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Stephan BCM, Cochrane L, Kafadar AH, Brain J, Burton E, Myers B, Brayne C, Naheed A, Anstey KJ, Ashor AW, Siervo M. Population attributable fractions of modifiable risk factors for dementia: a systematic review and meta-analysis. THE LANCET. HEALTHY LONGEVITY 2024; 5:e406-e421. [PMID: 38824956 PMCID: PMC11139659 DOI: 10.1016/s2666-7568(24)00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND More than 57 million people have dementia worldwide. Evidence indicates a change in dementia prevalence and incidence in high-income countries, which is likely to be due to improved life-course population health. Identifying key modifiable risk factors for dementia is essential for informing risk reduction and prevention strategies. We therefore aimed to estimate the population attributable fraction (PAF) for dementia associated with modifiable risk factors. METHODS In this systematic review and meta-analysis, we searched Embase, MEDLINE, and PsycINFO, via Ovid, from database inception up to June 29, 2023, for population-derived or community-based studies and reviews reporting a PAF value for one or more modifiable risk factor for later-life dementia (prevalent or incident dementia in people aged ≥60 years), with no restrictions on dementia subtype, the sex or baseline age of participants, or the period of study. Articles were independently screened for inclusion by four authors, with disagreements resolved through consensus. Data including unweighted and weighted PAF values (weighted to account for communality or overlap in risk) were independently extracted into a predefined template by two authors and checked by two other authors. When five or more unique studies investigated a given risk factor or combination of the same factors, random-effects meta-analyses were used to calculate a pooled PAF percentage estimate for the factor or combination of factors. The review protocol was registered on PROSPERO, CRD42022323429. FINDINGS 4024 articles were identified, and 74 were included in our narrative synthesis. Overall, PAFs were reported for 61 modifiable risk factors, with sufficient data available for meta-analysis of 12 factors (n=48 studies). In meta-analyses, the highest pooled unweighted PAF values were estimated for low education (17·2% [95% CI 14·4-20·0], p<0·0001), hypertension (15·8% [14·7-17·1], p<0·0001), hearing loss (15·6% [10·3-20·9], p<0·0001), physical inactivity (15·2% [12·8-17·7], p<0·0001), and obesity (9·4% [7·3-11·7], p<0·0001). According to weighted PAF values, low education (9·3% [6·9-11·7], p<0·0001), physical inactivity (7·3% [3·9-11·2], p=0·0021), hearing loss (7·2% [5·2-9·7], p<0·0001), hypertension (7·1% [5·4-8·8], p<0·0001), and obesity (5·3% [3·2-7·4], p=0·0001) had the highest pooled estimates. When low education, midlife hypertension, midlife obesity, smoking, physical inactivity, depression, and diabetes were combined (Barnes and Yaffe seven-factor model; n=9 studies), the pooled unweighted and weighted PAF values were 55·0% (46·5-63·5; p<0·0001) and 32·0% (26·6-37·5; p<0·0001), respectively. The pooled PAF values for most individual risk factors were higher in low-income and middle-income countries (LMICs) versus high-income countries. INTERPRETATION Governments need to invest in a life-course approach to dementia prevention, including policies that enable quality education, health-promoting environments, and improved health. This investment is particularly important in LMICs, where the potential for prevention is high, but resources, infrastructure, budgets, and research focused on ageing and dementia are limited. FUNDING UK Research and Innovation (Medical Research Council).
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Affiliation(s)
- Blossom C M Stephan
- Dementia Centre of Excellence, Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK.
| | - Louie Cochrane
- Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK
| | | | - Jacob Brain
- Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Elissa Burton
- Dementia Centre of Excellence, Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Bronwyn Myers
- Dementia Centre of Excellence, Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Mental Health, Alcohol, Substance Use, and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Aliya Naheed
- Non-Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia; Brain Health and Dementia Centre, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Ammar W Ashor
- Department of Internal Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
| | - Mario Siervo
- Dementia Centre of Excellence, Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; School of Population Health, Curtin University, Perth, WA, Australia
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Krefman AE, Stephen J, Carolan P, Sedaghat S, Mansolf M, Soumare A, Gross AL, Aiello AE, Singh-Manoux A, Ikram MA, Helmer C, Tzourio C, Satizabal C, Levine DA, Lloyd-Jones D, Briceño EM, Sorond FA, Wolters FJ, Himali J, Launer LJ, Zhao L, Haan M, Lopez OL, Debette S, Seshadri S, Judd SE, Hughes TM, Gudnason V, Scholtens D, Allen NB. Cohort Profile: Dementia Risk Prediction Project (DRPP). Int J Epidemiol 2024; 53:dyae012. [PMID: 38339864 PMCID: PMC10858348 DOI: 10.1093/ije/dyae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Stephen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Padraig Carolan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aïcha Soumare
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison E Aiello
- Robert N Butler Columbia Aging Center and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Claudia Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily M Briceño
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Farzaneh A Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Departments of Radiology & Nuclear Medicine, and Alzheimer Centre Erasmus MC, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jayandra Himali
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Oscar L Lopez
- Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stéphanie Debette
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy M Hughes
- Departments of Internal Medicine and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gannon O, Tremble SM, McGinn C, Guth R, Scoppettone N, Hunt RD, Prakash K, Johnson AC. Angiotensin II-mediated hippocampal hypoperfusion and vascular dysfunction contribute to vascular cognitive impairment in aged hypertensive rats. Alzheimers Dement 2024; 20:890-903. [PMID: 37817376 PMCID: PMC10917018 DOI: 10.1002/alz.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Chronic hypertension increases the risk of vascular cognitive impairment (VCI) by ∼60%; however, how hypertension affects the vasculature of the hippocampus remains unclear but could contribute to VCI. METHODS Memory, hippocampal perfusion, and hippocampal arteriole (HA) function were investigated in male Wistar rats or spontaneously hypertensive rats (SHR) in early (4 to 5 months old), mid (8 to 9 months old), or late adulthood (14 to 15 months old). SHR in late adulthood were chronically treated with captopril (angiotensin converting enzyme inhibitor) or apocynin (antioxidant) to investigate the mechanisms by which hypertension contributes to VCI. RESULTS Impaired memory in SHR in late adulthood was associated with HA endothelial dysfunction, hyperconstriction, and ∼50% reduction in hippocampal blood flow. Captopril, but not apocynin, improved HA function, restored perfusion, and rescued memory function in aged SHR. DISCUSSION Hippocampal vascular dysfunction contributes to hypertension-induced memory decline through angiotensin II signaling, highlighting the therapeutic potential of HAs in protecting neurocognitive health later in life. HIGHLIGHTS Vascular dysfunction in the hippocampus contributes to vascular cognitive impairment. Memory declines with age during chronic hypertension. Angiotensin II causes endothelial dysfunction in the hippocampus in hypertension. Angiotensin II-mediated hippocampal arteriole dysfunction reduces blood flow. Vascular dysfunction in the hippocampus impairs perfusion and memory function.
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Affiliation(s)
- Olivia Gannon
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Sarah M. Tremble
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Conor McGinn
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Ruby Guth
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Nadia Scoppettone
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Ryan D. Hunt
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Kirtika Prakash
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Abbie C. Johnson
- Department of Neurological SciencesUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
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Lefferts WK, Reed KS, Rosonke RE, Augustine JA, Moreau KL. Age-associated increases in middle cerebral artery pulsatility differ between men and women. Am J Physiol Heart Circ Physiol 2023; 325:H1118-H1125. [PMID: 37682233 PMCID: PMC10908402 DOI: 10.1152/ajpheart.00453.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023]
Abstract
Mechanisms underlying sex differences in brain aging remain unclear but may relate to changes in cerebral pulsatile blood flow. Sex differences in the stiffening of the large arteries and expansion of pulse pressure with age may accelerate changes in pulsatile (i.e., discontinuous) blood flow in the brain that contribute to brain health. The purpose of this cross-sectional, secondary analysis was to examine sex differences in age-associated changes in large artery (aorta and carotid) stiffness, carotid pulse pressure, and cerebral pulsatility in 206 men and 217 women between 18 and 72 yr of age. Outcomes included aortic stiffness [carotid-femoral pulse wave velocity (cfPWV)] and carotid pulse pressure via tonometry, carotid β-stiffness via ultrasound, and middle cerebral artery (MCA) pulsatility index via transcranial Doppler. Regression analyses revealed a significant age-by-sex interaction, with women exhibiting a slower rate of change compared with men for cfPWV (β = -0.21, P = 0.04), and greater rate of change for carotid stiffness (β = 0.27, P = 0.02), carotid pulse pressure (β = 0.98, P < 0.001), and MCA pulsatility index (β = 0.49, P = 0.002) after adjustment for covariates. The significant age-by-sex interaction for MCA pulsatility was abolished after further adjustment for carotid pulse pressure. Women exhibit accelerated increases in cerebral pulsatility during midlife, likely driven by exaggerated increases in carotid stiffness and pulse pressure compared with men. These data suggest that there are disproportionate increases in cerebral pulsatility in women during midlife that could contribute to accelerated brain aging compared with men.NEW & NOTEWORTHY We identify sex-specific associations between increasing age and cerebral pulsatility and its vascular mechanisms. When compared with men, women in our cross-sectional analysis exhibited greater age-associated increases in carotid stiffness, carotid pulse pressure, and cerebral pulsatility particularly during midlife. These data suggest that the rapid expansion of pulse pressure during midlife contributes to an exaggerated increase in cerebral pulsatility among women and suggest a potential mechanism contributing to sex differences in brain aging.
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Affiliation(s)
- Wesley K Lefferts
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | - Krista S Reed
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | - Rachel E Rosonke
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | | | - Kerrie L Moreau
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Daniel JM, Lindsey SH, Mostany R, Schrader LA, Zsombok A. Cardiometabolic health, menopausal estrogen therapy and the brain: How effects of estrogens diverge in healthy and unhealthy preclinical models of aging. Front Neuroendocrinol 2023; 70:101068. [PMID: 37061205 PMCID: PMC10725785 DOI: 10.1016/j.yfrne.2023.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
Research in preclinical models indicates that estrogens are neuroprotective and positively impact cognitive aging. However, clinical data are equivocal as to the benefits of menopausal estrogen therapy to the brain and cognition. Pre-existing cardiometabolic disease may modulate mechanisms by which estrogens act, potentially reducing or reversing protections they provide against cognitive decline. In the current review we propose mechanisms by which cardiometabolic disease may alter estrogen effects, including both alterations in actions directly on brain memory systems and actions on cardiometabolic systems, which in turn impact brain memory systems. Consideration of mechanisms by which estrogen administration can exert differential effects dependent upon health phenotype is consistent with the move towards precision or personalized medicine, which aims to determine which treatment interventions will work for which individuals. Understanding effects of estrogens in both healthy and unhealthy models of aging is critical to optimizing the translational link between preclinical and clinical research.
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Affiliation(s)
- Jill M Daniel
- Department of Psychology and Brain Institute, Tulane University, New Orleans, LA, United States.
| | - Sarah H Lindsey
- Department of Pharmacology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Ricardo Mostany
- Department of Pharmacology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Laura A Schrader
- Department of Cell & Molecular Biology and Brain Institute, Tulane University, New Orleans, LA, United States
| | - Andrea Zsombok
- Department of Physiology and Brain Institute, Tulane University, New Orleans, LA, United States
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Chuang SY, Liu WL, Chang HY, Hsu CC, Pan WH. Central obesity and elevated blood pressure in middle life are associated with physical and cognitive impairment in later life: A retrospective design with repeated measures. Exp Gerontol 2023; 173:112093. [PMID: 36669710 DOI: 10.1016/j.exger.2023.112093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Physical and cognitive function decline indicates the prestage of disability and is associated with mortality among older adults. We investigated the association of metabolic disorders in midlife with physical and cognitive function decline in later life in a retrospective cohort. MATERIAL AND METHODS A total of 618 older adults aged ≥60 years in wave-6 (2014-2017) were enrolled in the Cardiovascular Disease Risk Factor Two-Township Study to evaluate physical (hand grip strength and 4-m walking speed) and cognitive function (Mine-Mental State Examination [MMSE] score). Repeated metabolic disorder measures in wave-2, wave-3, and wave-5 were obtained to identify three trajectory pattern groups according to each metabolic disorder through group-based trajectory modeling. Linear and logistic regressions were conducted to investigate the association of metabolic disorders in middle life with physical and cognitive function decline in later life. RESULTS The prevalence rates of a weak hand grip (<28 kg for men and <18 kg for women), slow walking speed (<0.8 m/s), and poor cognitive function (MMSE <25) were 24.43 %, 16.83 % and 10.5 %, respectively, among the older adults. In the retrospective cohort with 15-year follow-up, those with a waist circumference of ≥95 cm for men and ≥85 cm for women in middle life exhibited a significantly weak hand grip (odds ratio: 2.78 [95 % confidence interval: 1.26, 6.11]) and slow walking speed (2.26 [1.15, 4.43]) in later life compared with those with a smaller waist circumference (<85 cm for men and <75 cm for women). Elevated blood pressure (systolic blood pressure [BP] ≥130 mmHg or diastolic BP ≥80 mmHg) was significantly associated with a higher risk of cognitive function decline in later life. Furthermore, the high-trajectory and middle-trajectory groups' body mass index (3.17 [1.25, 8.04] and 2.27 [1.28, 4.00], respectively) and waist circumference (4.39 [2.07, 9.31] and 2.54 [1.39, 4.67], respectively) were significantly associated with a weak hand grip and slow walking speed, respectively, compared with those of the low-trajectory group. The high-trajectory diastolic BP group was significantly associated with a higher risk of cognitive function decline compared with the low-trajectory diastolic BP group. CONCLUSION Waist circumference and BP in middle life were associated with physical function decline and poor cognitive function in later life. The management of central obesity and BP in midlife may slow the decline of physical and cognitive function in later life.
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Affiliation(s)
- Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC.
| | - Wen-Ling Liu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Wen-Harn Pan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, ROC; Department of Nutrition Food and Health Biotechnology, Asia University, Taichung, Taiwan
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Systolic blood pressure at age 40 and cognitive function 25 years later: the Akershus Cardiac Examination (ACE) 1950 Study. J Hypertens 2023; 41:132-139. [PMID: 36453656 DOI: 10.1097/hjh.0000000000003312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Hypertension in midlife is a risk factor for cognitive impairment. Still, the ideal midlife blood pressure (BP) remains unknown. We examined associations between different systolic blood pressure (SBP) levels at the age of 40-43 years and change in SBP over a 25-year period with cognitive function at age 62-65 years. METHODS We included 2424 individuals born in 1950 who had participated both in the Age 40 Program (1990-1993) and the Akershus Cardiac Examination (ACE) 1950 Study (2012-2015). The exposure was SBP at age 40-43 years and the outcome was cognitive function at age 62-65 years, assessed with Montreal Cognitive Assessment, Delayed recall trial from the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task, and Trail Making Test part B (TMT B). RESULTS Participants were 40.1 ± 0.3 years old with mean SPB 128 ± 13 mmHg at the Age 40 Program, and 63.9 ± 0.6 years old with mean SPB 138 ± 18 at the ACE 1950 Study. Adjusted linear regressions showed no associations between SBP and subsequent cognitive function. In logistic regressions, individuals with SBP ≥140 mmHg, compared to individuals with SBP <120 mmHg (odds ratio 2.29, 95% confidence interval 1.28-4.10, P-value 0.005) had increased risk of an abnormal TMT B-score. Change in SBP during the 25-year follow-up was not associated with cognitive function. CONCLUSIONS SBP ≥140 mmHg at age 40-43 was associated with reduced capacity on TMT B, a domain specific cognitive test sensitive to vascular impairment. No other associations were found between SBP, or change in SBP, and cognitive function.
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White LR, Corrada MM, Kawas CH, Cholerton BA, Edland SE, Flanagan ME, Montine TJ. Neuropathologic Changes of Alzheimer's Disease and Related Dementias: Relevance to Future Prevention. J Alzheimers Dis 2023; 95:307-316. [PMID: 37522210 PMCID: PMC10851925 DOI: 10.3233/jad-230331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Decedents with late-life dementia are often found at autopsy to have vascular pathology, cortical Lewy bodies, hippocampal sclerosis, and/or TDP-43 encephalopathy alone or with concurrent Alzheimer's disease (AD) lesions. Nonetheless, it is commonly believed that AD neuropathologic changes (NC) are the dominant or exclusive drivers of late-life dementia. OBJECTIVE Assess associations of end-of-life cognitive impairment with any one or any combination of five distinct NC. Assess impairment prevalence among subjects having natural resistance to each type of NC. METHODS Brains from 1,040 autopsied participants of the Honolulu-Asia Study, the Nun Study, and the 90 + Study were examined for NC of AD, Lewy body dementia, microvascular brain injury, hippocampal sclerosis, and limbic predominate TDP-43 encephalopathy. Associations with impairment were assessed for each NC and for NC polymorbidity (variable combinations of 2-5 concurrent NC). RESULTS Among 387 autopsied decedents with severe cognitive impairment, 20.4% had only AD lesions (ADNC), 25.3% had ADNC plus 1 other NC, 11.1% had ADNC plus 2 or more other NC, 28.7% had no ADNC but 1-4 other NC, and 14.5% had no/negligible NC. Combinations of any two, three, or four NC were highly frequent among the impaired. Natural resistance to ADNC or any other single NC had a modest impact on overall cohort impairment levels. CONCLUSION Polymorbidity involving 1-5 types of concurrent NC is a dominant neuropathologic feature of AD and related dementias. This represents a daunting challenge to future prevention and could explain failures of prior preventive intervention trials and of efforts to identify risk factors.
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Affiliation(s)
- Lon R. White
- Pacific Health Research and Education Institute, Honolulu, USA
| | | | | | | | - Steve E. Edland
- University of California at San Diego, School of Public Health, La Jolla, USA
| | - Margaret E Flanagan
- University of Texas Health San Antonio, Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Pathology, San Antonio, TX, USA
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Lespinasse J, Chêne G, Mangin J, Dubois B, Blanc F, Paquet C, Hanon O, Planche V, Gabelle A, Ceccaldi M, Annweiler C, Krolak‐Salmon P, Godefroy O, Wallon D, Sauvée M, Bergeret S, Chupin M, Proust‐Lima C, Dufouil C. Associations among hypertension, dementia biomarkers, and cognition: The MEMENTO cohort. Alzheimers Dement 2022. [PMID: 36464896 DOI: 10.1002/alz.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Approximately 40% of dementia cases could be delayed or prevented acting on modifiable risk factors including hypertension. However, the mechanisms underlying the hypertension-dementia association are still poorly understood. METHODS We conducted a cross-sectional analysis in 2048 patients from the MEMENTO cohort, a French multicenter clinic-based study of outpatients with either isolated cognitive complaints or mild cognitive impairment. Exposure to hypertension was defined as a combination of high blood pressure (BP) status and antihypertensive treatment intake. Pathway associations were examined through structural equation modeling integrating extensive collection of neuroimaging biomarkers and clinical data. RESULTS Participants treated with high BP had significantly lower cognition compared to the others. This association was mediated by higher neurodegeneration and higher white matter hyperintensities load but not by Alzheimer's disease (AD) biomarkers. DISCUSSION These results highlight the importance of controlling hypertension for prevention of cognitive decline and offer new insights on mechanisms underlying the hypertension-dementia association. HIGHLIGHTS Paths of hypertension-cognition association were assessed by structural equation models. The hypertension-cognition association is not mediated by Alzheimer's disease biomarkers. The hypertension-cognition association is mediated by neurodegeneration and leukoaraiosis. Lower cognition was limited to participants treated with uncontrolled blood pressure. Blood pressure control could contribute to promote healthier brain aging.
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Affiliation(s)
- Jérémie Lespinasse
- Inserm Research Center « Bordeaux Population Health », Bordeaux School of Public Health, CIC 1401‐EC Bordeaux University Bordeaux France
- Pôle de santé publique Centre Hospitalier Universitaire (CHU) de Bordeaux Bordeaux France
| | - Geneviève Chêne
- Inserm Research Center « Bordeaux Population Health », Bordeaux School of Public Health, CIC 1401‐EC Bordeaux University Bordeaux France
- Pôle de santé publique Centre Hospitalier Universitaire (CHU) de Bordeaux Bordeaux France
| | - Jean‐Francois Mangin
- CATI, US52‐UAR2031, CEA, ICM, SU, CNRS, INSERM, APHP Paris France
- Université Paris‐Saclay, CEA, CNRS, Neurospin, UMR9027 Baobab Gif‐sur‐Yvette France
| | - Bruno Dubois
- Sorbonne Université, CNRS, INSERM Laboratoire d'Imagerie Biomédicale Paris France
- Sorbonne‐Université, Service des maladies cognitives et comportementales et Institut de la mémoire et de la maladie d'Alzheimer (IM2A) Hôpital de la Salpêtrière Paris AP‐PH France
| | - Frederic Blanc
- Univ. Strasbourg, CNRS, ICube laboratory, UMR 7357, Fédération de Médecine Translationnelle de Strasbourg, Centre Mémoire de Ressources et de Recherches Departement de Gériatrie Strasbourg France
| | - Claire Paquet
- Univ. Paris, Inserm U1144, GHU APHP Nord Lariboisière Fernand‐Widal Paris France
| | - Olivier Hanon
- Univ. de Paris, EA 4468, Service de Gériatrie, AP‐HP Hôpital Broca Paris France
| | - Vincent Planche
- Univ. Bordeaux, CNRS UMR 5293, Institut des Maladies Neurodégénératives, Centre Mémoire de Ressources et de Recherches Pôle de Neurosciences Cliniques, CHU de Bordeaux Bordeaux France
| | - Audrey Gabelle
- Univ. Montpellier, i‐site MUSE, Inserm U1061, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Département de Neurologie, CHU de Montpellier Montpellier France
| | - Mathieu Ceccaldi
- Univ. Aix Marseille, Inserm UMR 1106, Institut de Neurosciences des Systèmes, Centre Mémoire de Ressources et de Recherches Département de Neurologie et de Neuropsychologie, AP‐HM Marseille France
| | - Cedric Annweiler
- Univ. Angers, UPRES EA 4638, Centre Mémoire de Ressources et de Recherches, Département de Gériatrie, CHU d'Angers Angers France
| | - Pierre Krolak‐Salmon
- Univ. Lyon, Inserm U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes Hospices Civils de Lyon Lyon France
| | - Olivier Godefroy
- Neurology Departement and Functional Neurosciences Lab. (UR UPJV 4559) Amiens University Hospital Amiens France
| | - David Wallon
- Normandie Univ, UNIROUEN, Inserm U1245, CHU Rouen, Department of Neurology and CNR‐MAJ, Normandy Center for Genomic and Personalized Medicine CIC‐CRB1404 Rouen France
| | - Mathilde Sauvée
- CMRR Grenoble Arc Alpin CHU Grenoble Grenoble France
- Laboratoire de Psychologie et NeuroCognition: LPNC CNRS 5105 Université Grenoble Alpes Grenoble France
| | - Sébastien Bergeret
- Département de Médecine NucléaireAP‐HP, Hôpital Pitié‐Salpêtrière ParisFrance
| | - Marie Chupin
- CATI, US52‐UAR2031, CEA, ICM, SU, CNRS, INSERM, APHP Paris France
| | - Cécile Proust‐Lima
- Inserm Research Center « Bordeaux Population Health », Bordeaux School of Public Health, CIC 1401‐EC Bordeaux University Bordeaux France
| | - Carole Dufouil
- Inserm Research Center « Bordeaux Population Health », Bordeaux School of Public Health, CIC 1401‐EC Bordeaux University Bordeaux France
- Pôle de santé publique Centre Hospitalier Universitaire (CHU) de Bordeaux Bordeaux France
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10
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Wu H, Ren Z, Gan J, Lü Y, Niu J, Meng X, Cai P, Li Y, Gang B, You Y, Lv Y, Liu S, Wang XD, Ji Y. Blood pressure control and risk of post-stroke dementia among the elderly: A population-based screening study. Front Neurol 2022; 13:956734. [PMID: 36016539 PMCID: PMC9396341 DOI: 10.3389/fneur.2022.956734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPost-stroke dementia (PSD) has adverse effects on the quality of work and life in elderly stroke survivors. There are inconsistent results on the impacts of blood pressure control on the risk of PSD in people aged 65 years and above.ObjectiveThis study was performed to explore whether poorly-controlled blood pressure was associated with an increasing risk of PSD.MethodsThe study population was enrolled from cross-sectional research conducted in 106 communities of rural northern China. In Phase I, a total of 7,448 people aged ≥65 years, including 830 with stroke history, completed a questionnaire, a physical examination, and a cognitive assessment. Phase II further confirmed the diagnosis of PSD. Well-controlled blood pressure was defined as an average systolic blood pressure of <140 mmHg and average diastolic blood pressure of <90 mmHg over two readings in person. Failure to meet these criteria was considered as poorly-controlled blood pressure.ResultsThe crude prevalence rate of PSD among stroke survivors aged 65 years and over was 17.8% [95% confidence interval (CI) 15.2–20.4%]. Among the 830 stroke survivors, the proportions of PSD gradually increased with age and the crude prevalence rates for PSD were 10.2% (95% CI 5.6–14.9%), 14.8% (95% CI 10.1–19.5%), 18.8% (95% CI 14.1–23.5%), and 27.4% (95% CI 20.8–34.1%) in subjects aged 65–69, 70–74, 75–79 and ≥80 years, respectively. Participants in the poorly-controlled blood pressure group were more likely to suffer from PSD (28.4 vs.15.3%, P < 0.001), be older (75.81 ± 4.97 vs. 74.74 ± 5.83, P < 0.05), and have a worse cognitive level (22.26 ± 7.05 vs. 24.10 ± 6.02, P < 0.05). Compared with well-controlled blood pressure patients, poorly-controlled blood pressure in stroke survivors significantly increased risk of PSD (odds ratio = 2.20, 95% CI 1.45–3.32) after adjusting for age, gender, and education.ConclusionsThe crude prevalence of PSD among stroke survivors aged ≥65 years was 17.8% at community level. In addition to lower education level and older age, poorly-controlled blood pressure was also an independent risk factor for PSD among the elderly, which is amenable to intervention. Therefore, it is essential to control blood pressure to reduce PSD incidence.
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Affiliation(s)
- Hao Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhihong Ren
- Department of Neurology, Capital Medical University Electric Teaching Hospital/State Gird Beijing Electric Power Hospital, Beijing, China
| | - Jinghuan Gan
- Department of Cognitive Disorder, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianping Niu
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xinling Meng
- Department of Neurology, Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, China
| | - Pan Cai
- Dementia Clinic, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yang Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Baozhi Gang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong You
- Department of Neurology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yan Lv
- Department of Neurology, Hainan General Hospital, Haikou, China
| | - Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiao-Dan Wang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Yong Ji
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
- *Correspondence: Yong Ji
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11
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de Almeida Faria ACR, Dall'Agnol JF, Gouveia AM, de Paiva CI, Segalla VC, Baena CP. Risk factors for cognitive decline in type 2 diabetes mellitus patients in Brazil: a prospective observational study. Diabetol Metab Syndr 2022; 14:105. [PMID: 35897033 PMCID: PMC9327152 DOI: 10.1186/s13098-022-00872-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) patients are twice as likely to develop dementia. The study's goal was to evaluate cognitive performance and risk factors for cognitive decline in this population. METHODS Prospective observational study was conducted with 400 T2DM adults, of whom, during routine baseline and follow-up appointments, had socio-demographic, clinical, and laboratory data collected, and underwent physical examination, screening for depression symptoms (Patient Health Questionaire-9-PHQ-9), and cognitive tests: Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A/B, and Word Memory Tests. Each cognitive test score was converted to a z-score and its average resulted in a new variable called Global Cognitive z-Score [GCS(z)]. Averages of the cognitive test scores and GCS(z) at both moments were compared by the Student's T-Test for paired samples. Multivariate binary logistic regression models were built to assess the association of GCS(z) < zero with risk factors for cognitive decline at the baseline and follow-up. RESULTS After exclusions, 251 patients were eligible, being 56.6% female, mean age of 61.1 (± 9.8) years, 12.6 (± 8.9) years of DM duration, and 7.6 (± 4.2) years of school education. Follow-up had 134 patients reevaluated and took place after a mean of 18.4(± 5.0) months. Eleven (14%) patients with a GCS(z) ≥ 0 at baseline turned into a GCS(z) < 0 at follow-up. There were no significant differences between the means of cognitive test scores and GCS(z) at the two evaluation moments. At the baseline, the multivariate logistic regression model identified five risk factors associated with GCS(z) < zero: age ≥ 65 years, schooling ≤ 6 years, arterial hypertension, depression symptoms, and diabetic retinopathy (DR), with odds ratio (OR) and 95% confidence interval (CI95%) respectively: 5.46 (2.42-12.34); 12.19 (5.62-26.46); 2.55 (0.88-7.39); 3.53 (1.55-8.07) e 2.50 (1.18-5.34). At follow-up, the risk factors for GCS(z) < zero were: schooling ≤ 6 years, DM duration ≥ 10 years, depression symptoms, arterial hypertension, and cardiovascular disease (CVD), OR and CI95% respectively: 10.15 (3.68-28.01); 2.68 (0.96-7.48); 4.92 (1.77-13.70); 7.21 (1.38-35.71) e 5.76 (1.93-17.18). CONCLUSIONS Based on our results, cognitive evaluation and follow-up should be incorporated on the routine of T2DM patients, especially for those with advanced age, low education level, prolonged DM duration, arterial hypertension, depression symptoms, CVD, and DR.
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Affiliation(s)
- Ana Cristina Ravazzani de Almeida Faria
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, 80215-901, Brazil
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Joceline Franco Dall'Agnol
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, 80215-901, Brazil
| | - Aline Maciel Gouveia
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Clara Inácio de Paiva
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | | | - Cristina Pellegrino Baena
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, 80215-901, Brazil.
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12
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Badji A, Cohen-Adad J, Girouard H. Relationship Between Arterial Stiffness Index, Pulse Pressure, and Magnetic Resonance Imaging Markers of White Matter Integrity: A UK Biobank Study. Front Aging Neurosci 2022; 14:856782. [PMID: 35800980 PMCID: PMC9252854 DOI: 10.3389/fnagi.2022.856782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/09/2022] [Indexed: 12/29/2022] Open
Abstract
Background Alzheimer's disease and dementia in general constitute one of the major public health problems of the 21st century. Research in arterial stiffness and pulse pressure (PP) play an important role in the quest to reduce the risk of developing dementia through controlling modifiable risk factors. Objective The aim of the study is to investigate the association between peripheral PP, arterial stiffness index (ASI) and brain integrity, and to discover if ASI is a better predictor of white matter integrity than peripheral PP. Materials and Methods 17,984 participants 63.09 ± 7.31 from the UK Biobank were used for this study. ASI was estimated using infrared light (photoplethysmography) and peripheral PP was calculated by subtracting the diastolic from the systolic brachial blood pressure value. Measure of fractional anisotropy (FA) was obtained from diffusion imaging to estimate white matter microstructural integrity. White matter hyperintensities were segmented from the combined T1 and T2-weighted FLAIR images as a measure of irreversible white matter damage. Results An important finding is that peripheral PP better predicts white matter integrity when compared to ASI. This finding is consistent until 75 years old. Interestingly, no significant relationship is found between either peripheral PP or ASI and white matter integrity after 75 years old. Conclusion These results suggest that ASI from plethysmography should not be used to estimate cerebrovascular integrity in older adults and further question the relationship between arterial stiffness, blood pressure, and white matter damage after the age of 75 years old.
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Affiliation(s)
- Atef Badji
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada.,Functional Neuroimaging Unit, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada.,Functional Neuroimaging Unit, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada.,Mila - Quebec AI Institute, Montréal, QC, Canada
| | - Hélène Girouard
- Functional Neuroimaging Unit, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Groupe de Recherche sur le Système Nerveux Central, Montréal, QC, Canada.,Centre Interdisciplinaire de Recherche sur le Cerveau et l'Apprentissage, Montréal, QC, Canada.,Groupe de Recherche Universitaire Sur le Médicament (GRUM), Montréal, QC, Canada
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13
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Seshadri S, Caunca MR, Rundek T. Vascular Dementia and Cognitive Impairment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Daniel GD, Chen H, Bertoni AG, Hughes TM, Hayden KM. High visit‐to‐visit blood pressure variability predicts global cognitive decline: The Multi‐Ethnic Study of Atherosclerosis. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12342. [PMID: 35898668 PMCID: PMC9310191 DOI: 10.1002/trc2.12342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 11/07/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- George D. Daniel
- Department of Neurobiology and Anatomy Wake Forest School of Medicine Winston‐Salem North Carolina USA
- Department of Psychology Howard University Washington DC USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Timothy M. Hughes
- Department of Epidemiology and Prevention Wake Forest School of Medicine Winston‐Salem North Carolina USA
- Department of Internal Medicine Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy Wake Forest School of Medicine Winston‐Salem North Carolina USA
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15
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Lee CJ, Lee JY, Han K, Kim DH, Cho H, Kim KJ, Kang ES, Cha BS, Lee YH, Park S. Blood Pressure Levels and Risks of Dementia: a Nationwide Study of 4.5 Million People. Hypertension 2021; 79:218-229. [PMID: 34775786 DOI: 10.1161/hypertensionaha.121.17283] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There are inconsistent results on the impacts of controlling blood pressure (BP) on the risk of dementia. We investigated the association between BP and risk of dementia subtypes by antihypertensive treatment and comorbidities. Using the Korean National Health Insurance Service-Health Screening Database from 2009 to 2012, a total of 4 522 447 adults aged 60+ years without a history of dementia were analyzed and followed up for a mean of 5.4 years. Individuals were classified according to their baseline systolic BP (SBP) and diastolic BP; SBP 130 to <140 mm Hg and diastolic BP 80 to <90 mm Hg were used as reference groups. The risk of overall dementia and probable Alzheimer disease was significantly higher in the SBP≥160 and lower SBP groups. These U-shaped associations were consistent regardless of antihypertensive use or comorbidities. The risk of probable vascular dementia (VaD) was not higher among lower SBP groups and increased gradually as SBP increased. Although there was a linear association between SBP and the risk of probable VaD in individuals not taking antihypertensives or without comorbidities, there was a U-shaped association in individuals taking antihypertensives or with comorbidities. Patterns of association between diastolic BP and risk of probable Alzheimer disease or probable VaD were similar to those with SBP, except for the risk of probable VaD in individuals taking antihypertensives. In conclusion, risks of probable Alzheimer disease and probable VaD were different among lower BP groups. Although the risk of dementia appears higher in people with lower BP receiving antihypertensives, this finding may be affected by comorbidities.
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Affiliation(s)
- Chan Joo Lee
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Lee
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (K.H.)
| | - Da Hye Kim
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (D.H.K.)
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital (H.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Division of Geriatrics (K.J.K.), Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
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Heizhati M, Li N, Wang L, Hong J, Li M, Yang W, Yao L, Lin M, Pan F, Yang Z, Wang Z, Abudereyimu R. Association of Hypertension with Mild Cognitive Impairment in Population from Less-Developed Areas of Multiethnic Northwest China. Neuroepidemiology 2021; 55:407-415. [PMID: 34515156 DOI: 10.1159/000517956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Relationship between hypertension and mild cognitive impairment (MCI) remains undetermined in population from less-developed regions. We aimed to explore whether hypertension is associated with MCI in this specific population. METHODS In this cross-sectional study, we enrolled subjects aged ≥18 years using multistage random sampling from Emin, China, in 2019. Participants underwent questionnaires and data collection including mini-mental state examination (MMSE) and blood pressure measurement. RESULTS Finally, 31,329 subjects were included, with 11,270 hypertensives. Compared with normotensive subjects, hypertensives were characterized by significantly older age (55.19 ± 12.25 vs. 43.26 ± 12.71), more men (52.5% vs. 42.9%), low education attainment (≤primary education: 42.4% vs. 26.3%), more abdominal obesity (39.7% vs. 19.1%), poor sleep quality (39.1% vs. 28.7%), and chronic kidney disease (6.6% vs. 3.4%, p for all <0.001). Prevalence of MCI in hypertensives was significantly higher than that of normotensive subjects (24.3% vs. 15.6%, p < 0.001). Multivariate logistic regression analysis showed in a fully adjusted model that the odds for MCI were significantly increased in hypertensives than in normotensive population (OR = 1.19, 95% CI: 1.09, 1.30, p < 0.001) and independent of all the parameters studied including age, education level, and stroke. In the age-stratified regression model, presence of hypertension significantly increased the odds of MCI by 1.17-fold (95% CI: 1.03, 1.33, p = 0.020) and by 1.22-fold (95% CI: 1.04, 1.44, p = 0.016) in middle-aged and elderly population. Sensitivity analysis of excluding those with stroke history showed that hypertension was still a risk factor for MCI in total, middle-aged, and elderly population. CONCLUSION Hypertension is in independent negative association with MCI in middle-aged and elderly population from underdeveloped regions.
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Affiliation(s)
- Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Lin Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Jing Hong
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Mei Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Wenbo Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Ling Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Mengyue Lin
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Fengyu Pan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Zhikang Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Zhongrong Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
| | - Reyila Abudereyimu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.,Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)", Urumqi, China
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Volpe R, Predieri S, Cianciabella M, Daniele GM, Gatti E, Magli M, Rodinò P, Schiavetto E, Sotis G, Urbinati S. EWHETA (Eat Well for a HEalthy Third Age) Project: novel foods to improve the nutrition in the elderly people. Aging Clin Exp Res 2021; 33:1353-1358. [PMID: 32770343 DOI: 10.1007/s40520-020-01671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Cardiovascular diseases (CVD) are the leading cause of mortality. However, by treating modifiable cardiovascular risk factors and following a healthy diet as the Mediterranean diet, we have opportunity to prevent CVD. In the EWHETA (Eat Well for a HEalthy Third Age) Project, our goal has been to develop novel foods ("Mediterranean Lasagne", MLs) in versions all nutritionally complete and well balanced in terms of calories, whole carbohydrates, fibers, source of vegetable proteins, and vegetable fats. MLs can be easy prepared at home (inexpensively) and used as fresh food or can be pre-prepared and used in residences for elderly people or in health care residencies. The project has saw the alliance between nutritionists and food and sensor scientists and the active involvement of older people in tasting the novel foods to achieve the final tasty versions of the MLs. We think that the nutritional components of these novel foods and its well-accepted taste, insert in a healthy diet and life style (fundamental aspects at every age), and could contribute to improve diet in the elderly people and prevent malnutrition.
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Affiliation(s)
- R Volpe
- Servizio Prevenzione e Protezione, SPP-CNR, Rome, Italy.
| | - S Predieri
- Istituto di BioEconomia IBE-CNR, Bologna, Italy.
| | | | - G M Daniele
- Istituto di BioEconomia IBE-CNR, Bologna, Italy
| | - E Gatti
- Istituto di BioEconomia IBE-CNR, Bologna, Italy
| | - M Magli
- Istituto di BioEconomia IBE-CNR, Bologna, Italy
| | - P Rodinò
- Servizio Prevenzione e Protezione, SPP-CNR, Rome, Italy
| | - E Schiavetto
- Servizio Prevenzione e Protezione, SPP-CNR, Rome, Italy
| | - G Sotis
- Servizio Prevenzione e Protezione, SPP-CNR, Rome, Italy
| | - S Urbinati
- Servizio Prevenzione e Protezione, SPP-CNR, Rome, Italy
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Daugherty AM. Hypertension-related risk for dementia: A summary review with future directions. Semin Cell Dev Biol 2021; 116:82-89. [PMID: 33722505 DOI: 10.1016/j.semcdb.2021.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 02/07/2023]
Abstract
Chronic hypertension, or high blood pressure, is the most prevalent vascular risk factor that accelerates cognitive aging and increases risk for Alzheimer's disease and related dementia. Decades of observational and clinical trials have demonstrated that midlife hypertension is associated with greater gray matter atrophy, white matter damage commiserate with demyelination, and functional deficits as compared to normotension over the adult lifespan. Critically, hypertension is a modifiable dementia risk factor: successful blood pressure control with antihypertensive treatment improves outcomes as compared to uncontrolled hypertension, but does not completely negate the risk for dementia. This suggests that hypertension-related risk for neural and cognitive decline in aging cannot be due to elevations in blood pressure alone. This summary review describes three putative pathways for hypertension-related dementia risk: oxidative damage and metabolic dysfunction; systemic inflammation; and autonomic control of heart rate variability. The same processes contribute to pre-clinical hypertension, and therefore hypertension may be an early symptom of an aging nervous system that then exacerbates cumulative and progressive neurodegeneration. Current evidence is reviewed and future directions for research are outlined, including blood biomarkers and novel neuroimaging methods that may be sensitive to test the specific hypotheses.
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Affiliation(s)
- Ana M Daugherty
- Department of Psychology, Department of Psychiatry and Behavioral Neurosciences, Institute of Gerontology, Wayne State University, 5057 Woodward Ave., Detroit, MI, USA.
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19
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Longitudinal analysis of premotor anthropometric and serological markers of Parkinson's disease. Sci Rep 2020; 10:20524. [PMID: 33239649 PMCID: PMC7688961 DOI: 10.1038/s41598-020-77415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Parkinson’s disease (PD) is a debilitating neurodegenerative disorder in which nonmotor symptoms, such as constipation and hyposmia, precede the onset of motor symptoms by 20 years. The aim of this study was to identify biomarkers at the premotor stage of PD. We assessed the differences in longitudinal changes in anthropometric and serological indices obtained from health check-up data before and after the onset of motor symptoms between male and female PD patients and healthy subjects. We enrolled 22 male and 23 female PD patients and 60 male and 60 female healthy controls. A mixed-effects model was used to estimate the trajectory of each clinical marker over the years before and after motor symptoms onset in the PD subjects, which were then compared with the trajectories of the healthy controls. The results showed a premotor blood pressure increase in female PD patients and premotor decreases in haematocrit, total cholesterol and low-density lipoprotein cholesterol in the male patients. Our results indicated that blood pressure, haematocrit and serum cholesterol levels are potential premotor markers of PD. Additionally, the changes in anthropometric and serological indices before PD motor symptoms onset were sex specific.
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Kapusta J, Kidawa TM, Rynkowska-Kidawa M, IrzmaŃski TR, Kowalski TJ. Evaluation of frequency of occurrence of cognitive impairment in the course of arterial hypertension in an elderly population. Psychogeriatrics 2020; 20:406-411. [PMID: 32020728 DOI: 10.1111/psyg.12521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/19/2019] [Accepted: 12/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dementia is a very serious problem with regard to geriatric population. In the population over the age of 80 the prevalence of dementia varies by up to 20%. It is very important to answer the question - are arterial hypertension and its duration associated with cognitive performance? METHODS One hundred and sixty people were qualified for participation in the study, women and men, diagnosed with arterial hypertension. The patients were divided into two pairs of groups. The first pair was group 1, patients with hypertension over the age of 85 and group 2, patients with hypertension aged 75-85. The second pair was group I, patients with up to 10 years of arterial hypertension and group II, patients with over 10 years of arterial hypertension. In the study, the Mini-Mental State Examination (MMSE) was used. Interpretation of impairment depended on the obtained numerical value. RESULTS In the tested group of patients, for individual correlations it was found that age is the independent variable which significantly affects the MMSE score. It was found that the time of duration of arterial hypertension did not have impact on the MMSE. CONCLUSION Cognitive functions evaluated through the MMSE were correct for the entire population. The length of the course of arterial hypertension did not have a significant adverse impact on cognitive functions and on the achieved MMSE result. Significant impact of age on the lowering of MMSE results and impairment of cognitive functions was shown.
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Affiliation(s)
- Joanna Kapusta
- Clinic of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Łódź, Poland
| | - Tit Michał Kidawa
- Department of Cardiac Intensive Care, Medical University of Lodz, Łódź, Poland
| | | | - Tit Robert IrzmaŃski
- Clinic of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Łódź, Poland
| | - Tit Jan Kowalski
- Clinic of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Łódź, Poland
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21
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Piovezan RD, Oliveira D, Arias N, Acosta D, Prince MJ, Ferri CP. Mortality Rates and Mortality Risk Factors in Older Adults with Dementia from Low- and Middle-Income Countries: The 10/66 Dementia Research Group Population-Based Cohort Study. J Alzheimers Dis 2020; 75:581-593. [PMID: 32310178 PMCID: PMC7306886 DOI: 10.3233/jad-200078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dementia is the main cause of disability in older people living in low- and middle-income countries (LMIC). Monitoring mortality rates and mortality risk factors in people with dementia (PwD) may contribute to improving care provision. OBJECTIVE We aimed to estimate mortality rates and mortality predictors in PwD from eight LMICs. METHODS This 3-5-year prospective cohort study involved a sample of 1,488 older people with dementia from eight LMIC. Total, age- and gender-specific mortality rates per 1,000 person-years at risk, as well as the total, age- and gender-adjusted mortality rates were estimated for each country's sub-sample. Cox's regressions were used to establish the predictors of mortality. RESULTS At follow-up, vital status of 1,304 individuals (87.6%) was established, of which 593 (45.5%) were deceased. Mortality rate was higher in China (65.9%) and lower in Mexico (26.9%). Mortality risk was higher in males (HR = 1.57; 95% CI: 1.32,1.87) and increased with age (HR = 1.04; 95% CI: 1.03,1.06). Neuropsychiatric symptoms (HR = 1.03; 95% CI: 1.01,1.05), cognitive decline (HR 1.04; 95% CI: 1.03,1.05), undernutrition (HR = 1.55; 95% CI: 1.19, 2.02), physical impairments (HR = 1.15; 95% CI: 1.03,1.29), and disease severity (HR = 1.43; 95% CI: 1.22,1.63) predicted higher mortality risk. CONCLUSION Several factors predicted higher mortality risk in PwD in LMICs. Males, those with higher age, higher severity of neuropsychiatric symptoms, higher number of physical impairments, higher disease severity, lower cognitive performance, and undernutrition had higher mortality risk. Addressing these indicators of long-term adverse outcomes may potentially contribute to improved advanced care planning, reducing the burden of disease in low-resourced settings.
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Affiliation(s)
- Ronaldo D. Piovezan
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychobiology, São Paulo, Brazil
| | - Déborah Oliveira
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, São Paulo, Brazil
| | - Nicole Arias
- Institute for Justice Research and Development, College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, Dominican Republic
| | - Martin J. Prince
- King’s College London, Health Services and Population Research, London, United Kingdom
| | - Cleusa P. Ferri
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychobiology, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, International Research Centre Health Technology Assessment Unit, Sao Paulo, Brazil
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22
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Lim S, Mohaimin S, Min D, Roberts T, Sohn YJ, Wong J, Sivanesathurai R, Kwon SC, Trinh-Shevrin C. Alzheimer's Disease and its Related Dementias among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review. J Alzheimers Dis 2020; 77:523-537. [PMID: 32675416 PMCID: PMC8638681 DOI: 10.3233/jad-200509] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer's disease and its related dementias (ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely ADRD diagnosis and services; yet little is known about ADRD in this population. OBJECTIVE The study objective is to conduct a systematic review on the published literature on ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans. METHODS The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline, and Web of Science for peer-reviewed articles describing ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 168 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge and attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities. CONCLUSION To our knowledge, this is the first systematic review on ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on ADRD among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine
| | - Sadia Mohaimin
- Department of Population Health, New York University Grossman School of Medicine
| | - Deborah Min
- Department of Population Health, New York University Grossman School of Medicine
| | - Timothy Roberts
- Health Science Library, New York University Grossman School of Medicine
| | - Young-Jin Sohn
- Department of Population Health, New York University Grossman School of Medicine
| | - Jazmine Wong
- Department of Population Health, New York University Grossman School of Medicine
| | | | - Simona C. Kwon
- Department of Population Health, New York University Grossman School of Medicine
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine
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Mogi M. Could Management of Blood Pressure Prevent Dementia in the elderly? Clin Hypertens 2019; 25:27. [PMID: 31867123 PMCID: PMC6902528 DOI: 10.1186/s40885-019-0135-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/25/2019] [Indexed: 01/07/2023] Open
Abstract
Background Hypertension is one of the most relevant risk factors in vascular aging, stroke and vascular dementia (VD). In the elderly, the prevalence of mixed dementia, which consists of Alzheimer’s disease (AD) and VD, is increased. Moreover, disorders of blood vessels are reported to be involved in the onset and progression of AD. Thus, hypertension generally plays an important role in dementia overall. Main Text Mid-life hypertension is reported to be related to the incidence of dementia, but it is reported that antihypertensive treatment in aged people cannot prevent the onset and progression of dementia. The renin-angiotensin system (RAS) is deeply involved in not only hypertension but also lifestyle-related diseases, and may contribute to the pathological mechanism in dementia; thus, RAS regulation is expected to prevent dementia. Small vessel structural changes in lifestyle-related diseases may play a role in dementia in the elderly. Conclusion Here, we discuss the role of blood pressure elevation in dementia and the therapeutic possibility of antihypertensive treatment against dementia.
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Affiliation(s)
- Masaki Mogi
- Department of Pharmacology, Ehime University, Graduate School of Medicine, Matsuyama, Japan
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24
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Grames MS, Dayton RD, Lu X, Schilke RM, Alexander JS, Orr AW, Barmada SJ, Woolard MD, Klein RL. Gene Transfer Induced Hypercholesterolemia in Amyloid Mice. J Alzheimers Dis 2019; 65:1079-1086. [PMID: 30124449 DOI: 10.3233/jad-180494] [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] [Indexed: 12/31/2022]
Abstract
A risk factor for cardiovascular disease (CVD), mutant PCSK9, was expressed in APP/PS1 mice to study the CVD-Alzheimer's disease inter-relationship. Cholesterol levels were elevated by 5-6-fold from 3 to 13 weeks after PCSK9 gene transfer. We tested whether hypercholesterolemia would increase amyloid-β plaques at a relatively early stage of plaque deposition. Plaque burden was increased in the hippocampus of PCSK9 treated mice though the increase was modest compared to the large elevation in cholesterol. Elevating cholesterol via gene transfer could be valuable in a variety of disease models compared to making crosses with germ-line transgenic mouse models of CVD.
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Affiliation(s)
- Mychal S Grames
- Department of Pharmacology, Toxicology, and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Robert D Dayton
- Department of Pharmacology, Toxicology, and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Xiaohong Lu
- Department of Pharmacology, Toxicology, and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
| | - Robert M Schilke
- Department of Microbiology and Immunology, LSU Health Sciences Center, Shreveport, LA, USA
| | - J Steven Alexander
- Department of Physiology, LSU Health Sciences Center, Shreveport, LA, USA
| | - A Wayne Orr
- Department of Pathology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Sami J Barmada
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew D Woolard
- Department of Microbiology and Immunology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Ronald L Klein
- Department of Pharmacology, Toxicology, and Neuroscience, LSU Health Sciences Center, Shreveport, LA, USA
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Gildner TE, Ng N, Wu F, Guo Y, Snodgrass JJ, Kowal P. Ideal Cardiovascular Health and Cognitive Test Performance: Testing a Modified Index of Life's Simple 7 Among Older Chinese Adults. Front Public Health 2018; 6:352. [PMID: 30547025 PMCID: PMC6279844 DOI: 10.3389/fpubh.2018.00352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/14/2018] [Indexed: 01/28/2023] Open
Abstract
Evidence suggests that cognitive decline in older adults is influenced by cardiovascular health (CVH), with metabolic and vascular mechanisms hypothesized to underlie the etiology of cognitive impairment. Research in high-income nations suggests that improved CVH is linked with decreased cognitive impairment risk, but it is unclear if this pattern is evident in low-income countries. Nationally-representative data collected in China were drawn from the World Health Organization's Study on global AGing and adult health Wave 1 (2007-2010; n = 11,295). Seven CVH factors were classified as "ideal" or "not ideal": smoking and drinking frequency, body mass index, physical activity level, blood pressure, diet, and self-reported anxiety. Additionally, scores from five cognitive performance tests (immediate and delayed verbal recall, forward and backward digit span, verbal fluency) were used to create a composite cognitive function variable. Linear regression analyses tested whether ideal CVH measures were associated with higher composite cognitive performance, controlling for sociodemographic factors. As hypothesized, ideal CVH was generally associated with higher cognitive performance. Low anxiety levels and reliable access to sufficient food (including produce) were particularly associated with higher cognitive function. These results suggest early detection and controlling modifiable CVH risks may protect aging individuals in China from cognitive decline.
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Affiliation(s)
- Theresa E. Gildner
- Department of Anthropology, Dartmouth College, Hanover, NH, United States
| | - Nawi Ng
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research, Faculty of Social Sciences, Umeå University, Umeå, Sweden
| | - Fan Wu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - J. Josh Snodgrass
- Department of Anthropology, Dartmouth College, Hanover, NH, United States
| | - Paul Kowal
- Department of Anthropology, Dartmouth College, Hanover, NH, United States
- World Health Organization SAGE, Geneva, Switzerland
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Lundberg GP, Mehta LS, Volgman AS. Specialized Care for Women: the Impact of Women's Heart Centers. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:76. [PMID: 30091012 DOI: 10.1007/s11936-018-0656-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF THE REVIEW Cardiovascular disease (CVD) has been and remains the leading cause of mortality in women in the United States. For decades, more women died every year of CVD compared to men. Heart centers for women (HCW) are developed in response to the need for greater patient and physician awareness of CVD in women and to conduct sex-specific research in women. Today, many HCW provide multispecialty and focused areas of cardiovascular care for women. HCW provide their female patients with expertise over the many stages of a woman's life. And HCW partner with national organizations to advance research and education through specialized and focused care for women. The purpose of this review is to review the historical development of heart centers for women and discuss the types of care they provide for women. RECENT FINDINGS Mortality rates from cardiovascular disease in women are finally reaching the levels of men after decades of focus on awareness, prevention, and evidence-based guideline-directed care for women. Heart centers for women have evolved to provide subspecialty and comprehensive care for women that includes education and research. Heart centers for women are partnering with many other disease-based and patient advocacy organizations to provide care for all women at all stages of life. Alarmingly, there has been increasing CVD mortality in both men and women recently.
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Affiliation(s)
- Gina P Lundberg
- Emory Women's Heart Center, Emory University School of Medicine, Atlanta, GA, USA.
| | - Laxmi S Mehta
- Women's Cardiovascular Program, The Ohio State University, Columbus, OH, USA
| | - Annabelle S Volgman
- Rush Heart Center for Women, Rush University Medical Center, Chicago, IL, USA
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Anstey KJ, Chen R. Invited Commentary: Secondhand Smoke-an Underrecognized Risk Factor for Cognitive Decline. Am J Epidemiol 2018; 187:919-921. [PMID: 29370342 DOI: 10.1093/aje/kwx378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 01/01/2023] Open
Abstract
Pan et al. (Am J Epidemiol. 2018;187(5):911-918) reported findings that exposure to secondhand smoke (SHS) was associated with cognitive decline over the course of 2 years among middle-aged and older Chinese women who never smoked, and they also reported a dose-response relationship. SHS exposure affects vulnerable people disproportionately because they have less control or choice over their living and working environment. Smoking is an established risk factor for dementia, but recent evidence reports on dementia-risk increase have not included SHS. Many epidemiologic studies collect data on smoking but not SHS exposure. SHS may be one of the most prevalent and modifiable risk factors for cognitive decline and therefore represents a major potential target for reduction of dementia risk. Given the high prevalence of smoking in China and other parts of the world, there is an urgent need to raise awareness of SHS reduction as part of global and national strategies to reduce cognitive decline and dementia and to introduce legislation that protects nonsmokers and vulnerable children and adults from SHS.
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Affiliation(s)
- Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, College of Medicine and Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ruoling Chen
- Centre for Health and Social Care Improvement, Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
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Tarraf W, Rodríguez CJ, Daviglus ML, Lamar M, Schneiderman N, Gallo L, Talavera GA, Kaplan RC, Fornage M, Conceicao A, González HM. Blood Pressure and Hispanic/Latino Cognitive Function: Hispanic Community Health Study/Study of Latinos Results. J Alzheimers Dis 2018; 59:31-42. [PMID: 28582859 DOI: 10.3233/jad-170017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hispanics/Latinos are at increased risk for cardiovascular disease and cognitive decline and dementias. High blood pressure (BP) has been implicated in both stroke and dementias. Associations between BP and cognition among diverse Latinos are still unpublished. OBJECTIVE We examined associations between cognition and four BP based measures among diverse Hispanics/Latinos. We hypothesized that higher BP, particularly systolic pressure, and increased arterial stiffness (i.e., pulse pressure), would be associated with lower cognitive function. METHODS We used baseline (2008-2011) Hispanic Community Health Study/Study of Latinos (HCHS/SOL; n = 9,019; ages 45-74 years) data to examine cognition in relation to BP measures. RESULTS In age, sex, and education adjusted models, systolic, pulse, and mean arterial pressure were consistently negatively associated with executive function, psychomotor speed and sustained attention, verbal episodic learning and memory, speech fluency, and mental status measures. These associations were attenuated but remained statistically significant in fully adjusted models. CONCLUSION Among middle-aged and older diverse Hispanics/Latinos, we found modest but consistent associations between indicators of arterial stiffness, and compromised blood flow and lower cognitive function. Clinical management and public health interventions to raise awareness and enhance BP management beginning in midlife could reduce disparities and improve population health by reducing cognitive decline burdens.
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Affiliation(s)
- Wassim Tarraf
- Department of Healthcare Sciences and Wayne State University, Institute of Gerontology, Detroit, MI, USA
| | - Carlos J Rodríguez
- Department of Medicine and Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Martha L Daviglus
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine at Chicago, Chicago, IL, USA
| | - Melissa Lamar
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine at Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Linda Gallo
- San Diego State University, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego, CA, USA
| | - Gregory A Talavera
- San Diego State University, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego, CA, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Myriam Fornage
- University of Texas Health Science Center, Institute of Molecular Medicine and Human Genetics Center, San Antonio, TX, USA
| | - Alan Conceicao
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Hector M González
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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Bhalla D, Lotfalinezhad E, Amini F, Salmannejad M, Reza Borhani Nezhad V, Rezai Kooshalshah SF, Delbari A, Fadayevatan R, Irmansyah I, Abdelrahman A, Bhatta NK, Gharagozli K. Incidence and Risk Profile of Dementia in the Regions of Middle East and North Africa. Neuroepidemiology 2018; 50:144-152. [PMID: 29550815 DOI: 10.1159/000487761] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/15/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The risk of dementia is reported as "epidemic" and "looming" over the Middle East and North Africa (MENA) region. For this, we performed a multi-language review and feasible analysis on the incidence of dementia to offer apt conclusions. METHODS Totally, 3 databases (Magiran, Scientific Information Database, and PubMed) and 1 non-database source (Google) were searched in French, English, and Persian by using specific keywords and their combinations. All searches were independent and had no restriction for the year or type of publication. We also calculated cumulative incidence of dementia for Egypt and Israel-Palestine from relevant prevalence estimates by using standard formula. RESULTS Little information on incidence was available, sparing Israel (2.4/100,000/year; pre-senile). Ten (48.0%) countries had none-to-little information (of any kind) on dementia, indicating considerable awareness deficit in this region. Cumulative incidence of dementia in Egypt and Israel-Palestine was 2.7% over 20 years (55 new cases) and 14.7% (130 new cases) over 6 years, respectively. In Lebanon, cumulative incidence was 7.5% over 20 years. Data looked across dementia-related factors (i.e., fertility rate, polygamy, violence, hypovitaminosis D, diabetes, hypertension, life expectancy, age structure) did not seem to support epidemic proportions of dementia for MENA. CONCLUSIONS MENA is youthful and dementia here is neither likely to be an epidemic nor looming over. The only possible exception might be Arab pocket in Israel. To us, previous attributions on dementia do not seem to be based on the realities of this region and, therefore, may prevent pragmatic addressal of dementia. Lastly, values-based collaborations are invited to jointly fill the awareness deficit in a unique low-cost manner.
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Affiliation(s)
- Devender Bhalla
- Iranian Epilepsy Association, Tehran, Iran.,Nepal Interest Group of Epilepsy and Neurology, Kathmandu, Nepal
| | - Elham Lotfalinezhad
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemah Amini
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Salmannejad
- Research Center on Electronic Health, Faculity of Science and Research, Islamic Azad University, Tehran, Iran
| | - Vahid Reza Borhani Nezhad
- Health Research Center of Social Determinants, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ahmed Delbari
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Fadayevatan
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | | | - Kurosh Gharagozli
- Department of Neurology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Maternal high-salt diet alters redox state and mitochondrial function in newborn rat offspring's brain. Br J Nutr 2018; 119:1003-1011. [PMID: 29502538 DOI: 10.1017/s0007114518000235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Excessive salt intake is a common feature of Western dietary patterns, and has been associated with important metabolic changes including cerebral redox state imbalance. Considering that little is known about the effect on progeny of excessive salt intake during pregnancy, the present study investigated the effect of a high-salt diet during pregnancy and lactation on mitochondrial parameters and the redox state of the brains of resulting offspring. Adult female Wistar rats were divided into two dietary groups (n 20 rats/group): control standard chow (0·675 % NaCl) or high-salt chow (7·2 % NaCl), received throughout pregnancy and for 7 d after delivery. On postnatal day 7, the pups were euthanised and their cerebellum, hypothalamus, hippocampus, prefrontal and parietal cortices were dissected. Maternal high-salt diet reduced cerebellar mitochondrial mass and membrane potential, promoted an increase in reactive oxygen species allied to superoxide dismutase activation and decreased offspring cerebellar nitric oxide levels. A significant increase in hypothalamic nitric oxide levels and mitochondrial superoxide in the hippocampus and prefrontal cortex was observed in the maternal high-salt group. Antioxidant enzymes were differentially modulated by oxidant increases in each brain area studied. Taken together, our results suggest that a maternal high-salt diet during pregnancy and lactation programmes the brain metabolism of offspring, favouring impaired mitochondrial function and promoting an oxidative environment; this highlights the adverse effect of high-salt intake in the health state of the offspring.
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Lourenco J, Serrano A, Santos-Silva A, Gomes M, Afonso C, Freitas P, Paul C, Costa E. Cardiovascular Risk Factors Are Correlated with Low Cognitive Function among Older Adults Across Europe Based on The SHARE Database. Aging Dis 2018; 9:90-101. [PMID: 29392084 PMCID: PMC5772862 DOI: 10.14336/ad.2017.0128] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/28/2017] [Indexed: 12/24/2022] Open
Abstract
Increased life expectancy is associated with a high prevalence of chronic, non-communicable diseases including cognitive decline and dementia. The purpose of this study was to evaluate the prevalence of cognitive impairment using three cognitive abilities (verbal fluency, numeracy and perceived memory) and their association with cardiovascular risk factors in seniors across Europe. Data from participants in wave 4 of the SHARE (Survey of Health, Ageing, and Retirement in Europe) database was used. Cognitive performance in perceived memory, verbal fluency and numeracy was evaluated using simple tests and a memory complaints questionnaire. Clinical and sociodemographic variables were also studied for potential associations. Standardised prevalence rates of cognitive impairment based on age and gender were calculated by country. The prevalence of cognitive impairment was 28.02% for perceived memory, 27.89% for verbal fluency and 20.75% for numeracy throughout the 16 evaluated countries. Years of education, being a current or former smoker, number of chronic diseases, diabetes or hyperglycemia, heart attack and stroke were all independent variables associated with impairment in the three studied cognitive abilities. We also found independent associations between physical inactivity and verbal fluency and numeracy impairment, as well as hypertension and perceived memory impairment. Lower performance in the evaluated cognitive abilities and higher memory complaints are highly prevalent, have a heterogeneous distribution across Europe, and are associated with multiple factors, most of which are potentially preventable or treatable, especially cardiovascular risk factors.
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Affiliation(s)
- Joana Lourenco
- 1Family Health Unit of Pedras Rubras, Maia, Portugal.,2Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,3Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | | | - Alice Santos-Silva
- 4UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Marcos Gomes
- 4UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Claudia Afonso
- 2Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Paula Freitas
- 5Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,6Faculty of Medicine, University of Porto, Porto, Portugal
| | - Constanca Paul
- 3Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,7Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Elisio Costa
- 4UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal
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Tau induces blood vessel abnormalities and angiogenesis-related gene expression in P301L transgenic mice and human Alzheimer's disease. Proc Natl Acad Sci U S A 2018; 115:E1289-E1298. [PMID: 29358399 PMCID: PMC5819390 DOI: 10.1073/pnas.1710329115] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Mixed pathology, with both Alzheimer's disease and vascular abnormalities, is the most common cause of clinical dementia in the elderly. While usually thought to be concurrent diseases, the fact that changes in cerebral blood flow are a prominent early and persistent alteration in Alzheimer's disease raises the possibility that vascular alterations and Alzheimer pathology are more directly linked. Here, we report that aged tau-overexpressing mice develop changes to blood vessels including abnormal, spiraling morphologies; reduced blood vessel diameters; and increased overall blood vessel density in cortex. Blood flow in these vessels was altered, with periods of obstructed flow rarely observed in normal capillaries. These changes were accompanied by cortical atrophy as well as increased expression of angiogenesis-related genes such as Vegfa, Serpine1, and Plau in CD31-positive endothelial cells. Interestingly, mice overexpressing nonmutant forms of tau in the absence of frank neurodegeneration also demonstrated similar changes. Furthermore, many of the genes we observe in mice are also altered in human RNA datasets from Alzheimer patients, particularly in brain regions classically associated with tau pathology such as the temporal lobe and limbic system regions. Together these data indicate that tau pathological changes in neurons can impact brain endothelial cell biology, altering the integrity of the brain's microvasculature.
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Davis D, Bendayan R, Muniz Terrera G, Hardy R, Richards M, Kuh D. Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort. Neuroepidemiology 2017; 49:121-128. [PMID: 29145205 DOI: 10.1159/000481136] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cognitive capabilities change in later life, although their onset and rate of decline, and how they are shaped by lifetime socioeconomic position, childhood cognition and adult health status are all unclear. METHODS From the Medical Research Council National Survey of Health and Development, we analysed 3,192 participants undergoing one or more cognitive assessments at ages 43, 53, 60-64 and 69. Linear mixed models described cognitive trajectories, adjusting for factors across the life course. RESULTS For both search speed and verbal memory, better performance at age 43 (the intercept) was associated with higher paternal and own education, childhood cognition, and adult occupational class. For search speed, the trajectory was best described as a quadratic function (decline of 45.6 letters/5-years + 4.6 letters). Verbal memory showed a linear decline of 0.20 words/5-years between ages 43 and 60 and a steeper linear decline of 0.95 words/5-years between ages 60 and 69. Decline in verbal memory in the latter period was steeper in those with higher educational achievements at age 26 (additional 0.28 words/5-years for highest attainment). CONCLUSIONS Decline in verbal memory and search speed across midlife is evident, though with different non-linear trajectories. By implication, pathways to cognitive impairment and dementia in older age may have their origins in this period.
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Affiliation(s)
- Daniel Davis
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Rebecca Bendayan
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | | | - Rebecca Hardy
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Marcus Richards
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Diana Kuh
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
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Peng M, Chen G, Tang KL, Quan H, Smith EE, Faris P, Hachinski V, Campbell NRC. Blood pressure at age 60-65 versus age 70-75 and vascular dementia: a population based observational study. BMC Geriatr 2017; 17:252. [PMID: 29078750 PMCID: PMC5658926 DOI: 10.1186/s12877-017-0649-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023] Open
Abstract
Background Vascular dementia (VaD) is the second most common form of dementia. However, there were mixed evidences about the association between blood pressure (BP) and risk of VaD in midlife and late life and limited evidence on the association between pulse pressure and VaD. Methods This is a population-based observational study. 265,897 individuals with at least one BP measurement between the ages of 60 to 65 years and 211,116 individuals with at least one BP measurement between the ages of 70 to 75 years were extracted from The Health Improvement Network in United Kingdom. Blood pressures were categorized into four groups: normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Cases of VaD were identified from the recorded clinical diagnoses. Multivariable survival analysis was used to adjust other confounders and competing risk of death. All the analysis were stratified based on antihypertensive drug use status. Multiple imputation was used to fill in missing values. Results After accounting for the competing risk of death and adjustment for potential confounders, there was an association between higher BP levels in the age 60–65 cohort with the risk of developing VaD (hazard ratio [HR] 1.53 (95% confidence interval: 1.04, 2.25) for prehypertension, 1.90 (1.30, 2.78) for stage 1 hypertension, and 2.19 (1.48, 3.26) for stage 2 hypertension) in the untreated group. There was no statistically significant association between BP levels and VaD in the treated group in the age 60–65 cohort and age 70–75 cohort. Analysis on Pulse Pressure (PP) stratified by blood pressure level showed that PP was not independently associated with VaD. Conclusion High BP between the ages of 60 to 65 years is a significant risk for VaD in late midlife. Greater efforts should be placed on early diagnosis of hypertension and tight control of BP for hypertensive patients for the prevention of VaD. Electronic supplementary material The online version of this article (10.1186/s12877-017-0649-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mingkai Peng
- Department of Community Health Sciences, University of Calgary, Calgary, T2N 1N4, Canada.
| | - Guanmin Chen
- Alberta Health Services, Calgary, T2N 4L7, Canada
| | - Karen L Tang
- Cumming School of Medicine, University of Calgary, Calgary, T2N 1N4, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, T2N 1N4, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, T2N 1N4, Canada
| | - Peter Faris
- Alberta Health Services, Calgary, T2N 4L7, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, N6A 5A5, Canada
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, T2N 1N4, Canada
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Haring B, Omidpanah A, Suchy-Dicey AM, Best LG, Verney SP, Shibata DK, Cole SA, Ali T, Howard BV, Buchwald D, Devereux RB. Left Ventricular Mass, Brain Magnetic Resonance Imaging, and Cognitive Performance: Results From the Strong Heart Study. Hypertension 2017; 70:964-971. [PMID: 28893898 DOI: 10.1161/hypertensionaha.117.09807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/15/2017] [Accepted: 08/18/2017] [Indexed: 01/14/2023]
Abstract
Left ventricular mass (LVM) has been shown to serve as a measure of target organ damage resulting from chronic exposure to several risk factors. Data on the association of midlife LVM with later cognitive performance are sparse. We studied 721 adults (mean age 56 years at baseline) enrolled in the Strong Heart Study (SHS, 1993-1995) and the ancillary CDCAI (Cerebrovascular Disease and Its Consequences in American Indians) Study (2010-2013), a study population with high prevalence of cardiovascular disease. LVM was assessed with transthoracic echocardiography at baseline in 1993 to 1995. Cranial magnetic resonance imaging and cognitive testing were undertaken between 2010 and 2013. Generalized estimating equations were used to model associations between LVM and later imaging and cognition outcomes. The mean follow-up period was 17 years. A difference of 25 g in higher LVM was associated with marginally lower hippocampal volume (0.01%; 95% confidence interval, 0.02-0.00; P=0.001) and higher white matter grade (0.10; 95% confidence interval, 0.02-0.18; P=0.014). Functionally, participants with higher LVM tended to have slightly lower scores on the modified mini-mental state examination (0.58; 95% confidence interval, 1.08-0.08; P=0.024). The main results persisted after adjusting for blood pressure levels or vascular disease. The small overall effect sizes are partly explained by survival bias because of the high prevalence of cardiovascular disease in our population. Our findings emphasize the role of cardiovascular health in midlife as a target for the prevention of deleterious cognitive and functional outcomes in later life.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.).
| | - Adam Omidpanah
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Astrid M Suchy-Dicey
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Lyle G Best
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Steven P Verney
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Dean K Shibata
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Shelley A Cole
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Tauqeer Ali
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Barbara V Howard
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Dedra Buchwald
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
| | - Richard B Devereux
- Department of Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany (B.V.H.); Initiative for Research and Education to Advance Community Health, Washington State University, Seattle (A.O., A.M.S.-D.); Missouri Breaks Industries Research Inc, Eagle Butte, SD (L.G.B.); Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque (S.P.V.); Department of Radiology, School of Medicine, University of Washington, Seattle (D.K.S.); Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.A.C.); Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Health Sciences Center (T.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); Initiative for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle (D.B.); and Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (R.B.D.)
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De Cola MC, Lo Buono V, Mento A, Foti M, Marino S, Bramanti P, Manuli A, Calabrò RS. Unmet Needs for Family Caregivers of Elderly People With Dementia Living in Italy: What Do We Know So Far and What Should We Do Next? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2017; 54:46958017713708. [PMID: 28617065 PMCID: PMC5798676 DOI: 10.1177/0046958017713708] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Care of the elderly with dementia represents one of the major challenges for the modern society worldwide. The burden of dementia care often falls on the family members, entailing heavy psychosocial and economic consequences. The aim of this study was to evaluate the caregiver's perspective concerning the support for disease management on behalf of the physicians and the local Sicilian administrations (Italy), and the burden of care and effects on their lifestyle, to propose new prevention strategies and service for managing dementia and caregiver's burden. Fifty-nine caregivers of Italian elderly people with dementia (mean age, 73; age range: 63-83) were interviewed, and 55 of them completed an ad hoc self-report questionnaire composed of 54 multiple-choice questions. Our findings suggest that caregivers need more information on the disease's management, as well as on how to deal with the stress due to the disease burden. Moreover, a negative perception about the services offered from the local administration emerged. Assistive technology (AT) could be useful in promoting interaction between general practitioners and specialized centers for diagnosis, pharmacological and psychosocial treatments, and in saving costs. Moreover, case manager could follow patients and support family members within the care pathway, besides collecting and sharing information among the different health professionals involved. Further studies should be aimed at investigating whether AT and/or the use of specific educational strategies could be the right approach for meeting the needs of families living with dementia.
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Affiliation(s)
| | | | - Agata Mento
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
| | - Mariella Foti
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
| | - Silvia Marino
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
| | | | - Alfredo Manuli
- 1 IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy
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Lamar M, Wu D, Durazo-Arvizu RA, Brickman AM, Gonzalez HM, Tarraf W, Daviglus ML. Cognitive Associates of Current and More Intensive Control of Hypertension: Findings From the Hispanic Community Health Study/Study of Latinos. Am J Hypertens 2017; 30:624-631. [PMID: 28402388 DOI: 10.1093/ajh/hpx023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/30/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hypertension control in Hispanics/Latinos lag behind general US trends by 10-15%. Intensive systolic blood pressure (SBP) management <120 mm Hg may significantly reduce morbidity/mortality risk in adults with hypertension; less is known about cognition. We investigated cross-sectional associations of cognition with observed hypertension control at currently recommended (SBP < 140 mm Hg) and more intensive (SBP < 120 mm Hg) levels using baseline data from the Hispanic Community Health Study/Study of Latinos. METHODS From this multicenter cohort study, we focused on 1,735 Hispanic/Latino men and women ages 45-74 years with hypertension and verified antihypertensive use. Verbal fluency, information processing speed, learning, and memory were tested in Spanish or English. RESULTS Separate linear regressions revealed that being on 1 vs. >1 antihypertensive medication was not associated with cognition; however, individuals with SBP controlled to currently recommended levels outperformed individuals with uncontrolled SBP on verbal fluency [Beta = 1.44 (0.52), P < 0.01] and information processing speed [Beta = 3.01 (0.89), P < 0.001] in age-adjusted regression analyses; only information processing speed remained significant (P < 0.05) after additional adjustments including acculturation, health insurance, and other cardiovascular disease risk factors. When regrouping individuals based on more intensive SBP control, individuals with levels <120 mm Hg outperformed individuals with higher SBP on verbal fluency regardless of adjustments (P < 0.01). More intensive rather than currently recommended levels of control associated with higher verbal fluency performance regardless of adjustments (P < 0.05). CONCLUSIONS Individual cognitive test scores related to distinct SBP management with more intensive management appearing more robust against confounders. While cognitive associations with hypertension in Hispanics/Latinos may be multifactorial, different levels of SBP control should be considered in future prospective intervention studies.
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Affiliation(s)
- Melissa Lamar
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Donghong Wu
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ramon A. Durazo-Arvizu
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain and the Gertrude H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Hector M. Gonzalez
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Martha L. Daviglus
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
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Ayala C, Tong X, Neeley E, Lane R, Robb K, Loustalot F. Home blood pressure monitoring among adults-American Heart Association Cardiovascular Health Consumer Survey, 2012. J Clin Hypertens (Greenwich) 2017; 19:584-591. [PMID: 28371252 DOI: 10.1111/jch.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/20/2016] [Accepted: 12/25/2016] [Indexed: 01/13/2023]
Abstract
Home blood pressure monitoring (HBPM) among hypertensive adults was assessed using the 2012 American Heart Association Cardiovascular Health Consumer Survey. The prevalence of hypertension was 25.5% and 53.8% of those reported HBPM. Approximately 63% of hypertensive adults 65 years and older reported HBPM followed by 51% and 34.6% (35-64 and 18-34 years, respectively; P=.001). Those who had seen a healthcare professional within a year reported HBPM compared with those who had not (54.8% vs 32.8%, P=.047). Those who believed that lowering blood pressure can reduce risk of heart attack and stroke had a higher percentage of HBPM compared with those who did not (55.5% vs 33.1%, P=.01). Age and the belief that lowering blood pressure could reduce cardiovascular disease risk were significant factors associated with HBPM. Half of the adult hypertensive patients reported HBPM and its use was greater among those who reported a positive attitude toward lowering blood pressure to reduce cardiovascular disease risk.
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Affiliation(s)
- Carma Ayala
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Eunice Neeley
- University of California at San Francisco Medical School, San Francisco, GA, USA
| | - Rashon Lane
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Karen Robb
- American Heart Association/American Stroke Association, Dallas, TX, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
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Quail MA, Short R, Pandya B, Steeden JA, Khushnood A, Taylor AM, Segers P, Muthurangu V. Abnormal Wave Reflections and Left Ventricular Hypertrophy Late After Coarctation of the Aorta Repair. Hypertension 2017; 69:501-509. [PMID: 28115510 PMCID: PMC5295491 DOI: 10.1161/hypertensionaha.116.08763] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/04/2016] [Accepted: 12/23/2016] [Indexed: 12/22/2022]
Abstract
Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM). Fifty adult patients with repaired coarctation and 25 age- and sex-matched controls were recruited. Ascending aorta area and flow waveforms were obtained using a high temporal-resolution spiral phase-contrast cardiovascular magnetic resonance flow sequence. These data were used to derive central hemodynamics and to perform wave intensity analysis noninvasively. Covariates associated with LVM were assessed using multivariable linear regression analysis. There were no significant group differences (P≥0.1) in brachial systolic, mean, or diastolic BP. However central aortic systolic blood pressure was significantly higher in patients compared with controls (113 versus 107 mm Hg, P=0.002). Patients had reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves compared with controls. LVM index was significantly higher in patients than controls (72 versus 59 g/m2, P<0.0005). The magnitude of the backward compression waves was independently associated with variation in LVM (P=0.01). Using a novel, noninvasive hemodynamic assessment, we have shown abnormal conduit vessel function after coarctation of the aorta repair, including abnormal wave reflections that are associated with elevated LVM.
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Affiliation(s)
- Michael A Quail
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Rebekah Short
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Bejal Pandya
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Jennifer A Steeden
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Abbas Khushnood
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Andrew M Taylor
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Patrick Segers
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.)
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom (M.A.Q., R.S., B.P., J.A.S., A.K., A.M.T., V.M.); Adult Congenital Heart Disease Department, St. Bartholomew's Hospital, London, United Kingdom (B.P.); and IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium (P.S.).
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Suleman R, Padwal R, Hamilton P, Senthilselvan A, Alagiakrishnan K. Association between central blood pressure, arterial stiffness, and mild cognitive impairment. Clin Hypertens 2017; 23:2. [PMID: 28105372 PMCID: PMC5237557 DOI: 10.1186/s40885-016-0058-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/26/2016] [Indexed: 01/23/2023] Open
Abstract
Background To determine the relationship between central blood pressure (CBP) indices and mild cognitive impairment (MCI) in adults over the age of 50. Methods A cross-sectional study conducted using a non-invasive SphygmoCor XCEL device. CBP indices and brachial blood pressure were measured in 50 inpatients and outpatients. MCI was assessed using the Montreal Cognitive Assessment (MoCA) instrument and by the European Consortium Criteria (ECC). Results Seventy-six percent of subjects had hypertension, and 52% were diagnosed as having MCI using the ECC. No significant association was found between any of the measured blood pressure variables and global cognition. A significant relationship was observed between augmentation index (AI) and abnormal clock-drawing (p = 0.04) and language (p = 0.02), and between pulse pressure amplification (PPA) and language (p = 0.03). Conclusion CBP indices like AI and PPA, which are markers of vascular stiffness, are associated with poor executive function and language cognitive domain deficits.
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Affiliation(s)
- R Suleman
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - R Padwal
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - P Hamilton
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - A Senthilselvan
- School of Public Health, University of Alberta, Edmonton, AB Canada
| | - K Alagiakrishnan
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Canada ; University of Alberta Hospital, B146, Clinical Sciences Building, 8440-112 Street, Edmonton, T6G 2G3 Canada
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Ikanga J, Hill EM, MacDonald DA. The conceptualization and measurement of cognitive reserve using common proxy indicators: Testing some tenable reflective and formative models. J Clin Exp Neuropsychol 2016; 39:72-83. [PMID: 27647132 DOI: 10.1080/13803395.2016.1201462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The examination of cognitive reserve (CR) literature reveals a lack of consensus regarding conceptualization and pervasive problems with its measurement. This study aimed at examining the conceptual nature of CR through the analysis of reflective and formative models using eight proxies commonly employed in the CR literature. We hypothesized that all CR proxies would significantly contribute to a one-factor reflective model and that educational and occupational attainment would produce the strongest loadings on a single CR factor. METHOD The sample consisted of 149 participants (82 male/67 female), with 18.1 average years of education and ages of 45-99 years. Participants were assessed for eight proxies of CR (parent socioeconomic status, intellectual functioning, level of education, health literacy, occupational prestige, life leisure activities, physical activities, and spiritual and religious activities). Primary statistical analyses consisted of confirmatory factor analysis (CFA) to test reflective models and structural equation modeling (SEM) to evaluate multiple indicators multiple causes (MIMIC) models. RESULTS CFA did not produce compelling support for a unitary CR construct when using all eight of our CR proxy variables in a reflective model but fairly cogent evidence for a one-factor model with four variable proxies. A second three-factor reflective model based upon an exploratory principal components analysis of the eight proxies was tested using CFA. Though all eight indicators significantly loaded on their assigned factors, evidence in support of overall model fit was mixed. Based upon the results involving the three-factor reflective model, two alternative formative models were developed and evaluated. While some support was obtained for both, the model in which the formative influences were specified as latent variables appeared to best account for the contributions of all eight proxies to the CR construct. CONCLUSION While the findings provide partial support for our hypothesis regarding CR as a one-dimensional reflective construct, the results strongly suggest that the construct is more complex than what can be captured in a reflective model alone. There is a need for theory to better identify and differentiate formative from reflective indicators and to articulate the mechanisms by which CR develops and operates.
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Affiliation(s)
- Jean Ikanga
- a Department of Rehabilitation Medicine , Emory University School of Medicine , Atlanta , GA , USA.,b Department of Psychology , University of Detroit Mercy , Detroit , MI , USA
| | - Elizabeth M Hill
- b Department of Psychology , University of Detroit Mercy , Detroit , MI , USA
| | - Douglas A MacDonald
- b Department of Psychology , University of Detroit Mercy , Detroit , MI , USA
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Piotrowicz K, Prejbisz A, Klocek M, Topór-Mądry R, Szczepaniak P, Kawecka-Jaszcz K, Narkiewicz K, Grodzicki T, Januszewicz A, Gąsowski J. Subclinical Mood and Cognition Impairments and Blood Pressure Control in a Large Cohort of Elderly Hypertensives. J Am Med Dir Assoc 2016; 17:864.e17-22. [PMID: 27502451 DOI: 10.1016/j.jamda.2016.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Blood pressure (BP) control in the elderly is often limited by poor compliance with prescribed regimen. Both can be influenced by clinical cognitive or mood impairments; however, the impact of subclinical alterations of cognition or mood remains unknown. OBJECTIVES To assess the relation between cognition, mood, and BP control in treated older hypertensive patients. DESIGN Cross-sectional association study. SETTING Predefined substudy to the POLFOKUS nationwide survey investigating the correlates of poor BP control in patients randomly drawn from primary and specialist practices across Poland. PARTICIPANTS 1988 outpatients ≥65 years of age treated for hypertension for at least 1 year. MEASUREMENTS BP was mean of at least 2 office measurements. We assessed adherence to antihypertensive medications using a questionnaire and performed screening tests for cognitive deficits [Abbreviated Mental Test Score (AMTS)] and mood disorders [Geriatric Depression Scale (GDS)]. In all patients, we used a unified (BP <140/90 mm Hg) and in ≥80 years old a unified or age-specific (<150 mm Hg systolic BP) definition of BP control. We fitted logistic regression models to assess the probability of poor BP control in association with cognitive and mood disturbances. RESULTS The mean [standard deviation (SD)] age of 1988 (65.6% women) patients was 73.9 (6.0) years (19.3% ≥80 years old). Cognitive and mood impairments were observed in 8.0% and 37.2%, respectively. Mean systolic and diastolic BP were 141.8 (16.4) and 83.6 (9.5) mm Hg, respectively. According to age-stratified and unified definition of proper BP control, goal BP was achieved in 65.4% and 38.5% patients ≥80 years of age, respectively. In younger patients, the control reached 46%. Globally, 66% patients adhered to antihypertensive medications. Poor compliance was related to cognitive and mood impairments. When unified goal was applied, there was a 15.0% higher risk of finding poor BP control per 1 score lost in AMTS and an 8.0% increase per 1 score gained in GDS (all P < .001). CONCLUSION Poorer BP control is related to subclinical worsening of cognition and mood, which supports widespread use of the Comprehensive Geriatric Assessment even in apparently self-dependent older patients with hypertension.
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Affiliation(s)
- Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Marek Klocek
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Roman Topór-Mądry
- Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | | | - Kalina Kawecka-Jaszcz
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland.
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Kelly A, Calamia M, Koval A, Terrera GM, Piccinin AM, Clouston S, Hassing LB, Bennett DA, Johansson B, Hofer SM. Independent and interactive impacts of hypertension and diabetes mellitus on verbal memory: A coordinated analysis of longitudinal data from England, Sweden, and the United States. Psychol Aging 2016; 31:262-73. [PMID: 26913926 PMCID: PMC4844806 DOI: 10.1037/pag0000078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The importance of preventing and controlling hypertension (HTN) and diabetes mellitus (DM) to mitigate risks to physical health has long been understood by health care professionals. More recently, a growing body of evidence implicates HTN and DM in age-related cognitive decline and risk for dementia, though consensus has yet to be reached on whether older adults living with comorbid HTN and DM are at heightened risk for cognitive impairment. The present study sought to contribute to this topic through a coordinated analysis of 3 longitudinal studies of aging from England, Sweden, and the United States (total N = 12,513). Identical multilevel linear growth models were fit to each to estimate the impact of baseline disease status on initial level and change in verbal declarative memory performance. Overall, few associations between HTN, DM, and cognition were observed. Rate of decline was steeper for Swedish participants with independent HTN but attenuated for their American counterparts. Americans with comorbid HTN and DM showed attenuated decline. Treatment with medication was substantially less prevalent in the earlier-born and lower-educated Swedish sample, which may help to explain our pattern of results. In addition, those living with multiple conditions may be more likely to receive treatment, mitigating cognitive decline. Our results present a nuanced view of the interactions between HTN, DM, and cognition, and lead us to recommend consideration of treatment status or proxies such as birth cohort and education, in combination with age at assessment and specific measure used to interpret research in this area. (PsycINFO Database Record
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Affiliation(s)
- Amanda Kelly
- Department of Psychology, University of Victoria
| | | | - Andrey Koval
- Department of Psychology, University of Victoria
| | | | | | - Sean Clouston
- Preventative Medicine Program in Public Health, Stony Brook University
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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Affiliation(s)
- Masaki Mogi
- Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University, Graduate School of Medicine
| | - Masatsugu Horiuchi
- Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University, Graduate School of Medicine
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Vascular Dementia and Cognitive Impairment. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Scott JA, Braskie MN, Tosun D, Thompson PM, Weiner M, DeCarli C, Carmichael OT. Cerebral Amyloid and Hypertension are Independently Associated with White Matter Lesions in Elderly. Front Aging Neurosci 2015; 7:221. [PMID: 26648866 PMCID: PMC4664630 DOI: 10.3389/fnagi.2015.00221] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/16/2015] [Indexed: 01/18/2023] Open
Abstract
In cognitively normal (CN) elderly individuals, white matter hyperintensities (WMH) are commonly viewed as a marker of cerebral small vessel disease (SVD). SVD is due to exposure to systemic vascular injury processes associated with highly prevalent vascular risk factors (VRFs) such as hypertension, high cholesterol, and diabetes. However, cerebral amyloid accumulation is also prevalent in this population and is associated with WMH accrual. Therefore, we examined the independent associations of amyloid burden and VRFs with WMH burden in CN elderly individuals with low to moderate vascular risk. Participants (n = 150) in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) received fluid attenuated inversion recovery (FLAIR) MRI at study entry. Total WMH volume was calculated from FLAIR images co-registered with structural MRI. Amyloid burden was determined by cerebrospinal fluid Aβ1-42 levels. Clinical histories of VRFs, as well as current measurements of vascular status, were recorded during a baseline clinical evaluation. We tested ridge regression models for independent associations and interactions of elevated blood pressure (BP) and amyloid to total WMH volume. We found that greater amyloid burden and a clinical history of hypertension were independently associated with greater WMH volume. In addition, elevated BP modified the association between amyloid and WMH, such that those with either current or past evidence of elevated BP had greater WMH volumes at a given burden of amyloid. These findings are consistent with the hypothesis that cerebral amyloid accumulation and VRFs are independently associated with clinically latent white matter damage represented by WMHs. The potential contribution of amyloid to WMHs should be further explored, even among elderly individuals without cognitive impairment and with limited VRF exposure.
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Affiliation(s)
- Julia A Scott
- IDeA Laboratory, Department of Neurology, University of California, Davis Davis, CA, USA
| | - Meredith N Braskie
- Imaging Genetics Center, Keck School of Medicine, University of Southern California Marina del Rey, CA, USA
| | - Duygu Tosun
- Center for Imaging Neurodegenerative Diseases, VA Medical Center, University of California, San Francisco San Francisco, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Keck School of Medicine, University of Southern California Marina del Rey, CA, USA
| | - Michael Weiner
- Center for Imaging Neurodegenerative Diseases, VA Medical Center, University of California, San Francisco San Francisco, CA, USA
| | - Charles DeCarli
- IDeA Laboratory, Department of Neurology, University of California, Davis Davis, CA, USA
| | - Owen T Carmichael
- Brain and Metabolism Imaging in Chronic Disease Lab, Pennington Biomedical Research Center, Louisiana State University Baton Rouge, LA, USA
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George MG, Hong Y, Bowman BA. Improving Population Blood Pressure Control for Brain and Heart Health. Public Health Rep 2015; 130:302-6. [PMID: 26345373 PMCID: PMC4547583 DOI: 10.1177/003335491513000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mary G. George
- Mary G. George is Deputy Associate Director for Science and Senior Medical Officer, Yuling Hong is Associate Director for Science, and Barbara A. Bowman is Director, all with the Division for Heart Disease and Stroke Prevention at CDC
| | - Yuling Hong
- Mary G. George is Deputy Associate Director for Science and Senior Medical Officer, Yuling Hong is Associate Director for Science, and Barbara A. Bowman is Director, all with the Division for Heart Disease and Stroke Prevention at CDC
| | - Barbara A. Bowman
- Mary G. George is Deputy Associate Director for Science and Senior Medical Officer, Yuling Hong is Associate Director for Science, and Barbara A. Bowman is Director, all with the Division for Heart Disease and Stroke Prevention at CDC
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