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Bernstein JPK, Stumps A, Fortenbaugh F, Fonda JR, McGlinchey RE, Milberg WP, Fortier CB, Esterman M, Amick M, DeGutis J. Associations between changes in somatic and psychiatric symptoms and disability alterations in recent-era U.S. veterans. J Trauma Stress 2022; 35:1011-1024. [PMID: 35187726 DOI: 10.1002/jts.22809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/07/2022]
Abstract
Cross-sectional work suggests that deployment-related posttraumatic sequelae are associated with increased disability in U.S. veterans deployed following the September 11, 2001 (9/11), terrorist attacks. However, few studies have examined the psychiatric and somatic variables associated with changes in functional disability over time. A total of 237 post-9/11 veterans completed comprehensive assessments of psychiatric and cognitive functioning, as well as a disability questionnaire, at baseline and 2-year follow-up. At baseline, higher levels of PTSD, depressive, and pain-related symptoms were associated with baseline global functional disability, semipartial r2 = .036-.044. Changes in symptoms of PTSD, depression, pain, and sleep, but not anxiety or alcohol use, were independently associated with changes in functional disability, semipartial r2 = .017-.068. Baseline symptoms of these conditions were unrelated to changes in disability, and cognitive performance was unrelated to disability at any assessment point. Together, this suggests that changes in psychiatric and somatic symptoms are tightly linked with changes in functional disability and should be frequently monitored, and even subclinical symptoms may be a target of intervention.
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Affiliation(s)
- John P K Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA
| | - Anna Stumps
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychological & Brain Sciences, University of Delaware, Newark, Delaware
| | - Francesca Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Esterman
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Melissa Amick
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA
| | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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2
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Older Adult Alcohol Use in Relation to Cognition: An Exploratory Analysis. CANADIAN JOURNAL OF ADDICTION 2020. [DOI: 10.1097/cxa.0000000000000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Grønkjær M, Flensborg-Madsen T, Osler M, Sørensen HJ, Becker U, Mortensen EL. Adult-Life Alcohol Consumption and Age-Related Cognitive Decline from Early Adulthood to Late Midlife. Alcohol Alcohol 2020; 54:446-454. [PMID: 31044220 DOI: 10.1093/alcalc/agz038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/19/2019] [Accepted: 04/11/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Alcohol consumption is a modifiable and plausible risk factor for age-related cognitive decline but more longitudinal studies investigating the association are needed. Our aims were to estimate associations of adult-life alcohol consumption and consumption patterns with age-related cognitive decline. METHODS We investigated the associations of self-reported adult-life weekly alcohol consumption and weekly extreme binge drinking (≥10 units on the same occasion) with changes in test scores on an identical validated test of intelligence completed in early adulthood and late midlife in 2498 Danish men from the Lifestyle and Cognition Follow-up study 2015. Analyses were adjusted for year of birth, retest interval, baseline IQ, education and smoking. RESULTS Men with adult-life alcohol consumption of more than 28 units/week had a larger decline in IQ scores from early adulthood to late midlife than men consuming 1-14 units/week (B29-35units/week = -3.6; P < 0.001). Likewise, a 1-year increase in weekly extreme binge drinking was associated with a 0.12-point decline in IQ scores (P < 0.001). Weekly extreme binge drinking explained more variance in IQ changes than average weekly consumption. In analyses including mutual adjustment of weekly extreme binge drinking and average weekly alcohol consumption, the estimated IQ decline associated with extreme binge drinking was largely unaffected, whereas the association with weekly alcohol consumption became non-significant. CONCLUSIONS Adult-life heavy alcohol consumption and extreme binge drinking appear to be associated with larger cognitive decline in men. Moreover, extreme binge drinking may be more important than weekly alcohol consumption in relation to cognitive decline.
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Affiliation(s)
- Marie Grønkjær
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Trine Flensborg-Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Holger J Sørensen
- Mental Health Centre Copenhagen, Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Bryant AN, Kim G. Regional and racial/ethnic variations in alcohol consumption among older adults. Aging Ment Health 2019; 23:1503-1509. [PMID: 30600687 PMCID: PMC6606409 DOI: 10.1080/13607863.2018.1506746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/23/2018] [Indexed: 10/27/2022]
Abstract
Objectives: This paper sought to examine the role of region and race/ethnicity in alcohol consumption among older adults. Methods: Data were obtained from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Participants aged 60 and older were included (n = 185, 190). Analyses of covariance (ANCOVAs) were conducted to examine the effects of region and race/ethnicity on alcohol consumption among older adults. Results: Results indicate that region and race/ethnicity are significantly related to the alcohol consumption of older adults. More specifically, results suggest that White older adults consume significantly more alcohol than other racial/ethnic groups among older adults. Regarding regional effects, results suggest that older adults in the West consume significantly more alcohol than older adults in the Midwest and South. Additionally, results suggest regional variation in alcohol consumption patterns by race/ethnicity. Conclusion: Findings provide additional insight into how and where alcohol is being used among older adults in the United States. Further, findings highlight the importance of taking race/ethnicity and geography into consideration when investigating the health behaviors of older adults.
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Affiliation(s)
- Ami N Bryant
- Department of Psychology, The University of Alabama, 253-345-1670,
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University
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Conditional Effects of Lifetime Alcohol Consumption on Methamphetamine-Associated Neurocognitive Performance. J Int Neuropsychol Soc 2019; 25:787-799. [PMID: 31179969 PMCID: PMC6733657 DOI: 10.1017/s1355617719000493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Methamphetamine (MA) dependence contributes to neurotoxicity and neurocognitive deficits. Although combined alcohol and MA misuse is common, how alcohol consumption relates to neurocognitive performance among MA users remains unclear. We hypothesized that alcohol and MA use would synergistically diminish neurocognitive functioning, such that greater reported alcohol consumption would exert larger negative effects on neurocognition among MA-dependent individuals compared to MA-nonusing persons. METHODS Eighty-seven MA-dependent (MA+) and 114 MA-nonusing (MA-) adults underwent neuropsychological and substance use assessments. Linear and logistic regressions examined the interaction between MA status and lifetime average drinks per drinking day on demographically corrected global neurocognitive T scores and impairment rates, controlling for recent alcohol use, lifetime cannabis use, WRAT reading performance, and lifetime depression. RESULTS MA+ displayed moderately higher rates of impairment and lower T scores compared to MA-. Lifetime alcohol use significantly interacted with MA status to predict global impairment (ORR = 0.70, p = .003) such that greater lifetime alcohol use increased likelihood of impairment in MA-, but decreased likelihood of impairment in MA+. Greater lifetime alcohol use predicted poorer global T scores among MA- (b = -0.44, p = .030) but not MA+ (b = 0.08, p = .586). CONCLUSIONS Contrary to expectations, greater lifetime alcohol use related to reduced risk of neurocognitive impairment among MA users. Findings are supported by prior research identifying neurobiological mechanisms by which alcohol may attenuate stimulant-driven vasoconstriction and brain thermotoxicity. Replication and examination of neurophysiologic mechanisms underlying alcohol use in the context of MA dependence are warranted to elucidate whether alcohol confers a degree of neuroprotection.
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Piumatti G, Moore SC, Berridge DM, Sarkar C, Gallacher J. The relationship between alcohol use and long-term cognitive decline in middle and late life: a longitudinal analysis using UK Biobank. J Public Health (Oxf) 2018; 40:304-311. [PMID: 29325150 PMCID: PMC6051452 DOI: 10.1093/pubmed/fdx186] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/27/2017] [Indexed: 01/15/2023] Open
Abstract
Background Using UK Biobank data, this study sought to explain the causal relationship between alcohol intake and cognitive decline in middle and older aged populations. Methods Data from 13 342 men and women, aged between 40 and 73 years were used in regression analysis that tested the functional relationship and impact of alcohol on cognitive performance. Performance was measured using mean reaction time (RT) and intra-individual variation (IIV) in RT, collected in response to a perceptual matching task. Covariates included body mass index, physical activity, tobacco use, socioeconomic status, education and baseline cognitive function. Results A restricted cubic spline regression with three knots showed how the linear (β1 = -0.048, 95% CI: -0.105 to -0.030) and non-linear effects (β2 = 0.035, 95% CI: 0.007-0.059) of alcohol use on mean RT and IIV in RT (β1 = -0.055, 95% CI: -0.125 to -0.034; β2 = 0.034, 95% CI: 0.002-0.064) were significant adjusting for covariates. Cognitive function declined as alcohol use increased beyond 10 g/day. Decline was more apparent as age increased. Conclusions The relationship between alcohol use and cognitive function is non-linear. Consuming more than one UK standard unit of alcohol per day is detrimental to cognitive performance and is more pronounced in older populations.
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Affiliation(s)
- Giovanni Piumatti
- Department of Psychiatry, University of Oxford, Oxford, UK
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Simon C Moore
- Violence & Society Research Group, School of Dentistry, Cardiff University, Cardiff, UK
| | - Damon M Berridge
- Farr Institute—CIPHER, Swansea University Medical School, Swansea UK
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, China
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
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Canham SL, Mahmood A, Stalman MN, King D, O'Rourke N. Personal theories of substance use among middle-aged and older adults with bipolar disorder. Aging Ment Health 2018; 22:813-818. [PMID: 28271715 DOI: 10.1080/13607863.2017.1299689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Most persons with bipolar disorder (BD) misuse alcohol and/or illicit drugs at some point, yet research specific to older adults with BD is nascent. The current study sought an in-depth understanding of the experiences and meanings of substance use in a sample of adults who self-reported substance misuse. METHODS Semi-structured interviews were conducted and thematically analyzed to understand the personal theories of substance use by 12 adults (9 women and 3 men; M = 49 years old) who self-reported diagnoses of BD and regular alcohol or illicit drug use. RESULTS Findings provide an in-depth picture of the theories middle-aged and older adults with BD have developed to explain their substance use. Participants' theories suggest multiple reasons for substance use, including self-medication; increased confidence with substance use; rejection of prescribed medications; easy access to alcohol; early social exposure/use as facilitator; and living in a culture of substance use. CONCLUSION Findings suggest multiple theories for the comorbid link between BD and substance use, primarily that persons with BD use drugs and/or alcohol to relieve stress or manage symptoms. It is clinically relevant to incorporate personal reasons for actively and regularly using substances as part of personalized substance treatment and BD symptom management.
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Affiliation(s)
- Sarah L Canham
- a Gerontology Research Centre , Simon Fraser University , Vancouver , Canada
| | - Atiya Mahmood
- b Department of Gerontology , Simon Fraser University , Vancouver , Canada
| | | | - David King
- c IRMACS Centre , Simon Fraser University , Burnaby , Canada
| | - Norm O'Rourke
- d Department of Public Health and Center for Multidisciplinary Research in Aging , Ben-Gurion University of the Negev , Be'er Sheva , Israel
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8
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Bø R, Landrø NI. Inhibitory control and response monitoring are not systematically related to weekly alcohol consumption in the general population. Psychopharmacology (Berl) 2017; 234:1761-1768. [PMID: 28280883 DOI: 10.1007/s00213-017-4578-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/20/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND In alcohol use disorder, deficits in cognitive control (i.e., inhibition and response monitoring) might underlie the loss of self-control and, thereby, failure to adjust alcohol consumption in response to associated negative consequences. According to the continuum hypothesis, the magnitude of these deficits should be related in a stair-case manner, with the greatest deficits among its heaviest consumers. The current study aims at investigating this association in the general population. METHODS This is a cross-sectional study of 397 participants aged 18-64 years, who self-reported their mean weekly alcohol consumption and were assessed with the stop-signal task, estimating inhibitory efficiency (stop-signal reaction time; SSRT) and response monitoring (post-error slowing; PES). Set-shifting ability was investigated by the intra-extra dimensional (IED) set-shifting task. Three ANCOVAs were performed with SSRT, PES, and IED as the dependent variables (DV), respectively, and alcohol consumption levels as the independent variable. Covariates were included when they were significantly associated with the DV. RESULTS Compared to the teetotalers, all levels of alcohol consumption were significantly associated to lower SSRT, which implies more efficient inhibitory control; however, there was no significant difference in SSRT between other consumption levels. The two highest consumption groups had significantly shorter PES when compared to teetotalers and/or the lowest consumption group, implying less behavioral adjustment after failures. IED was not significantly related to the alcohol consumption levels. CONCLUSIONS There was no stair-case relation between weekly consumption levels and cognitive control functions within this general population, which might be due to the limited consumption range investigated.
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Affiliation(s)
- Ragnhild Bø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, P.O. box 1094, Blindern, 0317, Oslo, Norway.
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, P.O. box 1094, Blindern, 0317, Oslo, Norway
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Silins E, Swift W, Slade T, Toson B, Rodgers B, Hutchinson DM. A prospective study of the substance use and mental health outcomes of young adult former and current cannabis users. Drug Alcohol Rev 2017; 36:618-625. [DOI: 10.1111/dar.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 10/15/2016] [Accepted: 10/17/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Edmund Silins
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Wendy Swift
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Tim Slade
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Barbara Toson
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
| | - Bryan Rodgers
- Australian Demographic and Social Research Institute; Australian National University; Canberra Australia
| | - Delyse M. Hutchinson
- National Drug and Alcohol Research Centre; UNSW Australia; Sydney Australia
- Australian Demographic and Social Research Institute; Australian National University; Canberra Australia
- Centre for Social and Early Emotional Development, School of Psychology; Deakin University; Geelong Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
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10
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Stockley CS. Wine consumption, cognitive function and dementias – A relationship? ACTA ACUST UNITED AC 2016. [DOI: 10.3233/nua-150055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kydd RM, Connor J. Inconsistency in reporting abstention and heavy drinking frequency: associations with sex and socioeconomic status, and potential impacts. Alcohol Alcohol 2015; 50:333-45. [PMID: 25648932 DOI: 10.1093/alcalc/agu106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023] Open
Abstract
AIMS To describe inconsistencies in reporting past-year drinking status and heavy drinking occasions (HDOs) on single questions from two different instruments, and to identify associated characteristics and impacts. METHODS We compared computer-presented Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) with categorical response options, and mental health interview (MHI) with open-ended consumption questions, completed on the same day. Participants were 464 men and 459 women aged 38 (91.7% of surviving birth cohort members). Differences in dichotomous single-item measures of abstention and HDO frequency, associations of inconsistent reporting with sex, socioeconomic status (SES) and survey order, and impacts of instrument choice on associations of alcohol with sex and SES were examined. RESULTS The AUDIT-C drinking frequency question estimated higher past-year abstention prevalence (AUDIT = 7.6%, MHI = 5.4%), with one-third of AUDIT-C abstainers being MHI drinkers. Only AUDIT-C produced significant sex differences in abstainer prevalence. Inconsistencies in HDO classifications were bidirectional, but with fewer HDOs reported on the MHI than AUDIT-C question. Lower SES was associated with inconsistency in abstention and weekly+ HDOs. Abstention and higher HDO frequency were associated with lower SES overall, but sex-specific associations differed by instrument. CONCLUSIONS In this context, data collection method affected findings, with inconsistencies in abstention reports having most impact. Future studies should: (a) confirm self-reported abstention; (b) consider piloting data collection methods in target populations; (c) expect impacts of sex and SES on measurements and analyses.
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Affiliation(s)
- Robyn M Kydd
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Tierney MC, Naglie G, Upshur R, Jaakkimainen L, Moineddin R, Charles J, Ganguli M. Factors associated with primary care physicians' recognition of cognitive impairment in their older patients. Alzheimer Dis Assoc Disord 2014; 28:320-5. [PMID: 24632991 PMCID: PMC4163135 DOI: 10.1097/wad.0000000000000039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although there are accurate screens for cognitive impairment, there is as yet no evidence that screening improves outcomes including primary care physicians' (PCP) medical decision making. PCPs' recognition of cognitive impairment being suboptimal, we investigated factors associated with improved recognition. Eligible patients were aged 65 years and above, without documented dementia or previous work-up for dementia, seen consecutively over 2 months by one of 13 PCPs. PCPs indicated whether they, the patient, or the family had concerns about each patient's cognition. We enrolled 130 patients with any cognitive concerns and a matched sample of 133 without cognitive concerns, and administered standardized neuropsychological tests. PCP's judgments of cognitive concern showed 61% sensitivity and 86% specificity against the neuropsychological standard. When combined with a Mini-Mental State Examination score ≤26, PCP recognition improved in sensitivity (82%) with some loss in specificity (74%). True positives increased when PCPs' practices included more cognitively impaired patients and when patients reported poor memory. False positives increased when patients had diabetes, reported poor memory, or no or light alcohol consumption. Medical decision making can be improved by the Mini-Mental State Examination and greater exposure to cognitively impaired patients, but knowledge of certain risk factors for cognitive impairment negatively affected these decisions.
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Affiliation(s)
- Mary C Tierney
- *Department of Family & Community Medicine ∥Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto †Primary Care Research Unit, Sunnybrook Health Sciences Centre ‡Department of Medicine and Rotman Research Institute, Baycrest Health Sciences §Research Department, Toronto Rehabilitation Institute, University Health Network ¶Institute for Clinical Evaluative Sciences, Toronto, ON, Canada #Departments of Psychiatry and Neurology, School of Medicine **Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health 2014; 14:643. [PMID: 24962204 PMCID: PMC4099157 DOI: 10.1186/1471-2458-14-643] [Citation(s) in RCA: 474] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 05/13/2014] [Indexed: 12/15/2022] Open
Abstract
Background Cognitive impairment, including dementia, is a major health concern with the increasing aging population. Preventive measures to delay cognitive decline are of utmost importance. Alzheimer’s disease (AD) is the most frequent cause of dementia, increasing in prevalence from <1% below the age of 60 years to >40% above 85 years of age. Methods We systematically reviewed selected modifiable factors such as education, smoking, alcohol, physical activity, caffeine, antioxidants, homocysteine (Hcy), n-3 fatty acids that were studied in relation to various cognitive health outcomes, including incident AD. We searched MEDLINE for published literature (January 1990 through October 2012), including cross-sectional and cohort studies (sample sizes > 300). Analyses compared study finding consistency across factors, study designs and study-level characteristics. Selecting studies of incident AD, our meta-analysis estimated pooled risk ratios (RR), population attributable risk percent (PAR%) and assessed publication bias. Results In total, 247 studies were retrieved for systematic review. Consistency analysis for each risk factor suggested positive findings ranging from ~38.9% for caffeine to ~89% for physical activity. Education also had a significantly higher propensity for “a positive finding” compared to caffeine, smoking and antioxidant-related studies. Meta-analysis of 31 studies with incident AD yielded pooled RR for low education (RR = 1.99; 95% CI: 1.30-3.04), high Hcy (RR = 1.93; 95% CI: 1.50-2.49), and current/ever smoking status (RR = 1.37; 95% CI: 1.23-1.52) while indicating protective effects of higher physical activity and n-3 fatty acids. Estimated PAR% were particularly high for physical activity (PAR% = 31.9; 95% CI: 22.7-41.2) and smoking (PAR%=31.09%; 95% CI: 17.9-44.3). Overall, no significant publication bias was found. Conclusions Higher Hcy levels, lower educational attainment, and decreased physical activity were particularly strong predictors of incident AD. Further studies are needed to support other potential modifiable protective factors, such as caffeine.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd,, Suite 100, Room #: 04B118, Baltimore, MD 21224, USA.
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14
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Beydoun MA, Gamaldo AA, Beydoun HA, Tanaka T, Tucker KL, Talegawkar SA, Ferrucci L, Zonderman AB. Caffeine and alcohol intakes and overall nutrient adequacy are associated with longitudinal cognitive performance among U.S. adults. J Nutr 2014; 144:890-901. [PMID: 24744319 PMCID: PMC4018952 DOI: 10.3945/jn.113.189027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Among modifiable lifestyle factors, diet may affect cognitive health. Cross-sectional and longitudinal associations may exist between dietary exposures [e.g., caffeine (mg/d), alcohol (g/d), and nutrient adequacy] and cognitive performance and change over time. This was a prospective cohort study, the Baltimore Longitudinal Study of Aging (n = 628-1305 persons depending on the cognitive outcome; ∼2 visits/person). Outcomes included 10 cognitive scores, spanning various domains of cognition. Caffeine and alcohol intakes and a nutrient adequacy score (NAS) were estimated from 7-d food diaries. Among key findings, caffeine intake was associated with better baseline global cognition among participants with a baseline age (Agebase) of ≥70 y. A higher NAS was associated with better baseline global cognition performance (overall, women, Agebase <70 y), better baseline verbal memory (immediate and delayed recall, Agebase ≥70 y), and slower rate of decline or faster improvement in the attention domain (women). For an Agebase of <70 y, alcohol consumption was associated with slower improvement on letter fluency and global cognition over time. Conversely, for an Agebase of ≥70 y and among women, alcohol intake was related to better baseline attention and working memory. In sum, patterns of diet and cognition associations indicate stratum-specific associations by sex and baseline age. The general observed trend was that of putative beneficial effects of caffeine intake and nutrient adequacy on domains of global cognition, verbal memory, and attention, and mixed effects of alcohol on domains of letter fluency, attention, and working memory. Further longitudinal studies conducted on larger samples of adults are needed to determine whether dietary factors individually or in combination are modifiers of cognitive trajectories among adults.
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Affiliation(s)
- May A. Beydoun
- Intramural Research Program (NIA/NIH/IRP), National Institute on Aging, Baltimore, MD,To whom correspondence should be addressed. E-mail:
| | - Alyssa A. Gamaldo
- Intramural Research Program (NIA/NIH/IRP), National Institute on Aging, Baltimore, MD,School of Aging Studies, University of South Florida, Tampa, FL
| | - Hind A. Beydoun
- Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA
| | - Toshiko Tanaka
- Intramural Research Program (NIA/NIH/IRP), National Institute on Aging, Baltimore, MD
| | | | - Sameera A. Talegawkar
- Department of International Health, Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, MD
| | - Luigi Ferrucci
- Intramural Research Program (NIA/NIH/IRP), National Institute on Aging, Baltimore, MD
| | - Alan B. Zonderman
- Intramural Research Program (NIA/NIH/IRP), National Institute on Aging, Baltimore, MD
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Silins E, Hutchinson D, Swift W, Slade T, Toson B, Rodgers B. Factors associated with variability and stability of cannabis use in young adulthood. Drug Alcohol Depend 2013; 133:452-8. [PMID: 23916322 DOI: 10.1016/j.drugalcdep.2013.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 07/02/2013] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study investigated the factors associated with initiating cannabis use, reverting to cannabis use and remaining a cannabis user in young adulthood. This is an important area of research as the risk for cannabis initiation is extending beyond adolescence and opportunities to influence cannabis use pathways can emerge throughout the life-course. METHODS A large, community-based sample was followed prospectively. Data from two successive waves (mean age 23 years and 27 years respectively) of the Path Through Life Study (PATH) were analysed (n=2045). The longitudinal design enabled change in cannabis use in young adulthood to be predicted based on factors assessed approximately four years prior. RESULTS An environment of licit drug use was strongly associated with initiating cannabis use (tobacco: OR=4.98, 95%CI: 2.31-10.76) and reverting to cannabis use in young adulthood (alcohol: OR=2.13, 95%CI: 1.42-3.19). Greater fun seeking was found to orientate people towards initiating cannabis use in young adulthood (OR=1.17, 95%CI: 1.04-1.30). Higher psychoticism increased the odds of remaining a cannabis user (OR=1.19, 95%CI: 1.07-1.33). Religious involvement was protective of cannabis initiation (OR=0.89, 95%CI: 0.83-0.95). Early childhood factors did not influence the pattern of cannabis use in young adulthood. CONCLUSIONS The findings make an important contribution to the development of prevention and intervention strategies for young adults by drawing attention to specific areas of risk and protection.
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Affiliation(s)
- Edmund Silins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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Hermens DF, Lee RSC, De Regt T, Lagopoulos J, Naismith SL, Scott EM, Hickie IB. Neuropsychological functioning is compromised in binge drinking young adults with depression. Psychiatry Res 2013; 210:256-62. [PMID: 23721946 DOI: 10.1016/j.psychres.2013.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 04/26/2013] [Accepted: 05/04/2013] [Indexed: 11/27/2022]
Abstract
For many young people, binge drinking is the most common form of alcohol misuse, particularly in those with a depressive disorder. Nonetheless, relatively little is known about the effects that the combination of depression and binge drinking has on neuropsychological outcomes. This study aimed to determine whether binge drinkers with depression show more pronounced neuropsychological dysfunction compared to their peers with depression alone or binge drinking alone. Neuropsychological testing was conducted on help-seeking young people (18-30 years) recently diagnosed with a depressive disorder and classified as either 'binge drinkers' (n=43) or 'non-bingers' (n=48). Two healthy control groups (i.e. binge drinkers, n=24 and non-bingers, n=21) were additionally recruited and also underwent the same testing. Qualitatively, binge-drinking patients with depression performed consistently below controls, depression alone, or binge drinking alone. In keeping with our hypotheses, visual learning and memory was significantly reduced in depressed binge drinkers, whereas mental flexibility was reduced at a trend level. There were no significant differences in neuropsychological performance in depressed alone or binge drinking alone individuals compared to controls. The findings suggest that when treating young people with a depressive disorder, strategies targeting binge drinking may contribute to preventing potential neurobiological changes underlying poorer long-term clinical outcomes.
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Affiliation(s)
- Daniel F Hermens
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Australia.
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Goosby BJ, Bellatorre A, Walsemann KM, Cheadle JE. Adolescent Loneliness and Health in Early Adulthood. SOCIOLOGICAL INQUIRY 2013; 83:10.1111/soin.12018. [PMID: 24187387 PMCID: PMC3810978 DOI: 10.1111/soin.12018] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Bridget J. Goosby
- Department of Sociology, University of Nebraska Lincoln, 742 Oldfather Hall, Lincoln, NE 68588, United States
| | - Anna Bellatorre
- Department of Sociology, University of Nebraska Lincoln, 731 Oldfather Hall, Lincoln, NE 68588, United States
| | - Katrina M. Walsemann
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter Street, Room 216, Columbia, SC, 29208, United States
| | - Jacob E. Cheadle
- Department of Sociology, University of Nebraska-Lincoln, 737 Oldfather Hall, Lincoln, NE 68588, United States
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Batterham PJ, Christensen H, Calear AL. Anxiety symptoms as precursors of major depression and suicidal ideation. Depress Anxiety 2013; 30:908-16. [PMID: 23494924 DOI: 10.1002/da.22066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/09/2013] [Accepted: 01/09/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Relative to depression symptoms, the role of anxiety symptoms in the development of depression and suicidal ideation has not been well established. This study aimed to identify the anxiety and depression symptoms that confer the greatest amount of risk for depression and suicidal ideation at the population level. METHOD The PATH through Life study is an Australian community-based longitudinal cohort study of 7,485 younger, middle-aged, and older adults. Adjusted population attributable risk (PAR) for incident depression and suicidal ideation after 4 years was assessed for 18 symptoms of anxiety and depression. RESULTS Anxiety symptoms contributed greater risk overall to both depression (45%) and suicidal ideation (23%) incidence than depression symptoms (35% and 16%, respectively). Anxiety symptoms had largest PARs among younger age groups. CONCLUSIONS Prevention programs for depression and suicide should aim to reduce anxiety symptoms in addition to depression symptoms, and target individuals reporting symptoms such as worrying or irritability.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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Gosling JA, Batterham PJ, Christensen H. Cognitive-behavioural factors that predict sleep disturbance 4 years later. J Psychosom Res 2012; 73:424-9. [PMID: 23148809 DOI: 10.1016/j.jpsychores.2012.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Cognitive models have identified a number of factors that maintain sleep disturbance. It is unknown whether similar factors lead to initial onset. This study tested whether three cognitive-behavioural factors: ruminative style, somatic sensitivity, and behavioural avoidance predicted sleep disturbance onset at four-year follow-up. METHODS Participants (n=4,042) were assessed using a) a composite measure of Somatic Sensitivity, b) the Ruminative Style Scale, c) the Behavioural Inhibition Scale of the BISBAS and d) sleep-related items from the Goldberg Depression and Anxiety Scale. RESULTS Sleep disturbance at 4 years was significantly predicted by all three cognitive-behavioural factors--somatic sensitivity, ruminative style and behavioural avoidance--and, in the final analysis, was independently predicted by somatic sensitivity (OR=1.427, p<0.001) and ruminative style (OR=1.035, p=0.002). CONCLUSION This study tested whether three cognitive-behavioural factors: ruminative style, somatic sensitivity, and behavioural avoidance were predictive of the onset of sleep disturbance after 4 years. Although all three factors were significantly associated with the onset of sleep disturbance, only ruminative style and somatic sensitivity were found to independently predict sleep disturbance, supporting these constructs as predisposing cognitive-behavioural risk factors.
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Affiliation(s)
- John A Gosling
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
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20
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Abstract
OBJECTIVES This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups. METHODS Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities). RESULTS Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status. DISCUSSION In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.
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Affiliation(s)
- Faika Zanjani
- Department of Gerontology, University of Kentucky, Lexington, KY, USA.
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21
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Alcohol use disorders in the elderly: a brief overview from epidemiology to treatment options. Exp Gerontol 2012; 47:411-6. [PMID: 22575256 DOI: 10.1016/j.exger.2012.03.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 02/09/2012] [Accepted: 03/27/2012] [Indexed: 11/24/2022]
Abstract
Alcohol-use-disorders (AUDs) afflict 1-3% of elderly subjects. The CAGE, SMAST-G, and AUDIT are the most common and validated questionnaires used to identify AUDs in the elderly, and some laboratory markers of alcohol abuse (AST, GGT, MCV, and CDT) may also be helpful. In particular, the sensitivity of MCV or GGT in detecting alcohol misuse is higher in older than in younger populations. The incidence of medical and neurological complications during alcohol withdrawal syndrome in elderly alcoholics is higher than in younger alcoholics. Chronic alcohol abuse is associated with tissue damage to several organs. Namely, an increased level of blood pressure is more frequent in the elderly than in younger adults, and a greater vulnerability to the onset of alcoholic liver disease, and an increasing risk of breast cancer in menopausal women have been described. In addition, the prevalence of dementia in elderly alcoholics is almost 5 times higher than in non-alcoholic elderly individuals, approximately 25% of elderly patients with dementia also present AUDs, and almost 20% of individuals aged 65 and over with a diagnosis of depression have a co-occurring AUD. Moreover, prevention of drinking relapse in older alcoholics is, in some cases, better than in younger patients; indeed, more than 20% of treated elderly alcohol-dependent patients remain abstinent after 4 years. Considering that the incidence of AUDs in the elderly is fairly high, and AUDs in the elderly are still underestimated, more studies in the fields of epidemiology, prevention and pharmacological and psychotherapeutic treatment of AUDs in the elderly are warranted.
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Anstey KJ, Christensen H, Butterworth P, Easteal S, Mackinnon A, Jacomb T, Maxwell K, Rodgers B, Windsor T, Cherbuin N, Jorm AF. Cohort profile: the PATH through life project. Int J Epidemiol 2011; 41:951-60. [PMID: 21349904 DOI: 10.1093/ije/dyr025] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Kaarin J Anstey
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia.
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Abstract
We reviewed 143 papers that described the relationship between moderate drinking of alcohol and some aspect of cognition. Two types of papers were found: (1) those that provided ratios of risk between drinkers and nondrinkers (74 papers in total) and (2) those that, although they did not provide such ratios, allowed cognition in drinkers to be rated as "better," "no different," or "worse" than cognition in nondrinkers (69 papers in total). The history of research on moderate drinking and cognition can be divided into two eras: 1977-1997 and 1998-present. Phase I (1977-1997) was the era of neuropsychological evaluation involving mostly young to middle-aged (18-50 years old) subjects. Although initial studies indicated moderate drinking impaired cognition, many later studies failed to confirm this, instead finding no difference in cognition between drinkers and nondrinkers. Phase II (1998-present) was and is the era of mental status exam evaluation involving mostly older (≥55 years old) subjects. These studies overwhelmingly found that moderate drinking either reduced or had no effect on the risk of dementia or cognitive impairment. When all the ratios of risk from all the studies in phase II providing such ratios are entered into a comprehensive meta-analysis, the average ratio of risk for cognitive risk (dementia or cognitive impairment/decline) associated with moderate "social" (not alcoholic) drinking of alcohol is 0.77, with nondrinkers as the reference group. The benefit of moderate drinking applied to all forms of dementia (dementia unspecified, Alzheimer's disease, and vascular dementia) and to cognitive impairment (low test scores), but no significant benefit against cognitive decline (rate of decline in test scores) was found. Both light and moderate drinking provided a similar benefit, but heavy drinking was associated with nonsignificantly higher cognitive risk for dementia and cognitive impairment. Although the meta-analysis also indicated that wine was better than beer or spirits, this was based on a relatively small number of studies because most studies did not distinguish among these different types of alcohol. Furthermore, a number of the studies that did make the distinction reported no difference among the effects of these different types of alcohol. Therefore, at present this question remains unanswered. Analysis also showed that the presence of the apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, this was based on a relatively small number of studies and several other studies have found a beneficial effect of the epsilon e4 allele. Further studies are necessary to settle this question. The benefit of moderate alcohol for cognition was seen in both men and women, although the amount and pattern of drinking is very different between the two sexes. Lastly, the finding of unaffected or significantly reduced cognitive risk in light to moderate drinkers was seen in 14/19 countries for which country-specific ratio data were available, with three of the five remaining countries showing nonsignificant reductions as well. Overall, light to moderate drinking does not appear to impair cognition in younger subjects and actually seems to reduce the risk of dementia and cognitive decline in older subjects.
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Affiliation(s)
- Edward J Neafsey
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
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24
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Gross AL, Rebok GW, Ford DE, Chu AY, Gallo JJ, Liang KY, Meoni LA, Shihab HM, Wang NY, Klag MJ. Alcohol consumption and domain-specific cognitive function in older adults: longitudinal data from the Johns Hopkins Precursors Study. J Gerontol B Psychol Sci Soc Sci 2010; 66:39-47. [PMID: 20937708 DOI: 10.1093/geronb/gbq062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The association of alcohol consumption with performance in different cognitive domains has not been well studied. METHODS The Johns Hopkins Precursors Study was used to examine associations between prospectively collected information about alcohol consumption ascertained on multiple occasions starting at age 55 years on average with domain-specific cognition at age 72 years. Cognitive variables measured phonemic and semantic fluency, attention, verbal memory, and global cognition. RESULTS Controlling for age, hypertension, smoking status, sex, and other cognitive variables, higher average weekly quantity and frequency of alcohol consumed in midlife were associated with lower phonemic fluency. There were no associations with four other measures of cognitive function. With respect to frequency of alcohol intake, phonemic fluency was significantly better among those who drank three to four alcoholic beverages per week as compared with daily or almost daily drinkers. A measure of global cognition was not associated with alcohol intake at any point over the follow-up. DISCUSSION Results suggest that higher alcohol consumption in midlife may impair some components of executive function in late life.
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Affiliation(s)
- Alden L Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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25
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Mather KA, Jorm AF, Anstey KJ, Milburn PJ, Easteal S, Christensen H. Cognitive performance and leukocyte telomere length in two narrow age-range cohorts: a population study. BMC Geriatr 2010; 10:62. [PMID: 20843367 PMCID: PMC2949672 DOI: 10.1186/1471-2318-10-62] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 09/16/2010] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cognitive function and telomere length both decline with age. A correlation between these two measures would suggest that they may be influenced by the same underlying age-related biological process. Several studies suggest telomere length may be positively correlated with cognitive performance but the evidence is equivocal. In this report, the relationships between telomere length and cognitive performance at Wave 2 and cognitive change from Wave 1 to Wave 2 are assessed in two narrow age-range population cohorts. METHODS We tested the hypothesis that leukocyte telomere length correlates positively with cognitive performance and cognitive decline in two community cohorts of middle-aged (n = 351, 44-49 years) and older (n = 295, 64-70 years) adults, who participated in two waves of a longitudinal study undertaken in the Canberra-Queanbeyan region of Australia. Telomere length was estimated at Wave 2. Cognitive performance was measured using the Symbol Digit Modalities Test, the immediate recall test of the California Verbal Learning Test, reaction time (simple & choice) and the Trails Test Part B. RESULTS Cross-sectionally at Wave 2, telomere length correlated with Symbol Digit Modalities Test scores (men) and simple reaction time (women) for the older cohort only, although the latter finding was in the opposite direction to that hypothesised. Telomere length measured at Wave 2 was not associated with cognitive change from Wave 1 to Wave 2 for either cohort, except for two associations of small magnitude (immediate recall in the older cohort, choice reaction time in older women), which were also in the contrary direction to that predicted. CONCLUSIONS These results do not give strong support to the hypothesis that leukocyte telomere length is associated with either levels of cognitive performance or age-related cognitive change.
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Affiliation(s)
- Karen A Mather
- Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia.
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26
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Mather KA, Jorm AF, Milburn PJ, Tan X, Easteal S, Christensen H. No Associations Between Telomere Length and Age-Sensitive Indicators of Physical Function in Mid and Later Life. J Gerontol A Biol Sci Med Sci 2010; 65:792-9. [DOI: 10.1093/gerona/glq050] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Piechatzek M, Indlekofer F, Daamen M, Glasmacher C, Lieb R, Pfister H, Tucha O, Lange KW, Wittchen HU, Schütz CG. Is moderate substance use associated with altered executive functioning in a population-based sample of young adults? Hum Psychopharmacol 2009; 24:650-65. [PMID: 19946940 DOI: 10.1002/hup.1069] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Substance use (SU) has been linked with impaired cognitive functioning. Evidence comes mainly from clinical studies or studies examining heavy users. Though, the majority of users are not involved in heavy use. This study investigates the association between moderate use and cognition in a population-based sample. METHODS A total of 284 young adults with ecstasy, cannabis or alcohol use and a control group were sampled from the EDSP database for participation in the Munich Assessment of Young Adults (MAYA) study. Subjects completed a comprehensive battery of neuropsychological tests (executive functions, working memory and impulsivity). Multiple linear regression models were conducted to examine the relationship between use and cognitive performance. RESULTS Increased ecstasy consumption was associated with increased error-proneness (Stroop task, CANTAB ID/ED-shift, spatial working memory). More frequent cannabis use and more extensive alcohol consumption were associated with a higher degree of impulsiveness. CONCLUSIONS Based on mild to moderate SU, little indication of differences in executive functioning was found. For ecstasy use, an increased error-proneness was revealed. The subtle differences in relatively young individuals warrant further investigation in prospective long-term studies to identify subjects at risk, and to examine effects of prolonged patterns of use on executive functioning.
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28
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Lucas N, Windsor TD, Caldwell TM, Rodgers B. Psychological distress in non-drinkers: associations with previous heavy drinking and current social relationships. Alcohol Alcohol 2009; 45:95-102. [PMID: 19917637 DOI: 10.1093/alcalc/agp080] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIMS The aim of this paper is to investigate two possible explanations for the higher levels of psychological distress observed among alcohol abstainers relative to light and moderate drinkers, and to investigate possible moderating effects of age on this association. The possible explanations were that: (i) the higher level of psychological distress among abstainers is due to the presence of a subset of former heavy drinkers in this group; and (ii) abstainers have poorer social relationships than light/moderate drinkers. METHODS A national cross-sectional survey yielded data from 2856 Australians aged 20-22, 30-32 and 40-42 years (response rate 15.9%). RESULTS The sample was representative for many socio-demographic factors but under-represented people not in the labour force and over-represented those with university qualifications. In the oldest but not the younger age groups, abstainers reported significantly higher psychological distress relative to light/moderate drinkers. While abstainers in the oldest age group who were former heavy drinkers showed the highest levels of distress, excluding them from the analysis did not account for differences in distress between current abstainers and light/moderate drinkers. Abstainers aged 40-42 years were less socially integrated, less extraverted and had lower social support than light/moderate drinkers, and controlling for these factors partially explained their increased distress. CONCLUSIONS Significantly increased psychological distress of abstainers compared to light/moderate drinkers was demonstrated only in the oldest age group (40-42 years). The higher distress reported by abstainers in this age group was partially explained by abstainers having poorer social relationships than light/moderate drinkers.
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Affiliation(s)
- Nina Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia.
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Bonner K. A dialogical exploration of the grey zone of health and illness: medical science, anthropology, and Plato on alcohol consumption. THEORETICAL MEDICINE AND BIOETHICS 2009; 30:81-103. [PMID: 19234871 DOI: 10.1007/s11017-009-9098-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 02/04/2009] [Indexed: 05/27/2023]
Abstract
This paper takes a phenomenological hermeneutic orientation to explicate and explore the notion of the grey zone of health and illness and seeks to develop the concept through an examination of the case of alcohol consumption. The grey zone is an interpretive area referring to the irremediable zone of ambiguity that haunts even the most apparently resolute discourse. This idea points to an ontological indeterminacy, in the face of which decisions have to be made with regard to the health of a person (e.g., an alcoholic), a system (e.g., the health system), or a society. The fundamental character of this notion will be developed in relation to the discourse on health and the limitations of different disciplinary practices. The case of alcohol consumption will be used to tease out the grey zone embedded in the different kinds of knowledge made available through the disciplinary traditions of medical science, with its emphasis on somatic well-being, and anthropology, with its focus on communal well-being. This tension or grey zone embedded in different knowledge outcomes will be shown to have a discursive parallel with the dialogue between the Athenian, the Spartan, and the Cretan in Plato's Laws. Making use of the dialogical approach as described by Gadamer, the Athenian's particular resolution of the tension will be explored as a case study to demonstrate the necessarily particular analysis involved in a grey zone resolution.
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Affiliation(s)
- Kieran Bonner
- St. Jerome's University in the University of Waterloo, Waterloo, ON, N2L 3G3, Canada.
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Anstey KJ, Burns R, von Sanden C, Luszcz MA. Psychological well-being is an independent predictor of falling in an 8-year follow-up of older adults. J Gerontol B Psychol Sci Soc Sci 2008; 63:P249-P257. [PMID: 18689768 DOI: 10.1093/geronb/63.4.p249] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A population-based sample (N = 787) was followed for 8 years and assessed three times on measures of well-being (depressive symptoms, morale, and control) and fall history. Marginal models assessed the association between baseline well-being measures and falling. Random effects models assessed change in well-being indicators as well as change in fall rate over 8 years. After adjustment for sociodemographics, psychotropic medication, health, and sensorimotor function, our results showed that depressive symptoms, control, and morale were risk factors for subsequent falling, and an increase in depressive symptoms or a reduction in morale was associated with an increasing fall rate. We conclude that the three well-being measures are independently associated with falling and need to be considered in fall-risk assessments and population-based prevention and intervention strategies.
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Affiliation(s)
- Kaarin J Anstey
- Centre for Mental Health Research, Australian National University, Canberra, Australia.
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Pitkänen T, Kokko K, Lyyra AL, Pulkkinen L. A developmental approach to alcohol drinking behaviour in adulthood: a follow-up study from age 8 to age 42. Addiction 2008; 103 Suppl 1:48-68. [PMID: 18426540 DOI: 10.1111/j.1360-0443.2008.02176.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To study the links of family background, child and adolescent social behaviour, and (mal)adaptation with heavy drinking by age 20 and with the frequency of drinking, binge drinking, Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire scores and problems due to drinking at ages 27 and 42 years. DESIGN In the Finnish Jyväskylä Longitudinal Study of Personality and Social Development, data have been collected by interviews, inventories and questionnaires. Behavioural data were gathered at ages 8 and 14; data on alcohol consumption were gathered at ages 14, 20, 27, 36 and 42. PARTICIPANTS A total of 184 males and 163 females; 94% of the original sample of the 8-year-olds. FINDINGS Family adversities, externalizing problem behaviours, low school success, truancy and substance use in adolescence were associated in early middle age with problems due to drinking in both genders, and to binge drinking and CAGE scores in females. The antecedents varied, however, across the indicators of drinking and gender. The frequency of drinking was least predictable by the studied antecedents. Childhood and adolescent antecedents and drinking up to age 20 explained 43% of males' and 31% of females' problem drinking at age 42; 31% and 19%, respectively, at age 27. CONCLUSIONS The early warning signs of drinking problems should be taken seriously in the preventive work for alcohol abuse. Problem drinking in early middle age is preceded by maladjustment to school, early age of onset of drinking and heavy drinking in adolescence even more significantly than problem drinking in early adulthood.
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Affiliation(s)
- Tuuli Pitkänen
- Department of Psychology, University of Jyväskylä, Finland.
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Merline A, Jager J, Schulenberg JE. Adolescent risk factors for adult alcohol use and abuse: stability and change of predictive value across early and middle adulthood. Addiction 2008; 103 Suppl 1:84-99. [PMID: 18426542 PMCID: PMC2649657 DOI: 10.1111/j.1360-0443.2008.02178.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To examine age-18 risk factors for alcohol use and heavy drinking during early (ages 22 and 26) and middle (age 35) adulthood, and for symptoms of alcohol use disorders (AUDs) in middle adulthood. DESIGN Nationally representative samples of US adolescents in their senior year of secondary school (age 18) were followed into middle adulthood. Structural equation models estimated the associations between age-18 characteristics and current drinking and heavy drinking at ages 22, 26 and 35 and symptoms of AUDs at age 35. PARTICIPANTS The sample consisted of 21,137 respondents from 11 senior year cohorts (1976-86) from the Monitoring the Future study. FINDINGS Many predictor variables had stable associations with alcohol use over time, although their ability to explain variance in alcohol use declined with increasing time lags. Being white predicted alcohol use, but not symptoms of AUDs. Parental drinking, risk taking and use of cigarettes and marijuana predicted heavy drinking to age 35. Planning to attend college predicted more heavy drinking at age 22 and less frequent heavy drinking by mid-life. High school theft and property damage predicted later AUD symptoms. Most associations were invariant across gender, with variations typically taking the form of stronger associations between predictors and alcohol use for men. Invariance in findings across cohorts indicates that results reflect general developmental trends rather than specific historically bounded ones. CONCLUSIONS Many adolescent individual and contextual characteristics remain important predictors of adult alcohol use and abuse, and their predictive impact varies as a function of age and type of alcohol outcome. These associations are largely equivalent across gender and cohort, thus reflecting robust developmental linkages.
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Affiliation(s)
- Alicia Merline
- American Academy of Pediatrics, Elk Grove Village, IL 60007, USA.
| | - Justin Jager
- University of Michigan Addiction Research Center, and Institute for Social Research, University of Michigan
| | - John E. Schulenberg
- Institute for Social Research, Department of Psychology, and Center for Human Growth and Development, University of Michigan
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Windsor TD, Anstey KJ, Butterworth P, Rodgers B. Behavioral approach and behavioral inhibition as moderators of the association between negative life events and perceived control in midlife. PERSONALITY AND INDIVIDUAL DIFFERENCES 2008. [DOI: 10.1016/j.paid.2007.10.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Windsor TD, Anstey KJ, Rodgers B. Volunteering and Psychological Well-Being Among Young-Old Adults: How Much Is Too Much? THE GERONTOLOGIST 2008; 48:59-70. [DOI: 10.1093/geront/48.1.59] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
PURPOSE OF REVIEW This paper briefly outlines new research on the epidemiology of alcohol and drug use in the older population, describes mental and cognitive consequences of substance use and summarizes recent treatment trials for alcohol dependence. RECENT FINDINGS Cross-sectional and longitudinal studies indicate that alcohol use is less prevalent in older groups, and it decreases over time. Comorbidity (alcohol and other drugs, alcohol with mental health disorders) is high. An inverse-U-shaped curve describes the association between alcohol consumption and cognitive impairment with increased impairment for abstainers and high users as compared with moderate users. Trials of alcohol use in the older population are rare, but they suggest that brief patient education may reduce drinking levels in primary care populations, and that, for some users, integrated primary care may be more useful than referral to specialist care. SUMMARY The basis for higher risk in abstainers is not resolved. More randomized controlled trials are needed, which target alcohol use and dependence and also focus on comorbid disorders.
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Affiliation(s)
- Helen Christensen
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
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Anstey KJ, Jorm AF, Réglade-Meslin C, Maller J, Kumar R, von Sanden C, Windsor TD, Rodgers B, Wen W, Sachdev P. Weekly alcohol consumption, brain atrophy, and white matter hyperintensities in a community-based sample aged 60 to 64 years. Psychosom Med 2006; 68:778-85. [PMID: 17012533 DOI: 10.1097/01.psy.0000237779.56500.af] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the association between weekly alcohol consumption and brain atrophy in adults aged 60 to 64 years. METHODS Brain magnetic resonance imaging scans from 385 adults recruited through a community survey were analyzed. Automated segmentation and manual tracing methods were used to obtain brain subvolumes and automated methods were used to obtain quantification and localization of white matter hyperintensities. Visual measures of cortical atrophy were obtained as were data on health and lifestyle factors. Alcohol consumption was assessed with the Alcohol Use Disorders Identification Test. RESULTS In men, weekly alcohol consumption had a positive linear association with ventricular volume and gray matter and a negative linear association with white matter. In women, weekly alcohol consumption had a nonlinear relationship with cerebrospinal fluid and white matter. Alcohol consumption was not associated with white matter hyperintensities, corpus callosum size, hippocampal or amygdala volumes in analyses adjusting for confounding variables. CONCLUSION An association between alcohol consumption and brain atrophy is evident at the population level. In women, detrimental effects of alcohol on the brain appear to occur at lower levels of consumption. It remains possible that low levels of alcohol consumption have neuroprotective benefits but is clear that high levels of consumption are detrimental.
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Affiliation(s)
- Kaarin J Anstey
- Centre for Mental Health Research, Australian National University, Canberra ACT 0200, Australia.
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Anstey KJ, Windsor TD, Rodgers B, Jorm AF, Christensen H. Lower cognitive test scores observed in alcohol abstainers are associated with demographic, personality, and biological factors: the PATH Through Life Project. Addiction 2005; 100:1291-301. [PMID: 16128718 DOI: 10.1111/j.1360-0443.2005.01159.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To identify variables that explain the association between alcohol abstention and cognitive performance. We hypothesized that demographic and personality variables would be important for explaining the association in all age cohorts, but that health variables would be more important in the older age-cohorts. DESIGN Three age cohorts (20-24, 40-44, 60-64 years) were sampled randomly, yielding a total of 7485 participants, with data from 602 alcohol abstainers and 4158 light or moderate drinkers used in this study. Setting The sample was drawn from the cities of Canberra and Queanbeyan, Australia. MEASUREMENTS Scales measuring demographic, health and personality variables and cognitive and physical tests were administered. Participants drinking at hazardous or harmful levels were excluded from the analysis. FINDINGS A range of demographic and physical function measures were found to explain partially the finding of abstainers having lower cognitive test scores. The effects of independent variables were largest in the 60-64-year-old age group with a trend for physical variables such as lung function and grip strength to become more important in the older age groups. In the 20-24-year-olds, the majority of the effect remained unexplained. CONCLUSION There is evidence that poorer cognitive test performance by abstainers reflects in part selection effects and poorer physical functioning, but does not appear to be due to mental or physical health conditions or personality.
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Affiliation(s)
- Kaarin J Anstey
- Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia.
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