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Zhu X, Ding R, Chen X, Wang X, He P, Wang G. Discrepancy between objective and subjective cognition and its association with the trajectory of symptoms and functioning in depressive patients. Psychol Med 2024; 54:808-822. [PMID: 37921011 DOI: 10.1017/s0033291723002556] [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: 11/04/2023]
Abstract
BACKGROUND Discrepancy between objective and subjective cognitive deficit is common among patients with major depressive disorders (MDDs) and may play a key role in the mechanism linking cognition with recovery of symptom and psychosocial function. This study, therefore, explores the cognitive discrepancy, and its association with the trajectory of symptoms and functioning over a 6-month period. METHODS We used data from the Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study, from which 598 patients were included. Cognitive discrepancy scores were computed using a novel methodology, with positive values indicating more subjective than objective deficit (i.e. 'underestimation') and negative values indicating more objective than subjective difficulties (i.e. 'overestimation'). Linear growth curve models were employed to examine the association of the cognitive discrepancy with the trajectory of depressive symptoms, psychosocial function, and quality of life. RESULTS About 68% of patients displayed disproportionately more objective than subjective cognitive deficit at baseline, and the mean cognitive discrepancy score was -1.4 (2.7). Overestimation was associated with a faster decrease of HDRS-17 (β = -0.46, p = 0.002) and a faster decrease of psychosocial function in social life (β = -0.13, p = 0.013) and family life (β = -0.12, p = 0.026), and a greater improvement of EQ-5D utility score (β = 0.01, p < 0.001). CONCLUSION We found a lower sensitivity of cognitive deficit at baseline and its decrease was associated with better health outcomes. Our findings have clinical implications of the necessity to assess both subjective and objective cognition for identification and categorization and to incorporate cognitive and psychological therapies for optimized treatment outcomes.
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Affiliation(s)
- Xuequan Zhu
- National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ruoxi Ding
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xu Chen
- National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiaoyi Wang
- Zhejiang BrainAu Medical Technology Co., Ltd, Shaoxing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Gang Wang
- National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Huang XT, Lv X, Jiang H. The weight-adjusted-waist index and cognitive impairment among U.S. older adults: a population-based study. Front Endocrinol (Lausanne) 2023; 14:1276212. [PMID: 38027119 PMCID: PMC10663941 DOI: 10.3389/fendo.2023.1276212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Multiple research projects have provided evidence of the correlation between obesity and cognitive impairment. WWI, a novel metric for assessing obesity, has the potential to provide a more precise assessment of muscle and fat mass. This research aimed to investigate the association between WWI and cognitive functioning among elderly individuals residing in the United States. Methods This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2014. Weighted multiple linear regression models, smoothed fitted curves, and generalized weighted models were employed to examine the associations between WWI and cognitive function in linear and nonlinear contexts. Results The study included a cohort of 2,764 adult volunteers aged 60 years and older, all with complete data. Upon controlling for all potential confounding variables, our analysis revealed statistically significant negative associations between WWI and the Digit Symbol Substitution Test (DSST) score. Specifically, for each 1-unit increase in WWI, there was a corresponding loss of 3.57 points in the DSST score [-3.57 (-4.31, -2.82)]. The negative correlations between WWI with CERAD total word recall [-0.63 (-0.85, -0.40)], CERAD delayed recall [-0.19 (-0.30, -0.07)], and AFT [-0.65 (-0.94, -0.37)] were significant only in partially adjusted models. Conclusion Higher WWI was associated with poorer cognitive function.
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Affiliation(s)
| | - Xiang Lv
- Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Jiang X, Hu X, Daamen M, Wang X, Fan C, Meiberth D, Spottke A, Roeske S, Fliessbach K, Spruth EJ, Altenstein S, Lohse A, Hansen N, Glanz W, Incesoy EI, Dobisch L, Janowitz D, Rauchmann BS, Ramirez A, Kilimann I, Munk MH, Wang X, Schneider LS, Gabelin T, Roy N, Wolfsgruber S, Kleineidam L, Hetzer S, Dechent P, Ewers M, Scheffler K, Amthauer H, Buchert R, Essler M, Drzezga A, Rominger A, Krause BJ, Reimold M, Priller J, Schneider A, Wiltfang J, Buerger K, Perneczky R, Teipel S, Laske C, Peters O, Düzel E, Wagner M, Jiang J, Jessen F, Boecker H, Han Y. Altered limbic functional connectivity in individuals with subjective cognitive decline: Converging and diverging findings across Chinese and German cohorts. Alzheimers Dement 2023; 19:4922-4934. [PMID: 37070734 DOI: 10.1002/alz.13068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION It remains unclear whether functional brain networks are consistently altered in individuals with subjective cognitive decline (SCD) of diverse ethnic and cultural backgrounds and whether the network alterations are associated with an amyloid burden. METHODS Cross-sectional resting-state functional magnetic resonance imaging connectivity (FC) and amyloid-positron emission tomography (PET) data from the Chinese Sino Longitudinal Study on Cognitive Decline and German DZNE Longitudinal Cognitive Impairment and Dementia cohorts were analyzed. RESULTS Limbic FC, particularly hippocampal connectivity with right insula, was consistently higher in SCD than in controls, and correlated with SCD-plus features. Smaller SCD subcohorts with PET showed inconsistent amyloid positivity rates and FC-amyloid associations across cohorts. DISCUSSION Our results suggest an early adaptation of the limbic network in SCD, which may reflect increased awareness of cognitive decline, irrespective of amyloid pathology. Different amyloid positivity rates may indicate a heterogeneous underlying etiology in Eastern and Western SCD cohorts when applying current research criteria. Future studies should identify culture-specific features to enrich preclinical Alzheimer's disease in non-Western populations. HIGHLIGHTS Common limbic hyperconnectivity across Chinese and German subjective cognitive decline (SCD) cohorts was observed. Limbic hyperconnectivity may reflect awareness of cognition, irrespective of amyloid load. Further cross-cultural harmonization of SCD regarding Alzheimer's disease pathology is required.
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Affiliation(s)
- Xueyan Jiang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
| | - Xiaochen Hu
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Marcel Daamen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Xiaoqi Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chunqiu Fan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Dix Meiberth
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Sandra Roeske
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Bonn, Germany
| | - Eike Jakob Spruth
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Slawek Altenstein
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Andrea Lohse
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Enise I Incesoy
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
- Department for Psychiatry and Psychotherapy, University Clinic Magdeburg, Magdeburg, Germany
| | - Laura Dobisch
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alfredo Ramirez
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Department of Psychiatry & Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, San Antonio, Texas, USA
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Matthias H Munk
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Xiao Wang
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Luisa-Sophie Schneider
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Tatjana Gabelin
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Nina Roy
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffen Wolfsgruber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Bonn, Germany
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Bonn, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Dechent
- MR-Research in Neurosciences, Department of Cognitive Neurology, Georg-August-University Goettingen, Goettingen, Germany
| | - Michael Ewers
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University of Tuebingen, Tuebingen, Germany
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Alexander Drzezga
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- Institute of Neuroscience and Medicine (INM-2), Molecular Organization of the Brain, Forschungszentrum Jülich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig-Maximilian-University Munich, Munich, Germany
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Centre, Rostock, Germany
| | - Matthias Reimold
- Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard-Karls-University, Tuebingen, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
- School of Medicine, Technical University of Munich, Department of Psychiatry and Psychotherapy, Munich, Germany
- University of Edinburgh and UK DRI, Edinburgh, UK
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Bonn, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Katharina Buerger
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, UK
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Bonn, Germany
| | - Jiehui Jiang
- Institute of Biomedical Engineering, Shanghai University, Shanghai, China
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Henning Boecker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Clinical Functional Imaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
- Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Beijing, China
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Cadar D, Brocklebank L, Yan L, Zhao Y, Steptoe A. Socioeconomic and Contextual Differentials in Memory Decline: A Cross-Country Investigation Between England and China. J Gerontol B Psychol Sci Soc Sci 2023; 78:544-555. [PMID: 36625075 PMCID: PMC9985334 DOI: 10.1093/geronb/gbac163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Although cognitive functioning is strongly associated with biological changes in the brain during the aging process, very little is known about the role of sociocultural differentials between the western and eastern parts of the world. We examined the associations between individual socioeconomic markers (e.g., education, household wealth) and contextual levels characteristics (e.g., urbanicity) with memory performance and memory decline over up to 8 years of follow-up in England and China. METHODS The analytical samples included participants aged 50+ from the English Longitudinal Study of Aging (n = 6,687) and the China Health and Retirement Longitudinal Study (n = 10,252). Mixed linear models were employed to examine the association between baseline individual socioeconomic markers (education, wealth) and contextual-level characteristics (urbanicity) on the change in memory over time. RESULTS Our analyses showed that higher education and wealth were associated with better baseline memory in both England and China. Still, the impact of contextual-level characteristics such as urbanicity differed between the 2 countries. For English individuals, living in a rural area showed an advantage in memory, while the opposite pattern was observed in China. Memory decline appeared to be socioeconomically patterned by higher education, wealth, and urbanicity in China but not in England. DISCUSSION Our findings highlight substantial socioeconomic and contextual inequity in memory performance in both England and China, as well as in the rate of memory decline primarily in China. Public health strategies for preventing memory decline should target the socioeconomic gaps at the individual and contextual levels to protect those particularly disadvantaged.
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Affiliation(s)
- Dorina Cadar
- Centre for Dementia Studies, Department of Neuroscience, Brighton and Sussex Medical School, Sussex, UK
- Department of Primary Care, Brighton and Sussex Medical School, Sussex, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Laura Brocklebank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Li Yan
- National School of Development, Peking University, Beijing, China
| | - Yaohui Zhao
- National School of Development, Peking University, Beijing, China
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
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Sheng C, Yang K, He B, Li T, Wang X, Du W, Hu X, Jiang J, Jiang X, Jessen F, Han Y. Cross-Cultural Longitudinal Study on Cognitive Decline (CLoCODE) for Subjective Cognitive Decline in China and Germany: A Protocol for Study Design. J Alzheimers Dis 2022; 87:1319-1333. [PMID: 35431240 DOI: 10.3233/jad-215452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Subjective cognitive decline (SCD) is considered as the first symptomatic manifestation of Alzheimer’s disease (AD), which is also affected by different cultural backgrounds. Establishing cross-cultural prediction models of SCD is challenging. Objective: To establish prediction models of SCD available for both the Chinese and European populations. Methods: In this project, 330 SCD from China and 380 SCD from Germany are intended to be recruited. For all participants, standardized assessments, including clinical, neuropsychological, apolipoprotein E (APOE) genotype, blood, and multi-parameter magnetic resonance imaging (MRI) at baseline will be conducted. Participants will voluntarily undergo amyloid positron emission tomography (PET) and are classified into amyloid-β (Aβ) positive SCD (SCD+) and Aβ negative SCD (SCD-). First, baseline data of all SCD individuals between the two cohorts will be compared. Then, key features associated with brain amyloidosis will be extracted in SCD+ individuals, and the diagnosis model will be established using the radiomics method. Finally, the follow-up visits will be conducted every 12 months and the primary outcome is the conversion to mild cognitive impairment or dementia. After a 4-year follow-up, we will extract factors associated with the conversion risk of SCD using Cox regression analysis. Results: At present, 141 SCD from China and 338 SCD from Germany have been recruited. Initial analysis showed significant differences in demographic information, neuropsychological tests, and regional brain atrophy in SCD compared with controls in both cohorts. Conclusion: This project may be of great value for future implications of SCD studies in different cultural backgrounds. Trial registration: ClinicalTrials.gov, NCT04696315. Registered 3 January 2021.
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Affiliation(s)
- Can Sheng
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kun Yang
- Evidence-Based Medicine Center, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Beiqi He
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
| | - Taoran Li
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiaoqi Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wenying Du
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiaochen Hu
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jiehui Jiang
- Institute of Biomedical Engineering, School of Information and Communication Engineering, Shanghai University, Shanghai, China
| | - Xueyan Jiang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
- German Center for Neurodegenerative Disease, Clinical Research Group, Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, Haikou, China
- Center of Alzheimer’s Disease, Beijing Institute for Brain Disorders, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Beijing, China
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Wu Q, Zhang P. Longitudinal validity of self-rated health: the presence and impact of response shift. Psychol Health 2021:1-21. [PMID: 34714204 DOI: 10.1080/08870446.2021.1994571] [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: 10/20/2022]
Abstract
Objective: This paper aimed to examine the longitudinal validity of self-rated health (SRH) and whether it would be affected by possible changes in evaluation standards (i.e., response shift) over time.Design: Data are from a longitudinal survey of a nationally representative sample in China. Analytical sample was restricted to respondents aged 45 and above (n = 15,893). Individual fixed effects models were used to analyze changes in ratings on health anchoring vignettes and self-rated health over time.Main outcome measures: SRH at two time points with a -two-year span.Results: Both SRH and anchoring vignettes ratings displayed changes over a two-year span for all the studied age groups. Compared with the self-assessed change in health ("How would you rate your health as compared to that of last year?"), changes in SRH reported over time displayed a more stable and optimistic pattern. SRH responded to doctor diagnosed chronic disease and changes in functional limitation, before and after adjusting for evaluation standards.Conclusion: SRH is responsive to the newly diagnosed chronic disease and functional limitation, regardless of whether we consider response shift within the same respondents over time.
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Affiliation(s)
- Qiong Wu
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Peikang Zhang
- Graduate School of Education, Peking University, Beijing, China
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Lyu D, Li T, Lyu X. Resting-state functional reorganisation in Alzheimer's disease and amnestic mild cognitive impairment: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e049798. [PMID: 34642194 PMCID: PMC8513263 DOI: 10.1136/bmjopen-2021-049798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The incidence of Alzheimer's disease (AD) is increasing rapidly, causing a growing burden to health and economic worldwide. Several clinical trials in the past decade failed to find solutions, and there remains a lack of an effective treatment. The evidence suggests that early intervention for neurodegeneration would likely be effective in preventing cognitive decline. Cognitive decline in AD occurs continuously over a long period; however, there remains a lack of simple, rapid and accurate approach for diagnosis of amnestic mild cognitive impairment or subjective cognitive decline due to underlying Alzheimer's pathology. Resting-state functional MRI (rs-fMRI) determines the functional activities of the human brain non-invasively. The amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF) and regional homogeneity (ReHo) are rs-fMRI indicators with high repeatability. They have been studied as early diagnostic imaging markers for other diseases and may be promising markers also for AD. METHODS AND ANALYSIS The following electronic literature databases will be searched from inception to December 2021: Medline-Ovid, Medline-PubMed, EMBase-Ovid, Cochrane Central and ClinicalTrials.gov. Two independent reviewers will select studies with eligible criteria, extract data and assess the quality of the original studies with our quality assessment tool individually. Missing data will be requested by sending emails to the corresponding authors. Brain regions will be presented for ALFF/fALFF and ReHo by performing activation likelihood estimation with the Seed-based d Mapping-Permutation of subject images V.6.21 software. Meta-regression will be performed to determine the potential brain regions that may strongly correlate with cognitive decline progression. Subgroup analysis, funnel plot, Egger's test and sensitivity analysis will be conducted to detect and explain potential heterogeneity. ETHICS AND DISSEMINATION This study does not require formal ethical approval. The findings will be submitted to a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42021229009.
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Affiliation(s)
- Diyang Lyu
- Capital Medical University, Beijing, China
| | - Taoran Li
- Capital Medical University, Beijing, China
| | - Xuanxin Lyu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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Dong QY, Li TR, Jiang XY, Wang XN, Han Y, Jiang JH. Glucose metabolism in the right middle temporal gyrus could be a potential biomarker for subjective cognitive decline: a study of a Han population. ALZHEIMERS RESEARCH & THERAPY 2021; 13:74. [PMID: 33827675 PMCID: PMC8028241 DOI: 10.1186/s13195-021-00811-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
Introduction Subjective cognitive decline (SCD) represents a cognitively normal state but at an increased risk for developing Alzheimer’s disease (AD). Recognizing the glucose metabolic biomarkers of SCD could facilitate the location of areas with metabolic changes at an ultra-early stage. The objective of this study was to explore glucose metabolic biomarkers of SCD at the region of interest (ROI) level. Methods This study was based on cohorts from two tertiary medical centers, and it was part of the SILCODE project (NCT03370744). Twenty-six normal control (NC) cases and 32 SCD cases were in cohort 1; 36 NCs, 23 cases of SCD, 32 cases of amnestic mild cognitive impairment (aMCIs), 32 cases of AD dementia (ADDs), and 22 cases of dementia with Lewy bodies (DLBs) were in cohort 2. Each subject underwent [18F]fluoro-2-deoxyglucose positron emission tomography (PET) imaging and magnetic resonance imaging (MRI), and subjects from cohort 1 additionally underwent amyloid-PET scanning. The ROI analysis was based on the Anatomical Automatic Labeling (AAL) template; multiple permutation tests and repeated cross-validations were conducted to determine the metabolic differences between NC and SCD cases. In addition, receiver operating characteristic curves were used to evaluate the capabilities of potential glucose metabolic biomarkers in distinguishing different groups. Pearson correlation analysis was also performed to explore the correlation between glucose metabolic biomarkers and neuropsychological scales or amyloid deposition. Results Only the right middle temporal gyrus (RMTG) passed the methodological verification, and its metabolic levels were correlated with the degrees of complaints (R = − 0.239, p = 0.009), depression (R = − 0.200, p = 0.030), and abilities of delayed memory (R = 0.207, p = 0.025), and were weakly correlated with cortical amyloid deposition (R = − 0.246, p = 0.066). Furthermore, RMTG metabolism gradually decreased across the cognitive continuum, and its diagnostic efficiency was comparable (NC vs. ADD, aMCI, or DLB) or even superior (NC vs. SCD) to that of the metabolism of the posterior cingulate cortex or precuneus. Conclusions These findings suggest that the hypometabolism of RMTG could be a typical feature of SCD, and the large-scale hypometabolism in patients with symptomatic stages of AD may start from the RMTG, which gradually progresses starting in the preclinical stage. The specificity of identifying SCD from the perspective of self-perceived symptoms is likely to be increased by the detection of RMTG metabolism. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00811-w.
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Affiliation(s)
- Qiu-Yue Dong
- Key laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Information and Communication Engineering, Shanghai University, Shanghai, China
| | - Tao-Ran Li
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xue-Yan Jiang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China.,German Center for Neurodegenerative Diseases, Clinical Research group, Venusberg Campus 1, Building 99, Bonn, Germany
| | - Xiao-Ni Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China. .,School of Biomedical Engineering, Hainan University, Haikou, China. .,Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. .,National Clinical Research Center for Geriatric Disorders, Beijing, China.
| | - Jie-Hui Jiang
- Key laboratory of Specialty Fiber Optics and Optical Access Networks, Joint International Research Laboratory of Specialty Fiber Optics and Advanced Communication, School of Information and Communication Engineering, Shanghai University, Shanghai, China.
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Wu Q, Zhang P. Do response styles affect the predictive validity of self-rated health among Chinese older men and women? Qual Life Res 2020; 29:2275-2285. [PMID: 32207027 DOI: 10.1007/s11136-020-02484-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study intended to examine whether correcting for response styles of the widely used self-rated health (SRH) question would affect its predictive validity in estimating respondents' mortality risks. METHODS We used data on a sample of 3319 men and 3250 women aged 60 and above from a nationally representative survey in China. Response styles were estimated with both ratings on two health anchoring vignettes and self-rated items in domains unrelated to health. Gender-stratified logistic regressions were used to estimate the effects of SRH on 4-year mortality risks. We compared the results before and after adjusting for response styles. RESULTS In the unconditional model, the effects of the five-point SRH on 4-year mortality risks were significant in both older women and men, and stronger among Chinese older men based on discrete change in probabilities of mortality at means. Gender difference was observed in response styles. Men assigned lower ratings to the vignettes than women, reflecting their higher standards in defining good health. Women presented higher proportions of extreme responses and lower proportions of midpoint responses. Correcting for response styles had no effect on the predictive validity of SRH for Chinese older men, but had some positive effects for Chinese older women when no other covariates were included. CONCLUSION Adjusting for response styles contributed to a small improvement in predicting mortality risks only among Chinese older women under restricted conditions, but not men.
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Affiliation(s)
- Qiong Wu
- Peking University, Beijing, China.
- Peking University, 5 Yiheyuan Road, Science Building 5, Room 608A, Haidian, Beijing, 100871, China.
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Jessen F, Amariglio RE, Buckley RF, van der Flier WM, Han Y, Molinuevo JL, Rabin L, Rentz DM, Rodriguez-Gomez O, Saykin AJ, Sikkes SAM, Smart CM, Wolfsgruber S, Wagner M. The characterisation of subjective cognitive decline. Lancet Neurol 2020; 19:271-278. [PMID: 31958406 DOI: 10.1016/s1474-4422(19)30368-0] [Citation(s) in RCA: 630] [Impact Index Per Article: 157.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/22/2023]
Abstract
A growing awareness about brain health and Alzheimer's disease in the general population is leading to an increasing number of cognitively unimpaired individuals, who are concerned that they have reduced cognitive function, to approach the medical system for help. The term subjective cognitive decline (SCD) was conceived in 2014 to describe this condition. Epidemiological data provide evidence that the risk for mild cognitive impairment and dementia is increased in individuals with SCD. However, the majority of individuals with SCD will not show progressive cognitive decline. An individually tailored diagnostic process might be reasonable to identify or exclude underlying medical conditions in an individual with SCD who actively seeks medical help. An increasing number of studies are investigating the link between SCD and the very early stages of Alzheimer's disease and other neurodegenerative diseases.
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Affiliation(s)
- Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Rebecca E Amariglio
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Department of Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel F Buckley
- Department of Neurology, Brigham and Women's Hospital and Department of Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Florey Institute, University of Melbourne, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China; Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China; Beijing Institute of Geriatrics, Beijing, China; National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - José Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic, Barcelona, Spain; Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Laura Rabin
- Department of Psychology, Brooklyn College and The Graduate Center of CUNY, Brooklyn, NY, USA; Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Dorene M Rentz
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Department of Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Octavio Rodriguez-Gomez
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sietske A M Sikkes
- Department of Neurology, Brigham and Women's Hospital and Department of Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Colette M Smart
- Department of Psychology, University of Victoria, Victoria, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Victoria, BC, Canada
| | | | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Neurodegeneration and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
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Statucka M, Cohn M. Origins Matter: Culture Impacts Cognitive Testing in Parkinson's Disease. Front Hum Neurosci 2019; 13:269. [PMID: 31440150 PMCID: PMC6694800 DOI: 10.3389/fnhum.2019.00269] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Cognitive decline is common in Parkinson’s disease (PD), and precise cognitive assessment is important for diagnosis, prognosis, and treatment. To date, there are no studies in PD investigating cultural bias on neuropsychological tests. Clinical practice in multicultural societies such as, Toronto Canada where nearly half of the population is comprised of first generation immigrants, presents important challenges as most neuropsychological tools were developed in Anglosphere cultures (e.g., USA, UK) and normed in more homogeneous groups. We examine total scores and rates of deficits on tests of visuoperceptual/visuospatial, attention, memory, and executive functions in Canadians with PD born in Anglosphere countries (n = 248) vs. in Canadians with PD born in other regions (International group; n = 167). The International group shows lower scores and greater rates of deficits on all visuoperceptual and some executive function tasks, but not on attention or memory measures. These biases are not explained by demographic and clinical variables as groups were comparable. Age at immigration, years in Canada, and English proficiency also do not account for the observed biases. In contrast, group differences are strongly mediated by the Historical Index of Human Development of the participants’ country of birth, which reflects economic, health, and educational potential of a country at the time of birth. In sum, our findings demonstrate lasting biases on neuropsychological tests despite significant exposure to, and participation in, Canadian culture. These biases are most striking on visuoperceptual measures and non-verbal executive tasks which many clinicians still considered to be “culture-fair” despite the growing evidence from the field of cross-cultural neuropsychology to the contrary. Our findings also illustrate that socio-development context captures important aspects of culture that relate to cognition, and have important implications for clinical practice.
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Affiliation(s)
- Marta Statucka
- Krembil Brain Institute, Toronto Western Hospital UHN, Toronto, ON, Canada
| | - Melanie Cohn
- Krembil Brain Institute, Toronto Western Hospital UHN, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
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Li X, Wang X, Su L, Hu X, Han Y. Sino Longitudinal Study on Cognitive Decline (SILCODE): protocol for a Chinese longitudinal observational study to develop risk prediction models of conversion to mild cognitive impairment in individuals with subjective cognitive decline. BMJ Open 2019; 9:e028188. [PMID: 31350244 PMCID: PMC6661672 DOI: 10.1136/bmjopen-2018-028188] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Understanding the biological mechanism of subjective cognitive decline (SCD) in preclinical Alzheimer's disease (AD) and identifying those who will soon convert to mild cognitive impairment (MCI) are critical for developing appropriate strategies for early diagnosis and intervention of AD. We present the study protocol of the Sino Longitudinal Study on Cognitive Decline (SILCODE), a longitudinal observational study focusing on SCD in the context of AD. METHODS AND ANALYSIS Within SILCODE, approximately 800 subjects with SCD who are between 50 and 79 years old will be recruited through standardised public advertisements or memory clinics. They will undergo extensive assessment, including clinical and neuropsychological assessments, blood sample collection for plasma beta-amyloid and ApoE genotype, urine samples collection for AD7c-NTP, and multimodal MRI scans (structural MRI, diffusion tensor imaging, resting-state functional MRI and optional task-based functional MRI) as well as optional glucose metabolism and amyloid positron emission tomography. Subjects will be contacted by telephone every 3 months and interviewed, on average, every 15 months for 5 years. The study endpoint is the development of mild cognitive impairment or dementia. Jak & Bondi's actuarial neuropsychological method will be used for diagnosis of MCI. The least absolute shrinkage and selection operator logistic regression model followed by the sub-distribution hazard function model with death as a competing risk will be constructed to establish risk prediction models. ETHICS AND DISSEMINATION The ethics committee of the Xuanwu Hospital of Capital Medical University has approved this study protocol (ID: [2017]046). The results will be published in peer-reviewed journals and presented at national and international scientific conferences. TRIAL REGISTRATION NUMBER NCT03370744; Pre-results.
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Affiliation(s)
- Xuanyu Li
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiaoni Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Li Su
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Sino-Britain Centre for Cognition and Ageing Research, Faculty of Psychology, Southwest University, Chonging, China
| | - Xiaochen Hu
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Center of Alzheimer’s Disease, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Institute of Geriatrics, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Beijing, China
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13
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Self-report oral health and disease experience among adults in China and NZ. Clin Oral Investig 2018; 23:2123-2128. [DOI: 10.1007/s00784-018-2652-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 09/20/2018] [Indexed: 11/25/2022]
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Wu Q. Subjective cognitive impairment of older adults: a comparison between the US and China. Int J Methods Psychiatr Res 2016; 25:68-75. [PMID: 26756167 PMCID: PMC6877257 DOI: 10.1002/mpr.1499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 11/05/2015] [Accepted: 11/10/2015] [Indexed: 11/07/2022] Open
Abstract
Subjective assessment may be incomparable across countries due to differences in reporting styles. Based on two nationally representative surveys from the US and China, this study used data from three anchoring vignettes to estimate to what extent the US and Chinese older adults aged 50 and above differed in their reporting styles of subjective cognitive impairment. Cross country differences of subjective cognitive impairment were then estimated, both before and after adjusting for reporting heterogeneity. Directly assessed word recall test scores were analyzed to evaluate whether findings based on subjective cognitive impairment was consistent with objective performance. The results revealed a discrepancy between self-reported subjective cognitive impairment and directly assessed memory function among older adults: while Chinese respondents reported lower severity levels of subjective cognitive impairment, the US respondents demonstrated better performance in immediate word recall tests. By accounting for differences in reporting styles using anchoring vignettes data, Chinese older adults showed higher levels of subjective cognitive impairment than the US older adults, which was consistent with results from direct assessment of memory function. Non-negligible differences are present in reporting styles of subjective cognitive impairment. Cross country comparison needs to take into account such reporting heterogeneity.
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Affiliation(s)
- Qiong Wu
- Institute of Social Science Survey, Peking University, Beijing, China
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