Centenarians and offspring in Milan : preliminary data on cognitive status and autonomy

In our study, we enrolled 34 centenarians living in the city of Milan and their offspring. They were contacted through mass mailing, phone calls, advertisements on newspapers or by contacts with general practitioner. We collected centenarians’ blood and urine samples in order to analyse immunological and haematological parameters such as lymphocytes subcategories, levels of factors of coagulation. We analyzed the cognitive status and the degree of autonomy of all the subjects using the mini-mental examination state test and the ADL and IADL scales. We collected the familiar, physiological, pathological and pharmacological anamnesis of the centenarians. The offspring of the centenarians underwent the same evaluation: they were divided into 2 groups according to the longevity of the other parent and we compared them to control subjects whose parents both died young because of illness. Centenarians were a very heterogeneous group, while we didn’t notice differences between their offspring and control subjects. We classified the centenarians into 3 groups according to health status: A (very good health), B (intermediate) and C (presence of one of the following: severe cognitive impairment defined as MMSE<12, severe physical impairment, presence of overt cancer or other severe illness). Only 4 centenarians were defined as A, 8 were defined B and 22 were defined C. Some centenarians tested brilliantly according to MMSE but were included in B or C for disability or cancer. The prevalence of severe dementia defined as MMSE<12 was relatively low- 8 subjects (23,5%)- while 15 centenarians presented a MMSE score ≥20 (44,1)%; in particular 6 people had a score >26 (17,6%).The level of instruction was relatively high, about 1/3 of centenarians had a secondary school or university degree. Nearly half of the centenarians (41%) presented total dependence in all the activities of the IADL scale (score=0); about 1/3 of the centenarians was instituzionalized- while 1 man and 2 women lived in their houses alone and in total independence. Nearly half of the people interviewed presented symptoms of depression (short GDS score>5/15). It seems to exist a marked gender difference, since male centenarians are more healthy than female centenarians. The female/male ratio was about 3/1 in the study, about 6/1 in the C group and there were no male centenarians in the group with severe dementia. Of the only 3 males included in the C group, 2 were included due to overt cancer, and 1 due to physical disability. The MMSE score ranged from 14 to 29 in male centenarians (average 23.38, SD 5.78), while it ranged from 0 to 29 in females (average 15.12, SD 8.73). We compared the two average scores by means of t student test: p=0.018. Only 2 males were institutionalized versus 10 women (female/male 5/1, squared-test: p=0.50). The ADL score ranged from 2 to 12/12 in males (median 8), while it ranged from 0 to 11 in females (median 4). The IADL median score was 6.5 in males and 1 in females. Women seemed to be more medicalized: the median number of drugs used resulted 5 in female centenarians (range 0-14) and 3.5 in male centenarians (range 1-9). Anyway, there was no correlation between the health status degree and the number of drugs used; we frequently observed poor compliance to physicians’ prescription, self-prescription and empiric use of drugs. Male centenarians seems to be favoured by a better social and familial network in comparison to females: many women lived alone for many years, male centenarians re-married and were still married at the moment of the interview or they were assisted by childrens. We also classified centenarians into 3 groups according to age of onset of some age-related diseases (chronic obstructive pulmonary disease, dementia, diabetes, heart disease, stroke, Parkinson and cancer): survivors (age<85), delayers (age ≥85) and escapers. Most centenarians were delayers. Few were survivors: one man of myocardial infarction at 55 years old, one woman of breast cancer diagnosed at 72 years of age and treated only surgically, one man of colon-rectum cancer). Regarding the “escapers”, we think that in some cases there is a bias due to missed diagnosis and lack of documentation. Interestingly, we have neuroimaging documentation of cerebral atrophy and lacunar necrosis in two women who don’t present clinical dementia and have a good degree of autonomy. When asked, about 2/3 of centenarians expressed a positive judgement on their health status; surprisingly, there was no correlation between the researcher’ s judgement and self-judgement.