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Zarezadeh M, Mahmoudinezhad M, Faghfouri AH, Mohammadzadeh Honarvar N, Regestein QR, Papatheodorou SI, Mekary RA, Willett WC. Alcohol consumption in relation to cognitive dysfunction and dementia: A systematic review and dose-response meta-analysis of comparative longitudinal studies. Ageing Res Rev 2024; 100:102419. [PMID: 39038743 DOI: 10.1016/j.arr.2024.102419] [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: 04/26/2024] [Revised: 07/13/2024] [Accepted: 07/14/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Alcohol use is associated with a wide spectrum of neurological disorders, including cognitive dysfunction and dementia. Likewise, the high prevalence of cognitive dysfunction and dementia specifies the urgent need to identify modifiable risk factors. Because findings on alcohol and cognitive dysfunction and dementia have been inconsistent, the present dose-response meta-analysis of cohort and case control studies was conducted to evaluate the available evidence. METHOD AND MATERIALS A systematic search was conducted on PubMed/MEDLINE, Scopus, Embase, and PsychInfo databases and Google Scholar up to April, 2023. In the dose-response meta-analysis, a restricted cubic spline regression model was conducted to evaluate a possible non-linear relation between alcohol intake and the outcomes. Random-effects model was used to perform the meta-analysis and evaluate heterogeneity. Egger's test and a funnel plot were used to assess small study effects. Subgroup analyses were carried out to explore possible sources of heterogeneity. RESULTS Seventeen eligible studies comprising 80,680 total persons with 4929 cases for dementia and 13,530 total persons with 1579 cases for cognitive dysfunction were included for dose-response analysis. When compared to the reference group of 0 g/day of alcohol intake, the dose-response meta-analysis revealed a significant non-linear (J-shaped) association between alcohol intake and the risk of each of cognitive dysfunction, (lower dose range: 1-30.5 g/day, RR: 0.97; 95 % CI 0.95-0.99; higher dose range: >30.5 g/day, RR: 1.07; 95 % CI 1.01-1.15) and dementia (lower dose range: 1-17.5 g/day, RR: 0.92; 95 % CI 0.88-0.96, higher dose range: >17.5 g/day, RR: 1.23; 95 % CI 1.09-1.35). The lowest risk was achieved at approximately 30 g/day of alcohol for cognitive dysfunction and 15 g/day for dementia. The J-shape association remained with subgroups defined by age (≤65; >65 years) or study duration (<10; ≥10 years) for dementia, and within age >65 and duration <10 years for cognitive dysfunction. CONCLUSION We observed a J-shape association between alcohol consumption and both cognitive dysfunction and dementia, with light-to-moderate alcohol intake being associated with a reduced risk in adults. Further studies are needed to clarify more specifically the association between alcohol consumption and six domains of cognitive dysfunction based on diagnostic and statistical manual of mental disorders (DSM) criteria.
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Affiliation(s)
- Meysam Zarezadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Mahmoudinezhad
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran; Department of Nutrition Science, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Amir Hossein Faghfouri
- Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Niyaz Mohammadzadeh Honarvar
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Quentin R Regestein
- Department of Psychiatry, Brigham and Women's Hospital., 1249 Boylston St, Boston, MA 02215, USA
| | - Stefania I Papatheodorou
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, 02115, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Boston, MA, 02115, USA
| | - Rania A Mekary
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, 02115, USA; School of Pharmacy, MCPHS University, Boston, MA, 02115, USA.
| | - Walter C Willett
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, 02115, USA.
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Van Asbroeck S, Köhler S, van Boxtel MPJ, Lipnicki DM, Crawford JD, Castro‐Costa E, Lima‐Costa MF, Blay SL, Shifu X, Wang T, Yue L, Lipton RB, Katz MJ, Derby CA, Guerchet M, Preux P, Mbelesso P, Norton J, Ritchie K, Skoog I, Najar J, Sterner TR, Scarmeas N, Yannakoulia M, Dardiotis T, Rolandi E, Davin A, Rossi M, Gureje O, Ojagbemi A, Bello T, Kim KW, Han JW, Oh DJ, Trompet S, Gussekloo J, Riedel‐Heller SG, Röhr S, Pabst A, Shahar S, Rivan NFM, Singh DKA, Jacobsen E, Ganguli M, Hughes T, Haan M, Aiello AE, Ding D, Zhao Q, Xiao Z, Narazaki K, Chen T, Chen S, Ng TP, Gwee X, Gao Q, Brodaty H, Trollor J, Kochan N, Lobo A, Santabárbara J, Gracia‐Garcia P, Sachdev PS, Deckers K. Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis. Alzheimers Dement 2024; 20:3972-3986. [PMID: 38676366 PMCID: PMC11180928 DOI: 10.1002/alz.13846] [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: 09/14/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. RESULTS A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. HIGHLIGHTS A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.
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Grants
- AG03949 NIH HHS
- Netherlands Programme for Research on Aging (NESTOR)
- The Alzheimer's Association Zenith Award
- 2009BAI77B03 China Ministry of Science and Technology
- CRC2017ZD02 Clinical Research Center, Shanghai Mental Health Center
- 03/0815 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- R01 AG057531 NIA NIH HHS
- Greek National Resources
- DCP-2017-002/1 Universiti Kebangsaan Malaysia Grand Challenge
- 20H04030 JSPS KAKENHI
- Stiftelsen Professor Bror Gadelius' Minnesfond
- 01/0255 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- The Alzheimer's Association Stephanie B Overstreet Scholars
- AgeCap-Center for Aging and Health
- The Bank of Sweden Tercentenary Foundation
- European Social Fund
- HJSV2023023 Stiftelsens Hjalmar Svenssons forskningsfond
- 06/0617 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- Fondo de Investigación Sanitaria
- R37AG02365 NIH/NIA
- Instituto de Salud Carlos III
- Epilife
- 16/00896 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- B15_23R Gobierno de Aragón
- B15_17R Gobierno de Aragón
- G03/128 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- AG03949 NIH/NIA
- LRGS/BU/2012/UKM-UKM/K/01 Long-term Research Grant Scheme (LGRS) Ministry of Higher Education, Malaysia
- Limoges University Hospital Appel à Projet des Equipes Émergentes et Labellisées scheme (APREL)
- 189 10276/8/9/2011 Alzheimer's Association
- NMRC/1108/2007 National Medical Research Council
- 97/1321E Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- AG03949 NIA NIH HHS
- Swedish Brain Power
- FORTE
- 2012-Project Public Health Institute [Inserm]-PREUXPierre-Marie AXA Research Fund
- National Strategic Reference Framework (NSFR) - EU Program Excellence Grant (ARISTEIA)
- PI16/00896 Fondo Europeo de Desarrollo Regional (FEDER) of the European Union "Una manera de hacer Europa"
- Shanghai Brain Health Foundation
- JP17K09146 JSPS KAKENHI
- NMRC/CIRG/1409/2014 National Medical Research Council
- AF-967865 Alzheimersfonden
- R37AG02365 NIH HHS
- HJSV2022059 Stiftelsens Hjalmar Svenssons forskningsfond
- 98/0103 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- RF1AG057531 NIH HHS
- Riksbankens Jubileumsfond
- Handlanden Hjalmar Svenssons Forskningsfond
- Stiftelsen för Gamla Tjänarinnor
- P01 AG003949 NIA NIH HHS
- IIRG-09-133014 Alzheimer's Association
- LRGS/1/2019/UM-UKM/1/4 Long-term Research Grant Scheme (LGRS) Ministry of Higher Education, Malaysia
- Wellcome Trust
- Swedish Research Council
- Leonard and Sylvia Marx Foundation
- Maastricht University Medical Center
- 733050511 Netherlands Organisation for Health Research and Development (ZonMw)
- BMRC/08/1/21/19/567 Agency for Science Technology and Research (A*STAR) Biomedical Research Council
- Associazione Alzheimer Milano
- 2017-0557 Fondazione CARIPLO, FrailBioTrack Project
- DCP-2017-002/2 Universiti Kebangsaan Malaysia Grand Challenge
- PI/19/01874 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- 72660 ALF-agreement
- 12/02254 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- Ministry for Health and Social Solidarity (Greece)
- 94/1562 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- 01KS9504 Interdisciplinary Centre for Clinical Research University of Leipzig (Interdisziplinäres Zentrum für Klinische Forschung/IZKF)
- Czap Foundation
- ANR-09-MNPS-009-01 French National Research Agency
- Stiftelsen Söderström-Königska Sjukhemmet
- National Institute on Aging
- National Institutes of Health
- Wellcome Trust
- Gobierno de Aragón
- Alzheimer's Association
- National Medical Research Council
- French National Research Agency
- AXA Research Fund
- Riksbankens Jubileumsfond
- FORTE
- Swedish Brain Power
- Swedish Research Council
- Stiftelsen för Gamla Tjänarinnor
- Instituto de Salud Carlos III
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Affiliation(s)
- Stephanie Van Asbroeck
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Martin P. J. van Boxtel
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Darren M. Lipnicki
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | - John D. Crawford
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | | | | | - Sergio Luis Blay
- Department of PsychiatryFederal University of São PauloSão PauloBrazil
| | - Xiao Shifu
- Department of Geriatric PsychiatryShanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tao Wang
- Department of Geriatric PsychiatryShanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Psychiatry & Affective Disorders CenterRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Alzheimer's Disease and Related Disorders CenterShanghai Jiao Tong UniversityShanghaiChina
| | - Ling Yue
- Department of Geriatric PsychiatryShanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Richard B. Lipton
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Psychiatry and Behavioral MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Mindy J. Katz
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Carol A. Derby
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Maëlenn Guerchet
- Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT ‐ Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealthLimogesFrance
| | - Pierre‐Marie Preux
- Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT ‐ Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealthLimogesFrance
| | - Pascal Mbelesso
- Department of NeurologyAmitié HospitalBanguiCentral African Republic
| | - Joanna Norton
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, InsermMontpellierFrance
| | - Karen Ritchie
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, InsermMontpellierFrance
- Institut du Cerveau TrocadéroParisFrance
| | - Ingmar Skoog
- Department of Psychiatry and NeurochemistryNeuropsychiatric Epidemiology UnitInstitute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP), University of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry ClinicGothenburgSweden
| | - Jenna Najar
- Department of Psychiatry and NeurochemistryNeuropsychiatric Epidemiology UnitInstitute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP), University of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry ClinicGothenburgSweden
- Department of Clinical GeneticsSection Genomics of Neurodegenerative Diseases and Aging, Vrije Universiteit Amsterdam, Amsterdam UMCAmsterdamThe Netherlands
| | - Therese Rydberg Sterner
- Department of Psychiatry and NeurochemistryNeuropsychiatric Epidemiology UnitInstitute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP), University of GothenburgGothenburgSweden
- Department of NeurobiologyAging Research CenterCare Sciences and Society, Karolinska Institute and Stockholm UniversityStockholmSweden
| | - Nikolaos Scarmeas
- 1st Department of NeurologyAiginition Hospital, Medical School, National and Kapodistrian University of AthensAthensGreece
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia UniversityNew YorkNew YorkUSA
| | - Mary Yannakoulia
- Department of Nutrition and DieteticsHarokopio UniversityAthensGreece
| | | | - Elena Rolandi
- Golgi Cenci FoundationMilanItaly
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | | | | | - Oye Gureje
- Department of PsychiatryWHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, University of IbadanIbadanNigeria
| | - Akin Ojagbemi
- Department of PsychiatryCollege of Medicine University of IbadanIbadanNigeria
| | - Toyin Bello
- Department of PsychiatryCollege of Medicine University of IbadanIbadanNigeria
| | - Ki Woong Kim
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamRepublic of Korea
- Department of PsychiatrySeoul National University College of MedicineSeoulRepublic of Korea
- Department of Brain and Cognitive SciencesSeoul National University College of Natural SciencesSeoulRepublic of Korea
| | - Ji Won Han
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamRepublic of Korea
- Department of PsychiatrySeoul National University College of MedicineSeoulRepublic of Korea
| | - Dae Jong Oh
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Stella Trompet
- Department of Internal Medicinesection of Gerontology and GeriatricsLeiden University Medical CenterLeidenthe Netherlands
| | - Jacobijn Gussekloo
- Department of Internal Medicinesection of Gerontology and GeriatricsLeiden University Medical CenterLeidenthe Netherlands
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
| | - Steffi G. Riedel‐Heller
- Institute of Social MedicineOccupational Health and Public HealthMedical FacultyUniversity of LeipzigLeipzigGermany
| | - Susanne Röhr
- Institute of Social MedicineOccupational Health and Public HealthMedical FacultyUniversity of LeipzigLeipzigGermany
- Health and Ageing Research Team (HART), School of Psychology, Massey UniversityPalmerston NorthAotearoa New Zealand
- Global Brain Health Institute (GBHI), Trinity College DublinDublinIreland
| | - Alexander Pabst
- Institute of Social MedicineOccupational Health and Public HealthMedical FacultyUniversity of LeipzigLeipzigGermany
| | - Suzana Shahar
- Center for Healthy Ageing & Wellness (H‐CARE)Faculty of Health SciencesUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Nurul Fatin Malek Rivan
- Center for Healthy Ageing & Wellness (H‐CARE)Faculty of Health SciencesUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Devinder Kaur Ajit Singh
- Center for Healthy Ageing & Wellness (H‐CARE)Faculty of Health SciencesUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Erin Jacobsen
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Mary Ganguli
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Departments of Neurology, and EpidemiologyUniversity of Pittsburgh School of Medicine and School of Public HealthPittsburghPennsylvaniaUSA
| | - Tiffany Hughes
- Department of Graduate Studies in Health and Rehabilitation SciencesBitonte College of Health and Human Services, Youngstown State UniversityYoungstownOhioUSA
| | - Mary Haan
- Department of Epidemiology and BiostatisticsSchool of Medicine, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Allison E. Aiello
- Columbia Aging Center and the Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew YorkNew YorkUSA
| | - Ding Ding
- Institute of NeurologyNational Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Qianhua Zhao
- Institute of NeurologyNational Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Zhenxu Xiao
- Institute of NeurologyNational Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Kenji Narazaki
- Center for Liberal Arts, Fukuoka Institute of TechnologyHigashi‐kuFukuokaJapan
| | - Tao Chen
- Department of Physical EducationSports and Health Research CenterTongji UniversityShanghaiChina
| | - Sanmei Chen
- Graduate School of Biomedical and Health Sciences, Hiroshima UniversityHiroshimaJapan
| | - Tze Pin Ng
- Department of Psychological MedicineGerontology Research Programme, Yong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Xinyi Gwee
- Department of Psychological MedicineGerontology Research Programme, Yong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Qi Gao
- Department of Psychological MedicineGerontology Research Programme, Yong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | - Julian Trollor
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
- Department of Developmental Disability NeuropsychiatryDiscipline of Psychiatry and Mental Health, University of New South WalesSydneyNew South WalesAustralia
| | - Nicole Kochan
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
| | - Antonio Lobo
- Department of Medicine and PsychiatryUniversidad de ZaragozaZaragozaSpain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón)ZaragozaSpain
- CIBERSAM, Instituto de Salud Carlos IIIMadridSpain
| | - Javier Santabárbara
- Instituto de Investigación Sanitaria Aragón (IIS Aragón)ZaragozaSpain
- CIBERSAM, Instituto de Salud Carlos IIIMadridSpain
- Department of Public HealthUniversidad de ZaragozaZaragozaSpain
| | - Patricia Gracia‐Garcia
- Department of Medicine and PsychiatryUniversidad de ZaragozaZaragozaSpain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón)ZaragozaSpain
- CIBERSAM, Instituto de Salud Carlos IIIMadridSpain
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical Medicine, University of New South WalesSydneyNew South WalesAustralia
- Neuropsychiatric Institute, The Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Kay Deckers
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologyMental Health and Neuroscience (MHeNs) Research InstituteMaastricht UniversityMaastrichtThe Netherlands
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Heger I, van Boxtel M, Deckers K, Bosma H, Verhey F, Köhler S. Socioeconomic position, modifiable dementia risk and cognitive decline: results of 12-year Maastricht Aging Study. Int Psychogeriatr 2023:1-13. [PMID: 37905417 DOI: 10.1017/s1041610223000819] [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] [Indexed: 11/02/2023]
Abstract
OBJECTIVES This study investigated whether the association between modifiable dementia risk and rate of cognitive decline differs across socioeconomic status (SES) strata. DESIGN, SETTING AND PARTICIPANTS Data were used from Maastricht Aging Study, a prospective cohort study with a 12-year follow-up. The baseline sample consisted of 1023 adults over 40 years old. MEASUREMENTS The "LIfestyle for BRAin health" (LIBRA) index was used to assess modifiable dementia risk. Cognitive performance was assessed at baseline, 6 and 12 years, and measured in the domains of information processing speed, executive functioning and verbal memory function. An SES score was calculated from equivalent income and educational level (tertiles). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline. RESULTS Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, P = 0.029; vs. high SES: X2 = 9.49, P = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, P < 0.001; vs. high SES: X2 = 16.68, P < 0.001) over 6 years compared to their middle- and high-SES counterparts. Higher (unhealthier) LIBRA scores were associated with more decline in information processing speed (X2 = 12.66, P = 0.002) over 12 years and verbal memory (X2 = 4.63, P = 0.032) over 6 years. No consistent effect modification by SES on the association between LIBRA and cognition was found. CONCLUSIONS Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavorable modifiable risk score suggesting more potential for lifestyle-based interventions.
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Affiliation(s)
- Irene Heger
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Carlisle TC, Medina LD, Holden SK. Original research: initial development of a pragmatic tool to estimate cognitive decline risk focusing on potentially modifiable factors in Parkinson's disease. Front Neurosci 2023; 17:1278817. [PMID: 37942138 PMCID: PMC10628974 DOI: 10.3389/fnins.2023.1278817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Cognitive decline is common in Parkinson's disease (PD). Calculating personalized risk of cognitive decline in PD would allow for appropriate counseling, early intervention with available treatments, and inclusion in disease-modifying trials. Methods Data were from the Parkinson's Progression Markers Initiative de novo cohort. Baseline scores were calculated for Lifestyle for Brain Health (LIBRA) and the Montreal Parkinson Risk of Dementia Scale (MoPaRDS) per prior literature and preliminary Parkinson's disease Risk Estimator for Decline In Cognition Tool (pPREDICT) by attributing a point for fourteen posited risk factors. Baseline and 5-year follow-up composite cognitive scores (CCSs) were calculated from a neuropsychological battery and used to define cognitive decliners (PD-decline) versus maintainers (PD-maintain). Results The PD-decline group (n = 44) had higher LIBRA (6.76 ± 0.57, p < 0.05), MoPaRDS (2.45 ± 1.41, p < 0.05) and pPREDICT (4.52 ± 1.66, p < 0.05) scores compared to the PD-maintain group (n = 263; LIBRA 4.98 ± 0.20, MoPaRDS 1.68 ± 1.16, pPREDICT 3.38 ± 1.69). Area-under-the-curve (AUC) for LIBRA was 0.64 (95% confidence interval [CI], 0.55-0.73), MoPaRDS was 0.66 (95% CI, 0.58-0.75) and for pPREDICT was 0.68 (95% CI, 0.61-0.76). In linear regression analyses, LIBRA (p < 0.05), MoPaRDS (p < 0.05) and pPREDICT (p < 0.05) predicted change in CCS. Only age stratified by sex (p < 0.05) contributed significantly to the model for LIBRA. Age and presence of hallucinations (p < 0.05) contributed significantly to the model for MoPaRDS. Male sex, older age, excessive daytime sleepiness, and moderate-severe motor symptoms (all p < 0.05) contributed significantly to the model for pPREDICT. Conclusion Although MoPaRDS is a PD-specific tool for predicting cognitive decline relying on only clinical features, it does not focus on potentially modifiable risk factors. LIBRA does focus on potentially modifiable risk factors and is associated with prediction of all-cause dementia in some populations, but pPREDICT potentially demonstrates improved performance in cognitive decline risk calculation in individuals with PD and may identify actionable risk factors. As pPREDICT incorporates multiple potentially modifiable risk factors that can be obtained easily in the clinical setting, it is a first step in developing an easily assessable tool for a personalized approach to reduce dementia risk in people with PD.
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Affiliation(s)
- Tara C. Carlisle
- Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samantha K. Holden
- Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- Department of Neurology, Movement Disorders Section, University of Colorado School of Medicine, Aurora, CO, United States
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Ye KX, Sun L, Wang L, Khoo ALY, Lim KX, Lu G, Yu L, Li C, Maier AB, Feng L. The role of lifestyle factors in cognitive health and dementia in oldest-old: A systematic review. Neurosci Biobehav Rev 2023; 152:105286. [PMID: 37321363 DOI: 10.1016/j.neubiorev.2023.105286] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
Oldest-old is the fastest growing segment of society. A substantial number of these individuals are cognitively impaired or demented. Given the lack of a cure, attention is directed to lifestyle interventions that could help alleviate the stress in patients, their families, and society. The aim of this review was to identify lifestyle factors with important roles in dementia prevention in oldest-old. Searches were conducted in PubMed, EMBASE, Scopus and Web of Science. We identified 27 observational cohort studies that met the inclusion criteria. Results showed that eating a healthy diet with plenty of fruits and vegetables, and participation in leisure and physical activities may protect against cognitive decline and cognitive impairment among oldest-old regardless of the APOE genotype. Combined lifestyles may generate multiplicative effects than individual factors. This is the first review known to systematically examine the association between lifestyle and cognitive health in oldest-old. Lifestyle interventions for diet, leisure, or a combination of lifestyles could be beneficial for cognitive function in oldest-old. Interventional studies are warranted to strengthen the evidence.
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Affiliation(s)
- Kaisy Xinhong Ye
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
| | - Lina Sun
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Lingyan Wang
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Anderson Li Yang Khoo
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
| | - Kai Xuan Lim
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
| | - Guohua Lu
- School of Psychology, Weifang Medical University, Weifang, China
| | - Lirong Yu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Changjiang Li
- School of Psychology, Weifang Medical University, Weifang, China
| | - Andrea Britta Maier
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore; Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lei Feng
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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6
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Brett BL, Aggarwal NT, Chandran A, Kerr ZY, Walton SR, DeFreese JD, Guskiewicz KM, Echemendia RJ, Meehan WP, McCrea MA, Mannix R. Incorporation of concussion history as part of the LIfestyle for BRAin Health (LIBRA) modifiable factors risk score and associations with cognition in older former National Football League players. Alzheimers Dement 2023; 19:3087-3097. [PMID: 36708229 PMCID: PMC10374874 DOI: 10.1002/alz.12929] [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: 08/14/2022] [Revised: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Investigate associations between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function, incorporating concussion history. METHODS Former National Football League (NFL) players (N = 1050; mean age = 64.8 ± 9.0-years) completed initial testing for integration of concussion history into LIBRA scores (i.e., modified-LIBRA) and completed the Brief Test of Adult Cognition by Telephone (BTACT). Modified-LIBRA score (including concussion history) associations with odds of MCI and cognitive dysfunction were assessed via logistic and linear regression. RESULTS The highest quartile LIBRA scores were six times more likely to have a diagnosis of MCI compared to the lowest quartile (OR = 6.27[3.61, 10.91], p < 0.001). Modified-LIBRA scores significantly improved model fit for odds of MCI above original LIBRA scores (χ2 (1) = 7.76, p = 0.005) and accounted for a greater fraction of variance in executive function (ΔR2 = 0.02, p = 0.003) and episodic memory (ΔR2 = 0.02, p = 0.002). CONCLUSIONS Modified-LIBRA score, incorporating concussion history, may help monitoring risk status in former contact sport athletes, by targeting modifiable, lifestyle-related risk factors.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Samuel R. Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin M. Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - William P. Meehan
- Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Rebekah Mannix
- Boston Children’s Hospital, Boston, MA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
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7
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Dingle SE, Bujtor MS, Milte CM, Bowe SJ, Daly RM, Torres SJ. Statistical Approaches for the Analysis of Combined Health-Related Factors in Association with Adult Cognitive Outcomes: A Scoping Review. J Alzheimers Dis 2023; 92:1147-1171. [PMID: 36872778 DOI: 10.3233/jad-221034] [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: 03/06/2023]
Abstract
BACKGROUND Dementia prevention is a global health priority, and there is emerging evidence to support associations between individual modifiable health behaviors and cognitive function and dementia risk. However, a key property of these behaviors is they often co-occur or cluster, highlighting the importance of examining them in combination. OBJECTIVE To identify and characterize the statistical approaches used to aggregate multiple health-related behaviors/modifiable risk factors and assess associations with cognitive outcomes in adults. METHODS Eight electronic databases were searched to identify observational studies exploring the association between two or more aggregated health-related behaviors and cognitive outcomes in adults. RESULTS Sixty-two articles were included in this review. Fifty articles employed co-occurrence approaches alone to aggregate health behaviors/other modifiable risk factors, eight studies used solely clustering-based approaches, and four studies used a combination of both. Co-occurrence methods include additive index-based approaches and presenting specific health combinations, and whilst simple to construct and interpret, do not consider the underlying associations between co-occurring behaviors/risk factors. Clustering-based approaches do focus on underlying associations, and further work in this area may aid in identifying at-risk subgroups and understanding specific combinations of health-related behaviors/risk factors of particular importance in the scope of cognitive function and neurocognitive decline. CONCLUSION A co-occurrence approach to aggregating health-related behaviors/risk factors and exploring associations with adult cognitive outcomes has been the predominant statistic approach used to date, with a lack of research employing more advanced statistical methods to explore clustering-based approaches.
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Affiliation(s)
- Sara E Dingle
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Melissa S Bujtor
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia.,Department of Psychological Medicine, Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Catherine M Milte
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Biostatistics Unit, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.,Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Susan J Torres
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
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8
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1250] [Impact Index Per Article: 1250.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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9
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Köhler S, Soons LM, Tange H, Deckers K, van Boxtel MP. Sleep Quality and Cognitive Decline Across the Adult Age Range: Findings from the Maastricht Aging Study (MAAS). J Alzheimers Dis 2023; 96:1041-1049. [PMID: 38007668 PMCID: PMC10741338 DOI: 10.3233/jad-230213] [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] [Accepted: 09/11/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Sleep disturbances have been linked with cognitive decline and a higher risk of dementia. However, there is a lack of studies with sufficient follow-up duration, a detailed neuropsychological assessment and adequate control of main confounders. OBJECTIVE To investigate the relation between self-reported sleep quality and cognitive decline over 12 years in cognitively healthy individuals from the general population. METHODS We used data from the Maastricht Aging Study (MAAS), a Dutch population-based prospective cohort study of 1,823 community-dwelling adults aged 24 to 82 years at baseline. Cognitive performance was measured at baseline, 6 and 12 years on verbal memory, executive functions, and information processing speed. Sleep quality was assessed at baseline using the sleep subscale score of the 90-item Symptom Checklist (SCL-90). Additional modifiable dementia risk factors were summarized in the LIfestyle for BRAin health (LIBRA) risk score. Weighted linear mixed models tested the association between continuous scores and tertiles of subjective sleep quality and change in cognitive performances over time. Models were adjusted for age, gender, educational level, LIBRA, and use of hypnotic (sleep) medication. RESULTS Worse sleep quality was associated with faster decline in processing speed. At older age (≥65 years), it was also associated with faster decline in verbal memory. Association were independent of other modifiable dementia risk factors and use of hypnotic medication. Directionally similar but non-significant associations were found between worse sleep quality and executive functions. CONCLUSIONS In this population-based study across the adult age range, poor self-reported sleep was associated with accelerated cognitive decline.
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Affiliation(s)
- Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lion M. Soons
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Huibert Tange
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Martin P.J. van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
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10
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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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11
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Stafford J, Chung WT, Sommerlad A, Kirkbride JB, Howard R. Psychiatric disorders and risk of subsequent dementia: Systematic review and meta-analysis of longitudinal studies. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5711. [PMID: 35460299 PMCID: PMC9325434 DOI: 10.1002/gps.5711] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although psychiatric disorders have been found to be associated with increased risk of dementia, previous findings are mixed, and the nature of these relationships remains poorly understood. We examined longitudinal associations between depression, anxiety, post-traumatic stress disorders (PTSD), bipolar disorder (BPD), psychotic disorders and subsequent dementia. METHODS We searched three databases for longitudinal, population-based studies investigating associations between psychiatric disorders and dementia (PROSPERO registration: CRD42020209638). We conducted narrative synthesis, and random-effects meta-analyses to obtain pooled estimates. We used meta-regression and stratified analyses to examine variation by sex, age-at-onset and follow-up time. RESULTS Fifty-seven citations met eligibility criteria. Most studies focussed on depression (n = 33), which was associated with subsequent all-cause dementia (pooled relative risk [RR]: 1.96, 95% confidence interval [CI]: 1.59-2.43; I2 = 96.5%), Alzheimer's Disease (pooled RR: 1.9, 95% CI: 1.52-2.38; I2 = 85.5%), and Vascular Dementia (pooled RR: 2.71, 95% CI: 2.48-2.97; I2 = 0). Associations were stronger in studies with shorter follow-up periods and for severe and late-onset depression. Findings regarding anxiety were mixed, and we did not find evidence of an overall association (pooled RR: 1.18, 95% CI: 0.96-1.45; I2 = 52.2%, n = 5). Despite sparse evidence, psychotic disorders (pooled RR: 2.19, 95% CI: 1.44-3.31; I2 = 99%), PTSD and BPD were associated with subsequent dementia. CONCLUSIONS People with psychiatric disorders represent high-risk groups for dementia, highlighting the importance of ongoing symptom monitoring in these groups. Findings regarding temporality and age-at-onset indicate that depression symptoms could reflect prodromal dementia for some individuals. Further longitudinal research is required to determine whether psychiatric disorders represent causal risk factors or early markers of dementia neuropathology.
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Affiliation(s)
- Jean Stafford
- MRC Unit for Lifelong Health and AgeingUniversity College London (UCL)LondonUK
| | - Wing Tung Chung
- Division of PsychiatryUniversity College London (UCL)LondonUK
| | | | | | - Robert Howard
- Division of PsychiatryUniversity College London (UCL)LondonUK
- Camden and Islington NHS Foundation TrustLondonUK
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12
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Iso-Markku P, Kujala UM, Knittle K, Polet J, Vuoksimaa E, Waller K. Physical activity as a protective factor for dementia and Alzheimer's disease: systematic review, meta-analysis and quality assessment of cohort and case-control studies. Br J Sports Med 2022; 56:701-709. [PMID: 35301183 PMCID: PMC9163715 DOI: 10.1136/bjsports-2021-104981] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 01/20/2023]
Abstract
Objective Physical activity (PA) is associated with a decreased incidence of dementia, but much of the evidence comes from short follow-ups prone to reverse causation. This meta-analysis investigates the effect of study length on the association. Design A systematic review and meta-analysis. Pooled effect sizes, dose–response analysis and funnel plots were used to synthesise the results. Data sources CINAHL (last search 19 October 2021), PsycInfo, Scopus, PubMed, Web of Science (21 October 2021) and SPORTDiscus (26 October 2021). Eligibility criteria Studies of adults with a prospective follow-up of at least 1 year, a valid cognitive measure or cohort in mid-life at baseline and an estimate of the association between baseline PA and follow-up all-cause dementia, Alzheimer’s disease or vascular dementia were included (n=58). Results PA was associated with a decreased risk of all-cause dementia (pooled relative risk 0.80, 95% CI 0.77 to 0.84, n=257 983), Alzheimer’s disease (0.86, 95% CI 0.80 to 0.93, n=128 261) and vascular dementia (0.79, 95% CI 0.66 to 0.95, n=33 870), even in longer follow-ups (≥20 years) for all-cause dementia and Alzheimer’s disease. Neither baseline age, follow-up length nor study quality significantly moderated the associations. Dose–response meta-analyses revealed significant linear, spline and quadratic trends within estimates for all-cause dementia incidence, but only a significant spline trend for Alzheimer’s disease. Funnel plots showed possible publication bias for all-cause dementia and Alzheimer’s disease. Conclusion PA was associated with lower incidence of all-cause dementia and Alzheimer’s disease, even in longer follow-ups, supporting PA as a modifiable protective lifestyle factor, even after reducing the effects of reverse causation.
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Affiliation(s)
- Paula Iso-Markku
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland .,HUS Diagnostic Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Keegan Knittle
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juho Polet
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eero Vuoksimaa
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Katja Waller
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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13
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2460] [Impact Index Per Article: 1230.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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14
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Anstey KJ, Zheng L, Peters R, Kootar S, Barbera M, Stephen R, Dua T, Chowdhary N, Solomon A, Kivipelto M. Dementia Risk Scores and Their Role in the Implementation of Risk Reduction Guidelines. Front Neurol 2022; 12:765454. [PMID: 35058873 PMCID: PMC8764151 DOI: 10.3389/fneur.2021.765454] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Dementia prevention is a global health priority. In 2019, the World Health Organisation published its first evidence-based guidelines on dementia risk reduction. We are now at the stage where we need effective tools and resources to assess dementia risk and implement these guidelines into policy and practice. In this paper we review dementia risk scores as a means to facilitate this process. Specifically, we (a) discuss the rationale for dementia risk assessment, (b) outline some conceptual and methodological issues to consider when reviewing risk scores, (c) evaluate some dementia risk scores that are currently in use, and (d) provide some comments about future directions. A dementia risk score is a weighted composite of risk factors that reflects the likelihood of an individual developing dementia. In general, dementia risks scores have a wide range of implementations and benefits including providing early identification of individuals at high risk, improving risk perception for patients and physicians, and helping health professionals recommend targeted interventions to improve lifestyle habits to decrease dementia risk. A number of risk scores for dementia have been published, and some are widely used in research and clinical trials e.g., CAIDE, ANU-ADRI, and LIBRA. However, there are some methodological concerns and limitations associated with the use of these risk scores and more research is needed to increase their effectiveness and applicability. Overall, we conclude that, while further refinement of risk scores is underway, there is adequate evidence to use these assessments to implement guidelines on dementia risk reduction.
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Affiliation(s)
- Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Lidan Zheng
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Ruth Peters
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Scherazad Kootar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhary
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alina Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Department of Neurobiology, Center for Alzheimer's Research, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Miia Kivipelto
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Department of Neurobiology, Center for Alzheimer's Research, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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15
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The role of cognitive and social leisure activities in dementia risk: assessing longitudinal associations of modifiable and non-modifiable risk factors. Epidemiol Psychiatr Sci 2022; 31:e5. [PMID: 35499392 PMCID: PMC8786616 DOI: 10.1017/s204579602100069x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS With the projected surge in global dementia cases and no curative treatment available, research is increasingly focusing on lifestyle factors as preventive measures. Social and cognitive leisure activities are promising targets, but it is unclear which types of activities are more beneficial. This study investigated the individual and joint contribution of cognitive and social leisure activities to dementia risk and whether they modify the risks associated with other potentially modifiable and non-modifiable risk factors. METHODS We used data from the English Longitudinal Study of Ageing (ELSA) from 7917 participants, followed up from 2008/2009 (Wave 4) until 2018/2019 (Wave 9) for incident dementia. Self-reported baseline cognitive activities (e.g. 'reading the newspaper'), the number of social memberships (e.g. being a member of a social club) and social participation (e.g. 'going to the cinema') were clustered into high and low based on a median split. Subsequently, their individual and joint contribution to dementia risk, as well as their interaction with other dementia risk factors, were assessed with Cox regression models, adjusting for age, sex, level of education, wealth and a composite score of 11 lifestyle-related dementia risk factors. RESULTS After a median follow-up period of 9.8 years, the dementia incidence rate was 54.5 cases per 10.000 person-years (95% CI 49.0-60.8). Adjusting for demographic and other lifestyle-related risk factors, higher engagement in cognitive activities (HR = 0.58; 95% CI 0.40-0.84), a greater number of social memberships (HR = 0.65; 95% CI 0.51-0.84) and more social participation (HR = 0.71; 95% CI 0.54-0.95) were associated with lower dementia risk. In a joint model, only engagement in cognitive activities (HR = 0.60; 95% CI 0.40-0.91) and social memberships (HR = 0.75; 95% CI 0.56-0.99) independently explained dementia risk. We did not find any interaction with other modifiable and non-modifiable risk factors. CONCLUSIONS Engagement in cognitive and social leisure activities may be beneficial for overall dementia risk, independent of each other and other risk factors. Both types of activities may be potential targets for dementia prevention measures and health advice initiatives.
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Brayne C, Wu YT. Population-Based Studies in Dementia and Ageing Research: A Local and National Experience in Cambridgeshire and the UK. Am J Alzheimers Dis Other Demen 2022; 37:15333175221104347. [PMID: 36000966 PMCID: PMC10581148 DOI: 10.1177/15333175221104347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dementia has been recognised as a key challenge in many ageing societies across the world. Several population-based studies have been developed to investigate dementia and cognitive ageing from perspectives of biology, health, psychology and social sciences. However, there is a need to provide a better understanding of 'contexts', the circumstance where these ageing populations existed, and heterogeneity within and across the populations in different time and places. In this article, we summarise some examples of earlier population-based studies undertaken by our research groups in England and Wales and their contribution to the epidemiology of dementia, neuropathology, cognitive and mental health in older age. We also describe how these studies illustrated variation among ageing populations and changes in their health conditions across time and place. These findings highlight the contribution that population-based studies can make, along with the vital to incorporate contexts in ageing research. A lifecourse approach within social context is needed to integrate life experiences, social circumstances, and multiple dimensions of cognition, functioning, physical health and wellbeing over the ageing process. We also discuss how evidence from population-based studies can support various international initiatives on dementia, healthy ageing and Sustainable Development Goals and facilitate tailored approaches for diverse populations across global societies.
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Affiliation(s)
- Carol Brayne
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yu-Tzu Wu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Vrijsen J, Abu-Hanna A, de Rooij SE, Smidt N. Association between dementia parental family history and mid-life modifiable risk factors for dementia: a cross-sectional study using propensity score matching within the Lifelines cohort. BMJ Open 2021; 11:e049918. [PMID: 34930728 PMCID: PMC8689157 DOI: 10.1136/bmjopen-2021-049918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Individuals with a parental family history (PFH) of dementia have an increased risk to develop dementia, regardless of genetic risks. The aim of this study is to investigate the association between a PFH of dementia and currently known modifiable risk factors for dementia among middle-aged individuals using propensity score matching (PSM). DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A subsample of Lifelines (35-65 years), a prospective population-based cohort study in the Netherlands was used. OUTCOME MEASURES Fourteen modifiable risk factors for dementia and the overall Lifestyle for Brain Health (LIBRA) score, indicating someone's potential for dementia risk reduction (DRR). RESULTS The study population included 89 869 participants of which 10 940 (12.2%) had a PFH of dementia (mean (SD) age=52.95 (7.2)) and 36 389 (40.5%) without a PFH of dementia (mean (SD) age=43.19 (5.5)). Of 42 540 participants (47.3%), PFH of dementia was imputed. After PSM, potential confounding variables were balanced between individuals with and without PFH of dementia. Individuals with a PFH of dementia had more often hypertension (OR=1.19; 95% CI 1.14 to 1.24), high cholesterol (OR=1.24; 95% CI 1.18 to 1.30), diabetes (OR=1.26; 95% CI 1.11 to 1.42), cardiovascular diseases (OR=1.49; 95% CI 1.18 to 1.88), depression (OR=1.23; 95% CI 1.08 to 1.41), obesity (OR=1.14; 95% CI 1.08 to 1.20) and overweight (OR=1.10; 95% CI 1.05 to 1.17), and were more often current smokers (OR=1.20; 95% CI 1.14 to 1.27) and ex-smokers (OR=1.21; 95% CI 1.16 to 1.27). However, they were less often low/moderate alcohol consumers (OR=0.87; 95% CI 0.83 to 0.91), excessive alcohol consumers (OR=0.93; 95% CI 0.89 to 0.98), socially inactive (OR=0.84; 95% CI 0.78 to 0.90) and physically inactive (OR=0.93; 95% CI 0.91 to 0.97). Having a PFH of dementia resulted in a higher LIBRA score (RC=0.15; 95% CI 0.11 to 0.19). CONCLUSION We found that having a PFH of dementia was associated with several modifiable risk factors. This suggests that middle-aged individuals with a PFH of dementia are a group at risk and could benefit from DRR. Further research should explore their knowledge, beliefs and attitudes towards DRR, and whether they are willing to assess their risk and change their lifestyle to reduce dementia risk.
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Affiliation(s)
- Joyce Vrijsen
- Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ameen Abu-Hanna
- Medical Informatics, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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18
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Heger IS, Deckers K, Schram MT, Stehouwer CDA, Dagnelie PC, van der Kallen CJH, Koster A, Eussen SJPM, Jansen JFA, Verhey FRJ, van Boxtel MPJ, Köhler S. Associations of the Lifestyle for Brain Health Index With Structural Brain Changes and Cognition: Results From the Maastricht Study. Neurology 2021; 97:e1300-e1312. [PMID: 34433680 PMCID: PMC8480401 DOI: 10.1212/wnl.0000000000012572] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/01/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Observational research has shown that a substantial proportion of all dementia cases worldwide are attributable to modifiable risk factors. Dementia risk scores might be useful to identify high-risk individuals and monitor treatment adherence. The objective of this study was to investigate whether a dementia risk score, the Lifestyle for Brain Health (LIBRA) index, is associated with MRI markers and cognitive functioning/impairment in the general population. Methods Cross-sectional data were used from the observational population-based cohort of The Maastricht Study. The weighted compound score of LIBRA (including 12 dementia risk and protective factors, e.g., hypertension, physical inactivity) was calculated, with higher scores indicating higher dementia risk. Standardized volumes of white matter, gray matter, and CSF (as proxy for general brain atrophy), white matter hyperintensities, and presence of cerebral small vessel disease were derived from 3T MRI. Cognitive functioning was tested in 3 domains: memory, information processing speed, and executive function and attention. Values ≤1.5 SDs below the average were defined as cognitive impairment. Multiple regression analyses and structural equation modeling were used, adjusted for age, sex, education, intracranial volume, and type 2 diabetes. Results Participants (n = 4,164; mean age 59 years; 49.7% men) with higher LIBRA scores (mean 1.19, range −2.7 to 9.2), denoting higher dementia risk, had higher volumes of white matter hyperintensities (β = 0.051, p = 0.002) and lower scores on information processing speed (β = −0.067, p = 0.001) and executive function and attention (β = −0.065, p = 0.004). Only in men, associations between LIBRA score and volumes of gray matter (β = −0.093, p < 0.001) and CSF (β = 0.104, p < 0.001) and memory (β = −0.054, p = 0.026) were found. White matter hyperintensities and CSF volume partly mediated the association between LIBRA score and cognition. Discussion Higher health- and lifestyle-based dementia risk is associated with markers of general brain atrophy, cerebrovascular pathology, and worse cognition, suggesting that LIBRA meaningfully summarizes individual lifestyle-related brain health. Improving LIBRA factors on an individual level might improve population brain health. Sex differences in lifestyle-related pathology and cognition need to be further explored. Classification of Evidence This study provides Class II evidence that higher LIBRA scores are significantly associated with lower scores in some cognitive domains and a higher risk of cognitive impairment.
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Affiliation(s)
- Irene S Heger
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands.
| | - Kay Deckers
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Miranda T Schram
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Coen D A Stehouwer
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Pieter C Dagnelie
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Carla J H van der Kallen
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Annemarie Koster
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Simone J P M Eussen
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Jacobus F A Jansen
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Frans R J Verhey
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Martin P J van Boxtel
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
| | - Sebastian Köhler
- From the School for Mental Health and Neuroscience (I.S.H., K.D., M.T.S., J.F.A.J., F.R.J.V., M.P.J.v.B., S.K.), Department of Psychiatry and Neuropsychology (I.S.H., K.D., F.R.J.V., M.P.J.v.B., S.K.), School for Cardiovascular Diseases (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K., S.J.P.M.E.), Care and Public Health Research Institute (A.K.), Department of Social Medicine (A.K.), and Department of Epidemiology (S.J.P.M.E.), Maastricht University; and Heart and Vascular Center (M.T.S.), Department of Internal Medicine (M.T.S., C.D.A.S., P.C.D., C.J.H.v.d.K.), and Department of Radiology (J.F.A.J.), Maastricht University Medical Center+, the Netherlands
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Sapkota S, McFall GP, Masellis M, Dixon RA. A Multimodal Risk Network Predicts Executive Function Trajectories in Non-demented Aging. Front Aging Neurosci 2021; 13:621023. [PMID: 34603005 PMCID: PMC8482841 DOI: 10.3389/fnagi.2021.621023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 08/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Multiple modalities of Alzheimer's disease (AD) risk factors may operate through interacting networks to predict differential cognitive trajectories in asymptomatic aging. We test such a network in a series of three analytic steps. First, we test independent associations between three risk scores (functional-health, lifestyle-reserve, and a combined multimodal risk score) and cognitive [executive function (EF)] trajectories. Second, we test whether all three associations are moderated by the most penetrant AD genetic risk [Apolipoprotein E (APOE) ε4+ allele]. Third, we test whether a non-APOE AD genetic risk score further moderates these APOE × multimodal risk score associations. Methods: We assembled a longitudinal data set (spanning a 40-year band of aging, 53-95 years) with non-demented older adults (baseline n = 602; Mage = 70.63(8.70) years; 66% female) from the Victoria Longitudinal Study (VLS). The measures included for each modifiable risk score were: (1) functional-health [pulse pressure (PP), grip strength, and body mass index], (2) lifestyle-reserve (physical, social, cognitive-integrative, cognitive-novel activities, and education), and (3) the combination of functional-health and lifestyle-reserve risk scores. Two AD genetic risk markers included (1) APOE and (2) a combined AD-genetic risk score (AD-GRS) comprised of three single nucleotide polymorphisms (SNPs; Clusterin[rs11136000], Complement receptor 1[rs6656401], Phosphatidylinositol binding clathrin assembly protein[rs3851179]). The analytics included confirmatory factor analysis (CFA), longitudinal invariance testing, and latent growth curve modeling. Structural path analyses were deployed to test and compare prediction models for EF performance and change. Results: First, separate analyses showed that higher functional-health risk scores, lifestyle-reserve risk scores, and the combined score, predicted poorer EF performance and steeper decline. Second, APOE and AD-GRS moderated the association between functional-health risk score and the combined risk score, on EF performance and change. Specifically, only older adults in the APOEε4- group showed steeper EF decline with high risk scores on both functional-health and combined risk score. Both associations were further magnified for adults with high AD-GRS. Conclusion: The present multimodal AD risk network approach incorporated both modifiable and genetic risk scores to predict EF trajectories. The results add an additional degree of precision to risk profile calculations for asymptomatic aging populations.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G. Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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20
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Van Asbroeck S, van Boxtel MPJ, Steyaert J, Köhler S, Heger I, de Vugt M, Verhey F, Deckers K. Increasing knowledge on dementia risk reduction in the general population: Results of a public awareness campaign. Prev Med 2021; 147:106522. [PMID: 33744328 DOI: 10.1016/j.ypmed.2021.106522] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
Strategies to reduce dementia risk are needed to minimize the burden of this growing public health concern. Most individuals are not aware that dementia risk reduction is possible, let alone how this could be achieved. Health education, such as public awareness campaigns on the topic of dementia risk reduction, can meet this need. A public health campaign (including social media and offering an online individual risk assessment tool) was carried out over a 7-month period in Flanders, Belgium. Impact was assessed in two independent online surveys, before (n = 1003) and after the campaign (n = 1008), in representative samples of adults aged 40-75 years. Questions regarding personal needs, wishes and barriers were also included. After the campaign, more individuals (10.3%) were aware that dementia risk reduction is possible than before the campaign, and more individuals correctly identified 10 out of 12 surveyed modifiable dementia risk and protective factors. However, no differences were observed in low-educated individuals. Further, specific differences in potential needs, wishes and barriers for future campaigns or interventions were observed between demographic strata. The majority of the respondents (89%) indicated that they would welcome more information on improving their brain-health. More than half (54%) also believed that they lacked the necessary knowledge to make brain-healthy behavior changes. In conclusion, effective public awareness campaigns on the topic of dementia risk reduction are feasible and timely, given the state of the evidence. Special efforts need to be made to develop effective campaigns, tailored towards low-educated individuals.
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Affiliation(s)
- Stephanie Van Asbroeck
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Martin P J van Boxtel
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Jan Steyaert
- Department of Sociology, University of Antwerp, Antwerp, Belgium; The Flanders Centre of Expertise on Dementia, Lokkaardstraat 8, 2018 Antwerp, Belgium.
| | - Sebastian Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Irene Heger
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Marjolein de Vugt
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Frans Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Kay Deckers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
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21
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Watermeyer T, Goerdten J, Johansson B, Muniz-Terrera G. Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old. Age Ageing 2021; 50:868-874. [PMID: 33196771 DOI: 10.1093/ageing/afaa232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. OBJECTIVE The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. METHODS Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. RESULTS Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. CONCLUSIONS The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.
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Affiliation(s)
- Tam Watermeyer
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Faculty of Health and Life Sciences, Department of Psychology, Northumbria University, Newcastle, UK
| | - Jantje Goerdten
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
| | - Boo Johansson
- Department of Psychology, Centre for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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22
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Yaffe K, Vittinghoff E, Hoang T, Matthews K, Golden SH, Zeki Al Hazzouri A. Cardiovascular Risk Factors Across the Life Course and Cognitive Decline: A Pooled Cohort Study. Neurology 2021; 96:e2212-e2219. [PMID: 33731482 PMCID: PMC8166431 DOI: 10.1212/wnl.0000000000011747] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Cardiovascular risk factors (CVRFs) are associated with increased risk of cognitive decline, but little is known about how early adult CVRFs and those across the life course might influence late-life cognition. To test the hypothesis that CVRFs across the adult life course are associated with late-life cognitive changes, we pooled data from 4 prospective cohorts (n = 15,001, ages 18-95). METHODS We imputed trajectories of body mass index (BMI), fasting glucose (FG), systolic blood pressure (SBP), and total cholesterol (TC) for older adults. We used linear mixed models to determine the association of early adult, midlife, and late-life CVRFs with late-life decline on global cognition (Modified Mini-Mental State Examination [3MS]) and processing speed (Digit Symbol Substitution Test [DSST]), adjusting for demographics, education, and cohort. RESULTS Elevated BMI, FG, and SBP (but not TC) at each time period were associated with greater late-life decline. Early life CVRFs were associated with the greatest change, an approximate doubling of mean 10-year decline (an additional 3-4 points for 3MS or DSST). Late-life CVRFs were associated with declines in early late life (<80 years) but with gains in very late life (≥80 years). After adjusting for CVRF exposures at all time periods, the associations for early adult and late-life CVRFs persisted. CONCLUSIONS We found that imputed CVRFs across the life course, especially in early adulthood, were associated with greater late-life cognitive decline. Our results suggest that CVRF treatment in early adulthood could benefit late-life cognition, but that treatment in very late life may not be as helpful for these outcomes.
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Affiliation(s)
- Kristine Yaffe
- From the Departments of Psychiatry and Neurology (K.Y.) and Epidemiology & Biostatistics (K.Y., E.V.), University of California San Francisco; San Francisco Veterans Affairs Medical Center (K.Y.); Northern California Institute Research for Research and Education (T.H.), San Francisco; Department of Psychiatry (K.M.), University of Pittsburgh, PA; Department of Medicine (S.H.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (S.H.G.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY.
| | - Eric Vittinghoff
- From the Departments of Psychiatry and Neurology (K.Y.) and Epidemiology & Biostatistics (K.Y., E.V.), University of California San Francisco; San Francisco Veterans Affairs Medical Center (K.Y.); Northern California Institute Research for Research and Education (T.H.), San Francisco; Department of Psychiatry (K.M.), University of Pittsburgh, PA; Department of Medicine (S.H.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (S.H.G.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tina Hoang
- From the Departments of Psychiatry and Neurology (K.Y.) and Epidemiology & Biostatistics (K.Y., E.V.), University of California San Francisco; San Francisco Veterans Affairs Medical Center (K.Y.); Northern California Institute Research for Research and Education (T.H.), San Francisco; Department of Psychiatry (K.M.), University of Pittsburgh, PA; Department of Medicine (S.H.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (S.H.G.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Karen Matthews
- From the Departments of Psychiatry and Neurology (K.Y.) and Epidemiology & Biostatistics (K.Y., E.V.), University of California San Francisco; San Francisco Veterans Affairs Medical Center (K.Y.); Northern California Institute Research for Research and Education (T.H.), San Francisco; Department of Psychiatry (K.M.), University of Pittsburgh, PA; Department of Medicine (S.H.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (S.H.G.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Sherita H Golden
- From the Departments of Psychiatry and Neurology (K.Y.) and Epidemiology & Biostatistics (K.Y., E.V.), University of California San Francisco; San Francisco Veterans Affairs Medical Center (K.Y.); Northern California Institute Research for Research and Education (T.H.), San Francisco; Department of Psychiatry (K.M.), University of Pittsburgh, PA; Department of Medicine (S.H.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (S.H.G.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Adina Zeki Al Hazzouri
- From the Departments of Psychiatry and Neurology (K.Y.) and Epidemiology & Biostatistics (K.Y., E.V.), University of California San Francisco; San Francisco Veterans Affairs Medical Center (K.Y.); Northern California Institute Research for Research and Education (T.H.), San Francisco; Department of Psychiatry (K.M.), University of Pittsburgh, PA; Department of Medicine (S.H.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (S.H.G.), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
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23
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De Krom FJW, Sivananthan S, Alkhotany F, Celen M, Hol IE, Houben KJG, Sivananthan P, Koekebakker H, Deckers K. Awareness of dementia risk reduction among current and future healthcare professionals: A survey study. J Public Health Res 2021; 10. [PMID: 33709642 PMCID: PMC8431871 DOI: 10.4081/jphr.2021.1961] [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: 09/22/2020] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The total number of people affected by dementia worldwide is increasing rapidly. Recent studies provided evidence for the contribution of modifiable risk and protective factors to dementia risk. Although healthcare professionals could play an essential role in informing the general public about the relationship between lifestyle and dementia, it is unclear what they know about this relationship. Therefore, this study assesses the awareness of dementia risk reduction among current and future healthcare professionals. Design and methods: An online survey was carried out among 182 healthcare students from Maastricht University and 20 general practitioners (GPs) and practice nurses in Limburg, The Netherlands. The survey assessed the knowledge about risk and protective factors of dementia and identified needs, wishes and barriers concerning dementia risk reduction strategies. Results: The majority of current (75.0%) and future (81.9%) healthcare professionals indicated that dementia risk reduction is possible. Among students, awareness of cardiovascular risk factors of dementia (e.g., coronary heart disease (44.5%), hypertension (53.8%)) was low. Most participants (>70.0%) would like to receive more information about dementia risk reduction. Conclusions: The majority of current and future healthcare professionals were aware of the relationship between lifestyle and dementia risk. However, there are still substantial gaps in knowledge regarding individual dementia risk factors. Given the essential role of healthcare professionals in providing lifestyle advice, there is a need to increase awareness by providing educational programs focused on dementia risk reduction. Significance for public health Since the number of individuals with dementia is increasing worldwide, dementia is a major public health concern. As there is no curative treatment for dementia yet, recent research has focused on the contribution of lifestyle factors to dementia risk. Cumulating evidence has shown that modifiable risk factors such as smoking, hypertension and depression are attributable to around 40% of all dementia cases. However, the majority of the general public is unaware of the relationship between lifestyle and dementia risk. Although current and future healthcare professionals play an important role in informing the general public about this relationship, the present study showed that there are gaps in knowledge on specific risk factors for dementia. Therefore, educational programs are urgently needed to increase awareness of dementia risk reduction among current and future healthcare professionals.
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Affiliation(s)
- Femke J W De Krom
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Sangavi Sivananthan
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Farah Alkhotany
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Martijn Celen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Indy Ezra Hol
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Kylia J G Houben
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Pavalya Sivananthan
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Hanneke Koekebakker
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
| | - Kay Deckers
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht.
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24
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Floud S, Balkwill A, Sweetland S, Brown A, Reus EM, Hofman A, Blacker D, Kivimaki M, Green J, Peto R, Reeves GK, Beral V. Cognitive and social activities and long-term dementia risk: the prospective UK Million Women Study. Lancet Public Health 2021; 6:e116-e123. [PMID: 33516288 PMCID: PMC7848753 DOI: 10.1016/s2468-2667(20)30284-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although dementia is associated with non-participation in cognitive and social activities, this association might merely reflect the consequences of dementia, rather than any direct effect of non-participation on the subsequent incidence of dementia. Because of the slowness with which dementia can develop, unbiased assessment of any such direct effects must relate non-participation in such activities to dementia detection rates many years later. Prospective studies with long-term follow-up can help achieve this by analysing separately the first and second decade of follow-up. We report such analyses of a large, 20-year study. METHODS The UK Million Women Study is a population-based prospective study of 1·3 million women invited for National Health Service (NHS) breast cancer screening in median year 1998 (IQR 1997-1999). In median year 2001 (IQR 2001-2003), women were asked about participation in adult education, groups for art, craft, or music, and voluntary work, and in median year 2006 (IQR 2006-2006), they were asked about reading. All participants were followed up through electronic linkage to NHS records of hospital admission with mention of dementia, the first mention of which was the main outcome. Comparing non-participation with participation in a particular activity, we used Cox regression to assess fully adjusted dementia risk ratios (RRs) during 0-4, 5-9, and 10 or more years, after information on that activity was obtained. FINDINGS In 2001, 851 307 women with a mean age of 60 years (SD 5) provided information on participation in adult education, groups for art, craft, or music, and voluntary work. After 10 years, only 9591 (1%) had been lost to follow-up and 789 339 (93%) remained alive with no recorded dementia. Follow-up was for a mean of 16 years (SD 3), during which 31 187 (4%) had at least one hospital admission with mention of dementia, including 25 636 (3%) with a hospital admission with dementia mentioned for the first time 10 years or more after follow-up began. Non-participation in cognitive or social activities was associated with higher relative risks of dementia detection only during the first decade after participation was recorded. During the second decade, there was little association. This was true for non-participation in adult education (RR 1·04, 99% CI 0·98-1·09), in groups for art, craft, or music (RR 1·04, 0·99-1·09), in voluntary work (RR 0·96, 0·92-1·00), or in any of these three (RR 0·99, 0·95-1·03). In 2006, 655 118 women provided information on reading. For non-reading versus any reading, there were similar associations with dementia, again with strong attenuation over time since reading was recorded, but longer follow-up is needed to assess this reliably. INTERPRETATION Life has to be lived forwards, but can be understood only backwards. Long before dementia is diagnosed, there is a progressive reduction in various mental and physical activities, but this is chiefly because its gradual onset causes inactivity and not because inactivity causes dementia. FUNDING UK Medical Research Council, Cancer Research UK.
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Affiliation(s)
- Sarah Floud
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
| | | | - Siân Sweetland
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - Anna Brown
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | | | - Albert Hofman
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - Richard Peto
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
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25
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Heger I, Köhler S, van Boxtel M, de Vugt M, Hajema K, Verhey F, Deckers K. Raising awareness for dementia risk reduction through a public health campaign: a pre-post study. BMJ Open 2020; 10:e041211. [PMID: 33158836 PMCID: PMC7651748 DOI: 10.1136/bmjopen-2020-041211] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Evaluate the effect of a health promotion campaign aimed at increasing awareness about dementia risk reduction in middle-aged community-dwelling individuals in the Netherlands. DESIGN A 10-month public health campaign using mass media and community participation, supported by eHealth. Population-level difference in awareness before and after the campaign, including variation between demographic groups, was assessed in two independent cross-sectional samples from the same target population. SETTING The public health campaign was launched in the Province of Limburg, the Netherlands, targeting all inhabitants aged 40-75 years old. Three specific districts within the Province were chosen for an additional community participation approach, in which local stakeholders were invited to support the campaign. RESULTS No pre- (n=590) post- (n=602) difference was observed in people agreeing to the statement that dementia risk reduction is possible (X2(1)=1.27, p=0.260). For the individual lifestyle factors, physical activity (7.6% increase (X2(1)=7.48, p=0.006)) and healthy diet (10.5% increase (X2(1)=12.37, p≤0.001)) were identified more often as being protective against dementia after the campaign. Of all risk/protective factors assessed, cognitive activity was identified most often at both preassessment (79.4%) and postassessment (80.4%), but there was no increase in awareness (X2(1)=0.17, p=0.677). Self-reported exposure to the campaign was associated with greater awareness and motivation for behavioural change (X2(1)=6.52, p=0.011). Compared with mass media only, the addition of community participation resulted in better recognition of campaign material and the eHealth platform. CONCLUSIONS This study was not able to reach a population-level increase of awareness of dementia risk reduction. Two out of the three lifestyle factors that formed the foundation of the campaign were identified more often after the campaign. Those reported having been exposed to the campaign were more aware and more inclined towards behavioural change.
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Affiliation(s)
- Irene Heger
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Frans Verhey
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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26
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Vrijsen J, Abu-Hanna A, Maeckelberghe EL, De Deyn PP, de Winter AF, Reesink FE, Oude Voshaar RC, Buskens E, de Rooij SE, Smidt N. Uptake and effectiveness of a tailor-made online lifestyle programme targeting modifiable risk factors for dementia among middle-aged descendants of people with recently diagnosed dementia: study protocol of a cluster randomised controlled trial (Demin study). BMJ Open 2020; 10:e039439. [PMID: 33067294 PMCID: PMC7569992 DOI: 10.1136/bmjopen-2020-039439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Descendants of patients with dementia have a higher risk to develop dementia. This study aims to investigate the uptake and effectiveness of an online tailor-made lifestyle programme for dementia risk reduction (DRR) among middle-aged descendants of people with recently diagnosed late-onset dementia. METHODS AND ANALYSIS Demin is a cluster randomised controlled trial, aiming to include 21 memory clinics of which 13 will be randomly allocated to the passive (poster and flyer in a waiting room) and 8 to the active recruitment strategy (additional personal invitation by members of the team of the memory clinic). We aim to recruit 378 participants (40-60 years) with a parent who is recently diagnosed with Alzheimer's disease or vascular dementia at one of the participating memory clinics. All participants receive a dementia risk assessment (online questionnaire, physical examination and blood sample) and subsequently an online tailor-made lifestyle advice regarding protective (Mediterranean diet, low/moderate alcohol consumption and high cognitive activity) and risk factors (physical inactivity, smoking, loneliness, cardiovascular diseases (CVD), hypertension, high cholesterol, diabetes, obesity, renal dysfunction and depression) for dementia. The primary outcome is the difference in uptake between the two recruitment strategies. Secondary outcomes are change(s) in (1) the Lifestyle for Brain Health score, (2) individual health behaviours, (3) health beliefs and attitudes towards DRR and (4) compliance to the tailor-made lifestyle advice. Outcomes will be measured at 3, 6, 9 and 12 months after baseline. The effectiveness of this online tailor-made lifestyle programme will be evaluated by comparing Demin participants to a matched control group (lifelines cohort). ETHICS AND DISSEMINATION This study has been approved by the Dutch Ministry of Health, Welfare and Sport according to the Population Screening Act. All participants have to give online informed consent using SMS-tan (transaction authentication number delivered via text message). Findings will be disseminated through peer-reviewed journals and (inter)national conferences. TRIAL REGISTRATION NUMBER NTR7434.
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Affiliation(s)
- Joyce Vrijsen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Els Lm Maeckelberghe
- Wenckebach Institute for Training and Education, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peter Paul De Deyn
- Department of Neurology and Alzheimer Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fransje E Reesink
- Department of Neurology and Alzheimer Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sophia E de Rooij
- Medical School Twente, Medical Spectrum Twente, Enschede, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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27
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Association between sedentary behavior and the risk of dementia: a systematic review and meta-analysis. Transl Psychiatry 2020; 10:112. [PMID: 32317627 PMCID: PMC7174309 DOI: 10.1038/s41398-020-0799-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
An increasing number of original studies suggest that sedentary behavior is associated with the risk of dementia, but the results remain inconsistent and inconclusive. In this meta-analysis, we analyzed available observational epidemiological evidence to identify the association between sedentary behavior and the risk of dementia. We searched PubMed and Embase from their inception to March 2019 to identify observational studies examining the association between sedentary behavior and risk of dementia. Two authors independently extracted data and assessed study quality using predefined criteria. The Q statistics and I² methods were used to test for heterogeneity. The publication bias of the included studies was also estimated using Begg's and Egger's tests. We identified 18 relevant cohort studies involving 250,063 participants and 2269 patients with dementia. Pooled result showed that sedentary behavior was significantly associated with increased risk of dementia (RR = 1.30; 95% CI: 1.12-1.51). In addition, subgroup analyses by state, and controlling for the concomitant effects of age, sex, education were conducted for the increase of dementia risk, relating to sedentary, respectively. In general, these subgroup analyses showed no statistically significant differences. The results of our meta-analysis suggested that sedentary behavior was independently associated with a significantly increased risk of dementia, which might have important implications in conducting etiological studies for dementia and developing strategies for dementia prevention.
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28
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Determinants of incident dementia in different old age groups: results of the prospective AgeCoDe/AgeQualiDe study. Int Psychogeriatr 2020; 32:645-659. [PMID: 31865929 DOI: 10.1017/s1041610219001935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To examine the impact of determinants of incident dementia in three different old age groups (75-79, 80-84, 85+years) in Germany. DESIGN Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals. SETTING Primary care medical record registry sample. PARTICIPANTS General practitioners' (GPs) patients aged 75+years at baseline. MEASUREMENTS Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset. RESULTS Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups. CONCLUSIONS This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.
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Deckers K, Barbera M, Köhler S, Ngandu T, van Boxtel M, Rusanen M, Laatikainen T, Verhey F, Soininen H, Kivipelto M, Solomon A. Long-term dementia risk prediction by the LIBRA score: A 30-year follow-up of the CAIDE study. Int J Geriatr Psychiatry 2020; 35:195-203. [PMID: 31736136 PMCID: PMC7003764 DOI: 10.1002/gps.5235] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 11/07/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE As no causal treatment for dementia is available yet, the focus of dementia research is slowly shifting towards prevention strategies. Therefore, this study aimed to examine the predictive accuracy of the "LIfestyle for BRAin Health" (LIBRA) score, a weighted compound score of 12 modifiable risk and protective factors, for dementia and mild cognitive impairment (MCI) in midlife and late-life, and in individuals with high or low genetic risk based on presence of the apolipoprotein (APOE) ε4 allele. METHODS The LIBRA score was calculated for participants from the Finnish Cardiovascular Risk Factors, Aging and Dementia (CAIDE) population-based study examined in midlife (n = 1024) and twice in late-life (n = 604) up to 30 years later. Diagnoses of MCI and dementia were made according to established criteria. Cox proportional hazards models were used to assess the association between LIBRA and risk of dementia and MCI in models adjusted for sex and education (age as timescale). RESULTS Higher midlife LIBRA scores were related to higher risk of dementia (hazard ratio [HR] = 1.27; 95% confidence interval [CI], 1.13-1.43) and MCI (unadjusted model: HR = 1.12; 95% CI, 1.03-1.22) up to 30 years later. Higher late-life LIBRA scores were related to higher risk of MCI (HR = 1.11; 95% CI, 1.00-1.25), but not dementia (HR = 1.02; 95% CI, 0.84-1.24). Higher late-life LIBRA scores were related to higher dementia risk among apolipoprotein E (APOE) ε4 non-carriers. CONCLUSIONS Findings emphasize the importance of modifiable risk and protective factors for dementia prevention.
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Affiliation(s)
- Kay Deckers
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
| | - Mariagnese Barbera
- Institute of Clinical Medicine/NeurologyUniversity of Eastern FinlandKuopioFinland
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
| | - Tiia Ngandu
- Public Health Promotion UnitNational Institute for Health and WelfareHelsinkiFinland,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
| | - Martin van Boxtel
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
| | - Minna Rusanen
- Public Health Promotion UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Tiina Laatikainen
- Public Health Promotion UnitNational Institute for Health and WelfareHelsinkiFinland,Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland,Hospital District of North KareliaJoensuuFinland
| | - Frans Verhey
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine/NeurologyUniversity of Eastern FinlandKuopioFinland,Neurocenter, Department of NeurologyKuopio University HospitalKuopioFinland
| | - Miia Kivipelto
- Institute of Clinical Medicine/NeurologyUniversity of Eastern FinlandKuopioFinland,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden,Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland,Ageing Epidemiology (AGE) Research Unit, School of Public HealthImperial College LondonLondonUnited Kingdom
| | - Alina Solomon
- Institute of Clinical Medicine/NeurologyUniversity of Eastern FinlandKuopioFinland,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and SocietyKarolinska InstitutetStockholmSweden
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McDonough IM, Allen RS. Biological markers of aging and mental health: A seed and soil model of neurocognitive disorders. Aging Ment Health 2019; 23:793-799. [PMID: 30449142 DOI: 10.1080/13607863.2018.1531383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As the population of the world gets older, cognitive and mental health decline in older adults has become one of the most pressing scientific problems of the 21st century. It has been well-established that multiple pathways exist that can lead to future cognitive decline and the development of age-related mental health conditions. Making matters more complicated is the fact that aging is not a homogenous or simple process; rather, each person brings a diverse set of circumstances to the table, leading to differences in biologically aging. Research is needed to identify how the intersection of environmental and biological factors may protect older adults or put them at future risk for cognitive decline and the development of age-related mental health conditions. Furthermore, each potential factor may impact different domains of cognition and mental health or may impact individuals differentially based on genetic, environmental, social, emotional, and behavioral factors. Neuroimaging is one key tool that can be used to discover and assess markers of cognitive and mental health. The goal of this special issue is to expand the science on how biological markers can aid the understanding of aging and mental health through the lens of the individual from an international perspective, representing Germany, Taiwan, Thailand, the United Kingdom, and the United States. Common themes from these articles are used to support the new Seed and Soil Model of Neurocognitive Disorders.
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Affiliation(s)
- Ian M McDonough
- a Department of Psychology , The University of Alabama , Tuscaloosa , AL , USA.,b Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , AL , USA
| | - Rebecca S Allen
- b Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , AL , USA.,c Department of Psychology , The University of Alabama , Tuscaloosa , AL , USA
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Zamboni G, Griffanti L, Mazzucco S, Pendlebury ST, Rothwell PM. Age-dependent association of white matter abnormality with cognition after TIA or minor stroke. Neurology 2019; 93:e272-e282. [PMID: 31201296 PMCID: PMC6656647 DOI: 10.1212/wnl.0000000000007772] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/04/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate if the association between MRI-detectable white matter hyperintensity (WMH) and cognitive status reported in previous studies persists at older ages (>80 years), when some white matter abnormality is almost universally reported in clinical practice. METHODS Consecutive eligible patients from a population-based cohort of all TIA/nondisabling stroke (Oxford Vascular Study) underwent multimodal MRI, including fluid-attenuated inversion recovery and diffusion-weighted imaging, allowing automated measurement of WMH volume, mean diffusivity (MD), and fractional anisotropy (FA) in normal-appearing white matter using FSL tools. These measures were related to cognitive status (Montreal Cognitive Assessment) at age ≤80 vs >80 years. RESULTS Of 566 patients (mean [range] age 66.7 [20-102] years), 107 were aged >80 years. WMH volumes and MD/FA were strongly associated with cognitive status in patients aged ≤80 years (all p < 0.001 for WMH, MD, and FA) but not in patients aged >80 years (not significant for WMH, MD, and FA), with age interactions for WMH volume (p interaction = 0.016) and MD (p interaction = 0.037). Voxel-wise analyses also showed that lower Montreal Cognitive Assessment scores were associated with frontal WMH in patients ≤80 years, but not >80 years. CONCLUSION MRI markers of white matter damage are strongly related to cognition in patients with TIA/minor stroke at younger ages, but not at age >80 years. Clinicians and patients should not overinterpret the significance of these abnormalities at older ages.
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Affiliation(s)
- Giovanna Zamboni
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy.
| | - Ludovica Griffanti
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Sara Mazzucco
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Sarah T Pendlebury
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
| | - Peter M Rothwell
- From the Centre for Prevention of Stroke and Dementia (G.Z., L.G., S.M., S.T.P., P.M.R.) and Wellcome Centre for Integrative Neuroimaging, FMRIB (G.Z., L.G.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; and Department of Biomedical, Metabolic and Neural Sciences and Centre for Neurosciences and Neurotechnology (G.Z.), University of Modena and Reggio Emilia, Italy
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Heger I, Deckers K, van Boxtel M, de Vugt M, Hajema K, Verhey F, Köhler S. Dementia awareness and risk perception in middle-aged and older individuals: baseline results of the MijnBreincoach survey on the association between lifestyle and brain health. BMC Public Health 2019; 19:678. [PMID: 31159779 PMCID: PMC6545627 DOI: 10.1186/s12889-019-7010-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 05/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The total number of people with dementia is increasing worldwide, due to our aging society. Without a disease-modifying drug available, risk reduction strategies are to date the only promising way to reduce dementia incidence in the future. Substantial evidence exists that lifestyle factors contribute to the risk of dementia, such as physical exercise, mental activity and (non-)smoking. Still, most people seem unaware of a relationship between lifestyle and brain health. This paper investigates dementia literacy and knowledge of modifiable risk and protective factors of dementia in a Dutch population-based sample. METHODS An online-survey was carried out among 590 community-dwelling people between 40 and 75 years old in the Province of Limburg, the Netherlands. The total group comprises both of a provincial sample (n = 381) and a sample of three specific districts within the province (n = 209). Dementia awareness and knowledge about 12 risk and protective factors was assessed with items derived from the British Social Attitudes (BSA) survey, supplemented with custom items developed by the research team. RESULTS The majority of participants (56%) were unaware of a relationship between lifestyle and dementia risk. Most individuals identified low cognitive activity, physical inactivity and unhealthy diet as dementia risk factors. Particular gaps in knowledge existed with regard to major cardiovascular risk factors such as hypertension, hypercholesterolemia and coronary heart disease. Although the level of awareness varied by age and level of education, most people (70%) were eager to learn more about the topic of brain health, and indicated to be interested in using eHealth (54%) to measure or improve brain health. CONCLUSIONS Most people still are unaware of the relation between lifestyle and brain health, indicating the need for public health campaigns. Increasing awareness in the general population about the presence of modifiable dementia risk and protective factors is a crucial first step prior to implementation of preventative measures. Targeting specific subgroups, such as individuals with low socioeconomic status and low health literacy, is essential for the reach and effect of a prevention campaign. Outcome of this study was the rationale for an awareness campaign in The Netherlands, called "MijnBreincoach" ("MyBraincoach").
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Affiliation(s)
- Irene Heger
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Kay Deckers
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Martin van Boxtel
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - KlaasJan Hajema
- GGD Zuid-Limburg, Postbus 33, 6400 AA Heerlen, The Netherlands
| | - Frans Verhey
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
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Hunter S, Smailagic N, Brayne C. Dementia Research: Populations, Progress, Problems, and Predictions. J Alzheimers Dis 2018; 64:S119-S143. [DOI: 10.3233/jad-179927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sally Hunter
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
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Göthlin M, Eckerström M, Rolstad S, Kettunen P, Wallin A. Better prognostic accuracy in younger mild cognitive impairment patients with more years of education. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:402-412. [PMID: 30094327 PMCID: PMC6072671 DOI: 10.1016/j.dadm.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Age and years of education influence the risk of dementia and may impact the prognostic accuracy of mild cognitive impairment subtypes. Methods Memory clinic patients without dementia (N = 358, age 64.0 ± 7.9) were stratified into four groups based on years of age (≤64 and ≥65) and education (≤12 and ≥13), examined with a neuropsychological test battery at baseline and followed up after 2 years. Results The prognostic accuracy of amnestic multi-domain mild cognitive impairment for dementia was highest in younger patients with more years of education and lowest in older patients with fewer years of education. Conversely, conversion rates to dementia were lowest in younger patients with more years of education and highest in older patients with fewer years of education. Discussion Mild cognitive impairment subtypes and demographic information should be combined to increase the accuracy of prognoses for dementia.
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Affiliation(s)
- Mattias Göthlin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Marie Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Sindre Rolstad
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Petronella Kettunen
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
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Pons A, LaMonica HM, Mowszowski L, Köhler S, Deckers K, Naismith SL. Utility of the LIBRA Index in Relation to Cognitive Functioning in a Clinical Health Seeking Sample. J Alzheimers Dis 2018; 62:373-384. [DOI: 10.3233/jad-170731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Anke Pons
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Haley M. LaMonica
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sharon L. Naismith
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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