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Gao Y, Zhang Z, Song J, Gan T, Lin Y, Hu M, Wu IX. Combined healthy lifestyle behaviours and incident dementia: A systematic review and dose-response meta-analysis of cohort studies. Int J Nurs Stud 2024; 156:104781. [PMID: 38744152 DOI: 10.1016/j.ijnurstu.2024.104781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The associations of combined healthy lifestyle behaviours and incident dementia have not been systematically reviewed and the dose-response relationship was uncertain. OBJECTIVES To evaluate the associations of combined healthy lifestyle behaviours with incident dementia and other cognitive outcomes, assess the dose-response relationship between the number of lifestyle behaviours and incident dementia, and summarise the adherence to healthy lifestyle behaviours. DESIGN Systematic review and meta-analysis. METHODS PubMed, EMBASE, Web of Science and PsycINFO were searched from inception to 20 Jan 2024. Cohort studies reporting associations of combined healthy lifestyle behaviours with incident dementia or other cognitive outcomes were included. We used the random-effects meta-analysis to pool the risk estimates and the robust error meta-regression method to examine the dose-response relationship. The methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 22 articles including 25 cohort studies mostly from high-income economics were included, with all assessed as high methodological quality. Adherence to a healthy lifestyle was associated with a decreased risk of incident dementia, either per healthy lifestyle behaviour increase (pooled hazard ratio 0.89, 95 % confidence interval 0.85-0.94) or the highest level versus the lowest level (pooled hazard ratio 0.61, 95 % confidence interval 0.49-0.76). An inverse, linear dose-response relationship (Pnon-linear = 0.845) between the number of healthy lifestyle behaviours and incident dementia was observed, with an 11 % risk reduction for each healthy behaviour increase. A relatively limited number of included studies indicated that adherence to a healthy lifestyle combination could yield benefits for cognitive decline, global cognition, memory and executive function. In addition, the adherence rates typically decreased as the number of healthy lifestyle behaviours increased. CONCLUSIONS Adherence to a healthy lifestyle was associated with a lower risk of incident dementia and other cognitive outcomes. It is important to find a subtle balance between the benefits and adherence. Further large cohort studies for combined lifestyle behaviours with specific cognitive outcomes and dose-response relationships are required, especially based on middle- and low-income populations. REGISTRATION The study was registered in PROSPERO (CRD42023418509). TWEETABLE ABSTRACT Engaging in a greater number of healthy lifestyle behaviours yields increased benefits in preventing dementia, albeit with lower adherence rates as a trade-off. Finding a delicate balance between the benefits and adherence is crucial.
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Affiliation(s)
- Yinyan Gao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Zixuan Zhang
- Changsha Center for Disease Control and Prevention, Changsha, China
| | - Jinlu Song
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Ting Gan
- School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Yali Lin
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Mingyue Hu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Irene Xinyin Wu
- Xiangya School of Public Health, Central South University, Changsha, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China.
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Beydoun MA, Beydoun HA, Hu YH, Maino Vieytes CA, Noren Hooten N, Song M, Georgescu MF, Fanelli-Kuczmarski MT, Meirelles O, Launer LJ, Evans MK, Zonderman AB. Plasma proteomic biomarkers and the association between poor cardiovascular health and incident dementia: The UK Biobank study. Brain Behav Immun 2024; 119:995-1007. [PMID: 38710337 PMCID: PMC11285716 DOI: 10.1016/j.bbi.2024.05.005] [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: 02/05/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The study examined how plasma proteome indicators may explain the link between poor cardiovascular health (CVH) and dementia risk. METHODS The present study involved 28,974 UK Biobank participants aged 50-74y at baseline (2006-2010) who were followed-up for ≤ 15 y for incidence of dementia. CVH was calculated using Life's Essential 8 (LE8) total scores. The scores were standardized and reverse coded to reflect poor CVH (LE8z_rev). OLINK proteomics was available on this sample (k = 1,463 plasma proteins). The study primarily tested the mediating effects of the plasma proteome in LE8z_rev-dementia effect. The total effect was decomposed into "mediation only" or pure indirect effect (PIE), "interaction only" or interaction referent (INTREF), "neither mediation nor interaction" or controlled direct effect (CDE), and "both mediation and interaction" or mediated interaction (INTMED). RESULTS The study found poorer CVH assessed by LE8z_rev increased the risk of all-cause dementia by 11 % [per 1 SD, hazard ratio, (HR) = 1.11, 95 % CI: 1.03-1.20, p = 0.005). The study identified 11 plasma proteins with strong mediating effects, with GDF15 having the strongest association with dementia risk (per 1 SD, HR = 1.24, 95 % CI: 1.16, 1.33, P < 0.001 when LE8z_rev is set at its mean value) and the largest proportion mediated combining PIE and INTMED (62.6 %; 48 % of TE is PIE), followed by adrenomedullin or ADM. A first principal component with 10 top mediators (TNFRSF1A, GDF15, FSTL3, COL6A3, PLAUR, ADM, GFRAL, ACVRL1, TNFRSF6B, TGFA) mediated 53.6 % of the LE8z_rev-dementia effect. Using all the significant PIE (k = 526) proteins, we used OLINK Insight pathway analysis to identify key pathways, which revealed the involvement of the immune system, signal transduction, metabolism, disease, protein metabolism, hemostasis, membrane trafficking, extracellular matrix organization, developmental biology, and gene expression among others. STRING analysis revealed that five top consistent proteomic mediators were represented in two larger clusters reflecting numerous interconnected biological gene ontology pathways, most notably cytokine-mediated signaling pathway for GDF15 cluster (GO:0019221) and regulation of peptidyl-tyrosine phosphorylation for the ADM cluster (GO:0050730). CONCLUSION Dementia is linked to poor CVH mediated by GDF15 and ADM among several key proteomic markers which collectively explained ∼ 54 % of the total effect.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States.
| | - Hind A Beydoun
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC 20420, United States; Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Christian A Maino Vieytes
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Minkyo Song
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Marie T Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Osorio Meirelles
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, United States
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Hillari L, Frank P, Cadar D. Systemic inflammation, lifestyle behaviours and dementia: A 10-year follow-up investigation. Brain Behav Immun Health 2024; 38:100776. [PMID: 38706574 PMCID: PMC11068506 DOI: 10.1016/j.bbih.2024.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/17/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives Lifestyle behaviours have been linked to dementia incidence, but their cumulative impact on dementia and the underlying mechanisms remain poorly understood. This study investigated the association of co-occurring lifestyle behaviours with dementia incidence and the mediating role of systemic inflammation in this association. Methods The sample comprised 3131 participants (55.2% female) from the English Longitudinal Study of Ageing aged 52-92 years at baseline (2008/09). Self-reported baseline lifestyle behaviours (alcohol intake, fruit and vegetable consumption, smoking, physical activity, sleep duration, social engagement, and cognitive activity) were summed to derive an index of lifestyle behaviours, ranging from 0 to 7, with higher scores denoting a higher number of health-risk behaviours. Incident dementia cases (n = 130, 4.2%) were identified through doctor-diagnosed dementia, informant interviews, and health records between 2014/15 and 2018/19. Systemic inflammation was measured through fasting plasma concentrations of C-reactive protein in 2012/13. Results Binary logistic regression models indicated that the odds of subsequent dementia increased by 1.19 for each additional health-risk behaviour (95% confidence intervals: 1.04, 1.37, p = 0.014) after adjusting for age, sex, ethnicity, wealth, education, marital status, body mass index, coronary heart disease, hypertension, stroke, and depression. However, this association was not mediated by C-reactive protein. Conclusions Co-occurring health-risk behaviours were associated with higher dementia incidence up to 10 years later, underscoring the importance of modifying health-risk behaviours for the prevention of dementia. Systemic inflammation did not explain the association between behaviours and dementia.
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Affiliation(s)
- Leah Hillari
- Behavioural Science and Health, University College London, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Philipp Frank
- Behavioural Science and Health, University College London, London, UK
- UCL Brain Sciences, University College London, London, UK
| | - Dorina Cadar
- Behavioural Science and Health, University College London, London, UK
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
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Tsiakiri A, Bakirtzis C, Plakias S, Vlotinou P, Vadikolias K, Terzoudi A, Christidi F. Predictive Models for the Transition from Mild Neurocognitive Disorder to Major Neurocognitive Disorder: Insights from Clinical, Demographic, and Neuropsychological Data. Biomedicines 2024; 12:1232. [PMID: 38927439 PMCID: PMC11201179 DOI: 10.3390/biomedicines12061232] [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: 04/27/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Neurocognitive disorders (NCDs) are progressive conditions that severely impact cognitive function and daily living. Understanding the transition from mild to major NCD is crucial for personalized early intervention and effective management. Predictive models incorporating demographic variables, clinical data, and scores on neuropsychological and emotional tests can significantly enhance early detection and intervention strategies in primary healthcare settings. We aimed to develop and validate predictive models for the progression from mild NCD to major NCD using demographic, clinical, and neuropsychological data from 132 participants over a two-year period. Generalized Estimating Equations were employed for data analysis. Our final model achieved an accuracy of 83.7%. A higher body mass index and alcohol drinking increased the risk of progression from mild NCD to major NCD, while female sex, higher praxis abilities, and a higher score on the Geriatric Depression Scale reduced the risk. Here, we show that integrating multiple factors-ones that can be easily examined in clinical settings-into predictive models can improve early diagnosis of major NCD. This approach could facilitate timely interventions, potentially mitigating the progression of cognitive decline and improving patient outcomes in primary healthcare settings. Further research should focus on validating these models across diverse populations and exploring their implementation in various clinical contexts.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.T.); (K.V.); (A.T.)
| | - Christos Bakirtzis
- B’ Department of Neurology and the MS Center, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Spyridon Plakias
- Department of Physical Education and Sport Science, University of Thessaly, 41500 Trikala, Greece;
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, 12243 Athens, Greece;
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.T.); (K.V.); (A.T.)
| | - Aikaterini Terzoudi
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.T.); (K.V.); (A.T.)
| | - Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.T.); (K.V.); (A.T.)
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Ponjoan A, Blanch J, Fages-Masmiquel E, Martí-Lluch R, Alves-Cabratosa L, Garcia-Gil MDM, Domínguez-Armengol G, Ribas-Aulinas F, Zacarías-Pons L, Ramos R. Sex matters in the association between cardiovascular health and incident dementia: evidence from real world data. Alzheimers Res Ther 2024; 16:58. [PMID: 38481343 PMCID: PMC10938682 DOI: 10.1186/s13195-024-01406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/31/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Cardiovascular health has been associated with dementia onset, but little is known about the variation of such association by sex and age considering dementia subtypes. We assessed the role of sex and age in the association between cardiovascular risk and the onset of all-cause dementia, Alzheimer's disease, and vascular dementia in people aged 50-74 years. METHODS This is a retrospective cohort study covering 922.973 Catalans who attended the primary care services of the Catalan Health Institute (Spain). Data were obtained from the System for the Development of Research in Primary Care (SIDIAP database). Exposure was the cardiovascular risk (CVR) at baseline categorized into four levels of Framingham-REGICOR score (FRS): low (FRS < 5%), low-intermediate (5% ≤ FRS < 7.5%), high-intermediate (7.5% ≤ FRS < 10%), high (FRS ≥ 10%), and one group with previous vascular disease. Cases of all-cause dementia and Alzheimer's disease were identified using validated algorithms, and cases of vascular dementia were identified by diagnostic codes. We fitted stratified Cox models using age parametrized as b-Spline. RESULTS A total of 51,454 incident cases of all-cause dementia were recorded over a mean follow-up of 12.7 years. The hazard ratios in the low-intermediate and high FRS groups were 1.12 (95% confidence interval: 1.08-1.15) and 1.55 (1.50-1.60) for all-cause dementia; 1.07 (1.03-1.11) and 1.17 (1.11-1.24) for Alzheimer's disease; and 1.34 (1.21-1.50) and 1.90 (1.67-2.16) for vascular dementia. These associations were stronger in women and in midlife compared to later life in all dementia types. Women with a high Framingham-REGICOR score presented a similar risk of developing dementia - of any type - to women who had previous vascular disease, and at age 50-55, they showed three times higher risk of developing dementia risk compared to the lowest Framingham-REGICOR group. CONCLUSIONS We found a dose‒response association between the Framingham-REGICOR score and the onset of all dementia types. Poor cardiovascular health in midlife increased the onset of all dementia types later in life, especially in women.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain.
- Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital. Parc Hospitalari Martí I Julià, (Ed. M2), C/Dr. Castany S/N, Salt (Girona), Catalonia, 17190, Spain.
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), C/ Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain.
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
| | - Ester Fages-Masmiquel
- Atenció Primària, Gerència Territorial de Girona, Institut Català de la Salut. C/Mossèn Joan Pons S/N, Girona, 17001, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital. Parc Hospitalari Martí I Julià, (Ed. M2), C/Dr. Castany S/N, Salt (Girona), Catalonia, 17190, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), C/ Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
| | - María Del Mar Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
| | - Gina Domínguez-Armengol
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), C/ Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
| | - Francesc Ribas-Aulinas
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), C/ Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
| | - Lluís Zacarías-Pons
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), C/ Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), C/Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain.
- Girona Biomedical Research Institute (IDIBGI), Dr. Trueta University Hospital. Parc Hospitalari Martí I Julià, (Ed. M2), C/Dr. Castany S/N, Salt (Girona), Catalonia, 17190, Spain.
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), C/ Maluquer Salvador nº11, Girona, Catalonia, 17002, Spain.
- Atenció Primària, Gerència Territorial de Girona, Institut Català de la Salut. C/Mossèn Joan Pons S/N, Girona, 17001, Spain.
- Translab Research Group, Department of Medical Sciences, University of Girona, C/Emili Grahit, 77, Girona, Catalonia, 17071, Spain.
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Cao Y, Zhu G, Feng C, Chen J, Gan W, Ma Y, Hu Y, Dhana K, Voortman T, Shen J, Li T, Zheng Y, Yuan C, Zong G. Cardiovascular risk burden, dementia risk and brain structural imaging markers: a study from UK Biobank. Gen Psychiatr 2024; 37:e101209. [PMID: 38292861 PMCID: PMC10826560 DOI: 10.1136/gpsych-2023-101209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024] Open
Abstract
Background Cardiovascular risk burden is associated with dementia risk and neurodegeneration-related brain structure, while the role of genetics and incident cardiovascular disease (CVD) remains unclear. Aims To examine the association of overall cardiovascular risk burden with the risk of major dementia subtypes and volumes of related brain regions in a large sample, and to explore the role of genetics and CVD onset. Methods A prospective study among 354 654 participants free of CVD and dementia (2006-2010, mean age 56.4 years) was conducted within the UK Biobank, with brain magnetic resonance imaging (MRI) measurement available for 15 104 participants since 2014. CVD risk burden was evaluated by the Framingham General Cardiovascular Risk Score (FGCRS). Dementia diagnosis was ascertained from inpatient and death register data. Results Over a median 12.0-year follow-up, 3998 all-cause dementia cases were identified. Higher FGCRS was associated with increased all-cause dementia risk after adjusting for demographic, major lifestyle, clinical factors and the polygenic risk score (PRS) of Alzheimer's disease. Comparing the high versus low tertile of FGCRS, the odds ratios (ORs) and 95% confidence intervals (CIs) were 1.26 (1.12 to 1.41) for all-cause dementia, 1.67 (1.33 to 2.09) for Alzheimer's disease and 1.53 (1.07 to 2.16) for vascular dementia (all ptrend<0.05). Incident stroke and coronary heart disease accounted for 14% (95% CI: 9% to 21%) of the association between FGCRS and all-cause dementia. Interactions were not detected for FGCRS and PRS on the risk of any dementia subtype. We observed an 83% (95% CI: 47% to 128%) higher all-cause dementia risk comparing the high-high versus low-low FGCRS-PRS category. For brain volumes, higher FGCRS was associated with greater log-transformed white matter hyperintensities, smaller cortical volume and smaller grey matter volume. Conclusions Our findings suggest that the positive association of cardiovascular risk burden with dementia risk also applies to major dementia subtypes. The association of cardiovascular risk burden with all-cause dementia is largely independent of CVD onset and genetic predisposition to dementia.
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Affiliation(s)
- Yaying Cao
- Department of Food Nutrition and Health, School of Medicine and Health, Harbin Institute of Technology, Harbin, Heilongjiang, China
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
| | - Gaohong Zhu
- Department of Nuclear Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chengwu Feng
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
| | - Jing Chen
- Neurology Department, Zhongshan Hospital Affiliated with Fudan University, Shanghai, China
| | - Wei Gan
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
- Department of Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK
| | - Yuan Ma
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Klodian Dhana
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Jie Shen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ting Li
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
- Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Mohanannair Geethadevi G, Quinn TJ, George J, Anstey KJ, Bell JS, Sarwar MR, Cross AJ. Multi-domain prognostic models used in middle-aged adults without known cognitive impairment for predicting subsequent dementia. Cochrane Database Syst Rev 2023; 6:CD014885. [PMID: 37265424 PMCID: PMC10239281 DOI: 10.1002/14651858.cd014885.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Dementia, a global health priority, has no current cure. Around 50 million people worldwide currently live with dementia, and this number is expected to treble by 2050. Some health conditions and lifestyle behaviours can increase or decrease the risk of dementia and are known as 'predictors'. Prognostic models combine such predictors to measure the risk of future dementia. Models that can accurately predict future dementia would help clinicians select high-risk adults in middle age and implement targeted risk reduction. OBJECTIVES Our primary objective was to identify multi-domain prognostic models used in middle-aged adults (aged 45 to 65 years) for predicting dementia or cognitive impairment. Eligible multi-domain prognostic models involved two or more of the modifiable dementia predictors identified in a 2020 Lancet Commission report and a 2019 World Health Organization (WHO) report (less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol intake, obesity, smoking, depression, social isolation, physical inactivity, diabetes mellitus, air pollution, poor diet, and cognitive inactivity). Our secondary objectives were to summarise the prognostic models, to appraise their predictive accuracy (discrimination and calibration) as reported in the development and validation studies, and to identify the implications of using dementia prognostic models for the management of people at a higher risk for future dementia. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ISI Web of Science Core Collection from inception until 6 June 2022. We performed forwards and backwards citation tracking of included studies using the Web of Science platform. SELECTION CRITERIA: We included development and validation studies of multi-domain prognostic models. The minimum eligible follow-up was five years. Our primary outcome was an incident clinical diagnosis of dementia based on validated diagnostic criteria, and our secondary outcome was dementia or cognitive impairment determined by any other method. DATA COLLECTION AND ANALYSIS Two review authors independently screened the references, extracted data using a template based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and assessed risk of bias and applicability of included studies using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We synthesised the C-statistics of models that had been externally validated in at least three comparable studies. MAIN RESULTS: We identified 20 eligible studies; eight were development studies and 12 were validation studies. There were 14 unique prognostic models: seven models with validation studies and seven models with development-only studies. The models included a median of nine predictors (range 6 to 34); the median number of modifiable predictors was five (range 2 to 11). The most common modifiable predictors in externally validated models were diabetes, hypertension, smoking, physical activity, and obesity. In development-only models, the most common modifiable predictors were obesity, diabetes, hypertension, and smoking. No models included hearing loss or air pollution as predictors. Nineteen studies had a high risk of bias according to the PROBAST assessment, mainly because of inappropriate analysis methods, particularly lack of reported calibration measures. Applicability concerns were low for 12 studies, as their population, predictors, and outcomes were consistent with those of interest for this review. Applicability concerns were high for nine studies, as they lacked baseline cognitive screening or excluded an age group within the range of 45 to 65 years. Only one model, Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE), had been externally validated in multiple studies, allowing for meta-analysis. The CAIDE model included eight predictors (four modifiable predictors): age, education, sex, systolic blood pressure, body mass index (BMI), total cholesterol, physical activity and APOEƐ4 status. Overall, our confidence in the prediction accuracy of CAIDE was very low; our main reasons for downgrading the certainty of the evidence were high risk of bias across all the studies, high concern of applicability, non-overlapping confidence intervals (CIs), and a high degree of heterogeneity. The summary C-statistic was 0.71 (95% CI 0.66 to 0.76; 3 studies; very low-certainty evidence) for the incident clinical diagnosis of dementia, and 0.67 (95% CI 0.61 to 0.73; 3 studies; very low-certainty evidence) for dementia or cognitive impairment based on cognitive scores. Meta-analysis of calibration measures was not possible, as few studies provided these data. AUTHORS' CONCLUSIONS We identified 14 unique multi-domain prognostic models used in middle-aged adults for predicting subsequent dementia. Diabetes, hypertension, obesity, and smoking were the most common modifiable risk factors used as predictors in the models. We performed meta-analyses of C-statistics for one model (CAIDE), but the summary values were unreliable. Owing to lack of data, we were unable to meta-analyse the calibration measures of CAIDE. This review highlights the need for further robust external validations of multi-domain prognostic models for predicting future risk of dementia in middle-aged adults.
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Affiliation(s)
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Kaarin J Anstey
- School of Psychology, The University of New South Wales, Sydney, Australia
- Ageing Futures Institute, The University of New South Wales, Sydney, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Muhammad Rehan Sarwar
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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8
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Dingle SE, Bujtor MS, Milte CM, Bowe SJ, Daly RM, Torres SJ. Statistical Approaches for the Analysis of Combined Health-Related Factors in Association with Adult Cognitive Outcomes: A Scoping Review. J Alzheimers Dis 2023; 92:1147-1171. [PMID: 36872778 DOI: 10.3233/jad-221034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Dementia prevention is a global health priority, and there is emerging evidence to support associations between individual modifiable health behaviors and cognitive function and dementia risk. However, a key property of these behaviors is they often co-occur or cluster, highlighting the importance of examining them in combination. OBJECTIVE To identify and characterize the statistical approaches used to aggregate multiple health-related behaviors/modifiable risk factors and assess associations with cognitive outcomes in adults. METHODS Eight electronic databases were searched to identify observational studies exploring the association between two or more aggregated health-related behaviors and cognitive outcomes in adults. RESULTS Sixty-two articles were included in this review. Fifty articles employed co-occurrence approaches alone to aggregate health behaviors/other modifiable risk factors, eight studies used solely clustering-based approaches, and four studies used a combination of both. Co-occurrence methods include additive index-based approaches and presenting specific health combinations, and whilst simple to construct and interpret, do not consider the underlying associations between co-occurring behaviors/risk factors. Clustering-based approaches do focus on underlying associations, and further work in this area may aid in identifying at-risk subgroups and understanding specific combinations of health-related behaviors/risk factors of particular importance in the scope of cognitive function and neurocognitive decline. CONCLUSION A co-occurrence approach to aggregating health-related behaviors/risk factors and exploring associations with adult cognitive outcomes has been the predominant statistic approach used to date, with a lack of research employing more advanced statistical methods to explore clustering-based approaches.
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Affiliation(s)
- Sara E Dingle
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Melissa S Bujtor
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia.,Department of Psychological Medicine, Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Catherine M Milte
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Biostatistics Unit, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.,Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Susan J Torres
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
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9
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Wu J, Xiong Y, Xia X, Orsini N, Qiu C, Kivipelto M, Rizzuto D, Wang R. Can dementia risk be reduced by following the American Heart Association's Life's Simple 7? A systematic review and dose-response meta-analysis. Ageing Res Rev 2023; 83:101788. [PMID: 36371016 DOI: 10.1016/j.arr.2022.101788] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
This study aimed to quantify the relationships between the American Heart Association (AHA) Cardiovascular Health (CVH) metrics, namely AHA Life's Simple 7, and cognitive outcomes. We searched PubMed and Embase (January 1, 2010-August 24, 2022) and finally included 14 longitudinal studies (311654 participants with 8006 incident dementia cases). Random-effects meta-analysis and one-stage linear mixed-effects models were performed. Increased CVH score seemed to associate with decreased risk of incident dementia in a linear manner, but this relationship varied by the measurement age of CVH metrics. That is, midlife CVH tended to have a linear association with late-life dementia risk, whereas a J-shaped association was observed between the late-life CVH score and dementia. In addition, late-life dementia risk was reduced significantly if individuals maintained an ideal level of AHA's CVH guidelines of physical activity, fasting plasma glucose, total cholesterol, and smoking. However, our meta-analysis did not show a significant association between CVH score and global cognitive decline rate. Following AHA's CVH guidelines and maintaining CVH at an optimal level would substantially reduce the late-life dementia risk. More research is required to explore the link between a favorable CVH score and cognitive trajectories among cognitively asymptomatic older populations.
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Affiliation(s)
- Jing Wu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Ying Xiong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Xin Xia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Theme Aging, Karolinska University Hospital, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Rui Wang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; The Swedish School of Sport and Health Science, GIH, Stockholm, Sweden; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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10
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Zhao YL, Ou YN, Ma YH, Huang YY, Bi YL, Tan L, Yu JT. Association between Life’s Simple 7 and cerebrospinal fluid biomarkers of Alzheimer’s disease pathology in cognitively intact adults: the CABLE study. Alzheimers Res Ther 2022; 14:74. [PMID: 35619174 PMCID: PMC9134665 DOI: 10.1186/s13195-022-01019-2] [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: 01/14/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Introduction
This study sought to explore the association between Life’s Simple 7 (LS7) and cerebrospinal fluid (CSF) Alzheimer’s disease (AD) pathological biomarkers in the cognitively normal northern Chinese population.
Methods
From the Chinese Alzheimer’s Biomarker and LifestylE (CABLE) study, 1106 cognitively normal participants were enrolled. The mean age was 62.34 years, and 39.6% were female. LS7 scores were summed with each metric assigned 0, 1, or 2 scores. The multiple linear regression models were used to investigate the association between LS7 scores and CSF AD biomarkers.
Results
We found that LS7 scores were significantly associated with CSF AD pathologies, including Aβ42/40 (β = 0.034, P = .041), p-tau181 (β = − 0.043, P = .006), and t-tau (β = − 0.044, P = .003). In subscales, the biological metrics (blood pressure, cholesterol, glucose) were significantly related to CSF tau-related biomarkers. These associations were observed in the APOE ε4 allele non-carriers, yet not in carriers. The relationship of behavior metrics was found in the middle age and males.
Conclusion
Improving LS7 scores might do a favor to alleviate the pathology of AD in the preclinical stage, especially among the APOE ε4 allele non-carriers.
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11
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Association of cardiovascular health with the risk of dementia in older adults. Sci Rep 2022; 12:15673. [PMID: 36123419 PMCID: PMC9485258 DOI: 10.1038/s41598-022-20072-3] [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: 02/04/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
It has been becoming important to identify modifiable risk factors to prevent dementia. We investigated the association of individual and combined cardiovascular health (CVH) on dementia risk in older adults. From the National Health Insurance Service of Korea-Senior database, 191,013 participants aged ≥ 65 years without prior dementia or cerebrovascular diseases who had check-ups between 2004 and 2012 were assessed. Participants were stratified into three groups according to the number of optimal levels of CVH (low, 0-2; moderate, 3-4; and high CVH status, 5-6) and grouped by levels of individual CVH metrics, the number of optimal CVH metrics, and the CVH score. Over a median follow-up of 6.2 years, 34,872 participants were diagnosed with dementia. Compared with low CVH status, moderate and high CVH status were associated with a decreased risk of dementia (hazard ratio [95% confidence interval], 0.91 [0.89-0.92] for moderate; 0.78 [0.75-0.80] for high CVH status) including Alzheimer's and vascular dementia. The risk of dementia decreased with an increase in the number of optimal CVH metrics (0.94 [0.93-0.94] per additional optimal metric) and with an increase in the CVH score (0.93 [0.93-0.94] per 1-point increase). After censoring for stroke, the association of CVH metrics with dementia risk was consistently observed. Among individual metrics, physical activity had the strongest association with the risk of dementia. In an older Asian population without prior dementia or cerebrovascular disease, a consistent relationship was observed between the improvement of a composite metric of CVH and the reduced risk of dementia.
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12
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Bellia C, Lombardo M, Meloni M, Della-Morte D, Bellia A, Lauro D. Diabetes and cognitive decline. Adv Clin Chem 2022; 108:37-71. [PMID: 35659061 DOI: 10.1016/bs.acc.2021.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epidemiologic studies have documented an association between diabetes and increased risk of cognitive decline in the elderly. Based on animal model studies, several mechanisms have been proposed to explain such an association, including central insulin signaling, neurodegeneration, brain amyloidosis, and neuroinflammation. Nevertheless, the exact mechanisms in humans remain poorly defined. It is reasonable, however, that many pathways may be involved in these patients leading to cognitive impairment. A major aim of clinicians is identifying early onset of neurologic signs and symptoms in elderly diabetics to improve quality of life of those with cognitive impairment and reduce costs associated with long-term complications. Several biomarkers have been proposed to identify diabetics at higher risk of developing dementia and diagnose early stage dementia. Although biomarkers of brain amyloidosis, neurodegeneration and synaptic plasticity are commonly used to diagnose dementia, especially Alzheimer disease, their role in diabetes remains unclear. The aim of this review is to explore the molecular mechanisms linking diabetes with cognitive decline and present the most important findings on the clinical use of biomarkers for diagnosing and predicting early cognitive decline in diabetics.
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Affiliation(s)
- Chiara Bellia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy.
| | - Mauro Lombardo
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Rome, Italy
| | - Marco Meloni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - David Della-Morte
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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13
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Jacob L, Smith L, Koyanagi A, Konrad M, Haro JM, Shin JI, Kostev K. Sex-Differential Associations Between Body Mass Index and the Incidence of Dementia. J Alzheimers Dis 2022; 88:631-639. [PMID: 35662122 DOI: 10.3233/jad-220147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the sex differences in the association between body mass index (BMI) and dementia in late life. OBJECTIVE Therefore, this retrospective cohort study aimed to analyze associations between BMI and dementia in older women and men separately in general practices in Germany. METHODS This study included patients followed in one of 832 general practices in Germany between 2006 and 2019 (index date: first visit date). Study variables included dementia (dependent variable), BMI (independent variable), age, sex, and comorbidities (control variables). Kaplan-Meier curves and adjusted Cox regression analyses were conducted to analyze associations between BMI and the 10-year incidence of dementia in women and men, separately. RESULTS There were 296,767 patients included in this study (mean [standard deviation] age 70.2 [5.9] years; 54.3% women). The proportion of underweight, normal weight, overweight, and obesity was 0.9%, 25.5%, 41.5%, and 32.1%, respectively. The 10-year incidence of dementia significantly decreased with increasing BMI, from 11.5% in women with underweight to 9.1% in those with obesity (log-rank p < 0.001). Respective figures in men were 12.0% and 8.2% (log-rank p < 0.001). In women, only overweight (versus normal weight) was significantly associated with dementia (HR = 0.93, 95% CI = 0.88-0.97). In contrast, in men, the only BMI category significantly associated with the incidence of dementia was underweight (HR = 1.58, 95% CI = 1.11-2.25). CONCLUSION In this study conducted in Germany, overweight was negatively associated with dementia in women, whereas there was a positive underweight-dementia relationship in men. More data are needed to confirm or refute these findings in other settings.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, Sant Boi de Llobregat, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Marcel Konrad
- Health & Social, FOM University of Applied Sciences for Economics and Management, Frankfurt am Main, Germany
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, Sant Boi de Llobregat, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Penfold RB, Carrell DS, Cronkite DJ, Pabiniak C, Dodd T, Glass AM, Johnson E, Thompson E, Arrighi HM, Stang PE. Development of a machine learning model to predict mild cognitive impairment using natural language processing in the absence of screening. BMC Med Inform Decis Mak 2022; 22:129. [PMID: 35549702 PMCID: PMC9097352 DOI: 10.1186/s12911-022-01864-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients and their loved ones often report symptoms or complaints of cognitive decline that clinicians note in free clinical text, but no structured screening or diagnostic data are recorded. These symptoms/complaints may be signals that predict who will go on to be diagnosed with mild cognitive impairment (MCI) and ultimately develop Alzheimer's Disease or related dementias. Our objective was to develop a natural language processing system and prediction model for identification of MCI from clinical text in the absence of screening or other structured diagnostic information. METHODS There were two populations of patients: 1794 participants in the Adult Changes in Thought (ACT) study and 2391 patients in the general population of Kaiser Permanente Washington. All individuals had standardized cognitive assessment scores. We excluded patients with a diagnosis of Alzheimer's Disease, Dementia or use of donepezil. We manually annotated 10,391 clinic notes to train the NLP model. Standard Python code was used to extract phrases from notes and map each phrase to a cognitive functioning concept. Concepts derived from the NLP system were used to predict future MCI. The prediction model was trained on the ACT cohort and 60% of the general population cohort with 40% withheld for validation. We used a least absolute shrinkage and selection operator logistic regression approach (LASSO) to fit a prediction model with MCI as the prediction target. Using the predicted case status from the LASSO model and known MCI from standardized scores, we constructed receiver operating curves to measure model performance. RESULTS Chart abstraction identified 42 MCI concepts. Prediction model performance in the validation data set was modest with an area under the curve of 0.67. Setting the cutoff for correct classification at 0.60, the classifier yielded sensitivity of 1.7%, specificity of 99.7%, PPV of 70% and NPV of 70.5% in the validation cohort. DISCUSSION AND CONCLUSION Although the sensitivity of the machine learning model was poor, negative predictive value was high, an important characteristic of models used for population-based screening. While an AUC of 0.67 is generally considered moderate performance, it is also comparable to several tests that are widely used in clinical practice.
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Affiliation(s)
- Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA.
| | - David S Carrell
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - David J Cronkite
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Chester Pabiniak
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Tammy Dodd
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Ashley Mh Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Ella Thompson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | | | - Paul E Stang
- Janssen Research and Development, LLC, Raritan, USA
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15
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Georgakis MK, Ntanasi E, Ramirez A, Grenier-Boley B, Lambert JC, Sakka P, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou GM, Charissis S, Mourtzi N, Hatzimanolis A, Scarmeas N. Vascular burden and genetic risk in association with cognitive performance and dementia in a population-based study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100145. [PMID: 36324400 PMCID: PMC9616333 DOI: 10.1016/j.cccb.2022.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 02/19/2022] [Accepted: 04/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND PURPOSE Vascular risk factors may influence cognitive function and thus represent possible targets for preventive approaches against dementia. Yet it remains unknown, if they associate with cognition independently of the individual genetic risk for dementia. METHODS In a population-based study of 1172 community-dwelling individuals aged ≥65 years in Greece, we constructed a vascular burden score (VBS; based on presence of hypertension, diabetes, hyperlipidemia, heart disease, and cerebrovascular disease, range 0-5) and a polygenic risk score (PRS) for clinically-diagnosed Alzheimer's disease (AD) based on 23 genetic variants. We then explored in joint models the associations of the PRS for AD and VBS with global cognitive performance, cognitive performance across multiple cognitive domains, and odds of dementia. RESULTS The mean age of study participants was 73.9 ± 5.2 years (57.1% females). Both the PRS for AD and VBS were associated with worse global cognitive performance (beta per-SD-increment in PRS: -0.06, 95%CI: -0.10 to -0.02, beta per-point-increment in VBS: -0.05, 95%CI: -0.09 to -0.02), worse performance across individual cognitive domains (memory, executive function, attention, language, visuospatial ability), and higher odds of dementia (OR per-SD increment in PRS: 1.56, 95%CI: 1.17-2.09, OR per-point increment in VBS: 1.38, 95%CI: 1.05-1.81). There was no evidence of an interaction between the two scores. Higher VBS was associated with worse cognitive performance equally across tertiles of the PRS for AD, even among individuals at the highest tertile. CONCLUSIONS Both genetic risk and vascular burden are independently and additively associated with worse cognitive performance and higher odds of dementia.
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Affiliation(s)
- Marios K. Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Feodor-Lynen-Str. 17, Munich 81377, Germany
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programme in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Eva Ntanasi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Alfredo Ramirez
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Benjamin Grenier-Boley
- U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liés au Vieillissement, University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Jean-Charles Lambert
- U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liés au Vieillissement, University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Marousi, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H. Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | | | - Sokratis Charissis
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Niki Mourtzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Hatzimanolis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
- Theodor-Theohari Cozzika Foundation, Neurobiology Research Institute, Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
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16
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Iso-Markku P, Kujala UM, Knittle K, Polet J, Vuoksimaa E, Waller K. Physical activity as a protective factor for dementia and Alzheimer's disease: systematic review, meta-analysis and quality assessment of cohort and case-control studies. Br J Sports Med 2022; 56:701-709. [PMID: 35301183 PMCID: PMC9163715 DOI: 10.1136/bjsports-2021-104981] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 01/20/2023]
Abstract
Objective Physical activity (PA) is associated with a decreased incidence of dementia, but much of the evidence comes from short follow-ups prone to reverse causation. This meta-analysis investigates the effect of study length on the association. Design A systematic review and meta-analysis. Pooled effect sizes, dose–response analysis and funnel plots were used to synthesise the results. Data sources CINAHL (last search 19 October 2021), PsycInfo, Scopus, PubMed, Web of Science (21 October 2021) and SPORTDiscus (26 October 2021). Eligibility criteria Studies of adults with a prospective follow-up of at least 1 year, a valid cognitive measure or cohort in mid-life at baseline and an estimate of the association between baseline PA and follow-up all-cause dementia, Alzheimer’s disease or vascular dementia were included (n=58). Results PA was associated with a decreased risk of all-cause dementia (pooled relative risk 0.80, 95% CI 0.77 to 0.84, n=257 983), Alzheimer’s disease (0.86, 95% CI 0.80 to 0.93, n=128 261) and vascular dementia (0.79, 95% CI 0.66 to 0.95, n=33 870), even in longer follow-ups (≥20 years) for all-cause dementia and Alzheimer’s disease. Neither baseline age, follow-up length nor study quality significantly moderated the associations. Dose–response meta-analyses revealed significant linear, spline and quadratic trends within estimates for all-cause dementia incidence, but only a significant spline trend for Alzheimer’s disease. Funnel plots showed possible publication bias for all-cause dementia and Alzheimer’s disease. Conclusion PA was associated with lower incidence of all-cause dementia and Alzheimer’s disease, even in longer follow-ups, supporting PA as a modifiable protective lifestyle factor, even after reducing the effects of reverse causation.
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Affiliation(s)
- Paula Iso-Markku
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland .,HUS Diagnostic Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Keegan Knittle
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juho Polet
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eero Vuoksimaa
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Katja Waller
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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17
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Speh A, Wang R, Winblad B, Kramberger MG, Bäckman L, Qiu C, Laukka EJ. The Relationship Between Cardiovascular Health and Rate of Cognitive Decline in Young-Old and Old-Old Adults: A Population-Based Study. J Alzheimers Dis 2021; 84:1523-1537. [PMID: 34690136 PMCID: PMC8764601 DOI: 10.3233/jad-210280] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Modifiable vascular risk factors have been associated with late-life cognitive impairment. The Life Simple 7 (LS7) score comprises seven cardiovascular health metrics: smoking, diet, physical activity, body mass index, plasma glucose, total serum cholesterol, and blood pressure. Objective: To investigate the association between individual and composite LS7 metrics and rate of cognitive decline, and potential differences in these associations between young-old and old-old individuals. Methods: This cohort study included 1,950 participants aged≥60 years (M = 70.7 years) from the Swedish National Study on Aging and Care-Kungsholmen (SNAC-K), who underwent repeated neuropsychological testing (episodic and semantic memory, verbal fluency, processing speed, global cognition) across 12 years. The LS7 score was assessed at baseline and categorized as poor, intermediate, or optimal. Level and change in cognitive performance as a function of LS7 categories were estimated using linear mixed-effects models. Results: Having an optimal LS7 total score was associated with better performance (expressed in standard deviation units) at baseline for perceptual speed (β= 0.21, 95%CI 0.12–0.29), verbal fluency (β= 0.08, 0.00–0.16), and global cognition (β= 0.06, 0.00–0.12) compared to the poor group. Age-stratified analyses revealed associations for cognitive level and change only in the young-old (< 78 years) group. For the specific metrics, diverging patterns were observed for young-old and old-old individuals. Conclusion: Meeting the LS7 criteria for ideal cardiovascular health in younger old age is associated with slower rate of cognitive decline. However, the LS7 criteria may have a different meaning for cognitive function in very old adults.
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Affiliation(s)
- Andreja Speh
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,The Swedish School of Sport and Health Science, GIH, Stockholm, Sweden.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Milica G Kramberger
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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18
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Guo J, Brickman AM, Manly JJ, Reitz C, Schupf N, Mayeux RP, Gu Y. Association of Life's Simple 7 with incident dementia and its modification by the apolipoprotein E genotype. Alzheimers Dement 2021; 17:1905-1913. [PMID: 33938146 DOI: 10.1002/alz.12359] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/24/2021] [Accepted: 04/05/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION There is limited and inconsistent reporting on the association between Life's Simple 7 (LS7) and dementia in the elderly population. METHODS Based on the Washington Heights-Inwood Columbia Aging Project (WHICAP), LS7 scores were estimated to assess cardiovascular health status. Associations between LS7 scores and incident dementia were investigated by Cox proportional hazards models. RESULTS Among 1987 subjects, 291 incident cases of dementia were identified over a median follow-up of 5.84 years. Compared with subjects in the poor cardiovascular health group (scores 0 to 5), those in intermediate (6 to 9) and optimal (10 to 14) groups had lower dementia risk, with the hazard ratio (HR; 95% confidence interval) being 0.74 (0.54 to 1.00) and 0.59 (0.38 to 0.91), respectively. These results were significant in apolipoprotein E genotype ε4 (APOE ε4) allele non-carriers but not in carriers. DISCUSSION Higher LS7 scores are protective for dementia, especially among the APOE ε4 noncarriers.
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Affiliation(s)
- Jing Guo
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, USA
| | - Adam M Brickman
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, USA.,The Department of Neurology, Columbia University, New York, USA.,The Gertrude H. Sergievsky Center, Columbia University, New York, USA
| | - Jennifer J Manly
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, USA.,The Department of Neurology, Columbia University, New York, USA.,The Gertrude H. Sergievsky Center, Columbia University, New York, USA
| | - Christiane Reitz
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, USA.,The Department of Neurology, Columbia University, New York, USA.,The Gertrude H. Sergievsky Center, Columbia University, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, USA
| | - Nicole Schupf
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, USA.,The Department of Neurology, Columbia University, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, USA
| | - Richard P Mayeux
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, USA.,The Department of Neurology, Columbia University, New York, USA.,The Gertrude H. Sergievsky Center, Columbia University, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, USA
| | - Yian Gu
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, USA.,The Department of Neurology, Columbia University, New York, USA.,The Gertrude H. Sergievsky Center, Columbia University, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, USA
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19
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Malik R, Georgakis MK, Neitzel J, Rannikmäe K, Ewers M, Seshadri S, Sudlow CLM, Dichgans M. Midlife vascular risk factors and risk of incident dementia: Longitudinal cohort and Mendelian randomization analyses in the UK Biobank. Alzheimers Dement 2021; 17:1422-1431. [PMID: 33749976 DOI: 10.1002/alz.12320] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/18/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Midlife clustering of vascular risk factors has been associated with late-life dementia, but causal effects of individual biological and lifestyle factors remain largely unknown. METHODS Among 229,976 individuals (mean follow-up 9 years), we explored whether midlife cardiovascular health measured by Life's Simple 7 (LS7) is associated with incident all-cause dementia and whether the individual components of the score are causally associated with dementia. RESULTS Adherence to the biological metrics of LS7 (blood pressure, cholesterol, glycemic status) was associated with lower incident dementia risk (hazard ratio = 0.93 per 1-point increase, 95% confidence interval [CI; 0.89-0.96]). In contrast, there was no association between the composite LS7 score and the lifestyle subscore (smoking, body mass index, diet, physical activity) and incident dementia. In Mendelian randomization analyses, genetically elevated blood pressure was associated with higher risk of dementia (odds ratio = 1.31 per one-standard deviation increase, 95% CI [1.05-1.60]). DISCUSSION These findings underscore the importance of blood pressure control in midlife to mitigate dementia risk.
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Affiliation(s)
- Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Kristiina Rannikmäe
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Sudha Seshadri
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Cathie L M Sudlow
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Nine Bioquarter, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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20
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Kunutsor SK, Laukkanen JA, Kauhanen J, Willeit P. Physical activity may not be associated with long-term risk of dementia and Alzheimer's disease. Eur J Clin Invest 2021; 51:e13415. [PMID: 32991743 PMCID: PMC7988584 DOI: 10.1111/eci.13415] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/21/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND While it is well established that physical activity is associated with reduced risk of vascular and nonvascular outcomes as well as mortality, evidence on the association between physical activity and dementia is inconsistent. We aimed to assess the associations of physical activity with the risk of dementia and Alzheimer's disease (AD). MATERIAL AND METHODS We analysed data on 2394 apparently healthy men with good baseline cognitive function from the prospective population-based Kuopio Ischaemic Heart Disease study. We assessed habits of physical activity at baseline using a 12-month leisure time physical activity (LTPA) questionnaire. Using Cox regression, we calculated hazard ratios adjusted for body mass index, systolic blood pressure, smoking status, history of type-2 diabetes, total cholesterol, high-density lipoprotein cholesterol, alcohol consumption, history of coronary heart disease and high-sensitivity C-reactive protein. RESULTS During a median follow-up of 24.9 years (interquartile range: 18.3-26.9), 208 men developed dementia and 128 developed AD. Multivariable adjusted hazard ratios for dementia comparing top vs bottom tertiles of physical activity were 0.97 (95% confidence intervals: 0.69-1.38) for total physical activity volume, 0.96 (0.69-1.34) for conditioning LTPA volume and 1.13 (0.80-1.61) for total LTPA volume. Corresponding hazard ratios for AD were 1.19 (0.76-1.85), 0.98 (0.64-1.49) and 1.22 (0.77-1.93). Associations were consistent in analyses restricted to participants with ≥10 years of follow-up. CONCLUSIONS In middle-aged Caucasian men, various physical activity exposures were not associated with all-cause dementia or AD. Future studies should address biases due to reverse causation and regression dilution and should involve objective measures of physical activity.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Learning & Research Building (Level 1), Southmead Hospital, University of Bristol, Bristol, UK
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Central Finland Health Care District Hospital District, Jyväskylä, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Peter Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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21
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Nakaoku Y, Takahashi Y, Tominari S, Nakayama T. Predictors of New Dementia Diagnoses in Elderly Individuals: A Retrospective Cohort Study Based on Prefecture-Wide Claims Data in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020629. [PMID: 33451034 PMCID: PMC7828475 DOI: 10.3390/ijerph18020629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/16/2022]
Abstract
Preventing dementia in elderly individuals is an important public health challenge. While early identification and modification of predictors are crucial, predictors of dementia based on routinely collected healthcare data are not fully understood. We aimed to examine potential predictors of dementia diagnosis using routinely collected claims data. In this retrospective cohort study, claims data from fiscal years 2012 (baseline) and 2016 (follow-up), recorded in an administrative claims database of the medical care system for the elderly (75 years or older) in Niigata prefecture, Japan, were used. Data on baseline characteristics including age, sex, diagnosis, and prescriptions were collected, and the relationship between subsequent new diagnoses of dementia and potential predictors was examined using multivariable logistic regression models. A total of 226,738 people without a diagnosis of dementia at baseline were followed. Of these, 26,092 incident dementia cases were detected during the study period. After adjusting for confounding factors, cerebrovascular disease (odds ratio, 1.15; 95% confidence interval, 1.11-1.18), depression (1.38; 1.31-1.44), antipsychotic use (1.40; 1.31-1.49), and hypnotic use (1.17; 1.11-1.24) were significantly associated with subsequent diagnosis of dementia. Analyses of routinely collected claims data revealed neuropsychiatric symptoms including depression, antipsychotic use, hypnotic use, and cerebrovascular disease to be predictors of new dementia diagnoses.
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Affiliation(s)
- Yuriko Nakaoku
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan; (Y.T.); (S.T.); (T.N.)
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
- Correspondence: ; Tel.: +81-6-6170-1070
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan; (Y.T.); (S.T.); (T.N.)
| | - Shinjiro Tominari
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan; (Y.T.); (S.T.); (T.N.)
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan; (Y.T.); (S.T.); (T.N.)
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22
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Liang Y, Ngandu T, Laatikainen T, Soininen H, Tuomilehto J, Kivipelto M, Qiu C. Cardiovascular health metrics from mid- to late-life and risk of dementia: A population-based cohort study in Finland. PLoS Med 2020; 17:e1003474. [PMID: 33320852 PMCID: PMC7737898 DOI: 10.1371/journal.pmed.1003474] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Very few studies have explored the patterns of cardiovascular health (CVH) metrics in midlife and late life in relation to risk of dementia. We examined the associations of composite CVH metrics from midlife to late life with risk of incident dementia. METHODS AND FINDINGS This cohort study included 1,449 participants from the Finnish Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study, who were followed from midlife (baseline from1972 to 1987; mean age 50.4 years; 62.1% female) to late life (1998), and then 744 dementia-free survivors were followed further into late life (2005 to 2008). We defined and scored global CVH metrics based on 6 of the 7 components (i.e., smoking, physical activity, and body mass index [BMI] as behavioral CVH metrics; fasting plasma glucose, total cholesterol, and blood pressure as biological CVH metrics) following the modified American Heart Association (AHA)'s recommendations. Then, the composite global, behavioral, and biological CVH metrics were categorized into poor, intermediate, and ideal levels. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Data were analyzed with Cox proportional hazards and the Fine and Gray competing risk regression models. During the follow-up examinations, dementia was diagnosed in 61 persons in 1998 and additional 47 persons in 2005 to 2008. The fully adjusted hazard ratio (HR) of dementia was 0.71 (95% confidence interval [CI]: 0.43, 1.16; p = 0.174) and 0.52 (0.29, 0.93; p = 0.027) for midlife intermediate and ideal levels (versus poor level) of global CVH metrics, respectively; the corresponding figures for late-life global CVH metrics were 0.60 (0.22, 1.69; p = 0.338) and 0.91 (0.34, 2.41; p = 0.850). Compared with poor global CVH metrics in both midlife and late life, the fully adjusted HR of dementia was 0.25 (95% CI: 0.08, 0.86; p = 0.028) for people with intermediate global CVH metrics in both midlife and late life and 0.14 (0.02, 0.76; p = 0.024) for those with midlife ideal and late-life intermediate global CVH metrics. Having an intermediate or ideal level of behavioral CVH in both midlife and late life (versus poor level in both midlife and late life) was significantly associated with a lower dementia risk (HR range: 0.03 to 0.26; p < 0.05), whereas people with midlife intermediate and late-life ideal biological CVH metrics had a significantly increased risk of dementia (p = 0.031). Major limitations of this study include the lack of data on diet and midlife plasma glucose, high rate of attrition, as well as the limited power for certain subgroup analyses. CONCLUSIONS In this study, we observed that having the ideal CVH metrics, and ideal behavioral CVH metrics in particular, from midlife onwards is associated with a reduced risk of dementia as compared with people having poor CVH metrics. Maintaining life-long health behaviors may be crucial to reduce late-life risk of dementia.
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Affiliation(s)
- Yajun Liang
- Aging Research Center & Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tiia Ngandu
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics & Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Tiina Laatikainen
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Hilkka Soininen
- Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia and Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics & Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom
- Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
- * E-mail: (MK); (CQ)
| | - Chengxuan Qiu
- Aging Research Center & Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- * E-mail: (MK); (CQ)
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23
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XING YL, Chen MA, SUN Y, Neradilek MB, WU XT, ZHANG D, HUANG W, CUI Y, YANG QQ, LI HW, ZHAO XQ. Atherosclerosis, its risk factors, and cognitive impairment in older adults. J Geriatr Cardiol 2020; 17:434-440. [PMID: 32863826 PMCID: PMC7416070 DOI: 10.11909/j.issn.1671-5411.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To examine the association of atherosclerotic cardiovascular disease (ASCVD) and its risk factors with cognitive impairment in older adults. METHODS Six hundred and fourteen subjects, aged ≥ 65 years, from one center (2016-2018) underwent clinical, laboratory assessments and the Montreal Cognitive Assessment (MoCA). Using regression analysis, the relationship between ASCVD and its risk factors was evaluated in subjects with and without cognitive impairment (MoCA score < 26). RESULTS Older age (β = -1.3 per 5 years, 95% CI: -1.7 to -0.9, P < 0.001), history of stroke (β = -1.6, 95% CI: -3.0 to -0.3, P = 0.01), and myocardial infarction (MI; β = -2.2, 95% CI: -3.6 to -0.8, P = 0.003) were independently associated with lower MoCA scores, whereas more education (β = 1.5 per 3 years, 95% CI: 1.1 to 1.9, P < 0.001), higher body mass index (BMI; β = 0.5 per 3 kg/m2, 95% CI: 0.0 to 1.0, P = 0.04), higher estimated glomerular filtration rate (eGFR; β = 0.8 per 15 U, 95% CI: 0.1 to 1.4, P = 0.03), left ventricular ejection fraction (LVEF; β = 0.4 per 5%, 95% CI: 0 to 0.8, P = 0.04) and statin use (β = 1.3, 95% CI: 0.3 to 2.3, P = 0.01) were associated with a higher MoCA score. Cognitive impairment was independently associated with older age (OR = 1.51 per 5 yrs, 95% CI: 1.28 to 1.79, P < 0.001), less education (OR = 0.55 per 3 years, 95% CI: 0.45 to 0.68, P < 0.001), lower BMI (OR = 0.78 per 3 kg/m2, 95% CI: 0.62 to 0.98, P = 0.03) and higher levels of high sensitivity c-reactive protein (hsCRP; OR = 1.08 per 1 mg/L, 95% CI: 1.02 to 1.15, P = 0.01). CONCLUSIONS Beyond age, cognitive impairment was associated with prior MI/stroke, higher hsCRP, statin use, less education, lower eGFR, BMI and LVEF.
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Affiliation(s)
- Yun-Li XING
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Michael A Chen
- Division of Cardiology, University of Washington, Seattle, WA, USA
- Michael A Chen, MD, PhD, Division of Cardiology, University of Washington, 325 9 Avenue, Box 359748, Seattle, WA 98104, USA. E-mail:
| | - Ying SUN
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Xi-Ting WU
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dai ZHANG
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei HUANG
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yining CUI
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qi-Qi YANG
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei LI
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Qiao ZHAO
- Division of Cardiology, University of Washington, Seattle, WA, USA
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24
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Qu Y, Hu HY, Ou YN, Shen XN, Xu W, Wang ZT, Dong Q, Tan L, Yu JT. Association of body mass index with risk of cognitive impairment and dementia: A systematic review and meta-analysis of prospective studies. Neurosci Biobehav Rev 2020; 115:189-198. [PMID: 32479774 DOI: 10.1016/j.neubiorev.2020.05.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/24/2020] [Accepted: 05/23/2020] [Indexed: 01/10/2023]
Abstract
Controversies persist about the associations of body mass index (BMI) with risk of cognitive impairment and dementia. This study aimed to evaluate these associations from various aspects, in which Embase, PubMed and Cochrane databases were searched to identify prospective studies up to May 2019. Random-effects meta-analyses and dose-response meta-analysis were conducted, involving twenty-nine of 20,083 identified literatures. Meta-analysis showed that midlife underweight, obesity and late-life underweight conferred 1.39-, 1.31- and 1.64-fold excess risk for cognitive impairment and dementia, while late-life overweight and obesity conferred 21% and 25% reduced risk. In dose-response meta-analysis, all cause dementia (ACD), Alzheimer's disease (AD) and vascular dementia (VaD) risk in midlife was significantly elevated when BMI surpassed 29, 30 and 32 kg/m2. AD risk in late-life was decreased when BMI was under 27 kg/m2, while this protection for VaD was absent when BMI surpassed 39 kg/m2. Higher BMI produced opposite exerted opposite effects on dementia in mid- and late-age population. Firstly reported, a dose-response relationship further supports the guideline from the standpoint of dementia prevention.
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Affiliation(s)
- Yi Qu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - He-Ying Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xue-Ning Shen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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Fayosse A, Nguyen DP, Dugravot A, Dumurgier J, Tabak AG, Kivimäki M, Sabia S, Singh-Manoux A. Risk prediction models for dementia: role of age and cardiometabolic risk factors. BMC Med 2020; 18:107. [PMID: 32423410 PMCID: PMC7236124 DOI: 10.1186/s12916-020-01578-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score is the only currently available midlife risk score for dementia. We compared CAIDE to Framingham cardiovascular Risk Score (FRS) and FINDRISC diabetes score as predictors of dementia and assessed the role of age in their associations with dementia. We then examined whether these risk scores were associated with dementia in those free of cardiometabolic disease over the follow-up. METHODS A total of 7553 participants, 39-63 years in 1991-1993, were followed for cardiometabolic disease (diabetes, coronary heart disease, stroke) and dementia (N = 318) for a mean 23.5 years. Cox regression was used to model associations of age at baseline, CAIDE, FRS, and FINDRISC risk scores with incident dementia. Predictive performance was assessed using Royston's R2, Harrell's C-index, Akaike's information criterion (AIC), the Greenwood-Nam-D'Agostino (GND) test, and calibration-in-the-large. Age effect was also assessed by stratifying analyses by age group. Finally, in multistate models, we examined whether cardiometabolic risk scores were associated with incidence of dementia in persons who remained free of cardiometabolic disease over the follow-up. RESULTS Among the risk scores, the predictive performance of CAIDE (C-statistic = 0.714; 95% CI 0.690-0.739) and FRS (C-statistic = 0.719; 95% CI 0.693-0.745) scores was better than FINDRISC (C-statistic = 0.630; 95% CI 0.602-0.659); p < 0.001), AIC difference > 3; R2 32.5%, 32.0%, and 12.5%, respectively. When the effect of age in these risk scores was removed by drawing data on risk scores at age 55, 60, and 65 years, the association with dementia in all age groups remained for FRS and FINDRISC, but not for CAIDE. Only FRS at age 55 was associated with dementia in persons who remained free of cardiometabolic diseases prior to dementia diagnosis while no such association was observed at older ages for any risk score. CONCLUSIONS Our analyses of CAIDE, FRS, and FINDRISC show the FRS in midlife to predict dementia as well as the CAIDE risk score, its predictive value being also evident among individuals who did not develop cardiometabolic events. The importance of age in the predictive performance of all three risk scores highlights the need for the development of multivariable risk scores in midlife for primary prevention of dementia.
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Affiliation(s)
- Aurore Fayosse
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Dinh-Phong Nguyen
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Aline Dugravot
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Julien Dumurgier
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Adam G Tabak
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France.,First Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France. .,Department of Epidemiology and Public Health, University College London, London, UK.
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McCoy TH, Han L, Pellegrini AM, Tanzi RE, Berretta S, Perlis RH. Stratifying risk for dementia onset using large-scale electronic health record data: A retrospective cohort study. Alzheimers Dement 2020; 16:531-540. [PMID: 31859230 DOI: 10.1016/j.jalz.2019.09.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Preventing dementia, or modifying disease course, requires identification of presymptomatic or minimally symptomatic high-risk individuals. METHODS We used longitudinal electronic health records from two large academic medical centers and applied a validated natural language processing tool to estimate cognitive symptomatology. We used survival analysis to examine the association of cognitive symptoms with incident dementia diagnosis during up to 8 years of follow-up. RESULTS Among 267,855 hospitalized patients with 1,251,858 patient years of follow-up data, 6516 (2.4%) received a new diagnosis of dementia. In competing risk regression, an increasing cognitive symptom score was associated with earlier dementia diagnosis (HR 1.63; 1.54-1.72). Similar results were observed in the second hospital system and in subgroup analysis of younger and older patients. DISCUSSION A cognitive symptom measure identified in discharge notes facilitated stratification of risk for dementia up to 8 years before diagnosis.
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Affiliation(s)
- Thomas H McCoy
- Center for Quantitative Health, Massachusetts General Hospital, Boston, MA, USA
| | - Larry Han
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amelia M Pellegrini
- Center for Quantitative Health, Massachusetts General Hospital, Boston, MA, USA
| | - Rudolph E Tanzi
- Genetics and Aging Research Unit, McCance Center for Brain Health, MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Sabina Berretta
- Translational Neuroscience Lab., Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
| | - Roy H Perlis
- Center for Quantitative Health, Massachusetts General Hospital, Boston, MA, USA
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Atkins JL, Delgado J, Pilling LC, Bowman K, Masoli JAH, Kuchel GA, Ferrucci L, Melzer D. Impact of Low Cardiovascular Risk Profiles on Geriatric Outcomes: Evidence From 421,000 Participants in Two Cohorts. J Gerontol A Biol Sci Med Sci 2019; 74:350-357. [PMID: 29982474 PMCID: PMC6376108 DOI: 10.1093/gerona/gly083] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Individuals with low cardiovascular risk factor profiles experience lower rates of cardiovascular diseases, but associations with geriatric syndromes are unclear. We tested whether individuals with low cardiovascular disease risk, aged 60-69 years old at baseline in two large cohorts, were less likely to develop aging-related adverse health outcomes. METHODS Data were from population representative medical records (Clinical Practice Research Datalink [CPRD] England, n = 239,591) and healthy volunteers (UK Biobank [UKB], n = 181,820), followed for ≤10 years. A cardiovascular disease risk score (CRS) summarized smoking status, LDL-cholesterol, blood pressure, body mass index, fasting glucose and physical activity, grouping individuals as low (ie, all factors near ideal), moderate, or high CRS. Logistic regression, Cox models, and Fine and Grey risk models tested the associations between the CRS and health outcomes. RESULTS Low CRS individuals had less chronic pain (UKB: baseline odds ratio = 0.52, confidence interval [CI] = 0.50-0.54), lower incidence of incontinence (CPRD: subhazard ratio [sub-HR] = 0.75, 0.63-0.91), falls (sub-HR = 0.82, CI = 0.73-0.91), fragility fractures (sub-HR = 0.78, CI = 0.65-0.93), and dementia (vs. high risks; UKB: sub-HR = 0.67, CI = 0.50-0.89; CPRD: sub-HR = 0.79, CI = 0.56-1.12). Only 5.4% in CPRD with low CRS became frail (Rockwood index) versus 24.2% with high CRS. All-cause mortality was markedly lower in the low CRS group (vs. high CRS; HR = 0.40, 95% CI = 0.35-0.47). All associations showed dose-response relationships, and results were similar in both cohorts. CONCLUSIONS Persons aged 60-69 years with near-ideal cardiovascular risk factor profiles have substantially lower incidence of geriatric conditions and frailty. Optimizing cardiovascular disease risk factors may substantially reduce the burden of morbidity in later life.
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Affiliation(s)
- Janice L Atkins
- Epidemiology and Public Health Group, University of Exeter Medical School, UK
| | - João Delgado
- Epidemiology and Public Health Group, University of Exeter Medical School, UK
| | - Luke C Pilling
- Epidemiology and Public Health Group, University of Exeter Medical School, UK
| | - Kirsty Bowman
- Epidemiology and Public Health Group, University of Exeter Medical School, UK
| | - Jane A H Masoli
- Epidemiology and Public Health Group, University of Exeter Medical School, UK.,Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, UK
| | - George A Kuchel
- Department of Geriatric Medicine, Center on Aging, University of Connecticut, Farmington
| | | | - David Melzer
- Epidemiology and Public Health Group, University of Exeter Medical School, UK
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Sabia S, Fayosse A, Dumurgier J, Schnitzler A, Empana JP, Ebmeier KP, Dugravot A, Kivimäki M, Singh-Manoux A. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. BMJ 2019; 366:l4414. [PMID: 31391187 PMCID: PMC6664261 DOI: 10.1136/bmj.l4414] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia. DESIGN Prospective cohort study. SETTING Civil service departments in London (Whitehall II study; study inception 1985-88). PARTICIPANTS 7899 participants with data on the cardiovascular health score at age 50. EXPOSURES The cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health. MAIN OUTCOME MEASURE Incident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017. RESULTS 347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were -1.5 (95% confidence interval -2.3 to -0.7) for the group with intermediate cardiovascular health and -1.9 (-2.8 to -1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score). CONCLUSION Adherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.
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Affiliation(s)
- Séverine Sabia
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aurore Fayosse
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
| | - Julien Dumurgier
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
- Cognitive Neurology Center, Lariboisière - Fernand Widal Hospital, AP-HP, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Alexis Schnitzler
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
| | - Jean-Philippe Empana
- Inserm, U970, Integrative Epidemiology of Cardiovascular Disease, Paris Descartes University, Paris, France
| | | | - Aline Dugravot
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
- Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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30
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Perales-Puchalt J, Vidoni ML, Rodríguez JL, Vidoni ED, Billinger S, Burns J, Guerchet M, Lee M. Cardiovascular health and dementia incidence among older adults in Latin America: Results from the 10/66 study. Int J Geriatr Psychiatry 2019; 34:1041-1049. [PMID: 30908765 PMCID: PMC6579616 DOI: 10.1002/gps.5107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. This study aimed to assess the longitudinal association between CVH and dementia in six Latin American countries. METHODS We analyzed longitudinal data from the 10/66 study that included nondementia residents at baseline aged 65+ in six Latin American countries (n = 6447) and were followed up for 3 years. An index of modifiable CVH factors (ranging from 0 to 14) was calculated. Incident dementia was modeled using competing risk regression to adjust for risk of death. RESULTS The sample included 6.2% participants with poor (0-5), 81.0% with moderate (6-10), and 12.8% with ideal CVH (11-14). At follow-up, 9.4% had developed dementia and 13.1% had died. Compared with those with poor CVH, participants with moderate and ideal levels of CVH had a significantly lower risk of dementia in both the unadjusted (subhazard ratio for moderate, 0.77; ideal, 0.59) and adjusted models (moderate, 0.73; ideal, 0.66). CONCLUSION Moderate and ideal levels of CVH in old age may protect against dementia incidence. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries.
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Affiliation(s)
| | | | - Juan Llibre Rodríguez
- Facultad de Medicina Finley-Albarrán, Universidad de Ciencias Médicas de la Habana, Habana, 11500, Cuba
| | - Eric D Vidoni
- University of Kansas Alzheimer’s Disease Center, MS6002, Fairway, KS 66205, USA
| | - Sandra Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jeffrey Burns
- University of Kansas Alzheimer’s Disease Center, MS6002, Fairway, KS 66205, USA
| | - Maëlenn Guerchet
- King’s College London, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, United Kingdom
| | - MinJae Lee
- The University of Texas Health Science Center at Houston, McGovern Medical School; Houston, TX 77030, USA
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Peters R, Booth A, Rockwood K, Peters J, D’Este C, Anstey KJ. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. BMJ Open 2019; 9:e022846. [PMID: 30782689 PMCID: PMC6352772 DOI: 10.1136/bmjopen-2018-022846] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health, Imperial College London, London, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Jean Peters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine D’Este
- Australian National University (ANU), Canberra, Australian Capital Territory, Australia
- University of Newcastle, Callaghan, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Lee J. The Relationship Between Physical Activity and Dementia: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Gerontol Nurs 2018; 44:22-29. [DOI: 10.3928/00989134-20180814-01] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/28/2018] [Indexed: 12/28/2022]
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Samieri C, Perier MC, Gaye B, Proust-Lima C, Helmer C, Dartigues JF, Berr C, Tzourio C, Empana JP. Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia. JAMA 2018; 320:657-664. [PMID: 30140876 PMCID: PMC6142948 DOI: 10.1001/jama.2018.11499] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE Evidence is limited regarding the relation between cardiovascular health level and dementia risk. OBJECTIVE To investigate the association between cardiovascular health level, defined using the 7-item tool from the American Heart Association (AHA), and risk of dementia and cognitive decline in older persons. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study of persons aged 65 years or older from Bordeaux, Dijon, and Montpellier, France, without history of cardiovascular diseases or dementia at baseline who underwent repeated in-person neuropsychological testing (January 1999-July 2016) and systematic detection of incident dementia (date of final follow-up, July 26, 2016). EXPOSURES The number of the AHA's Life's Simple 7 metrics at recommended optimal level (nonsmoking, body mass index <25, regular physical activity, eating fish twice a week or more and fruits and vegetables at least 3 times a day, cholesterol <200 mg/dL [untreated], fasting glucose <100 mg/dL [untreated], and blood pressure <120/80 mm Hg [untreated]; score range, 0-7) and a global cardiovascular health score (range, 0-14; poor, intermediate, and optimal levels of each metric assigned a value of 0, 1, and 2, respectively). MAIN OUTCOMES AND MEASURES Incident dementia validated by an expert committee and change in a composite score of global cognition (in standard units, with values indicating distance from population means, 0 equal to the mean, and +1 and -1 equal to 1 SD above and below the mean). RESULTS Among 6626 participants (mean age, 73.7 years; 4200 women [63.4%]), 2412 (36.5%), 3781 (57.1%), and 433 (6.5%) had 0 to 2, 3 to 4, and 5 to 7 health metrics at optimal levels, respectively, at baseline. Over a mean follow-up duration of 8.5 (range, 0.6-16.6) years, 745 participants had incident adjudicated dementia. Compared with the incidence rate of dementia of 1.76 (95% CI, 1.38-2.15) per 100 person-years among those with 0 or 1 health metrics at optimal levels, the absolute differences in incident dementia rates for 2, 3, 4, 5, and 6 to 7 metrics were, respectively, -0.26 (95% CI, -0.48 to -0.04), -0.59 (95% CI, -0.80 to -0.38), -0.43 (95% CI, -0.65 to -0.21), -0.93 (95% CI, -1.18 to -0.68), and -0.96 (95% CI, -1.37 to -0.56) per 100 person-years. In multivariable models, the hazard ratios for dementia were 0.90 (95% CI, 0.84-0.97) per additional optimal metric and 0.92 (95% CI, 0.89-0.96) per additional point on the global score. Furthermore, the gain in global cognition associated with each additional optimal metric at baseline was 0.031 (95% CI, 0.009-0.053) standard units at inclusion, 0.068 (95% CI, 0.045-0.092) units at year 6, and 0.072 (95% CI, 0.042-0.102) units at year 12. CONCLUSIONS AND RELEVANCE In this cohort of older adults, increased numbers of optimal cardiovascular health metrics and a higher cardiovascular health score were associated with a lower risk of dementia and lower rates of cognitive decline. These findings may support the promotion of cardiovascular health to prevent risk factors associated with cognitive decline and dementia.
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Affiliation(s)
- Cécilia Samieri
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Marie-Cécile Perier
- Université de Paris-Descartes, INSERM, Paris Cardiovascular Research Center, Paris, France
| | - Bamba Gaye
- Université de Paris-Descartes, INSERM, Paris Cardiovascular Research Center, Paris, France
| | - Cécile Proust-Lima
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Catherine Helmer
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
- INSERM CIC-1401 Bordeaux, Clinical Epidemiology Unit, Bordeaux, France
| | - Jean-François Dartigues
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
- CHU Bordeaux, Bordeaux, France
| | - Claudine Berr
- Université de Montpellier, INSERM, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Christophe Tzourio
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
- CHU Bordeaux, Bordeaux, France
| | - Jean-Philippe Empana
- Université de Paris-Descartes, INSERM, Paris Cardiovascular Research Center, Paris, France
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