Hearing loss was extremely common in this population. Because many of the identified hearing loss risk factors are modifiable, some of the burden associated with hearing loss in older people should be preventable.

Background: Vascular factors including medical history (heart disease, stroke, diabetes, and hypertension), smoking, and prediagnosis blood lipid measurements (cholesterol: total, high-density lipoprotein, lowdensity lipoprotein [LDL-C], and triglyceride concentrations) may be predictors for progression of Alzheimer disease (AD).Objective: To determine whether prediagnosis vascular risk factors are associated with progression of AD. Design: Inception cohort followed up longitudinally for a mean of 3.5 (up to 10.2) years.

Factors influencing survival in Alzheimer disease include race/ethnicity and comorbid diabetes and hypertension.

Objective-To determine whether APOE ε4 predicts rate of cognitive change in incident and prevalent AD.Methods-Individuals were recruited from two longitudinal cohort studies -the Washington Heights and Inwood Columbia Aging Project (WHICAP; population-based) and the Predictors Study (clinic-based), and were followed for an average of four years. Three samples of participants diagnosed with Alzheimer's disease, with diverse demographic characteristics and baseline cognitive functioning were studied: 1) 199 (48%) of the incident WHICAP cases; 2) 215 (54%) of the prevalent WHICAP cases; and 3)156 (71%) of the individuals diagnosed with AD in the Predictors Study. Generalized estimating equations (GEE) were used to test whether rate of cognitive change, measured using a composite cognitive score in WHICAP and the Mini-Mental Status Exam in Predictors, varied as a function of ε4 status in each sample.Results-The presence of at least one ε4 allele was associated with faster cognitive decline in the incident population-based AD group (p = .01). Parallel results were produced for the two prevalent dementia samples only when adjusting for disease severity or excluding the most impaired participants from the analysis.Conclusion-APOE ε4 may influence rate of cognitive decline most significantly in the earliest stages of AD.

Objective We aimed to determine whether hearing impairment (HI) in older adults is associated with the development of frailty and falls. Method Longitudinal analysis of observational data from the Health, Aging and Body Composition study of 2,000 participants aged 70 to 79 was conducted. Hearing was defined by the pure-tone-average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better hearing ear. Frailty was defined as a gait speed of <0.60 m/s and/or inability to rise from a chair without using arms. Falls were assessed annually by self-report. Results Older adults with moderate-or-greater HI had a 63% increased risk of developing frailty (adjusted hazard ratio [HR] = 1.63, 95% confidence interval [CI] = [1.26, 2.12]) compared with normal-hearing individuals. Moderate-or-greater HI was significantly associated with a greater annual percent increase in odds of falling over time (9.7%, 95% CI = [7.0, 12.4] compared with normal hearing, 4.4%, 95% CI = [2.6, 6.2]). Discussion HI is independently associated with the risk of frailty in older adults and with greater odds of falling over time.

Objectives To examine the association of cardiovascular disease (CVD) and its risk factors with age-associated hearing loss, in a cohort of older black and white adults. Study Design Cross-sectional cohort study Setting The Health, Aging, and Body Composition (Health ABC) study; A community-based cohort study of older adults from Pittsburgh, PA and Memphis TN. Participants 2,049 well-functioning adults (mean age: 77.5 years; 37% black) Measurements Pure-tone audiometry and history of clinical CVD were obtained at the 4th annual follow-up visit. Pure-tone averages in decibels reflecting low frequencies (250, 500, and 1000 Hz) middle frequencies (500, 1000, and 2000 Hz) and high frequencies (2000, 4000, and 8000Hz) were calculated for each ear. CVD risk factors, aortic pulse-wave velocity, and ankle-arm index were obtained at the study baseline. Results In gender-stratified models, after adjustment for age, race, study site and occupational noise exposure, risk factors associated with poorer hearing sensitivity among men included higher triglyceride levels, higher resting heart rate and history of smoking. Among women, poorer hearing sensitivity was associated with higher BMI, higher resting heart rate, faster pulse-wave velocity, and low ankle-arm index. Conclusion Modifiable risk factors for CVD may play a role in the development of age-related hearing loss.

HI in older adults is associated with increased mortality, independent of demographics and cardiovascular risk factors. Further research is necessary to understand the basis of this association and whether these pathways might be amenable to hearing rehabilitation.

Background: High rates of leisure activity have been associated with reduced risk of Alzheimer disease (AD). Objective: To determine whether prediagnosis leisure activity modifies the rate of cognitive decline in patients with AD. Design: Inception cohort followed up longitudinally for a mean of 5.3 years (up to 13.9 years). Setting: Urban community. Participants: A total of 283 patients with incident AD (mean age, 79 years; 56.2% Hispanic and 31.1% African American). Main Outcome Measures: Change in a composite cognitive score from diagnosis on and during the entire study follow-up. Results: In multivariate-adjusted generalized estimating equation models of postdiagnosis change (n=133), each leisure activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P=.17). In models expanded to include cognitive change during study follow-up, including evaluations before and after diagnosis (n=283), each activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P =.03). The association was strongest for intellectual activities. Conclusions: Greater participation in prediagnosis leisure activities, especially intellectual activities, was associated with faster cognitive decline, supporting the hypothesis that the disease course in AD may vary as a function of cognitive reserve.