Depressive Symptoms Increase the Risk of Mild Neurocognitive Disorders among Elderly Chinese

Modifiable risk factors for mild cognitive impairment among cognitively normal community-dwelling older adults: A systematic review and meta-analysis

Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.

Depression and bone loss as risk factors for cognitive decline: A systematic review and meta-analysis

BACKGROUND

Depression is linked to Alzheimer's disease (AD) but it is unclear whether depression is also associated with cognitive decline in the preclinical phase and mild cognitive impairment (MCI). Previous meta-analyses have only investigated AD as an outcome without accounting for individuals showing cognitive decline that does not meet the diagnostic criteria for AD. Other potentially modifiable risk factors such as bone loss have also been less explored and there remains uncertainty around their temporal relationship with cognitive decline.

AIMS

To conduct a systematic review and meta-analysis investigating depression and bone loss as risk factors for subsequent cognitive decline.

METHODS

A comprehensive search strategy was developed and applied using four databases; MEDLINE Complete, Embase, PsycINFO and CINAHL Complete. The pooled summary effects were estimated as odds ratios with 95% confidence intervals using a random-effects model. The study protocol was registered with PROSPERO (ID: CRD42020159369).

RESULTS

A total of 75 longitudinal cohort studies were identified for meta-analysis, of which 70 examined the impact of depression on cognitive decline and five examined the impact of bone loss. Prior exposure to depression was found to be associated with cognitive score reduction (OR 1.33 95% CI 1.17, 1.51), MCI incidence (OR 1.52 95% CI 1.28, 1.79) and AD incidence (OR 1.79 95% CI 1.46, 2.2). Bone loss was also associated with the incidence of AD (OR=1.81 95% CI 1.28, 2.55).

CONCLUSIONS

Overall, the results support the hypothesis that depression is associated with subsequent cognitive decline. Bone loss was also found to be associated with AD incidence; however, due to the small number of studies, the results should be viewed with caution.

Competing risk analysis of the association between dementia and major depressive disorder: a nationwide population-based study in Taiwan

Objectives: To investigate the association between major depressive disorder (MDD) and the competing risk of Alzheimer's dementia (AD) and non-Alzheimer's dementia (NAD) using a nationwide population-based health insurance database.Methods: From Taiwan's National Health Insurance Research Database, we extracted claims data of 13,067 patients with MDD and 52,268 non-MDD controls matched by index date, age, sex, geographical area, monthly income, and selected comorbidities through propensity score matching. Follow-up durations in person-years were calculated for each person until dementia diagnosis, death, or the end of 2013. Competing incident risks of AD and NAD between patients with MDD and non-MDD.Results: In this study, 335 (2.6%) of the 13,067 MDD patients and 313 (0.6%) of the 52,268 non-MDDs developed AD. During the follow-up period, 73 (0.59%) of the 13,067 MDD patients developed NAD and 80 (0.15%) of the 52,268 non-MDD developed NAD. The patients with MDD had 4.73 and 3.69 times higher risks of AD (adjusted subdistribution hazard ratio [SHR] 4.73; 95% confidence interval [CI] 4.05-5.52) and NAD (adjusted SHR 3.69; 95% CI 2.68-5.08), respectively, than the controls.Conclusions: The patients with MDD had significantly higher incidence rates of AD and NAD than the controls, in particular among aged 65 and above. Additional studies are required to clarify the underlying pathophysiology between the MDD-dementia association and investigate whether prompt intervention in MDD can reduce the risk of dementia.

Effects of choral singing versus health education on cognitive decline and aging: a randomized controlled trial

We conducted a randomized controlled trial to examine choral singing’s effect on cognitive decline in aging. Older Singaporeans who were at high risk of future dementia were recruited: 47 were assigned to choral singing intervention (CSI) and 46 were assigned to health education program (HEP). Participants attended weekly one-hour choral singing or weekly one-hour health education for two years. Change in cognitive function was measured by a composite cognitive test score (CCTS) derived from raw scores of neuropsychological tests; biomarkers included brain magnetic resonance imaging, oxidative damage and immunosenescence. The average age of the participants were 70 years and 73/93 (78.5%) were female. The change of CCTS from baseline to 24 months was 0.05 among participants in the CSI group and -0.1 among participants in the HEP group. The between-group difference (0.15, p=0.042) became smaller (0.12, p=0.09) after adjusting for baseline CCTS. No between-group differences on biomarkers were observed. Our data support the role of choral singing in improving cognitive health in aging. The beneficial effect is at least comparable than that of health education in preventing cognitive decline in a community of elderly people. Biological mechanisms underlying the observed efficacy should be further studied.

Medical Help-Seekers with Anxiety from Deterioration in Memory are Characterized with Risk Factors for Cognitive Decline

Objectives: Anxiety and subjective memory complaints (SMC) are major risk factors for Mild Cognitive Impairment (MCI) and dementia. However, the association between anxiety, SMC and medical help-seeking due to complaints is not clear. Here, we assessed anxiety which rose specifically by memory examination and compared it between help-seekers in memory clinics (HS) and non-help seekers (NHS).Methods: Twenty HS (60% female) were recruited from a memory Clinic, and 55 NHS (63% female) were recruited from the community. Participants (aged 59-82) completed objective memory assessment, Subjective Memory questionnaire, depression questionnaire and State-Trait Anxiety questionnaire. State-anxiety was assessed immediately following memory testing (indicating anxiety triggered by testing memory). For statistical evaluation, we used non-parametric tests.Results: HS participants reported significantly higher levels of state-anxiety and had more SMC compared to the NHS. No differences in objective memory tests and trait-anxiety were found.Conclusions: People who are seeking help in memory clinics (even those who do not meet any criteria for memory decline) are liable to be at high risk for MCI and dementia.Clinical Implications: We recommend that HS with SMC should be treated as a high-risk group, even if they do not show objective memory deficits.

Neurocognitive Disorders: Importance of Early/Timely Detection in Daily Clinical Practice

Neurocognitive disorders create important challenges for patients, their families, and clinicians who provide their health care. Early/timely detection in daily clinical practice allows for diagnosis and adequate treatment, psychosocial support, education, and engagement in shared decision-making related to health care, life planning, involvement in research, and financial matters. However, neurocognitive disorders, when present, are not detected or not diagnosed and not documented, in more than half of patients seen by primary care physicians. The aim of this paper is to highlight the strategies and the perspectives to improve the early/timely detection of neurocognitive disorders in daily clinical practice.