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Kim HK, Biessels GJ, Yu MH, Hong N, Lee YH, Lee BW, Kang ES, Cha BS, Lee EJ, Lee M. SGLT2 Inhibitor Use and Risk of Dementia and Parkinson Disease Among Patients With Type 2 Diabetes. Neurology 2024; 103:e209805. [PMID: 39292986 DOI: 10.1212/wnl.0000000000209805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the mechanistic potential of sodium-glucose cotransporter 2 inhibitor (SGLT2i) to improve neurologic outcomes, the efficacy of SGLT2i in neurodegenerative disorders among patients with type 2 diabetes is not well established. This population-based cohort study aimed to investigate the association of SGLT2i use with risks of incident dementia and Parkinson disease (PD) in patients with type 2 diabetes. METHODS This was a retrospective examination of data from a cohort of 1,348,362 participants with type 2 diabetes (≥40 years), who started antidiabetic drugs from 2014 to 2019, evaluated using the Korean National Health Insurance Service Database. Propensity score matching (1:1; SGLT2i to other oral antidiabetic drugs [OADs]) produced a cohort of 358,862 participants. Primary outcomes were the individual incidence of Alzheimer disease (AD), vascular dementia (VaD), and PD. Secondary outcomes were all-cause dementia (AD, VaD, and other dementia) and a composite of all-cause dementia and PD. Cox proportional hazards models were used to investigate the association between SGLT2i use and the risks of dementia and PD. RESULTS From the 358,862 participants analyzed (mean [SD] age, 57.8 [9.6] years; 58.0% male), 6,837 incident dementia or PD events occurred. Regarding the individual endpoints, SGLT2i use was associated with reduced risks of AD (adjusted hazard ratio [aHR] 0.81, 95% CI 0.76-0.87), VaD (aHR 0.69, 95% CI 0.60-0.78), and PD (aHR 0.80, 95% CI 0.69-0.91) with a 6-month drug use lag period. In addition, use of SGLT2i was associated with a 21% lower risk of all-cause dementia (aHR 0.79, 95% CI 0.69-0.90) and a 22% lower risk of all-cause dementia and PD than use of other OADs (aHR 0.78, 95% CI 0.73-0.83). The association between the use of SGLT2i and the lowered risk of these neurodegenerative disorders was not affected by sex, Charlson Comorbidity Index, diabetic complications, comorbidities, and medications. Sensitivity analysis further adjusting for bioclinical variables from health screening tests, including blood pressure, glucose, lipid profiles, and kidney function, yielded generally consistent results. DISCUSSION In this nationwide population-based study, SGLT2i use significantly reduced the risks of neurodegenerative disorders in patients with type 2 diabetes independent of various factors including comorbidities and bioclinical parameters. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that SGLT2 antidiabetic drugs decrease the risk of dementia and PD in people with diabetes.
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Affiliation(s)
- Hae Kyung Kim
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Geert Jan Biessels
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Heui Yu
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Namki Hong
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Ho Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung-Wan Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Seok Kang
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Bong-Soo Cha
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Jig Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minyoung Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Shardell M, Rathbun AM, Gruber-Baldini A, Ryan AS, Guralnik J, Kapogiannis D, Simonsick EM. The inverse association between cancer history and incident cognitive impairment: Addressing attrition bias. Alzheimers Dement 2024. [PMID: 39324538 DOI: 10.1002/alz.14268] [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: 06/10/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Cancer is inversely associated with cognitive impairment. Whether this is due to statistical handling of attrition (death and censoring) is unknown. METHODS We quantified associations between cancer history and incident cognitive impairment among Health, Aging, and Body Composition Study participants without baseline cognitive impairment or stroke (n = 2604) using multiple competing-risks models and their corresponding estimands: cause-specific, subdistribution, and marginal hazards, plus composite-outcome (cognitive impairment or all-cause mortality) hazards. All-cause mortality was also modeled. RESULTS After covariate adjustment (demographics, apolipoprotein E ε4, lifestyle, health conditions), cause-specific and marginal hazard ratios (HRs) were similar to each other (≈ 0.84; P values < 0.05). The subdistribution HR was 0.764 (95% confidence interval [CI] = 0.645-0.906), and composite-outcome Cox model HR was 1.149 (95% CI = 1.016-1.299). Cancer history was positively associated with all-cause mortality (HR = 1.813; 95% CI = 1.525-2.156). DISCUSSION Cause-specific, subdistribution, and marginal hazards models produced inverse associations between cancer and cognitive impairment. Competing risk models answer slightly different questions, and estimand choice influenced findings here. HIGHLIGHTS Cancer history is inversely associated with incident cognitive impairment. Findings were robust to handling of competing risks of death. All models also addressed possible informative censoring bias. Cancer history was associated with 16% lower hazard of cognitive impairment. Cancer history was associated with 81% higher all-cause mortality hazard.
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Affiliation(s)
- Michelle Shardell
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alan M Rathbun
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alice S Ryan
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, Baltimore VAMC, University of Maryland School of Medicine, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, Maryland, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dimitrios Kapogiannis
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
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Mandelblatt J, Dage JL, Zhou X, Small BJ, Ahles TA, Ahn J, Artese A, Bethea TN, Breen EC, Carroll JE, Cohen HJ, Extermann M, Graham D, Claudine I, Jim HSL, McDonald BC, Nakamura ZM, Patel SK, Rebeck GW, Rentscher KE, Root JC, Russ KA, Tometich DB, Turner RS, Van Dyk K, Zhai W, Huang LW, Saykin AJ. Alzheimer disease-related biomarkers and cancer-related cognitive decline: the Thinking and Living with Cancer study. J Natl Cancer Inst 2024; 116:1495-1507. [PMID: 38788675 PMCID: PMC11378315 DOI: 10.1093/jnci/djae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE We evaluated whether plasma Alzheimer disease (AD)-related biomarkers were associated with cancer-related cognitive decline among older breast cancer survivors. METHODS We included survivors aged 60-90 years with primary stage 0-III breast cancers (n = 236) and frequency-matched noncancer control paricipant (n = 154) who passed a cognitive screen and had banked plasma specimens. Participants were assessed at baseline (presystemic therapy) and annually for up to 60 months. Cognition was measured using tests of attention, processing speed, and executive function and learning and memory; perceived cognition was measured by the Functional Assessment of Cancer Therapy-Cognitive Function v3 Perceived Cognitive Impairments. Baseline plasma neurofilament light, glial fibrillary acidic protein, β-amyloid 42 and 40 and phosphorylated tau 181 were assayed using single molecule arrays. Mixed models tested associations between cognition and baseline AD biomarkers, time, group (survivor vs control participant), and their 2- and 3-way interactions, controlling for age, race, Wide Range 4 Achievement Test Word Reading score, comorbidity, and body mass index; 2-sided P values of .05 were considered statistically significant. RESULTS There were no group differences in baseline AD-related biomarkers except survivors had higher baseline neurofilament light levels than control participants (P = .013). Survivors had lower adjusted longitudinal attention, processing speed, and executive function than control participants starting from baseline and continuing over time (P ≤ .002). However, baseline AD-related biomarker levels were not independently associated with adjusted cognition over time, except control participants had lower attention, processing speed, and executive function scores with higher glial fibrillary acidic protein levels (P = .008). CONCLUSION The results do not support a relationship between baseline AD-related biomarkers and cancer-related cognitive decline. Further investigation is warranted to confirm the findings, test effects of longitudinal changes in AD-related biomarkers, and examine other mechanisms and factors affecting cognition presystemic therapy.
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Affiliation(s)
- Jeanne Mandelblatt
- Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Jeffrey L Dage
- Stark Neurosciences Research Institute, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
| | - Ashley Artese
- Department of Exercise Science and Health Promotion, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL, USA
| | - Traci N Bethea
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Elizabeth C Breen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Harvey J Cohen
- Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Martine Extermann
- Senior Adult Oncology Program, Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Isaacs Claudine
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sunita K Patel
- Department of Population Sciences and Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - G William Rebeck
- Department of Neuroscience, Georgetown University, Washington, DC, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristen A Russ
- Department of Medical and Molecular Genetics and National Centralized Repository for Alzheimer's and Related Dementias, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle B Tometich
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - R Scott Turner
- Department of Neurology, Georgetown University, Washington, DC, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
| | - Li-Wen Huang
- Division of Hematology/Oncology, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
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Huo K, Shang S, Wang J, Chen C, Dang L, Gao L, Wei S, Zeng L, Qu Q. Trends on Prevalence, All-Cause Mortality, and Survival Status of Dementia Patients in Rural China Based on Pooling Analysis. Int J Public Health 2024; 69:1606786. [PMID: 39238546 PMCID: PMC11374651 DOI: 10.3389/ijph.2024.1606786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 07/31/2024] [Indexed: 09/07/2024] Open
Abstract
Objectives No study has reported secular trends in dementia prevalence, all-cause mortality, and survival status in rural China. Methods We established two cohorts (XRRCC1 and XRRCC2) in the same region of China, 17 years apart, to compare dementia prevalence, all-cause mortality, and survival status, and performed regression analysis to identify associated factors. Results Dementia prevalence was 3.49% in XRRCC1 and 4.25% in XRRCC2, with XRRCC2 showing a significantly higher prevalence (OR = 1.79, 95%CI: 1.2-2.65). All-cause mortality rates for dementia patients were 62.0% in XRRCC1 and 35.7% in XRRCC2. Mortality in the normal population of XRRCC2 decreased by 66% compared to XRRCC1, mainly due to improved survival rates in women with dementia. Dementia prevalence was positively associated with age >65, spouse-absent status, and stroke, and negatively associated with ≥6 years of education. Conclusion Dementia prevalence in rural China increased over 17 years, while mortality decreased. Major risk factors include aging, no spouse, and stroke, with higher education offering some protection.
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Affiliation(s)
- Kang Huo
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Suhang Shang
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Wang
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chen Chen
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liangjun Dang
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ling Gao
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shan Wei
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Qiumin Qu
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Center for Brain Science, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Huang LW, Shi Y, Boscardin WJ, Steinman MA. Cognitive Trajectories in Older Adults Diagnosed With Hematologic Malignant Neoplasms. JAMA Netw Open 2024; 7:e2431057. [PMID: 39212987 PMCID: PMC11365001 DOI: 10.1001/jamanetworkopen.2024.31057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024] Open
Abstract
Importance More people are surviving long-term after diagnosis with hematologic malignant neoplasm (HMN), yet there are limited data on cancer-related cognitive impairment in people with HMN. Better understanding cognitive outcomes after HMN in older adults is important for patient counseling and management. Objective To model cognitive trajectories and rates of cognitive decline before and after HMN diagnosis in older adults compared with a matched noncancer cohort. Design, Setting, and Participants In this population-based cohort study, older adults from the Health and Retirement Study (HRS) diagnosed with HMN between 1998 and 2016 after age 65 years were matched 1:3 to participants without cancer from the same HRS wave using propensity scores incorporating variables relevant to cognition. Cognitive trajectories were modeled with piecewise linear splines, and rates of cognitive decline before, during, and after diagnosis were compared in the 2 groups. Data were analyzed from April 2022 to April 2024. Exposures HMN diagnosis by Medicare diagnosis codes. Main Outcomes and Measures Cognitive function was assessed by the Langa-Weir cognitive summary score from 1992 to 2020. Sociodemographic and health-related variables relevant to cognition were incorporated into propensity scores. Results At baseline, there were 668 participants in the HMN cohort (mean [SD] age, 76.8 [7.6] years; 343 [51.3%] male; 72 [10.8%] Black, 33 [4.9%] Hispanic, and 585 [87.6%] White) and 1994 participants in the control cohort (mean [SD] age, 76.5 [7.3] years; 1020 [51.2%] male; 226 [11.3%] Black, 91 [4.6%] Hispanic, and 1726 [86.6%] White). The HMN cohort consisted predominantly of more indolent diagnoses, and only 96 patients (14.4%) received chemotherapy. Before and in the 2 years around the time of diagnosis, the HMN and control cohorts had similar rates of cognitive decline. At 1 year postdiagnosis and beyond, the rate of cognitive decline was slower in the HMN cohort (-0.18; 95% CI, -0.23 to -0.14) than in the control group (-0.24; 95% CI, -0.26 to -0.23) (P = .02), but this difference was no longer significant after accounting for the competing risk of death (HMN group, -0.27; 95% CI, -0.34 to -0.19; control group, -0.30; 95% CI, -0.33 to -0.27; P = .48). Conclusions and Relevance In this cohort study of older adults, the HMN and matched noncancer control cohorts had similar rates of cognitive decline before, during, and after diagnosis after accounting for the competing risk of death.
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Affiliation(s)
- Li-Wen Huang
- Division of Hematology/Oncology, Department of Medicine, San Francisco Veterans Affairs Medical Center, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Ying Shi
- Division of Geriatrics, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - W. John Boscardin
- Division of Geriatrics, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Michael A. Steinman
- Division of Geriatrics, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
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Tasca CI, Zuccarini M, Di Iorio P, Ciruela F. Lessons from the physiological role of guanosine in neurodegeneration and cancer: Toward a multimodal mechanism of action? Purinergic Signal 2024:10.1007/s11302-024-10033-y. [PMID: 39004650 DOI: 10.1007/s11302-024-10033-y] [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: 03/07/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
Neurodegenerative diseases and brain tumours represent important health challenges due to their severe nature and debilitating consequences that require substantial medical care. Interestingly, these conditions share common physiological characteristics, namely increased glutamate, and adenosine transmission, which are often associated with cellular dysregulation and damage. Guanosine, an endogenous nucleoside, is safe and exerts neuroprotective effects in preclinical models of excitotoxicity, along with cytotoxic effects on tumour cells. However, the lack of well-defined mechanisms of action for guanosine hinders a comprehensive understanding of its physiological effects. In fact, the absence of specific receptors for guanosine impedes the development of structure-activity research programs to develop guanosine derivatives for therapeutic purposes. Alternatively, given its apparent interaction with the adenosinergic system, it is plausible that guanosine exerts its neuroprotective and anti-tumorigenic effects by modulating adenosine transmission through undisclosed mechanisms involving adenosine receptors, transporters, and purinergic metabolism. Here, several potential molecular mechanisms behind the protective actions of guanosine will be discussed. First, we explore its potential interaction with adenosine receptors (A1R and A2AR), including the A1R-A2AR heteromer. In addition, we consider the impact of guanosine on extracellular adenosine levels and the role of guanine-based purine-converting enzymes. Collectively, the diverse cellular functions of guanosine as neuroprotective and antiproliferative agent suggest a multimodal and complementary mechanism of action.
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Affiliation(s)
- Carla Inês Tasca
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
- Laboratory of Neurochemistry-4, Neuroscience Program/Biochemistry Program, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - Mariachiara Zuccarini
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100, Chieti, Italy
- Center for Advanced Studies and Technologies (CAST), University of Chieti-Pescara, 66100, Chieti, Italy
| | - Patrizia Di Iorio
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100, Chieti, Italy
- Center for Advanced Studies and Technologies (CAST), University of Chieti-Pescara, 66100, Chieti, Italy
| | - Francisco Ciruela
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Institute for Biomedical Research, 08907L'Hospitalet de Llobregat, Bellvitge, Spain
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Mejía-Guevara I, Periyakoil VS. Diverging Patterns of Cognitive Decline by Sex and Race-Ethnicity in Seriously Ill Older Americans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.27.24309609. [PMID: 38978668 PMCID: PMC11230332 DOI: 10.1101/2024.06.27.24309609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Objectives Differences in Cognitive decline are common in older adults in the last years of life, but differences across sex and race-ethnicity are poorly understood. This study investigated if sex and/or race-ethnicity moderated changes in cognitive function in older adults in the last years of life. Methods Data from the Health and Retirement Study (HRS) from 1993 to 2016 were used to analyze imputed cognition summary scores for total word recall and mental status of older adults aged 60-99. Loss of cognitive function was estimated using a multilevel mixed-effects model and accelerated cognitive decline was approximated by incorporating a change-point model using a restricted sample of decedent respondents who died aged 65-99. Results Notable disparities were seen in the rates of cognitive decline across sex and race-ethnic groups in the last years of life. Women consistently scored lower than men in word recall but higher in mental status, regardless of race-ethnicity. Non-Hispanic White respondents, men and women, consistently outperformed Hispanic and Black respondents in word recall tasks and mental status. Conclusions Our study shows that sex and race-ethnicity moderate cognitive decline in older adults during the last years of life. Older adults from underserved communities are at higher risk of cognitive decline. Our study could inform clinical practice and policy focused on mitigating the adverse impact of cognitive decline experienced by marginalized populations of older adults in the last years of life.
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Wang J, Sims KD, Ackley SF, Chen R, Kobayashi LC, Hayes‐Larson E, Mayeda ER, Buto P, Zimmerman SC, Graff RE, Glymour MM. Association of cancer history with structural brain aging markers of Alzheimer's disease and related dementias risk. Alzheimers Dement 2024; 20:880-889. [PMID: 37811979 PMCID: PMC10916958 DOI: 10.1002/alz.13497] [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: 05/15/2023] [Revised: 08/22/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Cancer survivors are less likely than comparably aged individuals without a cancer history to develop Alzheimer's disease and related dementias (ADRD). METHODS In the UK Biobank, we investigated associations between cancer history and five structural magnetic resonance imaging (MRI) markers for ADRD risk, using linear mixed-effects models to assess differences in mean values and quantile regression to examine whether associations varied across the distribution of MRI markers. RESULTS Cancer history was associated with smaller mean hippocampal volume (b = -19 mm3 , 95% CI = -36, -1) and lower mean cortical thickness in the Alzheimer's disease signature region (b = -0.004 mm, 95% CI = -0.007, -0.000). Quantile regressions indicated individuals most vulnerable to ADRD were more affected by cancer history. DISCUSSION Some brain MRI markers associated with ADRD risk were elevated in adults with a history of cancer. The magnitude of the adverse associations varied across quantiles of neuroimaging markers, and the pattern suggests possible harmful associations for individuals already at high ADRD risk. HIGHLIGHTS We found no evidence of an inverse association between cancer history and ADRD-related neurodegeneration. Cancer history was associated with smaller mean hippocampal volume and lower mean cortical thickness in the Alzheimer's disease signature region. Quantile regressions indicated individuals most vulnerable to ADRD were more affected by cancer history.
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Affiliation(s)
- Jingxuan Wang
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Kendra D. Sims
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Sarah F. Ackley
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Ruijia Chen
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Lindsay C. Kobayashi
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Eleanor Hayes‐Larson
- Department of EpidemiologyFielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Elizabeth Rose Mayeda
- Department of EpidemiologyFielding School of Public HealthUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Peter Buto
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Scott C. Zimmerman
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Rebecca E. Graff
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - M. Maria Glymour
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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9
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Bassil DT, Zheng B, Su B, Kafetsouli D, Udeh-Momoh C, Tzoulaki I, Ahmadi-Abhari S, Muller DC, Riboli E, Middleton LT. Lower Incidence of Dementia Following Cancer Diagnoses: Evidence from a Large Cohort and Mendelian Randomization Study. J Prev Alzheimers Dis 2024; 11:1397-1405. [PMID: 39350386 PMCID: PMC11436397 DOI: 10.14283/jpad.2024.135] [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: 11/23/2023] [Accepted: 04/07/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND The reported inverse association between cancer and subsequent Alzheimer's disease and related dementias (ADRD) remains uncertain. OBJECTIVES To investigate the association between these common conditions of old age and explore possible causal factors. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS We conducted a large population-based cohort analysis using data from 3,021,508 individuals aged 60 and over in the UK Clinical Practice Research Datalink (CPRD), over a period up to 30 years (1988-2018). Cox proportional hazards models were fitted to estimate hazard ratios (HR) for risk of dementia associated with previous cancer diagnosis. Competing risk models were employed to account for competing risk of death. Two-sample Mendelian Randomization analysis based on meta-analysis data from large-scale GWAS studies was also conducted. RESULTS In the CPRD cohort, 412,903 participants had cancer diagnosis and 230,558 were subsequently diagnosed with dementia over a median follow-up period of 7.9 years. Cancer survivors had a 25% lower risk of developing dementia (HR=0.75, 95% CI:0.74-0.76) after adjustment for potential confounders. Accounting for competing risk of death provided a sub-distribution HR of 0.56 (95% CI:0.55-0.56). Results were consistent for prevalent and incident cancer and different common cancer types. Two-sample Mendelian Randomization analysis, using 357 cancer-related instrumental single-nucleotide polymorphisms (SNPs) revealed evidence of vertical pleiotropy between genetically predicted cancer and reduced risk of Alzheimer's disease (OR=0.97,95% CI:0.95-0.99). CONCLUSION Our results provide strong epidemiological evidence of the inverse association between cancer and risk of ADRD and support the potential causal nature of this association via genetic instruments. Further investigations into the precise underlying biological mechanisms may reveal valuable information for new therapeutic approaches.
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Affiliation(s)
- D T Bassil
- Prof. Elio Riboli, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. , +44 (0)20 7594 3426
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10
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Wang J, Buto P, Ackley SF, Kobayashi LC, Graff RE, Zimmerman SC, Hayes-Larson E, Mayeda ER, Asiimwe SB, Calmasini C, Glymour MM. Association between cancer and dementia risk in the UK Biobank: evidence of diagnostic bias. Eur J Epidemiol 2023; 38:1069-1079. [PMID: 37634228 PMCID: PMC10854217 DOI: 10.1007/s10654-023-01036-x] [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: 12/08/2022] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
Epidemiological studies have identified an inverse association between cancer and dementia. Underlying methodological biases have been postulated, yet no studies have systematically investigated the potential for each source of bias within a single dataset. We used the UK Biobank to compare estimates for the cancer-dementia association using different analytical specifications designed to sequentially address multiple sources of bias, including competing risk of death, selective survival, confounding bias, and diagnostic bias. We included 140,959 UK Biobank participants aged ≥ 55 without dementia before enrollment and with linked primary care data. We used cancer registry data to identify cancer cases prevalent before UK Biobank enrollment and incident cancer diagnosed after enrollment. We used Cox models to evaluate associations of prevalent and incident cancer with all-cause dementia, Alzheimer's disease (AD), and vascular dementia. We used time-varying models to evaluate diagnostic bias. Over a median follow-up of 12.3 years, 3,310 dementia cases were diagnosed. All-site incident cancer was positively associated with all-cause dementia incidence (hazard ratio [HR] = 1.14, 95% CI: 1.02-1.29), but prevalent cancer was not (HR = 1.04, 95% CI: 0.92-1.17). Results were similar for vascular dementia. AD was not associated with prevalent or incident cancer. Dementia diagnosis was substantially elevated in the first year after cancer diagnosis (HR = 1.83, 95% CI: 1.42-2.36), after which the association attenuated to null, suggesting diagnostic bias. Following a cancer diagnosis, health care utilization or cognitive consequences of diagnosis or treatment may increase chance of receiving a dementia diagnosis, creating potential diagnostic bias in electronic health records-based studies.
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Affiliation(s)
- Jingxuan Wang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Peter Buto
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah F Ackley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Scott C Zimmerman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Eleanor Hayes-Larson
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephen B Asiimwe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Camilla Calmasini
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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11
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Ospina-Romero M, Brenowitz WD, Glymour MM, Westrick A, Graff RE, Hayes-Larson E, Mayeda ER, Ackley SF, Kobayashi LC. Education, incident cancer, and rate of memory decline in a national sample of US adults in mid-to-later-life. J Geriatr Oncol 2023; 14:101530. [PMID: 37210786 PMCID: PMC10332197 DOI: 10.1016/j.jgo.2023.101530] [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: 08/31/2022] [Revised: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Middle-aged and older adults who develop cancer experience memory loss following diagnosis, but memory decline in the years before and after cancer diagnosis is slower compared to their cancer-free counterparts. Educational attainment strongly predicts memory function during aging, but it is unclear whether education protects against memory loss related to cancer incidence or modifies long-term memory trajectories in middle-aged and older cancer survivors. MATERIALS AND METHODS Data were from 14,449 adults (3,248 with incident cancer, excluding non-melanoma skin cancer) aged 50+ in the population-based US Health and Retirement Study from 1998 to 2016. Memory was assessed every two years as a composite of immediate and delayed word recall tests and proxy assessments for impaired individuals. Memory scores all time points were standardized at to the baseline distribution. Using multivariate-adjusted linear mixed-effects models, we estimated rates of memory decline in the years before cancer diagnosis, shortly after diagnosis, and in the years after diagnosis. We compared rates of memory decline between incident cancer cases and age-matched cancer-free adults, overall and according to level of education (<12 years, "low"; 12 to <16 years, "intermediate"; ≥16 years, "high"). RESULTS Incident cancer diagnoses were followed by short-term declines in memory averaging 0.06 standard deviation (SD) units (95% confidence interval [CI]: -0.084, -0.036). Those with low education experienced the strongest magnitude of short-term decline in memory after diagnosis (-0.10 SD units, 95% CI: -0.15, -0.05), but this estimate was not statistically significantly different from the short-term decline in memory experienced by those with high education (-0.04 SD units, 95% CI: -0.08, 0.01; p-value for education as an effect modifier = 0.15). In the years prior to and following an incident cancer diagnosis, higher educational attainment was associated with better memory, but it did not modify the difference in rate of long-term memory decline between cancer survivors and those who remained cancer-free. DISCUSSION Education was associated with better memory function over time among both cancer survivors and cancer-free adults aged 50 and over. Low education may be associated with a stronger short-term decline in memory after a cancer diagnosis.
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Affiliation(s)
- Monica Ospina-Romero
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America; Department of Pathology and Laboratory Medicine, University of Wisconsin, United States of America.
| | - Willa D Brenowitz
- Department of Psychiatry, University of California San Francisco, United States of America; Kaiser Permanente Center for Health Research, Portland, United States of America
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Ashly Westrick
- Department of Epidemiology, School of Public Health, University of Michigan, United States of America
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Eleanor Hayes-Larson
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States of America
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States of America
| | - Sarah F Ackley
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, United States of America
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12
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Zhang DD, Ou YN, Yang L, Ma YH, Tan L, Feng JF, Cheng W, Yu JT. Investigating the association between cancer and dementia risk: a longitudinal cohort study. Alzheimers Res Ther 2022; 14:146. [PMID: 36199128 PMCID: PMC9533604 DOI: 10.1186/s13195-022-01090-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies found that cancer survivors had a reduced risk of dementia compared with the general population. However, these findings were uncertain because of survivor bias and a lack of stratification by cancer types. This current cohort study used data from the UK Biobank to explore these associations. METHODS Multivariable Cox regression analyses were used to examine the association of cancer status and the risk of dementia with its subtypes after adjusting for age and sex. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated as a measure of relative risk by comparing observed dementia incidence among cancer patients. RESULTS We included 263,151 participants in the observational analysis. During a median follow-up of 9.18 years, dementia was diagnosed in 472 individuals with cancer and 3685 individuals without cancer, respectively. Cancer patients had lower risks of dementia (hazard ratio: 0.89, confidence interval: 0.81-0.98) and its subtypes (Alzheimer's disease [AD]: 0.85 [0.74-0.98]; vascular dementia [VD]: 0.81 [0.66-0.99]) in the Cox regression adjusted for age and sex. Individuals with cancers in the male genital system had substantially reduced risks of dementia (0.66 [0.46-0.93]) and AD (0.53 [0.29-0.97]) than those with cancers in other systems. Moreover, non-melanoma skin cancer and prostate cancer were associated with a reduced risk of dementia (0.79 [0.62-0.99]; 0.69 [0.49-0.97]), but not with AD or VD (P>0.05). CONCLUSIONS The current study supported a negative association between cancer and dementia risk, and encourages further exploration of the mechanistic basis of this inverse relationship to improve understanding.
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Affiliation(s)
- Dan-Dan Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th WulumuqiZhong Road, Shanghai, 200040, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th WulumuqiZhong Road, Shanghai, 200040, China.
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13
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Karanth SD, Katsumata Y, Nelson PT, Fardo DW, McDowell JK, Schmitt FA, Kryscio RJ, Browning SR, Braithwaite D, Arnold SM, Abner EL. Cancer diagnosis is associated with a lower burden of dementia and less Alzheimer's-type neuropathology. Brain 2022; 145:2518-2527. [PMID: 35094057 PMCID: PMC9612796 DOI: 10.1093/brain/awac035] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 02/01/2023] Open
Abstract
Cancer and Alzheimer's disease are common diseases in ageing populations. Previous research has reported a lower incidence of Alzheimer's disease-type (amnestic) dementia among individuals with a diagnosis of cancer. Both cancer and amnestic dementia are prevalent and potentially lethal clinical syndromes. The current study was conducted to investigate the association of cancer diagnosis with neuropathological and cognitive features of dementia. Data were analysed from longitudinally evaluated participants in a community-based cohort study of brain ageing who came to autopsy at the University of Kentucky Alzheimer's Disease Research Center. These data were linked to the Kentucky Cancer Registry, a population-based state cancer surveillance system, to obtain cancer-related data. We examined the relationship between cancer diagnosis, clinical dementia diagnosis, Mini-Mental State Examination scores and neuropathological features using inverse probability weighting to address bias due to confounding and missing data. To address bias due to inclusion of participants with dementia at cohort baseline, we repeated all analyses restricted to the participants who were cognitively normal at baseline. Included participants (n = 785) had a mean ± standard deviation age of death of 83.8 ± 8.6 years; 60.1% were female. Cancer diagnosis was determined in 190 (24.2%) participants, and a diagnosis of mild cognitive impairment or dementia was determined in 539 (68.7%). APOE ɛ4 allele dosage was lower among participants with cancer diagnosis compared to cancer-free participants overall (P = 0.0072); however, this association was not observed among those who were cognitively normal at baseline. Participants with cancer diagnosis had lower odds of mild cognitive impairment or dementia, and higher cognitive test scores (e.g. Mini-Mental State Examination scores evaluated 6 and ≤2 years ante-mortem, P < 0.001 for both comparisons). Cancer diagnosis also associated with lower odds of higher Braak neurofibrillary tangle stages (III/IV) or (V/VI), moderate/frequent neuritic plaques, moderate/frequent diffuse plaques and moderate/severe cerebral amyloid angiopathy (all P < 0.05). By contrast, TDP-43, α-synuclein and cerebrovascular pathologies were not associated with cancer diagnosis. Cancer diagnosis was associated with a lower burden of Alzheimer's disease pathology and less cognitive impairment. These findings from a community-based cohort with neuropathological confirmation of substrates support the hypothesis that there is an inverse relationship between cancer and Alzheimer's disease.
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Affiliation(s)
- Shama D Karanth
- Aging and Geriatric Research, University of Florida, Gainesville, FL 32610, USA
- Cancer Control and Population Sciences Program, University of Florida, Gainesville, FL 32610, USA
| | - Yuriko Katsumata
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY 40536, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA
- Department of Pathology, University of Kentucky, Lexington, KY 40536, USA
| | - David W Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY 40536, USA
| | - Jaclyn K McDowell
- Department of Epidemiology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Control Program, Kentucky Cancer Registry, Lexington, KY 40504, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA
- Department of Neurology, University of Kentucky, Lexington, KY 40536, USA
| | - Richard J Kryscio
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY 40536, USA
- Department of Statistics, University of Kentucky, Lexington, KY 40536, USA
| | - Steven R Browning
- Department of Epidemiology, University of Kentucky, Lexington, KY 40536, USA
| | - Dejana Braithwaite
- Aging and Geriatric Research, University of Florida, Gainesville, FL 32610, USA
- Cancer Control and Population Sciences Program, University of Florida, Gainesville, FL 32610, USA
- Department of Population Sciences, University of Florida, Gainesville, FL 32610, USA
| | - Susanne M Arnold
- Markey Cancer Control Program, Kentucky Cancer Registry, Lexington, KY 40504, USA
- Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Erin L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY 40536, USA
- Department of Epidemiology, University of Kentucky, Lexington, KY 40536, USA
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14
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Ben Hassen C, Fayosse A, Landré B, Raggi M, Bloomberg M, Sabia S, Singh-Manoux A. Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study. BMJ 2022; 376:e068005. [PMID: 35110302 PMCID: PMC9086721 DOI: 10.1136/bmj-2021-068005] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the association of midlife and late life multimorbidity, including severity of multimorbidity, with incident dementia. DESIGN Prospective cohort study. SETTING Civil service departments in London (Whitehall II study, study inception in 1985-88). PARTICIPANTS 10 095 participants, aged 35 to 55 at baseline. MAIN OUTCOME MEASURE Incident dementia at follow-up between 1985 and 2019. Cause specific Cox proportional hazards regression was used to examine the association of multimorbidity overall and at age 55, 60, 65, and 70 with subsequent dementia, taking into account the competing risk of death. RESULTS The prevalence of multimorbidity (≥2 chronic diseases) was 6.6% (655/9937) at age 55 and 31.7% (2464/7783) at age 70; 639 cases of incident dementia occurred over a median follow-up of 31.7 years. After adjustment for sociodemographic factors and health behaviours, multimorbidity at age 55 was associated with subsequent risk of dementia (difference in incidence rate per 1000 person years 1.56, 95% confidence interval 0.62 to 2.77; hazard ratio 2.44, 95% confidence interval 1.82 to 3.26). The association weakened progressively with older age at onset of multimorbidity. At age 65, onset of multimorbidity before age 55 was associated with 3.86 (1.80 to 6.52) per 1000 person years higher incidence of dementia (hazard ratio 2.46, 1.80 to 2.26) and onset between 60 and 65 was associated with 1.85 (0.64 to 3.39) per 1000 person years higher incidence (1.51, 1.16 to 1.97). Severity of multimorbidity (≥3 chronic diseases) at age 55 was associated with a 5.22 (1.14 to 11.95) per 1000 person years higher incidence of dementia (hazard ratio 4.96, 2.54 to 9.67); the same analyses at age 70 showed 4.49 (2.33 to 7.19) per 1000 person years higher incidence (1.65, 1.25 to 2.18). CONCLUSION Multimorbidity, particularly when onset is in midlife rather than late life, has a robust association with subsequent dementia. The increasingly younger age at onset of multimorbidity makes prevention of multimorbidity in people with a first chronic disease important.
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Affiliation(s)
- Céline Ben Hassen
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Martina Raggi
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mikaela Bloomberg
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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Schneider S, Junghaenel DU, Zelinski EM, Meijer E, Stone AA, Langa KM, Kapteyn A. Subtle mistakes in self-report surveys predict future transition to dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12252. [PMID: 34934800 PMCID: PMC8652408 DOI: 10.1002/dad2.12252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION We investigate whether indices of subtle reporting mistakes derived from responses in self-report surveys are associated with dementia risk. METHODS We examined 13,831 participants without dementia from the prospective, population-based Health and Retirement Study (mean age 69 ± 10 years, 59% women). Participants' response patterns in 21 questionnaires were analyzed to identify implausible responses (multivariate outliers), incompatible responses (Guttman errors), acquiescent responses, random errors, and the proportion of skipped questions. Subsequent incident dementia was determined over up to 10 years of follow-up. RESULTS During follow-up, 2074 participants developed dementia and 3717 died. Each of the survey response indices was associated with future dementia risk controlling for confounders and accounting for death as a competing risk. Stronger associations were evident for participants who were younger and cognitively normal at baseline. DISCUSSION Mistakes in the completion of self-report surveys in longitudinal studies may be early indicators of dementia among middle-aged and older adults.
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Affiliation(s)
- Stefan Schneider
- Dornsife Center for Self‐Report Science & Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Doerte U. Junghaenel
- Dornsife Center for Self‐Report Science & Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Elizabeth M. Zelinski
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Erik Meijer
- Dornsife Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Arthur A. Stone
- Dornsife Center for Self‐Report Science & Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kenneth M. Langa
- Department of Internal MedicineInstitute for Social Research and VA Center for Clinical Management ResearchUniversity of MichiganAnn ArborMichiganUSA
| | - Arie Kapteyn
- Dornsife Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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16
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Novel predictive tools and therapeutic strategies for patients with initially diagnosed glottic cancer in the United States. Eur Arch Otorhinolaryngol 2021; 279:399-413. [PMID: 33821328 DOI: 10.1007/s00405-021-06788-4] [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: 01/26/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study is to identify valuable prognostic factors, build clinical prediction nomograms, and recommend the optimal therapeutic strategy for patients with initially diagnosed glottic cancer. METHODS Patients were extracted from the SEER database. Cox regression analyses, survival analyses, an internal validation, the propensity score analysis, and the competing risk analysis were performed. RESULTS Nine overlapped factors were considered as valuable prognostic factors. Furthermore, nomograms were established for clinical prediction models to assess the 1-, 3-, and 5-year overall survival (OS) and cancer-specific survival (CSS). C-indexes, receiver operating characteristic curves, calibration curves, and decision curve analyses proved that nomograms showed better predictive accuracy, ability, and prognostic value compared to the American Joint Committee on Cancer stage. For patients in stage I, primary site surgery alone would acquire best OS and CSS. For patients in stage II, primary site surgery and/or radiation would gain better OS and CSS. For patients in stage III, radiation plus chemotherapy or primary site surgery (alone or plus radiation) would acquire better OS and CSS. Moreover, for patients in stage IV, primary site surgery plus radiation would gain better OS and CSS. CONCLUSIONS Nomograms could be useful for patients' counseling and guide therapeutic decision-making. Primary site surgery alone may likely be the optimal therapy for stage I glottic cancer, and primary site surgery and/or radiation may be the recommended therapy for stage II glottic cancer. The combination treatment would be the preferred choice for advanced-stage (stage III & IV) glottic cancer, and the role of chemotherapy needs to be further explored.
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17
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Chamberlain JD, Rouanet A, Dubois B, Pasquier F, Hanon O, Gabelle A, Ceccaldi M, Krolak-Salmon P, Béjot Y, Godefroy O, Wallon D, Gentric A, Chêne G, Dufouil C. Investigating the association between cancer and the risk of dementia: Results from the Memento cohort. Alzheimers Dement 2021; 17:1415-1421. [PMID: 33656287 PMCID: PMC8518910 DOI: 10.1002/alz.12308] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 12/21/2022]
Abstract
Introduction Studies on the association of cancer and risk of dementia are inconclusive due to result heterogeneity and concerns of survivor bias and unmeasured confounding. Methods This study uses data from the Memento cohort, a French multicenter cohort following persons with either mild or isolated cognitive complaints for a median of 5 years. Illness‐death models (IDMs) were used to estimate transition‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) for incident cancer in relation to dementia from time since study entry. Results The analytical sample (N = 2258) excluded 65 individuals without follow‐up information. At the end of follow‐up, 286 individuals were diagnosed with dementia, 166 with incident cancer, and 95 died. Incident cancer was associated with a reduced risk of dementia (HR = 0.58, 95% CI = 0.35‐0.97), with a corresponding E‐value of 2.84 (lower CI = 1.21). Discussion This study supports a protective relationship between incident cancer and dementia, encouraging further investigations to understand potential underlying mechanisms.
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Affiliation(s)
- Jonviea D Chamberlain
- Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,CIC1401-EC, Inserm, Bordeaux, France
| | - Anaïs Rouanet
- Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | - Bruno Dubois
- Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, Boulevard de l'hôpital, Paris, France
| | | | - Olivier Hanon
- EA 4468, Université de Paris, Geriatric department Broca hospital, APHP, Paris, France
| | - Audrey Gabelle
- Centre Mémoire Ressources Recherche Département de Neurologie CHU Gui de Chauliac, Montpellier, France
| | - Mathieu Ceccaldi
- Ouest CHU Timone APHM & Aix Marseille Univ INSERM INS Inst Neurosci Syst, CMMR PACA, Marseille, France
| | | | - Yannick Béjot
- Department of Neurology and Memory Resource and Research Center of Dijon, EA7460, University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Olivier Godefroy
- Neurology Department, Amiens University Hospital, Amiens, France
| | - David Wallon
- Functional Neurosciences Lab (UR UPJV4559), Centre Universitaire de Recherche en Santé, Normandie Univ, UNIROUEN, Department of Neurology and CNR-MAJ, Inserm U1245 and Rouen University Hospital, Rouen, France
| | | | - Geneviève Chêne
- CIC1401-EC, Inserm, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Carole Dufouil
- CIC1401-EC, Inserm, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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