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Chen S, Underwood BR, Cardinal RN, Chen X, Chen S, Amin J, Jin H, Huang J, Mueller C, Yan LL, Brayne C, Kuper H. Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004-2019). BMC Med 2024; 22:268. [PMID: 38926751 PMCID: PMC11210022 DOI: 10.1186/s12916-024-03464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England. METHODS We used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES). RESULTS The overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004-2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004-2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased. CONCLUSIONS In England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.
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Affiliation(s)
- Shanquan Chen
- International Centre for Evidence in Disability, London, School of Hygiene & Tropical Medicine , London, WC1E 7HT, UK.
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Rudolf N Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Xi Chen
- School of Public Health, Yale University, New Haven, CT, USA
| | - Shu Chen
- The ARC Centre of Excellence in Population Ageing Research (CEPAR), School of Risk and Actuarial Studies, University of New South Wales, Sydney, Australia
| | - Jay Amin
- Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Huajie Jin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
- Institute for Global Health and Development, Peking University , Beijing, China
| | - Christoph Mueller
- King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lijing L Yan
- Institute for Global Health and Development, Peking University , Beijing, China
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- School of Public Health, Wuhan University, Wuhan, China
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Carol Brayne
- Institute of Public Health, Forvie Site, University of Cambridge, Cambridge, CB2 2SR, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London, School of Hygiene & Tropical Medicine , London, WC1E 7HT, UK
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Huang X, Hilal S. Marital History and Cognition in a Chinese Longevity Cohort. J Alzheimers Dis 2024:JAD240176. [PMID: 38943391 DOI: 10.3233/jad-240176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Background Marital factor has been associated with dementia and Alzheimer's disease, but there is limited evidence on the impact of holistic marital history over time. Objective This study aimed to examine association of marital history with cognition. Methods The study included 24,596 dementia-free participants from the Chinese Longitudinal Healthy Longevity Study (CLHLS). Holistic marital history was collected at baseline, categorizing participants into five groups: widow-single, widow-remarried, divorce-single, divorce-remarried and married based on the first two marriages. Dementia was collected at follow-up through self-report or from a delegate if the participant was deceased. For 15,355 participants, the Chinese Mini-Mental Status Examination (CMMSE) was administered at both baseline and follow-ups. Cognitive impairment was defined as a follow-up CMMSE score below 18, and rate of cognitive change was calculated as the change in CMMSE score between consecutive visits divided by the duration. Results Compared with married older adults, widow-single group had significantly higher risk of dementia (HR 1.28, 95% CI 1.05, 1.54), cognitive impairment (HR 1.31, 95% CI 1.17, 1.47) and significantly faster decline of MMSE score (β -0.09, 95% CI -0.17, -0.01). Meanwhile, widow-remarried group had significantly lower risk of dementia, cognitive impairment and slower MMSE score decline than widow-single group, although the differences were only significant among female but not male. Conclusions In this prospective cohort, married older adults and those widowed but with a second marriage had significantly better cognition than widowed individuals who did not remarry.
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Affiliation(s)
- Xiangyuan Huang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
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Ma L, Tan ECK, Bush AI, Masters CL, Goudey B, Jin L, Pan Y, Group AR. Elucidating the Link Between Anxiety/Depression and Alzheimer's Dementia in the Australian Imaging Biomarkers and Lifestyle (AIBL) Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00266-w. [PMID: 38896210 DOI: 10.1007/s44197-024-00266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The associations between mood disorders (anxiety and depression) and mild cognitive impairment (MCI) or Alzheimer's dementia (AD) remain unclear. METHODS Data from the Australian Imaging, Biomarker & Lifestyle (AIBL) study were subjected to logistic regression to determine both cross-sectional and longitudinal associations between anxiety/depression and MCI/AD. Effect modification by selected covariates was analysed using the likelihood ratio test. RESULTS Cross-sectional analysis was performed to explore the association between anxiety/depression and MCI/AD among 2,209 participants with a mean [SD] age of 72.3 [7.4] years, of whom 55.4% were female. After adjusting for confounding variables, we found a significant increase in the odds of AD among participants with two mood disorders (anxiety: OR 1.65 [95% CI 1.04-2.60]; depression: OR 1.73 [1.12-2.69]). Longitudinal analysis was conducted to explore the target associations among 1,379 participants with a mean age of 71.2 [6.6] years, of whom 56.3% were female. During a mean follow-up of 5.0 [4.2] years, 163 participants who developed MCI/AD (refer to as PRO) were identified. Only anxiety was associated with higher odds of PRO after adjusting for covariates (OR 1.56 [1.03-2.39]). However, after additional adjustment for depression, the association became insignificant. Additionally, age, sex, and marital status were identified as effect modifiers for the target associations. CONCLUSION Our study provides supportive evidence that anxiety and depression impact on the evolution of MCI/AD, which provides valuable epidemiological insights that can inform clinical practice, guiding clinicians in offering targeted dementia prevention and surveillance programs to the at-risk populations.
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Affiliation(s)
- Liwei Ma
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, Victoria, 3052
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - Edwin C K Tan
- Faculty of Medicine and Health, The University of Sydney School of Pharmacy, The University of Sydney, Camperdown, New South Wales, 2050, Australia
| | - Ashley I Bush
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, Victoria, 3052
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, Victoria, 3052
| | - Benjamin Goudey
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - Liang Jin
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, Victoria, 3052.
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, 3052, Australia.
| | - Yijun Pan
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, Victoria, 3052.
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, 3052, Australia.
- Department of Organ Anatomy, Graduate School of Medicine, Tohoku University, Sendai, 980-8575, Miyagi, Japan.
| | - Aibl Research Group
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, Victoria, 3052
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Birmingham WC, Herr RM, Cressman M, Patel N, Hung M. While You Are Sleeping: Marital Ambivalence and Blunted Nocturnal Blood Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:723. [PMID: 38928969 PMCID: PMC11204195 DOI: 10.3390/ijerph21060723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Marital relationships offer health benefits, including a lower risk of cardiovascular disease (CVD). However, quality of the relationship matters; ambivalent behaviors may increase CVD risk by affecting blunted nocturnal blood pressure (BP) dipping. This study tracked daytime and nocturnal SBP and DBP in 180 normotensive individuals (90 couples; participant mean age 25.04; 91.58% white) over a 24 h period using ambulatory blood pressure monitors to explore the impact of martial quality. Results showed that perceptions of spousal ambivalence were associated with blunted nocturnal BP dipping. Perceptions of one's own behavior as ambivalent also showed blunted nocturnal dipping. When in an ambivalent relationship, a gender interaction was found such that women were most likely to have blunted SBP dipping, but men were more likely to have blunted nocturnal DBP dipping. Overall, this study found an association between ambivalence and BP dipping, thus uncovering one virtually unexplored pathway by which marital relationships may have adverse effects on health.
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Affiliation(s)
| | - Raphael M. Herr
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Mikel Cressman
- Psychology Department, Brigham Young University, Provo, UT 84602, USA;
| | - Neha Patel
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA (M.H.)
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA (M.H.)
- Department of Orthopedic Surgery Operations, University of Utah, Salt Lake City, UT 84108, USA
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Enderami A, Rashedi V, Malakouti SK, Shariati B, Birgani NF, Gharaeipour M, Kodan Z, Pourshams M. Dementia prevalence among hospitalized older patients: a multicenter study in Iran. Dement Neuropsychol 2024; 18:e20230083. [PMID: 38469122 PMCID: PMC10926988 DOI: 10.1590/1980-5764-dn-2023-0083] [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: 09/08/2023] [Accepted: 12/15/2023] [Indexed: 03/13/2024] Open
Abstract
Dementia poses a significant societal and health challenge in the 21st century, with many hospitalized patients experiencing dementia without a documented diagnosis. Objective To evaluate the prevalence of dementia and its associated risk factors among older patients admitted to hospitals. Methods The study included older patients (≥ 60 years) admitted to medical departments of a general hospital in three major Iranian cities. Researchers utilized the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, the Geriatric Depression Scale (GDS), the Mini-Cog test, the 4 A's test (4AT), and the Abbreviated Mental Test Score (AMTS). Among the 420 recruited older inpatients, 228 (54.3%) were female. Results The mean age of participants was 71.39 years (standard deviation ±7.95), with 30.7% diagnosed with major neurocognitive disorder (dementia). The likelihood of dementia exhibited statistically significant correlations with gender, age, number of children, and occupation. Conclusions Screening older individuals for cognitive impairment upon hospital admission holds the potential to prevent adverse outcomes and enhance the quality of treatment for patients concurrently dealing with dementia.
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Affiliation(s)
- Athena Enderami
- Mazandaran University of Medical Sciences, Faculty of Medicine, Department of Psychiatry, Sari, Mazandaran, Iran
| | - Vahid Rashedi
- University of Social Welfare and Rehabilitation Sciences, Iranian Research Center on Aging, Department of Aging, Tehran, Iran
| | - Seyed Kazem Malakouti
- Iran University of Medical Sciences, Director School of Behavioral Sciences and Mental Health, Tehran, Iran
| | - Behnam Shariati
- Iran University of Medical Sciences, School of Medicine, Psychosocial Health Research Institute, Mental Health Research Center, Department of Psychiatry, Tehran, Iran
| | | | | | - Zeinab Kodan
- Department of Psychiatry, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences and Health Service, Sari, Mazandaran, Iran
| | - Maryam Pourshams
- Department of Psychiatry, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Osawa E, Sasaki Y, Hsu HC, Miura H. Attitudes toward active aging and their association with social determinants and views on older adults in Japan: a cross-sectional study. BMC Geriatr 2024; 24:140. [PMID: 38326743 PMCID: PMC10851495 DOI: 10.1186/s12877-024-04711-0] [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: 04/20/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Globally, the population of older adults has greatly increased, and active aging-whereby older adults can live healthy and fulfilling lives-is considered crucial for a sustainable society. However, the concept and practice of active aging are highly debated because it is unclear how people perceive active aging. This study explored Japanese people's attitudes toward active aging (ATAA) and examined the associations between ATAA scores and sociodemographic variables, views on older adults, and self-rated life and health. METHODS This study used data obtained from an online survey that originally targeted adults of all generations in Taiwan, South Korea, and Japan. In this study, we used only data from Japanese participants to elaborate on factors associated with ATAA in Japan. We conducted a one-way analysis of variance test and multiple linear regression analysis to evaluate the associations between the ATAA scores of 506 Japanese individuals and sociodemographic variables, views on older adults, and self-rated life and health. RESULTS The sample comprised 171 females and 335 males. The mean (± SD) ATAA score of the 506 respondents was 138.8 (± 20.80). Females had a significantly higher ATAA score than males (144.02 versus 136.13, F = 26.29, p < 0.001). The respondents with higher education attainment, religious beliefs, better views on older adults, and better self-rated health were more likely to have a positive ATAA score (B: 3.83, 95% CI: 0.11, 7.56; B: 4.31, 95% CI: 0.93, 7.69; B: 2.07, 95% CI: 1.61, 2.53; B: 2.87, 95% CI: 0.92, 4.82, respectively). Being male, single (i.e., never married, divorced, or widowed) and other non-married marital statuses, and satisfied with one's financial condition were negatively associated with ATAA (B: -8.73, 95% CI: -12.49, -4.96; B: -5.47, 95% CI: -9.07, -1.86; B: -2.04, 95% CI: -3.99, -0.09, respectively). CONCLUSIONS This study identified that females have more positive ATAA than males. Better views on older adults are a possible contributing factor that promotes ATAA among Japanese people. Our findings provide useful evidence that an approach towards those who are male, single, and economically satisfied is needed so that they have a positive attitude toward aging in Japan. It is necessary to address ageism and develop an environment in which individuals can expect to age actively.
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Affiliation(s)
- Eri Osawa
- Department of Public Health Policy, National Institute of Public Health, 351-0197, Saitama, Japan.
| | - Yuri Sasaki
- Department of Public Health Policy, National Institute of Public Health, 351-0197, Saitama, Japan
| | - Hui-Chuan Hsu
- School of Public Health, Research Centre of Health Equity, College of Public Health, Taipei Medical University, 11031, Taipei, Taiwan
| | - Hiroko Miura
- Division of Disease Control and Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, 061-0293, Tobetsu, Hokkaido, Japan
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Zsuffa JA, Katz S, Koszovacz V, Berente DB, Kamondi A, Csukly G, Mangialasche F, Rocha ASL, Kivipelto M, Horvath AA. Lifestyle and behavioural changes in older adults during the Covid-19 pandemic are associated with subjective cognitive complaints. Sci Rep 2024; 14:2502. [PMID: 38291110 PMCID: PMC10827799 DOI: 10.1038/s41598-024-52856-0] [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: 04/30/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
Subjective cognitive complaints (SCC) is a self-reported experience of persistently impaired cognitive functions which could be the earliest red flag of neurocognitive disorders. The COVID-19 pandemic and related restriction measures changed the lifestyle and behaviour of older adults. The aim of this study was to assess the relation of these changes and SCC status in Hungary. This cross-sectional study analysed the data of 359 elderly Hungarians who filled out the WW-FINGERS-SARS-CoV2 survey. A quarter of the respondents (n:88) reported SCC in connection with the pandemic. We compared sociodemographic features, health status, lifestyle, and social life parameters between subjects with reported SCC and without. To eliminate the potential interrelation across group differences, stepwise logistic regression was applied. Participants with SCC showed the following characteristics, compared to individuals without: (1) they were older; (2) they were more likely to be women; (3) they had a higher number of chronic disorders; (4) showed more prominent impairment in physical mobility; (5) had worse sleep quality; (6) spent less time with family; and (7) used internet more frequently during the pandemic (all p's < 0.001). Logistic regression highlighted that only two parameters were related to SCC status independently, the physical mobility (ability to walk 500 m without difficulties; OR = 1.186; p < 0.001; 95%CI = 1.101, 1.270) and changes in time spent with grandchildren (OR = 1.04; p = 0.015; 95%CI = 1.008, 1.073). Our study draws attention to the importance of physical mobility and quality time with family as key factors in the cognitive well-being of elderly people.
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Affiliation(s)
- Janos Andras Zsuffa
- Department of Family Medicine, Semmelweis University, 9 Stahly utca, Budapest, 1085, Hungary.
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
| | - Sandor Katz
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Department of Anatomy Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Vanda Koszovacz
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Dalida Borbala Berente
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Anita Kamondi
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Gabor Csukly
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Ana Sabsil Lopez Rocha
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Andras Attila Horvath
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
- Department of Anatomy Histology and Embryology, Semmelweis University, Budapest, Hungary
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Martin J, Reid N, Ward DD, King S, Hubbard RE, Gordon EH. Investigating Sex Differences in Risk and Protective Factors in the Progression of Mild Cognitive Impairment to Dementia: A Systematic Review. J Alzheimers Dis 2024; 97:101-119. [PMID: 38143350 DOI: 10.3233/jad-230700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Developing effective strategies for reducing dementia risk requires a detailed understanding of the risk and protective factors associated with the progression of mild cognitive impairment (MCI) to dementia. OBJECTIVE We aimed to systematically review the evidence for sex differences in these factors. METHODS Five online databases (PubMed/CINAHL/EMBASE/PsycINFO/Cochrane) were searched from inception until 17 October 2022 for cohort studies that focused on sex differences in risk and protective factors in the progression of MCI to dementia. RESULTS A total of 2,972 studies were identified, of which 12 studies from five countries were included in the systematic review. There was substantial variability in study designs, study populations and outcome measures. Sex differences were present in the associations of sociodemographic, health, psychological factors, genetic and other biomarkers with the progression of MCI to dementia. APOE ɛ4 status and depression appeared to increase the risk of progression for females, whereas history of stroke, MRI markers and cerebrospinal fluid biomarkers appeared to increase the risk of progression for males. APOE ɛ2 status and marital status (unmarried) were observed to reduce risk of progression in males and females, respectively. CONCLUSIONS The ability of studies to accurately detail risk factors for dementia are likely limited when solely controlling for the effects of sex. Although the heterogeneity and underpowered nature of the studies made it difficult to synthesize the findings for each risk factor, this study highlights the apparent need for further research examining risk factors for dementia in males and females with MCI separately.
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Affiliation(s)
- Jissa Martin
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David D Ward
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Shannon King
- Busselton Hospital, WA Country Health Service, Western Australia, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland, Australia
| | - Emily H Gordon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland, Australia
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Tahami Monfared AA, Khachatryan A, Hummel N, Kopiec A, Martinez M, Zhang R, Zhang Q. Assessing Quality of Life, Economic Burden, and Independence Across the Alzheimer's Disease Continuum Using Patient-Caregiver Dyad Surveys. J Alzheimers Dis 2024; 99:191-206. [PMID: 38640156 DOI: 10.3233/jad-231259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Alzheimer's disease (AD) and mild cognitive impairment (MCI) have negative quality of life (QoL) and economic impacts on patients and their caregivers and may increase along the disease continuum from MCI to mild, moderate, and severe AD. Objective To assess how patient and caregiver QoL, indirect and intangible costs are associated with MCI and AD severity. Methods An on-line survey of physician-identified patient-caregiver dyads living in the United States was conducted from June-October 2022 and included questions to both patients and their caregivers. Dementia Quality of Life Proxy, the Care-related Quality of Life, Work Productivity and Activity Impairment, and Dependence scale were incorporated into the survey. Regression analyses investigated the association between disease severity and QoL and cost outcomes with adjustment for baseline characteristics. Results One-hundred patient-caregiver dyads were assessed with the survey (MCI, n = 27; mild AD, n = 27; moderate AD, n = 25; severe AD, n = 21). Decreased QoL was found with worsening severity in patients (p < 0.01) and in unpaid (informal) caregivers (n = 79; p = 0.02). Dependence increased with disease severity (p < 0.01). Advanced disease severity was associated with higher costs to employers (p = 0.04), but not with indirect costs to caregivers. Patient and unpaid caregiver intangible costs increased with disease severity (p < 0.01). A significant trend of higher summed costs (indirect costs to caregivers, costs to employers, intangible costs to patients and caregivers) in more severe AD was observed (p < 0.01). Conclusions Patient QoL and functional independence and unpaid caregiver QoL decrease as AD severity increases. Intangible costs to patients and summed costs increase with disease severity and are highest in severe AD.
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Perfect CR, Lindquist J, Smith VA, Stanwyck C, Seidenfeld J, Van Houtven CH, Hastings SN. Are Geriatrics-Focused Primary Care Clinics Better at Diagnosing Dementia Than Traditional Clinics? A Matched Cohort Study. J Gen Intern Med 2023; 38:2710-2717. [PMID: 36941424 PMCID: PMC10506971 DOI: 10.1007/s11606-023-08136-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Dementia and mild cognitive impairment (MCI) are prevalent but underdiagnosed. OBJECTIVE To compare new dementia/MCI diagnosis rates in geriatrics-focused primary care clinics and traditional primary care clinics. DESIGN Secondary analysis of a prospective matched cohort study that spanned 2017-2021. PARTICIPANTS Community-dwelling Veterans over 65 receiving primary care in a geriatrics-focused medical home (GeriPACT) or traditional primary care home (PACT) at one of 57 Veterans Affairs sites. We excluded individuals with a documented diagnosis of dementia or MCI in the year prior to enrollment. MAIN MEASURES Diagnoses obtained from EHR. Cognitive status was assessed using modified Telephone Interview for Cognitive Status (mTICS) tool. KEY RESULTS The 470 participants included in this analysis were predominantly white, non-Hispanic males with an average age of 80.3 years. 9.4% of participants received a diagnosis of dementia/MCI after 24 months: 11.5% in GeriPACT and 7.2% in PACT. Adjusted OR for dementia/MCI diagnosis based on GeriPACT exposure was 1.47 (95% CI 0.65-3.29). Low mTICS score (≤ 27) (OR 4.89, 95% CI 2.36-10.13) and marital status (married/partnered) (OR 1.89, CI 0.99-3.59) were independent predictors of dementia/MCI diagnosis. When stratified by cognitive status: diagnosis rates were 20.8% in GeriPACT and 16.7% in PACT among those who scored lower on the cognitive assessment (mTICS ≤ 27); 7.4% in GeriPACT and 3.6% in PACT among those who scored higher (mTICS > 27). The OR for new dementia/MCI diagnosis in GeriPACT was 1.19 (95% CI 0.49-2.91) among those with a low mTICS score and 1.85 (95% CI 0.70-4.88) among those with a higher mTICS score. CONCLUSIONS Observed rates of new dementia/MCI diagnosis were higher in GeriPACT, but with considerable uncertainty around estimates. Geriatrics-focused primary care clinics may be a promising avenue for improving the detection of dementia in older adults, but further larger studies are needed to confirm this relationship.
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Affiliation(s)
- Chelsea R Perfect
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - J Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - V A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of General Internal Medicine, Duke University, Durham, NC, USA
| | - C Stanwyck
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
| | - J Seidenfeld
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Emergency Medicine, Durham VA Health Care System, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - C H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - S N Hastings
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatrics Research Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA
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11
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Skirbekk V, Bowen CE, Håberg A, Jugessur A, Engdahl B, Bratsberg B, Zotcheva E, Selbæk G, Kohler HP, Weiss J, Harris JR, Tom SE, Krokstad S, Stern Y, Strand BH. Marital Histories and Associations With Later-Life Dementia and Mild Cognitive Impairment Risk in the HUNT4 70+ Study in Norway. J Aging Health 2023; 35:543-555. [PMID: 36321864 PMCID: PMC10151439 DOI: 10.1177/08982643221131926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: Earlier studies suggest that being married in later life protects against dementia, and that being single in old age increases the risk of dementia. In this study, we examine midlife marital status trajectories and their association with dementia and mild cognitive impairment (MCI) at ages 70 plus using a large population based sample from Norway. Methods: Based on a general population sample linked to population registries (N = 8706), we used multinomial logistic regression to examine the associations between six types of marital trajectories (unmarried, continuously divorced, intermittently divorced, widowed, continuously married, intermittently married) between age 44 and 68 years from national registries and a clinical dementia or a MCI diagnosis after age 70. We estimated relative risk ratios (RRR) and used mediation analyses adjusting for education, number of children, smoking, hypertension, obesity, physical inactivity, diabetes, mental distress, and having no close friends in midlife. Inverse probability weighting and multiple imputations were applied. The population attributable fraction was estimated to assess the potential reduction in dementia cases due to marital histories. Results: Overall, 11.6% of the participants were diagnosed with dementia and 35.3% with MCI. Dementia prevalence was lowest among the continuously married (11.2%). Adjusting for confounders, the risk of dementia was higher for the unmarried (RRR = 1.73; 95% CI: 1.24, 2.40), continuously divorced (RRR = 1.66; 95% CI: 1.14, 2.43), and intermittently divorced (RRR = 1.50; 95% CI: 1.09, 2.06) compared to the continuously married. In general, marital trajectory was less associated with MCI than with dementia. In the counterfactual scenario, where all participants had the same risk of receiving a dementia diagnosis as the continuously married group, there would be 6.0% fewer dementia cases. Discussion: Our data confirm that staying married in midlife is associated with a lower risk of dementia and that divorced people account for a substantial share of dementia cases.
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Affiliation(s)
- Vegard Skirbekk
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Asta Håberg
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Astanand Jugessur
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bo Engdahl
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bernt Bratsberg
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Ragnar Frisch Center for Economic Research, Oslo, Norway
| | - Ekaterina Zotcheva
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University
| | - Jennifer R. Harris
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sarah E. Tom
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, USA
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway
| | - Yaakov Stern
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, USA
| | - Bjørn Heine Strand
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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12
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Nilaweera D, Gurvich C, Freak-Poli R, Woods R, Owen A, Murray A, Orchard SG, Britt C, Wu Z, McNeil J, Ryan J. Adverse events in older adults and the risk of dementia and cognitive decline. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 13:100592. [PMID: 37475782 PMCID: PMC10357969 DOI: 10.1016/j.jadr.2023.100592] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Increasing evidence suggests that stress could be a risk factor for dementia but this might vary by gender. This study investigated whether adverse life events were associated with cognitive decline and dementia in later-life, separately in men and women. Methods Participants were 12,789 community-dwelling Australians aged ≥ 70 years. Ten common adverse events in later-life were self-reported. Cognitive decline was defined as a 1.5 SD decline from participants' baseline score in tests of global cognition, psychomotor speed, episodic memory, and executive functioning, which were assessed regularly over a maximum of 10.3 years. Dementia was diagnosed according to DSM-IV criteria. Results An increased risk of dementia was observed in participants who experienced the death of a spouse/partner (HR: 1.72, 95% CI: 1.17 - 2.52) and for individuals who experienced major financial problems (HR: 1.53, 95% CI: 1.05 - 2.23). The latter also increased the risk of cognitive decline in men specifically (HR: 1.43, 95% CI: 1.10 - 1.86). In contrast, some events for women were associated with a reduced risk of dementia (e.g. close family or friends lost their job/retired (HR: 0.62, 95% CI: 0.40-0.95)). Limitations Events including major money problems may result from prodromal dementia symptoms, thus reverse causation needs to be considered. Conclusions Adverse life events may influence dementia risk in older adults, but associations vary depending on the nature of the event, and across genders. These findings support the need for early interventions in older people who have experienced adversities, particularly for the death of a loved one.
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Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Caroline Gurvich
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Anne Murray
- Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, USA
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Zimu Wu
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
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13
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He F, Luo H, Yin L, Roosaar A, Axéll T, Zhao H, Ye W. Poor Oral Health as a Risk Factor for Dementia in a Swedish Population: A Cohort Study with 40 Years of Follow-Up. J Alzheimers Dis 2023; 92:171-181. [PMID: 36710668 DOI: 10.3233/jad-215177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Whether poor oral health is associated with dementia risk remains unclear. OBJECTIVE We conducted a cohort study of 14,439 participants who were followed up for up to 40 years in Uppsala County, central Sweden, aiming to explore the association between poor oral health, namely the number of tooth loss, dental plaque status, and oral mucosal lesions, and the risk of dementia. METHODS We used Cox proportional hazards regression model to derive cause-specific hazard ratios (HR) and corresponding 95% confidence intervals (CI), while adjusting for baseline potential confounders as well as a time-varying covariate, Charlson's Comorbidity Index score. RESULTS Dementia risk was substantially higher among those with a higher number of tooth loss; compared to the group with tooth loss 0-10, the HRs were 1.21 (95% CI: 1.02, 1.42), 1.17 (95% CI: 0.97, 1.40), and 1.30 (95% CI: 1.09, 1.54) respectively for groups with increasing number of tooth loss. There was some evidence of dose-risk association in this study, with a HR of 1.10 (1.04, 1.18) comparing adjacent groups (ptrend = 0.001). In a stratified analysis by attained age, tooth loss was more pronouncedly associated with the risk of dementia onset before age 80 (those with 21-32 versus 0-10 lost teeth, HR = 1.82, (95% CI: 1.32, 2.51); HR = 1.22 (95% CI: 1.10, 1.35) comparing adjacent groups, ptrend < 0.001). CONCLUSION In summary, there are some indications that poor oral health, as indicated by more tooth loss, is positively associated with an increased risk of dementia, especially for dementia onset before age 80.
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Affiliation(s)
- Fei He
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Huizi Luo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ann Roosaar
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tony Axéll
- Maxillofacial Unit, Halland Hospital Halmstad, Halmstad, Sweden
| | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, Texas A & M University, College Station, TX, USA
| | - Weimin Ye
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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14
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Nerobkova N, Park YS, Shin J, Park EC. Marital transition and cognitive function among older adults: the korean Longitudinal Study of Aging (2006-2020). BMC Geriatr 2022; 22:1003. [PMID: 36577941 PMCID: PMC9798712 DOI: 10.1186/s12877-022-03697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Marital status has been suggested as an associated factor for cognitive impairment. The consequences of marital transitions are still understudied. This study evaluated the influence of marital transitions on cognitive function using longitudinal, nationwide data of Korean older adults. METHODS This research comprised a longitudinal sample of older adults aged ≥ 45 years old, drawn from the Korean Longitudinal Study of Aging (2006-2020). Marital transition was determined through the biennial assessment of change in marital status; cognitive function was measured using the Korean version of the Mini-Mental State Examination. We employed general estimating equations to assess the temporal effect of marital transition on cognitive function. RESULTS Compared to married individuals, the odds ratios (ORs) of cognitive decline were higher in not married and transitioned out of marriage participants: men (OR 1.32, 95% confidence interval (CI) 0.96-1.82; OR 1.42, 95% CI 0.90-2.24), women (OR 1.21, 95% CI 1.03-1.42; OR 1.20, 95% CI 1.01-1.52), respectively, despite the findings being not statistically significant in men. The participants who transitioned out of marriage over time also showed greater ORs for mild cognitive impairment: men (OR 1.39, 95% CI 0.79-1.87), women (OR 1.33, 95% CI 1.05-1.80), and dementia: men (OR 1.60, 95% CI 0.85-1.99), women: (OR 1.49, 95% CI 1.20-2.19). CONCLUSION Marital transition is found to be associated with cognitive function decline. Not-married individuals and those who became divorced or widowed were associated with the risk of cognitive function decline. Particular attention should be paid to these marital transitioned groups.
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Affiliation(s)
- Nataliya Nerobkova
- grid.15444.300000 0004 0470 5454Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Yu Shin Park
- grid.15444.300000 0004 0470 5454Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Jaeyong Shin
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.5386.8000000041936877XDepartment of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, NY USA
| | - Eun-Cheol Park
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722 Republic of Korea
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15
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Huang C, Zhu H. Functional hybrid factor regression model for handling heterogeneity in imaging studies. Biometrika 2022; 109:1133-1148. [PMID: 36531154 PMCID: PMC9754099 DOI: 10.1093/biomet/asac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
This paper develops a functional hybrid factor regression modelling framework to handle the heterogeneity of many large-scale imaging studies, such as the Alzheimer's disease neuroimaging initiative study. Despite the numerous successes of those imaging studies, such heterogeneity may be caused by the differences in study environment, population, design, protocols or other hidden factors, and it has posed major challenges in integrative analysis of imaging data collected from multicentres or multistudies. We propose both estimation and inference procedures for estimating unknown parameters and detecting unknown factors under our new model. The asymptotic properties of both estimation and inference procedures are systematically investigated. The finite-sample performance of our proposed procedures is assessed by using Monte Carlo simulations and a real data example on hippocampal surface data from the Alzheimer's disease study.
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Affiliation(s)
- C Huang
- Department of Statistics, Florida State University, 117 N. Woodward Ave., Tallahassee, Florida 32304, U.S.A
| | - H Zhu
- Department of Biostatistics, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina 27599, U.S.A
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16
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Jennings EA, Farrell M, Liu Y, Montana L. Associations between cognitive function and marital status in the U.S., South Africa, Mexico, and China. SSM Popul Health 2022; 20:101288. [DOI: 10.1016/j.ssmph.2022.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
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17
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Drinkwater E, Davies C, Spires-Jones TL. Potential neurobiological links between social isolation and Alzheimer's disease risk. Eur J Neurosci 2022; 56:5397-5412. [PMID: 34184343 DOI: 10.1111/ejn.15373] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022]
Abstract
It is estimated that 40% of dementia cases could be prevented by modification of lifestyle factors that associate with disease risk. One of these potentially modifiable lifestyle factors is social isolation. In this review, we discuss what is known about associations between social isolation and Alzheimer's disease, the most common cause of dementia. This is particularly relevant in the time of the COVID-19 pandemic when social isolation has been enforced with potential emerging negative impacts on cognition. While there are neurobiological mechanisms emerging that may account for the observed epidemiological associations between social isolation and Alzheimer's disease, more fundamental research is needed to fully understand the brain changes induced by isolation that may make people vulnerable to disease.
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Affiliation(s)
| | - Caitlin Davies
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK.,Translational Neuroscience PhD Programme, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Tara L Spires-Jones
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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18
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Xu Q, Zou K, Deng Z, Zhou J, Dang X, Zhu S, Liu L, Fang C. A Study of Dementia Prediction Models Based on Machine Learning with Survey Data of Community-Dwelling Elderly People in China. J Alzheimers Dis 2022; 89:669-679. [PMID: 35912742 DOI: 10.3233/jad-220316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For community-dwelling elderly individuals without enough clinical data, it is important to develop a method to predict their dementia risk and identify risk factors for the formulation of reasonable public health policies to prevent dementia. OBJECTIVE A community elderly survey data was used to establish machine learning prediction models for dementia and analyze the risk factors. METHODS In a cluster-sample community survey of 9,387 elderly people in 5 subdistricts of Wuxi City, data on sociodemographics and neuropsychological self-rating scales for depression, anxiety, and cognition evaluation were collected. Machine learning models were developed to predict their dementia risk and identify risk factors. RESULTS The random forest model (AUC = 0.686) had slightly better dementia prediction performance than logistic regression model (AUC = 0.677) and neural network model (AUC = 0.664). The sociodemographic data and psychological evaluation revealed that depression (OR = 3.933, 95% CI = 2.995-5.166); anxiety (OR = 2.352, 95% CI = 1.577-3.509); multiple physical diseases (OR = 2.486, 95% CI = 1.882-3.284 for three or above); "disability, poverty or no family member" (OR = 1.859, 95% CI = 1.337-2.585) and "empty nester" (OR = 1.339, 95% CI = 1.125-1.595) in special family status; "no spouse now" (OR = 1.567, 95% CI = 1.118-2.197); age older than 80 years (OR = 1.645, 95% CI = 1.335-2.026); and female (OR = 1.214, 95% CI = 1.048-1.405) were risk factors for suspected dementia, while a higher education level (OR = 0.365, 95% CI = 0.245-0.546 for college or above) was a protective factor. CONCLUSION The machine learning models using sociodemographic and psychological evaluation data from community surveys can be used as references for the prevention and control of dementia in large-scale community populations and the formulation of public health policies.
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Affiliation(s)
- Qing Xu
- Department of Geriatric Psychiatry, Wuxi MentalHealth Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Kai Zou
- Department of Geriatric Psychiatry, Wuxi MentalHealth Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhao'an Deng
- Department of Geriatric Psychiatry, Wuxi MentalHealth Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jianbang Zhou
- Department of Psychiatry, Haidong First People'sHospital, Haidong, Qinghai, China
| | - Xinghong Dang
- Department of Psychiatry, Haidong First People'sHospital, Haidong, Qinghai, China
| | - Shenglong Zhu
- Department of Psychiatry, Haidong First People'sHospital, Haidong, Qinghai, China
| | - Liang Liu
- Department of Geriatric Psychiatry, Wuxi MentalHealth Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chunxia Fang
- Combined TCM &Western Medicine Department, Wuxi Mental Health Center, NanjingMedical University, Wuxi, Jiangsu, China
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19
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Social determinants and lifestyle factors for brain health: implications for risk reduction of cognitive decline and dementia. Sci Rep 2022; 12:12965. [PMID: 35902604 PMCID: PMC9334303 DOI: 10.1038/s41598-022-16771-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/15/2022] [Indexed: 11/08/2022] Open
Abstract
Substantial evidence indicates a huge potential for risk reduction of cognitive decline and dementia based on modifiable health and lifestyle factors. To maximize the chances for risk reduction, it is useful to investigate associations of social determinants and lifestyle for brain health. We computed the "LIfestyle for BRAin health" (LIBRA) score for baseline participants of the Leipzig Research Centre for Civilization Diseases (LIFE) Adult Study, a population-based urban cohort in Germany. LIBRA predicts dementia in midlife and early late life populations, comprising 12 modifiable risk factors (heart disease, kidney disease, diabetes, obesity, hypertension, hypercholesterolemia, alcohol consumption, smoking, physical inactivity, diet, depression, cognitive inactivity). Associations of social determinants (living situation, marital status, social isolation, education, net equivalence income, occupational status, socioeconomic status/SES, employment) with LIBRA were inspected using age- and sex-adjusted multivariable linear regression analysis. Z-standardization and sampling weights were applied. Participants (n = 6203) were M = 57.4 (SD = 10.6, range 40-79) years old and without dementia, 53.0% were women. Except for marital status, all considered social determinants were significantly associated with LIBRA. Beta coefficients for the association with higher LIBRA scores were most pronounced for low SES (β = 0.80, 95% CI [0.72-0.88]; p < 0.001) and middle SES (β = 0.55, 95% CI [0.47-0.62]; p < 0.001). Social determinants, particularly socioeconomic factors, are associated with lifestyle for brain health, and should thus be addressed in risk reduction strategies for cognitive decline and dementia. A social-ecological public health perspective on risk reduction might be more effective and equitable than focusing on individual lifestyle behaviors alone.
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Hu FF, Cheng GR, Liu D, Liu Q, Gan XG, Li L, Wang XD, Zhang B, An LN, Chen C, Zou MJ, Xu L, Ou YM, Chen YS, Li JQ, Wei Z, Wang YY, Wu Q, Chen XX, Yang XF, Wu QM, Feng L, Zhang JJ, Xu H, Yu YF, Yang ML, Qian J, Lian PF, Fu LY, Duan TT, Tian Y, Cheng X, Li XW, Yan PT, Huang G, Dong H, Ji Y, Zeng Y. Population-attributable fractions of risk factors for all-cause dementia in China rural and urban areas: a cross-sectional study. J Neurol 2022; 269:3147-3158. [PMID: 34839456 DOI: 10.1007/s00415-021-10886-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The prevalence of dementia in China, particularly in rural areas, is consistently increasing; however, research on population-attributable fractions (PAFs) of risk factors for dementia is scarce. METHODS We conducted a cross-sectional survey, namely, the China Multicentre Dementia Survey (CMDS) in selected rural and urban areas from 2018 to 2020. We performed face-to-face interviews and neuropsychological and clinical assessments to reach a consensus on dementia diagnosis. Prevalence and weighted PAFs of eight modifiable risk factors (six classical: less childhood education, hearing impairment, depression, physical inactivity, diabetes, and social isolation, and two novels: olfactory decline and being unmarried) for all-cause dementia were estimated. RESULTS Overall, CMDS included 17,589 respondents aged ≥ 65 years, 55.6% of whom were rural residents. The age- and sex-adjusted prevalence for all-cause dementia was 9.11% (95% CI 8.96-9.26), 5.19% (5.07-5.31), and 11.98% (11.8-12.15) in the whole, urban, and rural areas of China, respectively. Further, the overall weighted PAFs of the eight potentially modifiable risk factors were 53.72% (95% CI 52.73-54.71), 50.64% (49.4-51.89), and 56.54% (55.62-57.46) in the whole, urban, and rural areas of China, respectively. The eight risk factors' prevalence differed between rural and urban areas. Lower childhood education (PAF: 13.92%) and physical inactivity (16.99%) were primary risk factors in rural and urban areas, respectively. CONCLUSIONS The substantial urban-rural disparities in the prevalence of dementia and its risk factors exist, suggesting the requirement of resident-specific dementia-prevention strategies.
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Affiliation(s)
- Fei-Fei Hu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Gui-Rong Cheng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Dan Liu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Qian Liu
- Department of Nutrition and Food Science, Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Xu-Guang Gan
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Lin Li
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Xiao-Dan Wang
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Bo Zhang
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Li-Na An
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Cong Chen
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Ming-Jun Zou
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Lang Xu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Yang-Ming Ou
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Yu-Shan Chen
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Jin-Quan Li
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Zhen Wei
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Yue-Yi Wang
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Qiong Wu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Xing-Xing Chen
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Xi-Fei Yang
- Key Laboratory of Modern Toxicology of Shenzhen, Shenzhen Center for Disease Control and Prevention, No. 8, Longyuan Road, Nanshan District, Shenzhen, 518055, China
| | - Qing-Ming Wu
- Tianyou Hospital affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jing-Jing Zhang
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Heng Xu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Ya-Fu Yu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Meng-Liu Yang
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Jin Qian
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Peng-Fei Lian
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Li-Yan Fu
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Ting-Ting Duan
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Yuan Tian
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Xi Cheng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Xin-Wen Li
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Pin-Ting Yan
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Guowei Huang
- Department of Nutrition and Food Science, Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Hongxin Dong
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China
| | - Yong Ji
- Department of Neurology, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, 100070, China.
| | - Yan Zeng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, West Huangjiahu Road, Hongshan District, Wuhan, 430065, China.
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21
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Zhang Z, Liu H, Zhang Y. Marital Loss and Cognitive Function: Does Timing Matter? J Gerontol B Psychol Sci Soc Sci 2022; 77:1916-1927. [PMID: 35512289 PMCID: PMC9535775 DOI: 10.1093/geronb/gbac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examines the association between age at marital loss (i.e., divorce or widowhood) and cognitive function in later life and whether the association differs by gender. METHODS We used mixed-effects models, drawing on longitudinal data from the Health and Retirement Study (1998-2016). The analytical samples included older adults aged 51 and older who had ever been widowed (N=5,639 with 25,537 person-waves) or divorced (N=10,685 with 50,689 person-waves). RESULTS We find that those who were widowed at younger ages had lower cognitive function than their counterparts who were widowed at older ages, for both men and women, after controlling for covariates. Household income and health-related factors partially accounted for the positive association between age at widowhood and cognitive function. Those who divorced at younger ages also had lower cognitive function than their counterparts who divorced at older ages, but this association was only present among men, not women. Health-related factors partially accounted for the associations between age at divorce and cognitive function among men. DISCUSSION Findings highlight the importance of considering the role of timing of marital loss in cognitive health among older adults.
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Affiliation(s)
- Zhenmei Zhang
- Address correspondence to: Zhenmei Zhang, PhD, Department of Sociology, Michigan State University, 509 East Circle Drive, 316 Berkey Hall, East Lansing, MI 48824-1111, USA. E-mail:
| | - Hui Liu
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Yan Zhang
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
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22
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Wu-Chung EL, Leal SL, Denny BT, Cheng SL, Fagundes CP. Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood. Neurosci Biobehav Rev 2022; 134:104487. [PMID: 34971701 PMCID: PMC8925984 DOI: 10.1016/j.neubiorev.2021.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.
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Affiliation(s)
| | | | - Bryan T. Denny
- Department of Psychological Sciences, Rice University, Houston, TX
| | | | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
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23
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Shin SH, Behrens EA, Parmelee PA, Kim G. The Role of Purpose in Life in the Relationship Between Widowhood and Cognitive Decline Among Older Adults in the U.S. Am J Geriatr Psychiatry 2022; 30:383-391. [PMID: 34417084 DOI: 10.1016/j.jagp.2021.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to examine the role of purpose in life in the relationship between widowhood and cognitive decline. METHODS This study used a sample of 12,856 respondents (20,408 observations) collected from a national panel survey, the 2006-2014 waves of the Health and Retirement Study (HRS), that sampled older adults aged 50 or older. The study estimated growth-curve models with years since spousal death, purpose in life, and interaction between the two to predict cognition using three measures-total cognition, fluid, and crystallized intelligence scores. We also estimated growth-curve models by sex, race/ethnicity, and education. RESULTS While years since spousal death negatively correlated with cognition, purpose in life positively correlated with cognition. Furthermore, purpose in life had a moderating effect on the relationship between years since spousal death and cognition. This effect was found by using total cognition (coef. = 0.0515; z = 2.64; p < 0.01) and fluid intelligence scores (coef. = 0.0576; z = 3.23; p < 0.05). The same effects were salient among females (coef. = 0.0556; z = 2.19; p < 0.05), Whites (coef. = 0.0526; z = 2.52; p < 0.05), and older adults with more education (coef. = 0.0635; z = 2.10; p < 0.05). CONCLUSION Higher purpose in life relates to the negative correlations between widowhood and cognition of older adults. Educational programs improving purpose in life are a possible avenue for reducing the adverse effect of widowhood on cognition and warrant future exploration.
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Affiliation(s)
- Su Hyun Shin
- Department of Family and Consumer Studies, University of Utah, UT
| | - Emily A Behrens
- Alabama Research Institute on Aging and Department of Psychology, The University of Alabama, AL
| | - Patricia A Parmelee
- Alabama Research Institute on Aging and Department of Psychology, The University of Alabama, AL
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea.
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24
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Larnyo E, Dai B, Nutakor JA, Ampon-Wireko S, Larnyo A, Appiah R. Examining the impact of socioeconomic status, demographic characteristics, lifestyle and other risk factors on adults' cognitive functioning in developing countries: an analysis of five selected WHO SAGE Wave 1 Countries. Int J Equity Health 2022; 21:31. [PMID: 35216605 PMCID: PMC8876754 DOI: 10.1186/s12939-022-01622-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Though extensive studies have been conducted on assessing the predictors of cognitive functioning among older adults in small community-based samples, very few studies have focused on understanding the impact of socioeconomic status (SES), demographic characteristics and other risk factors such as lifestyle and chronic diseases on the cognitive functioning among adults of all ages in a nationally representative population-based sample across low- and middle-income countries. This study, therefore, seeks to evaluate the impact of SES, demographic characteristics and risk factors on the cognitive functioning of adults across all ages in five selected developing countries. Methods Data from 12,430 observations obtained from the WHO Study on Global AGEing and Adult Health (SAGE) Wave 1; consisting of 2,486 observations each for China, Ghana, India, the Russian Federation, and South Africa, were used for the study. A meta-regression and a five-step hierarchical linear regression were used to analyze the data, with cognitive functioning as the dependent variable. Independent variables used in this study include SES; assessed by household income and education, demographic characteristics, other risk factors such as lifestyle, self-reported memory difficulty and chronic diseases. Results This study found that SES and lifestyle significantly predicted cognitive functioning in all the five selected countries as obtained by the pooled results of the meta-regression analysis. The hierarchical linear regression results also revealed that demographic characteristics such as age, type of residency, and self-reported memory difficulty significantly impact cognitive functioning in China, Ghana, Russia, and South Africa. Conclusion The findings in this study provide new insights for policymakers, caregivers, parents, and individuals, especially those in developing countries, to implement policies and actions targeted at improving SES and eliminating risk factors associated with cognitive decline, as these measures could help improve the cognitive functioning among their populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01622-7.
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Affiliation(s)
- Ebenezer Larnyo
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China. .,Department of Labor and Social Security, School of Public Health, Southeast University, 87# Dingjiaqiao, Nanjing, 210009, Jiangsu province, China.
| | - Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Sabina Ampon-Wireko
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Abigail Larnyo
- School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
| | - Ruth Appiah
- Department of Health Policy and Management, School of Management, Jiangsu University, 301# Xuefu Road, Zhenjiang, 212013, Jiangsu Province, China
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25
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Defining a Digital System for the Pedestrian Network as a Conceptual Implementation Framework. SUSTAINABILITY 2022. [DOI: 10.3390/su14052528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In cities today, the digitalization of mobility is one of the most crucial tools that link each single mobility service providers (e.g., ride sharing, public transportation, air travel, etc.) to users. Based on the smart pedestrian network model, the purpose of this study is to initially provide the requirements towards the digitalization of a pedestrian network model and subsequently to draft an institutional framework towards the effective implementation and management of pedestrian mobility that will develop/create a pedestrian network as a new structure in the city. The methodology is applied in three phases, with three separate approaches: “desk approach” for a data gathering standard that is knowledge-based and connected to walkability; a “digitalization approach” for citizen and stakeholder participation in policy co-creation; and a “business approach”. A business approach is defined as a set of operations that takes one or more types of input and produces a customer-valued outcome. In this case, customers are citizens and the business approach by applying a digital system is assessing policies and finding/defining an optimized combination of shared applicable/effective policies to implement the pedestrian network. By boosting an innovative linkage of these three phases, digitalization of the pedestrian network has great potential to improve the walkability planning process and therefore to create more sustainable and livable urban spaces.
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26
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Zhang Z, Zhao Y, Bian Y. A Role of Socioeconomic Status in Cognitive Impairment Among Older Adults in Macau: A Decomposition Approach. Front Aging Neurosci 2022; 14:804307. [PMID: 35211006 PMCID: PMC8862725 DOI: 10.3389/fnagi.2022.804307] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/13/2022] [Indexed: 12/25/2022] Open
Abstract
Background To explore the prevalence and inequality of cognitive impairment among older adults in Macau and the contributions of influencing factors to inequality in cognitive impairment. Methods The Montreal Cognitive Assessment (MoCA) was used to measure the prevalence of cognitive impairment. Socioeconomic status scores were used to describe economic level of the subjects. The concentration index was applied to measure the inequality of cognitive impairment associated with socioeconomic status (SES) and decomposed into its influencing factors. Results The prevalence of cognitive impairment was 44.35% in Macau. The concentration index of cognitive impairment among the elderly was −0.165 (95% CI: −0.232 to −0.098), indicating that the prevalence of cognitive impairment was concentrated in households with poor SES. Older age, poor SES, long or short sleep duration, other marital status, poor appetite, no tea/coffee drinking, no religious belief, and depression contributed positively to the inequality of cognitive impairment. Among these factors, SES made the largest contribution to inequality, accounting for 76.74%. Conclusion In Macau, the prevalence of cognitive impairment among people aged 65 years and older is concentrated among those who are in poor economic conditions. Reducing the gap between the rich and the poor at the source, increasing educational level of low SES population and improving their access to healthcare services will help to improve the inequity of cognitive impairment.
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Affiliation(s)
- Zhuo Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- School of Health Services Management, Xi’an Medical University, Xi’an, China
| | - Yonghua Zhao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- Yonghua Zhao,
| | - Ying Bian
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- *Correspondence: Ying Bian,
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27
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Liu Q, Vaci N, Koychev I, Kormilitzin A, Li Z, Cipriani A, Nevado-Holgado A. Personalised treatment for cognitive impairment in dementia: development and validation of an artificial intelligence model. BMC Med 2022; 20:45. [PMID: 35101059 PMCID: PMC8805393 DOI: 10.1186/s12916-022-02250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Donepezil, galantamine, rivastigmine and memantine are potentially effective interventions for cognitive impairment in dementia, but the use of these drugs has not been personalised to individual patients yet. We examined whether artificial intelligence-based recommendations can identify the best treatment using routinely collected patient-level information. METHODS Six thousand eight hundred four patients aged 59-102 years with a diagnosis of dementia from two National Health Service (NHS) Foundation Trusts in the UK were used for model training/internal validation and external validation, respectively. A personalised prescription model based on the Recurrent Neural Network machine learning architecture was developed to predict the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores post-drug initiation. The drug that resulted in the smallest decline in cognitive scores between prescription and the next visit was selected as the treatment of choice. Change of cognitive scores up to 2 years after treatment initiation was compared for model evaluation. RESULTS Overall, 1343 patients with MMSE scores were identified for internal validation and 285 [21.22%] took the drug recommended. After 2 years, the reduction of mean [standard deviation] MMSE score in this group was significantly smaller than the remaining 1058 [78.78%] patients (0.60 [0.26] vs 2.80 [0.28]; P = 0.02). In the external validation cohort (N = 1772), 222 [12.53%] patients took the drug recommended and reported a smaller MMSE reduction compared to the 1550 [87.47%] patients who did not (1.01 [0.49] vs 4.23 [0.60]; P = 0.01). A similar performance gap was seen when testing the model on patients prescribed with AChEIs only. CONCLUSIONS It was possible to identify the most effective drug for the real-world treatment of cognitive impairment in dementia at an individual patient level. Routine care patients whose prescribed medications were the best fit according to the model had better cognitive performance after 2 years.
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Affiliation(s)
- Qiang Liu
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Nemanja Vaci
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Andrey Kormilitzin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Institute of Mathematics, University of Oxford, Oxford, UK
| | - Zhenpeng Li
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Alejo Nevado-Holgado
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Akrivia Health, Oxford, UK
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28
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Adaralegbe AA, Egbuchiem H, Adeoti O, Abbasi K, Ezeani E, Adaralegbe NJF, Babarinde AO, Boms M, Nzeako C, Ayeni O. Do Personality Traits Influence the Association Between Depression and Dementia in Old Age? Gerontol Geriatr Med 2022; 8:23337214211068257. [PMID: 35071694 PMCID: PMC8772013 DOI: 10.1177/23337214211068257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Depression and personality traits are independent predictors of dementia or cognitive impairment. Despite the well-established relationship between these two psychosocial factors and dementia, no research has been documented on how personality traits can influence dementia in older adults exhibiting depressive symptoms. This study explores the influence of personality traits on the association between change in depression and dementia in old age. A population-based longitudinal cohort study involving two waves of data collected 5 years apart, containing 2210 American older adults, from the National Social Life, Health, and Aging Project to explore if personality traits influence how change in depression predicts the development of dementia. We assessed these relationships while adjusting for sociodemographic characteristics. Change in depression increased the likelihood of dementia at T2 by 4.2% (AOR = 1.04, p = 0.019) in the co-variate adjusted model. Personality traits, overall, did not influence how depression predicts the development of dementia. However, agreeableness individually nullified the effect of depression on the development of dementia, whereas extraversion was the only personality trait that significantly predicted dementia. Prosocial behaviors should be promoted in old age as these appear to be protective. In addition, early life education and a strong social support can keep the depression–dementia spectrum at bay in old age.
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Affiliation(s)
| | | | | | - Khuzeman Abbasi
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Esther Ezeani
- Department of Pulmonary Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | | | | | - Maureen Boms
- School of Public Health Tuscaloosa, The University of Alabama System, Tuscaloosa, AL, USA
| | | | - Olumide Ayeni
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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29
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Chen ZC, Wu H, Wang XD, Zeng Y, Huang G, Lv Y, Niu J, Meng X, Cai P, Shen L, Gang B, You Y, Lv Y, Ren Z, Shi Z, Ji Y. Association between marital status and cognitive impairment based on a cross-sectional study in China. Int J Geriatr Psychiatry 2022; 37. [PMID: 34729814 DOI: 10.1002/gps.5649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/31/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Marital status may have an impact on the elderly population's health, but few studies in China discussed about the association between marital status and cognitive impairment. OBJECTIVE To investigate the relationship between marital status and cognitive impairment. To compare the influences of marital status on dementia between men and women. METHODS This study was based on a representative national cross-sectional epidemiological survey in China. We randomly selected 13 provinces and municipalities and included 19,276 participants aged 65 years or older in our study. Data was collected by interviewing the participants about their sociodemographic characteristics, and neuropsychological testing was administered to the participants by neurologists. To analyze the association between marital status and cognitive impairment, multiple logistic regression was based on a series of models. RESULTS Among the 19,276 subjects, about 77.2% were married, 1.6% were single, 21.2% were divorced/separated or widowed. The odds ratios (OR) of dementia were higher in single (OR: 2.13, CI: 1.53-2.97; p < 0.001), divorced/separated/widowed when they were ≤55 years old (OR: 1.75, CI: 1.30-2.35; p < 0.001), and divorced/separated/widowed when they were >55 years old (OR: 1.16, CI: 1.03-1.31; p < 0.001) participants than in married ones. Divorced/separated/widowed ≤55 men had about 2.75 times increase in dementia risk than married men. CONCLUSION People with long-term divorced/separated/widowed status would be associated to cognitive impairment more than those with short-term divorced/separated/widowed status. Men may be affected by marriage disruption more than women in terms of increasing the risk of dementia.
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Affiliation(s)
- Zhi-Chao Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Wu
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiao-Dan Wang
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yan Zeng
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan, China
| | - Guowei Huang
- Department of Nutrition and Food Science, Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yang Lv
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianping Niu
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xinling Meng
- Department of Neurology, Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, China
| | - Pan Cai
- Dementia Clinic, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Baozhi Gang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong You
- Department of Neurology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yan Lv
- Department of Neurology, Hainan General Hospital, Haikou, China
| | - Zhihong Ren
- Department of Neurology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, China
| | - Zhihong Shi
- Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yong Ji
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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Lifestyle Variables Such as Daily Internet Use, as Promising Protective Factors against Cognitive Impairment in Patients with Subjective Memory Complaints. Preliminary Results. J Pers Med 2021; 11:jpm11121366. [PMID: 34945838 PMCID: PMC8708750 DOI: 10.3390/jpm11121366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Subjective memory complaints (SMCs) may be important markers in the prediction of cognitive deterioration. The aim of this study was to find associations between individual lifestyle factors, which may contribute to cognitive impairment (CI) in people with SMCs and to conduct a literature review on the relationship between internet use and CI in subjects over 50 years old, as a related factor. This was a case-controlled study that included 497 subjects aged over 50 years with SMCs who were recruited from 19 community pharmacies. Three screening tests were used to detect possible CIs, and individuals with at least one test result compatible with a CI were referred to primary care for evaluation. Having self-referred SMC increased the odds of obtaining scores compatible with CI and this factor was significantly related to having feelings of depression (OR = 2.24, 95% CI [1.34, 3.90]), taking anxiolytics or antidepressants (OR = 1.93, 95% CI [1.23, 3.05]), and being female (OR = 1.83, 95% CI [1.15, 2.88]). Thirty percent of our sample obtained scores compatible with CI. Age over 70 years increased the odds of obtaining scores compatible with CI. A high-level education, reading, and daily internet use were factors associated with a reduced risk of positive scores compatible with CI (37–91%, 7–18%, and 67–86%, respectively), while one extra hour television per day increased the risk by 8–30%. Among others, modifiable lifestyle factors such as reading, and daily internet usage may slow down cognitive decline in patients over 50 with SMCs. Four longitudinal studies and one quasi-experimental study found internet use to be beneficial against CI in patients over 50 years of age.
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31
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Kim Y. Gender Differences in the Link Between Marital Quality and Cognitive Decline Among Older Adults in Korea. Psychiatry Investig 2021; 18:1091-1099. [PMID: 34732025 PMCID: PMC8600211 DOI: 10.30773/pi.2021.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the association between positive marital quality and cognitive health over time and to examine gender differences in this association. METHODS Drawing on 2006-2018 Korean Longitudinal Study of Aging data (n=7,427 respondents, 35,066 person-year observations), a series of hybrid mixed-effects models were used to estimate the effects of time-invariant (gender) and time-variant (marital quality) variables on within-person changes and on between-person differences in cognitive decline over the observation period. RESULTS The results showed that individuals' likelihood of having higher cognitive health grew when their spousal relationship became more positive and that, compared with those with lower levels of marital quality, people with higher levels of marital quality were more likely to have higher cognitive health. Interestingly, improvements in marital quality were more beneficial for men than for women, whereas level of marital quality had similar effects on men's and women's cognitive health. CONCLUSION Couple-based intervention programs aiming to improve marital quality should be encouraged, especially among older adults.
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Affiliation(s)
- Yujin Kim
- Department of Sociology, Kangwon National University, Chuncheon, Republic of Korea
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32
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The association of marital status with cognitive function and the role of gender in Chinese community-dwelling older adults: a cross-sectional study. Aging Clin Exp Res 2021; 33:2273-2281. [PMID: 33156506 DOI: 10.1007/s40520-020-01743-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence of the association between marital status and cognitive function in Chinese older adults is limited. AIMS To examine the relationship between marital status and cognitive function and to explore the role of gender amongst older adults from three Chinese communities. METHODS A total of 1376 participants aged 60 years or over were included in this cross-sectional study. Cognitive function was assessed using the Chinese version of the mini-mental state examination (MMSE). Marital status and other variables were collected using a standardized questionnaire. Multiple linear regression models were used to examine associations between marital statuses and cognitive function amongst the target population. The moderating role of gender in these potential associations has also been explored. RESULTS In univariate linear regression models, compared to being married, both being widowed (β [95% CI]: -1.46[-2.78 to - 0.13]) and being single (β [95% CI]: - 4.88[-6.43 to - 3.38]) were associated with lower MMSE scores. After adjustment for confounding factors, the significant association of being widowed with MMSE scores disappeared (β [95% CI: - 0.08[- 1.04 to 0.86]), but the association of being single with MMSE scores still existed (β [95% CI]: - 1.87[- 3.17 to - 0.58]). Furthermore, the association of being single with MMSE scores was statistically significant in men (β [95% CI]: - 5.25[- 7.17 to - 3.33]) but not in women (β [95% CI: 0.88[- 0.87 to 2.64]). DISCUSSION AND CONCLUSIONS Being single was associated with poorer cognitive function compared with their married counterparts in older Chinese men but not in women. More preventive measurements should be implemented for single men to reduce or delay cognitive decline. This is particularly important in the context of an aging population in China.
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33
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Nakahori N, Sekine M, Yamada M, Tatsuse T, Kido H, Suzuki M. Association between marital status and cognitive function in Japan: results from the Toyama Dementia Survey. Psychogeriatrics 2021; 21:627-635. [PMID: 34034362 DOI: 10.1111/psyg.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/03/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aims to clarify the association between marital status and dementia in Japan, adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. METHODS Data from the Japanese Toyama Dementia Survey were used. Individuals aged ≥65 years living in Toyama Prefecture were randomly selected, and 1171 participants were analysed, with a sampling rate of 0.5%. The participants' marital status, socioeconomic status, lifestyle factors, and lifestyle-related diseases were assessed. The odds ratio (OR) of marital status for each lifestyle factor and medical histories were calculated by logistic regression analysis. The OR of marital status for dementia was also calculated by logistic regression analysis. RESULTS The prevalence of dementia was 7.4% for married, and 20.6% for non-married participants. Non-married participants showed a higher prevalence of a history of stroke than married participants. The age- and sex-adjusted OR of marital status for dementia was 1.99 (95% confidence interval (CI) 1.24-3.18) for non-married compared with married participants. Following variable adjustments, the OR for dementia was higher for non-married participants (adjusted OR 1.71; 95% CI 1.03-2.85). CONCLUSIONS Non-marital status was an independent risk factor for dementia in Japan even after adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. Non-married people were more likely to have dementia because of their history of stroke.
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Affiliation(s)
- Nobue Nakahori
- Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan.,Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan
| | - Masaaki Yamada
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, School of Medicine, University of Toyama, Toyama, Japan
| | | | - Michio Suzuki
- Department of Neuropsychiatry, School of Medicine, University of Toyama, Toyama, Japan
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Liu H, Zhang Z, Zhang Y. A national longitudinal study of marital quality and cognitive decline among older men and women. Soc Sci Med 2021; 282:114151. [PMID: 34174580 DOI: 10.1016/j.socscimed.2021.114151] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
We provide one of the first national longitudinal studies of the association between trajectories of marital quality and cognitive functioning among older adults, with close attention paid to gender differences. Data were drawn from the Health and Retirement Study (HRS) 2006-2016. Marital quality trajectories were assessed at three waves: 2006/2008, 2010/2012, and 2014/2016. Cognitive trajectories were assessed at five waves: 2008, 2010, 2012, 2014, and 2016. The final analytic sample included 7901 respondents age 50 and older (4334 men and 3567 women) who were either married or cohabiting during the study period. Results from parallel linear growth curve models suggest that among older adults, initial positive marital quality was associated with better initial cognition, and initial negative marital quality was associated with worse initial cognition. Results from multiple group analysis further suggest that marital quality was significantly associated with men's cognitive trajectories but not women's. Among men, an increase in positive marital quality was associated with a slower rate of cognitive decline, whereas an increase in negative marital quality was associated with a faster rate of cognitive decline. These findings suggest that older men who experience a decline in marital quality may be vulnerable to cognitive decline and that reducing marital strain and improving marital quality may protect men's cognitive health in later life.
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Affiliation(s)
- Hui Liu
- Department of Sociology, Michigan State University, East Lansing, MI, USA.
| | - Zhenmei Zhang
- Department of Sociology, Michigan State University, East Lansing, MI, USA
| | - Yan Zhang
- Department of Sociology, Michigan State University, East Lansing, MI, USA
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35
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Kim Y. Gender Differences in the Link Between Marital Status and the Risk of Cognitive Impairment: Results From the Korean Longitudinal Study of Aging. Int J Aging Hum Dev 2021; 94:415-435. [PMID: 34110927 DOI: 10.1177/00914150211024181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the context of South Korea, characterized by increasing population aging and a changing family structure, this study examined differences in the risk of cognitive impairment by marital status and investigated whether this association differs by gender. The data were derived from the 2006-2018 Korean Longitudinal Study of Aging. The sample comprised 7,568 respondents aged 45 years or older, who contributed 30,414 person-year observations. Event history analysis was used to predict the odds of cognitive impairment by marital status and gender. Relative to their married counterparts, never-married and divorced people were the most disadvantaged in terms of cognitive health. In addition, the association between marital status and cognitive impairment was much stronger for men than for women. Further, gender-stratified analyses showed that, compared with married men, never-married men had a higher risk of cognitive impairment, but there were no significant effects of marital status for women.
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Affiliation(s)
- Yujin Kim
- 34962 Department of Sociology, Kangwon National University, Chuncheon, Korea
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36
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Translation and Validation of 10/66 Dementia Diagnostic Battery in Urdu in Karachi, Pakistan. Alzheimer Dis Assoc Disord 2021; 34:163-169. [PMID: 31651419 DOI: 10.1097/wad.0000000000000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The 10/66 dementia research group (DRG) diagnostic tool was devised to diagnose dementia in people with low education in low and middle-income countries. This study aimed to validate the 10/66 DRG tool in Urdu in Pakistan. METHODOLOGY People older than or equal to 60 years were included: (1) With normal cognition: no/low education, high education, and depression; (2) People with mild and moderate dementia. The diagnostic and statistical manual IV-TR clinician diagnosis was used as the gold standard for dementia. The Clinician Dementia Rating scale was used to rate dementia severity. The geriatric mental status AGECAT stage I output was used to diagnose depression. The 10/66 battery was comprised of CSI-D (cognitive screening instrument for dementia), CERAD (consortium to establish a registry of Alzheimer disease), and animal naming test. RESULT The sensitivity and specificity of CSI-D COG score for diagnosing dementia was 86.7% and 72.1%, for CSI-D DF score was 71.1% and 96.1%, for CERAD-10 word list delayed recall was 85.9% and 62.2% at a cut point of ≥5 words, and 70.3% and 97.7% for 10/66 diagnostic algorithm. CONCLUSIONS The 10/66 DRG tool is a valid instrument for diagnosing dementia in the Urdu-speaking population, including with low education and depression, in Pakistan.
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37
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Zhang Z, Liu H, Choi SWE. Marital loss and risk of dementia: Do race and gender matter? Soc Sci Med 2021; 275:113808. [PMID: 33713925 PMCID: PMC8015783 DOI: 10.1016/j.socscimed.2021.113808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/02/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.
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Affiliation(s)
- Zhenmei Zhang
- Department of Sociology, Michigan State University, USA.
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Seung-Won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, USA
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38
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Hu M, Shu X, Yu G, Wu X, Välimäki M, Feng H. A Risk Prediction Model Based on Machine Learning for Cognitive Impairment Among Chinese Community-Dwelling Elderly People With Normal Cognition: Development and Validation Study. J Med Internet Res 2021; 23:e20298. [PMID: 33625369 PMCID: PMC7946590 DOI: 10.2196/20298] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Identifying cognitive impairment early enough could support timely intervention that may hinder or delay the trajectory of cognitive impairment, thus increasing the chances for successful cognitive aging. OBJECTIVE We aimed to build a prediction model based on machine learning for cognitive impairment among Chinese community-dwelling elderly people with normal cognition. METHODS A prospective cohort of 6718 older people from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) register, followed between 2008 and 2011, was used to develop and validate the prediction model. Participants were included if they were aged 60 years or above, were community-dwelling elderly people, and had a cognitive Mini-Mental State Examination (MMSE) score ≥18. They were excluded if they were diagnosed with a severe disease (eg, cancer and dementia) or were living in institutions. Cognitive impairment was identified using the Chinese version of the MMSE. Several machine learning algorithms (random forest, XGBoost, naïve Bayes, and logistic regression) were used to assess the 3-year risk of developing cognitive impairment. Optimal cutoffs and adjusted parameters were explored in validation data, and the model was further evaluated in test data. A nomogram was established to vividly present the prediction model. RESULTS The mean age of the participants was 80.4 years (SD 10.3 years), and 50.85% (3416/6718) were female. During a 3-year follow-up, 991 (14.8%) participants were identified with cognitive impairment. Among 45 features, the following four features were finally selected to develop the model: age, instrumental activities of daily living, marital status, and baseline cognitive function. The concordance index of the model constructed by logistic regression was 0.814 (95% CI 0.781-0.846). Older people with normal cognitive functioning having a nomogram score of less than 170 were considered to have a low 3-year risk of cognitive impairment, and those with a score of 170 or greater were considered to have a high 3-year risk of cognitive impairment. CONCLUSIONS This simple and feasible cognitive impairment prediction model could identify community-dwelling elderly people at the greatest 3-year risk for cognitive impairment, which could help community nurses in the early identification of dementia.
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Affiliation(s)
- Mingyue Hu
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xinhui Shu
- Henan Cancer Hospital Province, Zhengzhou University, Zhengzhou, China
| | - Gang Yu
- Department of Biomedical Engineering, School of Basic Medical Science, Central South University, Changsha, China
| | - Xinyin Wu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Maritta Välimäki
- Xiangya Nursing School, Central South University, Changsha, China
- Department of Nursing Science, University of Turku, Helsinki, Finland
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha, China
- Oceanwide Health Management Institute, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Sundström A, Adolfsson AN, Nordin M, Adolfsson R. Loneliness Increases the Risk of All-Cause Dementia and Alzheimer's Disease. J Gerontol B Psychol Sci Soc Sci 2021; 75:919-926. [PMID: 31676909 PMCID: PMC7161366 DOI: 10.1093/geronb/gbz139] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives To examine the effect of perceived loneliness on the development of dementia (all-cause), Alzheimer´s disease (AD), and vascular dementia (VaD). Method The study comprised 1,905 nondemented participants at baseline, drawn from the longitudinal Betula study in Sweden, with a follow-up time of up to 20 years (mean 11.1 years). Loneliness was measured with a single question: “Do you often feel lonely?”. Results During the follow-up, 428 developed dementia; 221 had AD, 157 had VaD, and 50 had dementia of other subtypes. The entire dementia group is denoted “all-cause dementia.” Cox regression models, adjusted for age, gender, and a baseline report of perceived loneliness, showed increased risk of all-cause dementia (hazard ratio [HR] = 1.46, 95% confidence interval [CI] 1.14–1.89), and AD (HR = 1.69, 95% CI 1.20–2.37), but not VaD (HR = 1.34, 95% CI 0.87–2.08). After adjusting for a range of potential confounders, and excluding participants with dementia onset within the first 5 years of baseline (to consider the possibility of reverse causality), the increased risk for the development of all-cause dementia and AD still remained significant (HR = 1.51, 95% CI 1.01–2.25 for all-cause dementia; HR = 2.50, 95% CI 1.44–4.36 for AD). Discussion The results suggest that perceived loneliness is an important risk factor for all-cause dementia and especially for AD, but not for VaD. These results underscore the importance of paying attention to subjective reports of loneliness among the elderly adults and identifying potential intervention strategies that can reduce loneliness.
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Affiliation(s)
- Anna Sundström
- Department of Psychology, Sweden.,Centre for Demographic and Ageing Research (CEDAR), Sweden
| | | | | | - Rolf Adolfsson
- Department of Clinical Sciences, Umeå University, Sweden
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Najar J, Aakre JA, Vassilaki M, Wetterberg H, Rydén L, Zettergren A, Skoog I, Jack CR, Knopman DS, Petersen RC, Kern S, Mielke MM. Sex Difference in the Relation Between Marital Status and Dementia Risk in Two Population-Based Cohorts. J Alzheimers Dis 2021; 83:1269-1279. [PMID: 34420952 PMCID: PMC8490335 DOI: 10.3233/jad-210246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The modifying effect of sex on the relation between marital status and dementia has yet to be determined. OBJECTIVE To examine if sex modifies the association between marital status and incident dementia. METHODS Population-based samples from the Mayo Clinic Study of Aging (MCSA, N = 3,471) and the Gothenburg H70 Birth Cohort Study (H70-study, N = 913) were used. A multiplicative interaction term was used to analyze the modifying effect of sex on the relation between marital status (married versus not married) and incident dementia using Cox regression models. Further, risk of dementia by marital status was also evaluated in models separated by sex. RESULTS In the MCSA, there was an interaction between marital status and sex in relation to dementia (p = 0.015). In contrast, in the H70-study, no significant interaction was observed (p = 0.28). Nevertheless, in both studies, not married men had increased risk of dementia compared to married men in models adjusted for age, education, and number of children (H70-study: 1.99; 1.06-3.76, MCSA: 1.43; 1.08-1.89). Associations remained similar after additional adjustment for depression, BMI, hypertension, dyslipidemia, and diabetes mellitus (H70-study: 2.00; 1.05-3.82, MCSA: 1.32; 0.99-1.76). Further, no significant association was observed between marital status and dementia in women (H70-study: 1.24; 0.82-1.89, MCSA: 0.82; 0.64-1.04). CONCLUSION Sex had a modifying effect on the association between marital status and incident dementia. In analyses separated by sex, not married men had an increased risk of dementia compared to married men, while no significant association was observed between marital status and risk of dementia in women.
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Affiliation(s)
- Jenna Najar
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Jeremiah A. Aakre
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Maria Vassilaki
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hanna Wetterberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Sweden
| | - Lina Rydén
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Anna Zettergren
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Sweden
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | | | | | - Ronald C. Petersen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Michelle M. Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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Kim S, Choe K, Lee K. Depression, Loneliness, Social Support, Activities of Daily Living, and Life Satisfaction in Older Adults at High-Risk of Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249448. [PMID: 33348548 PMCID: PMC7767125 DOI: 10.3390/ijerph17249448] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 12/19/2022]
Abstract
As the number of older adults with dementia increases, early diagnosis and intervention are crucially important. The purpose of this study was to conduct dementia screening on older adults to determine whether there are differences in depression, loneliness, social support, daily activities of living, and life satisfaction between older adults at high-risk for dementia compared with low-risk older adults. We hypothesized a negative relationship between high-risk older adults and these factors. This study also hypothesized a moderating effect for social support on the relationship between daily living activities and life satisfaction. This study used a cross-sectional design with survey data. Participants were recruited at 15 public community health centers in South Korea. A total of 609 older adults (male 208, female 401) living in the community were screened for early dementia, and 113 participants (18.9%) were assigned to the high-risk group. As hypothesized, participants in the high-risk group showed significantly more negative results in terms of activities of daily living, depression, loneliness, social support, and life satisfaction compared with participants in the low-risk group. The findings of this study provide a theoretical basis for the importance of early screening for dementia and policies for effective dementia prevention.
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Nyberg L, Boraxbekk CJ, Sörman DE, Hansson P, Herlitz A, Kauppi K, Ljungberg JK, Lövheim H, Lundquist A, Adolfsson AN, Oudin A, Pudas S, Rönnlund M, Stiernstedt M, Sundström A, Adolfsson R. Biological and environmental predictors of heterogeneity in neurocognitive ageing: Evidence from Betula and other longitudinal studies. Ageing Res Rev 2020; 64:101184. [PMID: 32992046 DOI: 10.1016/j.arr.2020.101184] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
Individual differences in cognitive performance increase with advancing age, reflecting marked cognitive changes in some individuals along with little or no change in others. Genetic and lifestyle factors are assumed to influence cognitive performance in ageing by affecting the magnitude and extent of age-related brain changes (i.e., brain maintenance or atrophy), as well as the ability to recruit compensatory processes. The purpose of this review is to present findings from the Betula study and other longitudinal studies, with a focus on clarifying the role of key biological and environmental factors assumed to underlie individual differences in brain and cognitive ageing. We discuss the vital importance of sampling, analytic methods, consideration of non-ignorable dropout, and related issues for valid conclusions on factors that influence healthy neurocognitive ageing.
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Affiliation(s)
- Lars Nyberg
- Department of Radiation Sciences, Umeå University, S-90187 Umeå, Sweden; Umeå Center for Functional Brain Imaging (UFBI), Umeå University, S-90187 Umeå, Sweden; Department of Integrative Medical Biology, Umeå University, S-90187 Umeå, Sweden.
| | - Carl-Johan Boraxbekk
- Department of Radiation Sciences, Umeå University, S-90187 Umeå, Sweden; Umeå Center for Functional Brain Imaging (UFBI), Umeå University, S-90187 Umeå, Sweden; Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Daniel Eriksson Sörman
- Department of Human Work Science, Luleå University of Technology, SE-97187 Luleå, Sweden
| | - Patrik Hansson
- Department of Psychology, Umeå University, S-90187 Umeå, Sweden
| | - Agneta Herlitz
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, S-17177 Stockholm, Sweden
| | - Karolina Kauppi
- Department of Integrative Medical Biology, Umeå University, S-90187 Umeå, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jessica K Ljungberg
- Department of Human Work Science, Luleå University of Technology, SE-97187 Luleå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
| | - Anders Lundquist
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, S-90187 Umeå, Sweden; Department of Statistics, USBE, Umeå University, 901 87 Umeå, Sweden
| | | | - Anna Oudin
- Department of Public Health and Clinical Medicine, Umeå University, S-90187 Umeå, Sweden; Environment Society and Health, Occupational and Environmental Medicine, Lund University
| | - Sara Pudas
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, S-90187 Umeå, Sweden; Department of Integrative Medical Biology, Umeå University, S-90187 Umeå, Sweden
| | | | - Mikael Stiernstedt
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, S-90187 Umeå, Sweden; Department of Integrative Medical Biology, Umeå University, S-90187 Umeå, Sweden
| | - Anna Sundström
- Department of Psychology, Umeå University, S-90187 Umeå, Sweden; Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, S-90187, Sweden
| | - Rolf Adolfsson
- Department of Clinical Sciences, Umeå University, S-90187 Umeå, Sweden
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Age-Related Changes in the Association Between Traumatic Brain Injury and Dementia in Older Men and Women. J Head Trauma Rehabil 2020; 36:E139-E146. [PMID: 33201033 DOI: 10.1097/htr.0000000000000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate age-related changes in the association between traumatic brain injury (TBI) and dementia in older men and women separately. SETTING A total of 243 general practices in the UK. PARTICIPANTS This study included 4760 patients who received a first TBI diagnosis between 1995 and 2010 (index date), and 4760 patients without TBI who were matched to those with TBI by age, sex, index year, Charlson Comorbidity Index, alcohol dependence, and physician (index date: a randomly selected visit date). DESIGN Retrospective cohort study. MAIN MEASURES Incidence of dementia in the decade following index date. RESULTS Within 10 years of index date, 8.8% of men with TBI and 4.8% of those without TBI were diagnosed with dementia, while the respective figures were 9.0% and 6.7% in women (P values < .01). There was a significant association between TBI and dementia in men (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.64-3.19) and in women (HR = 1.33, 95% CI: 1.07-1.64). Furthermore, the association between TBI and dementia was significant in men aged 60 to 70 (HR = 2.51, 95% CI: 1.27-4.96) and 71 to 80 years (HR = 3.00, 95% CI: 1.82-4.93), whereas the relationship was only significant and potentially unreliable in women aged 81 to 90 years (HR = 1.49, 95% CI: 1.03-2.14). CONCLUSIONS The age-related relationship between TBI and dementia differed between men and women. More research of a prospective nature and including behavioral data is needed to better understand these differences.
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45
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The association between sociodemographic characteristics and dementia in patients with atrial fibrillation. Aging Clin Exp Res 2020; 32:2319-2327. [PMID: 31927710 PMCID: PMC7591421 DOI: 10.1007/s40520-019-01449-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/11/2019] [Indexed: 01/02/2023]
Abstract
Objectives Association between socio-demographic factors and dementia risk is studied in general but not for atrial fibrillation (AF) patients. Methods We studied AF patients ≥ 45 years in Sweden 1998–2012 (n = 537,513) using the Total Population Register for socio-demographic factors, the Swedish Cause of Death Register, and the National Patient Register (NPR) for incident dementia. Cox regression with hazard ratios (HR) and 95% confidence intervals (CI) was used for the association between exposure and outcome, adjusting for age and comorbidities. Results Totally 30,332 patients (5.6%) were diagnosed with dementia during the follow-up (mean 5.4 years). Of these, 14,097 were men (4.9%) and 16,235 were women (6.5%). Lower educational levels (reference: highest level) were associated with increased dementia, HRs (95% CI) for basic school for men 1.23 (1.18–1.29) and women 1.36 (1.30–1.42), and middle-level school for men 1.17 (1.11–1.22) and women 1.28 (1.22–1.34). Divorced men and women (reference: married) showed increased risk of dementia, HR 1.07 (1.01–1.13) and 1.12 (1.06–1.18), respectively, while widowed men showed lower risk, HR 0.84 (0.80–0.88). High deprivation neighborhood socio-economic status (NSES; reference: medium level) was associated with increased dementia in men, HR 1.11 (1.05–1.17), and low deprivation neighborhood socio-economic status (NSES) with increased dementia in men and women, HR 1.12 (1.06–1.18) and 1.18 (1.12–1.24), respectively. Conclusions Some results were expected, i.e. association between lower educational level and dementia. The higher risk of dementia in low deprivation NSES-areas could be due to a higher awareness about dementia, and subsequent earlier diagnosis and treatment of dementia. Electronic supplementary material The online version of this article (10.1007/s40520-019-01449-3) contains supplementary material, which is available to authorized users.
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46
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Nabe-Nielsen K, Rod NH, Hansen ÅM, Prescott E, Grynderup MB, Islamoska S, Ishtiak-Ahmed K, Garde AH, Gyntelberg F, Mortensen EL, Phung TKT, Waldemar G, Westendorp RGJ. Perceived stress and dementia: Results from the Copenhagen city heart study. Aging Ment Health 2020; 24:1828-1836. [PMID: 31184203 DOI: 10.1080/13607863.2019.1625304] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: We investigated if perceived stress in midlife increased the risk of dementia. Furthermore, we explored differences between subgroups related to sex, age and employment status when reporting stress.Methods: In this longitudinal study, we used information on perceived stress from 10,814 participants (mean age 56.7 years). Participants were followed through Danish national registers for development of dementia. Participants were considered at risk of dementia from the date they turned 60 years. Perceived stress was assessed as a combination of self-reported intensity and frequency of stress, and categorized into low (score 0-1), medium (score 2-4), and high stress (score 5-6). We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI) and adjusted for sociodemographic factors and psychiatric morbidity at baseline (main model) as well as cardio/cerebrovascular diseases and health behaviors at baseline (additional model).Results: The mean follow-up time was 13.8 years, and 1,519 participants were registered with dementia. Dementia risk was higher in participants reporting medium stress (IRR = 1.11, 95% CI: 0.99-1.24) and high stress (IRR = 1.36, 95% CI: 1.13-1.65). Adjustment for cardio/cerebrovascular diseases and health behaviors did not alter the results. We did not find strong support for differences between subgroups, although the association between stress and dementia was stronger for those who were employed at the time of reporting high stress.Conclusion: Our results provide empirical support for an effect of perceived stress on the risk of dementia in old age.
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Affiliation(s)
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Adani G, Filippini T, Garuti C, Malavolti M, Vinceti G, Zamboni G, Tondelli M, Galli C, Costa M, Vinceti M, Chiari A. Environmental Risk Factors for Early-Onset Alzheimer's Dementia and Frontotemporal Dementia: A Case-Control Study in Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7941. [PMID: 33138082 PMCID: PMC7663191 DOI: 10.3390/ijerph17217941] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Background: Early-onset dementia (EOD) is defined as dementia with symptom onset before 65 years. The role of environmental risk factors in the etiology of EOD is still undefined. We aimed at assessing the role of environmental risk factors in EOD etiology, taking into account its different clinical types. Methods: Using a case-control study, we recruited all EOD cases referred to Modena hospitals from 2016 to 2019, while the referent population was drawn from cases' caregivers. We investigated residential history, occupational and environmental exposures to chemicals and lifestyle behaviors through a self-administered questionnaire. We computed the odds ratios of EOD risk (overall and restricting to the Alzheimer's dementia (AD) or frontotemporal dementia (FTD) diagnoses) and the corresponding 95% confidence intervals using an unconditional logistic regression model. Results: Fifty-eight EOD patients (19 FTD and 32 AD) and 54 controls agreed to participate. Most of the investigated exposures, such as occupational exposure to aluminum, pesticides, dyes, paints or thinners, were associated with an increased odds ratio (OR) for FTD but not for AD. Long-term use of selenium-containing dietary supplements was associated with increased OR for EOD and, particularly, for FTD. For both EOD forms, smoking and playing football showed an increased odds ratio, while cycling was associated with increased risk only in FTD. Overall sports practice appeared to be a protective factor for both types. Conclusions: Our results suggest a role of environmental and behavioral risk factors such as some chemical exposures and professional sports in EOD etiology, in particular with reference to FTD. Overall sports practice may be associated with a reduced EOD risk.
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Affiliation(s)
- Giorgia Adani
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Caterina Garuti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Marcella Malavolti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
| | - Giulia Vinceti
- Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (G.V.); (G.Z.)
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
| | - Giovanna Zamboni
- Center for Neurosciences and Neurotechnology, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (G.V.); (G.Z.)
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Manuela Tondelli
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
- Primary Care Department, Modena Local Health Authority, 41124 Modena, Italy
| | - Chiara Galli
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
- Primary Care Department, Modena Local Health Authority, 41124 Modena, Italy
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NeuroFARBA), University of Florence, 50139 Florence, Italy
| | - Manuela Costa
- Neurology Unit of Carpi Hospital, Modena Local Health Authority, 41012 Carpi, Italy;
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.A.); (T.F.); (C.G.); (M.M.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Annalisa Chiari
- Neurology Unit, Modena Policlinico-University Hospital, 41126 Modena, Italy; (M.T.); (C.G.); (A.C.)
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Deckers K, Nooyens A, van Boxtel M, Verhey F, Verschuren M, Köhler S. Gender and Educational Differences in the Association between Lifestyle and Cognitive Decline over 10 Years: The Doetinchem Cohort Study. J Alzheimers Dis 2020; 70:S31-S41. [PMID: 30507570 PMCID: PMC6700651 DOI: 10.3233/jad-180492] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Several modifiable risk factors for cognitive decline have been identified, but whether differences by gender and educational level exist is unclear. OBJECTIVE The present study aims to clarify this by prospectively investigating the relationship between health and lifestyle factors and cognitive functioning in different subgroups defined by gender and educational level. METHODS 2,347 cognitive healthy individuals (mean age = 54.8, SD = 6.8, range: 41-71; 51.8% female; 26.2% low education) from the Doetinchem Cohort Study were examined for cognitive function at baseline, and at 5- and 10-year follow-up. Health- and lifestyle factors were captured by a poly-environmental risk score labelled 'LIfestyle for BRAin Health' (LIBRA). This score consists of 12 modifiable risk and protective factors for cognitive decline and dementia, with higher scores indicating greater risk (range: -2.7 to +12.7). Heterogeneity in associations between LIBRA and decline in verbal memory, cognitive flexibility, and mental speed between males and females and individuals with different levels of education were assessed in linear mixed models. RESULTS Overall, higher LIBRA scores predicted faster decline in verbal memory, cognitive flexibility, and mental speed over 10 years. Higher LIBRA scores were further associated with increased risk for incident cognitive impairment (one-point increase in LIBRA: HR = 1.09, 1.04-1.14, p = 0.001). In general, these effects were similar across gender and educational level. CONCLUSION A composite risk score comprising unhealthy lifestyle and relatively poor health in midlife is significantly associated with a worse course of cognition 10 years later. These associations were for the most part unrelated to gender or educational differences.
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Affiliation(s)
- Kay Deckers
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Astrid Nooyens
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Martin van Boxtel
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frans Verhey
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Liu H, Zhang Z, Choi SW, Langa KM. Marital Status and Dementia: Evidence from the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2020; 75:1783-1795. [PMID: 31251349 PMCID: PMC7489107 DOI: 10.1093/geronb/gbz087] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We provide one of the first population-based studies of variation in dementia by marital status in the United States. METHOD We analyzed data from the Health and Retirement Study (2000-2014). The sample included 15,379 respondents (6,650 men and 8,729 women) aged 52 years and older in 2000 who showed no evidence of dementia at the baseline survey. Dementia was assessed using either the modified version of the Telephone Interview for Cognitive Status (TICS) or the proxy's assessment. Discrete-time hazard regression models were estimated to predict odds of dementia. RESULTS All unmarried groups, including the cohabiting, divorced/separated, widowed, and never married, had significantly higher odds of developing dementia over the study period than their married counterparts; economic resources and, to a lesser degree, health-related factors accounted for only part of the marital status variation in dementia. For divorced/separated and widowed respondents, the differences in the odds of dementia relative to married respondents were greater among men than among women. DISCUSSION These findings will be helpful for health policy makers and practitioners who seek to better identify vulnerable subpopulations and to design effective intervention strategies to reduce dementia risk.
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Affiliation(s)
- Hui Liu
- Department of Sociology, Michigan State University, East Lansing
| | - Zhenmei Zhang
- Department of Sociology, Michigan State University, East Lansing
| | - Seung-won Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock
| | - Kenneth M Langa
- Department of Internal Medicine, Institute for Social Research and VA Center for Clinical Management Research, University of Michigan, Ann Arbor
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50
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White L, Fishman P, Basu A, Crane PK, Larson EB, Coe NB. Dementia Is Associated With Earlier Mortality for Men and Women in the United States. Gerontol Geriatr Med 2020; 6:2333721420945922. [PMID: 32913883 PMCID: PMC7444147 DOI: 10.1177/2333721420945922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/30/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. Our study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Methods: Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, we identified a retrospective cohort of adults with at least one International Classification of Diseases—ninth revision—Clinical Modification (ICD-9-CM) dementia diagnosis code (n = 3,714). For each case, we randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year (n = 9,531), and assigned comparators the diagnosis date of their matched case. Participants were followed for up to 60 months following diagnosis. We estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. Results: On average, dementia cases were 80.5 years old at diagnosis. Most were female, had less than college-level education, and approximately 40% were married at diagnosis. In multivariate analyses, dementia diagnosis was associated with earlier mortality for women (predicted median survival of 54.5 months vs. 62.5 months; dementia coefficient = −0.13; 95% confidence interval [CI] = [−0.22, −0.04]; p = .003), but even more so among men (predicted median survival of 35.5 months vs. 54.5 months; dementia coefficient = −0.42; 95% CI = [−0.52, −0.31]; p < .001). We found substantial heterogeneity in the relationship between dementia and survival, associated with both education and marital status. Conclusion: Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.
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Affiliation(s)
| | | | - Anirban Basu
- University of Washington, Seattle, WA, USA.,National Bureau of Economic Research, Cambridge, MA, USA
| | | | | | - Norma B Coe
- National Bureau of Economic Research, Cambridge, MA, USA.,University of Pennsylvania, Philadelphia, PA, USA
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