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Dickerson F, Khan S, Origoni A, Rowe K, Katsafanas E, Harvin A, Yang S, Yolken R. Risk Factors for Natural Cause Mortality in Schizophrenia. JAMA Netw Open 2024; 7:e2432401. [PMID: 39254976 DOI: 10.1001/jamanetworkopen.2024.32401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Importance Schizophrenia is associated with premature mortality from mostly natural causes. Decreased cognitive functioning has been identified as a determinant of mortality in the general population. However, there have been few prospective studies of this issue in persons with schizophrenia. Objective To examine whether lower cognitive functioning is a risk factor for natural cause mortality in schizophrenia. Design, Setting, and Participants This prospective cohort study included persons with schizophrenia or schizoaffective disorder enrolled between February 1, 1999, and December 31, 2022, at a nonprofit psychiatric system in Baltimore, Maryland. Participants were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and other clinical measures. Exposure Natural cause mortality. Main Outcomes and Measures Associations of cognitive function, obesity, tobacco smoking, and medical conditions with natural cause mortality were evaluated using Cox proportional hazards regression models. Results Of the 844 participants enrolled (mean [SD] age, 39.6 [12.1] years; 533 male [63.2%]), 158 (18.7%) died of natural causes during a median follow-up of 14.4 years (range, 7.0 days to 23.9 years). The most significant factor associated with mortality was lower cognitive functioning as measured by the RBANS (Cox coefficient, -0.04; 95% CI, -0.05 to -0.03; z = -5.72; adjusted P < .001). Additional factors independently associated with mortality included the diagnosis of an autoimmune disorder (hazard ratio [HR], 2.86; 95% CI, 1.83-4.47; z = 4.62; adjusted P < .001), tobacco smoking (HR, 2.26; 95% CI, 1.55-3.30; z = 4.23; adjusted P < .001), diagnosis of chronic obstructive pulmonary disease (HR, 3.31; 95% CI, 1.69-6.49; z = 3.48; adjusted P = .006), body mass index as a continuous variable (HR, 1.06; 95% CI, 1.02-1.09; z = 3.30; adjusted P = .01), diagnosis of a cardiac rhythm disorder (HR, 2.56; 95% CI, 1.40-4.69; z = 3.06; adjusted P = .02), and being divorced or separated (HR, 1.80; 95% CI, 1.22-2.65; z = 2.97; adjusted P = .02). An RBANS score below the 50th percentile displayed a joint association with being a smoker, having an elevated body mass index, and having a diagnosis of an autoimmune or a cardiac rhythm disorder. Conclusions and Relevance In this prospective cohort study, lower cognitive functioning was a risk factor for natural cause mortality in schizophrenia. Efforts should be directed at methods to improve cognitive functioning, particularly among individuals with additional risk factors.
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Affiliation(s)
- Faith Dickerson
- Stanley Research Program, Sheppard Pratt, Baltimore, Maryland
| | - Sabahat Khan
- Stanley Research Program, Sheppard Pratt, Baltimore, Maryland
| | - Andrea Origoni
- Stanley Research Program, Sheppard Pratt, Baltimore, Maryland
| | - Kelly Rowe
- Stanley Research Program, Sheppard Pratt, Baltimore, Maryland
| | | | | | - Shuojia Yang
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robert Yolken
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Yang S, Zhou C, Ye Z, Liu M, Zhang Y, Gan X, Huang Y, Xiang H, He P, Zhang Y, Qin X. Association Between Cognitive Function and Risk of Chronic Kidney Disease: A Longitudinal Cohort and Mendelian Randomization Study. Mayo Clin Proc 2024; 99:1399-1410. [PMID: 39115510 DOI: 10.1016/j.mayocp.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/16/2024] [Accepted: 04/23/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To investigate the causal dose-response association between cognitive function and the risk of chronic kidney disease (CKD) by a longitudinal cohort and mendelian randomization study. METHODS The longitudinal cohort study included 396,600 participants without prior dementia and CKD from the UK Biobank. Cognitive function (including prospective memory, numeric memory, visuospatial memory, reaction time, and reasoning ability) was assessed by computerized touchscreen tests. Global cognitive function was defined as a composite score of those specific cognitive domains. A 2-stage mendelian randomization analysis was conducted with 12,979 cases of CKD and 379,424 controls. Genetically predicted global cognitive function was instrumented with 91 confirmed genome-wide significant variants. The study outcome was new-onset CKD. The study was conducted from March 13, 2006, to September 30, 2021. RESULTS During a median follow-up of 12.5 years, new-onset CKD developed in 13,090 participants. Per 1 SD score increments in reaction time (adjusted hazard ratio [HR], 0.97; 95% CI, 0.95 to 0.99), reasoning ability (adjusted HR, 0.91; 95% CI, 0.88 to 0.94), and global cognitive function (adjusted HR, 0.96; 95% CI, 0.95 to 0.98) were associated with a significantly lower risk of new-onset CKD. Compared with an incorrect answer in the prospective memory test, a correct answer was associated with a lower risk of new-onset CKD (adjusted HR, 0.82; 95% CI, 0.76 to 0.88). Mendelian randomization analyses found that per 1 SD score increments in genetically predicted global cognitive function resulted in a significantly (7%; 95% CI, 2% to 12%) lower risk of new-onset CKD. CONCLUSION A better cognitive function is causally associated with a lower risk of CKD in participants without prior dementia.
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Affiliation(s)
- Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xiaoqin Gan
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yu Huang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Hao Xiang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.
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Li S, He X, Wu L, Tang X, Ouyang Y, Jing W, Yang Y, Yang J, Che K, Pan C, Chen X, Zhang X, Zheng X, Xu J, Liao S, Yin M, Ni J. The association of cognitive function and its changes with all-cause mortality among community-dwelling older adults. Front Aging Neurosci 2024; 16:1419235. [PMID: 38934019 PMCID: PMC11199401 DOI: 10.3389/fnagi.2024.1419235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Background The association of cognitive function, its changes, and all-cause mortality has not reached a consensus, and the independence of the association between changes in cognitive function and mortality remains unclear. The purpose of this study was to evaluate the longitudinal association between baseline cognitive function and cognitive changes over 1 year with subsequent all-cause mortality among the older adults aged 60 and above. Methods A prospective cohort study utilizing the Community Older Adults Health Survey data. Initiated in 2018, the study annually assessed all individuals aged 60+ in Dalang Town, Dongguan City. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE). A total of 6,042 older adults individuals were included, and multivariate Cox proportional hazard models were used to examine cognitive function's impact on mortality. Results Participants' median age was 70 years, with 39% men. Over a median 3.08-year follow-up, 525 died. Mortality risk increased by 6% per MMSE score decrease (adjusted HR = 1.06, 95%CI: 1.05-1.08). Compared to those with normal cognitive function at baseline, participants with mild cognitive impairment and moderate to severe cognitive impairment had significantly higher mortality risks (adjusted HR = 1.40, 95%CI: 1.07-1.82; HR = 2.49, 95%CI: 1.91-3.24, respectively). The risk of death was 5% higher for each one-point per year decrease in cognitive function change rate (HR = 1.05, 95%CI: 1.02-1.08). Compared with participants with stable cognitive function, those with rapid cognitive decline had a 79% increased risk of death (adjusted HR = 1.79, 95% CI: 1.11-2.87), with baseline cognitive function influencing this relationship significantly (P for interaction = 0.002). Conclusion Baseline cognitive impairment and rapid cognitive decline are associated with higher all-cause mortality risks in Chinese older adults. Baseline function influences the mortality impact of cognitive changes.
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Affiliation(s)
- Shangjie Li
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Xiuping He
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Liang Wu
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Xinming Tang
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Yijiang Ouyang
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Wenyuan Jing
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Ya Yang
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jiacheng Yang
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Kechun Che
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Congcong Pan
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Xiaoting Chen
- Community Health Center of Dongguan Songshan Lake (Public Health Office), Dongguan, China
| | - Xiaoxia Zhang
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Xueting Zheng
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jiahao Xu
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Shaobin Liao
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Mingjuan Yin
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jindong Ni
- Shunde Women and Children’s Hospital, Maternal and Child Research Institute, Guangdong Medical University, Foshan, China
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
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Schneider WJ, Flanagan DP, Niileksela CR, Engler JR. The effect of measurement error on the positive predictive value of PSW methods for SLD identification: How buffer zones dispel the illusion of inaccuracy. J Sch Psychol 2024; 103:101280. [PMID: 38432731 DOI: 10.1016/j.jsp.2023.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/18/2023] [Accepted: 12/29/2023] [Indexed: 03/05/2024]
Abstract
Patterns of Strengths and Weaknesses (PSW) methods are widely used for identifying specific learning disabilities (SLDs). Several researchers, however, have reported that the diagnostic accuracy of PSW methods is unacceptably low when strict thresholds were used to identify students with SLDs. We believe these findings give a misleading impression of the magnitude of the diagnostic errors that are likely to arise in PSW assessments. In a simulation study of 10 million cases using a simplified PSW method for demonstration, most of what have been called diagnostic errors were cases in which observed scores and true scores fell on opposite sides of a strict threshold but were still within a buffer zone the size of a typical measurement error. Because small score differences do not result in meaningfully different case conceptualizations, the use of buffer zones reveals that previous estimates of the diagnostic accuracy of PSW methods are misleadingly low. We also demonstrate that diagnostic decisions become increasingly reliable when observed scores are comfortably distant from diagnostic thresholds. For practitioners, we present a flowchart and practical guidelines to improve the accuracy and stability of SLD identification decisions.
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Begde A, Wilcockson T, Brayne C, Hogervorst E. Visual processing speed and its association with future dementia development in a population-based prospective cohort: EPIC-Norfolk. Sci Rep 2024; 14:5016. [PMID: 38424122 PMCID: PMC10904745 DOI: 10.1038/s41598-024-55637-x] [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: 01/17/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
Visual processing deficits have frequently been reported when studied in individuals with dementia, which suggests their potential utility in supporting dementia screening. The study uses EPIC-Norfolk Prospective Population Cohort Study data (n = 8623) to investigate the role of visual processing speed assessed by the Visual Sensitivity Test (VST) in identifying the risk of future dementia using Cox regression analyses. Individuals with lower scores on the simple and complex VST had a higher probability of a future dementia diagnosis HR1.39 (95% CI 1.12, 1.67, P < 0.01) and HR 1.56 (95% CI 1.27, 1.90, P < 0.01), respectively. Although other more commonly used cognitive dementia screening tests were better predictors of future dementia risk (HR 3.45 for HVLT and HR 2.66, for SF-EMSE), the complex VST showed greater sensitivity to variables frequently associated with dementia risk. Reduced complex visual processing speed is significantly associated with a high likelihood of a future dementia diagnosis and risk/protective factors in this cohort. Combining visual processing tests with other neuropsychological tests could improve the identification of future dementia risk.
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Affiliation(s)
- Ahmet Begde
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Thomas Wilcockson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Carol Brayne
- Department of Public Health, University of Cambridge, Cambridge, Cambridgeshire, CB2 1PZ, UK
| | - Eef Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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Del Brutto OH, Rumbea DA, Costa AF, Patel M, Sedler MJ, Mera RM. Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study. Clin Neurol Neurosurg 2024; 236:108053. [PMID: 37992533 DOI: 10.1016/j.clineuro.2023.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE There is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. PATIENTS AND METHODS Middle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). RESULTS Analysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 - 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 - 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 - 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 - 2.18). CONCLUSIONS Cognitive impairment is associated with mortality in the study population.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Maitri Patel
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
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Demonceau C, Buckinx F, Reginster JY, Bruyère O. Assessment of risk factors associated with long-term mortality in nursing homes: result from the SENIOR cohort. Aging Clin Exp Res 2023; 35:2997-3005. [PMID: 37917376 DOI: 10.1007/s40520-023-02579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Previous studies on risk factors for death in nursing homes have focused on short-term observation and limited number risk factors. AIMS This study aims to identify factors predictive of 8-year survival in nursing homes. METHODS The study used the baseline measurements from the SENIOR cohort collected in 2013-2014. Data included clinical assessments (i.e., body composition, nutritional status, physical performance, level of dependence and cognition, frailty phenotype) as well as demographic information, number of medications and medical history. Mortality data were collected annually for 8 years. Univariate analyses were initially performed to assess potential predictive factors, followed by a Cox regression model using stepwise selection. RESULTS Of the 662 participants enrolled in the cohort, 58 (8.8%) were not further assessed due to the withdrawal of 2 nursing homes and 71 (10.7%) had no mortality data available (i.e., relocation, refusal to continue the study). Among the 533 patients included, 111 (20.8%) were still alive in 2022. Median survival time was 4 years (1.93-6.94). Multivariate regression showed that younger age (HR = 1.04 (1.03-1.06)), higher body mass index (HR = 0.96 (0.94-0.98)), higher score on the Mini-Mental State-Examination (HR = 0.97 (0.94-0.99)) and higher score on the Short Physical Performance Battery (HR = 0.93 (0.90-0.97)) were protective factors against mortality. CONCLUSIONS This study highlights that certain modifiable factors related to physical or mental health contribute to increased survival in nursing homes. Because of its ability to improve physical performance and partly cognitive function, promoting physical activity in nursing homes appears to be a public health priority.
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Affiliation(s)
- Céline Demonceau
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium.
| | - Fanny Buckinx
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
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Thorpe RJ, Huang A, Smail E, Clay OJ, Dean L, Aiken-Morgan A, Gellert A, Rebok GW. The Relationship Between Cognition and Mortality Among Older Black and White Men in Advanced Cognitive Training for Independent and Vital Elderly. J Aging Health 2023; 35:119S-125S. [PMID: 36148805 DOI: 10.1177/08982643221128906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the association between baseline cognition and all-cause mortality among Black men and White men. Methods: Data were from 614 Black and White men aged ≥65 years at baseline in the Advanced Cognitive Training for Independent and Vital Elderly trial and their linked mortality information. Cox proportional hazards models were used to determine the association between baseline cognition (memory, reasoning, speed of processing, Mini Mental State Exam) and mortality risk over 20 years, adjusting for covariates. Results: Among White men, higher performance on the memory composite measure was associated with a decreased risk of all-cause mortality (HR: 0.93; 95% CI: 0.89-0.98), whereas the other cognitive measures were not associated with all-cause mortality risk. Among Black men, none of the cognitive measures was associated with all-cause mortality risk. Discussion: There is a need for future work to recruit and retain a larger sample of older Black men to better understand the cognition-mortality relationship.
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Affiliation(s)
- Roland J Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison Huang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, , Baltimore, MD, USA
| | - Emily Smail
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, , Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama, Birmingham, AL, USA
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Adrienne Aiken-Morgan
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - George W Rebok
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, , Baltimore, MD, USA
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Lin J, Xiao J, Li Q, Cao L. Association between all-cause mortality and trajectories across quality and duration of sleep and cognitive function: based on Group-Based Multivariate Trajectory modeling. BMC Geriatr 2023; 23:528. [PMID: 37648983 PMCID: PMC10468863 DOI: 10.1186/s12877-023-04231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Sleep duration and quality are associated with cognition, but the interaction of the 3 indicators and their association with all-cause mortality is unclear. METHODS We used data from the Chinese Longitudinal Healthy Longevity Survey from 2005-2018 to identify latent trajectories of sleep duration, sleep quality, and cognitive function. Secondly, the multinomial logistic model was adopted to determine predictors of trajectory groups. Finally, the Cox regression model was used to examine the association between these trajectory groups and all-cause mortality. RESULTS A total of 5046 adults (49% women) with an average age of 76.34 were included in the study. The median follow-up period was 11.11 years, during which 1784 (35%) participants died. We identified 4 latent groups among older adults: 'Good-performance' (51%), 'Decreasing' (26%), 'Oversleep & cognitive impairment' (12%), and 'Sleep-deprived' (11%). Individuals in the 'Decreasing' had a 51% increased risk of all-cause mortality (HR = 1.51, 95% CI: 1.25 - 1.81, p < .001). Individuals in the 'Oversleep & cognitive impairment' had a 170% increased risk of all-cause mortality (HR = 2.7 95% CI: 2.13 - 3.43, p < .001). Women had a higher risk of all-cause mortality regardless of trajectory group (47-143% men VS. 74-365% women). Both urban and rural areas have a similarly increased risk of all-cause mortality (48-179%). CONCLUSIONS Our study reveals the latent trajectories across sleep duration, sleep quality, and cognitive function in older Chinese and further explores their association with death. These findings provide a rational basis for cognitive interventions and reduce all-cause mortality.
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Affiliation(s)
- Jianlin Lin
- International School of Public Health and One Health, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, Hainan, 571199, China
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, China
- Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, China
- Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, China
| | - Jian Xiao
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, 210003, China
| | - Qiao Li
- International School of Public Health and One Health, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, Hainan, 571199, China.
| | - Li Cao
- International School of Public Health and One Health, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, Hainan, 571199, China.
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10
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Adjoian Mezzaca T, Dodds LV, Rundek T, Zeki Al Hazzouri A, Caunca MR, Gomes-Osman J, Loewenstein DA, Schneiderman N, Elfassy T. Associations Between Cognitive Functioning and Mortality in a Population-Based Sample of Older United States Adults: Differences by Sex and Education. J Aging Health 2022; 34:905-915. [PMID: 35440227 DOI: 10.1177/08982643221076690] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine whether cognition is associated with mortality among older US adults. Methods: We studied 5,989 National Health and Nutrition Examination Survey participants age 60+ in years 1999-2014 with mortality follow-up through 2015. Cognitive function was measured in one standard deviation decrements using the Digit Symbol Substitution Test (DSST), Animal Fluency (AnFl), and two Consortium to Establish a Registry for Alzheimer's Disease (CERAD) tests. Results: Each decrement in cognitive function was associated with increased risk of mortality overall (DSST HR: 1.36, 95% CI: 1.25, 1.48), among women only (AnFl: 1.51, 95% CI: 1.02, 2.24), and among those with less than a high school education only (AnFl HR: 1.46, 95% CI: 1.09, 1.97; CERAD-WL HR: 1.34, 95% CI: 1.07, 1.67; and CERAD-DR HR: 1.38, 95% CI: 1.05, 1.82). Discussion: Among US adults, lower cognitive functioning was associated with mortality; associations were stronger among women and those with less education.
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Affiliation(s)
| | - Leah V Dodds
- Department of Public Health Sciences, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, 5798Columbia University, New York City, NY, USA
| | - Michelle R Caunca
- Department of Public Health Sciences, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joyce Gomes-Osman
- Department of Neurology, Evelyn F. McKnight Brain Institute, 12235University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Physical Therapy, Miami Miller School of Medicine, Miami, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neil Schneiderman
- Department of Psychology, 5452University of Miami, Coral Gables, FL, USA
| | - Tali Elfassy
- Department of Medicine, 12235University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Zhang XM, Jiao J, Guo N, Zhu C, Li Z, Lv D, Wang H, Jin J, Wen X, Zhao S, Wu X, Xu T. The association between cognitive impairment and 30-day mortality among older Chinese inpatients. Front Med (Lausanne) 2022; 9:896481. [PMID: 36091678 PMCID: PMC9449351 DOI: 10.3389/fmed.2022.896481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Although the association between cognitive impairment and mortality has been widely described among community-dwelling older adults, this association in hospitalized patients was limited. Objectives This study's purpose was to explore the association between cognitive impairment and 30-day mortality after adjustment of factors among Chinese in-patients. Methods This was a large-scale prospective study based on a cohort of patients aged 65 years and older, whose cognitive function was assessed using the Mini-Cog instrument, followed up at 30-days for mortality. Multivariate logistic regression models were used to assess the association between cognitive impairment and 30-day mortality. Results There were 9,194 inpatients in our study, with an average age of 72.41 ± 5.72. The prevalence of cognitive impairment using the Mini-Cog instrument was 20.5%. Multivariable analyses showed that patients with cognitive impairment have an increased risk of 30-day mortality, compared to those with normal cognitive function (OR = 2.83,95%CI:1.89–4.24) in an unadjusted model. In the fully adjusted model, Patients with cognitive impairment had an increased risk of 30-day mortality compared to those with normal cognitive function in the completely adjusted model (OR = 1.76,95% CI: 1.14–2.73). Additionally, this association still existed and was robust after performing a stratified analysis of age, gender, frailty and depression, with no significant interaction (P > 0.05). Conclusions Our study found that older Chinese in-patients with cognitive impairment have a 1.76-fold risk of 30-day mortality compared to patients with normal cognitive function, suggesting that clinicians and nurses need to early implement cognitive function screening and corresponding interventions to improve clinical outcomes for older in-patients.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
- *Correspondence: Jing Jiao
| | - Na Guo
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Zhen Li
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Wang
- Department of Nursing, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
- Xinjuan Wu
| | - Tao Xu
- Department of Epidemiology and Statistics, Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Beijing, China
- Tao Xu
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12
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Cukierman-Yaffe T, Gerstein HC, Basile J, Bethel MA, Cardona-Muñoz EG, Conget I, Dagenais G, Franek E, Hall S, Hancu N, Jansky P, Lakshmanan M, Lanas F, Leiter LA, Lopez-Jaramillo P, Pirags V, Pogosova N, Probstfield J, Rao-Melacini P, Ramasundarahettige C, Raubenheimer PJ, Riddle MC, Rydén L, Shaw JE, Sheu WHH, Temelkova-Kurktschiev T. Novel Indices of Cognitive Impairment and Incident Cardiovascular Outcomes in the REWIND Trial. J Clin Endocrinol Metab 2022; 107:e3448-e3454. [PMID: 35446415 DOI: 10.1210/clinem/dgac200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Low cognitive scores are risk factors for cardiovascular outcomes. Whether this relationship is stronger using novel cognitive indices is unknown. METHODS Participants in the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial who completed both the Montreal Cognitive Assessment (MoCA) score and Digit Substitution Test (DSST) at baseline (N = 8772) were included. These scores were used to identify participants with baseline substantive cognitive impairment (SCI), defined as a baseline score on either the MoCA or DSST ≥ 1.5 SD below either score's country-specific mean, or SCI-GM, which was based on a composite index of both scores calculated as their geometric mean (GM), and defined as a score that was ≥ 1.5 SD below their country's average GM. Relationships between these measures and incident major adverse cardiovascular events (MACE), and either stroke or death were analyzed. RESULTS Compared with 7867 (89.7%) unaffected participants, the 905 (10.3%) participants with baseline SCI had a higher incidence of MACE (unadjusted hazard ratio [HR] 1.34; 95% CI 1.11, 1.62; P = 0.003), and stroke or death (unadjusted HR 1.60; 95% CI 1.33, 1.91; P < 0.001). Stronger relationships were noted for SCI-GM and MACE (unadjusted HR 1.61; 95% CI 1.28, 2.01; P < 0.001), and stroke or death (unadjusted HR 1.85; 95% CI 1.50, 2.30; P < 0.001). For SCI-GM but not SCI, all these relationships remained significant in models that adjusted for up to 10 SCI risk factors. CONCLUSION Country-standardized SCI-GM was a strong independent predictor of cardiovascular events in people with type 2 diabetes in the REWIND trial.
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Affiliation(s)
- Tali Cukierman-Yaffe
- Endocrinology Institute, Sheba Medical Center, Ramat-Gan, and Epidemiology Department, Sackler School of Medicine, Herceg Institute of Aging, Tel Aviv University, Tel Aviv, Israel
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Jan Basile
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | | | - Ignacio Conget
- Endocrinology and Nutrition Dpt. Hospital Clinic i Universitari, Barcelona, Spain
| | - Gilles Dagenais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences and Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Stephanie Hall
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Nicolae Hancu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | | | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Valdis Pirags
- University of Latvia, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | | | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | | | - Matthew C Riddle
- Department of Medicine, Oregon Health & Science University Portland, OR, USA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | | | - Wayne H-H Sheu
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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13
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An intelligent mind in a healthy body? Predicting health by cognitive ability in a large European sample. INTELLIGENCE 2022. [DOI: 10.1016/j.intell.2022.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Behrendt T, Bielitzki R, Behrens M, Glazachev OS, Schega L. Effects of Intermittent Hypoxia-Hyperoxia Exposure Prior to Aerobic Cycling Exercise on Physical and Cognitive Performance in Geriatric Patients—A Randomized Controlled Trial. Front Physiol 2022; 13:899096. [PMID: 35694402 PMCID: PMC9178199 DOI: 10.3389/fphys.2022.899096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 01/04/2023] Open
Abstract
Background: It was recently shown that intermittent hypoxic-hyperoxic exposure (IHHE) applied prior to a multimodal training program promoted additional improvements in cognitive and physical performance in geriatric patients compared to physical training only. However, there is a gap in the literature to which extent the addition of IHHE can enhance the effects of an aerobic training. Therefore, the aim of this study was to investigate the efficacy of IHHE applied prior to aerobic cycling exercise on cognitive and physical performance in geriatric patients. Methods: In a randomized, two-armed, controlled, and single-blinded trial, 25 geriatric patients (77–94 years) were assigned to two groups: intervention group (IG) and sham control group (CG). Both groups completed 6 weeks of aerobic training using a motorized cycle ergometer, three times a week for 20 min per day. The IG was additionally exposed to intermittent hypoxic and hyperoxic periods for 30 min prior to exercise. The CG followed the similar procedure breathing sham hypoxia and hyperoxia (i.e., normoxia). Within 1 week before and after the interventions, cognitive performance was assessed with the Dementia-Detection Test (DemTect) and the Clock Drawing Test (CDT), while physical performance was measured using the Timed “Up and Go” Test (TUG) and the Short-Physical-Performance-Battery (SPPB). Results: No interaction effect was found with respect to the DemTect (ηp2 = 0.02). An interaction effect with medium effect size (ηp2 = 0.08) was found for CDT performance with a higher change over time for IG (d = 0.57) compared to CG (d = 0.05). The ANCOVA with baseline-adjustment indicated between-group differences with a large and medium effect size at post-test for the TUG (ηp2 = 0.29) and SPPB (ηp2 = 0.06) performance, respectively, in favour of the IG. Within-group post-hoc analysis showed that the TUG performance was worsened in the CG (d = 0.65) and remained unchanged in the IG (d = 0.19). Furthermore, SPPB performance was increased (d = 0.58) in IG, but no relevant change over time was found for CG (d = 0.00). Conclusion: The current study suggests that an additional IHHE prior to aerobic cycling exercise seems to be more effective to increase global cognitive functions as well as physical performance and to preserve functional mobility in geriatric patients in comparison to aerobic exercise alone after a 6-week intervention period.
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Affiliation(s)
- Tom Behrendt
- Department for Sport Science, Chair for Health and Physical Activity, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- *Correspondence: Tom Behrendt,
| | - Robert Bielitzki
- Department for Sport Science, Chair for Health and Physical Activity, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Behrens
- Department for Sport Science, Chair for Health and Physical Activity, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Oleg S. Glazachev
- Department Human Physiology, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Lutz Schega
- Department for Sport Science, Chair for Health and Physical Activity, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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15
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Assessment and Management of Cognitive Function in Patients with Prostate Cancer Treated with Second-Generation Androgen Receptor Pathway Inhibitors. CNS Drugs 2022; 36:419-449. [PMID: 35522374 PMCID: PMC9073450 DOI: 10.1007/s40263-022-00913-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
Preservation of cognitive function is an important outcome in oncology. Optimal patient management requires an understanding of cognitive effects of the disease and its treatment and an efficacious approach to assessment and management of cognitive dysfunction, including selection of treatments to minimize the risk of cognitive impairment. Awareness is increasing of the potentially detrimental effects of cancer-related cognitive dysfunction on functional independence and quality of life. Prostate cancer occurs most often in older men, who are more likely to develop cognitive dysfunction than younger individuals; this population may be particularly vulnerable to treatment-related cognitive disorders. Prompt identification of treatment-induced cognitive dysfunction is a crucial aspect of effective cancer management. We review the potential etiologies of cognitive decline in patients with prostate cancer, including the potential role of androgen receptor pathway inhibitors; commonly used tools for assessing cognitive function validated in metastatic castration-resistant prostate cancer and adopted in non-metastatic castration-resistant prostate cancer trials; and strategies for management of cognitive symptoms. Many methods are currently used to assess cognitive function. The prevalence and severity of cognitive dysfunction vary according to the instruments and criteria applied. Consensus on the definition of cognitive dysfunction and on the most appropriate approaches to quantify its extent and progression in patients treated for prostate cancer is lacking. Evidence-based guidance on the appropriate tools and time to assess cognitive function in patients with prostate cancer is required.
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16
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Zou T, Cao S, Liu W, Li L, Jiang J, Wu L. Is simple reaction time or choice reaction time an indicator of all-cause mortality or CVD mortality? Public Health 2021; 199:34-41. [PMID: 34534888 DOI: 10.1016/j.puhe.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 05/20/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Simple reaction time (SRT) and choice reaction time (CRT) have been shown to be good indicators for quantitatively assessing the level of human cognitive impairment, but these parameters have also been linked to the risk of human death. This study aimed to quantitatively assess the independent predictive value of SRT or CRT for all-cause mortality or cardiovascular disease (CVD) mortality by conducting a meta-analysis of prospective studies. STUDY DESIGN The study design of this study is a prospective cohort study. METHODS We conducted a meta-analysis by combining hazard ratios (HRs) and 95% confidence intervals (95% CIs) of SRT or CRT with all-cause mortality or CVD mortality in healthy community residents aged 18 and over. Heterogeneity was evaluated by using Q statistics and Cochrane's I2 statistics. RESULTS A total of seven prospective studies that examined all-cause mortality and CVD mortality were included. The pooled HR of all-cause mortality in SRT was 1.099 (1.065-1.134, I2 = 11.9%), and an increased risk of CVD mortality was associated with lower SRT (HR = 1.186, 95% CI = 1.137-1.236; I2 = 52.4%). Similarly, the pooled HR of all-cause mortality in CRT was 1.140 (95% CI = 1.085-1.197, I2 = 33.7%). However, lower CRT was not statistically associated with an increased risk of CVD mortality. CONCLUSION SRT may be a predictor of all-cause-mortality and CVD mortality, and CRT is significantly associated with an increased risk of all-cause mortality.
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Affiliation(s)
- T Zou
- School of Public Health, Nanchang University, Nanchang, Jiangxi Province Key Laboratory of Preventive Medicine, 461 BaYi St, Nanchang, 330006, PR China; Department of Health, Jiangxi Maternal and Child Health Hospital, 318 BaYi St, Nanchang, 330006, PR China
| | - S Cao
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu Province, 730000, PR China
| | - W Liu
- School of Public Health, Nanchang University, Nanchang, Jiangxi Province Key Laboratory of Preventive Medicine, 461 BaYi St, Nanchang, 330006, PR China.
| | - L Li
- School of Public Health, Nanchang University, Nanchang, Jiangxi Province Key Laboratory of Preventive Medicine, 461 BaYi St, Nanchang, 330006, PR China
| | - J Jiang
- New York University, 6 Metro Tech Center, Brooklyn, NY 11201, USA
| | - L Wu
- School of Public Health, Nanchang University, Nanchang, Jiangxi Province Key Laboratory of Preventive Medicine, 461 BaYi St, Nanchang, 330006, PR China.
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17
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Ong PA, Annisafitrie FR, Purnamasari N, Calista C, Sagita N, Sofiatin Y, Dikot Y. Dementia Prevalence, Comorbidities, and Lifestyle Among Jatinangor Elders. Front Neurol 2021; 12:643480. [PMID: 34367043 PMCID: PMC8345013 DOI: 10.3389/fneur.2021.643480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Research on dementia prevalence and the potentially related risk factors from Indonesia is scarce. We sought to identify the prevalence of dementia, health risk factors, and lifestyle in Jatinangor elders. Methods: A total of 686 participants completed questionnaires on lifestyle, health risk factors, and cognitive and functional tests from September 2013 to December 2013. We determined the prevalence of dementia; and the associations between health, leisure activities, dietary pattern, and dementia were analyzed using logistic regression. Results: The prevalence of dementia was 29.15%. The risk factors differed between age groups. Those aged 60–74 years and who have a lower education level, lower occupational attainment, and less active intellectual and recreational activities were associated with higher dementia risk. Those aged > 75 years living in a rural area and who take less fruit were associated with a higher risk of dementia. Conclusions: The prevalence of dementia in Jatinangor is high. The identified modifiable risk factors are a potential target for intervention and valuable for designing public health policies.
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Affiliation(s)
- Paulus Anam Ong
- Department of Neurology, Hasan Sadikin Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Febby Rosa Annisafitrie
- Department of Neurology, Hasan Sadikin Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Novita Purnamasari
- Department of Neurology, Hasan Sadikin Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Chandra Calista
- Department of Neurology, Hasan Sadikin Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Noveline Sagita
- Department of Neurology, Immanuel Hospital, Maranatha Christian University, Bandung, Indonesia
| | - Yulia Sofiatin
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Yustiani Dikot
- Department of Neurology, Faculty of Medicine, Achmad Yani University, Bandung, Indonesia
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18
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O'Shea DM, Davis JD, Tremont G. Verbal memory is associated with adherence to COVID-19 protective behaviors in community dwelling older adults. Aging Clin Exp Res 2021; 33:2043-2051. [PMID: 34131881 PMCID: PMC8204921 DOI: 10.1007/s40520-021-01905-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Background Adherence to protective behaviors is central to limiting the spread of COVID-19 and associated risk of serious illness and mortality in older populations. Whether cognition predicts adherence to protective behaviors has not been examined in older adults. Aims To examine whether specific cognitive abilities predict adherence to COVID-19 protective behaviors in older adults, independent of other relevant factors. Methods Data from 431 older adults (i.e., ≥ 65 years) who took part in the COVID-19 module of the Health and Retirement Study were included in the present study. Separate binary logistic regression models were used to examine whether performance on measures of immediate and delayed recall and working memory predicted adherence to COVID-19 protective behaviors, controlling for demographics, level of COVID-19 concern, depressive symptoms, and medical conditions. Results For every unit increase in immediate and delayed recall, the probability of adhering to COVID-19 protective behaviors increased by 47% and 69%, respectively. There was no association between the measure of working memory and adherence. Discussion It is of public interest to understand the factors that reduce adherence to protective behaviors so that we can better protect those most vulnerable and limit community spread. Our findings demonstrate that reduced memory predicts non-adherence to COVID-19 protective behaviors, independent of virus concern, and other relevant demographic and health factors. Conclusions Public health strategies aimed at increasing adherence to COVID-19 protective behaviors in community dwelling older adults, should account for the role of reduced cognitive function in limiting adherence.
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Affiliation(s)
- Deirdre M O'Shea
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.
| | - Jennifer D Davis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
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19
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Luksiene D, Sapranaviciute-Zabazlajeva L, Tamosiunas A, Radisauskas R, Bobak M. Lowered cognitive function and the risk of the first events of cardiovascular diseases: findings from a cohort study in Lithuania. BMC Public Health 2021; 21:792. [PMID: 33894765 PMCID: PMC8070287 DOI: 10.1186/s12889-021-10843-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains predict the risk of first cardiovascular disease (CVD) events in middle-aged and older populations. Methods Seven thousand eighty-seven participants, men and women aged 45–72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008 in the city of Kaunas, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at the baseline survey) was evaluated. Cox proportional hazards regression models were applied to examine how cognitive function predicts the first events of CVD. Results During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased the risk of a first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score – by 17% in men and 24% in women; and a composite score of cognitive function – by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of a first cardiovascular event according to the categories of a composite score of cognitive function, revealed that a lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p < 0.05). Conclusions The findings of this follow-up study suggest that men and women with lower cognitive functions have an increased risk for a first event of CVD compared to participants with a higher level of cognitive functions.
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Affiliation(s)
- Dalia Luksiene
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania. .,Department of Environmental and Occupational Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | | | - Abdonas Tamosiunas
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania.,Department of Environmental and Occupational Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
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20
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Deary IJ, Hill WD, Gale CR. Intelligence, health and death. Nat Hum Behav 2021; 5:416-430. [PMID: 33795857 DOI: 10.1038/s41562-021-01078-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
The field of cognitive epidemiology studies the prospective associations between cognitive abilities and health outcomes. We review research in this field over the past decade and describe how our understanding of the association between intelligence and all-cause mortality has consolidated with the appearance of new, population-scale data. To try to understand the association better, we discuss how intelligence relates to specific causes of death, diseases/diagnoses and biomarkers of health through the adult life course. We examine the extent to which mortality and health associations with intelligence might be attributable to people's differences in education, other indicators of socioeconomic status, health literacy and adult environments and behaviours. Finally, we discuss whether genetic data provide new tools to understand parts of the intelligence-health associations. Social epidemiologists, differential psychologists and behavioural and statistical geneticists, among others, contribute to cognitive epidemiology; advances will occur by building on a common cross-disciplinary knowledge base.
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Affiliation(s)
- Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - W David Hill
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Catharine R Gale
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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21
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Hayat SA, Luben R, Khaw KT, Brayne C. The Relationship Between Cognitive Performance Using Tests Assessing a Range of Cognitive Domains and Future Dementia Diagnosis in a British Cohort: A Ten-Year Prospective Study. J Alzheimers Dis 2021; 81:123-135. [PMID: 33867360 PMCID: PMC8203214 DOI: 10.3233/jad-210030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exploring the domains of cognitive function which are most strongly associated with future dementia may help with understanding risk factors for, and the natural history of dementia. OBJECTIVE To examine the association of performance on a range of cognitive tests (both global and domain specific) with subsequent diagnosis of dementia through health services in a population of relatively healthy men and women and risk of future dementia. METHODS We examined the association between performance on different cognitive tests as well as a global score and future dementia risk ascertained through health record linkage in a cohort of 8,581 individuals (aged 48-92 years) between 2004-2019 with almost 15 years follow-up (average of 10 years) before and after adjustment for socio-demographic, lifestyle, and health characteristics. RESULTS Those with poor performance for global cognition (bottom 10%) were almost four times as likely to receive a dementia diagnosis from health services over the next 15 years than those who performed well HR = 3.51 (95% CI 2.61, 4.71 p < 0.001) after adjustment for socioeconomic, lifestyle, and biological factors and also prevalent disease. Poor cognition performance in multiple tests was associated with 10-fold increased risk compared to those not performing poorly in any test HR = 10.82 (95% CI 6.85, 17.10 p < 0.001). CONCLUSION Deficits across multiple cognitive domains substantially increase risk of future dementia over and above neuropsychological test scores ten years prior to a clinical diagnosis. These findings may help further understanding of the natural history of dementia and how such measures could contribute to strengthening future models of dementia.
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Affiliation(s)
- Shabina A. Hayat
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Robert Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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22
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Flaatten H, Beil M, Guidet B. Elderly Patients in the Intensive Care Unit. Semin Respir Crit Care Med 2020; 42:10-19. [PMID: 32772353 DOI: 10.1055/s-0040-1710571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Very old intensive care unit (ICU) patients, aged ≥ 80 years, are by no mean newcomers, but during the last decades their impact on ICU admissions has grown in parallel with the increase in the number of elderly persons in the community. Hence, from being a "rarity," they have now become common and constitute one of the largest subgroups within intensive care, and may easily be the largest group in 20 years and make up 30 to 40% of all ICU admissions. Obviously, they are not admitted because they are old but because they are with various diseases and problems like any other ICU patient. However, their age and the presence of common geriatric syndromes such as frailty, cognitive decline, reduced activity of daily life, and several comorbid conditions makes this group particularly challenging, with a high mortality rate. In this review, we will highlight aspects of current and future epidemiology and current knowledge on outcomes, and describe the effects of the aforementioned geriatric syndromes. The major challenge for the coming decades will be the question of whom to treat and the quest for better triage criteria not based on age alone. Challenges with the level of care during the ICU stay will also be discussed. A stronger relationship with geriatricians should be promoted to create a better and more holistic care and aftercare for survivors.
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Affiliation(s)
- Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen Norway
| | - Michael Beil
- Institute of Health Sciences, Philosophisch-Theologische Hochschule Vallendar, Vallendar, Germany
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Paris, France
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23
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Rojer AG, Ramsey KA, Trappenburg MC, van Rijssen NM, Otten RH, Heymans MW, Pijnappels M, Meskers CG, Maier AB. Instrumented measures of sedentary behaviour and physical activity are associated with mortality in community-dwelling older adults: A systematic review, meta-analysis and meta-regression analysis. Ageing Res Rev 2020; 61:101061. [PMID: 32360669 DOI: 10.1016/j.arr.2020.101061] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/26/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sedentary behaviour (SB) and physical activity (PA) can be objectively assessed with inertial sensors to describe bodily movement. Higher SB and lower PA is associated with higher chronological age and negative health outcomes. This study aimed to quantify the association between instrumented measures of SB (i-SB) and PA (i-PA) and mortality in community-dwelling older adults, to subsequently compare the quantitative effect sizes and to determine the dose-response relationships. METHODS An electronic search in six databases from inception to 27th of June 2019 was conducted. All articles reporting on i-SB or i-PA and mortality in community-dwelling older adults aged 60 years or older were considered eligible. A meta-analysis was conducted for the association between i-SB and i-PA and mortality expressed in Hazard Ratios (HR) and 95% Confidence Intervals (95% CI). A meta-regression analysis was performed to determine the dose-response relationship between i-SB and steps per day and mortality. RESULTS Twelve prospective articles representing eleven cohorts, reporting data of 38,141 participants were included. In total 2502 (6.4%) participants died during follow-up (2.0 to 9.8 years). Comparing the most sedentary with the least sedentary groups of participants resulted in a pooled HR of 2.44 (95% CI 1.82-3.25). Comparing the least active with the most active groups of participants resulted in a pooled HR of 1.93 (95% CI 1.39-2.69); 2.66 (95% CI 2.11-3.35); 3.43 (95% CI 2.61-4.52), and 3.09 (95% CI 2.33-4.11) for light, moderate-to-vigorous-, total PA and steps per day, respectively. Meta-regression analyses showed clear dose-response relationships between i-SB and steps per day and mortality risk. CONCLUSION Both i-SB and i-PA are significantly associated with mortality in community-dwelling older adults, showing the largest effect size for total physical activity. Dose-response relationships could be observed for i-SB and steps per day.
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Kotwal AA, Lee SJ, Dale W, Boscardin WJ, Waite LJ, Smith AK. Integration of an Objective Cognitive Assessment Into a Prognostic Index for 5-Year Mortality Prediction. J Am Geriatr Soc 2020; 68:1796-1802. [PMID: 32356919 PMCID: PMC8189656 DOI: 10.1111/jgs.16451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index. DESIGN, SETTING, AND PARTICIPANTS The National Social Life Health and Aging Project Wave 2, a nationally representative, cross-sectional, in-home survey conducted in 2010 to 2011 on 3,199 community-dwelling adults aged 60 to 99 years. MEASUREMENTS Cognition was measured using a Survey-Adapted Montreal Cognitive Assessment (MoCA-SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18-23 points), and screen positive for dementia (<18 points). Single-item cognitive measures included clock-draw and five-word delayed recall. We constructed a modified Lee Prognostic Index (range = 0-18 points) based on age, behavior, function, and comorbidities shown to predict long-term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5-year mortality prediction. RESULTS The sample was 54% female and had a mean age of 72 years, MoCA-SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA-SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4-7 points or 8-12 points), the absolute mortality rate difference was 15% by cognitive status. The clock-draw and delayed-recall items added similar value to mortality predictions as the longer MoCA-SA. Cognition had the third highest fraction of new information of all 13 Lee index items. CONCLUSION Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5-year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk. J Am Geriatr Soc 68:1796-1802, 2020.
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Affiliation(s)
- Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - Sei J. Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - William Dale
- Department of Supportive Care Medicine, City of Hope National Medical Center
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
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25
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Kleineidam L, Chouraki V, Próchnicki T, van der Lee SJ, Madrid-Márquez L, Wagner-Thelen H, Karaca I, Weinhold L, Wolfsgruber S, Boland A, Martino Adami PV, Lewczuk P, Popp J, Brosseron F, Jansen IE, Hulsman M, Kornhuber J, Peters O, Berr C, Heun R, Frölich L, Tzourio C, Dartigues JF, Hüll M, Espinosa A, Hernández I, de Rojas I, Orellana A, Valero S, Stringa N, van Schoor NM, Huisman M, Scheltens P, Rüther E, Deleuze JF, Wiltfang J, Tarraga L, Schmid M, Scherer M, Riedel-Heller S, Heneka MT, Amouyel P, Jessen F, Boada M, Maier W, Schneider A, González-Pérez A, van der Flier WM, Wagner M, Lambert JC, Holstege H, Sáez ME, Latz E, Ruiz A, Ramirez A. PLCG2 protective variant p.P522R modulates tau pathology and disease progression in patients with mild cognitive impairment. Acta Neuropathol 2020; 139:1025-1044. [PMID: 32166339 PMCID: PMC7244617 DOI: 10.1007/s00401-020-02138-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
Abstract
A rare coding variant (rs72824905, p.P522R) conferring protection against Alzheimer's disease (AD) was identified in the gene encoding the enzyme phospholipase-C-γ2 (PLCG2) that is highly expressed in microglia. To explore the protective nature of this variant, we employed latent process linear mixed models to examine the association of p.P522R with longitudinal cognitive decline in 3595 MCI patients, and in 10,097 individuals from population-based studies. Furthermore, association with CSF levels of pTau181, total tau, and Aβ1-42 was assessed in 1261 MCI patients. We found that MCI patients who carried the p.P522R variant showed a slower rate of cognitive decline compared to non-carriers and that this effect was mediated by lower pTau181 levels in CSF. The effect size of the association of p.P522R with the cognitive decline and pTau181 was similar to that of APOE-ε4, the strongest genetic risk factor for AD. Interestingly, the protective effect of p.P522R was more pronounced in MCI patients with low Aβ1-42 levels suggesting a role of PLCG2 in the response to amyloid pathology. In line with this hypothesis, we observed no protective effect of the PLCG2 variant on the cognitive decline in population-based studies probably due to the lower prevalence of amyloid positivity in these samples compared to MCI patients. Concerning the potential biological underpinnings, we identified a network of co-expressed proteins connecting PLCG2 to APOE and TREM2 using unsupervised co-regulatory network analysis. The network was highly enriched for the complement cascade and genes differentially expressed in disease-associated microglia. Our data show that p.P522R in PLCG2 reduces AD disease progression by mitigating tau pathology in the presence of amyloid pathology and, as a consequence, maintains cognitive function. Targeting the enzyme PLCG2 might provide a new therapeutic approach for treating AD.
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Affiliation(s)
- Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Vincent Chouraki
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE-Facteurs de risque Et déterminants moléculaires des maladies liées au vieillissement, Lille, France
- Epidemiology and Public Health Department, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Tomasz Próchnicki
- Institute of Innate Immunity, University Hospitals Bonn, Bonn, Germany
| | - Sven J van der Lee
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Holger Wagner-Thelen
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ilker Karaca
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Steffen Wolfsgruber
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Anne Boland
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Évry, France
| | - Pamela V Martino Adami
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland
- Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Julius Popp
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
- Department of Geriatric Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Frederic Brosseron
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Iris E Jansen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marc Hulsman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Peters
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany
| | - Claudine Berr
- INSERM, University Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Reinhard Heun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, 53127, Bonn, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Christophe Tzourio
- Inserm, Bordeaux Population Health Research Center, UMR1219, University of Bordeaux, Bordeaux, France
| | - Jean-François Dartigues
- Inserm, Bordeaux Population Health Research Center, UMR1219, University of Bordeaux, Bordeaux, France
| | - Michael Hüll
- Department of Psychiatry and Psychotherapy, Center for Psychiatry, Clinic for Geriatric Psychiatry and Psychotherapy Emmendingen, University of Freiburg, Freiburg, Germany
| | - Ana Espinosa
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Hernández
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Itziar de Rojas
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Adelina Orellana
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
| | - Sergi Valero
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Najada Stringa
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Jean-Francois Deleuze
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Évry, France
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Lluis Tarraga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Michael T Heneka
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Philippe Amouyel
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE-Facteurs de risque Et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Merce Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Anja Schneider
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jean-Charles Lambert
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE-Facteurs de risque Et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Henne Holstege
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mª Eugenia Sáez
- Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain
| | - Eicke Latz
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Institute of Innate Immunity, University Hospitals Bonn, Bonn, Germany
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- Centre for Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology, Trondheim, Norway
| | - Agustin Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades-Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Ramirez
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany.
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Dommershuijsen LJ, Isik BM, Darweesh SKL, van der Geest JN, Ikram MK, Ikram MA. Unraveling the Association Between Gait and Mortality-One Step at a Time. J Gerontol A Biol Sci Med Sci 2020; 75:1184-1190. [PMID: 31807749 PMCID: PMC7243583 DOI: 10.1093/gerona/glz282] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Slowness of walking is one of the very first signs of aging and is considered a marker for overall health that is strongly associated with mortality risk. In this study, we sought to disentangle the clinical drivers of the association between gait and mortality. METHODS We included 4,490 participants of the Rotterdam Study who underwent a gait assessment between 2009 and 2015 and were followed-up for mortality until 2018. Gait was assessed with an electronic walkway and summarized into the domains Rhythm, Phases, Variability, Pace, Tandem, Turning, and Base of Support. Cox models adjusted for age, sex, and height were built and consecutively adjusted for six categories of health indicators (lifestyle, musculoskeletal, cardiovascular, pulmonary, metabolic, and neurological). Analyses were repeated in comorbidity-free individuals. RESULTS Multiple gait domains were associated with an increased risk of mortality, including Pace (hazard ratio (HR) per SD worse gait, adjusted for other domains: 1.34 [1.19-1.50]), Rhythm (HR: 1.12 [1.02-1.23]) and Phases (HR: 1.12 [1.03-1.21]). Similarly, a 0.1 m/s decrease in gait speed was associated with a 1.21 (1.15-1.27) times higher hazard of mortality (HR fully adjusted: 1.14 [1.08-1.20]). In a comorbidity-free subsample, the HR per 0.1 m/s decrease in gait speed was 1.25 (1.09-1.44). Cause-specific mortality analyses revealed an association between gait speed and multiple causes of death. CONCLUSIONS Several gait domains were associated with mortality risk, including Pace which primarily represents gait speed. The association between gait speed and mortality persisted after an extensive adjustment for covariates, suggesting that gait is a marker for overall health.
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Affiliation(s)
| | - Berna M Isik
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sirwan K L Darweesh
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos N van der Geest
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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27
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Ikram MA, Brusselle G, Ghanbari M, Goedegebure A, Ikram MK, Kavousi M, Kieboom BCT, Klaver CCW, de Knegt RJ, Luik AI, Nijsten TEC, Peeters RP, van Rooij FJA, Stricker BH, Uitterlinden AG, Vernooij MW, Voortman T. Objectives, design and main findings until 2020 from the Rotterdam Study. Eur J Epidemiol 2020; 35:483-517. [PMID: 32367290 PMCID: PMC7250962 DOI: 10.1007/s10654-020-00640-5] [Citation(s) in RCA: 298] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/23/2020] [Indexed: 12/19/2022]
Abstract
The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Guy Brusselle
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Brenda C T Kieboom
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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28
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Cognitive Function and Mortality: Results from Kaunas HAPIEE Study 2006-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072397. [PMID: 32244660 PMCID: PMC7178058 DOI: 10.3390/ijerph17072397] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022]
Abstract
Background: The purpose of the study is to evaluate the association between cognitive function and risk of all-cause and cardiovascular disease mortality during 10 years of the follow-up. Methods: 7087 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008. During 10 years of follow-up, all-cause and CVD mortality risk were evaluated. Results: During 10 years of follow-up, 768 (23%) men and 403 (11%) women died (239 and 107 from CVD). After adjustment for sociodemographic, biological, lifestyle factors, and illnesses, a decrease per 1 standard deviation in different cognitive function scores increased risk for all-cause mortality (by 13%–24% in men, and 17%–33% in women) and CVD mortality (by 19%–32% in men, and 69%–91% in women). Kaplan-Meier survival curves for all-cause and CVD mortality, according to tertiles of cognitive function, revealed that the lowest cognitive function (1st tertile) predicts shorter survival compared to second and third tertiles (p < 0.001). Conclusions: The findings of this follow-up study suggest that older participants with lower cognitive functions have an increased risk for all-cause and CVD mortality compared to older participants with a higher level of cognitive function.
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29
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Zhang Z, Liu H, Choi SW. Early-life socioeconomic status, adolescent cognitive ability, and cognition in late midlife: Evidence from the Wisconsin Longitudinal Study. Soc Sci Med 2020; 244:112575. [PMID: 31606188 PMCID: PMC6926157 DOI: 10.1016/j.socscimed.2019.112575] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023]
Abstract
Although the association between childhood socioeconomic status (SES) and late-life cognition is well-established, the mechanisms underlying this association are less clear. One important potential mediator seldom examined is adolescent cognitive ability. To address this gap, we examined 5,880 respondents from the Wisconsin Longitudinal Study, which follows a random sample of high school students who graduated from Wisconsin high schools in 1957. Structural equation models were used to examine the direct and indirect effects of childhood SES on cognition in late midlife through adolescent cognitive ability, educational attainment, midlife economic condition, and midlife health. Cognitive function was measured as a latent variable composed of scores from 6 cognitive assessments including immediate and delayed recall, digit ordering, letter and category fluency, and a subset of the Wechsler Adult Intelligence Scale similarities test. We found that childhood SES predicts cognition in late midlife, and this association is largely mediated by adolescent cognitive ability and educational attainment and to a lesser extent by midlife economic condition and health. The findings underscore the long-arm of childhood SES in cognitive function in later life and highlight the complex life-course pathways underlying the association between childhood SES and cognition.
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Affiliation(s)
- Zhenmei Zhang
- Department of Sociology, Michigan State University, United States.
| | - Hui Liu
- Department of Sociology, Michigan State University, United States
| | - Seung-Won Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, United States
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30
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Guidet B, de Lange DW, Boumendil A, Leaver S, Watson X, Boulanger C, Szczeklik W, Artigas A, Morandi A, Andersen F, Zafeiridis T, Jung C, Moreno R, Walther S, Oeyen S, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Flaatten H. The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study. Intensive Care Med 2019; 46:57-69. [PMID: 31784798 PMCID: PMC7223711 DOI: 10.1007/s00134-019-05853-1] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022]
Abstract
Purpose Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients’ characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike’s information criterion across imputations was used to evaluate the goodness of fit of our models. Results We included 3920 patients with a median age of 84 years (IQR: 81–87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83–8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3–6); IQCODE: 3.19 (3–3.69); ADL: 6 (4–6); Comorbidity and Polypharmacy score (CPS): 10 (7–14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.–1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14–1.17, p < 0.0001) and CFS (per point): 1.1 (1.05–1.15, p < 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model. Conclusion We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making. Electronic supplementary material The online version of this article (10.1007/s00134-019-05853-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Saint Antoine Hospital, AP-HP, Hôpital Saint-Antoine, service de réanimation, F75012, Paris, France.
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- AP-HP, Hôpital Saint-Antoine, service de réanimation, F75012, Paris, France
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, UK
| | | | - Carol Boulanger
- Chair NAHP Section ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Sabadell and Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sagrado Corazon-General de Cataluña University Hospitals, Quiron Salud, Barcelona, Spain
| | - Alessandro Morandi
- Department of Rehabilitation Hospital Ancelle di Cremona Italy, Geriatric Research Group, Brescia, Italy
| | - Finn Andersen
- Department of Anaesthesia and Intensive Care, NTNU, Dep of Circulation and Medical Imaging, Ålesund Hospital, Trondheim, Ålesund, Norway
| | | | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sten Walther
- Linkoping University Hospital, Linkoping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Flaatten
- Dep. of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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Cao Z, Wang R, Cheng Y, Yang H, Li S, Sun L, Xu W, Wang Y. Adherence to a healthy lifestyle counteracts the negative effects of risk factors on all-cause mortality in the oldest-old. Aging (Albany NY) 2019; 11:7605-7619. [PMID: 31525731 PMCID: PMC6781993 DOI: 10.18632/aging.102274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022]
Abstract
In the study, we examined the extent to which the harmful effects of risk factors on all-cause mortality can be counteracted by healthy lifestyle practices in the oldest-old (80 years of age and older). A total of 17,660 oldest-old from China were followed up for up to 10 years. The data were analyzed using the Cox proportional hazard model with adjustment for potential confounders. We found that having a rural residence, not being married, having lower economic status, physical disability, impaired cognitive function, or comorbidity were all associated with an elevated risk of mortality. Using these factors, we computed a weighted "risk score." Because never smoking, never drinking, doing physical exercise, having an ideal diet, and a normal weight were independently associated with lower mortality, we also combined them to compute a weighted "protection score." Both scores were divided into lowest, middle, and highest groups using their tertiles. In joint effect analyses, participants with the combined highest-risk score and lowest-protection score profile had a nearly threefold higher joint death risk. These analyses show that adherence to a healthy lifestyle counteracts the negative effect of risk factors on all-cause mortality in the oldest-old by more than 20%.
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Affiliation(s)
- Zhi Cao
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm SE-17177, Sweden
| | - Yangyang Cheng
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China.,Department of Biostatistics, School of Public Health, Yale University, New Haven, CT 06520, USA
| | - Shu Li
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Li Sun
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm SE-17177, Sweden
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
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Batty GD, Deary IJ, Shipley MJ. Association of change in cognitive function from early adulthood to middle age with risk of cause-specific mortality: the Vietnam Experience Study. J Epidemiol Community Health 2019; 73:712-716. [PMID: 31152074 DOI: 10.1136/jech-2019-212377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Studies with single baseline measurements of cognitive function consistently reveal inverse relationships with mortality risk. The relation of change in functioning, particularly from early in the life course, which may offer additional insights into causality, has not, to the best of our knowledge, been tested. AIMS To examine the association of change in cognition between late adolescence and middle age with cause-specific mortality using data from a prospective cohort study. METHODS The analytical sample consisted of 4289 former US male military personnel who were administered the Army General Technical Test in early adulthood (mean age 20.4 years) and again in middle age (mean age 38.3 years). RESULTS A 15-year period of mortality surveillance subsequent to the second phase of cognitive testing gave rise to 237 deaths. Following adjustment for age, a 10-unit increase in cognitive function was related to a reduced risk of death from all causes (HR 0.84; 95% CI 0.75 to 0.93) and cardiovascular disease (HR 0.78; 95% CI 0.64 to 0.95) but not from all cancers (HR 1.14; 95% CI 0.88 to 1.47) nor injury (HR 1.02; 95% CI 0.81 to 1.29). Adjustment for markers of socioeconomic status in middle age resulted in marked attenuation in the magnitude of these associations and statistical significance at conventional levels was lost in all analyses. CONCLUSIONS In the present study, the apparent link between increased cognition and mortality was mediated by socioeconomic status.
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Affiliation(s)
- G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK .,School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Ian J Deary
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
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