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Wang N, Albaroudi A, Benjenk I, Chen J. Exploring hospital-based health information technology functions for patients with Alzheimer's Disease and related Dementias. Prev Med Rep 2021; 23:101459. [PMID: 34258173 PMCID: PMC8256283 DOI: 10.1016/j.pmedr.2021.101459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/29/2022] Open
Abstract
This study investigated whether hospital-adopted health information technology (HIT) is associated with a reduction in the frequency of preventable emergency department (ED) visits for patients with Alzheimer's Disease and Related Dementias (ADRD). We used data from the 2015 State Emergency Department Databases, Area Health Resources File, and the American Hospital Association Annual Survey Information Technology Supplement. We employed multivariable logistic regression models to examine the variation of the likelihood of having preventable ED visits by hospitals' adoption of HIT functions and adjusted for patient, hospital, and county-level factors. We focused on hospital-HIT functions related to patient engagement, routine integration and availability of electronic clinical information, frequency of hospital reported use of electronic patient information, and the provision of electronic notification to the patient's primary care provider. Approximately 23% of ADRD patients went to a hospital that often used electronic records from outside providers, and 75% of ADRD patients went to a hospital that provided electronic notification to the patient's primary care provider. Regression results showed that hospital reported use of electronic patient health information from outside providers (OR = 0.88; p < 0.001), provision of electronic notification to the patient's primary care physician inside and outside of the system (OR = 0.91; p = 0.013), and hospital-HIT patient engagement functionalities (OR = 0.90; p < 0.001) were associated with significantly lower preventable ED visit rates. The results of our study suggest that certain types of HIT functionalities may be useful for reducing preventable ED visits for ADRD patients.
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Affiliation(s)
- Nianyang Wang
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
| | - Asmaa Albaroudi
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
| | - Ivy Benjenk
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
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Kuźma E, Littlejohns TJ, Khawaja AP, Llewellyn DJ, Ukoumunne OC, Thiem U. Visual Impairment, Eye Diseases, and Dementia Risk: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 83:1073-1087. [PMID: 34397414 DOI: 10.3233/jad-210250] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Visual impairment and eye diseases have been associated with dementia, though with mixed findings and often in cross-sectional studies. OBJECTIVE To identify prospective studies investigating associations between visual impairment or common eye diseases and risk of all-cause dementia or key dementia subtypes. METHODS We searched Medline, PsycINFO, and Embase from inception to January 2020. We also conducted backward and forward citation searches of included studies and set up alerts to identify studies published after the search date. Random-effects meta-analysis was used to combine adjusted estimates across studies. RESULTS Thirty studies met our eligibility criteria. For visual impairment, pooled estimates indicated an increased risk of all-cause dementia (37,705 participants, 3,415 cases, risk ratio [RR] = 1.38, 95%confidence interval [CI]: 1.19-1.59, I2 = 28.6%). Pooled estimates also suggested an increased dementia risk associated with cataract (6,659 participants, 1,312 cases, hazard ratio [HR] = 1.17, 95%CI 1.00-1.38, I2 = 0.0%) and diabetic retinopathy (43,658 participants, 7,060 cases, HR = 1.34, 95%CI 1.11-1.61, I2 = 63.9%), respectively. There was no evidence of an association between glaucoma (175,357 participants, 44,144 cases, HR = 0.97, 95%CI 0.90-1.04, I2 = 51.5%) or age-related macular degeneration (7,800,692 participants, > 2,559 cases, HR = 1.15, 95%CI 0.88-1.50, I2 = 91.0%) and risk of dementia, respectively. CONCLUSION As visual impairment, cataract, and diabetic retinopathy are associated with an increased likelihood of developing dementia, early diagnosis may help identify those at risk of dementia. Given most causes of visual impairment are treatable or preventable, the potential for dementia prevention warrants further investigation.
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Affiliation(s)
- Elżbieta Kuźma
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany
| | - Thomas J Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,Alan Turing Institute, London, United Kingdom
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, Exeter, United Kingdom
| | - Ulrich Thiem
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany.,University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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53
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Gbessemehlan A, Edjolo A, Helmer C, Delcourt C, Mbelesso P, Ndamba-Bandzouzi B, Samba H, Kehoua G, Dartigues JF, Houinato D, Preux PM, Guerchet M. Vision Impairment and Adverse Health Conditions in Congolese Older People: A Population-Based Study. Gerontology 2021; 68:387-396. [PMID: 34315162 DOI: 10.1159/000517044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In sub-Saharan Africa, many older people experience vision impairment (VI) and its adverse health outcomes. In this study, we examined separately the association between VI and each adverse health conditions (cognitive disorders, vision-related quality of life [VRQoL], and daily functioning interference [DFI]) among Congolese older people. We also explored whether VI had a significant effect on VRQoL components in our population. METHOD We performed cross-sectional analyses on data from 660 Congolese people aged ≥65 years who participated in the 2013 survey of the EPIDEMCA population-based cohort study. VI was defined as having a near visual acuity <20/40 (assessed at 30 cm using a Parinaud chart). Cognitive disorders were assessed using neuropsychological tests and neurological examinations. VRQoL was assessed using a reduced version of the National Eye Institute Visual Function Questionnaire (VFQ-22) and DFI using 11 items of participation restrictions and activity limitations. Regarding our main objective, each association was explored separately using multivariable logistic and linear regression models. Additionally, the effects of VI on each VRQoL components were explored using univariable linear regression models. RESULTS VI was not associated with cognitive disorders after adjustment for residence area (adjusted odds ratio = 1.7; 95% confidence interval [CI]: 0.6; 4.7), but it was associated with a low VRQoL score (adjusted β = -12.4; 95% CI: -17.5; -7.3) even after controlling for several covariates. An interaction between VI and age (p = 0.007) was identified, and VI was associated with DFI only among people aged >73 years (adjusted β = 0.5; 95% CI: 0.2; 0.8). Our exploratory analysis showed that all components of VRQoL decreased with a decrease in visual acuity (corrected p ≤ 0.05). CONCLUSION VI was associated with poor VRQoL and high DFI. Residence area seems to play a confounding role in the association between VI and cognitive disorders. Our findings suggest that targeting interventions on vision could reduce DFI among older people and improve their well-being.
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Affiliation(s)
- Antoine Gbessemehlan
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France, .,Laboratory of Chronic and Neurologic Diseases Epidemiology, Faculty of Health Sciences, LEMACEN, University of Abomey-Calavi, Cotonou, Benin,
| | - Arlette Edjolo
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Catherine Helmer
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Cécile Delcourt
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Pascal Mbelesso
- Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | | | - Harielle Samba
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France
| | - Gilles Kehoua
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France
| | - Jean-François Dartigues
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Dismand Houinato
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France.,Laboratory of Chronic and Neurologic Diseases Epidemiology, Faculty of Health Sciences, LEMACEN, University of Abomey-Calavi, Cotonou, Benin
| | - Pierre-Marie Preux
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France
| | - Maëlenn Guerchet
- INSERM, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, University of Limoges, Limoges, France
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Völter* C, Peter Thomas* J, Maetzler W, Guthoff R, Grunwald M, Hummel T. Sensory Dysfunction in Old Age. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:512-520. [PMID: 34158149 PMCID: PMC8476826 DOI: 10.3238/arztebl.m2021.0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/14/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The senses serve as the crucial interface between the individual and the environment. They are subject to aging and disease processes. METHODS This review is based on pertinent publications retrieved by a selective search in the Medline and Cochrane Library databases. RESULTS Approximately 40% of persons aged 70 to 79 manifest dysfunction in at least one, and more than 25% in multiple senses. Sensory changes are accompanied by diverse comorbidities which depend on the particular sense(s) affected. The presence of sensory deficits is associated with an increased risk of developing dementia (OR: 1.49 [95% confidence interval: 1.12; 1.98] for dysfunction in a single sensory modality, 2.85 [1.88; 4.30] for dysfunction in three or more sensory modalities). The risk of developing depressive symptoms is elevated as well (OR 3.36 [2.28; 4.96]). The individual's ability to cope with the demands of everyday life is largely determined by the ability to carry out multisensory integration, in which the perceptions of the different senses are bound together. This function itself is subject to age-related changes that can be either adaptive or maladaptive; it can, therefore, serve as an indicator for pathological aging processes. CONCLUSION Sensory dysfunction in old age should be detected as early as possible. This implies the need for close collaboration of all of the involved disciplines. It would be desirable to develop sensory screening tests as well as a procedure for testing multisensory integration in routine clinical practice.
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Affiliation(s)
- Christiane Völter*
- * Joint first authors
- Hearing Competence Center, St. Elisabeth- Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University of Bochum
| | - Jan Peter Thomas*
- * Joint first authors
- Department of Otorhinolaryngology, Head and Neck Surgery, St.-Johannes-Hospital, Dortmund
| | - Walter Maetzler
- Department of Neurology, Faculty of Medicine, University of Kiel
| | - Rainer Guthoff
- Department of Ophthalmology, Düsseldorf University Hospital
| | - Martin Grunwald
- Haptic Research Lab, Paul Flechsig Institute of Brain Research, Medical Faculty of the Universität Leipzig
| | - Thomas Hummel
- Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Carl Gustav Carus, Dresden
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55
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Liang Z, Li A, Xu Y, Qian X, Gao X. Hearing Loss and Dementia: A Meta-Analysis of Prospective Cohort Studies. Front Aging Neurosci 2021; 13:695117. [PMID: 34305572 PMCID: PMC8295986 DOI: 10.3389/fnagi.2021.695117] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Consensus is lacking with regard to whether hearing loss is an independent risk factor for dementia. We therefore conducted a meta-analysis to clarify the relationship of hearing loss and dementia. Methods: Prospective cohort studies investigating the association between hearing loss and the incidence of dementia in a community-derived population were included by searching electronic databases that included PubMed, Embase, and Cochrane's Library. A random-effects model was adopted to combine the results. Results: Fourteen cohorts including 726,900 participants were analyzed. It was shown that hearing loss was independently associated with dementia [adjusted hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.37 to 1.86, p < 0.001; I2 = 86%]. Sensitivity analysis sequentially excluding any of the individual studies included showed similar results. Subgroup analysis according to the diagnostic methods for hearing loss, validation strategy for dementia, follow-up duration, and adjustment of apolipoprotein E genotype also showed consistent results (p-values for subgroup differences all > 0.05). Meta-analysis with five studies showed that hearing loss was also connected to higher risk of Alzheimer's disease (adjusted HR: 2.24, 95% CI: 1.32 to 3.79, p = 0.003; I2 = 2%). Conclusions: Hearing loss may increase the risk of dementia in the adult population. Whether effective treatment for hearing loss could reduce the incidence of dementia should be explored in the future.
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Affiliation(s)
- Zheng Liang
- Jiangsu Provincial Key Medical Discipline (Laboratory), Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ao Li
- Jiangsu Provincial Key Medical Discipline (Laboratory), Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuanyuan Xu
- Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyun Qian
- Jiangsu Provincial Key Medical Discipline (Laboratory), Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xia Gao
- Jiangsu Provincial Key Medical Discipline (Laboratory), Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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56
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Liu CJ, Chang PS, Griffith CF, Hanley SI, Lu Y. The Nexus of Sensory Loss, Cognitive Impairment, and Functional Decline in Older Adults: A Scoping Review. THE GERONTOLOGIST 2021; 62:e457-e467. [PMID: 34131697 DOI: 10.1093/geront/gnab082] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of cognitive impairment and sensory loss in hearing or vision increases with age. Based on the Information Processing Model, cognitive impairment coupled with sensory loss may exacerbate disability in late life. Yet this issue has not been systematically studied. The purpose of this scoping review was to examine the literature that studied the relationship between cognitive impairment, sensory loss, and activities of daily living in older adults. RESEARCH DESIGN AND METHODS Two reviewers independently screened 1,410 studies identified from five electronic databases (Medline, EMBASE, PsycINFO, CINHAL, and the Web of Science). The search was completed in June 2020. A study was eligible if it included measurements of cognitive function, vision or hearing, and activities of daily living. Additionally, the data analyses must address how cognitive impairment and sensory loss are related to the performance of activities of daily living. RESULTS The final review included 15 studies. Findings show an additive effect of cognitive impairment and sensory loss on the activities of daily living. Cognitive impairment or vision loss independently relates to the decline in activities of daily living. Hearing loss relates to the decline only when the loss is severe, or if the daily task is hearing specific. DISCUSSION AND IMPLICATIONS Older adults with coexisting sensory loss and cognitive impairment have the highest risk or prevalence of disability, comparing to cognitive impairment or sensory loss alone. This finding highlights the importance of developing interventions to reduce the risk of disability for older adults experiencing multiple impairments.
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Affiliation(s)
- Chiung-Ju Liu
- Department of Occupational Therapy, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Pei-Shiun Chang
- Department of Community and Health Systems, Indiana University School of Nursing, Bloomington, Indiana, USA
| | - Cheryl F Griffith
- Academic Affairs, Office of Clinical Education, Indiana University Health, Indianapolis, Indiana, USA
| | - Stephanie I Hanley
- Department of Occupational Therapy, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Yvonne Lu
- Indiana University School of Nursing, Indianapolis, Indiana, USA
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57
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Farrell MT, Jia Y, Berkman LF, Wagner RG. Do You See What Eye See? Measurement, Correlates, and Functional Associations of Objective and Self-Reported Vision Impairment in Aging South Africans. J Aging Health 2021; 33:803-816. [PMID: 34029165 DOI: 10.1177/08982643211012839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Our study investigates measurement, correlates, and functional associations of vision impairment (VI) in an aging population in rural South Africa. Methods: 1582 participants aged 40-69 reported on near (NVI) and distance vision impairment (DVI) and completed objective vision tests. Logistic and linear regression were used to evaluate sociodemographic, health, and psychosocial correlates of VI and assess relationships between VI and cognitive and physical function. Results: VI prevalence was considerably higher according to objective testing (56%) versus self-reports (18%). Older adults were especially likely to underreport impairment. Objective VI was associated with age, education, cardiometabolic disease, and female sex. Conversely, self-reported VI was associated with psychosocial factors. Objective NVI and both types of DVI were associated with worse visual cognition and slower gait speed, respectively. Discussion: Self-reported and objective VI measures should not be used interchangeably in this context. Our findings highlight extensive burden of untreated VI in this region.
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Affiliation(s)
- Meagan T Farrell
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Yusheng Jia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lisa F Berkman
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ryan G Wagner
- University of the Witwatersrand, Johannesburg, South Africa
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Shang X, Zhu Z, Wang W, Ha J, He M. Reply. Ophthalmology 2021; 128:e39-e40. [PMID: 33958250 DOI: 10.1016/j.ophtha.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jason Ha
- Centre for Eye Research Australia, East Melbourne, VIC, Australia
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Eye Research Australia, East Melbourne, VIC, Australia.
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59
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Xiao Z, Wu W, Zhao Q, Zhang J, Hong Z, Ding D. Sensory impairments and cognitive decline in older adults: A review from a population-based perspective. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2020.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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60
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Vu TA, Fenwick EK, Gan ATL, Man REK, Tan BKJ, Gupta P, Ho KC, Reyes-Ortiz CA, Trompet S, Gussekloo J, O'Brien JM, Mueller-Schotte S, Wong TY, Tham YC, Cheng CY, Lee ATC, Rait G, Swenor BK, Varadaraj V, Brenowitz WD, Medeiros FA, Naël V, Narasimhalu K, Chen CLH, Lamoureux EL. The Bidirectional Relationship between Vision and Cognition: A Systematic Review and Meta-analysis. Ophthalmology 2021; 128:981-992. [PMID: 33333104 DOI: 10.1016/j.ophtha.2020.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022] Open
Abstract
TOPIC Visual impairment (VI) and cognitive impairment (CIM) are prevalent age-related conditions that impose substantial burden on the society. Findings on the hypothesized bidirectional association of VI and CIM remains equivocal. Hence, we conducted a systematic review and meta-analysis to examine this bidirectional relationship. CLINICAL RELEVANCE Sixty percent risk of CIM has not been well elucidated in the literature. A bidirectional relationship between VI and CIM may support the development of strategies for early detection and management of risk factors for both conditions in older people. METHODS PubMed, Embase, and Cochrane Central registers were searched systematically for observational studies, published from inception until April 6, 2020, in adults 40 years of age or older reporting objectively measured VI and CIM assessment using clinically validated cognitive screening tests or diagnostic evaluation. Meta-analyses on cross-sectional and longitudinal associations between VI and CIM outcomes (any CIM assessed using screening tests and clinically diagnosed dementia) were examined. Random effect models were used to generate pooled odds ratios (ORs) and 95% confidence intervals (CIs). We also examined study quality, publication bias, and heterogeneity. RESULTS Forty studies were included (n = 47 913 570). Meta-analyses confirmed that persons with VI were more likely to have CIM, with significantly higher odds of: (1) any CIM (cross-sectional: OR, 2.38 [95% CI, 1.84-3.07]; longitudinal: OR, 1.66 [95% CI, 1.46-1.89]) and (2) clinically diagnosed dementia (cross-sectional: OR, 2.43 [95% CI, 1.48-4.01]; longitudinal: OR, 2.09 [95% CI, 1.37-3.21]) compared with persons without VI. Significant heterogeneity was explained partially by differences in age, sex, and follow-up duration. Also, some evidence suggested that individuals with CIM, relative to cognitively intact persons, were more likely to have VI, with most articles (8/9 [89%]) reporting significantly positive associations; however, meta-analyses on this association could not be conducted because of insufficient data. DISCUSSION Overall, our work suggests that VI is a risk factor of CIM, although further work is needed to confirm the association of CIM as a risk factor for VI. Strategies for early detection and management of both conditions in older people may minimize individual clinical and public health consequences.
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Affiliation(s)
- Tai Anh Vu
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Eva K Fenwick
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Alfred T L Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Ryan E K Man
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Benjamin K J Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Kam Chun Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; School of Optometry and Visual Science, University of New South Wales, Sydney, Australia; Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Agricultural and Mechanical University, Florida
| | - Stella Trompet
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joan M O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sigrid Mueller-Schotte
- University Medical Center Utrecht, Utrecht, The Netherlands; University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Tien Yin Wong
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Ching-Yu Cheng
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Greta Rait
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Varshini Varadaraj
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Willa D Brenowitz
- Department of Psychiatry, University of California, San Francisco, California
| | - Felipe A Medeiros
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Virginie Naël
- Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Kaavya Narasimhalu
- Duke-NUS Medical School, Singapore, Republic of Singapore; National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Republic of Singapore
| | - Christopher L H Chen
- Memory Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Ecosse L Lamoureux
- Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, The University of Melbourne, Melbourne, Australia.
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Lee ATC, Richards M, Chan WC, Chiu HFK, Lee RSY, Lam LCW. Higher Dementia Incidence in Older Adults with Poor Visual Acuity. J Gerontol A Biol Sci Med Sci 2021; 75:2162-2168. [PMID: 32043518 PMCID: PMC7566398 DOI: 10.1093/gerona/glaa036] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background Longitudinal evidence of poor visual acuity associating with higher risk of incident dementia is mixed. This study aimed to examine if poor visual acuity was associated with higher dementia incidence in a large community cohort of older adults, independent of the possible biases relating to misclassification error, reverse causality, and confounding effects due to health problems and behaviors. Methods A total of 15,576 community-living older adults without dementia at baseline were followed for 6 years to the outcome of incident dementia, which was diagnosed according to the ICD-10 or a Clinical Dementia Rating of 1 to 3. Visual acuity was assessed using the Snellen’s chart at baseline and follow-up. Important variables including demographics (age, sex, education, and socioeconomic status), physical and psychiatric comorbidities (cardiovascular risks, ophthalmological conditions, hearing impairment, poor mobility, and depression), and lifestyle behaviors (smoking, diet, physical, intellectual, and social activities) were also assessed. Results Over 68,904 person-years of follow-up, 1,349 participants developed dementia. Poorer visual acuity at baseline was associated with higher dementia incidence in 6 years, even after adjusting for demographics, health problems, and lifestyle behaviors, and excluding those who developed dementia within 3 years after baseline. Compared with normal vision, the hazard ratio of dementia was 1.19 (p = .31), 2.09 (p < .001), and 8.66 (p < .001) for mild, moderate, and severe visual impairment, respectively. Conclusions Moderate-to-severe visual impairment could be a potential predictor and possibly a risk factor for dementia. From a clinical perspective, older adults with poor visual acuity might warrant further risk assessment for dementia.
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Affiliation(s)
- Allen T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Wai C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Helen F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong SAR, China
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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Tran EM, Stefanick ML, Henderson VW, Rapp SR, Chen JC, Armstrong NM, Espeland MA, Gower EW, Shadyab AH, Li W, Stone KL, Pershing S. Association of Visual Impairment With Risk of Incident Dementia in a Women's Health Initiative Population. JAMA Ophthalmol 2021; 138:624-633. [PMID: 32297918 DOI: 10.1001/jamaophthalmol.2020.0959] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Dementia affects a large and growing population of older adults. Although past studies suggest an association between vision and cognitive impairment, there are limited data regarding longitudinal associations of vision with dementia. Objective To evaluate associations between visual impairment and risk of cognitive impairment. Design, Setting, and Participants A secondary analysis of a prospective longitudinal cohort study compared the likelihood of incident dementia or mild cognitive impairment (MCI) among women with and without baseline visual impairment using multivariable Cox proportional hazards regression models adjusting for characteristics of participants enrolled in Women's Health Initiative (WHI) ancillary studies. The participants comprised community-dwelling older women (age, 66-84 years) concurrently enrolled in WHI Sight Examination (enrollment 2000-2002) and WHI Memory Study (enrollment 1996-1998, ongoing). The study was conducted from 2000 to the present. Exposures Objectively measured visual impairment at 3 thresholds (visual acuity worse than 20/40, 20/80, or 20/100) and self-reported visual impairment (determined using composite survey responses). Main Outcomes and Measures Hazard ratios (HRs) and 95% CIs for incident cognitive impairment after baseline eye examination were determined. Cognitive impairment (probable dementia or MCI) was based on cognitive testing, clinical assessment, and centralized review and adjudication. Models for (1) probable dementia, (2) MCI, and (3) probable dementia or MCI were evaluated. Results A total of 1061 women (mean [SD] age, 73.8 [3.7] years) were identified; 206 of these women (19.4%) had self-reported visual impairment and 183 women (17.2%) had objective visual impairment. Forty-two women (4.0%) were ultimately classified with probable dementia and 28 women (2.6%) with MCI that did not progress to dementia. Mean post-eye examination follow-up was 3.8 (1.8) years (range, 0-7 years). Women with vs without baseline objective visual impairment were more likely to develop dementia. Greatest risk for dementia was among women with visual acuity of 20/100 or worse at baseline (HR, 5.66; 95% CI, 1.75-18.37), followed by 20/80 or worse (HR, 5.20; 95% CI, 1.94-13.95), and 20/40 or worse (HR, 2.14; 95% CI, 1.08-4.21). Findings were similar for risk of MCI, with the greatest risk among women with baseline visual acuity of 20/100 or worse (HR, 6.43; 95% CI, 1.66-24.85). Conclusions and Relevance In secondary analysis of a prospective longitudinal cohort study of older women with formal vision and cognitive function testing, objective visual impairment appears to be associated with an increased risk of incident dementia. However, incident cases of dementia and the proportion of those with visual impairment were low. Research is needed to evaluate the effect of specific ophthalmic interventions on dementia.
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Affiliation(s)
- Elaine M Tran
- Byers Eye Institute at Stanford, Palo Alto, California.,Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
| | - Victor W Henderson
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California.,Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jiu-Chiuan Chen
- Department of Neurology, University of Southern California, Los Angeles
| | - Nicole M Armstrong
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland
| | - Mark A Espeland
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily W Gower
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill.,Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla
| | - Wenjun Li
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Suzann Pershing
- Byers Eye Institute at Stanford, Palo Alto, California.,Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Health Research and Policy (Health Services Research), Stanford University, Palo Alto, California
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63
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Shang X, Zhu Z, Wang W, Ha J, He M. The Association between Vision Impairment and Incidence of Dementia and Cognitive Impairment: A Systematic Review and Meta-analysis. Ophthalmology 2021; 128:1135-1149. [PMID: 33422559 DOI: 10.1016/j.ophtha.2020.12.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023] Open
Abstract
TOPIC The magnitude and direction of the association between vision impairment and incident dementia and cognitive impairment in prospective cohort studies was estimated by systematic review and meta-analysis. The global burden of dementia associated with vision impairment then was estimated. CLINICAL RELEVANCE Because a predominant proportion of vision impairment is preventable or treatable, investigating its association with dementia may help to identify an important modifiable factor for the prevention of dementia. METHODS A literature search was conducted using PubMed, Embase, Web of Science, and Google Scholar on September 15, 2020. Relative risks (RRs) were pooled using random-effects models and stratified analyses for subgroups representing different study characteristics. Publication bias was evaluated with funnel plots and the Egger test. The global burden of dementia associated with vision impairment was estimated based on the Global Burden of Disease Study data on the prevalence of dementia and vision impairment. RESULTS In the meta-analysis of 14 prospective cohort studies with 6 204 827 participants and 171 888 dementia patients, the pooled RR associated with vision impairment was 1.47 (95% confidence interval [CI], 1.36-1.60). In the meta-analysis of 12 prospective cohort studies with 45 313 participants and 13 350 patients with cognitive impairment, the pooled RR was 1.35 (95% CI, 1.28-1.41). Stratified analyses showed that the associations of vision impairment with incident dementia and cognitive impairment were similar across methods of vision assessment, length of follow-up, and study quality. The global number of people with dementia associated with moderate or severe vision impairment in 2016 was 2.1 million (80% uncertainty interval, 1.0-3.3 million), which accounted for 4.7% (95% CI, 2.3%-7.5%) of the global burden of dementia. Economic inequality was significant for the burden of dementia associated with vision impairment. DISCUSSION The overall quality of the body evidence was low because of the observational design of the studies included in the analysis. Vision impairment is associated with an increased risk of both dementia and cognitive impairment in older adults. Screening and treating vision impairment, especially in low- and middle-income countries, may help to alleviate the global burden of dementia.
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Affiliation(s)
- Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jason Ha
- Centre for Eye Research Australia, Melbourne, Australia
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Eye Research Australia, Melbourne, Australia.
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64
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Marengoni A, Roso-Llorach A, Vetrano DL, Fernández-Bertolín S, Guisado-Clavero M, Violán C, Calderón-Larrañaga A. Patterns of Multimorbidity in a Population-Based Cohort of Older People: Sociodemographic, Lifestyle, Clinical, and Functional Differences. J Gerontol A Biol Sci Med Sci 2021; 75:798-805. [PMID: 31125398 DOI: 10.1093/gerona/glz137] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim of this study is to identify clusters of older persons based on their multimorbidity patterns and to analyze differences among clusters according to sociodemographic, lifestyle, clinical, and functional characteristics. METHODS We analyzed data from the Swedish National Study on Aging and Care in Kungsholmen on 2,931 participants aged 60 years and older who had at least two chronic diseases. Participants were clustered by the fuzzy c-means cluster algorithm. A disease was considered to be associated with a given cluster when the observed/expected ratio was ≥2 or the exclusivity was ≥25%. RESULTS Around half of the participants could be classified into five clinically meaningful clusters: respiratory and musculoskeletal diseases (RESP-MSK) 15.7%, eye diseases and cancer (EYE-CANCER) 10.7%, cognitive and sensory impairment (CNS-IMP) 10.6%, heart diseases (HEART) 9.3%, and psychiatric and respiratory diseases (PSY-RESP) 5.4%. Individuals in the CNS-IMP cluster were the oldest, with the worst function and more likely to live in a nursing home; those in the HEART cluster had the highest number of co-occurring diseases and drugs, and they exhibited the highest mean values of serum creatinine and C-reactive protein. The PSY-RESP cluster was associated with higher levels of alcoholism and neuroticism. The other half of the cohort was grouped in an unspecific cluster, which was characterized by gathering the youngest individuals, with the lowest number of co-occurring diseases, and the best functional and cognitive status. CONCLUSIONS The identified multimorbidity patterns provide insight for setting targets for secondary and tertiary preventative interventions and for designing care pathways for multimorbid older people.
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Affiliation(s)
- Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.,Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.,Department of Geriatrics, Catholic University of Rome, vItaly.,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico "A. Gemelli," Scientific Institute for Research and Healthcare (IRCCS), Rome, Italy
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Marina Guisado-Clavero
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Concepción Violán
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
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Choi JW, Han E. Risk of new-onset depressive disorders after hearing impairment in adults: A nationwide retrospective cohort study. Psychiatry Res 2021; 295:113351. [PMID: 32807534 DOI: 10.1016/j.psychres.2020.113351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/25/2022]
Abstract
Previous studies reported that hearing impairment has been associated with depressive disorders, but little is known about the risk of newly diagnosed depression after hearing impairment diagnosed by a physician and registered with the government. We evaluated the risk of new-onset depressive disorders following hearing impairment in adults. We used data from the Korean National Health Insurance Service-National Sample Cohort and included adults with hearing impairment, and a comparison group without hearing impairment, selected by a 1:3 propensity score matching between 2004 and 2012. The dependent variable was a depressive disorder diagnosis. The hazard ratio of risk of depression was estimated using a Cox proportional hazard model. In the sample of 14,212 adults, 15.0% of people with hearing impairment (n = 3,553) experienced a depressive disorder following their hearing impairment. Those who had not experienced depression previously were more likely to develop a new-onset depressive disorder following hearing impairment than the comparison group. Male, female, old adults (60-74 years) and very-old adults (≥ 75 years) with hearing impairment were associated with an increased risk for a new-onset depressive disorders than their matched counterparts. These findings suggest a need for psychological support along with hearing rehabilitation, especially for older adults.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea.
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66
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Huang V, Hogan DB, Ismail Z, Maxwell CJ, Smith EE, Callahan BL. Evaluating the Real-World Representativeness of Participants with Mild Cognitive Impairment in Canadian Research Protocols: a Comparison of the Characteristics of a Memory Clinic Patients and Research Samples. Can Geriatr J 2020; 23:297-328. [PMID: 33282050 PMCID: PMC7704078 DOI: 10.5770/cgj.23.416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Studies of mild cognitive impairment (MCI) employ rigorous eligibility criteria, resulting in sampling that may not be representative of the broader clinical population. Objective To compare the characteristics of MCI patients in a Calgary memory clinic to those of MCI participants in published Canadian studies. Methods Clinic participants included 555 MCI patients from the PROspective Registry of Persons with Memory SyMPToms (PROMPT) registry in Calgary. Research participants included 4,981 individuals with MCI pooled from a systematic literature review of 112 original, English-language peer-reviewed Canadian studies. Both samples were compared on baseline sociodemographic variables, medical and psychiatric comorbidities, and cognitive performance for MCI due to Alzheimer’s disease and Parkinson’s disease. Results Overall, clinic patients tended to be younger, more often male, and more educated than research participants. Psychiatric disorders, traumatic brain injury, and sensory impairment were commonplace in PROMPT (up to 83% affected) but > 80% studies in the systematic review excluded these conditions. PROMPT patients also performed worse on global cognition measures than did research participants. Conclusion Stringent eligibility criteria in Canadian research studies excluded a considerable subset of MCI patients with comorbid medical or psychiatric conditions. This exclusion may contribute to differences in cognitive performance and outcomes compared to real-world clinical samples.
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Affiliation(s)
- Vivian Huang
- Department of Psychology, Ryerson University, Toronto, ON
| | - David B Hogan
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Colleen J Maxwell
- Hotchkiss Brain Institute, Calgary, AB.,Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON
| | - Eric E Smith
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Brandy L Callahan
- Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychology, University of Calgary, Calgary, AB
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67
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Pinto JO, Dores AR, Geraldo A, Peixoto B, Barbosa F. Sensory stimulation programs in dementia: a systematic review of methods and effectiveness. Expert Rev Neurother 2020; 20:1229-1247. [PMID: 32940543 DOI: 10.1080/14737175.2020.1825942] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Dementia is characterized by the presence of cognitive decline and can lead to sensory-perceptual alterations, compromising the functionality in activities of daily living. The main objective of this work is to review the characteristics of sensory stimulation programs in dementia and its effectiveness. AREAS COVERED Studies were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty studies were included in this review. The studies used multisensory stimulation at different stages of dementia. The results show a lack of consensus regarding frequency, duration, and number of sessions, as well as the duration of the interventions and assessment instruments used to evaluate the results. Multisensory stimulation, particularly Snoezelen, was the most widely used approach. Vision, hearing, touch, and smell were the most frequently stimulated senses. Most studies comprised pre- and post-intervention assessment, but few studies performed follow-up assessment. The interventions that revealed positive results in dementia were Snoezelen, multisensory environment other than Snoezelen, and Multi-sensory Behavior Therapy. EXPERT OPINION This review weakly supports sensory stimulation in dementia, providing useful information for rehabilitation and future investigations.
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Affiliation(s)
- Joana O Pinto
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Artemisa R Dores
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal.,School of Health, Polytechnic Institute of Porto , Porto, Portugal
| | - Andreia Geraldo
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
| | - Bruno Peixoto
- Department of Social and Behaviour Sciences, CESPU, University Institute of Health Sciences , Gandra, Portugal.,Center for Health Technology and Services Research (CINTESIS), NeuroGen research group , Porto, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Sciences, University of Porto , Porto, Portugal
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68
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VandeVrede L, Ljubenkov PA, Rojas JC, Welch AE, Boxer AL. Four-Repeat Tauopathies: Current Management and Future Treatments. Neurotherapeutics 2020; 17:1563-1581. [PMID: 32676851 PMCID: PMC7851277 DOI: 10.1007/s13311-020-00888-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Four-repeat tauopathies are a neurodegenerative disease characterized by brain parenchymal accumulation of a specific isoform of the protein tau, which gives rise to a wide breadth of clinical syndromes encompassing diverse symptomatology, with the most common syndromes being progressive supranuclear palsy-Richardson's and corticobasal syndrome. Despite the lack of effective disease-modifying therapies, targeted treatment of symptoms can improve quality of life for patients with 4-repeat tauopathies. However, managing these symptoms can be a daunting task, even for those familiar with the diseases, as they span motor, sensory, cognitive, affective, autonomic, and behavioral domains. This review describes current approaches to symptomatic management of common clinical symptoms in 4-repeat tauopathies with a focus on practical patient management, including pharmacologic and nonpharmacologic strategies, and concludes with a discussion of the history and future of disease-modifying therapeutics and clinical trials in this population.
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Affiliation(s)
- Lawren VandeVrede
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
| | - Peter A Ljubenkov
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Julio C Rojas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Peeters G, Almirall Sanchez A, Llibre Guerra J, Lawlor B, Kenny RA, Yaffe K, Llibre Rodriguez J. Risk Factors for Incident Dementia Among Older Cubans. Front Public Health 2020; 8:481. [PMID: 33014976 PMCID: PMC7511701 DOI: 10.3389/fpubh.2020.00481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Little is known about risk factors of dementia in Latin American countries. We aimed to identify socio–demographic, health and lifestyle risk factors of incident dementia in Cuban older adults. Methods: Data were from 1,846 participants in the Cuban cohort of the 10/66 Dementia Research Group. Participants completed questionnaires, health examinations, and cognitive tests at baseline (2003–2006) and 4.5 years later (2007–2010). Associations between risk factors (baseline) and incident dementia (follow-up) were examined using logistic regression. Results: Just over 9% of participants developed dementia. Overall, older age and low physical activity were associated with incident dementia. In those 65–74 years of age, depression, stroke and low physical activity were associated with incident dementia. In those ≥75 years of age, low physical activity, never eating fish, and smoking were associated with incident dementia. Conclusions: Modifiable lifestyle factors play an important role in developing dementia in Cuban older adults. This knowledge opens up opportunities for preventive strategies.
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Affiliation(s)
- Geeske Peeters
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Arianna Almirall Sanchez
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jorge Llibre Guerra
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Kristine Yaffe
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, San Francisco, CA, United States
| | - Juan Llibre Rodriguez
- Facultad de Medicina Finley-Albarrán, Universidad de Ciencias Médicas de la Habana, Havana, Cuba
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Wagner H, Stifter J, Engesser D, Atzrodt L, Betancor PK, Böhringer D, Faessler M, Wuermeling M, Reinhard T. Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge. Klin Monbl Augenheilkd 2020; 237:1326-1333. [PMID: 32869245 DOI: 10.1055/a-1194-5381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The demographic change in Germany will lead to an increase in irreversible age-related eye diseases. This will increase the need for specialised care facilities for visually impaired people. Due to reduced mobility, residents in such facilities often do not receive adequate ophthalmological care. New concepts must therefore be considered for this group of patients. One approach is to set up an ophthalmological examination unit within the facility combined with regular visits by an ophthalmologist. We now present the experience with such a model in a home for the blind. PATIENTS AND METHODS The project was initiated in 2009. Since then there have been visits by medical staff of the Eye Center at Medical Center, University of Freiburg, every two weeks. All patient records (2010 - 2017) were reviewed systematically. The following data were extracted in a structured and anonymous way: Age at first presentation, gender, ophthalmological diagnoses and if a therapy was initiated. This data set was finally analysed descriptively. RESULTS Out of 130 residents aged between 48 and 100 years, half were between 78 and 90 years old. The youngest resident was 48, the oldest 100 years old. The median visual acuity was 0.2. Sixty percent of the residents had at least mild visual impairment according to the WHO (visual acuity < 0.5; category 1 - 6). In one of 6 - 7 residents, visual acuity could not be determined using Snellen charts. The most frequent ophthalmological diagnoses included cataract (44%), age-related macular degeneration (36%) and glaucoma (29%). In 67 residents (52%), the ophthalmological examination lead to treatment, such as application of local therapy or planning an operation. CONCLUSION In every second resident, the ophthalmologist's visit lead to treatment during the observation period. This underlines the difficulty of providing ophthalmological care even in specialised institutions for the blind and visually impaired, which is possibly due to the residents' mobility problems. The concept presented here has established a low-threshold, sustainable and high-quality ophthalmological service on site. These positive experiences indicate that corresponding measures may also be useful for other locations. However, in order to implement such a project on a larger scale, suitable financing and accounting modalities for the construction measures, the nursing staff and the ophthalmological procedure still need to be developed.
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Affiliation(s)
- Helena Wagner
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Julia Stifter
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Diana Engesser
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Lisa Atzrodt
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Paola Kammrath Betancor
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Daniel Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | | | - Martin Wuermeling
- Augenarztpraxis Titisee-Neustadt, Augennetz Südbaden, Titisee-Neustadt
| | - Thomas Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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Piano M, Nilforooshan R, Evans S. Binocular Vision, Visual Function, and Pupil Dynamics in People Living With Dementia and Their Relation to the Rate of Cognitive Decline and Structural Changes Within the Brain: Protocol for an Observational Study. JMIR Res Protoc 2020; 9:e16089. [PMID: 32773379 PMCID: PMC7445601 DOI: 10.2196/16089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Visual impairment is a common comorbidity in people living with dementia. Addressing sources of visual difficulties can have a significant impact on the quality of life for people living with dementia and their caregivers. Depth perception problems are purportedly common in dementia and also contribute to falls, visuomotor task difficulties, and poorer psychosocial well-being. However, depth perception and binocular vision are rarely assessed in dementia research. Sleep fragmentation is also common for people living with dementia, and binocular cooperation for depth perception can be affected by fatigue. Pupillary responses under cognitive load also have the potential to be a risk marker for cognitive decline in people living with dementia and can be combined with the above measures for a comprehensive evaluation of clinical visual changes in people living with dementia and their relation to changes in cognitive status, sleep quality, and cortical structure or function. OBJECTIVE This study aims to characterize the nature of clinical visual changes and altered task-evoked pupillary responses that may occur in people living with dementia and evaluate whether these responses relate to changes in cognitive status (standardized Mini Mental State Examination [MMSE] score), Pittsburgh sleep quality index, and cortical structure or function. METHODS This proposed exploratory observational study will enroll ≤210 people with recently diagnosed dementia (within the last 24 months). The following parameters will be assessed on 3 occasions, 4 months apart (plus or minus 2 weeks): visual function (visual acuity and contrast sensitivity), binocular function (motor fusion and stereopsis), task-evoked pupillary responses (minimum and maximum pupil size, time to maximum dilation, and dilation velocity), cognitive status (MMSE score), and sleep quality (Pittsburgh Sleep Quality Index). A subset of patients (n=30) with Alzheimer disease will undergo structural and functional magnetic resonance imaging at first and third visits, completing a 10-day consensus sleep diary to monitor sleep quality, verified by sleep actimetry. RESULTS This research was funded in February 2018 and received National Health Service Research Ethics Committee approval in September 2018. The data collection period was from October 1, 2018, to November 30, 2019. A total of 24 participants were recruited for the study. The data analysis is complete, with results expected to be published before the end of 2020. CONCLUSIONS Findings will demonstrate how often people with dementia experience binocular vision problems. If frequent, diagnosing and treating them could improve quality of life by reducing the risk of falls and fine visuomotor task impairment and by relieving psychosocial anxiety. This research will also demonstrate whether changes in depth perception, pupillary responses, and quality of vision relate to changes in memory or sleep quality and brain structure or function. If related, these quick and noninvasive eye tests help monitor dementia. This would help justify whether binocular vision and pupillary response testing should be included in dementia-friendly eye-testing guidelines. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/16089.
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Affiliation(s)
- Marianne Piano
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
- National Vision Research Institute, Australian College of Optometry, Melbourne, Australia
| | | | - Simon Evans
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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Rouch L, Vidal JS, Hoang T, Cestac P, Hanon O, Yaffe K. Systolic blood pressure postural changes variability is associated with greater dementia risk. Neurology 2020; 95:e1932-e1940. [PMID: 32690802 DOI: 10.1212/wnl.0000000000010420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether orthostatic hypotension (OHYPO) and visit-to-visit blood pressure (BP) postural changes variability are associated with incident dementia. METHODS We studied 2,131 older adults from the Health, Aging, and Body Composition cohort study. Orthostatic BP was repeatedly assessed over a 5-year baseline period. OHYPO was defined as a fall ≥15 mm Hg in systolic or ≥7 mm Hg in diastolic BP after standing from a sitting position for one-third or more of the visits. Systolic OHYPO and diastolic OHYPO were also examined separately. BP postural changes variability over time was evaluated with several indicators, including SD and coefficient of variation (CV). Incident dementia was determined over 12 years after the baseline period by dementia medication use, ≥1.5 SD decline in Modified Mini-Mental State Examination score, or hospitalization records. RESULTS Of 2,131 participants (mean age 73 years, 53% female, 39% Black), 309 (14.5%) had OHYPO, 192 (9.0%) had systolic OHYPO, 132 (6.2%) had diastolic OHYPO, and 462 (21.7%) developed dementia. After adjustment for demographics, seated systolic BP (SBP), antihypertensive drugs, cerebrovascular disease, diabetes mellitus, depressive symptoms, smoking, alcohol, body mass index, and presence of 1 or 2 APOE ε4 alleles, systolic OHYPO was associated with greater dementia risk (adjusted hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.01-1.88), unlike diastolic OHYPO and OHYPO. SBP postural changes variability was also associated with higher dementia risk (highest tertile of variability [CV]: adjusted HR 1.35, 95% CI 1.06-1.71). CONCLUSION Systolic OHYPO and visit-to-visit SBP postural changes variability were associated with greater dementia risk. Our findings raise the question of potential preventive interventions to control orthostatic SBP and its fluctuations.
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Affiliation(s)
- Laure Rouch
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA.
| | - Jean-Sébastien Vidal
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Tina Hoang
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Philippe Cestac
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Olivier Hanon
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA
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Brenowitz WD, Kaup AR, Yaffe K. Incident dementia and faster rates of cognitive decline are associated with worse multisensory function summary scores. Alzheimers Dement 2020; 16:1384-1392. [PMID: 32657033 DOI: 10.1002/alz.12134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION We created a summary score for multiple sensory (multisensory) impairment and evaluated its association with dementia. METHODS We studied 1794 adults aged 70 to 79 who were dementia-free at enrollment and followed for up to 10 years in the Health, Aging, and Body Composition Study. The multisensory function score (0 to 12 points) was based on sample quartiles of objectively measured vision, hearing, smell, and touch summed overall. Risk of incident dementia and cognitive decline (measured by two cognitive tests) associated with the score were assessed in regression models adjusting for demographics and health conditions. RESULTS Dementia risk was 2.05 times higher (95% confidence interval [CI] 1.50-2.81) comparing "poor" to "good" multisensory score tertiles and 1.45 times higher comparing the "middle" to "good" tertiles (95% CI 1.09-1.91). Each point worse in the multisensory function score was associated with faster rates of cognitive decline (P < .05). CONCLUSIONS Worsening multisensory function, even at mild levels, was associated with accelerated cognitive aging.
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Affiliation(s)
- Willa D Brenowitz
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Allison R Kaup
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA.,The Neurology Center of Southern California, Carlsbad, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA.,Department of Epidemiology & Biostatistics and Neurology, University of California San Francisco, San Francisco, California, USA
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Hwang PH, Longstreth W, Brenowitz WD, Thielke SM, Lopez OL, Francis CE, DeKosky ST, Fitzpatrick AL. Dual sensory impairment in older adults and risk of dementia from the GEM Study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12054. [PMID: 32671180 PMCID: PMC7340796 DOI: 10.1002/dad2.12054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hearing and vision loss are independently associated with dementia, but the impact of dual sensory impairment (DSI) on dementia risk is not well understood. METHODS Self-reported measures of hearing and vision were taken from 2051 participants at baseline from the Gingko Evaluation of Memory Study. Dementia status was ascertained using standardized criteria. Cox models were used to estimate risk of dementia associated with number of sensory impairments (none, one, or two). RESULTS DSI was significantly associated with higher risk of all-cause dementia (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.25-2.76) and Alzheimer's disease (HR = 2.12; 95% CI = 1.34-3.36). Individually only visual impairment was independently associated with an increased risk of all-cause dementia (HR = 1.32; 95% CI = 1.02-1.71). DISCUSSION Older adults with DSI are at a significantly increased risk for dementia. Further studies are needed to evaluate whether treatments can modify this risk.
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Affiliation(s)
- Phillip H. Hwang
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - W.T. Longstreth
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Willa D. Brenowitz
- Department of PsychiatryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashingtonUSA
- Geriatric ResearchEducationand Clinical CenterPuget Sound VA Medical CenterSeattleWashingtonUSA
| | - Oscar L. Lopez
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | | | - Annette L. Fitzpatrick
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of Family MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Maruta M, Tabira T, Sagari A, Miyata H, Yoshimitsu K, Han G, Yoshiura K, Matsuo T, Kawagoe M. Impact of sensory impairments on dementia incidence and symptoms among Japanese older adults. Psychogeriatrics 2020; 20:262-270. [PMID: 31799771 DOI: 10.1111/psyg.12494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/28/2019] [Accepted: 11/08/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dementia and behavioural and psychological symptoms of dementia affect older adults' care-need levels. With aging comes an increase in the incidence of sensory impairments, which promotes the development of dementia. We investigated the association between sensory impairments - visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI), the behavioural and psychological symptoms of dementia, and dementia incidence. METHODS This was a retrospective study that used Japanese long-term care insurance certification data from 2010 to 2017 of City A. The 2190 older adults who did not have dementia in 2010 were classified into four impairment categories: VI, HI, DSI, and no sensory impairment. The incidence of dementia was examined using Kaplan-Meier survival analysis and log-rank testing. Cox proportional hazards analysis was used to investigate the risk of developing dementia associated with sensory impairments, compared to the risk for no sensory impairment. Pearson's χ2 tests were used to compare the prevalence of behavioural and psychological symptoms of dementia among the four groups. RESULTS HI and DSI were associated with a higher cumulative dementia incidence compared to no sensory impairment (log-rank χ2 = 10.42; P < 0.001, and log-rank χ2 = 39.92; P < 0.001, respectively), and DSI showed higher cumulative dementia incidence than HI (log-rank χ2 = 11.37; P = 0.001). Cox proportional hazards analysis showed that DSI is the greatest risk factor for developing dementia among sensory impairments (hazard ratio, 1.45; 95% CI, 1.22-1.71; P < 0.001). Older adults with VI had a significantly higher prevalence of day-night reversal than the other groups. CONCLUSIONS Our results indicate that older adults with sensory impairments have a high incidence of dementia, with DSI presenting the greatest risk. Older adults with VI were found to be more likely to have day-night reversal symptoms when dementia occurs.
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Affiliation(s)
- Michio Maruta
- Department of Rehabilitation, Medical Corporation, Sansyukai, Okatsu Hospital, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Akira Sagari
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Shinshu University, Nagano, Japan
| | - Hironori Miyata
- Faculty of Health Science, Department of Rehabilitation, Division of Occupational Therapy, Kumamoto Health Science University, Kumamoto, Japan
| | - Koji Yoshimitsu
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Gwanghee Han
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Kazuhiro Yoshiura
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Takashi Matsuo
- Faculty of Rehabilitation Sciences, Nishikyusyu University, Saga, Japan
| | - Masahiro Kawagoe
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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76
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Parada JC, Hillyer J, Parbery-Clark A. Performance on the standard and hearing-impaired Montreal Cognitive Assessment in cochlear implant users. Int J Geriatr Psychiatry 2020; 35:338-347. [PMID: 31989675 DOI: 10.1002/gps.5267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Commonly used cognitive screening tools were not originally developed for patients with hearing loss (HL) and rely heavily on the ability to hear the instructions and test stimuli. Recently, the Montreal Cognitive Assessment (MoCA) was modified for use with hearing-impaired populations (ie, HI-MoCA). In order to investigate the clinical utility of the HI-MoCA, we assessed performance between the standard MoCA and HI-MoCA among postlingually deafened cochlear implant (CI) users. METHODS We administered the standard MoCA and HI-MoCA to 21 CI users and compared their performance. We assessed differences in pass/fail status when items from the attention and language sections and the delayed recall task were removed. RESULTS There was no significant difference in performance between the standard MoCA and HI-MoCA. Participants scored higher on both test versions when the delayed recall task was removed. Participants also performed better on the delayed recall task on the HI-MoCA than on the standard MoCA. CONCLUSIONS While our findings suggest that the modality of presentation for the MoCA does not influence overall performance for postlingually deafened CI users, visual presentation of stimuli impacted performance on delayed recall. Furthermore, irrespective of presentation modality, our participants scored higher on both MoCA versions when the delayed recall task was removed. Clinically, modifications to the presentation of the MoCA might not be necessary for CI users; however, clinicians should be aware that the delayed recall task is inherently harder for these patients.
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Affiliation(s)
| | - Jake Hillyer
- School of Medicine, Oregon Health & Science University, Portland, OR
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Alattar AA, Bergstrom J, Laughlin GA, Kritz-Silverstein D, Richard EL, Reas ET, Harris JP, Barrett-Connor E, McEvoy LK. Hearing Impairment and Cognitive Decline in Older, Community-Dwelling Adults. J Gerontol A Biol Sci Med Sci 2020; 75:567-573. [PMID: 30753308 PMCID: PMC7328194 DOI: 10.1093/gerona/glz035] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hearing impairment is prevalent among older adults and has been identified as a risk factor for cognitive impairment and dementia. We evaluated the association of hearing impairment with long-term cognitive decline among community-dwelling older adults. METHODS A population-based longitudinal study of adults not using hearing aids who had hearing acuity and cognitive function assessed in 1992-1996, and were followed for a maximum of 24 years with up to five additional cognitive assessments. Hearing acuity was categorized based on pure-tone average (PTA) thresholds: normal (PTA ≤ 25 dB), mild impairment (PTA > 25-40 dB), moderate/severe impairment (PTA > 40 dB). RESULTS Of 1,164 participants (mean age 73.5 years, 64% women), 580 (49.8%) had mild hearing impairment and 196 (16.8%) had moderate/severe hearing impairment. In fully adjusted models, hearing impairment was associated with steeper decline on the Mini-Mental State Examination (MMSE) (mild impairment β = -0.04, p = .01; moderate/severe impairment β = -0.08, p = .002) and Trails B (mild impairment β = 1.21, p = .003; moderate/severe impairment β = 2.16, p = .003). Associations did not differ by sex or apolipoprotein E (APOE) ϵ4 status and were not influenced by social engagement. The MMSE-hearing association was modified by education: mild hearing impairment was associated with steeper decline on the MMSE among participants without college education but not among those with college education. Moderate/severe hearing impairment was associated with steeper MMSE decline regardless of education level. CONCLUSIONS Hearing impairment is associated with accelerated cognitive decline with age, and should be screened for routinely. Higher education may provide sufficient cognitive reserve to counter effects of mild, but not more severe, hearing impairment.
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Affiliation(s)
- Ali A Alattar
- School of Medicine, University of California San Diego, La Jolla
| | - Jaclyn Bergstrom
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Gail A Laughlin
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Donna Kritz-Silverstein
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Erin L Richard
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Emilie T Reas
- Department of Neurosciences, University of California San Diego, La Jolla
| | - Jeffrey P Harris
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Linda K McEvoy
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
- Department of Radiology, University of California San Diego, La Jolla
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Zhang Y, Ge M, Zhao W, Liu Y, Xia X, Hou L, Dong B. Sensory Impairment and All-Cause Mortality Among the Oldest-Old: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). J Nutr Health Aging 2020; 24:132-137. [PMID: 32003401 DOI: 10.1007/s12603-020-1319-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the association between sensory impairment and all-cause mortality among the oldest-old (aged 80 and older) in China. DESIGN Prospective cohort study. SETTING Community-based setting in 22 provinces of China. PARTICIPANTS A total of 8788 older adults aged 80 and over at baseline with complete hearing and vision function data were included as the study population. MEASUREMENTS Sensory impairment was categorized as no sensory impairment, hearing impairment (HI) only, vision impairment (VI) only and dual sensory impairment (DSI) according to hearing and vision function. Deaths were identified through interviews by close family members. Cox proportion hazards regression models were used to examine the association of sensory impairment with mortality, adjusting for socio-demographic data, life style factors and health status. RESULTS The mean age was 92.3 ± 7.6 years old, and 60.1% of participants were female. Among 8788 participants, 9.8% were recognized as DSI, 9.7% were HI only and 10.4% with VI only. Comparing with participants with no sensory impairment, those with VI only (HR=1.10, 95% CI=1.01-1.20) and DSI (HR=1.21, 95% CI=1.09-1.35) were significantly associated with higher risk of all-cause mortality in the fully adjusted model. CONCLUSION Our results demonstrated that VI only and DSI were significantly associated with higher risk of mortality among Chinese older adults aged 80 and over. The finding advocated that it is necessary to identify and manage sensory impairments for the advanced ages to reduce mortality risks.
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Affiliation(s)
- Y Zhang
- Birong Dong, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, Sichuan, China, 610041. , Fax: +86-028-85421550, Tel: +86-028-85421550
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Abstract
The current literature on peripheral cranial nerve stimulation for the purpose of achieving therapeutic effects via altering brain activity is reviewed. Vagus nerve stimulation, which is approved for use in refractory epilepsy, is the most extensively studied cranial nerve stimulator that has direct impact on the central nervous system. Despite the recognized central effects of peripheral cranial nerve stimulation, the mechanism of action for all indications remains incompletely understood. Further research on both mechanisms and indications of central effects of cranial nerve stimulation has the potential to alleviate burden of disease in a large array of conditions.
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Affiliation(s)
- Gavriel D Kohlberg
- Division of Otology and Neurotology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356161, Seattle, WA 98195 - 6161, USA
| | - Ravi N Samy
- Division of Otology/Neurotology, Neurotology Fellowship, Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Neurosensory Disorders Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati Children's Hospital Medical Center, 213 Albert Sabin, Way, MSB 6009C, Cincinnati, OH 45267-0528, USA.
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Falutz J, Kirkland S, Guaraldi G. Geriatric Syndromes in People Living with HIV Associated with Ageing and Increasing Comorbidities: Implications for Neurocognitive Complications of HIV Infection. Curr Top Behav Neurosci 2019; 50:301-327. [PMID: 31907879 DOI: 10.1007/7854_2019_119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Long-term survival of treated people living with HIV (PLWH) currently approaches that of the general population. The average age of PLWH is currently in the mid-50s in resource-rich countries and is predicted that over 40% of PLWH will be older than 60 within a decade. Similar trends have been confirmed in all communities of PLWH with access to antiretroviral therapies. However, the positive impact on survival has been challenged by several developments. Ageing PLWH have clinical features similar to the general population about 5-10 years older. In addition to the earlier occurrence of common age-related conditions common geriatric syndromes have also impacted this population prematurely. These are often difficult to evaluate and manage conditions usually of multifactorial aetiology. They include polypharmacy, frailty, impaired mobility and falls, sarcopenia, sensory impairment, and increasingly, non-dementing cognitive decline. Cognitive decline is of particular concern to PLWH and their care providers. In the general geriatric population cognitive impairment increases with age and occurs in all populations with a prevalence of over 25% in people over 80. Effective treatments are lacking and therefore minimizing risk factors plays an important role in maintaining healthspan. In the general population geriatric syndromes may increase the risk of cognitive decline. The corollary is that decreasing the risk of their development may limit cognitive impairment. Whether a similar status holds in PLWH is uncertain. This chapter will address the question of whether common geriatric syndromes in PLWH contribute to cognitive impairment. Common risk factors may provide clues to limit or delay cognitive decline.
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Affiliation(s)
- Julian Falutz
- McGill University Health Centre, Montreal, QC, Canada.
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