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Kazlauskaite R, Janssen I, Wilson RS, Appelhans BM, Evans DA, Arvanitakis Z, El Khoudary SR, Kravitz HM. Is Midlife Metabolic Syndrome Associated With Cognitive Function Change? The Study of Women's Health Across the Nation. J Clin Endocrinol Metab 2020; 105:5735651. [PMID: 32083676 PMCID: PMC7059989 DOI: 10.1210/clinem/dgaa067] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Metabolic syndrome (MetS) affects cognitive function in late life, particularly in women. But longitudinal research is scarce on associations of MetS with cognitive function during midlife. OBJECTIVE To determine associations between MetS exposure and cognitive function trajectories in midlife women. DESIGN AND SETTING This is a 17-year prospective, longitudinal study of multiracial/ethnic women in 7 US communities, with annual/biennial assessments. PARTICIPANTS Participants were 2149 US women traversing menopause. EXPOSURE Exposure consisted of MetS assessments (median 4 assessments over 4 years). MAIN OUTCOME MEASURES Main outcome measures were assessments of cognitive function in 3 domains: perceptual speed (symbol digit modalities test, SDMT), episodic memory (East Boston Memory Test, EBMT), and working memory (Digit Span Backward Test, DSB). RESULTS By their first cognitive assessment (age 50.7 ± 2.9 years), 29.5% met the criteria for MetS. Women completed a median (interquartile range [IQR]) of 6 (IQR 4-7) follow-up cognitive assessments over 11.2 (IQR 9.2-11.5) years. Women with MetS, compared with those without, had a larger 10-year decline in SDMT z-score (estimate -0.087, 95% confidence interval, -0.150 to -0.024; P = 0.007), after adjustment for cognitive testing practice effects, sociodemographics, lifestyle, mood, and menopause factors. As such, MetS accelerated the 10-year loss of perceptual speed by 24%. MetS did not differentially affect the rate of decline in either immediate (P = 0.534) or delayed (P = 0.740) episodic memory or in working memory (P = 0.584). CONCLUSIONS In midlife women MetS exposure was associated with accelerated decline in perceptual speed, but not episodic or working memory.
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Affiliation(s)
- Rasa Kazlauskaite
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
- Correspondence and Reprint Requests: Rasa Kazlauskaite, MD, Rush University Medical Center, 1750 W. Harrison St. (Jelke) Ste. 604w | Chicago, IL 60612. E-mail:
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
| | - Robert S Wilson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Denis A Evans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Zoe Arvanitakis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Samar R El Khoudary
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Howard M Kravitz
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
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Paul KC, Haan M, Mayeda ER, Ritz BR. Ambient Air Pollution, Noise, and Late-Life Cognitive Decline and Dementia Risk. Annu Rev Public Health 2020; 40:203-220. [PMID: 30935305 DOI: 10.1146/annurev-publhealth-040218-044058] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Exposure to ambient air pollution and noise is ubiquitous globally. A strong body of evidence links air pollution, and recently noise, to cardiovascular conditions that eventually may also affect cognition in the elderly. Data that support a broader influence of these exposures on cognitive function during aging is just starting to emerge. This review summarizes current findings and discusses methodological challenges and opportunities for research. Although current evidence is still limited, especially for chronic noise exposure, high exposure has been associated with faster cognitive decline either mediated through cerebrovascular events or resulting in Alzheimer's disease. Ambient environmental exposures are chronic and affect large populations. While they may yield relatively modest-sized risks, they nevertheless result in large numbers of cases. Reducing environmental pollution is clearly feasible, though lowering levels requires collective action and long-term policies such as standard setting, often at the national level as well as at the local level.
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Affiliation(s)
- Kimberly C Paul
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California 90095, USA; , ,
| | - Mary Haan
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California 94158, USA;
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California 90095, USA; , ,
| | - Beate R Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California 90095, USA; , , .,Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California 90095, USA
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Romero Starke K, Seidler A, Hegewald J, Klimova A, Palmer K. Retirement and decline in episodic memory: analysis from a prospective study of adults in England. Int J Epidemiol 2019; 48:1925-1936. [PMID: 31280313 PMCID: PMC6929525 DOI: 10.1093/ije/dyz135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Work has been associated with cognitive health. We examined whether retirement from work is associated with a decrease in episodic memory and whether this effect differs when considering workers' occupational class. METHODS In this prospective study using the English Longitudinal Study of Ageing (ELSA), we examined 1629 persons aged 50-75 years who were in paid work at baseline. A two-slope random effects linear regression centred at retirement was used to study the effect of retirement on episodic memory. The potential effect modification by occupational class was examined. RESULTS While memory trajectories show slightly decreasing memory scores before and afterretirement, the decreasing rates for both periods were similar [episodic memory β2b-β2a= -0.03, 95% confidence interval (CI) -0.08, 0.02]. When stratifying by occupational class, there was also no substantial difference in episodic memory trajectories before and after retirement. However, the lower occupational class showed a clear decline in episodic memory with time (pre-retirement β2a = -0.11, 95% CI -0.19, -0.03; post-retirement β2b = -0.13, 95% CI -0.19, -0.07) which was not evident for the higher occupational classes. CONCLUSIONS Our results show no observable difference in trajectories of change in episodic memory before and after retirement. However, the steeper memory decline in workers belonging to the lower occupational class may limit their prospect of prolonging their working lives. Hence enrichment programmes for the prevention of memory decline for these workers should be considered.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katie Palmer
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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Vonk JMJ, Arce Rentería M, Avila JF, Schupf N, Noble JM, Mayeux R, Brickman AM, Manly JJ. Secular trends in cognitive trajectories of diverse older adults. Alzheimers Dement 2019; 15:1576-1587. [PMID: 31672483 PMCID: PMC6925643 DOI: 10.1016/j.jalz.2019.06.4944] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 06/05/2019] [Accepted: 06/14/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION This study aimed to determine if later birth year influences trajectory of age-related cognitive decline across racial/ethnic groups and to test whether years of school, childhood socioeconomic status, and cardiovascular disease burden explain such secular trends. METHODS We compared cognitive trajectories of global cognition and subdomains in two successive racially/ethnically and educationally diverse birth cohorts of a prospective cohort study. RESULTS Later birth year was associated with higher initial cognitive levels for Whites and Blacks, but not Hispanics. Later birth year was also associated with less rapid rate of decline in all three racial/ethnic groups. More years of education, higher childhood socioeconomic status, and, to a smaller extent, greater cardiovascular disease burden accounted for higher intercepts in the later-born cohort, but did not account for attenuated slope of cognitive decline. DISCUSSION Later birth year is related to a slower rate of age-related decline in some cognitive domains in some racial/ethnic groups. Our analyses suggest that racial/ethnic and social inequalities are part of the mechanisms driving secular trends in cognitive aging and dementia.
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Affiliation(s)
- Jet M J Vonk
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Justina F Avila
- Center for Health Policy, University of New Mexico, Albuquerque, NM, USA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - James M Noble
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Ross RD, Shah RC, Leurgans S, Bottiglieri T, Wilson RS, Sumner DR. Circulating Dkk1 and TRAIL Are Associated With Cognitive Decline in Community-Dwelling, Older Adults With Cognitive Concerns. J Gerontol A Biol Sci Med Sci 2019; 73:1688-1694. [PMID: 29432613 DOI: 10.1093/gerona/glx252] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 12/22/2022] Open
Abstract
Background Osteoporosis and Alzheimer's disease are common diseases of aging that would seem to be unrelated, but may be linked through the influence of bone-derived signals on brain function. The aim of the current study is to investigate the relationship between circulating levels of bone-related biomarkers and cognition. Methods The population included 103 community-dwelling older individuals with memory concerns but without cognitive impairment. A global cognition summary measure was collected at baseline and 6, 12, and 18 months post-enrollment by converting raw scores from 19 cognitive function tests to z-scores and averaging. Baseline plasma concentrations of bone-related biomarkers, including undercarboxylated, carboxylated, and total osteocalcin, parathyroid hormone, C-terminal telopeptide of collagen 1 (CTX-1), procollagen type 1 amino-terminal propeptide, osteoprotegrin, osteopontin, Dickkopf WNT signaling pathway inhibitor 1 (Dkk1), sclerostin, and amyloid β peptides (Aβ40 and Aβ42), were measured. Results Using sex, age, and education-adjusted mixed-effects models, we found that baseline levels of TNF-related apoptosis-inducing ligand (TRAIL; p < .001), Dkk1 (p = .014), and CTX-1 (p = .046) were related to the annual rate of change of global cognition over the 18 month follow-up. In cognitive domain-specific analysis, baseline TRAIL was found to be positively related to the annual rate of change in episodic (p < .001) and working memory (p = .016), and baseline Dkk1 was positively related to semantic memory (p = .027) and negatively related to working memory (p = .016). Conclusions These results further confirm the link between bone and brain health and suggest that circulating levels of bone-related biomarkers may have diagnostic potential to predict worsening cognition.
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Affiliation(s)
- Ryan D Ross
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Raj C Shah
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois.,Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Sue Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | | | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Dale Rick Sumner
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois.,Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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56
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Lee PC, Artaud F, Cormier-Dequaire F, Rascol O, Durif F, Derkinderen P, Marques AR, Bourdain F, Brandel JP, Pico F, Lacomblez L, Bonnet C, Brefel-Courbon C, Ory-Magne F, Grabli D, Klebe S, Mangone G, You H, Mesnage V, Brice A, Vidailhet M, Corvol JC, Elbaz A. Examining the Reserve Hypothesis in Parkinson's Disease: A Longitudinal Study. Mov Disord 2019; 34:1663-1671. [PMID: 31518456 DOI: 10.1002/mds.27854] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether reserve plays a role in Parkinson's disease (PD) patients has received less attention than in dementia and has been mainly examined in relation with cognitive function. OBJECTIVE To investigate whether reserve plays a role in the severity and progression of motor, cognitive, and nonmotor PD symptoms by examining whether education level (proxy of reserve) is associated with baseline performance and rate of progression. METHODS We used data from a longitudinal cohort of PD patients (≤5-year disease duration at baseline) annually followed up to 5 years (n = 393; 41% women; mean age = 62.3 years, standard deviation = 10.0; mean disease duration = 2.6 years, standard deviation = 1.5). We examined the relationship of education with time to reach Hoehn and Yahr stage ≥3 using Cox regression and with baseline severity and progression of motor (Movement Disorder Society-Unified Parkinson's Disease Rating Scale parts II and III, gait speed), cognitive (Mini-Mental State Examination), and nonmotor (depression, anxiety, nonmotor symptoms scale, quality of life) symptoms using mixed models. RESULTS Education level was not associated with age at onset or diagnosis. Compared with the low-education group, the incidence of Hoehn and Yahr ≥3.0 was 0.42 times lower (95% confidence interval, 0.22-0.82, P = 0.012) in the high-education group. Higher education was associated with better baseline motor function (P < 0.001), but not with the rate of motor decline (P > 0.15). Similar results were observed for cognition. Education was not associated with nonmotor symptoms. CONCLUSIONS Higher education is associated with better baseline motor/cognitive function in PD, but not with rate of decline, and with a lower risk of reaching Hoehn and Yahr ≥3 during the follow-up. Our observations are consistent with a passive reserve hypothesis for motor/cognitive symptoms. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pei-Chen Lee
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.,Taipei City Hospital, Taipei, Taiwan
| | - Fanny Artaud
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
| | - Florence Cormier-Dequaire
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Olivier Rascol
- NS-PARK/FCRIN Network, Paris, France.,Universityof Toulouse 3, Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436, Départements de Neurosciences et de Pharmacologie Clinique, NeuroToul COEN center, Toulouse, France
| | - Franck Durif
- NS-PARK/FCRIN Network, Paris, France.,Department of Neurology, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Derkinderen
- NS-PARK/FCRIN Network, Paris, France.,Department of Neurology, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Ana-Raquel Marques
- NS-PARK/FCRIN Network, Paris, France.,Department of Neurology, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Fernando Pico
- Department of Neurology, Centre Hospitalier de Versailles; and Université Versailles Saint Quentin en Yvelines et Paris Saclay, Versailles, France
| | - Lucette Lacomblez
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Cecilia Bonnet
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Christine Brefel-Courbon
- NS-PARK/FCRIN Network, Paris, France.,Universityof Toulouse 3, Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436, Départements de Neurosciences et de Pharmacologie Clinique, NeuroToul COEN center, Toulouse, France
| | - Fabienne Ory-Magne
- NS-PARK/FCRIN Network, Paris, France.,Universityof Toulouse 3, Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436, Départements de Neurosciences et de Pharmacologie Clinique, NeuroToul COEN center, Toulouse, France
| | - David Grabli
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Stephan Klebe
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Graziella Mangone
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Hana You
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Valérie Mesnage
- Department of Neurology, Centre Hospitalo-Universitaire Saint-Antoine, Paris, France
| | - Alexis Brice
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Marie Vidailhet
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Jean-Christophe Corvol
- Department of Neurology and Genetics, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France.,Sorbonne Université, INSERM, Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, CNRS, Paris, France.,NS-PARK/FCRIN Network, Paris, France
| | - Alexis Elbaz
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
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Schoeni RF, Freedman VA, Langa KM. Introduction to a Supplement on Population Level Trends in Dementia: Causes, Disparities, and Projections. J Gerontol B Psychol Sci Soc Sci 2019; 73:S1-S9. [PMID: 29669106 DOI: 10.1093/geronb/gby007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 01/07/2023] Open
Affiliation(s)
- Robert F Schoeni
- Institute for Social Research, University of Michigan, Ann Arbor.,Ford School of Public Policy, University of Michigan, Ann Arbor.,Department of Economics, University of Michigan, Ann Arbor
| | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Institute for Social Research, University of Michigan, Ann Arbor.,University of Michigan Medical School, Ann Arbor.,Veterans Affairs, Ann Arbor Center for Clinical Management Research, Michigan
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Freedman VA, Kasper JD, Spillman BC, Plassman BL. Short-Term Changes in the Prevalence of Probable Dementia: An Analysis of the 2011-2015 National Health and Aging Trends Study. J Gerontol B Psychol Sci Soc Sci 2019; 73:S48-S56. [PMID: 29669099 DOI: 10.1093/geronb/gbx144] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 01/13/2023] Open
Abstract
Objectives Studies have reported decreasing dementia prevalence in recent decades in the United States. We explore with a new national data source whether declines have occurred since 2011, whether trends are attributable to shifts in dementia incidence or mortality, and whether trends are related to shifts in population composition or subgroup prevalence. Methods We use the 2011-2015 National Health and Aging Trends Study (N = 27,547) to examine prevalence of probable dementia among the 70 and older population. To minimize the influence of potential learning effects on prevalence rates, we require individuals to meet probable dementia criteria at two consecutive rounds. Results Prevalence of probable dementia declines over this period by 1.4% to 2.6% per year. Declines are concentrated among women, non-Hispanic white and black groups, and those with no vascular conditions or risk factors. The latter group also has experienced declines in dementia incidence. Declines in prevalence are largely attributable to age- and education-related shifts in population composition. Discussion Given the role of age and educational composition in short-term declines, the United States is likely to continue to experience short-term declines in dementia prevalence. However, persistently high rates among minority groups, especially of Hispanic origin, are concerning, and, barring new treatments, long-run trends may reverse course.
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Affiliation(s)
- Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Judith D Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Garcia MA, Downer B, Chiu CT, Saenz JL, Rote S, Wong R. Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States. THE GERONTOLOGIST 2019; 59:281-289. [PMID: 28958071 DOI: 10.1093/geront/gnx142] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To document racial/ethnic and nativity differences by gender in cognitive life expectancies among older adults in the United States. RESEARCH DESIGN AND METHODS Sullivan-based life tables were used to estimate cognitively normal, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults 50 years and older in the Health and Retirement Study. RESULTS Among women, the number of years spent living with dementia for Whites, Blacks, U.S.-born Hispanics, and foreign-born Hispanics was 1.6, 3.9, 4.7, and 6.0 years, respectively. For men, Whites lived 1.1 years with dementia compared to 3.1 years for Blacks, 3.0 years for U.S.-born Hispanics and 3.2 years for foreign-born Hispanics. Similar patterns were observed for race/ethnic and nativity differences in CIND life expectancies. Blacks and Hispanics spend a larger fraction of their remaining years with CIND and dementia relative to Whites, regardless of gender. Foreign-born Hispanic men and women and Black men are particularly disadvantaged in the proportion of years spent after age 50 with CIND and/or dementia. DISCUSSION AND IMPLICATIONS Disparities in cognitive life expectancies indicate that intervention strategies should target the specific needs of minority and immigrant older adults with dementia. Given that education is a strong predictor of cognitive health, improving access to the social and economic resources that delay dementia onset is key to improving the well-being of diverse older adults.
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Affiliation(s)
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Joseph L Saenz
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Sunshine Rote
- Kent School of Social Work, University of Louisville, Kentucky
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
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Younes L, Albert M, Moghekar A, Soldan A, Pettigrew C, Miller MI. Identifying Changepoints in Biomarkers During the Preclinical Phase of Alzheimer's Disease. Front Aging Neurosci 2019; 11:74. [PMID: 31001108 PMCID: PMC6454004 DOI: 10.3389/fnagi.2019.00074] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/14/2019] [Indexed: 01/29/2023] Open
Abstract
Objective: Several models have been proposed for the evolution of Alzheimer's disease (AD) biomarkers. The aim of this study was to identify changepoints in a range of biomarkers during the preclinical phase of AD. Methods: We examined nine measures based on cerebrospinal fluid (CSF), magnetic resonance imaging (MRI) and cognitive testing, obtained from 306 cognitively normal individuals, a subset of whom subsequently progressed to the symptomatic phase of AD. A changepoint model was used to determine which of the measures had a significant change in slope in relation to clinical symptom onset. Results: All nine measures had significant changepoints, all of which preceded symptom onset, however, the timing of these changepoints varied considerably. A single measure, CSF t-tau, had an early changepoint (34 years prior to symptom onset). A group of measures, including the remaining CSF measures (CSF Abeta and phosphorylated tau) and all cognitive tests had changepoints 10-15 years prior to symptom onset. A second group is formed by medial temporal lobe shape composite measures, with a 6-year time difference between the right and left side (respectively nine and 3 years prior to symptom onset). Conclusion: These findings highlight the long period of time prior to symptom onset during which AD pathology is accumulating in the brain. There are several significant findings, including the early changes in cognition and the laterality of the MRI findings. Additional work is needed to clarify their significance.
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Affiliation(s)
- Laurent Younes
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Michael I Miller
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
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Rabin JS, Perea RD, Buckley RF, Neal TE, Buckner RL, Johnson KA, Sperling RA, Hedden T. Global White Matter Diffusion Characteristics Predict Longitudinal Cognitive Change Independently of Amyloid Status in Clinically Normal Older Adults. Cereb Cortex 2019; 29:1251-1262. [PMID: 29425267 PMCID: PMC6499008 DOI: 10.1093/cercor/bhy031] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/08/2018] [Indexed: 02/07/2023] Open
Abstract
White matter degradation has been proposed as one possible explanation for age-related cognitive decline. In the present study, we examined 2 main questions: 1) Do diffusion characteristics predict longitudinal change in cognition independently or synergistically with amyloid status? 2) Are the effects of diffusion characteristics on longitudinal cognitive change tract-specific or global in nature? Cognitive domains of executive function, episodic memory, and processing speed were measured annually (mean follow-up = 3.93 ± 1.25 years). Diffusion tensor imaging and Pittsburgh Compound-B positron emission tomography were performed at baseline in 265 clinically normal older adults (aged 63-90). Tract-specific diffusion was measured as the mean fractional anisotropy (FA) for 9 major white matter tracts. Global diffusion was measured as the mean FA across the 9 white matter tracts. Linear mixed models demonstrated independent, rather than synergistic, effects of global FA and amyloid status on cognitive decline. After controlling for amyloid status, lower global FA was associated with worse longitudinal performance in episodic memory and processing speed, but not executive function. After accounting for global FA, none of the individual tracts predicted a significant change in cognitive performance. These findings suggest that global, rather than tract-specific, diffusion characteristics predict longitudinal cognitive decline independently of amyloid status.
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Affiliation(s)
- Jennifer S Rabin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rodrigo D Perea
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel F Buckley
- Florey Institutes of Neuroscience and Mental Health, Melbourne and Melbourne School of Psychological Science, University of Melbourne, Melbourne, Australia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Taylor E Neal
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Randy L Buckner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology and Center for Brain Science, Harvard University, Cambridge, MA, USA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA, USA
| | - Trey Hedden
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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62
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Arendash G, Cao C, Abulaban H, Baranowski R, Wisniewski G, Becerra L, Andel R, Lin X, Zhang X, Wittwer D, Moulton J, Arrington J, Smith A. A Clinical Trial of Transcranial Electromagnetic Treatment in Alzheimer's Disease: Cognitive Enhancement and Associated Changes in Cerebrospinal Fluid, Blood, and Brain Imaging. J Alzheimers Dis 2019; 71:57-82. [PMID: 31403948 PMCID: PMC6839500 DOI: 10.3233/jad-190367] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Small aggregates (oligomers) of the toxic proteins amyloid-β (Aβ) and phospho-tau (p-tau) are essential contributors to Alzheimer's disease (AD). In mouse models for AD or human AD brain extracts, Transcranial Electromagnetic Treatment (TEMT) disaggregates both Aβ and p-tau oligomers, and induces brain mitochondrial enhancement. These apparent "disease-modifying" actions of TEMT both prevent and reverse memory impairment in AD transgenic mice. OBJECTIVE To evaluate the safety and initial clinical efficacy of TEMT against AD, a comprehensive open-label clinical trial was performed. METHODS Eight mild/moderate AD patients were treated with TEMT in-home by their caregivers for 2 months utilizing a unique head device. TEMT was given for two 1-hour periods each day, with subjects primarily evaluated at baseline, end-of-treatment, and 2 weeks following treatment completion. RESULTS No deleterious behavioral effects, discomfort, or physiologic changes resulted from 2 months of TEMT, as well as no evidence of tumor or microhemorrhage induction. TEMT induced clinically important and statistically significant improvements in ADAS-cog, as well as in the Rey AVLT. TEMT also produced increases in cerebrospinal fluid (CSF) levels of soluble Aβ1-40 and Aβ1-42, cognition-related changes in CSF oligomeric Aβ, a decreased CSF p-tau/Aβ1-42 ratio, and reduced levels of oligomeric Aβ in plasma. Pre- versus post-treatment FDG-PET brain scans revealed stable cerebral glucose utilization, with several subjects exhibiting enhanced glucose utilization. Evaluation of diffusion tensor imaging (fractional anisotropy) scans in individual subjects provided support for TEMT-induced increases in functional connectivity within the cognitively-important cingulate cortex/cingulum. CONCLUSION TEMT administration to AD subjects appears to be safe, while providing cognitive enhancement, changes to CSF/blood AD markers, and evidence of stable/enhanced brain connectivity.
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Affiliation(s)
| | - Chuanhai Cao
- College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Haitham Abulaban
- University of South Florida Health/Byrd Alzheimer’s Institute, Tampa, FL, USA
| | | | | | | | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, FL, USA
- Department of Neurology, 2nd Faculty of Medicine, Charles University/Motol University Hospital, Prague, Czech Republic
| | - Xiaoyang Lin
- College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Xiaolin Zhang
- College of Pharmacy, University of South Florida, Tampa, FL, USA
| | | | | | | | - Amanda Smith
- University of South Florida Health/Byrd Alzheimer’s Institute, Tampa, FL, USA
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63
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Downer B, Garcia MA, Raji M, Markides KS. Cohort Differences in Cognitive Impairment and Cognitive Decline Among Mexican-Americans Aged 75 Years or Older. Am J Epidemiol 2019; 188:119-129. [PMID: 30202897 PMCID: PMC6321807 DOI: 10.1093/aje/kwy196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022] Open
Abstract
Research suggests that the prevalence and incidence of cognitive impairment among older adults is decreasing. This analysis used data from 9 waves (1993-2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess cognitive status and cognitive decline for 2 cohorts of Mexican-Americans aged ≥75 years in 1993-1994 versus 2004-2005. Logistic regression, joint longitudinal survival models, and illness-death models for interval-censored data were used to examine cohort differences in the odds of prevalent cognitive impairment, trajectories of cognitive decline, and the risk of 10-year incident cognitive impairment, respectively. Results indicated that compared with the 1993-1994 cohort, the 2004-2005 cohort had higher odds for prevalent cognitive impairment (odds ratio = 2.51, 95% confidence interval (CI): 1.92, 3.29), particularly among participants with <4 years of education (odds ratio = 2.99, 95% CI: 2.14, 4.18). Conversely, the 2004-2005 cohort exhibited significantly slower rates of cognitive decline (βˆ = 0.50, 95% CI: 0.39, 0.62) and had a significantly lower risk of incident cognitive impairment (hazard ratio = 0.75, 95% CI: 0.62, 0.91) compared with the 1993-1994 cohort. This analysis provides mixed results for cohort trends in the cognitive health of older Mexican-Americans. Continued research is needed to identify risk factors that contribute to these population-level trends.
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Affiliation(s)
- Brian Downer
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, Texas
| | - Marc A Garcia
- Department of Sociology, University of Nebraska, Lincoln, Lincoln, Nebraska
- Institute for Ethnic Studies, University of Nebraska, Lincoln, Lincoln, Nebraska
| | - Mukaila Raji
- Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Kyriakos S Markides
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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64
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Vable AM, Eng CW, Mayeda ER, Basu S, Marden JR, Hamad R, Glymour MM. Mother's education and late-life disparities in memory and dementia risk among US military veterans and non-veterans. J Epidemiol Community Health 2018; 72:1162-1167. [PMID: 30082424 PMCID: PMC6226315 DOI: 10.1136/jech-2018-210771] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/06/2018] [Accepted: 07/11/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Adverse childhood socioeconomic status (cSES) predicts higher late-life risk of memory loss and dementia. Veterans of U.S. wars are eligible for educational and economic benefits that may offset cSES disadvantage. We test whether cSES disparities in late-life memory and dementia are smaller among veterans than non-veterans. METHODS Data came from US-born men in the 1995-2014 biennial surveys of the Health and Retirement Study (n=7916 born 1928-1956, contributing n=38 381 cognitive assessments). Childhood SES was represented by maternal education. Memory and dementia risk were assessed with brief neuropsychological assessments and proxy reports. Military service (veteran/non-veteran) was evaluated as a modifier of the effect of maternal education on memory and dementia risk. We employed linear or logistic regression models to test whether military service modified the effect of maternal education on memory or dementia risk, adjusted for age, race, birthplace and childhood health. RESULTS Low maternal education was associated with worse memory than high maternal education (β = -0.07 SD, 95% CI -0.08 to -0.05), while veterans had better memory than non-veterans (β = 0.03 SD, 95% CI 0.02 to 0.04). In interaction analyses, maternal education disparities in memory were smaller among veterans than non-veterans (difference in disparities = 0.04 SD, 95% CI 0.01 to 0.08, p = 0.006). Patterns were similar for dementia risk. CONCLUSIONS Disparities in memory by maternal education were smaller among veterans than non-veterans, suggesting military service and benefits partially offset the deleterious effects of low maternal education on late-life cognitive outcomes.
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Affiliation(s)
- Anusha M Vable
- Center for Population Health Sciences, Stanford University, Palo Alto, California, USA.,Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, USA.,Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Chloe W Eng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Sanjay Basu
- Center for Population Health Sciences, Stanford University, Palo Alto, California, USA.,Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, USA.,Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rita Hamad
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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65
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Lee S, Zhou X, Gao Y, Vardarajan B, Reyes-Dumeyer D, Rajan KB, Wilson RS, Evans DA, Besser LM, Kukull WA, Bennett DA, Brickman AM, Schupf N, Mayeux R, Barral S. Episodic memory performance in a multi-ethnic longitudinal study of 13,037 elderly. PLoS One 2018; 13:e0206803. [PMID: 30462667 PMCID: PMC6248922 DOI: 10.1371/journal.pone.0206803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 10/21/2018] [Indexed: 02/02/2023] Open
Abstract
Age-related changes in memory are not uniform, even in the absence of dementia. Characterization of non-disease associated cognitive changes is crucial to gain a more complete understanding of brain aging. Episodic memory was investigated in 13,037 ethnically diverse elderly (ages 72 to 85 years) with two to 15 years of follow-up, and with known dementia status, age, sex, education, and APOE genotypes. Adjusted trajectories of episodic memory performance over time were estimated using Latent Class Mixed Models. Analysis was conducted using two samples at baseline evaluation: i) non-cognitively impaired individuals, and ii) all individuals regardless of dementia status. We calculated the age-specific annual incidence rates of dementia in the non-demented elderly (n = 10,220). Two major episodic memory trajectories were estimated: 1) Stable-consisting of individuals exhibiting a constant or improved memory function, and 2) Decliner-consisting of individuals whose memory function declined. The majority of the study participants maintain their memory performance over time. Compared to those with Stable trajectory, individuals characterized as Decliners were more likely to have non-white ethnic background, fewer years of education, a higher frequency of ε4 allele at APOE gene and five times more likely to develop dementia. The steepest decline in episodic memory was observed in Caribbean-Hispanics compared to non-Hispanic whites (p = 4.3 x 10(-15)). The highest incident rates of dementia were observed in the oldest age group, among those of Caribbean-Hispanics ancestry and among Decliners who exhibited rates five times higher than those with Stable trajectories (11 per 100 person-years versus 3 per 100 person-years. Age, education, ethnic background and APOE genotype influence the maintenance of episodic memory. Declining memory is one of the strongest predictors of incident dementia.
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Affiliation(s)
- Seonjoo Lee
- Research Foundation for Mental Hygiene and the Department of Biostatics, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
| | - Xingtao Zhou
- The Georgetown University Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., United States of America
| | - Yizhe Gao
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Badri Vardarajan
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Dolly Reyes-Dumeyer
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Kumar B. Rajan
- Department of Public Health Sciences, University of California at Davis, Davis, California, United States of America
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Denis A. Evans
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Lilah M. Besser
- School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Walter A. Kukull
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Adam M. Brickman
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Nicole Schupf
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Richard Mayeux
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Sandra Barral
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
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Gross AL, Chu N, Anderson L, Glymour MM, Jones RN. Do people with Alzheimer's disease improve with repeated testing? Unpacking the role of content and context in retest effects. Age Ageing 2018; 47:866-871. [PMID: 30124777 PMCID: PMC6201832 DOI: 10.1093/ageing/afy136] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/18/2018] [Accepted: 07/26/2018] [Indexed: 11/14/2022] Open
Abstract
Objective retest effects may be attributed to 'repeated content' in neuropsychological tests such as words in word list-learning tests, or the 'testing context' which involves procedural memory and reduced test anxiety following repeated administration. Alzheimer's Disease (AD) severely impairs episodic memory, so longitudinal cognitive testing among people with dementia may reveal the relative contributions of content versus context to retest effects in neuropsychological testing. Method we used data from the Critical Path Institute's repository of placebo arm data from randomized controlled trials (RCTs) of dementia conducted by participating pharmaceutical companies (N = 990 people, 4,170 study visits, up to 2.4 years of follow-up). To estimate retest effects on the Mini-Mental State Examination (MMSE), we used linear regressions with random effects for people and time, adjusting for age, sex and race, and longitudinal quantile regressions. Results average MMSE score (16.6 points, SD = 5.5, range 1, 27) declined by 2.0 points/year (95% confidence interval, CI: -2.3, -1.8). Mean retest effect was 0.6 points (95% CI: 0.4, 0.8) at second assessment (average 4 months after baseline). Retest effects were similar among participants with and without any recall on the short-delay word recall subscale score at baseline, and at the 30th, 50th and 70th percentiles of the MMSE distribution, suggesting similar retest effects across the spectrum from mild to severe cases of dementia. Conclusions retest effects are apparent in people with dementia despite reduced episodic memory, suggesting a prominent role of the testing context in RCTs and cohort studies.
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Affiliation(s)
- Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Nadia Chu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Loretta Anderson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Maria Glymour
- Departments of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Richard N Jones
- Departments of Psychiatry and Human Behavior and Neurology, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Foverskov E, Glymour MM, Mortensen EL, Holm A, Lange T, Lund R. Education and Cognitive Aging: Accounting for Selection and Confounding in Linkage of Data From the Danish Registry and Survey of Health, Ageing and Retirement in Europe. Am J Epidemiol 2018; 187:2423-2430. [PMID: 30099480 DOI: 10.1093/aje/kwy162] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Earlier studies report inconsistent associations between education and cognitive aging. We assessed the association, accounting for selective dropout due to death or dementia, and, in a subsample, accounting for confounding by early-life intelligence. Data from the Danish component of the Survey of Health, Ageing and Retirement in Europe (n = 3,400) were linked to registry data (education records, dementia diagnoses, and mortality) and the Danish Conscription Database (youth intelligence measurements for 854 men). Word recall and verbal fluency were assessed up to 4 times over 10 years (2004-2013) and combined by averaging the z scores. We fitted a joint model linking a time-to-event model for dementia or death to a linear mixed-effects model for cognitive change. Rate of cognitive decline was slower among people with high education compared with low education (β = 0.112, 95% confidence interval (CI): 0.056, 0.170). Adjusting for youth intelligence did not attenuate the association between education and cognitive decline (crude β = 0.136, 95% CI: 0.028, 0.244 vs. adjusted β = 0.145, 95% CI: 0.022, 0.269). The results suggest that higher education may slow cognitive decline in later life. In this sample, results changed little when accounting for selective attrition and confounding by intelligence.
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Affiliation(s)
- Else Foverskov
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anders Holm
- Department of Sociology, University of Western Ontario, London, Canada
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Tully PJ, Helmer C, Peters R, Tzourio C. Exploiting Drug-Apolipoprotein E Gene Interactions in Hypertension to Preserve Cognitive Function: The 3-City Cohort Study. J Am Med Dir Assoc 2018; 20:188-194.e4. [PMID: 30292766 DOI: 10.1016/j.jamda.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The objective was to test the hypothesis that antihypertensive drugs have a differential effect on cognition in carriers and noncarriers of the apolipoprotein ε4 (APOE4) polymorphism. DESIGN Prospective population-based cohort, France. SETTING AND PARTICIPANTS A total of 3359 persons using antihypertensive drugs (median age 74 years, 62% women) were serially assessed up to 10 years follow-up. MEASURES Exposure to antihypertensive drug use was established in the first 2 years. Cognitive function was assessed at baseline, 2, 4, 7, and 10 years with a validated test battery covering global cognition, verbal fluency, immediate visual recognition memory, processing speed, and executive function. Clinically significant change in cognitive function was determined using reliable change indices represented as z scores and analyzed with linear mixed-models. RESULTS From 3359 persons exposed to antihypertensive drugs, 653 were APOE4 carriers (5.1% homozygous, 94.9% heterozygous) and median follow-up was 5.2 years (interquartile range 3.7-8.0). In APOE4 carriers, improved general cognitive function over time was associated with exposure to angiotensin converting enzyme inhibitors [β = .14; 95% confidence interval (CI) .06-.23, P = .001] and angiotensin receptor blockers (β = .11; 95% CI .02-.21, P = .019). Improved verbal fluency was associated with angiotensin converting enzyme inhibitors (β = .11; 95% CI .03-.20, P = .012). CONCLUSIONS Renin-angiotensin-system blockade was associated with improved general cognitive function in APOE4 carriers. Findings did not support renin-angiotensin-system drugs' lipophilicity or ability to cross the blood-brain barrier as potential mechanisms. The findings have implications for selecting the optimal antihypertensive drug in older populations at risk of cognitive decline and dementia.
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Affiliation(s)
- Phillip J Tully
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team HEALTHY, Bordeaux, France; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team LEHA, Bordeaux, France
| | - Ruth Peters
- Center for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia; Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Christophe Tzourio
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team HEALTHY, Bordeaux, France
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Grasset L, Jacqmin-Gadda H, Proust-Lima C, Pérès K, Amieva H, Dartigues JF, Helmer C. Temporal Trends in the Level and Decline of Cognition and Disability in an Elderly Population: The PAQUID Study. Am J Epidemiol 2018; 187:2168-2176. [PMID: 29893786 DOI: 10.1093/aje/kwy118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
In line with declining trends in dementia incidence, we compared the cognitive and functional evolution of 2 "generations" of elderly individuals aged 78-88 years, who were included 10 years apart in the French Personnes Agées Quid cohort (n = 612 in 1991-1992 and n = 628 in 2001-2002) and followed-up for 12 years with assessments of cognition and disability. The impact of specific risk factors on this evolution was evaluated. Differences between the generations in baseline levels and decline over time were estimated using a joint model to account for differential attrition. Compared with the first generation, the second generation had higher performances at baseline on 4 cognitive tests (from P < 0.005). Differences in global cognition, verbal fluency, and processing speed, but not in working memory, were mostly explained by improvement in educational level. The second generation also exhibited less cognitive decline in verbal fluency and working memory. Progression of disability was less over the follow-up period for the second generation than for the first. The cognitive state of this elderly population improved, partially due to improvements in educational level.
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Affiliation(s)
- Leslie Grasset
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Karine Pérès
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Hélène Amieva
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Jean-François Dartigues
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Bordeaux University Hospital, Memory Consultation, Memory Resource and Research Centre, Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
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70
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Correction for retest effects across repeated measures of cognitive functioning: a longitudinal cohort study of postoperative delirium. BMC Med Res Methodol 2018; 18:69. [PMID: 29970000 PMCID: PMC6029140 DOI: 10.1186/s12874-018-0530-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 06/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have compared methods to correct for retest effects or practice effects in settings where an acute event could influence test performance, such as major surgery. Our goal in this study was to evaluate the use of different methods to correct for the effects of practice or retest on repeated test administration in the context of an observational study of older adults undergoing elective surgery. METHODS In a cohort of older surgical patients (N = 560) and a non-surgical comparison group (N = 118), we compared changes on repeated cognitive testing using a summary measure of general cognitive performance (GCP) between patients who developed post-operative delirium and those who did not. Surgical patients were evaluated pre-operatively and at 1, 2, 6, 12, and 18 months following surgery. Inferences from linear mixed effects models using four approaches were compared: 1) no retest correction, 2) mean-difference correction, 3) predicted-difference correction, and 4) model-based correction. RESULTS Using Approaches 1 or 4, which use uncorrected data, both surgical groups appeared to improve or remain stable after surgery. In contrast, Approaches 2 and 3, which dissociate retest and surgery effects by using retest-adjusted GCP scores, revealed an acute decline in performance in both surgical groups followed by a recovery to baseline. Relative differences between delirium groups were generally consistent across all approaches: the delirium group showed greater short- and longer-term decline compared to the group without delirium, although differences were attenuated after 2 months. Standard errors and model fit were also highly consistent across approaches. CONCLUSION All four approaches would lead to nearly identical inferences regarding relative mean differences between groups experiencing a key post-operative outcome (delirium) but produced qualitatively different impressions of absolute performance differences following surgery. Each of the four retest correction approaches analyzed in this study has strengths and weakness that should be evaluated in the context of future studies. Retest correction is critical for interpretation of absolute cognitive performance measured over time and, consequently, for advancing our understanding of the effects of exposures such as surgery, hospitalization, acute illness, and delirium.
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71
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Hale JM. Cognitive Disparities: The Impact of the Great Depression and Cumulative Inequality on Later-Life Cognitive Function. Demography 2018; 54:2125-2158. [PMID: 29164499 DOI: 10.1007/s13524-017-0629-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Population aging has driven a spate of recent research on later-life cognitive function. Greater longevity increases the lifetime risk of memory diseases that compromise the cognitive abilities vital to well-being. Alzheimer's disease, thought to be the most common underlying pathology for elders' cognitive dysfunction (Willis and Hakim 2013), is already the sixth leading cause of death in the United States (Alzheimer's Association 2016). Understanding social determinants of pathological cognitive decline is key to crafting interventions, but evidence is inconclusive for how social factors interact over the life course to affect cognitive function. I study whether early-life exposure to the Great Depression is directly associated with later-life cognitive function, influences risky behaviors over the life course, and/or accumulates with other life-course disadvantages. Using growth curve models to analyze the Health and Retirement Study, I find that early-life exposure to the Great Depression is associated with fluid cognition, controlling for intervening factors-evidence for a critical period model. I find little support for a social trajectory model. Disadvantage accumulates over the life course to predict worse cognitive function, providing strong evidence for a cumulative inequality model.
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Affiliation(s)
- Jo Mhairi Hale
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.
- Department of Sociology, University of California, Davis, CA, USA.
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72
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Wilson RS, Capuano AW, Yu L, Yang J, Kim N, Leurgans SE, Lamar M, Schneider JA, Bennett DA, Boyle PA. Neurodegenerative disease and cognitive retest learning. Neurobiol Aging 2018; 66:122-130. [PMID: 29558667 DOI: 10.1016/j.neurobiolaging.2018.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/28/2023]
Abstract
Retest learning impacts estimates of cognitive aging, but its bases are uncertain. Here, we test the hypothesis that dementia-related neurodegeneration impairs retest learning. Older persons without cognitive impairment at enrollment (n = 567) had annual cognitive testing for a mean of 11 years, died, and had a neuropathologic examination to quantify 5 neurodegenerative pathologies. Change point models were used to divide cognitive trajectories into an early retest sensitive component and a later component less sensitive to retest. Performance on a global cognitive measure (baseline mean = 0.227, standard deviation = 0.382) increased an estimated mean of 0.142-unit per year for a mean of 1.5 years and declined an estimated mean of 0.123-unit per year thereafter. No pathologic marker was related to cognitive change before the change point; each was related to cognitive decline after the change point. Results were comparable in analyses that used specific cognitive outcomes, included 220 individuals with mild cognitive impairment at enrollment, or allowed a longer retest learning period. The findings suggest that neurodegeneration does not impact cognitive retest learning.
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Affiliation(s)
- Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jingyun Yang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Namhee Kim
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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73
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Proust-Lima C, Philipps V, Dartigues JF, Bennett DA, Glymour MM, Jacqmin-Gadda H, Samieri C. Are latent variable models preferable to composite score approaches when assessing risk factors of change? Evaluation of type-I error and statistical power in longitudinal cognitive studies. Stat Methods Med Res 2017; 28:1942-1957. [PMID: 29165049 DOI: 10.1177/0962280217739658] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As with many health constructs, cognition is difficult to measure accurately; it is assessed by multiple psychometric tests. Two approaches are commonly adopted to address this multivariate aspect in longitudinal analyses: the composite score approach summarizes the tests into a single outcome and subsequently analyzes its change; the multivariate approach relates the tests to the underlying cognitive level and simultaneously analyzes its change. We compared the quality of inference of these approaches in a simulation study based on three combinations of tests inspired by two population-based cohorts. In the absence of missing data and with relatively Gaussian psychometric tests, the composite score approach provided similar type-I error rates and statistical power as the multivariate latent process approach. In the more plausible scenario with departures from normality, transformations of each constituent test or of the composite score were required to avoid excess type-I error rates. When missing tests were more likely in cognitively impaired subjects, inference with the composite was not correct. In conclusion, composite scores can be used to assess risk factors for cognitive change provided they are correctly normalized, constituent tests are reliable and the amount of uninformative missing tests remains small. Otherwise, latent variable models are recommended.
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Affiliation(s)
| | | | | | - David A Bennett
- 2 Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - M Maria Glymour
- 3 Departments of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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74
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Jacobs DM, Ard MC, Salmon DP, Galasko DR, Bondi MW, Edland SD. Potential implications of practice effects in Alzheimer's disease prevention trials. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:531-535. [PMID: 29124111 PMCID: PMC5671629 DOI: 10.1016/j.trci.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction Practice effects (PEs) present a potential confound in clinical trials with cognitive outcomes. A single-blind placebo run-in design, with repeated cognitive outcome assessments before randomization to treatment, can minimize effects of practice on trial outcome. Methods We investigated the potential implications of PEs in Alzheimer's disease prevention trials using placebo arm data from the Alzheimer's Disease Cooperative Study donepezil/vitamin E trial in mild cognitive impairment. Frequent ADAS-Cog measurements early in the trial allowed us to compare two competing trial designs: a 19-month trial with randomization after initial assessment, versus a 15-month trial with a 4-month single-blind placebo run-in and randomization after the second administration of the ADAS-Cog. Standard power calculations assuming a mixed-model repeated-measure analysis plan were used to calculate sample size requirements for a hypothetical future trial designed to detect a 50% slowing of cognitive decline. Results On average, ADAS-Cog 13 scores improved at first follow-up, consistent with a PE and progressively worsened thereafter. The observed change for a 19-month trial (1.18 points) was substantively smaller than that for a 15-month trial with 4-month run-in (1.79 points). To detect a 50% slowing in progression under the standard design (i.e., a 0.59 point slowing), a future trial would require 3.4 times more subjects than would be required to detect the comparable percent slowing (i.e., 0.90 points) with the run-in design. Discussion Assuming the improvement at first follow-up observed in this trial represents PEs, the rate of change from the second assessment forward is a more accurate representation of symptom progression in this population and is the appropriate reference point for describing treatment effects characterized as percent slowing of symptom progression; failure to accommodate this leads to an oversized clinical trial. We conclude that PEs are an important potential consideration when planning future trials.
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Affiliation(s)
- Diane M Jacobs
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
| | - M Colin Ard
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA.,Division of Biostatistics, Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
| | - Mark W Bondi
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Steven D Edland
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA.,Division of Biostatistics, Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
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75
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Wörn J, Ellwardt L, Aartsen M, Huisman M. Cognitive functioning among Dutch older adults: Do neighborhood socioeconomic status and urbanity matter? Soc Sci Med 2017. [PMID: 28647643 DOI: 10.1016/j.socscimed.2017.05.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Positive associations of neighborhood socioeconomic characteristics and older adults' cognitive functioning have been demonstrated in previous studies, but overall results have been mixed and evidence from European countries and particularly the Netherlands is scarce. We investigated the effects of socioeconomic status (SES) and urbanity of neighborhoods on four domains of cognitive functioning in a sample of 985 Dutch older adults aged 65-88 years from the Longitudinal Aging Study Amsterdam. Besides cross-sectional level differences in general cognitive functioning, processing speed, problem solving and memory, we examined cognitive decline over a period of six years. Growth models in a multilevel framework were used to simultaneously assess levels and decline of cognitive functioning. In models not adjusting for individual SES, we found some evidence of higher levels of cognitive functioning in neighborhoods with a higher SES. In the same models, urbanity generally showed positive or inversely U-shaped associations with levels of cognitive functioning. Overall, effects of neighborhood urbanity remained significant when adjusting for individual SES. In contrast, level differences by neighborhood SES were largely explained by the respondents' individual SES. This suggests that neighborhood SES does not influence levels of cognitive functioning beyond the fact that individuals with a similar SES tend to self-select into neighborhoods with a corresponding SES. No evidence of systematically faster decline in neighborhoods with lower SES or lower degrees of urbanity was found. The findings suggest that neighborhood SES has no independent effect on older adults cognitive functioning in the Netherlands. Furthermore, the study reveals that neighborhood urbanity should be considered a determinant of cognitive functioning. This finding is in line with theoretical approaches that assume beneficial effects of exposure to complex environments on cognitive functioning. We encourage further investigations into the effect of urbanity in other contexts before drawing firm conclusions.
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Affiliation(s)
- Jonathan Wörn
- University of Cologne, Research Training Group SOCLIFE, Albertus-Magnus-Platz, 50923 Cologne, Germany; University of Cologne, Institute of Sociology and Social Psychology, Albertus-Magnus-Platz, 50923 Cologne, Germany.
| | - Lea Ellwardt
- University of Cologne, Institute of Sociology and Social Psychology, Albertus-Magnus-Platz, 50923 Cologne, Germany.
| | - Marja Aartsen
- Oslo and Akershus University College of Applied Sciences, Norwegian Social Research, P.O. Box 4 St. Olavs Plass, 0130 Oslo, Norway.
| | - Martijn Huisman
- VU University Amsterdam, Medical Center, Department of Epidemiology and Biostatistics, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; VU University Amsterdam, Department of Sociology, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands.
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76
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Olaya B, Bobak M, Haro JM, Demakakos P. Trajectories of Verbal Episodic Memory in Middle-Aged and Older Adults: Evidence from the English Longitudinal Study of Ageing. J Am Geriatr Soc 2017; 65:1274-1281. [PMID: 28263362 DOI: 10.1111/jgs.14789] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify distinct latent groups of baseline levels and age-related decline in verbal episodic memory in middle-aged and older adults, and to identify factors associated with these trajectories. DESIGN Longitudinal study of six data collections over a period of 10 years. SETTING Population-based cohort in England. PARTICIPANTS 9,515 community-dwelling adults aged 50-79 years. MEASUREMENTS Six repeated measurements of immediate and delayed recall of 10 words over 10-year follow-up. Group-based trajectory modeling was used to identify patterns of baseline levels and subsequent decline in memory in two age categories (50-64 and 65-79 years), and to investigate associations between trajectories and baseline predictors of group membership (gender, education, household wealth, marital status, smoking and physical activity) and time-varying covariates (depressive symptoms and number of chronic conditions). RESULTS Four trajectories were identified and labelled according to baseline status and decline in memory: very low/decline (9.8%), low/stable (40.2%), average/stable (39.5%) and good/stable (10.5%) in the younger group, and very low/rapid decline (15.7%), low/decline (32.0%), average/stable (38.8%), and good/stable (13.5%) in older participants. In people with stable or declining trajectories, a higher number of depressive symptoms and the presence of cardiovascular diseases were associated with worse memory. Female sex, younger age, and higher education, wealth and physical activity were consistently associated with more favourable trajectories. CONCLUSIONS We identified four memory trajectories. Factors known to be associated with cognitive reserve (such as education, wealth and physical activity) were associated with better memory function while depressive symptoms and cardiovascular disease were associated with poorer memory. This suggests that interventions to reduce depressive symptoms and better manage cardiovascular risk factors and disease in midlife may help prevent or delay future memory decline.
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Affiliation(s)
- Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
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77
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Farooqui Z, Bakulski KM, Power MC, Weisskopf MG, Sparrow D, Spiro A, Vokonas PS, Nie LH, Hu H, Park SK. Associations of cumulative Pb exposure and longitudinal changes in Mini-Mental Status Exam scores, global cognition and domains of cognition: The VA Normative Aging Study. ENVIRONMENTAL RESEARCH 2017; 152:102-108. [PMID: 27770710 PMCID: PMC5135609 DOI: 10.1016/j.envres.2016.10.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/23/2016] [Accepted: 10/11/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND Lead (Pb) exposure has been associated with poorer cognitive function cross-sectionally in aging adults, however the association between cumulative Pb exposure and longitudinal changes in cognition is little characterized. METHODS In a 1993-2007 subcohort of the VA Normative Aging Study (Mini-mental status exam (MMSE) n=741; global cognition summary score n=715), we used linear mixed effects models to test associations between cumulative Pb exposure (patella or tibia bone Pb) and repeated measures of cognition (MMSE, individual cognitive tests, and global cognition summary). Cox proportional hazard modeling assessed the risk of an MMSE score falling below 25. RESULTS Among men 51-98 at baseline, higher patella Pb concentration (IQR: 21μg/g) was associated with -0.13 lower baseline MMSE (95% CI: -0.25, -0.004) and faster longitudinal MMSE decline (-0.016 units/year, 95% CI: -0.032, -0.0004) over 15 years. Each IQR increase in patella Pb was associated with increased risk of a MMSE score below 25 (HR=1.21, 95% CI: 0.99, 1.49; p=0.07). There were no significant associations between Pb and global cognition (both baseline and longitudinal change). Patella Pb was associated with faster longitudinal decline in Word List Total Recall in the language domain (0.014 units/year, 95% CI: -0.026, -0.001) and Word List Delayed Recall in the memory domain (0.014 units/year, 95% CI: -0.027, -0.002). We found weaker associations with tibia Pb. CONCLUSIONS Cumulative Pb exposure is associated with faster declines in MMSE and Word List Total and Delayed Recall tests. These findings support the hypothesis that Pb exposure accelerates cognitive aging.
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Affiliation(s)
- Zishaan Farooqui
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kelly M Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Sparrow
- VA Normative Aging Study, Veterans Affairs Boston Health Care System, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Avron Spiro
- VA Normative Aging Study, Veterans Affairs Boston Health Care System, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Pantel S Vokonas
- VA Normative Aging Study, Veterans Affairs Boston Health Care System, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Linda H Nie
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Howard Hu
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sung Kyun Park
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Coley N, Gallini A, Ousset PJ, Vellas B, Andrieu S. Evaluating the clinical relevance of a cognitive composite outcome measure: An analysis of 1414 participants from the 5-year GuidAge Alzheimer's prevention trial. Alzheimers Dement 2016; 12:1216-1225. [PMID: 27423962 DOI: 10.1016/j.jalz.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/02/2016] [Accepted: 06/06/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Composite cognitive scores have been developed as primary outcome measures for preclinical/prevention trials for Alzheimer's disease (AD), mainly using observational data and with little consideration of clinical relevance. METHODS Secondary analysis of placebo group data from a 5-year AD prevention trial. The composite score was the average of the following z scores: MMSE orientation items, Free and Cued Selective Reminding Test, Category Fluency, Trail Making Test-part B. RESULTS Composite score change from baseline differed significantly by age, APOE genotype, and CDR progression and AD dementia status. A 1 point decrease in baseline score was highly predictive of 5-year AD dementia risk (HR = 3.51, 95% CI, 2.62-4.71, P < .001). The 1 year minimum clinically important difference was estimated at -0.3 points and predicted AD dementia. DISCUSSION We explored the clinical relevance of a composite score in a prevention trial setting. This type of analysis facilitates the interpretation of composite scores and informs power calculations.
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Affiliation(s)
- Nicola Coley
- INSERM-University of Toulouse, UMR1027, Toulouse, France; Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France.
| | - Adeline Gallini
- INSERM-University of Toulouse, UMR1027, Toulouse, France; Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France
| | - Pierre-Jean Ousset
- INSERM-University of Toulouse, UMR1027, Toulouse, France; Department of Geriatric Medicine, CHU Toulouse, Gerontopole, Toulouse, France
| | - Bruno Vellas
- INSERM-University of Toulouse, UMR1027, Toulouse, France; Department of Geriatric Medicine, CHU Toulouse, Gerontopole, Toulouse, France
| | - Sandrine Andrieu
- INSERM-University of Toulouse, UMR1027, Toulouse, France; Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France
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