set out to investigate the relation of education and cognitive leisure activity as key markers of cognitive reserve to mini-mental state in old age (as an indicator of the extent of cognitive impairment) and its interplay with functional fitness status in a large sample of older adults. We assessed MMSE in 701 older adults (M = 70.4 years, SD = 6.9, range: 60–91). We measured functional fitness status using the Senior Fitness Test battery and interviewed individuals on their education and cognitive leisure activity. Results showed that better functional fitness status, longer education, and greater engagement in cognitive leisure activity were significantly related to higher MMSE scores. Moderation analyses showed that the relations of education and cognitive leisure activity to MMSE scores were significantly larger in individuals with low, compared to those with high functional fitness status. In conclusion, cognitive functioning in old age may more strongly depend on cognitive reserve accumulated during the life course in older adults with low, compared to those with high functional fitness status. These findings may be explained by cross-domain compensation effects in vulnerable individuals and may (at least partly) account for the large variability in cognitive reserve–cognition relations debated in the literature.
- The relationship of physical activity to high-density lipoprotein cholesterol level in a sample of community-dwelling older adults from Amazonas, BrazilPublication . Gouveia, Élvio R.; Ihle, Andreas; Kliegel, Matthias; Freitas, Duarte L.; Jurema, Jefferson; Tinôco, Maria A.; Odim, Angeany; Machado, Floramara T.; Muniz, Bárbara R.; Antunes, António M.; Ornelas, Rui T.; Gouveia, Bruna R.Objectives: (1) To study the relation of physical activity (PA) to high-density lipoprotein cholesterol (HDL-C) and (2) to investigate if the strength of these associations holds after adjustments for sex, age, and other key correlates. Methods: This study included 550 older adults from Amazonas. HDL-C was derived from fasting blood samples. PA at sport and leisure, smoking, alcohol consumption, and socioeconomic status (SES) were interviewed. Waist circumference (WACI) was assessed. Results: HDL-C was positively related to PA sport, PA leisure, and SES (0.22 ≤ r ≤ 0.34; p ≤ 0.001) and negatively related to smoking and WACI (r ≤−0.10; p < 0.05). Controlling for sex and age did not affect these relationships. Hierarchical multiple regression analyses showed that the relation of HDL-C to PA sport and leisure remainedsignificantwhencontrolling forallotherinvestigatedcorrelates (0.14 ≤β≤ 0.24;p ≤ 0.001). Discussion: In order to prevent low HDL-C in older adults, promoting PA seems to be an important additional component besides common recommendations concerning weight reduction.
- Cognitive function and its associations in older adults from Amazonas, BrazilPublication . Freitas, Duarte Luís; Gouveia, Bruna Raquel; Ribeiro, Euler Esteves; Muniz, Bárbara Régia; Odim, Angeany Pinto; Machado, Floramara Teles; Jurema, Jefferson; Kliegel, Matthias; Ihle, Andreas; Gouveia, Élvio Rúbio; Tinôco, Maria Antonieta de CamposThe objectives of this study were: (1) to investigate the age-related differences in cognitive function (CF), nutritional status (MNA), physical activity (AF), quality of life (QoL), depression, social satisfaction (SS) and socioeconomic status (SES), and (2) to explore the relationships between CF and the previous variables. This cross sectional study included 268 men and 433 women (aged 71.4 ± 7.0 years). CF was determined with the Cognitive Telephone Screening Instrument (COGTEL) and the Mini-Mental State Examination (MMSE). Correlates were as follows: Mini Nutritional Assessment (MNA), PA (Baecke questionnaire modified for older adults), Quality of life (QoL SF12), Geriatrics Depression Scale (GDS), Satisfaction and Social Support Scale, and Socioeconomic status (SES). All instruments were applied in a face to face interview. An independent t-test identified significantly higher scores in young-old adults (≤ 69 years) for CF (p < 0.001), PA (p = 0.046) and SES (p = 0.007), compared to old-old adults (≥ 70 years). The results of multiple linear regression analysis indicated that the most significant CF correlates were SES (β = 0.45; p < 0.001), age (β = -0.12; p < 0.001), SS (β = 0.12; p = 0.001), GDS (β = -0.11; p = 0.003) and QoL (β = 0.08; p = 0.017). The overall regression model explained 36% of the total variance in the COGTEL. The oldest and the more depressed adults obtained lower scores for FC. The present study suggests that, between the correlates studied, SES was the strongest predictor in the explanation of CF in older adults.
- Cognitive Functioning Mediates the Association of Cognitive Reserve with Health-Related Quality of LifePublication . Ihle, Andreas; Gouveia, Élvio R.; Gouveia, Bruna R.; Marques, Adilson; Marconcin, Priscila; Nascimento, Marcelo de Maio; Jurema, Jefferson; Tinôco, Maria A.; Kliegel, MatthiasWe investigated whether the relations of the cognitive reserve markers education and cogni tive level of work to the physical and the mental component of health-related quality of life (HRQoL) were mediated via cognitive functioning in a large sample of 701 older adults (mean age = 70.36 years, SD = 6.87). HRQoL was measured with the 12-item Short-Form Health Survey. To measure cog nitive functioning, we used the COGTEL, which is a cognitive test battery assessing prospective memory, verbal short-term memory, verbal long-term memory, working memory, verbal fluency, and inductive reasoning, combined into a composite score. Individuals reported information on their education and their main profession during their working life. Mediation analyses showed that better cognitive functioning mediated the association of higher values in the cognitive reserve markers (longer education and a high cognitive level of work) with higher HRQoL. In conclusion, the present study suggests that the sustainability of cognitive functioning in old age with the help of cognitive reserve is fundamental for the sustainability of quality of life, presumably particularly for the mental HRQoL component.