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Merrick R, Brayne C. Sex Differences in Dementia, Cognition, and Health in the Cognitive Function and Ageing Studies (CFAS). J Alzheimers Dis 2024:JAD240358. [PMID: 39121118 DOI: 10.3233/jad-240358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
Background There is renewed interest in whether sex differences in dementia risk exist, and what influence social and biological factors have. Objective To review evidence from the Cognitive Function and Ageing Studies (CFAS), a multi-center population-representative cohort study in the UK; focusing on dementia and cognition, incorporating findings on participants' health and social circumstances. Methods After identifying all CFAS publications, the results of all sex-stratified primary analyses of CFAS data were narratively reviewed. Results Of 337 publications, 94 report results by sex (including null findings), which are summarized by theme: dementia epidemiology, cognition, mental health, health expectancy, social context and biological resource (including neuropathology). Conclusions Where differences are found they most commonly favor men; however, greater mortality in men may confound associations with age-related outcomes. This 'survival bias' may explain findings of greater risk of dementia and faster cognitive decline in women. Age-specific dementia incidence was similar between sexes, although reduced incidence across study generations was more pronounced in men. Mood disorders were more prevalent in women, but adjusting for disability and deprivation attenuated the association. Prominent findings from other cohorts that women have more Alzheimer's disease pathology and greater risk of dementia from the Apolipoprotein E ɛ4 allele were not observed, warranting further investigation. The 'male-female health-survival paradox' is demonstrated whereby women live longer but with more comorbidity and disability. Examining why health expectancies changed differently over two decades for each sex (interacting with deprivation) may inform population interventions to improve cognitive, mental and physical health in later life.
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Affiliation(s)
- Richard Merrick
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Morris B, Roper L, Lloyd P, Shillito T, Dixon P, Marson AG, Noble AJ. "In the wilderness…dealing with difficult situations": Knowledge exchange with care home staff in England on managing seizures and epilepsy - An initial exploration. Epilepsy Behav 2024; 158:109936. [PMID: 38970890 DOI: 10.1016/j.yebeh.2024.109936] [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: 04/05/2024] [Revised: 06/04/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE With epilepsy increasingly affecting older adults, seizure-related care needs arise in new settings. Persons in these settings must receive optimal support and challenges identified for remediation. This may entail the epilepsy community researching in unfamiliar environments. One setting is care homes. Seizure-related ambulance incidents in them are common. We conducted the first qualitative study with care home staff to explore their experiences and challenges in managing suspected seizures. METHODS Three online focus groups were organised for January 2024 to explore ambulance calls, post-incident procedures, and challenges faced by care home staff when managing seizures. Persons were eligible to participate if they worked as a care assistant, nurse or manager in a care home in North-West England. Different recruitment pathways were employed including direct approach, a managers' network, social media and a register of research interested homes. Focus group audio recordings were transcribed and analysed using Hamilton's Rapid Analysis. RESULTS Recruitment was difficult; 13 care home staff from 12 different homes were ultimately recruited. Despite data saturation not being achieved, insights were gained regarding ambulance call decisions, paperwork navigation, and follow-up care challenges. Patients not having meaningful seizure action plans in place and regulatory restrictions were identified as factors that contributed to potentially avoidable calls for ambulance help being made. CONCLUSION This study highlights systemic issues in care homes' seizure care, emphasizing the need for further research. The epilepsy community may need to innovate to better research within this increasingly important setting. This study offers insights into the effectiveness of different recruitment strategies.
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Affiliation(s)
- Beth Morris
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Louise Roper
- Principal Health Psychologist, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Pete Dixon
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Antony G Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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Korhonen K, Moustgaard H, Murphy M, Martikainen P. Trends in Life Expectancy in Residential Long-Term Care by Sociodemographic Position in 1999-2018: A Multistate Life Table Study of Finnish Older Adults. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae067. [PMID: 38629853 PMCID: PMC11157624 DOI: 10.1093/geronb/gbae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES Residential long-term care (LTC) use has declined in many countries over the past years. This study quantifies how changing rates of entry, exit, and mortality have contributed to trends in life expectancy in LTC (i.e., average time spent in LTC after age 65) across sociodemographic groups. METHODS We analyzed population-register data of all Finns aged ≥65 during 1999-2018 (n = 2,016,987) with dates of LTC and death and sociodemographic characteristics. We estimated transition rates between home, LTC, and death using Poisson generalized additive models, and calculated multistate life tables across 1999-2003, 2004-2008, 2009-2013, and 2014-2018. RESULTS Between 1999-2003 and 2004-2008, life expectancy in LTC increased from 0.75 (95% CI: 0.74-0.76) to 0.89 (95% CI: 0.88-0.90) years among men and from 1.61 (95% CI: 1.59-1.62) to 1.83 (95% CI: 1.81-1.85) years among women, mainly due to declining exit rates from LTC. Thereafter, life expectancy in LTC decreased, reaching 0.80 (95% CI: 0.79-0.81) and 1.51 (95% CI: 1.50-1.53) years among men and women, respectively, in 2014-2018. Especially among women and nonmarried men, the decline was largely due to increasing death rates in LTC. Admission rates declined throughout the study period, which offset the increase in life expectancy in LTC attributable to declining mortality in the community. Marital status differences in life expectancy in LTC narrowed over time. DISCUSSION Recent declines in LTC use were driven by postponed LTC admission closer to death. The results suggest that across sociodemographic strata older adults enter LTC in even worse health and spend a shorter time in care than before.
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Affiliation(s)
- Kaarina Korhonen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Heta Moustgaard
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Institute for Social Sciences and Humanities (HSSH), University of Helsinki, Helsinki, Finland
| | - Michael Murphy
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Duval GT, Raud E, Gohier H, Dramé M, Tabue-Teguo M, Annweiler C. Orthostatic hypotension and cognitive impairment: Systematic review and meta-analysis of longitudinal studies. Maturitas 2024; 185:107866. [PMID: 38604094 DOI: 10.1016/j.maturitas.2023.107866] [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: 04/13/2023] [Revised: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 04/13/2024]
Abstract
The association between cognitive disorders and orthostatic hypotension (OH) has been empirically explored, but the results have been divergent, casting doubt on the presence and direction of the association. The objective of this meta-analysis was to systematically review and quantitatively synthesize the association of OH and cognitive function, specifically mean score on the Mini-Mental State Examination (MMSE), cognitive impairment and incident dementia. A Medline search was conducted in May 2022 with no date limit, using the MeSH terms "orthostatic hypotension" OR "orthostatic intolerance" OR "hypotension" combined with the Mesh terms "cognitive dysfunction" OR "Alzheimer disease" OR "dementia" OR "cognition disorder" OR "neurocognitive disorder" OR "cognition" OR "neuropsychological test". Of the 746 selected studies, 15 longitudinal studies met the selection criteria, of which i) 5 studies were eligible for meta-analysis of mean MMSE score comparison, ii) 5 studies for the association of OH and cognitive impairment, and iii) 6 studies for the association between OH and incident dementia. The pooled effect size in fixed-effects meta-analysis was: i) -0.25 (-0.42; -0.07) for the mean MMSE score, which indicates that the MMSE score was lower for those with OH; ii) OR (95 % CI) = 1.278 (1.162; 1.405), P < 0.0001, indicating a 28 % greater risk of cognitive impairment for those with OH at baseline; and iii) HR (95 % CI) = 1.267 (1.156; 1.388), P < 0.0001, indicating a 27 % greater risk of incident dementia for those with OH at baseline. Patients with OH had a lower MMSE score and higher risk of cognitive impairment and incident dementia in this meta-analysis of longitudinal studies. This study confirmed the presence of an association between OH and cognitive disorders in older adults.
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Affiliation(s)
- Guillaume T Duval
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
| | - Eve Raud
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Hugo Gohier
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Moustapha Dramé
- University of the French West Indies, EpiCliV Research Unit, Fort-de-France, Martinique; University Hospitals of Martinique, Department of Clinical Research and Innovation, Fort-de-France, Martinique
| | - Maturin Tabue-Teguo
- Department of Geriatrics, University Hospital of Martinique, Fort-de-France, Martinique
| | - Cédric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France; Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, St. Joseph's Health Care London, Gait and Brain Lab, Lawson Health Research Institute, the University of Western Ontario, London, ON, Canada; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Mukadam N, Wolters FJ, Walsh S, Wallace L, Brayne C, Matthews FE, Sacuiu S, Skoog I, Seshadri S, Beiser A, Ghosh S, Livingston G. Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies. Lancet Public Health 2024; 9:e443-e460. [PMID: 38942556 DOI: 10.1016/s2468-2667(24)00120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Some cohort studies have reported a decline in dementia prevalence and incidence over time, although these findings have not been consistent across studies. We reviewed evidence on changes in dementia prevalence and incidence over time using published population-based cohort studies that had used consistent methods with each wave and aimed to quantify associated changes in risk factors over time using population attributable fractions (PAFs). METHODS We searched for systematic reviews of cohort studies examining changes in dementia prevalence or incidence over time. We searched PubMed for publications from database inception up to Jan 12, 2023, using the search terms "systematic review" AND "dementia" AND ("prevalence" OR "incidence"), with no language restrictions. We repeated this search on March 28, 2024. From eligible systematic reviews, we searched the references and selected peer-reviewed publications about cohort studies where dementia prevalence or incidence was measured in the same geographical location, at a minimum of two timepoints, and that reported age-standardised prevalence or incidence of dementia. Additionally, data had to be from population-based samples, in which participants' cognitive status was assessed and where validated criteria were used to diagnose dementia. We extracted summary-level data from each paper about dementia risk factors, contacting authors when such data were not available in the published paper, and calculated PAFs for each risk factor at all available timepoints. Where possible, we linked changes in dementia prevalence or incidence with changes in the prevalence of risk factors. FINDINGS We identified 1925 records in our initial search, of which five eligible systematic reviews were identified. Within these systematic reviews, we identified 71 potentially eligible primary papers, of which 27 were included in our analysis. 13 (48%) of 27 primary papers reported change in prevalence of dementia, ten (37%) reported change in incidence of dementia, and four (15%) reported change in both incidence and prevalence of dementia. Studies reporting change in dementia incidence over time in Europe (n=5) and the USA (n=5) consistently reported a declining incidence in dementia. One study from Japan reported an increase in dementia prevalence and incidence and a stable incidence was reported in one study from Nigeria. Overall, across studies, the PAFs for less education or smoking, or both, generally declined over time, whereas PAFs for obesity, hypertension, and diabetes generally increased. The decrease in PAFs for less education and smoking was associated with a decline in the incidence of dementia in the Framingham study (Framingham, MA, USA, 1997-2013), the only study with sufficient data to allow analysis. INTERPRETATION Our findings suggest that lifestyle interventions such as compulsory education and reducing rates of smoking through country-level policy changes could be associated with an observed reduction, and therefore future reduction, in the incidence of dementia. More studies are needed in low-income and middle-income countries, where the burden of dementia is highest, and continues to increase. FUNDING National Institute for Health and Care Research Three Schools' Dementia Research Programme.
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Affiliation(s)
- Naaheed Mukadam
- UCL Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Frank J Wolters
- Department of Epidemiology and Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Lindsay Wallace
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Simona Sacuiu
- Cognitive Disorders Clinic, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology (EPINEP) and Centre for Ageing and Health (AgeCap), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology (EPINEP) and Centre for Ageing and Health (AgeCap), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Psychiatry Cognition and Old Age Psychiatry Department in Mölndal, Sahlgrenska University Hospital, Region Västra Götaland, Sweden
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Alexa Beiser
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Saptaparni Ghosh
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gill Livingston
- UCL Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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Meshref M, Ghaith HS, Hammad MA, Shalaby MMM, Ayasra F, Monib FA, Attia MS, Ebada MA, Elsayed H, Shalash A, Bahbah EI. The Role of RIN3 Gene in Alzheimer's Disease Pathogenesis: a Comprehensive Review. Mol Neurobiol 2024; 61:3528-3544. [PMID: 37995081 PMCID: PMC11087354 DOI: 10.1007/s12035-023-03802-0] [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: 09/08/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
Alzheimer's disease (AD) is a globally prevalent form of dementia that impacts diverse populations and is characterized by progressive neurodegeneration and impairments in executive memory. Although the exact mechanisms underlying AD pathogenesis remain unclear, it is commonly accepted that the aggregation of misfolded proteins, such as amyloid plaques and neurofibrillary tau tangles, plays a critical role. Additionally, AD is a multifactorial condition influenced by various genetic factors and can manifest as either early-onset AD (EOAD) or late-onset AD (LOAD), each associated with specific gene variants. One gene of particular interest in both EOAD and LOAD is RIN3, a guanine nucleotide exchange factor. This gene plays a multifaceted role in AD pathogenesis. Firstly, upregulation of RIN3 can result in endosomal enlargement and dysfunction, thereby facilitating the accumulation of beta-amyloid (Aβ) peptides in the brain. Secondly, RIN3 has been shown to impact the PICLAM pathway, affecting transcytosis across the blood-brain barrier. Lastly, RIN3 has implications for immune-mediated responses, notably through its influence on the PTK2B gene. This review aims to provide a concise overview of AD and delve into the role of the RIN3 gene in its pathogenesis.
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Affiliation(s)
- Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | | | - Faris Ayasra
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | | | - Mohamed S Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | | | - Hanaa Elsayed
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eshak I Bahbah
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
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Wu YT, Kitwiroon N, Beevers S, Barratt B, Brayne C, Cerin E, Franklin R, Houlden V, Woods B, Zied Abozied E, Prina M, Matthews F. The longitudinal associations between ambient air pollution exposure and dementia in the UK: results from the cognitive function and ageing study II and Wales. BMC Public Health 2024; 24:1233. [PMID: 38702710 PMCID: PMC11069162 DOI: 10.1186/s12889-024-18723-3] [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: 11/25/2023] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Air pollution has been recognised as a potential risk factor for dementia. Yet recent epidemiological research shows mixed evidence. The aim of this study is to investigate the longitudinal associations between ambient air pollution exposure and dementia in older people across five urban and rural areas in the UK. METHODS This study was based on two population-based cohort studies of 11329 people aged ≥ 65 in the Cognitive Function and Ageing Study II (2008-2011) and Wales (2011-2013). An algorithmic diagnosis method was used to identify dementia cases. Annual concentrations of four air pollutants (NO2, O3, PM10, PM2.5) were modelled for the year 2012 and linked via the participants' postcodes. Multistate modelling was used to examine the effects of exposure to air pollutants on incident dementia incorporating death and adjusting for sociodemographic factors and area deprivation. A random-effect meta-analysis was carried out to summarise results from the current and nine existing cohort studies. RESULTS Higher exposure levels of NO2 (HR: 1.04; 95% CI: 0.94, 1.14), O3 (HR: 0.90; 95% CI: 0.70, 1.15), PM10 (HR: 1.17; 95% CI: 0.86, 1.58), PM2.5 (HR: 1.41; 95% CI: 0.71, 2.79) were not strongly associated with dementia in the two UK-based cohorts. Inconsistent directions and strengths of the associations were observed across the two cohorts, five areas, and nine existing studies. CONCLUSIONS In contrast to the literature, this study did not find clear associations between air pollution and dementia. Future research needs to investigate how methodological and contextual factors can affect evidence in this field and clarity the influence of air pollution exposure on cognitive health over the lifecourse.
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Affiliation(s)
- Yu-Tzu Wu
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK.
| | - Nutthida Kitwiroon
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Benjamin Barratt
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Rachel Franklin
- Centre for Urban and Regional Development Studies (CURDS), School of Geography, Politics and Sociology, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, Gwynedd, UK
| | - Eman Zied Abozied
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Wang L, Xian X, Zhou M, Xu K, Cao S, Cheng J, Dai W, Zhang W, Ye M. Anti-Inflammatory Diet and Protein-Enriched Diet Can Reduce the Risk of Cognitive Impairment among Older Adults: A Nationwide Cross-Sectional Research. Nutrients 2024; 16:1333. [PMID: 38732579 PMCID: PMC11085298 DOI: 10.3390/nu16091333] [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: 04/04/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Cognitive impairment (CI) is a common mental health disorder among older adults, and dietary patterns have an impact on cognitive function. However, no systematic researches have constructed anti-inflammatory diet (AID) and protein-enriched diet (PED) to explore their association with CI among older adults in China. METHODS The data used in this study were obtained from the 2018 waves of the China Longitudinal Health and Longevity Survey (CLHLS). We construct AID, PED, and calculate scores for CI. We use binary logistic regression to explore the relationship between them, and use restrictive cubic splines to determine whether the relationships are non-linear. Subgroup analysis and sensitivity analysis were used to demonstrate the robustness of the results. RESULTS A total of 8692 participants (mean age is 83.53 years) were included in the analysis. We found that participants with a higher AID (OR = 0.789, 95% confidence interval: 0.740-0.842, p < 0.001) and PED (OR = 0.910, 95% confidence interval: 0.866-0.956, p < 0.001) score showed lower odds of suffering from CI. Besides, the relationship between the two dietary patterns and CI is linear, and the results of subgroup analysis and sensitivity analysis are also significant. CONCLUSION Higher intakes of AID and PED are associated with a lower risk of CI among older adults, which has important implications for future prevention and control of CI from a dietary and nutritional perspective.
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Affiliation(s)
- Liang Wang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (L.W.); (X.X.); (M.Z.); (K.X.); (J.C.); (W.Z.)
| | - Xiaobing Xian
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (L.W.); (X.X.); (M.Z.); (K.X.); (J.C.); (W.Z.)
| | - Mengting Zhou
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (L.W.); (X.X.); (M.Z.); (K.X.); (J.C.); (W.Z.)
| | - Ke Xu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (L.W.); (X.X.); (M.Z.); (K.X.); (J.C.); (W.Z.)
| | - Shiwei Cao
- School of the Second Clinical, Chongqing Medical University, Chongqing 400016, China;
| | - Jingyu Cheng
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (L.W.); (X.X.); (M.Z.); (K.X.); (J.C.); (W.Z.)
| | - Weizhi Dai
- School of the First Clinical, Chongqing Medical University, Chongqing 400016, China;
| | - Wenjia Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (L.W.); (X.X.); (M.Z.); (K.X.); (J.C.); (W.Z.)
| | - Mengliang Ye
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (L.W.); (X.X.); (M.Z.); (K.X.); (J.C.); (W.Z.)
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Walsh S, Wallace L, Kuhn I, Mytton O, Lafortune L, Wills W, Mukadam N, Brayne C. Population-level interventions for the primary prevention of dementia: a complex evidence review. EClinicalMedicine 2024; 70:102538. [PMID: 38495526 PMCID: PMC10940136 DOI: 10.1016/j.eclinm.2024.102538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
Dementia risk reduction is a global public health priority. Existing primary prevention approaches have favored individual-level interventions, with a research and policy gap for population-level interventions. We conducted a complex, multi-stage, evidence review to identify empirical evidence on population-level interventions for each of the modifiable risk factors identified by the Lancet Commission on dementia (2020). Through a comprehensive series of targeted searches, we identified 4604 articles, of which 135 met our inclusion criteria. We synthesized evidence from multiple sources, including existing non-communicable disease prevention frameworks, and graded the consistency and comprehensiveness of evidence. We derived a population-level intervention framework for dementia risk reduction, containing 26 high- and moderate-confidence policy recommendations, supported by relevant information on effect sizes, sources of evidence, contextual information, and implementation guidance. This review provides policymakers with the evidence they need, in a useable format, to address this critical public health policy gap. Funding SW is funded by a National Institute for Health and Care Research (NIHR) Doctoral Fellowship. WW and LF are part funded by the NIHR Applied Research Collaboration East of England. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | - Lindsay Wallace
- Cambridge Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | - Isla Kuhn
- University of Cambridge Medical School Library, School of Clinical Medicine, Cambridge CB2 0SP, UK
| | - Oliver Mytton
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Louise Lafortune
- Cambridge Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | - Wendy Wills
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London W1T 7BN, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge CB2 0SR, UK
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Morgan AE, Mc Auley MT. Vascular dementia: From pathobiology to emerging perspectives. Ageing Res Rev 2024; 96:102278. [PMID: 38513772 DOI: 10.1016/j.arr.2024.102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
Vascular dementia (VaD) is the second most common type of dementia. VaD is synonymous with ageing, and its symptoms place a significant burden on the health and wellbeing of older people. Despite the identification of a substantial number of risk factors for VaD, the pathological mechanisms underpinning this disease remain to be fully elucidated. Consequently, a biogerontological imperative exists to highlight the modifiable lifestyle factors which can mitigate against the risk of developing VaD. This review will critically examine some of the factors which have been revealed to modulate VaD risk. The survey commences by providing an overview of the putative mechanisms which are associated with the pathobiology of VaD. Next, the factors which influence the risk of developing VaD are examined. Finally, emerging treatment avenues including epigenetics, the gut microbiome, and pro-longevity pharmaceuticals are discussed. By drawing this key evidence together, it is our hope that it can be used to inform future experimental investigations in this field.
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Affiliation(s)
- Amy Elizabeth Morgan
- School of Health and Sports Sciences, Hope Park, Liverpool Hope University, Liverpool L16 9JD, United Kingdom.
| | - Mark Tomás Mc Auley
- School of Science, Engineering and Environment, University of Salford Manchester, Salford M5 4NT, United Kingdom
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Gerakios F, Yarnall AJ, Bate G, Wright L, Davis D, Stephan BCM, Robinson L, Brayne C, Stebbins G, Taylor JP, Burn DJ, Allan LM, Richardson SJ, Lawson RA. Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies. Age Ageing 2024; 53:afae046. [PMID: 38497236 PMCID: PMC10945294 DOI: 10.1093/ageing/afae046] [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: 08/04/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Inpatient prevalence of Parkinson's disease (PD) delirium varies widely across the literature. Delirium in general older populations is associated with adverse outcomes, such as increased mortality, dementia, and institutionalisation. However, to date there are no comprehensive prospective studies in PD delirium. This study aimed to determine delirium prevalence in hospitalised PD participants and the association with adverse outcomes, compared to a control group of older adults without PD. METHODS Participants were hospitalised inpatients from the 'Defining Delirium and its Impact in Parkinson's Disease' and the 'Delirium and Cognitive Impact in Dementia' studies comprising 121 PD participants and 199 older adult controls. Delirium was diagnosed prospectively using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Outcomes were determined by medical note reviews and/or home visits 12 months post hospital discharge. RESULTS Delirium was identified in 66.9% of PD participants compared to 38.7% of controls (p < 0.001). In PD participants only, delirium was associated with a significantly higher risk of mortality (HR = 3.3 (95% confidence interval [CI] = 1.3-8.6), p = 0.014) and institutionalisation (OR = 10.7 (95% CI = 2.1-54.6), p = 0.004) 12 months post-discharge, compared to older adult controls. However, delirium was associated with an increased risk of developing dementia 12 months post-discharge in both PD participants (OR = 6.1 (95% CI = 1.3-29.5), p = 0.024) and in controls (OR = 13.4 (95% CI = 2.5-72.6), p = 0.003). CONCLUSION Delirium is common in hospitalised PD patients, affecting two thirds of patients, and is associated with increased mortality, institutionalisation, and dementia. Further research is essential to understand how to accurately identify, prevent and manage delirium in people with PD who are in hospital.
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Affiliation(s)
- Florence Gerakios
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - Gemma Bate
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Wright
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Blossom C M Stephan
- Institute of Mental Health, School of Medicine, Nottingham University, Nottingham, UK
- Dementia Centre of Excellence, EnAble Institute, Curtin University, Perth, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Glenn Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, USA
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - David J Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Sarah J Richardson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
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Takakura T. Nutrition, Exercise, and Cognitive Rehabilitation for Dementia Prevention. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2024; 70:9-22. [PMID: 38854809 PMCID: PMC11154644 DOI: 10.14789/jmj.jmj23-0032-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/25/2023] [Indexed: 06/11/2024]
Abstract
Dementia is one of the most significant global challenges in medical and social care in the 21st century. It affects not only the patients themselves, but also their families, caregivers, and society in general, causing physical, psychological, and socioeconomic effects. As of 2020, there are approximately 6 million people in Japan aged 65 or older with dementia, and this number is expected to increase to around 7 million by 2025, meaning that one out of every five elderly people will have dementia. To prevent the onset and progression of dementia, it is crucial to have a proper understanding of its risks and adopt a healthy lifestyle. Leading an active life from an early stage can also aid in delaying or preventing the onset of dementia. Livingston has identified 12 risks that can lead to dementia, including physical inactivity, smoking, excessive alcohol consumption, air pollution, head injury, social isolation, poor educational history, obesity, hypertension, diabetes, depression, and hearing loss. Modifying one's lifestyle and leading an active life can be crucial in reducing these risks. The Mediterranean diet is gaining attention as a good practice for dementia prevention due to its diversity, richness in omega-3 fatty acids and vitamins. Exercise has been shown to prevent dementia on biological, behavioral, and socio-psychological levels. Repetitive transcranial magnetic stimulation is a non-invasive brain stimulation method that can alter brain plasticity and is being studied for clinical applications as a non-drug therapy for preventing dementia progression.
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Voigt RM, Ouyang B, Keshavarzian A. Outdoor Nighttime Light Exposure (Light Pollution) is Associated with Alzheimer's Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.14.24302831. [PMID: 38405987 PMCID: PMC10889016 DOI: 10.1101/2024.02.14.24302831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Alzheimer's disease (AD) prevalence has increased in the last century which can be attributed to increased lifespan, but environment is also important. This study evaluated the relationship between outdoor nighttime light exposure and AD prevalence in the United States. Higher outdoor nighttime light was associated with higher prevalence of AD. While atrial fibrillation, diabetes, hyperlipidemia, hypertension, and stroke were associated more strongly with AD prevalence than nighttime light intensity, nighttime light was more strongly associated with AD prevalence than alcohol abuse, chronic kidney disease, depression, heart failure, and obesity. Startlingly, nighttime light exposure more strongly associated with AD prevalence in those under the age of 65 than any other disease factor examined. These data indicate a need to investigate how nighttime light exposure influences AD pathogenesis.
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Affiliation(s)
- Robin M Voigt
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center; Chicago, IL, USA
- Department of Internal Medicine, Rush University Medical Center; Chicago, IL, USA
- Department of Anatomy & Cell Biology, Rush University Medical Center; Chicago, IL, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ali Keshavarzian
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center; Chicago, IL, USA
- Department of Internal Medicine, Rush University Medical Center; Chicago, IL, USA
- Department of Anatomy & Cell Biology, Rush University Medical Center; Chicago, IL, USA
- Department of Physiology, Rush University Medical Center, Chicago, IL, USA
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15
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Chen H, Ye KX, Feng Q, Cao K, Yu J, Li C, Zhang C, Yu L, Maier AB, Langa KM, Qiu C, Zeng Y, Feng L. Trends in the prevalence of cognitive impairment at old age in China, 2002-2018. Alzheimers Dement 2024; 20:1387-1396. [PMID: 38009699 PMCID: PMC10917034 DOI: 10.1002/alz.13545] [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: 06/27/2023] [Revised: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION China has the world's largest number of older adults with cognitive impairment (CI). We aimed to examine secular trends in the prevalence of CI in China from 2002 to 2018. METHODS Generalized estimating equations (GEE) was used to assess changes in CI trend in 44,154 individuals (72,027 observations) aged 65 to 105 years old. RESULTS The prevalence of CI increased from 2002 to 2008 and then decreased until 2018. The age-standardized prevalence increased from 25.7% in 2002, 26.1% in 2005, to 28.2% in 2008, then decreased to 26.0% in 2011, 25.3% in 2014, and 24.9% in 2018. Females and those ≥ 80 years old had greater CI prevalence. DISCUSSION The prevalence of CI showed an inverted U shape from early 2000s to late 2010s with a peak in 2008. Follow-up studies are needed to confirm the decreasing trend after 2008 and examine the contributing factors and underlying mechanisms of this trend. HIGHLIGHTS Generalized estimating equations (GEE) were used to assess trends of changes in cognitive impairment (CI). CI prevalence in China increased from 2002 to 2008 and then decreased until 2018. Females and those ≥ 80 years old had greater CI prevalence. Stroke, diabetes, and cigarette smoking were risk factors for CI.
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Affiliation(s)
- Huashuai Chen
- Business School, Xiangtan University, Xiangtan, China
| | - Kaisy Xinhong Ye
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
| | - Qiushi Feng
- Department of Sociology and Anthropology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Kai Cao
- Key Laboratory of Geographic Information Science (Ministry of Education) and School of Geographic Sciences, East China Normal University, Shanghai, China
| | - Jintai Yu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Chunbo Li
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychology and Behavioural Science, Shanghai Jiao Tong University, Shanghai, China
| | - Can Zhang
- Department of Neurology, Genetics and Aging Research Unit, McCance Centre for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lirong Yu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Andrea Britta Maier
- Key Laboratory of Geographic Information Science (Ministry of Education) and School of Geographic Sciences, East China Normal University, Shanghai, China
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Chengxuan Qiu
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Solna, Sweden
| | - Yi Zeng
- Centre for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China
- Centre for the Study of Aging and Human Development and Geriatrics Division, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Polis B, Samson AO. Enhancing cognitive function in older adults: dietary approaches and implications. Front Nutr 2024; 11:1286725. [PMID: 38356861 PMCID: PMC10864441 DOI: 10.3389/fnut.2024.1286725] [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: 08/31/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
Natural aging encompasses physiological and psychological changes that impact overall health and quality of life. Mitigating these effects requires physical and mental exercise, coupled with proper nutrition. Notably, protein malnutrition emerges as a potential risk factor for senile dementia, with insufficient intake correlating with premature cognitive decline. Adequate protein intake in the elderly positively associates with memory function and lowers cognitive impairment risk. Considering diet as a modifiable risk factor for cognitive decline, extensive research has explored diverse dietary strategies to prevent dementia onset in older adults. However, conclusive results remain limited. This review aims to synthesize recent evidence on effective dietary approaches to enhance cognitive function and prognosis in older individuals. Specifically, the study evaluates complex multicomponent programs, protein-rich diets, and branched-chain amino acid supplementation. By addressing the nexus of nutrition and cognitive health, this review contributes to understanding viable interventions for promoting cognitive well-being in aging populations.
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Affiliation(s)
- Baruh Polis
- Laboratory of Computational Biology and Drug Discovery, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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17
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O’Neal MA. Women and the risk of Alzheimer's disease. Front Glob Womens Health 2024; 4:1324522. [PMID: 38250748 PMCID: PMC10796575 DOI: 10.3389/fgwh.2023.1324522] [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: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose of the review This review will elucidate reasons to explain why women may be at greater risk for Alzheimer's disease. Recent findings Potential mechanisms to explain sex and gender differences in Alzheimer dementia include: differences in risk associated with the apolipoprotein E 4 allele; telomere shortening- which is linked with neurodegeneration, higher incidence of depression and insomnia in women as psychiatric co-morbidities which are linked with an increased Alzheimer disease risk, disorders of pregnancy including gestational hypertension and preeclampsia and psychosocial factors such as educational level which may contribute to differences in cognitive reserve. Summary The sex and gender differences in Alzheimer's disease can be explained by biological and psychosocial factors.
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Affiliation(s)
- Mary A. O’Neal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Perneczky R. Alzheimer's Disease Prevention and Treatment Based on Population-Based Approaches. Methods Mol Biol 2024; 2785:15-33. [PMID: 38427185 DOI: 10.1007/978-1-0716-3774-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The development of effective prevention and treatment strategies for Alzheimer's disease (AD) and dementia is hindered by limited knowledge of the underlying biological and environmental causes. While certain genetic factors have been associated with AD, and various lifestyle and environmental factors have been linked to dementia risk, the interactions between genes and the environment are not yet fully understood. To identify new avenues for dementia prevention, coordinated global efforts are needed to utilize existing cohorts and resources effectively and efficiently. This chapter provides an overview of current research on risk and protective factors for AD and dementia and discusses the opportunities and challenges associated with population-based approaches.
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Affiliation(s)
- Robert Perneczky
- Department of Psychiatry and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK.
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK.
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Wei J, Wang M, Guo Y, Liu Y, Dong X. Sleep structure assessed by objective measurement in patients with mild cognitive impairment: A meta-analysis. Sleep Med 2024; 113:397-405. [PMID: 38134714 DOI: 10.1016/j.sleep.2023.12.010] [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: 09/25/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES A meta-analysis was used to explore the characteristic changes in objective sleep structure of patients with mild cognitive impairment (MCI) compared with cognitively healthy older adults. MATERIALS AND METHODS PubMed, EMBAS, Cochrane Library, Scopus, and Web of Science were searched until November 2023. A literature quality evaluation was performed according to the Newcastle-Ottawa Scale, and a meta-analysis was performed by RevMan 5.3 software. RESULTS Fifteen studies with 771 participants were finally included. Compared with normal control groups, patients with MCI had a decreased total sleep time by 34.44 min, reduction in sleep efficiency by 7.96 %, increased waking after sleep onset by 19.61 min, and increased sleep latency by 6.97 min. Ten included studies showed that the patients with MCI had increased N1 sleep by 2.72 % and decreased N3 sleep by 0.78 %; however, there was no significant difference between the MCI and control groups in percentage of N2 sleep. Moreover, Twelve included studies reported the MCI groups had shorter REM sleep of 2.69 %. CONCLUSION Our results provide evidence of abnormal sleep architecture in patients with MCI. As a "plastic state," abnormal sleep architecture may be a promising therapeutic target for slowing cognitive decline and dementia prevention.
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Affiliation(s)
- Jianing Wei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Min Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuanli Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiaofang Dong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
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He SY, Su WM, Wen XJ, Lu SJ, Cao B, Yan B, Chen YP. Non-Genetic Risk Factors of Alzheimer's Disease: An Updated Umbrella Review. J Prev Alzheimers Dis 2024; 11:917-927. [PMID: 39044503 PMCID: PMC11266231 DOI: 10.14283/jpad.2024.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/09/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by intricate genetic and environmental etiology. The objective of this study was to identify robust non-genetic risk factors for AD through an updated umbrella review. METHODS We conducted a comprehensive search of meta-analyses and systematic reviews on non-genetic risk factors associated with AD in PubMed, Cochrane, Embase, and Ovid Medline up to June 30, 2023. After collecting data, we estimated the summary effect size and their 95% confidence intervals. The degree of heterogeneity between studies was assessed using I2 statistics and a 95% prediction interval was determined. Additionally, we evaluated potential excess significant bias and small study effects within the selected candidate studies. RESULTS The umbrella review encompassed a total of 53 eligible papers, which included 84 meta-analyses covering various factors such as lifestyle, diet, environmental exposures, comorbidity or infections, drugs, and biomarkers. Based on the evidence classification criteria employed in this study, two factors as convincing evidence (Class I), including rheumatoid arthritis (RA), potentially reduced the risk of AD, but diabetes significantly increased the risk of AD. Furthermore, three factors as highly suggestive evidence (Class II), namely depression, high homocysteine, and low folic acid level, potentially increased the risk of AD. CONCLUSION Our findings highlight several risk factors associated with AD that warrant consideration as potential targets for intervention. However, it is crucial to prioritize the identified modifiable risk factors, namely rheumatoid arthritis, diabetes, depression, elevated homocysteine levels, and low folic acid levels to effectively address this complex neurodegenerative disorder.
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Affiliation(s)
- S.-Y. He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - W.-M. Su
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - X.-J. Wen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - S.-J. Lu
- Department of Respiratory, The Fourth People’s Hospital of Chengdu, Mental Health Center of Chengdu, Chengdu, Sichuan, 610036 China
| | - B. Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Bo Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
| | - Yong-Ping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
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21
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Gjøra L, Strand BH, Bergh S, Bosnes I, Johannessen A, Livingston G, Skjellegrind HK, Selbæk G. Prevalence and Determinants of Diagnosed Dementia: A Registry Linkage Study Linking Diagnosis of Dementia in the Population-Based HUNT Study to Registry Diagnosis of Dementia in Primary Care and Hospitals in Norway. J Alzheimers Dis 2024; 99:363-375. [PMID: 38701153 DOI: 10.3233/jad-240037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background A timely diagnosis of dementia can be beneficial for providing good support, treatment, and care, but the diagnostic rate remains unknown and is probably low. Objective To determine the dementia diagnostic rate and to describe factors associated with diagnosed dementia. Methods This registry linkage study linked information on research-based study diagnoses of all-cause dementia and subtypes of dementias, Alzheimer's disease, and related dementias, in 1,525 participants from a cross-sectional population-based study (HUNT4 70+) to dementia registry diagnoses in both primary-care and hospital registries. Factors associated with dementia were analyzed with multiple logistic regression. Results Among those with research-based dementia study diagnoses in HUNT4 70+, 35.6% had a dementia registry diagnosis in the health registries. The diagnostic rate in registry diagnoses was 19.8% among home-dwellers and 66.0% among nursing home residents. Of those with a study diagnosis of Alzheimer's disease, 35.8% (95% confidence interval (CI) 32.6-39.0) had a registry diagnosis; for those with a study diagnosis of vascular dementia, the rate was 25.8% (95% CI 19.2-33.3) and for Lewy body dementias and frontotemporal dementia, the diagnosis rate was 63.0% (95% CI 48.7-75.7) and 60.0% (95% CI 43.3-75.1), respectively. Factors associated with having a registry diagnosis included dementia in the family, not being in the youngest or oldest age group, higher education, more severe cognitive decline, and greater need for help with activities of daily living. Conclusions Undiagnosed dementia is common, as only one-third of those with dementia are diagnosed. Diagnoses appear to be made at a late stage of dementia.
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Affiliation(s)
- Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physical Health and Ageing, Norwegian institute of Public Health, Oslo, Norway
| | - Sverre Bergh
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Ingunn Bosnes
- Department of Psychiatry, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Aud Johannessen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Håvard Kjesbu Skjellegrind
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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22
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Volloch V, Rits-Volloch S. Next Generation Therapeutic Strategy for Treatment and Prevention of Alzheimer's Disease and Aging-Associated Cognitive Decline: Transient, Once-in-a-Lifetime-Only Depletion of Intraneuronal Aβ ( iAβ) by Its Targeted Degradation via Augmentation of Intra- iAβ-Cleaving Activities of BACE1 and/or BACE2. Int J Mol Sci 2023; 24:17586. [PMID: 38139415 PMCID: PMC10744314 DOI: 10.3390/ijms242417586] [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: 10/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Although the long-standing Amyloid Cascade Hypothesis (ACH) has been largely discredited, its main attribute, the centrality of amyloid-beta (Aβ) in Alzheimer's disease (AD), remains the cornerstone of any potential interpretation of the disease: All known AD-causing mutations, without a single exception, affect, in one way or another, Aβ. The ACH2.0, a recently introduced theory of AD, preserves this attribute but otherwise differs fundamentally from the ACH. It posits that AD is a two-stage disorder where both stages are driven by intraneuronal (rather than extracellular) Aβ (iAβ) albeit of two distinctly different origins. The first asymptomatic stage is the decades-long accumulation of Aβ protein precursor (AβPP)-derived iAβ to the critical threshold. This triggers the activation of the self-sustaining AβPP-independent iAβ production pathway and the commencement of the second, symptomatic AD stage. Importantly, Aβ produced independently of AβPP is retained intraneuronally. It drives the AD pathology and perpetuates the operation of the pathway; continuous cycles of the iAβ-stimulated propagation of its own AβPP-independent production constitute an engine that drives AD, the AD Engine. It appears that the dynamics of AβPP-derived iAβ accumulation is the determining factor that either drives Aging-Associated Cognitive Decline (AACD) and triggers AD or confers the resistance to both. Within the ACH2.0 framework, the ACH-based drugs, designed to lower levels of extracellular Aβ, could be applicable in the prevention of AD and treatment of AACD because they reduce the rate of accumulation of AβPP-derived iAβ. The present study analyzes their utility and concludes that it is severely limited. Indeed, their short-term employment is ineffective, their long-term engagement is highly problematic, their implementation at the symptomatic stages of AD is futile, and their evaluation in conventional clinical trials for the prevention of AD is impractical at best, impossible at worst, and misleading in between. In contrast, the ACH2.0-guided Next Generation Therapeutic Strategy for the treatment and prevention of both AD and AACD, namely the depletion of iAβ via its transient, short-duration, targeted degradation by the novel ACH2.0-based drugs, has none of the shortcomings of the ACH-based drugs. It is potentially highly effective, easily evaluable in clinical trials, and opens up the possibility of once-in-a-lifetime-only therapeutic intervention for prevention and treatment of both conditions. It also identifies two plausible ACH2.0-based drugs: activators of physiologically occurring intra-iAβ-cleaving capabilities of BACE1 and/or BACE2.
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Affiliation(s)
- Vladimir Volloch
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Sophia Rits-Volloch
- Division of Molecular Medicine, Children’s Hospital, Boston, MA 02115, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
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23
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Milte R, Jemere D, Lay K, Hutchinson C, Thomas J, Murray J, Ratcliffe J. A scoping review of the use of visual tools and adapted easy-read approaches in Quality-of-Life instruments for adults. Qual Life Res 2023; 32:3291-3308. [PMID: 37344727 PMCID: PMC10624740 DOI: 10.1007/s11136-023-03450-w] [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] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Self-Reporting using traditional text-based Quality-of-Life (QoL) instruments can be difficult for people living with sensory impairments, communication challenges or changes to their cognitive capacity. Adapted communication techniques, such as Easy-Read techniques, or use of pictures could remove barriers to participation for a wide range of people. This review aimed to identify published studies reporting adapted communication approaches for measuring QoL, the methodology used in their development and validation among adult populations. METHODS A scoping review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews checklist was undertaken. RESULTS The initial search strategy identified 13,275 articles for screening, with 264 articles identified for full text review. Of these 243 articles were excluded resulting in 21 studies for inclusion. The majority focused on the development of an instrument (12 studies) or a combination of development with some aspect of validation or psychometric testing (7 studies). Nineteen different instruments were identified by the review, thirteen were developed from previously developed generic or condition-specific quality of life instruments, predominantly aphasia (7 studies) and disability (4 studies). Most modified instruments included adaptations to both the original questions, as well as the response categories. CONCLUSIONS Studies identified in this scoping review demonstrate that several methods have been successfully applied e.g. with people living with aphasia post-stroke and people living with a disability, which potentially could be adapted for application with more diverse populations. A cohesive and interdisciplinary approach to the development and validation of communication accessible versions of QOL instruments, is needed to support widespread application, thereby reducing reliance on proxy assessors and promoting self-assessment of QOL across multiple consumer groups and sectors.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Digisie Jemere
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Kiri Lay
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jolene Thomas
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Joanne Murray
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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24
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Sherlock L, Lee SF, Katsanos AH, Cukierman-Yaffe T, Canavan M, Joundi R, Sharma M, Shoamanesh A, Brayne C, Gerstein HC, O'Donnell MJ, Muniz-Terrera G, Yusuf S, Bosch J, Whiteley WN. Cognitive performance following stroke, transient ischaemic attack, myocardial infarction, and hospitalisation: an individual participant data meta-analysis of six randomised controlled trials. THE LANCET. HEALTHY LONGEVITY 2023; 4:e665-e674. [PMID: 38042159 DOI: 10.1016/s2666-7568(23)00207-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Survivors of stroke are often concerned about cognitive problems, and information on the risk of cognitive problems often comes from small studies. We aimed to estimate years of cognitive ageing associated with stroke compared with transient ischaemic attack, myocardial infarction, and other hospitalisations in a large population. METHODS Using data from six randomised controlled trials (ORIGIN, ONTARGET, TRANSCEND, COMPASS, HOPE-3, and NAVIGATE ESUS), we completed an individual participant data meta-analysis using data requested from the Public Health Research Institute to estimate the association of stroke (by type and severity), transient ischaemic attack, myocardial infarction, and other hospitalisations with cognitive performance measured at the end of each trial. We included participants in any of these randomised controlled trials with a cognitive assessment at baseline and at least one other timepoint. Cognitive performance was measured with the Mini-Mental State Examination or the Montreal Cognitive Assessment, transformed into Z scores. We estimated Z score differences in end of trial cognitive performance between people with and without events and calculated corresponding years of cognitive ageing in these trials, and additionally calculated using a population representative cohort-the Cognitive Function and Ageing Study. FINDINGS In 64 106 participants from 55 countries, compared with no event, stroke was associated with 18 years of cognitive ageing (1487 strokes included in the model, 95% CI 10 to 28; p<0·0001) and transient ischaemic attack with 3 years (660 transient ischaemic attacks included in the model, 0 to 6; p=0·021). Myocardial infarction (p=0·60) and other hospitalisations (p=0·26) were not associated with cognitive ageing. The mean difference in SD compared with people without an event was -0·84 (95% CI -0·91 to -0·76; p<0·0001) for disabling stroke, and -0·12 (-0·19 to -0·05; p=0·0012) for non-disabling stroke. Haemorrhagic stroke was associated with worse cognition (-0·75, -0·95 to -0·55; p<0·0001) than ischaemic stroke (-0·42, -0·48 to -0·36; p <0·0001). INTERPRETATION Stroke has a substantial effect on cognition. The effects of transient ischaemic attack were small, whereas myocardial infarction and hospitalisation had a neutral effect. Prevention of stroke could lead to a reduction in cognitive ageing in those at greatest risk. FUNDING Population Health Research Institute and Chief Scientist Office of Scotland.
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Affiliation(s)
- Laura Sherlock
- Population Health Research Institute, Hamilton, ON, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton, ON, Canada
| | - Aristeidis H Katsanos
- Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada
| | - Tali Cukierman-Yaffe
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel; Division of Endocrinology and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Michelle Canavan
- HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland; Department of Geriatric and Stroke Medicine, Galway University Hospital, Galway, Ireland
| | - Raed Joundi
- Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada
| | - Mukul Sharma
- Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada
| | - Ashkan Shoamanesh
- Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Martin J O'Donnell
- Population Health Research Institute, Hamilton, ON, Canada; HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland; Department of Geriatric and Stroke Medicine, Galway University Hospital, Galway, Ireland
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Department of Social Medicine, Ohio University, OH, USA
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Cardiology, McMaster University, Hamilton, ON, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - William N Whiteley
- Population Health Research Institute, Hamilton, ON, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Kuroda Y, Fujita K, Sugimoto T, Uchida K, Shimazu T, Saito J, Arai H, Sakurai T. Feasibility of a community-adapted multi-domain intervention for dementia prevention among older adults: a research protocol. Arch Public Health 2023; 81:191. [PMID: 37907936 PMCID: PMC10617126 DOI: 10.1186/s13690-023-01205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Multi-domain interventions effectively prevent dementia in clinical settings; however, their efficacy within local communities is unclear. This study assesses the feasibility of an adapted multi-domain intervention for dementia prevention in community-dwelling older adults. METHODS The single-arm trial enrolls 60 participants from two Obu City communities, Japan. PRIMARY OUTCOME participant retention in the adapted multi-domain intervention; secondary outcomes: health and implementation outcomes. Over 12 months, a team of researchers and public health nurse oversees the study in the first half, gradually shifting the management to public health nurses in the second half. Using the Framework for Reporting Adaptations and Modifications-Enhanced, the clinical programme is adjusted for the local community. It includes a 60-minute exercise and 30-minute group sessions, targeting lifestyle, diet, and social participation. DISCUSSION This pioneer study evaluates the feasibility of an adapted intervention programme for dementia prevention in a community setting. Challenges in disseminating dementia prevention programmes warrant further investigation into effective implementation as well as strategies and methods to appeal to the target population. Upon confirming this programme's feasibility, future studies can further evaluate its broader effectiveness. TRIAL REGISTRATION The protocol is registered with the Clinical Trials Registry (UMIN-CTR) of the University Hospital's Medical Information Network, under registration number UMIN000050581.
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Affiliation(s)
- Yujiro Kuroda
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan.
| | - Kosuke Fujita
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
| | - Taiki Sugimoto
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
| | - Taichi Shimazu
- Division of Behavioural Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Junko Saito
- Division of Behavioural Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Hidenori Arai
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, 474-8511, Aichi, Japan
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Kootar S, Huque MH, Kiely KM, Anderson CS, Jorm L, Kivipelto M, Lautenschlager NT, Matthews F, Shaw JE, Whitmer RA, Peters R, Anstey KJ. Study protocol for development and validation of a single tool to assess risks of stroke, diabetes mellitus, myocardial infarction and dementia: DemNCD-Risk. BMJ Open 2023; 13:e076860. [PMID: 37739460 PMCID: PMC10533692 DOI: 10.1136/bmjopen-2023-076860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Current efforts to reduce dementia focus on prevention and risk reduction by targeting modifiable risk factors. As dementia and cardiometabolic non-communicable diseases (NCDs) share risk factors, a single risk-estimating tool for dementia and multiple NCDs could be cost-effective and facilitate concurrent assessments as compared with a conventional single approach. The aim of this study is to develop and validate a new risk tool that estimates an individual's risk of developing dementia and other NCDs including diabetes mellitus, stroke and myocardial infarction. Once validated, it could be used by the public and general practitioners. METHODS AND ANALYSIS Ten high-quality cohort studies from multiple countries were identified, which met eligibility criteria, including large representative samples, long-term follow-up, data on clinical diagnoses of dementia and NCDs, recognised modifiable risk factors for the four NCDs and mortality data. Pooled harmonised data from the cohorts will be used, with 65% randomly allocated for development of the predictive model and 35% for testing. Predictors include sociodemographic characteristics, general health risk factors and lifestyle/behavioural risk factors. A subdistribution hazard model will assess the risk factors' contribution to the outcome, adjusting for competing mortality risks. Point-based scoring algorithms will be built using predictor weights, internally validated and the discriminative ability and calibration of the model will be assessed for the outcomes. Sensitivity analyses will include recalculating risk scores using logistic regression. ETHICS AND DISSEMINATION Ethics approval is provided by the University of New South Wales Human Research Ethics Committee (UNSW HREC; protocol numbers HC200515, HC3413). All data are deidentified and securely stored on servers at Neuroscience Research Australia. Study findings will be presented at conferences and published in peer-reviewed journals. The tool will be accessible as a public health resource. Knowledge translation and implementation work will explore strategies to apply the tool in clinical practice.
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Affiliation(s)
- Scherazad Kootar
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Md Hamidul Huque
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim M Kiely
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, George Institute for Global Health, Newtown, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Miia Kivipelto
- Division of Geriatric Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Nicola T Lautenschlager
- Academic Unit of Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Older Adult Mental Health Program, Royal Melbourne Hospital Mental Health Service, Parkville, Victoria, Australia
| | - Fiona Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Ruth Peters
- University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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27
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Suchsland MZ, Gaster B, Raetz J, Belza B, McGuire L, Olivari B, Tracy K, Fitzpatrick AL. Developing a cognitive assessment toolkit for primary care: qualitative assessment of providers' needs and perceptions of usability in clinical practice. BMC Health Serv Res 2023; 23:1006. [PMID: 37726722 PMCID: PMC10507963 DOI: 10.1186/s12913-023-09991-7] [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: 08/18/2022] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Burden of dementia is expected to substantially increase. Early dementia is underdiagnosed in primary care. Given the benefits of active management of dementia, earlier detection in primary care is imperative. The aim of this study was to understand primary care provider (PCP) perceptions of implementing a cognitive assessment toolkit in primary care. METHODS PCPs in a large health system in the US were recruited to a qualitative study utilizing semi-structured interviews. Interviews captured provider perceptions of options for implementing a cognitive assessment toolkit derived from the Gerontological Society of America (GSA) KAER (Kickstart, Assess, Evaluate, Refer) toolkit, including a workflow and adapted clinical tools. A content analysis approach distinguished themes and exemplary quotes. RESULTS Ten PCPs were interviewed. They found the toolkit useful, felt the term Kickstart was not specific to dementia care, and stressed that addressing cognitive evaluation would need to be easy to implement in a clinical workflow. Finally, providers knew many resources for referral but were unsure how to help patients navigate options. CONCLUSIONS Providers stressed simplicity, ease, and efficiency for implementation of a cognitive assessment toolkit. Incorporating these findings into the development of clinical tools and workflows may increase cognitive evaluations conducted by PCPs.
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Affiliation(s)
- Monica Zigman Suchsland
- Department of Family Medicine, University of Washington, 1959 NE Pacific St, Box 356390, Seattle, WA, 98195-6390, USA.
| | - Barak Gaster
- Department of Medicine, University of Washington, 1959 NE Pacific St, Box 356420, Seattle, WA, 98195-6390, USA
| | - Jaqueline Raetz
- Department of Family Medicine, University of Washington, 1959 NE Pacific St, Box 356390, Seattle, WA, 98195-6390, USA
| | - Basia Belza
- School of Nursing, University of Washington, 1959 NE Pacific St, Box 357260, Seattle, WA, 98195- 6390, USA
| | - Lisa McGuire
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA
| | - Benjamin Olivari
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329-4027, USA
| | - Karen Tracy
- The Gerontological Society of America, 1220 L Street NW, Suite 901, Washington, DC, 20005, USA
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, 1959 NE Pacific St, Box 356390, Seattle, WA, 98195-6390, USA
- Departments of Epidemiology and Global Health, University of Washington, UW Box 351619, Seattle, WA, 98195, USA
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28
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Harwood RH, Goldberg SE, Brand A, van Der Wardt V, Booth V, Di Lorito C, Hoare Z, Hancox J, Bajwa R, Burgon C, Howe L, Cowley A, Bramley T, Long A, Lock J, Tucker R, Adams EJ, O'Brien R, Kearney F, Kowalewska K, Godfrey M, Dunlop M, Junaid K, Thacker S, Duff C, Welsh T, Haddon-Silver A, Gladman J, Logan P, Pollock K, Vedhara K, Hood V, Das Nair R, Smith H, Tudor-Edwards R, Hartfiel N, Ezeofor V, Vickers R, Orrell M, Masud T. Promoting Activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED): randomised controlled trial. BMJ 2023; 382:e074787. [PMID: 37643788 PMCID: PMC10463053 DOI: 10.1136/bmj-2023-074787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To determine the effectiveness of an exercise and functional activity therapy intervention in adults with early dementia or mild cognitive impairment compared with usual care. DESIGN Randomised controlled trial. SETTING Participants' homes and communities at five sites in the United Kingdom. PARTICIPANTS 365 adults with early dementia or mild cognitive impairment who were living at home, and family members or carers. INTERVENTION The intervention, Promoting activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED), was a specially designed, dementia specific, rehabilitation programme focusing on strength, balance, physical activity, and performance of activities of daily living, which was tailored and progressive and addressed risk and the psychological needs of people with dementia. Up to 50 therapy sessions were provided over 12 months. The control group received usual care plus a falls risk assessment. Procedures were adapted during the covid-19 pandemic. MAIN OUTCOME MEASURES The primary outcome was score on the carer (informant) reported disability assessment for dementia scale 12 months after randomisation. Secondary outcomes were self-reported activities of daily living, physical activity, quality of life, balance, functional mobility, fear of falling, frailty, cognition, mood, carer strain, service use at 12 months, and falls between months 4 and 15. RESULTS 365 patient participants were randomised, 183 to intervention and 182 to control. The median age of participants was 80 years (range 65-95), median Montreal cognitive assessment score was 20 out of 30 (range 13-26), and 58% (n=210) were men. Intervention participants received a median of 31 therapy sessions (interquartile range 22-40) and reported completing a mean 121 minutes of PrAISED exercise each week. Primary outcome data were available for 149 intervention and 141 control participants. Scores on the disability assessment for dementia scale did not differ between groups: adjusted mean difference -1.3, 95% confidence interval -5.2 to 2.6; Cohen's d effect size -0.06, 95% confidence interval -0.26 to 0.15; P=0.51). Upper 95% confidence intervals excluded small to moderate effects on any of the range of outcome measures. Between months 4 and 15 the intervention group experienced 79 falls and the control group 200 falls (adjusted incidence rate ratio 0.78, 95% confidence interval 0.5 to 1.3; P=0.3). CONCLUSION The intensive PrAISED programme of exercise and functional activity training did not improve activities of daily living, physical activity, or quality of life; reduce falls; or improve any other secondary health status outcomes, despite good uptake. Future research should consider alternative approaches to maintaining ability and wellbeing in people with dementia. TRIAL REGISTRATION ISRCTN Registry ISRCTN15320670.
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Affiliation(s)
- Rowan H Harwood
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Veronika van Der Wardt
- Department of General, Preventative and Rehabilitation Medicine, Philipps-Universität Marburg 35032 Marburg, Germany
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Claudio Di Lorito
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Jennie Hancox
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rupinder Bajwa
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Clare Burgon
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Louise Howe
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Trevor Bramley
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Annabelle Long
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Juliette Lock
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Rachael Tucker
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Emma J Adams
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Rebecca O'Brien
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Fiona Kearney
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Katarzyna Kowalewska
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | | | | - Kehinde Junaid
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, UK
| | - Simon Thacker
- Centre for Research and Development, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Carol Duff
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Tomas Welsh
- The RICE Centre, Research Institute for the Care of Older People, Royal United Hospital, Bath, UK
| | - Annette Haddon-Silver
- Oxford Health NHS Foundation Trust, Research and Development, Warneford Hospital, Oxford, UK
| | - John Gladman
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Kavita Vedhara
- Centre for Academic Primary Care, Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Victoria Hood
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Roshan Das Nair
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- SINTEF, Torgarden, Trondheim, Norway
| | - Helen Smith
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Rhiannon Tudor-Edwards
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Robert Vickers
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Martin Orrell
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, UK
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Haque R, Alam K, Gow J, Neville C. Changes in the prevalence of dementia in Australia and its association with geographic remoteness. PLoS One 2023; 18:e0289505. [PMID: 37531396 PMCID: PMC10395934 DOI: 10.1371/journal.pone.0289505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The exact prevalence of dementia in Australia is ambiguous. Australia is a vast continent with a small population, and 80% of the population live in five cities. This study explores recent changes in the prevalence of dementia. It also investigates geographic remoteness as a potential risk factor for developing dementia. METHODS Survey of Disability, Ageing and Carers (SDAC), a nationally representative database, was used to conduct this study. A total of 74,862 and 65,487 individuals from 2015 and 2018, respectively, were considered for this study. A multivariable logistic regression model was used to evaluate the association between dementia and geographic remoteness for older adults aged 65 years and over. RESULTS The results reveal that from 2015 to 2018, the prevalence of dementia among adults aged 65 years and older was higher in 2018 (5,229 per 100,000) than in 2015 (5,099 per 100,000). Significant geographical differences in the prevalence of dementia are observed among Australian adults, and this trend appears to be increasing. Furthermore, the unadjusted model revealed that, in 2015, older adults living in major cities had 1.29 (AOR: 1.29, 95% CI: 1.17-1.41) times higher odds of having dementia compared with their counterparts from outer regional and remote areas. In 2018, the adjusted model found that older adults living in major cities had 1.12 (AOR: 1.12, 95% CI: 1.01-1.25) times elevated odds of having dementia than their peers living in outer regional and remote areas. CONCLUSION There is a rising prevalence of dementia in Australia. Further investigation is required to identify the causes of this increase. Increased public health initiatives should concentrate on behavioural characteristics and contextual environmental factors to ameliorate this trend.
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Affiliation(s)
- Rezwanul Haque
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, Bangladesh
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Christine Neville
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
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Wharton SB, Simpson JE, Ince PG, Richardson CD, Merrick R, Matthews FE, Brayne C. Insights into the pathological basis of dementia from population-based neuropathology studies. Neuropathol Appl Neurobiol 2023; 49:e12923. [PMID: 37462105 PMCID: PMC10946587 DOI: 10.1111/nan.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
The epidemiological neuropathology perspective of population and community-based studies allows unbiased assessment of the prevalence of various pathologies and their relationships to late-life dementia. In addition, this approach provides complementary insights to conventional case-control studies, which tend to be more representative of a younger clinical cohort. The Cognitive Function and Ageing Study (CFAS) is a longitudinal study of cognitive impairment and frailty in the general United Kingdom population. In this review, we provide an overview of the major findings from CFAS, alongside other studies, which have demonstrated a high prevalence of pathology in the ageing brain, particularly Alzheimer's disease neuropathological change and vascular pathology. Increasing burdens of these pathologies are the major correlates of dementia, especially neurofibrillary tangles, but there is substantial overlap in pathology between those with and without dementia, particularly at intermediate burdens of pathology and also at the oldest ages. Furthermore, additional pathologies such as limbic-predominant age-related TDP-43 encephalopathy, ageing-related tau astrogliopathy and primary age-related tauopathies contribute to late-life dementia. Findings from ageing population-representative studies have implications for the understanding of dementia pathology in the community. The high prevalence of pathology and variable relationship to dementia status has implications for disease definition and indicate a role for modulating factors on cognitive outcome. The complexity of late-life dementia, with mixed pathologies, indicates a need for a better understanding of these processes across the life-course to direct the best research for reducing risk in later life of avoidable clinical dementia syndromes.
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Affiliation(s)
- Stephen B. Wharton
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Julie E. Simpson
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Paul G. Ince
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | | | - Richard Merrick
- Cambridge Public Health, School of Clinical MedicineUniversity of CambridgeSheffieldUK
| | | | - Carol Brayne
- Cambridge Public Health, School of Clinical MedicineUniversity of CambridgeSheffieldUK
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31
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Volloch V, Rits-Volloch S. The Amyloid Cascade Hypothesis 2.0 for Alzheimer's Disease and Aging-Associated Cognitive Decline: From Molecular Basis to Effective Therapy. Int J Mol Sci 2023; 24:12246. [PMID: 37569624 PMCID: PMC10419172 DOI: 10.3390/ijms241512246] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
With the long-standing amyloid cascade hypothesis (ACH) largely discredited, there is an acute need for a new all-encompassing interpretation of Alzheimer's disease (AD). Whereas such a recently proposed theory of AD is designated ACH2.0, its commonality with the ACH is limited to the recognition of the centrality of amyloid-β (Aβ) in the disease, necessitated by the observation that all AD-causing mutations affect, in one way or another, Aβ. Yet, even this narrow commonality is superficial since AD-causing Aβ of the ACH differs distinctly from that specified in the ACH2.0: Whereas in the former, the disease is caused by secreted extracellular Aβ, in the latter, it is triggered by Aβ-protein-precursor (AβPP)-derived intraneuronal Aβ (iAβ) and driven by iAβ generated independently of AβPP. The ACH2.0 envisions AD as a two-stage disorder. The first, asymptomatic stage is a decades-long accumulation of AβPP-derived iAβ, which occurs via internalization of secreted Aβ and through intracellular retention of a fraction of Aβ produced by AβPP proteolysis. When AβPP-derived iAβ reaches critical levels, it activates a self-perpetuating AβPP-independent production of iAβ that drives the second, devastating AD stage, a cascade that includes tau pathology and culminates in neuronal loss. The present study analyzes the dynamics of iAβ accumulation in health and disease and concludes that it is the prime factor driving both AD and aging-associated cognitive decline (AACD). It discusses mechanisms potentially involved in AβPP-independent generation of iAβ, provides mechanistic interpretations for all principal aspects of AD and AACD including the protective effect of the Icelandic AβPP mutation, the early onset of FAD and the sequential manifestation of AD pathology in defined regions of the affected brain, and explains why current mouse AD models are neither adequate nor suitable. It posits that while drugs affecting the accumulation of AβPP-derived iAβ can be effective only protectively for AD, the targeted degradation of iAβ is the best therapeutic strategy for both prevention and effective treatment of AD and AACD. It also proposes potential iAβ-degrading drugs.
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Affiliation(s)
- Vladimir Volloch
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Sophia Rits-Volloch
- Division of Molecular Medicine, Children’s Hospital, Boston, MA 02115, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
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Juul Rasmussen I, Frikke-Schmidt R. Modifiable cardiovascular risk factors and genetics for targeted prevention of dementia. Eur Heart J 2023; 44:2526-2543. [PMID: 37224508 PMCID: PMC10481783 DOI: 10.1093/eurheartj/ehad293] [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: 09/27/2022] [Revised: 02/22/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
Dementia is a major global challenge for health and social care in the 21st century. A third of individuals >65 years of age die with dementia, and worldwide incidence numbers are projected to be higher than 150 million by 2050. Dementia is, however, not an inevitable consequence of old age; 40% of dementia may theoretically be preventable. Alzheimer's disease (AD) accounts for approximately two-thirds of dementia cases and the major pathological hallmark of AD is accumulation of amyloid-β. Nevertheless, the exact pathological mechanisms of AD remain unknown. Cardiovascular disease and dementia share several risk factors and dementia often coexists with cerebrovascular disease. In a public health perspective, prevention is crucial, and it is suggested that a 10% reduction in prevalence of cardiovascular risk factors could prevent more than nine million dementia cases worldwide by 2050. Yet this assumes causality between cardiovascular risk factors and dementia and adherence to the interventions over decades for a large number of individuals. Using genome-wide association studies, the entire genome can be scanned for disease/trait associated loci in a hypothesis-free manner, and the compiled genetic information is not only useful for pinpointing novel pathogenic pathways but also for risk assessments. This enables identification of individuals at high risk, who likely will benefit the most from a targeted intervention. Further optimization of the risk stratification can be done by adding cardiovascular risk factors. Additional studies are, however, highly needed to elucidate dementia pathogenesis and potential shared causal risk factors between cardiovascular disease and dementia.
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Affiliation(s)
- Ida Juul Rasmussen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hwangbo S, Lee JY, Han G, Chun MY, Jang H, Seo SW, Na DL, Won S, Kim HJ, Lim DH. Dementia incidence and population-attributable fraction for dementia risk factors in Republic of Korea: a 12-year longitudinal follow-up study of a national cohort. Front Aging Neurosci 2023; 15:1126587. [PMID: 37520131 PMCID: PMC10373584 DOI: 10.3389/fnagi.2023.1126587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Background We aimed to investigate the incidence of dementia by age and year as well as the population-attributable fractions (PAFs) for known dementia risk factors in Republic of Korea. Methods A 12-year, nationwide, population-based, retrospective cohort study was conducted. We used customized health information from the National Health Insurance Service (NHIS) data from 2002 to 2017. We analyzed age- and sex-adjusted incidence rates and PAF of dementia for each risk factor such as depression, diabetes, hemorrhagic stroke, ischemic stroke, hypertension, osteoporosis and physical inactivity using Levin's formula. Results Of the 794,448 subjects in the dementia-free cohort, 49,524 (6.2%) developed dementia. Dementia incidence showed annual growth from 1.56 per 1,000 person-years in 2006 to 6.94 per 1,000 person-years in 2017. Of all dementia cases, 34,544 subjects (69.8%) were female and 2,479 subjects (5.0%) were early onset dementia. AD dementia accounted for 66.5% of the total dementia incidence. Considering relative risk and prevalence, physical inactivity attributed the greatest to dementia (PAF, 8.1%), followed by diabetes (PAF, 4.2%), and hypertension (PAF, 2.9%). Altogether, the significant risk factors increased the risk of dementia by 18.0% (overall PAF). Conclusion We provided the incidence of dementia and PAFs for dementia risk factors in Republic of Korea using a 12-year, nationwide cohort. Encouraging lifestyle modifications and more aggressive control of risk factors may effectively prevent dementia.
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Affiliation(s)
- Song Hwangbo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin Young Lee
- Department of Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Gyule Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Young Chun
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin-si, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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Xiong Z, Li X, Yang D, Xiong C, Xu Q, Zhou Q. The association between cataract and incidence of cognitive impairment in older adults: A systematic review and meta-analysis. Behav Brain Res 2023; 450:114455. [PMID: 37148915 DOI: 10.1016/j.bbr.2023.114455] [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: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Cataract has been shown to be associated with an increased risk of cognitive impairment. However, the results of previous studies have been inconsistent. This systematic review and meta-analysis aimed to investigate the association between cataract and the incidence of cognitive impairment in older adults. METHODS A comprehensive search of electronic databases from inception to January 2023 was performed to identify relevant studies. Data were extracted from eligible studies and a meta-analysis was performed to calculate the pooled hazard ratio (HR) and 95% confidence interval (CI). RESULTS We included 13 studies with 25 study arms involving a total of 798,694 participants. Compared with participants without cataract, those with cataract had a higher risk of developing all-cause dementia (pooled HR: 1.22; 95% CI: 1.08-1.38; I2=86%; 9 studies), Alzheimer's disease dementia (pooled HR: 1.18; 95% CI: 1.07-1.30; I2=0%; 9 studies), vascular dementia (pooled HR: 1.21; 95% CI: 1.02-1.43; I2=77%;3 studies) and mild cognitive impairment (pooled HR: 1.30; 95% CI: 1.13-1.50; I2=0%;2 studies). There was no significant association between cataract and mixed dementia (pooled HR: 1.03; 95% CI: 0.52-2.04; I2=78%;2 studies). We assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale and found that most of them had a low or moderate risk of bias. The number of studies in each meta-analysis ranged from two to nine, with more studies available for all-cause dementia and Alzheimer's disease dementia than for vascular dementia and mixed dementia. CONCLUSIONS The findings suggest that cataract may be associated with cognitive impairment in older adults. However, the causal relationship between cataract and cognition remains unclear and requires further investigation.
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Affiliation(s)
- Zhenrong Xiong
- Public relations department, The First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China.
| | - Xinming Li
- Department of Neurology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Dejiang Yang
- Department of Neurology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Chongyu Xiong
- Public relations department, The First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China.
| | - Qinggang Xu
- Jiangxi College of Traditional Chinese Medicine, Fuzhou, Jiangxi, China.
| | - Qi Zhou
- Department of Neurology, The First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China.
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35
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Mullin DS, Stirland LE, Buchanan E, Convery CA, Cox SR, Deary IJ, Giuntoli C, Greer H, Page D, Robertson E, Shenkin SD, Szalek A, Taylor A, Weatherdon G, Wilkinson T, Russ TC. Identifying dementia using medical data linkage in a longitudinal cohort study: Lothian Birth Cohort 1936. BMC Psychiatry 2023; 23:303. [PMID: 37127606 PMCID: PMC10152609 DOI: 10.1186/s12888-023-04797-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The Lothian Birth Cohort 1936 (LBC1936) is a longitudinal study of ageing with well-characterised assessments, but until now, it has relied on self-report or proxies for dementia such as cognitive tests. Our aims were twofold: a) to describe a framework for identifying dementia in a cohort study. b) to report the age-specific incidence and prevalence of all-cause dementia and dementia subtypes in 865 individuals in the LBC1936. METHODS Electronic Health Records (EHR) of all participants were reviewed, and relevant information was extracted to form case vignettes for everyone with any record of cognitive dysfunction. The EHR data sources include hospital and clinic letters, general practitioner and hospital referrals, prescribed medications, imaging and laboratory results. Death certificate data were obtained separately. Clinician assessments were performed when there was concern about a participant's cognition. A diagnosis of probable dementia, possible dementia, or no dementia was agreed upon by a consensus diagnostic review board, comprised of a multidisciplinary team of clinical dementia experts who reviewed case vignettes and clinician assessment letters. For those with probable dementia, a subtype was also determined, where possible. We compared the agreement between our newly ascertained dementia diagnoses with the existing self-reported dementia diagnoses. RESULTS Self-reported dementia diagnoses were positive in only 17.8% of ascertained dementia diagnoses. The EHR review identified 163/865 (18.8%) individuals as having cognitive dysfunction. At the consensus diagnostic review board, 118/163 were diagnosed with probable all-cause dementia, a prevalence of 13.6%. Age-specific dementia prevalence increased with age from 0.8% (65-74.9 years) to 9.93% (85-89.9 years). Prevalence rates for women were higher in nearly all age groups. The most common subtype was dementia due to Alzheimer disease (49.2%), followed by mixed Alzheimer and cerebrovascular disease (17.0%), dementia of unknown or unspecified cause (16.1%), and dementia due to vascular disease (8.5%). CONCLUSIONS We present a robust systematic framework and guide for other cohort teams wanting to ascertain dementia diagnoses. The newly ascertained dementia diagnosis provides vital data for further analyses of LBC1936 to allow exploration of lifecourse predictors of dementia.
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Affiliation(s)
- Donncha S Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK.
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, EH10 5HF, UK.
| | - Lucy E Stirland
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Global Brain Health Institute, University of California San Francisco, San Francisco, UK
| | - Emily Buchanan
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Catherine-Anne Convery
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Simon R Cox
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Cinzia Giuntoli
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Holly Greer
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Danielle Page
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Robertson
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | | | - Anna Szalek
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Adele Taylor
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Georgina Weatherdon
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
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de Miguel-Diez J, Lopez-de-Andres A, Jimenez-Garcia R, Hernández-Barrera V, Carabantes-Alarcon D, Zamorano-Leon JJ, Omaña-Palanco R, González-Barcala FJ, Cuadrado-Corrales N. Trends in prevalence and the effects on hospital outcomes of dementia in patients hospitalized with acute COPD exacerbation. Respir Med 2023; 212:107223. [PMID: 36965589 DOI: 10.1016/j.rmed.2023.107223] [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: 02/06/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/27/2023]
Abstract
AIMS To assess changes in prevalence and the effects on hospital outcomes of dementia among patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD); and to evaluate sex-differences, as well as the impact of COVID-19 pandemic in this relationship. METHODS We used a nationwide discharge database to select patients admitted with AE-COPD in Spain from 2011 to 2020. We identified those with any type of dementia, vascular dementia (VaD) or Alzheimer's disease (AD). RESULTS We identified 658,429 hospitalizations with AE-COPD (4.45% had any type of dementia, 0.79% VaD and 1.57% AD). The presence of any type of dementia remained stable from 2011 to 2015, and increased significantly between 2016 and 2020. For VaD, the time trend showed no change until 2020, when a significant increment was found. The probability of AD decreased significantly overtime. The in-hospital mortality (IHM) among patients with any type of dementia remained stable overtime until 2020, when it increased significantly. Older age, higher comorbidity, COVID-19, and use of mechanical ventilation were variables associated to IHM. Women had lower risk of dying in the hospital than men in all subgroups. CONCLUSIONS After a previous period of stability, the prevalence of any type of dementia increased over the last 5 years of the study, although we identified different trends depending on the specific cause of dementia. The IHM remained stable overtime until 2020, when it increased, probably related to the COVID-19 pandemic. It is remarkable the protective effect of female sex for IHM.
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Affiliation(s)
- Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007, Madrid, Spain
| | - Ana Lopez-de-Andres
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040, Madrid, Spain.
| | - Rodrigo Jimenez-Garcia
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040, Madrid, Spain
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922, Alcorcón, Spain
| | - David Carabantes-Alarcon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040, Madrid, Spain
| | - Jose J Zamorano-Leon
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040, Madrid, Spain
| | - Ricardo Omaña-Palanco
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040, Madrid, Spain
| | - Francisco Javier González-Barcala
- Servicio de Neumología, Hospital Clínico Universitario de Santiago de Compostela. Universidad de Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040, Madrid, Spain
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Blaauw J, Hertog HMD, Holl DC, Thüss NS, van der Gaag NA, Jellema K, Dammers R, Kho KH, Groen RJM, Lingsma HF, Jacobs B, van der Naalt J. The cognitive status of chronic subdural hematoma patients after treatment: an exploratory study. Acta Neurochir (Wien) 2023; 165:701-709. [PMID: 36752891 PMCID: PMC10006248 DOI: 10.1007/s00701-023-05508-7] [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: 06/28/2022] [Accepted: 12/29/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common neurological condition, often affecting the elderly. Cognitive impairment is frequently observed at presentation. However, the course and longer term aspects of the cognitive status of CSDH patients are unknown. In this study, we aim to explore the cognitive status of CSDH patients after treatment. METHODS An exploratory study in which CSDH patients were assessed 3 months after treatment and compared to healthy controls. A total of 56 CSDH patients (age 72.1 SD ± 10.8 years with 43 [77%] males) and 60 healthy controls were included (age 67.5 ± SD 4.8 with 34 [57%] males). Cognitive testing was performed using the Telephonic Interview of Cognitive Status-modified (TICS-m), a 12-item questionnaire in which a total of 50 points can be obtained on several cognitive domains. RESULTS Median time between treatment and cognitive testing was 93 days (range 76-139). TICS-m scores of CSDH patients were significantly lower than healthy controls, after adjusting for age and sex: mean score 34.6 (95% CI: 33.6-35.9) vs. 39.6 (95% CI: 38.5-40.7), p value < 0.001. More than half (54%) of CSDH patients have cognitive scores at follow-up that correspond with cognitive impairment. CONCLUSION A large number of CSDH patients show significantly worse cognitive status 3 months after treatment compared to healthy controls. This finding underlines the importance of increased awareness for impaired cognition after CSDH. Further research on this topic is warranted.
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Affiliation(s)
- Jurre Blaauw
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
| | | | - Dana C Holl
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Nikki S Thüss
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Neurology, Subdepartment of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Niels A van der Gaag
- Haaglanden Medical Center &, University Neurosurgical Center Holland (UNCH), Leiden University Medical Center, Haga Teaching Hospital, Leiden & The Hague, Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Centre, The Hague, Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kuan H Kho
- Department of Neurosurgery, Medisch Spectrum Twente, NeurocenterEnschede, Netherlands
- Clinical Neurophysiology Group, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, Groningen, Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Duval GT, Schott AM, Rolland Y, Gautier J, Blain H, Duque G, Annweiler C. Orthostatic hypotension and neurocognitive disorders in older women: Results from the EPIDOS cohort study. PLoS One 2023; 18:e0281634. [PMID: 36827394 PMCID: PMC9955614 DOI: 10.1371/journal.pone.0281634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Although it is well-admitted that cardiovascular health affects cognition, the association between orthostatic hypotension (OH) and cognition remains unclear. The objectives of the present study were i) to determine among the EPIDOS cohort (EPIdémiologie de l'OStéoporose) whether OH was cross-sectionally associated with cognitive impairment at baseline, and ii) whether baseline OH could predict incident cognitive decline after 7 years of follow-up. METHODS Systolic and Diastolic Blood Pressure (SBP and DBP) changes while standing (ie, ΔSBP and ΔDBP, in %) were measured at baseline among 2,715 community-dwelling older women aged 75 years and older using no antihypertensive drugs from the French EPIDOS cohort. OH was defined as a decrease in SBP ≥20 mmHg and/or a decrease in DBP ≥10 mmHg within 3 min after standing. Cognitive impairment was defined as a Short Portable Mental Status Questionnaire (SPMSQ) score <8 (/10). Among those without cognitive impairment at baseline, a possible incident onset of cognitive decline was then sought after 7 years of follow-up among 257 participants. RESULTS Baseline ΔSBP was associated with baseline cognitive impairment (adjusted OR = 1.01, p = 0.047), but not with incident onset of cognitive decline after 7 years (adjusted OR = 0.98, p = 0.371). Neither baseline OH nor baseline ΔDBP were associated with cognitive impairment neither at baseline (p = 0.426 and p = 0.325 respectively) nor after 7 years (p = 0.180 and p = 0.345 respectively). CONCLUSIONS SBP drop while standing, but neither OH per se nor DBP drop while standing, was associated with baseline cognitive impairment in older women. The relationship between OH and cognitive impairment appears more complex than previously expected.
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Affiliation(s)
- Guillaume T. Duval
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France
- School of Medicine and UPRES EA 4638, University of Angers, Angers, France
- * E-mail:
| | - Anne-Marie Schott
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Service de Recherche et D’épidémiologie Cliniques, Lyon, France
| | - Yves Rolland
- Department of Geriatrics, Toulouse University Hospital, INSERM U1027, University of Toulouse III, Toulouse, France
| | - Jennifer Gautier
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France
| | - Hubert Blain
- Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University of Montpellier 1, Montpellier, France
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Melbourne Medical School–Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
| | - Cedric Annweiler
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France
- School of Medicine and UPRES EA 4638, University of Angers, Angers, France
- Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Lv B, Liang L, Chen A, Yang H, Zhang X, Guo F, Qian H. Mortality of Alzheimer's Disease and Other Dementias in China: Past and Future Decades. Int J Public Health 2023; 68:1605129. [PMID: 36816830 PMCID: PMC9935610 DOI: 10.3389/ijph.2023.1605129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives: This study aimed to explore the distribution features and trends of dementia mortality in China from 2011 to 2020 and make a prediction for the next decade. Methods: Mortality-relevant data were gathered from the Chinese Center for Disease Control and Prevention's Disease Surveillance Points system. Joinpoint regression was applied to evaluate the trends. Results: Crude Mortality Rate (CMR) of AD and other dementias increased from 3.7 per 100,000 to 6.2 per 100,000 in 2011-2020, with an Average Annual Percent Change (AAPC) of 5.3% (95% CI 4.4%-6.3%). Age-Standardized Mortality Rate (ASMR) slightly decreased from 5.0 per 100,000 to 4.1 per 100,000 in 2011-2020, with AAPC of -0.4% (95% CI -2.5%-1.8%). CMR will increase to 9.66 per 100,000 while ASMR will decline to 3.42 per 100,000 in the following decade. Conclusion: The upward trend in CMR and downward trend in ASMR suggested the further development of population aging and dementia mortality in the past and future decades. In China, there were gender, urban-rural, regional and age differences.
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Affiliation(s)
- Bin Lv
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li Liang
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Anan Chen
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hua Yang
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Xiaolan Zhang
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fangfang Guo
- Department of Outpatient, No.13 Cadre Santatorium of Beijing Garrison, Beijing, China
| | - Hairong Qian
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,*Correspondence: Hairong Qian,
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Camarillo J, Villarreal Rizzo A, Cabrero Castro JE, Downer B. Differences in the Cognitive Function of Mexican Adults Aged 60 and Older with Self-Reported Diabetes in 2001 and 2018. J Alzheimers Dis 2023; 95:1029-1039. [PMID: 37638436 PMCID: PMC10578237 DOI: 10.3233/jad-230286] [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] [Accepted: 07/12/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes in Mexico has nearly doubled for adults aged ≥60. Increases in education and healthcare resources to manage chronic conditions have contributed to population-level increases in the cognitive functioning of older adults. However, research has not focused on older adults with chronic conditions such as diabetes. OBJECTIVE Our objective was to compare the cognitive functioning of Mexican adults aged ≥60 with diabetes in 2001 and 2018. METHODS Data came from Mexican Health and Aging Study. Our study used a cross-sectional design and included participants aged ≥60 with self-reported diabetes during the 2001 (n = 1,052, mean age = 68.4, female = 59.6%) and 2018 (n = 2,469, mean age = 70.6, female = 62.0%) observation waves. Five cognitive tests were used to create a score of global cognition. Generalized estimating equations were used to compare global cognition in 2001 to 2018. RESULTS Older adults in 2018 had more education and were more likely than older adults in 2001 to take oral medication for diabetes, insulin, and to check blood sugar weekly. Older adults in 2018 had higher global cognition than in 2001 when adjusting for age, gender, education, and health insurance coverage (b = 0.38, SE = 0.02). This statistically significant difference remained after adjusting for health conditions, health behaviors, and diabetes management behaviors. CONCLUSIONS Older adults in Mexico with self-reported diabetes in 2018 had higher cognitive function than in 2001. Future research is needed to investigate causes of the cohort differences in cognitive functioning among Mexican older adults with self-reported diabetes.
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Affiliation(s)
- Joe Camarillo
- John Sealy School of Medicine, University of Texas Medical Branch. Galveston, TX, USA
| | - Alan Villarreal Rizzo
- John Sealy School of Medicine, University of Texas Medical Branch. Galveston, TX, USA
| | - Jose Eduardo Cabrero Castro
- Department of Population Health and Health Disparities. School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Department of Population Health and Health Disparities. School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Bogdan A, Fabre R, Desmidt T, Golebiowski J, Topin J, Bethus I, Hanon O, Boutoleau-Bretonniere C, Wagemann N, Annweiler C, Ousset PJ, Godefroy O, Rouch I, Paccalin M, Sukhorukova M, Gabelle A, Robert G, David R. Different Trajectories of Apathy and Depression Among Subjective Cognitive Impairment Individuals with or without Conversion to Dementia: Results from the Memento Cohort in France. J Alzheimers Dis 2023; 95:415-426. [PMID: 37545236 DOI: 10.3233/jad-230162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Apathy and depression are two early behavioral symptoms in Alzheimer's disease (AD) and related disorders that often occur prior to the onset of cognitive decline and memory disturbances. Both have been associated with an increased risk of conversion to dementia, with a distinct neuropathology. OBJECTIVE The assessment of the trajectories of apathy and depression and their independent impact on dementia conversion. METHODS Apathy and Depression were measured using the Neuropsychiatric Inventory for caregiver (NPI) and clinician (NPI-C), among the nondemented individuals reporting subjective cognitive decline (SCD) at baseline. They were followed up over a 60-month period. Some converted to dementia, according to the methodology carried out by the French Memento Cohort. RESULTS Among individuals with SCD (n = 2,323), the levels of apathy and depression were low and did not evolve significantly over the 60-month period, despite a trend in apathy increasing as of month 24. Regarding SCD individuals who converted to dementia within the 60-month period (n = 27), the prevalence of depression remained globally steady, while the levels of apathy increased over time. CONCLUSION Apathy and depression have different trajectories among individuals with SCD and apathy alone is more likely-compared to depression-to be associated with conversion to dementia.
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Affiliation(s)
- Anamaria Bogdan
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
| | - Roxane Fabre
- Nice University Hospital, Department of Public Health, Nice, France
| | | | | | - Jérémie Topin
- Côte D'Azur University, Chemistry Institute of Nice, France
| | - Ingrid Bethus
- Côte d'Azur University, IPMC (Institut de Pharmacologie Moléculaire et cellulaire), Sophia Antipolis, France
| | - Olivier Hanon
- Université Paris Cité - EA4468 APHP-Hôpitaux Universitaires Paris Centre - Service de Gériatrie- hôpital Broca, Paris, France
| | | | | | | | - Pierre-Jean Ousset
- Toulouse Clinical Research Center, Toulouse University Hospital, Toulouse, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Isabelle Rouch
- Memory Clinic (CMRR) Saint Etienne, INSERM U1219, Bordeaux, France
| | - Marc Paccalin
- Department of Geriatry, Memory Clinic (CMRR), CIC U1402, Poitiers University Hospital, Poitiers, France
| | | | - Audrey Gabelle
- Memory Clinic (CMRR), Montpellier University Hospital, Montpellier, France
| | | | - Renaud David
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
- NICE BRAIN non-profitorganization for research on brain, Nice, France
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Chung S, Providencia R, Sofat R, Pujades‐Rodriguez M, Torralbo A, Fatemifar G, Fitzpatrick NK, Taylor J, Li K, Dale C, Rossor M, Acosta‐Mena D, Whittaker J, Denaxas S. Incidence, morbidity, mortality and disparities in dementia: A population linked electronic health records study of 4.3 million individuals. Alzheimers Dement 2023; 19:123-135. [PMID: 35290719 PMCID: PMC10078672 DOI: 10.1002/alz.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/08/2021] [Accepted: 01/30/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION We report dementia incidence, comorbidities, reasons for health-care visits, mortality, causes of death, and examined dementia patterns by relative deprivation in the UK. METHOD A longitudinal cohort analysis of linked electronic health records from 4.3 million people in the UK was conducted to investigate dementia incidence and mortality. Reasons for hospitalization and causes of death were compared in individuals with and without dementia. RESULTS From 1998 to 2016 we observed 145,319 (3.1%) individuals with incident dementia. Repeated hospitalizations among senior adults for infection, unknown morbidity, and multiple primary care visits for chronic pain were observed prior to dementia diagnosis. Multiple long-term conditions are present in half of the individuals at the time of diagnosis. Individuals living in high deprivation areas had higher dementia incidence and high fatality. DISCUSSION There is a considerable disparity of dementia that informs priorities of prevention and provision of patient care.
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Affiliation(s)
- Sheng‐Chia Chung
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | | | - Reecha Sofat
- Department of Health InformaticsHealth Data Research UKLondonUK
| | | | - Ana Torralbo
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Ghazaleh Fatemifar
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Natalie K. Fitzpatrick
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Julie Taylor
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Ken Li
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Caroline Dale
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Martin Rossor
- Department of NeurodegenerationUCL Institute of NeurologyLondonUK
| | | | | | - Spiros Denaxas
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
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Walsh S, Merrick R, Brayne C. The relevance of social and commercial determinants for neurological health. Lancet Neurol 2022; 21:1151-1160. [PMID: 36402161 DOI: 10.1016/s1474-4422(22)00428-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022]
Abstract
A disconnect has developed over the past two decades between neurological and neuroscientific research, which have seen notable innovation and development, and our increasing understanding of the role of social and commercial determinants of health, including the health of the nervous system. Over the next two decades, grounding neurological research in public health and epidemiological principles can bring about a paradigm shift, away from reductionism, over-medicalisation, and health inequities towards neurological research that reduces inequalities and has true relevance to the populations it aims to serve. People who are involved in neurological and neuroscientific research and practice, as clinicians, researchers, publishers, and funders, can create change by being more aware of the social and commercial determinants of health, reprioritising research funding, and advocating for greater neurological health equity.
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Affiliation(s)
- Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Richard Merrick
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK.
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Fukuoka T, Irie S, Watanabe Y, Kutsuna T, Abe A. The relationship between spatiotemporal gait parameters and cognitive function in healthy adults: protocol for a cross-sectional study. Pilot Feasibility Stud 2022; 8:154. [PMID: 35879785 PMCID: PMC9310397 DOI: 10.1186/s40814-022-01122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Motor dysfunctions, such as slower walking speed, precede the occurrence of dementia and mild cognitive impairment, suggesting that walking parameters are effective biomarkers for detecting early sub-clinical cognitive risk. It is often also concurrent with self-complained cognitive dysfunction, called motoric cognitive risk (MCR) syndrome. Our preliminary study found several walking parameters, obtained by a three-dimensional motion capture system, to be correlated with computer-based assessments of various cognitive function modalities, although the sample size was small. The Cognitive-Gait (CoGait) Database Project, described in the current protocol, aims to establish a database of multi-dimensional walking and cognitive performance data, collected from a large sample of healthy participants, crucial for detecting early sub-clinical cognitive risk. Methods We will recruit healthy volunteers, 20 years or older, without any neurological musculoskeletal or psychiatric disorders. The estimated sample size is 450 participants, including a 10% attrition rate. Using computer-based cognitive assessments, participants will perform six tasks: (i) the simple reaction time task, (ii) Go/No-Go task, (iii) Stroop Color–Word Test, (iv) N-back test, (v) Trail Making Test, and (vi) digit span test. We will also conduct paper-based cognitive assessments such as the Mini-Mental State Examination, Montreal Cognitive Assessment, and the Geriatric Depression Scale-15 for assessing MCR. Gait will be measured through joint kinematics and global positioning in participants’ lower legs while walking at a comfortable and faster pace, using pants with an inertial measurement unit-based three-dimensional motion capture system. Finally, we will establish a prediction model for various cognitive performance modalities based on walking performance. Discussion This will be the first study to reveal the relationship between walking and cognitive performance using multi-dimensional data collected from a large sample of healthy adults, from the general population. Despite certain methodological limitations such as the accuracy of measurements, the CoGait database is expected to be the standard value for both walking and cognitive functions, supporting the evaluation of psychomotor function in early sub-clinical cognitive risk identification, including motoric-cognitive risk syndrome. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01122-z.
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Siette J, Dodds L, Dawes P, Richards D, Savage G, Strutt P, Ijaz K, Johnco C, Wuthrich V, Heger I, Deckers K, Köhler S, Armitage CJ. Protocol for a pre-post, mixed-methods feasibility study of the Brain Bootcamp behaviour change intervention to promote healthy brain ageing in older adults. PLoS One 2022; 17:e0272517. [PMID: 36445869 PMCID: PMC9707764 DOI: 10.1371/journal.pone.0272517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Behaviour change interventions represent key means for supporting healthy ageing and reducing dementia risk yet brief, scalable behaviour change interventions targeting dementia risk reduction in older adults is currently lacking. Here we describe the aims and design of the three-month Brain Bootcamp initiative that seeks to target multiple dementia risk and protective factors (healthy eating, physical, social and cognitive inactivity), through the use of multiple behaviour change techniques, including goal-setting for behaviour, information about health consequences and physical prompts to change behaviours that reduce dementia risk among older adults. Our secondary aim is to understand participants' views of dementia prevention and explore the acceptability and integration of this campaign into daily life. METHODS Brain Bootcamp is a pre-post feasibility trial conducted in Sydney, Australia beginning in January 2021 until late August. Participants aged ≥65 years living independently in the community (n = 252), recruited through social media and flyers, will provide information about their demographics, medical history, alcohol consumption, smoking habits, mental health, physical activity, cognitive activity, and diet to generate a dementia risk profile at baseline and assess change therein at three-month follow-up. During the intervention, participants will receive a resource pack containing their individual risk profile, educational booklet on dementia risk factors and four physical items designed to prompt physical, social and mental activity, and better nutrition. Outcome measures include change in dementia risk scores, dementia awareness and motivation. A qualitative process evaluation will interview a sample of participants on the acceptability and feasibility of the intervention. DISCUSSION This will be the first short-term multi-domain intervention targeting dementia risk reduction in older adults. Findings will generate a new evidence base on how to best support efforts targeting lifestyle changes and to identify ways to optimise acceptability and effectiveness towards brain health for older adults. TRIAL REGISTRATION NUMBER ACTRN 381046 (registered 17/02/2021); Pre-results.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Piers Dawes
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Deborah Richards
- Department of Computing, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Greg Savage
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Paul Strutt
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
- Department of Cognitive Science, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Viviana Wuthrich
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Irene Heger
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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Hudomiet P, Hurd MD, Rohwedder S. Trends in inequalities in the prevalence of dementia in the United States. Proc Natl Acad Sci U S A 2022; 119:e2212205119. [PMID: 36343247 PMCID: PMC9674270 DOI: 10.1073/pnas.2212205119] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
This paper presents estimates of the prevalence of dementia in the United States from 2000 to 2016 by age, sex, race and ethnicity, education, and a measure of lifetime earnings, using data on 21,442 individuals aged 65 y and older and 97,629 person-year observations from a nationally representative survey, the Health and Retirement Study (HRS). The survey includes a range of cognitive tests, and a subsample underwent clinical assessment for dementia. We developed a longitudinal, latent-variable model of cognitive status, which we estimated using the Markov Chain Monte Carlo method. This model provides more accurate estimates of dementia prevalence in population subgroups than do previously used methods on the HRS. The age-adjusted prevalence of dementia decreased from 12.2% in 2000 (95% CI, 11.7 to 12.7%) to 8.5% in 2016 (7.9 to 9.1%) in the 65+ population, a statistically significant decline of 3.7 percentage points or 30.1%. Females are more likely to live with dementia, but the sex difference has narrowed. In the male subsample, we found a reduction in inequalities across education, earnings, and racial and ethnic groups; among females, those inequalities also declined, but less strongly. We observed a substantial increase in the level of education between 2000 and 2016 in the sample. This compositional change can explain, in a statistical sense, about 40% of the reduction in dementia prevalence among men and 20% among women, whereas compositional changes in the older population by age, race and ethnicity, and cardiovascular risk factors mattered less.
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Affiliation(s)
- Péter Hudomiet
- Economics, Sociology, and Statistics Department, RAND Corporation, Santa Monica, CA 90401
| | - Michael D. Hurd
- Economics, Sociology, and Statistics Department, RAND Corporation, Santa Monica, CA 90401
- National Bureau of Economic Research, Cambridge, MA 02138
- Network for Studies on Pensions, Aging and Retirement (NETSPAR), 5037 Tilburg, The Netherlands
| | - Susann Rohwedder
- Economics, Sociology, and Statistics Department, RAND Corporation, Santa Monica, CA 90401
- Network for Studies on Pensions, Aging and Retirement (NETSPAR), 5037 Tilburg, The Netherlands
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Løkkegaard LE, Thinggaard M, Nygaard M, Hallas J, Osler M, Christensen K. Systemic hormone therapy and dementia: A nested case-control and co-twin control study. Maturitas 2022; 165:113-119. [PMID: 36184115 DOI: 10.1016/j.maturitas.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/12/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The effect of systemic hormone therapy (HT) on dementia risk is unclear. Our aim was to investigate the association between HT and dementia. STUDY DESIGN This register-based study consists of a nested case-control study and a co-twin control design, which controls for familial confounding, including shared genetics. MAIN OUTCOME MEASURES Through Danish national registries from 1995 to 2011, we identified: a) 2700 female singletons with incident dementia and 13,492 matched controls; b) 288 female twins with incident dementia and co-twins without dementia. Data on HT and education were retrieved, and analyses were performed using conditional logistic regression and McNemar's χ2-test. HT use decreased dramatically after the Women's Health Initiative study results were published in 2002, and the analyses were stratified accordingly to account for potentially different HT user characteristics. RESULTS The odds ratio (OR) for the association between systemic HT and dementia was 1.05, 95% CI = [0.93-1.19] in singletons and 2.10, 95% CI = [0.99-4.46] in twins. A statistically significant association was found for systemic HT before 2003 in both populations, with an OR of 1.14, 95% CI = [1.01-1.28] in singletons and an OR of 2.20, 95% CI = [1.04-4.65] in twins. CONCLUSION Using Danish nationwide registries and controlling for education and for familial factors in a subsample, systemic HT was found to be associated with increased dementia risk if used before 2003, when HT was more commonly prescribed.
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Affiliation(s)
- Laura Ekstrøm Løkkegaard
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; The Danish Twin Registry, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; Danish Aging Research Center, Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark.
| | - Mikael Thinggaard
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; The Danish Twin Registry, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; Danish Aging Research Center, Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark
| | - Marianne Nygaard
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; The Danish Twin Registry, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; Danish Aging Research Center, Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense University Hospital, J. B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; The Danish Twin Registry, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark; Danish Aging Research Center, Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense C, Denmark
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Ribeiro F, Teixeira-Santos AC, Caramelli P, Leist AK. Prevalence of dementia in Latin America and Caribbean countries: Systematic review and meta-analyses exploring age, sex, rurality, and education as possible determinants. Ageing Res Rev 2022; 81:101703. [PMID: 35931410 PMCID: PMC9582196 DOI: 10.1016/j.arr.2022.101703] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies have shown that the prevalence of dementia in Latin America and the Caribbean (LAC) may be higher than in high-income countries. Thus, we sought to systematically analyse the prevalence of dementia and explore possible drivers that lead to this disparity in LAC countries. METHOD We searched Pubmed, Web of Knowledge, Scopus, Lilacs, and SciELO for studies on dementia in LAC countries published in English, Spanish, and Portuguese. Random-effects model was applied. RESULTS Thirty-one studies from 17 LAC countries were included. Pooled prevalence of all-cause dementia was 10.66%. Further analyses with studies providing raw prevalence by sex, area, and educational level showed a higher prevalence for women (8.97%) than for men (7.26%). Also, dementia prevalence was higher for rural than urban residents (7.71% vs 8.68%, respectively). Participants without formal education presented more than double the prevalence of dementia (21.37%) compared to those with at least one year of formal education (9.88%). Studies with more recent data collection showed higher dementia prevalence. CONCLUSION Our findings suggest a high global dementia prevalence in LAC countries and an unequal burden of dementia for women, lower-educated, and rural residents. Secular increases in dementia prevalence call for greater public health efforts for preventative actions.
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Affiliation(s)
- Fabiana Ribeiro
- Department of Social Sciences, University of Luxembourg Belval Campus, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg,Correspondence to: University of Luxembourg, Department of Social Sciences, Esch-sur Alzette, Luxembourg.
| | - Ana C. Teixeira-Santos
- Department of Social Sciences, University of Luxembourg Belval Campus, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190 - sala 246, 30130-100 Belo Horizonte, Minas Gerais, Brazil
| | - Anja K. Leist
- Department of Social Sciences, University of Luxembourg Belval Campus, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
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Lin Y, Zhang Q, Wang T, Zeng Z. Effect of living arrangements on cognitive function in Chinese elders: a longitudinal observational study. BMJ Open 2022; 12:e050410. [PMID: 36202581 PMCID: PMC9540837 DOI: 10.1136/bmjopen-2021-050410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine how living arrangement as a social contextual factor can affect Chinese elders' cognitive function. SETTING AND PARTICIPANTS Our sample consists of 2486 Chinese elders from two waves (2014 and 2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that was administered in 22 of China's 31 provinces using a multi-stage, disproportionate, purposive random sampling method. The CLHLS aims to better understand the determinants of healthy longevity in China and collects extensive data on a large population of fragile elders aged 80-112 in China. OUTCOME MEASURES Cognitive function was measured by the Mini-Mental State Examination (MMSE). Living arrangement was divided into living in an institution, living alone and living with household members. Generalised linear regressions were carried out to examine the associations between baseline characteristics and cognitive function, while controlling age, gender and residential area. RESULTS A total of 2486 participants were included in the study at baseline in 2014. Of these, 1162 (46.7%) were men and 1324 (53.3%) were women. The mean age at baseline was 75.07 (±8.31) years. The mean years of schooling were 2.86 (±3.68). The number (proportion) of the three living arrangements (lived in institutions, lived alone and lived with household members) were 93 (3.8%), 463 (18.6%) and 1930 (77.6%), respectively. Among all participants, cognitive function declined over time. Those who lived alone presented with the highest MMSE scores at baseline and showed the lowest decline after 4 years. Living arrangements had significant effects on decreasing cognitive function. CONCLUSION Chinese elders living in institutions were most vulnerable to cognitive decline. Living alone was not a risk condition in itself for the elderly in terms of cognitive decline. In addition, the benefits of living with household members to support cognitive function were not found in our study.
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Affiliation(s)
- Yanwei Lin
- Department of Health Sociology, School of Humanities and Management, Guangdong Medical University, Dongguan, Guangdong, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, Guangdong, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia, USA
| | - Tingxian Wang
- School of public health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Zhirong Zeng
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, Guangdong, China
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