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Willis KD, Reid MP, Fox A, Kleva CS, Sherwood P, Loughan AR. The impact of a primary brain tumor diagnosis on caregivers: Insights from the patients' perspective. Support Care Cancer 2024; 32:595. [PMID: 39160352 PMCID: PMC11333512 DOI: 10.1007/s00520-024-08783-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: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE The diagnosis of a primary brain tumor (PBT) causes significant distress for the caregiver-patient dyad, warranting increased supportive care intervention. Although researchers have previously assessed caregivers' perceptions of their own supportive care needs, no study to date has identified how patients perceive the caregiving experience and/or patients' recommendations for integrating supportive care of caregivers in neuro-oncology. This qualitative study examined caregiver distress as well as caregiver supportive care needs from the patients' perspective to inform future intervention development. METHODS Adults with PBT (N = 15; Mage = 45; 53% female; 93% White) were divided into four, 90-min focus groups moderated by a clinical neuropsychologist. Patients responded to semi-structured interview questions regarding various supportive care needs throughout the course of disease. Each discussion was transcribed and coded using thematic content analysis and NVivo software. Inter-rater reliability was excellent (MKappa = 0.92, range = 0.85-0.93). RESULTS Seven distinct codes related to PBT caregivers emerged and were classified into two broader themes: Caregiver Impact (47% of coded content) and Caregiver Support (53% of coded content). Caregiver Impact refers to patients' perspective of the practical and emotional demands of caregiving. Under Caregiver Support, patients cited a strong need for increased support of caregivers, including bereavement care, individual psychotherapy, and joint caregiver-patient dyad sessions. CONCLUSION Patients with PBT expressed profound concerns regarding the demands of caregiving and its impact on the well-being of their loved ones. Findings emphasize the need for comprehensive dyadic support in neuro-oncology throughout the disease trajectory to enhance the overall quality-of-life for both patients and their caregivers.
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Affiliation(s)
- Kelcie D Willis
- Department of Psychiatry, Center for Psychiatric Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Morgan P Reid
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Amber Fox
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher S Kleva
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paula Sherwood
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashlee R Loughan
- Division of Neuro-Oncology, Department of Neurology, VCU School of Medicine, 1201 East Marshall St, Richmond, VA, 23298, USA.
- Massey Cancer Center, VCU School of Medicine, Richmond, VA, USA.
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Jimenez DE, Ross EJ, Weinstein E, Gouse H, Pan Y, Martinez Garza D, Burke SL, Joo JH, Behar-Zusman V. Preventing Cognitive Decline in Older Latino Adults With HIV Through a Culturally Tailored Health Promotion Intervention: Protocol for a Single-Arm Pilot Trial. JMIR Res Protoc 2024; 13:e55507. [PMID: 39133532 PMCID: PMC11347906 DOI: 10.2196/55507] [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: 12/14/2023] [Revised: 05/10/2024] [Accepted: 06/24/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Older Latino adults with HIV are at increased risk for mild cognitive impairment and earlier onset of aging-related cognitive decline. Improvements in cognitive functioning and cognitive outcomes are possible among people with HIV who adopt health promotion behaviors. However, health promotion interventions for older Latino adults with HIV have not been extensively used or widely recognized as viable treatment options. Happy Older Latinos are Active (HOLA) is a multicomponent, health promotion intervention that is uniquely tailored for older Latino adults with HIV. OBJECTIVE This study aims to (1) determine the feasibility and acceptability of an adapted version of HOLA aimed at improving cognitive functioning among older Latino adults with HIV; (2) explore whether HOLA will produce changes in cognitive functioning; (3) explore whether HOLA will produce changes in activity, psychosocial functioning, or biomarkers of cognition; and (4) explore whether changes in activity, psychosocial functioning or cognitive biomarkers correlate with changes in cognition, while accounting for genetic risk for dementia. METHODS A single-arm pilot trial with 30 Latino (aged 50 years and older) men and women with HIV was conducted to assess feasibility, acceptability, and preliminary effects on cognition. Participants were assessed at 2 time points (baseline and postintervention) on measures of neurocognitive and psychosocial functioning. In addition, blood samples were collected to determine biomarkers of cognition at baseline and postintervention. Successful recruitment was defined as meeting 100% of the targeted sample (N=30), with 20% (n=6) or less of eligible participants refusing to participate. Adequate retention was defined as 85% (n=25) or more of participants completing the postintervention assessment and acceptability was defined as 80% (n=38) or more of sessions attended by participants. RESULTS Participant recruitment began on February 22, 2022, and was completed on August 15, 2022. The last study visit took place on February 20, 2023. Data analysis is currently ongoing. CONCLUSIONS Encouraging findings from this exploratory study may provide a blueprint for scaling up the HOLA intervention to a larger cohort of older Latino adults with HIV who may be currently experiencing or are at risk for HIV-related cognitive challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT04791709; https://clinicaltrials.gov/study/NCT04791709. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55507.
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Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emily J Ross
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Elliott Weinstein
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Hetta Gouse
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - David Martinez Garza
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Shanna L Burke
- School of Social Work, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Jin Hui Joo
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Liu YH, Wu QX, Wang QH, Zhang QF, Tang Y, Liu D, Wang JJ, Liu XY, Wang LR, Li L, Xu C, Zhu J, Wang YJ. Tracking cognitive trajectories in older survivors of COVID-19 up to 2.5 years post-infection. NATURE AGING 2024:10.1038/s43587-024-00667-3. [PMID: 38987646 DOI: 10.1038/s43587-024-00667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/12/2024] [Indexed: 07/12/2024]
Abstract
Emerging evidence suggests that neurological and other post-acute sequelae of COVID-19 can persist beyond or develop following SARS-CoV-2 infection. However, the long-term trajectories of cognitive change after a COVID-19 infection remain unclear. Here we investigated cognitive changes over a period of 2.5 years among 1,245 individuals aged 60 years or older who survived infection with the original SARS-CoV-2 strain in Wuhan, China, and 358 uninfected spouses. We show that the overall incidence of cognitive impairment among older COVID-19 survivors was 19.1% at 2.5 years after infection and hospitalization, evaluated using the Telephone Interview for Cognitive Status-40. Cognitive decline primarily manifested in individuals with severe COVID-19 during the initial year of infection, after which the rate of decline decelerated. Severe COVID-19, cognitive impairment at 6 months and hypertension were associated with long-term cognitive decline. These findings reveal the long-term cognitive trajectory of the disease and underscore the importance of post-infection cognitive care for COVID-19 survivors.
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Affiliation(s)
- Yu-Hui Liu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China.
- State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, China.
| | - Quan-Xin Wu
- Cadre Ward Two, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Qing-Hua Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Qiao-Feng Zhang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Yi Tang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Di Liu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Jing-Juan Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Xiao-Yu Liu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Ling-Ru Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Li Li
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Xu
- Department of Oncology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Jie Zhu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Yan-Jiang Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China.
- State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, China.
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Du Y, Luo Y, Ren Z, Gram LZ, Zheng X, Liu J. What impact does hearing impairment have on cognitive health in older married couples in China? Soc Sci Med 2024; 352:116999. [PMID: 38796949 DOI: 10.1016/j.socscimed.2024.116999] [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: 08/02/2023] [Revised: 04/10/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Hearing impairment is a common geriatric health problem and chronic stressor, and it is associated with poor cognitive outcomes. However, little is known about the impact of hearing impairment in married couples, particularly its potential spillover effects on the cognitive health among spouses of individuals with impairment. Drawing on a stress-proliferation perspective, we used actor-partner interdependence models to examine (1) whether an individual's hearing impairment influences their spouse's cognitive function; and (2) whether AL, symptoms of depression, and social participation serve as mediators for such an association. We utilized data from the 2015 (baseline) and 2018 (3-year follow-up) waves of the China Health and Retirement Longitudinal Study. 4434 couples were included at baseline, and 2190 couples remained after the 3-year follow-up. Hearing impairment among married women was associated with negative impacts on their spouses' cognitive function. Symptoms of depression and social participation may have served as potential mediators in this relationship. For married men, there was no statistically significant association between hearing impairment and spouses' cognitive function. Our findings suggest that hearing impairment among one spouse can lead to negative impacts on the other, but that this effect may depend on gender. Early diagnosis and couple-based interventions for hearing impairment are important for the cognitive health of both hearing-impaired individuals and their spouses.
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Affiliation(s)
- Yushan Du
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Ziyang Ren
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lu Z Gram
- Institute for Global Health, University College London, London, United Kingdom
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
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Spangler HB, Lynch DH, Howard AG, Tien HC, Du S, Zhang B, Wang H, Gordon Larsen P, Batsis JA. Association Between Mid-arm Muscle Circumference and Cognitive Function: A Longitudinal Study of Chinese Adults. J Geriatr Psychiatry Neurol 2024; 37:272-281. [PMID: 37993115 PMCID: PMC11089828 DOI: 10.1177/08919887231218087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Dementia affects 55 million people worldwide and low muscle mass may be associated with cognitive decline. Mid-arm muscle circumference (MAMC) correlates with dual-energy Xray absorptiometry and bioelectrical impedance analyses, yet are not routinely available. Therefore, we examined the association between MAMC and cognitive performance in older adults. METHODS We included community-dwelling adults ≥55 years from the China Health and Nutrition Survey. Cognitive function was estimated based on a subset of the modified Telephone Interview for Cognitive Status (0-27, low-high) during years (1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, 2018). A multivariable linear mixed-effects model was used to test whether MAMC was associated with rate of cognitive decline across age groups and cognitive function overall. RESULTS Of 3702 adults (53% female, 63.2 ± 7.3 years), mean MAMC was 21.4 cm ± 3.0 and baseline cognitive score was 13.6 points ±6.6. We found no evidence that the age-related rate of cognitive decline differed by MAMC (P = .77). Declines between 5-year age groups ranged from -.80 [SE (standard error) .18] to -1.09 [.22] for those at a mean MAMC, as compared to -.86 [.25] to -1.24 [.31] for those at a 1 MAMC 1 standard deviation above the mean. Higher MAMC was associated with better cognitive function with .13 [.06] higher scores for each corresponding 1 standard deviation increase in MAMC across all ages. CONCLUSION Higher MAMC at any age was associated with better cognitive performance in older adults. Understanding the relationship between muscle mass and cognition may identify at-risk subgroups needing targeted interventions to preserve cognition.
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Affiliation(s)
- Hillary B. Spangler
- Division of Geriatric Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | - David H. Lynch
- Division of Geriatric Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | - Annie Green Howard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hsiao-Chuan Tien
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shufa Du
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Penny Gordon Larsen
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John A. Batsis
- Division of Geriatric Medicine, UNC School of Medicine, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cheng Y, Chen S, Zhang Y, Guo Y, Wu K, Huang Y, Aerqin Q, Kuo K, Li H, Chen S, Liu W, Dong Q, Yu J. Novel diagnostic and prognostic approach for rapidly progressive dementias: Indicators based on amyloid/tau/neurodegeneration (ATN) framework. CNS Neurosci Ther 2024; 30:e14857. [PMID: 39014454 PMCID: PMC11251870 DOI: 10.1111/cns.14857] [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: 02/12/2024] [Revised: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024] Open
Abstract
AIMS Apply established cerebrospinal fluid (CSF) and serum biomarkers and novel combined indicators based on the amyloid/tau/neurodegeneration (ATN) framework to improve diagnostic and prognostic power in patients with rapidly progressive dementias (RPDs). METHODS CSF and serum biomarkers of Alzheimer's disease (AD) common neuropathology including Aβ42, Aβ40, p-Tau, and t-Tau were measured in cognitively normal (CN) controls (n = 33) and three RPD groups with rapidly progressive AD (rpAD, n = 23), autoimmune encephalitis (AE, n = 25), and Creutzfeldt-Jakob disease (CJD, n = 28). Logistic regression and multiple linear regression were used for producing combined indicators and prognostic assessment, respectively, including A&T, A&N, T&N, A&T&N, etc. RESULTS: Combined diagnostic indicator with A&T&N had the potential for differentiating AE from other types of RPDs, identifying 62.51% and 75% of AE subjects based on CSF and serum samples, respectively, compared to 39.13% and 37.5% when using autoantibodies. CSF t-Tau was associated with survival in the CJD group (adjusted R-Square = 0.16, p = 0.02), and its prognosis value improved when using combined predictors based on the ATN framework (adjusted R-Square = 0.273, p = 0.014). CONCLUSION Combined indicators based on the ATN framework provide a novel perspective for establishing biomarkers for early recognition of RPDs due to treatment-responsive causes.
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Affiliation(s)
- Yuan Cheng
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Shu‐Fen Chen
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Ya‐Ru Zhang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Yu Guo
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Kai‐Min Wu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Yu‐Yuan Huang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Qiaolifan Aerqin
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Kevin Kuo
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Hong‐Qi Li
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Shi‐Dong Chen
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Wei‐Shi Liu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Qiang Dong
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
| | - Jin‐Tai Yu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
- National Center for Neurological DisordersShanghaiChina
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Zhou X, Qin JJ, Li H, Chen J, Zhang Q, Ye X. The effect of multimorbidity patterns on physical and cognitive function in diabetes patients: a longitudinal cohort of middle-aged and older adults in China. Front Aging Neurosci 2024; 16:1388656. [PMID: 38808035 PMCID: PMC11130586 DOI: 10.3389/fnagi.2024.1388656] [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: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
Background The prevalence of diabetes has increased rapidly, and comorbid chronic conditions are common among diabetes patients. However, little is known about the pattern of multimorbidity in diabetes patients and the effect on physical and cognitive function. This study aimed to assess the disease clusters and patterns of multimorbidity in diabetes patients using a novel latent class analysis (LCA) approach in middle-aged and older adults and explore the association between different clusters of multimorbidity in diabetes and the effect on physical and cognitive function. Methods This national observational study included 1,985 diabetes patients from the four waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2011 to 2018. Thirteen chronic diseases were used in latent class analysis to identify the patterns of multimorbidity in diabetes, which span the cardiovascular, physical, psychological, and metabolic systems. Cognitive function is assessed via a structured questionnaire in three domains: memory, executive function, and orientation. We combined activities of daily living (ADL) with instrumental activities of daily living (IADL) to measure physical function. Linear mixed models and negative binomial regression models were used to analyze the association between patterns of multimorbidity in diabetes and the effect on cognitive function and disability, respectively. Results A sample of 1,985 diabetic patients was identified, of which 1,889 (95.2%) had multimorbidity; their average age was 60.6 years (standard deviation (SD) = 9.5), and 53.1% were women. Three clusters were identified: "cardio-metabolic" (n = 972, 51.5%), "mental-dyslipidemia-arthritis" (n = 584, 30.9%), and "multisystem morbidity" (n = 333, 17.6%). Compared with diabetes alone, the "multisystem morbidity" class had an increased association with global cognitive decline. All patterns of multimorbidity were associated with an increased risk of memory decline and disability; however, the "multisystem morbidity" group also had the strongest association and presented a higher ADL-IADL disability (ratio = 4.22, 95% CI = 2.52, 7.08) and decline in memory Z scores (β = -0.322, 95% CI = -0.550, -0.095, p = 0.0058). Conclusion Significant longitudinal associations between different patterns of multimorbidity in diabetes patients and memory decline and disability were observed in this study. Future studies are needed to understand the underlying mechanisms and common risk factors for multimorbidity in diabetes patients and to propose treatments that are more effective.
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Affiliation(s)
| | | | | | | | - Qing Zhang
- School of Nursing, Department of Geriatric, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xujun Ye
- School of Nursing, Department of Geriatric, Zhongnan Hospital of Wuhan University, Wuhan, China
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8
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Eckert MA, Benitez A, Soler ZM, Dubno JR, Schlosser RJ. Gray matter and episodic memory associations with olfaction in middle-aged to older adults. Int Forum Allergy Rhinol 2024; 14:961-971. [PMID: 37897207 PMCID: PMC11045322 DOI: 10.1002/alr.23290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Age-related declines in olfaction contribute to low quality of life and appear to occur with declines in cognitive function, including diminished episodic memory. We tested the hypothesis that low gray matter volume within cortical regions that support olfaction and episodic memory can explain age-related differences in olfactory and episodic memory functions. METHODS T1-weighted images, Sniffin' Sticks olfactory measures, and the NIH Toolbox-Cognition Battery were administered to 131 middle-aged to older adults (50-86 years; 66% female). Correlation was used to examine the associations between these measures. A network-based image processing approach was then used to examine the degree to which spatial patterns of gray matter variance were related to the olfactory and cognitive measures. Structural equation modeling was used to characterize the relative specificity of olfactory, cognitive, gray matter, and aging associations. RESULTS Olfactory threshold, discrimination, and identification exhibited small to medium effect size associations with episodic memory performance (rs = 0.27-0.42, ps < 0.002). Gray matter volume within medial temporal and orbitofrontal cortex was also related to olfactory (discrimination and identification) and episodic memory function (rs = 0.21-0.36, ps < 0.019). Age and episodic memory explained the same variance in olfaction that was explained by the medial temporal and orbitofrontal pattern of gray matter volume. CONCLUSIONS The results of this cross-sectional study suggest that identifying mechanisms contributing to differences in medial temporal and orbitofrontal cortex will advance our understanding of co-morbid olfactory and cognitive declines.
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Affiliation(s)
- Mark A. Eckert
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
| | | | - Zachary M. Soler
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
| | - Judy R. Dubno
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
| | - Rodney J. Schlosser
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
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9
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Xu S, Su YJ, Ehrlich JR, Song Q. Associations Between Self-Reported Visual Difficulty, Age of Onset, and Cognitive Function Trajectories Among Chinese Older Adults. J Aging Health 2024:8982643241247251. [PMID: 38621713 DOI: 10.1177/08982643241247251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Objectives: This study examined the association between self-reported visual difficulty and age-related cognitive declines among older Chinese adults and how the timing of visual difficulty onset plays a role in cognitive trajectories. Methods: Data were drawn from the 2011-2018 wave of the China Health and Retirement Longitudinal Study, involving 9974 respondents aged 60 years or older (mean age 65.44 years, range 60-101 years). Results: At baseline, 14.16% respondents had self-reported visual difficulty. Growth curve models showed that Chinese older adults with visual difficulty experienced a faster decline in cognitive function compared to those without visual difficulty (β = -0.02, p < .01). Older adults who began experiencing visual difficulty between 61 and 75 years of age had steeper cognitive declines compared to those with earlier or later onset (β = -0.05, p < .01). Discussion: Older adults with self-reported visual difficulty experience faster rates of cognitive decline. Future research should explore potential factors that underlie the association between onset timing of visual difficulty and cognitive function.
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Affiliation(s)
- Shu Xu
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Yan-Jhu Su
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Qian Song
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
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10
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Liu C, Meng Q, Wei Y, Su X, Zhang Y, He P, Zhou C, Liu M, Ye Z, Qin X. J-shaped association between dietary thiamine intake and the risk of cognitive decline in cognitively healthy, older Chinese individuals. Gen Psychiatr 2024; 37:e101311. [PMID: 38390237 PMCID: PMC10882293 DOI: 10.1136/gpsych-2023-101311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/16/2023] [Indexed: 01/27/2024] Open
Abstract
Background The prospective association of dietary thiamine intake with the risk of cognitive decline among the general older adults remains uncertain. Aims To investigate the association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals. Methods The study included a total of 3106 participants capable of completing repeated cognitive function tests. Dietary nutrient intake information was collected through 3-day dietary recalls and using a 3-day food-weighed method to assess cooking oil and condiment consumption. Cognitive decline was defined as the 5-year decline rate in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified. Results The median follow-up duration was 5.9 years. There was a J-shaped relationship between dietary thiamine intake and the 5-year decline rate in global and composite cognitive scores, with an inflection point of 0.68 mg/day (95% confidence interval (CI): 0.56 to 0.80) and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake. Before the inflection point, thiamine intake was not significantly associated with cognitive decline. Beyond the inflection point, each unit increase in thiamine intake (mg/day) was associated with a significant decrease of 4.24 (95% CI: 2.22 to 6.27) points in the global score and 0.49 (95% CI: 0.23 to 0.76) standard units in the composite score within 5 years. A stronger positive association between thiamine intake and cognitive decline was observed in those with hypertension, obesity and those who were non-smokers (all p<0.05). Conclusions This study revealed a J-shaped association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals, with an inflection point at 0.68 mg/day and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake.
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Affiliation(s)
- Chengzhang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui, China
- 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, Guangdong, China
| | - Qiguo Meng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui, China
| | - Yuanxiu Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui, China
| | - Xinyue Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui, 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, Guangdong, 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, Guangdong, 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, Guangdong, 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, Guangdong, 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, Guangdong, China
| | - Xianhui Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Institute of Biomedicine, Anhui Medical University, Hefei, Anhui, China
- 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, Guangdong, China
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11
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Ijaz N, Jamil Y, Brown CH, Krishnaswami A, Orkaby A, Stimmel MB, Gerstenblith G, Nanna MG, Damluji AA. Role of Cognitive Frailty in Older Adults With Cardiovascular Disease. J Am Heart Assoc 2024; 13:e033594. [PMID: 38353229 PMCID: PMC11010094 DOI: 10.1161/jaha.123.033594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024]
Abstract
As the older adult population expands, an increasing number of patients affected by geriatric syndromes are seen by cardiovascular clinicians. One such syndrome that has been associated with poor outcomes is cognitive frailty: the simultaneous presence of cognitive impairment, without evidence of dementia, and physical frailty, which results in decreased cognitive reserve. Driven by common pathophysiologic underpinnings (eg, inflammation and neurohormonal dysregulation), cardiovascular disease, cognitive impairment, and frailty also share the following risk factors: hypertension, diabetes, obesity, sedentary behavior, and tobacco use. Cardiovascular disease has been associated with the onset and progression of cognitive frailty, which may be reversible in early stages, making it essential for clinicians to diagnose the condition in a timely manner and prescribe appropriate interventions. Additional research is required to elucidate the mechanisms underlying the development of cognitive frailty, establish preventive and therapeutic strategies to address the needs of older patients with cardiovascular disease at risk for cognitive frailty, and ultimately facilitate targeted intervention studies.
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Affiliation(s)
- Naila Ijaz
- Thomas Jefferson University HospitalPhiladelphiaPAUSA
| | - Yasser Jamil
- Yale University School of MedicineNew HavenCTUSA
| | | | | | - Ariela Orkaby
- New England GRECC, VA Boston Healthcare SystemBostonMAUSA
- Division of AgingBrigham & Women’s Hospital, Harvard Medical SchoolBostonMAUSA
| | | | | | | | - Abdulla A. Damluji
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- The Inova Center of Outcomes ResearchInova Heart and Vascular InstituteFalls ChurchVAUSA
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12
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Liu H, Chopik WJ, Shrout MR, Wang J. A national longitudinal dyadic analysis of spousal education and cognitive decline in the United States. Soc Sci Med 2024; 343:116603. [PMID: 38281387 PMCID: PMC10923139 DOI: 10.1016/j.socscimed.2024.116603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
Education plays a significant role in shaping cognitive functioning throughout an individual's life. However, existing research has not adequately explored how the educational attainment of the spouse can impact cognitive functioning over time. This study presents one of the first longitudinal analyses of how spousal education is linked to cognitive trajectories of each member within couples during their later life in the United States. Guided by the linked lives perspective, we analyze data from 8370 couples in the Health and Retirement Study spanning from 2000 to 2018. Results from the Actor-Partner Interdependence Model (APIM) integrated with latent growth curve models reveal that cognitive trajectories exhibit a correlation between spouses over time. Moreover, our analysis uncovers gender-specific effects of spousal education on cognition, shedding light on the underlying mechanisms driving this connection. Notably, the lower educational attainment of husbands is associated with a faster cognitive decline in both themselves and their wives. This association is partially explained by economic resources, but not by health and social behaviors. The lower educational attainment of wives is linked to their own faster cognitive decline as well as lower initial cognitive levels of their husbands, in part via economic resources. However, wives' educational attainment is largely unrelated to their husbands' cognitive decline. Intriguingly, wives' education has a more pronounced impact on the health and social behaviors of their husbands than vice versa, although these health and social behaviors do not appear to influence husbands' cognitive decline. In conclusion, these results underscore the importance of considering spousal education in comprehending the complexities of cognitive decline within dyadic relationships.
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Affiliation(s)
- Hui Liu
- Department of Sociology, Purdue University, USA; Center on Aging and the Life Course, Purdue University, USA.
| | | | - M Rosie Shrout
- Center on Aging and the Life Course, Purdue University, USA; Department of Human Development and Family Science, Purdue University, USA
| | - Juwen Wang
- Department of Sociology, Purdue University, USA; Center on Aging and the Life Course, Purdue University, USA
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13
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Hofmann BB, Gundlach EP, Fischer I, Muhammad S, Kram R, Beseoglu K, Cornelius JF. Evaluation of FRESH scores in predicting outcome and quality of life after aneurysmal subarachnoid haemorrhage in a European patient cohort. Acta Neurochir (Wien) 2024; 166:29. [PMID: 38261024 PMCID: PMC10806023 DOI: 10.1007/s00701-024-05909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Despite aneurysmal subarachnoid haemorrhage (aSAH) patients often experiencing physical and mental disabilities impacting their quality of life (QoL), routine assessment of long-term QoL data and predictive tools are limited. This study evaluates the newly developed "functional recovery expected after subarachnoid haemorrhage" (FRESH) scores with long-term outcomes and QoL in European aSAH patients. METHODS FRESH, FRESH-cog, and FRESH-quol scores were retrospectively obtained from aSAH patients. Patients were contacted, and the modified Rankin Scale (mRS), extended short form-36 (SF-36), and telephone interview for cognitive status (TICS) were collected and performed. The prognostic and empirical outcomes were compared. RESULTS Out of 374 patients, 171 patients (54.1%) completed the SF-36, and 154 patients completed the TICS. The SF-36 analysis showed that 32.7% had below-average physical component summary (PCS) scores, and 39.8% had below-average mental component summary (MCS) scores. There was no significant correlation between the FRESH score and PCS (p = 0.09736), MCS (p = 0.1796), TICS (p = 0.7484), or mRS 10-82 months (average 46 months) post bleeding (p = 0.024), respectively. There was also no significant correlation found for "FRESH-cog vs. TICS" (p = 0.0311), "FRESH-quol vs. PCS" (p = 0.0204), "FRESH-quol vs. MCS" (p = 0.1361) and "FRESH-quol vs. TICS" (p = 0.1608). CONCLUSIONS This study found no correlation between FRESH scores and validated QoL tools in a European population of aSAH patients. The study highlights the complexity of reliable long-term QoL prognostication in aSAH patients and emphasises the need for further prospective research to also focus on QoL as an important outcome parameter.
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Affiliation(s)
- Björn B Hofmann
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Evgenia P Gundlach
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Igor Fischer
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rainer Kram
- Department of Anesthesiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Kerim Beseoglu
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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14
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Yang L, Do Q, Zhu X, Leung JM, Sands LP. Assessing patterns of delirium symptoms reveals a novel subtype among elective surgical patients with postoperative delirium. Int J Geriatr Psychiatry 2024; 39:e6049. [PMID: 38168022 DOI: 10.1002/gps.6049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Prior studies reported incidence of hypoactive and hyperactive subtypes of postoperative delirium, but did not consider cognitive symptoms of delirium which are highlighted in the DSM-5 criteria for delirium. This study aims to address this gap in the literature by classifying cases of delirium according to their constellation of cognitive and motoric symptoms of delirium using a statistical technique called Latent Class Analysis (LCA). METHODS Data were from five independent study cohorts (N = 1968) of patients who underwent elective spine, knee/hip, or elective gastrointestinal and thoracic procedures, between 2001 and 2017. Assessments of delirium symptoms were conducted using the long form of the Confusion Assessment Method (CAM) pre- and post-surgery. Latent class analyses of CAM data from the first 2 days after surgery were conducted to determine subtypes of delirium based on patterns of cognitive and motoric symptoms of delirium. We also determined perioperative patient characteristics associated with each latent class of delirium and assessed whether the length of delirium for each of the patterns of delirium symptoms identified by the latent class analysis. RESULTS The latent class model from postoperative day 1 revealed three distinct patterns of delirium symptoms. One pattern of symptoms, denoted as the Hyperalert class, included patients whose predominant symptoms were being hyperalert or overly sensitive to environmental stimuli and having a low level of motor activity. Another pattern of symptoms, denoted as the Hypoalert class, included patients whose predominant symptom was being hypoalert (lethargic or drowsy). A third pattern of symptoms, denoted as the Cognitive Changes class, included patients who experienced new onset of disorganized thinking, memory impairment, and disorientation. Among 352 patients who met CAM criteria for delirium on postoperative day 1, 34% had symptoms that fit within the Hyperalert latent class, 39% had symptoms that fit within the Hypoalert latent class, and 27% had symptoms that fit within the Cognitive Changes latent class. Similar findings were found when latent class analysis was applied to those who met CAM criteria for delirium on postoperative day 2. Multinomial regression analyses revealed that ASA class, surgery type, and preoperative cognitive status as measured by the Telephone Interview for Cognitive Status (TICS) scores were associated with class membership. Length of delirium differed between the latent classes with the Cognitive Changes latent class having a longer duration compared to the other two classes. CONCLUSIONS Older elective surgery patients who did not have acute events or illnesses or a diagnosis of dementia prior to surgery displayed varying symptoms of delirium after surgery. Compared to prior studies that described hypoactive and hyperactive subtypes of delirium, we identified a novel subtype of delirium that reflects cognitive symptoms of delirium. The three subtypes of delirium reveal distinct patterns of delirium symptoms which provide insight into varying risks and care needs of patients with delirium, indicating the necessity of future research on reducing risk for cognitive symptoms of delirium.
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Affiliation(s)
- Leon Yang
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Quyen Do
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
| | - Xiaofan Zhu
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
| | - Jacqueline M Leung
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Laura P Sands
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, US
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15
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Alotaibi M, Lessard-Beaudoin M, Busch K, Loudghi A, Gaudreau P, Graham RK. Olfactory Dysfunction Associated with Cognitive Decline in an Elderly Population. Exp Aging Res 2024; 50:1-16. [PMID: 36545820 DOI: 10.1080/0361073x.2022.2160597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In many neurological disorders, including Alzheimer disease, early olfactory dysfunction is observed. OBJECTIVE In order to determine if deficits in olfactory memory are present in the elderly and if olfactory dysfunction correlates with cognitive impairment in the aging population, olfactory testing has been done on seniors from the NuAge cohort accepting to participate in the Olfactory Response Cognition and Aging (ORCA) secondary sub-study. The t-Mini Mental Statement Examination and the Telephone Interview for Cognitive Status tests were done to assess cognition levels. RESULTS Overall, 94% of the ORCA cohort displayed olfactory dysfunction. Deficits in olfactory memory were also present. A correlation was observed between olfactory function and cognitive test scores. Moreover, in women who smoked, there was an association between olfactory memory and cognitive scores. CONCLUSION Our results suggest that olfactory dysfunction may predict impending cognitive decline and highlights the need for olfactory training in seniors to improve olfaction and overall well-being.
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Affiliation(s)
- Majed Alotaibi
- King Abdullah International Medical Research Center, KSAU-HS, Riyadh, Saudi Arabia
- Department of Neuroscience, The University of Sheffield, Sheffiled, UK
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
| | - Melissa Lessard-Beaudoin
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
- Department of Pharmacology and Physiology, University of Sherbrooke, Sherbrooke, Canada
| | - Kate Busch
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
| | - Amal Loudghi
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
- Department of Pharmacology and Physiology, University of Sherbrooke, Sherbrooke, Canada
| | - Pierrette Gaudreau
- Department of Medicine, University of Montreal, Quebec, Canada
- Department of Biochemistry and Molecular Medicine, Centre Hospitalier de l'Université de Montréal Research Center, Montreal, Quebec, Canada
| | - Rona K Graham
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
- Department of Pharmacology and Physiology, University of Sherbrooke, Sherbrooke, Canada
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16
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Fong TG, Vasunilashorn SM, Kivisäkk P, Metzger E, Schmitt EM, Marcantonio ER, Jones RN, Shanes H, Arnold SE, Inouye SK, Ngo LH. Biomarkers of neurodegeneration and neural injury as potential predictors for delirium. Int J Geriatr Psychiatry 2024; 39:e6044. [PMID: 38161287 PMCID: PMC10798573 DOI: 10.1002/gps.6044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Determine if biomarkers of Alzheimer's disease and neural injury may play a role in the prediction of delirium risk. METHODS In a cohort of older adults who underwent elective surgery, delirium case-no delirium control pairs (N = 70, or 35 matched pairs) were matched by age, sex and vascular comorbidities. Biomarkers from CSF and plasma samples collected prior to surgery, including amyloid beta (Aβ)42 , Aβ40 , total (t)-Tau, phosphorylated (p)-Tau181 , neurofilament-light (NfL), and glial fibrillary acid protein (GFAP) were measured in cerebrospinal fluid (CSF) and plasma using sandwich enzyme-linked immunosorbent assays (ELISAs) or ultrasensitive single molecule array (Simoa) immunoassays. RESULTS Plasma GFAP correlated significantly with CSF GFAP and both plasma and CSF GFAP values were nearly two-fold higher in delirium cases. The median paired difference between delirium case and control without delirium for plasma GFAP was not significant (p = 0.074) but higher levels were associated with a greater risk for delirium (odds ratio 1.52, 95% confidence interval 0.85, 2.72 per standard deviation increase in plasma GFAP concentration) in this small study. No matched pair differences or associations with delirium were observed for NfL, p-Tau 181, Aβ40 and Aβ42 . CONCLUSIONS These preliminary findings suggest that plasma GFAP, a marker of astroglial activation, may be worth further investigation as a predictive risk marker for delirium.
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Affiliation(s)
- Tamara G. Fong
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sarinnapha M. Vasunilashorn
- Harvard Medical School, Boston, MA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Pia Kivisäkk
- Harvard Medical School, Boston, MA
- MGH Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA
| | - Eran Metzger
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Eva M. Schmitt
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, MA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Richard N. Jones
- Departments of Psychiatry and Human Behavior and Neurology, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Hannah Shanes
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Steven E. Arnold
- Harvard Medical School, Boston, MA
- MGH Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA
| | - Sharon K. Inouye
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Long H. Ngo
- Harvard Medical School, Boston, MA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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17
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Tanev KS, Camprodon JA, Caplan DN, Dickerson BC, Chemali Z, Eldaief MC, Kim DD, Josephy-Hernandez SE, Kritzer MD, Moo LR, Newhouse A, Perez DL, Ramirez Gomez LA, Razafsha M, Rivas-Grajales AM, Scharf JM, Schmahmann JD, Sherman JC. Telemedicine-Based Cognitive Examinations During COVID-19 and Beyond: Perspective of the Massachusetts General Hospital Behavioral Neurology & Neuropsychiatry Group. J Neuropsychiatry Clin Neurosci 2023; 36:87-100. [PMID: 38111331 DOI: 10.1176/appi.neuropsych.20220154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & neuropsychiatry (BNNP) have implemented the use of telemedicine platforms to perform cognitive examinations that were previously office based. In this perspective article, BNNP clinicians at Massachusetts General Hospital (MGH) describe their experience performing cognitive examinations via telemedicine. The article reviews the goals, prerequisites, advantages, and potential limitations of performing a video- or telephone-based telemedicine cognitive examination. The article shares the approaches used by MGH BNNP clinicians to examine cognitive and behavioral areas, such as orientation, attention and executive functions, language, verbal learning and memory, visual learning and memory, visuospatial function, praxis, and abstract abilities, as well as to survey for neuropsychiatric symptoms and assess activities of daily living. Limitations of telemedicine-based cognitive examinations include limited access to and familiarity with telecommunication technologies on the patient side, limitations of the technology itself on the clinician side, and the limited psychometric validation of virtual assessments. Therefore, an in-person examination with a BNNP clinician or a formal in-person neuropsychological examination with a neuropsychologist may be recommended. Overall, this article emphasizes the use of standardized cognitive and behavioral assessment instruments that are either in the public domain or, if copyrighted, are nonproprietary and do not require a fee to be used by the practicing BNNP clinician.
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Affiliation(s)
- Kaloyan S Tanev
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Joan A Camprodon
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David N Caplan
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Bradford C Dickerson
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Zeina Chemali
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Mark C Eldaief
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David Dongkyung Kim
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Sylvia E Josephy-Hernandez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Michael D Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Lauren R Moo
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Amy Newhouse
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - David L Perez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Liliana A Ramirez Gomez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Mahdi Razafsha
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Ana Maria Rivas-Grajales
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Jeremiah M Scharf
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Jeremy D Schmahmann
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
| | - Janet C Sherman
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Tanev, Camprodon, Chemali, Eldaief, Josephy-Hernandez, Kritzer, Newhouse, Perez, Razafsha, Rivas-Grajales, Scharf, Sherman); Division of Cognitive Behavioral Neurology (Camprodon, Caplan, Dickerson, Chemali, Eldaief, Josephy-Hernandez, Moo, Perez, Ramirez Gomez, Rivas-Grajales, Scharf, Schmahmann, Sherman) and Division of Movement Disorders (Scharf), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Adult Neurodevelopmental and Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto (Kim); Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (Newhouse); Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston (Rivas-Grajales); Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston (Sherman)
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Lawson KM, Sutin AR, Atherton OE, Robins RW. Are trajectories of personality and socioeconomic factors prospectively associated with midlife cognitive function? Findings from a 12-year longitudinal study of Mexican-origin adults. Psychol Aging 2023; 38:749-762. [PMID: 37326565 PMCID: PMC10721735 DOI: 10.1037/pag0000755] [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: 06/17/2023]
Abstract
Problems with memory, executive function, and language are a significant public health concern, especially when they begin during midlife. However, there is relatively little work on risk and protective factors for cognitive function in middle adulthood. Using data from 883 Mexican-origin adults assessed up to 6 times across 12 years (Mage at Time 1 = 38.2 years; range = 27-63 years), the present study examined whether developmental trajectories (levels and slopes) of Big Five personality domains and socioeconomic factors (per capita income, economic stress) were prospectively associated with cognitive function (memory, mental status, verbal fluency) at the final assessment. We found that individuals with higher levels of, and smaller decreases in, Neuroticism had worse cognitive function 12 years later. Further, individuals with higher initial Conscientiousness had better subsequent memory, mental status, and verbal fluency, and individuals with higher Openness and Extraversion had better subsequent verbal fluency (but not memory or mental status). The trajectories of per capita income and economic stress were robustly associated with cognitive function, such that higher initial levels and greater increases in socioeconomic resources had protective associations, whereas higher levels and greater increases in economic stress had deleterious associations with cognitive function. Higher education level was associated with better cognitive function 12 years later. These findings suggest that changes in personality and socioeconomic factors across adulthood are associated with cognitive function, which may be informative for interventions to support healthier cognitive aging starting at least as early as midlife. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Kitt K, Murphy R, Clarke A, Reddin C, Ferguson J, Bosch J, Whiteley W, Canavan M, Judge C, O’Donnell M. Antiplatelet therapy and incident cognitive impairment or dementia-a systematic review and meta-analysis of randomised clinical trials. Age Ageing 2023; 52:afad197. [PMID: 37897809 PMCID: PMC10612993 DOI: 10.1093/ageing/afad197] [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: 05/05/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVE The benefit of antiplatelet therapy in preventing cognitive impairment or dementia is uncertain. We investigated the association between antiplatelet therapy and incident cognitive impairment or dementia in randomised clinical trials. METHODS We searched PubMed, EMBASE and CENTRAL for randomised clinical trials published from database inception through 1 February 2023. Trials that evaluated the association of antiplatelet therapy with incident cognitive impairment or dementia were included. For single-agent antiplatelet, the control group was placebo. For dual agent antiplatelet therapy, the control group was single-agent monotherapy. A random-effects meta-analysis model was used to report pooled treatment effects and 95% confidence intervals (CIs). The primary outcome was incident cognitive impairment or dementia. Secondary outcomes included change in cognitive test scores. RESULTS A total of 11 randomised clinical trials were included (109,860 participants). All reported the incidence of cognitive impairment or dementia on follow-up. The mean (SD) age of trial participants was 66.2 (7.9) years. Antiplatelet therapy was not significantly associated with a reduced risk of cognitive impairment or dementia (11 trials; 109,860 participants) (3.49% versus 4.18% of patients over a mean trial follow-up of 5.8 years; odds ratio [OR], 0.94 [95% CI, 0.88-1.00]; absolute risk reduction, 0.2% [95% CI, -0.4% to 0.009%]; I2 = 0.0%). Antiplatelet therapy was not significantly associated with mean change in cognitive test scores. CONCLUSION In this meta-analysis, antiplatelet therapy was not significantly associated with a lower risk of incident cognitive impairment or dementia, but the CIs around this outcome do not exclude a modest preventative effect.
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Affiliation(s)
- Kevin Kitt
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
| | - Robert Murphy
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
| | - Aoibhin Clarke
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
| | - Catriona Reddin
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
- Wellcome Trust – HRB, Irish Clinical Academic Training, Galway, Ireland
| | - John Ferguson
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
| | - Jackie Bosch
- Population Health Research Institute, Hamilton, McMaster University, Ontario, Canda
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Michelle Canavan
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
| | - Conor Judge
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
| | - Martin O’Donnell
- HRB-Clinical Research Facility, University of Galway, Galway, Ireland
- Population Health Research Institute, Hamilton, McMaster University, Ontario, Canda
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Sison SDM, Shi SM, Kim KM, Steinberg N, Jeong S, McCarthy EP, Kim DH. A crosswalk of commonly used frailty scales. J Am Geriatr Soc 2023; 71:3189-3198. [PMID: 37289180 PMCID: PMC10592534 DOI: 10.1111/jgs.18453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/07/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Several validated scales have been developed to measure frailty, yet the direct relationship between these measures and their scores remains unknown. To bridge this gap, we created a crosswalk of the most commonly used frailty scales. METHODS We used data from 7070 community-dwelling older adults who participated in National Health and Aging Trends Study (NHATS) Round 5 to construct a crosswalk among frailty scales. We operationalized the Study of Osteoporotic Fracture Index (SOF), FRAIL Scale, Frailty Phenotype, Clinical Frailty Scale (CFS), Vulnerable Elder Survey-13 (VES-13), Tilburg Frailty Indictor (TFI), Groningen Frailty Indicator (GFI), Edmonton Frailty Scale (EFS), and 40-item Frailty Index (FI). A crosswalk between FI and the frailty scales was created using the equipercentile linking method, a statistical procedure that produces equivalent scoring between scales according to percentile distributions. To demonstrate its validity, we determined the 4-year mortality risk across all scales for low-risk (equivalent to FI <0.20), moderate-risk (FI 0.20 to <0.40), and high-risk (FI ≥0.40) categories. RESULTS Using NHATS, the feasibility of calculating frailty scores was at least 90% for all nine scales, with the FI having the highest number of calculable scores. Participants considered frail on FI (cutpoint of 0.25) corresponded to the following scores on each frailty measure: SOF 1.3, FRAIL 1.7, Phenotype 1.7, CFS 5.3, VES-13 5.5, TFI 4.4, GFI 4.8, and EFS 5.8. Conversely, individuals considered frail according to the cutpoint of each frailty measure corresponded to the following FI scores: 0.37 for SOF, 0.40 for FRAIL, 0.42 for Phenotype, 0.21 for CFS, 0.16 for VES-13, 0.28 for TFI, 0.21 for GFI, and 0.37 for EFS. Across frailty scales, the 4-year mortality risks between the same categories were similar in magnitude. CONCLUSION Our results provide clinicians and researchers with a useful tool to directly compare and interpret frailty scores across scales.
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Affiliation(s)
- Stephanie Denise M. Sison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - Sandra M. Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kyung Moo Kim
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Nessa Steinberg
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Sohyun Jeong
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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21
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Kim JH, Muniz-Terrera G, Leist AK. Does (re-)entering the labour market at advanced ages protect against cognitive decline? A matching difference-in-differences approach. J Epidemiol Community Health 2023; 77:663-669. [PMID: 37460205 PMCID: PMC10511963 DOI: 10.1136/jech-2022-220197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/20/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND While prolonged labour market participation becomes increasingly important in ageing societies, evidence on the impacts of entering or exiting work beyond age 65 on cognitive functioning is scarce. METHODS We use data from two large population-representative data sets from South Korea and the USA to investigate and compare the effects of the labour market (re-)entry and exit by matching employment and other confounder trajectories prior to the exposure. We chose the Korean Longitudinal Study of Aging (N=1872, 2006-2020) for its exceptionally active labour participation in later life and the Health and Retirement Study (N=4070, 2006-2020) for its growing inequality among US older adults in labour participation. We use the matching difference-in-differences (DID) method, which allows us to make causal claims by reducing biases through matching. RESULTS We find general positive effects of entering the labour market in South Korea (DID estimate: 0.653, 95% CI 0.167 to 1.133), while in the USA such benefit is not salient (DID estimate: 0.049, 95% CI -0.262 to 0.431). Exiting the late-life labour market leads to cognitive decline in both South Korea (DID estimate: -0.438, 95% CI -0.770 to -0.088) and the USA (DID estimate: -0.432, 95% CI -0.698 to -0.165). CONCLUSIONS Findings suggest that Korean participants cognitively benefited from late-life labour market participation, while US participants did not. Differences in participant characteristics and reasons for labour market participation may have led to the differential findings. We found the negative effects of exiting the late-life labour force in both countries.
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Affiliation(s)
- Jung Hyun Kim
- Department of Social Sciences, University of Luxembourg, Institute for Research on Socio-Economic Inequality, Esch-sur-Alzette, Luxembourg
| | - Graciela Muniz-Terrera
- Department of Social Medicine, Ohio University, Athens, Ohio, USA
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Anja K Leist
- Department of Social Sciences, University of Luxembourg, Institute for Research on Socio-Economic Inequality, Esch-sur-Alzette, Luxembourg
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22
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Vranceanu AM, Choukas NR, Rochon EA, Duarte B, Pietrzykowski MO, McDermott K, Hooker JE, Kulich R, Quiroz YT, Parker RA, Macklin EA, Ritchie C, Mace RA. Addressing the Chronic Pain-Early Cognitive Decline Comorbidity Among Older Adults: Protocol for the Active Brains Remote Efficacy Trial. JMIR Res Protoc 2023; 12:e47319. [PMID: 37768713 PMCID: PMC10570897 DOI: 10.2196/47319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/01/2023] [Accepted: 05/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chronic pain and early cognitive decline, which are costly to treat and highly prevalent among older adults, commonly co-occur, exacerbate one another over time, and can accelerate the development and progression of Alzheimer disease and related dementias. We developed the first mind-body activity program (Active Brains [AB]) tailored to the needs of older adults with chronic pain and early cognitive decline. Results from our previous study strongly supported the feasibility of conducting AB remotely and provided evidence for improvements in outcomes. OBJECTIVE We are conducting a single-blinded, National Institutes of Health stage-2, randomized clinical trial to establish the efficacy of AB versus a time-matched and dose-matched education control (Health Enhancement Program [HEP]) in improving self-reported and objective outcomes of physical, cognitive, and emotional functions in 260 participants. The methodology described in this paper was informed by the lessons learned from the first year of the trial. METHODS Participants are identified and recruited through multidisciplinary clinician-referred individuals (eg, pain psychologists and geriatricians), the Rally Research platform, social media, and community partnerships. Interested participants complete eligibility screening and electronic informed consent. Baseline assessments include self-report, performance-based measures (eg, 6-min walk test) and objective measures (eg, Repeatable Battery for the Assessment of Neuropsychological Status). Participants are mailed a wrist-worn ActiGraph device (ActiGraph LLC) to passively monitor objective function (eg, steps) during the week between the baseline assessment and the beginning of the programs, which they continue to wear throughout the programs. After baseline assessments, participants are randomized to either AB or HEP and complete 8 weekly, remote, group sessions with a Massachusetts General Hospital psychologist. The AB group receives a Fitbit (Fitbit Inc) to help reinforce increased activity. Assessments are repeated after the intervention and at the 6-month follow-up. Coprimary outcomes include multimodal physical function (self-report, performance based, and objective). Secondary outcomes are cognitive function (self-report and objective), emotional function, and pain. RESULTS We began recruitment in July 2022 and recruited 37 participants across 4 cohorts. Of them, all (n=37, 100%) have completed the baseline assessment, 26 (70%) have completed the posttest assessment, and 9 (24%) are actively enrolled in the intervention (total dropout: n=2, 5%). In the three cohorts (26/37, 70%) that have completed the AB or HEP, 26 (100%) participants completed all 8 group sessions (including minimal makeups), and watch adherence (1937/2072, 93.48%, average across ActiGraph and Fitbit devices) has been excellent. The fourth cohort is ongoing (9/37, 24%), and we plan to complete enrollment by March 2026. CONCLUSIONS We aim to establish the efficacy of the AB program over a time-matched and dose-matched control in a live video-based trial and test the mechanisms through theoretically driven mediators and moderators. Findings will inform the development of a future multisite effectiveness-implementation trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05373745; https://classic.clinicaltrials.gov/ct2/show/NCT05373745. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47319.
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Affiliation(s)
- Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nathaniel R Choukas
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Elizabeth A Rochon
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Brooke Duarte
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Malvina O Pietrzykowski
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Ronald Kulich
- Harvard Medical School, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Yakeel T Quiroz
- Harvard Medical School, Boston, MA, United States
- Multicultural Alzheimer's Prevention Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Robert A Parker
- Harvard Medical School, Boston, MA, United States
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Eric A Macklin
- Harvard Medical School, Boston, MA, United States
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Ritchie
- Harvard Medical School, Boston, MA, United States
- Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Monfared AAT, Hummel N, Chandak A, Khachatryan A, Zhang Q. Assessing out-of-pocket expenses and indirect costs for the Alzheimer disease continuum in the United States. J Manag Care Spec Pharm 2023; 29:1065-1077. [PMID: 37307097 PMCID: PMC10510674 DOI: 10.18553/jmcp.2023.23013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND: The societal costs of Alzheimer disease (AD) are considerable. Cost data stratified by cost category (direct and indirect) and AD severity in the United States are limited. OBJECTIVE: To describe out-of-pocket (OOP) expenses and indirect costs from unpaid caregiving and work impairment among patients with AD by severity and among patients with mild cognitive impairment (MCI) in a representative sample of the US population. METHODS: Data from the Health and Retirement Study (HRS) were used. HRS respondents were included if they reported an AD diagnosis or were considered as having MCI based on their cognitive performance. MCI and AD severity staging was performed using a crosswalk from results of the modified Telephone Interview of Cognitive Status to the Mini-Mental State Examination. OOP expenses were assessed along with indirect costs (costs to caregivers from providing unpaid help and costs to employers). Sensitivity analyses were performed by varying assumptions of caregiver employment, missed workdays, and early retirement. Patients with AD were stratified by nursing home status, type of insurance, and income level. All cost calculations applied sampling weights. RESULTS: A total of 18,786 patients were analyzed. Patients with MCI (n = 17,885) and AD (n = 901) were aged 67.8 ± 10.7 and 80.9 ± 9.3 years, were 55.7% and 63.3% female, and were 28.3% and 0.9% employed, respectively. OOP expenses per patient per month increased with AD severity, ranging from $420 in mild to $903 in severe AD but were higher in MCI ($554) than in mild AD. Indirect costs to employers were similar across the AD continuum ($197-$242). Costs from unpaid caregiving generally increased by disease severity, from $72 (MCI) to $1,298 (severe AD). Total OOP and indirect costs increased by disease severity, from $869 (MCI) to $2,398 (severe AD). Sensitivity analysis assuming nonworking caregivers and zero costs to employers decreased the total OOP and indirect costs by 32%-53%. OOP expenses were higher for patients with AD who had private insurance (P < 0.01), had higher incomes (P < 0.01), or were in nursing homes (P < 0.01). Indirect costs to caregivers were lower for patients with AD in nursing homes ($600 vs $1,372, P < 0.01). Total indirect costs were higher for patients with AD with lower incomes ($1,498 vs $1,136, P < 0.01) and for those not in nursing homes ($1,571 vs $799, P < 0.01). CONCLUSIONS: This study shows that OOP expenses and indirect costs increase with AD severity, OOP expenses increase with higher income, subscription of private insurance, and nursing home residency, and total indirect costs decrease with higher income and nursing home residency in the United States. DISCLOSURES This study was financially sponsored by Eisai. Drs Zhang and Tahami are employees of Eisai. Drs Chandak, Khachatryan, and Hummel are employees of Certara; Certara is a paid consultant to Eisai. The views expressed here are those of the authors and are not to be attributed to their respective affiliations. Laura De Benedetti, BSc, provided medical writing support to the manuscript; she is an employee of Certara.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai Inc., Nutley, NJ
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Truong QC, Cervin M, Choo CC, Numbers K, Bentvelzen AC, Merkin AG, Sachdev PS, Feigin VL, Brodaty H, Kochan NA, Medvedev ON. Using network analysis to validate domains of the modified telephone interview for cognitive status. Eur J Clin Invest 2023; 53:e14016. [PMID: 37191060 DOI: 10.1111/eci.14016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The modified Telephone Interview for Cognitive Status (TICS-M) is a widely used tool for assessing global cognitive functions and screening for cognitive impairments. The tool was conceptualised to capture various cognitive domains, but the validity of such domains has not been investigated against comprehensive neuropsychological assessments tools. Therefore, this study aimed to explore the associations between the TICS-M domains and neuropsychological domains to evaluate the validity of the TICS-M domains using network analysis. MATERIALS AND METHODS A longitudinal research design was used with a large sample of older adults (aged above 70 years; n = 1037 at the baseline assessment) who completed the TICS-M and comprehensive neuropsychological assessments biennially. We applied network analysis to identify unique links between the TICS-M domains and neuropsychological test scores. RESULTS At baseline, there were weak internal links between the TICS-M domains. The TICS-M memory and language domains were significantly related to their corresponding neuropsychological domains. The TICS-M attention domain had significant associations with executive function and visuospatial abilities. The TICS-M orientation domain was not significantly associated with any of the five neuropsychological domains. Despite an attrition of almost 50% at wave four, weak internal links between the TICS-M domains and most associations between TICS-M and neuropsychological domains that were found initially, remained stable at least over two waves within the 6-year period. CONCLUSIONS This study supports the overall structural validity of the TICS-M screener in assessing enduring global cognitive function. However, separate TICS-M cognitive domains should not be considered equivalent to the analogous neuropsychological domains.
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Affiliation(s)
| | - Matti Cervin
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carol C Choo
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Katya Numbers
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam C Bentvelzen
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexander G Merkin
- Auckland University of Technology, Auckland, New Zealand
- Centre for Precise Psychiatry and Neurosciences, Kaufbeuren, Germany
- Centre for Precise Psychiatry and Neurosciences, Schaffhausen, Switzerland
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Oleg N Medvedev
- School of Psychology, University of Waikato, Hamilton, New Zealand
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Liu Y, Zang B, Shao J, Ning N, He L, Ma Y. Predictor of cognitive impairment: metabolic syndrome or circadian syndrome. BMC Geriatr 2023; 23:408. [PMID: 37403015 DOI: 10.1186/s12877-023-03996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/24/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND It was reported that metabolic syndrome increases the risk for cognitive impairment and circadian rhythm may influence cognition behavior. Identifying the potential risk factors is essential to screen individuals with neuronal dysfunction, neuronal loss, and cognitive decline and prevent cognitive impairment and dementia development. METHODS We clarified participants by the presence of metabolic syndrome (MetS) and circadian syndrome (CircS) and employed three multivariable Generalized Estimating Equation (GEE) models to control the potential confounding factors and estimate the β values for cognitive function using as referents those had neither MetS nor CircS at baseline. The cognitive function consists of episodic memory and executive function was estimated via the modified Telephone Interview for Cognitive Status (TICS) every two years until 2015. RESULTS The mean age of the participants was 58.80 (8.93) years and 49.92% (male). The prevalence of MetS and CircS was 42.98% and 36.43%, respectively. 1,075 (11.00%) and 435 (4.45%) participants had either MetS or CircS alone and 3,124 (31.98%) had both CircS and MetS. Participants with both MetS and CircS compared with normal had a significantly decreased cognitive function score during the 4-years cohort (β = -0.32, 95% CI: -0.63, -0.01) with the complete model, as well as among participants who suffered from CircS alone (β = -0.82, 95% CI: -1.47, -0.16), while not among participants with MetS alone (β = 0.13, 95% CI: -0.27, 0.53). Specifically, compared with the normal population a significantly lower score was discovered in the episodic memory (β = -0.51, 95% CI: -0.95, -0.07), while slightly lower in executive function (β = -0.33, 95% CI: -0.68, -0.01) among individuals with CircS alone. CONCLUSIONS Individuals with CircS alone or both MetS and CircS have a high risk of cognitive impairment. The association was even stronger in participants with CircS alone than those with both MetS and CircS, suggesting CircS probably have a stronger association with cognitive functioning than MetS and could be a better predictor for cognitive impairment.
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Affiliation(s)
- Yang Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Boying Zang
- Department of Preventive Medicine, School of Public Heath, North China University of Science and Technology, Tangshan, Hebei, China
| | - Jinang Shao
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Ning Ning
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Lixia He
- Division of Molecular and Cellular Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, 02215, USA.
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China.
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Caughie C, Kronenberger O, Cobb J, Margaris H, McFarland C, Hall S. Age-based stereotype threat and neuropsychological performance in older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:620-637. [PMID: 35535023 DOI: 10.1080/13825585.2022.2068498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The current study investigated the effects of age-based stereotype threat on neuropsychological assessment outcomes in an older adult population. Community volunteers (n = 49) age 65 and older were screened for cognitive impairment, depression, and anticholinergic medication use. Screened individuals were randomly stratified into either an ABST or a Control group. All participants were administered a broad range of neuropsychological measures of cognition as well as a self-rating measure assessing subjective concern about cognitive ability. A main effect of ABST on subjective concern about cognitive ability was supported. Specifically, individuals in the ABST group were significantly more likely to attribute their memory errors to the onset of dementia (F(1,41) = 5.334, p = .026). However, results showed no significant difference between groups on objective neuropsychological performance measures. The current study discusses the importance of considering ABST effects in the context of neuropsychological assessment in older adult populations.
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Affiliation(s)
- Cali Caughie
- Department of Psychology, University of Montana, Missoula, MT USA
| | | | - Joshua Cobb
- Department of Psychology, University of Montana, Missoula, MT USA
| | - Helen Margaris
- Department of Psychology, University of Montana, Missoula, MT USA
| | - Craig McFarland
- Department of Psychology, University of Montana, Missoula, MT USA
| | - Stuart Hall
- Department of Psychology, University of Montana, Missoula, MT USA
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Wu W, Pu L, Hu X, Chen Q, Wang G, Wang Y. Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study. Front Neurosci 2023; 17:1161279. [PMID: 37325036 PMCID: PMC10266218 DOI: 10.3389/fnins.2023.1161279] [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: 02/08/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Background Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied. Objectives To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery. Methods In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND. Results In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05). Conclusion Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.
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Affiliation(s)
- Wenwen Wu
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihui Pu
- Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Brisbane, QL, Australia
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guan Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanyan Wang
- Science and Technology Department, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Chen X, Li W, Huang Y, Yang J, Tao Y, Huang L, Shen J, Ma Y, Liu Z, Xu X, Xu X, Zong G, Yuan C. Association of Type 2 Diabetes Mellitus with Cognitive Function in Adults: A Prospective Cohort Study. J Alzheimers Dis 2023:JAD220822. [PMID: 37212092 DOI: 10.3233/jad-220822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Cognitive role of untreated type 2 diabetes mellitus (T2DM) has been less well substantiated. OBJECTIVE We sought to explore the prospective association of T2DM and untreated T2DM with cognitive function among middle-aged and older Chinese adults. METHODS Data of 7,230 participants without baseline brain damage, mental retardation, or memory-related diseases in China Health and Retirement Longitudinal Study (CHARLS) from 2011- 2012 to 2015, were analyzed. Fasting plasma glucose and self-reported information on T2DM diagnosis and treatment were assessed. Participants were categorized into normoglycemia, impaired fasting glucose (IFG), and T2DM (including untreated and treated T2DM) groups. Episodic memory and executive function were assessed by modified Telephone Interview for Cognitive Status every two years. We used generalized estimating equation model to examine the association of baseline T2DM status with cognitive function in succeedingyears. RESULTS Compared to those with normoglycemia, T2DM was associated with worse overall cognitive function after controlling for demographic variables, lifestyles, follow-up time, major clinical factors, and baseline cognitive function, although the associations were statistically non-significant (β= -0.19, 95% CI: -0.39, 0.00). However, a significant association was mainly observed for those with untreated T2DM (β= -0.26, 95% CI: -0.47, -0.04), especially in the domain of executive function (β= -0.19, 95% CI: -0.35, -0.03). In general, IFG and treated T2DM individuals had similar levels of cognitive function with normoglycemia participants. CONCLUSION Our findings supported a detrimental role of untreated T2DM on cognitive function among middle-aged and older adults. Screening and early treatment for T2DM are warranted for maintaining better cognitive function in later life.
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Affiliation(s)
- Xiao Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wanlu Li
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuhui Huang
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiaxi Yang
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yang Tao
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liyan Huang
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiadong Shen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Zuyun Liu
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xin Xu
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaolin Xu
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Camara G, Alotaibi M, Lessard-Beaudoin M, Busch K, Gendron L, Graham RK. Specific olfactory deficit patterns observed in seniors and associated with cognitive decline. Prog Neuropsychopharmacol Biol Psychiatry 2023; 126:110775. [PMID: 37120003 DOI: 10.1016/j.pnpbp.2023.110775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
Olfactory dysfunction is a common symptom in neurodegenerative disorders and is regarded as a potential early predictor of impending cognitive decline. This study was undertaken in order to determine if olfactory dysfunction observed in the elderly is due to a general loss of smell or the inability to detect specific odours, and if misidentification of odours correlates with cognitive scores. Seniors for the Olfactory Response and Cognition in Aging (ORCA) sub-study were recruited from the Quebec Nutrition and Successful Aging (NuAge) cohort. The University of Pennsylvania smell identification test (UPSIT) was performed to measure olfactory function and the telephone Mini Mental State Examination (t-MMSE) and the French version of the Telephone Interview for Cognitive Status Modified (F-TICS-m) for cognitive status. The results demonstrate that seniors exhibit specific olfactory loss and had severe difficulty in particular in identifying lemon, pizza, fruit punch, cheddar cheese and lime. Furthermore, there was a significant difference in the ability to detect certain odours between the sexes. Results also showed that misidentification of certain scents was associated with cognitive scores, and when the sexes were assessed separately sex-specific misidentification of cognitive-associated odours was observed. The relationship between the cognitive scores and scent misidentification suggests that impending cognitive decline may be highlighted by the inability to smell specific odours. Our study provides additional support for the testing of olfactory function in the elderly and suggests that loss of smell for particular scents may become a useful diagnostic tool.
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Affiliation(s)
- Gemma Camara
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Canada; Dept of Pharmacology and Physiology, University of Sherbrooke, Sherbrooke, Canada
| | - Majed Alotaibi
- Medical Genomics Research Department, King Abdullah International Medical Research Center, United States of America; King Saud Bin Abdulaziz University for Health and Science, Riyadh, Kingdom of Saudi Arabia
| | - Melissa Lessard-Beaudoin
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Canada; Dept of Pharmacology and Physiology, University of Sherbrooke, Sherbrooke, Canada
| | - Kate Busch
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Canada
| | - Louis Gendron
- Dept of Pharmacology and Physiology, University of Sherbrooke, Sherbrooke, Canada
| | - Rona K Graham
- Research Centre on Aging CIUSSS de l'Estrie - CHUS, Canada; Dept of Pharmacology and Physiology, University of Sherbrooke, Sherbrooke, Canada.
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Rosso AL, Troxel WM, Gary-Webb TL, Weinstein AM, Butters MA, Palimaru A, Ghosh-Dastidar B, Wagner L, Nugroho A, Hunter G, Parker J, Dubowitz T. Design of the think PHRESH longitudinal cohort study: Neighborhood disadvantage, cognitive aging, and alzheimer's disease risk in disinvested, black neighborhoods. BMC Public Health 2023; 23:636. [PMID: 37013498 PMCID: PMC10069058 DOI: 10.1186/s12889-023-15381-9] [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: 11/22/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Black Americans have disproportionately higher rates and earlier onset of Alzheimer's disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying the risks, may contribute to elevated ADRD risk in Black Americans. METHODS The Think PHRESH study builds on existing, community-based research infrastructure, from the ongoing Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) studies, to examine the contributions of dynamic neighborhood socioeconomic conditions across the lifecourse to cognitive outcomes in mid- and late-life adults living in two historically disinvested, predominantly Black communities (anticipated n = 1133). This longitudinal, mixed-methods study rests on the premise that neighborhood racial segregation and subsequent disinvestment contributes to poor cognitive outcomes via factors including (a) low access to educational opportunities and (b) high exposure to race- and socioeconomically-relevant stressors, such as discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. This premise recognizes the importance of potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk/protective factors and biobehavioral mediators and will include: (1) up to three waves of cognitive assessments in participants ages 50 years + and one assessment in participants ages 35-49 years; clinical adjudication of ADRD will be completed in participants who are 50+, (2) extensive surveys of risk and protective factors, (3) two assessments of blood pressure and objectively measured sleep, (4) a comprehensive assessment of life and residential history; and (5) two rounds of in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by Black Americans in achieving optimal cognitive health in late life. DISCUSSION Understanding how structural racism has influenced the lived experience of Black Americans, including dynamic changes in neighborhood conditions over time, is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US.
| | - Wendy M Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US
| | | | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, US
| | - Alina Palimaru
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - La'Vette Wagner
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Alvin Nugroho
- Survey Research Group, RAND Corporation, Santa Monica, US
| | - Gerald Hunter
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - Tamara Dubowitz
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
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Ali T, Mroz EL, Valeika S, Mendez EN, Cohen AB, Monin JK. Navigating the COVID-19 pandemic together: Discussions between persons with early-stage dementia and their adult children. Int J Geriatr Psychiatry 2023; 38:e5905. [PMID: 36929513 PMCID: PMC10590087 DOI: 10.1002/gps.5905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Studies have separately examined the health impacts of the COVID-19 pandemic on persons with dementia and their caregivers. Less attention has been paid to the social and emotional impacts of the pandemic in this population or how these individuals are mutually coping with the pandemic. Guided by the social citizenship theory, this qualitative study sought to characterize how persons with dementia and their adult children are coping during this time with a focus on the strengths demonstrated by persons with dementia. METHODS Participants were 43 dyads of individuals aged 55 and older with early-stage dementia and their adult children. Discussions between parent-child dyads were recorded. Using reflexive thematic analysis, themes related to social and emotional impacts of the pandemic and coping strategies were identified. RESULTS Adult children shared with their parents how the pandemic resulted in reduced social engagement and challenging work arrangements. Dyads described how the pandemic positively impacted their relationship, allowing some of them to spend more time together. In coping with the pandemic, adult children provided instrumental support to their parents and parents reciprocated with emotional support. Participants also coped by making meaning of their situation during discussions. CONCLUSIONS Findings characterize the resilience of persons with dementia and the mutuality of the relationship between both members of the care partner dyad, as both parents and adult children offered support to one another. Facilitating dyadic discussions may be a cost-effective way to sustain social connections and offer ongoing coping support through the pandemic or other challenging circumstances.
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Affiliation(s)
- Talha Ali
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emily L. Mroz
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Andrew B. Cohen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joan K. Monin
- Department of Social and Behavioral Science, Yale School of Public Health, New Haven, Connecticut, USA
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Deng X, Geng Z, Yu J, Dai X, Kuang X, Chen X, Li R, Liu T, Li C. The Association Between Cataract and Cognitive Functions in Older Adults: A Longitudinal Cohort Study. J Alzheimers Dis 2023; 91:1097-1105. [PMID: 36565122 DOI: 10.3233/jad-220963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between cataracts and cognitive functions has been reported in several studies. However, the dynamic trajectories of cognitive changes in patients with cataracts remain unelucidated. OBJECTIVE The aim of the study was to evaluate the dynamic trajectories of cognitive changes in patients with cataracts. METHODS This observational cohort study recruited 1,146 patients with age-related cataracts (ARC) from the Department of Ophthalmology, Daping Hospital, from September 2020 to November 2021. The cognitive functions of the patients were assessed using a Chinese version of the Telephone Interview of Cognitive Status-40 (TICS-40) test at baseline and 6 months of follow-up. The trajectories and the associated risk factors for the longitudinal cognitive decline during the 6-month follow-up were investigated. RESULTS Patients with severe ARC [median (IQR): 0 month, 24 (22, 25); 6 months, 23 (21,25)] had lower TICS-40 scores than those with non-severe ARC [0 month, 31 (24, 33), p < 0.001; 6 months, 31 (23,33), p < 0.001] and controls [0 month, 32 (28, 35), p < 0.001; 6 months, 32 (28, 35), p < 0.001] at both baseline and 6 months of follow-up. Age (OR: 1.311, 95% CI: 1.229 to 1.398) and cataract grade (OR: 5.569, 95% CI: 2.337 to 13.273) were found to be the risk factors of cognitive decline as indicated by a decrease in the TICS-40 scores. CONCLUSION ARC is associated with an increased risk of longitudinal cognitive decline; however, the reversibility of such declines needs to be investigated further.
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Affiliation(s)
- Xiaoli Deng
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhao Geng
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Juan Yu
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoyan Dai
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Xunjie Kuang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Xia Chen
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ruifeng Li
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ting Liu
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chongyi Li
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
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Sarraf MA, Woodley of Menie MA, Peñaherrera-Aguirre M. The anti-Wilson effect: The decrease in heritability of general cognitive ability, as proxied by polygenic expressivity, with advanced age. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023. [DOI: 10.1016/j.paid.2022.111969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Loughan AR, Reid M, Willis KD, Barrett S, Lo K. The emotional journey of neuro-oncology: Primary brain tumor patients share their experience during this life-threatening disease. Neurooncol Pract 2023; 10:71-78. [PMID: 36659970 PMCID: PMC9837771 DOI: 10.1093/nop/npac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background To achieve patient-centric quality care in neuro-oncology, all aspects of the disease and its impact on quality survival need to be considered. This includes the psychological consequences of a brain tumor diagnosis and subsequent life-altering experiences. Far too often the voice of our patients is unheard. Empowering patients to advocate for their own psychological needs is essential. Methods Data were derived from four focus groups with adult patients with brain tumors (N = 15; M age = 46 years, 53% female). A trained moderator led each 90-min group and posed semi-structured questions regarding patients' care needs throughout their neuro-oncological disease trajectory. Emphasis was placed on the quality of life and distress reduction. Common themes were identified via thematic content analysis using NVivo software. A high inter-rater reliability (M kappa = 0.92, range = 0.85-0.93) was achieved. Two themes are presented here: Emotional Response to Stressors and Existential Considerations. Results Of the two themes presented, 14 codes emerged. Codes were classified into three broad categories: Fear, Despair, and Resilience. The frequency of each category ranged from 31.4% to 34.7%. Example quotes and a discussion of each category follows. Conclusions It is imperative that we include the patient perspective in the development of neuro-oncology programs, thereby considering the quality of survival in addition to quantity. Neuro-oncology quality care must be driven by our patients' experiences and should integrate support for emotional distress while promoting resilience throughout this life-threatening illness.
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Affiliation(s)
- Ashlee R Loughan
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Massey Cancer Center, Richmond, Virginia, USA
| | - Morgan Reid
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kelcie D Willis
- Massey Cancer Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah Barrett
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karen Lo
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Saucier J, Jose C, Beroual Z, Al-Qadi M, Chartrand S, Libert E, Losier MC, Cooling K, Girouard G, Jbilou J, Chamard-Witkowski L. Cognitive inhibition deficit in long COVID-19: An exploratory study. Front Neurol 2023; 14:1125574. [PMID: 37122293 PMCID: PMC10140516 DOI: 10.3389/fneur.2023.1125574] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Background and objectives An increasing number of research studies point toward the importance and prevalence of long-term neurocognitive symptoms following infection with COVID-19. Our objectives were to capture the prevalence of cognitive impairments from 1 to 16 months post-COVID-19 infection, assess the changes in neuropsychological functions over time, and identify factors that can predict long-term deficits in cognition. Methodology A cross-sectional research design was adopted to compare four sub-samples recruited over a 16-month timeframe (1-4, 5-8, 9-12, and 13-16 months). Phone interviews were conducted at least 6 weeks after being infected by COVID-19. Sociodemographic and clinical questionnaires were administered followed by standardized neurocognitive and psychological tests and health questionnaires screening cognitive symptoms, anxiety, depression, fatigue, and autonomy. Results Regarding general health questionnaires, 55.2% of the 134 participants had symptoms of psychiatric illness, while 21.6% of patients had moderate-to-severe anxiety or depression. Cognitive efficiency was diminished in 19.4% of our population. Executive dysfunction was screened in 56% of patients, and an impairment of cognitive flexibility and inhibition was revealed in 38.8%. Depression, hospital or intensive care unit (ICU) admission, and the duration of hospital or ICU stay were associated with an inhibition deficit. The duration elapsed from the initial infection, and the neurocognitive assessment was not associated with a decrease in inhibition deficit. The prevalence of cognitive impairments, other than inhibition deficit, tended to decrease during the study period. Discussion This study supports the extensive literature on the cognitive and neuropsychiatric sequelae of COVID-19 and highlights long-lasting inhibition deficits, while other cognitive functions seemed to improve over time. The severity of infection could interact as a catalyst in the complex interplay between depression and executive functions. The absence of a relation between inhibition deficits and sociodemographic or medical factors reinforces the need for cognitive screening in all COVID-19 patients. Future research should focus on inhibition deficits longitudinally to assess the progression of this impairment.
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Affiliation(s)
- Jacob Saucier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Caroline Jose
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Zaynab Beroual
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Mohammad Al-Qadi
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Simon Chartrand
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Eméraldine Libert
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Marie-Claire Losier
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Kendra Cooling
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Gabriel Girouard
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Jalila Jbilou
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- School of Psychology, Université de Moncton, Moncton, NB, Canada
| | - Ludivine Chamard-Witkowski
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
- *Correspondence: Ludivine Chamard-Witkowski,
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Ali HF, Fast L, Khalil A, Siebert E, Liman T, Endres M, Villringer K, Kufner A. White matter hyperintensities are an independent predictor of cognitive decline 3 years following first-ever stroke-results from the PROSCIS-B study. J Neurol 2023; 270:1637-1646. [PMID: 36471099 PMCID: PMC9971076 DOI: 10.1007/s00415-022-11481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/05/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND White matter hyperintensities (WMH) are the result of cerebral small vessel disease and may increase the risk of cognitive impairment (CI), recurrent stroke, and depression. We aimed to explore the association between selected cerebrovascular risk factors (CVRF) and WMH load as well as the effect of increased WMH burden on recurrent vascular events, CI, and depression in first-ever ischemic stroke patients. METHODS 431 from the PROSpective Cohort with Incident Stroke (PROSCIS) were included; Age-Related White Matter Changes (ARWMC) score was used to assess WMH burden on FLAIR. The presence of CVRF (defined via blood pressure, body-mass-index, and serological markers of kidney dysfunction, diabetes mellitus, and hyperlipoproteinemia) was categorized into normal, borderline, and pathological profiles based on commonly used clinical definitions. The primary outcomes included recurrent vascular events (combined endpoint of recurrent stroke, myocardial infarction and/or death), CI 3 years post-stroke, and depression 1-year post-stroke. RESULTS There was no clear association between CVRF profiles and WMH burden. High WMH lesion load (ARWMC score ≥ 10) was found to be associated with CI (adjusted OR 1.05 [95% CI 1.00-1.11]; p < 0.02) in a mixed-model analysis. Kaplan-Meier survival analysis showed a visible increase in the risk of recurrent vascular events following stroke; however, after adjustment, the risk was non-significant (HR 1.5 [95% CI 0.76-3]; p = 0.18). WMH burden was not associated with depression 1-year post stroke (adjusted OR 0.72 [95% CI 0.31-1.64]; p = 0.44). CONCLUSION Higher WMH burden was associated with a significant decline in cognition 3 years post-stroke in this cohort of first-ever stroke patients.
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Affiliation(s)
- Huma Fatima Ali
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea Fast
- Klinik für Psychiatrie and Psychotherapie, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmed Khalil
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany ,Center for Stroke Research Berlin (CSB), Klinik Für Neurologie, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Berlin Institute of Health (BIH), Berlin, Germany ,Max Planck Institute for Human Cognitive and Brain Sciences, Berlin, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
| | - Thomas Liman
- Center for Stroke Research Berlin (CSB), Klinik Für Neurologie, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB), Klinik Für Neurologie, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Klinik und Hochschulambulanz für Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany ,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany ,German Center for Neurodegerenative Diseases (DZNE), Partner Site Berlin, Berlin, Germany ,ExcellenceCluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin (CSB), Klinik Für Neurologie, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Kufner
- Center for Stroke Research Berlin (CSB), Klinik Für Neurologie, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,Klinik und Hochschulambulanz für Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany. .,ExcellenceCluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Herrmann D, Oudman E, Postma A. The era of our lives: The memory of Korsakoff patients for the first Covid-19 pandemic lockdown in the Netherlands. Conscious Cogn 2023; 107:103454. [PMID: 36525743 PMCID: PMC9742220 DOI: 10.1016/j.concog.2022.103454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Memories for worldwide and emotional events (such as 9/11) are more vividly relived and recalled than memories for everyday events. Previous studies have shown that flashbulb memories of a single event enhanced the memory strength in severe amnesia. It is currently unknown whether macro-events that stretch out over longer periods of time (weeks, months) strengthen memory even further. Our aim was therefore to investigate to what extent patients with severe amnesia, due to Korsakoff's syndrome (KS), were able to relive the first Covid-19 lockdown in the Netherlands, and whether experienced emotions enhanced reliving of the participants. We included 22 KS patients and 24 age-, education-, and gender-matched healthy controls. Covid-19 related memories were assessed by measures of autobiographical memory specificity, phenomenological reliving, emotional intensity and semantic-and episodic knowledge about the first lockdown in March 2020 - May 2020 in the Netherlands. Although amnesia patients remembered significantly fewer autobiographical details regarding the Covid-19 lockdown than healthy controls, one fourth of the KS patients recalled specific events. Amnesia patients reported levels of emotional intensity equivalent to those in the control group. Stronger autobiographical reliving was associated with higher emotional intensity. Both amnesia patients and healthy controls had higher recall of episodic than semantic lockdown related information. In conclusion, results demonstrate that information for macro-events can still be memorized and relived, most specifically when emotional valence is high, even by highly amnestic patients.
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Affiliation(s)
- Dianne Herrmann
- Helmholtz Institute, Experimental Psychology, Utrecht University, Utrecht, the Netherlands; Lelie Care Group, Slingedael Korsakoff Center, Slinge, 901, 3086 EZ Rotterdam, the Netherlands.
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Shieu MM, Braley TJ, Becker J, Dunietz GL. The Interplay Among Natural Menopause, Insomnia, and Cognitive Health: A Population-Based Study. Nat Sci Sleep 2023; 15:39-48. [PMID: 36820129 PMCID: PMC9938660 DOI: 10.2147/nss.s398019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE The interrelationships among age at menopause, sleep, and brain health have been insufficiently studied. This study sought to examine the influence of age at natural menopause and insomnia symptoms on long-term cognitive function among US women. PATIENTS AND METHODS Our study included a nationally representative cohort of US adults age 50+ from the Health and Retirement Study (2008-2018). We restricted this cohort to 5880 women age 50+, from a diverse racial and ethnic groups. Age at menopause was retrieved from baseline (2008) for women having natural menopause. Five questions were used to identify women with insomnia symptoms (2010 and 2012): trouble falling asleep, nighttime awakenings, early morning awakenings, feelings of nonrestorative sleep, and use of sleep aids. A battery of four neuropsychological tests was conducted biennially (years) to evaluate cognitive function. Longitudinal associations between age at natural menopause and cognitive function were estimated with mixed effects models with a random intercept. Insomnia symptoms were examined as potential mediators or modifiers in the pathway between age at menopause and cognition. RESULTS One year earlier in age at menopause was associated with a 0.49 lower mean in composite cognitive score, in any given survey year (adjusted p = 0.002). Earlier age at menopause was associated with higher risk of developing insomnia symptoms (eg, trouble falling asleep OR = 0.97; 95% CI: 0.96, 0.99), and insomnia symptoms were associated with worse cognitive performance (eg, trouble falling asleep, beta = -0.5, p-value = 0.02). Therefore, insomnia symptoms could potentially mediate the association between age at natural menopause and cognition. CONCLUSION Earlier age at menopause is associated with a lower score in cognitive performance. This association may be mediated by insomnia symptoms. Our findings spotlight that among women who experience early menopause, there is the need for studies of sleep-based interventions to mitigate cognitive decline.
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Affiliation(s)
- Monica M Shieu
- Neurology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Tiffany J Braley
- Neurology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Jill Becker
- Psychology, Medical School, University of Michigan, Ann Arbor, MI, USA
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Kazan J, Lyew T, Croswell E, Buysse DJ, Gebara MA, Karp JF, Krafty RT, Rashied AA, Reynolds CF, Rollman BL, Smagula SF, Stahl ST. A digital health intervention to stabilize the 24-hour rhythm of sleep, meals, and physical activity for reducing depression among older bereaved spouses: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 124:107016. [PMID: 36414207 PMCID: PMC9839623 DOI: 10.1016/j.cct.2022.107016] [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: 08/19/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite the high prevalence of depression and disruption to 24-h sleep-wake routines following the death of a spouse in late-life, no bereavement interventions have been developed to re-entrain a regular sleep-wake routine among older widow(er)s. We describe the rationale and methodology of the NIH-funded WELL Study (Widowed Elders' Lifestyle after Loss), a randomized controlled trial (RCT) comparing the efficacy of a digital health intervention (DHI) to enhanced usual care (EUC) arm for reducing depression symptoms in older spousally-bereaved adults. METHODS We will randomize approximately 200 recently bereaved (<12 months) adults aged 60+ years to one of two 12-week interventions: digital monitoring of the timing and regularity of sleep, meals, and physical activity plus weekly motivational health coaching; or enhanced usual care consisting of weekly telephone calls and similar assessment schedules. Participants will complete self-report and clinical assessments at baseline, post-intervention, and 3-, 6-, and 12-months post-intervention, and objective actigraphic assessments of their 24-h rest-activity rhythm (RAR) at baseline and 1-, 2-, and 3-months during the intervention. The primary outcome is change in depression symptoms burden (using the Hamilton Rating Scale for Depression) from pre- to post-intervention and over 12 months of follow-up. DISCUSSION WELL Study findings will inform the development of widely generalizable and scalable technology-based interventions to support bereaved spouses in community-based settings. Clinical http://Trials.gov Identifier: NCT04016896.
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Affiliation(s)
- Joseph Kazan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thandi Lyew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Ammar A Rashied
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Bruce L Rollman
- Center for Behavioral Health, Media, & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen F Smagula
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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De Luca V, Femminella GD, Patalano R, Formosa V, Lorusso G, Rivetta C, Di Lullo F, Mercurio L, Rea T, Salvatore E, Korkmaz Yaylagul N, Apostolo J, Silva RC, Dantas C, van Staalduinen WH, Liotta G, Iaccarino G, Triassi M, Illario M. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16050. [PMID: 36498125 PMCID: PMC9739796 DOI: 10.3390/ijerph192316050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Valeria Formosa
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Grazia Lorusso
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Cristiano Rivetta
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Federica Di Lullo
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Teresa Rea
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Joao Apostolo
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Rosa Carla Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | | | | | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
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Hlávka JP, Yu JC, Lakdawalla DN. Crosswalk between the Mini-Mental State Examination and the Telephone Interview for Cognitive Status (TICS-27/30/40). Alzheimers Dement 2022; 18:2036-2041. [PMID: 35103408 PMCID: PMC10373741 DOI: 10.1002/alz.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/08/2021] [Accepted: 12/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND We develop a crosswalk between the Mini-Mental State Examination (MMSE) and Telephone Interview for Cognitive Status (TICS)-27, TICS-30, and TICS-40 for adults 65 years and older. METHODS We examined the scores of 1809 participants, with and without cognitive impairment, who completed the MMSE and the TICS assessment in the 2016 Health and Retirement Study and the 2016 Harmonized Cognitive Assessment Protocol study. Crosswalks between MMSE and TICS-27/30/40 were developed via equipercentile equating. RESULTS We present crosswalks for MMSE and TICS-27/30/40 for the 65+ population representative of the US elderly. While monotonic, the pattern of the TICS-30 to MMSE crosswalk differs from the other two crosswalks (MMSE to TICS-27/40). CONCLUSION Our analysis offers an empirical crosswalk between two commonly used cognitive measures-the MMSE and TICS. Our findings suggest the need for validated and robust measures that allow for the comparison of scores on different cognitive scales.
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Affiliation(s)
- Jakub P Hlávka
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Jeffrey C Yu
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA.,School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Darius N Lakdawalla
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA.,School of Pharmacy, University of Southern California, Los Angeles, California, USA
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Lin L, Cao B, Chen W, Li J, Zhang Y, Guo VY. Association of Adverse Childhood Experiences and Social Isolation With Later-Life Cognitive Function Among Adults in China. JAMA Netw Open 2022; 5:e2241714. [PMID: 36367722 PMCID: PMC9652754 DOI: 10.1001/jamanetworkopen.2022.41714] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Studies investigating the association of threat-related and deprivation-related adverse childhood experiences (ACEs) with later-life cognitive decline are lacking. OBJECTIVES To evaluate the independent association of threat-related and deprivation-related ACEs with cognitive decline over time among middle-aged and older Chinese adults and to examine the modifying role of social isolation in such associations. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used cognitive data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey that was administered between June 1, 2011, and March 31, 2012, and the CHARLS follow-up survey administered between July 1 and September 30, 2015. The life history survey with information of ACEs was additionally administered between June 1 and December 31, 2014. Statistical analysis was performed from March 1 to July 31, 2022. The study population consisted of middle-aged and older adults (age range, 45-97 years) with complete data on ACEs and 2 cognitive assessments and without cognitive impairment at baseline. EXPOSURES Five threat-related ACEs (ie, physical abuse, household substance abuse, domestic violence, unsafe neighborhood, and bullying) and 5 deprivation-related ACEs (ie, emotional neglect, household mental illness, incarcerated household member, parental separation or divorce, and parental death) before 17 years of age were queried by questionnaires. The cumulative scores of the 2 ACE dimensions were calculated and grouped into 3 categories as 0, 1, and 2 or more in main analyses. MAIN OUTCOMES AND MEASURES Cognitive function was measured by episodic memory and executive function. Global cognition was further calculated as the total score of these 2 dimensions. The raw scores of each cognitive test were standardized to z scores using baseline means and SDs. Linear mixed-effects models were constructed to examine the association between 2 dimensions of ACEs and the rate of annual cognitive decline. The modifying role of baseline social isolation in such associations was assessed with 3-way interaction tests. RESULTS Of the 6466 participants included in main analyses, 3301 (51.1%) were men and the mean (SD) age was 57.2 (8.3) years. Compared with no exposures, experience of 1 deprivation-related ACE was associated with faster cognitive decline in global cognition (β = -0.012 [95% CI, -0.022 to -0.002] SD/y) and executive function (β = -0.010 [95% CI, -0.020 to -0.00002] SD/y), whereas individuals with at least 2 childhood deprivations had faster cognitive declines in all cognitive tests (β = -0.035 [95% CI, -0.050 to -0.019] SD/y for global cognition; β = -0.047 [95% CI, -0.068 to -0.025] SD/y for episodic memory; β = -0.019 [95% CI, -0.034 to -0.004] SD/y for executive function). However, such an association was not observed for threat-related ACEs. In addition, baseline social isolation was a significant modifier in the associations between deprivation-related ACEs and cognitive declines in global cognition (β = -0.033 [95% CI, -0.061 to -0.005] SD/y; P = .02 for 3-way interaction) and executive function (β = -0.032 [95% CI, -0.059 to -0.005] SD/y; P = .02 for 3-way interaction). CONCLUSIONS AND RELEVANCE Deprivation-related ACEs, but not threat-related ACEs, were associated with faster decline in later-life cognitive function, whereas social isolation could modify such detrimental impact. These findings highlight the potential benefits of promoting social integration in maintaining later-life cognitive function among individuals who have experienced childhood deprivation.
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Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bing Cao
- Department of Neurosurgery, Wu Tsai Neuroscience Institute, Stanford University School of Medicine, Stanford, California
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Zainal NH, Newman MG. Elevated Anxious and Depressed Mood Relates to Future Executive Dysfunction in Older Adults: A Longitudinal Network Analysis of Psychopathology and Cognitive Functioning. Clin Psychol Sci 2022; 11:218-238. [PMID: 36993876 PMCID: PMC10046395 DOI: 10.1177/21677026221114076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vulnerability models posit that executive-functioning (EF) problems centrally affect future common (vs. rare) psychopathology symptoms. Conversely, scar theory postulates that depression/anxiety (vs. other psychopathology) symptoms centrally influence reduced EF. However, most studies so far have been cross-sectional. We used cross-lagged panel network analysis to determine temporal and component-to-component relations on this topic. Community older adults participated across four time points. Cognitive tests and the caregiver-rated Neuropsychiatric Inventory assessed nine psychopathology and eight cognitive-functioning nodes. Nodes with the highest bridge expected influence cross-sectionally were agitation and episodic memory. Episodic memory had the strongest inverse relation with age. Agitation had the strongest negative association with global cognition. EF nodes tended to be centrally affected by prior depressed and anxious moods rather than influential on any future nodes. Heightened anxious and depressed mood (vs. other nodes) centrally predicted future decreased EF-related (vs. non-EF-related) nodes in older adults, supporting scar (vs. vulnerability) theory.
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Affiliation(s)
- Nur Hani Zainal
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
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Wei Y, Heun-Johnson H, Tysinger B. Using dynamic microsimulation to project cognitive function in the elderly population. PLoS One 2022; 17:e0274417. [PMID: 36107946 PMCID: PMC9477290 DOI: 10.1371/journal.pone.0274417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A long-term projection model based on nationally representative data and tracking disease progression across Alzheimer's disease continuum is important for economics evaluation of Alzheimer's disease and other dementias (ADOD) therapy. METHODS The Health and Retirement Study (HRS) includes an adapted version of the Telephone Interview for Cognitive Status (TICS27) to evaluate respondents' cognitive function. We developed an ordered probit transition model to predict future TICS27 score. This transition model is utilized in the Future Elderly Model (FEM), a dynamic microsimulation model of health and health-related economic outcomes for the US population. We validated the FEM TICS27 model using a five-fold cross validation approach, by comparing 10-year (2006-2016) simulated outcomes against observed HRS data. RESULTS In aggregate, the distribution of TICS27 scores after ten years of FEM simulation matches the HRS. FEM's assignment of cognitive/mortality status also matches those observed in HRS on the population level. At the individual level, the area under the receiver operating characteristic (AUROC) curve is 0.904 for prediction of dementia or dead with dementia in 10 years, the AUROC for predicting significant cognitive decline in two years for mild cognitive impairment patients is 0.722. CONCLUSIONS The FEM TICS27 model demonstrates its predictive accuracy for both two- and ten-year cognitive outcomes. Our cognition projection model is unique in its validation with an unbiased approach, resulting in a high-quality platform for assessing the burden of cognitive decline and translating the benefit of innovative therapies into long-term value to society.
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Affiliation(s)
- Yifan Wei
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
| | - Hanke Heun-Johnson
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
| | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
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Thomas BL, Holder LB, Cook DJ. Automated Cognitive Health Assessment Using Partially Complete Time Series Sensor Data. Methods Inf Med 2022; 61:99-110. [PMID: 36220111 PMCID: PMC9847015 DOI: 10.1055/s-0042-1756649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Behavior and health are inextricably linked. As a result, continuous wearable sensor data offer the potential to predict clinical measures. However, interruptions in the data collection occur, which create a need for strategic data imputation. OBJECTIVE The objective of this work is to adapt a data generation algorithm to impute multivariate time series data. This will allow us to create digital behavior markers that can predict clinical health measures. METHODS We created a bidirectional time series generative adversarial network to impute missing sensor readings. Values are imputed based on relationships between multiple fields and multiple points in time, for single time points or larger time gaps. From the complete data, digital behavior markers are extracted and are mapped to predicted clinical measures. RESULTS We validate our approach using continuous smartwatch data for n = 14 participants. When reconstructing omitted data, we observe an average normalized mean absolute error of 0.0197. We then create machine learning models to predict clinical measures from the reconstructed, complete data with correlations ranging from r = 0.1230 to r = 0.7623. This work indicates that wearable sensor data collected in the wild can be used to offer insights on a person's health in natural settings.
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Affiliation(s)
- Brian L. Thomas
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, Washington, United States
| | - Lawrence B. Holder
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, Washington, United States
| | - Diane J. Cook
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, Washington, United States
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Zeng Y, Lum TYS, Chen YC. The intersectionality of life course socioeconomic status, race, and cognitive decline: An 18-year follow-up. Int J Geriatr Psychiatry 2022; 37. [PMID: 35775714 DOI: 10.1002/gps.5774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Studies have documented the impact of childhood socioeconomic status (SES) on cognition. However, research that simultaneously considers SES in varied life stages, the multidimensional mechanisms, and racial differences is relatively understudied. This study examines the intersectionality across age, SES, and race and its impact on cognitive trajectories. METHODS Using 8376 respondents aged 65+ from the 1998-2016 Health and Retirement Study, we used latent growth curve modeling to examine the effects of four life course models (latency, pathway, accumulation, and mobility) on 18-year trajectories of mental status and episodic memory. We further tested for differences in the links between SES and cognitive trajectories between black and white respondents. RESULTS Cognitive function declines with age and is interrelated with SES and race. Adulthood has a stronger effect on cognitive performance than childhood. However, linked positive childhood and adulthood SES contributes to positive cognition. Accumulated SES disadvantages were associated with lower cognition. Older adults with downward mobility and low SES throughout their lifespans had the lowest cognition scores. Life course models operated differently on trajectories of cognitive decline, yet the effects were particularly evident among older black respondents. Overall, those with socioeconomic advantages tended to have a slower decline in cognition, while a faster decline occurred for those with accrued disadvantages. CONCLUSIONS Cognitive performance is a complex, longitudinal process intertwined with socioeconomic conditions and population heterogeneity shaped by life course contexts. Policies that facilitate healthy cognitive performance and address SES inequality could equalize health opportunities and address racial cognitive disparities later in life.
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Affiliation(s)
- Yue Zeng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Terry Yat Sang Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Yu-Chih Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
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Lazzari C, Rabottini M. COVID-19, loneliness, social isolation and risk of dementia in older people: a systematic review and meta-analysis of the relevant literature. Int J Psychiatry Clin Pract 2022; 26:196-207. [PMID: 34369248 DOI: 10.1080/13651501.2021.1959616] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES During the COVID-19 lockdown, social isolation and feelings of loneliness (SIFL) in the older population have increased, and they can be a risk of dementia, especially in vulnerable older people. The current research is a systematic review meta-analysis of the studies that approach the risk of dementia in older people with SIFL. METHODS The ten studies selected for meta-analysis utilised an opportunistic sample of older people in the community from age 50 to above with no dementia and enrolment. The populations consisted of cohorts of an average of 8,239 people, followed for a mean period of 6.41 years. Random effect meta-analysis summarised the Cox Proportional Hazard Ratios and Relative Risks of the individual studies. RESULTS Results of the meta-analysis show that in older people, the risk of developing dementia because of the impact of prolonged loneliness and social isolation is about 49 to 60% [HR/HR = 1.49; CI95=1.37-1.61] higher than in those who are not lonely and socially isolated. CONCLUSION The biopsychosocial model of dementia supports the need for more integrated social programs and reduced risks for the older persons who, during the COVID-19 lockdown, have suffered from deprivation of support from primary carers and restricted social interactions.KeypointsDuring the COVID-19 lockdown, social isolation and feelings of loneliness in the general population have increased.Older persons are more vulnerable to social isolation and feelings of loneliness (SIFL).SIFL in older people has been associated with an increased risk of dementia.The current study's findings suggest the need to improve healthcare policies to reduce the impact of SIFL in older persons during the COVID-19 pandemic.
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Affiliation(s)
- Carlo Lazzari
- Department of Psychiatry, International Centre for Healthcare and Medical Education, Bristol, United Kingdom
| | - Marco Rabottini
- Department of Psychiatry, International Centre for Healthcare and Medical Education, Bristol, United Kingdom
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Wu S, Shi H, Cheng R, Xiang Z, Huang SS. Impairment in activities of daily living and cognitive decline mediate the association between depressive symptoms and incident hip fractures in Chinese older adults. Bone 2022; 159:116374. [PMID: 35227932 DOI: 10.1016/j.bone.2022.116374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The presence of depressive symptoms is associated with increasing risks of hip fractures (HFs). However, few studies investigated the longitudinal relationship between depressive symptoms and incident HFs among Chinese older adults, and the underlying mechanisms remain unclear. OBJECTIVES To investigate the association between depressive symptoms and incident HFs, and the mediating role of cognitive function and impairment in activities of daily living (ADL) in the association among the older adults in China. METHODS This population-based cohort study included 6336 Chinese older adults (age range, 60-101 years) without the history of HFs at baseline and with complete data during the follow-up. Discrete-time Cox regression was used to evaluate the relationship between depressive symptoms and incident HFs, and bootstrapped multiple mediation analyses were conducted to examine the effects of cognitive function and ADL impairment on the association. RESULTS Among 6336 participants (3172 women [50.1%]; mean [SD] age, 67.9 [6.6] years), 264 (4.2%) subjects had HFs onset. After adjusting for age, sex, education, marital status, current residence, smoking status, drinking status, body mass index, number of chronic conditions, and falls history, elevated depressive symptoms were independently associated with increasing risks of HFs (adjusted hazard ratio [aHR]: 1.42; 95% CI: 1.07 to 1.88). However, this association was no longer significant (aHR: 1.09; 95% CI: 0.78 to 1.53) after adjusting for cognitive function and ADL impairment. When mortality and incident HFs were modeled as a composite outcome, the association between depressive symptoms and combined outcomes also remained non-significant after adjusting for cognitive function and ADL impairment. Furthermore, the mediation model demonstrated that cognitive decline (indirect effect: β = 0.002, 95% CI: 0.001 to 0.003) and ADL impairment (indirect effect: β = 0.002, 95% CI: 0.000 to 0.003) fully mediated the association between depressive symptoms and incident HFs after adjusting for age, sex, falls history, and number of chronic conditions. CONCLUSIONS The positive association between depressive symptoms and incident HFs was confirmed among Chinese older adults, which was fully mediated by cognitive decline and ADL impairment. This study shed new light on the potential role played by depressive symptoms in incident HFs.
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Affiliation(s)
- Shuang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China
| | - Hui Shi
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Rui Cheng
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China
| | - Shi-Shu Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China.
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Liu YH, Chen Y, Wang QH, Wang LR, Jiang L, Yang Y, Chen X, Li Y, Cen Y, Xu C, Zhu J, Li W, Wang YR, Zhang LL, Liu J, Xu ZQ, Wang YJ. One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China: A Longitudinal Cohort Study. JAMA Neurol 2022; 79:509-517. [PMID: 35258587 PMCID: PMC8905512 DOI: 10.1001/jamaneurol.2022.0461] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Determining the long-term impact of COVID-19 on cognition is important to inform immediate steps in COVID-19 research and health policy. Objective To investigate the 1-year trajectory of cognitive changes in older COVID-19 survivors. Design, Setting, and Participants This cohort study recruited 3233 COVID-19 survivors 60 years and older who were discharged from 3 COVID-19-designated hospitals in Wuhan, China, from February 10 to April 10, 2020. Their uninfected spouses (N = 466) were recruited as a control population. Participants with preinfection cognitive impairment, a concomitant neurological disorder, or a family history of dementia were excluded, as well as those with severe cardiac, hepatic, or kidney disease or any kind of tumor. Follow-up monitoring cognitive functioning and decline took place at 6 and 12 months. A total of 1438 COVID-19 survivors and 438 control individuals were included in the final follow-up. COVID-19 was categorized as severe or nonsevere following the American Thoracic Society guidelines. Main Outcomes and Measures The main outcome was change in cognition 1 year after patient discharge. Cognitive changes during the first and second 6-month follow-up periods were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Telephone Interview of Cognitive Status-40, respectively. Based on the cognitive changes observed during the 2 periods, cognitive trajectories were classified into 4 categories: stable cognition, early-onset cognitive decline, late-onset cognitive decline, and progressive cognitive decline. Multinomial and conditional logistical regression models were used to identify factors associated with risk of cognitive decline. Results Among the 3233 COVID-19 survivors and 1317 uninfected spouses screened, 1438 participants who were treated for COVID-19 (691 male [48.05%] and 747 female [51.95%]; median [IQR] age, 69 [66-74] years) and 438 uninfected control individuals (222 male [50.68%] and 216 female [49.32%]; median [IQR] age, 67 [66-74] years) completed the 12-month follow-up. The incidence of cognitive impairment in survivors 12 months after discharge was 12.45%. Individuals with severe cases had lower Telephone Interview of Cognitive Status-40 scores than those with nonsevere cases and control individuals at 12 months (median [IQR]: severe, 22.50 [16.00-28.00]; nonsevere, 30.00 [26.00-33.00]; control, 31.00 [26.00-33.00]). Severe COVID-19 was associated with a higher risk of early-onset cognitive decline (odds ratio [OR], 4.87; 95% CI, 3.30-7.20), late-onset cognitive decline (OR, 7.58; 95% CI, 3.58-16.03), and progressive cognitive decline (OR, 19.00; 95% CI, 9.14-39.51), while nonsevere COVID-19 was associated with a higher risk of early-onset cognitive decline (OR, 1.71; 95% CI, 1.30-2.27) when adjusting for age, sex, education level, body mass index, and comorbidities. Conclusions and Relevance In this cohort study, COVID-19 survival was associated with an increase in risk of longitudinal cognitive decline, highlighting the importance of immediate measures to deal with this challenge.
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Affiliation(s)
- Yu-Hui Liu
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yang Chen
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Qing-Hua Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ling-Ru Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Li Jiang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ying Yang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xian Chen
- Department of Anaesthesiology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ying Li
- Department of Ophthalmology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yuan Cen
- Department of Orthopedics, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Xu
- Department of Oncology, General Hospital of the Central Theatre Command of the People's Liberation Army, Wuhan, China
| | - Jie Zhu
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wei Li
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ye-Ran Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Li-Li Zhang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Juan Liu
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhi-Qiang Xu
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yan-Jiang Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
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Jiang J, Yao K, Huang X, Zhang Y, Shen F, Weng S. Longitudinal white matter hyperintensity changes and cognitive decline in patients with minor stroke. Aging Clin Exp Res 2022; 34:1047-1054. [PMID: 35084664 PMCID: PMC9135882 DOI: 10.1007/s40520-021-02024-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
Background and objective As reported, both minor stroke and white matter hyperintensities (WMHs) are associated with an increased risk of cognitive impairment and dementia. The underlying factors for dynamic changes in WMH volume and cognitive performances in patients with minor stroke remain poorly understood. A 2-year longitudinal study was designed to investigate the factors associated with the changes in white matter hyperintensity (WMH) volume on brain MRI and cognitive decline in patients with minor stroke. Methods A group of eligible patients with minor ischemic stroke was recruited in a row. At the initial and 2-year follow-up visits, all the participants underwent routine examinations, multimodal MRI, and cognitive assessment. Using a lesion prediction algorithm tool, we were able to automate the measurement of the change in WMH volume. During the 2-year follow-up, cognitive function was evaluated using Telephone Interview for Cognitive Status-Modified (TICS-m). Participants’ demographic, clinical, and therapeutic data were collected and statistically analyzed. Regression analyses were used to test the relationships between risk factors and changes in WMH volume and cognitive decline. Results Finally, we followed up with 225/261 participants for 2 years, with a mean age of 65.67 ± 10.73 years (65.6% men). WMH volume was observed to be increased in 113 patients, decreased in 74 patients, and remained stable in 58 patients. Patients with WMH progression were more often had a history of hypertension (p = 0.006) and a higher CSVD burden both at baseline and follow-up visit (p < 0.05). Longitudinally, the proportion of patients taking antihypertension medications on a regular basis in the regression group was higher than in the stable group (p = 0.01). When compared to the stable group, the presence of lacunes (OR 9.931, 95% CI 1.597–61.77, p = 0.014) was a stronger predictor of progression in WMH volume. 87 subjects (38.6%) displayed incident cognitive impairment. The progression of WMH volume was a significant risk factor for cognitive decline (p < 0.001). Conclusions The longitudinal change of WMH is dynamic. The regressive WMH volume was associated with the use of antihypertensive medications on a regular basis. The presence of lacunes at the initial visit of the study was a stronger predictor of WMH progression. The progression of WMH volume could be useful in predicting cognitive decline in patients with minor stroke.
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Affiliation(s)
- Jingwen Jiang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kanmin Yao
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Huang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanxia Shen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Suiqing Weng
- Department of Neurology, Shanghai Minhang Hospital, Shanghai Fu Dan University, Shanghai, China.
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