The type A behavior pattern and cardiovascular disease as predictors of dementia

Effects of adult education on cognitive function and risk of dementia in older adults: a longitudinal analysis

Introduction

Mid/late-life cognitive activities are associated with a lower rate of subsequent cognitive decline and lower subsequent dementia risk over time.

Methods

In this study, we investigated the association between adult education class participation and subsequent cognitive decline and dementia risk over time after adjusting for baseline cognitive function and genetic risk of dementia, correcting for several potential confounding variables, using a large prospective cohort data of participants from the UK Biobank study followed from 2006 to 2010.

Results

The results revealed that participation in adult education classes at baseline was associated with greater subsequent retention of fluid intelligence score. Cox proportional hazard models revealed that subjects who participated in adult education classes showed a significantly lower risk of incident dementia 5 years after baseline compared with those that did not at baseline.

Discussion

In this study, we show that participation in adult education classes preceded greater retention of subsequent fluid intelligence and a lower risk of developing dementia after 5 years: this association did not change after adjusting for cognitive function at baseline or genetic predisposition to dementia. Accordingly, participation in such classes could reduce the risk of developing dementia.

Association of Stress with Risk of Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

BACKGROUND

Although many studies have investigated the association between stress and risk of dementia, findings are inconsistent due to the variation in the measures used to assess stress.

OBJECTIVE

We conducted a systematic review and meta-analysis to investigate the association between psychological stress (including neuroticism, stressful life events, and perceived stress) and the risk of incident dementia and mild cognitive impairment in adults.

METHODS

PsycINFO, Embase, and MEDLINE were searched to October 2020 for eligible observational, prospective studies. Of the 1,607 studies screened, 26 (24 unique cohorts) were included in the qualitative analysis and 16 (15 unique cohorts) were included in the quantitative analysis.

RESULTS

Across studies, higher perceived stress was significantly associated with an increased risk of mild cognitive impairment (Cases/Total N = 207/860: hazard ratio [HR] = 1.19, 95% confidence interval [CI] = 1.03-1.38) and all-cause dementia (Cases/Total N = 203/1,882: HR = 1.44, 95% CI = 1.07-1.95). Exposure to two or more stressful life events (versus none) was significantly associated with an increased risk of all-cause dementia (Cases/Total N = 3,354/11,597: HR = 1.72, 95% CI = 1.14-2.60), while one or more stressful life events was not. Higher neuroticism was significantly associated with an increased risk of Alzheimer's disease dementia (Cases/Total N = 497/4,771: HR = 1.07, 95% CI = 1.01-1.12), but not all-cause dementia.

CONCLUSION

This review suggests that psychological stress in adulthood is associated with an increased risk of dementia. Further research is needed to clarify the mechanisms underlying these associations.

Type A Behavior Patterns Among Neurosurgeons and Neurosurgical Trainees

BACKGROUND

The busy and demanding work schedule of neurosurgeons suggests that they might have type A behavior patterns (TABPs). TABPs are also associated with multiple diseases; hence, their early identification could lead to behavioral changes and disease prevention. We aimed to determine the presence of TABPs among neurosurgeons and trainees in the Philippines and the association between demographic and clinical factors and TABPs.

METHODS

An online survey was sent to neurosurgeons and neurosurgical trainees in the Philippines. Data on age, sex, comorbid conditions, smoking, alcohol use, training institution, level of residency training, and place of practice were obtained. The modified Bortner scale was used to determine TABPs. Univariate and multiple regression analyses were used for analysis.

RESULTS

A total of 102 individuals (41 neurosurgeons and 61 trainees) completed the survey. Most of the respondents were men (74%), with a mean age of 36 years. The Bortner scores were normally distributed. TABPs were significantly associated with female sex (P = 0.0006) in the entire cohort. However, the trainee cohort also exhibited a significant association between TABPs and training in a public institution (P = 0.0027).

CONCLUSION

The presence of TABPs followed a normal distribution among neurosurgeons and neurosurgical trainees in the Philippines. A significant association was found between TABPs and female sex for both neurosurgeons and trainees, and training in a public institution was significantly associated with TABPs only among the trainees.

The relation of poor mastication with cognition and dementia risk: a population-based longitudinal study

We investigated the effect of poor masticatory ability on cognitive trajectories and dementia risk in older adults. 544 cognitively intact adults aged ≥50 were followed for up to 22 years. Cognitive domains (verbal, spatial/fluid, memory, and perceptual speed) were assessed at baseline and follow-ups. Dementia was ascertained according to standard criteria. Masticatory ability was assessed using the Eichner Index and categorized according to the number of posterior occlusal zones: A (all four), B (3-1), and C (none).

At baseline, 147 (27.0%) participants were in Eichner category A, 169 (31.1%) in B and 228 (41.9%) in C. After the age of 65, participants in Eichner category B and C showed an accelerated decline in spatial/fluid abilities (β: -0.16, 95% CI: -0.30 to -0.03) and (β: -0.15, 95% CI: -0.28 to -0.02), respectively. Over the follow-up, 52 incident dementia cases were identified. Eichner categories B or C were not associated with an increased risk of dementia, compared to category A (Hazard Ratio [HR]: 0.83, 95% CI: 0.39 to 1.76 and HR: 0.63, 95% CI: 0.30 to 1.29, respectively).

Poor masticatory ability is associated with an accelerated cognitive decline in fluid/spatial abilities, however it was not related to a higher risk of dementia.

Cognitive Trajectories of Older Adults With Prediabetes and Diabetes: A Population-Based Cohort Study

Background

Diabetes has been linked to dementia risk; however, the cognitive trajectories in older adults with diabetes remain unclear. We aimed to investigate the effect of prediabetes and diabetes on cognitive trajectories among cognitively intact older adults in a long-term follow-up study.

Methods

Within the Swedish Adoption/Twin Study of Aging, 793 cognitively intact older adults aged ≥50 were identified at baseline and followed for up to 23 years. Based on standardized scores from 11 cognitive tests, administered at baseline and up to seven follow-ups, four cognitive domains (verbal abilities, spatial/fluid, memory, perceptual speed) were identified by principal-component analysis. Prediabetes was defined according to blood glucose levels in diabetes-free participants. Diabetes was ascertained based on self-report, hypoglycemic medication use and blood glucose levels. Data were analyzed with linear mixed-effect models adjusting for potential confounders.

Results

At baseline, 68 participants (8.6%) had prediabetes and 45 (5.7%) had diabetes. Compared to diabetes-free individuals, people with diabetes had a steeper decline over time in perceptual speed and verbal abilities. The annual declines in these domains were greater than the annual decline in memory. Prediabetes was associated with lower performance in memory in middle-age, but also associated with a less steep memory decline over the follow-up.

Conclusions

Diabetes is associated with a faster decline in perceptual speed and verbal abilities, while prediabetes is associated with lower memory performance in middle-age. However, the detrimental effects of hyperglycemia seem to not affect memory over time.

Childhood social class and cognitive aging in the Swedish Adoption/Twin Study of Aging

In this report we analyzed genetically informative data to investigate within-person change and between-person differences in late-life cognitive abilities as a function of childhood social class. We used data from nine testing occasions spanning 28 y in the Swedish Adoption/Twin Study of Aging and parental social class based on the Swedish socioeconomic index. Cognitive ability included a general factor and the four domains of verbal, fluid, memory, and perceptual speed. Latent growth curve models of the longitudinal data tested whether level and change in cognitive performance differed as a function of childhood social class. Between-within twin-pair analyses were performed on twins reared apart to assess familial confounding. Childhood social class was significantly associated with mean-level cognitive performance at age 65 y, but not with rate of cognitive change. The association decreased in magnitude but remained significant after adjustments for level of education and the degree to which the rearing family was supportive toward education. A between-pair effect of childhood social class was significant in all cognitive domains, whereas within-pair estimates were attenuated, indicating genetic confounding. Thus, childhood social class is important for cognitive performance in adulthood on a population level, but the association is largely attributable to genetic influences.

Relationship between type A behavior patterns and risk of temporomandibular disorder in Japanese undergraduate students

Objective: Several studies have demonstrated the relationship between temporomandibular disorder (TMD) and emotional stress. Nonetheless, few surveys have examined the relationship between type A behavior patterns and TMD. The aim of this study was to clarify the relationships among TMD, type A behavior patterns, bruxism, and emotional stress in Japanese undergraduate students.

Methods: This study was undertaken in Nayoro City, Japan, in 2015, among students of Nayoro City University. The survey was conducted through an anonymous, self-administered, multiple-choice questionnaire. Information was gathered on items evaluating the extent of TMD symptoms, bruxism, type A behavior patterns, and proneness and sensitivity to emotional stress.

Results: The questionnaire recovery rate was 31.8% (175/551). There was a high likelihood of TMD in 16.1% of respondents, which is comparable to the findings of previous surveys on Japanese high school students. In keeping with previous studies, we confirmed significant relationships between TMD and both emotional stress and bruxism. A weak but statistically significant association was found between TMD and type A behavior patterns.

Conclusion: We propose that TMD may be one of the diseases related to the type A behavior pattern.

Stress: A Core Lifestyle Issue

Stress is a core issue to be addressed in lifestyle medicine. Not only does it influence disease directly (eg, cardiovascular disease), it also indirectly affects health by having a negative influence on other behaviors such as sleep and physical activity. The importance of stress is further highlighted by the fact that it is one of the most highly ranked health risks for employees globally. Practitioners are encouraged to attend to both significant life stressors and those that are encountered daily. Stress reduction strategies are further discussed.

The Personality and Psychological Stress Predict Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention for Five Years

To investigate the effects of personality type and psychological stress on the occurrence of major adverse cardiovascular events (MACEs) at 5 years in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Two hundred twenty patients with stable angina (SA) or non-ST segment elevation acute coronary syndrome (NSTE-ACS) treated with PCI completed type A behavioral questionnaire, type D personality questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Trait Coping Style Questionnaire (TCSQ), and Symptom Checklist 90 (SCL-90) at 3 days after PCI operation. Meanwhile, biomedical markers (cTnI, CK-MB, LDH, LDH1) were assayed. MACEs were monitored over a 5-year follow-up. NSTE-ACS group had higher ratio of type A behavior, type A/D behavior, and higher single factor scores of type A personality and type D personality than control group and SAP group. NSTE-ACS patients had more anxiety, depression, lower level of mental health (P < 0.05; P < 0.01), more negative coping styles and less positive coping styles. The plasma levels of biomedical predictors had positive relation with anxiety, depression, and lower level of mental health. Type D patients were at a cumulative increased risk of adverse outcome compared with non-type D patients (P < 0.05). Patients treated with PCI were more likely to have type A and type D personality and this tendency was associated with myocardial injury. They also had obvious anxiety, depression emotion, and lower level of mental health, which were related to personality and coping style. Type D personality was an independent predictor of adverse events.