ORCID Profile
0000-0003-1872-3314
Current Organisations
Alfred Health
,
Monash University
,
Monash University Central Clinical School
,
Peninsula Health
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Publisher: Elsevier BV
Date: 06-2020
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2015.12.016
Abstract: There is increasing interest in the use of administrative data (incorporating comorbidity index) and stroke severity score to predict ischemic stroke mortality. The aim of this study was to determine the optimal timing for the collection of stroke severity data and the minimum clinical dataset to be included in models of stroke mortality. To address these issues, we chose the Virtual International Stroke Trials Archive (VISTA), which contains National Institutes of Health Stroke Scale (NIHSS) on admission and at 24 hours, as well as outcome at 90 days. VISTA was searched for patients who had baseline and 24-hour NIHSS. Improvement in regression models was performed by the net reclassification improvement (NRI) method. The clinical data among 5206 patients were mean age, 69 ± 13 comorbidity index, 3.3 ± .9 median NIHSS at baseline, 12 (interquartile range [IQR] 8-17) NIHSS at 24 hours, 9 (IQR 8-15) and death at 90 days in 15%. The baseline model consists of age, gender, and comorbidity index. Adding the baseline NIHSS to model 1 improved the NRI by 0.671 (95% confidence interval [CI] 0.595-0.747) [or 67.1% correct reclassification between model 1 and model 2]. Adding the 24 hour NIHSS term to model 1 (model 3) improved the NRI by 0.929 (95% CI 0.857-1.000) for model 3 versus model 1. Adding the variable thrombolysis to model 3 (model 4) improve NRI by 0.1 (95% CI 0.023-0.178) [model 4 versus model 3]. The optimal model for the prediction of mortality was achieved by adding the 24-hour NIHSS and thrombolysis to the baseline model.
Publisher: Wiley
Date: 15-10-2019
DOI: 10.1111/AJAG.12725
Abstract: To explore the perceived acceptability of the Volunteer Dementia and Delirium Care (VDDC)© program components from the perspective of key stakeholders in a metropolitan health network. A mixed-methods design was used. Surveys (nurses) and focus groups and interviews (hospital staff, volunteers, patients and caregivers) were conducted simultaneously. Descriptive statistics were used to profile the survey responses. The framework method was used to analyse the qualitative data. The majority of nurses identified that it is acceptable for volunteers to read to, and converse and play games with patients. Hospital staff perceived risk in volunteers assisting with feeding and mobilisation. Overall participants believed the VDDC was acceptable and would be of benefit to the patients. Key stakeholders have a favourable view of the VDDC© program. Strategies can be developed to address the identified issues, and components of the program may be amended to ensure that implementation is acceptable.
Publisher: Wiley
Date: 06-11-2019
DOI: 10.1111/AJAG.12726
Abstract: To explore the perceived barriers and enablers to the implementation of the Volunteer Dementia and Delirium Focus groups and interviews with hospital staff, volunteers, patients and caregivers. Deductive analysis was conducted for the Behaviour Change Wheel (COM-B) domains, and inductive thematic analysis for emerging themes. Utilising the skills and knowledge of volunteers, making the program available to all patients, and recognising that volunteers will improve the care experience for patients were identified as enablers. Threats to volunteer safety, difficulty in defining roles and responsibilities of volunteers, volunteer attrition and availability and supervision of volunteers were perceived as barriers to implementation. To enhance the implementation of the program into a metropolitan setting, strategies addressing the identified barriers and enablers need to be developed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-12-2020
Publisher: Oxford University Press (OUP)
Date: 20-01-2020
Abstract: The contribution of cerebral small vessel disease (cSVD) to the pathogenesis of frailty remains uncertain. We aimed to examine the associations between cSVD with progression of frailty in a population-based study of older people. People aged between 60 and 85 years were randomly selected form the electoral roll to participate in the Tasmanian Study of Cognition and Gait. Participants underwent self-reported questionnaires, objective gait, cognitive and sensorimotor testing over three phases ranging between 2005 and 2012. These data were used to calculate a 41-item frailty index (FI) at three time points. Baseline brain magnetic resonance imaging was performed on all participants to measure cSVD. Generalized mixed models were used to examine associations between baseline cSVD and progression of frailty, adjusted for confounders of age, sex, level of education, and total intracranial volume. At baseline (n = 388) mean age was 72 years (SD = 7.0), 44% were female, and the median FI score was 0.20 (interquartile range [IQR] 0.12, 0.27). In fully adjusted models higher burden of baseline white matter hyperintensity (WMH) was associated with frailty progression over 4.4 years (β = 0.03, 95% CI: 0.01, 0.05 p = .004) independent of other SVD markers. Neither baseline infarcts (p = .23), nor microbleeds at baseline (p = .65) were associated with progression of frailty. We provide evidence for an association between baseline WMHs and progression of frailty. Our findings add to a growing body of literature suggesting WMH is a marker for frailty.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-01-2019
DOI: 10.1212/WNL.0000000000006851
Abstract: To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10 −8 and LINC00539/ZDHHC20, p = 5.82 × 10 −9 . Both have been associated with blood pressure (BP)–related phenotypes, but did not replicate in the smaller follow-up s le or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits ( p value for BI, p [BI] = 9.38 × 10 −25 p [SSBI] = 5.23 × 10 −14 for hypertension), smoking ( p [BI] = 4.4 × 10 −10 p [SSBI] = 1.2 × 10 −4 ), diabetes ( p [BI] = 1.7 × 10 −8 p [SSBI] = 2.8 × 10 −3 ), previous cardiovascular disease ( p [BI] = 1.0 × 10 −18 p [SSBI] = 2.3 × 10 −7 ), stroke ( p [BI] = 3.9 × 10 −69 p [SSBI] = 3.2 × 10 −24 ), and MRI-defined white matter hyperintensity burden ( p [BI] = 1.43 × 10 −157 p [SSBI] = 3.16 × 10 −106 ), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI ( p ≤ 0.0022), without indication of directional pleiotropy. In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifiable, causal risk factor for BI.
Publisher: Center for Open Science
Date: 21-09-2021
Abstract: The literature on large-scale resting-state functional brain networks across the adult lifespan was systematically reviewed. Studies published between 1986 and July 2021 were retrieved from PubMed. After reviewing 2,938 records, 144 studies were included. Results on 11 network measures were summarised and assessed for certainty of the evidence using a modified GRADE method. The evidence provides high certainty that older adults display reduced within-network and increased between-network functional connectivity. Older adults also show lower segregation, modularity, efficiency and hub function. Higher-order networks reliably showed age differences, whereas basic processing and control networks showed more variable results. The inflection point for network changes is often the third or fourth decade of life. Age effects were found with moderate certainty for increased hemispheric lateralisation at rest, reduced BOLD signal variability within-subjects and altered patterns and speed of dynamic connectivity. Research on connectivity using glucose uptake provides low certainty of age differences but warrants further study. Taken together, these age-related changes may contribute to the cognitive decline often seen in older adults.
Publisher: SAGE Publications
Date: 24-11-2012
DOI: 10.1111/J.1747-4949.2011.00725.X
Abstract: Cerebral small vessel disease is difficult to directly visualize in vivo. Therefore, we rely on radiological phenotypes as surrogate markers of disease. The principal phenotypes of clinical interest are small, deep brain infarcts, cerebral white matter lesions, deep brain haemorrhages, and cerebral microbleeds. The causes or mechanisms underlying these phenotypes are understood in varying degrees of detail. This review aims to summarize recent knowledge regarding these phenotypes and place it in context with classical clinicopathological observations to provide mechanistic, clinical, and therapeutic insights into small vessel disease.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.INJURY.2013.04.009
Abstract: There is a paucity of research into the outcomes and complications of cervical spine immobilisation (hard collar or halothoracic brace) in older people. To identify morbidity and mortality outcomes using geriatric medicine assessment techniques following cervical immobilisation in older people with isolated cervical spine fractures. We identified participants using an injury database. We completed a questionnaire measuring pre-admission medical co-morbidities and functional independence. We recorded the surgical plan and all complications. A further questionnaire was completed three months later recording complications and functional independence. Sixteen patients were recruited over a three month period. Eight were immobilised with halothoracic brace, 8 with external hard collar. Three deaths occurred during the study. Lower respiratory tract infection was the most common complication (7/16) followed by delirium (6/16). Most patients were unable to return home following the acute admission, requiring sub-acute care on discharge. The majority of patients were from home prior to a fall, 6/16 were residing there at 3 months. Most participants had an increase in their care needs at 3 months. There was no difference in the type or incidence of complications between the different modes of immobilisation. Geriatric medicine assessment techniques identified the morbidity and functional impairment associated with cervical spine immobilisation. This often results in a prolonged length of stay in supported care. This small pilot study recommends a larger study over a longer period using geriatric medicine assessment techniques to better define the issues.
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/3978428
Abstract: Type 2 diabetes mellitus increases the risk of dementia and neuronal dysfunction may occur years before perceptible cognitive decline. We aimed to study the impact of type 2 diabetes on brain activation during memory encoding in middle-aged people, controlling for age, sex, genes, and early-shared environment. Twenty-two twin pairs discordant for type 2 diabetes mellitus (mean age 60.9 years) without neurological disease were recruited from the Australian Twin Registry (ATR) and underwent functional magnetic resonance imaging (fMRI) during a memory encoding task, cognitive tests, and structural MRI. Type 2 diabetes was associated with significantly reduced activation in left hemisphere temporoparietal regions including angular gyrus, supramarginal gyrus, and middle temporal gyrus and significantly increased activation in bilateral posteriorly distributed regions. These findings were present in the absence of within-pair differences in standard cognitive test scores, brain volumes, or vascular lesion load. Differences in activation were more pronounced among monozygotic (MZ) pairs, with MZ in iduals with diabetes also displaying greater frontal activation. These results provide evidence for preclinical memory-related neuronal dysfunction in type 2 diabetes. They support the search for modifiable later-life environmental factors or epigenetic mechanisms linking type 2 diabetes and cognitive decline.
Publisher: Springer Science and Business Media LLC
Date: 12-07-2019
DOI: 10.1007/S11910-019-0973-4
Abstract: Type 2 diabetes (T2D) is a well-established risk factor for the development of dementia. Dementia and T2D share some underlying pathophysiology that has led to interest in the potential to repurpose drugs used in the management of T2D to benefit brain health. This review describes the scientific data available on the use of T2D medications for the risk reduction or management of dementia, in people with and without T2D. Results from basic laboratory research support the potential for commonly-used medications for T2D, including those with direct glucose-lowering properties, to have a beneficial effect on brain health. However, human studies have been mostly observational in nature and report conflicting results. Preliminary data suggest that intranasal insulin, metformin, and GLP-1 agonists show promise for dementia, but confirmatory evidence for their benefit in dementia is still lacking. Current evidence does not support the repurposing of T2D medications for dementia risk reduction or management. Research in the field of T2D and dementia is active, and further data are required before definitive conclusions can be drawn.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-10-2022
DOI: 10.1212/WNL.0000000000201028
Abstract: It is unknown whether there are sex-related profiles of cardiometabolic health that contribute differently to age-related changes in brain health during midlife. We studied how latent classes of middle-aged in iduals clustering by age, sex, menopause, and cardiometabolic health were associated with brain structure and cognitive performance. Health, brain, and abdominal MRI data from the UK Biobank cohort (men and women aged years in the United Kingdom) were used. We applied latent class analysis to identify groups of in iduals based on age, sex, menopausal status, and cardiometabolic health. We examined associations of class membership with brain volumes (total brain volume [TBV], gray matter volume [GMV], white matter volume [WMV], hippoc al volume, and white matter hyperintensity volume) and cognitive performance. Data were available for 36,420 in iduals (mean age 64.9 years, 48.5% women). Eight latent classes differing in age, sex, and cardiometabolic risk were identified. Class 1 (reference class) included in iduals with the lowest probability of older age and cardiometabolic risk, and the healthiest levels of brain volumes and cognition. In those aged years, but not in those aged 50–60 years, the negative associations of age with TBV, GMV, and WMV were greater in the class comprising healthier older women than classes comprising older men of varying cardiometabolic and vascular health. There were no age-class interactions for cognitive test performance. Latent class analysis detected groups of middle-aged in iduals clustering by cardiometabolic health. The relationship of age with brain volumes varies by sex, menopausal status, and cardiometabolic health profile.
Publisher: Elsevier
Date: 2018
Publisher: Frontiers Media SA
Date: 08-01-2017
Publisher: Wiley
Date: 09-2019
DOI: 10.1111/IMJ.14121
Abstract: Many hospitals use predictive scores to identify a person's risk of inpatient falls, pressure injury and malnutrition despite evidence of limited predictive accuracy. To examine whether we could improve predictive accuracy by generating a score combining all components of currently used tools. We performed a retrospective, cross-validation study in a single sub-acute (geriatrics and rehabilitation) hospital, extracting data regarding hospital risk scores, and incidence of falls, pressure injury and malnutrition from January 2014 to June 2016. The s le was randomly halved into training and testing data sets. For each harm outcome, model fit was examined using area under receiver operating characteristic curves (AUC) and proportions of people reclassified based on a combined score were calculated. Secondary analyses explored the predictive performance of in idual question-responses. Data were available for 4487 admissions (median age 83.0 years). A total of 667 (15%) people had at least one fall, 499 (11%) had at least one pressure injury and 20 (0.4%) malnutrition. The currently used tools had, at best, moderate ability to predict risk of harm outcomes (AUC 0.56-0.73). Testing of the combined score models resulted in minimal change in AUC (<5.1%) and did not add value to risk category reclassification. Most of the predictive ability of the currently used tools relied on the performance of two in idual question-responses. Combining scores or reducing to two-item question-responses did little to change predictive accuracy. This study highlights the limitations of hospital harm predictive scores and emphasises the importance of rigorous testing of predictive scores.
Publisher: American Diabetes Association
Date: 22-07-2015
DOI: 10.2337/DB14-0506
Abstract: Type 2 diabetes mellitus (T2DM) is associated with brain atrophy, but the mechanisms underlying this link are unknown. Advanced glycation end products (AGEs) accumulate in T2DM, resulting in inflammation, oxidative stress, and protein cross-linking, which are known contributors to neurodegeneration. We aimed to study whether tissue AGE accumulation is associated with T2DM-related brain atrophy. We performed brain magnetic resonance imaging, cognitive tests, and noninvasive skin autofluorescence (SAF a measure of tissue AGE levels) on people aged & years with and without T2DM. Multivariable linear regression was used to study the relationships among T2DM, SAF, and gray matter volume (GMV). There were 486 people included in the study. T2DM was associated with greater SAF. Greater SAF, T2DM, and cognitive impairment were each associated with lower GMV independently of age, sex, and total intracranial volume. SAF partially mediated the association between T2DM and GMV. Longitudinal studies may help confirm whether tissue AGE accumulation is associated with brain atrophy in T2DM.
Publisher: Wiley
Date: 11-04-2023
DOI: 10.1111/JGS.18353
Abstract: Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community‐dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort. Analysis included 19,114 community‐dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional‐hazards regression models were used to estimate the association between baseline PIMs exposure and disability‐free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities. At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability‐free survival (adjusted HR 1.02 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti‐psychotics and benzodiazepines, were associated with increased risk of disability. PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health.
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJDRC-2020-001646
Abstract: Women comprise two-thirds of people with dementia, making female sex a significant dementia risk factor. Both type 1 diabetes (T1D) and type 2 diabetes (T2D) are known dementia risk factors with an increasing global incidence. Understanding whether subtle sex differences persist in cognitive function prior to dementia in the context of diabetes may help elucidate the magnitude of sex effects on dementia risk. We examined cross-sectional data from the Study of Longevity in Diabetes (SOLID), a prospective cohort study of members of Kaiser Permanente Northern California aged 60 years and older with T1D (n=758), T2D (n=232) and without either T1D or T2D (n=247). We used factor analysis to generate summary scores of cognitive domains and used regression analyses to examine the associations between sex and cognition adjusting for sociodemographic and cardiovascular confounders. We included 1237 participants (630 women and 607 men) with mean age 68 years. By design, the distribution of men and women in T1D, T2D and no diabetes was similar. Women had better cognitive performance than men in global cognition (β=0.21, 95% CI 0.16 to 0.26), language (β=0.08, 95% CI 0.004 to 0.15), executive function (β=0.13, 95% CI 0.05 to 0.20), episodic verbal memory (β=0.68, 95% CI 0.59 to 0.77) and attention (β=0.20, 95% CI 0.11 to 0.28) but not in episodic visual memory (β=0.006, 95% CI −0.07 to 0.09) adjusting for age and education independent of diabetes status. We did not find an interaction between sex and diabetes status for any of the cognitive outcomes. Women in late mid-life have better cognitive performance than men in many cognitive domains independent of the presence of T1D or T2D. Further work is required to understand whether these differences change over time or in older cohorts and to understand their relationship to subsequent dementia.
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJDRC-2021-002557
Abstract: The incidence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing. Life expectancy is improving in T1D, resulting in a growing population of elderly adults with diabetes. While it is well established that older adults with T2D are at increased risk of cognitive impairment, little is known regarding cognitive aging in T1D and how their cognitive profiles may differ from T2D. We compared baseline cognitive function and low cognitive function by diabetes status (n=734 T1D, n=232 T2D, n=247 without diabetes) among in iduals from the Study of Longevity in Diabetes (mean age=68). We used factor analysis to group cognition into five domains and a composite measure of total cognition. Using linear and logistic regression models, we examined the associations between diabetes type and cognitive function, adjusting for demographics, comorbidities, depression, and sleep quality. T1D was associated with lower scores on total cognition, language, executive function sychomotor processing speed, and verbal episodic memory, and greater odds of low executive function sychomotor processing speed (OR=2.99, 95% CI 1.66 to 5.37) and verbal episodic memory (OR=1.92, 95% CI 1.07 to 3.46), compared with those without diabetes. T2D was associated with lower scores on visual episodic memory. Compared with T2D, T1D was associated with lower scores on verbal episodic memory and executive function sychomotor processing speed and greater odds of low executive function sychomotor processing speed (OR=1.74, 95% CI 1.03 to 2.92). Older adults with T1D had significantly poorer cognition compared with those with T2D and those without diabetes even after accounting for a range of comorbidities. Future studies should delineate how to reduce risk in this vulnerable population who are newly surviving to old age.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
DOI: 10.1161/STROKEAHA.115.009252
Abstract: White matter lesion (WML) progression on magnetic resonance imaging is related to cognitive decline and stroke, but its determinants besides baseline WML burden are largely unknown. Here, we estimated heritability of WML progression, and sought common genetic variants associated with WML progression in elderly participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium. Heritability of WML progression was calculated in the Framingham Heart Study. The genome-wide association study included 7773 elderly participants from 10 cohorts. To assess the relative contribution of genetic factors to progression of WML, we compared in 7 cohorts risk models including demographics, vascular risk factors plus single-nucleotide polymorphisms that have been shown to be associated cross-sectionally with WML in the current and previous association studies. A total of 1085 subjects showed WML progression. The heritability estimate for WML progression was low at 6.5%, and no single-nucleotide polymorphisms achieved genome-wide significance ( P ×10 −8 ). Four loci were suggestive ( P ×10 −5 ) of an association with WML progression: 10q24.32 (rs10883817, P =1.46×10 −6 ) 12q13.13 (rs4761974, P =8.71×10 −7 ) 20p12.1 (rs6135309, P =3.69×10 −6 ) and 4p15.31 (rs7664442, P =2.26×10 −6 ). Variants that have been previously related to WML explained only 0.8% to 11.7% more of the variance in WML progression than age, vascular risk factors, and baseline WML burden. Common genetic factors contribute little to the progression of age-related WML in middle-aged and older adults. Future research on determinants of WML progression should focus more on environmental, lifestyle, or host-related biological factors.
Publisher: Springer Science and Business Media LLC
Date: 22-01-2022
DOI: 10.1007/S11136-021-03071-1
Abstract: To appraise the measurement properties of generic patient-reported outcome measures (PROMs) measuring postoperative quality of life in adults undergoing elective abdominal surgery. We conducted a systematic review of PROMs administered after elective abdominal surgery. We systematically searched Ovid MEDLINE, Embase, the Cumulative Index to Nursing & Allied Health Literature database, and the Cochrane Library from earliest available dates to July 24, 2021, using relevant search terms. Articles were included if they reported assessment of measurement properties of a generic PROM/s measuring postoperative quality of life in adults who had undergone elective abdominal surgery. We used the Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) Risk of Bias checklist to assess methodological quality. We synthesized the data and used the COSMIN criteria for good measurement properties and the Grading of Recommendations, Assessment, Development and Evaluations criteria to rate the certainty of evidence. Of 12,121 identified articles, nine articles assessing five PROMs (SF-6D, EQ-5D, SF-36, SF-12, PROMIS-10) met inclusion criteria. Measurement properties assessed included internal consistency (n = 2), construct validity (n = 5), and responsiveness (n = 8). Two PROMs had high quality evidence for a single measurement property each. The SF-6D demonstrated high quality evidence for responsiveness and the EQ-5D had high quality evidence for construct validity. There is insufficient evidence to support the choice of a specific generic PROM to evaluate quality of life following elective abdominal surgery. Clinicians and researchers should be aware of the current limitations in knowledge of the measurement properties of available PROMs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-01-2019
DOI: 10.1212/WNL.0000000000006955
Abstract: To study longitudinal relationships between type 2 diabetes mellitus (T2DM), cortical thickness, and cognitive function in older people with normal cognition, mild cognitive impairment, and Alzheimer disease (AD). The s le was derived from the Alzheimer's Disease Neuroimaging Initiative cohort who underwent brain MRI and cognitive tests annually for 5 years. Presence of T2DM was based on fasting blood glucose ≥7.0mml/L or the use of glucose-lowering agents. We used latent growth curve modeling to explore longitudinal relationships between T2DM, cortical thickness, and cognitive function, adjusting for relevant covariates and testing for interactions. There were 124 people with T2DM (mean age 75.5 years, SD 6.2) and 693 without T2DM (mean age 75.1 years, SD 6.9) with at least 1 MRI available. AD and lower cortical thickness at study entry was associated with a lower chance of having a MRI available at each follow-up phase (all p 0.001). T2DM was associated with lower baseline cortical thickness ( p = 0.01). We found no direct effect of T2DM on decline in cortical thickness or cognitive function, but there was an indirect pathway linking T2DM and cognitive decline via baseline cortical thickness (β = −0.17, p = 0.022). There was an interaction between T2DM and education whereby the negative effect of T2DM on baseline cortical thickness was reduced in those with greater education (β = 0.34, p = 0.037). These associations changed minimally when adjusted for baseline cognitive diagnosis. In an older cohort with low cerebrovascular disease burden, T2DM contributes to cognitive decline via neurodegeneration. Prior brain and cognitive reserve may protect against this effect.
Publisher: Wiley
Date: 23-07-2020
DOI: 10.1111/AJAG.12824
Abstract: The aim of this study was to describe the demographics of patients from residential aged care facilities (RACFs) who underwent fixation of hip fracture and to compare 12‐month functional and mortality outcomes for those returning to their RACF with those admitted to a subacute facility (SAF) following their acute hospital stay. A retrospective review was undertaken of all patients from a RACF with high‐level care needs admitted to Alfred Hospital, Melbourne, for fixation of hip fracture in 2014‐2015. Data including demographic and hospital event details, length of stay (LOS), discharge destination and 12‐month functional outcomes measured by the Glasgow Outcome Scale‐Extended (GOS‐E), were collected. Factors related to discharge destination and outcomes were analysed. Ninety patients from a RACF were included in this study, with 68 patients (76%) returning to their RACF and 22 (24%) admitted to a SAF after acute hospital stay. Those discharged to a SAF had an average LOS at this facility of 20.79 days (SD 8.02). The SAF group also had a longer acute LOS (7 days IQR 5‐10, compared to 6 days IQR 4‐7.5) but there was no difference between groups at 12 months in terms of mortality or function, with 50% of all patients deceased at this time point (n = 40) and the remaining 40 patients (50%) reporting a poor functional outcome. Mobility status during acute and subacute stay, and 12‐month functional and mortality outcomes were similar in both groups irrespective of discharge destination, with the influence of cognition and concomitant medical issues currently unknown. Further research is required to evaluate the efficacy of current hip fracture models of care, the factors that influence clinician discharge planning decision‐making and to interrogate new models of care that support rehabilitation and complex medical management in RACFs.
Publisher: Wiley
Date: 28-03-2021
DOI: 10.1111/AJAG.12941
Abstract: To describe the patterns of personal emergency response systems (PERS) use in a statewide cohort of older Australians. PERS data from clients enrolled in the Personal Alarm Victoria program between January 2014 and June 2017 were analysed. Alarm activation reasons were extracted, and a medical record audit was performed for a sub‐cohort of patients admitted to a local hospital following an alarm event. Descriptive statistics were used. There were 42,180 clients enrolled during the study (mean age 80 years, 80% female, 93% living alone). An ambulance attended 44% of the fall‐related events and 81% of events coded as unwell. Activation reasons were distributed equally between a fall and feeling unwell, and a repeating pattern of activation reasons was observed. In our sub‐cohort (n = 92), the majority of admissions (86%) followed an alarm activation coded as unwell. We demonstrated recurring patterns associated with the reasons for alarm use.
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/IMJ.15481
Abstract: The predictive ability and efficiency of inpatient harm screening tools is unclear. We performed a retrospective analysis of approximately 25 000 people admitted to our hospital in 2019. We found that the discriminatory ability of the harm screening tools was at best moderate and could be attributed to one or two questions that overlapped with each other in the harm they predicted.
Publisher: American Diabetes Association
Date: 13-11-2013
DOI: 10.2337/DC13-0143
Abstract: Type 2 diabetes (T2DM) is associated with brain atrophy and cerebrovascular disease. We aimed to define the regional distribution of brain atrophy in T2DM and to examine whether atrophy or cerebrovascular lesions are feasible links between T2DM and cognitive function. This cross-sectional study used magnetic resonance imaging (MRI) scans and cognitive tests in 350 participants with T2DM and 363 participants without T2DM. With voxel-based morphometry, we studied the regional distribution of atrophy in T2DM. We measured cerebrovascular lesions (infarcts, microbleeds, and white matter hyperintensity [WMH] volume) and atrophy (gray matter, white matter, and hippoc al volumes) while blinded to T2DM status. With use of multivariable regression, we examined for mediation or effect modification of the association between T2DM and cognitive measures by MRI measures. T2DM was associated with more cerebral infarcts and lower total gray, white, and hippoc al volumes (all P & 0.05) but not with microbleeds or WMH. T2DM-related gray matter loss was distributed mainly in medial temporal, anterior cingulate, and medial frontal lobes, and white matter loss was distributed in frontal and temporal regions. T2DM was associated with poorer visuospatial construction, planning, visual memory, and speed (P ≤ 0.05) independent of age, sex, education, and vascular risk factors. The strength of these associations was attenuated by almost one-half when adjusted for hippoc al and total gray volumes but was unchanged by adjustment for cerebrovascular lesions or white matter volume. Cortical atrophy in T2DM resembles patterns seen in preclinical Alzheimer disease. Neurodegeneration rather than cerebrovascular lesions may play a key role in T2DM-related cognitive impairment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-09-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-11-2019
DOI: 10.1212/WNL.0000000000008612
Abstract: To address the variability in prevalence estimates and inconsistencies in potential risk factors for poststroke cognitive impairment (PSCI) using a standardized approach and in idual participant data (IPD) from international cohorts in the Stroke and Cognition Consortium (STROKOG) consortium. We harmonized data from 13 studies based in 8 countries. Neuropsychological test scores 2 to 6 months after stroke or TIA and appropriate normative data were used to calculate standardized cognitive domain scores. Domain-specific impairment was based on percentile cutoffs from normative groups, and associations between domain scores and risk factors were examined with 1-stage IPD meta-analysis. In a combined s le of 3,146 participants admitted to hospital for stroke (97%) or TIA (3%), 44% were impaired in global cognition and 30% to 35% were impaired in in idual domains 2 to 6 months after the index event. Diabetes mellitus and a history of stroke were strongly associated with poorer cognitive function after covariate adjustments hypertension, smoking, and atrial fibrillation had weaker domain-specific associations. While there were no significant differences in domain impairment among ethnoracial groups, some interethnic differences were found in the effects of risk factors on cognition. This study confirms the high prevalence of PSCI in erse populations, highlights common risk factors, in particular diabetes mellitus, and points to ethnoracial differences that warrant attention in the development of prevention strategies.
Publisher: Wiley
Date: 06-1992
Abstract: Adhesion molecules are substances which are involved in the interactions between cells, and between cells and the extracellular matrix in both benign and malignant tissues. Two members of this group--intercellular adhesion molecule-1 (ICAM-1) and MUC18--have previously been found to be expressed on melanoma however, studies seeking a correlation between expression and metastatic behaviour have yielded conflicting results. In this study we investigated the expression of these two antigens and that of a number of other adhesion molecules [VCAM-1, ELAM, and the neural cell adhesion molecule (NCAM)] on a range of benign and malignant melanocytic lesions. Both ICAM-1 and MUC18 were found on a high percentage of all melanocytic lesions including benign naevi. VCAM-1 was found to be expressed on 79 per cent of benign naevi, 62 per cent of primary melanomas less than 1.5 mm in depth, and 6 per cent of thick primaries. The antigen was present on 14 per cent of lymph node metastases and on no extranodal deposits. This suggests that loss of melanoma cell adhesion mediated by VCAM-1 may be important in the development of metastatic melanoma.
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1093/JN/NXAA052
Publisher: Elsevier BV
Date: 05-2019
Abstract: Glyoxal (GO) and methylglyoxal (MGO) are two important biomarkers in diabetes. Analytical methods for determination of GO and MGO in serum s les are either HPLC with UV-Vis (low sensitivity) or MS/MS (expensive) detection. These disadvantages have h ered the introduction of these biomarkers as a routine analyte for diabetes diagnostics into the clinical laboratory. In this study, we introduce a UHPLC method with fluorescence detection for the measurement of GO and MGO in serum s les by pre-column derivatization at neutral pH with 5, 6-diamino-2,4-dihydroxypyrimidine sulfate (DDP) to form lumazines. The method was validated as per FDA guidelines. Using this method, we have determined GO and MGO in a variety of animal serum s les, and for ex le, determined the GO and MGO concentration in adult bovine serum to be 852 ± 27 and 192 ± 10 nmol/L, respectively. In human serum, GO and MGO levels in non-diabetic subjects (n = 14) were determined to be 154 ± 88 and 98 ± 27 nmol/L, and in serum s les from subjects with diabetes (n = 14) 244 ± 137 and 190 ± 68 nmol/L, respectively. In addition, interference studies showed that physiological serum components did not lead to an artificial increase in the levels of GO and MGO.
Publisher: Springer Science and Business Media LLC
Date: 13-12-2018
DOI: 10.1007/S00125-018-4778-9
Abstract: The aims of the study were to examine whether type 2 diabetes mellitus is associated with greater brain atrophy and cognitive decline, and whether brain atrophy mediates associations between type 2 diabetes and cognitive decline. Participants without dementia aged 55-90 years from the Cognition and Diabetes in Older Tasmanians (CDOT) study underwent brain MRI (ventricular and total brain volume) and neuropsychological measures (global function and seven cognitive domains) at three time points over 4.6 years. Mixed models were used to examine longitudinal associations of type 2 diabetes with cognitive and MRI measures, adjusting for covariates. A test of mediation was used to determine whether brain atrophy explained associations between type 2 diabetes and cognitive decline. A total of 705 participants (diabetes: n = 348, mean age 68.2 years [SD 7.0] no diabetes: n = 357, mean age 72.5 years [SD 7.1]) were available at baseline. Adjusting for age, sex, education and vascular risk factors, there were significant diabetes × time interactions for verbal memory (β -0.06 95% CI -0.09, -0.02) and verbal fluency (β -0.03 95% CI -0.06, -0.00). Although people with diabetes had lower brain (β -14.273 95% CI -21.197, -6.580) and greater ventricular (β 2.672 95% CI 0.152, 5.193) volumes at baseline, there were no significant diabetes × time interactions (p > 0.05) or evidence of mediation of the diabetes-cognition relationship by brain atrophy. In older community-dwelling people, type 2 diabetes is associated with decline in verbal memory and fluency over ~5 years. The effect of diabetes on brain atrophy may begin earlier (midlife).
Publisher: Cold Spring Harbor Laboratory
Date: 11-02-2021
DOI: 10.1101/2021.02.10.430674
Abstract: Longitudinal MRI analysis is essential to accurately describe neuroanatomical changes over time. Loss of participants to followup (dropout) in longitudinal studies is inevitable and can lead to great difficulty in interpretation of statistical results if dropout is correlated with a study outcome or exposure. Beyond this, technical aspects of longitudinal MRI analysis require specialised processing pipelines to improve reliability while avoiding bias towards in idual timepoints. In this article we test whether there is an additional problem that must be considered in longitudinal imaging studies, namely whether dropout has an impact on the function of FreeSurfer, a popular software pipeline used to estimate important structural brain metrics. We find that the number of acquisitions available per in idual can impact the estimation of cortical thickness and brain volume using the FreeSurfer longitudinal pipeline, and can induce group differences in brain metrics. The effect on trajectories of brain metrics is smaller than the effect on brain metrics. Longitudinal MRI analysis is essential to accurately track neuroanatomical changes over time Longitudinal MRI analysis requires specialised processing pipelines to reduce bias towards single timepoints Participant drop out or loss can bias neuroanatomical measures derived from longitudinal pipelines We find that group differences in the number of acquisitions available to analyse can cause group differences in estimated cortical thickness and brain volume This bias appears to be due to the number of scans used to create in idualised templates in the Freesurfer longitudinal pipeline The effect on estimates of brain metric trajectories appears smaller than the effect on the estimates of brain metrics
Publisher: Oxford University Press (OUP)
Date: 02-08-2017
Abstract: Frailty is a prevalent geriatric condition associated with poor health outcomes. The pathogenesis of frailty is incompletely understood. We aimed to evaluate the relationship between cerebral small vessel disease (SVD) and frailty. People aged between 60 and 85 years were randomly selected from the electoral roll into the Tasmanian Study of Cognition and Gait. Participants completed standardized questionnaires regarding medical history and underwent objective sensorimotor, gait, and cognitive testing. These data were used to calculate a frailty index score. Magnetic resonance imaging was performed on all participants to measure SVD. Automated quantification was used to measure white matter hyperintensities (WMH), with manual consensus for subcortical infarction (SI) and cerebral microbleeds (CMB). Multivariable linear regression was used to determine the association between SVD and frailty. The mean age of the s le (n = 388) was 72.0 years (SD 7.0), 44% (172/388) were female and the median Frailty Index was 0.20 (interquartile range 0.12, 0.27). WMH, SI, and CMB in unadjusted models were positively associated with higher frailty scores (p < .05). In final models including all brain variables, higher burden of WMH (β = 2.16 95% confidence interval [CI] 0.75, 3.57 p = .003), but not SI (β = 2.96 95% CI -0.44, 6.35 p = .09) or CMB (β = -0.46 95% CI -4.88, 3.96 p = .84), was independently associated with a higher frailty score. We provide cross-sectional evidence for a positive association between larger burden of WMH and frailty. Longitudinal design is required to determine the temporality of this relationship.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1093/JN/NXZ139
Abstract: Unhealthy dietary patterns (DPs) are associated with poorer cognition, but few studies have investigated the underlying brain structural mechanisms. We aimed to examine the relations between DPs, brain structure, and cognition in older people with and without type 2 diabetes. This cross-sectional study consisted of a s le of people with (n = 343) and without type 2 diabetes (n = 346) aged 55-90 y. The 80-item Cancer Council of Victoria FFQ was used to assess dietary intake. Two DPs (prudent and traditional) for people with type 2 diabetes and 3 DPs (prudent, traditional, and Western) for those without type 2 diabetes were derived using principal component analysis. Neuropsychological tests assessed 6 cognitive domains. Brain MRI was performed to obtain gray, white matter, and hippoc al volumes and markers of small vessel disease (microbleeds, infarcts, and white matter hyperintensities). Multivariable linear regression was used to assess the cross-sectional associations between DPs, brain MRI, and cognitive variables. For those without type 2 diabetes, higher adherence to the Western DP was associated with lower gray matter volume (β = -3.03 95% CI: -5.67, -0.38 P = 0.03). The addition of a cardiovascular risk score, mood, and physical activity weakened associations such that they were no longer significant (β = -1.97 (95% CI: -4.68, 0.74) P = 0.15) for the Western DP. There were no significant associations for the other DPs in people with and without type 2 diabetes. In this cross-sectional study, DPs were not independently associated with brain structure in people with or without type 2 diabetes. Future prospective studies are needed to clarify the role of vascular risk factors on associations between DPs and brain health.
Publisher: Frontiers Media SA
Date: 20-09-2016
Abstract: Cerebral microbleeds (CMBs), cortical superficial siderosis, white matter lesions (WML), and cerebral atrophy may signify greater bleeding risk particularly in patients in whom anticoagulation is to be considered. We investigated their prevalence and associations with stroke type in patients with stroke and atrial fibrillation (AF). Cross-sectional s le, Monash Medical Centre (Melbourne, Australia) between 2010 and 2013, with brain MRI. MRI abnormalities were rated using standardized methods. Logistic regression was used to study associations adjusting for age and sex. There were 170 patients, mean age 78 years (SD 9.8), 154 (90.6%) with ischemic stroke. Prevalence of MRI markers were any microbleed 49%, multiple (≥2) microbleeds 30%, confluent WMLs 18.8%, siderosis 8.9%, severe cerebral atrophy 37.7%. Combinations of the severe manifestations of these markers were much less prevalent (2.9-12.4%). Compared with ischemic stroke, those with hemorrhagic stroke were more likely to have ≥10 microbleeds (OR 5.50 95% CI 1.46-20.77, Multiple CMBs, severe WML, and severe cerebral atrophy were common in idually in hospitalized patients with stroke and AF, but less so in combination. A higher burden of CMBs may be associated with intracerebral hemorrhage in stroke patients with AF.
Publisher: Wiley
Date: 09-01-2020
DOI: 10.1111/ANS.15633
Abstract: The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post-operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. Articles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE. We identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened. Establishing multidisciplinary collaborative services to provide person-centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large-scale studies should focus on implementing and evaluating such multicomponent models of care.
Publisher: Human Kinetics
Date: 04-2016
Abstract: Physical activity (PA) is important in managing Type 2 Diabetes Mellitus (T2DM). This study aimed to determine 1) the number of daily steps taken by older people with T2DM, 2) if T2DM is associated with taking fewer steps per day and less likelihood of meeting PA guidelines, and 3) whether these associations are modified by age or gender. PA was obtained by pedometer from 2 cohorts of older adults with and without T2DM. Multivariable regression was used to determine associations between T2DM, mean steps per day and meeting a guideline equivalent (7 100 steps per day). There were 293 participants with T2DM (mean age 67.6 ± 6.8 years) and 336 without T2DM (mean age 72.1 ± 7.1 years). In women, T2DM was associated with fewer mean steps per day (β = –1306.4 95% CI –2052.5, –560.3 P = .001) and not meeting the PA guidelines (OR 0.51 95% CI 0.28, 0.92 P = .03). Associations were not significant in men ( P .05). Only 29.7% of those with T2DM and 33.3% of those without T2DM met PA guidelines. Greater focus is needed on how to maintain and increase PA in older age with particular focus on women with T2DM.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.SCITOTENV.2017.08.187
Abstract: A novel nitrogen-doped biochar embedded with cobalt (Co-NB) was fabricated via pyrolysis of glucose pretreated with melamine (N donor) and Co(II). The Co-NB showed high catalytic capability by converting p-nitrophenol (PNP) into p-aminophenol (PAP) by NaBH
Publisher: Wiley
Date: 27-11-2021
DOI: 10.1111/AJAG.13020
Abstract: There is a lack of guidance on how to manage the multiple post‐discharge issues of older people following minimal trauma hip fracture. We developed a geriatrician‐staffed outpatient service for people aged ≥65 years admitted with a hip fracture who were not discharged to a nursing home. We aimed to evaluate the potential benefits of the addition of a dedicated hip fracture follow‐up clinic by measuring the actions performed by such a clinic. We evaluated the potential benefit of the clinic through a retrospective review of the medical records of all those referred to the clinic over a 2‐year period. A total of 80 people were provided a clinic appointment, with 43 (54%) attending. The median age of clinic attendees was 81 years. A total of 40/43 (93%) of attendees received inpatient rehabilitation in a sub‐acute facility before discharge. At the dedicated outpatient clinic, multiple issues were identified and managed including further fall reduction strategies ( n = 12), commencement of anti‐resorptive medications ( n = 11) and medication deprescribing ( n = 11). We found that the introduction of a dedicated hip fracture outpatient clinic identified and managed a broad range of issues. It is unclear if these needs would have been met by previously existing services. Further work is required to clarify whether managing these issues translates into improved patient outcomes and whether a dedicated clinic is a cost‐effective practice of achieving this.
Publisher: Elsevier
Date: 2018
Publisher: Wiley
Date: 10-03-2022
DOI: 10.1111/AJAG.13062
Abstract: To explore older persons’ perceptions of the impact of COVID‐19 restrictions on participating in community activities after discharge from inpatient rehabilitation. Mixed‐methods study design. Participants were older adults who were discharged home following inpatient rehabilitation. Interviews were conducted with 70 participants, with a variety of diagnoses, 8 weeks after discharge from inpatient rehabilitation. Frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Qualitative analysis was completed using qualitative content analysis and triangulated with FAI scores. In all, 70 older adults (mean age: 73.0 years, SD: 9.9 59% female) participated in the study. The overarching theme was that participants felt socially isolated following discharge from rehabilitation, with COVID‐19 restrictions increasing perceptions of social isolation and complicating their return to participating in community activities. The four categories informing the overarching theme were as follows: physical health was the primary limitation to participation in community activities COVID‐19 restrictions limited participation in social activities and centre‐based physical rehabilitation low uptake of videoconferencing to facilitate socialisation and rehabilitation and reduced incidental physical activity. Mean FAI score was 21.2 (SD 7.8), indicating that participants were moderately active. Participants most commonly performed domestic activities (mean: 10.0, SD: 4.1), followed by outdoor activities (mean: 6.6, SD: 3.5) and leisure/work activities (mean: 4.5, SD: 2.5). COVID‐19 restrictions exacerbated perceptions of social isolation and the limitations already imposed by poor physical health after discharge from rehabilitation. The findings highlight the need for rehabilitation that addresses the psychological and social dimensions of community reintegration.
Publisher: Wiley
Date: 15-09-2022
DOI: 10.1111/PSYP.14159
Abstract: The literature on large‐scale resting‐state functional brain networks across the adult lifespan was systematically reviewed. Studies published between 1986 and July 2021 were retrieved from PubMed. After reviewing 2938 records, 144 studies were included. Results on 11 network measures were summarized and assessed for certainty of the evidence using a modified GRADE method. The evidence provides high certainty that older adults display reduced within‐network and increased between‐network functional connectivity. Older adults also show lower segregation, modularity, efficiency and hub function, and decreased lateralization and a posterior to anterior shift at rest. Higher‐order functional networks reliably showed age differences, whereas primary sensory and motor networks showed more variable results. The inflection point for network changes is often the third or fourth decade of life. Age effects were found with moderate certainty for within‐ and between‐network altered patterns and speed of dynamic connectivity. Research on within‐subject bold variability and connectivity using glucose uptake provides low certainty of age differences but warrants further study. Taken together, these age‐related changes may contribute to the cognitive decline often seen in older adults.
Publisher: Public Library of Science (PLoS)
Date: 11-11-2015
Publisher: Elsevier BV
Date: 12-2021
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/6328953
Abstract: It is uncertain whether small vessel disease underlies the relationship between Type 2 Diabetes Mellitus (T2DM) and brain atrophy. We aimed to study whether retinal vascular architecture, as a proxy for cerebral small vessel disease, may modify or mediate the associations of T2DM with brain volumes. In this cross-sectional study using Magnetic Resonance Imaging (MRI) scans and retinal photographs in 451 people with and without T2DM, we measured brain volumes, geometric measures of retinal vascular architecture, clinical retinopathy, and MRI cerebrovascular lesions. There were 270 people with (mean age 67.3 years) and 181 without T2DM (mean age 72.9 years). T2DM was associated with lower gray matter volume ( p = 0.008 ). T2DM was associated with greater arteriolar diameter ( p = 0.03 ) and optimality ratio ( p = 0.04 ), but these associations were attenuated by adjustments for age and sex. Only optimality ratio was associated with lower gray matter volume ( p = 0.03 ). The inclusion of retinal measures in regression models did not attenuate the association of T2DM with gray matter volume. The association of T2DM with lower gray matter volume was independent of retinal vascular architecture and clinical retinopathy. Retinal vascular measures or retinopathy may not be sufficiently sensitive to confirm a microvascular basis for T2DM-related brain atrophy.
No related grants have been discovered for Chris Moran.