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Eyre HA, Stirland LE, Jeste DV, Reynolds CF, Berk M, Ibanez A, Dawson WD, Lawlor B, Leroi I, Yaffe K, Gatchel JR, Karp JF, Newhouse P, Rosand J, Letourneau N, Bayen E, Farina F, Booi L, Devanand DP, Mintzer J, Madigan S, Jayapurwala I, Wong STC, Falcoa VP, Cummings JL, Reichman W, Lock SL, Bennett M, Ahuja R, Steffens DC, Elkind MSV, Lavretsky H. Life-Course Brain Health as a Determinant of Late-Life Mental Health: American Association for Geriatric Psychiatry Expert Panel Recommendations. Am J Geriatr Psychiatry 2023; 31:1017-1031. [PMID: 37798224 PMCID: PMC10655836 DOI: 10.1016/j.jagp.2023.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities. Furthermore, our statement underscores the significance of prevention, early detection, and intervention in identifying cognitive decline, mood changes, and related mental illness. Action should also be taken to understand and address the needs of communities that traditionally have unequal access to preventive health information and services. By implementing culturally relevant and tailored evidence-based practices and advancing research in geriatric psychiatry, behavioral neurology, and geroscience, we can enhance the quality of life for older adults facing the unique challenges of aging. This position statement emphasizes the intrinsic link between brain health and mental health in aging, urging healthcare professionals, policymakers, and a broader society to prioritize comprehensive strategies that safeguard and promote brain health from birth through later years across all communities. The AAGP Expert Panel has the goal of launching further activities in the coming months and years.
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Affiliation(s)
- Harris A Eyre
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University (HAE), Houston, TX; Meadows Mental Health Policy Institute (HAE), Dallas, TX; Euro-Mediterranean Economists Association (HAE), Barcelona, Spain; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine (HAE), Houston, TX; Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center (HAE), Houston, TX; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Trinity College Dublin (HAE), Dublin, Ireland; FondaMental Fondation (HAE), Paris, France; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez (HAE, AI), Santiago de Chile, Chile; Houston Methodist Behavioral Health, Houston Methodist Academic Institute (HAE), Houston, TX.
| | - Lucy E Stirland
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh (LES), Edinburgh, UK
| | - Dilip V Jeste
- Global Research Network on Social Determinants of Mental Health and Exposomics (DVJ), La Jolla, CA
| | - Charles F Reynolds
- Department of Psychiatry, The University of Pittsburgh (CFR), Pittsburgh, PA
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne (MB), Parkville, Victoria, Australia; The Florey Institute for Neuroscience and Mental Health, University of Melbourne (MB), Parkville, Victoria, Australia; ORYGEN Youth Health, University of Melbourne (MB), Parkville, Victoria, Australia
| | - Agustin Ibanez
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez (HAE, AI), Santiago de Chile, Chile; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET) (AI), Buenos Aires, Argentina
| | - Walter D Dawson
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Oregon Alzheimer's Disease Research Center, School of Medicine, Oregon Health & Science University (WDD), Portland, OR; Institute on Aging, College of Urban & Public Affairs, Portland State University (WDD), Portland, OR
| | - Brian Lawlor
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA
| | - Iracema Leroi
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco (KY), San Francisco, CA; Department of Psychiatry and Neurology, University of California, San Francisco (KY), San Francisco, CA
| | - Jennifer R Gatchel
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School (JRG), Belmont, MA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School (JRG), Boston, MA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona (JFK), Tucson, AZ
| | - Paul Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center (PN), Nashville, TN; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs-Tennessee Valley Health Care System (PN), Nashville, TN
| | - Jonathan Rosand
- McCance Center for Brain Health, Department of Neurology, Mass General Brigham (JR), Boston, MA; Broad Institute of MIT and Harvard (JR), Cambridge, MA
| | - Nicole Letourneau
- Alberta Children's Hospital Research Institute, University of Calgary (NL), Calgary, Alberta, Canada
| | - Eleonore Bayen
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Department of Physical and Rehabilitation Medicine, Sorbonne Université - Pitié-Salpêtrière Hospital (EB), Paris, France
| | - Francesca Farina
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University (FF), Chicago, IL
| | - Laura Booi
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Centre for Dementia Research, School of Health, Leeds Beckett University (LB), Leeds, UK
| | - Devangere P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University (DPD), New York, NY
| | - Jacobo Mintzer
- Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina (JM), Charleston, SC
| | - Sheri Madigan
- University of Calgary (SM), Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute (SM), Calgary, Alberta, Canada
| | | | - Stephen T C Wong
- T.T. and W.F. Chao Center for BRAIN Houston Methodist Hospital (STCW), Houston, TX; Houston Methodist Cancer Center, Houston Methodist Hospital (STCW), Houston, TX; Department of Radiology, Weill Cornell Medicine (STCW), New York, NY; Department of Neurosciences, Weill Cornell Medicine (STCW), New York, NY; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine (STCW), New York, NY
| | - Veronica Podence Falcoa
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Hospital Beatriz Angelo (VPF), Lisbon, Portugal
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, University of Nevada (JLC), Las Vegas, NV
| | - William Reichman
- Department of Psychiatry, Faculty of Medicine, University of Toronto (WR), Toronto, Ontario, Canada
| | - Sarah Lenz Lock
- Global Council on Brain Health, Policy and Brain Health, AARP (SLL), Washington, DC
| | - Marc Bennett
- School of Psychology, University College Dublin (MB), Belfield, Dublin, Ireland; MRC-Cognition and Brain Sciences Unit, University of Cambridge (MB), England, UK
| | - Rajiv Ahuja
- Center for the Future of Aging, The Milken Institute (RA), Washington, DC
| | - David C Steffens
- Department of Psychiatry, University of Connecticut School of Medicine (DCS), Farmington, CT
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University (MSVE), New York City, NY; American Heart Association/American Stroke Association (MSVE), Dallas, TX
| | - Helen Lavretsky
- David Geffen School of Medicine, University of California, Los Angeles (UCLA) (HL), Los Angeles, CA; Semel Institute for Neuroscience and Human Behavior, UCLA (HL), Los Angeles, CA
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Farina FR, Regan J, Marquez M, An H, O'Loughlin P, Pavithra P, Taddeo M, Knight RC, Bennett M, Lenaert B, Griffith JW. Reducing fear and avoidance of memory loss improves mood and social engagement in community-based older adults: a randomized trial. BMC Geriatr 2023; 23:786. [PMID: 38030988 PMCID: PMC10688470 DOI: 10.1186/s12877-023-04470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life. METHODS Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up). RESULTS Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants' ability to participate in social activities and well-being were also observed. CONCLUSIONS Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04821960 .
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Affiliation(s)
- Francesca R Farina
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
| | - John Regan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Melissa Marquez
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Hosanna An
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | | | | | - Michelle Taddeo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Rachel C Knight
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Marc Bennett
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Bert Lenaert
- Faculty of Psychology, Open University, Heerlen, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
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Gregory S, Booi L, Jenkins N, Bridgeman K, Muniz-Terrera G, Farina FR. Hormonal contraception and risk for cognitive impairment or Alzheimer's disease and related dementias in young women: a scoping review of the evidence. Front Glob Womens Health 2023; 4:1289096. [PMID: 38025979 PMCID: PMC10679746 DOI: 10.3389/fgwh.2023.1289096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Women are significantly more likely to develop Alzheimer's disease and related dementias (ADRD) than men. Suggestions to explain the sex differences in dementia incidence have included the influence of sex hormones with little attention paid to date as to the effect of hormonal contraception on brain health. The aim of this scoping review is to evaluate the current evidence base for associations between hormonal contraceptive use by women and non-binary people in early adulthood and brain health outcomes. Methods A literature search was conducted using EMBASE, Medline and Google Scholar, using the keywords "hormonal contraception" OR "contraception" OR "contraceptive" AND "Alzheimer*" OR "Brain Health" OR "Dementia". Results Eleven papers were identified for inclusion in the narrative synthesis. Studies recruited participants from the UK, USA, China, South Korea and Indonesia. Studies included data from women who were post-menopausal with retrospective data collection, with only one study contemporaneously collecting data from participants during the period of hormonal contraceptive use. Studies reported associations between hormonal contraceptive use and a lower risk of ADRD, particularly Alzheimer's disease (AD), better cognition and larger grey matter volume. Some studies reported stronger associations with longer duration of hormonal contraceptive use, however, results were inconsistent. Four studies reported no significant associations between hormonal contraceptive use and measures of brain health, including brain age on MRI scans and risk of AD diagnosis. Discussion Further research is needed on young adults taking hormonal contraceptives, on different types of hormonal contraceptives (other than oral) and to explore intersections between sex, gender, race and ethnicity. Systematic Review Registration https://doi.org/10.17605/OSF.IO/MVX63, identifier: OSF.io: 10.17605/OSF.IO/MVX63.
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Affiliation(s)
- Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Booi
- Memory and Aging Center, Global Brain Health Institute, Trinity College, Dublin, Ireland
- Centre for Dementia Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Natalie Jenkins
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Katie Bridgeman
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Ohio University Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
| | - Francesca R. Farina
- Memory and Aging Center, Global Brain Health Institute, Trinity College, Dublin, Ireland
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Farina FR, Booi L, Occhipinti JA, Quoidbach V, Destrebecq F, Muniz-Terrera G, Eyre HA. Young Adult Brain Capital: A New Opportunity for Dementia Prevention. J Alzheimers Dis 2023:JAD230260. [PMID: 37302036 DOI: 10.3233/jad-230260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The potential for future prevention of Alzheimer's disease and related dementias (ADRD) through healthy lifestyle change is spurring a positive brain health movement. However, most ADRD research continues to focus on mid- and later life. We lack evidence regarding risk exposure and protective factors in young adulthood, i.e., 18-39 years. Brain capital is an emerging framework that represents the combination of education, knowledge, skills, and optimal brain health that people accumulate over their lives. Building on this framework, we present a new model that focuses on optimizing brain health in young adulthood; namely, young adult brain capital. Increasing focus on younger populations is critical for developing citizens who are emotionally intelligent, resilient and can anticipate and cope with rapid changes in the world. By understanding the values that are key drivers and motivators for young adults, we can empower the next generation to become active agents in optimizing their brain health and reducing their risk for future ADRD.
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Affiliation(s)
- Francesca R Farina
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
| | - Laura Booi
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
- Centre for Dementia Research, School of Health, Leeds Beckett University, Leeds, UK
| | - Jo-An Occhipinti
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Vinciane Quoidbach
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Frédéric Destrebecq
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Graciela Muniz-Terrera
- Ohio University Heritage College of Osteopathic Medicine, Warrensville Heights, OH, USA
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Harris A Eyre
- Global Brain Health Institute, Trinity College, Dublin, Ireland and University of California, USA
- Mental Wealth Initiative, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Australia
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Neuroscience-Inspired Policy Initiative, Organisation for Economic Co-operation and Development (OECD), Paris, France
- Center for Health and Bioscience, The Baker Institute for Public Policy, Rice University, Houston, TX, USA
- Meadows Mental Health Policy Institute, Dallas, TX, USA
- Euro-Mediterranean Economists Association, Barcelona, Catalonia, Spain
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
- Brain Capital Alliance, San Francisco, CA, USA
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