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Martinec Nováková L, Georgi H, Vlčková K, Kopeček M, Babuská A, Havlíček J. Small effects of olfactory identification and discrimination on global cognitive and executive performance over 1 year in aging people without a history of age-related cognitive impairment. Physiol Behav 2024; 282:114579. [PMID: 38710351 DOI: 10.1016/j.physbeh.2024.114579] [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: 01/25/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024]
Abstract
Olfactory and cognitive performance share neural correlates profoundly affected by physiological aging. However, whether odor identification and discrimination scores predict global cognitive status and executive function in healthy older people with intact cognition is unclear. Therefore, in the present study, we set out to elucidate these links in a convenience sample of 204 independently living, cognitively intact healthy Czech adults aged 77.4 ± 8.7 (61-97 years) over two waves of data collection (one-year interval). We used the Czech versions of the Montreal Cognitive Assessment (MoCA) to evaluate global cognition, and the Prague Stroop Test (PST), Trail Making Test (TMT), and several verbal fluency (VF) tests to assess executive function. As a subsidiary aim, we aimed to examine the contribution of olfactory performance towards achieving a MoCA score above vs. below the published cut-off value. We found that the MoCA scores exhibited moderate associations with both odor identification and discrimination. Furthermore, odor identification significantly predicted PST C and C/D scores. Odor discrimination significantly predicted PST C/D, TMT B/A, and standardized composite VF scores. Our findings demonstrate that olfaction, on the one hand, and global cognition and executive function, on the other, are related even in healthy older people.
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Affiliation(s)
- Lenka Martinec Nováková
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Pátkova 2137/5, 182 00 Prague 8 - Libeň, Czech Republic; Department of Chemical Education and Humanities, University of Chemistry and Technology, Prague, Technická 5, 166 28 Prague 6 - Dejvice, Czech Republic.
| | - Hana Georgi
- Prague College of Psychosocial Studies, Hekrova 805, 149 00 Prague 4, Czech Republic
| | - Karolína Vlčková
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10 - Vršovice, Czech Republic; Thomayer Teaching Hospital, Vídeňská 800, 140 59 Prague 4 - Krč, Czech Republic
| | - Miloslav Kopeček
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10 - Vršovice, Czech Republic; National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Anna Babuská
- Department of Zoology, Faculty of Science, Charles University, Viničná 7, 128 00 Prague 2, Czech Republic
| | - Jan Havlíček
- Department of Zoology, Faculty of Science, Charles University, Viničná 7, 128 00 Prague 2, Czech Republic
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Lam AKF, Carrick J, Kao CH, Phillips CL, Zheng YZ, Yee BJ, Kim JW, Grunstein RR, Naismith SL, D’Rozario AL. Electroencephalographic slowing during REM sleep in older adults with subjective cognitive impairment and mild cognitive impairment. Sleep 2024; 47:zsae051. [PMID: 38394454 PMCID: PMC11168761 DOI: 10.1093/sleep/zsae051] [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: 09/19/2023] [Revised: 12/27/2023] [Indexed: 02/25/2024] Open
Abstract
STUDY OBJECTIVES In older adults with Alzheimer's disease, slowing of electroencephalographic (EEG) activity during REM sleep has been observed. Few studies have examined EEG slowing during REM in those with mild cognitive impairment (MCI) and none have examined its relationship with cognition in this at-risk population. METHODS Two hundred and ten older adults (mean age = 67.0, SD = 8.2 years) underwent comprehensive neuropsychological, medical, and psychiatric assessment and overnight polysomnography. Participants were classified as subjective cognitive impairment (SCI; n = 75), non-amnestic MCI (naMCI, n = 85), and amnestic MCI (aMCI, n = 50). REM EEG slowing was defined as (δ + θ)/(α + σ + β) power and calculated for frontal, central, parietal, and occipital regions. Analysis of variance compared REM EEG slowing between groups. Correlations between REM EEG slowing and cognition, including learning and memory, visuospatial and executive functions, were examined within each subgroup. RESULTS The aMCI group had significantly greater REM EEG slowing in the parietal and occipital regions compared to the naMCI and SCI groups (partial η2 = 0.06, p < 0.05 and 0.06, p < 0.05, respectively), and greater EEG slowing in the central region compared to SCI group (partial η2 = 0.03, p < 0.05). Greater REM EEG slowing in parietal (r = -0.49) and occipital regions (r = -0.38 [O1/M2] and -0.33 [O2/M1]) were associated with poorer visuospatial performance in naMCI. CONCLUSIONS REM EEG slowing may differentiate older adults with memory impairment from those without. Longitudinal studies are now warranted to examine the prognostic utility of REM EEG slowing for cognitive and dementia trajectories.
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Affiliation(s)
- Aaron Kin Fu Lam
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Macquarie University, Sydney, NSW, Australia
| | - James Carrick
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
| | - Chien-Hui Kao
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Macquarie University, Sydney, NSW, Australia
| | - Craig L Phillips
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Macquarie University, Sydney, NSW, Australia
| | - Yi Zhong Zheng
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, Australia
| | - Brendon J Yee
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Jong Won Kim
- Department of Healthcare IT, Inje University, Gimhae, Gyeongsangnam-do, South Korea
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Angela L D’Rozario
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Macquarie University, Sydney, NSW, Australia
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Yu HH, Tan CC, Huang SJ, Zhang XH, Tan L, Xu W. Predicting the reversion from mild cognitive impairment to normal cognition based on magnetic resonance imaging, clinical, and neuropsychological examinations. J Affect Disord 2024; 353:90-98. [PMID: 38452935 DOI: 10.1016/j.jad.2024.03.009] [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] [Received: 06/13/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Reversion from mild cognitive impairment (MCI) to normal cognition (NC) is not uncommon and indicates a better cognitive trajectory. This study aims to identify predictors of MCI reversion and develop a predicting model. METHOD A total of 391 MCI subjects (mean age = 74.3 years, female = 61 %) who had baseline data of magnetic resonance imaging, clinical, and neuropsychological measurements were followed for two years. Multivariate logistic analyses were used to identify the predictors of MCI reversion after adjusting for age and sex. A stepwise backward logistic regression model was used to construct a predictive nomogram for MCI reversion. The nomogram was validated by internal bootstrapping and in an independent cohort. RESULT In the training cohort, the 2-year reversion rate was 19.95 %. Predictors associated with reversion to NC were higher education level (p = 0.004), absence of APOE4 allele (p = 0.001), larger brain volume (p < 0.005), better neuropsychological measurements performance (p < 0.001), higher glomerular filtration rate (p = 0.035), and lower mean arterial pressure (p = 0.060). The nomogram incorporating five predictors (education, hippocampus volume, the Alzheimer's Disease Assessment Scale-Cognitive score, the Rey Auditory Verbal Learning Test-immediate score, and mean arterial pressure) achieved good C-indexes of 0.892 (95 % confidence interval [CI], 0.859-0.926) and 0.806 (95 % CI, 0.709-0.902) for the training and validation cohort. LIMITATION Observational duration is relatively short; The predicting model warrant further validation in larger samples. CONCLUSION This prediction model could facilitate risk stratification and early management for the MCI population.
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Affiliation(s)
- Hai-Hong Yu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China; Medical College, Qingdao University, Qingdao, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Shu-Juan Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xin-Hao Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
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Pereira ML, Caramelli P, Sá VMD, Rocha PHM, Oliveira JPGD, Amorim RPD, Silva EVD, Delboni VS, Barbosa MT, Miranda LFJRD, de Souza LC. Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38849124 DOI: 10.1055/s-0044-1787138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. OBJECTIVE To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. METHODS Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire. RESULTS The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status. CONCLUSION Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.
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Affiliation(s)
- Marcos Leandro Pereira
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Khronus Saúde e Educação Ltda, Instituto Khronus de Desenvolvimento Humano, Patos de Minas MG, Brazil
- Centro Universitário de Patos de Minas, Curso de Medicina, Patos de Minas MG, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Vannessa Marinara de Sá
- Khronus Saúde e Educação Ltda, Instituto Khronus de Desenvolvimento Humano, Patos de Minas MG, Brazil
| | | | | | | | - Elvis Vieira da Silva
- Centro Universitário de Patos de Minas, Curso de Medicina, Patos de Minas MG, Brazil
| | | | - Maira Tonidandel Barbosa
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | | | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
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Miao W, Lu Y, Xv H, Zheng C, Yang W, Qian X, Chen J, Geng G. Study protocol for a prediction model for mild cognitive impairment in older adults with diabetes mellitus and construction of a nurse-led screening system: a prospective observational study. BMJ Open 2024; 14:e075466. [PMID: 38326248 PMCID: PMC10860066 DOI: 10.1136/bmjopen-2023-075466] [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: 05/09/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION With an increasing number of older adults in China, the number of people with cognitive impairment is also increasing. To decrease the risk of dementia, it is necessary to timely detect mild cognitive impairment (MCI), which is the preliminary stage of dementia. The prevalence of MCI is relatively high among older adults with diabetes mellitus (DM); however, no effective screening strategy has been designed for this population. This study will construct a nurse-led screening system to detect MCI in community-dwelling older adults with DM in a timely manner. METHODS AND ANALYSIS A total of 642 participants with DM will be recruited (n=449 for development, n=193 for validation). The participants will be divided into MCI and none-MCI groups. The candidate predictors will include demographic variables, lifestyle factors, history of diseases, physical examinations, laboratory tests and neuropsychological tests. Univariate analysis, least absolute shrinkage and selection operator regression screening, and multivariate logistic regression analysis will be conducted to identify the outcome indicators. Based on the multivariate logistic regression equation, we will develop a traditional model as a comparison criterion for the machine learning models. The Hosmer-Lemeshow goodness-of-fit test and calibration curve will be used to evaluate the calibration. Sensitivity, specificity, area under the curves and clinical decision curve analysis will be performed for all models. We will report the sensitivity, specificity, area under the curve and decision curve analysis of the validation dataset. A prediction model with better performance will be adopted to form the nurse-led screening system. ETHICS AND DISSEMINATION This prospective study has received institutional approval of the Medical Ethics Committee of Qidong Hospital of TCM (QDSZYY-LL-20220621). Study results will be disseminated through conference presentations, Chinese Clinical Trial Registry and publication. TRIAL REGISTRATION NUMBER ChiCTR2200062855.
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Affiliation(s)
- Weiwei Miao
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Yanling Lu
- Qidong Hospital of TCM, Nantong, Jiangsu, China
| | - Honglian Xv
- Nantong Shibei Nursing Home, Nantong, Jiangsu, China
| | - Chen Zheng
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Wenwen Yang
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Xiangyun Qian
- Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Jianqun Chen
- Nantong Shibei Nursing Home, Nantong, Jiangsu, China
| | - Guiling Geng
- Medical School, Nantong University, Nantong, Jiangsu, China
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Twait EL, Wu JH, Kamarioti M, Basten M, van der Flier WM, Gerritsen L, Geerlings MI. Association of amyloid-beta with depression or depressive symptoms in older adults without dementia: a systematic review and meta-analysis. Transl Psychiatry 2024; 14:25. [PMID: 38225253 PMCID: PMC10789765 DOI: 10.1038/s41398-024-02739-9] [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] [Received: 10/16/2023] [Revised: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024] Open
Abstract
Several lines of evidence have indicated that depression might be a prodromal symptom of Alzheimer's disease (AD). This systematic review and meta-analysis investigated the cross-sectional association between amyloid-beta, one of the key pathologies defining AD, and depression or depressive symptoms in older adults without dementia. A systematic search in PubMed yielded 689 peer-reviewed articles. After full-text screening, nine CSF studies, 11 PET studies, and five plasma studies were included. No association between amyloid-beta and depression or depressive symptoms were found using cerebrospinal fluid (CSF) (0.15; 95% CI: -0.08; 0.37), positron emission topography (PET) (Cohen's d: 0.09; 95% CI: -0.05; 0.24), or plasma (-0.01; 95% CI: -0.23; 0.22). However, subgroup analyses revealed an association in plasma studies of individuals with cognitive impairment. A trend of an association was found in the studies using CSF and PET. This systematic review and meta-analysis suggested that depressive symptoms may be part of the prodromal stage of dementia.
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Affiliation(s)
- Emma L Twait
- Amsterdam UMC, location Vrije Universiteit, Department of General Practice, Van der Boechorststraat 7, Amsterdam, The Netherlands
- Amsterdam Public Health; Aging & Later life, and Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience; Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jen-Hao Wu
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Maria Kamarioti
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lotte Gerritsen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Mirjam I Geerlings
- Amsterdam UMC, location Vrije Universiteit, Department of General Practice, Van der Boechorststraat 7, Amsterdam, The Netherlands.
- Amsterdam Neuroscience; Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
- Amsterdam UMC, location University of Amsterdam, Department of General Practice, Meibergdreef 9, Amsterdam, The Netherlands.
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Rofes A, Beran M, Jonkers R, Geerlings MI, Vonk JMJ. What Drives Task Performance in Animal Fluency in Individuals Without Dementia? The SMART-MR Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3473-3485. [PMID: 37494924 PMCID: PMC10558141 DOI: 10.1044/2023_jslhr-22-00445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/20/2022] [Accepted: 05/09/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE In this study, we aim to understand whether and how performance in animal fluency (i.e., total correct word count) relates to linguistic levels and/or executive functions by looking at sequence information and item-level metrics (i.e., clusters, switches, and word properties). METHOD Seven hundred thirty-one Dutch-speaking individuals without dementia from the Second Manifestations of ARTerial disease-Magnetic Resonance study responded to an animal fluency task (120 s). We obtained cluster size and number of switches for the task, and eight different word properties for each correct word produced. We detected variables that determine total word count with random forests, and used conditional inference trees to assess points along the scales of such variables, at which total word count changes significantly. RESULTS Number of switches, average cluster size, lexical decision response times, word frequency, and concreteness determined total correct word count in animal fluency. People who produced more correct words produced more switches and bigger clusters. People who produced fewer words produced fewer switches and more frequent words. CONCLUSIONS Concurrent with existing literature, individuals without dementia rely on language and executive functioning to produce words in animal fluency. The novelty of our work is that such results were shown based on a data-driven approach using sequence information and item-level metrics. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23713269.
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Affiliation(s)
- Adrià Rofes
- Center for Language and Cognition Groningen (CLCG), University of Groningen, the Netherlands
| | - Magdalena Beran
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, the Netherlands
| | - Roel Jonkers
- Center for Language and Cognition Groningen (CLCG), University of Groningen, the Netherlands
| | - Mirjam I. Geerlings
- Department of General Practice, Amsterdam UMC, Location University of Amsterdam, the Netherlands
- Aging & Later life, and Personalized Medicine, Amsterdam Public Health, Amsterdam UMC, the Netherlands
- Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam Neuroscience, Amsterdam UMC, the Netherlands
| | - Jet M. J. Vonk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, the Netherlands
- Memory and Aging Center, Department of Neurology, University of California San Francisco
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Palmer JM, Huentelman M, Ryan L. More than just risk for Alzheimer's disease: APOE ε4's impact on the aging brain. Trends Neurosci 2023; 46:750-763. [PMID: 37460334 DOI: 10.1016/j.tins.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 08/18/2023]
Abstract
The apolipoprotein ε4 (APOE ε4) allele is most commonly associated with increased risk for late-onset Alzheimer's disease (AD). However, recent longitudinal studies suggest that these risks are overestimated; most ε4 carriers will not develop dementia in their lifetime. In this article, we review new evidence regarding the impact of APOE ε4 on cognition among healthy older adults. We discuss emerging work from animal models suggesting that ε4 impacts brain structure and function in multiple ways that may lead to age-related cognitive impairment, independent from AD pathology. We discuss the importance of taking an individualized approach in future studies by incorporating biomarkers and neuroimaging methods that may better disentangle the phenotypic influences of APOE ε4 on the aging brain from prodromal AD pathology.
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Affiliation(s)
- Justin M Palmer
- The University of Arizona, Tucson, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA.
| | - Matthew Huentelman
- Translational Genomics Research Institute, Phoenix, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Lee Ryan
- The University of Arizona, Tucson, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA.
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9
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Abe T, Yamashita M, Fujiwara Y, Sasai H, Obuchi SP, Ishizaki T, Awata S, Toba K. Fluctuations in Cognitive Test Scores and Loss to Follow-Up in Community-Dwelling Older Adults: The IRIDE Cohort Study. Dement Geriatr Cogn Disord 2023; 52:296-303. [PMID: 37562370 DOI: 10.1159/000531764] [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] [Received: 03/16/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION We examined the relationship between previous fluctuations in Mini-Mental State Examination (MMSE) scores, future changes in MMSE scores, and attrition from follow-up surveys, which helps in a more comprehensive interpretation of repeatedly collected MMSE scores. METHODS This 4-year longitudinal study included 2,073 community-dwelling older adults aged ≥65 years in Japan. The MMSE was administered at baseline (T0), 2 years (T1), and 4 years (T2) follow-up. We performed multinomial logistic regression analysis with the dependent variable, indicating the change in MMSE score from T1 to T2 (categorized as increase, no change [reference category], and decrease) and attrition at T2. The independent variables included the change in MMSE scores from T0 to T1 and MMSE scores at T0 and T1. RESULTS The mean MMSE score was 29 across the three time points. A one-point decrease in MMSE score from T0 to T1 was associated with 79% (95% confidence interval: 1.62, 1.97) higher odds of an increase in MMSE score from T1 to T2 and 28% (1.17, 1.40) higher odds of attrition at T2. A one-point decrement in the MMSE score at T0 and T1 was also associated with an increase in the MMSE score from T1 to T2 and attrition at T2. CONCLUSION Focusing on cognitive fluctuation for 2 years, rather than cognitive function at a point in time, would have no remarkable advantage when focusing on future cognitive function and attrition. Our results emphasize the need for further studies to identify factors that distinguish between those who continue to attend follow-up surveys and show improvements in cognitive test scores and those who drop out.
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Affiliation(s)
- Takumi Abe
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mari Yamashita
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi P Obuchi
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kenji Toba
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Li Y, Ren Y, Cong L, Hou T, Song L, Wang M, Wang X, Han X, Tang S, Zhang Q, Dekhtyar S, Wang Y, Du Y, Qiu C. Association of Lifelong Cognitive Reserve with Dementia and Mild Cognitive Impairment among Older Adults with Limited Formal Education: A Population-Based Cohort Study. Dement Geriatr Cogn Disord 2023; 52:258-266. [PMID: 37517389 PMCID: PMC10614281 DOI: 10.1159/000532131] [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] [Received: 12/02/2022] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Early-life educational attainment contributes to cognitive reserve (CR). We investigated the associations of lifelong CR with dementia and mild cognitive impairment (MCI) among older people with limited formal education. METHODS This population-based cohort study included 2,127 dementia-free participants (≥60 years; 59.4% women; 81.5% with no or elementary school) who were examined at baseline (August-December 2014) and follow-up (March-September 2018). Lifelong CR score at baseline was generated from six lifespan intellectual factors. Dementia, MCI, and their subtypes were defined according to the international criteria. Data were analyzed using Cox proportional-hazards models. RESULTS During the total of 8,330.6 person-years of follow-up, 101 persons were diagnosed with dementia, including 74 with Alzheimer's disease (AD) and 26 with vascular dementia (VaD). The high (vs. low) tertile of lifelong CR score was associated with multivariable-adjusted hazards ratios (95% confidence interval) of 0.28 (0.14-0.55) for dementia and 0.18 (0.07-0.48) for AD. The association between higher CR and reduced AD risk was significant in people aged 60-74 but not in those aged ≥75 years (p for interaction = 0.011). Similarly, among MCI-free people at baseline (n = 1,635), the high (vs. low) tertile of lifelong CR score was associated with multivariable-adjusted hazard ratios of 0.51 (0.38-0.69) for MCI and 0.46 (0.33-0.64) for amnestic MCI. Lifelong CR was not related to VaD or non-amnestic MCI. DISCUSSION High lifelong CR is associated with reduced risks of dementia and MCI, especially AD and amnestic MCI. It highlights the importance of lifelong CR in maintaining late-life cognitive health even among people with no or limited education.
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Affiliation(s)
- Yuanjing Li
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Yifei Ren
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
- Cheeloo College of Medicine, Shandong University, Jinan, PR China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Lin Song
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Mingqi Wang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Xiaojuan Han
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Qinghua Zhang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Serhiy Dekhtyar
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
- Cheeloo College of Medicine, Shandong University, Jinan, PR China
| | - Chengxuan Qiu
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
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11
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Liu W, Huang J, Yan Z, Lin Y, Huang G, Chen X, Wang Z, Spencer PS, Liu J. Association of N-nitrosodimethylamine exposure with cognitive impairment based on the clues of mice and humans. Front Aging Neurosci 2023; 15:1137164. [PMID: 37441677 PMCID: PMC10333700 DOI: 10.3389/fnagi.2023.1137164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
N-nitrosodimethylamine (NDMA) is an environmental and food contaminant, but limited data to concern whether NDMA has adverse effects on the brain. This study first determined the concentration of NDMA in foods from aquaculture markets in Shenzhen, then analyzed the effects on C57BL/6 mice and further evaluated on the urine samples of elderly Chinese residents with normal cognition (NC, n = 144), cognitive decline (CD, n = 116) and mild cognitive impairment (MCI, n = 123). The excessive rate of NDMA in foods was 3.32% (27/813), with a exceeding range of 4.78-131.00 μg/kg. Behavioral tests showed that 60 days treatment of mice with 3 mg/kg NDMA reduced cognitive performance. Cognitive impairment in human was significantly associated with sex, educational levels, length of residence in Shenzhen, household registration, passive smoking, rice, fresh vegetables, bacon products. NDMA was detected in 55.4% (212/383) of urine samples, with a median concentration of 0.23 μg/L (1.20 × 10 -7-157.39 μg/L). The median concentration for NC, CD and MCI were 0.32, 0.27, and 0 μg/L, respectively. The urinary NDMA concentration had a strong negative correlation with cognitive impairment (Kendall's Tau-b = -0.89, P = 0.024). The median estimated daily intake (EDI) of NDMA was determined to be 6.63 ng/kg-bw/day. Taken together, there appears to be an association between NDMA and human and murine cognition, which provides a new clue to Alzheimer's disease (AD).
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Affiliation(s)
- Wei Liu
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020–2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jia Huang
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020–2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Zhi Yan
- Food Inspection and Quarantine Center, Shenzhen Customs, Shenzhen, China
| | - Yankui Lin
- Food Inspection and Quarantine Center, Shenzhen Customs, Shenzhen, China
| | - Guanqin Huang
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020–2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xiao Chen
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020–2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhou Wang
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020–2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Department of Nutrition and Food Safety, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Peter S. Spencer
- Department of Neurology, School of Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, United States
| | - Jianjun Liu
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020–2024), Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
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Levy BR, Slade MD. Role of Positive Age Beliefs in Recovery From Mild Cognitive Impairment Among Older Persons. JAMA Netw Open 2023; 6:e237707. [PMID: 37043204 PMCID: PMC10098975 DOI: 10.1001/jamanetworkopen.2023.7707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/16/2023] [Indexed: 04/13/2023] Open
Abstract
This cohort study examines the contribution of positive age beliefs to recovery from mild cognitive impairment among older persons.
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Affiliation(s)
- Becca R. Levy
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Martin D. Slade
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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13
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Overton M, Sjögren B, Elmståhl S, Rosso A. Mild Cognitive Impairment, Reversion Rates, and Associated Factors: Comparison of Two Diagnostic Approaches. J Alzheimers Dis 2023; 91:585-601. [PMID: 36463443 PMCID: PMC9912719 DOI: 10.3233/jad-220597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND As mild cognitive impairment (MCI) is typically used to identify prodromal stages of dementia, it is essential to identify MCI criteria with high diagnostic stability and prediction of dementia. Moreover, further investigation into pinpointing key factors for reversion is required to foresee future prognosis of MCI patients accurately. OBJECTIVE To explore disparities in diagnostic stability by examining reversion rates produced by two operationalizations of the MCI definition: the widely applied Petersen criteria and a version of the Neuropsychological (NP) criteria and to identify cognitive, lifestyle, and health related factors for reversion. METHODS MCI was retrospectively classified in a sample from the Swedish community-based study Good Aging in Skåne with the Petersen criteria (n = 744, median follow-up = 7.0 years) and the NP criteria (n = 375, median follow-up, 6.7 years), respectively. Poisson regression models estimated the effect of various factors on the likelihood of incident reversion. RESULTS Reversion rates were 323/744 (43.4%, 95% confidence intervals (CI): 39.8; 47.0) and 181/375 (48.3% 95% CI: 43.2; 53.5) for the Petersen criteria and NP criteria, respectively. Participants with impairment in a single cognitive domain, regular alcohol consumption, living with someone, older age, and lower body mass index had a higher likelihood of reverting to normal. CONCLUSION Reversion rates were similar for Petersen and NP criteria indicating that one definition is not superior to the other regarding diagnostic stability. Additionally, the results highlight important aspects such as multiple domain MCI, cohabitation, and the role of alcohol on predicting the trajectory of those diagnosed with MCI.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden,Correspondence to: Marieclaire Overton, Jan Waldenströms gata 35, CRC, Building 28, fl.13,
Skåne University Hospital, SE-205 02, Malmö, Sweden. Tel.: +46 709420138;
E-mail:
| | - Benjamin Sjögren
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Aldana Rosso
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
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Qin Y, Han H, Li Y, Cui J, Jia H, Ge X, Ma Y, Bai W, Zhang R, Chen D, Yi F, Yu H. Estimating Bidirectional Transitions and Identifying Predictors of Mild Cognitive Impairment. Neurology 2023; 100:e297-e307. [PMID: 36220593 PMCID: PMC9869761 DOI: 10.1212/wnl.0000000000201386] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Various resources exist for treating mild cognitive impairment (MCI) or dementia separately as terminal events or for focusing solely on a 1-way path from MCI to dementia without taking into account heterogeneous transitions. Little is known about the trajectory of reversion from MCI to normal cognition (NC) or near-NC and patterns of postreversion, which refers to cognitive trajectories of patients who have reversed from MCI to NC. Our objectives were to (1) quantitatively predict bidirectional transitions of MCI (reversion and progression), (2) explore patterns of future cognitive trajectories for postreversion, and (3) estimate the effects of demographic characteristics, APOE, cognition, daily activity ability, depression, and neuropsychiatric symptoms on transition probabilities. METHODS We constructed a retrospective cohort by reviewing patients with an MCI diagnosis at study entry and at least 2 follow-up visits between June 2005 and February 2021. Defining NC or near-NC and MCI as transient states and dementia as an absorbing state, we used continuous-time multistate Markov models to estimate instantaneous transition intensity between states, transition probabilities from one state to another at any given time during follow-up, and hazard ratios of reversion-related variables. RESULTS Among 24,220 observations from 6,651 participants, there were 2,729 transitions to dementia and 1,785 reversions. As for postreversion, there were 630 and 73 transitions of progression to MCI and dementia, respectively. The transition intensity of progression to MCI for postreversion was 0.317 (2.48-fold greater than that for MCI progression or reversion). For postreversion participants, the probability of progressing to dementia increased by 2% yearly. Participants who progressed to MCI were likely to reverse again (probability of 40% over 15 years). Age, independence level, APOE, cognition, daily activity ability, depression, and neuropsychiatric symptoms were significant predictors of bidirectional transitions. DISCUSSION The nature of bidirectional transitions cannot be ignored in multidimensional MCI research. We found that postreversion participants remained at an increased risk of progression to MCI or dementia over the longer term and experienced recurrent reversions. Our findings may serve as a valuable reference for future research and enable health care professionals to better develop proactive management plans and targeted interventions.
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Affiliation(s)
- Yao Qin
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Hongjuan Han
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Yang Li
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Jing Cui
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Haixia Jia
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Xiaoyan Ge
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Yifei Ma
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Wenlin Bai
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Rong Zhang
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Durong Chen
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Fuliang Yi
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China
| | - Hongmei Yu
- From the Department of Health Statistics (Y.Q., H.H., J.C., X.G., Y.M., W.B., R.Z., D.C., F.Y., H.Y.), School of Public Health, Shanxi Medical University, Taiyuan; Department of Medical Device Ethics (Y.L.), Shanxi Province Cancer Hospital, Taiyuan; Department of Neurology (H.J.), First Hospital of Shanxi Medical University, Taiyuan; and Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment (H.Y.), Taiyuan, China.
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Manly JJ, Jones RN, Langa KM, Ryan LH, Levine DA, McCammon R, Heeringa SG, Weir D. Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project. JAMA Neurol 2022; 79:1242-1249. [PMID: 36279130 PMCID: PMC9593315 DOI: 10.1001/jamaneurol.2022.3543] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
Importance Nationally representative data are critical for understanding the causes, costs, and outcomes associated with dementia and mild cognitive impairment (MCI) in the US and can inform policies aimed at reducing the impact of these conditions on patients, families, and public programs. The nationally representative Health and Retirement Study (HRS) is an essential resource for such data, but the HRS substudy providing dementia diagnostic information was fielded more than 20 years ago and more recent data are needed. Objective The Harmonized Cognitive Assessment Protocol (HCAP) was developed to update national estimates of the prevalence of MCI and dementia in the US and examine differences by age, race, ethnicity, and sex. Design, Setting, and Participants HRS is an ongoing longitudinal nationally representative study of people 51 years and older with staggered entry dates from 1992 to 2022 and follow-up ranging from 4 to 30 years. HCAP is a cross-sectional random sample of individuals in HRS who were 65 years or older in 2016. Of 9972 age-eligible HRS participants, 4425 were randomly selected for HCAP, and 3496 completed a comprehensive neuropsychological test battery and informant interview, none of whom were excluded. Dementia and MCI were classified using an algorithm based on standard diagnostic criteria and comparing test performance to a robust normative sample. Exposures Groups were stratified by age, sex, education, race, and ethnicity. Main Outcomes and Measures National prevalence estimates using population weights. Results The mean (SD) age of the study population sample (N = 3496) was 76.4 (7.6) years, and 2095 participants (60%) were female. There were 551 participants who self-identified as Black and not Hispanic (16%), 382 who self-identified as Hispanic regardless of race (16%), 2483 who self-identified as White and not Hispanic (71%), and 80 who self-identified as another race (2%), including American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, or another self-described race. A total of 393 individuals (10%; 95% CI, 9-11) were classified as having dementia and 804 (22%; 95% CI, 20-24) as having MCI. Every 5-year increase in age was associated with higher risk of dementia (weighted odds ratio [OR], 1.95 per 5-year age difference; 95%, CI, 1.77-2.14) and MCI (OR, 1.17 per 5-year age difference, 95% CI, 1.09-1.26). Each additional year of education was associated with a decrease in risk of dementia (OR, 0.93 per year of school, 95% CI, 0.89-0.97) and MCI (OR, 0.94, 95% CI, 0.91-0.97). Dementia was more common among non-Hispanic Black individuals (OR, 1.81; 95% CI, 1.20-2.75) and MCI in Hispanic individuals (OR, 1.42; 95% CI, 1.03-1.96) compared with non-Hispanic White individuals. Other group comparisons by race and ethnicity were not possible owing to small numbers. No differences in prevalence were found between female individuals and male individuals. Conclusions and Relevance Using a comprehensive neuropsychological test battery and large sample, the national prevalence of dementia and MCI in 2016 found in this cross-sectional study was similar to that of other US-based studies, indicating a disproportionate burden of dementia and MCI among older Black and Hispanic adults and those with lower education.
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Affiliation(s)
- Jennifer J. Manly
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Kenneth M. Langa
- Institute for Social Research, University of Michigan, Ann Arbor
- Cognitive Health Sciences Research Program and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Lindsay H. Ryan
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Deborah A. Levine
- Cognitive Health Sciences Research Program and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
| | - Ryan McCammon
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | - David Weir
- Institute for Social Research, University of Michigan, Ann Arbor
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Niotis K, Akiyoshi K, Carlton C, Isaacson R. Dementia Prevention in Clinical Practice. Semin Neurol 2022; 42:525-548. [PMID: 36442814 DOI: 10.1055/s-0042-1759580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over 55 million people globally are living with dementia and, by 2050, this number is projected to increase to 131 million. This poses immeasurable challenges for patients and their families and a significant threat to domestic and global economies. Given this public health crisis and disappointing results from disease-modifying trials, there has been a recent shift in focus toward primary and secondary prevention strategies. Approximately 40% of Alzheimer's disease (AD) cases, which is the most common form of dementia, may be prevented or at least delayed. Success of risk reduction studies through addressing modifiable risk factors, in addition to the failure of most drug trials, lends support for personalized multidomain interventions rather than a "one-size-fits-all" approach. Evolving evidence supports early intervention in at-risk patients using individualized interventions directed at modifiable risk factors. Comprehensive risk stratification can be informed by emerging principals of precision medicine, and include expanded clinical and family history, anthropometric measurements, blood biomarkers, neurocognitive evaluation, and genetic information. Risk stratification is key in differentiating subtypes of dementia and identifies targetable areas for intervention. This article reviews a clinical approach toward dementia risk stratification and evidence-based prevention strategies, with a primary focus on AD.
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Affiliation(s)
- Kellyann Niotis
- Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York
| | - Kiarra Akiyoshi
- Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York.,Department of Neurology, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida
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McGirr A, Nathan S, Ghahremani M, Gill S, Smith EE, Ismail Z. Progression to Dementia or Reversion to Normal Cognition in Mild Cognitive Impairment as a Function of Late-Onset Neuropsychiatric Symptoms. Neurology 2022; 98:e2132-e2139. [PMID: 35351783 PMCID: PMC9169943 DOI: 10.1212/wnl.0000000000200256] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mild cognitive impairment (MCI) is an at-risk state for dementia; however, not all individuals with MCI transition to dementia, and some revert to normal cognition (NC). Here, we investigate whether mild behavioral impairment (MBI), the late-life onset of persistent neuropsychiatric symptoms (NPS), improves the prognostic specificity of MCI. METHODS Participants with MCI from the National Alzheimer's Coordinating Center Uniform Data Set were included. NPS were operationalized with the Neuropsychiatric Inventory Questionnaire to identify participants without NPS and those with MBI (persistent, late-onset NPS). Individuals with late-onset NPS not meeting the MBI persistence criterion (NPS_NOT_MBI) were retained for secondary analyses. Progression to dementia, stable MCI, and reversion to NC after 3 years of follow-up were defined per National Institute on Aging-Alzheimer's Association and Petersen criteria. RESULTS The primary sample consisted of 739 participants (NPS- n = 409 and MBI+ n = 330; 75.16 ± 8.6 years old, 40.5% female). After 3 years, 238 participants (33.6%) progressed to dementia, and 90 (12.2%) reverted to NC. Compared to participants without NPS, participants with MBI were significantly more likely to progress to dementia (adjusted odds ratio [AOR] 2.13, 95% CI 1.52-2.99), with an annual progression rate of 14.7% (vs 8.3% for participants with MCI without NPS). Compared to participants without NPS, participants with MBI were less likely to revert to NC (AOR 0.48, 95% CI 0.28-0.83, 2.5% vs 5.3% annual reversion rate). The NPS_NOT_MBI group (n = 331, 76.5 ± 8.6 years old, 45.9% female) were more likely to progress to dementia (AOR 2.18, 95% CI 1.56-3.03, 14.3% annual progression rate) but not less likely to revert to NC than those without NPS. Accordingly, both NPS_NOT_MBI and MBI+ participants had lower Mini-Mental State Examination scores than NPS- participants after 3 years. DISCUSSION Late-onset NPS improve the specificity of MCI as an at-risk state for progression to dementia. However, only persistent late-onset NPS are associated with a lower likelihood of reversion to NC, with transient NPS (i.e., NPS_NOT_MBI) not differing from the NPS- group. Clinical prognostication can be improved by incorporating late-onset NPS, especially those that persist (i.e., MBI), into risk assessments. Clinical trials may benefit from enrichment with these higher-risk participants with MCI.
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Affiliation(s)
- Alexander McGirr
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Santhosh Nathan
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Maryam Ghahremani
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sascha Gill
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Eric E Smith
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Zahinoor Ismail
- From the Department of Psychiatry (A.M., Z.I.), Hotchkiss Brain Institute (A.M., S.N., M.G., S.G., E.S., Z.I.), Mathison Centre for Mental Health Research and Education (A.M., Z.I.), Department of Clinical Neurosciences (E.S., Z.I.), Department of Community Health Sciences (Z.I.), and O'Brien Institute for Public Health (Z.I.), Cumming School of Medicine, University of Calgary, Alberta, Canada
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Rajput A. Does essential tremor increase the risk of dementia? No. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:233-253. [PMID: 35750364 DOI: 10.1016/bs.irn.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Essential tremor (ET) is the most common neurological cause of tremor affecting adult humans affecting about 6% of those over age 65 years. In the United States, dementia has a prevalence of 15% in those age 68 and older. Overlap of the two conditions is therefore not surprising. Several studies report mild subclinical cognitive dysfunction in non-demented people with ET, likely related to overactivity of fronto-cerebellar circuitry involved in tremor pathophysiology. Frontal/executive dysfunction is often though not exclusively noted, and some studies have even shown areas of cognitive strengths. Mild cognitive impairment (MCI) is impairment which a person is aware of but does not interfere significantly with daily activities. While MCI has been considered to presage dementia this is not necessarily the case, as some persons with MCI revert to normal cognition in follow-up. Dementia is a clinical syndrome with cognitive impairment interfering with daily activities. Population-based and clinic-based studies have shown mixed results regarding rates of MCI in ET. A handful of studies have looked at development of dementia in ET with differing results. Brain pathology studies in ET and dementia or investigating Alzheimer-type pathology have thus far been unrevealing. There is evidence by some investigators supporting a greater risk of dementia for those having older onset tremor, while those having ET at a younger age faring at least as well as controls regarding risk of cognitive impairment and dementia. At present the evidence is inconclusive that ET as a group are at a greater risk of developing dementia.
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Affiliation(s)
- Alex Rajput
- Division of Neurology, Saskatchewan Movement Disorders Program, University of Saskatchewan/Saskatchewan Health Authority, Saskatoon, SK, Canada.
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.
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