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Wolski L, Bopp AK, Schwientek AK, Langer S, Dogan V, Grimmer T. [Brain check-up: a structured approach diagnosing mild cognitive impairment in the primary care setting]. Z Gerontol Geriatr 2024:10.1007/s00391-024-02319-y. [PMID: 38839657 DOI: 10.1007/s00391-024-02319-y] [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: 04/02/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The reason-related identification of mild cognitive impairment (MCI) in primary care is helpful to treat reversible causes or decelerate progression to dementia by optimal management of existing risk factors. In this process general practitioners are in a key position. The present feasibility study investigated the practicability of a diagnostic algorithm (brain check-up), comprising neuropsychological examinations, differential diagnoses and follow-up measures. METHOD By means of a standardized questionnaire, the utilization and practicability of the brain check-up was surveyed in n = 37 medical practices of general practitioners and internists in Germany. RESULTS The brain check-up was performed by n = 37 physicians in 389 patients (66%). The main barriers to implementation included patients' fear of facing the results, the professionals' lack of time, and costs. Overall, 73% of the participants agreed that the brain check-up was practical in everyday treatment. Long waiting times for an appointment with a neurological/psychiatric specialist were perceived as a barrier for optimal care. CONCLUSION The structured algorithm is convenient in physician's everyday practice and can contribute to identify patients with MCI more easily. Therefore, it appears to be a helpful tool in primary care. To achieve sustainability in everyday use, identified barriers need to be addressed during the implementation phase.
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Affiliation(s)
- Lucas Wolski
- Klinik für Psychiatrie und Psychotherapie, Zentrum für kognitive Störungen, Klinikum rechts der Isar, Technische Universität München, Möhlstraße 26, 81675, München, Deutschland.
| | | | - Ann-Kathrin Schwientek
- Klinik für Psychiatrie und Psychotherapie, Zentrum für kognitive Störungen, Klinikum rechts der Isar, Technische Universität München, Möhlstraße 26, 81675, München, Deutschland
| | | | - Vildan Dogan
- Klinik für Psychiatrie und Psychotherapie, Zentrum für kognitive Störungen, Klinikum rechts der Isar, Technische Universität München, Möhlstraße 26, 81675, München, Deutschland
| | - Timo Grimmer
- Klinik für Psychiatrie und Psychotherapie, Zentrum für kognitive Störungen, Klinikum rechts der Isar, Technische Universität München, Möhlstraße 26, 81675, München, Deutschland
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Cui X, Zheng X, Lu Y. Prediction Model for Cognitive Impairment among Disabled Older Adults: A Development and Validation Study. Healthcare (Basel) 2024; 12:1028. [PMID: 38786438 PMCID: PMC11121056 DOI: 10.3390/healthcare12101028] [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: 03/22/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Disabled older adults exhibited a higher risk for cognitive impairment. Early identification is crucial in alleviating the disease burden. This study aims to develop and validate a prediction model for identifying cognitive impairment among disabled older adults. A total of 2138, 501, and 746 participants were included in the development set and two external validation sets. Logistic regression, support vector machine, random forest, and XGBoost were introduced to develop the prediction model. A nomogram was further established to demonstrate the prediction model directly and vividly. Logistic regression exhibited better predictive performance on the test set with an area under the curve of 0.875. It maintained a high level of precision (0.808), specification (0.788), sensitivity (0.770), and F1-score (0.788) compared with the machine learning models. We further simplified and established a nomogram based on the logistic regression, comprising five variables: age, daily living activities, instrumental activity of daily living, hearing impairment, and visual impairment. The areas under the curve of the nomogram were 0.871, 0.825, and 0.863 in the internal and two external validation sets, respectively. This nomogram effectively identifies the risk of cognitive impairment in disabled older adults.
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Affiliation(s)
| | | | - Yun Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing 211198, China; (X.C.); (X.Z.)
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Canevelli M, Wallace LMK, Bruno G, Cesari M, Rockwood K, Ward DD. Frailty is associated with the clinical expression of neuropsychological deficits in older adults. Eur J Neurol 2024; 31:e16072. [PMID: 37738515 PMCID: PMC11235878 DOI: 10.1111/ene.16072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to determine whether frailty is associated with the relationship between neuropsychological markers and global cognition in older adults. METHODS Cross-sectional analyzes were conducted of baseline data from three large cohort studies: National Alzheimer's Coordinating Center (NACC), Rush Memory and Aging Project (MAP) and Alzheimer's Disease Neuroimaging Initiative (ADNI). Studies recruited North American participants along the spectrum of cognitive functioning (44% no cognitive impairment at baseline). A frailty index was computed in each dataset. Frailty indices, neuropsychological tests (including measures of processing speed, episodic, semantic and working memory) and Mini-Mental State Examination (MMSE) scores were the variables of interest, with age, sex, education and apolipoprotein E ε4 evaluated as confounders. RESULTS Across all studies, 23,819 participants aged 55-104 (57% female) were included in analyzes. Frailty index scores were significantly and inversely associated with MMSE scores and significantly moderated relationships between neuropsychological test scores and MMSE scores. In participants with higher frailty index scores, lower neuropsychological test scores were more strongly associated with lower MMSE scores (standardized interaction coefficients ranged from -0.19 to -1.17 in NACC, -0.03 to -2.27 in MAP and -0.04 to -0.38 in ADNI, depending on the neuropsychological test). These associations were consistent across the different databases and were mostly independent of the composition of frailty indices (i.e., after excluding possible symptoms of dementia). CONCLUSIONS Amongst older Americans, frailty is associated with the cognitive expression of neuropsychological deficits. Implementation of frailty assessment in routine neurological and neuropsychological practice should be considered to optimize care outcomes for older adults.
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Affiliation(s)
- Marco Canevelli
- Department of Human NeuroscienceSapienza UniversityRomeItaly
- Aging Research Center, Department of Neurobiology, Care Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
| | | | - Giuseppe Bruno
- Department of Human NeuroscienceSapienza UniversityRomeItaly
| | - Matteo Cesari
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Kenneth Rockwood
- Divisions of Geriatric Medicine, Department of Medicine & NeurologyDalhousie UniversityHalifaxNova ScotiaCanada
- Geriatric Medicine Research, Centre for Health Care of the ElderlyNova Scotia Health AuthorityHalifaxNova ScotiaCanada
- Kathryn Allen Weldon Professor of Alzheimer Research, Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - David D. Ward
- Divisions of Geriatric Medicine, Department of Medicine & NeurologyDalhousie UniversityHalifaxNova ScotiaCanada
- Geriatric Medicine Research, Centre for Health Care of the ElderlyNova Scotia Health AuthorityHalifaxNova ScotiaCanada
- Faculty of Medicine, Centre for Health Services ResearchThe University of QueenslandWoolloongabbaQueenslandAustralia
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Borson S, Small GW, O'Brien Q, Morrello A, Boustani M. Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician. BMC PRIMARY CARE 2023; 24:233. [PMID: 37932666 PMCID: PMC10626639 DOI: 10.1186/s12875-023-02185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Primary care clinicians (PCCs) are typically the first practitioners to detect cognitive impairment in their patients, including those with Alzheimer's disease or related dementias (ADRD). However, conversations around cognitive changes can be challenging for patients, family members, and clinicians to initiate, with all groups reporting barriers to open dialogue. With the expanding array of evidence-based interventions for ADRD, from multidomain care management to novel biotherapeutics for early-stage AD, incorporating conversations about brain health into routine healthcare should become a standard of care. We conducted a systematic review to identify barriers to and facilitators of brain health conversations in primary care settings. METHODS We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for qualitative or quantitative studies conducted in the US between January 2000 and October 2022 that evaluated perceptions of cognition and provider-patient brain health conversations prior to formal screening for, or diagnosis of, mild cognitive impairment or ADRD. We assessed the quality of the included studies using the Mixed Methods Appraisal Tool. RESULTS In total, 5547 unique abstracts were screened and 22 articles describing 19 studies were included. The studies explored perceptions of cognition among laypersons or clinicians, or provider-patient interactions in the context of a patient's cognitive concerns. We identified 4 main themes: (1) PCCs are hesitant to discuss brain health and cognitive concerns; (2) patients are hesitant to raise cognitive concerns; (3) evidence to guide clinicians in developing treatment plans that address cognitive decline is often poorly communicated; and (4) social and cultural context influence perceptions of brain health and cognition, and therefore affect clinical engagement. CONCLUSIONS Early conversations about brain health between PCCs and their patients are rare, and effective tools, processes, and strategies are needed to make these vital conversations routine.
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Affiliation(s)
- Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, 31 E. MacArthur Crescent B414, Santa Ana, Los Angeles, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Gary W Small
- Department of Psychiatry and Behavioral Health, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Quentin O'Brien
- Scientific and Medical Services, Health & Wellness Partners, LLC, Upper Saddle River, NJ, USA
- The School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Andrea Morrello
- Scientific and Medical Services, Health & Wellness Partners, LLC, Upper Saddle River, NJ, USA
| | - Malaz Boustani
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Holz MR, Kochhann R, da Silva PF, Wilson MA, Fonseca RP. Brief instrument for direct complex functionality assessment: a new ecological tool. Front Neurosci 2023; 17:1250188. [PMID: 38027502 PMCID: PMC10654966 DOI: 10.3389/fnins.2023.1250188] [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: 06/29/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Direct Assessment of Functional Status (DAFS) is the only instrument validated in Brazil that assesses functionality directly with the patient. However, this clinical tool takes a long time to be administered. This limits its use in hospitals and outpatient clinics that require brief assessment instruments. Additionally, we need to count with a direct assessment because the number of older adults living alone is increasing and we thus lack reliable informants. Objective This study aimed to present the development and content validity evidence of a direct complex functionality test for older adults, the Brief Instrument for Direct Functionality Assessment (BIDFA). Method A total sample of 30 older adults and eight expert judges took part in the study stages. The BIDFA construction stages were: (1) literature review of functionality instruments; (2) development of seven ecological tasks to evaluate the performance of daily complex activities with the older adults; (3) content analysis by eight expert judges; (4) pilot study with 30 older adults; (5) the ecological analysis of items; (6) focus group analysis; and (7) final version of the BIDFA. Results The BIDFA had evidence of content validity with an agreement index of 96.5%. The final version of BIDFA was left with six domains of complex functionality divided into semantic memory and time orientation; shopping skills; executive attention, math and finance skills; organization; planning and procedural memory; and problem-solving. The complex functionality score by BIDFA ranges from 0 to 100 points. Conclusion The BIDFA was found to have good content validity by the expert judges and by the ecological analysis of the items by the older adults. The new instrument is expected to help assess the functional status of older adults, in an abbreviated context including complex functionality demands, with a wider range of total and subdomain scores.
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Affiliation(s)
- Maila Rossato Holz
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Patrícia Ferreira da Silva
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Maximiliano A. Wilson
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris) and École des Sciences de La Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Rochele Paz Fonseca
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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O’Donovan MR, Cornally N, O’Caoimh R. Validation of a Harmonised, Three-Item Cognitive Screening Instrument for the Survey of Health, Ageing and Retirement in Europe (SHARE-Cog). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6869. [PMID: 37835139 PMCID: PMC10572728 DOI: 10.3390/ijerph20196869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/15/2023]
Abstract
More accurate and standardised screening and assessment instruments are needed for studies to better understand the epidemiology of mild cognitive impairment (MCI) and dementia in Europe. The Survey of Health, Ageing and Retirement in Europe (SHARE) does not have a harmonised multi-domain cognitive test available. The current study proposes and validates a new instrument, the SHARE cognitive instrument (SHARE-Cog), for this large European longitudinal cohort. Three cognitive domains/sub-tests were available across all main waves of the SHARE and incorporated into SHARE-Cog; these included 10-word registration, verbal fluency (animal naming) and 10-word recall. Subtests were weighted using regression analysis. Diagnostic accuracy was assessed from the area under the curve (AUC) of receiver operating characteristic curves. Diagnostic categories included normal cognition (NC), subjective memory complaints (SMC), MCI and dementia. A total of 20,752 participants were included from wave 8, with a mean age of 75 years; 55% were female. A 45-point SHARE-Cog was developed and validated and had excellent diagnostic accuracy for identifying dementia (AUC = 0.91); very good diagnostic accuracy for cognitive impairment (MCI + dementia), (AUC = 0.81); and good diagnostic accuracy for distinguishing MCI from dementia (AUC = 0.76) and MCI from SMC + NC (AUC = 0.77). SHARE-Cog is a new, short cognitive screening instrument developed and validated to assess cognition in the SHARE. In this cross-sectional analysis, it has good-excellent diagnostic accuracy for identifying cognitive impairment in this wave of SHARE, but further study is required to confirm this in previous waves and over time.
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Affiliation(s)
- Mark R. O’Donovan
- Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, T12WE28 Cork, Ireland;
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, T12AK54 Cork, Ireland;
| | - Rónán O’Caoimh
- Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, T12WE28 Cork, Ireland;
- Department of Geriatric Medicine, Mercy University Hospital, T12WE28 Cork, Ireland
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Åberg AC, Petersson JR, Giedraitis V, McKee KJ, Rosendahl E, Halvorsen K, Berglund L. Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study. BMC Geriatr 2023; 23:535. [PMID: 37660032 PMCID: PMC10475186 DOI: 10.1186/s12877-023-04262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults. METHODS The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models. RESULTS During follow-up time (median (range) 3.7 (0.1-6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up. CONCLUSIONS TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05893524: https://www. CLINICALTRIALS gov/study/NCT05893524?id=NCT05893524&rank=1 .
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Affiliation(s)
- Anna Cristina Åberg
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden.
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden.
| | - Johanna R Petersson
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden
| | - Vilmantas Giedraitis
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden
| | - Kevin J McKee
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden
| | - Kjartan Halvorsen
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Mechatronics, School of Engineering and Sciences, Campus Estado de Mexico, Tecnologico de Monterrey, Atizapan, Mexico, Carretera Lago de Guadalupe Km 3.5, 52926, Atizapan, Estado de Mexico, Mexico
| | - Lars Berglund
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden
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Glenn JM, Bryk K, Myers JR, Anderson J, Onguchi K, McFarlane J, Ozaki S. The efficacy and practicality of the Neurotrack Cognitive Battery assessment for utilization in clinical settings for the identification of cognitive decline in an older Japanese population. Front Aging Neurosci 2023; 15:1206481. [PMID: 37719874 PMCID: PMC10501833 DOI: 10.3389/fnagi.2023.1206481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Japan has the largest aging population with 33% of the population over the age of 60 years. The number of Japanese adults with dementia is estimated to be approximately 4.6 million, comprising nearly 15% of the older adult population. It is critical to administer cognitive assessments early in the disease state that have high reliability and low user burden to detect negative cognitive changes as early as possible; however, current preclinical AD detection methods are invasive, time-consuming, and expensive. A number of traditional and digital cognitive assessments are also available, but many of these tests are time-consuming, taxing to the user, and not widely scalable. The purpose of this study was to incorporate a digital cognitive assessment battery into a standard clinical assessment performed within a Japanese-based neuropsychology clinic to assess the diagnostic accuracy and the relationship between the digital Neurotrack Cognitive Assessment Battery (N-CAB) to traditional cognitive assessments. Methods Healthy individuals and probable Alzheimer's patients completed the N-CAB, as well as two traditional cognitive assessments, the Mini Mental Status Exam (MMSE) and the Revised Hasegawa's Dementia Scale (HDS-R). Results Our results demonstrate the Image Pairs hand-response phase of the N-CAB had the highest diagnostic accuracy with 95% sensitivity and 89% specificity to probable Alzheimer's disease. This was closely followed by the Symbol Match assessment, with a 96% sensitivity and 74% specificity to probable Alzheimer's disease. Additionally, Symbol Match and Path Points used in combination resulted in a sensitivity of 94%, specificity of 90%; a model with all N-CAB assessments resulted in a sensitivity and specificity of 100%. All N-CAB assessments had moderate to strong and significant correlations with the MMSE and HDS-R. Discussion Together, this suggests that the N-CAB assessment battery may be an appropriate alternative for the clinical screening of cognition for earlier detection of Alzheimer's disease.
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Affiliation(s)
- Jordan M. Glenn
- Neurotrack Technologies, Inc., Redwood City, CA, United States
| | - Kelsey Bryk
- Neurotrack Technologies, Inc., Redwood City, CA, United States
| | | | - John Anderson
- Neurotrack Technologies, Inc., Redwood City, CA, United States
| | - Kaori Onguchi
- Neurotrack Technologies, Inc., Redwood City, CA, United States
| | - Jacob McFarlane
- Neurotrack Technologies, Inc., Redwood City, CA, United States
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Tan LF, Li H, Pan A, Teng GG, Koh WP. Association between gout at midlife and cognitive impairment at late life - The Singapore Chinese Health Study. Arch Gerontol Geriatr 2023; 111:104996. [PMID: 36958148 DOI: 10.1016/j.archger.2023.104996] [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: 11/14/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES The association between gout and risk of cognitive impairment or dementia is not well established. We examined the relationship between having gout at midlife and the risk of developing cognitive impairment later on. METHODS We used data of 16,948 participants from the population-based Singapore Chinese Health Study cohort. Participants were recruited from 1993 to 1998 at mean age of 53 years and re-contacted for three follow-up interviews: 1999 to 2004 for follow-up 1, 2006 to 2010 for follow-up 2, and 2014 to 2016 for follow-up 3. History of physician-diagnosed gout was self-reported at follow-up 1 and follow-up 2, while cognitive function was assessed with the Singapore modified Mini-Mental State Examination during follow-up 3, when participants had a mean age of 73.2 years. RESULTS Gout was reported by 1281 (7.6%) participants at either follow-up 1 or 2, and 2243 (14.4%) had cognitive impairment at follow-up 3. A history of gout was associated with reduced risk of cognitive impairment (OR 0.78, 95% CI 0.65-0.93). This risk was reduced in a stepwise manner with either increased duration of gout or lower age at first diagnosis of gout (Ptrend <0.001). Compared to those without gout, those with gout for ≥20 years (OR 0.56, 95% CI 0.39-0.80) and those with age of onset of gout <50 years old (OR 0.59, 95% CI 0.37-0.94) had a lower risk of developing cognitive impairment. CONCLUSION A young age of onset or a long history of gout was associated with reduced risk of cognitive impairment in late life.
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Affiliation(s)
- Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, National University Health System, Singapore
| | - Huiqi Li
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gim Gee Teng
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore; Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore.
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
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Parfenov VA. Management of patients with cognitive impairment. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2023. [DOI: 10.14412/2074-2711-2023-1-97-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- V. A. Parfenov
- Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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Pépin M, Levassort H, Boucquemont J, Lambert O, Alencar de Pinho N, Turinici M, Helmer C, Metzger M, Cheddani L, Frimat L, Combe C, Fouque D, Laville M, Ayav C, Liabeuf S, Jacquelinet C, Teillet L, Stengel B, Massy ZA. Cognitive performance is associated with glomerular filtration rate in patients with chronic kidney disease: results from the CKD-REIN cohort. J Neurol Neurosurg Psychiatry 2023; 94:457-466. [PMID: 36693722 DOI: 10.1136/jnnp-2022-330347] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with cognitive impairment in general population. We assessed the association between kidney and cognitive functions in patients with CKD and the influence of cardiovascular (CV) risk factors, and depression on this association. METHODS The CKD-Renal Epidemiology and Information Network cohort included 3033 patients with CKD stages 3-4, followed for 5 years. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) and estimated glomerular filtration rate (eGFR) with the CKD-Epidemiology Collaboration equation-creatinin formula. Evolution of the MMSE score over time and its association with baseline eGFR were investigated with linear mixed models. We assessed the risk of incident cognitive outcome (hospitalisation or death with relevant International Classification of Disease-10 codes), with a Cox proportional hazard model. RESULTS The mean age was 66.8, the mean eGFR was 33 mL/min/1.73 m2 and 387 patients (13.0%) had an MMSE score below 24 at baseline. A 10 mL/min/1.73 m2 decrement of baseline eGFR was associated with a mean MMSE decrease of 0.12 (95% CI 0.04 to 0.19) after adjustment for demographic characteristics, depression, CV risk factors and disease; but baseline eGFR was not associated with MMSE temporal evolution. HR for cognitive outcome during follow-up (median 2.01 years) associated with a 10 mL/min/1.73 m2 decrement of baseline eGFR was 1.35 (1.07, 1.70) (p=0.01) after adjustment. CONCLUSIONS In patients with CKD, lower eGFR was associated with worse cognitive performance and incident cognitive events, independently of demographics, CV risk factors and depression. TRIAL REGISTRATION NUMBER NCT03381950.
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Affiliation(s)
- Marion Pépin
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France .,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Hélène Levassort
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Julie Boucquemont
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Oriane Lambert
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | | | - Monica Turinici
- Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,LIRAES ED 262, Universite de Paris, Paris, France
| | - Catherine Helmer
- Bordeaux Population Health Center, INSERM U1219, Bordeaux, France
| | - Marie Metzger
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Lynda Cheddani
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Luc Frimat
- Nephrology, Lorraine University, CHRU de Nancy, Vandoeuvre, France.,EA 4360, Lorraine University, INSERM CIC-EC, Apemac, France
| | - Christian Combe
- Nephrology, Bordeaux University Hospital, Bordeaux, France.,Biotis, INSERM U1026, Bordeaux, France
| | - Denis Fouque
- Nephrology, Claude Bernard Lyon 1 University, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Maurice Laville
- Carmen, INSERM U1060, University Claude Bernard Lyon 1, Pierre Benite, France
| | - Carole Ayav
- Clinical Epidemiology, INSERM, Lorraine University, CHRU de Nancy, Nancy, France
| | - Sophie Liabeuf
- Pharmacology, Amiens University, Amiens, France.,MP3CV Laboratory EA7517, Université de Picardie Jules Verne, Amiens, France
| | - Christian Jacquelinet
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Medical and Scientific Departement, Agence de la Biomedecine, La Plaine Saint-Denis, France
| | - Laurent Teillet
- Geriatrics, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France.,Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Bénédicte Stengel
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France
| | - Ziad A Massy
- Clinical Epidemiology, CESP, INSERM, Paris Saclay University, Villejuif, France.,Nephrology, APHP, UVSQ, Hopital Ambroise-Pare, Boulogne-Billancourt, France
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