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Kang JM, Kim N, Yun SK, Seo HE, Bae JN, Kim WH, Na KS, Cho SE, Ryu SH, Noh Y, Youn JH, Kang SG, Lee JY, Cho SJ. Exploring transfer effects on memory and its neural mechanisms through a computerized cognitive training in mild cognitive impairment: randomized controlled trial. Psychogeriatrics 2024; 24:1075-1086. [PMID: 39014538 DOI: 10.1111/psyg.13161] [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: 05/05/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Computerized cognitive training (CCT) has been proposed as a potential therapy for cognitive decline. One of the benefits of CCT is a transfer effect, but its mechanism on the memory domain is unclear. This study aimed to investigate the transfer effect of non-memory multidomain CCT on the memory domain and its neural basis in patients with mild cognitive impairment (MCI) through a randomized controlled trial. METHODS Patients with MCI recruited from memory clinics were randomly assigned to either the CCT or the control group. The CCT group received multidomain CCT training excluding memory training, while the control group read educational books with learning-based quizzes twice a week for 8 weeks. Participants underwent memory tests yielding a composite score, other cognitive domain tests, non-cognitive scales, and resting-state functional magnetic resonance imaging (rsfMRI), at baseline and after intervention. Within- and between-group comparisons, group × time interactions, and seed-to-voxel analyses in memory-involving brain networks were performed. RESULTS The CCT group showed improvement over the control group in memory domain (Group × time, F = 5.87, P = 0.03, η2 = 0.31), which was related with the increased connectivity in the hippocampal-frontal and fusiform-occipital network. No other cognitive and non-cognitive symptoms differed between groups after adjusting for covariates. CONCLUSION Eight weeks of multidomain CCT without memory training improved memory function and restored functional network in the hippocampal and medial temporal region in MCI patients. These results can provide evidence for the transferring ability of CCT on memory functioning with its neural basis.
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Affiliation(s)
- Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Nambeom Kim
- Department of Big Data & AI Master Business Administration, Sejong University, Seoul, Republic of Korea
| | - Seon Kyung Yun
- Department of Nursing, Saekyung University, Yeongwol, Republic of Korea
| | - Ha-Eun Seo
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jung-Hae Youn
- Department of Counselling Psychology, Cha University, Seongnam, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Huang LW, Shi Y, Boscardin WJ, Steinman MA. Cognitive Trajectories in Older Adults Diagnosed With Hematologic Malignant Neoplasms. JAMA Netw Open 2024; 7:e2431057. [PMID: 39212987 PMCID: PMC11365001 DOI: 10.1001/jamanetworkopen.2024.31057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024] Open
Abstract
Importance More people are surviving long-term after diagnosis with hematologic malignant neoplasm (HMN), yet there are limited data on cancer-related cognitive impairment in people with HMN. Better understanding cognitive outcomes after HMN in older adults is important for patient counseling and management. Objective To model cognitive trajectories and rates of cognitive decline before and after HMN diagnosis in older adults compared with a matched noncancer cohort. Design, Setting, and Participants In this population-based cohort study, older adults from the Health and Retirement Study (HRS) diagnosed with HMN between 1998 and 2016 after age 65 years were matched 1:3 to participants without cancer from the same HRS wave using propensity scores incorporating variables relevant to cognition. Cognitive trajectories were modeled with piecewise linear splines, and rates of cognitive decline before, during, and after diagnosis were compared in the 2 groups. Data were analyzed from April 2022 to April 2024. Exposures HMN diagnosis by Medicare diagnosis codes. Main Outcomes and Measures Cognitive function was assessed by the Langa-Weir cognitive summary score from 1992 to 2020. Sociodemographic and health-related variables relevant to cognition were incorporated into propensity scores. Results At baseline, there were 668 participants in the HMN cohort (mean [SD] age, 76.8 [7.6] years; 343 [51.3%] male; 72 [10.8%] Black, 33 [4.9%] Hispanic, and 585 [87.6%] White) and 1994 participants in the control cohort (mean [SD] age, 76.5 [7.3] years; 1020 [51.2%] male; 226 [11.3%] Black, 91 [4.6%] Hispanic, and 1726 [86.6%] White). The HMN cohort consisted predominantly of more indolent diagnoses, and only 96 patients (14.4%) received chemotherapy. Before and in the 2 years around the time of diagnosis, the HMN and control cohorts had similar rates of cognitive decline. At 1 year postdiagnosis and beyond, the rate of cognitive decline was slower in the HMN cohort (-0.18; 95% CI, -0.23 to -0.14) than in the control group (-0.24; 95% CI, -0.26 to -0.23) (P = .02), but this difference was no longer significant after accounting for the competing risk of death (HMN group, -0.27; 95% CI, -0.34 to -0.19; control group, -0.30; 95% CI, -0.33 to -0.27; P = .48). Conclusions and Relevance In this cohort study of older adults, the HMN and matched noncancer control cohorts had similar rates of cognitive decline before, during, and after diagnosis after accounting for the competing risk of death.
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Affiliation(s)
- Li-Wen Huang
- Division of Hematology/Oncology, Department of Medicine, San Francisco Veterans Affairs Medical Center, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Ying Shi
- Division of Geriatrics, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - W. John Boscardin
- Division of Geriatrics, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Michael A. Steinman
- Division of Geriatrics, University of California San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
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Cheng S, Yin R, Wu K, Wang Q, Zhang H, Ling L, Chen W, Shi L. Trajectories and influencing factors of cognitive function and physical disability in Chinese older people. Front Public Health 2024; 12:1380657. [PMID: 39026589 PMCID: PMC11256785 DOI: 10.3389/fpubh.2024.1380657] [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: 02/01/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Dementia and physical disability are serious problems faced by the aging population, and their occurrence and development interact. Methods Based on data from a national cohort of Chinese people aged 60 years and above from the China Health and Retirement Longitudinal Survey from 2011 to 2018, we applied the group-based trajectory model to identify the heterogeneous trajectories of cognitive function and physical disability in participants with different physical disability levels. Next, multinomial logistic regression models were used to explore the factors affecting these trajectories. Results The cognitive function trajectories of the Chinese older people could be divided into three characteristic groups: those who maintained the highest baseline level of cognitive function, those with a moderate baseline cognitive function and dramatic progression, and those with the worst baseline cognitive function and rapid-slow-rapid progression. The disability trajectories also fell into three characteristic groups: a consistently low baseline disability level, a low initial disability level with rapid development, and a high baseline disability level with rapid development. Compared with those free of physical disability at baseline, a greater proportion of participants who had physical disability at baseline experienced rapid cognitive deterioration. Education, income, type of medical insurance, gender, and marital status were instrumental in the progression of disability and cognitive decline in the participants. Discussion We suggest that the Chinese government, focusing on the central and western regions and rural areas, should develop education for the older people and increase their level of economic security to slow the rate of cognitive decline and disability among this age group. These could become important measures to cope with population aging.
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Affiliation(s)
- Shuyuan Cheng
- International Cooperation and Exchange Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Health Policy and Management Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Rong Yin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kunpeng Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Chang CW, Tan CH, Hong WP, Yu RL. GBA moderates cognitive reserve's effect on cognitive function in patients with Parkinson's disease. J Neurol 2024; 271:4392-4405. [PMID: 38656622 DOI: 10.1007/s00415-024-12374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Cognitive reserve (CR) involves an individual's ability to maintain cognitive vitality over their lifespan. Glucocerebrosidase (GBA) gene mutations contribute to additional effects on cognitive function in Parkinson's disease (PD) patients, but the interplay between GBA mutations and CR remains unclear. We investigated the interactions among CR, GBA, and diseases, aiming to examine whether the CR established at different stages interacts with specific genotypes to affect cognitive function. METHODS Three hundred and eighteen participants' CR indicators (i.e., education, occupation, and social function) and comprehensive neuropsychological function (i.e., tests for executive function, attention/working memory, visuospatial function, memory, and language) were evaluated. RESULTS We found that CR established in a specific life stage influences the individual's cognitive function, particularly in PD, based on their distinct GBA rs9628662 genotypes. Attention/working memory and memory performance are affected by occupational complexity in midlife in PD patients with the GG genotype (q < 0.0001; q < 0.0001) and healthy adults with the T genotype (q = 0.0440; q < 0.0001). Language is influenced by early education and occupation, and the effects of occupation are also observed in PD patients with the GG genotype (q = 0.0040) and in healthy adults carrying the T genotype (q = 0.0040). CONCLUSIONS CR, established at different life stages, can be influenced by the GBA rs9628662 genotype, impacting later-life cognition. Validating genotypes and incorporating genotype information when assessing cognitive reserve effects is crucial and can enhance targeted cognitive training.
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Affiliation(s)
- Chia-Wen Chang
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsiang Tan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Pin Hong
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Office of Strategic Planning, National Cheng Kung University, Tainan, Taiwan.
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Chen X, Ding J, Shi Z, Bai K, Shi S, Tian Q. Association of longitudinal trajectories of fasting plasma glucose with all-cause and cardiovascular mortality among a Chinese older population: a retrospective cohort study. BMC Public Health 2024; 24:1335. [PMID: 38760762 PMCID: PMC11102116 DOI: 10.1186/s12889-024-18823-0] [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: 03/05/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024] Open
Abstract
The association between fasting plasma glucose (FPG), an important indicator of overall glycemic status, and the risk of cardiovascular mortality has been well investigated. The longitudinal study can repeatedly collect measured results for the variables to be studied and then consider the potential effects of intraindividual changes in measurement. This study aimed to identify long-term FPG trajectories and investigate the association between trajectory groups and cardiovascular and all-cause mortality. A latent class growth mixture modeling (LCGMM) was used to identify FPG trajectories. Cox proportional hazard models were used to estimate associations between FPG trajectories and the risk of all-cause and cardiovascular mortality. A U-shaped relationship between FPG and all-cause and cardiovascular mortality was observed in the restricted cubic spline regression models. Two FPG longitudinal trajectories of low-level (mean FPG = 5.12mmol/L) and high-level (mean FPG = 6.74mmol/L) were identified by LCGMM. After being adjusted for potential confounders, compared with the low-level category, the hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.23(1.16-1.30) and 1.25(1.16-1.35), respectively, for the high-level group. Long-term FPG trajectories are significantly associated with and potentially impact the risk of all-cause and cardiovascular mortality.
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Affiliation(s)
- Xuejiao Chen
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jiacheng Ding
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhan Shi
- Department of pharmacy, Zhengzhou people's hospital, Zhengzhou, Henan, People's Republic of China
| | - Kaizhi Bai
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Songhe Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qingfeng Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Yang J, Zhou C, Li H. Effects of lifestyle and its interaction with anemia on cognitive function in older adults: A longitudinal study. Psych J 2024; 13:242-251. [PMID: 38105563 PMCID: PMC10990814 DOI: 10.1002/pchj.712] [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: 07/26/2023] [Accepted: 10/22/2023] [Indexed: 12/19/2023]
Abstract
A better understanding of the impact of lifestyle factors on cognitive function in older adults is critical for developing intervention strategies to achieve successful aging. Moreover, older adults who fulfill the World Health Organization criteria for anemia have a significantly higher risk of developing dementia. In the current study, we aimed to assess the buffering effects of lifestyle on cognitive function in older Chinese adults through a nationally representative survey. The sample consisted of 1201 participants (mean age: 82.39 ± 12.08 years, 52.1% female) from the 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Multiple linear regression analyses were used to explore the relationship between changes in lifestyle factors and the rate of cognitive function changes, as well as the effects of the interaction between lifestyle factors and anemia on cognitive function changes. Increased levels of participation in leisure activities, social activities, and dietary diversity delayed cognitive decline. Persistent anemia accelerated cognitive decline, while frequent participation in leisure activities delayed cognitive decline due to anemia. The increased levels of participation in leisure activities, social activities, and dietary diversity can alleviate the cognitive decline caused by aging itself, and more frequently participation in leisure activities can also alleviate the adverse effects of anemia on cognitive function in older adults.
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Affiliation(s)
- Jia Yang
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
- Zhejiang Museum of Natural HistoryHangzhouChina
| | - Chen Zhou
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Hui‐Jie Li
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
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Yu B, Jia P, Dou Q, Yang S. Toward a prognostic model for all-cause mortality among old people with disability in long-term care in China. Arch Gerontol Geriatr 2024; 119:105324. [PMID: 38266531 DOI: 10.1016/j.archger.2023.105324] [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: 09/16/2023] [Revised: 11/19/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Current prognostic model of all-cause mortality may not be applicable for old people with disability in long-term care due to the absence of injury- and care-related predictors. We aimed to develop a prognostic model specifically tailored to this population, based on comprehensive predictors. METHOD We conducted a prospective study involving 41,004 participants aged ≥60 with disability in long-term care across 16 study sites in Southwest China from 2017 to 2021. Participants' demographics, clinical characteristics, disability status, and injury- and care-related information at baseline were used as candidate predictors. We employed a LASSO Cox regression model to develop the prognostic model using the training set (70 % of participants), and the predictive performance was validated in the validation set (30 % of participants). The prognostic index (PI) scores of the prognostic model were used to quantify mortality risk. RESULTS At the end of the 4-year follow-up, 17,797 deaths (43.4 %) were observed. The prognostic model revealed several powerful and robust predictors of mortality across the total sample and subgroups, including higher age, living with comorbidities, physical and perceptual disability, and living with pressure sores. Non-professional care was an additional predictor in older participants. The risk of death for participants in the highest quartile of PI scores was approximately four-fold higher compared to those in the lowest quartile. CONCLUSIONS We developed and validated a prognostic model that can be practically utilized to identify individuals and populations at risk of death among old people with disability in long-term care.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University- The Hong Kong Polytechnic University, Chengdu, China; 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; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, 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; Respiratory Department, Chengdu Seventh People's Hospital, Chengdu, China.
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Feldberg C, Barreyro JP, Quián MDR, Hermida PD, Ofman SD, Irrazabal NC, Tartaglini MF, Serrano C. Occupational complexity of paid work and housework, and its impact on the cognitive performance in community dwelling older adults, preliminary results. Dement Neuropsychol 2024; 18:e20230038. [PMID: 38469121 PMCID: PMC10926987 DOI: 10.1590/1980-5764-dn-2023-0038] [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: 06/10/2023] [Accepted: 11/22/2023] [Indexed: 03/13/2024] Open
Abstract
Work and activity could be an important source of cognitive enrichment. Activities that are more challenging concerning the cognitive functions that are put into practice are associated with lower risk of cognitive decline in old age. Objective The present study aimed to assess the impact of occupational complexity and household tasks in three cognitive domains (verbal episodic memory, language, and executive functions) in older adults residing within the community. Methods A trail analysis was executed, using the structural equations procedure in 120 participants assessed with main lifetime occupational activity and household tasks questionnaire, as well as a neuropsychological assessment battery for memory, language, and executive functions. Results The regression weights analysis indicated that complexity in household chores showed moderate effects on executive functions (β=0.19; p=0.027) and that occupational complexity of paid work showed effects on memory (β=0.26; p=0.008), language (β=0.38; p<0.001), and executive functions (β=0.55; p<0.001). Conclusion Paid work promotes cognitive reserve, contrary to household activities which seem to have a moderate impact on cognition. Differences in activity complexity not only impact people´s economic and social status and possibilities but can also determine different courses of aging and cognitive risk.
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Affiliation(s)
- Carolina Feldberg
- Instituto de Neurociencias Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Capital Federal, Buenos Aires, Argentina
| | - Juan Pablo Barreyro
- Universidad de Buenos Aires, Facultad de Psicología, Consejo Nacional de Investigaciones Científicas y Técnicas, Capital Federal, Buenos Aires, Argentina
| | | | - Paula Daniela Hermida
- Instituto de Neurociencias Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Capital Federal, Buenos Aires, Argentina
| | - Silvia Deborah Ofman
- Instituto de Neurociencias Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Capital Federal, Buenos Aires, Argentina
| | - Natalia Carolina Irrazabal
- Universidad de Palermo, Facultad de Ciencias Sociales, Consejo Nacional de Investigaciones Científicas y Técnicas, Capital Federal, Buenos Aires, Argentina
| | - María Florencia Tartaglini
- Instituto de Neurociencias Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Capital Federal, Buenos Aires, Argentina
| | - Cecilia Serrano
- Instituto de Neurociencias Buenos Aires, Capital Federal, Buenos Aires, Argentina
- Hospital César Milstein, Servicio de Neurología Cognitiva, Capital Federal, Buenos Aires, Argentina
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Miller LR, Reed C, Divers R, Calamia M. Baseline Differences in Driving Frequency as a Predictor of Cognitive Decline and Alzheimer's Disease. J Geriatr Psychiatry Neurol 2024; 37:14-23. [PMID: 37148269 DOI: 10.1177/08919887231175436] [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: 05/08/2023]
Abstract
OBJECTIVE To extend prior research by examining daily driving frequency as a predictor of cognitive decline and later diagnosis of Alzheimer's disease. METHODS 1,426 older adults completed batteries of questionnaires and neuropsychological tests at baseline and yearly follow-ups (M = 6.8, SD = 4.9). Linear mixed effects models were estimated to examine whether daily driving frequency at baseline was predictive of cognitive decline while accounting for IADLs, mobility, depression, and demographics. Cox regression was used to examine driving frequency as a predictor of Alzheimer's disease diagnosis. RESULTS Less daily driving frequency was associated with greater decline in all cognitive domains over time except for working memory. Although driving frequency was associated with these changes in cognition, it did not uniquely predict the development of Alzheimer's disease when accounting for other factors (eg, other IADLs). CONCLUSIONS Our findings extend prior research linking driving cessation to greater levels of cognitive decline. Future work might benefit from examining the utility of driving habits (especially changes in driving) as measures of everyday functioning in older adult evaluations.
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Affiliation(s)
- Luke R Miller
- Department of Psychology, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, LA, USA
| | - Christopher Reed
- Department of Psychology, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, LA, USA
| | - Ross Divers
- Department of Psychology, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, LA, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, LA, USA
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Zheng W, Mu J, Yan Y, Chu C, Su X, Man Z, Zhang W, Luo D. Associations of blood pressure trajectories in early life with target organ damage in midlife : a 30-year cohort study. Hypertens Res 2023; 46:2613-2621. [PMID: 37553520 DOI: 10.1038/s41440-023-01387-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023]
Abstract
Hypertension is a pivotal factor in cardiovascular risk. However, the association of longitudinal blood pressure (BP) trajectories in the early life and cardiovascular risk assessed by target organ damage (TOD) in adulthood is poorly reported. The objective of this study was to identify the association between systolic BP, diastolic BP, and mean atrial pressure (MAP) trajectories early in life with a single or multiple TOD in later life. We identified BP trajectories from 6 to 45 year-old using group-based trajectory models among 2430 individuals in the Hanzhong Adolescent Hypertension Study and examined the relationship between BP trajectories and cardiovascular risk in later life. Four discrete long-term systolic BP, diastolic BP, and MAP trajectories were identified, namely, low stable, moderate stable, high stable (low increasing), and moderate increasing groups, based on the BP levels at baseline and in the 30-year follow-up. The carotid intima-media thickness were higher in persistently high or increasing trajectories in comparison to the low stable group. Individuals with deteriorative trajectories during early life were at an increased risk of suffering from a single TOD, including left ventricular hypertrophy (LVH) and carotid atherosclerosis (CA) in middle age (36-49 years old). Moreover, higher BP trajectories were correlated with the presence of combined TODs load stage which were assessed by CA, LVH, arteriosclerosis and subclinical renal damage (SRD). Higher longitudinal BP trajectories early in life were associated with increased cardiovascular risk in midlife, and identifying BP trajectories in early life can help screen individuals with TOD later. LVH, left Ventricular Hypertrophy; CA, carotid atherosclerosis; SRD, subclinical renal damage; TOD, target organ damage.
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Affiliation(s)
- Wenling Zheng
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University and Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, PR China
- Department of Geriatric-Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jianjun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University and Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, PR China.
| | - Yu Yan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University and Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, PR China
| | - Chao Chu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University and Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, PR China
| | - Xianming Su
- Department of Geriatric-Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Ziyue Man
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University and Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, PR China
| | - Wei Zhang
- Department of Geriatric-Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Dan Luo
- Department of Geriatric-Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
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Wang L, Ren L, Wang Y, Ji Z, Zhu R, Sun Y, Li J, Zhang L. Effect of body mass index trajectory on hypertension among children and adolescents aged 5-18 years: a retrospective cohort study. Ann Med 2023; 55:2267572. [PMID: 37844207 PMCID: PMC10580793 DOI: 10.1080/07853890.2023.2267572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Hypertension has become increasingly prevalent in Chinese children and adolescents in recent decades, which affects growth and development of children, leads to cognitive decline and multiple target organ damage. Here, we assessed the impact of different body mass index (BMI) trajectories on the occurrence of hypertension in children and adolescents using a cohort study in Northeast China. MATERIALS AND METHODS Children and adolescents aged 5-18 years was extracted for physical examination in Fuxin City, Liaoning Province, China during the 2009-2015 period. A latent category growth mixed model (LCGMM) was used to classify BMI changes and analyze the effect of different BMI trajectories on the risk of occurrence of hypertension in these participants within 5 years. RESULTS All participates were divided into five BMI trajectories by LCGMM method: slow increasing group (n = 2616, 30.8%), overweight and obesity (OW/OB) group (n = 1141, 13.4%), normal decreasing group (n = 232, 2.7%), stable normal group (n = 4383, 51.6%), and fast-increasing group (n = 120, 1.4%). Compared with the stable normal group, the slow increasing group [adjusted odds ratio (AOR): 1.610, 95% confidence interval (CI): 1.304-1.989], the OW/OB group (AOR: 3.172, 95% CI: 2.500-4.023) and the fast-increasing group (AOR: 2.708, 95% CI: 1.445-5.074) all increased the risk of developing hypertension in children and adolescents. CONCLUSION The potential of developing hypertension varies among groups of children aged 5-18 with different BMI trajectories. Children and adolescents in the normal BMI range (the slow growth group) still need to be aware of the change in BMI trajectory to stop or slow down the progression of BP abnormalities.
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Affiliation(s)
- Lu Wang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Longbing Ren
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Yuzhu Wang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Zixiang Ji
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Rongyu Zhu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jue Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Lijuan Zhang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Tongji University, Shanghai, China
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Frank CC, Mundy LM, Smith J. Life course engagement in enriching activities: When and how does it matter for cognitive aging? Psychol Aging 2023; 38:263-276. [PMID: 37067480 PMCID: PMC10238678 DOI: 10.1037/pag0000744] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Growing evidence suggests that participation in enriching activities (physical, social, and mental) across the life course is beneficial for cognitive functioning in older age. However, few studies have examined the effects of enrichment across the entire life course within the same participants. Using 2,931 participants in the Health and Retirement Study, we linked self-report data from later life and retrospective self-report data from early life and midlife to cognitive performance after Age 65. We categorized participants as having either high (top ∼25%) or average to low (bottom ∼75%) level of enrichment during each life period. Thus, eight groups were identified that reflected unique patterns of enrichment during early, mid, and later life (e.g., high-high-high). Using growth curve modeling, we found that life course enrichment patterns predicted both cognitive functioning and the rate of cognitive decline across five time points spanning 8 years (Aim 1). Groups with high enrichment during at least one life period had higher performance and slower decline in older age, compared to those who had average to low levels of enrichment throughout all three life periods. We also found that high enrichment during each life period independently predicted better cognitive performance and that high enrichment during early and later life also predicted slower cognitive decline (Aim 2). These findings support the idea that high enrichment is beneficial for cognition in later life and that the effects are long-lasting, even when individuals are inconsistent in enrichment engagement throughout the entire life course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Jacqui Smith
- Institute for Social Research, University of Michigan
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Duan X, Dang Y, Kang C, Rong P, Yan M, Zhang S, Cui J, Zhao Y, Chen F, Zhou J, Wang D, Pei L. Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study. Front Aging Neurosci 2023; 15:1084136. [PMID: 36845661 PMCID: PMC9950264 DOI: 10.3389/fnagi.2023.1084136] [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: 10/30/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Objectives This study aimed to investigate the relationship between long-term trajectories of changes in cardiovascular risk factors (CVRFs) and the risk of cognitive impairment among Chinese adults over 60 years old. Methods Data were obtained from the Chinese Longitudinal Healthy Longevity Survey 2005-2018. Cognitive function was evaluated longitudinally through the Chinese version of the Mini-Mental State Examination (C-MMSE), and cognitive impairment (C-MMSE ≤23) was used as the main outcome variable. The cardiovascular risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and body mass index (BMI), were continuously measured in the follow-up duration. The patterns of trajectories of changes in CVRFs were derived from the latent growth mixture model (LGMM). The Cox regression model was used to evaluate the cognitive impairment hazard ratio (HR) across different CVRF trajectories. Results A total of 5,164 participants aged ≥60 years with normal cognitive function at baseline were included in the study. After a median follow-up of 8 years, 2,071 participants (40.1%) developed cognitive impairment (C-MMSE ≤ 23). The four-class trajectories of SBP and BMI were obtained by means of LGMM, and the trajectories of DBP, MAP, and PP were grouped into a three-class subgroup. In the final adjusted Cox model, the lowered SBP [adjusted HR (aHR): 1.59; 95% CI: 1.17-2.16], lowered PP (aHR: 2.64; 95% CI: 1.66-4.19), and progressively obese (aHR: 1.28; 95% CI: 1.02-1.62) and stable slim (aHR: 1.13; 95% CI: 1.02-1.25) were associated with the higher risk of cognitive impairment. Low stable DBP (aHR: 0.80; 95% CI: 0.66-0.96) and elevated PP (aHR: 0.76; 95% CI: 0.63-0.92) decreased the risk for cognitive impairment among participants. Conclusion Lowered SBP, lowered PP, progressive obesity, and stable slim increased the risk for cognitive impairment in the Chinese elderly. Low stable DBP and elevated PP were protective against cognitive impairment, but more DBP lowering and ≥25 mmHg growth in PP contributed to a higher risk of cognitive impairment. The findings have important implications for preventing cognitive impairment in elder adults based on the long-term trajectories of changes in CVRFs.
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Affiliation(s)
- Xinyu Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yusong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Chenxi Kang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Peixi Rong
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Mingxin Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shutong Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jing Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yaling Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Fangyao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jing Zhou
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Duolao Wang
- Biostatistics Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom,Department of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Leilei Pei
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China,*Correspondence: Leilei Pei, ✉
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Del Bene VA, Gerstenecker A, Lazar RM. Formal Neuropsychological Testing: Test Batteries, Interpretation, and Added Value in Practice. Clin Geriatr Med 2023; 39:27-43. [PMID: 36404031 DOI: 10.1016/j.cger.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neuropsychologists evaluate patients for cognitive decline and dementia, using validated psychometric tests, along with behavioral observation, record review, clinical interview, and information about psychological functioning, to evaluate brain-behavior relationships and aid in differential diagnosis and treatment planning. Also considered are premorbid functioning, education, sex, socioeconomic status, primary language, culture, and race-related health disparities when selecting tests, interpreting performance, and providing a diagnostic impression. Neuropsychologists provide diagnostic clarity, explain symptoms and likely disease course to patients and family members, and assist the family with future planning, behavioral management strategies, and ways to mitigate caregiver burden.
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Affiliation(s)
- Victor A Del Bene
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA
| | - Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA
| | - Ronald M Lazar
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA; Department of Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35294, USA.
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15
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The association between different dimensions of social capital and cognition among older adults in China. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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16
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Ding J, Chen X, Shi Z, Bai K, Shi S. Association of body roundness index and its trajectories with all-cause and cardiovascular mortality among a Chinese middle-aged and older population: A retrospective cohort study. Front Public Health 2023; 11:1107158. [PMID: 37033022 PMCID: PMC10076882 DOI: 10.3389/fpubh.2023.1107158] [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: 11/24/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives The body roundness index (BRI) is a novel anthropometric index that is a better indicator for predicting fat distribution than the body mass index (BMI). The longitudinal study can repeatedly collect measured results for the variables to be studied and then consider the potential effects of intraindividual changes in measurement. However, few population-based, longitudinal studies of BRI have been conducted, especially among the Chinese population. The study aimed to investigate the association of BRI and its longitudinal trajectories with all-cause and cardiovascular mortality. Methods A total of 71,166 participants with four times BRI measurements between January 2010 and December 2019 were included in this longitudinal study, with a median follow-up was 7.93 years, and 11,538 deaths were recorded, of which 5,892 deaths were due to cardiovascular disease (CVD). A latent class growth mixture modeling (LCGMM) was used to identify BRI trajectories. Cox proportional hazard models were used to estimate associations between BRI trajectories and the risk of all-cause and cardiovascular mortality. Results In the restricted cubic spline regression models, a U-shaped relationship between BRI and all-cause and cardiovascular mortality was observed. Three BRI longitudinal trajectories of low-stable (mean BRI = 2.59), moderate-stable (mean BRI = 3.30), and high-stable (mean BRI = 3.65) were identified by LCGMM. After being adjusted for potential confounders, the HRs for all-cause mortality were 1.18 (1.13-1.24) for the moderate-stable group and 1.74 (1.66-1.82) for the high-stable group compared to the low-stable group. The HRs for cardiovascular mortality were 1.12 (1.05-1.18) for the moderate-stable group and 1.64 (1.53-1.75) for the high-stable group compared to the low-stable group. Conclusion A nonlinear association of BRI with all-cause and cardiovascular mortality was observed, and participants in the higher BRI longitudinal trajectory group were significantly associated with an increased risk of all-cause and cardiovascular mortality.
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Affiliation(s)
- Jiacheng Ding
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xuejiao Chen
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhan Shi
- Department of Pharmacy, Zhengzhou People’s Hospital, Zhengzhou, Henan, China
| | - Kaizhi Bai
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Songhe Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- *Correspondence: Songhe Shi,
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Wu Z, Woods RL, Chong TTJ, Orchard SG, Shah RC, Wolfe R, Storey E, Sheets KM, Murray AM, McNeil JJ, Ryan J. Cognitive Trajectories in Community-Dwelling Older Adults and Incident Dementia, Disability and Death: A 10-Year Longitudinal Study. Front Med (Lausanne) 2022; 9:917254. [PMID: 35833102 PMCID: PMC9271785 DOI: 10.3389/fmed.2022.917254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe inter-individual variability in cognitive changes may be early indicators of major health events. We aimed to determine whether late-life cognitive trajectories were associated with incident dementia, persistent physical disability and all-cause mortality.MethodsData came from a cohort of older community-dwelling individuals aged 70 years or above in Australia and the United States. Global cognition, verbal fluency, episodic memory and psychomotor speed were assessed regularly at up to seven waves between 2010 and 2017. Dementia, disability in activities of daily living, and death were adjudicated between 2017 and 2020. Latent classes of cognitive trajectories over seven years were determined using group-based trajectory modeling. Multivariable logistic regression was used for the prospective associations between cognitive trajectories and these outcomes.ResultsCognitive trajectories were defined for 16,174 participants (mean age: 78.9 years; 56.7% female) who were alive and without incident dementia or disability by 2017, among which 14,655 participants were included in the association analysis. Between three and five trajectory classes were identified depending on the cognitive test. Cognitive trajectories were strongly associated with the risk of dementia. For example, compared to those in the highest-functioning trajectory, the worst performers of episodic memory had a 37-fold increased risk of dementia (95% CI: 17.23–82.64). The lowest trajectories of both global cognition and episodic memory also predicted increased mortality risk (OR: 1.80, 95% CI: 1.28–2.52; OR: 1.61, 95% CI: 1.09–2.36, respectively), while only slow psychomotor speed was marginally associated with physical disability (OR: 2.39, 95% CI: 0.99–5.77).ConclusionsIn older individuals, cognitive trajectories appear to be early indicators of clinically relevant health outcomes. Systematic cognitive assessments as part of routine geriatric evaluation may facilitate early identification and interventions for those individuals at highest risk.
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Affiliation(s)
- Zimu Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Trevor T. J. Chong
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Clinical Neurosciences, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kerry M. Sheets
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- *Correspondence: Joanne Ryan
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Soares PSM, Gonzalez TN, Paludo CDS, Meucci RD. The Role of Physical Vulnerability in the Association Between Social Activities and Cognitive Performance in Rural Older Adults: A Longitudinal Study. Int J Aging Hum Dev 2022:914150221109917. [PMID: 35730138 DOI: 10.1177/00914150221109917] [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: 11/15/2022]
Abstract
The aim of this study was to examine the association of social activities with cognitive performance in older adults in the southern area of Brazil, considering the important moderating role of physical vulnerability. A prospective population-based study was conducted in the rural area of Rio Grande, Rio Grande do Sul, Brazil. Self-reported social activities were collected at baseline. Cognitive performance and physical vulnerability were measured in the second wave of data collection. The association of social activities with cognitive performance was determined using robust generalized linear models. In adjusted analysis, the social activities were positively associated with cognitive performance in physically vulnerable older adults. However, this association was not found in those who were nonvulnerable. Our findings may contribute to future investigations of possible explanatory avenues for the association between social activities and cognitive performance as well as the development of interventions aimed at improving cognitive skills.
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Affiliation(s)
- Pedro San Martin Soares
- Programa de Pós-Graduação em Epidemiologia, 37902Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Tatiane Nogueira Gonzalez
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Cristina Dos Santos Paludo
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Rodrigo Dalke Meucci
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
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Qiu J, Zhou C, Xiang S, Dong J, Zhu Q, Yin J, Lu X, Xiao Z. Association Between Trajectory Patterns of Body Mass Index Change Up to 10 Months and Early Gut Microbiota in Preterm Infants. Front Microbiol 2022; 13:828275. [PMID: 35572657 PMCID: PMC9093742 DOI: 10.3389/fmicb.2022.828275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Recent research suggests that gut microbiota plays an important role in the occurrence and development of excessive weight and obesity, and the early-life gut microbiota may be correlated with weight gain and later growth. However, the association between neonatal gut microbiota, particularly in preterm infants, and excessive weight and obesity remains unclear. To evaluate the relationship between gut microbiota and body mass index (BMI) growth trajectories in preterm infants, we examined microbial composition by performing 16S rDNA gene sequencing on the fecal samples from 75 preterm infants within 3 months after birth who were hospitalized in the neonatal intensive care unit of Hunan Children’s Hospital from August 1, 2018 to October 31, 2019. Then, we collected their physical growth information during 0–10 months. Latent growth mixture models were used to estimate growth trajectories of infantile BMI, and the relationship between the gut microbiota and the BMI growth trajectories was analyzed. The results demonstrated that there were 63,305 and 61 operational taxonomic units in the higher BMI group (n = 18), the lower BMI group (n = 51), and the BMI catch-up group (n = 6), respectively. There were significant differences in the abundance of the gut microbiota, but no significant differences in the diversity of it between the lower and the higher BMI group. The BMI growth trajectories could not be clearly distinguished because principal component analysis showed that gut microbiota composition among these three groups was similar. The three groups were dominated by Firmicutes and Proteobacteria in gut microbiota composition, and the abundance of Lactobacillus in the higher BMI group was significantly different from the lower BMI group. Further intervention experiments and dynamic monitoring are needed to determine the causal relationship between gut microbiota differences and the BMI change.
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Affiliation(s)
- Jun Qiu
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | - Changci Zhou
- Academy of Pediatrics, Hengyang Medical School, University of South China, Hengyang, China
| | - Shiting Xiang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | - Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | - Qifeng Zhu
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jieyun Yin
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Xiulan Lu
- Department of Intensive Care Unit, Hunan Children's Hospital, Changsha, China
| | - Zhenghui Xiao
- Department of Intensive Care Unit, Hunan Children's Hospital, Changsha, China
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Longitudinal associations between cancer history and cognitive functioning among older adults. Arch Gerontol Geriatr 2021; 97:104521. [DOI: 10.1016/j.archger.2021.104521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/23/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022]
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Kyheng M, Babykina G, Ternynck C, Devos D, Labreuche J, Duhamel A. Joint latent class model: Simulation study of model properties and application to amyotrophic lateral sclerosis disease. BMC Med Res Methodol 2021; 21:198. [PMID: 34592944 PMCID: PMC8482570 DOI: 10.1186/s12874-021-01377-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background In many clinical applications, evolution of a longitudinal marker is censored by an event occurrence, and, symmetrically, event occurrence can be influenced by the longitudinal marker evolution. In such frameworks joint modeling is of high interest. The Joint Latent Class Model (JLCM) allows to stratify the population into groups (classes) of patients that are homogeneous both with respect to the evolution of a longitudinal marker and to the occurrence of an event; this model is widely employed in real-life applications. However, the finite sample-size properties of this model remain poorly explored. Methods In the present paper, a simulation study is carried out to assess the impact of the number of individuals, of the censoring rate and of the degree of class separation on the finite sample size properties of the JLCM. A real-life application from the neurology domain is also presented. This study assesses the precision of class membership prediction and the impact of covariates omission on the model parameter estimates. Results Simulation study reveals some departures from normality of the model for survival sub-model parameters. The censoring rate and the number of individuals impact the relative bias of parameters, especially when the classes are weakly distinguished. In real-data application the observed heterogeneity on individual profiles in terms of a longitudinal marker evolution and of the event occurrence remains after adjusting to clinically relevant and available covariates; Conclusion The JLCM properties have been evaluated. We have illustrated the discovery in practice and highlights the usefulness of the joint models with latent classes in this kind of data even with pre-specified factors. We made some recommendations for the use of this model and for future research.
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Affiliation(s)
- Maéva Kyheng
- ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Univ. Lille, CHU Lille, Lille, France. .,Département de Biostatistiques, CHU Lille, Lille, France.
| | - Génia Babykina
- ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Univ. Lille, CHU Lille, Lille, France.,Département de Biostatistiques, CHU Lille, Lille, France
| | - Camille Ternynck
- ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Univ. Lille, CHU Lille, Lille, France.,Département de Biostatistiques, CHU Lille, Lille, France
| | - David Devos
- Expert center for ALS, Expert center for Parkinson, Medical Pharmacology, Univ. Lille, Lille Neuroscience & Cognition, Inserm, UMR-S1172, Lille, France
| | - Julien Labreuche
- Expert center for ALS, Expert center for Parkinson, Medical Pharmacology, Univ. Lille, Lille Neuroscience & Cognition, Inserm, UMR-S1172, Lille, France
| | - Alain Duhamel
- ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Univ. Lille, CHU Lille, Lille, France.,Département de Biostatistiques, CHU Lille, Lille, France
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Sapkota S, McFall GP, Masellis M, Dixon RA. A Multimodal Risk Network Predicts Executive Function Trajectories in Non-demented Aging. Front Aging Neurosci 2021; 13:621023. [PMID: 34603005 PMCID: PMC8482841 DOI: 10.3389/fnagi.2021.621023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 08/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Multiple modalities of Alzheimer's disease (AD) risk factors may operate through interacting networks to predict differential cognitive trajectories in asymptomatic aging. We test such a network in a series of three analytic steps. First, we test independent associations between three risk scores (functional-health, lifestyle-reserve, and a combined multimodal risk score) and cognitive [executive function (EF)] trajectories. Second, we test whether all three associations are moderated by the most penetrant AD genetic risk [Apolipoprotein E (APOE) ε4+ allele]. Third, we test whether a non-APOE AD genetic risk score further moderates these APOE × multimodal risk score associations. Methods: We assembled a longitudinal data set (spanning a 40-year band of aging, 53-95 years) with non-demented older adults (baseline n = 602; Mage = 70.63(8.70) years; 66% female) from the Victoria Longitudinal Study (VLS). The measures included for each modifiable risk score were: (1) functional-health [pulse pressure (PP), grip strength, and body mass index], (2) lifestyle-reserve (physical, social, cognitive-integrative, cognitive-novel activities, and education), and (3) the combination of functional-health and lifestyle-reserve risk scores. Two AD genetic risk markers included (1) APOE and (2) a combined AD-genetic risk score (AD-GRS) comprised of three single nucleotide polymorphisms (SNPs; Clusterin[rs11136000], Complement receptor 1[rs6656401], Phosphatidylinositol binding clathrin assembly protein[rs3851179]). The analytics included confirmatory factor analysis (CFA), longitudinal invariance testing, and latent growth curve modeling. Structural path analyses were deployed to test and compare prediction models for EF performance and change. Results: First, separate analyses showed that higher functional-health risk scores, lifestyle-reserve risk scores, and the combined score, predicted poorer EF performance and steeper decline. Second, APOE and AD-GRS moderated the association between functional-health risk score and the combined risk score, on EF performance and change. Specifically, only older adults in the APOEε4- group showed steeper EF decline with high risk scores on both functional-health and combined risk score. Both associations were further magnified for adults with high AD-GRS. Conclusion: The present multimodal AD risk network approach incorporated both modifiable and genetic risk scores to predict EF trajectories. The results add an additional degree of precision to risk profile calculations for asymptomatic aging populations.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G. Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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23
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Howlett J, Hill SM, Ritchie CW, Tom BDM. Disease Modelling of Cognitive Outcomes and Biomarkers in the European Prevention of Alzheimer's Dementia Longitudinal Cohort. Front Big Data 2021; 4:676168. [PMID: 34490422 PMCID: PMC8417903 DOI: 10.3389/fdata.2021.676168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/30/2021] [Indexed: 12/04/2022] Open
Abstract
A key challenge for the secondary prevention of Alzheimer’s dementia is the need to identify individuals early on in the disease process through sensitive cognitive tests and biomarkers. The European Prevention of Alzheimer’s Dementia (EPAD) consortium recruited participants into a longitudinal cohort study with the aim of building a readiness cohort for a proof-of-concept clinical trial and also to generate a rich longitudinal data-set for disease modelling. Data have been collected on a wide range of measurements including cognitive outcomes, neuroimaging, cerebrospinal fluid biomarkers, genetics and other clinical and environmental risk factors, and are available for 1,828 eligible participants at baseline, 1,567 at 6 months, 1,188 at one-year follow-up, 383 at 2 years, and 89 participants at three-year follow-up visit. We novelly apply state-of-the-art longitudinal modelling and risk stratification approaches to these data in order to characterise disease progression and biological heterogeneity within the cohort. Specifically, we use longitudinal class-specific mixed effects models to characterise the different clinical disease trajectories and a semi-supervised Bayesian clustering approach to explore whether participants can be stratified into homogeneous subgroups that have different patterns of cognitive functioning evolution, while also having subgroup-specific profiles in terms of baseline biomarkers and longitudinal rate of change in biomarkers.
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Affiliation(s)
- James Howlett
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Steven M Hill
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian D M Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
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24
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Lobo E, Gracia-García P, Lobo A, Saz P, De-la-Cámara C. Differences in Trajectories and Predictive Factors of Cognition over Time in a Sample of Cognitively Healthy Adults, in Zaragoza, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7092. [PMID: 34281039 PMCID: PMC8297330 DOI: 10.3390/ijerph18137092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022]
Abstract
Great inter-individual variability has been reported in the maintenance of cognitive function in aging. We examined this heterogeneity by modeling cognitive trajectories in a population-based longitudinal study of adults aged 55+ years. We hypothesized that (1) distinct classes of cognitive trajectories would be found, and (2) between-class differences in associated factors would be observed. The sample comprised 2403 cognitively healthy individuals from the Zaragoza Dementia and Depression (ZARADEMP) project, who had at least three measurements of the Mini-Mental State Examination (MMSE) in a 12-year follow-up. Longitudinal changes in cognitive functioning were modeled using growth mixture models (GMM) in the data. The best-fitting age-adjusted model showed 3 distinct trajectories, with 1-high-to-moderate (21.2% of participants), 2-moderate-stable (67.5%) and, 3-low-and-declining (9.9%) cognitive function over time, respectively. Compared with the reference 2-trajectory, the association of education and depression was significantly different in trajectories 1 and 3. Instrumental activities of daily living (iADLs) were only associated with the declining trajectory. This suggests that intervention strategies should be tailored specifically to individuals with different trajectories of cognitive aging, and intervention strategies designed to maintain cognitive function might be different from those to prevent decline. A stable cognitive performance ('successful cognitive aging') rather than a mild decline, might be more 'normal' than generally expected.
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Affiliation(s)
- Elena Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
| | - Patricia Gracia-García
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Antonio Lobo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Pedro Saz
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Concepción De-la-Cámara
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, 50009 Zaragoza, Spain
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25
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Kang JM, Kim N, Lee SY, Woo SK, Park G, Yeon BK, Park JW, Youn JH, Ryu SH, Lee JY, Cho SJ. Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24526. [PMID: 33955835 PMCID: PMC8138710 DOI: 10.2196/24526] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/26/2020] [Accepted: 04/11/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cognitive training can potentially prevent cognitive decline. However, the results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent. Objective We aimed to examine the hypothesis that cognitive training using fully immersive VR, which may facilitate visuospatial processes, could improve visuospatial functioning, comprehensive neuropsychological functioning, psychiatric symptoms, and functional connectivity in the visual brain network in predementia. Methods Participants over 60 years old with subjective cognitive decline or mild cognitive impairment from a memory clinic were randomly allocated to the VR (n=23) or the control (n=18) group. The VR group participants received multidomain and neuropsychologist-assisted cognitive training in a fully immersive VR environment twice a week for 1 month. The control group participants did not undergo any additional intervention except for their usual therapy such as pharmacotherapy. Participants of both groups were evaluated for cognitive function using face-to-face comprehensive neuropsychological tests, including the Rey-Osterrieth Complex Figure Test (RCFT) copy task; for psychiatric symptoms such as depression, apathy, affect, and quality of life; as well as resting-state functional magnetic resonance imaging (rsfMRI) at baseline and after training. Repeated-measures analysis of variance was used to compare the effect of cognitive training between groups. Seed-to-voxel–based analyses were used to identify the cognitive improvement–related functional connectivity in the visual network of the brain. Results After VR cognitive training, significant improvement was found in the total score (F1,39=14.69, P=.001) and basic components score of the RCFT copy task (F1,39=9.27, P=.005) compared with those of the control group. The VR group also showed improvements, albeit not significant, in naming ability (F1,39=3.55, P=.07), verbal memory delayed recall (F1,39=3.03, P=.09), and phonemic fluency (F1,39=3.08, P=.09). Improvements in psychiatric symptoms such as apathy (F1,39=7.02, P=.01), affect (F1,39=14.40, P=.001 for positive affect; F1,39=4.23, P=.047 for negative affect), and quality of life (F1,39=4.49, P=.04) were found in the VR group compared to the control group. Improvement in the RCFT copy task was associated with a frontal-occipital functional connectivity increase revealed by rsfMRI in the VR group compared to the control group. Conclusions Fully immersive VR cognitive training had positive effects on the visuospatial function, apathy, affect, quality of life, and increased frontal-occipital functional connectivity in older people in a predementia state. Future trials using VR cognitive training with larger sample sizes and more sophisticated designs over a longer duration may reveal greater improvements in cognition, psychiatric symptoms, and brain functional connectivity. Trial Registration Clinical Research Information Service KCT0005243; https://tinyurl.com/2a4kfasa
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Affiliation(s)
- Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.,Brain Health Center, Gil Medical Center, Incheon, Republic of Korea
| | - Nambeom Kim
- Biomedical Engineering Research Center, Gachon University, Incheon, Republic of Korea
| | - Sook Young Lee
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Soo Kyun Woo
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Geumjin Park
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Byeong Kil Yeon
- Department of Psychiatry, Gyeonggi Provincial Medical Center Suwon Hospital, Suwon, Republic of Korea
| | - Jung Woon Park
- Department of Game Engineering and IT Convergence Engineering, Graduate School of Gachon University, Seongnam, Republic of Korea
| | - Jung-Hae Youn
- Department of Counseling Psychology, Cha University, Seongnam, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University Medical Center, Konkuk University, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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26
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Meiner Z, Ayers E, Bennett DA, Wang C, Verghese J. Risk factors for the progression of motoric cognitive risk syndrome to dementia: Retrospective cohort analysis of two populations. Eur J Neurol 2021; 28:1859-1867. [PMID: 33780585 DOI: 10.1111/ene.14841] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by cognitive complaints and slow gait. MCR is associated with increased risk of cognitive decline and incident dementia. Predictors of transition to dementia in MCR patients are still obscure. METHODS We examined clinical, biological and lifestyle parameters related to conversion to dementia using Cox models in 439 older adults with prevalent MCR (mean age 79.87 ± 8.13 years, 70% women) from two cohorts, 268 from the Chicago-based Rush Memory and Aging project (MAP) and 171 from the Religious Orders Study (ROS), which enrolled religious clergy across the United States. RESULTS In the pooled sample, 439 (13.2%) had prevalent MCR (268 MAP and 171 ROS). There were 140 (31.9%) incident dementia cases over a median follow up of 4.0 years. Age predicted conversion from MCR to dementia in both cohorts. Male gender was a risk factor only in ROS. In the pooled data, only higher depressive symptoms were associated with higher risk of conversion to dementia (adjusted hazard ratio [aHR] 1.13, 95% CI 1.03-1.24). Lower cognitive activity participation (aHR 0.59, 95% CI 0.44-0.79) and apolipoprotein E ε4 allele (aHR 2.57, 95% CI 1.48-4.45) predicted conversion to dementia in MAP. CONCLUSIONS Depressive symptoms and other cohort-specific risk factors were identified as predictors of transition to dementia in individuals with MCR. These findings suggest common pathological mechanisms underlying mood, gait and cognitive declines in aging, which could help develop preventive strategies.
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Affiliation(s)
- Zeev Meiner
- Department of Physical Medicine and Rehabilitation, Hadassah Mount Scopus, Jerusalem, Israel
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David A Bennett
- Department of Neurology, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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27
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Williams BD, Pendleton N, Chandola T. Does the association between cognition and education differ between older adults with gradual or rapid trajectories of cognitive decline? NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2021; 29:1-21. [PMID: 33683174 DOI: 10.1080/13825585.2021.1889958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Education is associated with improved baseline cognitive performance in older adults, but the association with maintenance of cognitive function is less clear. Education may be associated with different types of active cognitive reserve in those following different cognitive trajectories. We used data on n = 5642 adults aged >60 from the English Longitudinal Study of Aging (ELSA) over 5 waves (8 years). We used growth mixture models to test if the association between educational attainment and rate of change in verbal fluency or immediate recall varied by latent class trajectory. For recall, 91.5% (n = 5164) of participants were in a gradual decline class and 8.5% (n = 478) in a rapid decline class. For fluency, 90.0% (n = 4907) were in a gradual decline class and 10.0% (n = 561) were in a rapid decline class. Educational attainment was associated with improved baseline performance for both verbal fluency and recall. In the rapidly declining classes, educational attainment was not associated with rate of change for either outcome. In the verbal fluency gradual decline class, education was associated with higher (an additional 0.05-0.38 words per 2 years) or degree level education (an additional 0.04-0.42 words per 2 years) when compared to those with no formal qualifications. We identified no evidence of a protective effect of education against rapid cognitive decline. There was some evidence of active cognitive reserve for verbal fluency but not recall, which may reflect a small degree of domain-specific protection against age-related cognitive decline.
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Affiliation(s)
| | - Neil Pendleton
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Tarani Chandola
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
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28
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Yan Y, Zheng W, Ma Q, Chu C, Hu J, Wang K, Liao Y, Chen C, Yuan Y, Lv Y, Xu X, Wang Y, Mu J. Child-to-adult body mass index trajectories and the risk of subclinical renal damage in middle age. Int J Obes (Lond) 2021; 45:1095-1104. [PMID: 33608649 DOI: 10.1038/s41366-021-00779-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although it is well established that obesity is a risk factor for chronic kidney disease, the impact of distinct long-term body mass index (BMI) developmental patterns on renal function in later life is poorly understood. METHODS This study utilized data derived from the Hanzhong Adolescent Hypertension Cohort, a prospective cohort followed over 30 years. We used latent class growth mixture modeling method to identify the BMI trajectories of participants who had received BMI measurements at least three times from childhood (age: 6-15 years) to adulthood (age: 36-45 years). The modified Poisson regression model was used to identify potential associations between BMI trajectories and subclinical renal damage (SRD) in midlife. RESULTS Within a total of 2162 individuals, we identified four distinct long-term BMI trajectories: stable normal (54.72%), moderately increasing overweight (32.42%), resolving (10.27%), and progressively increasing obese (2.59%). By the latest follow-up in 2017, a total of 257 (13.1%) individuals were diagnosed with SRD. Compared with the stable normal group, the moderately increasing overweight group and the progressively increasing obese group exhibited significantly a higher urinary albumin-to-creatinine ratio and a higher odd of existing SRD in 2017 (risk ratio [RR], 1.70 [95% confidence interval (CI), 1.33-2.19] and 4.35 [95% CI, 3.00-6.30], respectively). However, individuals who resolved their elevated BMI in early life had a similar risk for SRD as those who had never been obese or overweight (RR, 1.17 [95% CI, 0.77-1.79]). CONCLUSIONS Child-to-adult BMI trajectories that worsen or persist at high levels were associated with an increased risk for SRD in midlife. Maintaining a normal BMI or reversing an elevated BMI in early life may be beneficial to renal function over the long term.
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Affiliation(s)
- Yu Yan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Wenling Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Qiong Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Chao Chu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Jiawen Hu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Keke Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Yueyuan Liao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Chen Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Yue Yuan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Yongbo Lv
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Xianjing Xu
- Department of Cardiovascular Medicine, Henan Province People's Hospital, Zhengzhou, P.R. China
| | - Yang Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China.,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Jianjun Mu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China. .,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, P.R. China. .,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China.
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29
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Rajan KB, McAninch EA, Wilson RS, Weuve J, Barnes LL, Evans DA. Race, APOEɛ4, and Long-Term Cognitive Trajectories in a Biracial Population Sample. J Alzheimers Dis 2020; 72:45-53. [PMID: 31561363 DOI: 10.3233/jad-190538] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association of the APOEɛ4 allele with incident Alzheimer's dementia is higher among European Americans (EAs) than African Americans (AAs), but similar for the rate of cognitive decline. OBJECTIVE To examine the racial differences in the association of the APOEɛ4 allele with incident Alzheimer's dementia and cognitive decline. METHODS Using a population-based sample of 5,117 older adults (66% AAs and 63% females), we identified cognitive trajectory groups from a latent class mixed model and examined the association of the APOEɛ4 allele with these groups. RESULTS The frequency of the APOEɛ4 allele was higher among AAs than EAs (37% versus 26%). Four cognitive trajectories were identified: slow, mild, moderate, and rapid. Overall, AAs had a lower baseline global cognition than EAs, and a higher proportion had rapid (7% versus 5%) and moderate (20% versus 15%) decline, but similar mild (44% versus 46%), and lesser slow (29% versus 34%) decline compared to EAs. Additionally, 25% of AAs (13% of EAs) with mild and 5% (<1% of EAs) with slow decline were diagnosed with incident Alzheimer's dementia. The APOEɛ4 allele was associated with higher odds of rapid and moderate decline compared to slow decline among AAs and EAs, but not with mild decline. CONCLUSIONS AAs had lower cognitive levels and were more likely to meet the cognitive threshold for Alzheimer's dementia among mild and slow decliners, explaining the attenuated association of the ɛ4 allele with incident Alzheimer's dementia among AAs.
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Affiliation(s)
- Kumar B Rajan
- Department of Public Health Sciences, UC Davis, Davis, CA, USA
| | - Elizabeth A McAninch
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Weuve
- Department of Epidemiology, Boston University, Boston, MA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Denis A Evans
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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30
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Wu Z, Phyo AZZ, Al-Harbi T, Woods RL, Ryan J. Distinct Cognitive Trajectories in Late Life and Associated Predictors and Outcomes: A Systematic Review. J Alzheimers Dis Rep 2020; 4:459-478. [PMID: 33283167 PMCID: PMC7683100 DOI: 10.3233/adr-200232] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Cognitive aging is a dynamic process in late life with significant heterogeneity across individuals. Objective To review the evidence for latent classes of cognitive trajectories and to identify the associated predictors and outcomes. Methods A systematic search was performed in MEDLINE and EMBASE for articles that identified two or more cognitive trajectories in adults. The study was conducted following the PRISMA statement. Results Thirty-seven studies were included, ranging from 219 to 9,704 participants, with a mean age of 60 to 93.4 years. Most studies (n = 30) identified distinct cognitive trajectories using latent class growth analysis. The trajectory profile commonly consisted of three to four classes with progressively decreasing baseline and increasing rate of decline-a 'stable-high' class characterized as maintenance of cognitive function at high level, a 'minor-decline' class or 'stable-medium' class that declines gradually over time, and a 'rapid-decline' class with the steepest downward slope. Generally, membership of better classes was predicted by younger age, being female, more years of education, better health, healthier lifestyle, higher social engagement and lack of genetic risk variants. Some factors (e.g., education) were found to be associated with cognitive function over time only within individual classes. Conclusion Cognitive aging in late life is a dynamic process with significant inter-individual variability. However, it remains unclear whether similar patterns of cognitive aging are observed across all cognitive domains. Further research into unique factors which promote the maintenance of high-cognitive function is needed to help inform public policy.
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Affiliation(s)
- Zimu Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tagrid Al-Harbi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,PSNREC, Univ Montpellier, INSERM, Montpellier, France
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Evans IEM, Martyr A, Collins R, Brayne C, Clare L. Social Isolation and Cognitive Function in Later Life: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 70:S119-S144. [PMID: 30372678 PMCID: PMC6700717 DOI: 10.3233/jad-180501] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is some evidence to suggest that social isolation may be associated with poor cognitive function in later life. However, findings are inconsistent and there is wide variation in the measures used to assess social isolation. OBJECTIVE We conducted a systematic review and meta-analysis to investigate the association between social isolation and cognitive function in later life. METHODS A search for longitudinal studies assessing the relationship between aspects of social isolation (including social activity and social networks) and cognitive function (including global measures of cognition, memory, and executive function) was conducted in PsycInfo, CINAHL, PubMed, and AgeLine. A random effects meta-analysis was conducted to assess the overall association between measures of social isolation and cognitive function. Sub-analyses investigated the association between different aspects of social isolation and each of the measures of cognitive function. RESULTS Sixty-five articles were identified by the systematic review and 51 articles were included in the meta-analysis. Low levels of social isolation characterized by high engagement in social activity and large social networks were associated with better late-life cognitive function (r = 0.054, 95% CI: 0.043, 0.065). Sub-analyses suggested that the association between social isolation and measures of global cognitive function, memory, and executive function were similar and there was no difference according to gender or number of years follow-up. CONCLUSIONS Aspects of social isolation are associated with cognitive function in later life. There is wide variation in approaches to measuring social activity and social networks across studies which may contribute to inconsistencies in reported findings.
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Affiliation(s)
- Isobel E M Evans
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK.,University of Exeter Medical School, Exeter, UK.,Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health, University of New South Wales, Sydney, Australia
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Gullett JM, O'Shea A, Lamb DG, Porges EC, O'Shea DM, Pasternak O, Cohen RA, Woods AJ. The association of white matter free water with cognition in older adults. Neuroimage 2020; 219:117040. [PMID: 32534124 PMCID: PMC7429363 DOI: 10.1016/j.neuroimage.2020.117040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Extracellular free water within cerebral white matter tissue has been shown to increase with age and pathology, yet the cognitive consequences of free water in typical aging prior to the development of neurodegenerative disease remains unclear. Understanding the contribution of free water to cognitive function in older adults may provide important insight into the neural mechanisms of the cognitive aging process. METHODS A diffusion-weighted MRI measure of extracellular free water as well as a commonly used diffusion MRI metric (fractional anisotropy) along nine bilateral white matter pathways were examined for their relationship with cognitive function assessed by the NIH Toolbox Cognitive Battery in 47 older adults (mean age = 74.4 years, SD = 5.4 years, range = 65-85 years). Probabilistic tractography at the 99th percentile level of probability (Tracts Constrained by Underlying Anatomy; TRACULA) was utilized to produce the pathways on which microstructural characteristics were overlaid and examined for their contribution to cognitive function independent of age, education, and gender. RESULTS When examining the 99th percentile probability core white matter pathway derived from TRACULA, poorer fluid cognitive ability was related to higher mean free water values across the angular and cingulum bundles of the cingulate gyrus, as well as the corticospinal tract and the superior longitudinal fasciculus. There was no relationship between cognition and mean FA or free water-adjusted FA across the 99th percentile core white matter pathway. Crystallized cognitive ability was not associated with any of the diffusion measures. When examining cognitive domains comprising the NIH Toolbox Fluid Cognition index relationships with these white matter pathways, mean free water demonstrated strong hemispheric and functional specificity for cognitive performance, whereas mean FA was not related to age or cognition across the 99th percentile pathway. CONCLUSIONS Extracellular free water within white matter appears to increase with normal aging, and higher values are associated with significantly lower fluid but not crystallized cognitive functions. When using TRACULA to estimate the core of a white matter pathway, a higher degree of free water appears to be highly specific to the pathways associated with memory, working memory, and speeded decision-making performance, whereas no such relationship existed with FA. These data suggest that free water may play an important role in the cognitive aging process, and may serve as a stronger and more specific indicator of early cognitive decline than traditional diffusion MRI measures, such as FA.
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Affiliation(s)
- Joseph M Gullett
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32610-0165, USA.
| | - Andrew O'Shea
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32610-0165, USA
| | - Damon G Lamb
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32610-0165, USA; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608, USA; Department of Psychiatry, University of Florida, 100 S. Newell Dr., L4100, McKnight Brain Institute, Gainesville, FL, 32611, USA
| | - Eric C Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32610-0165, USA
| | - Deirdre M O'Shea
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32610-0165, USA
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St., Boston, MA, 02215, USA
| | - Ronald A Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32610-0165, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32610-0165, USA
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Shafto MA, Henson RN, Matthews FE, Taylor JR, Emery T, Erzinclioglu S, Hanley C, Rowe JB, Cusack R, Calder AJ, Marslen-Wilson WD, Duncan J, Dalgleish T, Brayne C, Cam-Can, Tyler LK. Cognitive Diversity in a Healthy Aging Cohort: Cross-Domain Cognition in the Cam-CAN Project. J Aging Health 2020; 32:1029-1041. [PMID: 31592706 PMCID: PMC7116501 DOI: 10.1177/0898264319878095] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Studies of "healthy" cognitive aging often focus on a limited set of measures that decline with age. The current study argues that defining and supporting healthy cognition requires understanding diverse cognitive performance across the lifespan. Method: Data from the Cambridge Centre for Aging and Neuroscience (Cam-CAN) cohort was examined across a range of cognitive domains. Performance was related to lifestyle including education, social engagement, and enrichment activities. Results: Results indicate variable relationships between cognition and age (positive, negative, or no relationship). Principal components analysis indicated maintained cognitive diversity across the adult lifespan, and that cognition-lifestyle relationships differed by age and domain. Discussion: Our findings support a view of normal cognitive aging as a lifelong developmental process with diverse relationships between cognition, lifestyle, and age. This reinforces the need for large-scale studies of cognitive aging to include a wider range of both ages and cognitive tasks.
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Affiliation(s)
| | | | | | | | - Tina Emery
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | | | | | - James B Rowe
- University of Cambridge, UK
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, Cambridge, UK
| | | | | | | | - John Duncan
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
- University of Oxford, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | | | - Cam-Can
- Cambridge Centre for Ageing and Neuroscience (Cam-CAN), UK
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Ritchie SJ, Hill WD, Marioni RE, Davies G, Hagenaars SP, Harris SE, Cox SR, Taylor AM, Corley J, Pattie A, Redmond P, Starr JM, Deary IJ. Polygenic predictors of age-related decline in cognitive ability. Mol Psychiatry 2020; 25:2584-2598. [PMID: 30760887 PMCID: PMC7515838 DOI: 10.1038/s41380-019-0372-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/13/2018] [Accepted: 01/11/2019] [Indexed: 12/11/2022]
Abstract
Polygenic scores can be used to distil the knowledge gained in genome-wide association studies for prediction of health, lifestyle, and psychological factors in independent samples. In this preregistered study, we used fourteen polygenic scores to predict variation in cognitive ability level at age 70, and cognitive change from age 70 to age 79, in the longitudinal Lothian Birth Cohort 1936 study. The polygenic scores were created for phenotypes that have been suggested as risk or protective factors for cognitive ageing. Cognitive abilities within older age were indexed using a latent general factor estimated from thirteen varied cognitive tests taken at four waves, each three years apart (initial n = 1091 age 70; final n = 550 age 79). The general factor indexed over two-thirds of the variance in longitudinal cognitive change. We ran additional analyses using an age-11 intelligence test to index cognitive change from age 11 to age 70. Several polygenic scores were associated with the level of cognitive ability at age-70 baseline (range of standardized β-values = -0.178 to 0.302), and the polygenic score for education was associated with cognitive change from childhood to age 70 (standardized β = 0.100). No polygenic scores were statistically significantly associated with variation in cognitive change between ages 70 and 79, and effect sizes were small. However, APOE e4 status made a significant prediction of the rate of cognitive decline from age 70 to 79 (standardized β = -0.319 for carriers vs. non-carriers). The results suggest that the predictive validity for cognitive ageing of polygenic scores derived from genome-wide association study summary statistics is not yet on a par with APOE e4, a better-established predictor.
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Affiliation(s)
- Stuart J Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK.
- Department of Psychology, The University of Edinburgh, Edinburgh, UK.
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
| | - W David Hill
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Riccardo E Marioni
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Gail Davies
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Saskia P Hagenaars
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Sarah E Harris
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Adele M Taylor
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Janie Corley
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Alison Pattie
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Paul Redmond
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, The University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
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Li H, Li C, Wang A, Qi Y, Feng W, Hou C, Tao L, Liu X, Li X, Wang W, Zheng D, Guo X. Associations between social and intellectual activities with cognitive trajectories in Chinese middle-aged and older adults: a nationally representative cohort study. Alzheimers Res Ther 2020; 12:115. [PMID: 32977839 PMCID: PMC7519540 DOI: 10.1186/s13195-020-00691-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/16/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Associations between the frequency of social and intellectual activities and cognitive trajectories are understudied in Chinese middle-aged and older adults. We aimed to examine this association in a nationally representative longitudinal study. METHODS The China Health and Retirement Longitudinal Study (CHARLS) is a nationally representative sample of Chinese middle-aged and older participants. The frequency of social and intellectual activities was measured at baseline. Interview-based cognitive assessments of orientation and attention, episodic memory, and visuospatial skills and the calculation of combined global scores were assessed every 2 years from 2011 to 2016. Cognitive aging trajectories over time were analyzed using group-based trajectory modeling, and the associations of the trajectory memberships with social and intellectual activities were analyzed using multinomial logistic regression. Odds ratios (OR) and 95% confidence intervals (CI) were reported. RESULTS Among 8204 participants aged 50-75 years at baseline, trajectory analysis identified three longitudinal patterns of cognitive function based on the global cognitive scores: "persistently low trajectory" (n = 1550, 18.9%), "persistently moderate trajectory" (n = 3194, 38.9%), and "persistently high trajectory" (n = 3460, 42.2%). After adjustment for sociodemographic variables, lifestyles, geriatric symptoms, and health conditions, more frequent intellectual activities (OR 0.54, 95% CI 0.38-0.77) and social activities (OR 0.79, 95% CI 0.65-0.95) were both associated with a lower likelihood of being in the "persistently low trajectory" for global cognitive function. CONCLUSIONS These findings suggested that more frequent social and intellectual activities were associated with more favorable cognitive aging trajectories.
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Affiliation(s)
- Haibin Li
- Department of Epidemiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, Louisiana, 70112, USA.
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanling Qi
- Department of Health Care Administration, College of Health and Human Services, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840, USA
| | - Wei Feng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Chengbei Hou
- Center for Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lixin Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiangtong Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia
| | - Wei Wang
- Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Perth, WA, 6027, Australia
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China.
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China.
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Blocker EM, Fry AC, Luebbers PE, Burns JM, Perales-Puchalt J, Hansen DM, Vidoni ED. Promoting Alzheimer's Risk-Reduction through Community-Based Lifestyle Education and Exercise in Rural America: A Pilot Intervention. Kans J Med 2020; 13:179-185. [PMID: 32695261 PMCID: PMC7363174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/08/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rural Americans (RA) have poorer vascular health and physical activity levels than their urban counterparts; all are dementia risk factors. Dementia risk reduction among rural individuals requires a tailored approach. The purpose of this project was to examine preliminary efficacy of a community-based physical exercise and/or dementia risk factor-reduction curriculum among rural adults 50 and older. METHODS Seventy-five rural dwelling adults 50 and older were randomized to one of three groups: 1) 10 weeks of Alzheimer's disease risk-reduction education (ED), 2) risk-reduction education and supervised exercise (EDEX) or 3) control group (CON). Outcomes included baseline to 10-week follow-up difference in dementia knowledge (primary outcome) and physical activity, muscular endurance, healthy lifestyle engagement, and anthropometrics (secondary outcomes). RESULTS Sixty-nine adults successfully completed the 10-week study. Dementia knowledge increased in a Treatment Arm-dependent manner (χ2 = 6.95 (2), p = 0.03), being ED and EDEX superior to CON. Engagement in healthy lifestyle behaviors did not change statistically. However, participation specifically in physical activity increased over time (χ2 = 11.47 (2), p = 0.003) with EDEX reporting the greatest increases. No significant change in average daily steps was observed for any group. CONCLUSION The results suggested dementia risk-reduction education, both with and without structured exercise, leads to improvements in dementia knowledge. When coupled with regular, supervised exercise, this education intervention also helped participants increase engagement in physical activity over 10 weeks. Tailored interventions that combine Alzheimer's disease education and regular, supervised exercise may help reduce dementia risk in rural communities.
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Affiliation(s)
- Erin M. Blocker
- University of Kansas, Department of Health, Sport and Exercise Science, Lawrence, KS,University of Kansas, Alzheimer’s Disease Center, Fairway, KS
| | - Andrew C. Fry
- University of Kansas, Department of Health, Sport and Exercise Science, Lawrence, KS
| | - Paul E. Luebbers
- Emporia State University, Department of Health, Physical Education, & Recreation, Emporia, KS
| | | | | | - David M. Hansen
- University of Kansas, Department of Educational Psychology, Lawrence, KS
| | - Eric D. Vidoni
- University of Kansas, Alzheimer’s Disease Center, Fairway, KS
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Trajectories of cognitive function and their determinants in older people: 12 years of follow-up in the Chinese Longitudinal Healthy Longevity Survey. Int Psychogeriatr 2020; 32:765-775. [PMID: 32336299 DOI: 10.1017/s1041610220000538] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive decline in advanced age is closely related to dementia. The trajectory of cognitive function in older Chinese is yet to be fully investigated. We aimed to investigate the trajectories of cognitive function in a nationally representative sample of older people living in China and to explore the potential determinants of these trajectories. METHODS This study included 2,038 cognitively healthy persons aged 65-104 years at their first observation in the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014. Cognitive function was measured using the Chinese version of the Mini-Mental State Examination (MMSE). Group-based trajectory modeling was used to identify potential heterogeneity of longitudinal changes over the 12 years and to investigate associations between baseline predictors of group membership and these trajectories. RESULTS Three trajectories were identified according to the following types of changes in MMSE scores: slow decline (14.0%), rapid decline (4.5%), and stable function (81.5%). Older age, female gender, having no schooling, a low frequency of leisure activity, and a low baseline MMSE score were associated with the slow decline trajectory. Older age, body mass index (BMI) less than 18.5 kg/m2, and having more than one cardiovascular disease (CVD) were associated with the rapid decline trajectory. CONCLUSION Three trajectories of cognitive function were identified in the older Chinese population. The identified determinants of these trajectories could be targeted for developing prevention and intervention strategies for dementia.
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Gates NJ, Rutjes AWS, Di Nisio M, Karim S, Chong L, March E, Martínez G, Vernooij RWM. Computerised cognitive training for 12 or more weeks for maintaining cognitive function in cognitively healthy people in late life. Cochrane Database Syst Rev 2020; 2:CD012277. [PMID: 32104914 PMCID: PMC7045394 DOI: 10.1002/14651858.cd012277.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasing age is associated with a natural decline in cognitive function and is the greatest risk factor for dementia. Cognitive decline and dementia are significant threats to independence and quality of life in older adults. Therefore, identifying interventions that help to maintain cognitive function in older adults or that reduce the risk of dementia is a research priority. Cognitive training uses repeated practice on standardised exercises targeting one or more cognitive domains and may be intended to improve or maintain optimal cognitive function. This review examines the effects of computerised cognitive training interventions lasting at least 12 weeks on the cognitive function of healthy adults aged 65 or older and has formed part of a wider project about modifying lifestyle to maintain cognitive function. We chose a minimum 12 weeks duration as a trade-off between adequate exposure to a sustainable intervention and feasibility in a trial setting. OBJECTIVES To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks on cognitive function in cognitively healthy people in late life. SEARCH METHODS We searched to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois), and we performed additional searches of MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP (www.apps.who.int/trialsearch), to ensure that the search was as comprehensive and as up-to-date as possible to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people, and at least 80% of the study population had to be aged 65 or older. Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; the duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions. DATA COLLECTION AND ANALYSIS We performed preliminary screening of search results using a 'crowdsourcing' method to identify RCTs. At least two review authors working independently screened the remaining citations against inclusion criteria. At least two review authors also independently extracted data and assessed the risk of bias of included RCTs. Where appropriate, we synthesised data in random-effects meta-analyses, comparing computerised cognitive training (CCT) separately with active and inactive controls. We expressed treatment effects as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We used GRADE methods to describe the overall quality of the evidence for each outcome. MAIN RESULTS We identified eight RCTs with a total of 1183 participants. The duration of the interventions ranged from 12 to 26 weeks; in five trials, the duration of intervention was 12 or 13 weeks. The included studies had moderate risk of bias, and the overall quality of evidence was low or very low for all outcomes. We compared CCT first against active control interventions, such as watching educational videos. Negative SMDs favour CCT over control. Trial results suggest slight improvement in global cognitive function at the end of the intervention period (12 weeks) (standardised mean difference (SMD) -0.31, 95% confidence interval (CI) -0.57 to -0.05; 232 participants; 2 studies; low-quality evidence). One of these trials also assessed global cognitive function 12 months after the end of the intervention; this trial provided no clear evidence of a persistent effect (SMD -0.21, 95% CI -0.66 to 0.24; 77 participants; 1 study; low-quality evidence). CCT may result in little or no difference at the end of the intervention period in episodic memory (12 to 17 weeks) (SMD 0.06, 95% CI -0.14 to 0.26; 439 participants; 4 studies; low-quality evidence) or working memory (12 to 16 weeks) (SMD -0.17, 95% CI -0.36 to 0.02; 392 participants; 3 studies; low-quality evidence). Because of the very low quality of the evidence, we are very uncertain about the effects of CCT on speed of processing and executive function. We also compared CCT to inactive control (no interventions). We found no data on our primary outcome of global cognitive function. At the end of the intervention, CCT may lead to slight improvement in episodic memory (6 months) (mean difference (MD) in Rivermead Behavioural Memory Test (RBMT) -0.90 points, 95% confidence interval (CI) -1.73 to -0.07; 150 participants; 1 study; low-quality evidence) but can have little or no effect on executive function (12 weeks to 6 months) (SMD -0.08, 95% CI -0.31 to 0.15; 292 participants; 2 studies; low-quality evidence), working memory (16 weeks) (MD -0.08, 95% CI -0.43 to 0.27; 60 participants; 1 study; low-quality evidence), or verbal fluency (6 months) (MD -0.11, 95% CI -1.58 to 1.36; 150 participants; 1 study; low-quality evidence). We could not determine any effects on speed of processing because the evidence was of very low quality. We found no evidence on quality of life, activities of daily living, or adverse effects in either comparison. AUTHORS' CONCLUSIONS We found low-quality evidence suggesting that immediately after completion of the intervention, small benefits of CCT may be seen for global cognitive function when compared with active controls, and for episodic memory when compared with an inactive control. These benefits are of uncertain clinical importance. We found no evidence that the effect on global cognitive function persisted 12 months later. Our confidence in the results was low, reflecting the overall quality of the evidence. In five of the eight trials, the duration of the intervention was just three months. The possibility that more extensive training could yield larger benefit remains to be more fully explored. We found substantial literature on cognitive training, and collating all available scientific information posed problems. Duration of treatment may not be the best way to categorise interventions for inclusion. As the primary interest of older people and of guideline writers and policymakers involves sustained cognitive benefit, an alternative would be to categorise by length of follow-up after selecting studies that assess longer-term effects.
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Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyNSWAustralia2000
| | - Anne WS Rutjes
- University of BernInstitute of Social and Preventive Medicine (ISPM)Mittelstrasse 43BernBernSwitzerland3012
- University of BernInstitute of Primary Health Care (BIHAM)Mittelstrasse 43BernBernSwitzerland3012
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | | | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyVICAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Robin WM Vernooij
- University Medical Center UtrechtDepartment of Nephrology and Hypertension and Julius Center for Health Sciences and Primary CareHeidelberglaan 100UtrechtNetherlands3584 CX
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Robison LS, Francis N, Popescu DL, Anderson ME, Hatfield J, Xu F, Anderson BJ, Van Nostrand WE, Robinson JK. Environmental Enrichment: Disentangling the Influence of Novelty, Social, and Physical Activity on Cerebral Amyloid Angiopathy in a Transgenic Mouse Model. Int J Mol Sci 2020; 21:E843. [PMID: 32012921 PMCID: PMC7038188 DOI: 10.3390/ijms21030843] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 11/16/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is the deposition of amyloid protein in the cerebral vasculature, a common feature in both aging and Alzheimer's disease (AD). However, the effects of environmental factors, particularly cognitive stimulation, social stimulation, and physical activity, on CAA pathology are poorly understood. These factors, delivered in the form of the environmental enrichment (EE) paradigm in rodents, have been shown to have beneficial effects on the brain and behavior in healthy aging and AD models. However, the relative importance of these subcomponents on CAA pathology has not been investigated. Therefore, we assessed the effects of EE, social enrichment (SOC), and cognitive enrichment (COG) compared to a control group that was single housed without enrichment (SIN) from 4 to 8 months of age in wild-type mice (WT) and Tg-SwDI mice, a transgenic mouse model of CAA that exhibits cognitive/behavioral deficits. The results show that individual facets of enrichment can affect an animal model of CAA, though the SOC and combined EE conditions are generally the most effective at producing physiological, cognitive/behavioral, and neuropathological changes, adding to a growing literature supporting the benefits of lifestyle interventions.
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Affiliation(s)
- Lisa S. Robison
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA; (L.S.R.); (N.F.); (D.L.P.); (M.E.A.); (B.J.A.)
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, USA
| | - Nikita Francis
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA; (L.S.R.); (N.F.); (D.L.P.); (M.E.A.); (B.J.A.)
- George & Anne Ryan Institute for Neuroscience, 130 Flagg Road, University of Rhode Island, Kingston, RI 02881, USA; (J.H.); (F.X.); (W.E.V.N.)
| | - Dominique L. Popescu
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA; (L.S.R.); (N.F.); (D.L.P.); (M.E.A.); (B.J.A.)
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 700 Butler Drive, Providence, RI 02906, USA
| | - Maria E. Anderson
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA; (L.S.R.); (N.F.); (D.L.P.); (M.E.A.); (B.J.A.)
- Department of Psychology, Farmingdale State College, 2350 Broadhollow Rd, Farmingdale, NY 11735, USA
| | - Joshua Hatfield
- George & Anne Ryan Institute for Neuroscience, 130 Flagg Road, University of Rhode Island, Kingston, RI 02881, USA; (J.H.); (F.X.); (W.E.V.N.)
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Feng Xu
- George & Anne Ryan Institute for Neuroscience, 130 Flagg Road, University of Rhode Island, Kingston, RI 02881, USA; (J.H.); (F.X.); (W.E.V.N.)
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Brenda J. Anderson
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA; (L.S.R.); (N.F.); (D.L.P.); (M.E.A.); (B.J.A.)
| | - William E. Van Nostrand
- George & Anne Ryan Institute for Neuroscience, 130 Flagg Road, University of Rhode Island, Kingston, RI 02881, USA; (J.H.); (F.X.); (W.E.V.N.)
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - John K. Robinson
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA; (L.S.R.); (N.F.); (D.L.P.); (M.E.A.); (B.J.A.)
- George & Anne Ryan Institute for Neuroscience, 130 Flagg Road, University of Rhode Island, Kingston, RI 02881, USA; (J.H.); (F.X.); (W.E.V.N.)
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI 02881, USA
- Department of Psychology, University of Rhode Island, Kingston, RI 02881, USA
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Villeneuve C, Rousseau A, Rerolle JP, Couzi L, Kamar N, Essig M, Etienne I, Westeel PF, Büchler M, Esposito L, Thierry A, Marquet P, Monchaud C. Adherence profiles in kidney transplant patients: Causes and consequences. PATIENT EDUCATION AND COUNSELING 2020; 103:189-198. [PMID: 31447197 DOI: 10.1016/j.pec.2019.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Adherence is a dynamic phenomenon and a critical determinant of transplant patients outcome. The objective of this longitudinal study was to explore adherence in kidney transplant patients followed-up for up to three years after transplantation. METHODS Adherence was repeatedly estimated using the Morisky-Green-Levine 4-Item Medication Adherence Scale, in two successive cohorts of 345 (EPIGREN) and 367 (EPHEGREN) kidney transplant recipients. Mixed effect modeling with latent processes and latent classes was used to describe adherence time-profiles. RESULTS Two latent classes were identified. The adherent class represented 85% of the patients. Patients of the poorer-adherence class displayed a lower adherence at one month (p<10-3), which worsened over time. Good adherence was associated with age >50 years, fewer depression episodes (5% vs. 13%, p = 0.001) and a better mental health component of quality of life (MCS-SF36 47 ± 11 vs. 41 ± 13, p = 0.015). Survival without acute rejection episodes was longer in the adherent class (p = 0.004). CONCLUSIONS The risk of poor adherence in renal transplant patients can be detected as early as one month post-transplantation, using appropriate and easy tools adapted to routine monitoring. PRACTICE IMPLICATIONS An early focus on vulnerable patients should allow putting into place actions in order to reduce the risk of poor outcome related to poor adherence.
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Affiliation(s)
- Claire Villeneuve
- CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France; INSERM, UMR-1248, F-87000 Limoges, France.
| | - Annick Rousseau
- INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Univ Limoges, Faculty of Pharmacy, Department of Biophysics, F-87000 Limoges, France
| | - Jean-Phillipe Rerolle
- INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Department of Nephrology, Dialysis and Transplantation, F-87000, Limoges, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis, Centre Hospitalier Universitaire (CHU) Pellegrin, Bordeaux, France; CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University, Bordeaux, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France; Université Paul Sabatier, Toulouse, France; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Marie Essig
- INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Department of Nephrology, Dialysis and Transplantation, F-87000, Limoges, France; Univ Limoges, Faculty of Medicine, F-87000 Limoges, France
| | - Isabelle Etienne
- Service de Nephrologie, Rouen University Hospital, Rouen, France
| | - Pierre-Francois Westeel
- Department of Nephrology and Kidney Transplantation, University Hospital of Amiens, Amiens, France
| | - Mathias Büchler
- FHU SUPORT, Limoges, F-87000, France; Department of Nephrology and Kidney Transplantation, University Hospital of Tours, Tours, France; François Rabelais University, EA 4245 Tours, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France
| | - Antoine Thierry
- FHU SUPORT, Limoges, F-87000, France; CHU Poitiers, Department of Nephrology, Dialysis and Transplantation, F-86000 Poitiers, France
| | - Pierre Marquet
- CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France; INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Univ Limoges, Faculty of Medicine, F-87000 Limoges, France
| | - Caroline Monchaud
- CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France; INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France
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Hussenoeder FS, Riedel-Heller SG, Conrad I, Rodriguez FS. Concepts of Mental Demands at Work That Protect Against Cognitive Decline and Dementia: A Systematic Review. Am J Health Promot 2019; 33:1200-1208. [DOI: 10.1177/0890117119861309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Workplace-related mental demands (WPMDs) are considered to be protective factors for cognitive health in old age and are linked to delayed onset of dementia. Yet, what exactly is meant by WPMDs differs greatly between studies, putting an enormous challenge on researchers and practitioners. Aim of our study was thus to create a systematic overview on WPMD concepts and to depict their associations with dementia and cognitive decline. Thereby, we want to create a solid basis for further work and implementation. Data Source: PubMed, PsycINFO, Web of Science. Inclusion/Exclusion Criteria: We included observational studies with populations older than 18 that addressed the association between WPMDs and dementia/cognitive functioning and that were published as journal articles. We excluded studies with emotional and physical demands, stress, and organizational frameworks such as exposure variables and quality of life, depressive symptoms, burnout, and Parkinson as outcome. Furthermore, we excluded study populations younger than 18 and students. Data Extraction: Standardized search string. Data Synthesis: Based on theoretical concepts. Results: Thirty-four studies that employed concepts of WPMDs in 5 different categories: complexity with people/data/things, cognitive demands, job control, novelty, and mental workload. Discussion: Challenges associated with categorizing WPMDs as well as theoretical and measurement-related implications are discussed. Conclusion: This review helps to better understand how workplaces can contribute to later life cognitive fitness, and it offers a conceptual overview for practitioners that want to create more protective working environments or improve existing ones.
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Affiliation(s)
- Felix S. Hussenoeder
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Ines Conrad
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Francisca S. Rodriguez
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
- Center for Cognitive Science, University of Kaiserslautern, Kaiserslautern, Germany
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Gates NJ, Rutjes AWS, Di Nisio M, Karim S, Chong L, March E, Martínez G, Vernooij RWM. Computerised cognitive training for maintaining cognitive function in cognitively healthy people in late life. Cochrane Database Syst Rev 2019; 3:CD012277. [PMID: 30864187 PMCID: PMC6414816 DOI: 10.1002/14651858.cd012277.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Increasing age is associated with a natural decline in cognitive function and is also the greatest risk factor for dementia. Cognitive decline and dementia are significant threats to independence and quality of life in older adults. Therefore, identifying interventions that help to maintain cognitive function in older adults or to reduce the risk of dementia is a research priority. Cognitive training uses repeated practice on standardised exercises targeting one or more cognitive domains and is intended to maintain optimum cognitive function. This review examines the effect of computerised cognitive training interventions lasting at least 12 weeks on the cognitive function of healthy adults aged 65 or older. OBJECTIVES To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks for the maintenance or improvement of cognitive function in cognitively healthy people in late life. SEARCH METHODS We searched to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois) and performed additional searches of MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP (www.apps.who.int/trialsearch) to ensure that the search was as comprehensive and as up-to-date as possible, to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people, and at least 80% of the study population had to be aged 65 or older. Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions. DATA COLLECTION AND ANALYSIS We performed preliminary screening of search results using a 'crowdsourcing' method to identify RCTs. At least two review authors working independently screened the remaining citations against inclusion criteria. At least two review authors also independently extracted data and assessed the risk of bias of included RCTs. Where appropriate, we synthesised data in random-effect meta-analyses, comparing computerised cognitive training (CCT) separately with active and inactive controls. We expressed treatment effects as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We used GRADE methods to describe the overall quality of the evidence for each outcome. MAIN RESULTS We identified eight RCTs with a total of 1183 participants. Researchers provided interventions over 12 to 26 weeks; in five trials, the duration of intervention was 12 or 13 weeks. The included studies had a moderate risk of bias. Review authors noted a lot of inconsistency between trial results. The overall quality of evidence was low or very low for all outcomes.We compared CCT first against active control interventions, such as watching educational videos. Because of the very low quality of the evidence, we were unable to determine any effect of CCT on our primary outcome of global cognitive function or on secondary outcomes of episodic memory, speed of processing, executive function, and working memory.We also compared CCT versus inactive control (no interventions). Negative SMDs favour CCT over control. We found no studies on our primary outcome of global cognitive function. In terms of our secondary outcomes, trial results suggest slight improvement in episodic memory (mean difference (MD) -0.90, 95% confidence interval (CI) -1.73 to -0.07; 150 participants; 1 study; low-quality evidence) and no effect on executive function (SMD -0.08, 95% CI -0.31 to 0.15; 292 participants; 2 studies; low-quality evidence), working memory (MD -0.08, 95% CI -0.43 to 0.27; 60 participants; 1 study; low-quality evidence), or verbal fluency (MD -0.11, 95% CI -1.58 to 1.36; 150 participants; 1 study; low-quality evidence). We could not determine any effects on speed of processing at trial endpoints because the evidence was of very low quality.We found no evidence on quality of life, activities of daily living, or adverse effects in either comparison. AUTHORS' CONCLUSIONS We found little evidence from the included studies to suggest that 12 or more weeks of CCT improves cognition in healthy older adults. However, our limited confidence in the results reflects the overall quality of the evidence. Inconsistency between trials was a major limitation. In five of the eight trials, the duration of intervention was just three months. The possibility that longer periods of training could be beneficial remains to be more fully explored.
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Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyNSWAustralia2000
| | - Anne WS Rutjes
- University of BernInstitute of Social and Preventive Medicine (ISPM)Mittelstrasse 43BernBernSwitzerland3012
- University of BernInstitute of Primary Health Care (BIHAM)Mittelstrasse 43BernBernSwitzerland3012
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | | | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyVICAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaBarcelonaSpain08025
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Gates NJ, Rutjes AWS, Di Nisio M, Karim S, Chong L, March E, Martínez G, Vernooij RWM. Computerised cognitive training for maintaining cognitive function in cognitively healthy people in midlife. Cochrane Database Syst Rev 2019; 3:CD012278. [PMID: 30864746 PMCID: PMC6415131 DOI: 10.1002/14651858.cd012278.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Normal aging is associated with changes in cognitive function that are non-pathological and are not necessarily indicative of future neurocognitive disease. Low cognitive and brain reserve and limited cognitive stimulation are associated with increased risk of dementia. Emerging evidence now suggests that subtle cognitive changes, detectable years before criteria for mild cognitive impairment are met, may be predictive of future dementia. Important for intervention and reduction in disease risk, research also suggests that engaging in stimulating mental activity throughout adulthood builds cognitive and brain reserve and reduces dementia risk. Therefore, midlife (defined here as 40 to 65 years) may be a suitable time to introduce cognitive interventions for maintaining cognitive function and, in the longer term, possibly preventing or delaying the onset of clinical dementia. OBJECTIVES To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks for maintaining or improving cognitive function in cognitively healthy people in midlife. SEARCH METHODS We searched up to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois), the specialised register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG). We ran additional searches in MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP at www.apps.who.int/trialsearch, to ensure that the search was as comprehensive and as up-to-date as possible, to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people between 40 and 65 years of age (80% of study population within this age range). Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions. DATA COLLECTION AND ANALYSIS For preliminary screening of search results, we used a 'crowd' method to identify RCTs. At least two review authors working independently screened remaining citations against inclusion criteria; independently extracted data; and assessed the quality of the included trial, using the Cochrane risk of bias assessment tool. We used GRADE to describe the overall quality of the evidence. MAIN RESULTS We identified one eligible study that examined the effect of computerised cognitive training (CCT) in 6742 participants over 50 years of age, with training and follow-up duration of six months. We considered the study to be at high risk of attrition bias and the overall quality of the evidence to be low.Researchers provided no data on our primary outcome. Results indicate that there may be a small advantage for the CCT group for executive function (mean difference (MD) -1.57, 95% confidence interval (CI) -1.85 to -1.29; participants = 3994; low-quality evidence) and a very small advantage for the control group for working memory (MD 0.09, 95% CI 0.03 to 0.15; participants = 5831; low-quality evidence). The intervention may have had little or no effect on episodic memory (MD -0.03, 95% CI -0.10 to 0.04; participants = 3090; low-quality evidence). AUTHORS' CONCLUSIONS We found low-quality evidence from only one study. We are unable to determine whether computerised cognitive training is effective in maintaining global cognitive function among healthy adults in midlife. We strongly recommend that high-quality studies be undertaken to investigate the effectiveness and acceptability of cognitive training in midlife, using interventions that last long enough that they may have enduring effects on cognitive and brain reserve, and with investigators following up long enough to assess effects on clinically important outcomes in later life.
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Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyAustralia2000
| | | | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | | | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaSpain08025
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Gates NJ, Vernooij RWM, Di Nisio M, Karim S, March E, Martínez G, Rutjes AWS. Computerised cognitive training for preventing dementia in people with mild cognitive impairment. Cochrane Database Syst Rev 2019; 3:CD012279. [PMID: 30864747 PMCID: PMC6415132 DOI: 10.1002/14651858.cd012279.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of people living with dementia is increasing rapidly. Clinical dementia does not develop suddenly, but rather is preceded by a period of cognitive decline beyond normal age-related change. People at this intermediate stage between normal cognitive function and clinical dementia are often described as having mild cognitive impairment (MCI). Considerable research and clinical efforts have been directed toward finding disease-modifying interventions that may prevent or delay progression from MCI to clinical dementia. OBJECTIVES To evaluate the effects of at least 12 weeks of computerised cognitive training (CCT) on maintaining or improving cognitive function and preventing dementia in people with mild cognitive impairment. SEARCH METHODS We searched to 31 May 2018 in ALOIS (www.medicine.ox.ac.uk/alois) and ran additional searches in MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO portal/ICTRP (www.apps.who.int/trialsearch) to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in which cognitive training via interactive computerised technology was compared with an active or inactive control intervention. Experimental computerised cognitive training (CCT) interventions had to adhere to the following criteria: minimum intervention duration of 12 weeks; any form of interactive computerised cognitive training, including computer exercises, computer games, mobile devices, gaming console, and virtual reality. Participants were adults with a diagnosis of mild cognitive impairment (MCI) or mild neurocognitive disorder (MND), or otherwise at high risk of cognitive decline. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias of the included RCTs. We expressed treatment effects as mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes and as risk ratios (RRs) for dichotomous outcomes. We used the GRADE approach to describe the overall quality of evidence for each outcome. MAIN RESULTS Eight RCTs with a total of 660 participants met review inclusion criteria. Duration of the included trials varied from 12 weeks to 18 months. Only one trial used an inactive control. Most studies were at unclear or high risk of bias in several domains. Overall, our ability to draw conclusions was hampered by very low-quality evidence. Almost all results were very imprecise; there were also problems related to risk of bias, inconsistency between trials, and indirectness of the evidence.No trial provided data on incident dementia. For comparisons of CCT with both active and inactive controls, the quality of evidence on our other primary outcome of global cognitive function immediately after the intervention period was very low. Therefore, we were unable to draw any conclusions about this outcome.Due to very low quality of evidence, we were also unable to determine whether there was any effect of CCT compared to active control on our secondary outcomes of episodic memory, working memory, executive function, depression, functional performance, and mortality. We found low-quality evidence suggesting that there is probably no effect on speed of processing (SMD 0.20, 95% confidence interval (CI) -0.16 to 0.56; 2 studies; 119 participants), verbal fluency (SMD -0.16, 95% CI -0.76 to 0.44; 3 studies; 150 participants), or quality of life (mean difference (MD) 0.40, 95% CI -1.85 to 2.65; 1 study; 19 participants).When CCT was compared with inactive control, we obtained data on five secondary outcomes, including episodic memory, executive function, verbal fluency, depression, and functional performance. We found very low-quality evidence; therefore, we were unable to draw any conclusions about these outcomes. AUTHORS' CONCLUSIONS Currently available evidence does not allow us to determine whether or not computerised cognitive training will prevent clinical dementia or improve or maintain cognitive function in those who already have evidence of cognitive impairment. Small numbers of trials, small samples, risk of bias, inconsistency between trials, and highly imprecise results mean that it is not possible to derive any implications for clinical practice, despite some observed large effect sizes from individual studies. Direct adverse events are unlikely to occur, although the time and sometimes the money involved in computerised cognitive training programmes may represent significant burdens. Further research is necessary and should concentrate on improving methodological rigour, selecting suitable outcomes measures, and assessing generalisability and persistence of any effects. Trials with long-term follow-up are needed to determine the potential of this intervention to reduce the risk of dementia.
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Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyAustralia2000
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaSpain08025
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
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Lavrencic LM, Richardson C, Harrison SL, Muniz-Terrera G, Keage HAD, Brittain K, Kirkwood TBL, Jagger C, Robinson L, Stephan BCM. Is There a Link Between Cognitive Reserve and Cognitive Function in the Oldest-Old? J Gerontol A Biol Sci Med Sci 2019; 73:499-505. [PMID: 28977420 DOI: 10.1093/gerona/glx140] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/17/2017] [Indexed: 12/22/2022] Open
Abstract
Background The oldest-old (aged ≥85 years) are the fastest growing age group, with the highest risk of cognitive impairment and dementia. This study investigated whether cognitive reserve applies to the oldest-old. This has implications for cognitive interventions in this age group. Methods Baseline and 5-year follow-up data from the Newcastle 85+ Study were used (N = 845, mean age = 85.5, 38% male). A Cognitive Reserve Index (CRI) was created, including: education, social class, marital status, engagement in mental activities, social participation, and physical activity. Global (Mini-Mental State Examination) and domain specific (Cognitive Drug Research Battery subtests assessing memory, attention, and speed) cognitive functions were assessed. Dementia diagnosis was determined by health records. Logistic regression analysis examined the association between CRI scores and incident dementia. Mixed effects models investigated baseline and longitudinal associations between the CRI scores and cognitive function. Analyses controlled for sex, age, depression, and cardiovascular disease history. Results Higher reserve associated with better cognitive performance on all baseline measures, but not 5-year rate of change. The CRI associated with prevalent, but not incident dementia. Conclusions In the oldest-old, higher reserve associated with better baseline global and domain-specific cognitive function and reduced risk of prevalent dementia; but not cognitive decline or incident dementia. Increasing reserve could promote cognitive function in the oldest-old. The results suggest there would be little impact on trajectories, but replication is needed. Development of preventative strategies would benefit from identifying the role of each factor in building reserve and why rate of change is not affected.
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Affiliation(s)
- Louise M Lavrencic
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Connor Richardson
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Adelaide, South Australia
| | | | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Thomas B L Kirkwood
- Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK.,University of Copenhagen Center for Healthy Aging, Copenhagen, Denmark
| | - Carol Jagger
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom C M Stephan
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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46
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Foverskov E, Glymour MM, Mortensen EL, Holm A, Lange T, Lund R. Education and Cognitive Aging: Accounting for Selection and Confounding in Linkage of Data From the Danish Registry and Survey of Health, Ageing and Retirement in Europe. Am J Epidemiol 2018; 187:2423-2430. [PMID: 30099480 PMCID: PMC6211246 DOI: 10.1093/aje/kwy162] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Earlier studies report inconsistent associations between education and cognitive aging. We assessed the association, accounting for selective dropout due to death or dementia, and, in a subsample, accounting for confounding by early-life intelligence. Data from the Danish component of the Survey of Health, Ageing and Retirement in Europe (n = 3,400) were linked to registry data (education records, dementia diagnoses, and mortality) and the Danish Conscription Database (youth intelligence measurements for 854 men). Word recall and verbal fluency were assessed up to 4 times over 10 years (2004-2013) and combined by averaging the z scores. We fitted a joint model linking a time-to-event model for dementia or death to a linear mixed-effects model for cognitive change. Rate of cognitive decline was slower among people with high education compared with low education (β = 0.112, 95% confidence interval (CI): 0.056, 0.170). Adjusting for youth intelligence did not attenuate the association between education and cognitive decline (crude β = 0.136, 95% CI: 0.028, 0.244 vs. adjusted β = 0.145, 95% CI: 0.022, 0.269). The results suggest that higher education may slow cognitive decline in later life. In this sample, results changed little when accounting for selective attrition and confounding by intelligence.
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Affiliation(s)
- Else Foverskov
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anders Holm
- Department of Sociology, University of Western Ontario, London, Canada
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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47
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Rodriguez FS, Matschinger H, Angermeyer MC, Luck T, Riedel-Heller SG. Compression of cognitive morbidity by higher education in individuals aged 75+ living in Germany. Int J Geriatr Psychiatry 2018; 33:1389-1396. [PMID: 30024067 DOI: 10.1002/gps.4950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/17/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous studies have shown that higher education may reduce dementia risk and promote a better cognitive functioning in older age. OBJECTIVE The study investigated to what extent higher education leads to compression of cognitive morbidity, and thus a shorter lifetime affected by cognitive impairment and dementia, in individuals aged 75 years and older living in Germany. METHODS Our sample included n = 742 individuals of the population-based Leipzig Longitudinal Study of the Aged (LEILA75+; 1998-2013), who were free of dementia at baseline. The impact of higher education on compression of cognitive morbidity was studied by analyzing the association between education and (1) cognitive functioning over the study period and age at dementia onset, (2) age at death, and (3) the cumulative lifetime cognitive morbidity. RESULTS Individuals with more years of education had a higher cumulative cognitive functioning over the lifetime period 75 to 100 years (weighted for survival probability), but not a later age of dementia onset nor a later age at death. CONCLUSION Our results suggest, in individuals aged 75 years and older, higher education only compresses cognitive morbidity prior to dementia onset. Findings may be specific to countries where education is not a necessary requirement for access to good quality health care services.
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Affiliation(s)
- Francisca S Rodriguez
- Center for Cognitive Science, University of Kaiserslautern, Kaiserslautern, Germany.,Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, Universität Leipzig, Germany
| | - Herbert Matschinger
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,Institute of Health Economics and Health Service Research, University of Hamburg, Germany
| | - Matthias C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria.,Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, Universität Leipzig, Germany.,Department of Economic and Social Sciences, University of Applied Sciences Nordhausen, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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48
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Geyer S, Eberhard S, Schmidt BMW, Epping J, Tetzlaff J. Morbidity compression in myocardial infarction 2006 to 2015 in terms of changing rates and age at occurrence: A longitudinal study using claims data from Germany. PLoS One 2018; 13:e0202631. [PMID: 30138437 PMCID: PMC6107226 DOI: 10.1371/journal.pone.0202631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/07/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND According to James Fries morbidity compression is present if morbidity rates are decreasing to a larger extent than mortality rates. Compression also occurs if age at onset is increasing at a faster pace than age at death. These two variants of the compression hypothesis were formulated as a population concept. Compression has seldom been studied with a specific disease as application. METHODS Morbidity compression was examined in terms of myocardial infarction (MI) by using German claims data covering the years 2006 to 2015. The findings are based on an annual case number of about 2 m women and men aged 18 years and older. Analyses were performed by means of proportional hazards regression and by using linear regression. RESULTS Decreases of morbidity rates were more pronounced than those of mortality. For men, the hazard ratio for contracting MI in 2015 as compared to 2006 was hr = 0.66 and hr = 0.71 for the female population. The respective results for mortality were hr = 0.75 in men and hr = 1.0 in women. They can be interpreted in favor of morbidity compression. For the subgroup of women and men with MI, changes of onset age revealed marked gender differences. For 2015 as compared with 2006, age at MI-occurrence in men increased by 10.5 months as compared to an increase of 10.4 months for age at death. In women changes were smaller and statistically not significant. The findings referring to women have to be interpreted against the backdrop of higher onset age and higher age at death than in men. CONCLUSIONS Taken together, morbidity compression has occurred in terms of decreasing MI-rates as well as in terms of increased onset age in men. It can be concluded that both processes have led to an improvement of healthy lifetime. Decreasing morbidity rates in women are also pointing towards morbidity compression, a finding that is not complemented by changes of onset age. Our data are demonstrating that morbidity rates and age at onset may vary independently. From this perspective morbidity compression is a multi-faceted phenomenon.
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Affiliation(s)
- Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Sveja Eberhard
- Local Statutory Health Insurance of Lower Saxony (AOK Niedersachsen), Hannover, Germany
| | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
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49
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Gracia-Rebled AC, Santabárbara J, Lopez-Anton R, Tomas C, Lobo E, Marcos G, Lobo A. [Influence of occupation on cognitive impairment with no dementia in a sample population over 55 years from Zaragoza]. Rev Esp Geriatr Gerontol 2018; 53:134-140. [PMID: 29208451 DOI: 10.1016/j.regg.2017.07.001] [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: 01/19/2017] [Revised: 06/05/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The prevalence of cognitive impairment with no dementia (CIND) varies between 5.1% and 35.9%, increasing between 65 and 85 years. The CIND increases the risk of dementia. Factors such as education, occupation, and social activities are associated with the risk of cognitive impairment. The main objective of this study was to analyse the association between the main occupation developed throughout life and CIND in a general population sample of over 55 years. METHODS In wave I of the ZARADEMP Project, a sample (n=4803) of people over 55 years was interviewed. CIND measurement was obtained through the Mini Mental State Examination. Occupational activity data were recoded into white collar, blue collar, homemakers, and farmers. The association between the occupation variables and CIND was estimated using the odds ratio, and 95% confidence intervals using logistic regression equations. RESULTS The prevalence of CIND in the sample was 28.2%. As regards white collar workers, the CIND diagnosis odds was 53% higher for blue collar workers, 77% higher for women who were homemakers and almost twice for farmers, after controlling for socio-demographic, behavioural and clinical variables. All results were statistically significant. CONCLUSIONS CIND frequency is influenced by the previous occupation of the subjects. An occupation with higher intellectual requirements can help keep cognitive functions intact for longer.
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Affiliation(s)
| | - Javier Santabárbara
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Instituto Universitario de Investigación Sanitaria de Aragón (IIS)
| | - Raul Lopez-Anton
- Instituto Universitario de Investigación Sanitaria de Aragón (IIS); Departamento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, España
| | - Concepción Tomas
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, España
| | - Elena Lobo
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Instituto Universitario de Investigación Sanitaria de Aragón (IIS)
| | - Guillermo Marcos
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Instituto Universitario de Investigación Sanitaria de Aragón (IIS); Hospital Clínico Universitario, Zaragoza, España
| | - Antonio Lobo
- Instituto Universitario de Investigación Sanitaria de Aragón (IIS); Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministerio de Ciencia e Innovación, Madrid, España
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50
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Buscot MJ, Thomson RJ, Juonala M, Sabin MA, Burgner DP, Lehtimäki T, Hutri-Kähönen N, Viikari JSA, Raitakari OT, Magnussen CG. Distinct child-to-adult body mass index trajectories are associated with different levels of adult cardiometabolic risk. Eur Heart J 2018; 39:2263-2270. [DOI: 10.1093/eurheartj/ehy161] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/28/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia
| | - Russell J Thomson
- Centre for Research in Mathematics, School of Computing, Engineering & Mathematics, Western Sydney University, Sydney, Australia
| | - Markus Juonala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Division of Medicine, Department of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David P Burgner
- Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Paediatrics, Monash Medical Centre, Melbourne, Australia
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Ltd and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere, Faculty of Medicine and Life Sciences and Tampere University Hospital, Finland
| | - Jorma S A Viikari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Division of Medicine, Department of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Division of Medicine, Department of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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