1
|
Ruppert EP, Rocha JVDF, da Silva AL, Tomaz KLDS, Friedlaender CV, Assenção JDCM, Rincon LP, Ribeiro NGF, Santos DCDS, Lima APZ, Allen IE, Caramelli P, Grinberg LT, Maciel FIP, Resende EDPF. Episodic memory improvement in illiterate adults attending late-life education irrespective of low socioeconomic status: insights from the PROAME study. Dement Neuropsychol 2024; 18:e20230098. [PMID: 38957727 PMCID: PMC11218930 DOI: 10.1590/1980-5764-dn-2023-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/29/2024] [Accepted: 03/03/2024] [Indexed: 07/04/2024] Open
Abstract
The majority of people with dementia live in low or middle-income countries (LMICs) where resources that play a crucial role in brain health, such as quality education, are still not widely available. In Brazil, illiteracy remains a prevalent issue, especially in communities with lower socioeconomic status (SES). The PROAME study set out to explore basic education in illiterate adults as a means to improve cognitive reserve. Objective This manuscript aims to explore the relationship between SES and learning, as well as cognitive outcomes, in an older illiterate population. Methods This six-month clinical trial (NCT04473235) involved 108 participants, of which 77 concluded all assessments, enrolled in late-life basic education. SES assessments included Quality of Urban Living Index, Municipal Human Development Index and Household SES calculated for each participant. Cognitive assessments encompassed the Free and Cued Selective Reminding Test (FCSRT), a word list to assess reading, and the Beta III matrix. Results The sample consisted primarily of women, with a mean age of 58.5. Participants improved their reading (p=0.01) and their FCSRT (p=0.003). Regarding episodic memory, women outperformed men (p=0.007) and younger participants improved more than their older counterparts (p=0.001). There was no association observed between SES and cognitive outcomes. Conclusion Irrespective of SES, participants demonstrated positive outcomes after attending basic education. These findings highlight that late life education could be an important non-pharmacologic preventative measure, especially in LMICs.
Collapse
Affiliation(s)
- Emma Patrice Ruppert
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brazil
- University of Pittsburgh, Pascoal Lab, Pittsburgh PA, USA
| | - João Victor de Faria Rocha
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Belo Horizonte MG, Brazil
| | | | - Kelle Luisa Dos Santos Tomaz
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Clarisse Vasconcelos Friedlaender
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Belo Horizonte MG, Brazil
| | - Joanna de Castro Magalhães Assenção
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Luciana Paula Rincon
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Norton Gray Ferreira Ribeiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | | | | | - Isabel Elaine Allen
- University of California San Francisco, Global Brain Health Institute, San Francisco CA, USA
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Lea Tenenholz Grinberg
- University of California San Francisco, Global Brain Health Institute, San Francisco CA, USA
- University of California, Memory and Aging Center, UCSF Weill Institute for Neurosciences, San Francisco CA, USA
| | - Francisca Izabel Pereira Maciel
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Elisa de Paula França Resende
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
- University of California San Francisco, Global Brain Health Institute, San Francisco CA, USA
| |
Collapse
|
2
|
Borelli WV, Noll G, Tonon AC, Leotti VB, Castilhos RM, Zimmer ER. Poor sleep quality is an important modifiable risk factor for dementia: Population attributable fraction of poor sleep in a Brazilian population-based study. Int J Geriatr Psychiatry 2024; 39:e6109. [PMID: 38831255 DOI: 10.1002/gps.6109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES The populational impact of poor sleep quality and the risk of dementia is unclear. We analyzed the Population Attributable Fraction (PAF) of poor sleep quality for dementia, and its association with other two sleep parameters through self-reported and single questions collected in a large-scale Brazilian cohort (ELSI-Brazil). METHODS A subset of the ELSI-Brazil with complete responses to sleep quality was retrieved for this study. This is a large representative sample of the Brazilian elderly population with an extensive assessment of sociodemographic and health risk variables. Prevalence of poor sleep quality was estimated according to the complex sample design, and its PAF was measured using a meta-analytic relative risk. A total of 6024 (56.3% women, mean 62.8 ± 9.5 years of age) individuals had complete responses. RESULTS The prevalence of poor sleep quality was 24.9% (95%CI 23%-26%), and the PAF of poor sleep quality including other 10 modifiable risk factors of dementia was 52.5% in Brazil. Secondary analyses identified that sleep quality, restorative sleep and sleep drug usage varied considerably according to age ranges, race, and gender. CONCLUSIONS Poor sleep quality is an important populational modifiable risk factor for dementia in Brazil. Targeted interventions may provide an important impact in preventing dementia in low- and middle-income countries.
Collapse
Affiliation(s)
- Wyllians Vendramini Borelli
- Pharmacology and Therapeutics Research Program, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Cognitive and Behavioral Neurology Center, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giovani Noll
- Cognitive and Behavioral Neurology Center, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Medicine: Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - André C Tonon
- Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vanessa Bielefeldt Leotti
- Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Estatística, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raphael Machado Castilhos
- Cognitive and Behavioral Neurology Center, Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo R Zimmer
- Department of Pharmacology, Graduate Program in Biological Sciences: Biochemistry (PPGBioq) and Pharmacology and Therapeutics (PPGFT), Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- McGill Centre for Studies in Aging, Verdun, Quebec, Canada
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
3
|
Luchesi BM, Kajiyama MT, Abreu AR, Kwiatkoski M, Martins TCR. Monitoring risk factors for dementia in middle-aged and older adults: a longitudinal study. Dement Neuropsychol 2024; 18:e20230095. [PMID: 38659628 PMCID: PMC11041916 DOI: 10.1590/1980-5764-dn-2023-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 04/26/2024] Open
Abstract
Given the importance of dementia syndrome and its impacts on the population, interest in studying modifiable risk factors for dementia is growing. Objective To compare the prevalence of risk factors for dementia in middle-aged and older adults over a two-year period and to identify what variables in baseline were predictive of cognitive decline in the follow-up. Methods Longitudinal and quantitative study, with follow-up evaluation after two years, conducted with 200 participants aged 45 years or more, registered in Primary Care Units. In the baseline (2018/2019) and follow-up (2021) assessments, sociodemographic data were collected, and cognitive performance and risk factors for dementia were evaluated (education, hearing loss, head trauma, high blood pressure, alcohol use, obesity, smoking, depressive symptoms, social isolation, physical inactivity, and diabetes mellitus). Data were compared using the McNemar's test. Individual multinomial logistic regression models were performed to identify the factors associated with cognitive decline after two years. Results The percentages of low education, traumatic brain injury, and smoking remained the same in both assessments. There was a significant increase in the prevalence of high blood pressure (from 55.0 to 62.0%) and physical inactivity (from 58.5 to 74.5%) and a significant reduction in social isolation (from 25.0 to 18.0%). Participants with depressive symptoms in baseline had a higher risk of cognitive decline in follow-up. Conclusion There was an increase in the prevalence of high blood pressure and physical inactivity and a reduction in social isolation after two years. Depressive symptoms predict cognitive decline.
Collapse
Affiliation(s)
- Bruna Moretti Luchesi
- Universidade Federal do Mato Grosso do Sul, Campus Três Lagoas, Faculdade de Medicina, Três Lagoas MS, Brazil
- Universidade Federal do Mato Grosso do Sul, Campus Três Lagoas, Programa de Graduação em Enfermagem, Três Lagoas MS, Brazil
| | - Mariana Tiemi Kajiyama
- Universidade Federal do Mato Grosso do Sul, Campus Três Lagoas, Faculdade de Medicina, Três Lagoas MS, Brazil
| | - Amanda Rocha Abreu
- Universidade Federal do Mato Grosso do Sul, Campus Três Lagoas, Faculdade de Medicina, Três Lagoas MS, Brazil
| | - Marcelo Kwiatkoski
- Universidade Federal do Mato Grosso do Sul, Campus Três Lagoas, Faculdade de Medicina, Três Lagoas MS, Brazil
| | - Tatiana Carvalho Reis Martins
- Universidade Federal do Mato Grosso do Sul, Campus Três Lagoas, Programa de Graduação em Enfermagem, Três Lagoas MS, Brazil
| |
Collapse
|
4
|
Ferguson J, Alvarez A, Mulligan M, Judge C, O'Donnell M. Bias assessment and correction for Levin's population attributable fraction in the presence of confounding. Eur J Epidemiol 2024; 39:111-119. [PMID: 38170371 PMCID: PMC10904572 DOI: 10.1007/s10654-023-01063-8] [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: 08/01/2023] [Accepted: 10/16/2023] [Indexed: 01/05/2024]
Abstract
In 1953, Morton Levin introduced a simple approach to estimating population attributable fractions (PAF) depending only on risk factor prevalence and relative risk. This formula and its extensions are still in widespread use today, particularly to estimate PAF in populations where individual data is unavailable. Unfortunately, Levin's approach is known to be asymptotically biased for the PAF when the risk factor-disease relationship is confounded even if relative risks that are correctly adjusted for confounding are used in the estimator. Here we describe a simple re-expression of Miettinen's estimand that depends on the causal relative risk, the unadjusted relative risk and the population risk factor prevalence. While this re-expression is not new, it has been underappreciated in the literature, and the associated estimator may be useful in estimating PAF in populations when individual data is unavailable provided estimated adjusted and unadjusted relative risks can be transported to the population of interest. Using the re-expressed estimand, we develop novel analytic formulae for the relative and absolute asymptotic bias in Levin's formula, solidifying earlier work by Darrow and Steenland that used simulations to investigate this bias. We extend all results to settings with non-binary valued risk factors and continuous exposures and discuss the utility of these results in estimating PAF in practice.
Collapse
Affiliation(s)
- John Ferguson
- HRB Clinical Research Facility Galway, University of Galway, Galway, Ireland.
| | - Alberto Alvarez
- HRB Clinical Research Facility Galway, University of Galway, Galway, Ireland
| | - Martin Mulligan
- HRB Clinical Research Facility Galway, University of Galway, Galway, Ireland
| | - Conor Judge
- HRB Clinical Research Facility Galway, University of Galway, Galway, Ireland
| | - Martin O'Donnell
- HRB Clinical Research Facility Galway, University of Galway, Galway, Ireland
| |
Collapse
|
5
|
Dawson WD, Booi L, Pintado-Caipa M, Okada de Oliveira M, Kornhuber A, Spoden N, Golonka O, Shallcross L, Davidziuk A, Cominetti MR, Vergara-Manríquez M, Kochhann R, Robertson I, Eyre HA, Ibáñez A. The Brain Health Diplomat's Toolkit: supporting brain health diplomacy leaders in Latin America and the Caribbean. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100627. [PMID: 38046464 PMCID: PMC10689283 DOI: 10.1016/j.lana.2023.100627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 12/05/2023]
Abstract
Maintaining and improving brain health, one of the most critical global challenges of this century, necessitates innovative, interdisciplinary, and collaborative strategies to address the growing challenges in Latin America and the Caribbean. This paper introduces Brain Health Diplomacy (BHD) as a pioneering approach to bridge disciplinary and geographic boundaries and mobilize resources to promote equitable brain health outcomes in the region. Our framework provides a toolkit for emerging brain health leaders, equipping them with essential concepts and practical resources to apply in their professional work and collaborations. By providing case studies, we highlight the importance of culturally sensitive, region-specific interventions to address unique needs of vulnerable populations. By encouraging dialogue, ideation, and cross-sector discussions, we aspire to develop new research, policy, and programmatic avenues. The novel BHD approach has the potential to revolutionize brain health across the region and beyond, ultimately contributing to a more equitable global cognitive health landscape.
Collapse
Affiliation(s)
- Walter D. Dawson
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
- Layton Aging & Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CR131, Portland, OR, 97239, USA
- Institute on Aging, Portland State University, 1825 SW Broadway, Portland, OR, 97201, USA
| | - Laura Booi
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
- Centre for Dementia Research, School of Health, Leeds Beckett University, City Campus, Leeds, LS1 3HE, United Kingdom
| | - Maritza Pintado-Caipa
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
- Department of Neurology, Peruvian Institute of Neurosciences, Bartolomé Herrera 161, Lince, 15046, Lima, Peru
| | - Maira Okada de Oliveira
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Cognitive Neurology and Behavioral Unit (GNCC), University of São Paulo, Butanta, São Paulo, Brazil
| | - Alex Kornhuber
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
| | - Natasha Spoden
- Layton Aging & Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CR131, Portland, OR, 97239, USA
| | - Ona Golonka
- Layton Aging & Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CR131, Portland, OR, 97239, USA
| | - Lenny Shallcross
- World Dementia Council, World Dementia Council Executive Team, Floor 2, 33 Cavendish Square, London, W1G 0PW, United Kingdom
| | - Alejandra Davidziuk
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
| | - Márcia Regina Cominetti
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Federal University of Sao Carlos, Rod. Washington Luís, Km 235, Monjolinho, São Carlos, SP, CEP 13565-905, Brazil
| | - Mayte Vergara-Manríquez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
- University of Udine, Via Monsignor Pasquale Margreth, 3, 33100, Udine UD, Italy
- Center of Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
| | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento, Ramiro Barcelos 610, Porto Alegre, RS, 90035-000, Brazil
| | - Ian Robertson
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
| | - Harris A. Eyre
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
- Baker Center for Public Policy, Rice University, 6100 Main St, Houston, TX, 77005, USA
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Health and Education Research Building (HERB) at Barwon Health Deakin University School of Medicine, PO Box 281, Geelong, Victoria, 3220, Australia
- Euro-Mediterranean Economists Association, C/ de St. Antoni Maria Claret, 167, 08025, Barcelona, Spain
- Meadows Mental Health Policy Institute, 2800 Swiss Ave, Dallas, TX, 75204, USA
- Department of Psychiatry, Baylor College of Medicine, 1977 Butler Blvd Suite E4.400, Houston, TX, 77030, USA
| | - Agustin Ibáñez
- Global Brain Health Institute at University of California, San Francisco (UCSF), GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA and Trinity College Dublin, Room 0.60, Lloyd Building, Dublin 2, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Diagonal las Torres 2640, Peñalolén, RM, 7941169, Chile
- Universidad San Andres, Vito Dumas 284, B1644BID, Victoria, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Godoy Cruz 2290 (C1425FQB), Buenos Aires, Argentina
| |
Collapse
|
6
|
Vicerra PMM. Variations in cognition by human capital characteristics: a cross-sectional analysis of Brazilian older adults. Front Public Health 2023; 11:1257961. [PMID: 37942239 PMCID: PMC10628778 DOI: 10.3389/fpubh.2023.1257961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction The productivity of individuals is assumed to decline upon reaching old age when cognitive ability is considered. This assumption is false, especially if the human development characteristics of people are analyzed, which highlights the need to recognize the heterogeneity among subpopulations. Methods Using Wave two of the Brazilian Longitudinal Study on Aging, conducted from 2019 to 2021, this study explored the onset and speed of cognitive aging among older individuals aged at least 60 in Brazil, with reference to their education and income levels. Results It was observed that although higher human capital characteristics yielded results toward later cognitive decline, women benefited more from having higher educational attainment levels. Such a pattern was similar among men and increased income levels. Disparities in cognitive performance, whether from education or income, were greatest at age 60, and this advantage diminished as age progressed. Conclusion Viewing the older population as homogeneous in terms of health function is restrictive. It should be recognized that variations in social status affect individuals' health status into old age and therefore their respective potential for productivity should be maximized.
Collapse
|
7
|
Feter N, Leite JS, da Silva LS, Cassuriaga J, de Paula D, Lopes GW, Hallal PRC, Lee IM, Rombaldi AJ. Systematic review and meta-analysis on population attributable fraction for physical inactivity to dementia. Alzheimers Dement 2023; 19:4688-4704. [PMID: 37575082 DOI: 10.1002/alz.13417] [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: 02/27/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION The number of cases of dementia attributable to physical inactivity remains unclear due to heterogeneity in physical inactivity definitions and statistical approaches used. METHODS Studies that used population-based samples to estimate the population attributable fraction (PAF) of physical inactivity for dementia were included in this review. Weighted PAFs were adjusted for communality among the risk factors (i.e., inactive persons may also share other risk factors) analyzed. Values were reported as percentage (%) of cases of dementia attributable to physical inactivity. RESULTS We included 22 studies. The overall impact of physical inactivity, defined by any criteria, on dementia ranged from 6.6% (95% CI: 3.6%, 9.6%; weighted) to 16.6% (95% CI: 14.4%, 18.9%; unweighted). Studies using the WHO criterion for physical inactivity estimated a higher unweighted impact (β = 7.3%; 95% CI: 2.0%, 12.6%) than studies using other criteria. DISCUSSION Conservatively, one in 15 cases of dementia may be attributable to physical inactivity, defined by any criteria.
Collapse
Affiliation(s)
- Natan Feter
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jayne S Leite
- Post Graduate Program in Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luísa Silveira da Silva
- Post Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Júlia Cassuriaga
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Danilo de Paula
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Wünsch Lopes
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - I-Min Lee
- Division of Preventive Medicine, Brigham & Women's Hospital, Harvard Medical School; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Airton José Rombaldi
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| |
Collapse
|
8
|
Santamaria-Garcia H, Sainz-Ballesteros A, Hernandez H, Moguilner S, Maito M, Ochoa-Rosales C, Corley M, Valcour V, Miranda JJ, Lawlor B, Ibanez A. Factors associated with healthy aging in Latin American populations. Nat Med 2023; 29:2248-2258. [PMID: 37563242 PMCID: PMC10504086 DOI: 10.1038/s41591-023-02495-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023]
Abstract
Latin American populations may present patterns of sociodemographic, ethnic and cultural diversity that can defy current universal models of healthy aging. The potential combination of risk factors that influence aging across populations in Latin American and Caribbean (LAC) countries is unknown. Compared to other regions where classical factors such as age and sex drive healthy aging, higher disparity-related factors and between-country variability could influence healthy aging in LAC countries. We investigated the combined impact of social determinants of health (SDH), lifestyle factors, cardiometabolic factors, mental health symptoms and demographics (age, sex) on healthy aging (cognition and functional ability) across LAC countries with different levels of socioeconomic development using cross-sectional and longitudinal machine learning models (n = 44,394 participants). Risk factors associated with social and health disparities, including SDH (β > 0.3), mental health (β > 0.6) and cardiometabolic risks (β > 0.22), significantly influenced healthy aging more than age and sex (with null or smaller effects: β < 0.2). These heterogeneous patterns were more pronounced in low-income to middle-income LAC countries compared to high-income LAC countries (cross-sectional comparisons), and in an upper-income to middle-income LAC country, Costa Rica, compared to China, a non-upper-income to middle-income LAC country (longitudinal comparisons). These inequity-associated and region-specific patterns inform national risk assessments of healthy aging in LAC countries and regionally tailored public health interventions.
Collapse
Affiliation(s)
- Hernando Santamaria-Garcia
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio Bogotá, San Ignacio, Colombia.
- Pontificia Universidad Javeriana (PhD Program in Neuroscience) Bogotá, San Ignacio, Colombia.
| | | | - Hernán Hernandez
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Faculty of Engineering, University of Concepción, Concepción, Chile
| | - Sebastian Moguilner
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Cognitive Neuroscience Center, Universidad de San Andrés and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo Maito
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Carolina Ochoa-Rosales
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Michael Corley
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Victor Valcour
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Memory and Aging Center, University California San Francisco, San Francisco, CA, USA
| | - J Jaime Miranda
- Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Lawlor
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Agustin Ibanez
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
- Latin American Brain Health Institute, Universidad Adolfo Ibañez, Santiago de Chile, Chile.
- Cognitive Neuroscience Center, Universidad de San Andrés and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
- Trinity College Dublin, The University of Dublin, Dublin, Ireland.
| |
Collapse
|
9
|
Borelli WV, Formoso CR, Bieger A, Ferreira PL, Zimmer ER, Pascoal TA, Chaves MLF, Castilhos RM. Race‐related population attributable fraction of preventable risk factors of dementia: A Latino population‐based study. ALZHEIMER'S & DEMENTIA : DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2023; 15:e12408. [PMID: 36968620 PMCID: PMC10031750 DOI: 10.1002/dad2.12408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 03/24/2023]
Abstract
Background Risk factors for dementia have distinct frequency and impact in relation to race. Our aim was to identify differences in modifiable risk factors of dementia related to races and estimate their population attributable fraction (PAF). Methods An epidemiological cohort was used to estimate the prevalence of 10 modifiable risk factors for dementia among five races—White, Black, Brown, Asian, and Indigenous. Sample weighting was used to estimate the prevalence and PAF of each risk factor in each race. Results A total of 9070 individuals were included. Overall adjusted PAF was the lowest in Indigenous (38.9%), and Asian individuals (41.2%). Race‐related prevalence of individual risk factors was widely variable in our population, but hearing loss was the most important contributor to the overall PAF in all races. Conclusions Public policies aiming to reduce preventable risk factors for dementia should take into consideration the race of the target populations. HIGHLIGHTS Preventable risk factors for dementia vary according to race. Hearing loss presented the highest prevalence among all races studied. Indigenous and Asian individuals presented the lowest population attributable fractions. Black and Brown individuals were more vulnerable to social determinants.
Collapse
Affiliation(s)
- Wyllians Vendramini Borelli
- Pharmacology and Therapeutics Research ProgramUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
- Cognitive and Behavioral Neurology CenterNeurology ServiceHospital de Clínicas de Porto Alegre (HCPA)Porto AlegreBrazil
| | - Carolina Rodrigues Formoso
- Cognitive and Behavioral Neurology CenterNeurology ServiceHospital de Clínicas de Porto Alegre (HCPA)Porto AlegreBrazil
- Faculty of MedicineUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | - Andrei Bieger
- Faculty of MedicineUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
- Department of BiochemistryInstitute of Health SciencesUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | | | - Eduardo R. Zimmer
- Pharmacology and Therapeutics Research ProgramUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | | | - Marcia Lorena Fagundes Chaves
- Cognitive and Behavioral Neurology CenterNeurology ServiceHospital de Clínicas de Porto Alegre (HCPA)Porto AlegreBrazil
- Faculty of MedicineUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | - Raphael Machado Castilhos
- Cognitive and Behavioral Neurology CenterNeurology ServiceHospital de Clínicas de Porto Alegre (HCPA)Porto AlegreBrazil
- Faculty of MedicineUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| |
Collapse
|
10
|
Brain J, Tully PJ, Turnbull D, Tang E, Greene L, Beach S, Siervo M, Stephan BCM. Risk factors for dementia in the context of cardiovascular disease: A protocol of an overview of reviews. PLoS One 2022; 17:e0271611. [PMID: 35862400 PMCID: PMC9302739 DOI: 10.1371/journal.pone.0271611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Dementia is a major public health priority. Although there is abundant evidence of an association between dementia and poor cardiovascular health, findings have been inconsistent and uncertain in identifying which factors increase dementia risk in those with cardiovascular disease. Indeed, multiple variables including sociodemographic, economic, health, lifestyle and education may indicate who is at higher vs. lower dementia risk and could be used in prediction modelling. Therefore, the aim of this review is to synthesise evidence on the key risk factors for dementia in those with a history of cardiovascular disease.
Methods
This is an overview of reviews protocol, registered on PROSPERO (CRD42021265363). Four electronic databases including MEDLINE, EMBASE, PsycINFO, and the Cochrane Database of Systematic Reviews will be searched. Studies will be included if they are systematic reviews and/or meta-analyses that have investigated the risk of incident dementia (all-cause and subtypes including Alzheimer’s disease and vascular dementia) in people with a history of coronary heart disease, heart failure, atrial fibrillation, hypertension, hyperlipidaemia, and vascular stiffness. Study selection will be completed by two independent researchers according to the eligibility criteria, and conflicts resolved by a third reviewer. References will be exported into Covidence for title and abstract sifting, full-text review, and data extraction. Methodological quality will be assessed using the AMSTAR-2 criteria and confidence of evidence will be assessed using the GRADE classification. This overview of reviews will follow PRISMA guidelines. If there is sufficient homogeneity in the data, the results will be pooled, and a meta-analysis conducted to determine the strength of association between each risk factor and incident all-cause dementia and its subtypes for each cardiovascular diagnoses separately.
Discussion
We will create a comprehensive summary of the key risk factors linking cardiovascular diseases to risk of incident dementia. This knowledge is essential for informing risk predictive model development as well as the development of risk reduction and prevention strategies.
Collapse
Affiliation(s)
- Jacob Brain
- Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Jubilee Campus, Nottingham, United Kingdom
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Phillip J. Tully
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, Australia
| | - Deborah Turnbull
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Eugene Tang
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Leanne Greene
- Clinical Trials Unit, College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, United Kingdom
- * E-mail:
| | - Sarah Beach
- University of Nottingham Libraries, University of Nottingham, King’s Meadow Campus, Nottingham, United Kingdom
| | - Mario Siervo
- Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Jubilee Campus, Nottingham, United Kingdom
| | - Blossom C. M. Stephan
- Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Jubilee Campus, Nottingham, United Kingdom
| |
Collapse
|
11
|
Borelli WV, Zimmer ER, Bieger A, Coelho B, Pascoal TA, Chaves MLF, Amariglio R, Castilhos RM. Subjective cognitive decline in Brazil: Prevalence and association with dementia modifiable risk factors in a population‐based study. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12368. [PMCID: PMC9663677 DOI: 10.1002/dad2.12368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/13/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Wyllians Vendramini Borelli
- Cognitive and Behavioral Neurology Center Neurology Service Hospital de Clínicas de Porto Alegre Porto Alegre Rio Grande do Sul Brazil
- Graduate Research Program in Biological Sciences: Pharmacology and Therapeutics Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Rio Grande do Sul Brazil
| | - Eduardo R. Zimmer
- Graduate Research Program in Biological Sciences: Pharmacology and Therapeutics Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Rio Grande do Sul Brazil
- Graduate Research Program in Biological Sciences: Biochemistry Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Rio Grande do Sul Brazil
- Department of Pharmacology Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Rio Grande do Sul Brazil
| | - Andrei Bieger
- Graduate Research Program in Biological Sciences: Biochemistry Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Rio Grande do Sul Brazil
| | - Bruna Coelho
- Federal University of Pelotas Pelotas Rio Grande do Sul Brazil
| | - Tharick A. Pascoal
- Department of Neurology and Psychiatry University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Márcia Lorena Fagundes Chaves
- Cognitive and Behavioral Neurology Center Neurology Service Hospital de Clínicas de Porto Alegre Porto Alegre Rio Grande do Sul Brazil
| | - Rebecca Amariglio
- Departments of Neurology Massachusetts General Hospital and Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA
| | - Raphael Machado Castilhos
- Cognitive and Behavioral Neurology Center Neurology Service Hospital de Clínicas de Porto Alegre Porto Alegre Rio Grande do Sul Brazil
- Graduate Program in Medicine Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Rio Grande do Sul Brazil
| |
Collapse
|