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Herold F, Theobald P, Gronwald T, Kaushal N, Zou L, de Bruin ED, Bherer L, Müller NG. The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions. JMIR Aging 2024; 7:e56433. [PMID: 39083334 PMCID: PMC11325123 DOI: 10.2196/56433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 08/02/2024] Open
Abstract
A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.
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Affiliation(s)
- Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Paula Theobald
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Hamburg, Germany
| | - Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN, United States
| | - Liye Zou
- Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen, China
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St Gallen, Switzerland
| | - Louis Bherer
- Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Université de Montreal, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal, Montreal, QC, Canada
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
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2
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Dawes P, Munro KJ. Hearing Loss and Dementia: Where to From Here? Ear Hear 2024; 45:529-536. [PMID: 38379156 PMCID: PMC11008448 DOI: 10.1097/aud.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
Victorian era psychologists were the first to comment on associations between sensory and cognitive function. More recently, hearing loss has been shown as a marker of risk for dementia. However, it is not known whether this association represents a causal impact of hearing loss, nor whether treating hearing loss may help prevent dementia. Most studies on relationships between hearing loss and cognitive outcomes are observational, are at risk of confounding, and cannot reach conclusions about causation. A recent high quality randomized controlled trial, relatively uncommon in audiology, reported no impact of a comprehensive hearing intervention in mitigating cognitive decline in older adults. Although secondary analysis revealed potential benefits in a sub-sample of adults, this finding may be spurious. Encouraging policymakers, patients, and other health care practitioners to address hearing loss in terms of dementia prevention may be inappropriate on the grounds of both relevance at individual level and lack of clear evidence of benefit. In addition, advocating need to address hearing loss in terms of mitigating dementia risk may reduce the importance of addressing hearing loss in its own right. Linking hearing loss to dementia risk may also exacerbate the stigma of hearing loss, inadvertently discouraging people from seeking help for hearing. We suggest that treating hearing loss may have important benefits in preventing or delaying diagnosis of dementia via improving orientation and functioning in daily life, without changing the underlying pathology. Rather than linking hearing loss to dementia risk, we suggest a positive message focusing on the known benefits of addressing hearing loss in terms of improved communication, quality of life, and healthy aging.
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Affiliation(s)
- Piers Dawes
- Centre for Hearing Research, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia
- Manchester Centre for Audiology and Deafness, University of Manchester, UK
| | - Kevin J. Munro
- Manchester Centre for Audiology and Deafness, University of Manchester, UK
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3
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Giacona JM, Bates BM, Sundaram V, Brinker S, Moss E, Paspula R, Kassa S, Zhang R, Ahn C, Zhang S, Basit M, Burkhalter L, Cullum CM, Carlew A, Kelley BJ, Plassman BL, Vazquez M, Vongpatanasin W. Preventing cognitive decline by reducing BP target (PCOT): A randomized, pragmatic, multi-health systems clinical trial. Contemp Clin Trials 2024; 138:107443. [PMID: 38219797 DOI: 10.1016/j.cct.2024.107443] [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: 08/03/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Growing evidence suggests that intensive lowering of systolic blood pressure (BP) may prevent mild cognitive impairment (MCI) and dementia. However, current guidelines provide inconsistent recommendations regarding optimal BP targets, citing safety concerns of excessive BP lowering in the diverse population of older adults. We are conducting a pragmatic trial to determine if an implementation strategy to reduce systolic BP to <130 and diastolic BP to <80 mmHg will safely slow cognitive decline in older adults with hypertension when compared to patients receiving usual care. METHODS The Preventing Cognitive Decline by Reducing BP Target Trial (PCOT) is an embedded randomized pragmatic clinical trial in 4000 patients from two diverse health-systems who are age ≥ 70 years with BP >130/80 mmHg. Participants are randomized to the intervention arm or usual care using a permuted block randomization within each health system. The intervention is a combination of team-based care with clinical decision support to lower home BP to <130/80 mmHg. The primary outcome is cognitive decline as determined by the change in the modified Telephone Interview for Cognitive Status (TICS-m) scores from baseline. As a secondary outcome, patients who decline ≥3 points on the TICS-m will complete additional cognitive assessments and this information will be reviewed by an expert panel to determine if they meet criteria for MCI or dementia. CONCLUSION The PCOT trial will address the effectiveness and safety of hypertension treatment in two large health systems to lower BP targets to reduce risk of cognitive decline in real-world settings.
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Affiliation(s)
- John M Giacona
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA; Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, USA
| | - Brooke M Bates
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA; Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA
| | | | - Stephanie Brinker
- Division of General Internal Medicine, University of Texas Southwestern Medical Center, USA
| | - Elizabeth Moss
- Ambulatory Clinical Pharmacy Services, Parkland Health & Hospital System, USA
| | - Raja Paspula
- Geriatrics and Senior Care Center, Parkland Health & Hospital System, USA
| | - Sentayehu Kassa
- Vickery Health Center, Parkland Health & Hospital System, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, USA; Department of Neurology, UT Southwestern Medical Center, USA
| | - Chul Ahn
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, USA
| | - Song Zhang
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, USA
| | - Mujeeb Basit
- Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA
| | - Lorrie Burkhalter
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, USA
| | - C Munro Cullum
- Department of Neurology, UT Southwestern Medical Center, USA; Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, USA
| | - Anne Carlew
- Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, USA
| | | | - Brenda L Plassman
- Behavioral Medicine & Neurosciences Division, Department of Psychiatry, Duke University School of Medicine, USA
| | - Miguel Vazquez
- Nephrology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA.
| | - Wanpen Vongpatanasin
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA; Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, USA.
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Cross AJ, Geethadevi GM, Magin P, Baker AL, Bonevski B, Godbee K, Ward SA, Mahal A, Versace V, Bell JS, Mc Namara K, O'Reilly SL, Thomas D, Manias E, Anstey KJ, Varnfield M, Jayasena R, Elliott RA, Lee CY, Walker C, van den Bosch D, Tullipan M, Ferreira C, George J. A novel, multidomain, primary care nurse-led and mHealth-assisted intervention for dementia risk reduction in middle-aged adults (HAPPI MIND): study protocol for a cluster randomised controlled trial. BMJ Open 2023; 13:e073709. [PMID: 38114278 DOI: 10.1136/bmjopen-2023-073709] [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: 12/21/2023] Open
Abstract
INTRODUCTION Middle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster randomised controlled trial (cRCT), HAPPI MIND (Holistic Approach in Primary care for PreventIng Memory Impairment aNd Dementia). HAPPI MIND will evaluate the efficacy of a multidomain, nurse-led, mHealth supported intervention for assessing dementia risk and reducing associated risk factors in middle-aged adults in the Australian primary care setting. METHODS AND ANALYSIS General practice clinics (n≥26) across Victoria and New South Wales, Australia, will be recruited and randomised. Practice nurses will be trained to implement the HAPPI MIND intervention or a brief intervention. Patients of participating practices aged 45-65 years with ≥2 potential dementia risk factors will be identified and recruited (approximately 15 patients/clinic). Brief intervention participants receive a personalised report outlining their risk factors for dementia based on Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) scores, education booklet and referral to their general practitioner as appropriate. HAPPI MIND participants receive the brief intervention as well as six individualised dementia risk reduction sessions with a nurse trained in motivational interviewing and principles of behaviour change, a personalised risk reduction action plan and access to the purpose-built HAPPI MIND smartphone app for risk factor self-management. Follow-up data collection will occur at 12, 24 and 36 months. Primary outcome is ANU-ADRI score change at 12 months from baseline. Secondary outcomes include change in cognition, quality of life and individual risk factors of dementia. ETHICS AND DISSEMINATION Project approved by Monash University Human Research Ethics Committee (ID: 28273). Results will be disseminated in peer-reviewed journals and at healthcare conferences. If effective in reducing dementia risk, the HAPPI MIND intervention could be integrated into primary care, scaled up nationally and sustained over time. TRIAL REGISTRATION NUMBER ACTRN12621001168842.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Gopisankar Mohanannair Geethadevi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Parker Magin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kali Godbee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, St Kilda, Victoria, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Kevin Mc Namara
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Deakin Rural Health, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
- School of Exercise and Nutrition Science, Deakin University, Melbourne, Victoria, Australia
| | - Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marlien Varnfield
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Herston, Queensland, Australia
| | - Rajiv Jayasena
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Parkville, Victoria, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
| | - Cik Y Lee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Walker
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Denise van den Bosch
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Mary Tullipan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Catherine Ferreira
- North Western Melbourne Primary Health Network, Parkville, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, St Kilda, Victoria, Australia
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5
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Lindhout JE, van Dalen JW, van Gool WA, Richard E. The challenge of dementia prevention trials and the role of quasi-experimental studies. Alzheimers Dement 2023; 19:3722-3730. [PMID: 36960651 DOI: 10.1002/alz.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 03/25/2023]
Abstract
Observational studies have shown consistently that modifiable risk factors during life are associated with increased dementia risk in old age but randomized controlled trials (RCTs) on dementia prevention evaluating the treatment of these risk factors did not find consistent effects on cognitive outcomes. The discrepancy in findings is potentially attributable to inherent differences between the two study designs. Although RCTs are the gold standard for establishing causality, designing and conducting an RCT for dementia prevention is complex. Quasi-experimental studies (QESs) may contribute to investigating causality without randomization. QESs use variation in exposure to a risk factor or intervention in an observational setting to deduct causal effects. Design-specific approaches are used to control for confounding, the main caveat of QESs. In this article we address the challenges, opportunities, and limitations of QESs for research into dementia prevention. HIGHLIGHTS: Despite consistent associations between modifiable risk factors and dementia, the mostly neutral effects of randomized controlled trials (RCTs) challenge the causality of these associations. RCTs in the field of dementia prevention are often problematic due to ethical, practical, or financial constraints, and their results may have limited generalizability. Four quasi-experimental study (QES) designs may be suitable to study causality between risk factors and dementia; we critically appraise these study designs for dementia-prevention studies. We describe how specific QES designs can be used to study the effects of risk-factor modification for 12 known risk factors for dementia.
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Affiliation(s)
- Josephine E Lindhout
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Willem van Dalen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Qureshi AI, Baskett WI, Huang W, Akinci Y, Suri MFK, Naqvi SH, French BR, Siddiq F, Gomez CR, Shyu CR. New cardiovascular events in the convalescent period among survivors of SARS-CoV-2 infection. Int J Stroke 2023; 18:437-444. [PMID: 35796639 PMCID: PMC10037124 DOI: 10.1177/17474930221114561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have an increased risk of acute cardiovascular events in the convalescent period. AIMS To determine whether patients with SARS-CoV-2 infection have an increased risk of cardiovascular events during the convalescent period. METHODS We analyzed 10,691 hospitalized adult pneumonia patients with SARS-CoV-2 infection and contemporary matched controls of pneumonia patients without SARS-CoV-2 infection. The risk of new cardiovascular events following >30 days pneumonia admission (convalescent period) was ascertained using Cox proportional hazards regression analysis to adjust for potential confounders. RESULTS Among 10,691 pneumonia patients with SARS-CoV-2 infection, 697 patients (5.8%; 95% CI, 5.4-6.2%) developed new cardiovascular events (median time interval of 218 days post pneumonia admission; interquartile range Q1 = 117 days, Q3 = 313 days). The risk of new cardiovascular events was not significantly higher among pneumonia patients with SARS-CoV-2 infection compared with those with pneumonia without SARS-CoV-2 infection (hazard ratio (HR), 0.90, 95% CI, 0.80-1.02) after adjustment for potential confounders. In addition, no significant difference in the rate of a new ischemic stroke (HR, 0.84; 95% CI, 0.70-1.02) or ischemic heart disease (HR, 1.00; 95% CI, 0.87-1.15) was observed between the pneumonia patients with and without SARS-CoV-2 infection. CONCLUSION Our study suggests that new cardiovascular events rate in the convalescent period among pneumonia patients with SARS-CoV-2 infection was not significantly higher than the rate seen with other pneumonias.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - William I Baskett
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Wei Huang
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Yasemin Akinci
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | | | - S Hasan Naqvi
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Brandi R French
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Farhan Siddiq
- Division of Neurosurgery, University of Missouri, Columbia, MO, USA
| | - Camilo R Gomez
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Medicine, University of Missouri, Columbia, MO, USA
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
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Treacy C, Levenstein JM, Jefferies A, Metse AP, Schaumberg MA, Villani A, Boucas AP, Hermens DF, Lagopoulos J, Andrews SC. The LEISURE Study: A Longitudinal Randomized Controlled Trial Protocol for a Multi-Modal Lifestyle Intervention Study to Reduce Dementia Risk in Healthy Older Adults. J Alzheimers Dis 2023; 94:841-856. [PMID: 37334601 DOI: 10.3233/jad-230193] [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] [Indexed: 06/20/2023]
Abstract
Dementia is understood to arise from a mixed etiology, enveloping chronic inflammatory and vascular impacts on the brain, driven by a constellation of modifiable risk factors which are largely mediated by lifestyle-related behaviors. These risk factors manifest over a prolonged preclinical period and account for up to 40% of the population attributable risk for dementia, representing viable targets for early interventions aimed at abating disease onset and progression. Here we outline the protocol for a 12-week randomized control trial (RCT) of a multimodal Lifestyle Intervention Study for Dementia Risk Reduction (LEISURE), with longitudinal follow-up at 6-months and 24-months post-intervention. This trial integrates exercise, diet, sleep, and mindfulness to simultaneously target multiple different etiopathogenetic mechanisms and their interplay in a healthy older adult population (aged 50-85 years), and assesses dementia risk reduction as the primary endpoint. The LEISURE study is located in the Sunshine Coast region of Australia, which has one of the nation's highest proportions of adults aged over 50 years (36.4%), and corresponding dementia prevalence. This trial is novel in its inclusion of mindfulness and sleep as multidomain lifestyle targets, and in its comprehensive suite of secondary outcomes (based on psychological, physical health, sleep activity, and cognitive data) as well as exploratory neuroimaging (magnetic resonance imaging and electroencephalography) and molecular biology measures. These measures will provide greater insights into the brain-behavioral underpinnings of dementia prevention, as well as the predictors and impacts of the proposed lifestyle intervention. The LEISURE study was prospectively registered (ACTRN12620000054910) on 19 January 2020.
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Affiliation(s)
- Ciara Treacy
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Jacob M Levenstein
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Annelise Jefferies
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Alexandra P Metse
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
- School of Psychological Sciences, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Mia A Schaumberg
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
- Manna Institute, University of the Sunshine Coast, QLD, Australia
| | - Anthony Villani
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Ana P Boucas
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Sophie C Andrews
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
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Godbee K, Guccione L, Palmer VJ, Gunn J, Lautenschlager N, Francis JJ. Dementia Risk Reduction in Primary Care: A Scoping Review of Clinical Guidelines Using a Behavioral Specificity Framework. J Alzheimers Dis 2022; 89:789-802. [DOI: 10.3233/jad-220382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Primary care practitioners are being called upon to work with their patients to reduce dementia risk. However, it is unclear who should do what with whom, when, and under what circumstances. Objective: This scoping review aimed to identify clinical guidelines for dementia risk reduction (DRR) in primary care settings, synthesize the guidelines into actionable behaviors, and appraise the guidelines for specificity. Methods: Terms related to “dementia”, “guidelines”, and “risk reduction” were entered into two academic databases and two web search engines. Guidelines were included if they referred specifically to clinical practices for healthcare professionals for primary prevention of dementia. Included guidelines were analyzed using a directed content analysis method, underpinned by the Action-Actor-Context-Target-Time framework for specifying behavior. Results: Sixteen guidelines were included in the analysis. Together, the guidelines recommended six distinct clusters of actions for DRR. These were to 1) invite patients to discuss DRR, 2) identify patients with risk factors for dementia, 3) discuss DRR, 4) manage dementia risk factors, 5) signpost to additional support, and 6) follow up. Guidelines recommended various actors, contexts, targets, and times for performing these actions. Together, guidelines lacked specificity and were at times contradictory. Conclusion: Currently available guidelines allow various approaches to promoting DRR in primary care. Primary care teams are advised to draw on the results of the review to decide which actions to undertake and the locally appropriate actors, contexts, targets, and times for these actions. Documenting these decisions in more specific, local guidelines for promoting DRR should facilitate implementation.
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Affiliation(s)
- Kali Godbee
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Lisa Guccione
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department on Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Victoria J. Palmer
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- The ALIVE National Centre for Mental Health Research Translation, University of Melbourne, Melbourne, Australia
| | - Jane Gunn
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- The ALIVE National Centre for Mental Health Research Translation, University of Melbourne, Melbourne, Australia
| | - Nicola Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- The ALIVE National Centre for Mental Health Research Translation, University of Melbourne, Melbourne, Australia
| | - Jill J. Francis
- Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Kwan J, Hafdi M, Chiang LLW, Myint PK, Wong LS, Quinn TJ. Antithrombotic therapy to prevent cognitive decline in people with small vessel disease on neuroimaging but without dementia. Cochrane Database Syst Rev 2022; 7:CD012269. [PMID: 35833913 PMCID: PMC9281623 DOI: 10.1002/14651858.cd012269.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cerebral small vessel disease is a progressive disease of the brain's deep perforating blood vessels. It is usually diagnosed based on lesions seen on brain imaging. Cerebral small vessel disease is a common cause of stroke but can also cause a progressive cognitive decline. As antithrombotic therapy is an established treatment for stroke prevention, we sought to determine whether antithrombotic therapy might also be effective in preventing cognitive decline in people with small vessel disease. OBJECTIVES To assess the effects of antithrombotic therapy for prevention of cognitive decline in people with small vessel disease on neuroimaging but without dementia. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Review Group's Specialised Register, and the Cochrane Stroke Group's Specialised Register; the most recent search was on 21 July 2021. We also searched MEDLINE, Embase, four other databases and two trials registries. We searched the reference lists of the articles retrieved from these searches. As trials with a stroke focus may include relevant subgroup data, we complemented these searches with a focussed search of all antithrombotic titles in the Cochrane Stroke Group database. SELECTION CRITERIA: We included randomised controlled trials (RCT) of people with neuroimaging evidence of at least mild cerebral small vessel disease (defined here as white matter hyperintensities, lacunes of presumed vascular origin and subcortical infarcts) but with no evidence of dementia. The trials had to compare antithrombotic therapy of minimum 24 weeks' duration to no antithrombotic therapy (either placebo or treatment as usual), or compare different antithrombotic treatment regimens. Antithrombotic therapy could include antiplatelet agents (as monotherapy or combination therapy), anticoagulants or a combination. DATA COLLECTION AND ANALYSIS Two review authors independently screened all the titles identified by the searches. We assessed full texts for eligibility for inclusion according to our prespecified selection criteria, extracted data to a proforma and assessed risk of bias using the Cochrane tool for RCTs. We evaluated the certainty of evidence using GRADE. Due to heterogeneity across included participants, interventions and outcomes of eligible trials, it was not possible to perform meta-analyses. MAIN RESULTS We included three RCTs (3384 participants). One study investigated the effect of antithrombotic therapy in participants not yet on antithrombotic therapy; two studies investigated the effect of additional antithrombotic therapy, one in a population already taking a single antithrombotic agent and one in a mixed population (participants on an antithrombotic drug and antithrombotic-naive participants). Intervention and follow-up durations varied from 24 weeks to four years. Jia 2016 was a placebo-controlled trial assessing 24 weeks of treatment with DL-3-n-butylphthalide (a compound with multimodal actions, including a putative antiplatelet effect) in 280 Chinese participants with vascular cognitive impairment caused by subcortical ischaemic small vessel disease, but without dementia. There was very low-certainty evidence for a small difference in cognitive test scores favouring treatment with DL-3-n-butylphthalide, as measured by the 12-item Alzheimer's Disease Assessment Scale-Cognitive subscale (adjusted mean difference -1.07, 95% confidence interval (CI) -2.02 to -0.12), but this difference may not be clinically relevant. There was also very low-certainty evidence for greater proportional improvement measured with the Clinician Interview-Based Impression of Change-Plus Caregiver Input (57% with DL-3-n-butylphthalide versus 42% with placebo; P = 0.01), but there was no difference in other measures of cognition (Mini-Mental State Examination and Clinical Dementia Rating) or function. There was no evidence of a difference in adverse events between treatment groups. The SILENCE RCT compared antithrombotic therapy (aspirin) and placebo during four years of treatment in 83 participants with 'silent brain infarcts' who were on no prior antithrombotic therapy. There was very low-certainty evidence for no difference between groups across various measures of cognition and function, rates of stroke or adverse events. The Secondary Prevention of Subcortical Stroke Study (SPS3) compared dual antiplatelet therapy (clopidogrel plus aspirin) to aspirin alone in 3020 participants with recent lacunar stroke. There was low-certainty evidence of no effect on cognitive outcomes as measured by the Cognitive Abilities Screening Instruments (CASI) assessed annually over five years. There was also low-certainty evidence of no difference in the annual incidence of mild cognitive decline between the two treatment groups (9.7% with dual antiplatelet therapy versus 9.9% with aspirin), or the annual stroke recurrence rate (2.5% with dual antiplatelet therapy versus 2.7% with aspirin). Bleeding risk may be higher with dual antiplatelet therapy (hazard ratio (HR) 2.15, 95% CI 1.49 to 3.11; low certainty evidence), but there may be no significant increase in intracerebral bleeding risk (HR 1.52, 95% CI 0.79 to 2.93; low-certainty evidence). None of the included trials assessed the incidence of new dementia. AUTHORS' CONCLUSIONS We found no convincing evidence to suggest any clinically relevant cognitive benefit of using antithrombotic therapy in addition to standard treatment in people with cerebral small vessel disease but without dementia, but there may be an increased bleeding risk with this approach. There was marked heterogeneity across the trials and the certainty of the evidence was generally poor.
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Affiliation(s)
- Joseph Kwan
- Department of Brain Sciences, Imperial College London, London, UK
| | - Melanie Hafdi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lorraine L W Chiang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Phyo K Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Li Siang Wong
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Yassine HN, Samieri C, Livingston G, Glass K, Wagner M, Tangney C, Plassman BL, Ikram MA, Voigt RM, Gu Y, O’Bryant S, Minihane AM, Craft S, Fink HA, Judd S, Andrieu S, Bowman GL, Richard E, Albensi B, Meyers E, Khosravian S, Solis M, Carrillo M, Snyder H, Grodstein F, Scarmeas N, Schneider LS. Nutrition state of science and dementia prevention: recommendations of the Nutrition for Dementia Prevention Working Group. THE LANCET. HEALTHY LONGEVITY 2022; 3:e501-e512. [PMID: 35821792 PMCID: PMC9273104 DOI: 10.1016/s2666-7568(22)00120-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Observational studies suggest that nutritional factors have a potential cognitive benefit. However, systematic reviews of randomised trials of dietary and nutritional supplements have reported largely null effects on cognitive outcomes and have highlighted study inconsistencies and other limitations. In this Personal View, the Nutrition for Dementia Prevention Working Group presents what we consider to be limitations in the existing nutrition clinical trials for dementia prevention. On the basis of this evidence, we propose recommendations for incorporating dietary patterns and the use of genetic, and nutrition assessment tools, biomarkers, and novel clinical trial designs to guide future trial developments. Nutrition-based research has unique challenges that could require testing both more personalised interventions in targeted risk subgroups, identified by nutritional and other biomarkers, and large-scale and pragmatic study designs for more generalisable public health interventions across diverse populations.
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Affiliation(s)
| | | | - Gill Livingston
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Kimberly Glass
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Maude Wagner
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Christy Tangney
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Brenda L Plassman
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - M Arfan Ikram
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Robin M Voigt
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Yian Gu
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Sid O’Bryant
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Anne Marie Minihane
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Suzanne Craft
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Howard A Fink
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Suzanne Judd
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Sandrine Andrieu
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Gene L Bowman
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Edo Richard
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Benedict Albensi
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Emily Meyers
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Serly Khosravian
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Michele Solis
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Maria Carrillo
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | - Heather Snyder
- Department of Medicine (H N Yassine MD) and Department of Neurology (H
N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience
(Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck
School of Medicine and Department of Medicine (S Khosravian BA), University of
Southern California, Los Angeles, CA, USA; Bordeaux population health U1219,
National Institute of Health and Medical Research (INSERM)—University of
Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University
College London, London, UK (G Livingston MD); Camden and Islington NHS
Foundation Trust, London, UK (G Livingston); Channing Division of Network
Medicine, Brigham and Women’s Hospital, Boston MA, USA (K Glass PhD);
Department of Medicine, Harvard Medical School (K Glass) and Department of
Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard
University, Boston MA, USA; Rush Alzheimer’s Disease Center (M Wagner
PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine
(C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M
Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of
Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner)
and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush
University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences,
Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD);
Department of Neurology and Department of Epidemiology, Taub Institute,
Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and
Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA;
University of North Texas Health Science Center, University of North Texas, Fort
Worth, Texas TX, USA (S O’Bryant PhD); Norwich Medical School (A M
Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University
of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake
Forest University School of Medicine, Wake Forest University, Wake Forest, NC,
USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis
VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics
School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA
(S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in
Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical
Epidemiology and Public Health, University of Toulouse Hospital, University of
Toulouse III—Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton
Aging and Alzheimer’s Disease Research Center, Department of Neurology,
Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH);
Helfgott Research Institute, National University of Natural Medicine, Portland
OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain,
Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
(E Richard MD PhD); Department of Public and Occupational Health, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E
Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova
Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital
Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and
Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi);
Alzheimer’s Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M
Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
(N Scarmeas)
| | | | | | | |
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Shawaqfeh B, Hughes CM, McGuinness B, Barry HE. A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5722. [PMID: 35524704 PMCID: PMC9320938 DOI: 10.1002/gps.5722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This systematic review aimed to assess the types and effectiveness of interventions that sought to reduce anticholinergic burden (ACB) in people with dementia (PwD) in primary care. METHODS One trial registry and eight electronic databases were systematically searched to identify eligible English language studies from inception until December 2021. To be eligible for inclusion, studies had to be randomised controlled trials (RCTs) or non-randomised studies (NRS), including controlled before-and-after studies and interrupted time-series studies, of interventions to reduce ACB in PwD aged ≥65 years (either community-dwelling or care home residents). All outcomes were to be considered. Quality was to be assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I tool for NRS. If data could not be pooled for meta-analysis, a narrative synthesis was to be conducted. RESULTS In total, 1880 records were found, with 1594 records remaining after removal of duplicates. Following title/abstract screening, 13 full-text articles were assessed for eligibility. None of these studies met the inclusion criteria for this review. Reasons for exclusion were incorrect study design, ineligible study population, lack of focus on reducing ACB, and studies conducted outside the primary care setting. CONCLUSIONS This 'empty' systematic review highlights the lack of interventions to reduce ACB in PwD within primary care, despite this being highlighted as a priority area for research in recent clinical guidance. Future research should focus on development and testing of interventions to reduce ACB in this patient population through high-quality clinical trials.
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Cheng YH, Wu CH, Wang WT, Lu YY, Wu MK. Trigeminal Neuralgia Is a Dementia Risk Factor: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106073. [PMID: 35627610 PMCID: PMC9142042 DOI: 10.3390/ijerph19106073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Background: Dementia, a worldwide public-health issue, is regarded as a disorder rather than a normal aging process. Trigeminal neuralgia (TN) is a chronic debilitating pain disorder that impairs daily activities. Both are most prevalent in females and in patients older than 50 years. Recent studies reveal that pain and dementia may have a reciprocal interaction with each other. Objective: In response, we estimated whether adults with TN have an increased dementia risk. Methodology: By means of Taiwan's National Health Insurance Research Database, between 1996 and 2010, 762 patients aged over 50 years in the TN group were matched with 3048 patients in the non-TN group at a ratio of 1:4. Kaplan-Meier method and Cox proportional hazard regression models were also used to determine the cumulative incidence and compare the hazard ratios of dementia in each group. Results: The incidence of dementia was higher in the TN group compared to the non-TN group. After adjusting for covariates, the TN group had a 4.47-fold higher risk of dementia compared to the non-TN group. Additionally, the impact of TN on dementia risk was larger in young-aged patients than in old-aged patients. As well, the age at the time of dementia diagnosis was younger in the TN group compared to the non-TN group. Conclusions: TN is a dementia risk factor. Given the lack of a curative therapy for dementia, early identification of TN patients may help to prevent dementia sequelae.
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Affiliation(s)
- Yung-Han Cheng
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chieh-Hsin Wu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wei-Ting Wang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Department of Health and Beauty, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
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13
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Ibarrondo O, Huerta JM, Amiano P, Andreu-Reinón ME, Mokoroa O, Ardanaz E, Larumbe R, Colorado-Yohar SM, Navarro-Mateu F, Chirlaque MD, Mar J. Dementia Risk Score for a Population in Southern Europe Calculated Using Competing Risk Models. J Alzheimers Dis 2022; 86:1751-1762. [PMID: 35253747 PMCID: PMC9108562 DOI: 10.3233/jad-215211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dementia prevention can be addressed if the intervention is applied early. Objective: The objective of this study was to develop and validate competing risk models to predict the late risk of dementia based on variables assessed in middle age in a southern European population. Methods: We conducted a prospective observational study of the EPIC-Spain cohort that included 25,015 participants. Dementia cases were identified from electronic health records and validated by neurologists. Data were gathered on sociodemographic characteristics and cardiovascular risk factors. To stratify dementia risk, Fine and Gray competing risk prediction models were constructed for the entire sample and for over-55-year-olds. Risk scores were calculated for low (the 30% of the sample with the lowest risk), moderate (> 30% –60%), and high (> 60% –100%) risk. Results: The 755 cases of dementia identified represented a cumulative incidence of 3.1% throughout the study period. The AUC of the model for over-55-year-olds was much higher (80.8%) than the overall AUC (68.5%) in the first 15 years of follow-up and remained that way in the subsequent follow-up. The weight of the competing risk of death was greater than that of dementia and especially when the entire population was included. Conclusion: This study presents the first dementia risk score calculated in a southern European population in mid-life and followed up for 20 years. The score makes it feasible to achieve the early identification of individuals in a southern European population who could be targeted for the prevention of dementia based on the intensive control of risk factors.
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Affiliation(s)
- Oliver Ibarrondo
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
| | - José María Huerta
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Department of Epidemiology. Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pilar Amiano
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, SanSebastián, Spain
| | - María Encarnación Andreu-Reinón
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Section of Neurology, Department of Internal Medicine, Rafael Méndez Hospital, Murcian Health Service, Lorca, Spain
| | - Olatz Mokoroa
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, SanSebastián, Spain
| | - Eva Ardanaz
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain
- Neuroepigenetics Laboratory, Navarrabiomed, Public University of Navarre (UPNA), Navarre, Spain
| | - Rosa Larumbe
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain
- Neuroepigenetics Laboratory, Navarrabiomed, Public University of Navarre (UPNA), Navarre, Spain
- Department of Neurology, Complejo Hospitalario deNavarra, Pamplona, Spain
| | - Sandra M. Colorado-Yohar
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Department of Epidemiology. Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Fernando Navarro-Mateu
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unidad deDocencia, Investigación y Formación en Salud Mental(UDIF-SM), Murcian Health Service, IMIB-Arrixaca, Murcia, Spain
| | - María Dolores Chirlaque
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Department of Epidemiology. Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Javier Mar
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
- Kronikgune Health Services Research Institute, Barakaldo, Spain
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van Dalen JW, Brayne C, Crane PK, Fratiglioni L, Larson EB, Lobo A, Lobo E, Marcum ZA, Moll van Charante EP, Qiu C, Riedel-Heller SG, Röhr S, Rydén L, Skoog I, van Gool WA, Richard E. Association of Systolic Blood Pressure With Dementia Risk and the Role of Age, U-Shaped Associations, and Mortality. JAMA Intern Med 2022; 182:142-152. [PMID: 34901993 PMCID: PMC8669604 DOI: 10.1001/jamainternmed.2021.7009] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE The optimal systolic blood pressure (SBP) to minimize the risk of dementia in older age is unknown. OBJECTIVE To investigate whether the association between SBP and dementia risk is U-shaped and whether age and comorbidity play a role in this association. DESIGN, SETTING, AND PARTICIPANTS This cohort study used an individual participant data approach to analyze 7 prospective, observational, population-based cohort studies that were designed to evaluate incident dementia in older adults. These studies started between 1987 and 2006 in Europe and the US. Participants had no dementia diagnosis and had SBP and/or diastolic blood pressure (BP) data at baseline and incident dementia status during follow-up. Data analysis was conducted from November 7, 2019, to October 3, 2021. EXPOSURES Baseline systolic BP. MAIN OUTCOMES AND MEASURES All-cause dementia (defined using Diagnostic and Statistical Manual of Mental Disorders [Third Edition Revised] or Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] and established at follow-up measurements or in clinical practice), mortality, and combined dementia and mortality were the outcomes. Covariates included baseline antihypertensive medication use, sex, educational level, body mass index, smoking status, diabetes, stroke history, myocardial infarction history, and polypharmacy. Cox proportional hazards regression models were used, and nonlinear associations were explored using natural splines. RESULTS The study analyzed 7 cohort studies with a total of 17 286 participants, among whom 10 393 were women (60.1%) and the mean (SD) baseline age was 74.5 (7.3) years. Overall, dementia risk was lower for individuals with higher SBP, with the lowest risk associated with an SBP of approximately 185 mm Hg (95% CI, 161-230 mm Hg; P = .001). Stratified by overlapping 10-year baseline age groups, the lowest dementia risk was observed at somewhat lower systolic BP levels in those older than 75 years (158 [95% CI, 152-178] mm Hg to 170 [95% CI, 160-260] mm Hg). For mortality, there was a clear U-shaped association, with the lowest risk at 160 mm Hg (95% CI, 154-181 mm Hg; P < .001). This U-shape occurred across all age groups, with the lowest dementia risk associated with an SBP of 134 mm Hg (95% CI, 102-149 mm Hg; P = .03) in those aged 60 to 70 years and increasing to between 155 mm Hg (95% CI, 150-166 mm Hg; P < .001) and 166 mm Hg (95% CI, 154-260 mm Hg; P = .02) for age groups between 70 and 95 years. Combined dementia and mortality risk curves closely resembled those for mortality. Associations of diastolic BP with dementia risk were generally similar but were less distinct. CONCLUSIONS AND RELEVANCE This cohort study found that dementia risk was lower for older individuals with higher SBP levels and that more distinctly U-shaped associations appeared for those older than 75 years, but these associations cannot be explained by SBP-associated changes in mortality risk. The findings may warrant future trials on tailored BP management in older age groups that take life expectancy and health context into consideration.
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Affiliation(s)
- Jan Willem van Dalen
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Paul K. Crane
- University of Washington, School of Medicine, Seattle
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Antonio Lobo
- Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Lobo
- Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Eric P. Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Lina Rydén
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
| | - Willem A. van Gool
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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15
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Hafdi M, Hoevenaar-Blom MP, Richard E. Multi-domain interventions for the prevention of dementia and cognitive decline. Cochrane Database Syst Rev 2021; 11:CD013572. [PMID: 34748207 PMCID: PMC8574768 DOI: 10.1002/14651858.cd013572.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dementia is a worldwide concern. Its global prevalence is increasing. Currently, no effective medical treatment exists to cure or to delay the onset of cognitive decline or dementia. Up to 40% of dementia is attributable to potentially modifiable risk factors, which has led to the notion that targeting these risk factors might reduce the incidence of cognitive decline and dementia. Since sporadic dementia is a multifactorial condition, thought to derive from multiple causes and risk factors, multi-domain interventions may be more effective for the prevention of dementia than those targeting single risk factors. OBJECTIVES To assess the effects of multi-domain interventions for the prevention of cognitive decline and dementia in older adults, including both unselected populations and populations at increased risk of cognitive decline and dementia. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), and ClinicalTrials.gov on 28 April 2021. We also reviewed citations of reference lists of included studies, landmark papers, and review papers to identify additional studies and assessed their suitability for inclusion in the review. SELECTION CRITERIA We defined a multi-domain intervention as an intervention with more than one component, pharmacological or non-pharmacological, but not consisting only of two or more drugs with the same therapeutic target. We included randomised controlled trials (RCTs) evaluating the effect of such an intervention on cognitive functioning and/or incident dementia. We accepted as control conditions any sham intervention or usual care, but not single-domain interventions intended to reduce dementia risk. We required studies to have a minimum of 400 participants and an intervention and follow-up duration of at least 12 months. DATA COLLECTION AND ANALYSIS We initially screened search results using a 'crowdsourcing' method in which members of Cochrane's citizen science platform identify RCTs. We screened the identified citations against inclusion criteria by two review authors working independently. At least two review authors also independently extracted data, assessed the risk of bias and applied the GRADE approach to assess the certainty of evidence. We defined high-certainty reviews as trials with a low risk of bias across all domains other than blinding of participants and personnel involved in administering the intervention (because lifestyle interventions are difficult to blind). Critical outcomes were incident dementia, incident mild cognitive impairment (MCI), cognitive decline measured with any validated measure, and mortality. Important outcomes included adverse events (e.g. cardiovascular events), quality of life, and activities of daily living (ADL). Where appropriate, we synthesised data in random-effects meta-analyses. We expressed treatment effects as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). MAIN RESULTS We included nine RCTs (18.452 participants) in this review. Two studies reported incident dementia as an outcome; all nine studies reported a measure for cognitive functioning. Assessment of cognitive functioning was very heterogeneous across studies, ranging from complete neuropsychological assessments to short screening tests such as the mini-mental state examination (MMSE). The duration of the interventions varied from 12 months to 10 years. We compared multi-domain interventions against usual care or a sham intervention. Positive MDs and RRs <1 favour multi-domain interventions over control interventions. For incident dementia, there was no evidence of a difference between the multi-domain intervention group and the control group (RR 0.94, 95% CI 0.76 to 1.18; 2 studies; 7256 participants; high-certainty evidence). There was a small difference in composite Z-score for cognitive function measured with a neuropsychological test battery (NTB) (MD 0.03, 95% CI 0.01 to 0.06; 3 studies; 4617 participants; high-certainty evidence) and with the Montreal Cognitive Assessment (MoCA) scale (MD 0.76 point, 95% CI 0.05 to 1.46; 2 studies; 1554 participants), but the certainty of evidence for the MoCA was very low (due to serious risk of bias, inconsistency and indirectness) and there was no evidence of an effect on the MMSE (MD 0.02 point, 95% CI -0.06 to 0.09; 6 studies; 8697participants; moderate-certainty evidence). There was no evidence of an effect on mortality (RR 0.93, 95% CI 0.84 to 1.04; 4 studies; 11,487 participants; high-certainty evidence). There was high-certainty evidence for an interaction of the multi-domain intervention with ApoE4 status on the outcome of cognitive function measured with an NTB (carriers MD 0.14, 95% CI 0.04 to 0.25, noncarriers MD 0.04, 95% CI -0.02 to 0.10, P for interaction 0.09). There was no clear evidence for an interaction with baseline cognitive status (defined by MMSE-score) on cognitive function measured with an NTB (low baseline MMSE group MD 0.06, 95% CI 0.01 to 0.11, high baseline MMSE group MD 0.01, 95% CI -0.01 to 0.04, P for interaction 0.12), nor was there clear evidence for an effect in participants with a Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score > 6 points (MD 0.07, 95%CI -0.00 to 0.15). AUTHORS' CONCLUSIONS We found no evidence that multi-domain interventions can prevent incident dementia based on two trials. There was a small improvement in cognitive function assessed by a NTB in the group of participants receiving a multi-domain intervention, although this effect was strongest in trials offering cognitive training within the multi-domain intervention, making it difficult to rule out a potential learning effect. Interventions were diverse in terms of their components and intensity.
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Affiliation(s)
- Melanie Hafdi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke P Hoevenaar-Blom
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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16
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Eggink E, Hafdi M, Hoevenaar-Blom MP, Song M, Andrieu S, Barnes LE, Birck C, Brooks RL, Coley N, Ford E, Georges J, van der Groep A, van Gool WA, Handels R, Hou H, Li D, Liu H, Lyu J, van Marwijk H, van der Meijden M, Niu Y, Sadhwani S, Wang W, Wang Y, Wimo A, Ye X, Yu Y, Zeng Q, Zhang W, Wang W, Brayne C, Moll van Charante EP, Richard E. Prevention of dementia using mobile phone applications (PRODEMOS): protocol for an international randomised controlled trial. BMJ Open 2021; 11:e049762. [PMID: 34108173 PMCID: PMC8191602 DOI: 10.1136/bmjopen-2021-049762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/14/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Profiles of high risk for future dementia are well understood and are likely to concern mostly those in low-income and middle-income countries and people at greater disadvantage in high-income countries. Approximately 30%-40% of dementia cases have been estimated to be attributed to modifiable risk factors, including hypertension, smoking and sedentary lifestyle. Tailored interventions targeting these risk factors can potentially prevent or delay the onset of dementia. Mobile health (mHealth) improves accessibility of such prevention strategies in hard-to-reach populations while at the same time tailoring such approaches. In the current study, we will investigate the effectiveness and implementation of a coach-supported mHealth intervention, targeting dementia risk factors, to reduce dementia risk. METHODS AND ANALYSIS The prevention of dementia using mobile phone applications (PRODEMOS) randomised controlled trial will follow an effectiveness-implementation hybrid design, taking place in the UK and China. People are eligible if they are 55-75 years old, of low socioeconomic status (UK) or from the general population (China); have ≥2 dementia risk factors; and own a smartphone. 2400 participants will be randomised to either a coach-supported, interactive mHealth platform, facilitating self-management of dementia risk factors, or a static control platform. The intervention and follow-up period will be 18 months. The primary effectiveness outcome is change in the previously validated Cardiovascular Risk Factors, Ageing and Incidence of Dementia dementia risk score. The main secondary outcomes include improvement of individual risk factors and cost-effectiveness. Implementation outcomes include acceptability, adoption, feasibility and sustainability of the intervention. ETHICS AND DISSEMINATION The PRODEMOS trial is sponsored in the UK by the University of Cambridge and is granted ethical approval by the London-Brighton and Sussex Research Ethics Committee (reference: 20/LO/01440). In China, the trial is approved by the medical ethics committees of Capital Medical University, Beijing Tiantan Hospital, Beijing Geriatric Hospital, Chinese People's Liberation Army General Hospital, Taishan Medical University and Xuanwu Hospital. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN15986016.
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Affiliation(s)
- Esmé Eggink
- Department of General Practice, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Melanie Hafdi
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
| | - Sandrine Andrieu
- INSERM-University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Linda E Barnes
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | | | - Nicola Coley
- INSERM-University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Willem A van Gool
- Department of Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ron Handels
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Haifeng Hou
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, China
| | - Dong Li
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, China
| | - Hongmei Liu
- Beijing Neurosurgical Institute, Beijing, China
| | - Jihui Lyu
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | - Yixuan Niu
- Department of Geriatrics, The Second Medical Centre and National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Shanu Sadhwani
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Wenzhi Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyan Ye
- Fuzhou Comvee Network & Technology Co., Ltd, Fuzhou, China
| | - Yueyi Yu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiang Zeng
- Health Management Institute, The Second Medical Centre and National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Trambaiolli LR, Cassani R, Mehler DMA, Falk TH. Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:682683. [PMID: 34177558 PMCID: PMC8221422 DOI: 10.3389/fnagi.2021.682683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Dementia describes a set of symptoms that occur in neurodegenerative disorders and that is characterized by gradual loss of cognitive and behavioral functions. Recently, non-invasive neurofeedback training has been explored as a potential complementary treatment for patients suffering from dementia or mild cognitive impairment. Here we systematically reviewed studies that explored neurofeedback training protocols based on electroencephalography or functional magnetic resonance imaging for these groups of patients. From a total of 1,912 screened studies, 10 were included in our final sample (N = 208 independent participants in experimental and N = 81 in the control groups completing the primary endpoint). We compared the clinical efficacy across studies, and evaluated their experimental designs and reporting quality. In most studies, patients showed improved scores in different cognitive tests. However, data from randomized controlled trials remains scarce, and clinical evidence based on standardized metrics is still inconclusive. In light of recent meta-research developments in the neurofeedback field and beyond, quality and reporting practices of individual studies are reviewed. We conclude with recommendations on best practices for future studies that investigate the effects of neurofeedback training in dementia and cognitive impairment.
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Affiliation(s)
- Lucas R Trambaiolli
- Basic Neuroscience Division, McLean Hospital - Harvard Medical School, Boston, MA, United States
| | - Raymundo Cassani
- Institut National de la Recherche Scientifique - Energy, Materials, and Telecommunications Centre (INRS-EMT), University of Québec, Montréal, QC, Canada
| | - David M A Mehler
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tiago H Falk
- Institut National de la Recherche Scientifique - Energy, Materials, and Telecommunications Centre (INRS-EMT), University of Québec, Montréal, QC, Canada
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Palta P, Sharrett AR, Gabriel KP, Gottesman RF, Folsom AR, Power MC, Evenson KR, Jack CR, Knopman DS, Mosley TH, Heiss G. Prospective Analysis of Leisure-Time Physical Activity in Midlife and Beyond and Brain Damage on MRI in Older Adults. Neurology 2021; 96:e964-e974. [PMID: 33408144 PMCID: PMC8055339 DOI: 10.1212/wnl.0000000000011375] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that greater levels of leisure-time moderate to vigorous intensity physical activity (MVPA) in midlife or late life are associated with larger gray matter volumes, less white matter disease, and fewer cerebrovascular lesions measured in late life, we utilized data from 1,604 participants enrolled in the Atherosclerosis Risk in Communities study. METHODS Leisure-time MVPA was quantified using a past-year recall, interviewer-administered questionnaire at baseline and 25 years later and classified as none, low, middle, and high at each time point. The presence of cerebrovascular lesions, white matter hyperintensities (WMH), white matter integrity (mean fractional anisotropy [FA] and mean diffusivity [MD]), and gray matter volumes were quantified with 3T MRI in late life. The odds of cerebrovascular lesions were estimated with logistic regression. Linear regression estimated the mean differences in WMH, mean FA and MD, and gray matter volumes. RESULTS Among 1,604 participants (mean age 53 years, 61% female, 27% Black), 550 (34%), 176 (11%), 250 (16%), and 628 (39%) reported no, low, middle, and high MVPA in midlife, respectively. Compared to no MVPA in midlife, high MVPA was associated with more intact white matter integrity in late life (mean FA difference 0.13 per SD [95% confidence interval (CI) 0.004, 0.26]; mean MD difference -0.11 per SD [95% CI -0.21, -0.004]). High MVPA in midlife was also associated with a lower odds of lacunar infarcts (odds ratio 0.68, 95% CI 0.46, 0.99). High MVPA was not associated with gray matter volumes. High MVPA compared to no MVPA in late life was associated with most brain measures. CONCLUSION Greater levels of physical activity in midlife may protect against cerebrovascular sequelae in late life.
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Affiliation(s)
- Priya Palta
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson.
| | - A Richey Sharrett
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Kelley Pettee Gabriel
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Rebecca F Gottesman
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Aaron R Folsom
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Melinda C Power
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Kelly R Evenson
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Clifford R Jack
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - David S Knopman
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Thomas H Mosley
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Gerardo Heiss
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
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van Dalen JW, Marcum ZA, Gray SL, Barthold D, Moll van Charante EP, van Gool WA, Crane PK, Larson EB, Richard E. Association of Angiotensin II-Stimulating Antihypertensive Use and Dementia Risk: Post Hoc Analysis of the PreDIVA Trial. Neurology 2020; 96:e67-e80. [PMID: 33154085 PMCID: PMC7884979 DOI: 10.1212/wnl.0000000000010996] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess whether angiotensin II-stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin I receptor blockers) convey a lower risk of incident dementia compared to angiotensin II-inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, β-blockers, and nondihydropyridine calcium channel blockers), in accordance with the "angiotensin hypothesis." METHODS We performed Cox regression analyses of incident dementia (or mortality as competing risk) during 6-8 years of follow-up in a population sample of 1,909 community-dwelling individuals (54% women) without dementia, aged 70-78 (mean 74.5 ± 2.5) years. RESULTS After a median of 6.7 years of follow-up, dementia status was available for 1,870 (98%) and mortality for 1,904 (>99%) participants. Dementia incidence was 5.6% (27/480) in angiotensin II-stimulating, 8.2% (59/721) in angiotensin II-inhibiting, and 6.9% (46/669) in both antihypertensive type users. Adjusted for dementia risk factors including blood pressure and medical history, angiotensin II-stimulating antihypertensive users had a 45% lower incident dementia rate (hazard ratio [HR], 0.55; 95% CI, 0.34-0.89) without excess mortality (HR, 0.86; 95% CI, 0.64-1.16), and individuals using both types had a nonsignificant 20% lower dementia rate (HR, 0.80; 95% CI,0.53-1.20) without excess mortality (HR, 0.97; 95% CI, 0.76-1.24), compared to angiotensin II-inhibiting antihypertensive users. Results were consistent for subgroups based on diabetes and stroke history, but may be specific for individuals without a history of cardiovascular disease. CONCLUSIONS Users of angiotensin II-stimulating antihypertensives had lower dementia rates compared to angiotensin II-inhibiting antihypertensive users, supporting the angiotensin hypothesis. Confounding by indication must be examined further, although subanalyses suggest this did not influence results. If replicated, dementia prevention could become a compelling indication for older individuals receiving antihypertensive treatment.
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Affiliation(s)
- Jan Willem van Dalen
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle.
| | - Zachary A Marcum
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Shelly L Gray
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Douglas Barthold
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Eric P Moll van Charante
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Willem A van Gool
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Paul K Crane
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Eric B Larson
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
| | - Edo Richard
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.) and General Practice (E.P.M.v.C.), Amsterdam UMC, University of Amsterdam; Department of Neurology (J.W.v.D., E.R.), Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, the Netherlands; Schools of Pharmacy (Z.A.M., S.L.G., D.B.) and Medicine (P.K.C.), University of Washington; and Kaiser Permanente Washington Health Research Institute (E.B.L.), Seattle
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Affiliation(s)
- Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, UK
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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van Eersel MEA, Joosten H, Gansevoort RT, Slaets JPJ, Izaks GJ. Treatable Vascular Risk and Cognitive Performance in Persons Aged 35 Years or Older: Longitudinal Study of Six Years. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2020; 6:42-49. [PMID: 30569085 PMCID: PMC6515561 DOI: 10.14283/jpad.2018.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Poor cognitive performance is associated with high vascular risk. However,
this association is only investigated in elderly. As neuropathological changes
precede clinical symptoms of cognitive impairment by several decades, it is likely
that cognitive performance is already associated with vascular risk at
middle-age. Objectives To investigate the association of cognitive performance with treatable
vascular risk in middle-aged and old persons. Design Longitudinal study with three measurements during follow-up period of 5.5
years. Setting City of Groningen, the Netherlands. Participants Cohort of 3,572 participants (age range, 35–82 years; mean age, 54 years; men,
52%). Exposure Treatable vascular risk as defined by treatable components of the Framingham
Risk Score for Cardiovascular Disease at the first measurement (diabetes mellitus,
smoking, hypercholesterolemia and hypertension). Measurements Change in cognitive performance during follow-up. Cognitive performance was
measured with Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT),
and calculated as the average of the standardized RFFT and VAT score per
participant. Results The mean (SD) cognitive performance changed from 0.00 (0.79) at the first
measurement to 0.15 (0.83) at second measurement and to 0.39 (0.82) at the third
measurement (Ptrend<0.001). This change was negatively associated with
treatable vascular risk: the change in cognitive performance between two
measurements decreased with 0.004 per one-point increment of treatable vascular
risk (95%CI, -0.008 to 0.000; P=0.05) and with 0.006 per one-year increment of age
(95%CI, -0.008 to -0.004; P<0.001). Conclusions Change in cognitive performance was associated with treatable vascular risk in
persons aged 35 years or older. Electronic Supplementary Material Supplementary material is available for this article at 10.14283/jpad.2018.47 and is accessible for authorized users.
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Affiliation(s)
- M E A van Eersel
- Marlise E.A. van Eersel (MEAE), University Center for Geriatric Medicine, University Medical Center Groningen, Internal Postcode: AA41, PO Box 30.001, 9700 RB Groningen, The Netherlands, Phone: 0031(0)50 361 39 21, Fax: 0031(0)50 361 90 69,
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van Eersel MEA, Visser ST, Joosten H, Gansevoort RT, Slaets JPJ, Izaks GJ. Pharmacological treatment of increased vascular risk and cognitive performance in middle-aged and old persons: six-year observational longitudinal study. BMC Neurol 2020; 20:242. [PMID: 32532237 PMCID: PMC7291556 DOI: 10.1186/s12883-020-01822-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Lowering vascular risk is associated with a decrease in the prevalence of cardiovascular disease and dementia. However, it is still unknown whether lowering of vascular risk with pharmacological treatment preserves cognitive performance in general. Therefore, we compared the change in cognitive performance in persons with and without treatment of vascular risk factors. Methods In this longitudinal observational study, 256 persons (mean age, 58 years) were treated for increased vascular risk during a mean follow-up period of 5.5 years (treatment group), whereas 1678 persons (mean age, 50 years) did not receive treatment (control group). Cognitive performance was three times measured during follow-up using the Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT), and calculated as the average of standardized RFFT and VAT score per participant. Because treatment allocation was nonrandomized, additional analyses were performed in demographic and vascular risk-matched samples and adjusted for propensity scores. Results In the treatment group, mean (SD) cognitive performance changed from − 0.30 (0.80) to − 0.23 (0.80) to 0.02 (0.87), and in control group, from 0.08 (0.77) to 0.24 (0.79) to 0.49 (0.74) at the first, second and third measurement, respectively (ptrend < 0.001). After adjustment for demographics and vascular risk, the change in cognitive performance during follow-up was not statistically significantly different between the treatment and control group: mean estimated difference, − 0.10 (95%CI − 0.21 to 0.01; p = 0.08). Similar results were found in matched samples and after adjustment for propensity score. Conclusion Change in cognitive performance during follow-up was similar in treated and untreated persons. This suggests that lowering vascular risk preserves cognitive performance.
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Affiliation(s)
- Marlise E A van Eersel
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, AA41, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
| | - Sipke T Visser
- Department of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics (PTE2), University of Groningen, Groningen, the Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris P J Slaets
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, AA41, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - Gerbrand J Izaks
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, AA41, PO Box 30.001, 9700, RB, Groningen, The Netherlands
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Welberry HJ, Brodaty H, Hsu B, Barbieri S, Jorm LR. Measuring dementia incidence within a cohort of 267,153 older Australians using routinely collected linked administrative data. Sci Rep 2020; 10:8781. [PMID: 32472058 PMCID: PMC7260191 DOI: 10.1038/s41598-020-65273-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/28/2020] [Indexed: 12/29/2022] Open
Abstract
To estimate dementia incidence rates using Australian administrative datasets and compare the characteristics of people identified with dementia across different datasets. This data linkage study used a cohort of 267,153 from the Australian 45 and Up Study. Participants completed a survey in 2006-2009 and subsequent dementia was identified through pharmaceutical claims, hospitalisations, aged care eligibility assessments, care needs at residential aged care entry and death certificates. Age-specific, and age-standardised incidence rates, incidence rate ratios and survival from first dementia diagnosis were estimated. Estimated age-standardised dementia incidence rates using all linked datasets was 16.8 cases per 1000 person years for people aged 65+. Comparing incidence rates to the global published rates suggested 77% of cases were identified but this varied by age with highest coverage among those aged 80-84 years (92%). Incidence rate ratios were inconsistent across datasets for: sex, socio-economic disadvantage, size of support network, marital status, functional limitations and diabetes. Median survival from first dementia diagnosis ranged from 1.80 years in the care needs dataset to 3.74 years in the pharmaceutical claims dataset. Characteristics of people identified with dementia in different administrative datasets reflect the factors that drive interaction with specific services; this may introduce bias in observational studies using a single data-source to identify dementia.
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Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Hafdi M, Hoevenaar‐Blom MP, Richard E. Multi‐domain interventions for the prevention of dementia and cognitive decline. Cochrane Database Syst Rev 2020; 2020:CD013572. [PMCID: PMC7114912 DOI: 10.1002/14651858.cd013572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of multi‐domain interventions for the prevention of cognitive decline and dementia (a) in unselected populations and (b) in populations with or without cognitive impairment who are at increased risk of cognitive decline and dementia.
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Affiliation(s)
- Melanie Hafdi
- Amsterdam UMC, University of AmsterdamDepartment of NeurologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Marieke P. Hoevenaar‐Blom
- Amsterdam UMC, University of AmsterdamDepartment of NeurologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Edo Richard
- Amsterdam UMC, University of AmsterdamDepartment of NeurologyMeibergdreef 9AmsterdamNetherlands1105 AZ
- Radboud University Nijmegen Medical CenterDepartment of Neurology, Donders Institute for Brain, Behaviour and CognitionNijmegenNetherlands
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25
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Custodio N, Herrera-Pérez E, Montesinos R, Lira D, Metcalf T. Brief cognitive tests validated in Peru for detection of cognitive impairment A systematic mapping of the scientific literature. Dement Neuropsychol 2020; 14:134-144. [PMID: 32595882 PMCID: PMC7304273 DOI: 10.1590/1980-57642020dn14-020006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/31/2020] [Indexed: 12/25/2022] Open
Abstract
Brief cognitive tests (BCTs) are necessary for early detection of cognitive impairment, particularly in primary care settings. OBJECTIVE This report describes a systematic review of BCTs evaluated in Peruvian populations. METHODS We used systematic mapping techniques to identify articles on screening tests for cognitive impairment involving Peruvian subjects. We included studies published in English and Spanish up to 2018. We reviewed 6 reference databases within the Virtual Health Library network, as well as the Web of Science, Scopus (MEDLINE), and EMBASE databases. RESULTS Ten out of 447 articles met the inclusion criteria. Studies included both outpatient (9) and community-based (2) samples. Eligibility criteria of the studies were similar. Although different protocols were applied, the diagnostic criteria were standardized. For discrimination between dementia and controls, IFS (AUC: 0.99) and ACE (AUC: 0.95 to 1.00) showed superior performance, as did the M@T (AUC: 1.00) and CDT-Mv (AUC: 0.94 to 1.00) for discriminating between Alzheimer's disease (AD) and controls. CONCLUSION The available evidence is limited. However, our analysis of national data suggests that the ACE may be a good choice whenever it can be applied to Peruvian patients. Alternatively, the M@T and IFS can be used for screening patients with suspected AD or FTD, respectively.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela de Postgrado, Universidad Católica San Pablo, Arequipa, Perú
| | - Eder Herrera-Pérez
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Rosa Montesinos
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela de Postgrado, Universidad Católica San Pablo, Arequipa, Perú
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias. Lima, Perú
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela de Postgrado, Universidad Católica San Pablo, Arequipa, Perú
| | - Tatiana Metcalf
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
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Liu T, Luo H, Tang JY, Wong GH. Does lifestyle matter? Individual lifestyle factors and their additive effects associated with cognitive function in older men and women. Aging Ment Health 2020; 24:405-412. [PMID: 30520690 DOI: 10.1080/13607863.2018.1539833] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives: This study investigated the association between healthy lifestyle comprised of multiple domains, gender, and cognitive function in older Chinese people in Hong Kong.Methods: We conducted a cross-sectional analysis with data from 1,831 community-dwellers aged 65 years and above. Participants' basic demographics, comorbidity, and six lifestyle factors: diet; smoking; alcohol drinking; and physical, mental, and social activities were surveyed. Cognitive function was assessed using the Cantonese Chinese Montreal Cognitive Assessment (CC-MoCA). Linear regressions were performed to examine the associations between lifestyle, gender, and cognitive performance.Results: There were gender differences in lifestyle: men smoked (χ2(1) = 159.4) and drank more (χ2(1) = 85.9) and were more active in mentally stimulating activities (χ2(1) = 14.3, all p<.001); while women were more socially active (χ2(1) = 28.0). Age, gender and education explained the greatest variance in cognition (R2=.32). Being active/healthy in more domains further contributed to better cognitive function, although the effect was small (ΔR2=0.03 in women; ΔR2=0.01 in men, both p<.05). Among the lifestyle domains, physical activity showed the strongest effects on cognitive function (ΔR2=0.004 in men and ΔR2=0.02 in women, both p<.05).Conclusions: Naturalistically, a physically active lifestyle and being active/healthy in more domains is associated with better cognitive function in older people after controlling for non-modifiable and early-life factors. The effects are however small. There are gender differences in lifestyle and the impact of lifestyle on cognitive function. Preventive strategies targeting lifestyle domains for cognitive health in older people may consider these naturalistic associations.
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Affiliation(s)
- Tianyin Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | | | - Gloria Hy Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.,Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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Palta P, Heiss G, Sharrett AR, Gabriel KP, Walker K, Evenson KR, Knopman D, Mosley TH, Wong DF, Gottesman RF. Mid- and Late-Life Leisure-Time Physical Activity and Global Brain Amyloid Burden: The Atherosclerosis Risk in Communities (ARIC)-PET Study. J Alzheimers Dis 2020; 76:139-147. [PMID: 32444546 PMCID: PMC8011955 DOI: 10.3233/jad-200152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Physical activity (PA) may slow the development of dementia by reducing the accumulation of amyloid. OBJECTIVE We tested the hypothesis that higher levels of leisure-time PA in mid- or late-life were associated with lower brain amyloid burden in late-life among 326 non-demented participants from the Atherosclerosis Risk in Communities Study of brain florbetapir positron emission tomography (ARIC-PET) ancillary. METHODS Self-reported PA was quantified using a past-year recall, interviewer-administered questionnaire in mid-life (1987-1989, aged 45-64 years) and late-life (2011-2013, aged 67-89 years). Continuous PA estimates were classified as 1) any leisure-time PA participation (yes/no); 2) meeting the 2018 United States' PA guidelines (yes/no); and 3) per 1 standard deviation (SD) higher metabolic equivalent of task (MET) minutes per week (MET·min·wk-1). A brain magnetic resonance imaging scan with Florbetapir PET was performed in late-life. Adjusted odds ratios (OR) of elevated amyloid burden, defined as a global cortical standardized uptake value ratio (>1.2), compared to no elevated amyloid burden were estimated according to PA measures. RESULTS Among the 326 participants (mean age: 76 years, 42% male, 41% Black), 52% had elevated brain amyloid burden. Mid-life leisure-time PA did not show a statistically significant lower odds of elevated late-life amyloid burden (OR = 0.71, 95% CI: 0.43-1.18). A 1 SD (970 MET. min. wk-1) higher PA level in mid-life was also not significantly associated withelevated amyloid burden (OR = 0.89, 95% CI: 0.69-1.15). Similar estimates were observed for meeting versus not meeting PA guidelines in both mid- and late-life. CONCLUSION Self-reported higher mid- and late-life leisure-time PA were not significantly associated with lower amyloid burden. Data show a trend of an association, which is, however, imprecise, suggesting replication in larger studies.
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Affiliation(s)
- Priya Palta
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keenan Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Thomas H. Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Dean F. Wong
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Washington University in St. Louis, School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
| | - Rebecca F. Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kivipelto M, Mangialasche F, Ngandu T. Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat Rev Neurol 2019; 14:653-666. [PMID: 30291317 DOI: 10.1038/s41582-018-0070-3] [Citation(s) in RCA: 620] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Research into dementia prevention is of paramount importance if the dementia epidemic is to be halted. Observational studies have identified several potentially modifiable risk factors for dementia, including hypertension, dyslipidaemia and obesity at midlife, diabetes mellitus, smoking, physical inactivity, depression and low levels of education. Randomized clinical trials are needed that investigate whether interventions targeting these risk factors can reduce the risk of cognitive decline and dementia in elderly adults, but such trials are methodologically challenging. To date, most preventive interventions have been tested in small groups, have focused on a single lifestyle factor and have yielded negative or modest results. Given the multifactorial aetiology of dementia and late-onset Alzheimer disease, multidomain interventions that target several risk factors and mechanisms simultaneously might be necessary for an optimal preventive effect. In the past few years, three large multidomain trials (FINGER, MAPT and PreDIVA) have been completed. The FINGER trial showed that a multidomain lifestyle intervention can benefit cognition in elderly people with an elevated risk of dementia. The primary results from the other trials did not show a statistically significant benefit of preventive interventions, but additional analyses among participants at risk of dementia showed beneficial effects of intervention. Overall, results from these three trials suggest that targeting of preventive interventions to at-risk individuals is an effective strategy. This Review discusses the current knowledge of lifestyle-related risk factors and results from novel trials aiming to prevent cognitive decline and dementia. Global initiatives are presented, including the World Wide FINGERS network, which aims to harmonize studies on dementia prevention, generate high-quality scientific evidence and promote its implementation.
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Affiliation(s)
- Miia Kivipelto
- Public Health Promotion Unit, National Institute for Health and Welfare (THL), Helsinki, Finland. .,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland. .,Neuroepidemiology and Ageing Unit, School of Public Health, Imperial College London, London, UK.
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Tiia Ngandu
- Public Health Promotion Unit, National Institute for Health and Welfare (THL), Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Soldevila-Domenech N, Boronat A, Langohr K, de la Torre R. N-of-1 Clinical Trials in Nutritional Interventions Directed at Improving Cognitive Function. Front Nutr 2019; 6:110. [PMID: 31396517 PMCID: PMC6663977 DOI: 10.3389/fnut.2019.00110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 07/08/2019] [Indexed: 12/30/2022] Open
Abstract
Longer life expectancy has led to an increase in the prevalence of age-related cognitive decline and dementia worldwide. Due to the current lack of effective treatment for these conditions, preventive strategies represent a research priority. A large body of evidence suggests that nutrition is involved in the pathogenesis of age-related cognitive decline, but also that it may play a critical role in slowing down its progression. At a population level, healthy dietary patterns interventions, such as the Mediterranean and the MIND diets, have been associated with improved cognitive performance and a decreased risk of neurodegenerative disease development. In the era of evidence-based medicine and patient-centered healthcare, personalized nutritional recommendations would offer a considerable opportunity in preventing cognitive decline progression. N-of-1 clinical trials have emerged as a fundamental design in evidence-based medicine. They consider each individual as the only unit of observation and intervention. The aggregation of series of N-of-1 clinical trials also enables population-level conclusions. This review provides a general view of the current scientific evidence regarding nutrition and cognitive decline, and critically states its limitations when translating results into the clinical practice. Furthermore, we suggest methodological strategies to develop N-of-1 clinical trials focused on nutrition and cognition in an older population. Finally, we evaluate the potential challenges that researchers may face when performing studies in precision nutrition and cognition.
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Affiliation(s)
- Natalia Soldevila-Domenech
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Anna Boronat
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Klaus Langohr
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Statistics and Operations Research, Universitat Politècnica de Barcelona/Barcelonatech, Barcelona, Spain
| | - Rafael de la Torre
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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30
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Blood pressure-lowering interventions to prevent dementia: a systematic review and meta-analysis. J Hypertens 2019; 36:1780-1787. [PMID: 29927845 DOI: 10.1097/hjh.0000000000001829] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Our objective was to study the preventive effect of lowering blood pressure (BP) by medication and/or lifestyle changes on incident all-cause dementia, Alzheimer's disease and vascular dementia. In this systematic review, we included randomized controlled trials with a BP-lowering intervention. Of the nine included trials, seven assessed the effect of antihypertensive medication and two of a lifestyle or combined intervention. In the intervention arm, 1041 out of 29 029 (3.6%) participants were diagnosed with dementia compared with 1090 out of 28 653 (3.8%) controls during a median follow-up of 3.9 years [range 2-10], resulting in a pooled risk ratio of 0.93 (95% confidence interval 0.84-1.02; I 16%). Three trials specified dementia subtypes, with no significant effect on Alzheimer's disease or vascular dementia. To conclude, lowering BP by medication and/or lifestyle changes did not lead to a significantly reduced risk of dementia. This appeared independent of dementia subtype.
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31
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Eggink E, Moll van Charante EP, van Gool WA, Richard E. A Population Perspective on Prevention of Dementia. J Clin Med 2019; 8:E834. [PMID: 31212802 PMCID: PMC6617301 DOI: 10.3390/jcm8060834] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 01/21/2023] Open
Abstract
The global number of people living with dementia is expected to increase to 130 million in 2050. Based on extensive evidence from observational studies, it is estimated that about 30% of dementia cases may be attributable to potentially modifiable risk factors. This suggests that interventions targeting these factors could perhaps delay or prevent the onset of dementia. Since the vast majority of people with dementia live in low- and middle-income countries, such interventions should preferably be easy and affordable to implement across a wide range of health care systems. However, to date, results from dementia prevention trials do not provide convincing evidence that treatment of these risk factors reduces the risk of dementia. The current paper aims to give an overview of available evidence for the potential for dementia prevention. In particular, we discuss methodological issues that might complicate the development of effective prevention interventions and explore the opportunities and challenges for future dementia prevention research. Currently, several ongoing and planned trials are testing the effect of multi-domain interventions on dementia risk in high-risk populations. It is desirable that future dementia strategies also target the wider population, through interventions on the individual, community, and population level, in order to constrain the growing prevalence of dementia worldwide.
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Affiliation(s)
- Esmé Eggink
- Department of General Practice, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Willem A van Gool
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Edo Richard
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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Heffernan M, Andrews G, Fiatarone Singh MA, Valenzuela M, Anstey KJ, Maeder AJ, McNeil J, Jorm L, Lautenschlager NT, Sachdev PS, Ginige JA, Hobbs MJ, Boulamatsis C, Chau T, Cobiac L, Cox KL, Daniel K, Flood VM, Guerrero Y, Gunn J, Jain N, Kochan NA, Lampit A, Mavros Y, Meiklejohn J, Noble Y, O’Leary F, Radd-Vagenas S, Walton CC, Brodaty H. Maintain Your Brain: Protocol of a 3-Year Randomized Controlled Trial of a Personalized Multi-Modal Digital Health Intervention to Prevent Cognitive Decline Among Community Dwelling 55 to 77 Year Olds. J Alzheimers Dis 2019; 70:S221-S237. [PMID: 30475762 PMCID: PMC6700632 DOI: 10.3233/jad-180572] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Maintain Your Brain (MYB) is a randomized controlled trial of an online multi-modal lifestyle intervention targeting modifiable dementia risk factors with its primary aim being to reduce cognitive decline in an older age cohort. METHODS MYB aims to recruit 8,500 non-demented community dwelling 55 to 77 year olds from the Sax Institute's 45 and Up Study in New South Wales, Australia. Participants will be screened for risk factors related to four modules that comprise the MYB intervention: physical activity, nutrition, mental health, and cognitive training. Targeting risk factors will enable interventions to be personalized so that participants receive the most appropriate modules. MYB will run for three years and up to four modules will be delivered sequentially each quarter during year one. Upon completing a module, participants will continue to receive less frequent booster activities for their eligible modules (except for the mental health module) until the end of the trial. DISCUSSION MYB will be the largest internet-based trial to attempt to prevent cognitive decline and potentially dementia. If successful, MYB will provide a model for not just effective intervention among older adults, but an intervention that is scalable for broad use.
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Affiliation(s)
- Megan Heffernan
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Australia
| | - Maria A. Fiatarone Singh
- Sydney Medical School, University of Sydney, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
- Hebrew SeniorLife and Jean Meyer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA USA
| | - Michael Valenzuela
- Sydney Medical School, University of Sydney, Australia
- Brain and Mind Centre, University of Sydney, Australia
| | | | - Anthony J. Maeder
- College of Nursing & Health Sciences, Flinders University, Australia
| | | | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Australia
| | - Nicola T. Lautenschlager
- University of Melbourne, Australia
- North Western Mental Health, Melbourne Health, Melbourne, Australia
| | | | | | - Megan J. Hobbs
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Australia
| | | | - Tiffany Chau
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
| | | | - Kay L. Cox
- Medical School, University of Western Australia, Perth, Australia
| | - Kenneth Daniel
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Victoria M. Flood
- Faculty of Health Sciences, University of Sydney, Australia
- Western Sydney Local Health District, Westmead Hospital, Australia
| | - Yareni Guerrero
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Nidhi Jain
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
| | - Amit Lampit
- Brain and Mind Centre, University of Sydney, Australia
- University of Melbourne, Australia
| | - Yorgi Mavros
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Jacinda Meiklejohn
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Yian Noble
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Fiona O’Leary
- Nutrition and Dietetics Group, School of Life and Environmental Science, Faculty of Science & The Charles Perkins Centre, University of Sydney, Australia
| | - Sue Radd-Vagenas
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
| | - Courtney C. Walton
- Brain and Mind Centre, University of Sydney, Australia
- School of Psychology, University of Queensland, Melbourne, Australia
| | - Maintain Your Brain Collaborative Team
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Australia
- Sydney Medical School, University of Sydney, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia
- Brain and Mind Centre, University of Sydney, Australia
- School of Psychology, University of New South Wales, Australia
- College of Nursing & Health Sciences, Flinders University, Australia
- Monash University, Australia
- Centre for Big Data Research in Health, University of New South Wales, Australia
- University of Melbourne, Australia
- Western Sydney University, Australia
- CSIRO Health and Biosecurity
- Medical School, University of Western Australia, Perth, Australia
- Faculty of Health Sciences, University of Sydney, Australia
- Western Sydney Local Health District, Westmead Hospital, Australia
- Nutrition and Dietetics Group, School of Life and Environmental Science, Faculty of Science & The Charles Perkins Centre, University of Sydney, Australia
- North Western Mental Health, Melbourne Health, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
- School of Psychology, University of Queensland, Melbourne, Australia
- Hebrew SeniorLife and Jean Meyer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA USA
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
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Debette S, Strbian D, Wardlaw JM, van der Worp HB, Rinkel GJE, Caso V, Dichgans M. Fourth European stroke science workshop. Eur Stroke J 2018; 3:206-219. [PMID: 31009021 PMCID: PMC6453207 DOI: 10.1177/2396987318774443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022] Open
Abstract
Lake Eibsee, Garmisch-Partenkirchen, 16 to 18 November, 2017: The European Stroke Organisation convened >120 stroke experts from 21 countries to discuss latest results and hot topics in clinical, translational and basic stroke research. Since its inception in 2011, the European Stroke Science Workshop has become a cornerstone of European Stroke Organisation's academic activities and a major highlight for researchers in the field. Participants include stroke researchers at all career stages and with different backgrounds, who convene for plenary lectures and discussions. The workshop was organised in seven scientific sessions focusing on the following topics: (1) acute stroke treatment and endovascular therapy; (2) small vessel disease; (3) opportunities for stroke research in the omics era; (4) vascular cognitive impairment; (5) intracerebral and subarachnoid haemorrhage; (6) alternative treatment concepts and (7) neural circuits, recovery and rehabilitation. All sessions started with a keynote lecture providing an overview on current developments, followed by focused talks on a timely topic with the most recent findings, including unpublished data. In the following, we summarise the key contents of the meeting. The program is provided in the online only Data Supplement. The workshop started with a key note lecture on how to improve the efficiency of clinical trial endpoints in stroke, which was delivered by Craig Anderson (Sydney, Australia) and set the scene for the following discussions.
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Affiliation(s)
- S Debette
- Inserm Centre Bordeaux Population Health (U1219), University of Bordeaux, Bordeaux, France
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - D Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - JM Wardlaw
- Centre for Clinical Brain Sciences, and UK Dementia Research Institute at the University of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - HB van der Worp
- Department of Neurology and neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - GJE Rinkel
- Department of Neurology and neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - V Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - M Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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van Middelaar T, Hoevenaar-Blom MP, van Gool WA, Moll van Charante EP, van Dalen JW, Deckers K, Köhler S, Richard E. Modifiable dementia risk score to study heterogeneity in treatment effect of a dementia prevention trial: a post hoc analysis in the preDIVA trial using the LIBRA index. ALZHEIMERS RESEARCH & THERAPY 2018; 10:62. [PMID: 29960597 PMCID: PMC6026510 DOI: 10.1186/s13195-018-0389-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/27/2018] [Indexed: 12/01/2022]
Abstract
Background Selecting high-risk participants for dementia prevention trials based on a modifiable dementia risk score may be advantageous, as it increases the opportunity for intervention. We studied whether a multi-domain intervention can prevent all-cause dementia and cognitive decline in older people across three different levels of a modifiable dementia risk score. Methods Prevention of Dementia by Intensive Vascular Care (preDIVA) is a randomised controlled trial studying the effect of multi-domain vascular care during 6–8 years on incident all-cause dementia in community-dwelling people aged 70–78 years. For this post hoc analysis, we stratified preDIVA participants in tertiles based on their baseline LIfestyle for BRAin Health (LIBRA) index, a modifiable dementia risk score. With Cox proportional hazards regression, the intervention effect on dementia was assessed. The effect on cognition was measured every 2 years with the Mini-Mental State Examination and Visual Association Test. Results Dementia developed in 220 of 3274 (6.7%) participants. In participants with a low, intermediate and high LIBRA index, the hazard ratio (HR) of the intervention on incident dementia was respectively 0.71 (95% CI 0.45–1.12), 1.06 (95% CI 0.66–1.69) and 1.02 (95% CI 0.64–1.62). Also, when adding the non-modifiable risk factors age, education and sex to the index, results were comparable (respectively HR 0.88, 95% CI 0.54–1.43; HR 0.91, 95% CI 0.57–1.47; HR 0.92, 95% CI 0.59–1.41). There was no statistically significant intervention effect on cognition during follow-up across the LIBRA groups. Conclusions In the preDIVA study population aged 70–78 years, the LIBRA modifiable dementia risk score did not identify a (high-)risk group in whom the multi-domain intervention was effective in preventing dementia or cognitive decline. Trial registration International Standard Randomised Controlled Trial Number registry, ISRCTN29711771. Registered on 14 February 2006. Electronic supplementary material The online version of this article (10.1186/s13195-018-0389-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tessa van Middelaar
- Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. .,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Marieke P Hoevenaar-Blom
- Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Jan-Willem van Dalen
- Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Edo Richard
- Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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Levy B, Tsoy E, Gable S. Developing Cognitive Markers of Alzheimer's Disease for Primary Care: Implications for Behavioral and Global Prevention. J Alzheimers Dis 2018; 54:1259-1272. [PMID: 27567831 DOI: 10.3233/jad-160309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A comprehensive approach to the prevention of Alzheimer's disease (AD) warrants a synergy across multiple domains and procedures. Whereas the study of biological markers has mobilized major activity in the field, the development of cognitive markers is largely ignored, despite the unique advantages they may offer. Cognitive markers essentially assess the core clinical feature that biological markers intend to predict. In this respect, cognitive markers expand the foundation of preclinical diagnostics and disease staging in a manner that integrates both physiological and psychological factors. In addition, the cost-effective implementation of cognitive markers makes them remarkably conducive to community-wide screenings, and thereby a vital component of any global blueprint for prevention. Specifically, in the primary care setting, cognitive markers may provide effective gate keeping for more invasive, labor intensive, and expensive procedures. From this perspective, cognitive markers may provide the first step for identifying preclinical treatment recipients in general public. Moreover, the detection of preclinical decline via cognitive markers can increase awareness of AD risk and the motivation for making protective lifestyle changes. The behavioral approach might be expedient for prevention in light of the compelling evidence of lifestyle amelioration of AD risk. In an integrative view, incorporating cognitive markers to primary care may facilitate a synergetic development in preventive interventions that carries epidemiological significance. This paper addresses the theoretical, methodological, and pragmatic aspects of this prospect.
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Marengoni A, Rizzuto D, Fratiglioni L, Antikainen R, Laatikainen T, Lehtisalo J, Peltonen M, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M, Ngandu T. The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise, Cognitive Training, and Monitoring of Vascular Risk on Chronic Morbidity-the FINGER Randomized Controlled Trial. J Am Med Dir Assoc 2017; 19:355-360.e1. [PMID: 29108888 DOI: 10.1016/j.jamda.2017.09.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To verify whether a multidomain intervention lowers the risk of developing new chronic diseases in older adults. METHODS Multicenter, double-blind randomized controlled trial started in October 2009, with 2-year follow-up. A total of 1260 people aged 60 to 77 years were enrolled in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were randomly assigned in a 1:1 ratio to a 2-year multidomain intervention (n = 631) (nutritional guidance, exercise, cognitive training, and management of metabolic and vascular risk factors) or a control group (n = 629) (general health advice). Data on most common chronic diseases were collected by a physician at baseline and 2 years later. RESULTS At 2-year follow-up, the average number of new chronic diseases was 0.47 [standard deviation (SD) 0.7] in the intervention group and 0.58 (SD 0.8) in the control group (P < .01). The incidence rate per 100 person-years for developing 1+ new disease(s) was 17.4 [95% confidence interval (CI) = 15.1-20.1] in the intervention group and 20.5 (95% CI = 18.0-23.4) in the control group; for developing 2+ new diseases, 4.9 (95% CI = 3.7-6.4) and 6.1 (95% CI = 4.8-7.8); and for 3+ new diseases, 0.7 (95% CI = 0.4-1.5) and 1.8 (95% CI = 1.1-2.8), respectively. After adjustment for age, sex, education, current smoking, alcohol intake, and the number of chronic diseases at baseline, the intervention group had a hazard ratio ranging from 0.80 (0.66-0.98) for developing 1+ new chronic disease(s) to 0.38 (0.16-0.88) for developing 3+ new chronic diseases compared to the control group. CONCLUSIONS Findings from this randomized controlled trial suggest that a multidomain intervention could reduce the risk of developing new chronic diseases in older people.
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Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Riitta Antikainen
- Center for Life Course Health Research/Geriatrics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland; Oulu City Hospital, Oulu, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Joint municipal authority for North Karelia social and health services, Joensuu, Finland
| | - Jenni Lehtisalo
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Peltonen
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Timo Strandberg
- Center for Life Course Health Research/Geriatrics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland; University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Tuomilehto
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; South Ostrobothnia Central Hospital, Seinäjoki, Finland; Dasman Diabetes Institute, Dasman, Kuwait; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Miia Kivipelto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden; Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholms Sjukhem, Research & Development unit, Stockholm, Sweden
| | - Tiia Ngandu
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Tariq S, Barber PA. Dementia risk and prevention by targeting modifiable vascular risk factors. J Neurochem 2017; 144:565-581. [PMID: 28734089 DOI: 10.1111/jnc.14132] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/23/2017] [Accepted: 07/15/2017] [Indexed: 01/04/2023]
Abstract
The incidence of dementia is expected to double in the next 20 years and will contribute to heavy social and economic burden. Dementia is caused by neuronal loss that leads to brain atrophy years before symptoms manifest. Currently, no cure exists and extensive efforts are being made to mitigate cognitive impairment in late life in order to reduce the burden on patients, caregivers, and society. The most common type of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) often co-exists in the brain and shares common, modifiable risk factors, which are targeted in numerous secondary prevention trials. There is a growing need for non-pharmacological interventions and infrastructural support from governments to encourage psychosocial and behavioral interventions. Secondary prevention trials need to be redesigned based on the risk profile of individual subjects, which require the use of validated and standardized clinical, biological, and neuroimaging biomarkers. Multi-domain approaches have been proposed in high-risk populations that target optimal treatment; clinical trials need to recruit individuals at the highest risk of dementia before symptoms develop, thereby identifying an enriched disease group to test preventative and disease modifying strategies. The underlying aim should be to reduce microscopic brain tissue loss by modifying vascular and lifestyle risk factors over a relatively short period of time, thus optimizing the opportunity for preventing dementia in the future. Collaboration between international research groups is of key importance to the optimal use and allocation of existing resources, and the development of new techniques in preventing dementia. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Sana Tariq
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
| | - Philip A Barber
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada.,Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
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38
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Custodio N, Lira D, Herrera-Perez E, Montesinos R, Castro-Suarez S, Cuenca-Alfaro J, Valeriano-Lorenzo L. Memory Alteration Test to Detect Amnestic Mild Cognitive Impairment and Early Alzheimer's Dementia in Population with Low Educational Level. Front Aging Neurosci 2017; 9:278. [PMID: 28878665 PMCID: PMC5572224 DOI: 10.3389/fnagi.2017.00278] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/07/2017] [Indexed: 12/03/2022] Open
Abstract
Background/Aims: Short tests to early detection of the cognitive impairment are necessary in primary care setting, particularly in populations with low educational level. The aim of this study was to assess the performance of Memory Alteration Test (M@T) to discriminate controls, patients with amnestic Mild Cognitive Impairment (aMCI) and patients with early Alzheimer’s Dementia (AD) in a sample of individuals with low level of education. Methods: Cross-sectional study to assess the performance of the M@T (study test), compared to the neuropsychological evaluation (gold standard test) scores in 247 elderly subjects with low education level from Lima-Peru. The cognitive evaluation included three sequential stages: (1) screening (to detect cases with cognitive impairment); (2) nosological diagnosis (to determinate specific disease); and (3) classification (to differentiate disease subtypes). The subjects with negative results for all stages were considered as cognitively normal (controls). The test performance was assessed by means of area under the receiver operating characteristic (ROC) curve. We calculated validity measures (sensitivity, specificity and correctly classified percentage), the internal consistency (Cronbach’s alpha coefficient), and concurrent validity (Pearson’s ratio coefficient between the M@T and Clinical Dementia Rating (CDR) scores). Results: The Cronbach’s alpha coefficient was 0.79 and Pearson’s ratio coefficient was 0.79 (p < 0.01). The AUC of M@T to discriminate between early AD and aMCI was 99.60% (sensitivity = 100.00%, specificity = 97.53% and correctly classified = 98.41%) and to discriminate between aMCI and controls was 99.56% (sensitivity = 99.17%, specificity = 91.11%, and correctly classified = 96.99%). Conclusions: The M@T is a short test with a good performance to discriminate controls, aMCI and early AD in individuals with low level of education from urban settings.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,GESIDLima, Peru.,Instituto Nacional de Salud del NiñoLima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Medicina de Rehabilitación, Instituto Peruano de NeurocienciasLima, Peru
| | - Sheila Castro-Suarez
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias NeurológicasLima, Peru
| | - José Cuenca-Alfaro
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
| | - Lucía Valeriano-Lorenzo
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
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Stowe AM, Ireland SJ, Ortega SB, Chen D, Huebinger RM, Tarumi T, Harris TS, Cullum CM, Rosenberg R, Monson NL, Zhang R. Adaptive lymphocyte profiles correlate to brain Aβ burden in patients with mild cognitive impairment. J Neuroinflammation 2017; 14:149. [PMID: 28750671 PMCID: PMC5530920 DOI: 10.1186/s12974-017-0910-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 07/06/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We previously found that subjects with amnestic mild cognitive impairment exhibit a pro-inflammatory immune profile in the cerebrospinal fluid similar to multiple sclerosis, a central nervous system autoimmune disease. We therefore hypothesized that early neuroinflammation would reflect increases in brain amyloid burden during amnestic mild cognitive impairment. METHODS Cerebrospinal fluid and blood samples were collected from 24 participants with amnestic mild cognitive impairment (12 men, 12 women; 66 ± 6 years; 0.5 Clinical Dementia Rating) enrolled in the AETMCI study. Analyses of cerebrospinal fluid and blood included immune profiling by multi-parameter flow cytometry, genotyping for apolipoprotein (APO)ε, and quantification of cytokine and immunoglobin levels. Amyloid (A)β deposition was determined by 18F-florbetapir positron emission tomography. Spearman rank order correlations were performed to assess simple linear correlation for parameters including amyloid imaging, central and peripheral immune cell populations, and protein cytokine levels. RESULTS Soluble Aβ42 in the cerebrospinal fluid declined as Aβ deposition increased overall and in the precuneous and posterior cingulate cortices. Lymphocyte profiling revealed a significant decline in T cell populations in the cerebrospinal fluid, specifically CD4+ T cells, as Aβ deposition in the posterior cingulate cortex increased. In contrast, increased Aβ burden correlated positively with increased memory B cells in the cerebrospinal fluid, which was exacerbated in APOε4 carriers. For peripheral circulating lymphocytes, only B cell populations decreased with Aβ deposition in the precuneous cortex, as peripheral T cell populations did not correlate with changes in brain amyloid burden. CONCLUSIONS Elevations in brain Aβ burden associate with a shift from T cells to memory B cells in the cerebrospinal fluid of subjects with amnestic mild cognitive impairment in this exploratory cohort. These data suggest the presence of cellular adaptive immune responses during Aβ accumulation, but further study needs to determine whether lymphocyte populations contribute to, or result from, Aβ dysregulation during memory decline on a larger cohort collected at multiple centers. TRIAL REGISTRATION AETMCI NCT01146717.
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Affiliation(s)
- Ann M Stowe
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA
| | - Sara J Ireland
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA
| | - Sterling B Ortega
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA
| | - Ding Chen
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA
| | - Ryan M Huebinger
- Department of Surgery, UT Southwestern Medical Center, 6000 Harry Hines, Dallas, 75390, TX, USA
| | - Takashi Tarumi
- Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, 7232 Greenville Ave, Dallas, 75231, TX, USA
| | - Thomas S Harris
- Department of Radiology, UT Southwestern Medical Center, 6000 Harry Hines, Dallas, 75390, TX, USA
| | - C Munro Cullum
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA.,Department of Psychiatry, UT Southwestern Medical Center, 6000 Harry Hines, Dallas, 75390, TX, USA
| | - Roger Rosenberg
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA
| | - Nancy L Monson
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA. .,Department of Immunology, UT Southwestern Medical Center, 6000 Harry Hines, Dallas, 75390, TX, USA.
| | - Rong Zhang
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, NL9.110E, 6000 Harry Hines Blvd, Dallas, 75390, TX, USA.,Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, 7232 Greenville Ave, Dallas, 75231, TX, USA
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40
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Jongstra S, Wijsman LW, Cachucho R, Hoevenaar-Blom MP, Mooijaart SP, Richard E. Cognitive Testing in People at Increased Risk of Dementia Using a Smartphone App: The iVitality Proof-of-Principle Study. JMIR Mhealth Uhealth 2017; 5:e68. [PMID: 28546139 PMCID: PMC5465383 DOI: 10.2196/mhealth.6939] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/26/2017] [Accepted: 03/14/2017] [Indexed: 12/01/2022] Open
Abstract
Background Smartphone-assisted technologies potentially provide the opportunity for large-scale, long-term, repeated monitoring of cognitive functioning at home. Objective The aim of this proof-of-principle study was to evaluate the feasibility and validity of performing cognitive tests in people at increased risk of dementia using smartphone-based technology during a 6 months follow-up period. Methods We used the smartphone-based app iVitality to evaluate five cognitive tests based on conventional neuropsychological tests (Memory-Word, Trail Making, Stroop, Reaction Time, and Letter-N-Back) in healthy adults. Feasibility was tested by studying adherence of all participants to perform smartphone-based cognitive tests. Validity was studied by assessing the correlation between conventional neuropsychological tests and smartphone-based cognitive tests and by studying the effect of repeated testing. Results We included 151 participants (mean age in years=57.3, standard deviation=5.3). Mean adherence to assigned smartphone tests during 6 months was 60% (SD 24.7). There was moderate correlation between the firstly made smartphone-based test and the conventional test for the Stroop test and the Trail Making test with Spearman ρ=.3-.5 (P<.001). Correlation increased for both tests when comparing the conventional test with the mean score of all attempts a participant had made, with the highest correlation for Stroop panel 3 (ρ=.62, P<.001). Performance on the Stroop and the Trail Making tests improved over time suggesting a learning effect, but the scores on the Letter-N-back, the Memory-Word, and the Reaction Time tests remained stable. Conclusions Repeated smartphone-assisted cognitive testing is feasible with reasonable adherence and moderate relative validity for the Stroop and the Trail Making tests compared with conventional neuropsychological tests. Smartphone-based cognitive testing seems promising for large-scale data-collection in population studies.
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Affiliation(s)
- Susan Jongstra
- Academic Medical Center, Department of Neurology, University of Amsterdam, Amsterdam, Netherlands
| | - Liselotte Willemijn Wijsman
- Leiden University Medical Center, Department of gerontology & geriatrics, University of Leiden, Leiden, Netherlands
| | - Ricardo Cachucho
- Leiden Institute of Advanced Computer Sciences, LIACS, University of Leiden, Leiden, Netherlands
| | | | - Simon Pieter Mooijaart
- Leiden University Medical Center, Department of gerontology & geriatrics, University of Leiden, Leiden, Netherlands.,Institute of Evidence-based Medicine in Old Age - IEMO, LUMC, Leiden, Netherlands
| | - Edo Richard
- Academic Medical Center, Department of Neurology, University of Amsterdam, Amsterdam, Netherlands.,Donders Institute for Brain, Behaviour and Cognition, Department of Neurology, Radboud UMC, Nijmegen, Netherlands
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41
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Can lifestyle changes prevent cognitive impairment? Lancet Neurol 2017; 16:338-339. [DOI: 10.1016/s1474-4422(17)30080-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 12/26/2022]
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Hsu DC, Marshall GA. Primary and Secondary Prevention Trials in Alzheimer Disease: Looking Back, Moving Forward. Curr Alzheimer Res 2017; 14:426-440. [PMID: 27697063 PMCID: PMC5329133 DOI: 10.2174/1567205013666160930112125] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/10/2016] [Accepted: 09/22/2016] [Indexed: 12/20/2022]
Abstract
The field of Alzheimer disease (AD) prevention has been a culmination of basic science, clinical, and translational research. In the past three years since the new 2011 AD diagnostic guidelines, large-scale collaborative efforts have embarked on new clinical trials with the hope of someday preventing AD. This review will shed light on the historical and scientific contexts in which these trials were based on, as well as discuss potential challenges these trials may face in the coming years. Primary preventive measures, such as lifestyle, multidomain, medication, and supplemental interventions, will be analyzed. Secondary prevention as represented by disease-modifying interventions, such as antiamyloid therapy and pioglitazone, will also be reviewed. Finally, hypotheses on future directions for AD prevention trials will be proposed.
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Affiliation(s)
- David C. Hsu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Gad A. Marshall
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Contreras JA, Goñi J, Risacher SL, Amico E, Yoder K, Dzemidzic M, West JD, McDonald BC, Farlow MR, Sporns O, Saykin AJ. Cognitive complaints in older adults at risk for Alzheimer's disease are associated with altered resting-state networks. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 6:40-49. [PMID: 28149942 PMCID: PMC5266473 DOI: 10.1016/j.dadm.2016.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pathophysiological changes that accompany early clinical symptoms in prodromal Alzheimer's disease (AD) may have a disruptive influence on brain networks. We investigated resting-state functional magnetic resonance imaging (rsfMRI), combined with brain connectomics, to assess changes in whole-brain functional connectivity (FC) in relation to neurocognitive variables. METHODS Participants included 58 older adults who underwent rsfMRI. Individual FC matrices were computed based on a 278-region parcellation. FastICA decomposition was performed on a matrix combining all subjects' FC. Each FC pattern was then used as a response in a multilinear regression model including neurocognitive variables associated with AD (cognitive complaint index [CCI] scores from self and informant, an episodic memory score, and an executive function score). RESULTS Three connectivity independent component analysis (connICA) components (RSN, VIS, and FP-DMN FC patterns) associated with neurocognitive variables were identified based on prespecified criteria. RSN-pattern, characterized by increased FC within all resting-state networks, was negatively associated with self CCI. VIS-pattern, characterized by an increase in visual resting-state network, was negatively associated with CCI self or informant scores. FP-DMN-pattern, characterized by an increased interaction of frontoparietal and default mode networks (DMN), was positively associated with verbal episodic memory. DISCUSSION Specific patterns of FC were differently associated with neurocognitive variables thought to change early in the course of AD. An integrative connectomics approach relating cognition to changes in FC may help identify preclinical and early prodromal stages of AD and help elucidate the complex relationship between subjective and objective indices of cognitive decline and differences in brain functional organization.
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Affiliation(s)
- Joey A. Contreras
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Network Science Institute, Indiana University, Bloomington, IN, USA
| | - Joaquín Goñi
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
- School of Industrial Engineering, Purdue University, West-Lafayette, IN, USA
- Weldon School of Biomedical Engineering, Purdue University, West-Lafayette, IN, USA
| | - Shannon L. Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Enrico Amico
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Karmen Yoder
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mario Dzemidzic
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John D. West
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brenna C. McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Martin R. Farlow
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Olaf Sporns
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Network Science Institute, Indiana University, Bloomington, IN, USA
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Network Science Institute, Indiana University, Bloomington, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Corresponding author.
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Szoeke C, Lehert P, Henderson VW, Dennerstein L, Desmond P, Campbell S. Predictive Factors for Verbal Memory Performance Over Decades of Aging: Data from the Women's Healthy Ageing Project. Am J Geriatr Psychiatry 2016; 24:857-67. [PMID: 27562941 DOI: 10.1016/j.jagp.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 04/25/2016] [Accepted: 05/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abnormalities in brain structure and function can occur several decades prior to the onset of cognitive decline. It is in the preceding decades that an intervention is most likely to be effective, when informed by an understanding of factors contributing to the disease prodrome. Few studies, however, have sufficient longitudinal data on relevant risks to determine the optimum targets for interventions to improve cognition in aging. In this article we examine the timing and exposure of factors contributing to verbal memory performance in later life. METHODS 387 participants from the population-based Women's Healthy Ageing Project, mean age at baseline of 49.6 years (range: 45-55 years), had complete neuropsychiatric assessments, clinical information, physical measures, and biomarkers collected at baseline, with at least three follow-up visits that included at least one cognitive reassessment. Mixed linear models were conducted to assess the significance of risk factors on later-life verbal memory. We explored the influence of early, contemporaneous, and cumulative exposures. RESULTS Younger age and better education were associated with baseline memory test performance (CERAD). Over the 20 years of study follow-up, cumulative mid- to late-life physical activity had the strongest effect on better later life verbal memory (0.136 [0.058, 0.214]). The next most likely contributors to verbal memory in late life were the negative effect of cumulative hypertension (-0.033 [-0.047, -0.0.18] and the beneficial effect of HDL cholesterol (0.818 [0.042, 1.593]). CONCLUSIONS Findings suggest that midlife interventions focused on physical activity, hypertension control, and achieving optimal levels of HDL cholesterol will help maintain later-life verbal memory skills.
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Affiliation(s)
- Cassandra Szoeke
- Department of Medicine, University of Melbourne, Melbourne, Australia.
| | | | - Victor W Henderson
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA; Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | | | - Patricia Desmond
- Department of Radiology, University of Melbourne, Melbourne, Australia
| | - Stephen Campbell
- The Australian Healthy Ageing Organisation, Melbourne, Australia
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Moll van Charante EP, Richard E, Eurelings LS, van Dalen JW, Ligthart SA, van Bussel EF, Hoevenaar-Blom MP, Vermeulen M, van Gool WA. Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet 2016; 388:797-805. [PMID: 27474376 DOI: 10.1016/s0140-6736(16)30950-3] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiovascular risk factors are associated with an increased risk of dementia. We assessed whether a multidomain intervention targeting these factors can prevent dementia in a population of community-dwelling older people. METHODS In this open-label, cluster-randomised controlled trial, we recruited individuals aged 70-78 years through participating general practices in the Netherlands. General practices within each health-care centre were randomly assigned (1:1), via a computer-generated randomisation sequence, to either a 6-year nurse-led, multidomain cardiovascular intervention or control (usual care). The primary outcomes were cumulative incidence of dementia and disability score (Academic Medical Center Linear Disability Score [ALDS]) at 6 years of follow-up. The main secondary outcomes were incident cardiovascular disease and mortality. Outcome assessors were masked to group assignment. Analyses included all participants with available outcome data. This trial is registered with ISRCTN, number ISRCTN29711771. FINDINGS Between June 7, 2006, and March 12, 2009, 116 general practices (3526 participants) within 26 health-care centres were recruited and randomly assigned: 63 (1890 participants) were assigned to the intervention group and 53 (1636 participants) to the control group. Primary outcome data were obtained for 3454 (98%) participants; median follow-up was 6·7 years (21 341 person-years). Dementia developed in 121 (7%) of 1853 participants in the intervention group and in 112 (7%) of 1601 participants in the control group (hazard ratio [HR] 0·92, 95% CI 0·71-1·19; p=0·54). Mean ALDS scores measured during follow-up did not differ between groups (85·7 [SD 6·8] in the intervention group and 85·7 [7·1] in the control group; adjusted mean difference -0·02, 95% CI -0·38 to 0·42; p=0·93). 309 (16%) of 1885 participants died in the intervention group, compared with 269 (16%) of 1634 participants in the control group (HR 0·98, 95% CI 0·80-1·18; p=0·81). Incident cardiovascular disease did not differ between groups (273 [19%] of 1469 participants in the intervention group and 228 [17%] of 1307 participants in the control group; HR 1·06, 95% CI 0·86-1·31; p=0·57). INTERPRETATION A nurse-led, multidomain intervention did not result in a reduced incidence of all-cause dementia in an unselected population of older people. This absence of effect might have been caused by modest baseline cardiovascular risks and high standards of usual care. Future studies should assess the efficacy of such interventions in selected populations. FUNDING Dutch Ministry of Health, Welfare and Sport; Dutch Innovation Fund of Collaborative Health Insurances; and Netherlands Organisation for Health Research and Development.
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Affiliation(s)
| | - Edo Richard
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands; Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lisa S Eurelings
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Suzanne A Ligthart
- Department of General Practice, Academic Medical Centre, Amsterdam, Netherlands
| | - Emma F van Bussel
- Department of General Practice, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Marinus Vermeulen
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands.
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Shatenstein B, Barberger-Gateau P, Mecocci P. Prevention of Age-Related Cognitive Decline: Which Strategies, When, and for Whom? J Alzheimers Dis 2016; 48:35-53. [PMID: 26401926 DOI: 10.3233/jad-150256] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Brain aging is characterized by the progressive and gradual accumulation of detrimental changes in structure and function, which increase risk of age-related cognitive decline and dementia. This devastating chronic condition generates a huge social and economic burden and accounts for 11.2% of years of disability. The increase in lifespan has contributed to the increase in dementia prevalence; however, there is currently no curative treatment for most causes of dementias. This paper reviews evidence-based strategies to build, enhance, and preserve cognition over the lifespan by examining approaches that work best, proposing when in the life course they should be implemented, and in which population group(s). Recent work shows a tendency to decreased age-specific prevalence and incidence of cognitive problems and dementia among people born later in the first half of the 20th century, citing higher educational levels, improvements in lifestyle, and better handling of vascular risk factors. This implies that we can target modifiable environmental, lifestyle, and health risk factors to modify the trajectory of cognitive decline before the onset of irreversible dementia. Because building cognitive reserve and prevention of cognitive decline are of critical importance, interventions are needed at every stage of the life course to foster cognitive stimulation, and enable healthy eating habits and physical activity throughout the lifespan. Preventive interventions to decrease and delay cognitive decline and its consequences in old age will also require collaboration and action on the part of policy-makers at the political and social level.
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Affiliation(s)
- Bryna Shatenstein
- Département de nutrition, Université de Montréal, Montréal, Québec, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS Centre-est-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Pascale Barberger-Gateau
- University of Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
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47
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Richard E, Jongstra S, Soininen H, Brayne C, Moll van Charante EP, Meiller Y, van der Groep B, Beishuizen CRL, Mangialasche F, Barbera M, Ngandu T, Coley N, Guillemont J, Savy S, Dijkgraaf MGW, Peters RJG, van Gool WA, Kivipelto M, Andrieu S. Healthy Ageing Through Internet Counselling in the Elderly: the HATICE randomised controlled trial for the prevention of cardiovascular disease and cognitive impairment. BMJ Open 2016; 6:e010806. [PMID: 27288376 PMCID: PMC4908903 DOI: 10.1136/bmjopen-2015-010806] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Cardiovascular disease and dementia share a number of risk factors including hypertension, hypercholesterolaemia, smoking, obesity, diabetes and physical inactivity. The rise of eHealth has led to increasing opportunities for large-scale delivery of prevention programmes encouraging self-management. The aim of this study is to investigate whether a multidomain intervention to optimise self-management of cardiovascular risk factors in older individuals, delivered through an coach-supported interactive internet platform, can improve the cardiovascular risk profile and reduce the risk of cardiovascular disease and cognitive decline. METHODS AND ANALYSIS HATICE is a multinational, multicentre, prospective, randomised, open-label blinded end point (PROBE) trial with 18 months intervention. Recruitment of 2600 older people (≥65 years) at increased risk of cardiovascular disease will take place in the Netherlands, Finland and France. Participants randomised to the intervention condition will have access to an interactive internet platform, stimulating self-management of vascular risk factors, with remote support by a coach. Participants in the control group will have access to a static internet platform with basic health information.The primary outcome is a composite score based on the average z-score of the difference between baseline and 18 months follow-up values of systolic blood pressure, low-density-lipoprotein and body mass index. Main secondary outcomes include the effect on the individual components of the primary outcome, the effect on lifestyle-related risk factors, incident cardiovascular disease, mortality, cognitive functioning, mood and cost-effectiveness. ETHICS AND DISSEMINATION The study was approved by the medical ethics committee of the Academic Medical Center in Amsterdam, the Comité de Protection des Personnes Sud Ouest et Outre Mer in France and the Northern Savo Hospital District Research Ethics Committee in Finland.We expect that data from this study will result in a manuscript published in a peer-reviewed clinical open access journal. TRIAL REGISTRATION NUMBER ISRCTN48151589.
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Affiliation(s)
- Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Susan Jongstra
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Eric P Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yannick Meiller
- Department of Information and Operations Management, ESCP Europe, Paris, France
| | | | - Cathrien R L Beishuizen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Mariagnese Barbera
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Nicola Coley
- INSERM, University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | | | - Stéphanie Savy
- INSERM, University of Toulouse UMR1027, Toulouse, France
| | - Marcel G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Miia Kivipelto
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden
| | - Sandrine Andrieu
- INSERM, University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
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48
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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Nutrition and Dementia: Evidence for Preventive Approaches? Nutrients 2016; 8:144. [PMID: 26959055 PMCID: PMC4808873 DOI: 10.3390/nu8030144] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 02/21/2016] [Accepted: 02/29/2016] [Indexed: 11/16/2022] Open
Abstract
In recent years, the possibility of favorably influencing the cognitive trajectory through promotion of lifestyle modifications has been increasingly investigated. In particular, the relationship between nutritional habits and cognitive health has attracted special attention. The present review is designed to retrieve and discuss recent evidence (published over the last 3 years) coming from randomized controlled trials (RCTs) investigating the efficacy of nutritional interventions aimed at improving cognitive functioning and/or preventing cognitive decline in non-demented older individuals. A systematic review of literature was conducted, leading to the identification of 11 studies of interest. Overall, most of the nutritional interventions tested by the selected RCTs were found to produce statistically significant cognitive benefits (defined as improved neuropsychological test scores). Nevertheless, the clinical meaningfulness of such findings was not adequately discussed and appears controversial. In parallel, only 2 studies investigated between-group differences concerning incident dementia and mild cognitive impairment cases, reporting conflicting results. Results of the present review suggest that several dietary patterns and nutritional components may constitute promising strategies in postponing, slowing, and preventing cognitive decline. However, supporting evidence is overall weak and further studies are needed.
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50
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Dubois B, Hampel H, Feldman HH, Scheltens P, Aisen P, Andrieu S, Bakardjian H, Benali H, Bertram L, Blennow K, Broich K, Cavedo E, Crutch S, Dartigues JF, Duyckaerts C, Epelbaum S, Frisoni GB, Gauthier S, Genthon R, Gouw AA, Habert MO, Holtzman DM, Kivipelto M, Lista S, Molinuevo JL, O'Bryant SE, Rabinovici GD, Rowe C, Salloway S, Schneider LS, Sperling R, Teichmann M, Carrillo MC, Cummings J, Jack CR. Preclinical Alzheimer's disease: Definition, natural history, and diagnostic criteria. Alzheimers Dement 2016; 12:292-323. [PMID: 27012484 PMCID: PMC6417794 DOI: 10.1016/j.jalz.2016.02.002] [Citation(s) in RCA: 1168] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
During the past decade, a conceptual shift occurred in the field of Alzheimer's disease (AD) considering the disease as a continuum. Thanks to evolving biomarker research and substantial discoveries, it is now possible to identify the disease even at the preclinical stage before the occurrence of the first clinical symptoms. This preclinical stage of AD has become a major research focus as the field postulates that early intervention may offer the best chance of therapeutic success. To date, very little evidence is established on this "silent" stage of the disease. A clarification is needed about the definitions and lexicon, the limits, the natural history, the markers of progression, and the ethical consequence of detecting the disease at this asymptomatic stage. This article is aimed at addressing all the different issues by providing for each of them an updated review of the literature and evidence, with practical recommendations.
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Affiliation(s)
- Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A) and Brain and Spine Institute (ICM) UMR S 1127 Frontlab, Department of Neurology, AP_HP, Pitié-Salpêtrière University Hospital, Sorbonne Universities, Pierre et Marie Curie University, Paris 06, Paris, France.
| | - Harald Hampel
- Institute of Memory and Alzheimer's Disease (IM2A) and Brain and Spine Institute (ICM) UMR S 1127 Frontlab, Department of Neurology, AP_HP, Pitié-Salpêtrière University Hospital, Sorbonne Universities, Pierre et Marie Curie University, Paris 06, Paris, France; AXA Research Fund & UPMC Chair, Paris, France
| | | | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU University Medical Center and Neuroscience Campus, Amsterdam, The Netherlands
| | - Paul Aisen
- University of Southern California San Diego, CA, USA
| | - Sandrine Andrieu
- UMR1027, INSERM, Université Toulouse III, Toulouse University Hospital, France
| | - Hovagim Bakardjian
- IHU-A-ICM-Institut des Neurosciences translationnelles de Paris, Paris, France
| | - Habib Benali
- INSERM U1146-CNRS UMR 7371-UPMC UM CR2, Site Pitié-Salpêtrière, Paris, France
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics and Integrative and Experimental Genomics, University of Lübeck, Lübeck, Germany; School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Lab, Department of Neuroscience and Physiology, University of Gothenburg, Mölndal Hospital, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Karl Broich
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Enrica Cavedo
- AXA Research Fund & UPMC Chair, Paris, France; Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sebastian Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | | | - Charles Duyckaerts
- University Pierre et Marie Curie, Assistance Publique des Hôpitaux de Paris, Alzheimer-Prion Team Institut du Cerveau et de la Moelle (ICM), Paris, France
| | - Stéphane Epelbaum
- Institute of Memory and Alzheimer's Disease (IM2A) and Brain and Spine Institute (ICM) UMR S 1127 Frontlab, Department of Neurology, AP_HP, Pitié-Salpêtrière University Hospital, Sorbonne Universities, Pierre et Marie Curie University, Paris 06, Paris, France
| | - Giovanni B Frisoni
- University Hospitals and University of Geneva, Geneva, Switzerland; IRCCS Fatebenefratelli, Brescia, Italy
| | - Serge Gauthier
- McGill Center for Studies in Aging, Douglas Mental Health Research Institute, Montreal, Canada
| | - Remy Genthon
- Fondation pour la Recherche sur Alzheimer, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alida A Gouw
- UMR1027, INSERM, Université Toulouse III, Toulouse University Hospital, France; Department of Clinical Neurophysiology/MEG Center, VU University Medical Center, Amsterdam
| | - Marie-Odile Habert
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Nucléaire, Paris, France
| | - David M Holtzman
- Department of Neurology, Washington University, Hope Center for Neurological Disorders, St. Louis, MO, USA; Department of Neurology, Washington University, Knight Alzheimer's Disease Research Center, St. Louis, MO, USA
| | - Miia Kivipelto
- Center for Alzheimer Research, Karolinska Institutet, Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; Institute of Clinical Medicine/ Neurology, University of Eastern Finland, Kuopio, Finland
| | | | - José-Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Sid E O'Bryant
- Center for Alzheimer's & Neurodegenerative Disease Research, University of North Texas Health Science Center, TX, USA
| | - Gil D Rabinovici
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Rowe
- Department of Molecular Imaging, Austin Health, University of Melbourne, Australia
| | - Stephen Salloway
- Memory and Aging Program, Butler Hospital, Alpert Medical School of Brown University, USA; Department of Neurology, Alpert Medical School of Brown University, USA; Department of Psychiatry, Alpert Medical School of Brown University, USA
| | - Lon S Schneider
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Reisa Sperling
- Harvard Medical School, Memory Disorders Unit, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Memory Disorders Unit, Center for Alzheimer Research and Treatment, Massachusetts General Hospital, Boston, USA
| | - Marc Teichmann
- Institute of Memory and Alzheimer's Disease (IM2A) and Brain and Spine Institute (ICM) UMR S 1127 Frontlab, Department of Neurology, AP_HP, Pitié-Salpêtrière University Hospital, Sorbonne Universities, Pierre et Marie Curie University, Paris 06, Paris, France
| | - Maria C Carrillo
- The Alzheimer's Association Division of Medical & Scientific Relations, Chicago, USA
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Cliff R Jack
- Department of Radiology, Mayo Clinic, Rochester MN, USA
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