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Dolatshahi Y, Mayhew A, O'Connell ME, Liu-Ambrose T, Taler V, Smith EE, Hogan DB, Kirkland S, Costa AP, Wolfson C, Raina P, Griffith L, Jones A. Prevalence and population attributable fractions of potentially modifiable risk factors for dementia in Canada: A cross-sectional analysis of the Canadian Longitudinal Study on Aging. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00920-7. [PMID: 39048849 DOI: 10.17269/s41997-024-00920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES We investigated the prevalence and population attributable fraction (PAF) of 12 potentially modifiable risk factors for dementia in middle-aged and older Canadians. METHODS We conducted a cross-sectional study of 30,097 adults aged 45 to 85 with baseline data from the Canadian Longitudinal Study on Aging (2011‒2015). Risk factors and associated relative risks were taken from a highly cited systematic review. We calculated the prevalence of each risk factor using sampling weights. Individual PAFs were calculated both crudely and weighted for communality, and combined PAFs were calculated using both multiplicative and additive assumptions. Analyses were stratified by household income and repeated at CLSA's first follow-up (2015‒2018). RESULTS The most prevalent risk factors were physical inactivity (63.8%; 95% CI, 62.8-64.9), hypertension (32.8%; 31.7-33.8), and obesity (30.8%; 29.7-31.8). The highest crude PAFs were physical inactivity (19.9%), traumatic brain injury (16.7%), and hypertension (16.6%). The highest weighted PAFs were physical inactivity (11.6%), depression (7.7%), and hypertension (6.0%). We estimated that the 12 risk factors combined accounted for 43.4% (37.3‒49.0) of dementia cases assuming weighted multiplicative interactions and 60.9% (55.7‒65.5) assuming additive interactions. There was a clear gradient of increasing prevalence and PAF with decreasing income for 9 of the 12 risk factors. CONCLUSION The findings of this study can inform individual- and population-level dementia prevention strategies in Canada. Differences in the impact of individual risk factors between this study and other international and regional studies highlight the importance of tailoring national dementia strategies to the local distribution of risk factors.
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Affiliation(s)
- Yasaman Dolatshahi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexandra Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, Hamilton, ON, Canada
| | - Megan E O'Connell
- Department of Psychology & Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging, SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - David B Hogan
- Division of Geriatric Medicine and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology and Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, Hamilton, ON, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health & Department of Medicine, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, Hamilton, ON, Canada
| | - Lauren Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, Hamilton, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- McMaster Institute for Research on Aging, Hamilton, ON, Canada.
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Hedges DW, Chase M, Farrer TJ, Gale SD. Psychiatric Disease as a Potential Risk Factor for Dementia: A Narrative Review. Brain Sci 2024; 14:722. [PMID: 39061462 PMCID: PMC11274614 DOI: 10.3390/brainsci14070722] [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: 06/24/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Neurodegenerative disease is a major global health problem with 150 million people predicted to have dementia by 2050. Genetic factors, environmental factors, demographics, and some diseases have been associated with dementia. In addition to associations between diseases such as hypertension and cerebrovascular disease and dementia, emerging findings associate some psychiatric disorders with incident dementia. Because of the high and increasing global prevalence of dementia and the high worldwide prevalence of psychiatric disorders, the primary objective of this narrative review was to evaluate published findings that evaluate the association between bipolar disorder, depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, schizophrenia and other psychosis syndromes, and personality disorders and personality traits and incident dementia. Here, we highlight findings indicating possible associations between these psychiatric disorders and subsequent dementia and suggest that some psychiatric disorders may be risk factors for incident dementia. Further research, including more large longitudinal studies and additional meta-analyses, however, is needed to better characterize the associations between psychiatric disorders and incident dementia, to identify possible mechanisms for these putative associations, and to identify risk factors within psychiatric disorders that predispose some people with a psychiatric disorder but not others to subsequent dementia. Additional important questions concern how the treatment of psychiatric disorders might affect the risk of incident dementia.
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Affiliation(s)
- Dawson W. Hedges
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA;
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
| | - Morgan Chase
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
| | - Thomas J. Farrer
- Idaho WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA;
| | - Shawn D. Gale
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA;
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA;
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3
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Contador I, Buch-Vicente B, del Ser T, Llamas-Velasco S, Villarejo-Galende A, Benito-León J, Bermejo-Pareja F. Charting Alzheimer's Disease and Dementia: Epidemiological Insights, Risk Factors and Prevention Pathways. J Clin Med 2024; 13:4100. [PMID: 39064140 PMCID: PMC11278014 DOI: 10.3390/jcm13144100] [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: 05/23/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Alzheimer's disease (AD), the most common cause of dementia, is a complex and multifactorial condition without cure at present. The latest treatments, based on anti-amyloid monoclonal antibodies, have only a modest effect in reducing the progression of cognitive decline in AD, whereas the possibility of preventing AD has become a crucial area of research. In fact, recent studies have observed a decrease in dementia incidence in developed regions such as the US and Europe. However, these trends have not been mirrored in non-Western countries (Japan or China), and the contributing factors of this reduction remain unclear. The Lancet Commission has delineated a constrained classification of 12 risk factors across different life stages. Nevertheless, the scientific literature has pointed to over 200 factors-including sociodemographic, medical, psychological, and sociocultural conditions-related to the development of dementia/AD. This narrative review aims to synthesize the risk/protective factors of dementia/AD. Essentially, we found that risk/protective factors vary between individuals and populations, complicating the creation of a unified prevention strategy. Moreover, dementia/AD explanatory mechanisms involve a diverse array of genetic and environmental factors that interact from the early stages of life. In the future, studies across different population-based cohorts are essential to validate risk/protective factors of dementia. This evidence would help develop public health policies to decrease the incidence of dementia.
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Affiliation(s)
- Israel Contador
- Department of Basic Psychology, Psychobiology, and Methodology of Behavioral Sciences, Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 17117 Stockholm, Sweden
| | - Bárbara Buch-Vicente
- Department of Basic Psychology, Psychobiology, and Methodology of Behavioral Sciences, Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain
| | - Teodoro del Ser
- Alzheimer Centre Reina Sofia—CIEN Foundation, Institute of Health Carlos III, 28031 Madrid, Spain;
| | - Sara Llamas-Velasco
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.L.-V.); (A.V.-G.); (J.B.-L.)
- Department of Neurology, University Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Alberto Villarejo-Galende
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.L.-V.); (A.V.-G.); (J.B.-L.)
- Department of Neurology, University Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Julián Benito-León
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain; (S.L.-V.); (A.V.-G.); (J.B.-L.)
- Department of Neurology, University Hospital 12 de Octubre, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University, 28040 Madrid, Spain
| | - Félix Bermejo-Pareja
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University, 28040 Madrid, Spain
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Zülke AE, Pabst A, Luppa M, Oey A, Weise S, Fankhänel T, Kosilek RP, Schillok H, Brettschneider C, Czock D, Wiese B, Thyrian JR, Hoffmann W, Frese T, Gensichen J, König HH, Kaduszkiewicz H, Riedel-Heller SG. Effects of a multidomain intervention against cognitive decline on dementia risk profiles - Results from the AgeWell.de trial. Alzheimers Dement 2024. [PMID: 38967275 DOI: 10.1002/alz.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/10/2024] [Accepted: 05/29/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Dementia risk scores constitute promising surrogate outcomes for lifestyle interventions targeting cognitive function. We investigated whether dementia risk, assessed using the LIfestyle for BRAin health (LIBRA) index, was reduced by the AgeWell.de intervention. METHODS Secondary analyses of the AgeWell trial, testing a multicomponent intervention (including optimization of nutrition, medication, and physical, social, and cognitive activity) in older adults with increased dementia risk. We analyzed data from n = 461 participants with complete information on risk/protective factors comprised by LIBRA at the 24-month follow-up. Intervention effects on LIBRA and LIBRA components were assessed using generalized linear models. RESULTS The intervention reduced LIBRA scores, indicating decreased dementia risk at follow-up (b = -0.63, 95% confidence interval [CI]: -1.14, -0.12). Intervention effects were particularly due to improvements in diet (odds ratio [OR]: 1.60, 95% CI: 1.16, 2.22) and hypertension (OR: 1.61, 95% CI: 1.19, 2.18). DISCUSSION The AgeWell.de intervention reduced dementia risk. However, several risk factors did not improve, possibly requiring more intensive interventions. HIGHLIGHTS The AgeWell.de intervention reduced dementia risk according to LIfestyle for BRAin health (LIBRA) scores. Beneficial effects on LIBRA are mainly due to changes in diet and blood pressure. A pragmatic lifestyle intervention is apt to reduce dementia risk in an at-risk population.
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Affiliation(s)
- Andrea E Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Anke Oey
- State Health Department of Lower Saxony, Hannover, Germany
| | - Solveig Weise
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Fankhänel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Robert P Kosilek
- Institute of General Practice and Family Medicine, University Hospital LMU Munich, Munich, Germany
| | - Hannah Schillok
- Institute of General Practice and Family Medicine, University Hospital LMU Munich, Munich, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Service Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Birgitt Wiese
- MHH Information Technology-Science & Laboratory, Hannover Medical School, Hannover, Germany
| | - Jochen René Thyrian
- German Centre for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- Faculty V: School of Life Sciences, University of Siegen, Siegen, Germany
| | - Wolfgang Hoffmann
- German Centre for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital LMU Munich, Munich, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Service Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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Hillari L, Frank P, Cadar D. Systemic inflammation, lifestyle behaviours and dementia: A 10-year follow-up investigation. Brain Behav Immun Health 2024; 38:100776. [PMID: 38706574 PMCID: PMC11068506 DOI: 10.1016/j.bbih.2024.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/17/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives Lifestyle behaviours have been linked to dementia incidence, but their cumulative impact on dementia and the underlying mechanisms remain poorly understood. This study investigated the association of co-occurring lifestyle behaviours with dementia incidence and the mediating role of systemic inflammation in this association. Methods The sample comprised 3131 participants (55.2% female) from the English Longitudinal Study of Ageing aged 52-92 years at baseline (2008/09). Self-reported baseline lifestyle behaviours (alcohol intake, fruit and vegetable consumption, smoking, physical activity, sleep duration, social engagement, and cognitive activity) were summed to derive an index of lifestyle behaviours, ranging from 0 to 7, with higher scores denoting a higher number of health-risk behaviours. Incident dementia cases (n = 130, 4.2%) were identified through doctor-diagnosed dementia, informant interviews, and health records between 2014/15 and 2018/19. Systemic inflammation was measured through fasting plasma concentrations of C-reactive protein in 2012/13. Results Binary logistic regression models indicated that the odds of subsequent dementia increased by 1.19 for each additional health-risk behaviour (95% confidence intervals: 1.04, 1.37, p = 0.014) after adjusting for age, sex, ethnicity, wealth, education, marital status, body mass index, coronary heart disease, hypertension, stroke, and depression. However, this association was not mediated by C-reactive protein. Conclusions Co-occurring health-risk behaviours were associated with higher dementia incidence up to 10 years later, underscoring the importance of modifying health-risk behaviours for the prevention of dementia. Systemic inflammation did not explain the association between behaviours and dementia.
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Affiliation(s)
- Leah Hillari
- Behavioural Science and Health, University College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Philipp Frank
- Behavioural Science and Health, University College London, London, UK
- UCL Brain Sciences, University College London, London, UK
| | - Dorina Cadar
- Behavioural Science and Health, University College London, London, UK
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
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6
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Deckers K, Zwan MD, Soons LM, Waterink L, Beers S, van Houdt S, Stiensma B, Kwant JZ, Wimmers SCPM, Heutz RAM, Claassen JAHR, Oosterman JM, de Heus RAA, van de Rest O, Vermeiren Y, Voshaar RCO, Smidt N, Broersen LM, Sikkes SAM, Aarts E, Köhler S, van der Flier WM. A multidomain lifestyle intervention to maintain optimal cognitive functioning in Dutch older adults-study design and baseline characteristics of the FINGER-NL randomized controlled trial. Alzheimers Res Ther 2024; 16:126. [PMID: 38872204 PMCID: PMC11170777 DOI: 10.1186/s13195-024-01495-8] [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: 05/02/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Evidence on the effectiveness of multidomain lifestyle interventions to prevent cognitive decline in older people without dementia is mixed. Embedded in the World-Wide FINGERS initiative, FINGER-NL aims to investigate the effectiveness of a 2-year multidomain lifestyle intervention on cognitive functioning in older Dutch at risk individuals. METHODS Multi-center, randomized, controlled, multidomain lifestyle intervention trial with a duration of 24 months. 1210 adults between 60-79 years old with presence of ≥ 2 modifiable risk factors and ≥ 1 non-modifiable risk factor for cognitive decline were recruited between January 2022 and May 2023 via the Dutch Brain Research Registry and across five study sites in the Netherlands. Participants were randomized to either a high-intensity or a low-intensity intervention group. The multidomain intervention comprises a combination of 7 lifestyle components (physical activity, cognitive training, cardiovascular risk factor management, nutritional counseling, sleep counseling, stress management, and social activities) and 1 nutritional product (Souvenaid®) that could help maintain cognitive functioning. The high-intensity intervention group receives a personalized, supervised and hybrid intervention consisting of group meetings (on-site and online) and individual sessions guided by a trained lifestyle coach, and access to a digital intervention platform that provides custom-made training materials and selected lifestyle apps. The low-intensity intervention group receives bi-monthly online lifestyle-related health advice via the digital intervention platform. Primary outcome is 2-year change on a cognitive composite score covering processing speed, executive function, and memory. RESULTS Within 17 months, participant recruitment has been successfully completed (N = 1210; mean age: 67.7 years (SD: 4.6); 64% female). Modifiable risk factors commonly present at baseline were physical inactivity (89%), low mental/cognitive activity (50%), low social engagement (39%), hypertension (39%) and high alcohol consumption (39%). The mean body mass index of participants was 28.3 (SD: 4.2) and the total serum cholesterol was 5.4 mmol/L (SD: 1.2). CONCLUSIONS Baseline lifestyle and clinical measurements showed successful recruitment of participants with sufficient potential for prevention. Results of FINGER-NL will provide further insight into the efficacy of a multidomain lifestyle intervention to prevent cognitive decline in older adults. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT05256199)/2022-01-11.
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Affiliation(s)
- Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Lion M Soons
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Lisa Waterink
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Sonja Beers
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Sofie van Houdt
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Berrit Stiensma
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judy Z Kwant
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophie C P M Wimmers
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Rachel A M Heutz
- Department of Geriatrics, Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Cardiovascular Sciences, Leicester University, Leicester, UK
| | - Joukje M Oosterman
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Rianne A A de Heus
- Department of Geriatrics, Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Yannick Vermeiren
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sietske A M Sikkes
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Esther Aarts
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Epidemiology & Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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7
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Truin LS, Köhler S, Heger IS, van Boxtel MP, Schram MT, Backes WH, Jansen JF, van Dongen MM, de Vries NK, de Vries H, Eussen SJ, Stehouwer CD, de Vugt ME, Deckers K. Associations of an individual's need for cognition with structural brain damage and cognitive functioning/impairment: cross-sectional population-based study. Br J Psychiatry 2024; 224:189-197. [PMID: 38105553 PMCID: PMC7615981 DOI: 10.1192/bjp.2023.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND High cognitive activity possibly reduces the risk of cognitive decline and dementia. AIMS To investigate associations between an individual's need to engage in cognitively stimulating activities (need for cognition, NFC) and structural brain damage and cognitive functioning in the Dutch general population with and without existing cognitive impairment. METHOD Cross-sectional data were used from the population-based cohort of the Maastricht Study. NFC was measured using the Need For Cognition Scale. Cognitive functioning was tested in three domains: verbal memory, information processing speed, and executive functioning and attention. Values 1.5 s.d. below the mean were defined as cognitive impairment. Standardised volumes of white matter hyperintensities (WMH), cerebrospinal fluid (CSF) and presence of cerebral small vessel disease (CSVD) were derived from 3T magnetic resonance imaging. Multiple linear and binary logistic regression analyses were used adjusted for demographic, somatic and lifestyle factors. RESULTS Participants (n = 4209; mean age 59.06 years, s.d. = 8.58; 50.1% women) with higher NFC scores had higher overall cognition scores (B = 0.21, 95% CI 0.17-0.26, P < 0.001) and lower odds for CSVD (OR = 0.74, 95% CI 0.60-0.91, P = 0.005) and cognitive impairment (OR = 0.60, 95% CI 0.48-0.76, P < 0.001) after adjustment for demographic, somatic and lifestyle factors. The association between NFC score and cognitive functioning was similar for individuals with and without prevalent cognitive impairment. We found no significant association between NFC and WMH or CSF volumes. CONCLUSIONS A high need to engage in cognitively stimulating activities is associated with better cognitive functioning and less presence of CSVD and cognitive impairment. This suggests that, in middle-aged individuals, motivation to engage in cognitively stimulating activities may be an opportunity to improve brain health.
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Affiliation(s)
- Lotte S. Truin
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Sebastian Köhler
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Irene S. Heger
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Martin P.J. van Boxtel
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Miranda T. Schram
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Internal Medicine, Maastricht University Medical Center
- Maastricht Heart and Vascular Center, Maastricht University Medical Center
| | - Walter H. Backes
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center
| | - Jacobus F.A. Jansen
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
| | | | - Nanne K. de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Hein de Vries
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Simone J.P.M. Eussen
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Coen D.A. Stehouwer
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Marjolein E. de Vugt
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | - Kay Deckers
- School for Mental Health & Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University
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8
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Neuffer J, Wagner M, Moreno E, Le Grand Q, Mishra A, Trégouët D, Leffondre K, Proust‐Lima C, Foubert‐Samier A, Berr C, Tzourio C, Helmer C, Debette S, Samieri C. Association of LIfestyle for BRAin health risk score (LIBRA) and genetic susceptibility with incident dementia and cognitive decline. Alzheimers Dement 2024; 20:4250-4259. [PMID: 38775256 PMCID: PMC11180843 DOI: 10.1002/alz.13801] [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: 10/12/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Evaluating whether genetic susceptibility modifies the impact of lifestyle-related factors on dementia is critical for prevention. METHODS We studied 5170 participants from a French cohort of older persons free of dementia at baseline and followed for up to 17 years. The LIfestyle for BRAin health risk score (LIBRA) including 12 modifiable factors was constructed at baseline (higher score indicating greater risk) and was related to both subsequent cognitive decline and dementia incidence, according to genetic susceptibility to dementia (reflected by the apolipoprotein E [APOE] ε4 allele and a genetic risk score [GRS]). RESULTS The LIBRA was associated with higher dementia incidence, with no significant effect modification by genetics (hazard ratio for one point score = 1.09 [95% confidence interval, 1.05; 1.13]) in APOE ε4 non-carriers and = 1.15 [1.08; 1.22] in carriers; P = 0.15 for interaction). Similar findings were obtained with the GRS and with cognitive decline. DISCUSSION Lifestyle-based prevention may be effective whatever the genetic susceptibility to dementia.
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Affiliation(s)
- Jeanne Neuffer
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
| | - Maude Wagner
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
- Rush Alzheimer's Disease Center, Rush University Medical CenterChicagoIllinoisUSA
| | - Elisa Moreno
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
| | - Quentin Le Grand
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
| | - Aniket Mishra
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
| | | | - Karen Leffondre
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
- Clinical and Epidemiological Research UnitINSERM CIC1401BordeauxFrance
| | - Cécile Proust‐Lima
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
| | | | - Claudine Berr
- University of Montpellier, INSERM, Institute for Neurosciences of Montpellier (INM)MontpellierFrance
| | - Christophe Tzourio
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
| | - Catherine Helmer
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
- Clinical and Epidemiological Research UnitINSERM CIC1401BordeauxFrance
| | - Stéphanie Debette
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
| | - Cécilia Samieri
- Bordeaux Population Health Research Center, INSERMUniversity of BordeauxBordeauxFrance
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9
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Van Asbroeck S, Köhler S, van Boxtel MPJ, Lipnicki DM, Crawford JD, Castro‐Costa E, Lima‐Costa MF, Blay SL, Shifu X, Wang T, Yue L, Lipton RB, Katz MJ, Derby CA, Guerchet M, Preux P, Mbelesso P, Norton J, Ritchie K, Skoog I, Najar J, Sterner TR, Scarmeas N, Yannakoulia M, Dardiotis T, Rolandi E, Davin A, Rossi M, Gureje O, Ojagbemi A, Bello T, Kim KW, Han JW, Oh DJ, Trompet S, Gussekloo J, Riedel‐Heller SG, Röhr S, Pabst A, Shahar S, Rivan NFM, Singh DKA, Jacobsen E, Ganguli M, Hughes T, Haan M, Aiello AE, Ding D, Zhao Q, Xiao Z, Narazaki K, Chen T, Chen S, Ng TP, Gwee X, Gao Q, Brodaty H, Trollor J, Kochan N, Lobo A, Santabárbara J, Gracia‐Garcia P, Sachdev PS, Deckers K. Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis. Alzheimers Dement 2024; 20:3972-3986. [PMID: 38676366 PMCID: PMC11180928 DOI: 10.1002/alz.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. RESULTS A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. HIGHLIGHTS A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.
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Grants
- AG03949 NIH HHS
- Netherlands Programme for Research on Aging (NESTOR)
- The Alzheimer's Association Zenith Award
- 2009BAI77B03 China Ministry of Science and Technology
- CRC2017ZD02 Clinical Research Center, Shanghai Mental Health Center
- 03/0815 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- R01 AG057531 NIA NIH HHS
- Greek National Resources
- DCP-2017-002/1 Universiti Kebangsaan Malaysia Grand Challenge
- 20H04030 JSPS KAKENHI
- Stiftelsen Professor Bror Gadelius' Minnesfond
- 01/0255 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- The Alzheimer's Association Stephanie B Overstreet Scholars
- AgeCap-Center for Aging and Health
- The Bank of Sweden Tercentenary Foundation
- European Social Fund
- HJSV2023023 Stiftelsens Hjalmar Svenssons forskningsfond
- 06/0617 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- Fondo de Investigación Sanitaria
- R37AG02365 NIH/NIA
- Instituto de Salud Carlos III
- Epilife
- 16/00896 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- B15_23R Gobierno de Aragón
- B15_17R Gobierno de Aragón
- G03/128 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- AG03949 NIH/NIA
- LRGS/BU/2012/UKM-UKM/K/01 Long-term Research Grant Scheme (LGRS) Ministry of Higher Education, Malaysia
- Limoges University Hospital Appel à Projet des Equipes Émergentes et Labellisées scheme (APREL)
- 189 10276/8/9/2011 Alzheimer's Association
- NMRC/1108/2007 National Medical Research Council
- 97/1321E Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- AG03949 NIA NIH HHS
- Swedish Brain Power
- FORTE
- 2012-Project Public Health Institute [Inserm]-PREUXPierre-Marie AXA Research Fund
- National Strategic Reference Framework (NSFR) - EU Program Excellence Grant (ARISTEIA)
- PI16/00896 Fondo Europeo de Desarrollo Regional (FEDER) of the European Union "Una manera de hacer Europa"
- Shanghai Brain Health Foundation
- JP17K09146 JSPS KAKENHI
- NMRC/CIRG/1409/2014 National Medical Research Council
- AF-967865 Alzheimersfonden
- R37AG02365 NIH HHS
- HJSV2022059 Stiftelsens Hjalmar Svenssons forskningsfond
- 98/0103 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- RF1AG057531 NIH HHS
- Riksbankens Jubileumsfond
- Handlanden Hjalmar Svenssons Forskningsfond
- Stiftelsen för Gamla Tjänarinnor
- P01 AG003949 NIA NIH HHS
- IIRG-09-133014 Alzheimer's Association
- LRGS/1/2019/UM-UKM/1/4 Long-term Research Grant Scheme (LGRS) Ministry of Higher Education, Malaysia
- Wellcome Trust
- Swedish Research Council
- Leonard and Sylvia Marx Foundation
- Maastricht University Medical Center
- 733050511 Netherlands Organisation for Health Research and Development (ZonMw)
- BMRC/08/1/21/19/567 Agency for Science Technology and Research (A*STAR) Biomedical Research Council
- Associazione Alzheimer Milano
- 2017-0557 Fondazione CARIPLO, FrailBioTrack Project
- DCP-2017-002/2 Universiti Kebangsaan Malaysia Grand Challenge
- PI/19/01874 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- 72660 ALF-agreement
- 12/02254 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- Ministry for Health and Social Solidarity (Greece)
- 94/1562 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- 01KS9504 Interdisciplinary Centre for Clinical Research University of Leipzig (Interdisziplinäres Zentrum für Klinische Forschung/IZKF)
- Czap Foundation
- ANR-09-MNPS-009-01 French National Research Agency
- Stiftelsen Söderström-Königska Sjukhemmet
- National Institute on Aging
- National Institutes of Health
- Wellcome Trust
- Gobierno de Aragón
- Alzheimer's Association
- National Medical Research Council
- French National Research Agency
- AXA Research Fund
- Riksbankens Jubileumsfond
- FORTE
- Swedish Brain Power
- Swedish Research Council
- Stiftelsen för Gamla Tjänarinnor
- Instituto de Salud Carlos III
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Affiliation(s)
- Stephanie Van Asbroeck
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Martin P. J. van Boxtel
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Darren M. Lipnicki
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | - John D. Crawford
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | | | | | - Sergio Luis Blay
- Department of PsychiatryFederal University of São PauloSão PauloBrazil
| | - Xiao Shifu
- Department of Geriatric PsychiatryShanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tao Wang
- Department of Geriatric PsychiatryShanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Psychiatry & Affective Disorders CenterRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Alzheimer's Disease and Related Disorders CenterShanghai Jiao Tong UniversityShanghaiChina
| | - Ling Yue
- Department of Geriatric PsychiatryShanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Richard B. Lipton
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Psychiatry and Behavioral MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Mindy J. Katz
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Carol A. Derby
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Maëlenn Guerchet
- Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT ‐ Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealthLimogesFrance
| | - Pierre‐Marie Preux
- Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT ‐ Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealthLimogesFrance
| | - Pascal Mbelesso
- Department of NeurologyAmitié HospitalBanguiCentral African Republic
| | - Joanna Norton
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, InsermMontpellierFrance
| | - Karen Ritchie
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, InsermMontpellierFrance
- Institut du Cerveau TrocadéroParisFrance
| | - Ingmar Skoog
- Department of Psychiatry and NeurochemistryNeuropsychiatric Epidemiology UnitInstitute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP), University of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry ClinicGothenburgSweden
| | - Jenna Najar
- Department of Psychiatry and NeurochemistryNeuropsychiatric Epidemiology UnitInstitute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP), University of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry ClinicGothenburgSweden
- Department of Clinical GeneticsSection Genomics of Neurodegenerative Diseases and Aging, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamThe Netherlands
| | - Therese Rydberg Sterner
- Department of Psychiatry and NeurochemistryNeuropsychiatric Epidemiology UnitInstitute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP), University of GothenburgGothenburgSweden
- Department of NeurobiologyAging Research CenterCare Sciences and Society, Karolinska Institute and Stockholm UniversityStockholmSweden
| | - Nikolaos Scarmeas
- 1st Department of NeurologyAiginition Hospital, Medical School, National and Kapodistrian University of AthensAthensGreece
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia UniversityNew YorkNew YorkUSA
| | - Mary Yannakoulia
- Department of Nutrition and DieteticsHarokopio UniversityAthensGreece
| | | | - Elena Rolandi
- Golgi Cenci FoundationMilanItaly
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | | | | | - Oye Gureje
- Department of PsychiatryWHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, University of IbadanIbadanNigeria
| | - Akin Ojagbemi
- Department of PsychiatryCollege of Medicine University of IbadanIbadanNigeria
| | - Toyin Bello
- Department of PsychiatryCollege of Medicine University of IbadanIbadanNigeria
| | - Ki Woong Kim
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamRepublic of Korea
- Department of PsychiatrySeoul National University College of MedicineSeoulRepublic of Korea
- Department of Brain and Cognitive SciencesSeoul National University College of Natural SciencesSeoulRepublic of Korea
| | - Ji Won Han
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamRepublic of Korea
- Department of PsychiatrySeoul National University College of MedicineSeoulRepublic of Korea
| | - Dae Jong Oh
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Stella Trompet
- Department of Internal Medicinesection of Gerontology and GeriatricsLeiden University Medical CenterLeidenthe Netherlands
| | - Jacobijn Gussekloo
- Department of Internal Medicinesection of Gerontology and GeriatricsLeiden University Medical CenterLeidenthe Netherlands
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
| | - Steffi G. Riedel‐Heller
- Institute of Social MedicineOccupational Health and Public HealthMedical FacultyUniversity of LeipzigLeipzigGermany
| | - Susanne Röhr
- Institute of Social MedicineOccupational Health and Public HealthMedical FacultyUniversity of LeipzigLeipzigGermany
- Health and Ageing Research Team (HART), School of Psychology, Massey UniversityPalmerston NorthAotearoa New Zealand
- Global Brain Health Institute (GBHI), Trinity College DublinDublinIreland
| | - Alexander Pabst
- Institute of Social MedicineOccupational Health and Public HealthMedical FacultyUniversity of LeipzigLeipzigGermany
| | - Suzana Shahar
- Center for Healthy Ageing & Wellness (H‐CARE)Faculty of Health SciencesUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Nurul Fatin Malek Rivan
- Center for Healthy Ageing & Wellness (H‐CARE)Faculty of Health SciencesUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Devinder Kaur Ajit Singh
- Center for Healthy Ageing & Wellness (H‐CARE)Faculty of Health SciencesUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Erin Jacobsen
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Mary Ganguli
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Departments of Neurology, and EpidemiologyUniversity of Pittsburgh School of Medicine and School of Public HealthPittsburghPennsylvaniaUSA
| | - Tiffany Hughes
- Department of Graduate Studies in Health and Rehabilitation SciencesBitonte College of Health and Human Services, Youngstown State UniversityYoungstownOhioUSA
| | - Mary Haan
- Department of Epidemiology and BiostatisticsSchool of Medicine, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Allison E. Aiello
- Columbia Aging Center and the Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew YorkNew YorkUSA
| | - Ding Ding
- Institute of NeurologyNational Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Qianhua Zhao
- Institute of NeurologyNational Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Zhenxu Xiao
- Institute of NeurologyNational Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Kenji Narazaki
- Center for Liberal Arts, Fukuoka Institute of TechnologyHigashi‐kuFukuokaJapan
| | - Tao Chen
- Department of Physical EducationSports and Health Research CenterTongji UniversityShanghaiChina
| | - Sanmei Chen
- Graduate School of Biomedical and Health Sciences, Hiroshima UniversityHiroshimaJapan
| | - Tze Pin Ng
- Department of Psychological MedicineGerontology Research Programme, Yong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Xinyi Gwee
- Department of Psychological MedicineGerontology Research Programme, Yong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Qi Gao
- Department of Psychological MedicineGerontology Research Programme, Yong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | - Julian Trollor
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
- Department of Developmental Disability NeuropsychiatryDiscipline of Psychiatry and Mental Health, University of New South WalesSydneyNew South WalesAustralia
| | - Nicole Kochan
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | - Antonio Lobo
- Department of Medicine and PsychiatryUniversidad de ZaragozaZaragozaSpain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón)ZaragozaSpain
- CIBERSAM, Instituto de Salud Carlos IIIMadridSpain
| | - Javier Santabárbara
- Instituto de Investigación Sanitaria Aragón (IIS Aragón)ZaragozaSpain
- CIBERSAM, Instituto de Salud Carlos IIIMadridSpain
- Department of Public HealthUniversidad de ZaragozaZaragozaSpain
| | - Patricia Gracia‐Garcia
- Department of Medicine and PsychiatryUniversidad de ZaragozaZaragozaSpain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón)ZaragozaSpain
- CIBERSAM, Instituto de Salud Carlos IIIMadridSpain
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
- Neuropsychiatric Institute, The Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Kay Deckers
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
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10
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Aguilar-Navarro SG, Yeverino-Castro SG, Mejía-Arango S, Moctezuma R, Juárez-Cedillo T, Mimenza-Alvarado AJ. Brain health index as a predictor of possible vascular dementia in the Mexican health and aging study 2012-2015. PLoS One 2024; 19:e0304234. [PMID: 38781152 PMCID: PMC11115212 DOI: 10.1371/journal.pone.0304234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
To determine the burden of disease among subjects at risk of developing stroke or dementia, brain health indexes (BHI) tend to rely on anatomical features. Recent definitions emphasize the need of a broader perspective that encompasses cardiovascular risk factors (CVRFS) and lifestyle components which can be considered partial contributors to optimal brain health. In this study, we aimed to establish the association and risk detected by a Brain Health Index and the risk of possible vascular dementia (PVD) using data from the Mexican Health and Aging Study (MHAS) 2012-2015. The MHAS is a longitudinal study of adults aged ≥ 50 years. We analyzed the data obtained between 2012 and 2015. CVRFS included in the index were diabetes mellitus, hypertension, myocardial infarction, depression, obesity, physical inactivity, and smoking history. A PVD diagnosis was established when scores in the Cross-Cultural Cognitive Examination were below reference norms and limitations in ≥1 instrumental activities of daily living and a history of stroke were present. A multinomial regression model was developed to determine the association between BHI scores and PVD. In 2015, 75 PVD cases were identified. Mean age was 67.1 ±13.2 years, 35.8% were female, and the mean educational level was 5.8 ±5.5 years. In cases with a higher score in the BHI, the model revealed a hazards ratio of 1.63 (95% CI: 1.63-1.64, p< 0.001) for PVD. In this longitudinal study, with the use of a feasible multifactorial BHI in the Mexican population, a greater score was associated with a 1.63-fold risk of developing PVD during the 3-year follow-up, while the risk for stroke was 1.75. This index could potentially be used to predict the risk of PVD in adults with modifiable CVRFS.
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Affiliation(s)
- Sara G. Aguilar-Navarro
- Deparment of Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Sara G. Yeverino-Castro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
- CHRISTUS Center of Excellence and Innovation, San Pedro Garza García, Nuevo León, México
| | - Silvia Mejía-Arango
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, México
| | - Rogelio Moctezuma
- Deparment of Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Teresa Juárez-Cedillo
- Epidemiologic and Health Service Research Unit, Aging Area, Mexican Institute of Social Security, National Medical Center Century XXI, Mexico City, Mexico
| | - Alberto José Mimenza-Alvarado
- Deparment of Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
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11
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DeJong NR, Jansen JFA, van Boxtel MPJ, Schram MT, Stehouwer CDA, van Greevenbroek MMJ, van der Kallen CJH, Koster A, Eussen SJPM, de Galan BE, Backes WH, Köhler S. Brain structure and connectivity mediate the association between lifestyle and cognition: The Maastricht Study. Brain Commun 2024; 6:fcae171. [PMID: 38846531 PMCID: PMC11154141 DOI: 10.1093/braincomms/fcae171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/12/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
Life-course exposure to risk and protective factors impacts brain macro- and micro-structure, which in turn affects cognition. The concept of brain-age gap assesses brain health by comparing an individual's neuroimaging-based predicted age with their calendar age. A higher BAG implies accelerated brain ageing and is expected to be associated with worse cognition. In this study, we comprehensively modelled mutual associations between brain health and lifestyle factors, brain age and cognition in a large, middle-aged population. For this study, cognitive test scores, lifestyle and 3T MRI data for n = 4881 participants [mean age (± SD) = 59.2 (±8.6), 50.1% male] were available from The Maastricht Study, a population-based cohort study with extensive phenotyping. Whole-brain volumes (grey matter, cerebrospinal fluid and white matter hyperintensity), cerebral microbleeds and structural white matter connectivity were calculated. Lifestyle factors were combined into an adapted LIfestyle for BRAin health weighted sum score, with higher score indicating greater dementia risk. Cognition was calculated by averaging z-scores across three cognitive domains (memory, information processing speed and executive function and attention). Brain-age gap was calculated by comparing calendar age to predictions from a neuroimaging-based multivariable regression model. Paths between LIfestyle for BRAin health tertiles, brain-age gap and cognitive function were tested using linear regression and structural equation modelling, adjusting for sociodemographic and clinical confounders. The results show that cerebrospinal fluid, grey matter, white matter hyperintensity and cerebral microbleeds best predicted brain-age gap (R 2 = 0.455, root mean squared error = 6.44). In regression analysis, higher LIfestyle for BRAin health scores (greater dementia risk) were associated with higher brain-age gap (standardized regression coefficient β = 0.126, P < 0.001) and worse cognition (β = -0.046, P = 0.013), while higher brain-age gap was associated with worse cognition (β=-0.163, P < 0.001). In mediation analysis, 24.7% of the total difference in cognition between the highest and lowest LIfestyle for BRAin health tertile was mediated by brain-age gap (β indirect = -0.049, P < 0.001; β total = -0.198, P < 0.001) and an additional 3.8% was mediated via connectivity (β indirect = -0.006, P < 0.001; β total = -0.150, P < 0.001). Findings suggest that associations between health- and lifestyle-based risk/protective factors (LIfestyle for BRAin health) and cognition can be partially explained by structural brain health markers (brain-age gap) and white matter connectivity markers. Lifestyle interventions targeted at high-risk individuals in mid-to-late life may be effective in promoting and preserving cognitive function in the general public.
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Affiliation(s)
- Nathan R DeJong
- Faculty of Health, Medicine and Life Sciences, School for Mental Health & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Alzheimer Centrum Limburg, Maastricht University Medical Center+, 6229 ET Maastricht, The Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Jacobus F A Jansen
- Faculty of Health, Medicine and Life Sciences, School for Mental Health & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Martin P J van Boxtel
- Faculty of Health, Medicine and Life Sciences, School for Mental Health & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
- Alzheimer Centrum Limburg, Maastricht University Medical Center+, 6229 ET Maastricht, The Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Miranda T Schram
- Faculty of Health, Medicine and Life Sciences, School for Mental Health & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- Maastricht Heart & Vascular Center, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Marleen M J van Greevenbroek
- Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Carla J H van der Kallen
- Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Annemarie Koster
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Simone J P M Eussen
- Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Bastiaan E de Galan
- Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Walter H Backes
- Faculty of Health, Medicine and Life Sciences, School for Mental Health & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Sebastian Köhler
- Faculty of Health, Medicine and Life Sciences, School for Mental Health & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Alzheimer Centrum Limburg, Maastricht University Medical Center+, 6229 ET Maastricht, The Netherlands
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12
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Güney S, Çiçek Doğan Ö, Bakır A, Öztürk A, Oldaç T. Dementia Risk Awareness, Health Behaviors and Motivation for Dementia Prevention in Middle-Aged and Older Adults in Türkiye. J Appl Gerontol 2024:7334648241251771. [PMID: 38741256 DOI: 10.1177/07334648241251771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
This study aimed to investigate factors influencing motivation for dementia preventive behaviors in a population aged 40 and over. We conducted a descriptive cross-sectional study between December 2022 and May 2023, involving 483 participants in an online survey. We collected data on dementia risk awareness, healthy lifestyle choices, and motivation for dementia risk reduction. The majority of respondents, comprising 41.6%, demonstrated a moderate level of risk awareness, with 50.5% believing that prevention is beyond anyone's control. Motivations for lifestyle change were significantly higher in women (p < .001) and `participants with university degree education (p < .05). Regression analysis identified gender (female), education level (higher education), and dementia risk awareness, emerged as significant predictors of motivation to change lifestyle (beta: .138, beta: .136, beta: .114, p < .001, respectively). This study underscores the importance of risk awareness in motivating dementia prevention, suggesting avenues for future research to explore specific determinants of motivation to reduce dementia risks.
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Affiliation(s)
- Seda Güney
- Faculty of Nursing, Koç University, Istanbul, Turkey
| | | | - Aylin Bakır
- Faculty of Nursing, Koç University, Istanbul, Turkey
| | - Ayça Öztürk
- Faculty of Nursing, Koç University, Istanbul, Turkey
| | - Tuğçe Oldaç
- Faculty of Nursing, Koç University, Istanbul, Turkey
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13
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Brooks K, Yoshimura H, Gonzalez-Izquierdo A, Zakkak N, Kukendra-Rajah K, Lip GYH, Providencia R. The association between atrial fibrillation and dementia: A UK linked electronic health records cohort study. Eur J Clin Invest 2024; 54:e14154. [PMID: 38217524 DOI: 10.1111/eci.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/27/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND We investigated the association between atrial fibrillation (AF) and dementia, and its subtypes (vascular-VaD, Alzheimer, mixed and rare dementia), and identified predictors for dementia in AF patients. METHODS The analysis was based on 183,610 patients with new-onset AF and 367,220 non-AF controls in the United Kingdom between 1998 and 2016, identified in three prospectively collected, linked electronic health records sources. Time-to-event (dementia or subtypes) analyses were performed using Cox proportional hazards and weighted Cox. Sub-analyses performed: including & censoring stroke and age (median used as cut-off). RESULTS Over a median follow-up of 2.67 years (IQR .65-6.02) for AF patients and 5.84 years for non-AF patients (IQR 2.26-11.80), incidence of dementia in the AF cohort was 2.65 per 100 person-years, compared to 2.02 in the non-AF cohort. After adjustment, a significant association was observed between AF and all-cause dementia (HR = 1.38, 95% CI: 1.31-1.45), driven by a strong association with VaD (HR = 1.55, 95% CI: 1.41-1.70). AF was also associated with mixed dementia (HR = 1.26, 95% CI: 1.01-1.56), but we could not confirm an association with Alzheimer (HR = 1.05, 95% CI: .94-1.16) and rare dementia forms (HR = 1.19, 95% CI: .90-1.56). Ischemic stroke (HR = 1.40, 95% CI: 1.26-1.56), subarachnoid haemorrhage (HR = 2.08, 95% CI: 1.47-2.96), intracerebral haemorrhage (HR = 1.95, 95% CI: 1.54-2.48) and diabetes (HR = 1.32, 95% CI: 1.24-1.41) were identified as the strongest predictors of dementia in AF patients. CONCLUSIONS AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia.
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Affiliation(s)
- Kieran Brooks
- Institute of Health Informatics Research, University College London, London, UK
| | - Hiroyuki Yoshimura
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Nadine Zakkak
- Institute of Health Informatics Research, University College London, London, UK
| | - Kishore Kukendra-Rajah
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Rui Providencia
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
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14
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Höfler M, Giesche A. Avoidance of causality outside experiments: Hypotheses from cognitive dissonance reduction. Sci Prog 2024; 107:368504241235505. [PMID: 38567445 PMCID: PMC10993686 DOI: 10.1177/00368504241235505] [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] [Indexed: 04/04/2024]
Abstract
The avoidance of causality in the design, analysis and interpretation of non-experimental studies has often been criticised as an untenable scientific stance, because theories are based on causal relations (and not associations) and a rich set of methodological tools for causal analysis has been developed in recent decades. Psychology researchers (n = 106 with complete data) participated in an online study presenting a causal statement about the results of a fictitious paper on the potential effect of drinking clear water for years on the risk of dementia. Two randomised groups of participants were then asked to reflect on the conflict between the goal of approaching a causal answer and the prevailing norm of avoiding doing so. One of the two groups was also instructed to think about possible benefits of addressing causality. Both groups then responded to a list of 19 items about attitudes to causal questions in science. A control group did this without reflecting on conflict or benefits. Free-text assessments were also collected during reflection, giving some indication of how and why causality is avoided. We condense the exploratory findings of this study into five new hypotheses about the how and why, filtered through what can be explained by cognitive dissonance reduction theory. These concern the cost of addressing causality, the variety of ways in which dissonance can be reduced, the need for profound intervention through teaching and social aspects. Predictions are derived from the hypotheses for confirmation trials in future studies and recommendations for teaching causality. Open data are provided for researchers' own analyses.
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Affiliation(s)
- Michael Höfler
- Clinical Psychology and Behavioural Neuroscience, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Alexander Giesche
- Clinical Psychology and Behavioural Neuroscience, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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15
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Soons LM, Deckers K, Tange H, van Boxtel MPJ, Köhler S. Cognitive change in prevalent and incident hearing loss: The Maastricht Aging Study. Alzheimers Dement 2024; 20:2102-2112. [PMID: 38236753 PMCID: PMC10984489 DOI: 10.1002/alz.13606] [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: 07/18/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 03/16/2024]
Abstract
INTRODUCTION Hearing loss (HL) has been associated with cognitive decline and dementia. We examined the temporal association between prevalent and incident HL and cognitive change. METHODS A total of 1823 participants (24-82 years) from the Maastricht Aging Study (MAAS) were assessed at baseline, 6 and 12 years, including pure-tone audiometry. Linear-mixed models were used to test the association between HL and cognition, adjusted for demographics and other dementia risk factors. RESULTS Participants with prevalent and incident HL showed a faster decline in verbal memory, information processing speed, and executive function than participants without HL. Decline was steady from baseline to 6 and 12 years for prevalent HL, but time-delayed from 6 to 12 years for incident HL. Having a hearing aid did not change associations. DISCUSSION Findings support the notion that HL is a risk factor for cognitive decline independent of other dementia risk factors. Onset of HL preceded onset of cognitive decline. HIGHLIGHTS We examined cognitive change in prevalent and incident hearing loss. Prevalent and incident hearing loss were associated with faster cognitive decline. For prevalent hearing loss, decline was steady from baseline to 6 and 12 years. Onset of hearing loss preceded the onset of cognitive decline. Having a hearing aid did not change the observed associations.
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Affiliation(s)
- Lion M. Soons
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtThe Netherlands
| | - Kay Deckers
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtThe Netherlands
| | - Huibert Tange
- Care and Public Health Research Institute (CAPHRI)Department of Family MedicineFaculty of HealthMedicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Martin P. J. van Boxtel
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtThe Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtThe Netherlands
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16
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Wang X, Bakulski KM, Karvonen‐Gutierrez CA, Park SK, Morgan D, Albin RL, Paulson HL. Blood-based biomarkers for Alzheimer's disease and cognitive function from mid- to late life. Alzheimers Dement 2024; 20:1807-1814. [PMID: 38126555 PMCID: PMC10984504 DOI: 10.1002/alz.13583] [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: 08/30/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION We investigated associations of Alzheimer's disease (AD) serum biomarkers with longitudinal changes in cognitive function from mid- to late life among women. METHODS The study population included 192 women with the median age of 53.3 years at baseline, from the Study of Women's Health Across the Nation Michigan Cohort, followed up over 14 years. Associations between baseline serum amyloid β (Aβ)42, the Aβ42/40 ratio, phosphorylated tau181 (p-tau181), and total tau with longitudinal changes in cognition were evaluated using linear mixed effects models. RESULTS After adjusting for confounders, lower Aβ42/40 ratios were associated with faster declines in the Digit Span Backward Test. Higher p-tau181 also showed a borderline statistically significant association with more rapid decline in the Symbol Digit Modalities Test. DISCUSSION Our findings suggest that mid-life serum AD biomarkers could be associated with accelerated cognitive decline from mid- to late life in women. Future studies with larger samples are needed to validate and extend our findings. HIGHLIGHTS This study investigates midlife serum AD biomarkers on longitudinal cognitive function changes in women. Mid-life serum AD biomarkers are associated with accelerated cognitive decline. A decrease in the Aβ42/40 ratio was associated with a faster decline in the DSB score. A higher p-tau181 concentration was associated with a faster decline in the SDMT score.
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Affiliation(s)
- Xin Wang
- Department of EpidemiologySchool of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Kelly M. Bakulski
- Department of EpidemiologySchool of Public HealthUniversity of MichiganAnn ArborMichiganUSA
- Michigan Alzheimer's Disease CenterUniversity of MichiganAnn ArborMichiganUSA
| | | | - Sung Kyun Park
- Department of EpidemiologySchool of Public HealthUniversity of MichiganAnn ArborMichiganUSA
- Department of Environmental Health SciencesSchool of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - David Morgan
- Department of Translational NeuroscienceCollege of Human MedicineGrand Rapids Research CenterMichigan State UniversityGrand RapidsMichiganUSA
| | - Roger L. Albin
- Michigan Alzheimer's Disease CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
- Neurology Service & GRECCVAAAHSAnn ArborMichiganUSA
| | - Henry L. Paulson
- Michigan Alzheimer's Disease CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
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17
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Rosenau C, Köhler S, Soons LM, Anstey KJ, Brayne C, Brodaty H, Engedal K, Farina FR, Ganguli M, Livingston G, Lyketsos CG, Mangialasche F, Middleton LE, Rikkert MGMO, Peters R, Sachdev PS, Scarmeas N, Salbæk G, van Boxtel MPJ, Deckers K. Umbrella review and Delphi study on modifiable factors for dementia risk reduction. Alzheimers Dement 2024; 20:2223-2239. [PMID: 38159267 PMCID: PMC10984497 DOI: 10.1002/alz.13577] [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: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. HIGHLIGHTS: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.
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Affiliation(s)
- Colin Rosenau
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Lion M. Soons
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kaarin J. Anstey
- School of PsychologyUniversity of New South WalesKensingtonNew South WalesAustralia
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
| | - Carol Brayne
- Cambridge Public HealthUniversity of CambridgeCambridgeUK
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Knut Engedal
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
| | - Francesca R. Farina
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Mary Ganguli
- Departments of PsychiatryNeurologyand EpidemiologySchool of Medicine and School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Constantine G. Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer's DiseaseJohns Hopkins BayviewJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Francesca Mangialasche
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingMedical Unit AgingKarolinska University HospitalStockholmSweden
| | - Laura E. Middleton
- Department of Kinesiology and Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐UW Research Institute for AgingWaterlooOntarioCanada
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineRadboud University Medical CenterNijmegenthe Netherlands
- Radboudumc Alzheimer CenterDonders Center of Medical NeurosciencesNijmegenthe Netherlands
| | - Ruth Peters
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
- The George Institute for Global HealthNewtownNew South WalesAustralia
- School of Biomedical SciencesUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nikolaos Scarmeas
- 1st Department of NeurologyAiginition HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | - Geir Salbæk
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Martin P. J. van Boxtel
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kay Deckers
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
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Bayram S, Akkaş ÖA. Adaptation of the Australian National University Alzheimer's Disease Risk Index-Short Form (ANU-ADRI-SF) into Turkish. Int J Older People Nurs 2024; 19:e12608. [PMID: 38509777 DOI: 10.1111/opn.12608] [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: 02/07/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The 'Australian National University Alzheimer's Disease Risk Index' (ANU-ADRI) assesses the risk of developing Alzheimer's disease (AD) and is a potential tool for its prevention. OBJECTIVES The aim of this study is to adapt the ANU-ADRI-SF (the short version of ANU-ADRI) into the Turkish language and Turkish cultural context. METHODS The study was methodological and involved the translation and intercultural adaptation of the ANU-ADRI-SF into the Turkish language. The study included 384 community-based participants from a province in the Western Black Sea Region of Türkiye. Data was collected via an online form prepared using Google Forms. RESULTS The index was translated from its original language, English, into Turkish and then retranslated to English by bilingual translators. It was then reviewed and evaluated for possible issues related to translation and degrees of equivalence. When TR-ANU-ADRI-SF levels were compared according to sex, the mean risk scores were found to be 11.25 ± 7.02 for males and 11.69 ± 7.99 for females. After cross-cultural adaptation, the TR-ANU-ADRI-SF was conceptually intelligible to Turkish adults. CONCLUSIONS The TR-ANU-ADRI-SF is a valid and reliable AD risk assessment tool. IMPLICATIONS FOR PRACTICE Given the increase in AD and its impact on people's health, there is a great need for strategies to be implemented by health professionals to improve the lifestyle of the adult population. For use in conjunction with these strategies, a localised AD risk assessment tool that can be applied by clinicians or by individual patients has been adapted and introduced to the Turkish literature.
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Affiliation(s)
- Serap Bayram
- Elderly Care Program, Vocational School of Health Services, Düzce University, Düzce, Turkey
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19
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Bernini S, Conti S, Perdixi E, Jesuthasan N, Costa A, Severgnini M, Ramusino MC, Prinelli F. Investigating the individual and joint effects of socioeconomic status and lifestyle factors on mild cognitive impairment in older Italians living independently in the community: results from the NutBrain study. J Nutr Health Aging 2024; 28:100040. [PMID: 38280834 DOI: 10.1016/j.jnha.2024.100040] [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: 11/21/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Despite extensive research, a clear understanding of the role of the interaction between lifestyle and socioeconomic status (SES) on cognitive health is still lacking. We investigated the joint association of socioeconomic factors in early to midlife and lifestyle in later life and Mild Cognitive Impairment (MCI). DESIGN Observational cross-sectional study. SETTING NutBrain study in northern Italy. PARTICIPANTS 773 community-dwelling adults aged 65 years and older (73.2 ± 6.0 SD, 58.6% females) participating in the NutBrain study (2019-2023). MEASUREMENTS Three SES indicators (home ownership, educational level, occupation) and five lifestyle factors (adherence to Mediterranean diet, physical activity, smoking habits, social network, leisure activities) were selected. Each factor was scored and summed to calculate SES and healthy lifestyle scores; their joint effect was also examined. The association with MCI was assessed by logistic regression controlling for potential confounders. Sex-stratified analysis was performed. RESULTS In total, 24% of the subjects had MCI. The multivariable logistic model showed that a high SES and a high lifestyle score were associated with 81.8% (OR0.182; 95%CI 0.095-0.351), and 44.1% (OR0.559; 95%CI 0.323-0.968) lower odds of having MCI, respectively. When examining the joint effect of SES and lifestyle factors, the cognitive benefits of a healthy lifestyle were most pronounced in participants with low SES. A healthier lifestyle score was found to be significantly associated with lower odds of MCI, only in females. CONCLUSIONS According to our findings, SES was positively associated with preserved cognitive function, highlighting the importance of active lifestyles in reducing socioeconomic health inequalities, particularly among those with a relatively low SES. TRIAL REGISTRATION Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).
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Affiliation(s)
- Sara Bernini
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Silvia Conti
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Elena Perdixi
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Department of Neurology, IRCCS Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - Nithiya Jesuthasan
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Alfredo Costa
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Unit of Behavioral Neurology IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Marco Severgnini
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Matteo Cotta Ramusino
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Unit of Behavioral Neurology IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Federica Prinelli
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy.
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20
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Kuate Defo A, Bakula V, Pisaturo A, Labos C, Wing SS, Daskalopoulou SS. Diabetes, antidiabetic medications and risk of dementia: A systematic umbrella review and meta-analysis. Diabetes Obes Metab 2024; 26:441-462. [PMID: 37869901 DOI: 10.1111/dom.15331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
AIMS The objective of this umbrella review and meta-analysis was to evaluate the effect of diabetes on risk of dementia, as well as the mitigating effect of antidiabetic treatments. MATERIALS AND METHODS We conducted a systematic umbrella review on diabetes and its treatment, and a meta-analysis focusing on treatment. We searched MEDLINE/PubMed, Embase, PsycINFO, CINAHL and the Cochrane Library for systematic reviews and meta-analyses assessing the risk of cognitive decline/dementia in individuals with diabetes until 2 July 2023. We conducted random-effects meta-analyses to obtain risk ratios and 95% confidence intervals estimating the association of metformin, thiazolidinediones, pioglitazone, dipeptidyl peptidase-4 inhibitors, α-glucosidase inhibitors, meglitinides, insulin, sulphonylureas, glucagon-like peptide-1 receptor agonists (GLP1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) with risk of dementia from cohort/case-control studies. The subgroups analysed included country and world region. Risk of bias was assessed with the AMSTAR tool and Newcastle-Ottawa Scale. RESULTS We included 100 reviews and 27 cohort/case-control studies (N = 3 046 661). Metformin, thiazolidinediones, pioglitazone, GLP1RAs and SGLT2is were associated with significant reduction in risk of dementia. When studies examining metformin were divided by country, the only significant effect was for the United States. Moreover, the effect of metformin was significant in Western but not Eastern populations. No significant effect was observed for dipeptidyl peptidase-4 inhibitors, α-glucosidase inhibitors, or insulin, while meglitinides and sulphonylureas were associated with increased risk. CONCLUSIONS Metformin, thiazolidinediones, pioglitazone, GLP1RAs and SGLT2is were associated with reduced risk of dementia. More longitudinal studies aimed at determining their relative benefit in different populations should be conducted.
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Affiliation(s)
- Alvin Kuate Defo
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Veselko Bakula
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Christopher Labos
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Simon S Wing
- Division of Endocrinology & Metabolism, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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21
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Dingle SE, Bowe SJ, Bujtor M, Milte CM, Daly RM, Byles J, Cavenagh D, Torres SJ. Data-driven lifestyle patterns and risk of dementia in older Australian women. Alzheimers Dement 2024; 20:798-808. [PMID: 37777990 PMCID: PMC10916984 DOI: 10.1002/alz.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Many lifestyle factors have been associated with dementia, but there is limited evidence of how these group together. The aim of this study was to examine the clustering of lifestyle behaviors and associations with dementia. METHODS This population-based study included 9947 older Australian women. Latent class analysis was employed to identify distinct lifestyle classes, and Cox proportional hazard regression compared these with incident dementia over 17 years. RESULTS Three classes were identified: (1) "highly social and non-smokers" (54.9%), (2) "highly social, smokers, and drinkers" (25.1%), and (3) "inactive and low socializers" (20.0%). Women in Class 3 exhibited a higher risk of dementia compared to both Class 1 (hazard ratio [HR] = 1.19, 95% confidence interval [CI]: 1.08 to 1.30) and Class 2 (HR = 1.12, 95% CI: 1.00 to 1.25). DISCUSSION A lifestyle pattern characterized by physical inactivity and low social engagement may be particularly detrimental for dementia risk in older women and should be prioritized in preventive strategies. HIGHLIGHTS Latent class analysis was employed to identify distinct lifestyle clusters. Three lifestyle-related clusters were differentially associated with dementia risk. Inactive and low socializers exhibited the greatest risk of dementia. Targeting physical inactivity and low social engagement in prevention is vital.
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Affiliation(s)
- Sara E Dingle
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
| | - Steven J Bowe
- Biostatistics UnitFaculty of HealthDeakin UniversityVictoriaAustralia
- Faculty of HealthVictoria University of WellingtonWellingtonNew Zealand
| | - Melissa Bujtor
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
- StressPsychiatry and Immunology LaboratoryDepartment of Psychological MedicineInstitute of PsychiatryPsychology & Neuroscience, King's CollegeLondonUK
| | - Catherine M Milte
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
| | - Robin M Daly
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
| | - Julie Byles
- Centre for Women's Health ResearchThe University of NewcastleNew South WalesAustralia
| | - Dominic Cavenagh
- Centre for Women's Health ResearchThe University of NewcastleNew South WalesAustralia
| | - Susan J Torres
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
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22
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Hendriks S, Ranson JM, Peetoom K, Lourida I, Tai XY, de Vugt M, Llewellyn DJ, Köhler S. Risk Factors for Young-Onset Dementia in the UK Biobank. JAMA Neurol 2024; 81:134-142. [PMID: 38147328 PMCID: PMC10751655 DOI: 10.1001/jamaneurol.2023.4929] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/30/2023] [Indexed: 12/27/2023]
Abstract
Importance There is limited information on modifiable risk factors for young-onset dementia (YOD). Objective To examine factors that are associated with the incidence of YOD. Design, Setting, and Participants This prospective cohort study used data from the UK Biobank, with baseline assessment between 2006 and 2010 and follow-up until March 31, 2021, for England and Scotland, and February 28, 2018, for Wales. Participants younger than 65 years and without a dementia diagnosis at baseline assessment were included in this study. Participants who were 65 years and older and those with dementia at baseline were excluded. Data were analyzed from May 2022 to April 2023. Exposures A total of 39 potential risk factors were identified from systematic reviews of late-onset dementia and YOD risk factors and grouped into domains of sociodemographic factors (education, socioeconomic status, and sex), genetic factors (apolipoprotein E), lifestyle factors (physical activity, alcohol use, alcohol use disorder, smoking, diet, cognitive activity, social isolation, and marriage), environmental factors (nitrogen oxide, particulate matter, pesticide, and diesel), blood marker factors (vitamin D, C-reactive protein, estimated glomerular filtration rate function, and albumin), cardiometabolic factors (stroke, hypertension, diabetes, hypoglycemia, heart disease, atrial fibrillation, and aspirin use), psychiatric factors (depression, anxiety, benzodiazepine use, delirium, and sleep problems), and other factors (traumatic brain injury, rheumatoid arthritis, thyroid dysfunction, hearing impairment, and handgrip strength). Main Outcome and Measures Multivariable Cox proportional hazards regression was used to study the association between the risk factors and incidence of YOD. Factors were tested stepwise first within domains and then across domains. Results Of 356 052 included participants, 197 036 (55.3%) were women, and the mean (SD) age at baseline was 54.6 (7.0) years. During 2 891 409 person-years of follow-up, 485 incident YOD cases (251 of 485 men [51.8%]) were observed, yielding an incidence rate of 16.8 per 100 000 person-years (95% CI, 15.4-18.3). In the final model, 15 factors were significantly associated with a higher YOD risk, namely lower formal education, lower socioeconomic status, carrying 2 apolipoprotein ε4 allele, no alcohol use, alcohol use disorder, social isolation, vitamin D deficiency, high C-reactive protein levels, lower handgrip strength, hearing impairment, orthostatic hypotension, stroke, diabetes, heart disease, and depression. Conclusions and Relevance In this study, several factors, mostly modifiable, were associated with a higher risk of YOD. These modifiable risk factors should be incorporated in future dementia prevention initiatives and raise new therapeutic possibilities for YOD.
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Affiliation(s)
- Stevie Hendriks
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | | | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | | | - Xin You Tai
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - David J Llewellyn
- University of Exeter Medical School, Exeter, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
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23
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Paauw D, Heger I, Bjerre JF, Ringgaard MF, Stensgård V, Horstkötter D, Köhler S, Deckers K. Increasing awareness for dementia risk reduction through a public awareness campaign in Denmark: A pre-post study. Prev Med 2024; 179:107848. [PMID: 38215992 DOI: 10.1016/j.ypmed.2024.107848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE It is estimated that about 40% of all dementia cases are potentially attributable to modifiable risk factors, but awareness of this is relatively lacking. METHODS An 18-months nation-wide public awareness campaign on dementia risk reduction was rolled out in Denmark that combined a mass-media approach with an online risk assessment tool and knowledge bank targeting all inhabitants aged between 40 and 75 years. Campaign effects (increase in awareness and knowledge of modifiable dementia risk and protective factors) were assessed via online surveys in two independent random samples before (n = 1003) and after the campaign (n = 1076). RESULTS After adjusting for differences in educational level between the two samples, there was no significant difference in awareness of dementia risk reduction between the pre-campaign (66.5% aware) and post-campaign (63.4% aware) sample (probit z = -0.08, p = 0.151). The number of correctly identified risk/protective factors was significantly higher in the post-campaign sample. After adjusting for potential confounding factors, self-reported exposure to the campaign was associated with more awareness, better recognition of risk/protective factors, more motivation for and actual implementation of lifestyle changes. CONCLUSIONS This mass-media campaign did not increase overall awareness that dementia risk is partly modifiable. However, exposure to the campaign was associated with more awareness and willingness to take action to improve brain health. Future campaigns should tailor messages to specific subgroups to broaden the reach (e.g., males), co-create materials with the target group, and give special attention to the contribution of metabolic/cardiovascular risk factors to dementia risk.
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Affiliation(s)
- Dominique Paauw
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Irene Heger
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Dorothee Horstkötter
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands; Department of Health Ethics and Society, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Kay Deckers
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
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24
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Öksüz N, Ghouri R, Taşdelen B, Uludüz D, Özge A. Mild Cognitive Impairment Progression and Alzheimer's Disease Risk: A Comprehensive Analysis of 3553 Cases over 203 Months. J Clin Med 2024; 13:518. [PMID: 38256652 PMCID: PMC10817043 DOI: 10.3390/jcm13020518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
This study aimed to elucidate the long-term progression of mild cognitive impairment (MCI) within a comprehensive longitudinal dataset, distinguish it from healthy aging, explore the influence of a dementia subtype on this progression, and identify potential contributing factors. Patients with prodromal and preclinical cases underwent regular neuropsychological assessments utilizing various tools. The study included a total of 140 participants with MCI, categorized into Alzheimer's disease (AD) and non-AD subtypes. Our dataset revealed an overall progression rate of 92.8% from MCI to the clinical stage of dementia during the follow-up period, with an annual rate of 15.7%. Notably, all prodromal cases of Lewy body dementia/Parkinson's disease (LBD/PDD) and frontotemporal dementia (FTD) advanced to clinical stages, whereas 7% of vascular dementia (VaD) cases and 8.4% of AD cases remained in the prodromal stage throughout follow-up. Furthermore, we observed a faster progression rate in MCI-AD cases compared to non-AD sufferers (53.9% vs. 35.5%, Entropy: 0.850). This study revealed significant cognitive changes in individuals with MCI over time. The mini-mental state examination (MMSE), global deterioration scale (GDS), and calculation tests were the most effective tests for evaluation of MCI. These findings may offer valuable insights for the development of personalized interventions and management strategies for individuals with MCI.
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Affiliation(s)
- Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Turkey; (N.Ö.); (R.G.)
| | - Reza Ghouri
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Turkey; (N.Ö.); (R.G.)
| | - Bahar Taşdelen
- Department of Biostatistics, School of Medicine, Mersin University, Mersin 33110, Turkey;
| | - Derya Uludüz
- Department of Neurology, Brain 360 Holistic Approach Center, İstanbul 34353, Turkey;
| | - Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Turkey; (N.Ö.); (R.G.)
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25
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Ma C, Yu B, Fan Y, Jia P, Yang S. Exploring Interrelationships between Mental Health Symptoms and Cognitive Impairment in Aging People Living with HIV in China. Dement Geriatr Cogn Disord 2024; 53:19-28. [PMID: 38232713 DOI: 10.1159/000536056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Mental health symptoms and cognitive impairment are highly prevalent and intertwined among aging people living with HIV (PLWH). This study aimed to assess the interrelationships and strength of connections between individual mental health symptoms and cognitive impairment. We sought to identify specific symptoms linking mental health and cognitive impairment in aging PLWH. METHODS Participants in the Sichuan Older People with HIV Infections Cohort Study (SOHICS) were recruited between November 2018 and April 2021 in China. Mental health symptoms, including depression and anxiety, were assessed by the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder-7 (GAD-7), respectively. Cognitive impairment was assessed by the Montreal Cognitive Assessment-Basic (MoCA-B). Partial correlation networks were used to depict the interrelationships between mental health symptoms and cognitive impairment, and bridge strength was used to identify specific symptoms linking mental health and cognitive impairment. RESULTS Of the 1,587 recruited participants with a mean age of 63.0 years old, 47.0% had mild or severe cognitive impairment. Network analysis revealed that cognitive function, visual perception, and problem-solving task of the MoCA-B were negatively correlated with appetite, energy, and motor of the PHQ-9, respectively. Based on their interrelationships, problem-solving task and motor acted as bridge symptoms. CONCLUSION Problem-solving task and motor may be potential intervention targets to reduce the overall risk of mental health symptoms and cognitive impairment. Future research could assess the feasibility and effectiveness of specific interventions designed for the two symptoms of aging PLWH.
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Affiliation(s)
- Chunlan Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
- Sichuan Research Center of Sexual Sociology and Sex Education, Chengdu, China
| | - Yunzhe Fan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- Hubei Luojia Laboratory, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
- Renmin Hospital, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- Department of Clinical Medical College, Affiliated Hospital of Chengdu University, Chengdu, China
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26
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Bruinsma J, Loukas VS, Kassiotis T, Heger I, Rosenberg A, Visser LNC, Mangialasche F, Fotiadis DI, Hanke S, Crutzen R. Socio-Cognitive Determinants of Lifestyle Behavior in the Context of Dementia Risk Reduction: A Population-Based Study in the Netherlands. J Alzheimers Dis 2024; 99:941-952. [PMID: 38759007 PMCID: PMC11191482 DOI: 10.3233/jad-231369] [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] [Accepted: 03/27/2024] [Indexed: 05/19/2024]
Abstract
Background Unhealthy behavior increases the risk of dementia. Various socio-cognitive determinants influence whether individuals persist in or alter these unhealthy behaviors. Objective This study identifies relevant determinants of behavior associated to dementia risk. Methods 4,104 Dutch individuals (40-79 years) completed a screening questionnaire exploring lifestyle behaviors associated with dementia risk. Subsequently, 3,065 respondents who engaged in one or more unhealthy behaviors completed a follow-up questionnaire investigating socio-cognitive determinants of these behaviors. Cross-tables were used to assess the accuracy of participants' perceptions regarding their behavior compared to recommendations. Confidence Interval-Based Estimation of Relevance (CIBER) was used to identify the most relevant determinants of behavior based on visual inspection and interpretation. Results Among the respondents, 91.3% reported at least one, while 65% reported two or more unhealthy lifestyle behaviors associated to dementia risk. Many of them were not aware they did not adhere to lifestyle recommendations. The most relevant determinants identified include attitudes (i.e., lacking a passion for cooking and finding pleasure in drinking alcohol or smoking), misperceptions on social comparisons (i.e., overestimating healthy diet intake and underestimating alcohol intake), and low perceived behavioral control (i.e., regarding changing physical inactivity, altering diet patterns, and smoking cessation). Conclusions Individual-level interventions that encourage lifestyle change should focus on enhancing accurate perceptions of behaviors compared to recommendations, while strengthening perceived control towards behavior change. Given the high prevalence of dementia risk factors, combining interventions at both individual and environmental levels are likely to be the most effective strategy to reduce dementia on a population scale.
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Affiliation(s)
- Jeroen Bruinsma
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
| | - Vasileios S. Loukas
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology–Hellas, FORTH-BRI, Ioannina, Greece
| | - Thomas Kassiotis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology – Hellas, FORTH-ICS-CBML, Heraklion, Greece
| | - Irene Heger
- Department of Psychiatry and Neuropsychology of the School for Mental Health and Neuroscience at Maastricht University, Maastricht, The Netherlands
| | - Anna Rosenberg
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Leonie N. C. Visser
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Psychology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care/Personalized Medicine, Amsterdam, The Netherlands
| | - Francesca Mangialasche
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- FINGERS Brain Health Institute, Stockholm, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Solna, Sweden
| | - Dimitrios I. Fotiadis
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology–Hellas, FORTH-BRI, Ioannina, Greece
| | - Sten Hanke
- Institute of eHealth at University of Applied Science at FH Joanneum, Graz, Austria
| | - Rik Crutzen
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
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27
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Schröder VE, Skrozic A, Erz D, Kaysen A, Fritz JV, Loureiro JM, McIntyre D, Pauly L, Kemp J, Schmitz SK, Wagner S, Reyes M, Soare R, Satagopam V, Vega C, Gawron P, Roomp K, Conde PM, Klucken J, Köhler S, Hartmann T, Dodel R, Leist AK, Kalbe E, Krüger R. Programme Dementia Prevention (pdp): A Nationwide Program for Personalized Prevention in Luxembourg. J Alzheimers Dis 2024; 97:791-804. [PMID: 38189752 PMCID: PMC10836551 DOI: 10.3233/jad-230794] [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] [Accepted: 11/06/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND With continuously aging societies, an increase in the number of people with cognitive decline is to be expected. Aside from the development of causative treatments, the successful implementation of prevention strategies is of utmost importance to reduce the high societal burden caused by neurodegenerative diseases leading to dementia among which the most common cause is Alzheimer's disease. OBJECTIVE The aim of the Luxembourgish "programme dementia prevention (pdp)" is to prevent or at least delay dementia in an at-risk population through personalized multi-domain lifestyle interventions. The current work aims to provide a detailed overview of the methodology and presents initial results regarding the cohort characteristics and the implementation process. METHODS In the frame of the pdp, an extensive neuropsychological evaluation and risk factor assessment are conducted for each participant. Based on the results, individualized multi-domain lifestyle interventions are suggested. RESULTS A total number of 450 participants (Mean age = 69.5 years; SD = 10.8) have been screened at different recruitment sites throughout the country, among whom 425 participants (94.4%) met the selection criteria. CONCLUSIONS We provide evidence supporting the feasibility of implementing a nationwide dementia prevention program and achieving successful recruitment of the target population by establishing a network of different healthcare providers.
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Affiliation(s)
- Valerie E. Schröder
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Neurology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Amna Skrozic
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Neurology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Dorothee Erz
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Neurology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Anne Kaysen
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Joëlle V. Fritz
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
| | - Joao M. Loureiro
- Department of Neurology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Deborah McIntyre
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
| | - Laure Pauly
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Neurology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Jennifer Kemp
- Department of Geriatrics, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Sabine K. Schmitz
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Sophie Wagner
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Margarita Reyes
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Ruxandra Soare
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Venkata Satagopam
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Carlos Vega
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Piotr Gawron
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Kirsten Roomp
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Patricia Martins Conde
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Jochen Klucken
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Digital Medicine, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
- Digital Medicine, Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Tobias Hartmann
- Deutsches Institut für Demenz Prävention (DIDP), Medical Faculty, Saarland University, Homburg, Germany
- Department of Experimental Neurology, Saarland University, Homburg, Germany
| | - Richard Dodel
- Chair of Geriatric Medicine, University Duisburg-Essen, Essen, Germany
| | - Anja K. Leist
- Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rejko Krüger
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Neurology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
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Van Asbroeck S, Köhler S, Wimmers SC, Muris JW, van Boxtel MP, Deckers K. Multidomain Dementia Risk Reduction in Primary Care is Feasible: A Proof-of-concept study. J Alzheimers Dis 2024; 99:1455-1471. [PMID: 38759017 PMCID: PMC11191460 DOI: 10.3233/jad-240229] [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] [Accepted: 04/19/2024] [Indexed: 05/19/2024]
Abstract
Background Dementia risk reduction is a public health priority, but interventions that can be easily implemented in routine care are scarce. Objective To evaluate the feasibility of integrating dementia risk reduction in regular consultations in primary care and the added value of a dedicated smartphone app ('MyBraincoach'). Methods 188 participants (40-60 years), with modifiable dementia risk factors were included from ten Dutch general practices in a cluster-randomized trial (NL9773, 06/10/2021). Practices were randomly allocated (1 : 1) to provide a risk-reduction consultation only or to additionally provide the app. During the consultation, participants learned about dementia risk reduction and how to improve their risk profile. The app group received daily microteaching-notifications about their personally relevant risk factors. Feasibility was evaluated after 3 months using questionnaires assessing knowledge on dementia risk reduction and health behavior change. The primary outcome was change in the validated "LIfestyle for BRAin health" (LIBRA) score. In-depth interviews were conducted with participants and primary care providers (PCPs). Results The interventions were positively perceived, with 72.0% finding the consultation informative and 69.2% considering the app useful. Drop-out was low (6.9%). LIBRA improved similarly in both groups, as did Mediterranean diet adherence and body mass index. Knowledge of dementia risk reduction increased, but more in the app group. Interviews provided insight in participants' and PCPs' needs and wishes. Conclusions Integrating dementia risk reduction in primary care, supported by a smartphone app, is a viable approach towards dementia risk reduction. Larger trials are needed to establish (cost-)effectiveness.
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Affiliation(s)
- Stephanie Van Asbroeck
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Sophie C.P.M. Wimmers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Jean W.M. Muris
- Department of Family Medicine, Careand Public Health Research Institute (CAPHRI), MaastrichtUniversity, Maastricht, the Netherlands
| | - Martin P.J. van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
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29
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Du L, Hermann BP, Jonaitis EM, Cody KA, Rivera-Rivera L, Rowley H, Field A, Eisenmenger L, Christian BT, Betthauser TJ, Larget B, Chappell R, Janelidze S, Hansson O, Johnson SC, Langhough R. Harnessing cognitive trajectory clusterings to examine subclinical decline risk factors. Brain Commun 2023; 5:fcad333. [PMID: 38107504 PMCID: PMC10724051 DOI: 10.1093/braincomms/fcad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Cognitive decline in Alzheimer's disease and other dementias typically begins long before clinical impairment. Identifying people experiencing subclinical decline may facilitate earlier intervention. This study developed cognitive trajectory clusters using longitudinally based random slope and change point parameter estimates from a Preclinical Alzheimer's disease Cognitive Composite and examined how baseline and most recently available clinical/health-related characteristics, cognitive statuses and biomarkers for Alzheimer's disease and vascular disease varied across these cognitive clusters. Data were drawn from the Wisconsin Registry for Alzheimer's Prevention, a longitudinal cohort study of adults from late midlife, enriched for a parental history of Alzheimer's disease and without dementia at baseline. Participants who were cognitively unimpaired at the baseline visit with ≥3 cognitive visits were included in trajectory modelling (n = 1068). The following biomarker data were available for subsets: positron emission tomography amyloid (amyloid: n = 367; [11C]Pittsburgh compound B (PiB): global PiB distribution volume ratio); positron emission tomography tau (tau: n = 321; [18F]MK-6240: primary regions of interest meta-temporal composite); MRI neurodegeneration (neurodegeneration: n = 581; hippocampal volume and global brain atrophy); T2 fluid-attenuated inversion recovery MRI white matter ischaemic lesion volumes (vascular: white matter hyperintensities; n = 419); and plasma pTau217 (n = 165). Posterior median estimate person-level change points, slopes' pre- and post-change point and estimated outcome (intercepts) at change point for cognitive composite were extracted from Bayesian Bent-Line Regression modelling and used to characterize cognitive trajectory groups (K-means clustering). A common method was used to identify amyloid/tau/neurodegeneration/vascular biomarker thresholds. We compared demographics, last visit cognitive status, health-related factors and amyloid/tau/neurodegeneration/vascular biomarkers across the cognitive groups using ANOVA, Kruskal-Wallis, χ2, and Fisher's exact tests. Mean (standard deviation) baseline and last cognitive assessment ages were 58.4 (6.4) and 66.6 (6.6) years, respectively. Cluster analysis identified three cognitive trajectory groups representing steep, n = 77 (7.2%); intermediate, n = 446 (41.8%); and minimal, n = 545 (51.0%) cognitive decline. The steep decline group was older, had more females, APOE e4 carriers and mild cognitive impairment/dementia at last visit; it also showed worse self-reported general health-related and vascular risk factors and higher amyloid, tau, neurodegeneration and white matter hyperintensity positive proportions at last visit. Subtle cognitive decline was consistently evident in the steep decline group and was associated with generally worse health. In addition, cognitive trajectory groups differed on aetiology-informative biomarkers and risk factors, suggesting an intimate link between preclinical cognitive patterns and amyloid/tau/neurodegeneration/vascular biomarker differences in late middle-aged adults. The result explains some of the heterogeneity in cognitive performance within cognitively unimpaired late middle-aged adults.
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Affiliation(s)
- Lianlian Du
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bruce P Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Karly Alex Cody
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Leonardo Rivera-Rivera
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
| | - Howard Rowley
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Aaron Field
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bradley T Christian
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bret Larget
- Department of Statistics, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Rick Chappell
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53726, USA
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund 205 02, Sweden
| | - Sterling C Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Rebecca Langhough
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
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Singh S, Mahajan M, Kumar D, Singh K, Chowdhary M, Amit. An inclusive study of recent advancements in Alzheimer's disease: A comprehensive review. Neuropeptides 2023; 102:102369. [PMID: 37611472 DOI: 10.1016/j.npep.2023.102369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
Alzheimer's disease (AD) has remained elusive in revealing its pathophysiology and mechanism of development. In this review paper, we attempt to highlight several theories that abound about the exact pathway of AD development. The number of cases worldwide has prompted a constant flow of research to detect high-risk patients, slow the progression of the disease and discover improved methods of treatment that may prove effective. We shall focus on the two main classes of drugs that are currently in use; and emerging ones with novel mechanisms that are under development. As of late there has also been increased attention towards factors that were previously thought to be unrelated to AD, such as the gut microbiome, lifestyle habits, and diet. Studies have now shown that all these factors make an impact on AD progression, thus bringing to our attention more areas that could hold the key to combating this disease. This paper covers all the aforementioned factors concisely. We also briefly explore the relationship between mental health and AD, both before and after the diagnosis of the disease.
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Affiliation(s)
- Sukanya Singh
- Department of Zoology, Hansraj College, University of Delhi, New Delhi, Delhi 110007, India
| | - Mitali Mahajan
- Department of Zoology, Hansraj College, University of Delhi, New Delhi, Delhi 110007, India
| | - Dhawal Kumar
- Department of Zoology, Hansraj College, University of Delhi, New Delhi, Delhi 110007, India
| | - Kunika Singh
- Department of Zoology, Hansraj College, University of Delhi, New Delhi, Delhi 110007, India
| | - Mehvish Chowdhary
- Department of Zoology, Hansraj College, University of Delhi, New Delhi, Delhi 110007, India
| | - Amit
- Department of Zoology, Hansraj College, University of Delhi, New Delhi, Delhi 110007, India.
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Trinca V, Anderson ND, Fiocco AJ, Ferland G, Laurin D, Keller HH. Nutrition risk and cognitive performance in community-living older adults without cognitive impairment: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Appl Physiol Nutr Metab 2023; 48:896-906. [PMID: 37590990 DOI: 10.1139/apnm-2023-0211] [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] [Indexed: 08/19/2023]
Abstract
Malnutrition is correlated with poor cognition; however, an understanding of the association between nutrition risk, which precedes malnutrition, and cognition is lacking. This study aimed to determine if nutrition risk measured with the SCREEN-8 tool is associated with cognitive performance among cognitively healthy adults aged 55+, after adjusting for demographic and lifestyle covariates. Sex- and age-stratified analyses were also explored. Baseline data from the Canadian Longitudinal Study on Aging was used. Cognition was determined using a 6-measure composite score based on four executive functions and two memory tasks, taking into account age, sex, and education. Multivariable linear regression was performed while adjusting for body mass index (BMI), lifestyle, and health covariates in the entire sample (n = 11 378) and then stratified by sex and age. Approximately half of participants were female (54.5%) aged 65+ (54.1%). Greater nutrition risk was associated with poorer cognitive performance in the entire sample (F[1, 11 368] = 5.36, p = 0.021) and among participants aged 55-64 (n = 5227; F[1, 5217] = 5.45, p = 0.020). Sex differences in lifestyle and health factors associated with cognition were apparent, but nutrition risk was not associated with cognition in sex-stratified models. Based on this analysis, there may be an association between nutrition risk and cognitive performance in older adults. When screening for either cognitive impairment or nutrition risk, complementary assessments for these conditions is warranted, as early intervention may provide benefit.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Nicole D Anderson
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Departments of Psychology & Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alexandra J Fiocco
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Guylaine Ferland
- Département de Nutrition, Université de Montréal, Montreal, QC, Canada
| | - Danielle Laurin
- Centre de recherche du CHU de Québec-Université Laval, VITAM-Centre de recherche en santé durable, CIUSSS-Capitale Nationale and Institut sur le vieillissement et la participation sociale des aînés, Québec, QC, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, QC, Canada
- Faculté de pharmacie, Université Laval and Institut sur la nutrition et les aliments fonctionnels (INAF) de l'Université Laval, Québec, QC, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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32
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Newby D, Orgeta V, Marshall CR, Lourida I, Albertyn CP, Tamburin S, Raymont V, Veldsman M, Koychev I, Bauermeister S, Weisman D, Foote IF, Bucholc M, Leist AK, Tang EYH, Tai XY, Llewellyn DJ, Ranson JM. Artificial intelligence for dementia prevention. Alzheimers Dement 2023; 19:5952-5969. [PMID: 37837420 PMCID: PMC10843720 DOI: 10.1002/alz.13463] [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: 04/12/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION A wide range of modifiable risk factors for dementia have been identified. Considerable debate remains about these risk factors, possible interactions between them or with genetic risk, and causality, and how they can help in clinical trial recruitment and drug development. Artificial intelligence (AI) and machine learning (ML) may refine understanding. METHODS ML approaches are being developed in dementia prevention. We discuss exemplar uses and evaluate the current applications and limitations in the dementia prevention field. RESULTS Risk-profiling tools may help identify high-risk populations for clinical trials; however, their performance needs improvement. New risk-profiling and trial-recruitment tools underpinned by ML models may be effective in reducing costs and improving future trials. ML can inform drug-repurposing efforts and prioritization of disease-modifying therapeutics. DISCUSSION ML is not yet widely used but has considerable potential to enhance precision in dementia prevention. HIGHLIGHTS Artificial intelligence (AI) is not widely used in the dementia prevention field. Risk-profiling tools are not used in clinical practice. Causal insights are needed to understand risk factors over the lifespan. AI will help personalize risk-management tools for dementia prevention. AI could target specific patient groups that will benefit most for clinical trials.
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Affiliation(s)
- Danielle Newby
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, W1T 7BN, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 4NS, UK
- Department of Neurology, Royal London Hospital, London, E1 1BB, UK
| | - Ilianna Lourida
- Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK
- University of Exeter Medical School, Exeter, EX1 2HZ, UK
| | - Christopher P Albertyn
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, 37129, Italy
| | - Vanessa Raymont
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Michele Veldsman
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 9DU, UK
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
| | - Ivan Koychev
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Sarah Bauermeister
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - David Weisman
- Abington Neurological Associates, Abington, PA 19001, USA
| | - Isabelle F Foote
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 4NS, UK
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Magda Bucholc
- Cognitive Analytics Research Lab, School of Computing, Engineering & Intelligent Systems, Ulster University, Derry, BT48 7JL, UK
| | - Anja K Leist
- Institute for Research on Socio-Economic Inequality (IRSEI), Department of Social Sciences, University of Luxembourg, L-4365, Luxembourg
| | - Eugene Y H Tang
- Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK
| | - Xin You Tai
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, OX3 9DU, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, OX3 9DU, UK
| | | | - David J. Llewellyn
- University of Exeter Medical School, Exeter, EX1 2HZ, UK
- The Alan Turing Institute, London, NW1 2DB, UK
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Bao X, Li W, Liu Y, Li X, Yue L, Xiao S. Impairment of delayed recall as a predictor of amnestic mild cognitive impairment development in normal older adults: a 7-year of longitudinal cohort study in Shanghai. BMC Psychiatry 2023; 23:892. [PMID: 38031039 PMCID: PMC10685709 DOI: 10.1186/s12888-023-05309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Amnestic mild cognitive impairment (aMCI) is considered a prodromal phase of Alzheimer's disease (AD). However, little is known about the neuropsychological characteristic at pre-MCI stage. This study aimed to investigate which neuropsychological tests could significantly predict aMCI from a seven-year longitudinal cohort study. METHODS The present study included 123 individuals with baseline cognitive normal (NC) diagnosis and a 7-year follow-up visit. All the subjects were from the China Longitudinal Aging Study (CLAS) study. Participants were divided into two groups, non-converter and converter based on whether progression to aMCI at follow-up. All participants underwent standardized comprehensive neuropsychological tests, including the mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), auditory verbal learning test (AVLT), the digital span test, the verbal fluency test, the visual recognition test, the WAIS picture completion task, and WAIS block design. Logistic regression analysis was used to evaluate the predictive power of baseline cognitive performance for the transformation of amnestic mild cognitive impairment. Receiver operating characteristic (ROC) curve was used to test the most sensitive test for distinguishing different groups. RESULTS Between the non-converter group and converter group, there were significant differences in the baseline scores of AVLT-delayed recall (AVLT-DR) (8.70 ± 3.61 vs. 6.81 ± 2.96, p = 0.001) and WAIS block design (29.86 ± 7.07 vs. 26.53 ± 8.29, p = 0.041). After controlling for gender, age, and education level, converter group showed lower baseline AVLT-DR than non-converter group, while no significant difference was found in WAIS block design. Furthermore, converter group had lower AVLT-DR score after controlling for somatic disease. The area under the curve of regression equation model was 0.738 (95%CI:0.635-0.840), with a sensitivity 83.9%, specificity of 63.6%. CONCLUSIONS Our results proved the value of delayed recall of AVLT in predicting conversion to aMCI. Early and careful checking of the cognitive function among older people should be emphasized.
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Affiliation(s)
- Xiaoqian Bao
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Shanghai Huangpu District Mental Health Center, Shanghai, China
| | - Wei Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanyuan Liu
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Xia Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Ling Yue
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Shifu Xiao
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
- Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
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Heger I, van Boxtel M, Deckers K, Bosma H, Verhey F, Köhler S. Socioeconomic position, modifiable dementia risk and cognitive decline: results of 12-year Maastricht Aging Study. Int Psychogeriatr 2023:1-13. [PMID: 37905417 DOI: 10.1017/s1041610223000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES This study investigated whether the association between modifiable dementia risk and rate of cognitive decline differs across socioeconomic status (SES) strata. DESIGN, SETTING AND PARTICIPANTS Data were used from Maastricht Aging Study, a prospective cohort study with a 12-year follow-up. The baseline sample consisted of 1023 adults over 40 years old. MEASUREMENTS The "LIfestyle for BRAin health" (LIBRA) index was used to assess modifiable dementia risk. Cognitive performance was assessed at baseline, 6 and 12 years, and measured in the domains of information processing speed, executive functioning and verbal memory function. An SES score was calculated from equivalent income and educational level (tertiles). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline. RESULTS Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, P = 0.029; vs. high SES: X2 = 9.49, P = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, P < 0.001; vs. high SES: X2 = 16.68, P < 0.001) over 6 years compared to their middle- and high-SES counterparts. Higher (unhealthier) LIBRA scores were associated with more decline in information processing speed (X2 = 12.66, P = 0.002) over 12 years and verbal memory (X2 = 4.63, P = 0.032) over 6 years. No consistent effect modification by SES on the association between LIBRA and cognition was found. CONCLUSIONS Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavorable modifiable risk score suggesting more potential for lifestyle-based interventions.
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Affiliation(s)
- Irene Heger
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Carlisle TC, Medina LD, Holden SK. Original research: initial development of a pragmatic tool to estimate cognitive decline risk focusing on potentially modifiable factors in Parkinson's disease. Front Neurosci 2023; 17:1278817. [PMID: 37942138 PMCID: PMC10628974 DOI: 10.3389/fnins.2023.1278817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Cognitive decline is common in Parkinson's disease (PD). Calculating personalized risk of cognitive decline in PD would allow for appropriate counseling, early intervention with available treatments, and inclusion in disease-modifying trials. Methods Data were from the Parkinson's Progression Markers Initiative de novo cohort. Baseline scores were calculated for Lifestyle for Brain Health (LIBRA) and the Montreal Parkinson Risk of Dementia Scale (MoPaRDS) per prior literature and preliminary Parkinson's disease Risk Estimator for Decline In Cognition Tool (pPREDICT) by attributing a point for fourteen posited risk factors. Baseline and 5-year follow-up composite cognitive scores (CCSs) were calculated from a neuropsychological battery and used to define cognitive decliners (PD-decline) versus maintainers (PD-maintain). Results The PD-decline group (n = 44) had higher LIBRA (6.76 ± 0.57, p < 0.05), MoPaRDS (2.45 ± 1.41, p < 0.05) and pPREDICT (4.52 ± 1.66, p < 0.05) scores compared to the PD-maintain group (n = 263; LIBRA 4.98 ± 0.20, MoPaRDS 1.68 ± 1.16, pPREDICT 3.38 ± 1.69). Area-under-the-curve (AUC) for LIBRA was 0.64 (95% confidence interval [CI], 0.55-0.73), MoPaRDS was 0.66 (95% CI, 0.58-0.75) and for pPREDICT was 0.68 (95% CI, 0.61-0.76). In linear regression analyses, LIBRA (p < 0.05), MoPaRDS (p < 0.05) and pPREDICT (p < 0.05) predicted change in CCS. Only age stratified by sex (p < 0.05) contributed significantly to the model for LIBRA. Age and presence of hallucinations (p < 0.05) contributed significantly to the model for MoPaRDS. Male sex, older age, excessive daytime sleepiness, and moderate-severe motor symptoms (all p < 0.05) contributed significantly to the model for pPREDICT. Conclusion Although MoPaRDS is a PD-specific tool for predicting cognitive decline relying on only clinical features, it does not focus on potentially modifiable risk factors. LIBRA does focus on potentially modifiable risk factors and is associated with prediction of all-cause dementia in some populations, but pPREDICT potentially demonstrates improved performance in cognitive decline risk calculation in individuals with PD and may identify actionable risk factors. As pPREDICT incorporates multiple potentially modifiable risk factors that can be obtained easily in the clinical setting, it is a first step in developing an easily assessable tool for a personalized approach to reduce dementia risk in people with PD.
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Affiliation(s)
- Tara C. Carlisle
- Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samantha K. Holden
- Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- Department of Neurology, Movement Disorders Section, University of Colorado School of Medicine, Aurora, CO, United States
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Steinberg N, Parisi JM, Feger DM, Clay OJ, Willis SL, Ball KK, Marsiske M, Harrell ER, Sisco SM, Rebok GW. Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial. J Aging Health 2023; 35:107S-118S. [PMID: 35604034 DOI: 10.1177/08982643221102718] [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] [Indexed: 11/15/2022]
Abstract
ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.
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Affiliation(s)
- Nessa Steinberg
- Marcus Institute for Aging, Hebrew SeniorLife, Boston, MA, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Danielle M Feger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
- University of Alabama Alzheimer's Disease Research Center, Birmingham, AL, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
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Siette J, Dodds L, Brooks C, Deckers K. Older adults' perspectives towards optimizing lifestyle behaviors and strategies to support healthy brain ageing during COVID-19 restrictions. Front Public Health 2023; 11:1205001. [PMID: 37711233 PMCID: PMC10499331 DOI: 10.3389/fpubh.2023.1205001] [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: 04/13/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction It is unknown how the impact of COVID-19 restrictions has affected brain healthy behaviors that contribute to dementia risk reduction in older adults. Our aim was to explore perspectives of older adults on lifestyle behaviors that support positive brain health and dementia risk reduction during and following COVID-19 restrictions. Methods Community-dwelling older Australians (N = 159) during June to October 2021 (the second wave of COVID-19 restrictions) who had taken part in a pre-post dementia risk reduction intervention program were invited to discuss the impact of COVID-19 on their lifestyle behaviors. Semi-structured interviews explored individual's adaptability to pandemic restrictions, intended behavior changes following restrictions easing, and feedback on the effectiveness of ongoing intervention programs for sustaining brain health. Thematic data analysis was performed using a deductive approach. Results Participants had an average age of 73.1 years (SD = 5.6; range: 65-90), majority were female (74.7%), lived in a major city (82.2%) and mean 9.5 years (SD = 1.7) of education. Older adults' views about lifestyle prevention strategies during the pandemic were both positive (e.g., more spare time and adaptive leisure activities) and negative (e.g., social isolation, lack of motivation, adverse emotions). Participants highlighted a continuous conscious effort to adapt certain brain healthy behaviors despite the persistence of adverse impacts of COVID-19 restrictions. Participants also expressed the intention and desire to revert to their previous lifestyle before the COVID-19 pandemic or a sense of the 'new normal'. Conclusion This formative research will inform future interventions targeting dementia risk reduction to consider the immediate and lasting effects of COVID-19 restrictions on older adult's lifestyle behavior.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Laura Dodds
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia
| | - Cristy Brooks
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Kay Deckers
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, Netherlands
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Brett BL, Aggarwal NT, Chandran A, Kerr ZY, Walton SR, DeFreese JD, Guskiewicz KM, Echemendia RJ, Meehan WP, McCrea MA, Mannix R. Incorporation of concussion history as part of the LIfestyle for BRAin Health (LIBRA) modifiable factors risk score and associations with cognition in older former National Football League players. Alzheimers Dement 2023; 19:3087-3097. [PMID: 36708229 PMCID: PMC10374874 DOI: 10.1002/alz.12929] [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: 08/14/2022] [Revised: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Investigate associations between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function, incorporating concussion history. METHODS Former National Football League (NFL) players (N = 1050; mean age = 64.8 ± 9.0-years) completed initial testing for integration of concussion history into LIBRA scores (i.e., modified-LIBRA) and completed the Brief Test of Adult Cognition by Telephone (BTACT). Modified-LIBRA score (including concussion history) associations with odds of MCI and cognitive dysfunction were assessed via logistic and linear regression. RESULTS The highest quartile LIBRA scores were six times more likely to have a diagnosis of MCI compared to the lowest quartile (OR = 6.27[3.61, 10.91], p < 0.001). Modified-LIBRA scores significantly improved model fit for odds of MCI above original LIBRA scores (χ2 (1) = 7.76, p = 0.005) and accounted for a greater fraction of variance in executive function (ΔR2 = 0.02, p = 0.003) and episodic memory (ΔR2 = 0.02, p = 0.002). CONCLUSIONS Modified-LIBRA score, incorporating concussion history, may help monitoring risk status in former contact sport athletes, by targeting modifiable, lifestyle-related risk factors.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Samuel R. Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - William P. Meehan
- Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Rebekah Mannix
- Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
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Mohanannair Geethadevi G, Quinn TJ, George J, Anstey KJ, Bell JS, Sarwar MR, Cross AJ. Multi-domain prognostic models used in middle-aged adults without known cognitive impairment for predicting subsequent dementia. Cochrane Database Syst Rev 2023; 6:CD014885. [PMID: 37265424 PMCID: PMC10239281 DOI: 10.1002/14651858.cd014885.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Dementia, a global health priority, has no current cure. Around 50 million people worldwide currently live with dementia, and this number is expected to treble by 2050. Some health conditions and lifestyle behaviours can increase or decrease the risk of dementia and are known as 'predictors'. Prognostic models combine such predictors to measure the risk of future dementia. Models that can accurately predict future dementia would help clinicians select high-risk adults in middle age and implement targeted risk reduction. OBJECTIVES Our primary objective was to identify multi-domain prognostic models used in middle-aged adults (aged 45 to 65 years) for predicting dementia or cognitive impairment. Eligible multi-domain prognostic models involved two or more of the modifiable dementia predictors identified in a 2020 Lancet Commission report and a 2019 World Health Organization (WHO) report (less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol intake, obesity, smoking, depression, social isolation, physical inactivity, diabetes mellitus, air pollution, poor diet, and cognitive inactivity). Our secondary objectives were to summarise the prognostic models, to appraise their predictive accuracy (discrimination and calibration) as reported in the development and validation studies, and to identify the implications of using dementia prognostic models for the management of people at a higher risk for future dementia. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ISI Web of Science Core Collection from inception until 6 June 2022. We performed forwards and backwards citation tracking of included studies using the Web of Science platform. SELECTION CRITERIA: We included development and validation studies of multi-domain prognostic models. The minimum eligible follow-up was five years. Our primary outcome was an incident clinical diagnosis of dementia based on validated diagnostic criteria, and our secondary outcome was dementia or cognitive impairment determined by any other method. DATA COLLECTION AND ANALYSIS Two review authors independently screened the references, extracted data using a template based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and assessed risk of bias and applicability of included studies using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We synthesised the C-statistics of models that had been externally validated in at least three comparable studies. MAIN RESULTS: We identified 20 eligible studies; eight were development studies and 12 were validation studies. There were 14 unique prognostic models: seven models with validation studies and seven models with development-only studies. The models included a median of nine predictors (range 6 to 34); the median number of modifiable predictors was five (range 2 to 11). The most common modifiable predictors in externally validated models were diabetes, hypertension, smoking, physical activity, and obesity. In development-only models, the most common modifiable predictors were obesity, diabetes, hypertension, and smoking. No models included hearing loss or air pollution as predictors. Nineteen studies had a high risk of bias according to the PROBAST assessment, mainly because of inappropriate analysis methods, particularly lack of reported calibration measures. Applicability concerns were low for 12 studies, as their population, predictors, and outcomes were consistent with those of interest for this review. Applicability concerns were high for nine studies, as they lacked baseline cognitive screening or excluded an age group within the range of 45 to 65 years. Only one model, Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE), had been externally validated in multiple studies, allowing for meta-analysis. The CAIDE model included eight predictors (four modifiable predictors): age, education, sex, systolic blood pressure, body mass index (BMI), total cholesterol, physical activity and APOEƐ4 status. Overall, our confidence in the prediction accuracy of CAIDE was very low; our main reasons for downgrading the certainty of the evidence were high risk of bias across all the studies, high concern of applicability, non-overlapping confidence intervals (CIs), and a high degree of heterogeneity. The summary C-statistic was 0.71 (95% CI 0.66 to 0.76; 3 studies; very low-certainty evidence) for the incident clinical diagnosis of dementia, and 0.67 (95% CI 0.61 to 0.73; 3 studies; very low-certainty evidence) for dementia or cognitive impairment based on cognitive scores. Meta-analysis of calibration measures was not possible, as few studies provided these data. AUTHORS' CONCLUSIONS We identified 14 unique multi-domain prognostic models used in middle-aged adults for predicting subsequent dementia. Diabetes, hypertension, obesity, and smoking were the most common modifiable risk factors used as predictors in the models. We performed meta-analyses of C-statistics for one model (CAIDE), but the summary values were unreliable. Owing to lack of data, we were unable to meta-analyse the calibration measures of CAIDE. This review highlights the need for further robust external validations of multi-domain prognostic models for predicting future risk of dementia in middle-aged adults.
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Affiliation(s)
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Kaarin J Anstey
- School of Psychology, The University of New South Wales, Sydney, Australia
- Ageing Futures Institute, The University of New South Wales, Sydney, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Muhammad Rehan Sarwar
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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Iadecola C, Smith EE, Anrather J, Gu C, Mishra A, Misra S, Perez-Pinzon MA, Shih AY, Sorond FA, van Veluw SJ, Wellington CL. The Neurovasculome: Key Roles in Brain Health and Cognitive Impairment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e251-e271. [PMID: 37009740 PMCID: PMC10228567 DOI: 10.1161/str.0000000000000431] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Preservation of brain health has emerged as a leading public health priority for the aging world population. Advances in neurovascular biology have revealed an intricate relationship among brain cells, meninges, and the hematic and lymphatic vasculature (the neurovasculome) that is highly relevant to the maintenance of cognitive function. In this scientific statement, a multidisciplinary team of experts examines these advances, assesses their relevance to brain health and disease, identifies knowledge gaps, and provides future directions. METHODS Authors with relevant expertise were selected in accordance with the American Heart Association conflict-of-interest management policy. They were assigned topics pertaining to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS The neurovasculome, composed of extracranial, intracranial, and meningeal vessels, as well as lymphatics and associated cells, subserves critical homeostatic functions vital for brain health. These include delivering O2 and nutrients through blood flow and regulating immune trafficking, as well as clearing pathogenic proteins through perivascular spaces and dural lymphatics. Single-cell omics technologies have unveiled an unprecedented molecular heterogeneity in the cellular components of the neurovasculome and have identified novel reciprocal interactions with brain cells. The evidence suggests a previously unappreciated diversity of the pathogenic mechanisms by which disruption of the neurovasculome contributes to cognitive dysfunction in neurovascular and neurodegenerative diseases, providing new opportunities for the prevention, recognition, and treatment of these conditions. CONCLUSIONS These advances shed new light on the symbiotic relationship between the brain and its vessels and promise to provide new diagnostic and therapeutic approaches for brain disorders associated with cognitive dysfunction.
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Siette J, Dodds L, Deckers K, Köhler S, Armitage CJ. Cross-sectional survey of attitudes and beliefs towards dementia risk reduction among Australian older adults. BMC Public Health 2023; 23:1021. [PMID: 37254125 DOI: 10.1186/s12889-023-15843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Little is known about what drives older adults' motivation to change their behaviour and whether that is associated with their personal dementia risk profile. Our aims were to (i) understand what sociodemographic factors are associated with older Australians' motivation to change behaviour to reduce their dementia risk, and (ii) explore the relationship between socio-demographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk scores in older adults. METHODS A cross-sectional online postal or telephone survey was administered to community-dwelling older adults in New South Wales, Australia between January and March 2021. Measures included socioeconomic status, locality, and health status, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale and the lifestyle-based dementia risk score (LIBRA index). Multiple linear regression analyses were used to explore the associations for (i) sociodemographic factors and motivation to reduce dementia risk (MCLHB-DRR scales) and (ii) sociodemographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk (LIBRA index). RESULTS A total of 857 older adults (mean age 73.3 years, SD = 6.0, range 65-94; 70% women; 34.6% less than grade 6 education) completed the survey. Respondents reported high levels of motivation to adopt behaviour changes, agreeing on the importance of good health. Individuals who were younger were more likely to have greater motivation to modify lifestyle to reduce dementia risk and had higher perceived benefits to gain by adopting a healthy lifestyle. Dementia risk scores were moderately low (mean LIBRA index =- 2.8 [SD = 2.0], range - 5.9-3.8), indicating relatively moderate-to-good brain health. Men with low socioeconomic status and higher perceived barriers to lifestyle change had higher dementia risk scores. CONCLUSIONS Public health campaigns need to overcome motivational barriers to support reductions in dementia risk. A multifaceted and inclusive approach targeting both sociodemographic differences and impediments to brain healthy lifestyles is required to achieve genuine change. TRIAL REGISTRATION ACTRN12621000165886, Date of registration: 17/02/2021.
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Affiliation(s)
- Joyce Siette
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, 2145, Australia.
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - Laura Dodds
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, 2145, Australia
| | - Kay Deckers
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK
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Yang M, Liu Y, Hu X, Ren D, Yang Q, Mao J, Chen J. Association of Life's Simple 7 with mild cognitive impairment in community-dwelling older adults in China: a cross-sectional study. Front Aging Neurosci 2023; 15:1203920. [PMID: 37293665 PMCID: PMC10244635 DOI: 10.3389/fnagi.2023.1203920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Background Life's Simple 7 (LS7), a metric composed of seven intervenable cardiovascular risk factors, is initiated by the American Heart Association to improve cardiovascular health. The components of LS7 have been reported as risk factors for dementia. However, few studies investigated the association between LS7 metric and mild cognitive impairment (MCI). Methods The study was carried out in a primary care facility between 8 June and 10 July 2022. A total of 297 community-dwelling residents aged 65 years or older were recruited. Sociodemographic, comorbidity, and lifestyle characteristics were collected through the questionnaires, and biological parameters were obtained from blood sample examinations. Logistic regression was used to analyze the association between LS7 scores (overall, behavioral, and biological) and individual components with MCI, adjusting sex, age, education, and cardiovascular disease (CVD). Results In comparison with the cognitively intact group (n = 195), the MCI group (n = 102) had a lower education level and a higher proportion of hypertension. Multivariate logistic regression analysis, adjusting sex, age, education, and CVD demonstrated a significant association between MCI and overall LS7 score [odd ratio = 0.805, 95% confidence interval (0.690, 0.939)] and biological score [odd ratio = 0.762, 95% confidence interval (0.602, 0.965)]. Conclusion Life's Simple 7 was associated with MCI in community-dwelling older adults, indicating that LS7 could be used as guidance in the prevention of dementia in the community.
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Affiliation(s)
- Mengshu Yang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yilan Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiuzhen Hu
- Xinmin Community Health Center, Wuhan, Hubei, China
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qing Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Chen
- Xinmin Community Health Center, Wuhan, Hubei, China
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Saenz J, Milani S, Mejía-Arango S. Gender, Personality, and Cognitive Resilience Against Early-Life Disadvantage. J Gerontol B Psychol Sci Soc Sci 2023; 78:913-924. [PMID: 36715207 PMCID: PMC10174201 DOI: 10.1093/geronb/gbad017] [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: 04/25/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Early-life disadvantage (ELD) relates to lower late-life cognition. However, personality factors, including having an internal locus of control (LOC) or a conscientious personality, relate to resilience and effective stress coping. We explore whether personality factors convey resilience against the negative effects of ELD on cognition, by gender, in Mexico. METHODS Using the 2015 Mexican Health and Aging Study, we estimated expected cognition using multiple ELD markers to identify a subsample in the lowest quartile of expected cognition given ELD (n = 2,086). In this subsample, we estimated cross-sectional associations between personality and having above-median observed cognitive ability (n = 522) using logistic regression. RESULTS Among those in the lowest quartile of expected cognition, a more internal LOC (β = 0.32 [men] and β = 0.44 [women]) and conscientious personality (β = 0.39 [men] and β = 0.17 [women]) were significantly associated with having above-median cognitive ability in models adjusted for demographic confounders. Larger benefits of conscientiousness were observed for men than women. Associations between personality and having above-median cognitive ability remained statistically significant after further adjustment for health, stress, and cognitive stimulation variables, regardless of gender. DISCUSSION Personality factors may convey resilience among individuals who experienced ELD, potentially breaking the link between ELD and worse late-life cognition. Structural factors and gender roles may affect how much women benefit from personality factors.
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Affiliation(s)
- Joseph L Saenz
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Sadaf Arefi Milani
- Department of Epidemiology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Silvia Mejía-Arango
- Institute of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
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Wang X, Bakulski KM, Paulson HL, Albin RL, Park SK. Associations of healthy lifestyle and socioeconomic status with cognitive function in U.S. older adults. Sci Rep 2023; 13:7513. [PMID: 37160962 PMCID: PMC10170128 DOI: 10.1038/s41598-023-34648-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
We investigated the complex relations of socioeconomic status (SES) and healthy lifestyles with cognitive functions among older adults in 1313 participants, aged 60 years and older, from the National Health and Nutrition Examination Survey 2011-2014. Cognitive function was measured using an average of the standardized z-scores of the Consortium to Establish a Registry for Alzheimer's Disease Word Learning and delayed recall tests, the Animal Fluency Test, and the Digit Symbol Substitution Test. Latent class analysis of family income, education, occupation, health insurance, and food security was used to define composite SES (low, medium, high). A healthy lifestyle score was calculated based on smoking, alcohol consumption, physical activity, and the Healthy-Eating-Index-2015. In survey-weighted multivariable linear regressions, participants with 3 or 4 healthy behaviors had 0.07 (95% CI 0.005, 0.14) standard deviation higher composite cognitive z-score, relative to those with one or no healthy behavior. Participants with high SES had 0.37 (95% CI 0.29, 0.46) standard deviation higher composite cognitive z-score than those with low SES. No statistically significant interaction was observed between healthy lifestyle score and SES. Our findings suggested that higher healthy lifestyle scores and higher SES were associated with better cognitive function among older adults in the United States.
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Affiliation(s)
- Xin Wang
- Department of Epidemiology, School of Public Health, University of Michigan, 6630 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Kelly M Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, 6630 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
- Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Henry L Paulson
- Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
- Neurology Service & GRECC, VAAAHS, Ann Arbor, MI, 48109, USA
| | - Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, 6630 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
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McDonough IM, Cody SL, Harrell ER, Garrett SL, Popp TE. Cognitive differences across ethnoracial category, socioeconomic status across the Alzheimer's disease spectrum: Can an ability discrepancy score level the playing field? Mem Cognit 2023; 51:543-560. [PMID: 35338450 DOI: 10.3758/s13421-022-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 12/29/2022]
Abstract
An ability discrepancy (crystallized minus fluid abilities) might be a personally relevant cognitive marker of risk for Alzheimer's disease (AD) and might help reduce measurement bias often present in traditional measures of cognition. In a large national sample of adults aged 60-104 years (N = 14,257), we investigated whether the intersectionality of group characteristics previously shown to pose a risk for AD including ethnoracial category, socioeconomic status, and sex (a) differed in ability discrepancy compared to traditional neuropsychological tests and (b) moderated the relationship between an ability discrepancy and AD symptom severity. In cognitively normal older adults, results indicated that across each decade, fluid and memory composite scores generally exhibited large group differences with sex, education, and ethnoracial category. In contrast, the ability discrepancy score showed much smaller group differences, thus removing much of the biases inherent in the tests. Women with higher education differed in discrepancy performance from other groups, suggesting a subgroup in which this score might reduce bias to a lesser extent. Importantly, a greater ability discrepancy was associated with greater AD symptom severity across the AD continuum. Subgroup analyses suggest that this relationship holds for all groups except for some subgroups of Hispanic Americans. These findings suggest that an ability discrepancy measure might be a better indicator of baseline cognition than traditional measures that show more egregious measurement bias across diverse groups of people.
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Affiliation(s)
- Ian M McDonough
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA.
| | - Shameka L Cody
- College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | - Erin R Harrell
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | | | - Taylor E Popp
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
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Mollayeva T, Tran A, Hurst M, Escobar M, Colantonio A. The effect of sleep disorders on dementia risk in patients with traumatic brain injury: A large-scale cohort study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12411. [PMID: 37234486 PMCID: PMC10207584 DOI: 10.1002/dad2.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 05/28/2023]
Abstract
Introduction We investigated the association between sleep disorders (SDs) and incident dementia in adults with traumatic brain injury (TBI). Methods Adults with a TBI between 2003 and 2013 were followed until incident dementia. Sleep disorders at TBI were predictors in Cox regression models, controlling for other dementia risks. Results Over 52 months, 4.6% of the 712,708 adults (59% male, median age 44, <1% with SD) developed dementia. An SD was associated with a 26% and a 23% of increased risk of dementia in male and female participants (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.11-1.42 and HR 1.23, 95% CI 1.09-1.40, respectively). In male participants, SD was associated with a 93% increased risk of early-onset dementia (HR 1.93, 95% CI 1.29-2.87); this did not hold in female participants (HR 1.38, 95% CI 0.78-2.44). Discussion In a province-wide cohort, SDs at TBI were independently associated with incident dementia. Clinical trials testing sex-specific SD care after TBI for dementia prevention are timely. Highlights TBI and sleep disorders are linked to each other, and to dementia.It is unclear if sleep disorders pose a sex-specific dementia risk in brain injury.In this study, presence of a sleep disorder increased dementia risk in both sexes.The risk differed by type of sleep disorder, which differed between the sexes.Sleep disorder awareness and care in persons with brain injury is vital for dementia prevention.
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Affiliation(s)
- Tatyana Mollayeva
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- Rehabilitation Sciences InstituteTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Andrew Tran
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Mackenzie Hurst
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Michael Escobar
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Angela Colantonio
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- Rehabilitation Sciences InstituteTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
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Associations between physical activity and cognitive dysfunction in older companion dogs: results from the Dog Aging Project. GeroScience 2023; 45:645-661. [PMID: 36129565 PMCID: PMC9886770 DOI: 10.1007/s11357-022-00655-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/02/2022] [Indexed: 02/03/2023] Open
Abstract
Canine cognitive dysfunction (CCD) is a form of dementia that shares many similarities with Alzheimer's disease. Given that physical activity is believed to reduce risk of Alzheimer's disease in humans, we explored the association between physical activity and cognitive health in a cohort of companion dogs, aged 6-18 years. We hypothesized that higher levels of physical activity would be associated with lower (i.e., better) scores on a cognitive dysfunction rating instrument and lower prevalence of dementia, and that this association would be robust when controlling for age, comorbidities, and other potential confounders. Our sample included 11,574 companion dogs enrolled through the Dog Aging Project, of whom 287 had scores over the clinical threshold for CCD. In this observational, cross-sectional study, we used owner-reported questionnaire data to quantify dog cognitive health (via a validated scale), physical activity levels, health conditions, training history, and dietary supplements. We fit regression models with measures of cognitive health as the outcome, and physical activity-with several important covariates-as predictors. We found a significant negative relationship between physical activity and current severity of cognitive dysfunction symptoms (estimate = - 0.10, 95% CI: - 0.11 to - 0.08, p < 0.001), extent of symptom worsening over a 6-month interval (estimate = - 0.07, 95% CI: - 0.09 to - 0.05, p < 0.001), and whether a dog reached a clinical level of CCD (odds ratio = 0.53, 95% CI: 0.45 to 0.63, p < 0.001). Physical activity was robustly associated with better cognitive outcomes in dogs. Our findings illustrate the value of companion dogs as a model for investigating relationships between physical activity and cognitive aging, including aspects of dementia that may have translational potential for Alzheimer's disease. While the current study represents an important first step in identifying a relationship between physical activity and cognitive function, it cannot determine causality. Future studies are needed to rule out reverse causation by following the same dogs prospectively over time, and to evaluate causality by administering physical activity interventions.
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Kodesh A, Bental T, Vaknin-Assa H, Talmor-Barkan Y, Codner P, Levi A, Kornowski R, Perl L. The independent impact of dementia in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Clin Cardiol 2023; 46:279-286. [PMID: 36632766 PMCID: PMC10018096 DOI: 10.1002/clc.23967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although age and frailty are associated with worse prognoses for patients who undergo percutaneous coronary intervention (PCI), little is known regarding the independent impact of dementia. HYPOTHESIS The aim of this study was to evaluate the association between dementia and outcomes for patients with acute myocardial infarction (AMI). METHODS Consecutive patients with ST-elevation or non-ST elevation MI who had undergone PCI as part of our AMI registry were included in this study. We compared outcomes within the 1-year period of their PCI, including death and major adverse cardiac events (MACE) and corrected for confounders using Cox regression. RESULTS Of 28 274 patients, 9167 patients who had undergone PCI for AMI were included in this study, 250 with dementia; Mean age (77.4 ± 9.4 in the dementia group vs. 63.6 ± 12.7 in the control), female gender (32.4 vs. 24.2%, p = .003), diabetes mellitus (54.0 vs. 42.4%, p < .001) and chronic kidney disease (44.4 vs. 19.3%, p < .001) were higher. At 12 months, unadjusted rates of death (25.5 vs. 9.8%, p < .001) and MACE (33.8 vs. 17.6%, p < .001) were higher for patients with dementia. After standardizing for confounding variables, dementia remained an independent risk factor for death (HR 1.90; CI 1.37-2.65; p < .001) and MACE (HR 1.73; CI 1.30-2.31; p < .001), as well as in propensity score matched analysis (HR 1.54; CI: 1.03-2.28; p < .001 and HR 1.49; CI: 1.09-2.02; p < .001, respectively). CONCLUSIONS Dementia is an independent predictor of worse outcomes in patients undergoing PCI for AMI. Future intervention and specialized healthcare measures to mitigate this risk is warranted.
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Affiliation(s)
- Afek Kodesh
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamir Bental
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hana Vaknin-Assa
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yeela Talmor-Barkan
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pablo Codner
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amos Levi
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran Kornowski
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Leor Perl
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Dingle SE, Bujtor MS, Milte CM, Bowe SJ, Daly RM, Torres SJ. Statistical Approaches for the Analysis of Combined Health-Related Factors in Association with Adult Cognitive Outcomes: A Scoping Review. J Alzheimers Dis 2023; 92:1147-1171. [PMID: 36872778 DOI: 10.3233/jad-221034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Dementia prevention is a global health priority, and there is emerging evidence to support associations between individual modifiable health behaviors and cognitive function and dementia risk. However, a key property of these behaviors is they often co-occur or cluster, highlighting the importance of examining them in combination. OBJECTIVE To identify and characterize the statistical approaches used to aggregate multiple health-related behaviors/modifiable risk factors and assess associations with cognitive outcomes in adults. METHODS Eight electronic databases were searched to identify observational studies exploring the association between two or more aggregated health-related behaviors and cognitive outcomes in adults. RESULTS Sixty-two articles were included in this review. Fifty articles employed co-occurrence approaches alone to aggregate health behaviors/other modifiable risk factors, eight studies used solely clustering-based approaches, and four studies used a combination of both. Co-occurrence methods include additive index-based approaches and presenting specific health combinations, and whilst simple to construct and interpret, do not consider the underlying associations between co-occurring behaviors/risk factors. Clustering-based approaches do focus on underlying associations, and further work in this area may aid in identifying at-risk subgroups and understanding specific combinations of health-related behaviors/risk factors of particular importance in the scope of cognitive function and neurocognitive decline. CONCLUSION A co-occurrence approach to aggregating health-related behaviors/risk factors and exploring associations with adult cognitive outcomes has been the predominant statistic approach used to date, with a lack of research employing more advanced statistical methods to explore clustering-based approaches.
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Affiliation(s)
- Sara E Dingle
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Melissa S Bujtor
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia.,Department of Psychological Medicine, Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Catherine M Milte
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Biostatistics Unit, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.,Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Susan J Torres
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
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50
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Ranson JM, Bucholc M, Lyall D, Newby D, Winchester L, Oxtoby NP, Veldsman M, Rittman T, Marzi S, Skene N, Al Khleifat A, Foote IF, Orgeta V, Kormilitzin A, Lourida I, Llewellyn DJ. Harnessing the potential of machine learning and artificial intelligence for dementia research. Brain Inform 2023; 10:6. [PMID: 36829050 PMCID: PMC9958222 DOI: 10.1186/s40708-022-00183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/26/2022] [Indexed: 02/26/2023] Open
Abstract
Progress in dementia research has been limited, with substantial gaps in our knowledge of targets for prevention, mechanisms for disease progression, and disease-modifying treatments. The growing availability of multimodal data sets opens possibilities for the application of machine learning and artificial intelligence (AI) to help answer key questions in the field. We provide an overview of the state of the science, highlighting current challenges and opportunities for utilisation of AI approaches to move the field forward in the areas of genetics, experimental medicine, drug discovery and trials optimisation, imaging, and prevention. Machine learning methods can enhance results of genetic studies, help determine biological effects and facilitate the identification of drug targets based on genetic and transcriptomic information. The use of unsupervised learning for understanding disease mechanisms for drug discovery is promising, while analysis of multimodal data sets to characterise and quantify disease severity and subtype are also beginning to contribute to optimisation of clinical trial recruitment. Data-driven experimental medicine is needed to analyse data across modalities and develop novel algorithms to translate insights from animal models to human disease biology. AI methods in neuroimaging outperform traditional approaches for diagnostic classification, and although challenges around validation and translation remain, there is optimism for their meaningful integration to clinical practice in the near future. AI-based models can also clarify our understanding of the causality and commonality of dementia risk factors, informing and improving risk prediction models along with the development of preventative interventions. The complexity and heterogeneity of dementia requires an alternative approach beyond traditional design and analytical approaches. Although not yet widely used in dementia research, machine learning and AI have the potential to unlock current challenges and advance precision dementia medicine.
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Affiliation(s)
- Janice M Ranson
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Magda Bucholc
- Cognitive Analytics Research Lab, School of Computing, Engineering & Intelligent Systems, Ulster University, Derry, UK
| | - Donald Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Neil P Oxtoby
- Department of Computer Science, UCL Centre for Medical Image Computing, University College London, London, UK
| | | | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Sarah Marzi
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Nathan Skene
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Ahmad Al Khleifat
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | | | - Ilianna Lourida
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - David J Llewellyn
- University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
- The Alan Turing Institute, London, UK
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