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Background: In 1986, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was mandated to develop a brief neuropsychological assessment battery (CERAD-NAB) for AD, for uniform neuropsychological assessment, and information aggregation. Initially used across the National Institutes of Aging-funded Alzheimer's Disease Research Centers, it has become widely adopted wherever information is desired on cognitive status and change therein, particularly in older populations. Objective: Our purpose is to provide information on the multiple uses of the CERAD-NAB since its inception, and possible further developments. Methods: Since searching on "CERAD neuropsychological assessment battery" or similar terms missed important information, "CERAD" alone was entered into PubMed and SCOPUS, and CERAD-NAB use identified from the resulting studies. Use was sorted into major categories, e.g., psychometric information, norms, dementia/differential dementia diagnosis, epidemiology, intervention evaluation, genetics, etc., also translations, country of use, and alternative data gathering approaches. Results: CERAD-NAB is available in ∼20 languages. In addition to its initial purpose assessing AD severity, CERAD-NAB can identify mild cognitive impairment, facilitate differential dementia diagnosis, determine cognitive effects of naturally occurring and experimental interventions (e.g., air pollution, selenium in soil, exercise), has helped to clarify cognition/brain physiology-neuroanatomy, and assess cognitive status in dementia-risk conditions. Surveys of primary and tertiary care patients, and of population-based samples in multiple countries have provided information on prevalent and incident dementia, and cross-sectional and longitudinal norms for ages 35–100 years. Conclusion: CERAD-NAB has fulfilled its original mandate, while its uses have expanded, keeping up with advances in the area of dementia. [ABSTRACT FROM AUTHOR]

Background. To ascertain accuracy of self-reported height, weight (and hence body mass index) in African American and white women and men older than 70 years of age. Method. The sample consisted of cognitively intact participants at the third in-person wave (1992-1993) of the Duke Established Populations for Epidemiologic Studies of the Elderly (age 71 and older, N = 1761; residents of five adjacent counties, one urban, four rural). During in-person, in-home interviews using trained interviewers, height and weight were self-reported (and measured later in the same visit using a standardized protocol), and information were obtained on race, sex, and age. Results. Accuracy of self-reported height and weight was high (intraclass correlation coefficient 0.85 and 0.97, respectively) but differed as a function of race and age. On average, all groups overestimated their height; whereas (non-Hispanic) white men and women underestimated their weight, African Americans overestimated their weight. Overestimation of height and weight was more marked in persons 85 years and older. Specificity for overweight (body mass index [kg/ [m.sup.2]] [greater than or equal to] 25) and obesity (body mass index [greater than or equal to] 30) ranged from 0.90 to 0.99 for African Americans and whites, but sensitivity was better for African Americans (overweight: 0.81, obesity: 0.89), than for whites (0.66 and 0.57, respectively). Conclusions. Height and weight self-reported by African Americans and whites over the age of 70 can be used in epidemiological studies, with greater caution needed for self-reports of whites, and of persons 85 years of age or older. Key Words: Height--Weight--Body mass index--Elderly--African American. doi: 10.1093/gerona/glq096

Purpose: The aim of this study was to ascertain whether the determinants of death differ as a function of type of analysis in a representative sample of older African American and White people with comparable mortality rates. Design and Methods: Participants included all African American (n = 2,261) and White (n = 1,875) people at the Duke site of the Established Populations for Epidemiological Studies of the Elderly. Baseline information used to predict mortality 12 years later included demographic, health, and functional characteristics. Mortality (55% for African American people and 54% for White people) was determined through the National Death Index. Cox proportional hazards models, logistic regression, and tree-based classification analysis were used (separately for African American and White people) to identify risk factors for mortality. Results: Risk factors for mortality were comparable, but the constellation of characteristics indicating higher risk for death differed between African American and White people. Implications: Proportional hazards and logistic regression identified risk factors in general; tree-based classification models identified the characteristics of groups at risk. The analysis used may influence the type and manner of intervention. Key Words: Proportional hazards models, Logistic regression, Classification tree analysis, Racial differences

Background. Few studies have examined the relationship of race to falls. This study evaluated the association between potential risk factors and falls in a representative sample of 1049 African American and 1947 white participants of the second in-person wave of the Duke Established Populations for Epidemiologic Studies of the Elderly. Methods. Information about sociodemographic characteristics, health-related behaviors, health status, visual function, and drug use was determined during baseline in-home interviews. Three years later, falls in the previous 12 months were assessed by self-report. Results. One or more falls occurred in 22.2% of the participants. Nearly half the fallers reported more than one fall. Multivariable analysis revealed that African Americans were less likely than whites to have any fall (adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62-0.94). Increased age and education, arthritis, diabetes, and history of broken bones were also significant (p < .05) independent risk factors for any fall. In multivariable analyses comparing those with two or more falls to those with none, again, increased age and education, arthritis, and diabetes were significant (p < .05) independent risk factors while smoking was protective. Race was not a significant predictor of multiple falls (adjusted OR 0.90, 95% CI 0.64-1.26). Conclusions. Similar sociodemographic characteristics and health problems appear to be important risk factors for any and multiple falls in community-dwelling African American and white elderly residents, with white elders at greater risk of one-time falls.

Purpose: The goal of this study was to determine whether the [epsilon]4 allele of apolipoprotein E is predictive of mortality in a community-based sample. Design and Methods: Of the stratified random household sample of 4,162 participants age 65 years and older enrolled in the Duke site of the Established Populations for Epidemiologic Studies of the Elderly, those included in the present study were the 1,998 who were genotyped for apolipoprotein E (alleles [epsilon]2, [epsilon]3, and [epsilon]4) six years after baseline, and for whom survival status eight years later was known by search of the National Death Index. Information on demographic characteristics, physical and mental health status, functional status, and health services use was determined by structured questionnaires administered in person in the home. Results: The [epsilon]4 allele did not predict mortality for the group as a whole, or for those who were cognitively impaired. It did predict mortality for those who reported having had a heart attack or stroke. Implications: The apolipoprotein [epsilon]4 allele--although a risk factor for Alzheimer's disease, heart disease, and stroke--was only found to be a risk factor for mortality for those community residents who had had a heart attack or stroke. Otherwise, for this community-based sample, 71 years of age and older, it did not predict time to death and was not a risk factor for mortality. Key Words: Apolipoprotein E, Mortality, Race, African American, White

Objectives. This study examines the relationship between the lack of private supplemental health insurance coverage and the development of disability among adults aged 65 and olden Methods. Data are from the baseline and six follow-up waves of the Duke Established Populations for Epidemiologic Studies of the Elderly survey (N = 4,000). Discrete-time hazard models were used to estimate the impact of insurance coverage and other risk factors on the incidence of disability among those unimpaired at baseline. Results. Controlling for education, income, and other potential confounders, the odds of developing disability were 35-49% higher among those without private coverage. Insurance coverage also statistically explained part of the increased risk of disability among low-income persons. Discussion. The results indicate that changes in health insurance coverage as well as in individual behaviors may be needed to reduce disability generally and disability among the socioeconomically disadvantaged, in particular.

Introduction Investigation of medication use patterns in a population (or pharmaco-epidemiology) is useful for describing variations in medication use and potentially detecting overuse or underuse of medications [1]. Pharmaco-epidemiological studies [...]

Introduction Elderly people are substantial consumers of medications [1-7]. Community-based surveys reveal that they take an average of 2.7 to 3.9 prescription and nonprescription medications [3, 5-7]. While medications can [...]

The dynamic nature of household composition in a population of elderly persons, with particular focus on Black-White and urban-rural differences, is described in this study. The Duke EPESE is a stratified, random household sample (N = 4,162) of elderly persons in a five-county mixed urban-rural area of North Carolina with respondents contacted annually to report on health and social factors. Between 1986 and 1990, 35 percent of the households underwent some change in composition, with 14-percent contracting and/or expanding more than once. Where elders lived alone and where married elders lived with the spouse and/or others, Black elders were significantly more likely to experience a net expansion of their household than were White elders of the same age, gender, socioeconomic, and functional status. Elderly residents of rural areas who lived alone were slightly more likely to add one or more persons to their households than were comparable elderly urban residents. No additional risk of household instability was noted in sociodemographic or health-related subgroups by race or residence. Future analyses should examine the outcomes of instability.

This study examines the prevalence of functional disability (limitation in at least one basic activity of daily living) among elderly Black and White community residents in the New Haven (n = 2812) and North Carolina (n = 4162) sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). In New Haven, elderly Blacks, particularly women below age 75, had a higher prevalence of disability compared with Whites, which was partially attributable to a higher prevalence of chronic conditions. In North Carolina, Blacks had only a slightly higher risk of being disabled than Whites, and this was fully accounted for by differences in socioeconomic status. Black-White differences in the prevalence of functional disability reveal geographic variation. (Am J Public Health. 1995; 85:994-998), Elderly blacks are more likely to have functional disabilities than whites. Researchers compared data on elderly living in two different geographic areas. One group consisted of 2748 people aged 65 and over living in New Haven and the other group consisted of 4162 elderly persons living in North Carolina, half in an urban county. Interviews were conducted in 1982 and 1986, respectively. Blacks were more likely to have difficulty with daily living than whites, but the gap was smaller in North Carolina than in New Haven. In both areas disabled elderly blacks tended to be younger, less educated, poorer, and have more mental disability. Elderly black women tended to weigh more and were more likely to have two or more chronic conditions. Socioeconomic factors accounted completely for the increased likelihood of disability among North Carolina blacks but not among New Haven blacks. The discrepancy between whites and blacks tended to increase with age, especially among women.

Objectives. To examine and compare concomitants of prescription and nonprescription drug use of Black and White community-dwelling elderly. Methods. Information on prescription and nonprescription drug use, demographic and health characteristics, and use of health services was obtained from a probability-based sample of Black (n = 2152) and White (n = 1821) community-resident elderly in the Piedmont area of North Carolina. Descriptive statistics were calculated. Linear regression, in which sample weights and design effects were taken into account, was used for the final models. Results. For prescription drug use, 37% and 32% of the variance was explained for Whites and Blacks, respectively (6% and 5% for nonprescription drugs). Health status and use of medical services were the strongest predictors of prescription drug use for both races (with Medigap insurance also important for Whites and Medicaid important for Blacks). Demographic characteristics and self-assessed health were significant factors in the use of nonprescription drugs. Race independently predicted use of both types of drugs but explained only a small proportion of the variance. Conclusions. Health status and use of health services are importantly related to prescription drug use. Nonprescription drug use is difficult to explain., Prescription drug use is related strongly to health status and utilization of health services. No such connection can be made for nonprescription drug use. Using data on prescription and nonprescription drug use, as well as demographics, health status and overall use of health services, researchers derived statistics for elderly residents of a North Carolina community. Factors related to the use of prescription and nonprescription drugs among elderly blacks and whites were analyzed. Among blacks and whites in the same state of health, blacks tended to use fewer prescription and nonprescription drugs. Coverage by Medigap insurance was an important factor in prescription drug use by whites, as was Medicaid coverage for blacks. Use of nonprescription drugs was influenced by demographics and subjective assessment of health status. When all other factors were taken into account, some difference remained between the drug use of older blacks and whites.

Educational level is most strongly associated with predicting active life expectancy of blacks and whites 65 years old and older. It is a more significant predictor of active life and total life expectancy than race. A study of 2,219 blacks and 1,838 whites found that men and women who were 65 years old and who had 12 or more years of education had a two-to-four year longer active life expectancy than participants with less education. Measurements of active life expectancy included assessing participants' abilities to dress, wash and eat by themselves, as well as their ability to use the toilet without assistance and their ability to walk across a room unassisted. Study participants were initially interviewed in 1986 and 1987 and contacted yearly thereafter. Those who were classified as disabled during the first interview had a mortality rate two-to-three times higher than those who were not initially classified as disabled.