Update in Geriatrics

Update in Geriatrics

William J. Hall, MD

From the University of Rochester School of Medicine, Rochester, New York.

2006 Series: Update Sessions from ACP's 2006 Annual Session

The articles in this Update in Geriatrics came from a review of approximately 30 peer-reviewed journals during 2005. The selected articles are important clinical research studies that pertain to elderly patients in the primary care setting, with a concentration on improving functionality. Topics covered are cognitive and physical function, stroke, age and frailty, and quality of care. Changes to clinical practice emerging from these articles are shown in the Table .

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Table. Changes to Practice Emerging from Articles Important to Geriatricians in 2005*

Cognitive and Physical Function

Higher Homocysteine Levels Are Linked with Worse Cognitive Function

SchaferJH,
GlassTA,
BollaKI

et al.Homocysteine and cognitive function in a population-based study of older adults.J Am Geriatr Soc200553381-8

Schafer JH, Glass TA, Bolla KI, et al. Homocysteine and cognitive function in a population-based study of older adults. J Am Geriatr Soc. 2005;53:381-8. [PMID: 15743278]

Homocysteine is associated with cardiovascular and cerebrovascular disease, and some epidemiologic studies suggest that homocysteine levels may be a risk factor for cognitive dysfunction. Schafer and colleagues' population-based study aimed to better assess the potential relationship between homocysteine levels and cognitive function in older adults while adjusting for common confounding risk factors. They studied patients who were enrolled in the Baltimore Memory Study, a cohort study of risk factors for cognitive decline in 1140 randomly selected Baltimore, Maryland, residents 50 to 70 years of age (mean age, 59 years). Sixty-five percent of participants were women, 54% were white, and 41% were African American.

Schafer and colleagues evaluated the relationship between homocysteine levels and 20 neurobehavioral test scores in 8 cognitive domains, adjusting for confounding factors, such as age, sex, race or ethnicity, blood lead levels, and apolipoprotein E haplotypes. They found that higher homocysteine levels were strongly and independently associated with worse performance on the cognitive tests. Homocysteine levels were associated with performance in all 8 domains, but the association was strongest and most consistent in the verbal memory and learning, eye–hand coordination, and psychomotor speed domains. The effect of elevated homocysteine levels was statistically significant: Differences between the 25th and 75th percentile were equivalent in association to those in neurobehavioral test scores associated with an average increase in age …

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