A principal component model of medical health: implications for cognitive deficits and decline among adults in a population-based sample

Hippocampal volume, and the anterior-posterior sub regions relates to recall and recognition over five years: Bidirectional brain-behaviour associations

Longitudinal studies of brain-behavior links between episodic memory (EM) and the hippocampus (HC), including anterior-posterior subregions, are few. This study assessed brain-cognition relationships between HC volumes, including the anterior-posterior subregions, item recall, and recognition, in 358 adults (52%♀; 20-80 yrs. at baseline, 221 returned at follow-up). Bivariate latent change score models assessed mean change, variance, and bidirectional associations between the hippocampal regions and the EM tasks. The influence of chronological age, sex, and education were included as covariates. The results showed that: larger baseline HC volume slowed subsequent decline in EM scores; higher associative memory scores at offset mitigated five-year HC volume loss; larger anterior HC volumes slowed decline in recognition memory, while larger posterior volumes mitigated decline in recall scores; the volume of the anterior HC was not associated with change in recall scores; and posterior HC volume did not predict change in recognition memory scores. The covariates examined - age, sex, and education- had some cross-sectional influence, but only limited longitudinal effects. The results explain the bidirectional associations in brain-cognition links, and how the distinct sub-regional HC correlates for recall and recognition, respectively. These results also shed light on potential links between maintained brain volumes and restored cognitive functions during the aging process.

Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis

OBJECTIVE

To systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia.

DESIGN

A systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken.

DATA SOURCES

Databases Medline, Embase and PsycINFO were searched from 1999 to 2017.

ELIGIBILITY CRITERIA

For inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors.

RESULTS

Seventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure.

CONCLUSIONS

The strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is needed to establish whether particular combinations of risk factors confer greater risk than others.

PROSPERO REGISTRATION NUMBER

42016052914.

Pulse Pressure Magnifies the Effect of COMT Val(158)Met on 15 Years Episodic Memory Trajectories

We investigated whether a physiological marker of cardiovascular health, pulse pressure (PP), and age magnified the effect of the functional COMT Val(158)Met (rs4680) polymorphism on 15-years cognitive trajectories [episodic memory (EM), visuospatial ability, and semantic memory] using data from 1585 non-demented adults from the Betula study. A multiple-group latent growth curve model was specified to gauge individual differences in change, and average trends therein. The allelic variants showed negligible differences across the cognitive markers in average trends. The older portion of the sample selectively age-magnified the effects of Val(158)Met on EM changes, resulting in greater decline in Val compared to homozygote Met carriers. This effect was attenuated by statistical control for PP. Further, PP moderated the effects of COMT on 15-years EM trajectories, resulting in greater decline in Val carriers, even after accounting for the confounding effects of sex, education, cardiovascular diseases (diabetes, stroke, and hypertension), and chronological age, controlled for practice gains. The effect was still present after excluding individuals with a history of cardiovascular diseases. The effects of cognitive change were not moderated by any other covariates. This report underscores the importance of addressing synergistic effects in normal cognitive aging, as the addition thereof may place healthy individuals at greater risk for memory decline.

Synergy effects of HbA1c and variants of APOE and BDNFVal66Met explains individual differences in memory performance

We aimed at exploring if synergy effects of Brain-Derived Neurotrophic Factor (BDNF) Val(66)Met, Apolipoprotein E (APOE) and HbA1c (glycated haemoglobin) could explain individual differences in memory performance over 10 years in a population based sample of nondemented adults (N=888, 35-85 years at baseline). Episodic memory was affected by such agents, wheras semantic memory was spared. Both age and HbA1c were associated with episodic memory decline. BDNF(66)Met carriers with higher HbA1c levels evidenced slope decline in episodic recall. We found support for joint effects of BDNFVal(66)Met×APOE×HbA1c and BDNFVal(66)Met×APOE×age on rates of episodic memory change over ten years, after controlling for age, sex, education and cardiovascular diseases. We conclude that variants of genetic polymorphisms act in synergy with long-term blood glucose control in shaping patterns of cognitive aging.