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Liu AC, Patel MD, Gross AL, Mosley TH, Schneider ALC, Kucharska-Newton AM, Sharrett AR, Gottesman RF, Koton S. Occupation, Retirement Age, and 20-Year Cognitive Decline: The Atherosclerosis Risk in Communities Neurocognitive Study. Neuroepidemiology 2024; 58:292-299. [PMID: 38387450 PMCID: PMC11300158 DOI: 10.1159/000534791] [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: 03/13/2023] [Accepted: 10/23/2023] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION We examined the association of both midlife occupation and age at retirement with cognitive decline in the Atherosclerosis Risk in Communities (ARIC) biracial community-based cohort. METHODS Current or most recent occupation at ARIC baseline (1987-1989; aged 45-64 years) was categorized based on 1980 US Census major occupation groups and tertiles of the Nam-Powers-Boyd occupational status score (n = 14,090). Retirement status via annual follow-up questionnaires administered ascertained in 1999-2007 was classified as occurring before or after age 70 (n = 7,503). Generalized estimating equation models were used to examine associations of occupation and age at retirement with trajectories of global cognitive factor scores, assessed from visit 2 (1990-1992) to visit 5 (2011-2013). Models were a priori stratified by race and sex and adjusted for demographics and comorbidities. RESULTS Low occupational status and blue-collar occupations were associated with low baseline cognitive scores in all race-sex strata. Low occupational status and homemaker status were associated with faster decline in white women but slower decline in black women compared to high occupational status. Retirement before age 70 was associated with slower cognitive decline in white men and women and in black men. Results did not change substantially after accounting for attrition. CONCLUSION Low occupational status was associated with cognitive decline in women but not in men. Earlier retirement was associated with a slower cognitive decline in white participants and in black men. Further research should explore reasons for the observed associations and race-sex differences.
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Affiliation(s)
- Albert C Liu
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA,
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA,
| | - Mehul D Patel
- Department of Emergency Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alden L Gross
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas H Mosley
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Andrea L C Schneider
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - A Richey Sharrett
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Silvia Koton
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Niederhauser L, Gunser S, Waser M, Mast FW, Caversaccio M, Anschuetz L. Training and proficiency level in endoscopic sinus surgery change residents' eye movements. Sci Rep 2023; 13:79. [PMID: 36596830 PMCID: PMC9810736 DOI: 10.1038/s41598-022-25518-2] [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: 07/13/2022] [Accepted: 11/30/2022] [Indexed: 01/04/2023] Open
Abstract
Nose surgery is challenging and needs a lot of training for safe and efficient treatments. Eye tracking can provide an objective assessment to measure residents' learning curve. The aim of the current study was to assess residents' fixation duration and other dependent variables over the course of a dedicated training in functional endoscopic sinus surgery (FESS). Sixteen residents performed a FESS training over 18 sessions, split into three surgical steps. Eye movements in terms of percent fixation on the screen and average fixation duration were measured, in addition to residents' completion time, cognitive load, and surgical performance. Results indicated performance improvements in terms of completion time and surgical performance. Cognitive load and average fixation duration showed a significant change within the last step of training. Percent fixation on screen increased within the first step, and then stagnated. Results showed that eye movements and cognitive load differed between residents of different proficiency levels. In conclusion, eye tracking is a helpful objective measuring tool in FESS. It provides additional insights of the training level and changes with increasing performance. Expert-like gaze was obtained after half of the training sessions and increased proficiency in FESS was associated with increased fixation duration.
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Affiliation(s)
- Laura Niederhauser
- grid.5734.50000 0001 0726 5157Department of Psychology, University of Bern, Bern, Switzerland
| | - Sandra Gunser
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
| | - Manuel Waser
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
| | - Fred W. Mast
- grid.5734.50000 0001 0726 5157Department of Psychology, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
| | - Lukas Anschuetz
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
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Nakamura JS, Chen Y, VanderWeele TJ, Kim ES. What makes life purposeful? Identifying the antecedents of a sense of purpose in life using a lagged exposure-wide approach. SSM Popul Health 2022; 19:101235. [PMID: 36203472 PMCID: PMC9529595 DOI: 10.1016/j.ssmph.2022.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022] Open
Abstract
Aims Prior research documents strong associations between an increased sense of purpose in life and improved health and well-being outcomes. However, less is known about candidate antecedents that lead to more purpose among older adults. Methods We used data from 13,771 participants in the Health and Retirement Study (HRS) — a diverse, national panel study of adults aged >50 in the United States, to evaluate a large number of candidate predictors of purpose. Specifically, using linear regression with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (between t0;2006/2008 and t1;2010/2012) were associated with purpose four years later (t2;2014/2016) after adjustment for a rich set of baseline covariates. Results Some health behaviors (e.g., physical activity ≥1x/week [β = 0.14, 95% CI: 0.09, 0.19]), physical health conditions (e.g., stroke [β = −0.25, 95% CI: −0.40, −0.10]), and psychosocial factors (e.g., depression [β = −0.21, 95% CI: −0.27, −0.15]) were associated with subsequent purpose four years later. However, there was little evidence that other health behaviors, physical health conditions, and psychosocial factors such as smoking, drinking, or financial strain, were associated with subsequent purpose. Conclusions Several of our candidate predictors such as volunteering, time with friends, and physical activity may be important targets for interventions and policies aiming to increase purpose among older adults. However, some effect sizes were modest and contrast with prior work on younger populations, suggesting purpose may be more easily formed earlier in life. Factors that lead to increased purpose in life in older adults remain unclear. We leveraged a large and prospective cohort of US adults aged >50. We evaluated associations between 61 predictors and subsequent purpose in life. Some health/well-being factors were associated with purpose in life 4 years later, but not others.
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Affiliation(s)
- Julia S. Nakamura
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Corresponding author. Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S. Kim
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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4
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Nakamura JS, Lee MT, Chen FS, Archer Lee Y, Fried LP, VanderWeele TJ, Kim ES. Identifying pathways to increased volunteering in older US adults. Sci Rep 2022; 12:12825. [PMID: 35896597 PMCID: PMC9328015 DOI: 10.1038/s41598-022-16912-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
While growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national sample of older adults in the United States—we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t0; 2006/2008 and t1; 2010/2012) were associated with volunteer activity four years later (t2; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity ≥ 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults.
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Affiliation(s)
- Julia S Nakamura
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Matthew T Lee
- Institute for Studies of Religion, Baylor University, Waco, TX, USA.,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Frances S Chen
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Yeeun Archer Lee
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S Kim
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.,Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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5
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Do Teachers maintain their Expectation Bias for students? A longitudinal investigation. SOCIAL PSYCHOLOGY OF EDUCATION 2022. [DOI: 10.1007/s11218-022-09714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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6
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Wei J, Gianattasio KZ, Bennett EE, Stewart JD, Xu X, Park ES, Smith RL, Ying Q, Whitsel EA, Power MC. The Associations of Dietary Copper With Cognitive Outcomes. Am J Epidemiol 2022; 191:1202-1211. [PMID: 35238336 PMCID: PMC9890213 DOI: 10.1093/aje/kwac040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/30/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Dietary copper intake may be associated with cognitive decline and dementia. We used data from 10,269 participants of the Atherosclerosis Risks in Communities Study to study the associations of dietary copper intake with 20-year cognitive decline and incident dementia. Dietary copper intake from food and supplements was quantified using food frequency questionnaires. Cognition was assessed using 3 cognitive tests at study visits; dementia was ascertained at study visits and via surveillance. Multiple imputation by chained equations was applied to account for the missing information of cognitive function during follow-up. Survival analysis with parametric models and mixed-effect models were used to estimate the associations for incident dementia and cognitive decline, respectively. During 20 years of follow-up (1996-1998 to 2016-2017), 1,862 incident cases of dementia occurred. Higher intake of dietary copper from food was associated with higher risk of incident dementia among those with high intake of saturated fat (hazard ratio = 1.49, 95% confidence interval: 1.04, 1.95). Higher intake of dietary copper from food was associated with greater decline in language overall (beta = -0.12, 95% confidence interval: -0.23, -0.02). Therefore, a diet high in copper, particularly when combined with a diet high in saturated fat, may increase the risk of cognitive impairment.
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Affiliation(s)
- Jingkai Wei
- Correspondence to Dr. Jingkai Wei, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208 (e-mail: )
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7
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Rösel I, Serna-Higuita LM, Al Sayah F, Buchholz M, Buchholz I, Kohlmann T, Martus P, Feng YS. What difference does multiple imputation make in longitudinal modeling of EQ-5D-5L data? Empirical analyses of simulated and observed missing data patterns. Qual Life Res 2022; 31:1521-1532. [PMID: 34797507 PMCID: PMC9023409 DOI: 10.1007/s11136-021-03037-3] [Citation(s) in RCA: 6] [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] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Although multiple imputation is the state-of-the-art method for managing missing data, mixed models without multiple imputation may be equally valid for longitudinal data. Additionally, it is not clear whether missing values in multi-item instruments should be imputed at item or score-level. We therefore explored the differences in analyzing the scores of a health-related quality of life questionnaire (EQ-5D-5L) using four approaches in two empirical datasets. METHODS We used simulated (GR dataset) and observed missingness patterns (ABCD dataset) in EQ-5D-5L scores to investigate the following approaches: approach-1) mixed models using respondents with complete cases, approach-2) mixed models using all available data, approach-3) mixed models after multiple imputation of the EQ-5D-5L scores, and approach-4) mixed models after multiple imputation of EQ-5D 5L items. RESULTS Approach-1 yielded the highest estimates of all approaches (ABCD, GR), increasingly overestimating the EQ-5D-5L score with higher percentages of missing data (GR). Approach-4 produced the lowest scores at follow-up evaluations (ABCD, GR). Standard errors (0.006-0.008) and mean squared errors (0.032-0.035) increased with increasing percentages of simulated missing GR data. Approaches 2 and 3 showed similar results (both datasets). CONCLUSION Complete cases analyses overestimated the scores and mixed models after multiple imputation by items yielded the lowest scores. As there was no loss of accuracy, mixed models without multiple imputation, when baseline covariates are complete, might be the most parsimonious choice to deal with missing data. However, multiple imputation may be needed when baseline covariates are missing and/or more than two timepoints are considered.
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Affiliation(s)
- Inka Rösel
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Medical Clinic, Department of Sports Medicine, University Hospital Tuebingen, Tübingen, Germany
| | - Lina María Serna-Higuita
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Fatima Al Sayah
- Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, Alberta, Canada
| | - Maresa Buchholz
- Institute for Nursing Science and Interprofessional Education, Medical University Greifswald, Greifswald, Germany
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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8
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Deal JA, Gross AL, Sharrett AR, Abraham AG, Coresh J, Carlson M, Griswold M, Mosley T, Power MC, Ramulu P, Reed NS, Lin FR, Swenor BK. Hearing impairment and missing cognitive test scores in a population-based study of older adults: The Atherosclerosis Risk in Communities neurocognitive study. Alzheimers Dement 2021; 17:1725-1734. [PMID: 33844443 DOI: 10.1002/alz.12339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Hearing impairment is associated with poor cognitive test performance in older adults. However, hearing's impact on cognitive test completion is poorly described, and missing cognitive data due to hearing impairment could misestimate the association. METHODS We investigated if hearing impairment is associated with missing neurocognitive scores in 3678 adults (72-94 years). Hearing impairment was defined by the better-ear pure tone average of speech-frequency thresholds (0.5-4 kHz) >25 decibels. RESULTS Hearing impairment was associated with greater missingness on all auditory-only tests, including Logical Memory (prevalence ratio [PR] comparing ≥ moderate impairment vs normal hearing:1.68, 95% confidence interval [CI] 1.26, 2.25) and Digits Backwards (PR 1.62; 95% CI 1.21, 2.17); and two non-auditory tests, Boston Naming (PR 1.61; 95% CI 1.21, 2.17) and Trail Making B (PR 1.55; 95% CI 1.29, 1.86). Models that imputed missing cognitive scores showed the strongest hearing-cognition associations. DISCUSSION Older adults with hearing impairment are less likely to complete cognitive testing, thereby underestimating the hearing impairment-cognition relationship.
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Affiliation(s)
- Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison G Abraham
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Denver, Colorado, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,George W. Comstock Center for Public Health Research and Prevention, Johns Hopkins Bloomberg School of Public Health, Hagerstown, Maryland, USA.,Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michelle Carlson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Griswold
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Pradeep Ramulu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bonnielin K Swenor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wang G, Ma M, Jiang L, Chen F, Xu L. Multiple imputation of maritime search and rescue data at multiple missing patterns. PLoS One 2021; 16:e0252129. [PMID: 34143787 PMCID: PMC8213137 DOI: 10.1371/journal.pone.0252129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/11/2021] [Indexed: 11/21/2022] Open
Abstract
Based on the missing situation and actual needs of maritime search and rescue data, multiple imputation methods were used to construct complete data sets under different missing patterns. Probability density curves and overimputation diagnostics were used to explore the effects of multiple imputation. The results showed that the Data Augmentation (DA) algorithm had the characteristics of high operation efficiency and good imputation effect, but the algorithm was not suitable for data imputation when there was a high data missing rate. The EMB algorithm effectively restored the distribution of datasets with different data missing rates, and was less affected by the missing position; the EMB algorithm could obtain a good imputation effect even when there was a high data missing rate. Overimputation diagnostics could not only reflect the data imputation effect, but also show the correlation between different datasets, which was of great importance for deep data mining and imputation effect improvement. The Expectation-Maximization with Bootstrap (EMB) algorithm had a poor estimation effect on extreme data and failed to reflect the dataset’s variability characteristics.
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Affiliation(s)
- Guobo Wang
- China Waterborne Transport Research Institute, Beijing, PR China
| | - Minglu Ma
- China Waterborne Transport Research Institute, Beijing, PR China
| | - Lili Jiang
- China Waterborne Transport Research Institute, Beijing, PR China
- * E-mail:
| | - Fengyun Chen
- China Waterborne Transport Research Institute, Beijing, PR China
| | - Liansheng Xu
- China Waterborne Transport Research Institute, Beijing, PR China
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Neurodevelopmental Outcomes after Premedication with Atropine/Propofol vs Atropine/Atracurium/Sufentanil for Neonatal Intubation: 2-Year Follow-Up of a Randomized Clinical Trial. J Pediatr 2021; 231:273-277.e3. [PMID: 33301785 DOI: 10.1016/j.jpeds.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 01/07/2023]
Abstract
This study followed 173 newborn infants in the PREmedication Trial for Tracheal Intubation of the NEOnate multicenter, double-blind, randomized controlled trial of atropine-propofol vs atropine-atracurium-sufentanil for premedication before nonemergency intubation. At 2 years of corrected age, there was no significant difference between the groups in death or risk of neurodevelopmental delay assessed with the Ages and Stages Questionnaire. Trial registration Clinicaltrials.gov: NCT01490580.
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Low Serum Magnesium is Associated with Incident Dementia in the ARIC-NCS Cohort. Nutrients 2020; 12:nu12103074. [PMID: 33050118 PMCID: PMC7600951 DOI: 10.3390/nu12103074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 01/02/2023] Open
Abstract
Higher serum magnesium is associated with lower risk of multiple morbidities, including diabetes, stroke, and atrial fibrillation, but its potential neuroprotective properties have also been gaining traction in cognitive function and decline research. We studied 12,040 participants presumed free of dementia in the Atherosclerosis Risk in Communities (ARIC) study. Serum magnesium was measured in fasting blood samples collected in 1990–1992. Dementia status was ascertained through cognitive examinations in 2011–2013, 2016–2017, and 2018–2019, along with informant interviews and indicators of dementia-related hospitalization events and death. Participants’ cognitive functioning capabilities were assessed up to five times between 1990–1992 and 2018–2019. The cognitive function of participants who did not attend follow-up study visits was imputed to account for attrition. We identified 2519 cases of dementia over a median follow-up period of 24.2 years. The lowest quintile of serum magnesium was associated with a 24% higher rate of incident dementia compared to those in the highest quintile of magnesium (HR, 1.24; 95% CI, 1.07, 1.44). No relationship was found between serum magnesium and cognitive decline in any cognitive domain. Low midlife serum magnesium is associated with increased risk of incident dementia, but does not appear to impact rates of cognitive decline.
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12
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Kim ES, Shiba K, Boehm JK, Kubzansky LD. Sense of purpose in life and five health behaviors in older adults. Prev Med 2020; 139:106172. [PMID: 32593729 PMCID: PMC7494628 DOI: 10.1016/j.ypmed.2020.106172] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/10/2020] [Accepted: 06/14/2020] [Indexed: 11/19/2022]
Abstract
Accumulating evidence shows that a higher sense of purpose in life is associated with lower risk of chronic conditions and premature mortality. Health behaviors might partially explain these findings, however, the prospective association between sense of purpose and health behaviors is understudied. We tested whether a higher sense of purpose at baseline was associated with lower likelihood of developing unhealthy behaviors over time. Prospective data were from the Health and Retirement Study, a national sample of U.S. older adults. Our sample included 13,770 adults assessed up to five times across eight years. Among people who met recommended guidelines for a given health behavior outcome at baseline, those in the top versus lowest quartile of purpose in life had 24% lower likelihood of becoming physically inactive (95% CI: 0.68-0.85), 33% lower likelihood of developing sleep problems (95% CI: 0.58-0.79), and 22% lower likelihood of developing unhealthy body mass index (BMI) (95% CI: 0.69-0.87) in sociodemographic-adjusted models. Further there was a marginal reduction in smoking relapse (HR = 0.65, 95% CI: 0.41-1.03) and no association with heavy alcohol use (HR = 1.02, 95% CI: 0.81-1.29). Findings for physical inactivity, sleep problems, and unhealthy BMI remained evident after further adjusting for baseline health status and depression. Our results, suggest that a sense of purpose in life might emerge (with further research) as a valuable target to consider for interventions aimed at helping older adults maintain some health behaviors.
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Affiliation(s)
- Eric S Kim
- Department of Psychology, University of British Columbia, Vancouver, Canada; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States of America.
| | - Koichiro Shiba
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, CA, United States of America
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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13
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Kim ES, Ryff C, Hassett A, Brummett C, Yeh C, Strecher V. Sense of Purpose in Life and Likelihood of Future Illicit Drug Use or Prescription Medication Misuse. Psychosom Med 2020; 82:715-721. [PMID: 32697442 PMCID: PMC7484217 DOI: 10.1097/psy.0000000000000842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In the United States, 28.6 million people used illicit drugs or misused prescription drugs in the last 30 days. Thus, identifying factors linked with lower likelihood of future drug misuse is an important target for research and practice. Sense of purpose in life has been linked with better behavioral and physical health outcomes. Furthermore, a higher sense of purpose may reduce the likelihood of drug misuse because it has been linked with several protective factors including enhanced ability to handle stress, higher pain tolerance, and lower impulsivity. However, the association between sense of purpose and drug misuse has been understudied. Thus, we tested whether people with a higher sense of purpose at baseline had a lower likelihood of future drug misuse 9 to 10 years later. METHODS This study included 3535 middle-aged adults from the Midlife in the United States Study who were not misusing drugs at baseline. Using multiple logistic regression models, we assessed whether baseline purpose in life was associated with risk of misusing drugs 9 to 10 years later. RESULTS Among respondents not misusing drugs at baseline, people in the highest quartile of purpose (versus lowest quartile) had a substantially lower likelihood of future drug misuse in a model adjusting for demographic variables (odds ratio = 0.50, 95% confidence interval = 0.31-0.83). Associations remained evident after additionally adjusting for psychological distress, baseline health, and health behaviors. CONCLUSIONS A growing knowledge base suggests that a sense of purpose can be increased. Additional research is needed to evaluate sense of purpose as a novel target in the prevention and reduction of drug misuse.
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Affiliation(s)
- Eric S. Kim
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA
- Program on Integrative Knowledge and Human Flourishing, Institute for Quantitative Social Science, Harvard University, Cambridge, MA
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Carol Ryff
- Department of Psychology, University of Wisconsin, Madison, WI
- Institute on Aging, University of Wisconsin, Madison, WI
| | - Afton Hassett
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Chad Brummett
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | | | - Victor Strecher
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI
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Kim ES, Whillans AV, Lee MT, Chen Y, VanderWeele TJ. Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach. Am J Prev Med 2020; 59:176-186. [PMID: 32536452 PMCID: PMC7375895 DOI: 10.1016/j.amepre.2020.03.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Growing evidence documents strong associations between volunteering and favorable health and well-being outcomes. However, epidemiological studies have not evaluated whether changes in volunteering are associated with subsequent health and well-being outcomes. METHODS Data were from 12,998 participants in the Health and Retirement Study-a large, diverse, prospective, and nationally representative cohort of U.S. adults aged >50 years. Using multiple logistic, linear, and generalized linear regression models, this study evaluated if changes in volunteering (between t0, 2006/2008 and t1, 2010/2012) were associated with 34 indicators of physical health, health behaviors, and psychosocial well-being (in t2, 2014/2016). Models adjusted for sociodemographics, physical health, health behaviors, psychosocial factors, and personality, as well as volunteering and all outcomes in the prebaseline wave (t0, 2006/2008). Results accounted for multiple testing and data were analyzed in 2019. RESULTS During the 4-year follow-up period, participants who volunteered ≥100 hours/year (versus 0 hours/year) had a reduced risk of mortality and physical functioning limitations, higher physical activity, and better psychosocial outcomes (higher: positive affect, optimism, and purpose in life; lower: depressive symptoms, hopelessness, loneliness, and infrequent contact with friends). Volunteering was not associated with other physical health outcomes (diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, cognitive impairment, and chronic pain), health behaviors (binge drinking, smoking, and sleep problems), or psychosocial outcomes (life satisfaction, mastery, health/financial mastery, depression, negative affect, perceived constraints, and contact with other family/children). CONCLUSIONS With further research, volunteering is an activity that physicians might suggest to their willing and able patients as a way of simultaneously enhancing health and society.
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Affiliation(s)
- Eric S Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts.
| | - Ashley V Whillans
- Negotiation, Organizations, and Markets Unit, Harvard Business School, Cambridge, Massachusetts
| | - Matthew T Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Spratlen MJ, Perera FP, Lederman SA, Rauh VA, Robinson M, Kannan K, Trasande L, Herbstman J. The association between prenatal exposure to perfluoroalkyl substances and childhood neurodevelopment. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 263:114444. [PMID: 32272335 PMCID: PMC7362877 DOI: 10.1016/j.envpol.2020.114444] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 05/05/2023]
Abstract
Perfluoroalkyl substances (PFAS) were among various persistent organic pollutants suspected to have been released during the collapse of the World Trade Center (WTC) on 9/11. Evidence on the association between prenatal PFAS exposure and child neurodevelopment is limited and inconsistent. This study evaluated the association between prenatal PFAS exposure and child cognitive outcomes measured at 5 different time points in a population prenatally exposed to the WTC disaster. The study population included 302 pregnant women in the Columbia University WTC birth cohort enrolled between December 13, 2001 and June 26, 2002 at three hospitals located near the WTC site: Beth Israel, St. Vincent's, and New York University Downtown. We evaluated the association between prenatal exposure to four PFAS (perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA)) and child neurodevelopment measured using the Bayley Scales of Infant Development (BSID-II) at approximately 1, 2 and 3 years of age and using The Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at approximately 4 and 6 years of age. Geometric mean (range) concentrations of PFAS were 6.03 (1.05, 33.7), 2.31 (0.18, 8.14), 0.43 (<LOQ, 10.3) and 0.67 (<LOQ, 15.8) ng/mL for PFOS, PFOA, PFNA and PFHxS, respectively. Several PFAS were associated with increases in cognitive outcomes in females and overall (males and females combined). Child sex modified the association between PFOS and the mental development index measured using BSID-II, with the observed relationship being positive for females and negative for males. Through principal component analyses, we observed a negative relationship between PFNA and the psychomotor development index measured using BSID-II and the verbal IQ measured using WPPSI. Our results suggest a sex- and compound-specific relationship between prenatal PFAS exposures and childhood neurodevelopment.
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Affiliation(s)
- Miranda J Spratlen
- Columbia Center for Children's Environmental Health, Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sally Ann Lederman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Virginia A Rauh
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Morgan Robinson
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Julie Herbstman
- Columbia Center for Children's Environmental Health, Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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Johnson EL, Krauss GL, Walker KA, Brandt J, Kucharska-Newton A, Mosley TH, Yasar S, Gottesman RF. Late-onset epilepsy and 25-year cognitive change: The Atherosclerosis Risk in Communities (ARIC) study. Epilepsia 2020; 61:1764-1773. [PMID: 32710450 PMCID: PMC7718433 DOI: 10.1111/epi.16616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To define the association between late-onset epilepsy (LOE) and 25-year change in cognitive performance. METHODS The Atherosclerosis Risk in Communities (ARIC) study is a multicenter longitudinal cohort study with participants from four U.S. communities. From linked Medicare claims, we identified cases of LOE, defined as ≥2 seizure-related diagnostic codes starting at age ≥67. The ARIC cohort underwent evaluation with in-person visits at intervals of 3-15 years. Cognition was evaluated 4 times over >25 years (including before the onset of seizures) using the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT); a global z-score was also calculated. We compared the longitudinal cognitive changes of participants with and without LOE, adjusting for demographics and LOE risk factors. RESULTS From 8033 ARIC participants with midlife cognitive testing and Medicare claims data available (4523 [56%] female, 1392 [17%] Black), we identified 585 cases of LOE. The rate of cognitive decline was increased on all measures in the participants who developed LOE compared to those without LOE. On the measure of global cognition, participants with LOE declined by -0.43 z-score points more over 25 years than did participants without epilepsy (95% confidence interval [CI] -0.59 to -0.27). Prior to the onset of seizures, cognitive decline was more rapid on the DWRT, DSST, and global z-scores in those who would later develop LOE than it was in non-LOE participants. Results were similar after excluding data from participants with dementia. SIGNIFICANCE Global cognition, verbal memory, executive function, and word fluency declined faster over time in persons developing LOE than without LOE. Declines in cognition preceding LOE suggest these are linked; it will be important to investigate causes for midlife cognitive declines associated with LOE.
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Affiliation(s)
- Emily L Johnson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory L Krauss
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Keenan A Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jason Brandt
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anna Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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17
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Love SAM, North KE, Zeng D, Petruski-Ivleva N, Kucharska-Newton A, Palta P, Graff M, Loehr L, Jones SB, Heiss G. Nine-Year Ethanol Intake Trajectories and Their Association With 15-Year Cognitive Decline Among Black and White Adults. Am J Epidemiol 2020; 189:788-800. [PMID: 31971233 PMCID: PMC7407608 DOI: 10.1093/aje/kwaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/14/2022] Open
Abstract
Faster rates of age-related cognitive decline might result in early onset of cognitive impairment and dementia. The relationship between ethanol intake and cognitive decline, although studied extensively, remains poorly understood. Previous studies used single measurements of ethanol, and few were conducted in diverse populations. We assessed the association of 9-year trajectories of ethanol intake (1987-1998) with 15-year rate of decline in cognitive performance from mid- to late life (1996-2013) among 2,169 Black and 8,707 White participants of the US Atherosclerosis Risk in Communities study using multivariable linear regression models. We hypothesized that stable, low to moderate drinking would be associated with lesser 15-year cognitive decline, and stable, heavy drinking with greater 15-year cognitive decline. Stable, low to moderate drinking (for Blacks, adjusted mean difference (MD) = 0.03 (95% confidence interval (CI): -0.13, 0.19); for Whites, adjusted MD = 0.02 (95% CI: -0.05, 0.08)) and stable, heavy drinking (for Blacks, adjusted MD = 0.08 (95% CI: -0.34, 0.50); for Whites, adjusted MD = -0.03 (95% CI: -0.18, 0.11)) in midlife compared with stable never-drinking were not associated with 15-year decline in general cognitive function from mid- to late life. No association was observed for the stable former and "mostly" drinking trajectories with 15-year cognitive decline. Stable low, low to moderate, and stable heavy drinking in midlife are not associated with lesser and greater cognitive decline, respectively, from mid- to late life among Black and White adults.
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Affiliation(s)
- Shelly-Ann M Love
- Correspondence to Dr. Shelly-Ann M. Love, Department of Epidemiology, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27516 (e-mail: )
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Alam AB, Wu A, Power MC, West NA, Alonso A. Associations of serum uric acid with incident dementia and cognitive decline in the ARIC-NCS cohort. J Neurol Sci 2020; 414:116866. [PMID: 32387846 PMCID: PMC7293945 DOI: 10.1016/j.jns.2020.116866] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Elevated serum uric acid (SUA) is associated with cardiovascular risk factors, which often contribute to dementia and dementia-like morbidity, yet several cross-sectional studies have shown protective associations with cognition, which would be consistent with other work showing benefits of elevated SUA through its antioxidant properties. METHODS We studied 11,169 participants free of dementia and cardiovascular disease from the Atherosclerosis Risk in Communities (ARIC) cohort. SUA was measured in blood samples collected in 1990-92, baseline for this study (age range 47-70 years). Incident dementia was ascertained based on clinical assessments in 2011-13 and 2016-17, surveillance based on dementia screeners conducted over telephone interviews, hospitalization discharge codes, and death certificates. Cognitive function was assessed up to four times between 1990 and 92 and 2016-17. We estimated the association of SUA, categorized into quartiles, with incidence of dementia using Cox regression models adjusting for potential confounders. The association between cognitive decline and SUA was assessed using generalized estimating equations. RESULTS Over a median follow-up period of 24.1 years, 2005 cases of dementia were identified. High baseline SUA was associated with incident dementia (HR, 1.29; 95% CI, 1.12, 1.47) when adjusted for sociodemographic variables. However, after further adjustment including cardiovascular risk factors, this relationship disappeared (HR, 1.03; 95% CI, 0.88, 1.21). Elevated baseline SUA was associated with faster cognitive decline even after further adjustment (25-year global z-score difference, -0.149; 95% CI, -0.246, -0.052). CONCLUSION Higher levels of mid-life SUA were associated with faster cognitive decline, but not necessarily with higher risk of dementia.
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Affiliation(s)
- Aniqa B Alam
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Aozhou Wu
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, Milken School of Public Health, George Washington University, Washington D.C., USA
| | - Nancy A West
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Deal JA, Power MC, Palta P, Alonso A, Schneider AL, Perryman K, Bandeen-Roche K, Sharrett AR. Relationship of Cigarette Smoking and Time of Quitting with Incident Dementia and Cognitive Decline. J Am Geriatr Soc 2020; 68:337-345. [PMID: 31675113 PMCID: PMC7002272 DOI: 10.1111/jgs.16228] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/30/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Understanding how dementia risk is impacted by timing of smoking cessation has public health implications for prevention efforts. We investigated the relationship of cigarette smoking and cessation with dementia risk and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study. DESIGN Ongoing prospective cohort study. SETTING Begun in 1987-1989, ARIC was conducted in four US communities. PARTICIPANTS A total of 13 002 men and women (25% African American) aged 52 to 75 years. MEASUREMENTS All-cause dementia was defined using standardized algorithms incorporating longitudinal cognitive data, proxy report, and hospital and death certificate dementia codes. Cognitive decline was measured using a composite cognitive score created from three tests measured at two time points (1996-1998 and 2011-2013). Smoking and cessation status were defined by self-report using data from 1987-1989 (visit 1) and 1996-1998 (visit 4). Incident dementia risk and differences in cognitive change by smoking status were estimated with Cox proportional hazards and linear regression models, respectively. To address smoking-related attrition, cognitive scores were imputed for living participants with incomplete cognitive testing. RESULTS The proportion of never, former, and current smokers was 44%, 41%, and 14%; 79% of former smokers quit 9 years or more before baseline. A total of 1347 participants developed dementia. After adjustment, compared with never smoking, the hazard ratio for all-cause dementia for current smoking was 1.33 (95% confidence interval [CI] = 1.12-1.59) and for recent quitting (<9 y before baseline) was 1.24 (95% CI = 1.01-1.52). Quitting 9 years or more before baseline was not associated with dementia. We found no differences in rates of cognitive decline by smoking status. CONCLUSION Although quitting at any time suggested benefit, dementia risk depended on time since smoking cessation. Our study highlights the importance of early midlife cessation to decrease dementia risk. J Am Geriatr Soc 68:337-345, 2020.
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Affiliation(s)
- Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Priya Palta
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Kelly Perryman
- Neurosurgery, Florida Cancer Specialists and Research Institute, Palm Beach Gardens, FL
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Pokharel Y, Mouhanna F, Schneider ALC, Rawlings AM, Knopman DS, Nambi V, Virani SS, Hoogeveen RC, Alonso A, Heiss G, Coresh J, Mosley T, Gottesman R, Selvin E, Ballantyne C, Power MC. High-Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change. J Am Geriatr Soc 2019; 67:2353-2361. [PMID: 31359423 PMCID: PMC6861618 DOI: 10.1111/jgs.16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Cardiac troponin T, measured using a high-sensitive assay (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with increased stroke risk and perhaps with cognitive decline. However, few well-designed prospective studies with extended follow-up have been conducted. We aimed to estimate the association of hs-cTnT and NT-proBNP with 15-year cognitive change in the Atherosclerosis Risk in Communities (ARIC) study. DESIGN Prospective cohort study. SETTING Four US communities. PARTICIPANTS A total of 9114 and 9108 participants from the Atherosclerosis Risk in Communities study for analyses of hs-cTnT and NT-proBNP, respectively. MEASUREMENTS We examined association of hs-cTnT and NT-proBNP with 15-year change (1996-1998 to 2011-2013) in three cognitive tests of executive function (Digit Symbol Substitution Test), verbal learning memory (Delayed Word Recall Test), and semantic fluency (Word Fluency Test), and an overall score combining the three tests using multivariable linear mixed effect models. We conducted several sensitivity analyses including multiple imputations to address bias due to missing data and attrition, and we compared associations within groups combining hs-cTnT and NT-proBNP into a three-level categorical variable. RESULTS At baseline (1996-1998), mean age was 63.4 (standard deviation [SD] = 5.7) years; 56.4% were women, and 17.5% were black. The hs-cTnT at baseline was not associated with cognitive change in any measure. Some evidence indicated accelerated decline in verbal learning and memory when comparing those in the highest with the lowest NT-proBNP quintiles; however, this association was not replicated when considering clinically relevant cutoffs or deciles of exposure in survivors. Sensitivity analyses were consistent with our primary analyses. There was little evidence to support effect modification by any considered factors. People with highest levels of both biomarkers had excessive decline in global z scores vs people with lowest levels (-.34; 95% confidence interval = -.63 to -.04). CONCLUSION Markers of myocardial injury and stretch were not associated with cognitive decline following 15 years among survivors, but when combined together they were suggestive in post hoc analysis. Whether this represents targets of intervention should be examined in the future. J Am Geriatr Soc 67:2353-2361, 2019.
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Affiliation(s)
- Yashashwi Pokharel
- Saint Luke’s Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Farah Mouhanna
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrea L. C. Schneider
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea M. Rawlings
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Vijay Nambi
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
- Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Salim S. Virani
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
- Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ron C. Hoogeveen
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Josef Coresh
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christie Ballantyne
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
- Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
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Fashanu OE, Zhao D, Schneider ALC, Rawlings AM, Sharrett AR, Lutsey PL, Gottesman RF, Gross AL, Guallar E, Alonso A, Mosley TH, Michos ED. Mid-life serum Vitamin D concentrations were associated with incident dementia but not late-life neuropsychological performance in the Atherosclerosis Risk in Communities (ARIC) Study. BMC Neurol 2019; 19:244. [PMID: 31640594 PMCID: PMC6805504 DOI: 10.1186/s12883-019-1483-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 10/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Activated Vitamin D has anti-inflammatory properties and adequate 25-hydroxyvitamin D [25(OH)D] concentrations may be important for neurocognitive function and protection against neurologic injury. We examined whether mid-life 25(OH) D concentrations were associated with later-life performance on neuropsychological testing, functional ability, depressive symptoms, and incident dementia. METHODS We studied 13,039 white and black ARIC participants who had serum 25(OH) D measured mid-life at visit 2 (1990-1992). Over the next ~ 20 years through visit 5 (2011-2013), participants underwent 3 additional in-person visits, annual telephone calls, and hospitalization surveillance. An extensive battery of neuropsychological outcomes were assessed at visit 5 using standardized protocols. Incident dementia was ascertained through a formal algorithm that included data from in-person cognitive testing, telephone interviews, hospital discharge codes, and death certificate codes. Diagnoses of dementia were adjudicated by expert clinician committee. For the primary cognitive analyses, we imputed for missing covariates and outcomes and used linear regression to evaluate non-concurrent cross-sectional associations of mid-life 25(OH) D (visit 2) with late-life neuropsychological outcomes (visit 5). We also used Cox regression models to examine associations of mid-life 25(OH) D and incident dementia. RESULTS In mid-life, the mean (SD) age of participants was 57 (6) years, 57% were women, and 24% black. Mean (SD) 25(OH) D was 24.3 (8.6) ng/mL; 33% had deficient (< 20 ng/mL), 44% intermediate (20- < 30 ng/mL), and 23% sufficient (≥30 ng/mL) 25(OH) D concentrations. Association between mid-life 25(OH) D and late-life performance on neuropsychological testing were mostly null. There was no significant association with functional ability or depressive symptoms. Results were similar in a sensitivity analysis using complete-case data (no imputation). However, after a median follow-up of 20 years, low 25(OH) D concentrations were associated with increased risk for incident dementia (p = 0.01 for trend across categories), with HR of 1.26 (95% CI 1.06, 1.49) for participants with deficient 25(OH) D, compared to sufficient concentrations. CONCLUSION In this community cohort, mid-life serum 25(OH) D concentrations were associated with incident dementia but not with performance on neuropsychological testing, functional ability, or depressive symptoms, 20 years later. Whether serum 25(OH) D concentrations are causally related to dementia or confounded by poorer health status remains uncertain. TRIAL REGISTRATION Registered on clinicaltrials.gov NCT00005131 .
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Affiliation(s)
- Oluwaseun E Fashanu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L C Schneider
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andreea M Rawlings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eliseo Guallar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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22
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Pokharel Y, Mouhanna F, Nambi V, Virani SS, Hoogeveen R, Alonso A, Heiss G, Coresh J, Mosley T, Gottesman RF, Ballantyne CM, Power MC. ApoB, small-dense LDL-C, Lp(a), LpPLA 2 activity, and cognitive change. Neurology 2019; 92:e2580-e2593. [PMID: 31043469 PMCID: PMC6556082 DOI: 10.1212/wnl.0000000000007574] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/29/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the association of specific lipoproteins/inflammatory enzyme with cognitive change. METHODS We examined the association of apolipoprotein B (ApoB), small-dense low-density lipoprotein cholesterol (sdLDL-C), lipoprotein (a) (Lp[a]), and lipoprotein-associated phospholipase A2 (LpPLA2) activity with 15-year change in Delayed Word Recall Test, Digit Symbol Substitution Test (DSST), Word Fluency Test (WFT), and overall summary score in 9,350 participants in the Atherosclerosis Risk in Communities study. We assessed interaction by race, sex, education, APOE ε4 status, and statin use. We also addressed questions of informative missingness, the role of stroke, and the influence of fasting status. RESULTS The mean (SD) age was 63.4 (5.7) years; 56.4% were women and 17.4% were black. We observed faster cognitive decline on DSST and global z scores with every 10-mg/dL higher sdLDL-C level (Δ DSST z score, -0.010; 95% confidence interval [CI] -0.017, -0.002 and Δ global z score, -0.011; -0.021, -0.001) and the highest vs the lowest ApoB quintiles (Δ DSST z score, -0.092; -0.0164, -0.019 and Δ global z score, -0.101; -0.200, -0.002). Association for the ApoB quintiles with Δ global z score (-0.10) was comparable with that of having 1 APOE ε4 allele (-0.11). Higher Lp(a) was associated with slower decline in DSST, WFT, and global z scores. LpPLA2 activity was not associated with cognitive change. Results were similar in sensitivity analyses. The associations of sdLDL-C or Lp(a) on cognitive change were more pronounced in statin users. CONCLUSIONS Optimal control of atherogenic lipoproteins such as ApoB and sdLDL-C in midlife for cardiovascular health may also benefit late-life cognitive health.
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Affiliation(s)
- Yashashwi Pokharel
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD.
| | - Farah Mouhanna
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Vijay Nambi
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Salim S Virani
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ron Hoogeveen
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Alvaro Alonso
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Gerardo Heiss
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Thomas Mosley
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Rebecca F Gottesman
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Christie M Ballantyne
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Melinda C Power
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
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23
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Deal JA, Sharrett AR, Albert M, Bandeen-Roche K, Burgard S, Thomas SD, Gottesman RF, Knopman D, Mosley T, Klein B, Klein R. Retinal signs and risk of incident dementia in the Atherosclerosis Risk in Communities study. Alzheimers Dement 2019; 15:477-486. [PMID: 30439332 PMCID: PMC6408967 DOI: 10.1016/j.jalz.2018.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/24/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The easily-imaged retinal microvasculature may reflect the brain microvasculature and therefore be related to dementia. METHODS In a population-based study of 12,482 adults aged 50-73 years (22% African American), we estimated the relationship of retinal characteristics from fundus photography (1993-1995) with incident all-cause dementia (1993-1995 to 2011-2013) and with etiologic subtype of dementia/mild cognitive impairment (2011-13). RESULTS A total of 1259 (10%) participants developed dementia over a mean 15.6 years. Moderate/severe (vs. no) retinopathy (hazard ratio [HR], 1.86; 95% confidence interval [CI]: 1.36-2.55) and central retinal arteriolar equivalent (narrowest quartile vs. widest three quartiles; HR, 1.26; 95% CI: 1.09-1.45) were associated with all-cause dementia. Results were qualitatively stronger (but not statistically significantly different) in participants with diabetes. Retinopathy was associated with a joint outcome of cerebrovascular-related, but not Alzheimer's disease-related, dementia/mild cognitive impairment (HR, 2.29; 95% CI: 1.24-4.23). DISCUSSION Exploration of measures in the eye may provide surrogate indices of microvascular lesions relevant to dementia.
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Affiliation(s)
- Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Barbara Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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24
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Wang S, Fashanu OE, Zhao D, Guallar E, Gottesman RF, Schneider ALC, McEvoy JW, Norby FL, Aladin AI, Alonso A, Michos ED. Relation of Elevated Resting Heart Rate in Mid-Life to Cognitive Decline Over 20 Years (from the Atherosclerosis Risk in Communities [ARIC] Study). Am J Cardiol 2019; 123:334-340. [PMID: 30424869 PMCID: PMC6309583 DOI: 10.1016/j.amjcard.2018.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
Abstract
Resting heart rate (RHR) is independently associated with cardiovascular disease (CVD) risk. We determined whether RHR, measured in mid-life, is also associated with cognitive decline. We studied 13,720 middle-aged white and black ARIC participants without a history of stroke or atrial fibrillation. RHR was obtained from a 12-lead resting electrocardiogram at the baseline visit (1990 to 1992) and categorized into groups as <60 (reference), 60 to 69, 70 to 79 and ≥80 beats/min. Cognitive scores were obtained at baseline and at up to 2 additional visits (1996 to 1998 and 2011 to 2013). The primary outcome was a global composite cognitive score (Z-score) derived from 3 tests: delayed word recall, digit symbol substitution, and word fluency. The associations of RHR with cognitive decline and incident dementia were examined using linear mixed-effects and Cox hazard models, respectively, adjusting for sociodemographics, CVD risk factors, and AV-nodal blockade use. Multiple imputation methods were used to account for attrition over follow-up. Participants had mean ± SD age of 58 ± 6 years; 56% were women, 24% black. Average RHR was 66 ± 10 beats/min. Over a mean follow-up of 20 years, those with RHR ≥80 beats/min had greater global cognitive decline (average adjusted Z-score difference -0.12 [95% confidence interval -0.21, -0.03]) and increased risk for incident dementia (hazard ratio 1.28 (1.04, 1.57), compared with those with RHR <60 beats/min. In conclusion, elevated RHR is independently associated with greater cognitive decline and incident dementia over 20 years. Further studies are needed to determine whether the associations are causal or secondary to another underlying process, and whether modification of RHR can affect cognitive decline.
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Affiliation(s)
- Stephanie Wang
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Oluwaseun E Fashanu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eliseo Guallar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Amer I Aladin
- Department of Cardiology, Wake Forest University Baptist Health, Winston Salem, North Carolina
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Erin D Michos
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.
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25
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Palta P, Sharrett AR, Deal JA, Evenson KR, Gabriel KP, Folsom AR, Gross AL, Windham BG, Knopman D, Mosley TH, Heiss G. Leisure-time physical activity sustained since midlife and preservation of cognitive function: The Atherosclerosis Risk in Communities Study. Alzheimers Dement 2018; 15:273-281. [PMID: 30321503 DOI: 10.1016/j.jalz.2018.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/25/2018] [Accepted: 08/21/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We tested the hypotheses that higher levels of and persistence of midlife leisure-time physical activity (LTPA) are associated long-term with lower cognitive decline and less incident dementia. METHODS A total of 10,705 participants (mean age: 60 years) had LTPA (no, low, middle, or high) measured in 1987-1989 and 1993-1995. LTPA was assessed in relation to incident dementia and 14-year change in general cognitive performance. RESULTS Over a median follow-up of 17.4 years, 1063 dementia cases were observed. Compared with no LTPA, high LTPA in midlife was associated with lower incidence of dementia (hazard ratio [95% confidence interval], 0.71 [0.61, 0.86]) and lower declines in general cognitive performance (-0.07 standard deviation difference [-0.12 to -0.04]). These associations were stronger when measured against persistence of midlife LTPA over 6 years. DISCUSSION LTPA is a readily modifiable factor associated inversely with long-term dementia incidence and cognitive decline.
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Affiliation(s)
- Priya Palta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelley Pettee Gabriel
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Austin, TX, USA; Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Young JC, Conover MM, Jonsson Funk M. Measurement Error and Misclassification in Electronic Medical Records: Methods to Mitigate Bias. CURR EPIDEMIOL REP 2018; 5:343-356. [PMID: 35633879 PMCID: PMC9141310 DOI: 10.1007/s40471-018-0164-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW We sought to: 1) examine common sources of measurement error in research using data from electronic medical records (EMR), 2) discuss methods to assess the extent and type of measurement error, and 3) describe recent developments in methods to address this source of bias. RECENT FINDINGS We identified eight sources of measurement error frequently encountered in EMR studies, the most prominent being that EMR data usually reflect only the health services and medications delivered within the specific health facility/system contributing to the EMR data. Methods for assessing measurement error in EMR data usually require gold standard or validation data, which may be possible using data linkage. Recent methodological developments to address the impact of measurement error in EMR analyses were particularly rich in the multiple imputation literature. SUMMARY Presently, sources of measurement error impacting EMR studies are still being elucidated, as are methods for assessing and addressing them. Given the magnitude of measurement error that has been reported, investigators are urged to carefully evaluate and rigorously address this potential source of bias in studies based in EMR data.
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Welch CA, Sabia S, Brunner E, Kivimäki M, Shipley MJ. Does pattern mixture modelling reduce bias due to informative attrition compared to fitting a mixed effects model to the available cases or data imputed using multiple imputation?: a simulation study. BMC Med Res Methodol 2018; 18:89. [PMID: 30157752 PMCID: PMC6114233 DOI: 10.1186/s12874-018-0548-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informative attrition occurs when the reason participants drop out from a study is associated with the study outcome. Analysing data with informative attrition can bias longitudinal study inferences. Approaches exist to reduce bias when analysing longitudinal data with monotone missingness (once participants drop out they do not return). However, findings may differ when using these approaches to analyse longitudinal data with non-monotone missingness. METHODS Different approaches to reduce bias due to informative attrition in non-monotone longitudinal data were compared. To achieve this aim, we simulated data from a Whitehall II cohort epidemiological study, which used the slope coefficients from a linear mixed effects model to investigate the association between smoking status at baseline and subsequent decline in cognition scores. Participants with lower cognitive scores were thought to be more likely to drop out. By using a simulation study, a range of scenarios using distributions of variables which exist in real data were compared. Informative attrition that would introduce a known bias to the simulated data was specified and the estimates from a mixed effects model with random intercept and slopes when fitted to: available cases; data imputed using multiple imputation (MI); imputed data adjusted using pattern mixture modelling (PMM) were compared. The two-fold fully conditional specification MI approach, previously validated for non-monotone longitudinal data under ignorable missing data assumption, was used. However, MI may not reduce bias because informative attrition is non-ignorable missing. Therefore, PMM was applied to reduce the bias, usually unknown, by adjusting the values imputed with MI by a fixed value equal to the introduced bias. RESULTS With highly correlated repeated outcome measures, the slope coefficients from a mixed effects model were found to have least bias when fitted to available cases. However, for moderately correlated outcome measurements, the slope coefficients from fitting a mixed effects model to data adjusted using PMM were least biased but still underestimated the true coefficients. CONCLUSIONS PMM may potentially reduce bias in studies analysing longitudinal data with suspected informative attrition and moderately correlated repeated outcome measurements. Including additional auxiliary variables in the imputation model may also reduce any remaining bias.
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Affiliation(s)
- Catherine A Welch
- Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 7HB, UK.
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 7HB, UK.,INSERM U1018, Centre for Research in Epidemiology and Population Health, Düsternbrooker Weg, 20, Villejuif, France
| | - Eric Brunner
- Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 7HB, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 7HB, UK
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 7HB, UK
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Schneider ALC, Zhao D, Lutsey PL, Gottesman RF, Sharrett AR, Rawlings AM, Alonso A, Knopman D, Mosley TH, Selvin E, Michos ED. Serum Vitamin D Concentrations and Cognitive Change Over 20 Years: The Atherosclerosis Risk in Communities Neurocognitive Study. Neuroepidemiology 2018; 51:131-137. [PMID: 30092587 PMCID: PMC6240500 DOI: 10.1159/000490912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/13/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND/AIMS 25-hydroxyvitamin D (25[OH]D) concentrations have been associated with cognitive decline and incident dementia in elderly populations; however, these relationships are susceptible to reverse causation. Less is known about the association of midlife 25(OH)D with long-term cognitive decline. METHODS This was a prospective cohort study of 13,044 participants (mean age 57 years at baseline) in the Atherosclerosis Risk in Communities Study. 25(OH)D was measured from serum collected at baseline (1990-1992) using liquid chromatography tandem high-sensitivity mass spectrometry. Cognition was assessed using 3 neuropsychological tests at 3 time points, which were combined into a composite cognitive Z-score. Multivariable-adjusted linear mixed-effects models with random intercepts and slopes were used to estimate associations between 25(OH)D and cognitive change over 20 years. RESULTS Compared to persons with sufficient 25(OH)D (≥30 ng/mL), those with deficient (< 20 ng/mL) and intermediate (20-< 30 ng/mL) 25(OH)D concentrations had similar cognitive decline in composite cognitive Z-scores (deficient versus sufficient: -0.035 [95% CI -0.104 to 0.033] and intermediate versus sufficient: -0.029 [95% CI -0.080 to 0.023]). CONCLUSIONS Lower concentrations of 25(OH)D measured in midlife were not significantly associated with more rapid cognitive decline over a 20-year follow-up period. The results of this prospective study are less susceptible to reverse causation than prior studies.
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Affiliation(s)
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andreea M Rawlings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alvaro Alonso
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Erin D Michos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Rawlings AM, Juraschek SP, Heiss G, Hughes T, Meyer ML, Selvin E, Sharrett AR, Windham BG, Gottesman RF. Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline. Neurology 2018; 91:e759-e768. [PMID: 30045960 DOI: 10.1212/wnl.0000000000006027] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 05/19/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine associations of orthostatic hypotension (OH) with dementia and long-term cognitive decline and to update previously published results in the same cohort for stroke with an additional 16 years of follow-up. METHODS We analyzed data from 11,709 participants without a history of coronary heart disease or stroke who attended the baseline examination (1987-1989) of the prospective Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a drop in systolic blood pressure (BP) of at least 20 mm Hg or a drop in diastolic BP of at least 10 mm Hg on standing. Dementia was ascertained via examination, contact with participants or their proxy, or medical record surveillance. Ischemic stroke was ascertained via cohort surveillance of hospitalizations, cohort follow-up, and linkage with registries. Both outcomes were adjudicated. Cognitive function was ascertained via 3 neuropsychological tests administered in 1990 to 1992 and 1996 to 1998 and a full battery of tests in 2011 to 2013. Scores were summarized and reported as SDs. We used adjusted Cox regression and linear mixed models. RESULTS Over ≈25 years, 1,068 participants developed dementia and 842 had an ischemic stroke. Compared to persons without OH at baseline, those with OH had a higher risk of dementia (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20-1.97) and ischemic stroke (HR 2.08, 95% CI 1.65-2.62). Persons with OH had greater, although nonsignificant, cognitive decline over 20 years (SD 0.09, 95% CI -0.02 to 0.21). CONCLUSIONS OH assessed in midlife was independently associated with incident dementia and ischemic stroke. Additional studies are needed to elucidate potential mechanisms for these associations and possible applications for prevention.
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Affiliation(s)
- Andreea M Rawlings
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson.
| | - Stephen P Juraschek
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Gerardo Heiss
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Timothy Hughes
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michelle L Meyer
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Elizabeth Selvin
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - A Richey Sharrett
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - B Gwen Windham
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Rebecca F Gottesman
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
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Deal JA, Sharrett AR, Rawlings AM, Gottesman RF, Bandeen-Roche K, Albert M, Knopman D, Selvin E, Wasserman BA, Klein B, Klein R. Retinal signs and 20-year cognitive decline in the Atherosclerosis Risk in Communities Study. Neurology 2018; 90:e1158-e1166. [PMID: 29490915 PMCID: PMC5880633 DOI: 10.1212/wnl.0000000000005205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To test the hypothesis that retinal vascular signs are associated with greater cognitive decline over 20 years in 12,317 men and women 50 to 73 years of age at baseline. METHODS A composite cognitive score was created with 3 neuropsychological tests measured at 3 time points (1990-1992 to 2011-2013). Retinal signs were measured with fundus photography (1993-1995). Differences in cognitive change by retinal signs status were estimated with linear mixed models. Cognitive scores were imputed for living participants with incomplete cognitive testing. RESULTS In multivariable-adjusted analyses that controlled for attrition, loss of vascular integrity (retinopathy and its components) was associated with greater 20-year decline (difference in 20-year cognitive change for moderate/severe vs no retinopathy -0.53 SD, 95% confidence interval -0.74 to -0.33). Estimated differences were similar in participants with and without diabetes mellitus and in white and black participants. CONCLUSIONS Retinopathy was associated with accelerated rates of 20-year cognitive decline. These findings support the exploration of more sensitive measures in the eye such as optical coherence tomography angiography, which may provide surrogate indexes of microvascular lesions relevant to cognitive decline in older adults.
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Affiliation(s)
- Jennifer A Deal
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison.
| | - A Richey Sharrett
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Andreea M Rawlings
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Rebecca F Gottesman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Karen Bandeen-Roche
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Marilyn Albert
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - David Knopman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Elizabeth Selvin
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce A Wasserman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Barbara Klein
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Ronald Klein
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
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Chen LY, Norby FL, Gottesman RF, Mosley TH, Soliman EZ, Agarwal SK, Loehr LR, Folsom AR, Coresh J, Alonso A. Association of Atrial Fibrillation With Cognitive Decline and Dementia Over 20 Years: The ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study). J Am Heart Assoc 2018; 7:e007301. [PMID: 29514809 PMCID: PMC5907543 DOI: 10.1161/jaha.117.007301] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous studies have reported that atrial fibrillation (AF) is associated with cognitive decline and dementia. These studies, however, had limited follow-up, were based mostly on white and highly selected populations, and did not account for attrition. We evaluated the association of incident AF with 20-year change in cognitive performance (accounting for attrition) and incident dementia in the ARIC (Atherosclerosis Risk in Communities) Study. METHODS AND RESULTS We analyzed data from 12 515 participants (mean age, 56.9 [SD, 5.7] years in 1990-1992; 56% women and 24% black) from 1990 to 1992 through 2011 to 2013. Incident AF was ascertained from study ECGs and hospital discharge codes. Cognitive tests were performed in 1990 to 1992, 1996 to 1998, and 2011 to 2013. Incident dementia was clinician adjudicated. We used generalized estimating equations and Cox proportional hazards models to assess the association of time-dependent AF with change in Z scores of cognitive tests and incident dementia, respectively. During 20 years, 2106 participants developed AF and 1157 participants developed dementia. After accounting for cardiovascular risk factors, including ischemic stroke, the average decline over 20 years in global cognitive Z score was 0.115 (95% confidence interval, 0.014-0.215) greater in participants with AF than in those without AF. Further adjustment for attrition by multiple imputation by chained equations strengthened the association. In addition, incident AF was associated with an increased risk of dementia (hazard ratio, 1.23; 95% confidence interval, 1.04-1.45), after adjusting for cardiovascular risk factors, including ischemic stroke. CONCLUSIONS AF is associated with greater cognitive decline and increased risk of dementia, independent of ischemic stroke. Because cognitive decline is a precursor to dementia, our findings prompt further investigation to identify specific treatments for AF that will delay the trajectory of cognitive decline and, thus, prevent dementia in patients with AF.
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Affiliation(s)
- Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas H Mosley
- Department of Neurology, University of Mississippi School of Medicine, Jackson, MS
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sunil K Agarwal
- Department of Medicine, Mount Sinai School of Medicine, New York, NY
| | - Laura R Loehr
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina, Chapel Hill, NC
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
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Milk Intake at Midlife and Cognitive Decline over 20 Years. The Atherosclerosis Risk in Communities (ARIC) Study. Nutrients 2017; 9:nu9101134. [PMID: 29039795 PMCID: PMC5691750 DOI: 10.3390/nu9101134] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/29/2017] [Accepted: 10/10/2017] [Indexed: 02/06/2023] Open
Abstract
Background: Faster rates of cognitive decline are likely to result in earlier onset of cognitive impairment and dementia. d-galactose, a derivative of lactose, is used in animal studies to induce neurodegeneration. Milk is the primary source of lactose in the human diet, and its effects on cognitive decline have not been fully evaluated. Objective: Assess the association of milk intake with change in cognitive function over 20 years. Methods: A total of 13,751 participants of the Atherosclerosis Risk in Communities (ARIC) cohort completed a food frequency questionnaire and three neurocognitive evaluations from 1990 through 2013. Two single nucleotide polymorphisms (SNPs) were used to determine lactase persistence (LCT-13910 C/T for Whites and LCT-14010 G/C for Blacks). Mixed-effects models were used to study the association of milk intake with cognitive change. Multiple imputations by chained equations were used to account for attrition. Results: Milk intake greater than 1 glass/day was associated with greater decline in the global z-score over a 20-year period. The difference in decline was 0.10 (95% CI: 0.16, 0.03) z-scores, or an additional 10% decline, relative to the group reporting “almost never” consuming milk. Conclusions: Replication of these results is warranted in diverse populations with greater milk intake and higher variability of lactase persistence genotype.
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Kim ES, Kawachi I, Chen Y, Kubzansky LD. Association Between Purpose in Life and Objective Measures of Physical Function in Older Adults. JAMA Psychiatry 2017; 74:1039-1045. [PMID: 28813554 PMCID: PMC5710461 DOI: 10.1001/jamapsychiatry.2017.2145] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Higher purpose in life is hypothesized to reduce the likelihood of developing weak grip strength and slow walking speed because purpose has been linked with a range of positive health behaviors and biological processes that are potentially protective against declining physical function. However, the association between purpose in life and objective physical function has not been examined. OBJECTIVE To assess whether higher purpose in life among adequately functioning older adults is associated with lower risk of developing weak grip strength and slow walking speed over time. DESIGN, SETTING, AND PARTICIPANTS Data for a longitudinal cohort study were collected in 2006 and again in 2010 from the Health and Retirement Study, a nationally representative study of US adults older than 50 years. Data analysis was conducted from November 23, 2016, to June 2, 2017. MAIN OUTCOMES AND MEASURES The risk of developing weak grip strength (assessed as a binary yes or no outcome) or slow walking speed (yes or no) during the 4-year follow-up period. Grip strength was assessed using Smedley spring-type hand dynamometers, and walking speed was assessed by asking respondents to walk 2.5 m at their normal walking pace. RESULTS In this study, 4486 adults had grip scores at baseline indicating adequate function (2665 women and 1821 men; mean [SD] age, 63.0 [8.2] years) and 1461 adults had walking scores at baseline indicating adequate function (801 women and 660 men; mean [SD] age, 70.8 [6.5] years). After controlling for sociodemographic factors, each 1-SD increase in purpose was associated with a 13% decreased risk (95% CI, 1%-23%) of developing weak grip strength and a 14% decreased risk (95% CI, 8%-20%) of developing slow walking speed. Associations with walking speed were maintained in all covariate models (fully adjusted model: risk ratio, 0.89; 95% CI, 0.83-0.95), but associations with grip strength did not reach conventional levels of statistical significance after additionally adjusting for relevant baseline health factors, depressive symptoms, and health behaviors (fully adjusted model: risk ratio, 0.91; 95% CI, 0.80-1.04). CONCLUSIONS AND RELEVANCE Purpose in life was prospectively associated with a decreased risk of developing weak grip strength and slow walking speed, although the findings were more robust for walking speed than for grip strength. These findings suggest that a sense of purpose in life, a modifiable factor, may play an important role in maintaining physical function among older adults.
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Affiliation(s)
- Eric S. Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ying Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Association of midlife lipids with 20-year cognitive change: A cohort study. Alzheimers Dement 2017; 14:167-177. [PMID: 28916238 DOI: 10.1016/j.jalz.2017.07.757] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Existing studies predominantly consider the association of late-life lipid levels and subsequent cognitive change. However, midlife rather than late-life risk factors are often most relevant to cognitive health. METHODS We quantified the association between measured serum lipids in midlife and subsequent 20-year change in performance on three cognitive tests in 13,997 participants of the Atherosclerosis Risk in Communities study. RESULTS Elevated total cholesterol, low-density lipoprotein cholesterol, and triglycerides were associated with greater 20-year decline on a test of executive function, sustained attention, and processing speed. Higher total cholesterol and triglycerides were also associated with greater 20-year decline in memory scores and a measure summarizing performance on all three tests. High-density lipoprotein cholesterol was not associated with cognitive change. Results were materially unchanged in sensitivity analyses addressing informative missingness. DISCUSSION Elevated total cholesterol, low-density lipoprotein cholesterol, and triglycerides in midlife were associated with greater 20-year cognitive decline.
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Rawlings AM, Sharrett AR, Mosley TH, Ballew SH, Deal JA, Selvin E. Glucose Peaks and the Risk of Dementia and 20-Year Cognitive Decline. Diabetes Care 2017; 40:879-886. [PMID: 28500217 PMCID: PMC5481977 DOI: 10.2337/dc16-2203] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hemoglobin A1c (HbA1c), a measure of average blood glucose level, is associated with the risk of dementia and cognitive impairment. However, the role of glycemic variability or glucose excursions in this association is unclear. We examined the association of glucose peaks in midlife, as determined by the measurement of 1,5-anhydroglucitol (1,5-AG) level, with the risk of dementia and 20-year cognitive decline. RESEARCH DESIGN AND METHODS Nearly 13,000 participants from the Atherosclerosis Risk in Communities (ARIC) study were examined. Dementia was ascertained from surveillance, neuropsychological testing, telephone calls with participants or their proxies, or death certificate dementia codes. Cognitive function was assessed using three neuropsychological tests at three visits over 20 years and was summarized as z scores. We used Cox and linear mixed-effects models. 1,5-AG level was dichotomized at 10 μg/mL and examined within clinical categories of HbA1c. RESULTS Over a median time of 21 years, dementia developed in 1,105 participants. Among persons with diabetes, each 5 μg/mL decrease in 1,5-AG increased the estimated risk of dementia by 16% (hazard ratio 1.16, P = 0.032). For cognitive decline among participants with diabetes and HbA1c <7% (53 mmol/mol), those with glucose peaks had a 0.19 greater z score decline over 20 years (P = 0.162) compared with those without peaks. Among participants with diabetes and HbA1c ≥7% (53 mmol/mol), those with glucose peaks had a 0.38 greater z score decline compared with persons without glucose peaks (P < 0.001). We found no significant associations in persons without diabetes. CONCLUSIONS Among participants with diabetes, glucose peaks are a risk factor for cognitive decline and dementia. Targeting glucose peaks, in addition to average glycemia, may be an important avenue for prevention.
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Affiliation(s)
- Andreea M Rawlings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Demakakos P, Muniz-Terrera G, Nouwen A. Type 2 diabetes, depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers: A prospective cohort study. PLoS One 2017; 12:e0175827. [PMID: 28414754 PMCID: PMC5393617 DOI: 10.1371/journal.pone.0175827] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/01/2017] [Indexed: 01/14/2023] Open
Abstract
We examined the individual and synergistic effects of type 2 diabetes and elevated depressive symptoms on memory and executive function trajectories over 10 and eight years of follow-up, respectively. Our sample comprised 10,524 community-dwellers aged ≥50 years in 2002–03 from the English Longitudinal Study of Ageing. With respect to memory (word recall), participants with either diabetes or elevated depressive symptoms recalled significantly fewer words compared with those free of these conditions (reference category), but more words compared with those with both conditions. There was a significant acceleration in the rate of memory decline in participants aged 50–64 years with both conditions (-0.27, 95% CI, -0.45 to -0.08, per study wave), which was not observed in those with either condition or aged ≥65 years. With respect to executive function (animal naming), participants aged ≥65 years with diabetes or those with elevated depressive symptoms named significantly fewer animals compared with the reference category, while those with both conditions named fewer animals compared with any other category. The rate of executive function decline was significantly greater in participants with both conditions (-0.54, 95% CI, -0.99 to -0.10; and –0.71, 95% CI, -1.16 to -0.27, per study wave, for those aged 50–64 and ≥65 years, respectively), but not in participants with either condition. Diabetes and elevated depressive symptoms are inversely associated with memory and executive function, but, individually, do not accelerate cognitive decline. The co-occurrence of diabetes and elevated depressive symptoms significantly accelerates cognitive decline over time, especially among those aged 50–64 years.
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Affiliation(s)
- Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | | | - Arie Nouwen
- Department of Psychology, Middlesex University, London, United Kingdom
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