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Chen S, Underwood BR, Cardinal RN, Chen X, Chen S, Amin J, Jin H, Huang J, Mueller C, Yan LL, Brayne C, Kuper H. Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004-2019). BMC Med 2024; 22:268. [PMID: 38926751 PMCID: PMC11210022 DOI: 10.1186/s12916-024-03464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England. METHODS We used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES). RESULTS The overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004-2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004-2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased. CONCLUSIONS In England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.
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Affiliation(s)
- Shanquan Chen
- International Centre for Evidence in Disability, London, School of Hygiene & Tropical Medicine , London, WC1E 7HT, UK.
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Rudolf N Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Xi Chen
- School of Public Health, Yale University, New Haven, CT, USA
| | - Shu Chen
- The ARC Centre of Excellence in Population Ageing Research (CEPAR), School of Risk and Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Jay Amin
- Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Huajie Jin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University , Beijing, China
| | - Christoph Mueller
- King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lijing L Yan
- Institute for Global Health and Development, Peking University , Beijing, China
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- School of Public Health, Wuhan University, Wuhan, China
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Carol Brayne
- Institute of Public Health, Forvie Site, University of Cambridge, Cambridge, CB2 2SR, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London, School of Hygiene & Tropical Medicine , London, WC1E 7HT, UK
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Nguyen HXT, Hyde Z, McNamara BJ, Hughson JA, Radford K, Russell S, Flicker L, Quigley R, Malay R, Strivens E, Withall A, Lavrencic L, Draper B, Delbaere K, Cumming R, LoGiudice D. Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies. BMC Neurol 2024; 24:185. [PMID: 38824519 PMCID: PMC11143581 DOI: 10.1186/s12883-024-03688-y] [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: 09/28/2023] [Accepted: 05/23/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Rates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia. METHODS/DESIGN Three cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI). DISCUSSION Greater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.
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Affiliation(s)
- Huong X T Nguyen
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia.
| | - Zoë Hyde
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
- Centre for Aboriginal Medical and Dental Health, Medical School, University of Western Australia, Perth, Australia
| | - Bridgette J McNamara
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
- Barwon South-West Public Health Unit, Barwon Health, Geelong, VIC, Australia
| | - Jo-Anne Hughson
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Roslyn Malay
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Adrienne Withall
- School of Psychology, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Louise Lavrencic
- Neuroscience Research Australia, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Brian Draper
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- School of Population Health, University of New South Wales, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
| | - Robert Cumming
- School of Public Health, University of Sydney, Sydney, Australia
| | - Dina LoGiudice
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia
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Kiadarbandsari A, Lemalu MT, Wilson S, Fa'alau F. Dementia among Minority Populations: A Scoping Review of Meaning, Language, and Translation. Dement Geriatr Cogn Disord 2024:1-11. [PMID: 38776886 DOI: 10.1159/000539446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Dementia as a neurocognitive disorder is becoming increasingly common worldwide, and minority groups are more vulnerable than the general population. Many factors may contribute to their vulnerability such as misconceptions, language barriers, cultural factors, invalid assessment tools, lack of knowledge, or assigning spiritual beliefs to dementia symptoms. Therefore, this scoping literature review aimed to clarify how empirical studies reflect the meaning of dementia, language, and translation among minority ethnic groups. SUMMARY The PRISMA extension for the scoping review protocol was used. Thirty-eight studies published in English were reviewed and analysed. The findings revealed that lack of knowledge about dementia and attributing the disease to the normal ageing process were frequent among minority groups. Furthermore, their cultural-specific perspectives and worldviews of wellness and well-being can impact the way dementia is perceived, consequent help-seeking behaviours, or caregiving. Facilitating educational programs to enhance the knowledge and experiences of ethnic communities might be beneficial. Moreover, language is shown to be an important aspect in dementia assessment and participants' educational level could significantly impact their functional capacity when responding to cognitive measures. Even though there are some useful screening tests, diagnosis barriers might be eased by assessment tool development, modifications, and accurate translations for ethnic communities. KEY MESSAGES A promising pathway to support ethnically diverse communities regarding dementia can be raising awareness, providing ethnic-specific services, developing cultural-specific tools to assess dementia or any cognitive impairment by considering perceptions, language, and culture among ethnic groups. Cultural and spiritual considerations could also encourage engagement during assessment.
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Affiliation(s)
- Atefeh Kiadarbandsari
- Pacific Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Miraneta Tafue Lemalu
- Pacific Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sharyn Wilson
- Counselling Service, Soul Talk, Auckland, New Zealand
| | - Fuafiva Fa'alau
- Pacific Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Ma'u E, Cullum S, Cheung G. Navigating ethnic diversity: Rethinking dementia prevention in Aotearoa New Zealand. Aust N Z J Psychiatry 2024; 58:381-384. [PMID: 38506472 DOI: 10.1177/00048674241240586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Etuini Ma'u
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Mental Health Services for Older People, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Mental Health Services for Older People, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Mental Health Services for Older People, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
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Jaisa-aad M, Muñoz-Castro C, Serrano-Pozo A. Update on modifiable risk factors for Alzheimer's disease and related dementias. Curr Opin Neurol 2024; 37:166-181. [PMID: 38265228 PMCID: PMC10932854 DOI: 10.1097/wco.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
PURPOSE OF REVIEW All human beings undergo a lifelong cumulative exposure to potentially preventable adverse factors such as toxins, infections, traumatisms, and cardiovascular risk factors, collectively termed exposome. The interplay between the individual's genetics and exposome is thought to have a large impact in health outcomes such as cancer and cardiovascular disease. Likewise, a growing body of evidence is supporting the idea that preventable factors explain a sizable proportion of Alzheimer's disease and related dementia (ADRD) cases. RECENT FINDINGS Here, we will review the most recent epidemiological, experimental preclinical, and interventional clinical studies examining some of these potentially modifiable risk factors for ADRD. We will focus on new evidence regarding cardiovascular risk factors, air pollution, viral and other infectious agents, traumatic brain injury, and hearing loss. SUMMARY While greater and higher quality epidemiological and experimental evidence is needed to unequivocally confirm their causal link with ADRD and/or unravel the underlying mechanisms, these modifiable risk factors may represent a window of opportunity to reduce ADRD incidence and prevalence at the population level via health screenings, and education and health policies.
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Affiliation(s)
- Methasit Jaisa-aad
- Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | - Clara Muñoz-Castro
- Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
- Universidad de Sevilla, Sevilla (Spain)
| | - Alberto Serrano-Pozo
- Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
- Massachusetts Alzheimer’s Disease Research Center
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Rosenau C, Köhler S, Soons LM, Anstey KJ, Brayne C, Brodaty H, Engedal K, Farina FR, Ganguli M, Livingston G, Lyketsos CG, Mangialasche F, Middleton LE, Rikkert MGMO, Peters R, Sachdev PS, Scarmeas N, Salbæk G, van Boxtel MPJ, Deckers K. Umbrella review and Delphi study on modifiable factors for dementia risk reduction. Alzheimers Dement 2024; 20:2223-2239. [PMID: 38159267 PMCID: PMC10984497 DOI: 10.1002/alz.13577] [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: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. HIGHLIGHTS: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.
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Affiliation(s)
- Colin Rosenau
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Lion M. Soons
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kaarin J. Anstey
- School of PsychologyUniversity of New South WalesKensingtonNew South WalesAustralia
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
| | - Carol Brayne
- Cambridge Public HealthUniversity of CambridgeCambridgeUK
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Knut Engedal
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
| | - Francesca R. Farina
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Mary Ganguli
- Departments of PsychiatryNeurologyand EpidemiologySchool of Medicine and School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Constantine G. Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer's DiseaseJohns Hopkins BayviewJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Francesca Mangialasche
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingMedical Unit AgingKarolinska University HospitalStockholmSweden
| | - Laura E. Middleton
- Department of Kinesiology and Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐UW Research Institute for AgingWaterlooOntarioCanada
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineRadboud University Medical CenterNijmegenthe Netherlands
- Radboudumc Alzheimer CenterDonders Center of Medical NeurosciencesNijmegenthe Netherlands
| | - Ruth Peters
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
- The George Institute for Global HealthNewtownNew South WalesAustralia
- School of Biomedical SciencesUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nikolaos Scarmeas
- 1st Department of NeurologyAiginition HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | - Geir Salbæk
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Martin P. J. van Boxtel
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kay Deckers
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
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Topçu S, Uçar T. Echocardiographic Screening of Rheumatic Heart Disease: Current Concepts and Challenges. Turk Arch Pediatr 2024; 59:3-12. [PMID: 38454255 PMCID: PMC10837514 DOI: 10.5152/turkarchpediatr.2024.23162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/10/2023] [Indexed: 03/09/2024]
Abstract
The incidence of acute rheumatic fever (ARF), which most commonly affects children aged 5-15 years after group A Streptococcus (GAS) infection, ranges from 8 to 51 per 100 000 people worldwide. Rheumatic heart disease (RHD), which occurs when patients with ARF are inappropriately treated or not given regular prophylaxis, is the most common cause of non-congenital heart disease in children and young adults in low-income countries. Timely treatment of GAS infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF. Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is a key aspect of RHD control. The most important factor determining the prognosis of RHD is the severity of cardiac involvement. Although approximately 70% of patients with carditis in the acute phase of the disease recover without sequelae, carditis is important because it is the only complication of ARF that causes sequelae. One-third of patients with ARF are asymptomatic. Patients with mild symptoms of recurrent ARF and silent RHD will develop severe morbidities within 5-10 years if they do not receive secondary preventive treatments. A new screening program should be established to prevent cardiac morbidities of ARF in moderate- and highrisk populations. In the present study, we examined the applicability of echocardiographic screening programs for RHD. Cite this article as: Topçu S, Uçar T. Echocardiographic screening of rheumatic heart disease: Current concepts and challenges. Turk Arch Pediatr. 2024;59(1):3-12.
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Affiliation(s)
- Seda Topçu
- Division of Social Pediatrics, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Nguyen HXT, Bradley K, McNamara BJ, Watson R, Malay R, LoGiudice D. Risk, protective, and biomarkers of dementia in Indigenous peoples: A systematic review. Alzheimers Dement 2024; 20:563-592. [PMID: 37746888 PMCID: PMC10917055 DOI: 10.1002/alz.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Dementia is an emergent health priority for Indigenous peoples worldwide, yet little is known about disease drivers and protective factors. METHODS Database searches were conducted in March 2022 to identify original publications on risk, protective, genetic, neuroradiological, and biological factors related to dementia and cognitive impairment involving Indigenous peoples. RESULTS Modifiable risk factors featured across multiple studies include childhood adversity, hearing loss, low education attainment, unskilled work history, stroke, head injury, epilepsy, diabetes, hypertension, hyperlipidemia, depression, low BMI, poor mobility, and continence issues. Non-modifiable risk factors included increasing age, sex, and genetic polymorphisms. Education, ex-smoking, physical and social activity, and engagement with cultural or religious practices were highlighted as potential protective factors. There is a paucity of research on dementia biomarkers involving Indigenous peoples. DISCUSSION Greater understanding of modifiable factors and biomarkers of dementia can assist in strength-based models to promote healthy ageing and cognition for Indigenous peoples.
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Affiliation(s)
- Huong X. T. Nguyen
- Department of MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Department of Population Health and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Kate Bradley
- Department of MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Bridgette J. McNamara
- Centre for Epidemiology and BiostatisticsUniversity of MelbourneVictoriaAustralia
- Barwon South‐West Public Health UnitBarwon HealthGeelongVictoriaAustralia
| | - Rosie Watson
- Department of MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Department of Population Health and ImmunityWalter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Roslyn Malay
- Western Australian Centre for Health and AgeingUniversity of Western AustraliaPerthWAAustralia
| | - Dina LoGiudice
- Department of MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
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Welberry HJ, Tisdell CC, Huque MH, Jorm LR. Have We Been Underestimating Modifiable Dementia Risk? An Alternative Approach for Calculating the Combined Population Attributable Fraction for Modifiable Dementia Risk Factors. Am J Epidemiol 2023; 192:1763-1771. [PMID: 37326043 PMCID: PMC10558200 DOI: 10.1093/aje/kwad138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Abstract
Estimating the fraction of dementia cases in a population attributable to a risk factor or combination of risk factors (the population attributable fraction (PAF)) informs the design and choice of dementia risk-reduction activities. It is directly relevant to dementia prevention policy and practice. Current methods employed widely in the dementia literature to combine PAFs for multiple dementia risk factors assume a multiplicative relationship between factors and rely on subjective criteria to develop weightings for risk factors. In this paper we present an alternative approach to calculating the PAF based on sums of individual risk. It incorporates individual risk factor interrelationships and enables a range of assumptions about the way in which multiple risk factors will combine to affect dementia risk. Applying this method to global data demonstrates that the previous estimate of 40% is potentially too conservative an estimate of modifiable dementia risk and would necessitate subadditive interaction between risk factors. We calculate a plausible conservative estimate of 55.7% (95% confidence interval: 55.2, 56.1) based on additive risk factor interaction.
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Affiliation(s)
- Heidi J Welberry
- Correspondence to Dr. Heidi J. Welberry, Centre for Big Data Research in Health, AGSM Building, University of New South Wales, Sydney, NSW 2052, Australia (e-mail: )
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Malheiro RM, Peleteiro B, Silva G, Lebre A, Paiva JA, Correia S. Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors. Infect Control Hosp Epidemiol 2023; 44:1601-1606. [PMID: 36945140 DOI: 10.1017/ice.2023.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF). DESIGN Retrospective cohort study. SETTING Portuguese hospitals performing regular surveillance. PATIENTS We identified patients who underwent colorectal procedures in hospitals that reported colorectal surgeries every year between 2015 and 2019. Among 42 reporting hospitals, 18 hospitals were included. METHODS Risk-factor incidence was estimated using the National Epidemiological Surveillance platform from 2015 to 2019. This platform follows the methodology recommended by the European Centre for Disease Prevention and Control. American Society of Anaesthesiologists (ASA) physical classification, wound classification, open surgery, urgent operation, antibiotic prophylaxis, operation time, and male sex were included as risk factors. Measures of association were retrieved from published meta-analyses. PAFs were calculated using the Levin formula. To account for interaction between risk factors, communality of risk factors was used in a weighted-sum approach, providing a combined value that serves as a measure of the comprehensiveness of surveillance. RESULTS Among 11,219 reported procedures, the cumulative SSI incidence was 16.8%. The proportion of SSI attributed to all risk factors was 61%. Modifiable variables accounted for 31% of procedures; the highest was laparotomy (16.8%), and urgent operations (2.7%) had the lowest value. Nonmodifiable factors accounted for 28.7%; the highest was wound classification (14.3%). CONCLUSIONS A relevant proportion (39%) of SSI remains unaccounted for by current surveillance. Almost one-third of SSI cases have potentially modifiable factors. Interventions focusing on shorter, less invasive procedures may be optimally effective in reducing the SSI incidence.
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Affiliation(s)
- Rui M Malheiro
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Bárbara Peleteiro
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departmento de Saúde Pública, Ciências forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
| | - Goreti Silva
- Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal
| | - Ana Lebre
- Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal
- Instituto Português de Oncologia do Porto Francisco Gentil, E.E., Porto, Portugal
| | - José Artur Paiva
- Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal
- Unidade de Cuidados Intensivos, Centro Hospitalar Universitário São João, Porto, Portugal
- Departmento de Medicina, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
| | - Sofia Correia
- Departmento de Saúde Pública, Ciências forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
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11
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Zhang Y, Chen SD, Deng YT, You J, He XY, Wu XR, Wu BS, Yang L, Zhang YR, Kuo K, Feng JF, Cheng W, Suckling J, David Smith A, Yu JT. Identifying modifiable factors and their joint effect on dementia risk in the UK Biobank. Nat Hum Behav 2023; 7:1185-1195. [PMID: 37024724 DOI: 10.1038/s41562-023-01585-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023]
Abstract
Previous hypothesis-driven research has identified many risk factors linked to dementia. However, the multiplicity and co-occurrence of risk factors have been underestimated. Here we analysed data of 344,324 participants from the UK Biobank with 15 yr of follow-up data for 210 modifiable risk factors. We first conducted an exposure-wide association study and then combined factors associated with dementia to generate composite scores for different domains. We then evaluated their joint associations with dementia in a multivariate Cox model. We estimated the potential impact of eliminating the unfavourable profiles of risk domains on dementia using population attributable fraction. The associations varied by domain, with lifestyle (16.6%), medical history (14.0%) and socioeconomic status (13.5%) contributing to the majority of dementia cases. Overall, we estimated that up to 47.0%-72.6% of dementia cases could be prevented.
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Affiliation(s)
- Yi Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Shi-Dong Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Yue-Ting Deng
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Jia You
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
| | - Xiao-Yu He
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Xin-Rui Wu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Bang-Sheng Wu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Ya-Ru Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Kevin Kuo
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Wei Cheng
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A David Smith
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China.
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12
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Thompson F, Russell S, Quigley R, Sagigi B, Miller G, Esterman A, Harriss LR, Taylor S, McDermott R, Strivens E. Dementia Risk Models in an Australian First Nations Population: Cross-Sectional Associations and Preparation for Follow-Up. J Alzheimers Dis Rep 2023; 7:543-555. [PMID: 37313487 PMCID: PMC10259055 DOI: 10.3233/adr-220093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/01/2023] [Indexed: 06/15/2023] Open
Abstract
Background Reducing the burden of dementia in First Nations populations may be addressed through developing population specific methods to quantify future risk of dementia. Objective To adapt existing dementia risk models to cross-sectional dementia prevalence data from a First Nations population in the Torres Strait region of Australia in preparation for follow-up of participants. To explore the diagnostic utility of these dementia risk models at detecting dementia. Methods A literature review to identify existing externally validated dementia risk models. Adapting these models to cross-sectional data and assessing their diagnostic utility through area under the receiver operating characteristic curve (AUROC) analyses and calibration using Hosmer-Lemeshow Chi2. Results Seven risk models could be adapted to the study data. The Aging, Cognition and Dementia (AgeCoDe) study, the Framingham Heart Study (FHS), and the Brief Dementia Screening Indicator (BDSI) had moderate diagnostic utility in identifying dementia (i.e., AUROC >0.70) before and after points for older age were removed. Conclusion Seven existing dementia risk models could be adapted to this First Nations population, and three had some cross-sectional diagnostic utility. These models were designed to predict dementia incidence, so their applicability to identify prevalent cases would be limited. The risk scores derived in this study may have prognostic utility as participants are followed up over time. In the interim, this study highlights considerations when transporting and developing dementia risk models for First Nations populations.
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Rachel Quigley
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | | | - Edward Strivens
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
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13
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Farina FR, Booi L, Occhipinti JA, Quoidbach V, Destrebecq F, Muniz-Terrera G, Eyre HA. Young Adult Brain Capital: A New Opportunity for Dementia Prevention. J Alzheimers Dis 2023:JAD230260. [PMID: 37302036 DOI: 10.3233/jad-230260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The potential for future prevention of Alzheimer's disease and related dementias (ADRD) through healthy lifestyle change is spurring a positive brain health movement. However, most ADRD research continues to focus on mid- and later life. We lack evidence regarding risk exposure and protective factors in young adulthood, i.e., 18-39 years. Brain capital is an emerging framework that represents the combination of education, knowledge, skills, and optimal brain health that people accumulate over their lives. Building on this framework, we present a new model that focuses on optimizing brain health in young adulthood; namely, young adult brain capital. Increasing focus on younger populations is critical for developing citizens who are emotionally intelligent, resilient and can anticipate and cope with rapid changes in the world. By understanding the values that are key drivers and motivators for young adults, we can empower the next generation to become active agents in optimizing their brain health and reducing their risk for future ADRD.
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Affiliation(s)
- Francesca R Farina
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
| | - Laura Booi
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
- Centre for Dementia Research, School of Health, Leeds Beckett University, Leeds, UK
| | - Jo-An Occhipinti
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Vinciane Quoidbach
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Frédéric Destrebecq
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Graciela Muniz-Terrera
- Ohio University Heritage College of Osteopathic Medicine, Warrensville Heights, OH, USA
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Harris A Eyre
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Neuroscience-Inspired Policy Initiative, Organisation for Economic Co-operation and Development (OECD), Paris, France
- Center for Health and Bioscience, The Baker Institute for Public Policy, Rice University, Houston, TX, USA
- Meadows Mental Health Policy Institute, Dallas, TX, USA
- Euro-Mediterranean Economists Association, Barcelona, Catalonia, Spain
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
- Brain Capital Alliance, San Francisco, CA, USA
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14
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Chan AHY, Hikaka JA, To E, Cullum S, Ma'u E, Ryan B, Rivera-Rodriguez C, Cheung G. Anti-dementia medication use in Aotearoa New Zealand: An exploratory study using health data from the Integrated Data Infrastructure (IDI). Aust N Z J Psychiatry 2023; 57:895-903. [PMID: 36053008 DOI: 10.1177/00048674221121091] [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: 11/15/2022]
Abstract
OBJECTIVE Anti-dementia medications such as acetylcholinesterase inhibitors are an important part of the management pathway for dementia. However, there are limited data in New Zealand that have examined the rates and patterns of use of funded anti-dementia medication and how use differs with ethnicity, age and sex. METHODS This was a retrospective population-based descriptive study. Using the Integrated Data Infrastructure, we identified individuals of all ages coded for a diagnosis of dementia and estimated the proportion dispensed funded anti-dementia medication - donepezil tablets and rivastigmine patches - between 1 July 2016 and 30 June 2020. Rates of medication use in five main ethnic groups (Māori, Pacific peoples, Asian, European, and Middle Eastern, Latin American and African) in the <65, 65-79 and 80 and over (80+) age groups were compared and also between males and females in all sub-groups. Log-binomial models were used to calculate relative risks to determine any differences in anti-dementia medication use in the five ethnic groups and the three age groups and between males and females in each of the four study years. RESULTS Overall, one-third of the dementia population received a funded anti-dementia medication in the total population (all ages) between 2016 and 2020. Donepezil tablets were dispensed in 31.6-34.0% and rivastigmine patches in 1.4-2.1% across the four study years. Compared to people of European ethnicity, Māori, Pacific peoples, and Middle Eastern, Latin American and African groups were less likely to be dispensed an anti-dementia medication (Māori: relative risk = 0.79-0.81, p < 0.0001; Pacific peoples: relative risk = 0.72-0.74, p < 0.0001; Middle Eastern, Latin American and African: relative risk = 0.73-0.78, p < 0.05). Compared to the age 80+ group, the 65-79 age group was more likely (relative risk = 1.50-1.54, p < 0.0001), while the age <65 group was less likely (relative risk = 0.67-0.71, p < 0.0001) to be dispensed an anti-dementia medication. There were no statistically significant differences in anti-dementia medication use between males and females. CONCLUSION This study provides important information about funded anti-dementia medication use in New Zealand and how this differs by ethnicity, age and sex. Despite higher dementia prevalence in Māori and Pacific peoples, these groups were less likely to receive funded anti-dementia medication.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jo Anna Hikaka
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Edith To
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Brigid Ryan
- Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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15
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Sommerlad A, Kivimäki M, Larson EB, Röhr S, Shirai K, Singh-Manoux A, Livingston G. Social participation and risk of developing dementia. NATURE AGING 2023; 3:532-545. [PMID: 37202513 DOI: 10.1038/s43587-023-00387-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/22/2023] [Indexed: 05/20/2023]
Abstract
The increasing number of people with dementia globally illustrates the urgent need to reduce dementia's scale and impact. Lifetime social participation may affect dementia risk by increasing cognitive reserve, and through brain maintenance by reducing stress and improving cerebrovascular health. It may therefore have important implications for individual behavior and public health policy aimed at reducing dementia burden. Observational study evidence indicates that greater social participation in midlife and late life is associated with 30-50% lower subsequent dementia risk, although some of this may not be causal. Social participation interventions have led to improved cognition but, partly due to short follow-up and small numbers of participants, no reduction in risk of dementia. We summarize the evidence linking social participation with dementia, discuss potential mechanisms by which social participation is likely to reduce and mitigate the impact of neuropathology in the brain, and consider the implications for future clinical and policy dementia prevention interventions.
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Affiliation(s)
- Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK.
- Camden and Islington NHS Foundation Trust, London, UK.
| | - Mika Kivimäki
- Division of Psychiatry, University College London, London, UK
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eric B Larson
- University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
| | - Susanne Röhr
- School of Psychology, Massey University, Manawatu, New Zealand
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Kokoro Shirai
- Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Archana Singh-Manoux
- Division of Psychiatry, University College London, London, UK
- Université Paris Cité, Inserm, U1153, Paris, France
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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16
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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.
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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
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Trettel CDS, Pelozin BRDA, Barros MP, Bachi ALL, Braga PGS, Momesso CM, Furtado GE, Valente PA, Oliveira EM, Hogervorst E, Fernandes T. Irisin: An anti-inflammatory exerkine in aging and redox-mediated comorbidities. Front Endocrinol (Lausanne) 2023; 14:1106529. [PMID: 36843614 PMCID: PMC9951776 DOI: 10.3389/fendo.2023.1106529] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/12/2023] Open
Abstract
Human beings lead largely sedentary lives. From an evolutionary perspective, such lifestyle is not beneficial to health. Exercise can promote many enabling pathways, particularly through circulating exerkines, to optimize individual health and quality of life. Such benefits might explain the protective effects of exercise against aging and noncommunicable diseases. Nevertheless, the miRNA-mediated molecular mechanisms and exerkine interorgan crosstalk that underlie the beneficial effects of exercise remain poorly understood. In this mini review, we focused on the exerkine, irisin, mainly produced by muscle contraction during adaptation to exercise and its beneficial effects on body homeostasis. Herein, the complex role of irisin in metabolism and inflammation is described, including its subsequent effects on thermogenesis through browning to control obesity and improve glycemic regulation for diabetes mellitus control, its potential to improve cognitive function (via brain derived neurotrophic factor), and its pathways of action and role in aging.
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Affiliation(s)
- Caio dos Santos Trettel
- Interdisciplinary Program in Health Sciences, Institute of Physical Activity Sciences and Sports, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Bruno Rocha de Avila Pelozin
- Laboratory of Biochemistry and Molecular Biology of Exercise, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Paes Barros
- Interdisciplinary Program in Health Sciences, Institute of Physical Activity Sciences and Sports, Cruzeiro do Sul University, Sao Paulo, Brazil
| | | | - Pedro Gabriel Senger Braga
- Laboratory of Metabolism and Lipids, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Guilherme Eustáquio Furtado
- Applied Research Institute, Polytechnic Institute of Coimbra, Coimbra, Portugal
- Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2020), Faculty of Sport Sciences and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Pedro Afonso Valente
- Research Centre for Sport and Physical Activity, Faculty of Sport Science and Physical Education, University of Coimbra, Coimbra, Portugal
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Edilamar Menezes Oliveira
- Laboratory of Biochemistry and Molecular Biology of Exercise, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Eef Hogervorst
- National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Tiago Fernandes
- Laboratory of Biochemistry and Molecular Biology of Exercise, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
- *Correspondence: Tiago Fernandes,
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Suemoto CK, Mukadam N, Brucki SM, Caramelli P, Nitrini R, Laks J, Livingston G, Ferri CP. Risk factors for dementia in Brazil: Differences by region and race. Alzheimers Dement 2022; 19:1849-1857. [PMID: 36326095 DOI: 10.1002/alz.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Twelve risk factors (RFs) account for 40% of dementia cases worldwide. However, most data for population attributable fractions (PAFs) are from high-income countries (HIC). We estimated how much these RFs account for dementia cases in Brazil, stratifying estimates by race and socioeconomic level. METHODS We calculated the prevalence and communalities of 12 RFs using 9412 Brazilian Longitudinal Study of Aging participants, then stratified according to self-reported race and country macro-regions. RESULTS The overall weighted PAF was 48.2%. Less education had the largest PAF (7.7%), followed by hypertension (7.6%), and hearing loss (6.8%). PAF was 49.0% and 54.0% in the richest and poorest regions, respectively. PAFs were similar among White and Black individuals (47.8% and 47.2%, respectively) but the importance of the main RF varied by race. DISCUSSION Brazil's potential for dementia prevention is higher than in HIC. Education, hypertension, and hearing loss should be priority targets.
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Affiliation(s)
- Claudia K. Suemoto
- Division of Geriatrics Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | | | - Sonia M.D. Brucki
- Department of Neurology Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Paulo Caramelli
- Department of Internal Medicine Faculdade de Medicina Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Ricardo Nitrini
- Department of Neurology Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Jerson Laks
- Department of Psychiatry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | | | - Cleusa P. Ferri
- Health Technology Assessment Unit Hospital Alemão Oswaldo Cruz São Paulo Brazil
- Department of Psychiatry Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
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Fonseka L, Wang D, Ryan B, Cheung G, Ma’u E. Incidence of Young Onset Dementia in Waikato, New Zealand: A Population-Based Study. J Alzheimers Dis 2022; 90:1321-1327. [DOI: 10.3233/jad-220802] [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: There is limited epidemiological research on the incidence of young onset dementia (YOD). Estimates of YOD incidence in New Zealand are extrapolated from international studies that do not reflect New Zealand’s population and ethnic diversity. Objective: To determine the incidence of YOD in the geographical area served by the Waikato District Health Board Methods: All new inpatient and outpatient in the age range 30–64 years with a documented diagnosis of dementia at Waikato Hospital between 1 January 2014 –31 December 2016 were identified. Incidence rates were calculated by 5-year age-band, sex, and ethnicity. Results: 64 incident cases of YOD were included. Incidence rates for all cause YOD were 13.3 (95% CI 10.3–17.0) and 22.7 (95% CI 17.5–29.1) per 100,000 person-years in the age range 30–64 years and 45–64 years respectively. The incidence rate in Māori (20.0, 95% CI 11.4–32.4) was higher compared to non-Māori (12.0, 95% CI 8.9–15.9), but this difference was not statistically significant (p = 0.09). Conclusion: The incidence of YOD in this study is similar to global estimates. Incidence may be higher in Māori compared to non-Māori, highlighting the need for culturally appropriate approaches to dementia prevention, intervention, and care.
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Affiliation(s)
| | - David Wang
- Department of Medicine, University of Otago, DunedinNew Zealand
| | - Brigid Ryan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Etuini Ma’u
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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20
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Cheung G, To E, Rivera-Rodriguez C, Ma'u E, Chan AHY, Ryan B, Cullum S. Dementia prevalence estimation among the main ethnic groups in New Zealand: a population-based descriptive study of routinely collected health data. BMJ Open 2022; 12:e062304. [PMID: 36691174 PMCID: PMC9454053 DOI: 10.1136/bmjopen-2022-062304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Estimates of dementia prevalence in New Zealand (NZ) have previously been extrapolated from limited Australasian studies, which may be neither accurate nor reflect NZ's unique population and diverse ethnic groups. This study used routinely collected health data to estimate the 1-year period prevalence for diagnosed dementia for each of the 4 years between July 2016 and June 2020 in the age 60+ and age 80+ populations and for the four main ethnic groups. DESIGN A population-based descriptive study. SETTING Seven national health data sets within the NZ Integrated Data Infrastructure (IDI) were linked. Diagnosed dementia prevalence for each year was calculated using the IDI age 60+ and age 80+ populations as the denominator and also age-sex standardised to allow comparison across ethnic groups. PARTICIPANTS Diagnosed dementia individuals in the health datasets were identified by diagnostic or medication codes used in each of the data sets with deduplication of those who appeared in more than one data set. RESULTS The crude diagnosed dementia prevalence was 3.8%-4.0% in the age 60+ population and 13.7%-14.4% in the age 80+ population across the four study years. Dementia prevalence age-sex standardised to the IDI population in the last study period of 2019-2020 was 5.4% for Māori, 6.3% for Pacific Islander, 3.7% for European and 3.4% for Asian in the age 60+ population, and 17.5% for Māori, 22.2% for Pacific Islander, 13.6% for European and 13.5% for Asian in the age 80+ population. CONCLUSIONS This study provides the best estimate to date for dementia prevalence in NZ but is limited to those people who were identified as having dementia based on data from the seven included data sets. The findings suggest that diagnosed dementia prevalence is higher in Māori and Pacific Islanders. A nationwide NZ community-based dementia prevalence study is much needed to confirm the findings of this study.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Edith To
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | | | - Etuini Ma'u
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Brigid Ryan
- Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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21
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Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, Campbell S, Esterman A, Harriss LR, Miller G, Strivens E, McDermott R. Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A cross sectional analysis using population attributable fractions. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100532. [PMID: 35833207 PMCID: PMC9272378 DOI: 10.1016/j.lanwpc.2022.100532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Dementia is highly prevalent among Australia's First Nations peoples, including Torres Strait Islander and Aboriginal peoples in Far North Queensland (FNQ). It is likely that historically recent exposure to modifiable risk factors underlies these rates, and a large proportion of dementia may be potentially preventable. Methods Data from two adult community health checks (2015-2018) were analyzed to determine the prevalence of 11 modifiable dementia risk factors among the First Nations residents of the Torres Strait and Northern Peninsula Area of FNQ. Population attributable fractions (PAF%) for dementia were calculated using age-standardized prevalence estimates derived from these health checks and relative risks obtained from previous meta-analyses in other populations. PAF% estimates were weighted for communality to account for overlap of risk factors. Findings Half (52·1%) of the dementia burden in this population may be attributed to 11 potentially modifiable risk factors. Hypertension (9·4%), diabetes mellitus (9·0%), obesity (8·0%), and smoking (5·3%) were the highest contributing risk factors. The contribution of depression (2·0%) and alcohol (0·3%) was lower than other global and national estimates. While the adjusted PAF% for social isolation was low based on the adult community health check data (1·6%), it was higher (4·2%) when official census data were analyzed. Interpretation These results suggest that a substantial proportion of dementia in FNQ First Nations peoples could potentially be prevented. Government investment in preventative health now is essential to reduce the future burden of dementia. Funding National Health and Medical Research Council (NHMRC, GNT1107140, GNT1191144, GNT1106175, GNT0631947).
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
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22
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Tippett LJ, Cawston EE, Morgan CA, Melzer TR, Brickell KL, Ilse C, Cheung G, Kirk IJ, Roberts RP, Govender J, Griner L, Le Heron C, Buchanan S, Port W, Dudley M, Anderson TJ, Williams JM, Cutfield NJ, Dalrymple-Alford JC, Wood P. Dementia Prevention Research Clinic: a longitudinal study investigating factors influencing the development of Alzheimer’s disease in Aotearoa, New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2098780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Lynette J. Tippett
- NZ-Dementia Prevention Research Clinic, New Zealand
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Erin E. Cawston
- NZ-Dementia Prevention Research Clinic, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Department of Pharmacology, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Catherine A. Morgan
- NZ-Dementia Prevention Research Clinic, New Zealand
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Tracy R. Melzer
- NZ-Dementia Prevention Research Clinic, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Kiri L. Brickell
- NZ-Dementia Prevention Research Clinic, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Christina Ilse
- NZ-Dementia Prevention Research Clinic, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Gary Cheung
- NZ-Dementia Prevention Research Clinic, New Zealand
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Ian J. Kirk
- NZ-Dementia Prevention Research Clinic, New Zealand
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Reece P. Roberts
- NZ-Dementia Prevention Research Clinic, New Zealand
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Jane Govender
- NZ-Dementia Prevention Research Clinic, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Leon Griner
- NZ-Dementia Prevention Research Clinic, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Department of Pharmacology, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Campbell Le Heron
- NZ-Dementia Prevention Research Clinic, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Dept of Neurology, Canterbury District Health Board, Christchurch, New Zealand
| | - Sarah Buchanan
- NZ-Dementia Prevention Research Clinic, New Zealand
- Department of Neurology, Southern District Health Board, Dunedin, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Waiora Port
- NZ-Dementia Prevention Research Clinic, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Makarena Dudley
- NZ-Dementia Prevention Research Clinic, New Zealand
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Tim J. Anderson
- NZ-Dementia Prevention Research Clinic, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Dept of Neurology, Canterbury District Health Board, Christchurch, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Joanna M. Williams
- NZ-Dementia Prevention Research Clinic, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin, New Zealand
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Nicholas J. Cutfield
- NZ-Dementia Prevention Research Clinic, New Zealand
- Department of Neurology, Southern District Health Board, Dunedin, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - John C. Dalrymple-Alford
- NZ-Dementia Prevention Research Clinic, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
| | - Phil Wood
- NZ-Dementia Prevention Research Clinic, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
- Ministry of Health, Wellington, New Zealand
- Department of Older Adults and Home Health, Waitemata District Health Board, Auckland, New Zealand
- Brain Research New Zealand, Rangahau Roro Aotearoa, Dunedin, New Zealand
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23
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Ryan B, To E, Ma'u E, Chan AHY, Rivera-Rodriguez C, Curtis MA, Cullum S, Cheung G. Prevalence of young-onset dementia: nationwide analysis of routinely collected data. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329126. [PMID: 35995550 DOI: 10.1136/jnnp-2022-329126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/23/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Young-onset dementia prevalence is understudied internationally. Previous studies have been limited by low case numbers, reliance on single sources of routinely collected health data for case identification and inclusion of a limited age range. Our objective was to determine the 1-year period prevalence of diagnosed dementia in people aged 0-64 in the entire New Zealand population using routinely collected health data. METHODS A population-based descriptive study was carried out in New Zealand (population 4.8 million) using routinely collected deidentified health data from 2016 to 2020. Dementia cases in seven linked health datasets in the New Zealand Integrated Data Infrastructure were identified using diagnostic codes and/or use of antidementia medication. Prevalence for each of the four study years was calculated by age, sex and ethnicity. RESULTS From a total population of 4 027 332-4 169 754 individuals aged 0-64, we identified 3396-3474 cases of 'all-cause' dementia in each of the study years (prevalence crude range: 83-84/100 000 people aged 0-64; 139-141/100 000 people aged 30-64 years; 204-207/100 000 people aged 45-64 years). Age-standardised prevalence was higher in males than females. Age-standardised and sex-standardised prevalence was higher in Māori and Pacific People than European and Asian. DISCUSSION By using a large study population and multiple national health datasets, we have minimised selection bias and estimated the national prevalence of diagnosed young-onset dementia with precision. Young-onset dementia prevalence for the total New Zealand population was similar to reported global prevalence, validating previous estimates. Prevalence differed by ethnicity, which has important implications for service planning.
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Affiliation(s)
- Brigid Ryan
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
| | - Edith To
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | - Maurice A Curtis
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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24
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Lee M, Whitsel E, Avery C, Hughes TM, Griswold ME, Sedaghat S, Gottesman RF, Mosley TH, Heiss G, Lutsey PL. Variation in Population Attributable Fraction of Dementia Associated With Potentially Modifiable Risk Factors by Race and Ethnicity in the US. JAMA Netw Open 2022; 5:e2219672. [PMID: 35793088 PMCID: PMC9260480 DOI: 10.1001/jamanetworkopen.2022.19672] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Identifying modifiable risk factors that are associated with dementia burden across racial and ethnic groups in the population can yield insights into the potential effectiveness of interventions in preventing dementia and reducing disparities. OBJECTIVE To calculate the population attributable fraction (PAF) of dementia associated with 12 established modifiable risk factors for all US adults, as well as separately by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used survey data from nationally representative samples of US adults. PAFs were calculated using relative risks and prevalence estimates for 12 risk factors. Relative risks were taken from meta-analyses, as reported in a 2020 systematic review. Prevalence estimates for risk factors were derived from nationally representative cross-sectional survey data collected between 2011 and 2018. Combined PAFs were adjusted for risk factor communality using weights derived from the Atherosclerosis Risk in Communities (ARIC) study (1987-2018). Analyses were conducted May through October 2021. EXPOSURES Low education, hearing loss, traumatic brain injury, hypertension, excessive alcohol consumption, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and air pollution. MAIN OUTCOMES AND MEASURES PAF for each dementia risk factor, a combined PAF, and the decrease in the number of prevalent dementia cases in 2020 that would be expected given a 15% proportional decrease in each exposure. RESULTS Among all US adults, an estimated 41.0% (95% CI, 22.7%-55.9%) of dementia cases were attributable to 12 risk factors. A 15% proportional decrease in each risk factor would reduce dementia prevalence in the population by an estimated 7.3% (95% CI, 3.7%-10.9%). The estimated PAF was greater for Black and Hispanic than it was for White and Asian individuals. The greatest attributable fraction of dementia cases was observed for hypertension (PAF, 20.2%; 95% CI, 6.3%-34.4%), obesity (PAF, 20.9%; 95% CI, 13.0%-28.8%), and physical inactivity (PAF, 20.1%; 95% CI, 9.1%-29.6%). These factors were also highest within each racial and ethnic group, although the proportions varied. CONCLUSIONS AND RELEVANCE A large fraction of dementia cases in the US were associated with potentially modifiable risk factors, especially for Black and Hispanic individuals. Targeting and reducing these risk factors may curb the projected rise in dementia cases over the next several decades.
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Affiliation(s)
- Mark Lee
- Department of Sociology, University of Minnesota, Minneapolis
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Eric Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Christy Avery
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Alzheimer’s Disease Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Thomas H. Mosley
- School of Medicine, University of Mississippi Medical Center, Jackson
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
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