Chronic Physical Conditions, Multimorbidity, and Mild Cognitive Impairment in Low- and Middle-Income Countries

Mild Cognitive Impairment and Suicidal Ideation Among Adults Aged 65 Years or Older From Low- and Middle-Income Countries

OBJECTIVES

Mild cognitive impairment (MCI) is a unique indicator of underlying distress that may be strongly associated with suicide risk. Despite this, to date, no study has examined the association between MCI and suicidal ideation. Therefore, the present study aimed to examine the association between MCI and suicidal ideation among adults aged ≥65 years from 6 low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Cross-sectional, nationally representative data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression and meta-analysis were conducted to assess associations.

RESULTS

Data on 13,623 individuals aged ≥65 years were analyzed. The prevalence of suicidal ideation ranged from 0.5% in China to 6.0% in India, whereas the range of the prevalence of MCI was 9.7% (Ghana) to 26.4% (China). After adjustment for potential confounders, MCI was significantly associated with 1.66 (95% confidence interval [95% CI] = 1.12-2.46) times higher odds for suicidal ideation.

DISCUSSION

Mild cognitive impairment was significantly associated with higher odds for suicidal ideation among older adults in LMICs. Future longitudinal studies from LMICs are necessary to assess whether MCI is a risk factor for suicidal ideation.

A methodological and reporting quality assessment of systematic reviews/meta-analyses on exercise interventions for cognitive function in older adults with mild cognitive impairment

Objective

To assess the methodological quality of meta-analytic literature on exercise interventions for cognitive function in patients with mild cognitive impairment (MCI) and the certainty of evidence for its outcome indicators, and to provide clinicians and researchers with more reliable data for making decisions.

Methods

Meta-analytic literature related to the effect of exercise intervention on cognitive function in patients with mild cognitive impairment was searched through PubMed, Cochrane Library, Embase, Scopus, Physiotherapy Evidence Database and Web of Science, all with a search period frame of each database until June 1, 2024. The AMSTAR2 scale was used to evaluate the methodological quality of the included studies.

Results

Seventeen meta-analyses were included. The AMSTAR2 scale evaluation results showed that there was one medium-quality studies (5.55%), seven low-quality studies (38.88%), and 10 very low-quality studies (55.55%). Methodological deficiencies included failure to prepare a plan and provide a registration number, literature screening, data extraction, reasons for exclusion not described in detail, poor implementation process for systematic evaluation, and failure to describe the source of funding for the included studies or relevant conflicts of interest.

Conclusion

The overall methodological quality of the meta-analytic literature is low, and the certainty of evidence is low. We encourage the conduction of high-quality randomized trials to generate stronger evidence. Subsequent systematic reviews can then synthesize this evidence to inform future research and clinical guidelines.

Interrelationships between physical multimorbidity, depressive symptoms and cognitive function among older adults in China, India and Indonesia: A four-way decomposition analysis

OBJECTIVE

This paper explores the role of depressive symptoms (mediator/moderator) in the association between physical multimorbidity (exposure) and cognitive function (outcome) among older adults in the three most populous middle-income countries.

METHODS

This study used cross-sectional data from China (2015 China Health and Retirement Longitudinal Study), India (2017/2018 Longitudinal Ageing Study in India), and Indonesia (2014/2015 Indonesian Family Life Survey), with a total sample of 73,199 respondents aged ≥ 45 years. Three domains of cognitive tests were harmonised across surveys, including time orientation, word recall, and numeracy. The four-way decomposition analysis assessed the mediation and interaction effects between exposure, mediator/moderator, and outcome, adjusted for covariates.

RESULTS

The mean age of the respondents (in years) was slightly younger in Indonesia (56.0, SD = 8.8) than in China (59.5, SD = 9.3) and India (60.0, SD = 10.5). The proportion of male respondents was 49.3 % in China, 47.3 % in India, and 47.5 % in Indonesia. Respondents in China had the highest mean cognitive function z scores (54.7, SD = 19.9), followed by India (51.1, SD = 20.0) and Indonesia (51.0, SD = 18.4). Physical multimorbidity was associated with lower cognitive function in China and India (p < 0.0001), with 48.4 % and 40.0 % of the association explained by the mediating effect of depressive symptoms ('overall proportion due to mediation'). The association was not found in Indonesia.

CONCLUSION

Cognitive functions were lower among individuals with physical multimorbidity, and depressive symptoms mainly explained the association. Addressing depressive symptoms among persons with physical multimorbidity is likely to have not only an impact on their mental health but could prevent cognitive decline.

Association of handgrip strength with suicidal ideation among adults aged ≥50 years from low- and middle-income countries

INTRODUCTION

This study aimed to investigate the association between handgrip strength and suicidal ideation in representative samples of adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Cross-sectional, community-based data from the World Health Organization's Study on Global Aging and Adult Health were analyzed. Handgrip strength quintiles by sex were created based on the average value of two handgrip measurements of the dominant hand. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression analysis was conducted to assess associations.

RESULTS

Data on 34,129 individuals were analyzed [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.1% females]. After adjustment for potential confounders, in the overall sample, compared to the handgrip strength quintile with the highest values [Quintile 1 (Q1)], Q2, Q3, Q4, and Q5 were associated with significant 2.15 (95% CI = 1.05-4.39), 2.78 (95% CI = 1.06-7.32), 3.53 (95% CI = 1.68-7.42), and 6.79 (95% CI = 2.80-16.48) times higher odds for suicidal ideation.

CONCLUSIONS

Lower handgrip strength was significantly and dose-dependently associated with higher odds for suicidal ideation in adults aged ≥50 years from LMICs. Future longitudinal studies are needed to understand the underlying mechanisms, and whether increasing general muscular strength and physical function may lead to reduction in suicidal ideation.

The effect of multimorbidity patterns on physical and cognitive function in diabetes patients: a longitudinal cohort of middle-aged and older adults in China

Background

The prevalence of diabetes has increased rapidly, and comorbid chronic conditions are common among diabetes patients. However, little is known about the pattern of multimorbidity in diabetes patients and the effect on physical and cognitive function. This study aimed to assess the disease clusters and patterns of multimorbidity in diabetes patients using a novel latent class analysis (LCA) approach in middle-aged and older adults and explore the association between different clusters of multimorbidity in diabetes and the effect on physical and cognitive function.

Methods

This national observational study included 1,985 diabetes patients from the four waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2011 to 2018. Thirteen chronic diseases were used in latent class analysis to identify the patterns of multimorbidity in diabetes, which span the cardiovascular, physical, psychological, and metabolic systems. Cognitive function is assessed via a structured questionnaire in three domains: memory, executive function, and orientation. We combined activities of daily living (ADL) with instrumental activities of daily living (IADL) to measure physical function. Linear mixed models and negative binomial regression models were used to analyze the association between patterns of multimorbidity in diabetes and the effect on cognitive function and disability, respectively.

Results

A sample of 1,985 diabetic patients was identified, of which 1,889 (95.2%) had multimorbidity; their average age was 60.6 years (standard deviation (SD) = 9.5), and 53.1% were women. Three clusters were identified: "cardio-metabolic" (n = 972, 51.5%), "mental-dyslipidemia-arthritis" (n = 584, 30.9%), and "multisystem morbidity" (n = 333, 17.6%). Compared with diabetes alone, the "multisystem morbidity" class had an increased association with global cognitive decline. All patterns of multimorbidity were associated with an increased risk of memory decline and disability; however, the "multisystem morbidity" group also had the strongest association and presented a higher ADL-IADL disability (ratio = 4.22, 95% CI = 2.52, 7.08) and decline in memory Z scores (β = -0.322, 95% CI = -0.550, -0.095, p = 0.0058).

Conclusion

Significant longitudinal associations between different patterns of multimorbidity in diabetes patients and memory decline and disability were observed in this study. Future studies are needed to understand the underlying mechanisms and common risk factors for multimorbidity in diabetes patients and to propose treatments that are more effective.

Association between sedentary behavior and dynapenic abdominal obesity among older adults from low- and middle-income countries

BACKGROUND

Sedentary behavior, or time spent sitting, may increase risk for dynapenic abdominal obesity (DAO), but there are currently no studies on this topic.

AIMS

Therefore, we investigated the association between sedentary behaviour and DAO in a nationally representative sample of older adults from six low- and middle-income countries.

METHODS

Cross-sectional data from the Study on Global AGEing and Adult Health were analysed. Dynapenia was defined as handgrip strength < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm (> 80 cm for Asian countries) for women and > 102 cm (> 90 cm) for men. DAO was defined as having both dynapenia and abdominal obesity. Self-reported sedentary behavior was categorized as ≥ 8 h/day (high sedentary behaviour) or < 8 h/day. Multivariable multinomial logistic regression was conducted.

RESULTS

Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. In the overall sample, ≥ 8 h of sedentary behavior per day (vs. <8 h) was significantly associated with 1.52 (95%CI = 1.11-2.07) times higher odds for DAO (vs. no dynapenia and no abdominal obesity), and this was particularly pronounced among males (OR = 2.27; 95%CI = 1.42-3.62). Highly sedentary behavior was not significantly associated with dynapenia alone or abdominal obesity alone.

DISCUSSION

High sedentary behaviour may increase risk for DAO among older adults.

CONCLUSIONS

Interventions to reduce sedentary behaviour may also lead to reduction of DAO and its adverse health outcomes, especially among males, pending future longitudinal research.

Characterizing Caregiver Roles and Conflict in Health Management Support to Older People With Multiple Chronic Conditions

Caregivers provide critical support for older adults managing multiple chronic conditions (MCCs), but few studies describe the assistance caregivers provide or identify factors influencing their provision of support. We conducted qualitative interviews with 25 caregivers to older adults with MCCs to describe caregivers' roles and identify the factors that influence caregivers' ability to carry out these roles. Transcripts were analyzed using the Framework Method. Caregivers supported the management of MCCs in several ways, including monitoring conditions, communicating with clinicians, and tracking health information. Disagreement, or conflicted relationships, between caregivers and older adults over health and behaviors influenced the provision of support, resulting in less involved and less effective caregivers. Caregivers in conflicted relationships were more challenged by resistance from older adults. Greater agreement, or collaboration, between caregivers and older adults resulted in more involved and effective caregivers. Addressing health-related conflict may enhance caregivers' capacity to support older adults with MCCs.

Factors That Influence Meeting the Recommended Weekly Physical Activity Target Among Older People With Physical Multimorbidity: Evidence From 6 Low- and Middle-Income Countries

BACKGROUND

There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations.

RESULTS

Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%).

CONCLUSIONS

Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.

Multimorbidity, healthy lifestyle, and the risk of cognitive impairment in Chinese older adults: a longitudinal cohort study

BACKGROUND

Evidence on the association between multimorbidity and cognitive impairment in Chinese older population is limited. In addition, whether a healthy lifestyle can protect cognitive function in multimorbid older population remains unknown.

METHODS

A total of 6116 participants aged ≥ 65 years from the Chinese Longitudinal Healthy Longevity Survey were followed up repeatedly. The number of coexisting chronic diseases was used for assessing multimorbidity and cardiometabolic multimorbidity. Three lifestyle statuses (unhealthy, intermediate, and healthy) were defined based on a lifestyle score covering smoking, alcohol drinking, body mass index, outdoor activities, and dietary pattern. Cognitive impairment was defined as the Mini-Mental State Examination score < 24. A modified Poisson regression model with robust error variance was used to assess the associations between multimorbidity, healthy lifestyle, and cognitive impairment.

RESULTS

During a median follow-up period of 5.8 years, 1621 incident cases of cognitive impairment were identified. The relative risk (RR) of cognitive impairment associated with heavy multimorbidity burden (≥ 3 conditions) was 1.39 (95% confidence interval: 1.22-1.59). This association declined with age, with RRs being 3.08 (1.78-5.31), 1.40 (1.04-1.87), and 1.19 (1.01-1.40) in subjects aged < 70 years, ≥ 70 and < 80 years, and ≥ 80 years, respectively (P for interaction = 0.001). Compared to unhealthy lifestyle, a healthy lifestyle was related to an approximately 40% reduced risk of cognitive impairment regardless of multimorbidity burden. Among the 5 lifestyle factors assessed, daily outdoor activities and a healthy dietary pattern showed convincing protective effects on cognitive function.

CONCLUSIONS

The relationship between multimorbidity and cognitive impairment is age-dependent but remains significant in the population aged 80 years or older. A healthy lifestyle may protect cognitive function regardless of the multimorbidity burden. These findings highlight the importance of targeting individuals with heavy multimorbidity burden and promoting a heathy lifestyle to prevent cognitive impairment in Chinese older population.

The risk of dementia or cognitive impairment in patients with cataracts: a systematic review and meta-analysis

OBJECTIVES

The aim of this study was to investigate whether cataract disease is associated with the risk of developing dementia or cognitive impairment.

METHODS

A systematic search of the literature in PubMed, the Extracts Database (Embase), the Cochrane Library and the Web of Science databases was performed from the inception data of each database until 1 September 2022. Sensitivity analyses were performed to assess the robustness and reliability of the overall findings. All extracted data were statistically analyzed using Stata software v.16.0. Publication bias was assessed using funnel plots and the Egger test.

RESULTS

There were 11 publications included in this study, which consisted of 489,211participants, spanning 10 countries from 2012 to 2022. Aggregation suggested that cataracts were associated with cognitive impairment (odds ratio [OR] = 1.32; 95% CI: 1.21-1.43; I 2 = 45.4.%; p = 0.000). The presence of cataracts is significantly associated with an increased risk of developing all-cause dementia (relative risk [RR] = 1.17; 95% CI: 1.08-1.26; I2 = 0.0%; p = 0.000). In subgroup analyses, having cataracts may increase the risk of Alzheimer's disease (hazard ratio [HR] = 1.28; 95% CI: 1.13-1.45; I2 = 0.0%; p = 0.000) and vascular dementia (HR = 1.35; 95% CI = 1.06-1.73; I2 = 0.0%, p = 0.015). The data from the Egger's test showed no significant evidence of publication bias.

CONCLUSIONS

Cataracts are associated with the risk of cognitive impairment and dementia, including Alzheimer's disease, and vascular dementia.

Barker's Hypothesis Among the Global Poor: Positive Long-Term Cardiovascular Effects of in Utero Famine Exposure

An influential literature on the Developmental Origins of Health and Disease (DOHaD) has documented that poor conditions in utero lead to higher risk of cardiovascular disease at older ages. Evidence from low-income countries (LICs) has hitherto been missing, despite the fact that adverse in utero conditions are far more common in LICs. We find that Malawians exposed in utero to the 1949 Nyasaland famine have better cardiovascular health 70 years later. These findings highlight the potential context specificity of the DOHaD hypothesis, with in utero adversity having different health implications among aging LIC individuals who were exposed to persistent poverty.

Unclean Cooking Fuel Use and Slow Gait Speed Among Older Adults From 6 Countries

BACKGROUND

Outdoor air pollution has been reported to be associated with frailty (including slow gait speed) in older adults. However, to date, no literature exists on the association between indoor air pollution (eg, unclean cooking fuel use) and gait speed. Therefore, we aimed to examine the cross-sectional association between unclean cooking fuel use and gait speed in a sample of older adults from 6 low- and middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Cross-sectional, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Unclean cooking fuel use referred to the use of kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass based on self-report. Slow gait speed referred to the slowest quintile based on height, age, and sex-stratified values. Multivariable logistic regression and meta-analysis were done to assess associations.

RESULTS

Data on 14 585 individuals aged ≥65 years were analyzed (mean [standard deviation] age 72.6 [11.4] years; 45.0% males). Unclean cooking fuel use (vs clean cooking fuel use) was significantly associated with higher odds for slow gait speed (odds ratio = 1.45; 95% confidence interval: 1.14-1.85) based on a meta-analysis using country-wise estimates. The level of between-country heterogeneity was very low (I2 = 0%).

CONCLUSIONS

Unclean cooking fuel use was associated with slower gait speed among older adults. Future studies of longitudinal design are warranted to provide insight into the underlying mechanisms and possible causality.

Food insecurity and subjective cognitive complaints among adults aged ≥ 65 years from low- and middle-income countries

PURPOSE

To date, no study has investigated the association between food insecurity and subjective cognitive complaints (SCC). Thus, the aims of the present study were to examine this association among older adults in low- and middle-income countries (LMICs), and to identify the potential mediators in this association, given the importance of SCC in dementia risk among older people, and the projected particularly large increase in dementia in this setting.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and Adult Health (SAGE) collected between 2007 and 2010 were analyzed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable linear regression and mediation (Karlson-Holm-Breen method) analyses were conducted to assess associations.

RESULTS

Data on 14,585 individuals aged ≥ 65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Severe food insecurity (vs. no food insecurity) was associated with 9.16 (95% CI = 6.95-11.37) points higher mean SCC score. Sleep/energy (mediated% 37.9%; P < 0.001), perceived stress (37.2%; P = 0.001), and depression (13.7%; P = 0.008) partially explained the association between severe food insecurity and SCC.

CONCLUSION

Food insecurity was associated with SCC among older adults in LMICs. Future studies should assess whether addressing food insecurity among older adults in LMICs can improve cognitive health.

Cognitive status and its risk factors in patients with hypertension and diabetes in a low-income rural area of China: A cross-sectional study

OBJECTIVES

The proportion of older people with dementia in China is gradually increasing with the increase in the aging population over recent years. Hypertension and diabetes are common non-communicable diseases among rural populations in China. However, it remains unclear whether these conditions affect the occurrence and development of cognitive impairment as there is limited research on cognitive status and its risk factors among residents of rural areas.

METHODS

A multi-stage stratified cluster random sampling method was used to select 5400 participants from rural permanent residents. A self-designed structured questionnaire was used to investigate demographic data of the participants. Cognitive function was assessed using the Montreal Cognitive Function Assessment Scale (MoCA). The results were analyzed using chi-square test, ANOVA and multiple linear regression analysis.

RESULTS

A total of 5028 participants returned the survey, giving a response rate of 93.1%. Higher education (odds ratio (OR) = 3.2, 95% confidence interval (CI) 2.87-3.54, p < 0.001), higher income (OR = 1.61, 95% CI 1.16-2.07, p < 0.001), and dietary control (OR = 0.66, 95%CI 0.34-0.98, p < 0.001) were protective factors. A visual representation of the relationship between annual income and MoCA score showed an inverted U-curve, the group with an annual income of 6000-7999 RMB had a maximum OR of 1.93 (95%CI 0.12-2.74, p < 0.001). While difficulty in maintaining sleep were risk factors for cognitive impairment (OR = -2.28, 95% CI-4.18-0.39, p = 0.018).

CONCLUSIONS

Participants with middle incomes had better cognitive status than those with the highest incomes. Higher education, proper diet control and good sleep are beneficial to the cognitive status of residents in rural areas.

Association of Fruit and Vegetable Consumption With Mild Cognitive Impairment in Low- and Middle-Income Countries

BACKGROUND

Inadequate fruit and vegetable intake may be associated with cognitive decline but its association with mild cognitive impairment (MCI; a preclinical stage of dementia) is largely unknown. Therefore, we examined the association of fruit and vegetable consumption with MCI among middle-aged and older adults from low- and middle-income countries (LMICs).

METHODS

Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Quintiles of vegetable and fruit consumption were created based on the number of servings consumed on a typical day. Multivariable logistic regression analysis was conducted.

RESULTS

Data on 32 715 individuals aged ≥50 years were analyzed (mean [standard deviation] age 62.1 [15.6] years; 51.7% females). Greater fruit consumption was dose-dependently associated with lower odds for MCI. For example, the highest quintile (vs lowest) had 47% lower odds for MCI (odds ratio [OR] = 0.53; 95% confidence interval [CI] = 0.43-0.66). For vegetable consumption, compared to the lowest quintile, the second to fourth quintiles had significant 38%-44% lower odds for MCI but there was no significant difference for the highest quintile (OR = 0.82; 95% CI = 0.59-1.15).

CONCLUSIONS

Higher fruit and vegetable consumption was associated with lower odds for MCI among middle-aged and older adults from LMICs, but no significant differences were found between the highest and lowest quintiles of vegetable consumption. Future longitudinal studies are required to explore these findings in more depth, and mechanistic studies are required to elucidate on the observed possible U-shaped association between vegetable consumption and MCI.

Association Between Pain and Sarcopenia Among Adults Aged ≥65 Years from Low- and Middle-Income Countries

BACKGROUND

Pain may increase the risk for sarcopenia, but existing literature is only from high-income countries, while the mediators of this association are largely unknown. Thus, we aimed to investigate the association between pain and sarcopenia using nationally representative samples of older adults from 6 low- and middle-income countries (LMICs), and to identify potential mediators.

METHODS

Cross-sectional data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Sarcopenia was defined as having low skeletal muscle mass and weak handgrip strength, while the presence and severity of pain in the last 30 days were self-reported. Multivariable logistic regression and mediation analyses were performed. The control variables included age, sex, education, wealth, and chronic conditions, while affect, sleep/energy, disability, social participation, sedentary behavior, and mobility were considered potential mediators.

RESULTS

Data on 14,585 adults aged ≥65 years were analyzed (mean [SD] age 72.6 [11.5] years; 55.0% females). Compared to no pain, mild, moderate, severe, and extreme pain were associated with 1.42 (95% confidence interval [CI] = 1.05-1.94), 1.43 (95%CI = 1.02-2.00), 1.92 (95%CI = 1.09-3.37), and 2.88 (95%CI = 1.10-7.54) times higher odds for sarcopenia, respectively. Disability (mediated percentage 18.0%), sedentary behavior (12.9%), and low mobility (56.1%) were significant mediators in the association between increasing levels of pain and sarcopenia.

CONCLUSIONS

Higher levels of pain were associated with higher odds for sarcopenia among adults aged ≥65 years in 6 LMICs. Disability, sedentary behavior, and mobility problems were identified as potential mediators. Targeting these factors in people with pain may decrease the future risk of sarcopenia onset, pending future longitudinal research.

Pain and mild cognitive impairment among adults aged 50 years and above residing in low- and middle-income countries

BACKGROUND

Previous studies on the association between pain and cognitive decline or impairment have yielded mixed results, while studies from low- and middle-income countries (LMICs) or specifically on mild cognitive impairment (MCI) are scarce. Thus, we investigated the association between pain and MCI in LMICs and quantified the extent to which perceived stress, sleep/energy problems, and mobility limitations explain the pain/MCI relationship.

METHODS

Data analysis of cross-sectional data from six LMICs from the Study on Global Ageing and Adult Health (SAGE) were performed. MCI was based on the National Institute on Aging-Alzheimer's Association criteria. "Overall in the last 30 days, how much of bodily aches or pain did you have?" was the question utilized to assess pain. Associations were examined by multivariable logistic regression analysis and meta-analysis.

RESULTS

Data on 32,715 individuals aged 50 years and over were analysed [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, compared to no pain, mild, moderate, and severe/extreme pain were dose-dependently associated with 1.36 (95% CI = 1.18-1.55), 2.15 (95% CI = 1.77-2.62), and 3.01 (95% CI = 2.36-3.85) times higher odds for MCI, respectively. Mediation analysis showed that perceived stress, sleep/energy problems, and mobility limitations explained 10.4%, 30.6%, and 51.5% of the association between severe/extreme pain and MCI.

CONCLUSIONS

Among middle-aged to older adults from six LMICs, pain was associated with MCI dose-dependently, and sleep problems and mobility limitations were identified as potential mediators. These findings raise the possibility of pain as a modifiable risk factor for developing MCI.

Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study

BACKGROUND

Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association.

METHODS

We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores.

FINDINGS

The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years  (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, β=-0·15 [95% CI -0·17 to -0·13]; two diseases, β=-0·37 [-0·40 to -0·34]; three diseases, β=-0·57 [-0·64 to -0·50]), with comorbid diabetes and stroke (β=-0·23 [-0·29 to -0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888).

INTERPRETATION

These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people.

FUNDING

Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.

The association between cataract and incidence of cognitive impairment in older adults: A systematic review and meta-analysis

BACKGROUND

Cataract has been shown to be associated with an increased risk of cognitive impairment. However, the results of previous studies have been inconsistent. This systematic review and meta-analysis aimed to investigate the association between cataract and the incidence of cognitive impairment in older adults.

METHODS

A comprehensive search of electronic databases from inception to January 2023 was performed to identify relevant studies. Data were extracted from eligible studies and a meta-analysis was performed to calculate the pooled hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

We included 13 studies with 25 study arms involving a total of 798,694 participants. Compared with participants without cataract, those with cataract had a higher risk of developing all-cause dementia (pooled HR: 1.22; 95% CI: 1.08-1.38; I²=86%; 9 studies), Alzheimer's disease dementia (pooled HR: 1.18; 95% CI: 1.07-1.30; I²=0%; 9 studies), vascular dementia (pooled HR: 1.21; 95% CI: 1.02-1.43; I²=77%;3 studies) and mild cognitive impairment (pooled HR: 1.30; 95% CI: 1.13-1.50; I²=0%;2 studies). There was no significant association between cataract and mixed dementia (pooled HR: 1.03; 95% CI: 0.52-2.04; I²=78%;2 studies). We assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale and found that most of them had a low or moderate risk of bias. The number of studies in each meta-analysis ranged from two to nine, with more studies available for all-cause dementia and Alzheimer's disease dementia than for vascular dementia and mixed dementia.

CONCLUSIONS

The findings suggest that cataract may be associated with cognitive impairment in older adults. However, the causal relationship between cataract and cognition remains unclear and requires further investigation.

Multimorbidity increases the risk of dementia: a 15 year follow-up of the SHARE study

AIMS

the literature regarding the association between multimorbidity and dementia is still unclear. Therefore, we aimed to explore the potential association between multimorbidity at the baseline and the risk of future dementia in the SHARE (Survey of Health, Ageing and Retirement in Europe) study, a large European research survey, with a follow-up of 15 years.

METHODS

in this longitudinal study, multimorbidity was defined as the presence of two or more chronic medical conditions, among 14 self-reported at the baseline evaluation. Incident dementia was ascertained using self-reported information. Cox regression analysis, adjusted for potential confounders, was run and hazard ratios (HRs), with their 95% confidence intervals (CIs), that were estimated in the whole sample and by 5 year groups.

RESULTS

among 30,419 participants initially considered in wave 1, the 23,196 included participants had a mean age of 64.3 years. The prevalence of multimorbidity at baseline was 36.1%. Multimorbidity at baseline significantly increased the risk of dementia in the overall sample (HR = 1.14; 95% CI: 1.03-1.27) and in participants younger than 55 years (HR = 2.06; 95% CI: 1.12-3.79), in those between 60 and 65 years (HR = 1.66; 95% CI: 1.16-2.37) and in those between 65 and 70 years (HR = 1.54; 95% CI: 1.19-2.00). In the overall sample, high cholesterol levels, stroke, diabetes and osteoporosis increased the risk of dementia, particularly if present among participants between 60 and 70 years of age.

CONCLUSIONS

multimorbidity significantly increases the risk of dementia, particularly in younger people, indicating the need for early detection of multimorbidity for preventing cognitive worsening.

Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries

PURPOSE

Multimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs.

METHODS

Cross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations.

RESULTS

The final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient - 5.89; 95% CI - 6.83, - 4.95), 3 (- 8.35; - 9.63, - 7.06), 4 (- 10.87; - 12.37, - 9.36), and ≥ 5 (- 13.48; - 15.91, - 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%).

CONCLUSION

A greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.

Leisure-time physical activity and sarcopenia among older adults from low- and middle-income countries

BACKGROUND

There are no data on the association between leisure-time physical activity (LTPA) and sarcopenia in older adults from low- and middle-income countries (LMICs). This study aimed to investigate the association between LTPA and sarcopenia in individuals aged ≥65 years living in six LMICs.

METHODS

Cross-sectional data from the Study on Global AGEing and Adult Health (China, Ghana, India, Mexico, Russia and South Africa) were analysed. Sarcopenia referred to the presence of both low skeletal muscle mass and weak handgrip strength. LTPA was assessed using the Global Physical Activity Questionnaire and was analysed as a dichotomized variable [high LTPA (>150 min/week of moderate-to-vigorous LTPA) or low LTPA (≤150 min/week)]. Multivariable logistic regression analysis was conducted to assess associations.

RESULTS

There were 14 585 individuals included in this study [mean (SD) age 72.6 (11.5) years; 55.0% women]. The prevalence of high LTPA and sarcopenia was 8.9% and 12.0%, respectively. After adjusting for potential confounders, low LTPA was significantly associated with higher odds for sarcopenia [prevalence odds ratio (POR) = 1.85, 95% confidence interval (CI) = 1.29-2.65] compared with high LTPA. Significant associations were found in women (POR = 3.22, 95% CI = 1.82-5.68) but not in men (POR = 1.52, 95% CI = 0.99-2.35).

CONCLUSIONS

A positive and significant association between low LTPA and sarcopenia was found among older adults from LMICs. The promotion of LTPA among older adults in LMICs may aid in the prevention of sarcopenia, especially among females, pending future longitudinal research.

Body mass index categories and anxiety symptoms among adults aged ≥ 50 years from low and middle income countries

BACKGROUND

Body weight may be a risk factor for anxiety; however, there is a scarcity of studies on this association in older adults especially from low and middle income countries (LMICs). Therefore, we investigated the association between body mass index (BMI) and anxiety symptoms among adults aged ≥ 50 years from 6 LMICs.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analyzed. The BMI was based on measured weight and height and was categorized as: < 18.5 kg/m² (underweight), 18.5-24.9 kg/m² (normal weight), 25.0-29.9 kg/m² (overweight), 30.0-34.9 kg/m² (obesity class I), 35.0-39.9 kg/m² (obesity class II), and ≥ 40 kg/m² (obesity class III). Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30 days. Multivariable logistic regression analysis was conducted.

RESULTS

Data on 34,129 individuals aged ≥ 50 years (mean age 62.4 years, SD 16.0 years; 52.1% female) were analyzed. Overall, compared to normal weight, only underweight was significantly associated with anxiety symptoms (odds ratio, OR = 1.56; 95% confidence interval, CI = 1.26-1.95). Obesity class III (vs. normal weight) was associated with significantly increased odds for anxiety symptoms (OR = 4.15; 95%CI = 1.49-11.59) only among males.

CONCLUSION

In this large representative sample of older adults from LMICs, underweight was associated with anxiety symptoms in males and females. Class III obesity was associated with anxiety symptoms only in males. Future studies to shed light on the reason why severe obesity was associated with anxiety symptoms only among males in LMICs are needed.

Physical multimorbidity, suicidal ideation, and suicide attempts among adults aged ≥50 years from low- and middle-income countries

OBJECTIVES

The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs.

METHODS

Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

The final sample consisted of 34,129 adults aged ≥50 years (mean [SD] age 62.4 (16.0) years; maximum age 114 years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR = 2.99; 95% CI = 2.06-4.34) and suicide attempts (OR = 2.79; 95% CI = 1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%).

CONCLUSIONS

Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts.

The association of physical multimorbidity with suicidal ideation and suicide attempts in England: A mediation analysis of influential factors

BACKGROUND

Suicide is one of the most important causes of deaths in the United Kingdom, and the numbers are currently increasing.

AIM

There are numerous identified determinants of suicidality, and physical multimorbidity is potentially important but is currently understudied. Thus, this study aims to investigate the association of physical multimorbidity with suicidality.

METHODS

Cross-sectional data from the Adult Psychiatric Morbidity Survey 2007, which was conducted in England between October 2006 and December 2007 by the National Center for Social Research and Leicester University were analyzed. Respondents were asked about 20 physical health conditions, and suicidal ideation and suicide attempts were assessed.

RESULTS

Out of 7,403 individuals aged 16 years or over, the prevalence of physical multimorbidity, suicidal ideation, and suicide attempts were 35.1%, 4.3%, and 0.7%, respectively. After adjustment for potential confounders, compared to no physical conditions, 1, 2, 3, and ⩾4 conditions were associated with significant 1.79 (95% CI [1.25, 2.57]), 2.39 (95% CI [1.63, 3.51]), 2.88 (95% CI [1.83, 4.55]), and 6.29 (95% CI [4.12, 9.61]) times higher odds for suicidal ideation. Mediation analysis showed that cognitive problems (mediated percentage 39.2%) and disability (37.5%) explained the largest proportion between multimorbidity and suicidal ideation. Pain (38.0%) and cognitive problems (30.7%) explained the largest proportion between multimorbidity and suicide attempts.

CONCLUSION

In this large sample of UK adults, physical multimorbidity was associated with significantly higher odds for suicidal ideation and suicide attempts. Moreover, several potential mediators were identified, and these may serve as future targets for interventions that aim to prevent suicidality among people with physical multimorbidity.

Association between multimorbidity status and incident dementia: a prospective cohort study of 245,483 participants

Multimorbidity (the presence of two or more long-term conditions [LTCs]) was suggested to exacerbate the neuronal injuries. The impact of multimorbidity on dementia has not been fully elucidated. We aimed to investigate the association between multimorbidity and dementia risk. We used the prospective data from 245,483 UK Biobank participants during a 9-year follow-up. Multimorbidity status was evaluated based on the LTC counts and multimorbidity patterns. Cox regression models adjusted for potential confounders were used to examine the associations of multimorbidity status with all-cause dementia (ACD), Alzheimer's disease (AD) and vascular dementia (VD). Participants with multimorbidity at baseline had higher risks of ACD and VD, and the risks were elevated with the increase of LTC counts (ACD: hazard ratios [HR] = 1.15, 95% confidence intervals [CI] = 1.01-1.31 with 2 LTCs; HR = 1.18, CI = 1.01-1.39 with 3 LTCs; HR = 1.65, CI = 1.44-1.88 with ≥4 LTCs; VD: HR = 1. 66, CI = 1.24-2.21 with 2 LTCs; HR = 2.10, CI = 1.53-2.88 with 3 LTCs; HR = 3.17, CI = 2.43-4.13 with ≥4 LTCs). Participants with ≥4 LTCs also had a higher risk of AD (HR = 1.34, CI = 1.08-1.66]. Participants with the cardio-cerebrovascular/respiratory/metabolic/musculoskeletal/depressive multimorbidity were 1.46, 1.28, and 2.50 times more likely to develop ACD (HR = 1.46, 95% CI = 1.28-1.67), AD (HR = 1.28, CI = 1.04-1.58), and VD (HR = 2.50, CI = 1.90-3.27), respectively. Those with tumor/genitourinary/digestive disorders had a 11% higher hazard of ACD (HR = 1.11, CI = 1.00-1.24) and a 73% elevated risk of VD (HR = 1.73, CI = 1.37-2.18). The prevention of LTC accumulation and the identification of specific multimorbidity patterns might be beneficial to the prevention of dementia and its subtypes, AD as well as VD.

Moderated-mediation analysis of multimorbidity and health-related quality of life among the Chinese elderly: The role of functional status and cognitive function

OBJECTIVES

To investigate the relationship between multimorbidity and health-related quality of life (HRQoL), and explore the effects of functional status and cognitive function on Chinses elderly behind this relationship.

METHODS

The Multivariate logistic regression and Tobit regression models were used to determine the influence of multimorbidity on HRQoL. Bootstrap analysis was used to probe the mediating effects of functional status and the moderating role of cognition on multimorbidity and HRQoL.

RESULTS

Results of the 2,887 participants age  ≥ 60  years included in the analysis, 51.69% had chronic diseases. Stroke (β = -0.190; 95% confidence interval [CI], -0.232, -0.149; p < 0.001) and the combination of hypertension and stroke (β = -0.210; 95% CI, -0.259, -0.160; p < 0.001) had the greatest influence on HRQoL. Functional status partially mediated the relationship between the number of non-communicable diseases (No. of NCDs) and HRQoL, while cognitive function had a moderating effect not only in the A-path (No. of NCDs to functional status, β = 0.143; t = 7.18; p < 0.001) and but also in the C-path (No. of NCDs to HRQoL, β = 0.007; t = 6.08; p < 0.001).

CONCLUSION

Functional status partially mediated the relationship between multimorbidity and HRQoL in older adults. And cognitive function, if declined, may strengthen this relationship. These findings suggested that improving cognitive function and functional status in those who developed multimorbidity could be a viable prevention or treatment strategy to improve HRQoL in elderly patients.

Social participation and mild cognitive impairment in low- and middle-income countries

Social participation may theoretically decrease risk for mild cognitive impairment (MCI). However, to date, no study has specifically investigated the association between social participation and MCI in LMICs, while the mediating role of loneliness is unknown. Thus, we investigated this association in a sample of adults aged ≥50 years from six low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, South Africa) using nationally representative datasets. We analyzed cross-sectional, community-based data from the Study on Global Ageing and Adult Health. A social participation score (range 0-10 with higher scores corresponding to greater levels of social participation) was created based on nine questions about involvement in community activities in the last 12 months. The National Institute on Ageing-Alzheimer's Association criteria were used to define MCI. Multivariable logistic regression and mediation analysis was performed. The analytical sample consisted of 32,715 individuals aged ≥50 years with preserved functional abilities [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, after adjustment for potential confounders, a one-unit increase in the social participation score was associated with a 13% decrease in odds for MCI (OR = 0.87; 95%CI = 0.82-0.93). Loneliness only explained 3.0% of the association. Greater levels of social participation were associated with a reduced odds for MCI, and this was not largely explained by loneliness. It may be prudent to implement interventions in LMICs to increase levels of social participation to aid in the prevention of MCI and ultimately dementia.

Association between sarcopenia and quality of life among adults aged ≥ 65 years from low- and middle-income countries

BACKGROUND

Sarcopenia has been associated with a lower quality of life (QoL). However, studies on this association from low- and middle-income countries (LMICs) are scarce.

AIMS

To examine the association between sarcopenia and QoL, in a large nationally representative sample of older adults from six LMICs.

METHODS

Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Non-severe sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength but no slow gait speed, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression analysis was conducted.

RESULTS

Data on 14,585 people aged ≥ 65 years were analyzed [mean (SD) age 72.6 (11.5) years; 55.0% female]. After adjustment for potential confounders, compared to no sarcopenia, severe sarcopenia was associated with a significant - 3.37 points [95% CI - 5.56, - 1.18] lower QoL score. Non-severe sarcopenia was not significantly associated with lower QoL.

DISCUSSION

The association between sarcopenia and QoL observed in our study may be explained by factors such as functional impairment and disability related with sarcopenia.

CONCLUSIONS

In this large representative sample of older adults from multiple LMICs, compared to no sarcopenia, only severe sarcopenia was associated with a significantly lower QoL score. Interventions to prevent or manage sarcopenia among older adults in LMICs may contribute to better QoL in this population.

Patterns of multimorbidity and some psychiatric disorders: A systematic review of the literature

Objective

The presence of two or more chronic diseases results in worse clinical outcomes than expected by a simple combination of diseases. This synergistic effect is expected to be higher when combined with some conditions, depending on the number and severity of diseases. Multimorbidity is a relatively new term, with the first fundamental definitions appearing in 2015. Studies usually define it as the presence of at least two chronic medical illnesses. However, little is known regarding the relationship between mental disorders and other non-psychiatric chronic diseases. This review aims at investigating the association between some mental disorders and non-psychiatric diseases, and their pattern of association.

Methods

We performed a systematic approach to selecting papers that studied relationships between chronic conditions that included one mental disorder from 2015 to 2021. These were processed using Covidence, including quality assessment.

Results

This resulted in the inclusion of 26 papers in this study. It was found that there are strong associations between depression, psychosis, and multimorbidity, but recent studies that evaluated patterns of association of diseases (usually using clustering methods) had heterogeneous results. Quality assessment of the papers generally revealed low quality among the included studies.

Conclusions

There is evidence of an association between depressive disorders, anxiety disorders, and psychosis with multimorbidity. Studies that tried to examine the patterns of association between diseases did not find stable results.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021216101, identifier: CRD42021216101.

The Association Between Osteoarthritis with Risk of Dementia and Cognitive Impairment: A Meta-Analysis and Systematic Review

Background: The relationship between osteoarthritis (OA) and risk of dementia and cognitive impairment (CIM) has long been debated; however, uncertainties still persist. Objective: The aim of our present meta-analysis and systematic review was to roundly illuminate the association between OA and the risk of dementia and CIM. Methods: We identified relevant studies by searching PubMed, Embase, and Web of Science up to October 2021. The relative risk (RR) or odds ratio (OR) with 95% confidence interval (CI) were aggregated using random-effects methods. Credibility of each meta-analysis was assessed. Meta-regression and subgroup analyses were conducted. Publication bias was explored using funnel plot. Results: Of 21,925 identified literatures, 8 were eligible for inclusion in the systematic review and 19 observational studies involving 724,351 individuals were included in the meta-analysis. The risk of developing dementia and CIM among OA patients was demonstrated in 11 prospective studies (RR = 1.42, 95% CI = 1.07–1.86, I2 = 98.9%, p <  0.001), 2 retrospective cohort studies (RR = 1.35, 95% CI = 1.19–1.52, I2 = 61.0%, p = 0.109), 3 retrospective case-control studies (OR = 1.21, 95% CI = 0.96–1.53, I2 = 95.2%, p <  0.001), and 4 cross-sectional studies (OR = 1.51, 95% CI = 1.09–2.09, I2 = 75.8%, p = 0.006). Meta-regression analyses did not find any valid moderators. Heterogeneity in subgroup analyses for population age, OA location, year of publication, outcome type, adjusted for BMI, depression, and comorbidity decreased to zero. No significant evidence of publication bias was found. Conclusion: OA associated with an increased risk of dementia and CIM. Effective interventions in OA patients may decrease new incidence of dementia or CIM.

Association between cooking fuels and mild cognitive impairment among older adults from six low- and middle-income countries

There is a small body of evidence suggesting that unclean cooking fuel use may be associated with cognitive decline. However, to date, no study has investigated the association between unclean cooking fuel and mild cognitive impairment (MCI). Thus, we investigated the association between cooking fuel type or ventilation type and MCI among adults aged ≥ 65 years using nationally representative datasets from six low- and middle-income countries. Cross-sectional, community-based data from the World Health Organization (WHO) Study on global Ageing and adult health (SAGE) were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Unclean cooking fuel referred to kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass. Multivariable logistic regression analysis was conducted to assess associations. Data on 13,623 individuals were analyzed [mean (SD) age 72.8 (11.0) years; 45.5% males]. Unclean cooking fuel (vs. clean cooking fuel) was associated with a significant 1.48 (95% CI = 1.08–2.03) times higher odds for MCI. Having no chimney or hood for cooking ventilation was also associated with significantly higher odds for MCI (OR = 1.88; 95% CI = 1.25–2.84). Unclean cooking fuel use and lack of chimney or hood for cooking ventilation were associated with higher odds for MCI. Findings support the implementation of the United Nations Sustainable Goal 7, which advocates affordable, reliable, sustainable, and modern energy for all, as this may also help reduce MCI and ultimately dementia.

Sleep duration and sarcopenia in adults aged ≥ 65 years from low and middle-income countries

BACKGROUND

Sleep duration may influence risk for sarcopenia but studies on this topic are scarce, especially from low and- middle-income countries (LMICs). Thus, the aim of the present study was to investigate the association between sleep duration and sarcopenia among adults aged ≥ 65 years from five LMICs (China, Ghana, India, Russia, South Africa).

METHODS

Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. Self-reported sleep duration in the past two nights were averaged and classified as ≤ 6, > 6 to ≤ 9, and ≥ 9 h/day. Multivariable logistic regression analysis was conducted.

RESULTS

Data on 13,210 adults aged ≥ 65 years [mean (SD) age 72.6 (11.3) years; 55.0% females] were analyzed. In the overall sample, compared to > 6 to ≤ 9 h/day of sleep duration, > 9 h/day was associated with 1.70 (95% CI 1.15-2.51) and 1.75 (95% CI 1.08-2.84) times higher odds for sarcopenia and severe sarcopenia, respectively. No significant associations were observed among males, but associations were particularly pronounced among females [i.e., OR = 2.19 (95% CI 1.26-3.81) for sarcopenia, and OR = 2.26 (95% CI 1.20-4.23) for severe sarcopenia].

CONCLUSIONS

Long sleep duration was associated with an increased odds of sarcopenia and severe sarcopenia in LMICs, particularly in females. Future studies should investigate whether addressing long sleep duration among females can lead to lower risk for sarcopenia onset in LMICs.

Aging and hypertension among the global poor-Panel data evidence from Malawi

Hypertension is a rapidly growing disease burden among older persons in low-income countries (LICs) that is often inadequately diagnosed and treated. Yet, most LIC research on hypertension is based on cross-sectional data that does not allow inferences about the onset or persistence of hypertension, its correlates, and changes in hypertension as individuals become older. The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) is used to provide among the first panel analyses of hypertension for older individuals in a sub-Saharan LIC using blood pressure measurements obtained in 2013 and 2017. We find that high blood pressure is very common among mature adults aged 45+, and hypertension is more prevalent among older as compared to middle-aged respondents. Yet, in panel analyses for 2013-17, we find no increase in the prevalence of hypertension as individuals become older. Hypertension often persists over time, and the onset of hypertension is predicted by factors such as being overweight/obese, or being in poor physical health. Otherwise, however, hypertension has few socioeconomic predictors. There is also no gender differences in the level, onset or persistence in hypertension. While hypertension is associated with several negative health or socioeconomic consequences in longitudinal analyses, cascade-of-care analyses document significant gaps in the diagnosis and treatment of hypertension. Overall, our findings indicate that hypertension and related high cardiovascular risks are widespread, persistent, and often not diagnosed or treated in this rural sub-Saharan population of older individuals. Prevalence, onset and persistence of hypertension are common across all subgroups-including, importantly, both women and men. While age is an important predictor of hypertension risk, even in middle ages 45-55 years, hypertension is already widespread. Hypertension among adults aged 45+ in Malawi is thus more similar to a "generalized epidemic" than in high-income countries where cardiovascular risk has strong socioeconomic gradients.

Health-Related Predictors of Changes in Cognitive Status in Community-Dwelling Older Individuals

Given the rising numbers of older people living with dementia, this study focuses on identifying modifiable health-related factors associated with changes in cognitive status. The predictors of 1-year conversion from Preserved Cognitive Health (PCH) and Mild Cognitive Impairment (MCI) in older adults were evaluated. Two logistic regression models were performed on data from an Italian multicenter population-based study; both included sociodemographic factors, family history of dementia (FHD), risk behaviors, and depressive symptoms. The first model considered also disease clusters, while the second one included diseases' number and biochemical parameters. The sample involved 459 participants (61.4% women, median age 75 years). Of the 80 PCH individuals at baseline, after 1 year 35 (43.8%) were stable, 44 (55.0%) progressed to MCI, none to dementia, and one to unclassified status. Of the 379 MCI participants at baseline, after 1 year 281 (74.1%) remained stable, 38 (10.0%) reverted to PCH, 15 (4.0%) progressed to dementia, and 45 (11.9%) become unclassifiable. Hypertension/bone and joint diseases cluster was the only predictor of PCH progression to MCI; age and depression were associated with MCI progression to dementia; FHD was associated with MCI reversion to PCH. More diseases and fewer white blood cells were associated with MCI progression to dementia; more diseases and lower platelets were associated with the transition from MCI to unclassifiable; higher Na and lower TSH levels were associated with MCI reversion. The treatment or management of some chronic conditions and electrolyte imbalances may help attenuate cognitive deterioration in older adults with no or MCI.

Correlates of Adherence of Multimodal Non-pharmacological Interventions in Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study

Background

Non-pharmacological interventions are promising for delaying cognitive decline in older adults with mild cognitive impairment (MCI). Although some studies have demonstrated adherence rates and factors influencing participation in single modality non-pharmacological interventions, little is known about the level and correlates of adherence to multimodal non-pharmacological interventions (MNPIs) in older adults with MCI.

Objective

This study aimed to explore the adherence level and the correlates of adherence to MNPIs in older adults with MCI.

Methods

A cross-sectional design was employed. Community-dwelling older adults aged 60 years and over were recruited from senior community centers and healthcare centers in Huzhou from March 2019 to December 2020. Data were collected by a general information questionnaire and the adherence scale of cognitive dysfunction management (AS-CDM) in older adults with MCI. Hierarchical regression analyses were applied to explore the correlates of adherence to MNPIs.

Results

A total of 216 completed questionnaires were finally analyzed. Of these, 68.52% were female, and 45.4% of the participants had no less than 6 years of education. The overall mean score for adherence was 117.58 (SD = 10.51) out of 160, equivalent to 73.49 in the hundred-mark system, indicating a medium-level adherence to MNPIs in older adults with MCI. Of the five dimensions of adherence (AS-CDM), self-efficacy scored the highest, and the lowest was perceived barriers. The univariate analysis showed that the factors associated with the adherence to MNPIs were: regular physical exercise, meat-vegetable balance, absence of multimorbidity, high level of education, living alone, and living in urban (p < 0.05). In the hierarchical regression analysis, the final model explained 18.8% of variance in overall adherence (p < 0.01), which high school (Beta = 0.161, p < 0.05), college and above more (Beta = 0.171, p < 0.05), meat-vegetarian balance (Beta = 0.228, p < 0.05), regular physical exercise (Beta = 0.234, p < 0.05), and presence of multimorbidity (Beta = -0.128, p < 0.05) significantly contributed to adherence. In addition, nearly 80% of older adults with MCI preferred MNPIs.

Conclusion

Early assessment and management of adherence to MNPIs were essential in older adults with MCI. Furthermore, the findings shed light on several critical areas of intervention to improve adherence to MNPIs in older adults with MCI.

Clinical Trial Registration

http://www.chictr.org.cn/showproj.aspx?proj=35363, ChiCTR1900020950 (Registered on January 23, 2019).

Disability and cognitive impairment are interdependent in primary antiphospholipid syndrome

BACKGROUND

Cognitive impairment (CI) occurs at a high frequency in primary antiphospholipid syndrome (PAPS). Its psychosocial-related factors are of interest.

OBJECTIVE

We aimed to determine disability and perceived stress and their correlation with CI in PAPS.

METHODS

First study phase: a longitudinal study including patients with PAPS and paired controls for cardiovascular risk factors, age, and sex, determining CI with Montreal Cognitive Assessment (MoCA) and then repeating the measurement 1 year later. Second study phase: a cross-sectional analytical study by quantification of disability with the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and perceived stress with the Perceived Stress Scale (PSS-14). Descriptive statistics and Spearman correlation coefficient were used.

RESULTS

Sixty-three patients with PAPS and 60 controls were studied. In PAPS, age (range, 48.0 ± 13.5 years), thrombotic artery events (TAE) (44.4%), and stroke/TIA (42.8%) were found. Disability was documented in the majority of WHODAS 2.0 domains and the total score for this was higher in participation and mobility, the stress level was normal, and 65.1% had CI. PAPS exhibited greater deterioration in the WHODAS 2.0 total score (p .017) and the MoCA test (p < .0001). Personal domains and the total WHODAS 2.0 score correlated inversely with MoCA. Life activities (rho = -0.419) and self-care (rho = -0.407) were those that correlated to the greatest degree. Stroke conferred risk for CI.

CONCLUSIONS

Disability in PAPS and CI are interdependent. New treatment options and neurocognitive stimulation strategies are necessary to maintain functionality and prevent further cognitive dysfunction in PAPS patients.

Association of objective and subjective far vision impairment with perceived stress among older adults in six low- and middle-income countries

OBJECTIVES

To assess the association between far vision impairment (objective and subjective) and perceived stress among older adults from six low- and middle-income countries (LMICs, i.e., China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Data from the WHO Study on global AGEing and adult health were analyzed. Objective visual acuity was measured using the tumbling E LogMAR chart and was used as a four-category variable (no, mild, moderate, and severe visual impairment). Subjective visual impairment referred to difficulty in seeing and recognizing an object or a person across the road. Using two questions from the Perceived Stress Scale, a perceived stress variable was computed, and ranged from 0 (lowest stress) to 100 (highest stress). Multivariable linear regression with perceived stress as the outcome was conducted.

RESULTS

Data on 14,585 adults aged ≥65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Only severe objective visual impairment (versus no visual impairment) was significantly associated with higher levels of stress (b = 6.91; 95% CI = 0.94-12.89). In terms of subjective visual impairment, compared with no visual impairment, mild (b = 2.67; 95% CI = 0.56-4.78), moderate (b = 8.18; 95% CI = 5.84-10.52), and severe (b = 11.86; 95% CI = 9.11-14.61) visual impairment were associated with significantly higher levels of perceived stress.

CONCLUSIONS

This large study showed that far vision impairment was associated with increased perceived stress levels among older adults in LMICs. Increased availability of eye care services may reduce stress among those with visual impairment in LMICs, while more research is needed to better characterize the directionality of the far vision impairment-perceived stress relationship.

Physical multimorbidity and depression: A mediation analysis of influential factors among 34,129 adults aged ≥50 years from low- and middle-income countries

BACKGROUND

There is a scarcity of literature on the association between physical multimorbidity (i.e., ≥2 chronic physical conditions) and depression among older adults, especially from low- and middle-income countries (LMICs). In addition, the mediators in this association are largely unknown. Therefore, we aimed to examine this association among adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa), and to identify potential mediators.

METHODS

Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. Depression was defined as past-12 months DSM-IV depression or receiving depression treatment in the last 12 months. Information on 11 chronic physical conditions were obtained. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

Data on 34,129 individuals aged ≥50 years were analyzed [mean (SD) age 62.4 (16.0) years; maximum 114 years; 52.1% females]. Compared to no chronic conditions, 2, 3, 4, and ≥5 chronic conditions were associated with 2.55 (95% CI = 1.90-3.42), 3.12 (95% CI = 2.25-4.34), 5.68 (95% CI = 4.02-8.03), and 8.39 (95% CI = 5.87-12.00) times higher odds for depression. Pain/discomfort (% mediated 39.0%), sleep/energy (33.2%), mobility (27.5%), cognition (13.8%), perceived stress (7.3%), disability (6.7%), loneliness (5.5%), and food insecurity (1.5%) were found to be significant mediators in the association between physical multimorbidity and depression.

CONCLUSIONS

Older adults with physical multimorbidity are at increased odds of depression in LMICs. Future studies should assess whether addressing the identified potential mediators in people with physical multimorbidity can lead to reduction in depression in this population.

Effects of Changes in Multiple Chronic Conditions on Medical Costs among Older Adults in South Korea

This study aims to analyze the relationship between cognitive function and out-of-pocket cost of the state change of multiple chronic conditions in individuals aged 60 or older. Data from the 2014 to 2018 Korean Longitudinal Study of Aging were used for 2202 older adults who were cognitively “normal” at the start of the survey. Four status change groups were established (“Good → Good,” “Good → Bad,” “Bad → Good,” and “Bad → Bad”) according to the change in the number of chronic diseases. Generalized estimating equation modeling analyzed the association between these changes and out-of-pocket medical cost. Out-of-pocket cost was significantly higher among older adults with multiple chronic conditions (p < 0.0001). Total out-of-pocket medical cost and out-of-pocket cost for outpatient care and prescription drugs were significantly higher for Bad→ Bad or Good → Bad changes. Older adults with cognitive decline had significantly higher total out-of-pocket medical cost and out-of-pocket cost for prescription drugs. This study demonstrates the need to improve the multiple chronic conditions management construction model to enhance the health of older adults in Korea and secure national health care finances long-term. It provides a foundation for related medical and medical expenses-related systems.

Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study

OBJECTIVE

To examine the association of midlife and late life multimorbidity, including severity of multimorbidity, with incident dementia.

DESIGN

Prospective cohort study.

SETTING

Civil service departments in London (Whitehall II study, study inception in 1985-88).

PARTICIPANTS

10 095 participants, aged 35 to 55 at baseline.

MAIN OUTCOME MEASURE

Incident dementia at follow-up between 1985 and 2019. Cause specific Cox proportional hazards regression was used to examine the association of multimorbidity overall and at age 55, 60, 65, and 70 with subsequent dementia, taking into account the competing risk of death.

RESULTS

The prevalence of multimorbidity (≥2 chronic diseases) was 6.6% (655/9937) at age 55 and 31.7% (2464/7783) at age 70; 639 cases of incident dementia occurred over a median follow-up of 31.7 years. After adjustment for sociodemographic factors and health behaviours, multimorbidity at age 55 was associated with subsequent risk of dementia (difference in incidence rate per 1000 person years 1.56, 95% confidence interval 0.62 to 2.77; hazard ratio 2.44, 95% confidence interval 1.82 to 3.26). The association weakened progressively with older age at onset of multimorbidity. At age 65, onset of multimorbidity before age 55 was associated with 3.86 (1.80 to 6.52) per 1000 person years higher incidence of dementia (hazard ratio 2.46, 1.80 to 2.26) and onset between 60 and 65 was associated with 1.85 (0.64 to 3.39) per 1000 person years higher incidence (1.51, 1.16 to 1.97). Severity of multimorbidity (≥3 chronic diseases) at age 55 was associated with a 5.22 (1.14 to 11.95) per 1000 person years higher incidence of dementia (hazard ratio 4.96, 2.54 to 9.67); the same analyses at age 70 showed 4.49 (2.33 to 7.19) per 1000 person years higher incidence (1.65, 1.25 to 2.18).

CONCLUSION

Multimorbidity, particularly when onset is in midlife rather than late life, has a robust association with subsequent dementia. The increasingly younger age at onset of multimorbidity makes prevention of multimorbidity in people with a first chronic disease important.

Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis

INTRODUCTION

Multimorbidity is a major public health challenge, with a rising prevalence in low/middle-income countries (LMICs). This review aims to systematically synthesise evidence on the prevalence, patterns and factors associated with multimorbidity of non-communicable diseases (NCDs) among adults residing in LMICs.

METHODS

We conducted a systematic review and meta-analysis of articles reporting prevalence, determinants, patterns of multimorbidity of NCDs among adults aged >18 years in LMICs. For the PROSPERO registered review, we searched PubMed, EMBASE and Cochrane libraries for articles published from 2009 till 30 May 2020. Studies were included if they reported original research on multimorbidity of NCDs among adults in LMICs.

RESULTS

The systematic search yielded 3272 articles; 39 articles were included, with a total of 1 220 309 participants. Most studies used self-reported data from health surveys. There was a large variation in the prevalence of multimorbidity; 0.7%-81.3% with a pooled prevalence of 36.4% (95% CI 32.2% to 40.6%). Prevalence of multimorbidity increased with age, and random effect meta-analyses showed that female sex, OR (95% CI): 1.48, 1.33 to 1.64, being well-off, 1.35 (1.02 to 1.80), and urban residence, 1.10 (1.01 to 1.20), respectively were associated with higher odds of NCD multimorbidity. The most common multimorbidity patterns included cardiometabolic and cardiorespiratory conditions.

CONCLUSION

Multimorbidity of NCDs is an important problem in LMICs with higher prevalence among the aged, women, people who are well-off and urban dwellers. There is the need for longitudinal data to access the true direction of multimorbidity and its determinants, establish causation and identify how trends and patterns change over time.

PROSPERO REGISTRATION NUMBER

CRD42019133453.

Fruit and Vegetable Intake and Non-Communicable Diseases among Adults Aged ≥50 Years in Low- and Middle-Income Countries

OBJECTIVES

The relationship between consuming ≥2 servings of fruits and ≥3 servings of vegetables a day, which has been identified as optimal for health (i.e., adequate fruit/vegetable consumption), and non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is largely unknown. Therefore, using data from six LMICs, we investigated the independent association between inadequate fruit/vegetable consumption and 12 NCDs, and estimated the prevalence of inadequate fruit/vegetable consumption among people with NCDs.

DESIGN AND SETTING

Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed.

PARTICIPANTS

Data on 34129 individuals aged ≥50 years were analyzed [mean (SD) age 62.4 (16.0); maximum age 114 years; 52.1% females].

MEASUREMENTS

Information on the number of servings of fruits and vegetables consumed on a typical day was self-reported. Twelve NCDs were assessed. Multivariable logistic regression analysis was conducted.

RESULTS

Overall, 67.2% had inadequate fruit/vegetable consumption. Inadequate fruit/vegetable consumption was independently associated with significantly higher odds for chronic lung disease (OR=1.25), diabetes (OR=1.45), hearing problems (OR=1.75), and visual impairment (OR=2.50). The prevalence of inadequate fruit/vegetable consumption was particularly high among people with visual impairment (92.5%), depression (90.5%), asthma (79.8%), and hearing problems (78.4%).

CONCLUSION

Promotion of fruit and vegetable consumption (≥2 servings of fruits and ≥3 servings of vegetables a day) in LMICs may lead to prevention of some NCDs (e.g., diabetes, chronic lung disease). Furthermore, people with certain NCDs (e.g., visual impairment, depression) had particularly high prevalence of inadequate fruit/vegetable consumption, and it is thus important to target this population to increase fruit/vegetable consumption.

Caminho na rede formal de cuidado em saúde de pacientes pós-alta hospitalar segundo multimorbidade

Introdução: A gestão de informações associadas à multimorbidade na atenção hospitalar é relevante para o planejamento de estratégias de prevenção de agravos à saúde em pacientes de maior risco, a fim de oportunizar a organização de sistemas de saúde de modo eficiente. Objetivo: O presente trabalho objetivoudelinear o caminho formal percorrido por pacientes com e sem multimorbidade, considerando o uso da rede pública de saúde após a internação hospitalar. Materiais e métodos: Realizou-se um estudo quantitativo, transversal, descritivo, utilizando dados primários de 445 pacientes internados em um hospital universitário, no ano de 2018. Os dados foram coletados através de análise do prontuário médico e entrevista telefônica. Os resultados foram analisados por meio de frequência absoluta e relativa. Resultados: Desenvolveu-se um fluxograma, representando os pontos da rede de saúde utilizados pelo paciente após a alta hospitalar, segundo multimorbidade. Verificou-se uma alta prevalência de encaminhamento (com multimorbidade (CM) 93,52%; sem multimorbidade (SM) 97,71%) e comparecimento na atenção secundária à saúde (CM 86,15%; SM 89,63%), um baixo encaminhamento (CM 42,45%; SM 36,27%) e comparecimento na atenção primária à saúde (CM 61,29%; SM 64,81%), e considerando os 3 níveis de atenção juntos, houve um baixo comparecimento (CM 17,98%; SM 21,89%) para ambos os grupos investigados. Discussão: Entende-se que a semelhança de comparecimento em todos os pontos da rede por ambos os grupos é um problema, por tratar de forma igual populações desiguais e consequentemente com necessidades diversas. Conclusões: Sinaliza-se a importância de maior incentivo ao acompanhamento de pacientes com multimorbidade na rede primária de saúde, especialmente no período de pós-alta hospitalar, e a necessidade de fortalecimento da Rede de Atenção à Saúde.

The Association of Objective and Subjective Vision Impairment With Self-Reported Time Spent in Sedentary Behaviors in Low- and Middle-Income Countries

BACKGROUND

There is a scarcity of studies on the relationship between visual impairment (VI) and time spent in sedentary behavior (SB), especially from low- and middle-income countries (LMICs). Thus, we investigated the association of objectively and subjectively measured VI with SB in adults aged ≥18 years across 6 LMICs.

METHODS

Cross-sectional data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Objective and subjective visual acuity were measured. Information on self-reported SB was also collected. Multivariable multinomial logistic regression analysis was conducted to assess associations with time spent in SB as the outcome.

RESULTS

The sample consisted of 42,489 individuals (mean age = 43.8 [14.4] y; 50.1% females). Only severe objective VI (vs no VI) was significantly associated with ≥11 hours per day of SB (vs <4 h/d) (odds ratio = 4.50; 95% confidence interval, 1.57-12.92). Increasing severity of subjective VI was associated with greater odds for ≥8 hours per day of SB (vs <4 h/d) dose dependently.

CONCLUSIONS

The present study identified an association of both objectively and subjectively measured VI with time spent in SB in adults residing in LMICs, with subjectively measured VI being a stronger predictor of time spent in SB. Targeted interventions to decrease SB especially in those who perceive themselves to have VI are needed in LMICs.

Body Mass Index and Mild Cognitive Impairment Among Middle-Aged and Older Adults from Low- and Middle-Income Countries

BACKGROUND

The effect of weight modification on future dementia risk is currently a subject of debate and may be modified by age.

OBJECTIVE

The aim of the present study was to investigate the association between body mass index (BMI) status with mild cognitive impairment (MCI) (a preclinical stage of dementia) in middle-aged and older adults residing in six low- and middle-income countries using nationally representative data.

METHODS

Cross-sectional data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. BMI (kg/m2) was based on measured weight and height and categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

RESULTS

Data on 32,715 individuals aged ≥50 years with preservation in functional abilities were analyzed [mean (SD) age 62.1 (15.6) years; 51.7% females]. Among those aged 50-64 years, compared to normal weight, underweight (OR = 1.44; 95% CI = 1.14-1.81), overweight (OR = 1.17; 95% CI = 1.002-1.37), and obesity (OR = 1.46; 95% CI = 1.09-1.94) were all significantly associated with higher odds for MCI. In those aged ≥65 years, underweight (OR = 0.71; 95% CI = 0.54-0.95) and overweight (OR = 0.72; 95% CI = 0.55-0.94) were associated with significantly lower odds for MCI, while obesity was not significantly associated with MCI.

CONCLUSION

The results of the study suggest that the association between BMI and MCI is likely moderated by age. Future longitudinal studies are required to confirm or refute the present findings before recommendations for policy and practice can be made.

Traditional Chinese Mind-Body Exercise Baduanjin Modulate Gray Matter and Cognitive Function in Older Adults with Mild Cognitive Impairment: A Brain Imaging Study

Background:

Previous studies found traditional Chinese mind-body exercise Baduanjin could modulate cognition of community older adults.

Objective:

This study aims to investigate the effect of 6 months of Baduanjin exercise on brain structure and cognitive function in older adults with mild cognitive impairment (MCI).

Methods:

The MCI older adults were randomly assigned into either Baduanjin training, brisk walking training or usual physical activity control group. Magnetic Resonance Imaging (MRI), Montreal Cognitive Assessment (MoCA) and Wechsler Memory Scale-Chinese Revised (WMS-CR) were applied to measure gray matter volume (GMV), global cognitive ability and memory at baseline and end of intervention.

Results:

Compared to usual physical activity, Baduanjin exercise significantly improved MoCA, WMS-CR scores, WMS-MQ, and mental control and comprehension memory subscores of the WMS-CR; significantly increased the GMV in the temporal gyrus, frontal gyrus, parietal gyrus, medial occipital gyrus, cingulate gyrus and angular gyrus after 6 months of intervention. Compared to brisk walking, Baduanjin significantly improved MoCA scores and picture reproduction subscores of memory, and significantly increased the GMV in the right frontal gyrus, precentral gyrus, occipital gyrus. Furthermore, the increased GMV in the right medial temporal gyrus was significantly associated with improvement in the MoCA scores.

Conclusion:

The present study suggested that regular Baduanjin training could have a positive effect in increasing brain gray matter and improving cognitive function in older adults with MCI.

Objectively measured far vision impairment and sarcopenia among adults aged ≥ 65 years from six low- and middle-income countries

BACKGROUND

There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65 years and over from six low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression.

RESULTS

Fourteen thousand five hundred and eighty five individuals aged ≥ 65 years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar.

CONCLUSIONS

The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.

The association between objective vision impairment and mild cognitive impairment among older adults in low- and middle-income countries

AIM

The association between visual impairment and mild cognitive impairment (MCI) has not been investigated to date. Thus, we assessed this association among older adults from six low- and middle-income countries (LMICs) (China, India, Ghana, Mexico, Russia, and South Africa) using nationally representative datasets.

METHODS

Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Visual acuity was measured using the tumbling ElogMAR chart, and vision impairment (at distance and near) was defined as visual acuity worse than 6/18 (0.48 logMAR) in the better-seeing eye. The definition of MCI was based on the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression was conducted.

RESULTS

Data on 32,715 individuals aged ≥ 50 years [mean (SD) age 62.1 (15.6) years; 51.2% females] were analyzed. Compared to those without far or near vision impairment, those with near vision impairment but not far vision impairment (OR = 1.33; 95% CI = 1.16-1.52), and those with both far and near vision impairment (OR = 1.70; 95% CI = 1.27-2.29) had significantly higher odds for MCI. Only having far vision impairment was not significantly associated with MCI.

CONCLUSIONS

Visual impairment is associated with increased odds for MCI among older adults in LMICs with the exception of far vision impairment only. Future longitudinal and intervention studies should examine causality and whether improvements in visual acuity, or early intervention, can reduce risk for MCI and ultimately, dementia.

Prevalence of mild cognitive impairment in patients with hypertension: a systematic review and meta-analysis

Mild cognitive impairment (MCI) is common in patients with hypertension. Prevalence estimates of MCI in hypertensive patients are needed to guide both public health and clinical decision making. A literature search was conducted in four databases, including PubMed, Embase, Cochrane Library, and Web of Science, from their inception to February 2021. The methodological quality assessment used the risk of bias tool. The pooled prevalence of MCI in hypertensive patients was determined by a random-effects model. Heterogeneity was explored using sensitivity analysis, subgroup analysis, and random effects meta-regression. Of 2314 references, 11 studies (47,179 participants) were included in the meta-analysis. The overall pooled prevalence of MCI in patients with hypertension was 30% (95% CI, 25-35), with significant heterogeneity present (I² = 99.3%, p < 0.001). In subgroup analyses, Asian and European samples had a prevalence of 26% (95% CI, 20-31) and 40% (95% CI, 14-66), respectively; cross-sectional and cohort studies had a prevalence of 28% (95% CI, 24-32) and 38% (95% CI, -5-81); age older than 60 years had a prevalence of 28% (95% CI, 23-33); community-based and clinic-based samples had a prevalence of 17% (95% CI, 15-19) and 42% (95% CI, 23-62); and MCI diagnosis using the MoCA, NIA-AA, MMSE, and Peterson criteria had a prevalence of 64% (95% CI, 59-68), 18% (95% CI, 16-19), 19% (95% CI, 15-23), and 13% (95% CI, 9-17). Meta-regression analysis showed that different MCI diagnostic criteria could be the source of heterogeneity in the pooled results. MCI is common in patients with hypertension, with an overall prevalence of 30%. Earlier cognitive screening and management in hypertensive patients should be advocated.