Mapping risk factors for depression across the lifespan: An umbrella review of evidence from meta-analyses and Mendelian randomization studies

The development of depression may involve a complex interplay of environmental and genetic risk factors. PubMed and PsycInfo databases were searched from inception through August 3, 2017, to identify meta-analyses and Mendelian randomization (MR) studies of environmental risk factors associated with depression. For each eligible meta-analysis, we estimated the summary effect size and its 95% confidence interval (CI) by random-effects modeling, the 95% prediction interval, heterogeneity with I², and evidence of small-study effects and excess significance bias. Seventy meta-analytic reviews met the eligibility criteria and provided 134 meta-analyses for associations from 1283 primary studies. While 109 associations were nominally significant (P < 0.05), only 8 met the criteria for convincing evidence and, when limited to prospective studies, convincing evidence was found in 6 (widowhood, physical abuse during childhood, obesity, having 4-5 metabolic risk factors, sexual dysfunction, job strain). In studies in which depression was assessed through a structured diagnostic interview, only associations with widowhood, job strain, and being a Gulf War veteran were supported by convincing evidence. Additionally, 8 MR studies were included and provided no consistent evidence for the causal effects of obesity, smoking, and alcohol consumption. The proportion of variance explained by genetic risk factors was extremely small (0.1-0.4%), which limited the evidence provided by the MR studies. Our findings suggest that despite the large number of putative risk factors investigated in the literature, few associations were supported by robust evidence. The current findings may have clinical and research implications for the early identification of individuals at risk for depression.

Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety

PURPOSE OF REVIEW

The purpose of this paper was to provide a comprehensive narrative review of the relationship between physical activity (PA) and anxiety and the rationale for including it as a treatment option for anxiety disorders. Several gaps in the literature are highlighted alongside recommendations for future research.

RECENT FINDINGS

PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing. Recent epidemiological data further suggests that people who are more active may be less likely to have anxiety disorders. In addition, evidence from systematic reviews of randomised control trials suggests that exercise training, a subset of PA, can reduce symptoms in anxiety and stress-related disorders, such as post-traumatic stress disorder, agoraphobia and panic disorder. Anxiety disorders are common, burdensome and costly to individuals and wider society. In addition to the profound negative impact on individuals' wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality. Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease. Given the combined anxiolytic and physical health benefits of increased activity, PA presents a promising additional treatment option for people with anxiety disorders. However, there remain key gaps in the literature regarding the mechanisms underlying the effects of PA, optimal PA protocols, methods of improving adherence and the importance of physical fitness. These must be addressed for PA to be successfully implemented in mental health services.

The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses

BACKGROUND

Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested that depression could be associated with excess all-cause mortality across different settings and populations, although the causality of these associations remains unclear.

METHODS

We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. PubMed, PsycINFO, and Embase electronic databases were searched through January 20, 2018. Systematic reviews and meta-analyses that investigated associations of depression and all-cause and cause-specific mortality were selected for the review. The evidence was graded as convincing, highly suggestive, suggestive, or weak based on quantitative criteria that included an assessment of heterogeneity, 95% prediction intervals, small-study effects, and excess significance bias.

RESULTS

A total of 26 references providing 2 systematic reviews and data for 17 meta-analytic estimates met inclusion criteria (19 of them on all-cause mortality); data from 246 unique studies (N = 3,825,380) were synthesized. All 17 associations had P < 0.05 per random effects summary effects, but none of them met criteria for convincing evidence. Associations of depression and all-cause mortality in patients after acute myocardial infarction, in individuals with heart failure, in cancer patients as well as in samples from mixed settings met criteria for highly suggestive evidence. However, none of the associations remained supported by highly suggestive evidence in sensitivity analyses that considered studies employing structured diagnostic interviews. In addition, associations of depression and all-cause mortality in cancer and post-acute myocardial infarction samples were supported only by suggestive evidence when studies that tried to adjust for potential confounders were considered.

CONCLUSIONS

Even though associations between depression and mortality have nominally significant results in all assessed settings and populations, the evidence becomes weaker when focusing on studies that used structured interviews and those that tried to adjust for potential confounders. A causal effect of depression on all-cause and cause-specific mortality remains unproven, and thus interventions targeting depression are not expected to result in lower mortality rates at least based on current evidence from observational studies.

Pain and severe sleep disturbance in the general population: Primary data and meta-analysis from 240,820 people across 45 low- and middle-income countries

OBJECTIVE

Pain and sleep disturbances are widespread, and are an important cause of a reduced quality of life. Despite this, there is a paucity of multinational population data assessing the association between pain and sleep problems, particularly among low- and middle-income countries (LMICs). Therefore, we investigated the relationship between pain and severe sleep disturbance across 45 LMICs.

METHOD

Community-based data on 240,820 people recruited via the World Health Survey were analyzed. Multivariable logistic regression analyses adjusted for multiple confounders were performed to quantify the association between pain and severe sleep problems in the last 30 days. A mediation analysis was conducted to explore potential mediators of the relationship between pain and severe sleep disturbance.

RESULTS

The prevalence of mild, moderate, severe, and extreme levels of pain was 26.0%, 16.2%, 9.1%, and 2.2% respectively, whilst 7.8% of adults had severe sleep problems. Compared to those with no pain, the odds ratio (OR, 95% CI) for severe sleep problems was 3.65 (3.24-4.11), 9.35 (8.19-10.67) and 16.84 (13.91-20.39) for those with moderate, severe and extreme pain levels respectively. A country wide meta-analysis adjusted for age and sex demonstrated a significant increased OR across all 45 countries. Anxiety, depression and stress sensitivity explained 12.9%, 3.6%, and 5.2%, respectively, of the relationship between pain and severe sleep disturbances.

CONCLUSION

Pain and sleep problems are highly co-morbid across LMICs. Future research is required to better understand this relationship. Moreover, future interventions are required to prevent and manage the pain and sleep disturbance comorbidity.

Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies

OBJECTIVE

The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators.

METHOD

Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I²=0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations.

CONCLUSIONS

Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.

Abstract 4256: Handgrip strength and cognitive function in elderly cancer survivors

Aim: Cancer and cancer treatment-related cognitive impairments are frequently reported in cancer survivors, presenting as lack of attention, impaired executive function and short-term money loss. The aetiology of these impairments is largely unknown. Recently, serum level of brain-derived neurotrophic factor (BDNF) has been associated with cancer related cognitive impairments. BDNF is a neurotrophin, secreted in responses to muscle contraction. Meanwhile, muscle dysfunction, characterized by muscle strength and muscle composition, is common in cancer survivors. Yet its impact on cancer survivors' cognitive function is unknown. To address this gap we evaluated for the first time the associations of muscle strength determined by handgrip with two cognitive function outcomes in cancer survivors using data from the National Health and Nutrition Examination Survey (NHANES). Method: Data in two waves of NHANES (2011-2014) were aggregated. Handgrip strength in kilogram (kg) was measured with the Takei Digital Grip Strength Dynamometer, defined as the maximum value achieved using either hand. Data on two cognitive function tests were extracted, both were conducted among adults 60 years and older: the Animal Fluency Test (AFT) which examines categorical verbal fluency (a component of executive function), and the Digital Symbol Substitution test (DSST) which assesses processing speed, sustained attention and working memory. Survey analysis procedures were used to account for the complex sampling design of the NHANES. Gender-specific multivariable linear regression models were used to estimate associations of handgrip strength with cognitive test scores, adjusting for confounders (age, gender, race/ethnicity, education, marital status, smoking status, depression and leisure time physical activity). For explorative purpose, we further adjusted for handgrip strength squared. Results: There were 383 cancer survivors (mean age=70.9 years, mean BMI=29.3 kg/m2) with detailed data for analyses. Prevalent cancer types were breast (22.9%), prostate (16.4%), colon (6.9%) and cervix (6.2%). The prevalence of handgrip strength defined sarcopenia was 10.9% in men (&lt;30kg) and 20.4 % in women (&lt;20kg). Scores on AFT and DSST were 18.0 (s.e. 0.4) and 51.7 (s.e. 1.0), respectively. We observed significant linear associations of handgrip strength with both test scores in women. Each increase kg of handgrip strength was associated with 0.20 (95% CI: 0.08 to 0.33) higher score on AFT and 0.83 (95% CI: 0.30 to 1.35) higher score on DSST. In men, we observed inverted U-shape association between handgrip strength and DSST score, which peaked at handgrip strength of 40-42 kg. Conclusion: Handgrip determined muscle strength appears to be associated with aspects of cognitive functions in cancer survivors. Prospective studies are needed to identify the role of muscle on cancer related-cognitive impairments in men and women cancer survivors.

Citation Format: Lin Yang, Lee Smith, Liang Hu, Graham A. Colditz, Adetunji T. Toriola, Davy Vancampfort, Mark Hamer, Brendon Stubbs, Thomas Waldhör. Handgrip strength and cognitive function in elderly cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4256.

Association Between Muscular Strength and Cognition in People With Major Depression or Bipolar Disorder and Healthy Controls

IMPORTANCE

Objective physical fitness measures, such as handgrip strength, are associated with physical, mental, and cognitive outcomes in the general population. Although people with mental illness experience reduced physical fitness and cognitive impairment, the association between muscular strength and cognition has not been examined to date.

OBJECTIVE

To determine associations between maximal handgrip strength and cognitive performance in people with major depression or bipolar disorder and in healthy controls.

DESIGN, SETTING, AND PARTICIPANTS

In a multicenter, population-based study conducted between February 13, 2005, and October 1, 2010, in the United Kingdom, cross-sectional analysis was conducted of baseline data from 110 067 participants in the UK Biobank. Data analysis was performed between August 3 and August 18, 2017. Invitations were mailed to approximately 9.2 million UK homes, recruiting 502 664 adults, all aged 37 to 73 years. Clinically validated measures were used to identify individuals with major recurrent depression (moderate or severe) or bipolar disorder (type I or type II) and healthy controls (those with no indication of present or previous mood disorders).

MAIN OUTCOMES AND MEASURES

Handgrip dynamometry was used to measure muscular function. Cognitive functioning was assessed using computerized tasks of reaction time, visual memory, number memory, reasoning, and prospective memory. Generalized linear mixed models assessed the association between handgrip strength and cognitive performance, controlling for age, educational level, sex, body weight, and geographic region.

RESULTS

Of the 110 067 participants, analyses included 22 699 individuals with major depression (mean [95% range] age, 55.5 [41-68] years; 7936 [35.0%] men), 1475 with bipolar disorder (age, 54.4 [41-68] years; 748 [50.7%] men), and 85 893 healthy controls (age, 53.7 [41-69] years; 43 000 [50.0%] men). In those with major depression, significant positive associations (P < .001) between maximal handgrip strength and improved performance on all 5 cognitive tasks were found, including visual memory (coefficient, -0.146; SE, 0.014), reaction time (coefficient, -0.036; SE, 0.002), reasoning (coefficient, 0.213; SE, 0.02), number memory (coefficient, 0.160; SE, 0.023), and prospective memory (coefficient, 0.341; SE, 0.024). Similar results were found in healthy controls. Among participants with bipolar disorder, handgrip strength was positively associated with improved visual memory (coefficient, -0.129; SE, 0.052; P = .01), reaction time (coefficient, -0.047; SE, 0.007; P < .001), prospective memory (coefficient, 0.262; SE, 0.088; P = .003), and reasoning (coefficient, 0.354; SE, 0.08; P < .001).

CONCLUSIONS AND RELEVANCE

Grip strength may provide a useful indicator of cognitive impairment in people with major depression and bipolar disorder. Future research should investigate causality, assess the functional implications of handgrip strength in psychiatric populations, and examine how interventions to improve muscular fitness affect neurocognitive status and socio-occupational functioning.

Psychometric properties of the modified Yale Food Addiction Scale 2.0 in a large Brazilian sample

Objective:

The field of food addiction has attracted growing research attention. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a screening tool based on DSM-5 criteria for substance use disorders. However, there is no validated instrument to assess food addiction.

Methods:

The mYFAS 2.0 has been transculturally adapted to Brazilian Portuguese. The data for this study was obtained through an anonymous web-based research platform: participants provided sociodemographic data and answered Brazilian versions of the the mYFAS 2.0 and the Barratt Impulsivity Scale (BIS-11). Analysis included an assessment of the Brazilian mYFAS 2.0’s internal consistency reliability, factor structure, and convergent validity in relation to BIS-11 scores.

Results:

Overall, 7,639 participants were included (71.3% females; age: 27.2±7.9 years). The Brazilian mYFAS 2.0 had adequate internal consistency reliability (Cronbach’s alpha = 0.89). A single factor solution yielded the best goodness-of-fit parameters for both the continuous and categorical version of the mYFAS 2.0 in confirmatory factor analysis. In addition, mYFAS 2.0 correlated with BIS-11 total scores (Spearman’s rho = 0.26, p < 0.001) and subscores.

Conclusion:

The Brazilian mYFAS 2.0 demonstrated adequate psychometric properties in our sample; however, future studies should further evaluate its discriminant validity.

Grip Strength Is Associated With Cognitive Performance in Schizophrenia and the General Population: A UK Biobank Study of 476559 Participants

Background

Handgrip strength may provide an easily-administered marker of cognitive functional status. However, further population-scale research examining relationships between grip strength and cognitive performance across multiple domains is needed. Additionally, relationships between grip strength and cognitive functioning in people with schizophrenia, who frequently experience cognitive deficits, has yet to be explored.

Methods

Baseline data from the UK Biobank (2007-2010) was analyzed; including 475397 individuals from the general population, and 1162 individuals with schizophrenia. Linear mixed models and generalized linear mixed models were used to assess the relationship between grip strength and 5 cognitive domains (visual memory, reaction time, reasoning, prospective memory, and number memory), controlling for age, gender, bodyweight, education, and geographical region.

Results

In the general population, maximal grip strength was positively and significantly related to visual memory (coefficient [coeff] = -0.1601, standard error [SE] = 0.003), reaction time (coeff = -0.0346, SE = 0.0004), reasoning (coeff = 0.2304, SE = 0.0079), number memory (coeff = 0.1616, SE = 0.0092), and prospective memory (coeff = 0.3486, SE = 0.0092: all P < .001). In the schizophrenia sample, grip strength was strongly related to visual memory (coeff = -0.155, SE = 0.042, P < .001) and reaction time (coeff = -0.049, SE = 0.009, P < .001), while prospective memory approached statistical significance (coeff = 0.233, SE = 0.132, P = .078), and no statistically significant association was found with number memory and reasoning (P > .1).

Conclusions

Grip strength is significantly associated with cognitive functioning in the general population and individuals with schizophrenia, particularly for working memory and processing speed. Future research should establish directionality, examine if grip strength also predicts functional and physical health outcomes in schizophrenia, and determine whether interventions which improve muscular strength impact on cognitive and real-world functioning.

Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies

OBJECTIVE

To perform a systematic review and meta-analysis of observational studies that investigated the putative association between internet addiction and suicidality.

DATA SOURCES

Major electronic databases (PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, Science Direct, and ClinicalTrials.gov) were searched using the following keywords (internet addiction OR internet gaming disorder OR internet use disorder OR pathological internet use OR compulsive internet use OR problematic internet use) AND (suicide OR depression) to identify observational studies from inception to October 31, 2017.

STUDY SELECTION

We included 23 cross-sectional studies (n = 270,596) and 2 prospective studies (n = 1,180) that investigated the relationship between suicide and internet addiction.

DATA EXTRACTION

We extracted the rates of suicidal ideation, planning, and attempts in individuals with internet addiction and controls.

RESULTS

The individuals with internet addiction had significantly higher rates of suicidal ideation (odds ratio [OR] = 2.952), planning (OR = 3.172), and attempts (OR = 2.811) and higher severity of suicidal ideation (Hedges g = 0.723). When restricted to adjusted ORs for demographic data and depression, the odds of suicidal ideation and attempts were still significantly higher in the individuals with internet addiction (ideation: pooled adjusted OR = 1.490; attempts: pooled adjusted OR = 1.559). In subgroup analysis, there was a significantly higher prevalence rate of suicidal ideation in children (age less than 18 years) than in adults (OR = 3.771 and OR = 1.955, respectively).

CONCLUSIONS

This meta-analysis provides evidence that internet addiction is associated with increased suicidality even after adjusting for potential confounding variables including depression. However, the evidence was derived mostly from cross-sectional studies. Future prospective studies are necessary to confirm these findings.

Hand grip strength and cognitive function among elderly cancer survivors

Background

We evaluated the associations of handgrip strength and cognitive function in cancer survivors ≥ 60 years old using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

Data in two waves of NHANES (2011–2014) were aggregated. Handgrip strength in kilogram (kg) was defined as the maximum value achieved using either hand. Two cognitive function tests were conducted among adults 60 years and older. The Animal Fluency Test (AFT) examines categorical verbal fluency (a component of executive function), and the Digital Symbol Substitution test (DSST) assesses processing speed, sustained attention, and working memory. Survey analysis procedures were used to account for the complex sampling design of the NHANES. Multiple linear regression models were used to estimate associations of handgrip strength with cognitive test scores, adjusting for confounders (age, gender, race/ethnicity, education, marital status, smoking status, depressive symptoms and leisure time physical activity).

Results

Among 383 cancer survivors (58.5% women, mean age = 70.9 years, mean BMI = 29.3 kg/m²), prevalent cancer types were breast (22.9%), prostate (16.4%), colon (6.9%) and cervix (6.2%). In women, each increase in kg of handgrip strength was associated with 0.20 (95% CI: 0.08 to 0.33) higher score on AFT and 0.83 (95% CI: 0.30 to 1.35) higher score on DSST. In men, we observed an inverted U-shape association where cognitive function peaked at handgrip strength of 40–42 kg.

Conclusions

Handgrip strength, a modifiable factor, appears to be associated with aspects of cognitive functions in cancer survivors. Prospective studies are needed to address their causal relationship.

Leisure time physical activity and future psychological distress: A thirteen year longitudinal population-based study

A number of cross-sectional studies have suggested that physical activity (PA) is negatively associated with psychological distress in adulthood. A paucity of regionally representative and longitudinal studies has considered this relationship. This study investigated the association between leisure time light and moderate-vigorous PA (MVPA) and psychological distress over 13 years in a regionally representative sample. A total of 4754 men (mean age: 47.2 years) and 5571 women from (mean age: 46.9 years) the Tromsø Study were followed for 13 years. Light PA and MVPA was captured at baseline and psychological distress was captured using the Hopkins Symptom Check List-10 scale. Ordinary least square and Poisson regression models were used, adjusting for multiple confounders to investigate the relationship between light PA/MVPA and psychological distress. In the fully-adjusted model, accounting sociodemographics, history of parental psychopathology, socioeconomic status, marital status, smoking, social support and risk factors, we found evidence that both light PA (β 0.11, 95% CI: 0.03, 0.19; p < 0.01) and MVPA (β 0.19, 95% CI: 0.12, 0.26; p < 0.001) confered protection against psychological distress at follow-up. Among men, a lower MVPA was associated with 14% (RR = 1.14, 95% CI: 1.01, 1.28) increased risk of clinically significant psychological distress; while among women, the risk was 15% (RR = 1.15, 95% CI: 1.06, 1.26; p < 0.001). In this regionally representative cohort, our study suggests that both higher levels of light PA and MVPA confer protection against future psychological distress. However, a key limitation of this study is that psychological distress at baseline was not controlled-for.

Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels

Background

Self-management strategies such as physical activity (PA) can address disability and optimize mental, physical, social and economic outcomes for persons living with HIV (PLWH). Understanding factors that influence PA behavior in PLWH is a first step in order to devise effective interventions.

Objective

The present review provides a systematic review of the correlates of PA in PLWH in sub-Saharan Africa.

Methods

Electronic databases were searched till April 2016. Keywords included ‘physical activity’ or ‘exercise’ or ‘sports’ and ‘AIDS’ or ‘HIV’.

Results

Ten correlates were identified in 6 studies including 1,015 (329♂) PLWH (mean age range=30.5–40.8years). Lower levels of PA were associated with older age (2/2 studies), a lower number of CD4 cells/µl (1/1), a more severe HIV-stage (1/1), a higher HIV load (1/1), the presence of opportunistic infections (1/1) and a higher BMI (1/1). Fisher's exact tests showed there were more significant correlates in objective tools versus subjective self-report (P=0.03).

Conclusion

The current review shows that participation in PA by PLWH in sub-Saharan Africa is associated with a range of complex factors which should be considered in the daily care of PLWH. This however might require repackaging of the current interventions for PLWH to allow a focus on PA.

Predictors of Falls and Fractures Leading to Hospitalization in People With Dementia: A Representative Cohort Study

OBJECTIVES

Investigate predictors of falls and fractures leading to hospitalization in a large cohort of people with dementia.

DESIGN

A retrospective cohort study.

SETTING AND PARTICIPANTS

People with diagnosed dementia between January 2007 and March 2013, aged >65 years, were assembled using data from the Maudsley Biomedical Research Centre Case Register, from 4 boroughs in London serving a population of 1.3 million people.

MEASURES

Falls and/or fractures leading to hospitalization were ascertained from linked national records. Demographic data, cognitive test scores, medications, and symptom and functioning scores from Health of the Nation Outcome Scales (HoNOS65+) were modeled in multivariate survival analyses to identify predictors of falls and fractures.

RESULTS

Of 8036 people with dementia (63.9% female), 2500 (31.1%, incidence rate 125.5 per 1000 person-years) had a fall during a mean follow-up of 2.5 years and 1437 (17.7%, incidence rate 65.5 per 1000 person-years) had a fracture. In multivariable models, significant predictors of falls were increased age, female gender, physical health problems, previous fall or fracture, vascular dementia vs Alzheimer's disease, higher neighborhood deprivation, noncohabiting status, and problems with living conditions. Ethnic minority status was protective of falls (eg, Caribbean/Asian ethnicity). Medications (including psychotropic and antipsychotics), neuropsychiatric symptoms, cognitive (Mini-Mental State Examination scores), or functional problems did not predict hospitalized falls. Predictors of fractures were similar to those predicting falls.

IMPLICATIONS

Over an average of 2.5 years, a third of people with dementia had a fall leading to hospitalization, necessitating action in clinical practice. Clinicians should consider that besides established demographic and physical health-related factors, the risk of hospitalization due to a fall or fractures in dementia is largely determined by environmental and socioeconomic factors. Interestingly, our data suggest that neuropsychiatric symptoms, cognitive status, functioning, or pharmacotherapy were not associated with falls/fractures.

Cross-sectional associations of active transport, employment status and objectively measured physical activity: analyses from the National Health and Nutrition Examination Survey

Background

To investigate associations between active transport, employment status and objectively measured moderate-to-vigorous physical activity (MVPA) in a representative sample of US adults.

Methods

Cross-sectional analyses of data from the National Health and Nutrition Examination Survey. A total of 5180 adults (50.2 years old, 49.0% men) were classified by levels of active transportation and employment status. Outcome measure was weekly time spent in MVPA as recorded by the Actigraph accelerometer. Associations between active transport, employment status and objectively measured MVPA were examined using multivariable linear regression models adjusted for age, BMI, race and ethnicity, education level, marital status, smoking status, working hour duration (among the employed only), and self-reported leisure time physical activity.

Results

Patterns of active transport were similar between the employed (n=2,897) and unemployed (n=2,283), such that 76.0% employed and 77.5% unemployed engaged in no active transport. For employed adults, those engaging in high levels of active transport (≥90 min/week) had higher amount of MVPA than those who did not engage in active transport. This translated to 40.8 (95% CI: 15.7, 65.9) additional minutes MVPA per week in men and 57.9 (95% CI: 32.1, 83.7) additional minutes MVPA per week in women. Among the unemployed adults, higher levels of active transport were associated with more MVPA among men (44.8 min/week MVPA, 95% CI: 9.2, 80.5), only.

Conclusions

Findings from the present study support interventions to promote active transport to increase population level physical activity. Additional strategies are likely required to promote physical activity among unemployed women.

Associations of smoking and alcohol consumption with healthy ageing: a systematic review and meta-analysis of longitudinal studies

OBJECTIVES

The number of older people is growing across the world; however, quantitative synthesis of studies examining the impact of lifestyle factors on the ageing process is rare. We conducted a systematic review and meta-analysis of longitudinal studies to synthesise the associations of smoking and alcohol consumption with healthy ageing (HA).

METHODS

Major electronic databases were searched from inception to March 2017 (prospectively registered systematic reviews registration number CRD42016038130). Studies were assessed for methodological quality. Random-effect meta-analysis was performed to calculate pooled ORs and 95% CI.

RESULTS

In total, we identified 28 studies (n=184 543); 27 studies reported results on smoking, 22 on alcohol consumption. 23 studies reported a significant positive association of never or former smoking with HA and 4 non-significant. 12 studies reported a significant positive association of alcohol consumption with HA, 9 no association and 1 negative. Meta-analysis revealed increased pooled OR of HA for never smokers compared with current smokers (2.36, 95% CI 2.03 to 2.75), never smokers compared with former smokers (1.32, 95% CI 1.23 to 1.41), former or never smokers compared with current smokers (1.72, 95% CI 1.20 to 2.47), never smokers compared with past or current smokers (1.29, 95% CI 1.16 to 1.43); drinkers compared with non-drinkers (1.28, 95% CI 1.08 to 1.52), light drinkers compared with non-drinkers (1.12, 95% CI 1.03 to 1.22), moderate drinkers compared with non-drinkers (1.35, 95% CI 0.93 to 1.97) and high drinkers compared with non-drinkers (1.25, 95% CI 1.09 to 1.44). There was considerable heterogeneity in the definition and measurement of HA and alcohol consumption.

CONCLUSIONS

There is consistent evidence from longitudinal studies that smoking is negatively associated with HA. The associations of alcohol consumption with HA are equivocal. Future research should focus on the implementation of a single metric of HA, on the use of consistent drinking assessment among studies and on a full-range of confounding adjustment. Our research also highlighted the limited research on ageing in low-and-middle-income countries.

Female-specific association among I, J and K mitochondrial genetic haplogroups and cancer: A longitudinal cohort study

Recent studies highlighted the role of mitochondrial dysregulation in cancer, suggesting that the different mitochondrial haplogroups might play a role in tumorigenesis and risk of cancer development. Our aim is to investigate whether any mitochondrial haplogroups carried a significant higher risk of cancer development in a large prospective cohort of North American people. The haplogroup assignment was performed by a combination of sequencing and PCR-RFLP techniques. Our specific outcome of interest was the incidence of any cancer during follow-up period. Overall, 3222 participants were included in the analysis. Women having I, J, K haplogroup reported a significant higher incidence of cancer compared to people with other haplogroups (p < 0.0001), whilst in men non association was found. In the multivariate analysis, women having I, J, K mitochondrial haplogroup reported a 50% increased risk of cancer (HR = 1.50; 95%CI: 1.04-2.16; p = 0.03). This gender-linked association may be partly explained by the role of mitochondrial function in female-specific (e.g. BRCA-driven) oncogenesis, but further studies are needed to better understand this potential correlation. Our findings may have important implications for cancer epidemiology and prevention.

Chronic Physical Conditions, Multimorbidity, and Mild Cognitive Impairment in Low- and Middle-Income Countries

OBJECTIVES

To assess the association between chronic physical conditions and multimorbidity and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs).

DESIGN

Nationally representative, cross-sectional, community-based study.

SETTING

Six countries that participated in the World Health Organization Study on Global Ageing and Adult Health.

PARTICIPANTS

Individuals aged 50 and older (N=32,715; mean age 62.1 ± 15.6; 51.7% female).

MEASUREMENTS

The definition of MCI was based on the recommendations of the National Institute on Ageing and Alzheimer's Association. Ten chronic conditions were assessed (angina pectoris, arthritis, asthma, cataract, chronic lung disease, diabetes mellitus, edentulism, hearing problems, hypertension, stroke). Multivariable logistic regression analysis was conducted to assess the association between chronic physical conditions, multimorbidity (≥2 chronic conditions), and MCI.

RESULTS

The prevalence of multimorbidity was 49.8% (95% confidence interval (CI)=48.1-51.5%) and of MCI was 15.3% (95% CI=14.4-16.3%). After adjustment for potential confounders, edentulism (odds ratio (OR)=1.24), arthritis (OR=1.24), chronic lung disease (OR=1.29), cataract (OR=1.33), stroke (OR=1.94), hearing problems (OR=2.27), and multimorbidity (OR=1.40) were significantly associated with MCI. There was a gradual increase in the likelihood of MCI (1 condition: OR=1.21, 95% CI=1.03-1.42; ≥4 conditions: OR=2.07, 95% CI=1.70-2.52).

CONCLUSION

These results highlight the need to investigate the underlying mechanisms linking chronic conditions and MCI and whether prevention or treatment of chronic conditions or multimorbidity can reduce the onset of cognitive decline and subsequent dementia, especially in LMICs.

The Endoplasmic Reticulum Stress Response in Neuroprogressive Diseases: Emerging Pathophysiological Role and Translational Implications

The endoplasmic reticulum (ER) is the main cellular organelle involved in protein synthesis, assembly and secretion. Accumulating evidence shows that across several neurodegenerative and neuroprogressive diseases, ER stress ensues, which is accompanied by over-activation of the unfolded protein response (UPR). Although the UPR could initially serve adaptive purposes in conditions associated with higher cellular demands and after exposure to a range of pathophysiological insults, over time the UPR may become detrimental, thus contributing to neuroprogression. Herein, we propose that immune-inflammatory, neuro-oxidative, neuro-nitrosative, as well as mitochondrial pathways may reciprocally interact with aberrations in UPR pathways. Furthermore, ER stress may contribute to a deregulation in calcium homoeostasis. The common denominator of these pathways is a decrease in neuronal resilience, synaptic dysfunction and even cell death. This review also discusses how mechanisms related to ER stress could be explored as a source for novel therapeutic targets for neurodegenerative and neuroprogressive diseases. The design of randomised controlled trials testing compounds that target aberrant UPR-related pathways within the emerging framework of precision psychiatry is warranted.