Multimorbidity burden and dementia risk in older adults: The role of inflammation and genetics

COVID-19 outcomes among patients with dementia and age-matched controls who were hospitalized in 21 US health-care systems

INTRODUCTION

COVID-19 had devastating impacts worldwide. However, most research examining the impact of dementia on COVID-19 outcomes has been conducted in Europe and Asia and has not examined dementia subtypes.

METHODS

A retrospective analysis of electronic health record data from 21 US health-care systems examined relationships of all-cause dementia, Alzheimer's disease (AD), and vascular dementia with in-hospital mortality, intensive care unit (ICU) admission, and hospital stay duration.

RESULTS

All-cause dementia, but not AD or vascular dementia independently, was associated with increased mortality risk, the inclusion of discharge to hospice as a mortality equivalent increased risk for mortality for all-cause dementia, and AD and vascular dementia. Patients with all-cause dementia and AD were less likely to be admitted to the ICU than patients without. Patients with any form of dementia had longer hospital stays than patients without.

DISCUSSION

Dementia was associated with increased mortality or hospice discharge, decreased ICU admissions, and longer hospital stays.

HIGHLIGHTS

Only all-cause dementia was associated with increased mortality risk. This risk was lower than what has been published in previous research. Combining mortality and hospice discharge increased risk for all dementia subtypes. All-cause and Alzheimer's disease (AD) dementia were associated with decreased intensive care unit admissions. All-cause, vascular, and AD dementia were associated with longer hospital stays.

Multimorbidity measures associated with cognitive function among community-dwelling older Chinese adults

INTRODUCTION

Older adults with multimorbidity are at high risk of cognitive impairment development. There is a lack of research on the associations between different multimorbidity measures and cognitive function among older Chinese adults living in the community.

METHODS

We used the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2018 and included data on dementia-free participants aged ≥65 years. Multimorbidity measures included condition counts, multimorbidity patterns, and trajectories. The association of multimorbidity measures with cognitive function was examined by generalized estimating equation and linear and logistic regression models.

RESULTS

Among 14,093 participants at baseline, 43.2% had multimorbidity. Multimorbidity patterns were grouped into cancer-inflammatory, cardiometabolic, and sensory patterns. Multimorbidity trajectories were classified as "onset-condition," "newly developing," and "severe condition." The Mini-Mental State Examination scores were significantly lower for participants with more chronic conditions, with cancer-inflammatory/cardiometabolic/sensory patterns, and with developing multimorbidity trajectories.

DISCUSSION

Condition counts, sensory pattern, cardiometabolic pattern, cancer-inflammatory pattern, and multimorbidity developmental trajectories were prospectively associated with cognitive function.

HIGHLIGHTS

Elderly individuals with a higher number of chronic conditions were associated with lower MMSE scores in the Chinese Longitudinal Healthy Longevity Survey data. MMSE scores were significantly lower for participants with specific multimorbidity patterns. Individuals with developing trajectories of multimorbidity were associated with lower MMSE scores and a higher risk of mild cognitive impairment.

Multimorbidity, lifestyle, and cognitive function: A cross-cultural study on the role of diabetes, cardiovascular disease, cancer, and chronic respiratory diseases

BACKGROUND

The effect of lifestyle factors on cognitive function related to four major noncommunicable diseases (NCDs) including diabetes, cardiovascular disease, cancer, and chronic respiratory diseases, and the relationship between these NCDs and cognitive function have not been fully studied. We aimed to investigate the longitudinal associations between these NCDs and cognitive function in middle-aged and older people, and the combined effects of lifestyle factors.

METHODS

By employing the data from three large-scale cohort studies from the U.S. Health and Retirement Study (2010-2019), English Longitudinal Study of Aging (2014-2019), and China Health and Retirement Longitudinal Study (2011-2019), this study carried out a multi-cohort analysis to 77, 210 participants. Fixed-effects regression models were used to examine associations between NCD status and cognitive function. Margin plots were used to illustrate the effect of lifestyle factors.

RESULTS

Our findings revealed the dose-dependent association between mounting these NCDs and declining cognitive performance, ranging from one NCD (β = -0.05, 95 % CI: -0.08 to -0.02) to four NCDs (β = -0.51, 95 % CI: -0.75 to -0.28). Decline in cognitive function associated with NCDs was exacerbated with physical inactivity, current smoking status, and an increase in unhealthy lifestyle behaviors.

LIMITATIONS

The observational study design precludes causal interrogation of lifestyles and four NCDs on cognitive function.

CONCLUSIONS

An increasing number of these NCDs were dose-dependently associated with the decline in cognitive function score. Unhealthy lifestyle factors expedite decline in cognitive function linked to these NCDs.

Cardiometabolic multimorbidity, peripheral biomarkers, and dementia in rural older adults: The MIND-China study

INTRODUCTION

Evidence has emerged that cardiometabolic multimorbidity (CMM) is associated with dementia, but the underlying mechanisms are poorly understood.

METHODS

This population-based study included 5704 older adults. Of these, data were available in 1439 persons for plasma amyloid-β (Aβ), total tau, and neurofilament light chain (NfL) and in 1809 persons for serum cytokines. We defined CMM following two common definitions used in previous studies. Data were analyzed using general linear, logistic, and mediation models.

RESULTS

The presence of CMM was significantly associated with an increased likelihood of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) (p < 0.05). CMM was significantly associated with increased plasma Aβ40, Aβ42, and NfL, whereas CMM that included visceral obesity was associated with increased serum cytokines. The mediation analysis suggested that plasma NfL significantly mediated the association of CMM with AD.

DISCUSSION

CMM is associated with dementia, AD, and VaD in older adults. The neurodegenerative pathway is involved in the association of CMM with AD.

HIGHLIGHTS

The presence of CMM was associated with increased likelihoods of dementia, AD, and VaD in older adults. CMM was associated with increased AD-related plasma biomarkers and serum inflammatory cytokines. Neurodegenerative pathway was partly involved in the association of CMM with AD.

Association of cognitive reserve with transitions across cognitive states and death in older adults: A 15-year follow-up study

INTRODUCTION

We investigated the association of cognitive reserve (CR) with transitions across cognitive states and death.

METHODS

This population-based cohort study included 2631 participants (age ≥60 years) who were dementia-free at baseline and regularly examined up to 15 years. Data were analyzed using the Markov multistate models.

RESULTS

Each 1-point increase in the composite CR score (range: -4.25 to 3.46) was significantly associated with lower risks of transition from normal cognition to cognitive impairment, no dementia (CIND) (multivariable-adjusted hazards ratio = 0.78; 95% confidence interval = 0.72-0.85) and death (0.85; 0.79-0.93), and from CIND to death (0.82; 0.73-0.91), but not from CIND to normal cognition or dementia. A greater composite CR score was associated with a lower risk of transition from CIND to death in people aged 60-72 but not in those aged ≥ 78 years.

DISCUSSION

CR contributes to cognitive health by delaying cognitive deterioration in the prodromal phase of dementia.

HIGHLIGHTS

We use Markov multistate model to examine the association between cognitive reserve and transitions across cognitive states and death. A great cognitive reserve contributes to cognitive health by delaying cognitive deterioration in the prodromal phase of dementia. A great cognitive reserve is associated with a lower risk of transition from cognitive impairment, no dementia to death in people at the early stage of old age, but not in those at the late stage of old age.

Crosstalk between bone and brain in Alzheimer's disease: Mechanisms, applications, and perspectives

Alzheimer's disease (AD) is a neurodegenerative disease that involves multiple systems in the body. Numerous recent studies have revealed bidirectional crosstalk between the brain and bone, but the interaction between bone and brain in AD remains unclear. In this review, we summarize human studies of the association between bone and brain and provide an overview of their interactions and the underlying mechanisms in AD. We review the effects of AD on bone from the aspects of AD pathogenic proteins, AD risk genes, neurohormones, neuropeptides, neurotransmitters, brain-derived extracellular vesicles (EVs), and the autonomic nervous system. Correspondingly, we elucidate the underlying mechanisms of the involvement of bone in the pathogenesis of AD, including bone-derived hormones, bone marrow-derived cells, bone-derived EVs, and inflammation. On the basis of the crosstalk between bone and the brain, we propose potential strategies for the management of AD with the hope of offering novel perspectives on its prevention and treatment. HIGHLIGHTS: The pathogenesis of AD, along with its consequent changes in the brain, may involve disturbing bone homeostasis. Degenerative bone disorders may influence the progression of AD through a series of pathophysiological mechanisms. Therefore, relevant bone intervention strategies may be beneficial for the comprehensive management of AD.

Associations between multimorbidity and neuropathology in dementia: consideration of functional cognitive disorders, psychiatric illness and dementia mimics

BACKGROUND

Multimorbidity, the presence of two or more health conditions, has been identified as a possible risk factor for clinical dementia. It is unclear whether this is due to worsening brain health and underlying neuropathology, or other factors. In some cases, conditions may reflect the same disease process as dementia (e.g. Parkinson's disease, vascular disease), in others, conditions may reflect a prodromal stage of dementia (e.g. depression, anxiety and psychosis).

AIMS

To assess whether multimorbidity in later life was associated with more severe dementia-related neuropathology at autopsy.

METHOD

We examined ante-mortem and autopsy data from 767 brain tissue donors from the UK, identifying physical multimorbidity in later life and specific brain-related conditions. We assessed associations between these purported risk factors and dementia-related neuropathological changes at autopsy (Alzheimer's-disease related neuropathology, Lewy body pathology, cerebrovascular disease and limbic-predominant age-related TDP-43 encephalopathy) with logistic models.

RESULTS

Physical multimorbidity was not associated with greater dementia-related neuropathological changes. In the presence of physical multimorbidity, clinical dementia was less likely to be associated with Alzheimer's disease pathology. Conversely, conditions which may be clinical or prodromal manifestations of dementia-related neuropathology (Parkinson's disease, cerebrovascular disease, depression and other psychiatric conditions) were associated with dementia and neuropathological changes.

CONCLUSIONS

Physical multimorbidity alone is not associated with greater dementia-related neuropathological change; inappropriate inclusion of brain-related conditions in multimorbidity measures and misdiagnosis of neurodegenerative dementia may better explain increased rates of clinical dementia in multimorbidity.

Characteristics of Older Adults with Alzheimer's Disease Who Were Hospitalized during the COVID-19 Pandemic: A Secondary Data Analysis

We aim to investigate the relationships between the population characteristics of patients with Alzheimer's Disease (AD) and their Healthcare Utilization (HU) during the COVID-19 pandemic. Electronic health records (EHRs) were utilized. The study sample comprised those with ICD-10 codes G30.0, G30.1, G30.8, and G30.9 between 1 January 2020 and 31 December 2021. Pearson's correlation and multiple regression were used. The analysis utilized 1537 patient records with an average age of 82.20 years (SD = 7.71); 62.3% were female. Patients had an average of 1.64 hospitalizations (SD = 1.18) with an average length of stay (ALOS) of 7.45 days (SD = 9.13). Discharge dispositions were primarily home (55.1%) and nursing facilities (32.4%). Among patients with multiple hospitalizations, a negative correlation was observed between age and both ALOS (r = -0.1264, p = 0.0030) and number of hospitalizations (r = -0.1499, p = 0.0004). Predictors of longer ALOS included male gender (p = 0.0227), divorced or widowed (p = 0.0056), and the use of Medicare Advantage and other private insurance (p = 0.0178). Male gender (p = 0.0050) and Black race (p = 0.0069) were associated with a higher hospitalization frequency. We recommend future studies including the co-morbidities of AD patients, larger samples, and longitudinal data.

Caregivers' Burden on Patients with Dementia Having Multiple Chronic Diseases

Purpose

This study aimed to find the caregiving burden level for patients with dementia who had multiple chronic diseases by simultaneously considering both patient and caregiver factors.

Participants and Methods

A cross-sectional study with 284 patients with dementia having multiple chronic diseases managed by the dementia collaborative care team at Changhua Christian Hospital in Taiwan was conducted. The input variables were from patients, such as age, gender, mood symptoms, and behavioral and psychological symptoms, and caregivers, including age, relation to the patient, caregiver's mood, and caregiving burden. The Apriori algorithm was employed to determine the association between patient and caregiver factors and different caregiving burden levels by setting up the minimum support of 1% and confidence of 90% along with lift >1.

Results

When caring for patients with dementia, twenty scenarios were found for caregivers with a severe burden. In addition, 1936 scenarios were related to caregivers with a moderate-to-severe burden. Specifically, there were eight scenarios for patients with three chronic diseases which could be further categorized into five general rules. Two hundred and fifty scenarios belonging to patients with two chronic diseases could be classified into 16 different combinations from eight chronic diseases of the database.

Conclusion

Caregiver's mood, patients with mild dementia, and patients aged 75-84 years were associated with a severe caregiving burden. College and above education of the caregiver, the patient aged 85 years or more, and at least one of caregiver's moods were the variables to result in a moderate-to-severe burden for caregivers caring for patients with three multiple chronic diseases. Moreover, college and above education of the caregiver, mood symptom, age of the caregiver, and age of the patient were important variables for caregivers who had a moderate-to-severe burden taking care of patients with two chronic diseases.

Prevalence of fatigue and cognitive impairment after traumatic brain injury

BACKGROUND

Following traumatic brain injury (TBI) some patients develop lingering comorbid symptoms of fatigue and cognitive impairment. The mild cognitive impairment self-reported by patients is often not detected with neurocognitive tests making it difficult to determine how common and severe these symptoms are in individuals with a history of TBI. This study was conducted to determine the relative prevalence of fatigue and cognitive impairment in individuals with a history of TBI.

METHODS

The Fatigue and Altered Cognition Scale (FACs) digital questionnaire was used to assess self-reported fatigue and cognitive impairment. Adults aged 18-70 were digitally recruited for the online anonymous study. Eligible participants provided online consent, demographic data, information about lifetime TBI history, and completed the 20 item FACs questionnaire.

RESULTS

A total of 519 qualifying participants completed the online digital study which included 204 participants with a history of TBI of varied cause and severity and 315 with no history of TBI. FACs Total Score was significantly higher in the TBI group (57.7 ± 22.2) compared to non-TBI (39.5 ± 23.9; p<0.0001) indicating more fatigue and cognitive impairment. When stratified by TBI severity, FACs score was significantly higher for all severity including mild (53.9 ± 21.9, p<0.0001), moderate (54.8 ± 24.4, p<0.0001), and severe (59.7 ± 20.9, p<0.0001) TBI. Correlation analysis indicated that more severe TBI was associated with greater symptom severity (p<0.0001, r = 0.3165). Ancillary analysis also suggested that FACs scores may be elevated in participants with prior COVID-19 infection but no history of TBI.

CONCLUSIONS

Adults with a history of even mild TBI report significantly greater fatigue and cognitive impairment than those with no history of TBI, and symptoms are more profound with greater TBI severity.

Sex Differences in the Role of Multimorbidity on Poststroke Disability: The Taiwan Stroke Registry

BACKGROUND AND OBJECTIVES

Multimorbidity is common in patients who experience stroke. Less is known about the effect of specific multimorbidity patterns on long-term disability in patients with stroke. Furthermore, given the increased poststroke disability frequently seen in female vs male patients, it is unknown whether multimorbidity has a similar association with disability in both sexes. We assessed whether specific multimorbidity clusters were associated with greater long-term poststroke disability burden overall and by sex.

METHODS

In the Taiwan Stroke Registry, an ongoing nationwide prospective registry, patients with first-ever ischemic stroke were enrolled; this analysis is restricted to those individuals surviving to at least 6 months poststroke. Using a hierarchical clustering approach, clusters of prestroke multimorbidity were generated based on 16 risk factors; the algorithm identified 5 distinct clusters. The association between clusters and 12-month poststroke disability, defined using the modified Rankin Scale (mRS), was determined using logistic regression models, with additional models stratified by sex. The longitudinal association between multimorbidity and functional status change was assessed using mixed-effects models.

RESULTS

Nine-thousand eight hundred eighteen patients with first-ever ischemic stroke were included. The cluster with no risk factors was the reference, "healthier" risk group (N = 1,373). Patients with a cluster profile of diabetes, peripheral artery disease (PAD), and chronic kidney disease (CKD) (N = 1882) had significantly greater disability (mRS ≥ 3) at 1 month (OR [95% CI] = 1.36 [1.13-1.63]), 3 months (OR [95% CI] = 1.27 [1.04-1.55]), and 6 months (OR [95% CI] = 1.30 [1.06-1.59]) but not at 12 months (OR [95% CI] = 1.16 [0.95-1.42]) than patients with a healthier risk factor profile. In the sex-stratified analysis, the associations with this risk cluster remained consistent in male patients (OR [95% CI] = 1.42 [1.06-1.89]) at 12 months, who also had a higher comorbidity burden, but not in female patients (OR [95% CI] = 0.95 [0.71-1.26]), who had higher proportions of severe strokes and severe disability (p-interaction = 0.04).

DISCUSSION

Taiwanese patients with multimorbidity, specifically the concurrent presence of diabetes, PAD, and CKD, had higher odds of a worse functional outcome in the first 6 months poststroke. Clusters of multimorbidity may be less informative for long-term disability in female patients. Further studies should evaluate other mechanisms for worse disability in female patients poststroke.

Multimorbidity, cognitive phenotypes, and Alzheimer's disease plasma biomarkers in older adults: A population-based study

INTRODUCTION

To examine the burden and clusters of multimorbidity in association with mild cognitive impairment (MCI), dementia, and Alzheimer's disease (AD)-related plasma biomarkers among older adults.

METHODS

This population-based study included 5432 participants (age ≥60 years); of these, plasma amyloid beta (Aβ), total tau, and neurofilament light chain (NfL) were measured in a subsample (n = 1412). We used hierarchical clustering to generate five multimorbidity clusters from 23 chronic diseases. We diagnosed dementia and MCI following international criteria. Data were analyzed using logistic and linear regression models.

RESULTS

The number of chronic diseases was associated with dementia (multivariable-adjusted odds ratio = 1.22; 95% confidence interval [CI] = 1.11 to 1.33), AD (1.13; 1.01 to 1.26), vascular dementia (VaD) (1.44; 1.25 to 1.64), and non-amnestic MCI (1.25; 1.13 to 1.37). Metabolic cluster was associated with VaD and non-amnestic MCI, whereas degenerative ocular cluster was associated with AD (p < 0.05). The number of chronic diseases was associated with increased plasma Aβ and NfL (p < 0.05).

DISCUSSION

Multimorbidity burden and clusters are differentially associated with subtypes of dementia and MCI and AD-related plasma biomarkers in older adults.

HIGHLIGHTS

We used hierarchical clustering to generate five clusters of multimorbidity. The presence and load of multimorbidity were associated with dementia and mild cognitive impairment. Multimorbidity clusters were differentially associated with subtypes of dementia and Alzheimer's disease plasma biomarkers.

Association of mild and complex multimorbidity with structural brain changes in older adults: A population-based study

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.

Genetic characterization of the ALFA study: Uncovering genetic profiles in the Alzheimer's continuum

INTRODUCTION

In 2013, the ALzheimer's and FAmilies (ALFA) project was established to investigate pathophysiological changes in preclinical Alzheimer's disease (AD), and to foster research on early detection and preventive interventions.

METHODS

We conducted a comprehensive genetic characterization of ALFA participants with respect to neurodegenerative/cerebrovascular diseases, AD biomarkers, brain endophenotypes, risk factors and aging biomarkers. We placed particular emphasis on amyloid/tau status and assessed gender differences. Multiple polygenic risk scores were computed to capture different aspects of genetic predisposition. We additionally compared AD risk in ALFA to that across the full disease spectrum from the Alzheimer's Disease Neuroimaging Initiative (ADNI).

RESULTS

Results show that the ALFA project has been successful at establishing a cohort of cognitively unimpaired individuals at high genetic predisposition of AD.

DISCUSSION

It is, therefore, well-suited to study early pathophysiological changes in the preclinical AD continuum. Highlights Prevalence of ε4 carriers in ALzheimer and FAmilies (ALFA) is higher than in the general European population The ALFA study is highly enriched in Alzheimer's disease (AD) genetic risk factors beyond APOE AD genetic profiles in ALFA are similar to clinical groups along the continuum ALFA has succeeded in establishing a cohort of cognitively unimpaired individuals at high genetic AD risk ALFA is well suited to study pathogenic events/early pathophysiological changes in AD.

Leading determinants of incident dementia among individuals with and without the apolipoprotein E ε4 genotype: a retrospective cohort study

BACKGROUND

Little is known regarding the leading risk factors for dementia/Alzheimer's disease (AD) in individuals with and without APOE4. The identification of key risk factors for dementia/Alzheimer's disease (AD) in individuals with and without the APOE4 gene is of significant importance in global health.

METHODS

Our analysis included 110,354 APOE4 carriers and 220,708 age- and sex-matched controls aged 40-73 years at baseline (between 2006-2010) from UK Biobank. Incident dementia was ascertained using hospital inpatient, or death records until January 2021. Individuals of non-European ancestry were excluded. Furthermore, individuals without medical record linkage were excluded from the analysis. Moderation analysis was tested for 134 individual factors.

RESULTS

During a median follow-up of 11.9 years, 4,764 cases of incident all-cause dementia and 2065 incident AD cases were documented. Hazard ratios (95% CIs) for all-cause dementia and AD associated with APOE4 were 2.70(2.55-2.85) and 3.72(3.40-4.07), respectively. In APOE4 carriers, the leading risk factors for all-cause dementia included low self-rated overall health, low household income, high multimorbidity risk score, long-term illness, high neutrophil percentage, and high nitrogen dioxide air pollution. In non-APOE4 carriers, the leading risk factors included high multimorbidity risk score, low overall self-rated health, low household income, long-term illness, high microalbumin in urine, high neutrophil count, and low greenspace percentage. Population attributable risk for these individual risk factors combined was 65.1%, and 85.8% in APOE4 and non-APOE4 carriers, respectively. For 20 risk factors including multimorbidity risk score, unhealthy lifestyle habits, and particulate matter air pollutants, their associations with incident dementia were stronger in non-APOE4 carriers. For only 2 risk factors (mother's history of dementia, low C-reactive protein), their associations with incident all-cause dementia were stronger in APOE4 carriers.

CONCLUSIONS

Our findings provide evidence for personalized preventative approaches to dementia/AD in APOE4 and non-APOE4 carriers. A mother's history of dementia and low levels of C-reactive protein were more important risk factors of dementia in APOE4 carriers whereas leading risk factors including unhealthy lifestyle habits, multimorbidity risk score, inflammation and immune-related markers were more predictive of dementia in non-APOE4 carriers.

Somatic disease burden and depression risk in late life: a community-based study

AIMS

Co-occurring somatic diseases exhibit complex clinical profiles, which can differentially impact the development of late-life depression. Within a community-based cohort, we aimed to explore the association between somatic disease burden, both in terms of the number of diseases and their patterns, and the incidence of depression in older people.

METHODS

We analysed longitudinal data of depression- and dementia-free individuals aged 60+ years from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression diagnoses were clinically ascertained following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision over a 15-year follow-up. Somatic disease burden was assessed at baseline through a comprehensive list of chronic diseases obtained by combining information from clinical examinations, medication reviews and national registers and operationalized as (i) disease count and (ii) patterns of co-occurring diseases from latent class analysis. The association of somatic disease burden with depression incidence was investigated using Cox models, accounting for sociodemographic, lifestyle and clinical factors.

RESULTS

The analytical sample comprised 2904 people (mean age, 73.2 [standard deviation (SD), 10.5]; female, 63.1%). Over the follow-up (mean length, 9.6 years [SD, 4 years]), 225 depression cases were detected. Each additional disease was associated with the occurrence of any depression in a dose-response manner (hazard ratio [HR], 1.16; 95% confidence interval [CI]: 1.08, 1.24). As for disease patterns, individuals presenting with sensory/anaemia (HR, 1.91; 95% CI: 1.03, 3.53), thyroid/musculoskeletal (HR, 1.90; 95% CI: 1.06, 3.39) and cardiometabolic (HR, 2.77; 95% CI: 1.40, 5.46) patterns exhibited with higher depression hazards, compared to those without 2+ diseases (multimorbidity). In the subsample of multimorbid individuals (85%), only the cardiometabolic pattern remained associated with a higher depression hazard compared to the unspecific pattern (HR, 1.71; 95% CI: 1.02, 2.84).

CONCLUSIONS

Both number and patterns of co-occurring somatic diseases are associated with an increased risk of late-life depression. Mental health should be closely monitored among older adults with high somatic burden, especially if affected by cardiometabolic multimorbidity.

Increased risk of dementia differs across cardiovascular diseases and types of dementia - Data from a nationwide study

AIMS

Dementia is a major health problem. Cardiovascular diseases (CVD) and risk factors are associated with incident dementia. However, whether there is an association among CVD, Alzheimer's disease (AD) and vascular dementia (VD) at the population level remains unclear.

METHODS

We analysed the association between CVD (heart failure [HF], atrial fibrillation [AF], myocardial infarction [MI], peripheral arterial disease, stroke and transient ischemic attack) and the incidence of dementia using nationwide FinnGen data of 218,192 individuals. The last follow-up information on dementia was available from October 2021.

RESULTS

The age at the end of the follow-up was 61.7 ± 17.1 years, and 53% were women. Overall, we observed 9701 (4.4%) dementia, 6323 (2.9%) AD and 1918 (0.7%) VD cases. Individuals with CVD had a higher risk of developing dementia than unexposed individuals. In the multivariable-adjusted Cox models, stroke was most strongly associated with dementia (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.6-1.8). CVD was more strongly associated with VD than with AD. Individuals with HF and MI had an increased risk of AD (HF: HR 1.11, 95% CI 1.04-1.19; MI: HR 1.10, 95% CI 1.02-1.18). AF was associated with VD (HR 1.58, 95% CI 1.42-1.77), but not with AD (HR 1.03, 95% CI 0.97-1.09). Clinical characteristics, such as diabetes, smoking and alcohol abuse, were associated with both types of dementia.

CONCLUSION

All major CVDs were associated with an increased risk of developing dementia, particularly VD. Therefore, CVD onset should prompt an assessment of cognitive decline and possible preventive measures.

Associations between multimorbidity burden and Alzheimer's pathology in older adults without dementia: the CABLE study

Studies have shown that multimorbidity may be associated with the Alzheimer's disease (AD) stages, but it has not been fully characterized in patients without dementia. A total of 1402 Han Chinese older adults without dementia from Chinese Alzheimer's Biomarker and LifestylE (CABLE) study were included and grouped according to their multimorbidity patterns, defined by the number of chronic disorders and cluster analysis. Multivariable linear regression models were used to detect the associations with AD-related cerebrospinal fluid (CSF) biomarkers. Multimorbidity and severe multimorbidity (≥4 chronic conditions) were significantly associated with CSF amyloid and tau levels (pFDR < 0.05). Metabolic patterns were significantly associated with higher levels of CSF Aβ40 (β = 0.159, pFDR = 0.036) and tau (P-tau: β = 0.132, pFDR = 0.035; T-tau: β = 0.126, pFDR = 0.035). The above associations were only significant in the cognitively normal (CN) group. Multimorbidity was associated with brain AD pathology before any symptomatic evidence of cognitive impairment. Identifying such high-risk groups might allow tailored interventions for AD prevention.

Multimorbidity, healthy lifestyle, and the risk of cognitive impairment in Chinese older adults: a longitudinal cohort study

BACKGROUND

Evidence on the association between multimorbidity and cognitive impairment in Chinese older population is limited. In addition, whether a healthy lifestyle can protect cognitive function in multimorbid older population remains unknown.

METHODS

A total of 6116 participants aged ≥ 65 years from the Chinese Longitudinal Healthy Longevity Survey were followed up repeatedly. The number of coexisting chronic diseases was used for assessing multimorbidity and cardiometabolic multimorbidity. Three lifestyle statuses (unhealthy, intermediate, and healthy) were defined based on a lifestyle score covering smoking, alcohol drinking, body mass index, outdoor activities, and dietary pattern. Cognitive impairment was defined as the Mini-Mental State Examination score < 24. A modified Poisson regression model with robust error variance was used to assess the associations between multimorbidity, healthy lifestyle, and cognitive impairment.

RESULTS

During a median follow-up period of 5.8 years, 1621 incident cases of cognitive impairment were identified. The relative risk (RR) of cognitive impairment associated with heavy multimorbidity burden (≥ 3 conditions) was 1.39 (95% confidence interval: 1.22-1.59). This association declined with age, with RRs being 3.08 (1.78-5.31), 1.40 (1.04-1.87), and 1.19 (1.01-1.40) in subjects aged < 70 years, ≥ 70 and < 80 years, and ≥ 80 years, respectively (P for interaction = 0.001). Compared to unhealthy lifestyle, a healthy lifestyle was related to an approximately 40% reduced risk of cognitive impairment regardless of multimorbidity burden. Among the 5 lifestyle factors assessed, daily outdoor activities and a healthy dietary pattern showed convincing protective effects on cognitive function.

CONCLUSIONS

The relationship between multimorbidity and cognitive impairment is age-dependent but remains significant in the population aged 80 years or older. A healthy lifestyle may protect cognitive function regardless of the multimorbidity burden. These findings highlight the importance of targeting individuals with heavy multimorbidity burden and promoting a heathy lifestyle to prevent cognitive impairment in Chinese older population.

Mediating Factors Associated With Physical Activity in Older Adults at Increased Dementia Risk

While regular physical-activity (PA) is beneficial, multimorbid individuals at increased dementia risk may exhibit reduced PA levels. Thus, a more comprehensive understanding of mediating factors responsible for inactivity in this population is needed. This study investigated the impact of a multimodal intervention on PA changes at 24-month follow-up and associated mediating factors among community-dwelling patients aged 60-77, with increased dementia risk determined by the CAIDE Dementia Risk Score. Of 1030 participants recruited, 819 completed the assessment. Thus, a generalized estimating equations model initially assessed differences in PA over 24 months, followed by a tree analysis identifying mediating factors influencing PA changes post-intervention. While no significant effect on regular PA was found during the follow-up (P = .674), subgroup analysis revealed improved self-efficacy (P = .000) associated with increased engagement in PA. Incorporating self-efficacy elements into future strategies is crucial for promoting PA among individuals with multimorbidity and at increased dementia risk.

A scoping review finds a growing trend in studies validating multimorbidity patterns and identifies five broad types of validation methods

OBJECTIVES

Multimorbidity, the presence of two or more long-term conditions, is a growing public health concern. Many studies use analytical methods to discover multimorbidity patterns from data. We aimed to review approaches used in published literature to validate these patterns.

STUDY DESIGN AND SETTING

We systematically searched PubMed and Web of Science for studies published between July 2017 and July 2023 that used analytical methods to discover multimorbidity patterns.

RESULTS

Out of 31,617 studies returned by the searches, 172 were included. Of these, 111 studies (64%) conducted validation, the number of studies with validation increased from 53.13% (17 out of 32 studies) to 71.25% (57 out of 80 studies) in 2017-2019 to 2022-2023, respectively. Five types of validation were identified: assessing the association of multimorbidity patterns with clinical outcomes (n = 79), stability across subsamples (n = 26), clinical plausibility (n = 22), stability across methods (n = 7) and exploring common determinants (n = 2). Some studies used multiple types of validation.

CONCLUSION

The number of studies conducting a validation of multimorbidity patterns is clearly increasing. The most popular validation approach is assessing the association of multimorbidity patterns with clinical outcomes. Methodological guidance on the validation of multimorbidity patterns is needed.

The Relationship between Subjective Aging and Cognition in Elderly People: A Systematic Review

There is a growing body of evidence on the effects of subjective aging on health, well-being and quality of life. This review aims to synthesize findings about the link between subjective aging and cognition and cognitive decline. Furthermore, it provides an examination of variation sources such as subjective aging construct, cognitive domains, measures employed, age and moderator variables. A systematic search was performed in PubMed, PsychInfo and Web of Science, as well as grey literature searches in Google Scholar, OpenGrey, WorldCat and NDLTD, which resulted in 59 reports being included. Subjective aging is a relevant construct in the explanation and prediction of cognitive aging and cognitive decline in elderly adults. More positive views about own aging and self-perceptions of aging, as well as a younger subjective age, were consistently related to better cognition and lower risk of cognitive decline. However, there were differences due to subjective aging subdimensions and cognitive domains, as well as an effect of age. Additionally, there were concerns about the content validity of some measures employed, such as the Philadelphia Geriatric Center Morale Scale for subjective aging and the Mini Mental State Examination for global cognition. Further studies should employ longitudinal designs with a process-based approach to cognition and precise subjective aging measures.

Chronic Pain, Analgesics, and Cognitive Status: A Comprehensive Mendelian Randomization Study

BACKGROUND

Observational studies have suggested an intricate relationship among chronic pain (CP), use of analgesics, and cognitive status, but it remains unclear whether these associations are of a causal nature.

METHODS

To investigate the causal relationship among them, summary statistics of 9 types of CP (headache, hip, neck/shoulder, stomach/abdominal, back, knee, facial, general, and multisite CP), analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, salicylic acid and derivatives, and anilides), and cognitive status (cognitive function, Alzheimer's disease [AD], vascular dementia, Lewy body dementia [LBD], and dementia) were included in this Mendelian randomization (MR) study. As both CP and analgesic use were associated with cognitive status and vice versa, we performed a bidirectional MR analysis between CP or analgesics and dementia using strong genetic instruments ( P < .001) identified from genome-wide association studies (GWAS). The inverse-variance weighted method was applied to calculate estimates. The MR estimated odds ratio (OR) was interpreted as odds of outcome per unit increase in the exposure. The Benjamini-Hochberg method was applied to adjust the P value for multiple testing, and P < .05 means statistically significant.

RESULTS

Multisite CP (MCP) was associated with worse cognitive function (OR [95% confidence interval], 0.69 [0.53-0.89], P = .043), but no significant reverse effect of cognitive status on CP was found. There were no significant associations observed between analgesics and cognitive status. Unexpectedly, patients with AD and LBD had significantly lower exposure to anilides (AD: OR = 0.97 [0.94-0.99], P = .034; LBD: OR = 0.97 [0.96-0.99], P = .012) and NSAIDs (AD: OR = 0.96 [0.93-0.98], P = .012; LBD: OR = 0.98 [0.96-0.99], P = .034).

CONCLUSIONS

Our findings indicate that an elevated number of CP sites predict future cognitive decline. Patients with dementia had lower exposure to anilides and NSAIDs, suggesting that they might not be adequately medicated for pain.

Dementia in Germany: epidemiology, trends and challenges

Background

Dementia poses a growing challenge for individuals, healthcare, social support, and society amidst the ongoing ageing of populations. To evaluate the care requirements and social implications of dementia in Germany, reliable statistics regarding its current and future occurrence are necessary.

Methods

Using existing data sources and recent research results, this paper compiles and analyses relevant statistics on the occurrence of dementia in Germany, presents protective and risk factors, and options for care provision.

Results

Recent projections indicate a potential surge in the number of dementia patients in Germany, predicted to rise from 1.7 million at present to up to 3.0 million by the year 2070. Cognitive and motor deterioration and behavioural changes associated with dementia lower the ability to live independently. These changes are often tied to social exclusion and stigma and, particularly in the severe phase of the disease, necessitate extensive medical and care requirements. This contributes to dementia being one of the most costly diseases at old age from an overall societal perspective. Currently, there are no curative treatment options available.

Conclusions

To reduce the increase in the number of dementia patients and associated costs in the future, preventive approaches, particularly promoting a healthy lifestyle, may prove effective. Simultaneously, the healthcare system, society, and caregivers must prepare for the increasing number of dementia patients. Improved diagnostics, new forms of therapy, and social innovations that support those who are affected and their relatives can help reduce the burden of dementia and its associated costs.

Multimorbidity patterns and 18-year transitions from normal cognition to dementia and death: A population-based study

BACKGROUND

Several chronic diseases accelerate cognitive decline; however, it is still unknown how different patterns of multimorbidity influence individuals' trajectories across the cognitive continuum.

OBJECTIVES

We aimed to investigate the impact of multimorbidity and of specific multimorbidity patterns on the transitions across cognitive stages (normal cognition, cognitive impairment, no dementia [CIND], dementia) and death.

METHODS

We included 3122 dementia-free individuals from the Swedish National study on Aging and Care in Kungsholmen. Using fuzzy c-means cluster analysis, multimorbid participants were classified into mutually exclusive groups characterized by commonly coexisting chronic diseases. Participants were followed up to 18 years to detect incident CIND, dementia, or death. Transition hazard ratios (HRs), life expectancies, and time spent in different cognitive stages were estimated using multistate Markov models.

RESULTS

At baseline, five multimorbidity patterns were identified: neuropsychiatric, cardiovascular, sensory impairment/cancer, respiratory/metabolic/musculoskeletal, and unspecific. Compared to the unspecific pattern, the neuropsychiatric and sensory impairment/cancer ones showed reduced hazards of reverting from CIND to normal cognition (HR 0.53, 95% CI 0.33-0.85 and HR 0.60, 95% CI 0.39-0.91). Participants in the cardiovascular pattern exhibited an increased hazard of progression from CIND to dementia (HR 1.70, 95% CI 1.15-2.52) and for all transitions to death. Subjects with the neuropsychiatric and cardiovascular patterns showed reduced life expectancy at age 75, with an anticipation of CIND (up to 1.6 and 2.2 years, respectively) and dementia onset (up to 1.8 and 3.3 years, respectively).

CONCLUSIONS

Multimorbidity patterns differentially steer individual trajectories across the cognitive continuum of older adults and may be used as a risk stratification tool.

Disease severity and mortality in Alzheimer's disease: an analysis using the U.S. National Alzheimer's Coordinating Center Uniform Data Set

BACKGROUND

Evidence on the relative risk of death across all stages of Alzheimer's disease (AD) is lacking but greatly needed for the evaluation of new interventions. We used data from the Uniform Data Set (UDS) of the National Alzheimer's Coordinating Center (NACC) to assess the expected survival of a person progressing to a particular stage of AD and the relative risk of death for a person in a particular stage of AD compared with cognitively normal (CN) people.

METHODS

This was a retrospective observational cohort study of mortality and its determinants in participants with incident mild cognitive impairment (MCI) due to AD or AD dementia compared with CN participants. Overall survival and hazard ratios of all-cause mortality in participants ≥ 50 years of age with clinically assessed or diagnosed MCI due to AD, or mild, moderate, or severe AD dementia, confirmed by Clinical Dementia Rating scores, versus CN participants were estimated, using NACC UDS data. Participants were followed until death, censoring, or until information to determine disease stage was missing.

RESULTS

Aged between 50 and 104 years, 12,414 participants met the eligibility criteria for the study. Participants progressing to MCI due to AD or AD dementia survived a median of 3-12 years, with higher mortality observed in more severe stages. Risk of death increased with the severity of AD dementia, with the increase significantly higher at younger ages. Participants with MCI due to AD and CN participants had a similar risk of death after controlling for confounding factors.

CONCLUSIONS

Relative all-cause mortality risk increases with AD severity, more so at younger ages. Mortality does not seem to be higher for those remaining in MCI due to AD. Findings might imply potential benefit of lower mortality if preventing or delaying the progression of AD is successful, and importantly, this potential benefit might be greater in relatively younger people. Future research should replicate our study in other samples more representative of the general US population as well as other populations around the world.

Retirement age and disability status as pathways to later-life cognitive impairment: Evidence from the Norwegian HUNT Study linked with Norwegian population registers

BACKGROUND

Research shows that retirement age is associated with later-life cognition but has not sufficiently distinguished between retirement pathways. We examined how retirement age was associated with later-life dementia and mild cognitive impairment (MCI) for people who retired via the disability pathway (received a disability pension prior to old-age pension eligibility) and those who retired via the standard pathway.

METHODS

The study sample comprised 7210 participants from the Norwegian Trøndelag Health Study (HUNT4 70+, 2017-2019) who had worked for at least one year in 1967-2019, worked until age 55+, and retired before HUNT4. Dementia and MCI were clinically assessed in HUNT4 70+ when participants were aged 69-85 years. Historical data on participants' retirement age and pathway were retrieved from population registers. We used multinomial regression to assess the dementia/MCI risk for women and men retiring via the disability pathway, or early (<67 years), on-time (age 67, old-age pension eligibility) or late (age 68+) via the standard pathway.

RESULTS

In our study sample, 9.5% had dementia, 35.3% had MCI, and 28.1% retired via the disability pathway. The disability retirement group had an elevated risk of dementia compared to the on-time standard retirement group (relative risk ratio [RRR]: 1.64, 95% CI 1.14-2.37 for women, 1.70, 95% CI 1.17-2.48 for men). MCI risk was lower among men who retired late versus on-time (RRR, 0.76, 95% CI 0.61-0.95).

CONCLUSION

Disability retirees should be monitored more closely, and preventive policies should be considered to minimize the dementia risk observed among this group of retirees.

Impact of asthma on the brain: evidence from diffusion MRI, CSF biomarkers and cognitive decline

Chronic systemic inflammation increases the risk of neurodegeneration, but the mechanisms remain unclear. Part of the challenge in reaching a nuanced understanding is the presence of multiple risk factors that interact to potentiate adverse consequences. To address modifiable risk factors and mitigate downstream effects, it is necessary, although difficult, to tease apart the contribution of an individual risk factor by accounting for concurrent factors such as advanced age, cardiovascular risk, and genetic predisposition. Using a case-control design, we investigated the influence of asthma, a highly prevalent chronic inflammatory disease of the airways, on brain health in participants recruited to the Wisconsin Alzheimer's Disease Research Center (31 asthma patients, 186 non-asthma controls, aged 45-90 years, 62.2% female, 92.2% cognitively unimpaired), a sample enriched for parental history of Alzheimer's disease. Asthma status was determined using detailed prescription information. We employed multi-shell diffusion weighted imaging scans and the three-compartment neurite orientation dispersion and density imaging model to assess white and gray matter microstructure. We used cerebrospinal fluid biomarkers to examine evidence of Alzheimer's disease pathology, glial activation, neuroinflammation and neurodegeneration. We evaluated cognitive changes over time using a preclinical Alzheimer cognitive composite. Using permutation analysis of linear models, we examined the moderating influence of asthma on relationships between diffusion imaging metrics, CSF biomarkers, and cognitive decline, controlling for age, sex, and cognitive status. We ran additional models controlling for cardiovascular risk and genetic risk of Alzheimer's disease, defined as a carrier of at least one apolipoprotein E (APOE) ε4 allele. Relative to controls, greater Alzheimer's disease pathology (lower amyloid-β42/amyloid-β40, higher phosphorylated-tau-181) and synaptic degeneration (neurogranin) biomarker concentrations were associated with more adverse white matter metrics (e.g. lower neurite density, higher mean diffusivity) in patients with asthma. Higher concentrations of the pleiotropic cytokine IL-6 and the glial marker S100B were associated with more salubrious white matter metrics in asthma, but not in controls. The adverse effects of age on white matter integrity were accelerated in asthma. Finally, we found evidence that in asthma, relative to controls, deterioration in white and gray matter microstructure was associated with accelerated cognitive decline. Taken together, our findings suggest that asthma accelerates white and gray matter microstructural changes associated with aging and increasing neuropathology, that in turn, are associated with more rapid cognitive decline. Effective asthma control, on the other hand, may be protective and slow progression of cognitive symptoms.

Dynapenic abdominal obesity and incident multimorbidity: findings from the English longitudinal study on ageing

BACKGROUND

Dynapenic abdominal obesity (DAO) (i.e., impairment in muscle strength and high waist circumference) is gaining interest, as it is associated with several important adverse health outcomes. However, the association between DAO and multimorbidity is largely unclear. Thus, the aim of the present study was to investigate the association between DAO at baseline and new onset multimorbidity over ten years of follow-up.

METHODS

People participating in the English Longitudinal Study of Ageing were included. DAO was defined as waist circumference > 102 cm in men and > 88 cm in women, and a concomitant presence of dynapenia (handgrip strength defined as < 27 kg for men and < 16 kg for women). Multimorbidity was defined as having two or more chronic conditions. The association between DAO and incident multimorbidity was assessed using a multivariable logistic regression analysis, reporting the data as odds ratios (ORs) and their 95% confidence intervals (CIs).

RESULTS

Overall, 3302 participants (mean age: 63.4 years, males: 50.3%) without multimorbidity at baseline were followed-up for ten years. After adjusting for several variables, compared to participants without dynapenia nor abdominal obesity, the presence of abdominal obesity (OR = 1.505; 95%CI: 1.272-1.780; p < 0.0001) and DAO (OR = 1.671; 95%CI: 1.201-2.325; p = 0.002) significantly increased the risk of multimorbidity. Compared to no dynapenia nor abdominal obesity, DAO was associated with significantly higher risk for arthritis and diabetes.

CONCLUSIONS

DAO was significantly associated with a higher risk of incident multimorbidity, over 10 years of follow-up. The results of our study suggest that addressing DAO can potentially decrease risk for multimorbidity.

Association between sleep problems and multimorbidity patterns in older adults

BACKGROUND

Sleep problems are frequent in older adults and are associated with chronic diseases. However, the association with multimorbidity patterns is still unknown. Considering the negative impacts that multimorbidity patterns can have on older adults' life, knowledge of this association can help in the screening and early identification of older adults with sleep problems. The objective was to verify the association between sleep problems and multimorbidity patterns in older Brazilian adults.

METHODS

This was a cross-sectional study conducted with data from 22,728 community-dwelling older adults from the 2019 National Health Survey. The exposure variable was self-reported sleep problems (yes/no). The study outcomes were: multimorbidity patterns, analyzed by self-report of the coexistence of two or more chronic diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; (3) musculoskeletal; (4) coexisting patterns.

RESULTS

Older adults with sleep problems had 1.34 (95%CI: 1.21; 1.48), 1.62 (95%CI: 1.15; 2.28), 1.64 (95%CI: 1.39; 1.93), and 1.88 (95%CI: 1.52; 2.33) greater odds of presenting vascular-metabolic, cardiopulmonary, musculoskeletal, and coexisting patterns, respectively.

CONCLUSIONS

These results suggest that public health programs aimed at preventing sleep problems in older adults are essential to reduce possible adverse health outcomes, including multimorbidity patterns and their negative consequences for older adults' health.

Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study

BACKGROUND

Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association.

METHODS

We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores.

FINDINGS

The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years  (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, β=-0·15 [95% CI -0·17 to -0·13]; two diseases, β=-0·37 [-0·40 to -0·34]; three diseases, β=-0·57 [-0·64 to -0·50]), with comorbid diabetes and stroke (β=-0·23 [-0·29 to -0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888).

INTERPRETATION

These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people.

FUNDING

Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.

Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records

BACKGROUND

Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia.

METHODS

447 888 dementia-free participants of the UK Biobank cohort at baseline (2006-2010) were followed-up until 31 May 2020 with a median follow-up duration of 11.3 years to identify incident cases of dementia. Latent class analysis (LCA) was used to identify multimorbidity patterns at baseline and covariate adjusted Cox regression was used to investigate their predictive effects on the risk of developing dementia. Potential effect moderations by C reactive protein (CRP) and Apolipoprotein E (APOE) genotype were assessed via statistical interaction.

RESULTS

LCA identified four multimorbidity clusters representing Mental health, Cardiometabolic, Inflammatory/autoimmune and Cancer-related pathophysiology, respectively. Estimated HRs suggest that multimorbidity clusters dominated by Mental health (HR=2.12, p<0.001, 95% CI 1.88 to 2.39) and Cardiometabolic conditions (2.02, p<0.001, 1.87 to 2.19) have the highest risk of developing dementia. Risk level for the Inflammatory/autoimmune cluster was intermediate (1.56, p<0.001, 1.37 to 1.78) and that for the Cancer cluster was least pronounced (1.36, p<0.001, 1.17 to 1.57). Contrary to expectation, neither CRP nor APOE genotype was found to moderate the effects of multimorbidity clusters on the risk of dementia.

CONCLUSIONS

Early identification of older adults at higher risk of accumulating multimorbidity of specific pathophysiology and tailored interventions to prevent or delay the onset of such multimorbidity may help prevention of dementia.

Diagnostic groups of hospital stays and outpatient visits during 10 years before Alzheimer's disease

BACKGROUND

Alzheimer's disease (AD) is a major determinant of healthcare costs and increase in the healthcare service use occur already before the AD diagnosis. However, little is known how the different diagnosis categories contribute to this increase in healthcare use. We investigated how the hospitalizations and specialized healthcare outpatient visits from different diagnosis categories, based on the International Classification of Diseases (ICD-10) chapters, contribute to increased specialized healthcare service use during ten-year period preceding AD diagnosis.

METHODS

A register-based nationwide cohort of 42,934 community-dwelling persons who received clinically verified AD diagnosis in between 2008 and 2011 in Finland and 1:1 age, sex and hospital district- matched comparison cohort were included. Hospitalizations and specialized healthcare visits were categorized by the main diagnosis, according to the ICD-10 chapters. AD and dementia were separated to their own category. The number of persons with visits and stays was calculated for every 6 months, irrespective of the frequency of visits/stays individual had during that time window. Furthermore, the relative distribution of the diagnosis categories was computed.

RESULTS

AD cohort was more likely to have visits and stays during the 10-year period (OR 1.19, 95% CI 1.17-1.21). The number of persons with visits and stays peaked in AD cohort from 1.5 years before the diagnosis when the differences in relative distribution of different diagnosis categories also became evident. The largest differences were observed for visits/stays with cognitive disorders, symptoms of unspecified diseases and psychiatric disorders diagnoses, and those with missing diagnosis codes in the last time window before AD diagnosis.

CONCLUSIONS AND IMPLICATIONS

Increased healthcare service use before AD diagnosis does not seem to arise from differences in specific diagnosis categories of ICD-10 such as diseases of the circulatory system, but from the higher frequency of visits and stays among persons with AD across diagnosis categories. Based on the relative distribution of diagnosis categories, the steep increase in healthcare service use just before and during the diagnostic process is likely due to prodromal symptoms and visits related to cognition.

Multimorbidity increases the risk of dementia: a 15 year follow-up of the SHARE study

AIMS

the literature regarding the association between multimorbidity and dementia is still unclear. Therefore, we aimed to explore the potential association between multimorbidity at the baseline and the risk of future dementia in the SHARE (Survey of Health, Ageing and Retirement in Europe) study, a large European research survey, with a follow-up of 15 years.

METHODS

in this longitudinal study, multimorbidity was defined as the presence of two or more chronic medical conditions, among 14 self-reported at the baseline evaluation. Incident dementia was ascertained using self-reported information. Cox regression analysis, adjusted for potential confounders, was run and hazard ratios (HRs), with their 95% confidence intervals (CIs), that were estimated in the whole sample and by 5 year groups.

RESULTS

among 30,419 participants initially considered in wave 1, the 23,196 included participants had a mean age of 64.3 years. The prevalence of multimorbidity at baseline was 36.1%. Multimorbidity at baseline significantly increased the risk of dementia in the overall sample (HR = 1.14; 95% CI: 1.03-1.27) and in participants younger than 55 years (HR = 2.06; 95% CI: 1.12-3.79), in those between 60 and 65 years (HR = 1.66; 95% CI: 1.16-2.37) and in those between 65 and 70 years (HR = 1.54; 95% CI: 1.19-2.00). In the overall sample, high cholesterol levels, stroke, diabetes and osteoporosis increased the risk of dementia, particularly if present among participants between 60 and 70 years of age.

CONCLUSIONS

multimorbidity significantly increases the risk of dementia, particularly in younger people, indicating the need for early detection of multimorbidity for preventing cognitive worsening.

Association between multimorbidity and memory-related diseases among middle-aged and older adults: Evidence from the China Health and Retirement Longitudinal Study

Objectives

This study aimed to examine the cross-sectional and longitudinal association between multimorbidity and memory-related diseases (MDs) among Chinese middle-aged and older adults.

Methods

This study included 8,338 subjects who participated in the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression and Cox proportional hazards regression models were used to explore the association and effect of multimorbidity on MDs.

Results

The overall prevalence of MDs was 2.52%, and the mean multimorbidity number was 1.87. In a cross-sectional analysis, compared with the no multimorbidity group, groups of multimorbidity with four or more non-communicable diseases (NCDs) were more likely to have MDs (OR: 6.49, 95%CI: 4.35–9.68). Within 2.7 years of follow-up, 82 cases of MDs (1.12%) were reported, and participants with multimorbidity were more likely to have new-onset MDs than participants without multimorbidity (HR: 2.93, 95%CI: 1.74–4.96).

Conclusion

Multimorbidity is associated with MDs among Chinese middle-aged and older adults. This relationship gradually strengthens with the severity of multimorbidity, which indicates that early prevention for people with multimorbidity may reduce the risk of MDs.

Multimorbid Patterns and Cognitive Performance in the Presence of Informative Dropout Among Community-Dwelling Taiwanese Older Adults

Background and Objectives

Longitudinal studies among older adults often feature elevated dropout rates and multiple chronic conditions. How Taiwanese multimorbid patterns relate to different cognitive domains remains unclear. This study aims to identify sex-specific multimorbid patterns and associate them with cognitive performance while modeling the risk for dropout.

Research Design and Methods

A prospective cohort study (2011-19) in Taiwan recruited 449 Taiwanese older adults without dementia. Global and domain-specific cognition were assessed biennially. We used exploratory factor analysis to identify baseline sex-specific multimorbid patterns of 19 self-reported chronic conditions. We utilized a joint model incorporating longitudinal and time-to-dropout data to examine the association between multimorbid patterns and cognitive performance accounting for the informative dropout via the shared random effect.

Results

At the end of the study, 324 participants (72.1%) remained in the cohort, with an average annual attrition rate of 5.5%. We found that advanced age, low levels of physical activities, and poor cognition at baseline were associated with increased dropout risks. Besides, 6 multimorbid patterns were identified, labeled Mental, Renal-vascular, and Cancer-urinary patterns in men, and Mental, Cardiometabolic, and Cancer-endocrine patterns in women. For men, as the follow-up time increased, the Mental pattern was associated with poor global cognition and attention; the Renal-vascular pattern was associated with poor executive function. For women, the Mental pattern was associated with poor memory; as follow-up time increased, and Cardiometabolic patterns were related to poor memory.

Discussion and Implications

Sex-specific multimorbid patterns identified in the Taiwanese older population showed differences (notably Renal-vascular pattern in men) from patterns found in Western countries and were differentially associated with cognitive impairment over time. When informative dropout is suspected, appropriate statistical methods should be applied.

Hypertension, a dementia polygenic risk score, APOE genotype, and incident dementia

INTRODUCTION

There is inconsistent evidence on whether genetic risk for dementia modifies the association between hypertension and dementia.

METHODS

In 198,965 dementia-free participants aged ≥60 years, Cox proportional-hazards models were used to investigate the association between hypertension and incident dementia. A polygenic risk score (PRS) based on 38 non-apolipoprotein E (APOE) single nucleotide polymorphisms and APOE ε4 status were used to determine genetic risk for dementia.

RESULTS

Over 15 years follow-up, 6270 participants developed dementia. Hypertension was associated with a 19% increased risk of dementia (hazard ratio = 1.19, 95% confidence interval 1.11-1.27). The associations remained similar when stratifying by genetic risk, with no evidence for multiplicative interaction by dementia PRS (P = 0.20) or APOE ε4 status (P = 0.16). However, the risk difference between those with and without hypertension was larger among those at higher genetic risk.

DISCUSSION

Hypertension was associated with an increased risk of dementia regardless of genetic risk for dementia.

Care Need Combinations for Dementia Patients with Multiple Chronic Diseases

Purpose

The purpose of this study was to find care need combinations for dementia patients with multiple chronic diseases and their caregivers.

Patients and Methods

A cross-sectional study was conducted with 83 patients who had multiple chronic diseases. Variables from patients included age, gender, severity of clinical dementia rating, feeding, hypnotics, mobility, getting lost, mood symptoms, and behavioral and psychological symptoms. Moreover, 26 types of care needs were included in this study. The Apriori algorithm was employed to first identify care need combinations and then to find the relationships between care needs and variables from dementia patients with multiple chronic diseases.

Results

Six rules were generated for care need combinations. Four care needs could be formed as a basic care need bundle. Moreover, two additional care needs could be added to provide a wider coverage for patients. In the second stage, 93 rules were found and categorized into three groups, including 2, 6, and 28 general rules with support of 30% but less than 40%, 20% but less than 30%, and 10% but less than 20%, respectively. When the support value is 10% but less than 20%, more variables from patients were found in rules which help the dementia collaborative care team members provide tailor-made care need bundles.

Conclusion

Four basic care needs were social resources referral and legal support (Care (1)), drug knowledge education (Care (3)), memory problem care (Care (5)), and fall prevention (Care (8)). Besides, disease knowledge education (Care (2)) and hypertension care (Care (16)) were frequent unmet needs in this specific population. Moreover, care for the mood of the caregiver (Care (11)) should be considered especially in dementia patients with preserved ambulatory function or with symptoms of hallucination. The collaborative care team should pay more attention to those care needs when assessing this specific population.

Association of Anemia with Cognitive Function and Dementia Among Older Adults: The Role of Inflammation

BACKGROUND

The association of anemia with cognitive function and dementia remains unclear.

OBJECTIVE

We aimed to investigate the association of anemia with cognitive function and dementia risk and to explore the role of inflammation in these associations.

METHODS

Within the UK Biobank, 207,203 dementia-free participants aged 60+ were followed for up to 16 years. Hemoglobin (HGB) and C-creative protein (CRP) were measured from blood samples taken at baseline. Anemia was defined as HGB <13 g/dL for males and <12 g/dL for females. Inflammation was categorized as low or high according to the median CRP level (1.50 mg/L). A subset of 18,211 participants underwent cognitive assessments (including global and domain-specific cognitive). Data were analyzed using linear mixed-effects model, Cox regression, and Laplace regression.

RESULTS

Anemia was associated with faster declines in global cognition (β= -0.08, 95% confidence interval [CI]: -0.14, -0.01) and processing speed (β= -0.10, 95% CI: -0.19, -0.01). During the follow-up of 9.76 years (interquartile range 7.55 to 11.39), 6,272 developed dementia. The hazard ratio of dementia was 1.57 (95% CI: 1.38, 1.78) for people with anemia, and anemia accelerated dementia onset by 1.53 (95% CI: 1.08, 1.97) years. The risk of dementia tended to be higher in people with both anemia and high CRP (1.89, 95% CI: 1.60, 2.22). There was a statistically significant interaction between anemia and CRP on dementia risk (p-interaction = 0.032).

CONCLUSIONS

Anemia is associated with cognitive decline (specifically for processing speed) and increased risk of dementia, especially in people with high inflammation.

Social Health and Cognitive Change in Old Age: Role of Brain Reserve

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.

Association between multimorbidity status and incident dementia: a prospective cohort study of 245,483 participants

Multimorbidity (the presence of two or more long-term conditions [LTCs]) was suggested to exacerbate the neuronal injuries. The impact of multimorbidity on dementia has not been fully elucidated. We aimed to investigate the association between multimorbidity and dementia risk. We used the prospective data from 245,483 UK Biobank participants during a 9-year follow-up. Multimorbidity status was evaluated based on the LTC counts and multimorbidity patterns. Cox regression models adjusted for potential confounders were used to examine the associations of multimorbidity status with all-cause dementia (ACD), Alzheimer's disease (AD) and vascular dementia (VD). Participants with multimorbidity at baseline had higher risks of ACD and VD, and the risks were elevated with the increase of LTC counts (ACD: hazard ratios [HR] = 1.15, 95% confidence intervals [CI] = 1.01-1.31 with 2 LTCs; HR = 1.18, CI = 1.01-1.39 with 3 LTCs; HR = 1.65, CI = 1.44-1.88 with ≥4 LTCs; VD: HR = 1. 66, CI = 1.24-2.21 with 2 LTCs; HR = 2.10, CI = 1.53-2.88 with 3 LTCs; HR = 3.17, CI = 2.43-4.13 with ≥4 LTCs). Participants with ≥4 LTCs also had a higher risk of AD (HR = 1.34, CI = 1.08-1.66]. Participants with the cardio-cerebrovascular/respiratory/metabolic/musculoskeletal/depressive multimorbidity were 1.46, 1.28, and 2.50 times more likely to develop ACD (HR = 1.46, 95% CI = 1.28-1.67), AD (HR = 1.28, CI = 1.04-1.58), and VD (HR = 2.50, CI = 1.90-3.27), respectively. Those with tumor/genitourinary/digestive disorders had a 11% higher hazard of ACD (HR = 1.11, CI = 1.00-1.24) and a 73% elevated risk of VD (HR = 1.73, CI = 1.37-2.18). The prevention of LTC accumulation and the identification of specific multimorbidity patterns might be beneficial to the prevention of dementia and its subtypes, AD as well as VD.

Association of Psychological distress and Physical Health with Subjective and Objective Memory in Older Adults

ObjectivesTo investigate how indicators of psychological stress and physical health differentially influence subjective and objective memory in older adults. Methods: 404 adults aged ≥55 without cognitive impairment participated in remote assessment of physical health (PHY; multimorbidity, body-mass-index), psychological distress (PDS; perceived stress, anxiety, depression), subjective memory complaints (SM), and task-based objective memory performance (OM). Results: Separately, both PHY and PDS significantly predicted SM (p < 0.01), but only PHY was associated with OM (p = 0.05). Combined models showed that PHY and PDS maintained significant association with SM (p < 0.01, R² = 0.30), while only PHY was associated with OM (p = .07, R² = 0.03; for associative OM, p = 0.04). Discussion: SM is associated with participants' psychological profile, highlighting the importance of addressing these factors when assessing SM. The results also reveal that remotely-administered OM tasks are more immune to participants' psychological profile, and support previously-established links between physical health and objective and subjective memory function.

Multimorbidity burden and developmental trajectory in relation to later‐life dementia: A prospective study

INTRODUCTION

This study assessed the associations of multimorbidity burden and its developmental trajectory with later-life dementia.

METHODS

Among 5923 Health and Retirement Study participants, major chronic conditions including hypertension, diabetes mellitus, cancer, lung diseases, heart disease, stroke, psychological disorders, and arthritis were self- or proxy-reported in 1994-2008. Dementia diagnosis was self- or proxy-reported in 2008-2018. We used Cox regression to assess the associations of multimorbidity with incident dementia.

RESULTS

During follow-up (median = 8 years), 701 participants developed dementia. Each additional chronic condition in 2008 was related to 15% (confidence interval: 9% to 22%) higher hazard of dementia. Multimorbidity trajectories in 1994-2008 were classified as "rapid growth", "steady growth", "slow growth", and "no new condition" by the group-based trajectory modelling methods. Compared to "no new condition", the "rapid growth" trajectory was related to 32% (3% to 69%) higher dementia risk.

CONCLUSIONS

Both multimorbidity burden and its developmental trajectory were prospectively associated with risk of dementia.

Dementia and Related Comorbidities in the Population Aged 90 and Over in the Vitality 90+ Study, Finland: Patterns and Trends From 2001 to 2018

OBJECTIVES

To examine trends in the prevalence of dementia and related comorbidities among the oldest old.

METHODS

Six repeated cross-sectional surveys were conducted between 2001 and 2018, each including all inhabitants aged over 90 in Tampere, Finland (n = 5386). Co-occurring conditions and their time trends among participants with dementia were examined using logistic regression and generalized estimating equations.

RESULTS

The prevalence of dementia decreased from 47% in 2007 to 41% in 2018. Throughout the study period, depression was more common among people with dementia compared to those without. The prevalence of hypertension, diabetes, and osteoarthritis increased and the prevalence of depression decreased among people with dementia. The mean number of comorbidities increased from 2.0 in 2001 to 2.3 in 2018.

DISCUSSION

Dementia remains highly prevalent among the oldest old and it is accompanied by an increasing burden of comorbidities, posing a challenge to people with dementia, their caregivers, and care systems.

Emotion Recognition in a Health Continuum: Comparison of Healthy Adults of Advancing Age, Community Dwelling Adults Bearing Vascular Risk Factors and People Diagnosed with Mild Cognitive Impairment

The identification of basic emotions plays an important role in social relationships and behaviors linked to survival. In neurodegenerative conditions such as Alzheimer's disease (AD), the ability to recognize emotions may already be impaired at early stages of the disease, such as the stage of Mild Cognitive Impairment (MCI). However, as regards vascular pathologies related to cognitive impairment, very little is known about emotion recognition in people bearing vascular risk factors (VRF). Therefore, the aim of the present study was to examine emotion recognition ability in the health continuum "healthy advancing age-advancing age with VRF-MCI". The sample consisted of 106 adults divided in three diagnostic groups; 43 adults with MCI, 41 adults bearing one or more VRF, and 22 healthy controls of advancing age (HC). Since HC were more educated and younger than the other two groups, the age-group and level of educational were taken into account in the statistical analyses. A dynamic visual test was administered to examine recognition of basic emotions and emotionally neutral conditions. The results showed only a significant diagnostic group x educational level interaction as regards total emotion recognition ability, F (4, 28.910) = 4.117 p = 0.004 η² = 0.166. High educational level seems to contribute to a high-level-emotion-recognition-performance both in healthy adults of advancing age and in adults bearing vascular risk factors. Medium educational level appears to play the same role only in healthy adults. Neither educational level can help MCI people to enhance their significantly lower emotion recognition ability.

Association of resting heart rate with cognitive decline and dementia in older adults: A population-based cohort study

INTRODUCTION

Resting heart rate (RHR) predicts future risk for cardiovascular disease (CVD). However, longitudinal studies investigating the relationship of RHR with cognitive decline are scarce.

METHODS

This population-based cohort study included 2147 participants (age≥60) in SNAC-K who were free of dementia and regularly followed from 2001-2004 to 2013-2016. RHR was assessed with electrocardiogram. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders 4th Revision criteria. Global cognitive function was assessed using Mini-Mental State Examination (MMSE). Data were analyzed using Cox and linear mixed-effects models.

RESULTS

RHR≥80 (vs. 60-69) bpm was associated with a multi-adjusted hazard ratio of 1.55 (95% confidence interval 1.06-2.27) for dementia. The association remained significant after excluding participants with prevalent and incident CVDs. Similarly, RHR≥80 bpm was associated with a multi-adjusted β-coefficient of -0.13 (-0.21 to -0.04) for MMSE score.

DISCUSSION

Higher RHR is associated with increased risk for dementia and faster cognitive decline independent of CVDs in a general population of elderly people.