1
|
Qiang YX, Deng YT, Zhang YR, Wang HF, Zhang W, Dong Q, Feng JF, Cheng W, Yu JT. Associations of blood cell indices and anemia with risk of incident dementia: A prospective cohort study of 313,448 participants. Alzheimers Dement 2023; 19:3965-3976. [PMID: 37102212 DOI: 10.1002/alz.13088] [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] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Low hemoglobin and anemia are associated with cognitive impairment and Alzheimer's disease (AD). However, the associations of other blood cell indices with incident dementia risk and the underlined mechanisms are unknown. METHODS Three hundred thirteen thousand four hundred forty-eight participants from the UK Biobank were included. Cox and restricted cubic spline models were used to investigate linear and non-linear longitudinal associations. Mendelian randomization analysis was used to identify causal associations. Linear regression models were used to explore potential mechanisms driven by brain structures. RESULTS During a mean follow-up of 9.03 years, 6833 participants developed dementia. Eighteen indices were associated with dementia risk regarding erythrocytes, immature erythrocytes, and leukocytes. Anemia was associated with a 56% higher risk of developing dementia. Hemoglobin and red blood cell distribution width were causally associated with AD. Extensive associations exist between most blood cell indices and brain structures. DISCUSSION These findings consolidated associations between blood cells and dementia. HIGHLIGHT Anemia was associated with 56% higher risk for all-cause dementia. Hematocrit percentage, mean corpuscular volume, platelet crit, and mean platelet volume had U-shaped associations with incident dementia risk. Hemoglobin (HGB) and red blood cell distribution width had causal effects on Alzheimer's risk. HGB and anemia were associated with brain structure alterations.
Collapse
Affiliation(s)
- Yi-Xuan Qiang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue-Ting Deng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Ru Zhang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Qiang Dong
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Wei Cheng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
- Shanghai Medical College and Zhongshan Hospital Immunotherapy Technology Transfer Center, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Zenebe Y, Necho M, Yimam W, Akele B. Worldwide Occurrence of HIV-Associated Neurocognitive Disorders and Its Associated Factors: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:814362. [PMID: 35711575 PMCID: PMC9193596 DOI: 10.3389/fpsyt.2022.814362] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/05/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorders are common in people living with HIV/AIDS and affect the adherence of patients to prescriptions, activities of daily living, and quality of life of patients. However, there is a lack of summative evidence in the area. The present meta-analysis was therefore addressing this gap. METHODS We did our electronic search in Psych-Info, EMBASE, Scopus, and PubMed. The retrieved articles were stored with the endnote reference manager and data was extracted using Meta-XL version 5.3. The quality of studies was evaluated with the modified Newcastle-Ottawa Scale (NOS). A random-effect model and STATA-16 were used to compute the average estimate of HAND. Heterogeneity was weighed with I2 statistics. A sensitivity analysis and subgroup analysis were employed. The existence/nonexistence of a publication bias was checked with the Eggers test of publication bias. RESULTS The average prevalence of HAND was 50.41% (95% CI: 45.56, 55.26). The average estimate of HAND in Europe was found to be 50.015% whereas in Africa, Asia, and the United States of America (USA) it was 49.566, 52.032, and 50.407% respectively. The prevalence of HAND in studies that used the HIV Dementia Scale (IHDS) was 36.883% and 59.956% at cutoff points of IHDS <9.5 and IHDS <10 respectively. Besides, the estimated average of HAND with the global dementia scale (GDS) was 40.766%. The prevalence of HAND in cross-sectional, cohort, and case-control studies was 49.52, 54.087, and 44.45% in that order. Socio-demographic variables; low level of education and older age, clinical and HIV related variables; the advanced stage of the illness and CD4 count of 500 cells/dl or less and psychological variables such as comorbidity of depression increases the risk of HAND. CONCLUSION The prevalence of HIV-associated neurocognitive disorders was about 50.41%. Low level of education and older age, clinical and HIV related variables such as the advanced stage of the illness and CD4 count of 500 cells/dl or less, and comorbidity of depression were associated with HIV associated neurocognitive disorders. Public health interventions for HIV patients should target these essential problems.
Collapse
Affiliation(s)
- Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wondwosen Yimam
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Baye Akele
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
3
|
Cao Q, Tan CC, Xu W, Hu H, Cao XP, Dong Q, Tan L, Yu JT. The Prevalence of Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 73:1157-1166. [PMID: 31884487 DOI: 10.3233/jad-191092] [Citation(s) in RCA: 204] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dementia is a severe neurodegenerative disorder and it can be categorized into several subtypes by different pathogenic causes. We sought to comprehensively analyzed the prevalence of dementia from perspectives of geographic region (Asia, Africa, South America, and Europe/North America), age, and gender. We searched PubMed and EMBASE for relevant articles on dementia published from January 1985 to August 2019. In these studies, analyses were stratified by geographic region, age, and gender. Meta-regression was conducted to identify if there were significant differences between groups. We included forty-seven studies. Among the individuals aged 50 and over in the community, the pooled prevalence for all-cause dementia, Alzheimer's disease, and vascular dementia were 697 (CI95%: 546-864) per 10,000 persons, 324 (CI95%: 228-460) per 10,000 persons, and 116 (CI95%: 86-157) per 10,000 persons, respectively. In our study, the prevalence of all-type dementia in individuals aged 100 years and older (6,592 per 10,000 cases) is 244 times higher than in those aged 50-59 (27 per 10,000 cases). The number of people living with dementia approximately doubles every five years. The prevalence was greater in women than in men (788 cases versus 561 cases per 10,000 persons) in overall analysis. In individuals aged 60 to 69 years, AD prevalence in females was 1.9 times greater than that in males (108 cases versus 56 cases per 10,000 persons), while the prevalence of VaD was 1.8 times greater in males than in females (56 cases versus 32 cases per 10,000 persons). Prevalence rate was higher in Europe and North America than in Asia, Africa, and South America.
Collapse
Affiliation(s)
- Qing Cao
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hao Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- Department of Neurology & Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-Tai Yu
- Department of Neurology & Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
4
|
Huang CJ, Weng SF, Wang JJ, Hsieh HM. Competing risk analysis of the association between dementia and major depressive disorder: a nationwide population-based study in Taiwan. Aging Ment Health 2021; 25:766-772. [PMID: 32009453 DOI: 10.1080/13607863.2020.1720598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To investigate the association between major depressive disorder (MDD) and the competing risk of Alzheimer's dementia (AD) and non-Alzheimer's dementia (NAD) using a nationwide population-based health insurance database.Methods: From Taiwan's National Health Insurance Research Database, we extracted claims data of 13,067 patients with MDD and 52,268 non-MDD controls matched by index date, age, sex, geographical area, monthly income, and selected comorbidities through propensity score matching. Follow-up durations in person-years were calculated for each person until dementia diagnosis, death, or the end of 2013. Competing incident risks of AD and NAD between patients with MDD and non-MDD.Results: In this study, 335 (2.6%) of the 13,067 MDD patients and 313 (0.6%) of the 52,268 non-MDDs developed AD. During the follow-up period, 73 (0.59%) of the 13,067 MDD patients developed NAD and 80 (0.15%) of the 52,268 non-MDD developed NAD. The patients with MDD had 4.73 and 3.69 times higher risks of AD (adjusted subdistribution hazard ratio [SHR] 4.73; 95% confidence interval [CI] 4.05-5.52) and NAD (adjusted SHR 3.69; 95% CI 2.68-5.08), respectively, than the controls.Conclusions: The patients with MDD had significantly higher incidence rates of AD and NAD than the controls, in particular among aged 65 and above. Additional studies are required to clarify the underlying pathophysiology between the MDD-dementia association and investigate whether prompt intervention in MDD can reduce the risk of dementia.
Collapse
Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hui-Min Hsieh
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
5
|
Saito Y, Kim JK, Davarian S, Hagedorn A, Crimmins EM. Cognitive Performance Among Older Persons in Japan and the United States. J Am Geriatr Soc 2019; 68:354-361. [PMID: 31509240 DOI: 10.1111/jgs.16163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance. DESIGN Nationally representative studies with harmonized collection of data on cognitive functioning. SETTING Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study. PARTICIPANTS A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older. MEASUREMENTS Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s. RESULTS Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20-point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5-point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years. CONCLUSION Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. J Am Geriatr Soc 68:354-361, 2020.
Collapse
Affiliation(s)
- Yasuhiko Saito
- College of Economics, Nihon University, Tokyo, Japan.,Population Research Institute, Nihon University, Tokyo, Japan
| | - Jung Ki Kim
- Davis School of Gerontology, University of Southern California, Los Angeles, California
| | - Shieva Davarian
- Los Angeles County Public Health Department, Los Angeles, California
| | - Aaron Hagedorn
- School of Social Work, University of Texas Arlington, Arlington, Texas
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, California
| |
Collapse
|
6
|
Brewer GJ. Avoiding Alzheimer's disease: The important causative role of divalent copper ingestion. Exp Biol Med (Maywood) 2019; 244:114-119. [PMID: 30727765 DOI: 10.1177/1535370219827907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPACT STATEMENT The work described in this review is very important to scientists working on Alzheimer's disease (AD) because it reveals a cause for the explosive epidemic of this disease. It is also important to the public because it provides a method to avoid this newly revealed cause, and thereby avoid AD. The field is advanced because this review reveals new information about the mechanism of AD pathogenesis, namely copper, and specifically divalent copper, toxicity is important. New information about divalent copper toxicity in the brain affecting cognition is revealed. The field is impacted strongly because, in view of the frustrations that have occurred in treatment developed, now most AD can be prevented. This means the suffering of the patient, the prolonged and difficult care required by caregivers, and the enormous expenditures for this one disease, can now be avoided.
Collapse
Affiliation(s)
- George J Brewer
- University of Michigan, Department of Human Genetics, MI 48103, USA
| |
Collapse
|
7
|
Abstract
The Hisayama Study is a population-based prospective cohort study designed to evaluate the risk factors for lifestyle-related diseases, such as stroke, coronary heart disease, hypertension, diabetes, and dementia, in a general Japanese population. The prospective follow-up surveys have been conducted in subjects aged 40 or older since 1961. Notable characteristics of this study include its high participation rate (70-80% of all residents aged 40 or older), high follow-up rate (99% or over), and high autopsy rate (approximately 75% of deceased cases). The Hisayama Study has provided valuable evidence of secular change in the prevalence and incidence of several lifestyle-related disease and their risk factors. The study has thereby contributed to elucidation of the preventive strategies for lifestyle-related disease. Research efforts in this cohort are ongoing and will provide additional data for the improvement of human health and longevity.
Collapse
Affiliation(s)
- Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
8
|
Javanshiri K, Waldö ML, Friberg N, Sjövall F, Wickerström K, Haglund M, Englund E. Atherosclerosis, Hypertension, and Diabetes in Alzheimer’s Disease, Vascular Dementia, and Mixed Dementia: Prevalence and Presentation. J Alzheimers Dis 2018; 65:1247-1258. [DOI: 10.3233/jad-180644] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Keivan Javanshiri
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden
| | - Maria Landqvist Waldö
- Department of Clinical Sciences Lund, Division of Clinical Sciences Helsingborg, Lund University, Sweden
| | - Niklas Friberg
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden
| | - Fredrik Sjövall
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden
| | - Karin Wickerström
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden
| | - Mattias Haglund
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden
| | - Elisabet Englund
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Sweden
| |
Collapse
|
9
|
Banerjee TK, Dutta S, Das S, Ghosal M, Ray BK, Biswas A, Hazra A, Chaudhuri A, Paul N, Das SK. Epidemiology of dementia and its burden in the city of Kolkata, India. Int J Geriatr Psychiatry 2017; 32:605-614. [PMID: 27251089 DOI: 10.1002/gps.4499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 03/21/2016] [Accepted: 04/14/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Increase in aging population is expected to lead to increasing prevalence of dementia in India. In this study, we aimed to determine prevalence, incidence, and mortality of dementia and its subtypes and assess dementia burden in terms of disability-adjusted life years (DALY). METHODS A community study was conducted over 5 years (2003-2008) in Kolkata, India, on 100,802 (males 53,209) randomly selected subjects to assess prevalence and capture data on incident cases and deaths. Standard case definitions were used. The data were used to estimate years of life lost (YLL) due to premature mortality, years of life lived with disability (YLD), and DALY, based on Global Burden of Disease 2010 approach. RESULTS During 2003-2004, there were 103 (men 55) cases of dementia. The prevalence was 1.53% (age adjusted 1.12%) at age ≥65 years. In those ≥55 years age, average annual incidence rate of dementia was 72.57 per 100,000. All-cause standardized mortality ratio in dementia cases was 4.74 (men 6.19, women 3.03). The burden of dementia in 2007-2008 revealed that overall YLL was 47.13 per 100,000 and YLD ranged from 1.87 to 16.95 per 100,000 depending on the clinical severity of dementia. The overall DALY lost per 100,000 due to dementia for the year 2007-2008 was 74.19. CONCLUSIONS This community study revealed a low prevalence and incidence of dementia with consequent low DALY-derived burden of illness compared with many industrialized nations. YLL formed major component of DALY indicating premature mortality to be an outcome of dementia burden. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Saunak Dutta
- Department of Statistics, University of Calcutta Ballygunj Campus, Kolkata, India
| | - Sujata Das
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, India
| | - Malay Ghosal
- Department of Psychiatry, Medical College Kolkata, Kolkata, India
| | - Biman Kanti Ray
- Department of Neurology, R. G. Kar Medical College, Kolkata, India
| | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | - Arijit Chaudhuri
- Sampling Unit, Department of Applied Statistics, Indian Statistical Institute, Kolkata, India
| | - Neelanjana Paul
- Department of psychiatry, ICARE Institute of Medical Sciences & Research, Haldia, West Bengal, India
| | - Shyamal Kumar Das
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, India
| |
Collapse
|
10
|
El-Sohemy A, Brewer GJ, Prasad AS. Summaries of the Micronutrient Symposium of the 2016 Meeting of the American College of Nutrition. J Am Coll Nutr 2017; 36:310-316. [DOI: 10.1080/07315724.2017.1305256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ahmed El-Sohemy
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George J. Brewer
- Sellner Emeritus Professor of Human Genetics and Emeritus Professor of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ananda S. Prasad
- Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Center, Detroit, Michigan
| |
Collapse
|
11
|
Brewer GJ. Copper-2 Hypothesis for Causation of the Current Alzheimer's Disease Epidemic Together with Dietary Changes That Enhance the Epidemic. Chem Res Toxicol 2017; 30:763-768. [PMID: 28161940 DOI: 10.1021/acs.chemrestox.6b00373] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Alzheimer's disease, the most common cause of dementia, is at epidemic proportions (15 to 44% depending on age, of those age 65 to 84) in the U.S. and other developed countries but remains relatively rare in undeveloped countries. Surprisingly, solid historical data reveal the epidemic is a creature of the last century. That is, the disease was also rare in developed countries, until the 20th century. It is disappointing that these historical and demographic facts have been ignored by the Alzheimer's disease scientific community. Disappointing because these facts clearly point at an environmental change in the 20th century in developed countries as a major factor in causing the epidemic. Some scientists have discarded the claimed rarity of the disease in the 19th century as incorrect, saying that Alzheimer's disease is a disease of aging and that the increasing lifespan of people accounts for the current high prevalence of the disease, but this cavalier attitude ignores historical data indicating there were many elderly people in the 19th century who were not getting Alzheimer's disease with any significant frequency. In this review, after documenting that the observed assertions about historical and demographic facts are correct, evidence is amassed that the main environmental culprit causing the Alzheimer's epidemic is ingestion of divalent copper or copper-2. The two sources of copper-2 ingestion are drinking water and multimineral supplement pills containing copper. The increase in copper plumbing use in developed countries parallels the increasing prevalence of Alzheimer's disease. It has been shown that enough copper is leached from copper plumbing in most households to cause Alzheimer's disease, using the Alzheimer's disease animal model studies as a guide to toxic levels. It is relatively easy to avoid or greatly diminish copper-2 ingestion by not using copper containing supplement pills and testing drinking water for copper levels. If the copper in water is too high, a simple device can be put on the tap to remove copper. In addition to the copper-2 hypothesis, this review covers dietary changes that enhance the epidemic.
Collapse
Affiliation(s)
- George J Brewer
- University of Michigan Medical School, University of Michigan , Ann Arbor, Michigan 48103, United States
| |
Collapse
|
12
|
Zimmer Z, Ofstedal MB, Chang MC. Impact of Cognitive Status and Decline on Service and Support Utilization among Older Adults in Taiwan. Res Aging 2016. [DOI: 10.1177/0164027501233001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using a sample of older adults in Taiwan, this study examines the impact of cognition on the use of informal support and formal health services. Results confirm the hypothesis that cognitive impairment is associated with increased use of informal care, while effects on formal service utilization are less consequential. A scale constructed from a subset of the Mini-Mental State Exam is significantly associated with receipt of instrumental activities of daily living assistance, while correlations with use of formal services such as hospitalization and physician visits are insignificant. A decline in cognitive status over time is correlated with the initiation of informal support but is not associated with formal service utilization. Implications of these results for a rapidly aging society such as Taiwan are discussed. With current low levels of fertility, future generations of older adults will have fewer social network resources. Absent of dramatic changes in cultural norms with respect to familial support in old age, the future will see an expanding care burden that must be borne by fewer family members.
Collapse
|
13
|
Brewer GJ. Copper-2 Ingestion, Plus Increased Meat Eating Leading to Increased Copper Absorption, Are Major Factors Behind the Current Epidemic of Alzheimer's Disease. Nutrients 2015; 7:10053-64. [PMID: 26633489 PMCID: PMC4690065 DOI: 10.3390/nu7125513] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 07/24/2015] [Accepted: 10/27/2015] [Indexed: 01/20/2023] Open
Abstract
It has become clear that copper toxicity is playing a major role in Alzheimer's disease; but why is the brain copper toxicity with cognition loss in Alzheimer's disease so much different clinically than brain copper toxicity in Wilson's disease, which results in a movement disorder? Furthermore, why is the inorganic copper of supplement pills and in drinking water so much more damaging to cognition than the organic copper in food? A recent paper, which shows that almost all food copper is copper-1, that is the copper-2 of foods reverts to the reduced copper-1 form at death or harvest, gives new insight into these questions. The body has an intestinal transport system for copper-1, Ctr1, which channels copper-1 through the liver and into safe channels. Ctr1 cannot absorb copper-2, and some copper-2 bypasses the liver, ends up in the blood quickly, and is toxic to cognition. Humans evolved to handle copper-1 safely, but not copper-2. Alzheimer's is at least in part, a copper-2 toxicity disease, while Wilson's is a general copper overload disease. In this review, we will show that the epidemiology of the Alzheimer's epidemic occurring in developed, but not undeveloped countries, fits with the epidemiology of exposure to copper-2 ingestion leached from copper plumbing and from copper supplement pill ingestion. Increased meat eating in developed countries is also a factor, because it increases copper absorption, and thus over all copper exposure.
Collapse
Affiliation(s)
- George J Brewer
- Human Genetics, University of Michigan, 3820 Gensley Road, Ann Arbor, MI 48103, USA.
| |
Collapse
|
14
|
Brewer GJ. Divalent Copper as a Major Triggering Agent in Alzheimer’s Disease. J Alzheimers Dis 2015; 46:593-604. [DOI: 10.3233/jad-143123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
15
|
Cognitive impairment and cardiovascular diseases in the elderly. A heart-brain continuum hypothesis. Ageing Res Rev 2014; 18:41-52. [PMID: 25107566 DOI: 10.1016/j.arr.2014.07.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/09/2014] [Accepted: 07/17/2014] [Indexed: 12/30/2022]
Abstract
The aging population is increasing and, therefore, a higher prevalence of cardiac disease is emerging; including hypertension, coronary artery disease, atrial fibrillation and chronic heart failure. Large cohort studies have revealed a relationship among increased risk for cognitive impairment and dementia in cardiovascular diseases probably due to embolic stroke or chronic cerebral hypoperfusion. Thus, the aim of the present review is to overview the studies that investigate the presence and/or the development of cognitive impairments and dementia in patients with varied types of cardiovascular disease. Finally, a continuum among hypertension, coronary artery disease, atrial fibrillation and chronic heart failure with to the development of cognitive impairment and progression to dementia has been hypothesized.
Collapse
|
16
|
Arizaga RL, Gogorza RE, Allegri RF, Baumann PD, Morales MC, Harris P, Pallo V, Cegarra MM. Cognitive impairment and risk factor prevalence in a population over 60 in Argentina. Dement Neuropsychol 2014; 8:364-370. [PMID: 29213927 PMCID: PMC5619185 DOI: 10.1590/s1980-57642014dn84000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/10/2014] [Indexed: 11/22/2022] Open
Abstract
Epidemiological data on dementia and cognitive impairment are scarce in South America. In Argentina, no dementia/cognitive impairment population-based epidemiological studies are available. The Ceibo Study is a population-based epidemiological study of dementia and cognitive impairment in individuals over 60 to be conducted. The present paper reports the results of the pilot phase (survey of cognitive impairment) conducted in Cañuelas (province of Buenos Aires). METHODS In a door-to-door survey, trained high school students evaluated 1453 individuals aged 60 years and over in one day using a demographic data and risk factors questionnaire, the Mini-Mental State Examination (MMSE) and the 15-item Geriatric Depression Scale (GDS). RESULTS Mean age of the individuals was 70.9 (±7.5) years, 61.4% were women, mean schooling was 5.5 (±3.5) years. Mean MMSE score was 24.5 (±4.7) and mean GDS 3.1 (±2.7). Risk factors of higher prevalence in the population under study were: hypertension (40.6%), smoking (35.1%), alcohol consumption (32.8%), high cholesterol (16.1%), diabetes (12.5%), cranial trauma with loss of consciousness (12.5%), 7 points or more on the GDS (11.7%). Prevalence of cognitive impairment for the whole sample was 23%, and 16.9% in subjects aged 60-69, 23.3% in 70-79 and 42.5% in subjects aged 80 or over . A significant correlation of cognitive impairment with age, functional illiteracy, cranial trauma, high blood pressure, inactivity and depression was found. CONCLUSION In this pilot study, the prevalence of cognitive impairment was comparable with previous international studies.
Collapse
Affiliation(s)
- Raul L Arizaga
- PRONADIAL (Programa Nacional de Datos, Docencia e
Investigación en Alzheimer y otros Trastornos Cognitivos). Departamento de
Salud Pública. Facultad de Medicina. Universidad de Buenos Aires,
Argentina
- Unidad de Investigación en Neurología Cognitiva,
Synapse, Buenos Aires, Argentina
| | - Roxana E Gogorza
- Unidad de Investigación en Neurología Cognitiva,
Synapse, Buenos Aires, Argentina
| | | | - Patricia D Baumann
- Unidad de Investigación en Neurología Cognitiva,
Synapse, Buenos Aires, Argentina
| | - María C Morales
- Unidad de Investigación en Neurología Cognitiva,
Synapse, Buenos Aires, Argentina
| | - Paula Harris
- Centro de Memoria y Envejecimiento, FLENI, Buenos Aires,
Argentina
| | - Vicente Pallo
- Hospital Francisco Santojanni, GCBA, Buenos Aires, Argentina
| | - María M Cegarra
- Unidad de Investigación en Neurología Cognitiva,
Synapse, Buenos Aires, Argentina
| |
Collapse
|
17
|
Gąsecki D, Kwarciany M, Nyka W, Narkiewicz K. Hypertension, brain damage and cognitive decline. Curr Hypertens Rep 2014; 15:547-58. [PMID: 24146223 PMCID: PMC3838597 DOI: 10.1007/s11906-013-0398-4] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Loss of cognitive function is one the most devastating manifestations of ageing and vascular disease. Cognitive decline is rapidly becoming an important cause of disability worldwide and contributes significantly to increased mortality. There is growing evidence that hypertension is the most important modifiable vascular risk factor for development and progression of both cognitive decline and dementia. High blood pressure contributes to cerebral small and large vessel disease resulting in brain damage and dementia. A decline in cerebrovascular reserve capacity and emerging degenerative vascular wall changes underlie complete and incomplete brain infarcts, haemorrhages and white matter hyperintensities. This review discusses the complexity of factors linking hypertension to brain functional and structural changes, and to cognitive decline and dementia. The evidence for possible clinical markers useful for prevention of decreased cognitive ability, as well as recent data on vascular mechanism in the pathogenesis of cognitive decline, and the role of antihypertensive therapies in long-term prevention of late-life cognitive decline will be reviewed.
Collapse
Affiliation(s)
- Dariusz Gąsecki
- Department of Neurology of Adults, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | | |
Collapse
|
18
|
Kim YJ, Han JW, So YS, Seo JY, Kim KY, Kim KW. Prevalence and trends of dementia in Korea: a systematic review and meta-analysis. J Korean Med Sci 2014; 29:903-12. [PMID: 25045221 PMCID: PMC4101777 DOI: 10.3346/jkms.2014.29.7.903] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/24/2014] [Indexed: 11/20/2022] Open
Abstract
Through a systematic review and meta-analysis of epidemiological studies on dementia, we assessed the prevalence of dementia and its subtypes-Alzheimer' disease (AD) and vascular dementia (VaD)-in Korea. We searched for epidemiological studies on dementia published in 1990-2013 using PubMed, Scopus, EMBASE, KoreaMed, KISS, and RiCH. Dementia prevalence in elderly patients (aged≥65 yr) was 9.2% (95% confidence interval [CI], 8.2%-10.4%) from 11 studies, which was higher than those from Western and other Asian countries. AD was the most prevalent dementia type, with a prevalence of 5.7% (95% CI, 5.0%-6.4%) from 10 studies compared with 2.1% (95% CI, 1.6%-2.7%) for VaD from 9 studies. The age-specific prevalence of dementia approximately doubled with each 5.8-yr increase of age. Although a significant increasing trend of dementia prevalence was not observed, it increased slightly from 7.3% to 8.7% after 2005; AD prevalence increased after 1995 and VaD prevalence decreased after the early 2000s. The AD/VaD ratio increased from 1.96 in the early 1990s to 4.13 in the 2010s, similar to the worldwide ratio. Owing to this high prevalence in the aging population, dementia will impose significant economic burdens to Korean society.
Collapse
Affiliation(s)
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Seop So
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Young Seo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ka Young Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- National Institute of Dementia, Seongnam, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
| |
Collapse
|
19
|
Rizzi L, Rosset I, Roriz-Cruz M. Global epidemiology of dementia: Alzheimer's and vascular types. BIOMED RESEARCH INTERNATIONAL 2014; 2014:908915. [PMID: 25089278 PMCID: PMC4095986 DOI: 10.1155/2014/908915] [Citation(s) in RCA: 362] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/03/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Abstract
The prevalence of dementia varies substantially worldwide. This is partially attributed to the lack of methodological uniformity among studies, including diagnostic criteria and different mean population ages. However, even after considering these potential sources of bias, differences in age-adjusted dementia prevalence still exist among regions of the world. In Latin America, the prevalence of dementia is higher than expected for its level of population aging. This phenomenon occurs due to the combination of low average educational attainment and high vascular risk profile. Among developed countries, Japan seems to have the lowest prevalence of dementia. Studies that evaluated the immigration effect of the Japanese and blacks to USA evidenced that acculturation increases the relative proportion of AD cases compared to VaD. In the Middle East and Africa, the number of dementia cases will be expressive by 2040. In general, low educational background and other socioeconomic factors have been associated with high risk of obesity, sedentarism, diabetes, hypertension, dyslipidemia, and metabolic syndrome, all of which also raise the risk of VaD and AD. Regulating these factors is critical to generate the commitment to make dementia a public health priority.
Collapse
Affiliation(s)
- Liara Rizzi
- Division of Geriatric Neurology, Service of Neurology, “Hospital de Clínicas de Porto Alegre” (HCPA), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
- Department of Internal Medicine, “Universidade Federal do Rio Grande do Sul” (UFRGS), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
| | - Idiane Rosset
- Division of Gerontological Nursing, Faculty of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), São Manoel Street 963, 90620-110 Porto Alegre, RS, Brazil
| | - Matheus Roriz-Cruz
- Division of Geriatric Neurology, Service of Neurology, “Hospital de Clínicas de Porto Alegre” (HCPA), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
- Department of Internal Medicine, “Universidade Federal do Rio Grande do Sul” (UFRGS), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
| |
Collapse
|
20
|
Brewer GJ. Alzheimer's disease causation by copper toxicity and treatment with zinc. Front Aging Neurosci 2014; 6:92. [PMID: 24860501 PMCID: PMC4030141 DOI: 10.3389/fnagi.2014.00092] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/28/2014] [Indexed: 11/13/2022] Open
Abstract
Evidence will be presented that the Alzheimer's disease (AD) epidemic is new, the disease being very rare in the 1900s. The incidence is increasing rapidly, but only in developed countries. We postulate that the new emerging environmental factor partially causal of the AD epidemic is ingestion of inorganic copper from drinking water and taking supplement pills, along with a high fat diet. Inorganic copper can be partially directly absorbed and elevate the serum free copper pool. The Squitti group has shown that serum free copper is elevated in AD, correlates with cognition, and predicts cognition loss. Thus, our inorganic copper hypothesis fits well with the Squitti group data. We have also shown that AD patients are zinc deficient compared to age-matched controls. Because zinc is a neuronal protective factor, we postulate that zinc deficiency may also be partially causative of AD. We carried out a small 6 month double blind study of a new zinc formulation and found that in patients age 70 and over, it protected against cognition loss. Zinc therapy also significantly reduced serum free copper in AD patients, so efficacy may come from restoring normal zinc levels, or from lowering serum free copper, or from both.
Collapse
Affiliation(s)
- George J. Brewer
- Department of Human Genetics, University of Michigan Health SystemAnn Arbor, MI, USA
| |
Collapse
|
21
|
Park JH, Eum JH, Bold B, Cheong HK. Burden of disease due to dementia in the elderly population of Korea: present and future. BMC Public Health 2013; 13:293. [PMID: 23552095 PMCID: PMC3626581 DOI: 10.1186/1471-2458-13-293] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 03/27/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND With the rapid aging of populations around the world, dementia has become one of the most important public health problems in Eastern Asian countries. The purpose of the present study was to provide an estimate of the burden of dementia and forecast its future burden, as generalized to the Korean population, and to provide detailed gender- and age-specific information regarding the burden of dementia in the elderly population of Korea. METHODS 'Disability-adjusted life years' (DALYs) were used to estimate the burden of dementia. Epidemiologic data from national statistics and nationwide epidemiologic studies in the year 2008 were used to obtain representative outcomes for the Korean population. We estimated the DALYs due to dementia from the years 2010 to 2050 by applying demographic structure projections in terms of 5-year age groups in Korea. RESULTS The burden of disease due to dementia in Korea is 528 per 100,000 population (males: 435, females: 622) and 5,117 per 100,000 in those over the age of 65 years (males: 5,228; females: 5,041); this accounts for 4.5% of the total burden of disease in the year 2008. In the year 2050, DALYs due to dementia (814,629) are expected to be 3.0 times higher than those in the year 2010 (274,849). CONCLUSION Dementia has the highest burden of disease in the elderly Korean population, and this burden will increase sharply with the aging of the population. More comprehensive and multi-dimensional approaches, including clinical, psychological, social, and political means will be needed for the management of the dramatically increasing burden of dementia.
Collapse
Affiliation(s)
- Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 440-746, Republic of Korea
- Center for Molecular Medicine, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Jin-Hee Eum
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 440-746, Republic of Korea
| | - Bolor Bold
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 440-746, Republic of Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 440-746, Republic of Korea
- Center for Molecular Medicine, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| |
Collapse
|
22
|
Au R, Seshadri S, Knox K, Beiser A, Himali JJ, Cabral HJ, Auerbach S, Green RC, Wolf PA, McKee AC. The Framingham Brain Donation Program: neuropathology along the cognitive continuum. Curr Alzheimer Res 2012; 9:673-86. [PMID: 22471865 DOI: 10.2174/156720512801322609] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 12/30/2011] [Accepted: 01/12/2012] [Indexed: 11/22/2022]
Abstract
The Framingham Heart Study has enrolled 3 generations of participants, the original cohort (gen 1) enrolled in 1948, the offspring cohort (gen 2) enrolled in 1971 and the third generation enrolled in 2002. Participants have been undergoing prospective surveillance for incident stroke and dementia and embedded within this cohort is the voluntary Framingham Brain Donation Program that was begun in 1997. Participants who register to become brain donors have had one or more brain MR and cognitive test batteries administered. In addition, they undergo neurological evaluation as indicated, record review and post-mortem next-of-kin interview to determine the presence, type and extent of antemortem, clinical neurological diagnoses and to assign a retrospective clinical dementia rating (CDR) Scale score. Between 1997 and 2009 there were 1806 deaths, 186 of which were among registered brain donors and of these 139 brains could be examined. 58% were deemed cognitively normal at death. We present results for 3 projects; the first was to examine the sensitivity and specificity of our clinical diagnosis against the gold standard of pathological AD in 59 persons who underwent detailed cognitive assessment in the two years prior to death; we observed a 77.3% sensitivity (2 persons with AD were diagnosed clinically as Lewy body dementia) and a 91.9% specificity. The second examined the correlation of regional Alzheimer-type pathology to cognitive status at death among 34 persons who were over the age of 75 and without any significant vascular or alternative neurodegenerative pathology and found that neurofibrillary tangle counts distinguished between persons who were controls, had mild cognitive impairment, mild or moderate dementia; tangles in dorsolateral frontal cortex best distinguished MCI and controls. The third project examined the extent and severity of vascular pathology, again in a larger sample of varying cognitive abilities and in a subsample of persons with either amnestic or nonamnestic MCI. We observed that an aggregate ischemic injury score was significantly higher in persons with a CDR score of 0.5 than in normal controls.
Collapse
Affiliation(s)
- Rhoda Au
- Department of Neurology, Boston University School of Medicine, 715 Albany Street, Boston, MA 02118, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Brewer GJ. Metals in the causation and treatment of Wilson’s disease and Alzheimer’s disease, and copper lowering therapy in medicine. Inorganica Chim Acta 2012. [DOI: 10.1016/j.ica.2012.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Abstract
The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868-.988; AUC(MoCA short version) = .936; 95% IC = .849-.981; AUC(MMSE) = .860; 95% IC = .754-.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients.
Collapse
|
25
|
Trends in the prevalence of dementia in Japan. Int J Alzheimers Dis 2012; 2012:956354. [PMID: 23091769 PMCID: PMC3469105 DOI: 10.1155/2012/956354] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/23/2012] [Indexed: 11/18/2022] Open
Abstract
There is a paucity of data regarding trends in dementia and its subtype prevalence in Japan. Our aims in the current paper are to: (1) summarize epidemiological studies of dementia in Japan including relevant details of study protocol and diagnostic criteria, (2) compare the age-specific prevalence of all-cause dementia among studies, and (3) assess the trends in Alzheimer's disease (AD) versus vascular dementia (VaD) over time. We reviewed diagnostic criteria, all-cause dementia prevalence, and the AD/VaD ratio from 8 large population studies of dementia in Japan. Compared with the Okinawa 1992 study, studies conducted in 1994, 1998, 2005, and 2008 had a higher prevalence of all-cause dementia using Poisson regression models, after controlling for age and sex. In contrast to the US and some European countries, all-cause dementia prevalence is increasing in Japan. The prevalence of AD as opposed to VaD seems to be increasing over time, but large variability in diagnostic criteria, possible regional variability, and differences in prevalence of subtypes of dementia between men and women make it difficult to draw a conclusion about this trend at the national level. Further studies, for example, comparing the population attributable risk of vascular diseases to the prevalence and incidence of dementia could help to clarify the regional variations in etiological subtypes.
Collapse
|
26
|
Honda M, Kusaka Y, Morita A, Nagasawa S, Umino K, Isaki K. A cross-sectional population-based study on senile dementia in a rural city. Environ Health Prev Med 2012; 5:31-6. [PMID: 21432208 DOI: 10.1007/bf02935913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/1999] [Accepted: 02/08/2000] [Indexed: 11/28/2022] Open
Abstract
All residents aged 65 or over in a rural city (n=5340) were studied with a self-administered questionnaire on psychiatric symptoms, physical health status, medical history, and environmental factors. After the screening, the clinical diagnosis of senile dementia was made by psychiatrists. The overall prevalence was 4.0% among responders staying at home (201/4969). The prevalence increased with age for both males and females and tended to be higher for females than males. The multilogistic analysis of the above variables showed that in the cerebrovascular type, stroke and inactive physical status might be risk factors for both gender groups. For the Alzheimer's type, age and inactive physical status might be risk factors. For overall dementia, age, stroke, and inactive physical status might be risk factors.
Collapse
Affiliation(s)
- M Honda
- Department of Psychiatry, School of Medicine, Fukui Medical University, Matsuoka, Fukui
| | | | | | | | | | | |
Collapse
|
27
|
Brewer GJ. Copper toxicity in Alzheimer's disease: cognitive loss from ingestion of inorganic copper. J Trace Elem Med Biol 2012; 26:89-92. [PMID: 22673823 DOI: 10.1016/j.jtemb.2012.04.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/04/2012] [Indexed: 11/16/2022]
Abstract
In this review I present the hypothesis that a toxic substance, inorganic copper, ingested from drinking water and vitamin/mineral supplements containing inorganic copper, is at least partially causal of the epidemic of Alzheimer's disease (AD) we are seeing in developed countries. I set the stage for this hypothesis by pointing out that the epidemic is a new disease phenomenon coinciding temporally with the use of copper plumbing in developed countries. The evidence is good that AD was nonexistent or rare in the 1800 s and early 1900 s, and the arguments that elderly people did not exist in those times, or that AD was simply attributed to senility, are refuted. The web of evidence tying ingestion of inorganic copper as a causal factor in AD is strong, and includes AD animal model data where trace amounts of inorganic copper in the drinking water markedly worsened AD, human studies where ingestion of copper supplements, along with a high fat diet, is associated with a marked loss of cognition, human studies showing a markedly higher mortality in elderly women ingesting copper supplements, as well as other data. It is likely that a high fat diet works in conjunction with ingestion of inorganic copper to increase the risk of AD. It is clear that some factor toxic to the brain is present in the environment in developed countries, but not undeveloped countries, and is a major risk factor for AD. I believe that that toxic factor is ingestion of inorganic copper.
Collapse
Affiliation(s)
- George J Brewer
- The Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
28
|
Johnson ML, Parikh N, Kunik ME, Schulz PE, Patel JG, Chen H, Aparasu RR, Morgan RO. Antihypertensive drug use and the risk of dementia in patients with diabetes mellitus. Alzheimers Dement 2012; 8:437-44. [DOI: 10.1016/j.jalz.2011.05.2414] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 04/20/2011] [Accepted: 05/20/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Michael L. Johnson
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
- Houston Center for Quality of Care & Utilization Studies; Veterans Affairs Medical Center; Houston TX USA
| | - Niraj Parikh
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Mark E. Kunik
- Houston Center for Quality of Care & Utilization Studies; Veterans Affairs Medical Center; Houston TX USA
- Menninger Department of Psychiatry and Behavioral Sciences; Baylor College of Medicine; Houston TX USA
- Veterans Affairs South Central Mental Illness Research; Education and Clinical Center; Houston TX USA
| | - Paul E. Schulz
- Department of Neurology; The Mischer Neuroscience Institute at The University of Texas Health Science Center; Memorial Hermann Hospital; Houston TX USA
| | - Jeetvan G. Patel
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Hua Chen
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Rajender R. Aparasu
- Department of Clinical Sciences and Administration; Division of Pharmacy Administration and Public Health; University of Houston; College of Pharmacy; Houston TX USA
| | - Robert O. Morgan
- Houston Center for Quality of Care & Utilization Studies; Veterans Affairs Medical Center; Houston TX USA
- School of Public Health; Division of Management; Policy and Community Health at The University of Texas Health Science Center; Houston TX USA
| |
Collapse
|
29
|
Brewer GJ. Copper excess, zinc deficiency, and cognition loss in Alzheimer's disease. Biofactors 2012; 38:107-13. [PMID: 22438177 DOI: 10.1002/biof.1005] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/17/2012] [Indexed: 01/28/2023]
Abstract
In this special issue about biofactors causing cognitive impairment, we present evidence for and discuss two such biofactors. One is excess copper, causing neuronal toxicity. The other is zinc deficiency, causing neuronal damage. We present evidence that Alzheimer's disease (AD) has become an epidemic in developed, but not undeveloped, countries and that the epidemic is a new disease phenomenon, beginning in the early 1900s and exploding in the last 50 years. This leads to the conclusion that something in the developed environment is a major risk factor for AD. We hypothesize that the factor is inorganic copper, leached from the copper plumbing, the use of which coincides with the AD epidemic. We present a web of evidence supporting this hypothesis. Regarding zinc, we have shown that patients with AD are zinc deficient when compared with age-matched controls. Zinc has critical functions in the brain, and lack of zinc can cause neuronal death. A nonblinded study about 20 years ago showed considerable improvement in AD with zinc therapy, and a mouse AD model study also showed significant cognitive benefit from zinc supplementation. In a small blinded study we carried out, post hoc analysis revealed that 6 months of zinc therapy resulted in significant benefit relative to placebo controls in two cognitive measuring systems. These two factors may be linked in that zinc therapy significantly reduced free copper levels. Thus, zinc may act by lowering copper toxicity or by direct benefit on neuronal health, or both.
Collapse
Affiliation(s)
- George J Brewer
- Department of Human Genetics, Medical School University of Michigan, Ann Arbor, MI 48103, USA.
| |
Collapse
|
30
|
Brewer GJ. Issues raised involving the copper hypotheses in the causation of Alzheimer's disease. Int J Alzheimers Dis 2011; 2011:537528. [PMID: 21922048 PMCID: PMC3172975 DOI: 10.4061/2011/537528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 06/04/2011] [Accepted: 06/10/2011] [Indexed: 12/02/2022] Open
Abstract
I present evidence that the epidemic of Alzheimer's disease is a new phenomenon exploding in the latter part of the 20th century in developed countries. I postulate that a major causative factor in the epidemic is the coincident use of copper plumbing, and the ingestion of inorganic copper leaching from the copper plumbing. I present evidence to support this hypothesis and discuss various objections and criticisms that have been raised about the hypothesis, and my responses to these criticisms. I conclude that the hypothesis is well supported by the evidence and deserves serious consideration, because if it is valid, it indentifies a partially preventable cause of Alzheimer's disease.
Collapse
Affiliation(s)
- George J Brewer
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
31
|
Yang YH, Roe CM, Morris JC. Relationship between late-life hypertension, blood pressure, and Alzheimer's disease. Am J Alzheimers Dis Other Demen 2011; 26:457-62. [PMID: 21921085 PMCID: PMC3312309 DOI: 10.1177/1533317511421779] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Relationship between late-life hypertension and Alzheimer's disease (AD) remains less clear. Both cross-sectional and longitudinal methods were used to examine whether systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP), and self-reported hypertension (S-HTN) in late life were associated with having and developing AD. The cross-sectional examination included 1768 individuals with AD and 818 nondemented individuals, and AD was not significantly associated with S-HTN or any of blood pressure measures (S-HTN: P = .236; SBP: P = .095; DBP: P = .429; PP: P = .145; MAP: P = .162). In the longitudinal examination, 594 nondemented individuals, 171 with and 423 without S-HTN at entry, were included. Diastolic blood pressure was significantly related to the development of AD (P = .030) but not S-HTN (P = .251), SBP (P = .294) PP (P = .919), and MAP (P = .060). The association underscores the necessity of further investigation to outline the detailed mechanisms and biological relevance, if any, of late-life DBP to later AD.
Collapse
Affiliation(s)
- Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of and Master’s Program in Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine M. Roe
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - John C. Morris
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
32
|
Sharp SI, Aarsland D, Day S, Sønnesyn H, Ballard C. Hypertension is a potential risk factor for vascular dementia: systematic review. Int J Geriatr Psychiatry 2011; 26:661-9. [PMID: 21495075 DOI: 10.1002/gps.2572] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/16/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of the study was to conduct a meta-analysis of epidemiological and case control studies to determine whether arterial hypertension is specifically associated with an increased risk of vascular dementia (VaD). DESIGN Longitudinal and cross-sectional prospective studies using operationalised criteria to define VaD and hypertension, with a normal control comparison group were systematically reviewed. Cochrane Library, Embase, Medline, and PsycInfo data sources were searched along with reference lists of included articles and reviews. Original, prevalence or incidence studies were included if operationalised criteria for hypertension and VaD as well as number of cases with and without hypertension in VaD and non-demented groups were provided. Intervention studies and post-stroke and CADASIL studies were excluded. RESULTS Eleven studies recruiting either volunteers or clinical patients, or which were population-based, examined a total of 768 people with VaD and 9857 control cases. A meta-analysis of the six longitudinal studies showed that hypertension was significantly associated with increased risk of incident VaD (odds ratio, OR: 1.59, CI: 1.29-1.95, p < 0.0001). A similar association between hypertension and the risk of prevalent VaD was found in the five cross-sectional studies (OR: 4.84, CI: 3.52-6.67, p < 0.00001). CONCLUSIONS Hypertension significantly increases the risk of vascular dementia. The current meta-analysis highlights the potential importance of rigorous treatment of hypertension as a key measure to help prevent the development of VaD.
Collapse
Affiliation(s)
- Sally I Sharp
- Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, UK
| | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Suzuki T, Murase S. Influence of outdoor activity and indoor activity on cognition decline: use of an infrared sensor to measure activity. Telemed J E Health 2011; 16:686-90. [PMID: 20575611 DOI: 10.1089/tmj.2009.0175] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The increasing number of dementia patients causes serious social problems. Previously, we reported that elderly individuals with cognitive impairment show a low frequency of activity. This study was designed to investigate the correlation of daily activity to the decline in cognitive function. METHODS The study enrolled 53 elderly who live alone. The cognitive function of subjects was assessed by the mini-mental state examination (MMSE) before the investigation. Passive infrared sensors were installed in the subjects' houses. The subjects' in-house movements were recorded by the sensors for approximately 1 year. The activities of daily life were assessed, based on these records. The subjects' cognitive function was assessed again after the investigation and categorized into two groups: the cognition decline group (MMSE score: <24, n=6) and the normal group (MMSE score: over 24, n=44). The activity parameters were compared between the two groups. RESULTS The subjects in the cognition decline group had a significantly lower number of outings (8.8 vs. 17.3, p<0.01) and there was no cognition decline in patients in the frequent outings group (over 20 outings per month). In addition, the indoor movement decreased in the cognition decline group during the study period and the indoor movement of the normal group was maintained at the baseline level. CONCLUSIONS This study objectively evaluated the behavior of elderly individuals with infrared sensors and revealed that elderly people who have few occasions to go out tend to show a decrease in cognitive function.
Collapse
Affiliation(s)
- Toshiro Suzuki
- First Department of Internal Medicine, Shinshu University School of Medicine, Shinshu University Hospital, Matsumoto City, Japan.
| | | |
Collapse
|
35
|
Cho MJ, Lee JY, Kim BS, Lee HW, Sohn JH. Prevalence of the major mental disorders among the Korean elderly. J Korean Med Sci 2011; 26:1-10. [PMID: 21218022 PMCID: PMC3012831 DOI: 10.3346/jkms.2011.26.1.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 10/01/2010] [Indexed: 11/20/2022] Open
Abstract
With a rapidly aging society, geriatric mental health is emerging as important public health concern. Despite the short history of psychiatric epidemiology in Korea, recently, epidemiologic data regarding geriatric psychiatric problems has started to accumulate. In the current study, we reviewed epidemiological findings regarding geriatric mental health in Korea. It was found that up to 10% of the elderly suffer from dementia, and 10% to 20% from depressive disorder. Further, prevalence estimates of Alzheimer's disease ranged from 4.2% to 9.0%, and vascular dementia from 1.0% to 4.8%. Annual incidence rates for Alzheimer's were 2.7% to 3.4% whereas that for vascular dementia was found to be as low as 0.3%. The prevalence of major depressive disorder was 4.2% to 9.1%, while that of clinically significant depressive symptom was between 9.1% and 33.0%. Finally, those with alcohol use disorders were found to comprise up to 13.6% of elderly population and additionally, 22% to 58% of the elderly were found to have sleep difficulties. Thus major mental disorders are already prevalent among the Korean elderly and are likely to increase rapidly.
Collapse
Affiliation(s)
- Maeng Je Cho
- Department of Psychiatry & Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.
| | | | | | | | | |
Collapse
|
36
|
Abstract
Alzheimer's disease (AD) and vascular dementia (VaD) are the most common causes of dementia in the elderly. Although AD can be diagnosed with a considerable degree of accuracy, the distinction between isolated AD, VaD and mixed dementia (MD) [when both pathologies coexist in the same patient] remains a controversial issue and one of the most difficult diagnostic challenges. MD represents a very common pathology, especially in the elderly, as reported in neuropathological studies. Accurate diagnosis of MD is of crucial significance for epidemiological purposes and for preventive and therapeutic strategies. Until recently, pharmacological studies have generally focused on pure disease, either AD or VaD, and have provided few data on the best therapeutic approach to MD. There is only one original randomized clinical trial on (acetyl)cholinesterase inhibitor therapy (GAL-INT-6, galantamine) for MD; the other studies are post hoc analyses of AD trial subgroups (AD2000, donepezil) or of VaD trial subgroups (VantagE, rivastigmine). Cholinesterase inhibitors have reproducible beneficial effects on cognitive and functional outcomes in patients with MD. These benefits are of a similar magnitude to those previously reported for the treatment of AD. It is likely that the beneficial effects of memantine (an NMDA receptor antagonist) in AD may also apply to MD, but randomized controlled trials are still lacking. Treatment of cardiovascular risk factors, especially hypertension, may protect brain function and should be included in prevention strategies for MD.
Collapse
Affiliation(s)
- Dina Zekry
- Rehabilitation and Geriatrics Department, Geneva University, Thônex, Switzerland.
| | | |
Collapse
|
37
|
Brewer GJ, Kanzer SH, Zimmerman EA, Celmins DF, Heckman SM, Dick R. Copper and ceruloplasmin abnormalities in Alzheimer's disease. Am J Alzheimers Dis Other Demen 2010; 25:490-7. [PMID: 20631161 PMCID: PMC10845669 DOI: 10.1177/1533317510375083] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The idea that copper may play a role in the pathogenesis of Alzheimer's disease is gaining momentum. Serum copper and ceruloplasmin were measured by both enzymatic (eCp) and immunologic (iCp) methods in 28 patients with Alzheimer's disease and 29 age-matched controls. ''Free copper'' was determined by subtracting copper accounted for in the eCp assay from total serum copper. Percentage free copper, that is the proportion of serum copper not bound to ceruloplasmin, was significantly elevated in patients with Alzheimer's compared to controls. There was significantly more ''defective'' ceruloplasmin, which is apoceruloplamin lacking its copper, in Alzheimer's disease than in normal controls. This abnormality may precede the clinical onset of the disease and help predict risk of disease onset. Increased exposure to environmental copper (eg, the spread of copper plumbing and the use of copper in supplements) and/or defective ceruloplasmin function may play a role in the current epidemic of Alzheimer's disease.
Collapse
Affiliation(s)
- George J Brewer
- Department of Human Genetics, University of Michigan, Ann Arbor, 48103, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Cherubini A, Lowenthal DT, Paran E, Mecocci P, Williams LS, Senin U. Hypertension and cognitive function in the elderly. Dis Mon 2010; 56:106-47. [PMID: 20189499 DOI: 10.1016/j.disamonth.2009.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease is the most prevalent and common form of cognitive impairment, ie, dementia, in the elderly followed in second place by vascular dementia due to the microangiopathy associated with poorly-controlled hypertension. Besides blood pressure elevation, advancing age is the strongest risk factor for dementia. Deterioration of intellectual function and cognitive skills that leads to the elderly patient becoming more and more dependent in his, her, activities of daily living, ie, bathing, dressing, feeding self, locomotion, and personal hygiene. It has been known and demonstrated for many years that lowering of blood pressure from a previous hypertensive point can result in stroke prevention yet lowering of blood pressure does not prevent the microangiopathy that leads to white matter demyelinization which when combined with the clinical cognitive deterioration is compatible with a diagnosis of vascular dementia. It is known from many large studies, ie, SHEP, SCOPE, and HOPE, that lowering of blood pressure gradually will not and should not worsen the cognitive impairment. However, if the pressure is uncontrolled a stroke which might consequently occur would further worsen their cognitive derangement. So an attempt at slow reduction of blood pressure since cerebral autoregulation is slower as age increases is in the patient's best interest. It is also important to stress that control of blood glucose can also be seen as an attempt to prevent vascular dementia from uncontrolled hyperglycemia. Vascular dementia is not considered one of the reversible causes of dementia. Reversible causes of cognitive impairment are over medication with centrally acting drugs such as sedatives, hypnotics, antidepressants, and antipsychotics, electrolyte imbalance such as hyponatremia, azotemia, chronic liver disease, and poor controlled chronic congestive heart failure. Criteria for the clinical diagnosis of vascular dementia include cognitive decline in regards to preceding functionally higher level characterized by alterations in memory and in two or more superior cortical functions that include orientation, attention, verbal linguistic capacities, visual spacial skills, calculation, executive functioning, motor control, abstraction and judgment. Patients with disturbances of consciousness, delirium (acute confusional states), psychosis, serious aphasia, or sensory-motor alterations that preclude proper execution of neuro-psychological testing are also considered to have probably vascular dementia. Furthermore, these are ten of the other essential cerebral or systematic pathologies present that would be able to produce a dementia syndrome.
Collapse
|
39
|
Seoung YH, Choe BY. Morphologic Assessment of Corpus Callosum in the Patient of Alzheimer Disease using Magnetic Resonance Imaging. JOURNAL OF THE KOREAN MAGNETIC RESONANCE SOCIETY 2009. [DOI: 10.6564/jkmrs.2009.13.2.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
40
|
Pimentel ÉML. Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia. Dement Neuropsychol 2009; 3:214-221. [PMID: 29213631 PMCID: PMC5618976 DOI: 10.1590/s1980-57642009dn30300007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The prevalence of dementia increases significantly from the age of 65 years,
doubling every five years thereafter. Alzheimer’s disease (AD) and vascular
dementia (VaD) constitute the two main dementia types. Differentiating them
encompasses anamnesis, neurological examination, laboratory and neuroimaging
exams and neuropsychological assessment. Neuropsychological assessment produces
different findings for each dementia type, and reveals those areas most impaired
as well as those most preserved. The aim of the present article was to describe
the role of neuropsychology in diagnosing dementia and achieving a differential
diagnosis between AD and VaD. A general overview follows of the most widely
known instruments used to assess cognitive function in dementia, and the
cognitive changes seen in AD and VaD. The conclusion drawn was that there is
significant overlap in cognitive changes between both these dementia types,
while each type has its own specific characteristics which are identifiable and
quantifiable on neuropsychological assessments and provide the basis for
reaching a differential diagnosis.
Collapse
Affiliation(s)
- Érica Maria Lima Pimentel
- Universidade Federal do Ceará (UFC) e Pós-graduada em Neuropsicologia pela Faculdade Christus, Fortaleza, CE, Brazil
| |
Collapse
|
41
|
Kennelly SP, Lawlor B, Kenny R. Blood pressure and the risk for dementia: a double edged sword. Ageing Res Rev 2009; 8:61-70. [PMID: 19063999 DOI: 10.1016/j.arr.2008.11.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 11/13/2008] [Accepted: 11/13/2008] [Indexed: 11/24/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia (VaD) are important causes of cognitive decline in the elderly. As a result of the aging population, the incidence of dementia is expected to increase substantially over the coming decades. Many studies have identified that vascular risk factors are implicated in the pathogenesis of both AD and VaD. Longitudinal studies have suggested that high blood pressure in midlife is associated with a higher incidence of both AD and VaD in later life. The association appears weaker for hypertension in later life. Some studies also suggest that hypotension; especially low diastolic blood pressure in late-life is also associated with an increased risk of AD. Long-standing hypertension may lead to severe atherosclerosis and impaired cerebrovascular autoregulation. A decline in blood pressure in later life may contribute to diminished cerebral perfusion. The subsequent ischaemic state may lead to increased cerebral beta-amyloid accumulation.
Collapse
|
42
|
Choi SJ, Jung SS, You YS, Shin BS, Kim JE, Yoon SW, Jeon DW, Baek JH, Park SW, Lee JG, Kim YH. Prevalence of Alzheimer's dementia and its risk factors in community-dwelling elderly koreans. Psychiatry Investig 2008; 5:78-85. [PMID: 20046349 PMCID: PMC2796020 DOI: 10.4306/pi.2008.5.2.78] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE We estimated the prevalence of Alzheimer's dementia (AD) and mild cognitive impairment (MCI) and their risk factors in an urban community setting, focusing especially on metabolic syndrome. METHODS A two-phase investigation based on a door-to-door survey was performed. In Phase I, we administered the Korean version of the Mini-Mental State Examination (MMSE-KC) of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K). Assessment Packet and the Korean version of the Geriatric Depression Scales (GDS-K) to all 706 participants aged 65 years or older. In Phase II of the study, 175 persons underwent physical and neurological examinations according to the protocol of the CERAD-K clinical assessment battery [CERAD-K (C)] and the neuropsychological assessment battery [CERAD-K (N)]. We also examined the association between cognitive decline and metabolic syndrome. AD and MCI were defined using the DSM-IV-TR criteria and the Clinical Dementia Rating (CDR) scales. RESULTS The mean age (+/-SD) of the subjects was 74.3+/-16.7 years and the ratio of males to females was 53.2 to 46.8. The prevalence of Alzheimer's dementia was 9.0%, while that of MCI was 32.9%. Old age and lower educational level had significant associations with cognitive decline in the elderly, but gender, years of alcohol intake or smoking, and metabolic syndrome were not associated with AD or MCI. CONCLUSION In this study, metabolic syndrome was not associated with Alzheimer's AD or MCI. Information regarding an association between Alzheimer's dementia and metabolic syndrome in this study will be helpful in formulating future public health policy and prevention strategies in Korea.
Collapse
Affiliation(s)
- Seok-Ju Choi
- Department of Psychiatry, Dong Nam Mental Hospital, Gimhae, Korea
| | - Sung-Soo Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Sun You
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Bae-Seob Shin
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji-Eun Kim
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung-Wook Yoon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jun-Hyung Baek
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung-Woo Park
- Paik Institute for Clinical Research, Inje University, Busan, Korea
| | - Jung-Goo Lee
- Paik Institute for Clinical Research, Inje University, Busan, Korea
| | - Young-Hoon Kim
- Department of Psychiatry, School of Medicine and Paik Institute for Clinical Research, Inje University, Busan, Korea
| |
Collapse
|
43
|
Abstract
Alzheimer's disease is the most prevalent and common form of cognitive impairment, ie, dementia, in the elderly followed in second place by vascular dementia due to the microangiopathy associated with poorly-controlled hypertension. Besides blood pressure elevation, advancing age is the strongest risk factor for dementia. Deterioration of intellectual function and cognitive skills that leads to the elderly patient becoming more and more dependent in his, her, activities of daily living, ie, bathing, dressing, feeding self, locomotion, and personal hygiene. It has been known and demonstrated for many years that lowering of blood pressure from a previous hypertensive point can result in stroke prevention yet lowering of blood pressure does not prevent the microangiopathy that leads to white matter demyelinization which when combined with the clinical cognitive deterioration is compatible with a diagnosis of vascular dementia. It is known from many large studies, ie, SHEP, SCOPE, and HOPE, that lowering of blood pressure gradually will not and should not worsen the cognitive impairment. However, if the pressure is uncontrolled a stroke which might consequently occur would further worsen their cognitive derangement. So an attempt at slow reduction of blood pressure since cerebral autoregulation is slower as age increases is in the patient's best interest. It is also important to stress that control of blood glucose can also be seen as an attempt to prevent vascular dementia from uncontrolled hyperglycemia. Vascular dementia is not considered one of the reversible causes of dementia. Reversible causes of cognitive impairment are over medication with centrally acting drugs such as sedatives, hypnotics, antidepressants, and antipsychotics, electrolyte imbalance such as hyponatremia, azotemia, chronic liver disease, and poor controlled chronic congestive heart failure. Criteria for the clinical diagnosis of vascular dementia include cognitive decline in regards to preceding functionally higher level characterized by alterations in memory and in two or more superior cortical functions that include orientation, attention, verbal linguistic capacities, visual spacial skills, calculation, executive functioning, motor control, abstraction and judgment. Patients with disturbances of consciousness, delirium (acute confusional states), psychosis, serious aphasia, or sensory-motor alterations that preclude proper execution of neuro-psychological testing are also considered to have probably vascular dementia. Furthermore, these are ten of the other essential cerebral or systematic pathologies present that would be able to produce a dementia syndrome.
Collapse
|
44
|
Zhao L, Brinton RD. WHI and WHIMS follow-up and human studies of soy isoflavones on cognition. Expert Rev Neurother 2008; 7:1549-64. [PMID: 17997703 DOI: 10.1586/14737175.7.11.1549] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent follow-up analyses of the previous findings from the Women's Health Initiative and the Women's Health Initiative Memory Study confirmed some health benefits of estrogen-containing hormone therapy (HT) in women within 10 years from the onset of menopause. However, the potential risks associated with long-term administration of HT, such as breast cancer and stroke, remain a concern for therapy recipients, underlying the need for an alternative treatment that is functionally equivalent but with a greater safety profile. Owing to their structural and functional resemblance to mammalian estrogens and lack of evident adverse effects, research interest in plant-derived phytoestrogens has increased in the past decade. While multiple health-promoting benefits of phytoestrogens have been proposed from basic science, the clinical data remain inconclusive. This review provides a comparative analysis of human studies on the effects of soy-based isoflavones on cognition. Of the eight studies published in 2000-2007, seven were conducted in postmenopausal women, four of which revealed a positive impact of isoflavones on cognitive function. Multiple factors could have contributed to the discrepant outcomes across studies, such as variation in the composition of phytoestrogen interventions and the heterogeneous characteristics of the study population. Thus, a well-designed clinical study based on a standardized stable formulation in a well-characterized study population is required in order to reach a clinical consensus. A formulation composed of select estrogen receptor beta-selective phytoestrogens with a rationally designed composition would avoid the potential antagonism present in a mixture and thus enhance therapeutic efficacy. In addition, inclusion of equol in a study formulation offers a potential synergistic effect from equol in both equol-producing and nonproducing individuals, as well as added benefits for men. With respect to the design of study population, a clinically consistent effect could potentially be achieved by stratifying populations based on genotype, age, hormonal history and even diets. Development of an effective phytoestrogen formulation would benefit both women and men to prevent or treat hormone-dependent conditions and, most of all, to improve neurological health and reduce the risk of Alzheimer's disease.
Collapse
Affiliation(s)
- Liqin Zhao
- Department of Pharmacology & Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA.
| | | |
Collapse
|
45
|
Reitz C, Luchsinger JA. Relation of Blood Pressure to Cognitive Impairment and Dementia. Curr Hypertens Rev 2007; 3:166-176. [PMID: 22545032 DOI: 10.2174/157340207781386747] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the past decade several studies have assessed the relation of blood pressure with cognitive function and dementia. While some cross-sectional studies have shown an inverse association between blood pressure levels and cognitive performance or dementia, longitudinal studies yielded controversial results. Most studies relating blood pressure levels in mid-life with late-life risk of cognitive decline or dementia reported a harmful effect of higher blood pressure levels on cognitive function. Studies assessing the effect of late-life blood pressure levels reported that low diastolic and very high systolic levels may increase the risk. Observational studies and randomized cinical trials provide limited evidence for a protective effect of antihypertensive therapy. It seems that the older the person and the more advanced the disease process, the less harmful or even inverted the effect of blood pressure elevation on dementia risk. The reason for this may be that blood pressure declines with age-related pathology, such as vessel stiffening, weight loss, and changes in the autonomic regulation of blood flow.
Collapse
Affiliation(s)
- Christiane Reitz
- The Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | |
Collapse
|
46
|
Abstract
Cognitive impairment of any severity associated with cerebrovascular damage is defined as vascular cognitive impairment as proposed by O'Brien. This is a heterogeneous syndrome with many subtypes, the most prevalent being vascular cognitive impairment without dementia. Neuropathological studies confirm that cerebrovascular disease and Alzheimer's disease frequently coexist. Diagnosis depends on criteria for dementia and vascular pathologies. Brain imaging is an important diagnostic tool. Although there is no approved intervention specifically for vascular cognitive impairment, general treatments (such as antiplatelet and antihypertensives) aimed at the prevention and management of stroke are used. Evidence from randomised, placebo-controlled studies of cholinesterase inhibitors for vascular dementia suggests that there may be beneficial effects for cognitive function, and clinical global impression is more favourable for the cholinesterase inhibitors compared with placebo. The effect of memantine also seems to be modest and similar to the effect that is demonstrated in patients with Alzheimer's disease. The accumulated evidence is not as comprehensive as that which exists for Alzheimer's disease. The cholinesterase inhibitors and memantine have not been extensively studied in vascular cognitive impairment without dementia. For the purposes of this review, the authors focus on interventions that have been evaluated by randomised controlled trials.
Collapse
Affiliation(s)
- Jacqueline Birks
- University of Oxford, Cochrane Dementia and Cognitive Improvement Group, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | | |
Collapse
|
47
|
Abstract
BACKGROUND Dementia is a widespread condition characterized by acquired global impairment of intellect, memory and personality, but with no impairment of consciousness. There is no definitive medical or surgical treatment for vascular dementia. Acupuncture is an ancient Chinese method which has been used for both the prevention and treatment of diseases for over three thousand years. Preliminary searches revealed more than 105 studies of acupuncture for treating vascular dementia. Benefit was reported in up to 70-91% of the treatment group. Body acupuncture and electroacupuncture were the most commonly used techniques. A comparison of electroacupuncture and acupuncture therapy alone suggested that the former was more effective in promoting the recovery of cognitive function. OBJECTIVES The objective is to assess the efficacy and possible adverse effects of acupuncture therapy for treating vascular dementia. SEARCH STRATEGY The trials were identified from a search of the Cochrane Dementia and Cognitive Improvement group's Specialized Register on 2 February 2007 which contains records from all major health care databases and many ongoing trials databases. In addition the Allied and Complementary Medicine Database was searched and the web was searched using the search engine Copernic. SELECTION CRITERIA Randomized controlled trials testing acupuncture therapy in the treatment of vascular dementia were included regardless of language and publication types. The intervention and control group had to receive identical treatment apart from the acupuncture intervention. In view of possible confounding, studies in which acupuncture was combined with other treatments were subjected to subgroup analyses. DATA COLLECTION AND ANALYSIS Titles and abstracts identified from the searches were checked by two reviewers. If it was clear that the study did not refer to a randomized controlled trial in vascular dementia, it was excluded. If it was not clear from the abstract and title, then the full text of study was obtained for an independent assessment by two reviewers. The outcomes measured in clinical trials of dementia and cognitive impairment often arise from ordinal rating scales. Summary statistics were required for each rating scale at each assessment time for each treatment group in each trial for change from baseline. MAIN RESULTS In the absence of any suitable randomised placebo-controlled trials in this area, we were unable to perform a meta-analysis. AUTHORS' CONCLUSIONS The effectiveness of acupuncture for vascular dementia is uncertain. More evidence is required to show that vascular dementia can be treated effectively by acupuncture. There are no RCTs and high quality trials are few. Randomised double-blind placebo controlled trials are urgently needed.
Collapse
Affiliation(s)
- W N Peng
- Guang'anmen Hospital, Acupuncture, No.5 Bei Xian Ge Street, Beijing, Xuanwu District, China, 100053.
| | | | | | | |
Collapse
|
48
|
Jellinger KA. The enigma of vascular cognitive disorder and vascular dementia. Acta Neuropathol 2007; 113:349-88. [PMID: 17285295 DOI: 10.1007/s00401-006-0185-2] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 12/08/2006] [Accepted: 12/08/2006] [Indexed: 12/20/2022]
Abstract
The prevalence, morphology and pathogenesis of vascular dementia (VaD), recently termed vascular cognitive impairment, are a matter of discussion, and currently used clinical diagnostic criteria show moderate sensitivity (average 50%) and variable specificity (range 64-98%). In Western clinic-based series, VaD is suggested in 8-10% of cognitively impaired aged subjects. Its prevalence in autopsy series varies from 0.03 to 58%, with reasonable values of 8-15%, while in Japan it is seen in 22-35%. Neuropathologic changes associated with cognitive impairment include multifocal and/or diffuse disease and focal lesions: multi-infarct encephalopathy, white matter lesions or arteriosclerotic subcortical (leuko)encephalopathy, multilacunar state, mixed cortico-subcortical type, borderline/watershed lesions, rare granular cortical atrophy, post-ischemic encephalopathy and hippocampal sclerosis. They result from systemic, cardiac and local large or small vessel disease. Recent data indicate that cognitive decline is commonly associated with widespread small ischemic/vascular lesions (microinfarcts, lacunes) throughout the brain with predominant involvement of subcortical and functionally important brain areas. Their pathogenesis is multifactorial, and their pathophysiology affects neuronal networks involved in cognition, memory, behavior and executive functioning. Vascular lesions often coexist with Alzheimer disease (AD) and other pathologies. Minor cerebrovascular lesions, except for severe amyloid angiopathy, appear not essential for cognitive decline in full-blown AD, while both mild Alzheimer pathology and small vessel disease may interact synergistically. The lesion pattern of "pure" VaD, related to arteriosclerosis and microangiopathies, differs from that in mixed-type dementia (AD with vascular encephalopathy), more often showing large infarcts, which suggests different pathogenesis of both types of lesions. Due to the high variability of cerebrovascular pathology and its causative factors, no validated neuropathologic criteria for VaD are available, and a large variability across laboratories still exists in the procedures for morphologic examination and histology techniques.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, 1070, Vienna, Austria.
| |
Collapse
|
49
|
Abstract
Cerebrovascular disease (CVD) is an important cause of psychiatric disability in the elderly. Much of this disability can be attributed to dementia and lesser degrees of cognitive impairment, which result from strokes and other forms of cerebrovascular pathology. While vascular dementia is common, estimates of its frequency vary due to its clinical and pathologic heterogeneity, the challenges involved in its measurement and its frequent co-occurrence with Alzheimer's disease. Nevertheless the clinical features and natural histories of vascular dementia can be described, and risk factors have been identified and include hypertension, diabetes mellitus, hyperlipidaemia, other conditions that promote atherosclerosis, and rare genetic mutations. While vascular dementia is not curable, treatments are available. For example, a few recent clinical trials suggest that cholinesterase inhibitors have some efficacy. Our knowledge of the risk factors has also provided opportunities for the primary and secondary prevention of vascular dementia, and indicates promising avenues for research.
Collapse
Affiliation(s)
- Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
50
|
Markesbery WR. Commentary on “Vascular cognitive impairment: Today and tomorrow”. Alzheimers Dement 2006; 2:205-6. [DOI: 10.1016/j.jalz.2006.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 04/06/2006] [Indexed: 11/25/2022]
Affiliation(s)
- William R. Markesbery
- Sanders‐Brown Center on Aging and Alzheimer's Disease CenterUniversity of KentuckyLexingtonKYUSA
| |
Collapse
|