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Zawada SJ, Ganjizadeh A, Conte GM, Demaerschalk BM, Erickson BJ. Accelerometer-Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank. J Am Heart Assoc 2024; 13:e032965. [PMID: 38818948 DOI: 10.1161/jaha.123.032965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate-to-vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). METHODS AND RESULTS In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929-0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001-1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001-1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771-0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997-0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827-0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002-1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977-0.992]). No between-group differences were significant at subgroup analysis. CONCLUSIONS Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.
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Affiliation(s)
| | - Ali Ganjizadeh
- Mayo Clinic Artificial Intelligence Laboratory Rochester MN
| | | | - Bart M Demaerschalk
- Mayo Clinic College of Medicine and Science Phoenix AZ
- Mayo Clinic Division of Stroke and Cerebrovascular Diseases Department of Neurology Phoenix AZ
- Mayo Clinic Center for Digital Health Phoenix AZ
| | - Bradley J Erickson
- Mayo Clinic College of Medicine and Science Phoenix AZ
- Mayo Clinic Artificial Intelligence Laboratory Rochester MN
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Yerramalla MS, Darin-Mattsson A, Udeh-Momoh CT, Holleman J, Kåreholt I, Aspö M, Hagman G, Kivipelto M, Solomon A, Marseglia A, Sindi S. Cognitive reserve, cortisol, and Alzheimer's disease biomarkers: A memory clinic study. Alzheimers Dement 2024. [PMID: 38837661 DOI: 10.1002/alz.13866] [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: 01/10/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Cognitive reserve might mitigate the risk of Alzheimer's dementia among memory clinic patients. No study has examined the potential modifying role of stress on this relation. METHODS We examined cross-sectional associations of the cognitive reserve index (CRI; education, occupational complexity, physical and leisure activities, and social health) with cognitive performance and AD-related biomarkers among 113 memory clinic patients. The longitudinal association between CRI and cognition over a 3-year follow-up was assessed. We examined whether associations were influenced by perceived stress and five measures of diurnal salivary cortisol. RESULTS Higher CRI scores were associated with better cognition. Adjusting for cortisol measures reduced the beneficial association of CRI on cognition. A higher CRI score was associated with better working memory in individuals with higher (favorable) cortisol AM/PM ratio, but not among individuals with low cortisol AM/PM ratio. No association was found between CRI and AD-related biomarkers. DISCUSSION Physiological stress reduces the neurocognitive benefits of cognitive reserve among memory clinic patients. HIGHLIGHTS Physiological stress may reduce the neurocognitive benefits accrued from cognitively stimulating and enriching life experiences (cognitive reserve [CR]) in memory clinic patients. Cortisol awakening response modified the relation between CR and P-tau181, a marker of Alzheimer's disease (AD). Effective stress management techniques for AD and related dementia prevention are warranted.
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Affiliation(s)
- Manasa Shanta Yerramalla
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Chinedu T Udeh-Momoh
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Brain and Mind Institute, The Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jasper Holleman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Hagman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anna Marseglia
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Ra Y, Chang I, Kim J. Discriminant analysis of ecological factors influencing sarcopenia in older people in South Korea. Front Public Health 2024; 12:1346315. [PMID: 38864021 PMCID: PMC11165097 DOI: 10.3389/fpubh.2024.1346315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/14/2024] [Indexed: 06/13/2024] Open
Abstract
This study aimed to investigate the ecological system factors that influence discrimination of sarcopenia among older individuals living in contemporary society. Data analysis included information from 618 older adults individuals aged 65 years or older residing in South Korea. To assess variations in ecological system factors related to SARC-F scores, we conducted correlation analysis and t-tests. Discriminant analysis was used to identify factors contributing to group discrimination. The key findings are summarized as follows. First, significant differences at the p < 0.001 level were observed between the SARC-F score groups in various aspects, including attitudes toward life, wisdom in life, health management, social support, media availability, sports environment, collectivist values, and values associated with death. Further, service environment differences were significant at p < 0.01 level, while social belonging and social activities exhibited significance at p < 0.05. Second, factors influencing group discrimination based on the SARC-F scores were ranked in the following order: health management, attitudes toward life, fear of own death, wisdom in life, physical environment, sports environment, media availability, social support, fear of the own dying, collectivist values, service environment, social activities, and social belonging. Notably, the SARC-F tool, which is used for sarcopenia discrimination, primarily concentrates on physical functioning and demonstrates relatively low sensitivity. Therefore, to enhance the precision of sarcopenia discrimination within a score-based group discrimination process, it is imperative to incorporate ecological system factors that exert a significant influence. These modifications aimed to enhance the clarity and precision of the text in an academic context.
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Affiliation(s)
- Yoonho Ra
- Institute of Human Convergence Health Science, Gachon University, Incheon, Republic of Korea
| | - Ikyoung Chang
- Department of Sport Coaching, Korea National Sport University, Seoul, Republic of Korea
| | - Jiyoun Kim
- Department of Exercise Rehabilitation, Gachon University, Incheon, Republic of Korea
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Feter N, de Paula D, Dos Reis RCP, Raichlen D, Patrão AL, Barreto SM, Suemoto CK, Duncan BB, Schmidt MI. Leisure-Time Physical Activity May Attenuate the Impact of Diabetes on Cognitive Decline in Middle-Aged and Older Adults: Findings From the ELSA-Brasil Study. Diabetes Care 2024; 47:427-434. [PMID: 38181314 DOI: 10.2337/dc23-1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To assess leisure-time physical activity (LTPA) as a modifier of the diabetes/cognitive decline association in middle-aged and older participants in the Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) study. RESEARCH DESIGN AND METHODS ELSA-Brasil is a cohort of 15,105 participants (age 35-74 years) enrolled between 2008 and 2010. We evaluated global cognitive function, summing the scores of six standardized tests evaluating memory and verbal fluency, including the Trail-Making Test, at baseline and follow-up. Incident cognitive impairment was defined as a global cognitive function score at follow-up lower than -1 SD from baseline mean. Participants reporting ≥150 min/week of moderate to vigorous LTPA at baseline were classified as physically active. We assessed the association of LTPA with global cognition change in those with diabetes in the context of our overall sample through multivariable regression models. RESULTS Participants' (N = 12,214) mean age at baseline was 51.4 (SD 8.8) years, and 55.5% were women. During a mean follow-up of 8.1 (SD 0.6) years, 9,345 (76.5%) inactive participants and 1,731 (14.1%) participants with diabetes at baseline experienced faster declines in global cognition than those who were active (β = -0.003, -0.004, and -0.002) and those without diabetes (β = -0.004, -0.005, and -0.003), respectively. Diabetes increased the risk of cognitive impairment (hazard ratio [HR] 1.71; 95% Cl 1.22, 2.39) in inactive but not in active adults (HR 1.18; 95% CI 0.73, 1.90). Among participants with diabetes, those who were active showed a delay of 2.73 (95% CI 0.94, 4.51) years in the onset of cognitive impairment. CONCLUSIONS In adults living with diabetes, LTPA attenuated the deleterious association between diabetes and cognitive function.
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Affiliation(s)
- Natan Feter
- Post Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Danilo de Paula
- Post Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo Citton P Dos Reis
- Post Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David Raichlen
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA
| | - Ana Luísa Patrão
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Sandhi Maria Barreto
- Deparment of Preventive and Social Medicine, Faculdade de Medicina and Clinical Hospital/Empresa Brasileira de Serviços Hospitalares, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Bruce B Duncan
- Post Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Post Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Valletta M, Vetrano DL, Calderón‐Larrañaga A, Kalpouzos G, Canevelli M, Marengoni A, Laukka EJ, Grande G. Association of mild and complex multimorbidity with structural brain changes in older adults: A population-based study. Alzheimers Dement 2024; 20:1958-1965. [PMID: 38170758 PMCID: PMC10984455 DOI: 10.1002/alz.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION We quantified the association of mild (ie, involving one or two body systems) and complex (ie, involving ≥3 systems) multimorbidity with structural brain changes in older adults. METHODS We included 390 dementia-free participants aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen who underwent brain magnetic resonance imaging at baseline and after 3 and/or 6 years. Using linear mixed models, we estimated the association between multimorbidity and changes in total brain tissue, ventricular, hippocampal, and white matter hyperintensities volumes. RESULTS Compared to non-multimorbid participants, those with complex multimorbidity showed the steepest reduction in total brain (β*time -0.03, 95% CI -0.05, -0.01) and hippocampal (β*time -0.05, 95% CI -0.08, -0.03) volumes, the greatest ventricular enlargement (β*time 0.03, 95% CI 0.01, 0.05), and the fastest white matter hyperintensities accumulation (β*time 0.04, 95% CI 0.01, 0.07). DISCUSSION Multimorbidity, particularly when involving multiple body systems, is associated with accelerated structural brain changes, involving both neurodegeneration and vascular pathology. HIGHLIGHTS Multimorbidity accelerates structural brain changes in cognitively intact older adults These brain changes encompass both neurodegeneration and cerebrovascular pathology The complexity of multimorbidity is associated with the rate of brain changes' progression.
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Affiliation(s)
- Martina Valletta
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - Davide Liborio Vetrano
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - Amaia Calderón‐Larrañaga
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - Grégoria Kalpouzos
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - Marco Canevelli
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
- Department of Human NeuroscienceSapienza UniversityRomeItaly
| | - Alessandra Marengoni
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Erika J Laukka
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - Giulia Grande
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
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Zhou C, Dong C, Wang Q, Fu C, Xie Z, Hao W, Sun H, Zhu D. Healthy lifestyle and all-cause and cause-specific dementia in individuals with type 2 diabetes and the roles of diabetes duration and insulin use in UK Biobank cohort. Diabetes Obes Metab 2023; 25:3202-3211. [PMID: 37435782 DOI: 10.1111/dom.15215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
AIMS To examine the effect of a healthy lifestyle score derived from seven lifestyle factors recommended by the diabetes management guidelines on all-cause and cause-specific dementia in individuals with type 2 diabetes mellitus (T2DM), and how diabetes duration and insulin use status modify their association. MATERIALS AND METHODS This study analysed data of 459 840 participants from the UK Biobank. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals for the association of an overall healthy lifestyle score with all-cause and cause-specific dementia of Alzheimer's disease, vascular dementia and non-Alzheimer non-vascular dementia. RESULTS Using diabetes-free participants who scored 5-7 as the reference group, in diabetes-free participants, we observed higher healthy lifestyle score was related to lower risk of all-cause and cause-specific dementia. However, in people with T2DM, those scored 2-3, 4 and 5-7 all had around the two-time risk of all-cause dementia (HR: 2.20-2.36), while those scored 0-1 had over a three-time risk (HR: 3.14, 95% confidence interval 2.34-4.21). A dose-response trend was observed with vascular dementia (each 2-point increase: 0.75, 0.61-0.93) and no significant association with Alzheimer's disease (0.95, 0.77-1.16). The reduced risk of all-cause and cause-specific dementia with higher lifestyle score was observed in patients with a diabetes duration less than 10 years, or in patients with no insulin use. CONCLUSION In people with T2DM, higher healthy lifestyle score was associated with lower risk of all-cause dementia. Diabetes duration and insulin use moderated the association between healthy lifestyle score and risk of dementia.
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Affiliation(s)
- Chunmiao Zhou
- Department of Epidemiology, School of Public Halth, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Caiyun Dong
- Department of Epidemiology, School of Public Halth, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Chunying Fu
- Department of Epidemiology, School of Public Halth, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ziwei Xie
- Department of Epidemiology, School of Public Halth, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenting Hao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Huizi Sun
- Department of Epidemiology, School of Public Halth, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Halth, Cheeloo College of Medicine, Shandong University, Jinan, China
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Guo Y, Liang R, Ren J, Cheng L, Wang M, Chai H, Cheng X, Yang Y, Sun Y, Li J, Zhao S, Hou W, Zhang J, Liu F, Wang R, Niu Q, Yu H, Yang S, Bai J, Zhang H, Qin X, Xia N. Cognitive status and its risk factors in patients with hypertension and diabetes in a low-income rural area of China: A cross-sectional study. Int J Geriatr Psychiatry 2023; 38:e6010. [PMID: 37794769 DOI: 10.1002/gps.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES The proportion of older people with dementia in China is gradually increasing with the increase in the aging population over recent years. Hypertension and diabetes are common non-communicable diseases among rural populations in China. However, it remains unclear whether these conditions affect the occurrence and development of cognitive impairment as there is limited research on cognitive status and its risk factors among residents of rural areas. METHODS A multi-stage stratified cluster random sampling method was used to select 5400 participants from rural permanent residents. A self-designed structured questionnaire was used to investigate demographic data of the participants. Cognitive function was assessed using the Montreal Cognitive Function Assessment Scale (MoCA). The results were analyzed using chi-square test, ANOVA and multiple linear regression analysis. RESULTS A total of 5028 participants returned the survey, giving a response rate of 93.1%. Higher education (odds ratio (OR) = 3.2, 95% confidence interval (CI) 2.87-3.54, p < 0.001), higher income (OR = 1.61, 95% CI 1.16-2.07, p < 0.001), and dietary control (OR = 0.66, 95%CI 0.34-0.98, p < 0.001) were protective factors. A visual representation of the relationship between annual income and MoCA score showed an inverted U-curve, the group with an annual income of 6000-7999 RMB had a maximum OR of 1.93 (95%CI 0.12-2.74, p < 0.001). While difficulty in maintaining sleep were risk factors for cognitive impairment (OR = -2.28, 95% CI-4.18-0.39, p = 0.018). CONCLUSIONS Participants with middle incomes had better cognitive status than those with the highest incomes. Higher education, proper diet control and good sleep are beneficial to the cognitive status of residents in rural areas.
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Affiliation(s)
- Yuyan Guo
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Ruifeng Liang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jingjuan Ren
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Liting Cheng
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
- Jinzhong Center for Disease Control and Prevention, Health Commission of Shanxi Province, Jinzhong, China
| | - Mengqin Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Huilin Chai
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoyu Cheng
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yaowen Yang
- Health Commission Supervision & Inspection Center, Health Commission of Shanxi Province, Taiyuan, China
| | - Yajuan Sun
- Evaluation Center for Medical Service and Administration, Health Commission of Shanxi Province, Taiyuan, China
| | - Jiantao Li
- Department of Health Economics, School of Management, Shanxi Medical University, Taiyuan, China
| | - Shuhong Zhao
- Evaluation Center for Medical Service and Administration, Health Commission of Shanxi Province, Taiyuan, China
| | - Wenjing Hou
- Evaluation Center for Medical Service and Administration, Health Commission of Shanxi Province, Taiyuan, China
| | - Jianhua Zhang
- Health Commission and Sports Bureau of Yangqu County, Taiyuan, China
| | - Feng Liu
- Yangqu People's Hospital, Taiyuan, China
| | - Rong Wang
- Yangqu People's Hospital, Taiyuan, China
| | - Qiao Niu
- Department of Occupational Health, School of Public Health, Shanxi Medical University, Taiyuan, China
- Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Shoulin Yang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jianying Bai
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hongmei Zhang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaojiang Qin
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Na Xia
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, China
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Zhang JJ, Wu ZX, Tan W, Liu D, Cheng GR, Xu L, Hu FF, Zeng Y. Associations among multidomain lifestyles, chronic diseases, and dementia in older adults: a cross-sectional analysis of a cohort study. Front Aging Neurosci 2023; 15:1200671. [PMID: 37600519 PMCID: PMC10438989 DOI: 10.3389/fnagi.2023.1200671] [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: 04/05/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Background Unhealthy lifestyles and chronic diseases are commonly seen and treatable factors in older adults and are both associated with dementia. However, the synergistic effect of the interaction of lifestyles and chronic diseases on dementia is unknown. Methods We determined independent associations of multidomain lifestyles and chronic diseases (cerebrovascular disease, diabetes, and hypertension) with dementia and examined their synergistic impact on dementia among older adults. The data were drawn from the Hubei Memory and Aging Cohort Study. We created a summary score of six factors for multidomain lifestyles. Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders IV. Logistic regression and multiple correspondence analyses were used to explore the relationships among multidomain lifestyles, chronic diseases, and dementia. A sensitivity analysis was performed to minimize the interference of reverse causality and potential confounders. Results Independent associations with dementia were found in unhealthy (OR = 1.90, 95% CI: 1.38-2.61) and intermediate healthy lifestyles (OR, 3.29, 2.32-4.68), hypertension (OR, 1.21, 1.01-1.46), diabetes (OR, 1.30, 1.04-1.63), and cerebrovascular disease (OR, 1.39, 1.12-1.72). Interactions of diabetes (p = 0.004), hypertension (p = 0.004), and lifestyles were significant, suggesting a combined impact on dementia. Sensitivity analysis supported the strong association among multidomain lifestyles, chronic diseases, and dementia prevalence. Conclusion An unhealthy lifestyle was associated with a higher prevalence of dementia, regardless of whether the participants had chronic diseases; however, this association was stronger in individuals with chronic diseases. Multidomain lifestyles and chronic diseases may have an enhanced impact on dementia.
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Affiliation(s)
- Jing-jing Zhang
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Zhao-xia Wu
- Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Wei Tan
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Dan Liu
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Gui-rong Cheng
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Lang Xu
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Fei-fei Hu
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Yan Zeng
- Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
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Kim J, Ra Y, Yi E. Effects of Community Environment, Leisure, and Social Activities on Health Status of Older Adults with Diabetes in South Korea. Healthcare (Basel) 2023; 11:2105. [PMID: 37510546 PMCID: PMC10379404 DOI: 10.3390/healthcare11142105] [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: 06/26/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
This study investigates the effects of community environment, leisure, and social activities on the health status of older adults with diabetes, a serious disease in modern society. Data from the 2020 National Survey of Older Koreans were analyzed. Descriptive statistics were used to assess participants' characteristics, and regression analyses were conducted to assess the effects of community environment, leisure, and social activities. Mediating effects were tested using hierarchical regression analysis and bootstrapping. The key results are as follows. (a) Community environmental satisfaction affected participation in leisure and social activities. (b) Community accessibility had a negative effect on subjective health, while community environmental satisfaction had a positive effect on subjective health, cognitive function, and chronic diseases. (c) Leisure activities had a positive effect on cognitive health, while social activities influenced subjective health, cognitive function, and chronic diseases. (d) Analysis of the mediating effect of leisure and social activities on the relationship between the community environment and health status of older adults with diabetes confirmed a partial mediating effect. To improve older adults' mental and physical health, mere quantitative increases in the community environment will not be sufficient. It is necessary to cultivate and manage professionals to increase opportunities for participation by increasing social exchanges and systematically managing older adults' health.
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Affiliation(s)
- Jiyoun Kim
- Department of Exercise Rehabilitation, Gachon University, Incheon 21936, Republic of Korea
| | - Yoonho Ra
- Institute of Human Convergence Health Science, Gachon University, Incheon 21936, Republic of Korea
| | - Eunsurk Yi
- Department of Exercise Rehabilitation, Gachon University, Incheon 21936, Republic of Korea
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10
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Dintica CS, Calderón-Larrañaga A, Vetrano DL, Xu W. Association Between Sensory Impairment and Dementia: The Roles of Social Network and Leisure Activity. J Alzheimers Dis 2023:JAD230041. [PMID: 37334593 PMCID: PMC10357179 DOI: 10.3233/jad-230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Evidence suggests that sensory impairment is linked to dementia; however, the role of social network and leisure activity in this relationship is unclear. OBJECTIVE Examine the association of hearing and visual impairment with dementia, and whether a rich social network and leisure activity moderates this association. METHODS Dementia-free older adults from the Swedish National Study on Aging and Care in Kungsholmen (n = 2,579) were followed up for up for a median of 10 years (interquartile range = 6). Visual impairment was assessed with a reading acuity test, and hearing impairment was ascertained via self-report and medical records. Dementia was diagnosed following international criteria. Data on social network and leisure activity was collected via self-report. Hazard ratios (HRs) of dementia risk were derived from Cox regression models. RESULTS Dual impairment, but not single impairment in hearing and vision was associated with a higher risk of dementia (HR: 1.62, 95% CI: 1.16 to 2.27). Compared to participants with no sensory impairment and a moderate-to-rich social network, those with dual impairment and low social network or leisure activity had higher dementia risk (HR: 2.08, 95% CI: 1.43 to 3.22; HR: 2.08, 95% CI: 1.43 to 3.22, respectively), whereas participants with dual impairment with a moderate-to-rich social network or leisure activity did not have significantly higher dementia risk (HR; 1.42, 95% CI: 0.87 to 2.33; HR; 1.42, 95% CI: 0.87 to 2.33, respectively). CONCLUSION A richer social network and participation in stimulating activities may mitigate the higher dementia risk in older adults with dual impairment in vision and hearing.
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Affiliation(s)
- Christina S Dintica
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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11
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Marseglia A, Kalpouzos G, Laukka EJ, Maddock J, Patalay P, Wang HX, Bäckman L, Westman E, Welmer AK, Dekhtyar S. Social Health and Cognitive Change in Old Age: Role of Brain Reserve. Ann Neurol 2022; 93:844-855. [PMID: 36579809 DOI: 10.1002/ana.26591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Individual aspects of social health (SH; eg, network, engagement, support) have been linked to cognitive health. However, their combined effect and the role of the structural properties of the brain (brain reserve [BR]) remain unclear. We investigated the interplay of SH and BR on cognitive change in older adults. METHODS Within the Swedish National Study on Aging and Care-Kungsholmen, 368 dementia-free adults aged ≥60 years with baseline brain magnetic resonance imaging were followed over 12 years to assess cognitive change. A measure of global cognition was computed at each of the 5 waves of assessment by averaging domain-specific Z scores for episodic memory, perceptual speed, semantic memory, and letter and category fluency. An SH composite score was computed at baseline by combining leisure activities and social network. BR was proxied by total brain tissue volume (TBTV). Linear mixed models (adjusted for sociodemographic, vascular, and genetic factors) were used to estimate cognitive trajectories in relation to SH and TBTV. Interaction analysis and stratification were used to examine the interplay between SH and TBTV. RESULTS Moderate-good SH (n = 245; vs poor, β-slope = 0.01, 95% confidence interval [CI] = 0.002-0.02, p = 0.018) and moderate-to-large TBTV (n = 245; vs small, β-slope = 0.03, 95% CI = 0.02-0.04, p < 0.001) were separately associated with slower cognitive decline. In stratified analysis, moderate-good SH was associated with higher cognitive levels (but not change) only in participants with moderate-to-large TBTV (β-intercept = 0.21, 95% CI = 0.06-0.37, p < 0.01; interaction SH * TBTV, p < 0.05). INTERPRETATION Our findings highlight the interplay between SH and BR that likely unfolds throughout the entire life course to shape old-age cognitive outcomes. ANN NEUROL 2023.
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Affiliation(s)
- Anna Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Grégoria Kalpouzos
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Jane Maddock
- Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London, UK.,Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Hui-Xin Wang
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
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12
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Vernooij-Dassen M, Verspoor E, Samtani S, Sachdev PS, Ikram MA, Vernooij MW, Hubers C, Chattat R, Lenart-Bugla M, Rymaszewska J, Szczesniak D, Brodaty H, Welmer AK, Maddock J, van der Velpen IF, Wiegelmann H, Marseglia A, Richards M, Melis R, de Vugt M, Moniz-Cook E, Jeon YH, Perry M, Wolf-Ostermann K. Recognition of social health: A conceptual framework in the context of dementia research. Front Psychiatry 2022; 13:1052009. [PMID: 36590639 PMCID: PMC9798783 DOI: 10.3389/fpsyt.2022.1052009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The recognition of dementia as a multifactorial disorder encourages the exploration of new pathways to understand its origins. Social health might play a role in cognitive decline and dementia, but conceptual clarity is lacking and this hinders investigation of associations and mechanisms. The objective is to develop a conceptual framework for social health to advance conceptual clarity in future studies. Process We use the following steps: underpinning for concept advancement, concept advancement by the development of a conceptual model, and exploration of its potential feasibility. An iterative consensus-based process was used within the international multidisciplinary SHARED project. Conceptual framework Underpinning of the concept drew from a synthesis of theoretical, conceptual and epidemiological work, and resulted in a definition of social health as wellbeing that relies on capacities both of the individual and the social environment. Consequently, domains in the conceptual framework are on both the individual (e.g., social participation) and the social environmental levels (e.g., social network). We hypothesize that social health acts as a driver for use of cognitive reserve which can then slow cognitive impairment or maintain cognitive functioning. The feasibility of the conceptual framework is demonstrated in its practical use in identifying and structuring of social health markers within the SHARED project. Discussion The conceptual framework provides guidance for future research and facilitates identification of modifiable risk and protective factors, which may in turn shape new avenues for preventive interventions. We highlight the paradigm of social health in dementia as a priority for dementia research.
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Affiliation(s)
- Myrra Vernooij-Dassen
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eline Verspoor
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suraj Samtani
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - Perminder S. Sachdev
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Claudia Hubers
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | | | - Dorota Szczesniak
- Department of Psychiatry, Wrocław Medical University, Wrocław, Poland
| | - Henry Brodaty
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
- Dementia Centre for Research Collaboration, Sydney, NSW, Australia
| | - Anna-Karin Welmer
- Department of Neurobiology Care Sciences and Society, Aging Research Center & Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, United Kingdom
| | - Isabelle F. van der Velpen
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Henrik Wiegelmann
- Department of Nursing Science Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Anna Marseglia
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, United Kingdom
| | - Rene Melis
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, Faculty of Health, Medicine and Life Sciences, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherland
| | - Esme Moniz-Cook
- Department of Clinical Psychology, University of Hull, Hull, United Kingdom
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marieke Perry
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin Wolf-Ostermann
- Department of Nursing Science Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
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13
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Wang B, Wang N, Sun Y, Tan X, Zhang J, Lu Y. Association of Combined Healthy Lifestyle Factors With Incident Dementia in Patients With Type 2 Diabetes. Neurology 2022; 99:e2336-e2345. [PMID: 36104282 DOI: 10.1212/wnl.0000000000201231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Type 2 diabetes and lifestyle factors have been associated with dementia risk, but the effect of a healthy lifestyle on diabetes-related dementia remains largely unknown. We aimed to investigate whether the increased risk of dementia among individuals with diabetes can be offset by a broad combination of healthy lifestyle factors. METHODS This prospective study used data from the UK Biobank cohort. An overall lifestyle score ranging from 0 to 7 was created, with 1 point for each of the 7 healthy lifestyle factors: no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, adequate sleep duration, less sedentary behavior, and frequent social contact. Incident dementia was ascertained using linkage with electronic health records. Cox proportional hazards models were used to examine the associations between diabetes, healthy lifestyle score, and dementia incidence. RESULTS We included 167,946 participants aged 60 years or older without dementia at baseline (mean age 64.1 [SD 2.8] years, 51.7% female). During a median follow-up of 12.3 years, 4,351 developed all-cause dementia. Participants with diabetes, but not those with prediabetes, showed a higher risk of dementia than those with normoglycemia. Compared with diabetes-free participants who had a lifestyle score of 7, the hazard ratios (HRs) for dementia were 4.01 (95% CI 3.06-5.25) and 1.74 (95% CI 1.11-2.72) for those with diabetes who had a lifestyle score of 0-2 and 7, respectively. Among participants with diabetes, the HR for dementia comparing a lifestyle score of 7 vs 0-2 was 0.46 (95% CI 0.28-0.75). This finding corresponded to a reduction in the 10-year absolute risk of dementia from 5.22% (95% CI 3.94%-6.73%) to 1.72% (95% CI 0.92%-2.97%). The association between higher lifestyle score and lower dementia risk was independent of glycemic control and diabetes medication. DISCUSSION Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of dementia among participants with diabetes. Behavioral lifestyle modification through multifactorial approaches should be a priority for prevention and delayed onset of dementia in patients with diabetes.
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Affiliation(s)
- Bin Wang
- From the Institute and Department of Endocrinology and Metabolism (B.W., Y.S., N.W., Y.L.), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Neuroscience (X.T.), Uppsala University, Sweden; Department of Clinical Neuroscience (X.T.), Karolinska Institutet, Sweden; and Guangdong Mental Health Center (J.Z.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ningjian Wang
- From the Institute and Department of Endocrinology and Metabolism (B.W., Y.S., N.W., Y.L.), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Neuroscience (X.T.), Uppsala University, Sweden; Department of Clinical Neuroscience (X.T.), Karolinska Institutet, Sweden; and Guangdong Mental Health Center (J.Z.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Sun
- From the Institute and Department of Endocrinology and Metabolism (B.W., Y.S., N.W., Y.L.), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Neuroscience (X.T.), Uppsala University, Sweden; Department of Clinical Neuroscience (X.T.), Karolinska Institutet, Sweden; and Guangdong Mental Health Center (J.Z.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao Tan
- From the Institute and Department of Endocrinology and Metabolism (B.W., Y.S., N.W., Y.L.), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Neuroscience (X.T.), Uppsala University, Sweden; Department of Clinical Neuroscience (X.T.), Karolinska Institutet, Sweden; and Guangdong Mental Health Center (J.Z.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jihui Zhang
- From the Institute and Department of Endocrinology and Metabolism (B.W., Y.S., N.W., Y.L.), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Neuroscience (X.T.), Uppsala University, Sweden; Department of Clinical Neuroscience (X.T.), Karolinska Institutet, Sweden; and Guangdong Mental Health Center (J.Z.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingli Lu
- From the Institute and Department of Endocrinology and Metabolism (B.W., Y.S., N.W., Y.L.), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Neuroscience (X.T.), Uppsala University, Sweden; Department of Clinical Neuroscience (X.T.), Karolinska Institutet, Sweden; and Guangdong Mental Health Center (J.Z.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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14
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Dove A, Marseglia A, Shang Y, Grande G, Vetrano DL, Laukka EJ, Fratiglioni L, Xu W. Cardiometabolic multimorbidity accelerates cognitive decline and dementia progression. Alzheimers Dement 2022; 19:821-830. [PMID: 35708183 DOI: 10.1002/alz.12708] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Cardiometabolic diseases (CMDs) have been individually associated with adverse cognitive outcomes, but their combined effect has not been investigated. METHODS A total of 2577 dementia-free participants 60 years of age or older were followed for 12 years to observe changes in cognitive function and to detect incident cognitive impairment, no dementia (CIND) and dementia. CMDs (including type 2 diabetes, heart disease, and stroke) were assessed at baseline through medical records and clinical examinations. Cardiometabolic multimorbidity was defined as the presence of two or more CMDs. Data were analyzed using multi-adjusted linear mixed-effects models, Cox regression, and Laplace regression. RESULTS CMD multimorbidity was associated with cognitive decline, CIND (hazard ratio [HR] 1.73; 95% confidence interval CI 1.23 to 2.44), and its progression to dementia (HR 1.86; 95% CI 1.17 to 2.97). CMD multimorbidity accelerated the onset of CIND by 2.3 years and dementia by 1.8 years. CONCLUSIONS CMD multimorbidity accelerates cognitive decline and increases the risk of both CIND and its conversion to dementia. HIGHLIGHTS We explored the combined impact of cardiometabolic diseases (CMDs) on cognition. An increasing number of CMDs dose-dependently accelerated cognitive decline. CMD multimorbidity increased the risk of both cognitive impairment and dementia. Co-morbid CMDs could be ideal targets for interventions to protect cognitive health.
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Affiliation(s)
- Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anna Marseglia
- Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Ying Shang
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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15
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Felisatti F, Gonneaud J, Palix C, Garnier-Crussard A, Mézenge F, Landeau B, Chocat A, Quillard A, Ferrand-Devouge E, de La Sayette V, Vivien D, Chételat G, Poisnel G. Role of Cardiovascular Risk Factors on the Association Between Physical Activity and Brain Integrity Markers in Older Adults. Neurology 2022; 98:e2023-e2035. [PMID: 35418459 PMCID: PMC9162049 DOI: 10.1212/wnl.0000000000200270] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Physical activity has been associated with a decreased risk for dementia, but the mechanisms underlying this association remain to be determined. Our objective was to assess whether cardiovascular risk factors mediate the association between physical activity and brain integrity markers in older adults. METHODS At baseline, participants from the Age-Well study completed a physical activity questionnaire and underwent cardiovascular risk factors collection (systolic blood pressure, body mass index [BMI], current smoker status, and high-density lipoprotein cholesterol, total cholesterol, and insulin levels) and multimodal neuroimaging (structural MRI, diffusion MRI, FDG-PET, and florbetapir PET). Multiple regressions were conducted to assess the association among physical activity, cardiovascular risk factors, and neuroimaging. Mediation analyses were performed to test whether cardiovascular risk factors mediated the associations between physical activity and neuroimaging. RESULTS A total of 134 cognitively unimpaired older adults (≥65 years) were included. Higher physical activity was associated with higher gray matter (GM) volume (β = 0.174, p = 0.030) and cerebral glucose metabolism (β = 0.247, p = 0.019) but not with amyloid deposition or white matter integrity. Higher physical activity was associated with lower insulin level and BMI but not with the other cardiovascular risk factors. Lower insulin level and BMI were related to higher GM volume but not to cerebral glucose metabolism. When controlling for insulin level and BMI, the association between physical activity and cerebral glucose metabolism remained unchanged, while the association with GM volume was lost. When insulin level and BMI were entered in the same model, only BMI remained a significant predictor of GM volume. Mediation analyses confirmed that insulin level and BMI mediated the association between physical activity and GM volume. Analyses were replicated within Alzheimer disease-sensitive regions and results remained overall similar. DISCUSSION The association between physical activity and GM volume is mediated by changes in insulin level and BMI. In contrast, the association with cerebral glucose metabolism seems to be independent from cardiovascular risk factors. Older adults engaging in physical activity experience cardiovascular benefits through the maintenance of a lower BMI and insulin level, resulting in greater structural brain integrity. This study has implications for understanding how physical activity affects brain health and may help in developing strategies to prevent or delay age-related decline. TRIAL REGISTRATION INFORMATION EudraCT: 2016-002,441-36; IDRCB: 2016-A01767-44; ClinicalTrials.gov Identifier: NCT02977819.
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Affiliation(s)
- Francesca Felisatti
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Julie Gonneaud
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Cassandre Palix
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Antoine Garnier-Crussard
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Florence Mézenge
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Brigitte Landeau
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Anne Chocat
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Anne Quillard
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Eglantine Ferrand-Devouge
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Vincent de La Sayette
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Denis Vivien
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Gaël Chételat
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
| | - Géraldine Poisnel
- From PhIND, "Physiopathology and Imaging of Neurological Disorders" (F.F., J.G., C.P., A.G.-C., F.M., B.L., A.C., A.Q., E.F.-D., D.V., G.C., G.P.), Institut Blood and Brain at Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, Caen; Clinical and Research Memory Center of Lyon (A.G.-C.), Lyon Institute For Elderly, Charpennes Hospital, Hospices Civils de Lyon; Claude Bernard University Lyon 1 (A.G.-C.); Department of General Practice (E.F.-D.), Normandie Univ, UNIROUEN, Rouen; Rouen University Hospital, CIC-CRB 1404 (E.F.-D.); PSL Université, EPHE (V.d.L.S.), Normandie Univ, UNICAEN, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH; and Département de Recherche Clinique (D.V.), CHU Caen-Normandie, Caen, France
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The role of cognitive and social leisure activities in dementia risk: assessing longitudinal associations of modifiable and non-modifiable risk factors. Epidemiol Psychiatr Sci 2022; 31:e5. [PMID: 35499392 PMCID: PMC8786616 DOI: 10.1017/s204579602100069x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS With the projected surge in global dementia cases and no curative treatment available, research is increasingly focusing on lifestyle factors as preventive measures. Social and cognitive leisure activities are promising targets, but it is unclear which types of activities are more beneficial. This study investigated the individual and joint contribution of cognitive and social leisure activities to dementia risk and whether they modify the risks associated with other potentially modifiable and non-modifiable risk factors. METHODS We used data from the English Longitudinal Study of Ageing (ELSA) from 7917 participants, followed up from 2008/2009 (Wave 4) until 2018/2019 (Wave 9) for incident dementia. Self-reported baseline cognitive activities (e.g. 'reading the newspaper'), the number of social memberships (e.g. being a member of a social club) and social participation (e.g. 'going to the cinema') were clustered into high and low based on a median split. Subsequently, their individual and joint contribution to dementia risk, as well as their interaction with other dementia risk factors, were assessed with Cox regression models, adjusting for age, sex, level of education, wealth and a composite score of 11 lifestyle-related dementia risk factors. RESULTS After a median follow-up period of 9.8 years, the dementia incidence rate was 54.5 cases per 10.000 person-years (95% CI 49.0-60.8). Adjusting for demographic and other lifestyle-related risk factors, higher engagement in cognitive activities (HR = 0.58; 95% CI 0.40-0.84), a greater number of social memberships (HR = 0.65; 95% CI 0.51-0.84) and more social participation (HR = 0.71; 95% CI 0.54-0.95) were associated with lower dementia risk. In a joint model, only engagement in cognitive activities (HR = 0.60; 95% CI 0.40-0.91) and social memberships (HR = 0.75; 95% CI 0.56-0.99) independently explained dementia risk. We did not find any interaction with other modifiable and non-modifiable risk factors. CONCLUSIONS Engagement in cognitive and social leisure activities may be beneficial for overall dementia risk, independent of each other and other risk factors. Both types of activities may be potential targets for dementia prevention measures and health advice initiatives.
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Dove A, Shang Y, Xu W, Grande G, Laukka EJ, Fratiglioni L, Marseglia A. The impact of diabetes on cognitive impairment and its progression to dementia. Alzheimers Dement 2021; 17:1769-1778. [PMID: 34636485 DOI: 10.1002/alz.12482] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Diabetes is a well-established risk factor for dementia, but its impact on the prodromal phase of dementia is unclear. METHODS Cohorts of older adults who were cognitively healthy (n = 1840) or had cognitive impairment-no dementia (CIND; n = 682) were followed over 12 years to detect incident CIND and dementia, respectively. RESULTS Poorly controlled diabetes (glycated hemoglobin [HbA1c] ≥7.5%; reference = normoglycemia) was associated with double the risk of CIND (Cox regression multi-adjusted hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.13-3.58) and triple the risk CIND progressing to dementia (HR 2.87, 95% CI 1.20-6.85). Co-morbid diabetes and heart disease doubled the risk of incident CIND and dementia, although neither disease conferred a significant risk of either outcome alone. Elevated systemic inflammation contributed to the diabetes-associated increased dementia risk. CONCLUSIONS Diabetes characterized by poor glycemic control or cardiovascular complications is related to a greater risk of the development and progression of cognitive impairment. Inflammation may play a role in these relationships.
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Affiliation(s)
- Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ying Shang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
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18
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Marseglia A, Darin-Mattsson A, Skoog J, Rydén L, Hadarsson-Bodin T, Kern S, Rydberg Sterner T, Shang Y, Zettergren A, Westman E, Skoog I. Metabolic syndrome is associated with poor cognition: a population-based study of 70-year-olds without dementia. J Gerontol A Biol Sci Med Sci 2021; 76:2275-2283. [PMID: 34228116 PMCID: PMC8599084 DOI: 10.1093/gerona/glab195] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Individual conditions of metabolic syndrome (MetS) have been related to dementia; however, their combined impact on the preclinical stage is unknown. We investigated the associations between MetS and domain-specific cognitive function as well as the role of sociodemographic, cardiovascular, and genetic factors. Methods Within the Gothenburg H70 Birth Cohort Study-Birth cohort 1944, 1131 dementia-free participants (aged 70 years) were examined during 2014–2016. MetS (central obesity plus at least 2 factors [reduced HDL-cholesterol, elevated triglycerides, blood pressure, or blood glucose]) was identified according to the International Diabetes Federation criteria. Five cognitive domains (memory, attention/perceptual speed, executive function, verbal fluency, visuospatial abilities) were generated after z-standardizing raw scores from 10 neuropsychological tests. Education, heart disease, claudication (indicating peripheral atherosclerosis), and apolipoprotein genotype were ascertained by trained staff. Data were analyzed with linear regression models. Results Overall, 618 participants (55%) had MetS. In multiadjusted linear regressions, MetS was related to poorer performance in attention/perceptual speed (β −0.14 [95% CI −0.25, −0.02]), executive function (β −0.12 [95% CI −0.23, −0.01]), and verbal fluency (β −0.19 [95% CI −0.30, −0.08]). These associations were present only among individuals who did not carry any APOE-ε4 allele or were highly educated. However, among those with MetS, high education was related to better cognitive performance. MetS together with comorbid heart disease or claudication was associated with even worse cognitive performance than each alone. Conclusions MetS is associated with poor attention/perceptual speed, executive function, and verbal fluency performance. Education, apolipoprotein E-ε4 allele, and comorbid cardiovascular disease influenced the observed associations.
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Affiliation(s)
- Anna Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Darin-Mattsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Skoog
- Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden.,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Lina Rydén
- Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden.,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Psychiatry Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
| | - Timothy Hadarsson-Bodin
- Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden.,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Silke Kern
- Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden.,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Therese Rydberg Sterner
- Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden.,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Ying Shang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna Zettergren
- Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden.,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Skoog
- Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden.,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Psychiatry Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
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Grande G, Marengoni A, Vetrano DL, Roso-Llorach A, Rizzuto D, Zucchelli A, Qiu C, Fratiglioni L, Calderón-Larrañaga A. Multimorbidity burden and dementia risk in older adults: The role of inflammation and genetics. Alzheimers Dement 2021; 17:768-776. [PMID: 33403740 PMCID: PMC8247430 DOI: 10.1002/alz.12237] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 12/30/2022]
Abstract
Introduction We investigate dementia risk in older adults with different disease patterns and explore the role of inflammation and apolipoprotein E (APOE) genotype. Methods A total of 2,478 dementia‐free participants with two or more chronic diseases (ie, multimorbidity) part of the Swedish National study on Aging and Care in Kungsholmen (SNAC‐K) were grouped according to their multimorbidity patterns and followed to detect clinical dementia. The potential modifier effect of C‐reactive protein (CRP) and apolipoprotein E (APOE) genotype was tested through stratified analyses. Results People with neuropsychiatric, cardiovascular, and sensory impairment/cancer multimorbidity had increased hazards for dementia compared to the unspecific (Hazard ration (HR) 1.66, 95% confidence interval [CI] 1.13‐2.42; 1.61, 95% CI 1.17‐2.29; 1.32, 95% CI 1.10‐1.71, respectively). Despite the lack of statistically significant interaction, high CRP increased dementia risk within these patterns, and being APOE ε4 carriers heightened dementia risk for neuropsychiatric and cardiovascular multimorbidity. Discussion Individuals with neuropsychiatric, cardiovascular, and sensory impairment/cancer patterns are at increased risk for dementia and APOE ε4, and inflammation may further increase the risk. Identifying such high‐risk groups might allow tailored interventions for dementia prevention.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Centro di Medicina dell'Invecchiamento, IRCCS Fondazione Policlinico "A. Gemelli" and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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