Objective: Biomarkers for Alzheimer disease (AD) can detect the disease pathology in asymptomatic subjects and individuals with mild cognitive impairment (MCI), but their cognitive prognosis remains uncertain. We aimed to determine the prognostic value of b-amyloid imaging, alone and in combination with memory performance, hippocampal atrophy, and apolipoprotein E e4 status in nondemented, older individuals. Methods: A total of 183 healthy individuals (age 5 72.0 6 7.26 years) and 87 participants with MCI (age 5 73.7 6 8.27) in the Australian Imaging, Biomarkers, and Lifestyle study of ageing were studied. Clinical reclassification was performed after 3 years, blind to biomarker findings. b-Amyloid imaging was considered positive if the 11 C-Pittsburgh compound B cortical to reference ratio was 1.5. Results: Thirteen percent of healthy persons progressed (15 to MCI, 8 to dementia), and 59% of the MCI cohort progressed to probable AD. Multivariate analysis showed b-amyloid imaging as the single variable most strongly associated with progression. Of combinations, subtle memory impairment (Z score 5 20.5 to 21.5) with a positive amyloid scan was most strongly associated with progression in healthy individuals (odds ratio [OR] 5 16, 95% confidence interval [CI] 5 3.7-68; positive predictive value [PPV] 5 50%, 95% CI 5 19-81; negative predictive value [NPV] 5 94%, 95% CI 5 88-98). Almost all amnestic MCI subjects (Z score 21.5) with a positive amyloid scan developed AD (OR 5 1; PPV 5 86%, 95% CI 5 72-95; NPV 5 100%, 95% CI 5 80-100). Hippocampal atrophy and e4 status did not add further predictive value.View this article online at wileyonlinelibrary.com.
Cost-effective strategies to maintain healthy active lifestyle in aging populations are required to address the global burden of age-related diseases. ASPREE will examine whether the potential primary prevention benefits of low dose aspirin outweigh the risks in older healthy individuals. Our primary hypothesis is that daily oral 100 mg enteric-coated aspirin will extend a composite primary endpoint termed ‘disability-free life’ including onset of dementia, total mortality, or persistent disability in at least one of the Katz Activities of Daily Living in 19,000 healthy participants aged 65 years and above (‘US minorities’) and 70 years and above (non ‘US minorities’). ASPREE is a double-blind, randomized, placebo-controlled trial of oral 100 mg enteric-coated acetyl salicylic acid (ASA) or matching placebo being conducted in Australian and US community settings on individuals free of dementia, disability and cardiovascular disease (CVD) events. Secondary endpoints are all-cause and cause specific mortality, fatal and non-fatal cardiovascular events, fatal and non-fatal cancer (excluding non-melanoma skin cancer), dementia, mild cognitive impairment, depression, physical disability, and clinically significant bleeding. To 20 September 2013 14383 participants have been recruited. Recruitment and study completion is anticipated in July 2014 and December 2018 respectively. In contrast to other aspirin trials that have largely focused on cardiovascular endpoints, ASPREE has a unique composite primary endpoint to better capture the overall risk and benefit of aspirin to extend healthy independent lifespan in older adults in the US and Australia.
Maintaining weight within older adults, irrespective of initial body weight, may be important in preventing functional and mobility limitations. Excessive weight is associated with an increased risk of limitation in function and mobility, both key components of health-related quality of life.
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