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Kaur A, Fouad MH, Pozzebon C, Behlouli H, Rajah MN, Pilote L. Sex Differences in the Association Between Vascular Risk Factors and Cognitive Decline: A UK Biobank Study. JACC. ADVANCES 2024; 3:100930. [PMID: 39130034 PMCID: PMC11312777 DOI: 10.1016/j.jacadv.2024.100930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 08/13/2024]
Abstract
Background Age-related cognitive decline is accelerated by vascular risk factors for cerebral small vessel disease. However, the association of vascular risk factors with cerebral small vessel disease contributing to the sex differences in cognitive decline remains unclear. Objectives The purpose of this study was to evaluate sex differences in cognitive decline and the association between vascular risk factors and cognitive decline by sex. Methods We used data from the UK Biobank (>55 years of age; n = 19,067) to assess cognitive tests (executive function, processing speed, and memory) while adjusting for baseline measurements to examine how vascular risk factors affect cognition. A univariate regression analysis was used to assess sex differences at the first time point (2014). A repeated measure analysis with a mixed effect model was used to determine cognitive decline (between 2014 and 2019). Any significant interaction between vascular risk factors and sex was investigated. Results Females had lower scores in all 3 domains at the first cognitive tests (2014). We found a significant sex-by-time interaction over a 5-year period in matrix pattern completion (P = 0.03). After adjusting for vascular risk factors, this interaction was reduced (P = 0.08). High low-density lipoprotein, low education, and high blood pressure had a greater effect on the rate of cognitive decline in the executive function for females compared to males for the sex∗vascular risk factor interaction (P < 0.05). Conclusions The rate of cognitive decline did not differ significantly between males and females. However, the impact of several vascular risk factors on cognitive decline was greater in females than in males.
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Affiliation(s)
- Amanpreet Kaur
- Department of Medicine, McGill University Health center, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Canada
| | - Moustafa H. Fouad
- Department of Medicine, McGill University Health center, Montreal, Canada
| | - Chelsea Pozzebon
- Department of Medicine, McGill University Health center, Montreal, Canada
| | - Hassan Behlouli
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Canada
| | - M. Natasha Rajah
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine & Health Sciences, McGill University, Montreal, Canada
| | - Louise Pilote
- Department of Medicine, McGill University Health center, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Canada
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Teverovsky EG, Gildengers A, Ran X, Jacobsen E, Chang CCH, Ganguli M. Benzodiazepine use and risk of incident MCI and dementia in a community sample. Int Psychogeriatr 2024; 36:142-148. [PMID: 37231775 PMCID: PMC10676448 DOI: 10.1017/s1041610223000455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Older adults commonly take benzodiazepines (BZDs) that may have long-term adverse cognitive effects. We investigated whether BZD use was related to developing mild cognitive impairment (MCI) or dementia in cognitively normal older adults in the community. SETTING/PARTICIPANTS A population-based cohort (n = 1959) of adults aged 65 and over, recruited from communities of low socioeconomic status. MEASUREMENTS BZD use, Clinical Dementia Rating (CDR), anxiety symptoms, depression symptoms, sleep difficulties, and APOE genotype. DESIGN We examined time from study entry to MCI (CDR = 0.5) and time from study entry to dementia (CDR ≥ 1) in participants who were cognitively normal at baseline (CDR = 0). We used survival analysis (Cox model), adjusted for age, sex, education, sleep, anxiety, and depression. For all the models, we included an interaction term between BZD use and APOE*4. RESULTS Taking BZDs was significantly associated with higher risk of developing MCI, but not of developing dementia. The effect was not affected by APOE genotype. CONCLUSIONS In a population-based sample of cognitively normal older adults, BZD use is associated with developing MCI, but not dementia. BZD use may be a potentially modifiable risk factor for MCI.
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Affiliation(s)
- Esther G Teverovsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Xinhui Ran
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chung-Chou H Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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van Gils V, Ramakers I, Jansen WJ, Banning L, Kučikienė D, Costa AS, Schulz JB, Visser PJ, Verhey F, Reetz K, Vos SJ. Contributions of Vascular Burden and Amyloid Abnormality to Cognitive Decline in Memory Clinic Patients. J Alzheimers Dis Rep 2023; 7:1299-1311. [PMID: 38143773 PMCID: PMC10742024 DOI: 10.3233/adr-230040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/01/2023] [Indexed: 12/26/2023] Open
Abstract
Background Alzheimer's disease pathology and vascular burden are highly prevalent and often co-occur in elderly. It remains unclear how both relate to cognitive decline. Objective To investigate whether amyloid abnormality and vascular burden synergistically contribute to cognitive decline in a memory clinic population. Methods We included 227 patients from Maastricht and Aachen memory clinics. Amyloid abnormality (A+) was defined by CSF Aβ42 using data-driven cut-offs. Vascular burden (V+) was defined as having moderate to severe white matter hyperintensities, or any microbleeds, macrohemorrhage or infarcts on MRI. Longitudinal change in global cognition, memory, processing speed, executive functioning, and verbal fluency was analysed across the A-V-, A-V+, A+V-, A+V+ groups by linear mixed models. Additionally, individual MRI measures, vascular risk and vascular disease were used as V definitions. Results At baseline, the A+V+ group scored worse on global cognition and verbal fluency compared to all other groups, and showed worse memory compared to A-V+ and A-V- groups. Over time (mean 2.7+ - 1.5 years), A+V+ and A+V- groups showed faster global cognition decline than A-V+ and A-V- groups. Only the A+V- group showed decline on memory and verbal fluency. The A-V+ group did not differ from the A-V- group. Individual MRI vascular measures only indicated an independent association of microbleeds with executive functioning decline. Findings were similar using other V definitions. Conclusions Our study demonstrates that amyloid abnormality predicts cognitive decline independent from vascular burden in a memory clinic population. Vascular burden shows a minor contribution to cognitive decline in these patients. This has important prognostic implications.
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Affiliation(s)
- Veerle van Gils
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Inez Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Willemijn J. Jansen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Leonie Banning
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Domantė Kučikienė
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ana Sofia Costa
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and RWTH Aachen University, Aachen, Germany
| | - Jörg B. Schulz
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and RWTH Aachen University, Aachen, Germany
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Kathrin Reetz
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and RWTH Aachen University, Aachen, Germany
| | - Stephanie J.B. Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
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Sánchez-Vincitore LV, Cubilla-Bonnetier D, Marte-Santana H, Duñabeitia JA. Cognitive decline monitoring through a web-based application. Front Aging Neurosci 2023; 15:1212496. [PMID: 37869371 PMCID: PMC10585037 DOI: 10.3389/fnagi.2023.1212496] [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: 04/27/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Cognitive decline usually begins after individuals reach maturity, which is more evident in late adulthood. Rapid and constant cognitive screenings allow early detection of cognitive decline and motivate individuals to participate in prevention interventions. Due to accelerated technological advances, cognitive screening and training are now available to the layperson using electronic devices connected to the internet. Large datasets generated by these platforms provide a unique opportunity to explore cognitive development throughout life and across multiple naturalistic environments. However, such data collection mechanisms must be validated. This study aimed to determine whether the data gathered by commercial visuospatial and phonological working memory tests (CogniFit Inc., San Francisco, USA) confirm the well-established argument that age predicts cognitive decline. Data from 3,212 participants (2,238 females) who were 45 years old or older were analyzed. A linear regression analysis explored the relationship between age and working memory while controlling for gender, sleep quality, and physical activity (variables that are known to affect working memory). We found that age negatively predicts working memory. Furthermore, there was an interaction between age and gender for visuospatial working memory, indicating that although male participants significantly outperformed females, the relationship between age and working memory differs for females and males. Our results suggest that the computerized assessment of visuospatial and phonological working memory is sensible enough to predict cognitive functions in aging. Suggestions for improving the sensitivity of self-reports are discussed. Further studies must explore the nature of gender effects on cognitive aging.
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Affiliation(s)
- Laura V. Sánchez-Vincitore
- Laboratorio de Neurocognición y Psicofisiología, Universidad Iberoamericana (Unibe), Santo Domingo, Dominican Republic
| | - Daniel Cubilla-Bonnetier
- Laboratorio de Neurocognición y Psicofisiología, Universidad Iberoamericana (Unibe), Santo Domingo, Dominican Republic
| | - Hugo Marte-Santana
- Laboratorio de Neurocognición y Psicofisiología, Universidad Iberoamericana (Unibe), Santo Domingo, Dominican Republic
| | - Jon Andoni Duñabeitia
- Centro de Investigación Nebrija en Cognición, Universidad Nebrija, Madrid, Spain
- Department of Language and Culture, The Arctic University of Norway, Tromsø, Norway
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Almeria M, Alvarez I, Molina-Seguin J, Besora S, Buongiorno M, Romero S, Casas L, Cano C, Castejon J, Arribas S, Krupinski J. Citicoline May Prevent Cognitive Decline in Patients with Cerebrovascular Disease. Clin Interv Aging 2023; 18:1093-1102. [PMID: 37489128 PMCID: PMC10363355 DOI: 10.2147/cia.s409994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Introduction Neuroprotective drugs such as citicoline could improve cognitive performance and quality of life. We studied the effect of citicoline treatment and its association with Vascular Risk Factors (VRF) and APOE on cognition in patients with Subjective Cognitive Complaints (SCC) and Mild Cognitive Impairment (MCI). Methods This is an observational and prospective study with citicoline during 12 months follow-up. Eighty-one subjects who met criteria for SCC/MCI, aged 50-75 years with VRF were included and prescribed citicoline 1g/day. Subjects with previous cognitive impairment and any other central nervous system affection were excluded. Wilcoxon Signed Ranks test and paired samples t-test were used to analyze the change in neuropsychological performance. Results Mean age of the sample was 68.2 (SD 6.8) years and 26 (32.09%) were females. Fifteen subjects (24.6%) were APOE-ε4 carriers, fifty-six (76.7%) had hypertension, fifty-eight (79.5%) had dyslipidemia, twenty-one (28.8%) had diabetes mellitus and twenty-six (35.6%) had cardiopathy. Thirty-two (43.8%) subjects were diagnosed as SCC and forty-one (56.16%) as MCI. During the follow-up, Tweny-six patients (81.25%) in the group of SCC remained stable, six subjects (18.8%) converted to MCI. Twelve patients (29.9%) with MCI reverted to SCC and twenty-nine patients (70.7%) remained stable. At follow-up, SCC subjects had an improvement in the global language domain (p=0.03), naming (p<0.001), attention (p=0.01) and visuospatial abilities (p<0.01). MCI group showed an improvement in the screening test (p=0.03), delayed memory (p<0.01), global cognition (p=0.04) and in cognitive flexibility (p=0.03). Presence of APOE-ε4 had no impact on the above findings. Discussion SCC subjects showed an improvement in language and attention domains, while those with MCI performed better after 12 months in total scores of MoCA and RBANS domains, some converting back to SCC. This supports the idea that citicoline may prevent cognitive decline in patients with cognitive deficits.
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Affiliation(s)
- Marta Almeria
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Ignacio Alvarez
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Jessica Molina-Seguin
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sarah Besora
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Mariateresa Buongiorno
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Silvia Romero
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Laura Casas
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Cristina Cano
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Judith Castejon
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sonia Arribas
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Jerzy Krupinski
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
- Healthcare Sciences, Manchester Metropolitan University, Manchester, UK
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Weigand AJ, Ortiz G, Walker KS, Galasko DR, Bondi MW, Thomas KR. APOE differentially moderates cerebrospinal fluid and plasma phosphorylated tau181 associations with multi-domain cognition. Neurobiol Aging 2023; 125:1-8. [PMID: 36780762 DOI: 10.1016/j.neurobiolaging.2022.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/19/2023]
Abstract
Biofluid markers of phosphorylated tau181 (p-tau181) are increasingly popular for the detection of early Alzheimer's pathologic changes. However, the differential dynamics of cerebrospinal fluid (CSF) and plasma p-tau181 remain under investigation. We studied 727 participants from the Alzheimer's Disease Neuroimaging Initiative with plasma and CSF p-tau181 data, apolipoprotein (APOE) ε4 carrier status, amyloid positron emission tomography (PET) imaging, and neuropsychological data. Higher levels of plasma and CSF p-tau181 were observed among APOE ε4 carriers. CSF and plasma p-tau181 were significantly associated with memory, and this effect was greater in APOE ε4 carriers. However, whereas CSF p-tau181 was not significantly associated with language or attention/executive function among ε4 carriers or non-carriers, APOE ε4 status moderated the association of plasma p-tau181 with both language and attention/executive function. These findings lend support to the notion that p-tau181 biofluid markers are useful in measuring AD pathologic changes but also suggest that CSF and plasma p-tau181 have unique properties and dynamics that should be considered when using these markers in research and clinical practice.
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Affiliation(s)
- Alexandra J Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Gema Ortiz
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Kayla S Walker
- San Diego State University, Department of Psychology, San Diego, CA, USA
| | - Douglas R Galasko
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Neurosciences, La Jolla, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
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Chai YL, Rajeev V, Poh L, Selvaraji S, Hilal S, Chen CP, Jo DG, Koo EH, Arumugam TV, Lai MKP. Chronic cerebral hypoperfusion alters the CypA-EMMPRIN-gelatinase pathway: Implications for vascular dementia. J Cereb Blood Flow Metab 2023; 43:722-735. [PMID: 36537035 PMCID: PMC10108186 DOI: 10.1177/0271678x221146401] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 03/21/2023]
Abstract
Chronic cerebral hypoperfusion (CCH) is postulated to underlie multiple pathophysiological processes in vascular dementia (VaD), including extracellular matrix dysfunction. While several extracellular matrix proteins, namely cyclophilin A (CypA), extracellular matrix metalloproteinase inducer (EMMPRIN) and gelatinases (matrix metalloproteinases, MMP-2 and -9) have been investigated in acute stroke, their involvement in CCH and VaD remains unclear. In this study, CypA-EMMPRIN-gelatinase proteins were analysed in a clinical cohort of 36 aged, cognitively unimpaired subjects and 48 VaD patients, as well as in a bilateral carotid artery stenosis mouse model of CCH. Lower CypA and higher EMMPRIN levels were found in both VaD serum and CCH mouse brain. Furthermore, gelatinases were differentially altered in CCH mice and VaD patients, with significant MMP-2 increase in CCH brain and serum, whilst serum MMP-9 was elevated in VaD but reduced in CCH, suggesting complex CypA-EMMPRIN-gelatinase regulatory mechanisms. Interestingly, subjects with cortical infarcts had higher serum MMP-2, while white matter hyperintensities, cortical infarcts and lacunes were associated with higher serum MMP-9. Taken together, our data indicate that perturbations of CypA-EMMPRIN signalling may be associated with gelatinase-mediated vascular sequelae, highlighting the potential utility of the CypA-EMMPRIN-gelatinase pathway as clinical biomarkers and therapeutic targets in VaD.
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Affiliation(s)
- Yuek Ling Chai
- Department of Pharmacology, Yong
Loo Lin School of Medicine, National University of Singapore, Kent Ridge,
Singapore
- Memory, Aging and Cognition Centre,
National University Health System, Kent Ridge, Singapore
| | - Vismitha Rajeev
- Department of Pharmacology, Yong
Loo Lin School of Medicine, National University of Singapore, Kent Ridge,
Singapore
| | - Luting Poh
- Department of Pharmacology, Yong
Loo Lin School of Medicine, National University of Singapore, Kent Ridge,
Singapore
| | - Sharmelee Selvaraji
- Department of Pharmacology, Yong
Loo Lin School of Medicine, National University of Singapore, Kent Ridge,
Singapore
| | - Saima Hilal
- Department of Pharmacology, Yong
Loo Lin School of Medicine, National University of Singapore, Kent Ridge,
Singapore
- Saw Swee Hock School of Public
Health, National University of Singapore, Kent Ridge, Singapore
| | - Christopher P Chen
- Department of Pharmacology, Yong
Loo Lin School of Medicine, National University of Singapore, Kent Ridge,
Singapore
- Memory, Aging and Cognition Centre,
National University Health System, Kent Ridge, Singapore
| | - Dong-Gyu Jo
- School of Pharmacy, Sungkyunkwan
University, Suwon, Republic of Korea
| | - Edward H Koo
- Department of Medicine, National
University of Singapore, Kent Ridge, Singapore
- Graduate School for Integrative
Sciences and Engineering, National University of Singapore, Kent Ridge,
Singapore
- Department of Neurosciences,
University of California San Diego, San Diego, CA, USA
| | - Thiruma V Arumugam
- School of Pharmacy, Sungkyunkwan
University, Suwon, Republic of Korea
- Centre for Cardiovascular Biology
and Disease Research, Department of Microbiology, Anatomy, Physiology and
Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe
University, Bundoora, VIC, Australia
| | - Mitchell KP Lai
- Department of Pharmacology, Yong
Loo Lin School of Medicine, National University of Singapore, Kent Ridge,
Singapore
- Memory, Aging and Cognition Centre,
National University Health System, Kent Ridge, Singapore
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Masika GM, Nyundo A, Msisiri L. Cognitive Impairment and the Associated Factors Among Older People in Rural Central Tanzania. Alzheimer Dis Assoc Disord 2023; 37:100-106. [PMID: 37253122 DOI: 10.1097/wad.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/28/2022] [Indexed: 06/01/2023]
Abstract
AIM This study examined the profile of cognitive impairment and associated factors among older people in rural central Tanzania. METHODS We conducted a cross-sectional study involving 462 community-dwelling older adults. We performed cognitive, psychosocial, and clinical assessments and face-to-face interviews with all older adults. Descriptive, bivariate and multivariate linear regression analyses were performed to determine the participant's cognitive performance and the associated factors. RESULTS The mean cognitive score on the Identification and Intervention for Dementia in Elderly Africans cognitive test was 11.04 (SD=2.89). Per the proposed cut-off scores to define probable and possible dementia, 13.2% of the population had probable dementia and another 13.9% had possible dementia. Increase in age was associated with poor cognitive performance (β=-0.076, 95% CI=-0.109 to -0.043, P<0.001); whereas male sex (β=0.989, 95% CI=0.333 to 1.645, P=0.003), higher educational attainment (β=2.575, 95% CI=0.557 to 4.594, P=0.013) and performance in instrumental activities of daily living (β=0.552, 95% CI=0.376 to 0.729, P<0.001) were associated with higher cognitive performance. DISCUSSION Older people in rural settings of central Tanzania have poor cognitive functions and are at high risk of further cognitive decline. Preventive and therapeutic programs for the affected older people are warranted to prevent further decline and maintain quality of life.
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Affiliation(s)
- Golden M Masika
- Department of Clinical Nursing School of Nursing and Public Health
| | - Azan Nyundo
- Department of Psychiatry, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - Laidi Msisiri
- Department of Clinical Nursing School of Nursing and Public Health
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9
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Kong W, Zang Y. Alzheimer's disease biomarkers in patients with obstructive sleep apnea hypopnea syndrome and effects of surgery: A prospective cohort study. Front Aging Neurosci 2023; 14:959472. [PMID: 36733500 PMCID: PMC9887197 DOI: 10.3389/fnagi.2022.959472] [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: 09/13/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023] Open
Abstract
Background Obstructive sleep apnea hypopnea syndrome (OSAHS) may cause Alzheimer's disease (AD), t-tau, p-tau, Aβ42, and Aβ40 are important elements in the process of AD, and changes in the levels of these biomarkers may affect the cognitive functioning of patients. Our objective was to investigate whether uvulopalatopharyngoplasty could reduce the plasma levels of AD biomarkers in OSAHS patients and the potential correlations of AD biomarkers with cognitive impairment and sleepiness, and explore the independent influencing factors of cognitive function. Methods Alzheimer's disease biomarkers were measured in the plasma of 35 patients with severe OSAHS requiring surgical treatment and 16 healthy controls without OSAHS. The cognitive function and sleepiness of OSAHS patients was also evaluated. The case group was given uvulopalatopharyngoplasty and followed at the postoperative sixth month, the follow-up cases were 27, and plasma AD biomarker levels, cognitive function, and sleepiness were re-evaluated. The preoperative and postoperative AD biomarker levels OSAHS patients were compared with each other and those of the control group. Linear stepwise regression and lasso regression were used to explore the relationships of AD biomarkers with cognitive impairment and sleepiness. Results Significantly higher Aβ40, t-tau, p-tau in plasma were observed preoperatively in OSAHS patients comparing to controls (29.24 ± 32.52 vs. 13.18 ± 10.78, p = 0.049; 11.88 ± 7.05 vs. 7.64 ± 4.17, p = 0.037; 26.31 ± 14.41 vs. 17.34 ± 9.12, p = 0.027). The sixth month of postoperation, the plasma AD biomarkers (Aβ42, Aβ40, t-tau, p-tau) in plasma levels decreased significantly (0.23 ± 0.17 vs. 0.20 ± 0.16, p = 0.0001; 29.24 ± 32.52 vs. 23.52 ± 24.46, p = 0.0046; 11.88 ± 7.05 vs. 8.88 ± 6.21, p = 0.0001;26.31 ± 14.41 vs. 20.43 ± 10.50, p = 0.0001). A comparison of MMSE and ESS scores from before to after surgery revealed obvious differences (27.14 ± 1.65 vs. 29.07 ± 1.78, p = 0.0001; 11.91 ± 4.84 vs. 5.89 ± 2.83, p = 0.0001). Changes in cognitive function and sleepiness scores from before to after uvulopalatopharyngoplasty were significantly correlated with AD biomarkers. Body mass index and t-tau were potential influencing factors cognitive function. Conclusion Obstructive sleep apnea hypopnea syndrome can increase plasma AD biomarkers levels. Uvulopalatopharyngoplasty can improve patients' cognition and sleepiness, and the mechanism may be related to changes in plasma AD biomarkers. Higher AHI and higher t-tau level were identified as independent risk factors for cognitive decline.
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Affiliation(s)
- Weili Kong
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zang
- Department of Information Management, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China,*Correspondence: Yi Zang,
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Lobo JD, Goodman ZT, Schmaus JA, Uddin LQ, McIntosh RC. Association of cardiometabolic health factors with age-related executive function and episodic memory. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:746-760. [PMID: 33938379 PMCID: PMC9020729 DOI: 10.1080/13825585.2021.1915948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Although decline of cognitive abilities in late life is regarded as a common facet of aging, there is inter-individual variability in this decline. Possible contributors are cardiometabolic risk factors associated with cerebrovascular dysfunction, but a dearth in unifying health-cognition models confound exactly how these risk factors mediate age-related changes in executive function (EF) and episodic memory. This study investigated the indirect effect of age on these cognitive abilities via cardiometabolic risk factors using a structural equation modeling approach. Participants included 738 adults (64% female) ranging from 21 to 85 years of age (M = 47.47, SD = 18.28). An exploratory factor analysis was applied to an EF battery yielding a two-factor solution, consisting of inhibition and cognitive flexibility, that showed acceptable fit (χ2(48) = 101.84, p < .001, CFI = .980, RMSEA = .039, SRMR = .035). The EF latent factors were then included in a confirmatory factor analysis exploring the indirect role of age on episodic memory and EF via blood pressure, cholesterol, triglycerides and body mass index. The theoretical model demonstrated acceptable fit, χ2(108) = 204.071, p < .001, CFI = .972, RMSEA = .035, SRMR = .035. Blood pressure was associated with lower cognitive flexibility (β = -.20, p < .001) and there was a significant indirect effect of age on episodic memory through cognitive flexibility (β = .07, p = .021). Results support the "Executive Decline Hypothesis" of age-related episodic memory decline and specifically implicate lower blood pressure control and cognitive flexibility in these changes.
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Affiliation(s)
- Judith D. Lobo
- Department of Psychiatry, University of California, San DiegodUnited St
| | - Zachary T. Goodman
- Department of Psychology, University of Miami, Coral Gables, United States
| | | | - Lucina Q. Uddin
- Department of Psychology, University of Miami, Coral Gables, United States
| | - Roger C. McIntosh
- Department of Psychology, University of Miami, Coral Gables, United States
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11
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Xu L, Yang Y, Cui D. Association between blood pressure control status, visit-to-visit blood pressure variability, and cognitive function in elderly Chinese: A nationwide study. Front Public Health 2022; 10:877192. [PMID: 35991063 PMCID: PMC9386068 DOI: 10.3389/fpubh.2022.877192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cognitive function is a concern among the elderly, which is related to the quality of life, life expectancy, and economic burdens. The relationship between blood pressure (BP) control status, visit-to-visit BP variability, and cognitive function remains controversial. Methods We aimed to explore the association between BP control status at baseline, visit-to-visit BP variability, and cognitive function. This study included 3,511 elderlies in the China Health and Retirement Longitudinal Study, covering four waves for 7-year follow-up (baseline 2011, 2013, 2015, and 2018). BP was measured in Wave 2011, 2013, and 2015. Cognitive function was measured by Mini-Mental State Exam in Wave 2018. Participants were divided into two groups: mid-old group for reflecting midlife BP and cognition (45–59 years at baseline but aged 60 or over in Wave 2018), and old-old group for reflecting late-life BP and cognition (aged 60 or over at baseline). We use univariate analysis and general linear model to analyze. Results Late-life BP showed stronger associations with cognitive function than midlife BP. As to late-life BP control status, controlled hypertension group get higher cognitive score than uncontrolled hypertension group in language (adjusted β = −0.34, 95%CI −0.68 to 0.00), and untreated hypertension group in orientation (adjusted β = −0.41, 95%CI −0.72 to −0.11), language (adjusted β = −0.35, 95%CI −0.67 to −0.04), and total (adjusted β = −0.99, 95%CI −1.85 to −0.12). Regarding visit-to-visit BP variability, midlife visit-to-visit systolic blood pressure (SBP) variability was associated with language (adjusted β = −3.70, 95% CI −5.83 to −1.57), while late-life visit-to-visit SBP variability was associated with orientation (adjusted β = −2.99, 95% CI −4.84 to −1.14), recall (adjusted β = −1.69, 95% CI −2.89 to −0.48), language (adjusted β = −2.26, 95% CI −4.13 to −0.38), and total (adjusted β = −9.50, 95% CI −14.71 to −4.28); Midlife diastolic blood pressure (DBP) variability and pulse pressure (PP) variability showed a significant relationship with language (adjusted β = 3.25, 95% CI −1.31 to −5.19) and calculation (adjusted β = −0.26, 95% CI −0.47 to −0.04), respectively. No significant correlation was found between midlife BP control status, late-life visit-to-visit DBP variability, late-life visit-to-visit PP variability, and cognitive score. There was no significant correlation between BP and memory. Conclusions BP control status and visit-to-visit BP variability were significantly related to cognitive function among the Chinese elderly. Receiving effective late-life antihypertensive treatment and keeping SBP stable might contribute to prevent the development of cognitive impairment and dementia, especially for orientation and language function.
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Affiliation(s)
- Luxinyi Xu
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Ying Yang
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
- *Correspondence: Dan Cui
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12
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LaPlume AA, McKetton L, Levine B, Troyer AK, Anderson ND. The adverse effect of modifiable dementia risk factors on cognition amplifies across the adult lifespan. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12337. [PMID: 35845262 PMCID: PMC9277708 DOI: 10.1002/dad2.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/28/2022] [Accepted: 05/21/2022] [Indexed: 11/09/2022]
Abstract
Background Reversible lifestyle behaviors (modifiable risk factors) can reduce dementia risk by 40%, but their prevalence and association with cognition throughout the adult lifespan is less well understood. Methods The associations between the number of modifiable risk factors for dementia (low education, hypertension, hearing loss, traumatic brain injury, alcohol or substance abuse, diabetes, smoking, and depression) and cognition were examined in an online sample (N = 22,117, ages 18–89). Findings Older adults (ages 66–89) had more risk factors than middle‐aged (ages 45–65) and younger adults (ages 18–44). Polynomial regression revealed that each additional risk factor was associated with lower cognitive performance (equivalent to 3 years of aging), with a larger association as age increased. People with no risk factors in their forties to seventies showed similar cognitive performance to people 10 or 20 years younger with many risk factors. Interpretation Modifiable dementia risk factors amplify lifespan age differences in cognitive performance.
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Affiliation(s)
| | - Larissa McKetton
- Rotman Research Institute Baycrest Health Sciences Toronto Canada
| | - Brian Levine
- Rotman Research Institute Baycrest Health Sciences Toronto Canada.,Department of Psychology University of Toronto Toronto Canada.,Department of Medicine (Neurology) University of Toronto Toronto Canada
| | - Angela K Troyer
- Department of Psychology University of Toronto Toronto Canada.,Neuropsychology and Cognitive Health Program Baycrest Health Sciences Toronto Canada
| | - Nicole D Anderson
- Rotman Research Institute Baycrest Health Sciences Toronto Canada.,Department of Psychology University of Toronto Toronto Canada.,Department of Psychiatry University of Toronto Toronto Canada
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13
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Huo N, Vemuri P, Graff-Radford J, Syrjanen J, Machulda M, Knopman DS, Jack CR, Petersen R, Mielke MM. Sex Differences in the Association Between Midlife Cardiovascular Conditions or Risk Factors With Midlife Cognitive Decline. Neurology 2022; 98:e623-e632. [PMID: 34987078 PMCID: PMC8829960 DOI: 10.1212/wnl.0000000000013174] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of midlife cardiovascular conditions and risk factors is higher in men than women. Associations between midlife cardiovascular conditions or risk factors and midlife cognitive decline have been reported, but few studies have assessed sex differences in these associations. METHODS We included 1,857 participants enrolled in the population-based Mayo Clinic Study of Aging who were 50 to 69 years of age at baseline. Participants were evaluated every 15 months by a coordinator, including neurologic evaluation and neuropsychological testing. The neuropsychological testing used 9 tests to calculate global cognitive and domain-specific (memory, language, executive function, and visuospatial skills) z scores. Nurse abstractors reviewed participant medical records to determine the presence of cardiovascular conditions (coronary heart disease, arrhythmias, congestive heart failure) and risk factors (hypertension, diabetes, dyslipidemia, obesity, ever smoking). Linear mixed-effect models evaluated the association between baseline cardiovascular conditions or risk factors and global and domain-specific cognitive decline. Multivariable models adjusted for demographics, APOE genotype, depression, and other medical conditions. Interactions between sex and each cardiovascular condition or risk factor were examined, and results were stratified by sex. RESULTS Overall, 1,465 (78.9%) participants had at least 1 cardiovascular condition or risk factor; the proportion of men was higher than women (767 [83.4%] vs 698 [74.5%], p < 0.0001). Cross-sectionally, coronary heart disease and ever smoking were associated with a lower visuospatial z score in multivariable models. Longitudinally, several cardiovascular conditions and risk factors were associated with declines in global and domain-specific z scores but not visuospatial z scores. Most cardiovascular conditions were more strongly associated with cognition among women: coronary heart disease and other cardiovascular conditions were associated with global cognitive decline only in women (all p < 0.05). In addition, diabetes, dyslipidemia, and coronary heart disease were associated with language z score decline only in women (all p < 0.05). However, congestive heart failure was associated with language z score decline only in men (all p < 0.05). DISCUSSION Midlife cardiovascular conditions and risk factors are associated with midlife cognitive decline. Moreover, specific cardiovascular conditions and risk factors have stronger associations with cognitive decline in midlife for women than men despite the higher prevalence of those conditions in men.
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Affiliation(s)
- Nan Huo
- From the Mayo Clinic, Rochester, MN
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14
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Vintimilla R, Balasubramanian K, Hall J, Johnson L, Bryant SO. Comparing Framingham risk score and cognitive performance in a Mexican American cohort. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Huang LC, Hsieh SW, Tsai CC, Chen CH, Yang YH. The Role of Cilostazol and Inflammation in Cognitive Impairment After Ischemic Stroke. Am J Alzheimers Dis Other Demen 2021; 36:15333175211016185. [PMID: 34008421 PMCID: PMC10624089 DOI: 10.1177/15333175211016185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this study is to examine the potential effect of cilostazol and inflammation on cognitive impairment after stroke in an Asian population. METHODS Forty-five patients with cognitive impairment after ischemic stroke using cilostazol were enrolled as the study group and 45 patients using aspirin or clopidogrel were enrolled as the control group. Neuropsychiatric assessments were administered at the start of the study and after 6 months. Multiple logistic regression analysis was used to estimate the association between the cognitive change and cilostazol use. Macrophage polarization were assessed using flow cytometry in 7 patients. RESULTS There were a significantly higher number of patients with peripheral arterial occlusive disease in the cilostazol group. No significant differences were observed in the cognitive change between the cilostazol and control groups. M1 macrophage subset increment were observed in the patient having a declined cognitive change. CONCLUSION Cilostazol did not make a significant difference in cognitive change after ischemic stroke. M1 macrophage subset increment may indicate post stroke cognitive decline. Due to limited number of subjects, these findings should be examined further in large-scale randomized clinical trials.
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Affiliation(s)
- Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chia-Chan Tsai
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung City, Taiwan
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16
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Predictors of Dementia in the Oldest Old: A Novel Machine Learning Approach. Alzheimer Dis Assoc Disord 2020; 34:325-332. [PMID: 32701513 DOI: 10.1097/wad.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incidence of dementia increases exponentially with age; little is known about its risk factors in the ninth and 10th decades of life. We identified predictors of dementia with onset after age 85 years in a longitudinal population-based cohort. METHODS On the basis of annual assessments, incident cases of dementia were defined as those newly receiving Clinical Dementia Rating (CDR) ≥1. We used a machine learning method, Markov modeling with hybrid density-based and partition-based clustering, to identify variables associated with subsequent incident dementia. RESULTS Of 1439 participants, 641 reached age 85 years during 10 years of follow-up and 45 of these became incident dementia cases. Using hybrid density-based and partition-based, among those aged 85+ years, probability of incident dementia was associated with worse self-rated health, more prescription drugs, subjective memory complaints, heart disease, cardiac arrhythmia, thyroid disease, arthritis, reported hypertension, higher systolic and diastolic blood pressure, and hearing impairment. In the subgroup aged 85 to 89 years, risk of dementia was also associated with depression symptoms, not currently smoking, and lacking confidantes. CONCLUSIONS An atheoretical machine learning method revealed several factors associated with increased probability of dementia after age 85 years in a population-based cohort. If independently validated in other cohorts, these findings could help identify the oldest-old at the highest risk of dementia.
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17
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Blood pressure and cognitive performances in middle-aged adults: the Aging, Health and Work longitudinal study. J Hypertens 2020; 37:1244-1253. [PMID: 30624363 DOI: 10.1097/hjh.0000000000002013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Our objective was to investigate the impact of both prevalent and incident hypertension on cognition in middle-aged individuals followed up for 10 years and to explore the extent to which blood pressure control by antihypertensive drugs could modify this relationship. METHOD Three thousand, two hundred and one participants from the Vieillissement Santé Travail (Aging, Health and Work) (VISAT) cohort study, aged 32, 42, 52 and 62 years at baseline were followed up 5 and 10 years later. Blood pressure, antihypertensive medication use as well as memory and speed cognitive performances were assessed at baseline and follow-up. Linear mixed models were used for analyses. RESULTS At 10-year follow-up, compared with nonhypertensive participants, prevalent hypertensive individuals showed poorer global cognitive performances (β = -2.99 ± 0.96, P = 0.002 for participants aged 32 or 42 years at baseline and β = -5.94 ± 1.00, P < 0.001 for those aged 52 or 62). Patients with incident hypertension had poorer global cognitive performances over time compared with patients without hypertension. When considering prevalent hypertension and blood pressure control status by antihypertensive therapy, untreated and uncontrolled hypertension were associated with poorer cognitive performances than controlled and no hypertension (untreated hypertension compared with no hypertension: β = -5.51 ± 0.75, P < 0.001; uncontrolled hypertension compared with no hypertension: β = -6.13 ± 1.40, P < 0.001). CONCLUSION Our findings showed that both prevalent and incident hypertension are associated with poorer global cognitive function in middle-aged individuals and suggested a potential preventive effect of antihypertensive therapy on cognition. Thus, for brain functioning, heightened efforts to detect hypertension and adequately treat it are of critical importance.
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18
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Olaya B, Moneta MV, Bobak M, Haro JM, Demakakos P. Cardiovascular risk factors and memory decline in middle-aged and older adults: the English Longitudinal Study of Ageing. BMC Geriatr 2019; 19:337. [PMID: 31791248 PMCID: PMC6889660 DOI: 10.1186/s12877-019-1350-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated the association between trajectories of verbal episodic memory and burden of cardiovascular risk factors in middle-aged and older community-dwellers. METHODS We analysed data from 4372 participants aged 50-64 and 3005 persons aged 65-79 years old from the English Longitudinal Study of Ageing who were repeatedly evaluated every 2 years and had six interviews of a 10-year follow-up. We measured the following baseline risk factors: diabetes, hypertension, smoking, physical inactivity and obesity to derive a cardiovascular risk factor score (CVRFs). Adjusted linear mixed effect regression models were estimated to determine the association between number of CVFRs and six repeated measurements of verbal memory scores, separately for middle-aged and older adults. RESULTS CVRFs was not significantly associated with memory at baseline. CVFRs was significantly associated with memory decline in middle-aged (50-64y), but not in older (65-79y) participants. This association followed a dose-response pattern with increasing number of CVFRs being associated with greater cognitive decline. Comparisons between none versus some CVRFs yielded significant differences (p < 0.05). CONCLUSIONS Our findings confirm that the effect of cumulative CVRFs on subsequent cognitive deterioration is age-dependent. CVRFs are associated with cognitive decline in people aged 50-64 years, but not in those aged ≥65 years. Although modest, the memory decline associated with accumulation of cardiovascular risk factors in midlife may increase the risk of late-life dementia.
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Affiliation(s)
- Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Maria Victoria Moneta
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
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19
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de Oliveira FF, Chen ES, Smith MC, Bertolucci PHF. Associations of Blood Pressure with Functional and Cognitive Changes in Patients with Alzheimer's Disease. Dement Geriatr Cogn Disord 2018; 41:314-23. [PMID: 27398980 DOI: 10.1159/000447585] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Midlife hypertension followed by late life hypotension resulting from neurodegeneration increases amyloidogenesis and tauopathy. METHODS Consecutive outpatients with late-onset Alzheimer's disease (AD) at various stages and their respective caregivers were assessed for score variations in 1 year of tests assessing caregiver burden, functionality and cognition according to blood pressure (BP) variations and APOE haplotypes, while also taking into account differential effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, calcium channel blockers, diuretics, or no antihypertensive medication on score changes. The diagnosis and treatment of arterial hypertension followed the JNC 7 report. RESULTS Variations in systolic BP (-11.76 ± 17.1 mm Hg), diastolic BP (-4.92 ± 10.3 mm Hg) and pulse pressure (-6.84 ± 12.6 mm Hg) were significant after 1 year (n = 191; x03C1; < 0.01). For APOE4+ carriers, rises in systolic or diastolic BP improved Clinical Dementia Rating Scale Sum of Boxes scores (x03C1; < 0.04), with marginally significant improvements in Mini-Mental State Examination scores resulting from risen systolic (x03C1; = 0.069) or diastolic BP (x03C1; = 0.079), and in basic independence only regarding risen diastolic BP (x03C1; = 0.055). APOE4- carriers resisted any functional or cognitive effects of BP variations. No differences were found regarding any antihypertensive class for variations in BP or any test scores, regardless of APOE haplotypes. CONCLUSIONS Targeting mild BP elevations brings better functional and cognitive results for APOE4+ carriers with AD.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Departments of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of Sx00E3;o Paulo (UNIFESP), Sx00E3;o Paulo, Brazil
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20
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Temporal Cognitive Decline Associated With Exposure to Infectious Agents in a Population-based, Aging Cohort. Alzheimer Dis Assoc Disord 2017; 30:216-22. [PMID: 26710257 DOI: 10.1097/wad.0000000000000133] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Numerous cross-sectional studies have related exposure to neurotropic infectious agents with cognitive dysfunction in older adults, however, the temporal sequence is uncertain. METHODS In a representative, well-characterized, population-based aging cohort, we determined whether the temporal trajectories of multiple cognitive domains are associated with exposure to cytomegalovirus (CMV), Herpes Simplex virus, type 1 (HSV-1), Herpes Simplex virus, type 2 (HSV-2), or Toxoplasma gondii (TOX). Complex attention, executive functions, memory, language, and visuospatial function were assessed annually for 5 years among consenting individuals. Study entry IgG antibody titers indexing exposure to each infectious agent were examined in relation to slopes of subsequent temporal cognitive decline using multiple linear regressions adjusted for potential confounders. RESULTS The IgG levels for HSV-2 were significantly associated with baseline cognitive domain scores (N=1022 participants). Further, the IgG levels for HSV-2, TOX, and CMV, but not HSV-1 were significantly associated with greater temporal cognitive decline that varied by type of infection. CONCLUSIONS Exposure to CMV, HSV-2, or TOX is associated with cognitive deterioration in older individuals, independent of general age-related variables. An increased understanding of the role of infectious agents in cognitive decline may lead to new methods for its prevention and treatment.
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21
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Olaya B, Moneta MV, Caballero FF, Tyrovolas S, Bayes I, Ayuso-Mateos JL, Haro JM. Latent class analysis of multimorbidity patterns and associated outcomes in Spanish older adults: a prospective cohort study. BMC Geriatr 2017; 17:186. [PMID: 28821233 PMCID: PMC5563011 DOI: 10.1186/s12877-017-0586-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/10/2017] [Indexed: 01/08/2023] Open
Abstract
Background This study sought to identify multimorbidity patterns and determine the association between these latent classes with several outcomes, including health, functioning, disability, quality of life and use of services, at baseline and after 3 years of follow-up. Methods We analyzed data from a representative Spanish cohort of 3541 non-institutionalized people aged 50 years old and over. Measures were taken at baseline and after 3 years of follow-up. Latent Class Analysis (LCA) was conducted using eleven common chronic conditions. Generalized linear models were conducted to determine the adjusted association of multimorbidity latent classes with several outcomes. Results 63.8% of participants were assigned to the “healthy” class, with minimum disease, 30% were classified under the “metabolic/stroke” class and 6% were assigned to the “cardiorespiratory/mental/arthritis” class. Significant cross-sectional associations were found between membership of both multimorbidity classes and poorer memory, quality of life, greater burden and more use of services. After 3 years of follow-up, the “metabolic/stroke” class was a significant predictor of lower levels of verbal fluency while the two multimorbidity classes predicted poor quality of life, problems in independent living, higher risk of hospitalization and greater use of health services. Conclusions Common chronic conditions in older people cluster together in broad categories. These broad clusters are qualitatively distinct and are important predictors of several health and functioning outcomes. Future studies are needed to understand underlying mechanisms and common risk factors for patterns of multimorbidity and to propose more effective treatments. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0586-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beatriz Olaya
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain. .,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Maria Victoria Moneta
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Francisco Félix Caballero
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Stefanos Tyrovolas
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ivet Bayes
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - José Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Carrer Dr. Antoni Pujadas, 42, Esplugues de Llobregat, 08830, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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22
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Brunner EJ, Welch CA, Shipley MJ, Ahmadi-Abhari S, Singh-Manoux A, Kivimäki M. Midlife Risk Factors for Impaired Physical and Cognitive Functioning at Older Ages: A Cohort Study. J Gerontol A Biol Sci Med Sci 2017; 72:237-242. [PMID: 27271050 PMCID: PMC5233910 DOI: 10.1093/gerona/glw092] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/28/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Previous studies examined midlife risk factors separately for old-age impaired physical and cognitive functioning. We determined the overlap of risk factors for both domains of functioning within the same setting. METHODS Biological and behavioral risk factors at age 50 years and cognitive and physical functioning were assessed 18 (SD = 5) years later in the Whitehall II study (N = 6,316). Impaired physical functioning was defined as ≥1 limitation on the activities of daily living scale. Impaired cognitive functioning was defined as Mini-Mental State Examination score <27. Two statistical analyses were employed: minimally adjusted analysis (for age, sex, and ethnicity) and mutually adjusted analysis (including all risk factors). Missing data on risk factors were imputed. RESULTS After confounder adjustment, impaired physical and cognitive functioning at older ages were predicted by hypertension (odds ratios [ORs] 1.80 95% confidence interval [CI] 1.39-2.33 and 1.57 95% CI 1.07-2.31, respectively), poor lung function (1.51 95% CI 1.28-1.78 and 1.31 95% CI 1.08-1.59), and physical inactivity, marginally in the case of cognitive function (1.50 95% CI 1.19-1.90 and 1.27 95% CI 0.99-1.62) at age 50 years. Impaired physical functioning but not cognitive functioning was additionally predicted by depression and higher body mass index (1.72 95% CI 1.46-2.03 and 1.29 95% CI 1.16-1.44, respectively). CONCLUSIONS Several midlife risk factors are associated with impaired physical and cognitive functioning in old age, supporting a unified prevention policy. Analysis of 12 risk factors at age 50 suggests that strategies targeting physical inactivity, hypertension, and poor lung function will reduce impairments in both cognitive and physical functioning in old age.
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Affiliation(s)
- Eric J Brunner
- Research Department of Epidemiology and Public Health, University College London, UK.
| | - Catherine A Welch
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Martin J Shipley
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Sara Ahmadi-Abhari
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Archana Singh-Manoux
- Research Department of Epidemiology and Public Health, University College London, UK
- INSERM U1018, Center for Research in Epidemiology and Population Health, Paul Brousse Hospital, Villejuif, France
| | - Mika Kivimäki
- Research Department of Epidemiology and Public Health, University College London, UK
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23
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Setién-Suero E, Suárez-Pinilla M, Suárez-Pinilla P, Crespo-Facorro B, Ayesa-Arriola R. Homocysteine and cognition: A systematic review of 111 studies. Neurosci Biobehav Rev 2016; 69:280-98. [PMID: 27531233 DOI: 10.1016/j.neubiorev.2016.08.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 06/14/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elevated plasma homocysteine (Hcy) levels have been associated with cognitive dysfunction in a wide range of conditions. The aim of this review is to establish which cognitive domains and populations are the most affected. METHODS We systematically review the literature and consider all articles that showed any relationship between plasma Hcy levels and scores achieved on cognitive performance tests in both, the general population and patients suffering from central nervous system disorders and other diseases. When effect sizes were available and combinable, several meta-analyses were performed. RESULTS We found 111 pertinent articles. There were 24 cohort studies, 18 randomized trials, 21 case-control studies, and 48 cross-sectional studies. This review reveals a positive trend between cognitive decline and increased plasma Hcy concentrations in general population and in patients with cognitive impairments. Results from the meta-analyses also confirm this trend. Treatment with vitamin supplementation fails to show a reduction in cognitive decline. DISCUSSION Further investigations are warranted to clarify this relationship. Earlier detection of the elevated Hcy levels may be an effective intervention to prevent cognitive impairment and dementia.
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Affiliation(s)
- Esther Setién-Suero
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Marta Suárez-Pinilla
- Sackler Centre for Consciousness Science, Department of Informatics, University of Sussex, United Kingdom
| | - Paula Suárez-Pinilla
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Benedicto Crespo-Facorro
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
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24
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Weimar C, Winkler A, Dlugaj M, Lehmann N, Hennig F, Bauer M, Kröger K, Kälsch H, Mahabadi AA, Dragano N, Moebus S, Hoffmann B, Jöckel KH, Erbel R. Ankle-Brachial Index but Neither Intima Media Thickness Nor Coronary Artery Calcification is Associated With Mild Cognitive Impairment. J Alzheimers Dis 2016; 47:433-42. [PMID: 26401565 DOI: 10.3233/jad-150218] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies have reported an association of atherosclerosis with mild cognitive impairment (MCI) and dementia independent of cardiovascular risk factors. OBJECTIVE To compare the cross-sectional association of the ankle-brachial index (ABI), intima media thickness (IMT), and coronary artery calcification (CAC) with MCI and its subtypes, amnestic MCI (aMCI) and non-amnestic MCI (naMCI) in the population-based Heinz Nixdorf Recall cohort study. METHODS 4,086 participants performed a validated brief cognitive assessment at the first follow-up examination (2006-2008). MCI was diagnosed according to previously published criteria. Prevalence ratio (PR) regression models adjusted for age, gender, education, cardiovascular risk factors, and APOE genotype were used to compare the association of the ABI, the CAC-Agatston score and the IMT with MCI and its subtypes. RESULTS We identified 490 participants with MCI (mean age 66.1 ± 7.8, 46.9 % male, aMCI n = 249, naMCI n = 241) and 1,242 cognitively normal participants. A decreasing ABI (per 0.1) was significantly associated with a higher MCI prevalence in fully adjusted models (PR 1.06; 95% confidence interval (CI) 1.01-1.11), whereas an increasing CAC (log(CAC+1)) or IMT (per 0.1 mm) were not associated after adjustment. A decreasing ABI was also significantly associated with naMCI in fully adjusted models (PR 1.12; CI 1.03-1.21) but not with aMCI. CONCLUSIONS Our data show that the degree of generalized atherosclerosis as measured by the ABI is associated with MCI and with naMCI in a population-based cohort.
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Affiliation(s)
- Christian Weimar
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Angela Winkler
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Martha Dlugaj
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Frauke Hennig
- IUF-Leibniz Research Institute for Environmental Medicine
| | - Marcus Bauer
- Clinic of Cardiology, West German Heart Centre, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Knut Kröger
- Department of Angiology, Helios Kliniken Krefeld, Germany
| | - Hagen Kälsch
- Clinic of Cardiology, West German Heart Centre, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Amir-Abass Mahabadi
- Clinic of Cardiology, West German Heart Centre, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Nico Dragano
- Institute for Medical Sociology, Centre for Healthy and Society, Medical Faculty, University of Düsseldorf, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Barbara Hoffmann
- IUF-Leibniz Research Institute for Environmental Medicine.,Medical Faculty, Deanery of Medicine, Heinrich-Heine-University of Düsseldorf, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Raimund Erbel
- Clinic of Cardiology, West German Heart Centre, University Hospital of Essen, University Duisburg-Essen, Germany
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25
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Graziane JA, Beer JC, Snitz BE, Chang CCH, Ganguli M. Dual Trajectories of Depression and Cognition: A Longitudinal Population-Based Study. Am J Geriatr Psychiatry 2016; 24:364-73. [PMID: 26560510 PMCID: PMC4841743 DOI: 10.1016/j.jagp.2015.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the relationships over time between dual trajectories of depressive symptoms and several cognitive domains. METHODS In a 5-year longitudinal study, 1,978 randomly selected individuals aged 65+ years at recruitment were assessed annually. Repeated measures were of depressive symptoms on the modified Center for Epidemiologic Studies Depression Scale and composite scores in the cognitive domains of attention, executive function, memory, language, and visuospatial function. Latent class trajectories were identified for depression and for each cognitive domain and their associations investigated using dual trajectory modeling. Cognitive trajectories with z scores below -1 were designated as persistently low. RESULTS Five depressive symptom trajectories were observed: rarely depressed (60.5%); low-grade, decreasing symptoms (18.5%); low-grade, increasing symptoms (9.6%); moderate-grade symptoms (7.4%); and consistent higher-grade symptoms (4.0%). For each cognitive domain six trajectories were observed. The rarely depressed and low-grade decreasing symptom groups were the least likely to have persistently low cognition. The symptom trajectory most strongly associated with persistently low functioning in each domain was not the higher-grade group but rather the low-grade increasing group in the case of attention and the moderate-grade trajectory in the other four domains. CONCLUSION Consistently higher-grade depressive symptoms are less strongly associated with poor cognitive functioning than with either moderate- or low-grade increasing depressive symptom trajectories, over time and across different domains. Examining both depression and cognition longitudinally allows heterogeneity of both to be addressed, revealing latent groups with potential diagnostic and prognostic implications.
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Affiliation(s)
- Julie A. Graziane
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Joanne C. Beer
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Beth E. Snitz
- University of Pittsburgh School of Medicine, Department of Neurology
| | - Chung-Chou H. Chang
- University of Pittsburgh School of Medicine, Department of Medicine,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics
| | - Mary Ganguli
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh School of Medicine, Department of Neurology,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
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26
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Wayde EN, Black SR, Gilpin A. Decision-making quality of younger and older adults in familiar and unfamiliar domains. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 24:135-157. [PMID: 27123545 DOI: 10.1080/13825585.2016.1176110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Age-related differences in purchasing decisions were examined as a function of age and familiarity. On each trial, participants received purchasing options which varied in quality but ultimately cost the same amount of money. On half the trials, participants made decisions about items familiar to younger adults and on the other half of the trials, participants made decisions about products familiar to older adults. The participants' task was to choose the option that provided the best value for the money. We were particularly interested in participants' performance when inferencing was required to select the optimal option from the two choices. Younger adults outperformed older adults in unfamiliar but not familiar domains. It appeared that both younger and older adults used inferencing and elaborative processing to make the best decision in familiar domains but that only younger adults used inferencing and elaborative processing in unfamiliar domains.
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Affiliation(s)
- Ernest N Wayde
- a Psychology Department , University of Alabama , Tuscaloosa , AL , USA
| | - Sheila R Black
- a Psychology Department , University of Alabama , Tuscaloosa , AL , USA
| | - Ansley Gilpin
- a Psychology Department , University of Alabama , Tuscaloosa , AL , USA
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27
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Miu J, Negin J, Salinas-Rodriguez A, Manrique-Espinoza B, Sosa-Ortiz AL, Cumming R, Kowal P. Factors associated with cognitive function in older adults in Mexico. Glob Health Action 2016; 9:30747. [PMID: 27032808 PMCID: PMC4816813 DOI: 10.3402/gha.v9.30747] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/19/2016] [Accepted: 02/20/2016] [Indexed: 11/24/2022] Open
Abstract
Background As populations age, cognitive decline and dementia pose significant burdens for societies and health care systems, including low- and middle-income countries such as Mexico. Minor age-related declines in cognitive function appear to represent a stable but heterogeneous phase in the continuum between normal cognitive ageing and dementia. Loss of cognitive function has impacts at societal and individual levels and understanding the risk factors can help provide a framework for health policies and interventions to target at-risk groups. Design A cohort of older Mexican adults (50+) from the World Health Organization's Study on global AGEing and adult health (WHO SAGE) was used to examine cognitive function, including a total of 2315 respondents, with 325 respondents aged 80 years and older. Cognition was objectively evaluated using verbal recall, verbal fluency, forward digit span and backward digit span, with differences in an overall cognitive score assessed against sociodemographic variables, and associated factors using linear regression. Results The most significant predictors of poorer cognitive function were found to be older age (β=−13.88), rural living (β=−2.25), low income (β=−8.28), self-reported severe or extreme memory difficulties (β=−6.62), and difficulty with two or more activities of daily living (β=−2.02). Conclusions These findings can inform public health initiatives to address cognitive impairment in ageing populations in Mexico and other middle-income countries.
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Affiliation(s)
- Jenny Miu
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Joel Negin
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia;
| | - Aarón Salinas-Rodriguez
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Betty Manrique-Espinoza
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ana Luisa Sosa-Ortiz
- Laboratory of Dementias, National Institute of Neurology and Neurosurgery, Mexico DF, Mexico
| | - Robert Cumming
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Paul Kowal
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia.,World Health Organization Study on global AGEing and adult health (SAGE), Geneva, Switzerland
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28
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Winkler A, Weimar C, Jöckel KH, Erbel R, Dragano N, Broecker-Preuss M, Moebus S, Führer-Sakel D, Dlugaj M. Thyroid-Stimulating Hormone and Mild Cognitive Impairment: Results of the Heinz Nixdorf Recall Study. J Alzheimers Dis 2015; 49:797-807. [PMID: 26519440 DOI: 10.3233/jad-150561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although some studies reported on the association of serum thyroid-stimulating hormone (TSH) concentration and cognition, only one population-based study investigated the association of TSH concentration and mild cognitive impairment (MCI). OBJECTIVE To investigate the gender-specific association of low- and high-normal TSH concentrations with MCI in euthyroid participants. METHODS Analysis sample 1 included 2,563 euthyroid participants (aged 50-80 years) from the second examination of the population-based Heinz Nixdorf Recall study. Gender-specific TSH quintiles (Q1 low, Q2-Q4 middle, Q5 high TSH concentration) were determined and group comparisons of age- and education-adjusted mean scores were performed for all cognitive subtests. Analysis sample 2 included 378 participants with MCI and 931 cognitively normal participants. MCI was diagnosed according to previously published MCI criteria. Multivariate logistic regression models were performed using TSH quintiles (Q2-Q4 as reference) to assess the association of low- and high-normal TSH concentration with MCI. Models were performed unadjusted and adjusted for sociodemographic and cardiovascular risk factors. RESULTS Group comparisons showed significant differences only in the immediate recall of the verbal memory task in women. Only women showed a strong association of high-normal TSH concentration with MCI (unadjusted: odds ratio 2.09, 95% confidence interval 1.29-3.37, full adjusted: 1.86, 1.06-3.27). There was no association with low-normal TSH concentration in women and no association of either low- or high-normal TSH concentration with MCI in men. CONCLUSIONS These results suggest that women with high-normal TSH concentration might be at higher risk of cognitive decline. This needs to be confirmed in the longitudinal analysis.
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Affiliation(s)
- Angela Winkler
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Christian Weimar
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Raimund Erbel
- Clinic of Cardiology, West German Heart Centre, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Nico Dragano
- Institute for Medical Sociology, Centre for Healthy and Society, University of Düsseldorf, Germany
| | - Martina Broecker-Preuss
- Department of Endocrinology and Metabolism, and Division of Laboratory Research, University Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany
| | - Dagmar Führer-Sakel
- Department of Endocrinology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Martha Dlugaj
- Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Germany
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29
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Ganguli M, Lee CW, Snitz BE, Hughes TF, McDade E, Chang CCH. Rates and risk factors for progression to incident dementia vary by age in a population cohort. Neurology 2014; 84:72-80. [PMID: 25471390 PMCID: PMC4336092 DOI: 10.1212/wnl.0000000000001113] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To estimate rate of progression from normal cognition or mild impairment to dementia, and to identify potential risk and protective factors for incident dementia, based on age at dementia onset in a prospective study of a population-based cohort (n = 1,982) aged 65 years and older. METHODS Following the cohort annually for up to 5 years, we estimated incidence of dementia (Clinical Dementia Rating ≥1) among individuals previously normal or mildly impaired (Clinical Dementia Rating 0 or 0.5). In the whole cohort, and also stratified by median onset age, we examined several vascular, metabolic, and inflammatory variables as potential risk factors for developing dementia, using interval-censored survival models. RESULTS Based on 67 incident cases of dementia, incidence rate (per 1,000 person-years) was 10.0 overall, 5.8 in those with median onset age of 87 years or younger, and 31.5 in those with onset age after 87 years. Adjusting for demographics, the risk of incident dementia with onset age of 87 years or younger (n = 33) was significantly increased by baseline smoking, stroke, low systolic blood pressure, and APOE*4 genotype, and reduced by current alcohol use. Among those with dementia with onset after 87 years (n = 34), no risk or protective factor was significant. CONCLUSION Risk and protective factors were only found for incident dementia with onset before the median onset age of 87 years, and not for those with later onset. Either unexplored risk factors explain the continued increase in incidence with age, or unknown protective factors are allowing some individuals to delay onset into very old age.
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Affiliation(s)
- Mary Ganguli
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA.
| | - Ching-Wen Lee
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Beth E Snitz
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Tiffany F Hughes
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Eric McDade
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Chung-Chou H Chang
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
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30
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Mather KA, Kwok JB, Armstrong N, Sachdev PS. The role of epigenetics in cognitive ageing. Int J Geriatr Psychiatry 2014; 29:1162-71. [PMID: 25098266 DOI: 10.1002/gps.4183] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/02/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE As the population is ageing, a better understanding of the underlying causes of age-related cognitive decline (cognitive ageing) is required. Epigenetic dysregulation is proposed as one of the underlying mechanisms for cognitive ageing. We review the current knowledge on epigenetics and cognitive ageing and appraise the potential of epigenetic preventative and therapeutic interventions. DESIGN Articles on cognitive ageing and epigenetics in English were identified. RESULTS Epigenetic dysregulation occurs with cognitive ageing, with changes in histone post-translational modifications, DNA methylation and non-coding RNA reported. However, human studies are lacking, with most being cross-sectional using peripheral blood samples. Pharmacological and lifestyle factors have the potential to change aberrant epigenetic profiles; but few studies have examined this in relation to cognitive ageing. CONCLUSIONS The relationship between epigenetic modifications and cognitive ageing is only beginning to be investigated. Epigenetic dysregulation appears to be an important feature in cognitive ageing, but whether it is an epiphenomenon or a causal factor remains to be elucidated. Clarification of the relationship between epigenetic profiles of different cell types is essential and would determine whether epigenetic marks of peripheral tissues can be used as a proxy for changes occurring in the brain. The use of lifestyle and pharmacological interventions to improve cognitive performance and quality of life of older adults needs more investigation.
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Affiliation(s)
- Karen A Mather
- Centre for Healthy Brain Ageing, Psychiatry, University of New South Wales, Sydney, Australia
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