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Pescador Jimenez M, Wagner M, Laden F, Hart JE, Grodstein F, James P. Midlife Residential Greenness and Late-Life Cognitive Decline among Nurses' Health Study Participants. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:77003. [PMID: 39016600 PMCID: PMC11253812 DOI: 10.1289/ehp13588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Midlife residential exposure to greenspace may slow cognitive decline by increasing opportunities for physical activity and social connection, restoring attention, or reducing stress or adverse environmental exposures. However, prospective studies on the association between greenness and cognitive decline are sparse. OBJECTIVE We investigated the prospective association between greenness at midlife and cognitive decline later in life. We explored effect measure modification by apolipoprotein E (APOE)-ɛ4 carrier status, neighborhood socioeconomic status (NSES), and rural/urban regions. METHODS The Nurses' Health Study (N = 121,700 ) started in 1976 with married female nurses, 30-55 years of age, located across 11 US states. We examined 16,962 nurses who were enrolled in a substudy starting in 1995-2001 (mean age = 74 y ) through 2008. We assessed average summer residential greenness in a 270 -m buffer using Landsat Normalized Difference Vegetation Index data from 1986-1994. Starting in 1995-2001, participants underwent up to four repeated measures of five cognitive tests. A global composite score was calculated as the average of all z -scores for each task to evaluate overall cognition. We used linear mixed models to evaluate the association of average greenness exposure at midlife with cognitive decline in later life, adjusted for age, education, NSES, and depression. RESULTS In adjusted models, higher midlife greenness exposure [per interquartile range (IQR): 0.18] was associated with a 0.004-unit (95% CI: 0.001, 0.006) slower annual rate of cognitive decline. For comparison, we found that 1 year of age is related to a - 0.006 mean annual difference for global cognition in the full sample; thus, higher midlife greenness appeared equivalent to slowing cognitive decline by ∼ 8 months. In analysis exploring gene-environment interactions, we found that among APOE-ɛ4 carriers, an IQR increase in greenness was associated with a rate of decline that was slower by 0.01 units of global composite score (95% CI: 0.0004, 0.02). This association was attenuated among APOE-ɛ4 noncarriers. We did not observe associations between greenness and baseline or annual rate of cognitive decline of verbal memory. DISCUSSION Higher midlife greenness exposure is associated with slower cognitive decline later in life. Future research is necessary to confirm these findings. https://doi.org/10.1289/EHP13588.
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Affiliation(s)
- Marcia Pescador Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Maude Wagner
- Department of Internal Medicine, Rush Medical College and Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
| | - Francine Laden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jaime E. Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Francine Grodstein
- Department of Internal Medicine, Rush Medical College and Rush Alzheimer’s Disease Center, Chicago, Illinois, USA
| | - Peter James
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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Plans-Beriso E, Babb-de-Villiers C, Petrova D, Barahona-López C, Diez-Echave P, Hernández OR, Fernández-Martínez NF, Turner H, García-Ovejero E, Craciun O, Fernández-Navarro P, Fernández-Larrea N, García-Esquinas E, Kuhn I, Jiménez-Planet V, Moreno V, Rodríguez-Artalejo F, Sánchez MJ, Pollan-Santamaria M, Blackburn L, Kroese M, Pérez-Gómez B. Biomarkers for personalised prevention of chronic diseases: a common protocol for three rapid scoping reviews. Syst Rev 2024; 13:147. [PMID: 38824585 PMCID: PMC11143646 DOI: 10.1186/s13643-024-02554-9] [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: 10/19/2023] [Accepted: 05/03/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Personalised prevention aims to delay or avoid disease occurrence, progression, and recurrence of disease through the adoption of targeted interventions that consider the individual biological, including genetic data, environmental and behavioural characteristics, as well as the socio-cultural context. This protocol summarises the main features of a rapid scoping review to show the research landscape on biomarkers or a combination of biomarkers that may help to better identify subgroups of individuals with different risks of developing specific diseases in which specific preventive strategies could have an impact on clinical outcomes. This review is part of the "Personalised Prevention Roadmap for the future HEalThcare" (PROPHET) project, which seeks to highlight the gaps in current personalised preventive approaches, in order to develop a Strategic Research and Innovation Agenda for the European Union. OBJECTIVE To systematically map and review the evidence of biomarkers that are available or under development in cancer, cardiovascular and neurodegenerative diseases that are or can be used for personalised prevention in the general population, in clinical or public health settings. METHODS Three rapid scoping reviews are being conducted in parallel (February-June 2023), based on a common framework with some adjustments to suit each specific condition (cancer, cardiovascular or neurodegenerative diseases). Medline and Embase will be searched to identify publications between 2020 and 2023. To shorten the time frames, 10% of the papers will undergo screening by two reviewers and only English-language papers will be considered. The following information will be extracted by two reviewers from all the publications selected for inclusion: source type, citation details, country, inclusion/exclusion criteria (population, concept, context, type of evidence source), study methods, and key findings relevant to the review question/s. The selection criteria and the extraction sheet will be pre-tested. Relevant biomarkers for risk prediction and stratification will be recorded. Results will be presented graphically using an evidence map. INCLUSION CRITERIA Population: general adult populations or adults from specific pre-defined high-risk subgroups; concept: all studies focusing on molecular, cellular, physiological, or imaging biomarkers used for individualised primary or secondary prevention of the diseases of interest; context: clinical or public health settings. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/7JRWD (OSF registration DOI).
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Affiliation(s)
- E Plans-Beriso
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | | | - D Petrova
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
| | - C Barahona-López
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - P Diez-Echave
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - O R Hernández
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - N F Fernández-Martínez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
| | - H Turner
- PHG Foundation, University of Cambridge, Cambridge, UK
| | - E García-Ovejero
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - O Craciun
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - P Fernández-Navarro
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - N Fernández-Larrea
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - E García-Esquinas
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - I Kuhn
- Cambridge University Medical Library, Cambridge, UK
| | - V Jiménez-Planet
- National Library of Health Sciences, Instituto de Salud Carlos III, Madrid, Spain
| | - V Moreno
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Colorectal Cancer Group, ONCOBELL Program, Institut de Recerca Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08908, Spain
| | - F Rodríguez-Artalejo
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - M J Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
| | - M Pollan-Santamaria
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - L Blackburn
- PHG Foundation, University of Cambridge, Cambridge, UK
| | - M Kroese
- PHG Foundation, University of Cambridge, Cambridge, UK
| | - B Pérez-Gómez
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Chang HT, Chan PC, Chiu PY. Non-linear relationship between serum cholesterol levels and cognitive change among older people in the preclinical and prodromal stages of dementia: a retrospective longitudinal study in Taiwan. BMC Geriatr 2024; 24:474. [PMID: 38816835 PMCID: PMC11138028 DOI: 10.1186/s12877-024-05030-0] [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: 01/31/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Adverse effects of rigorously lowering low-density lipoprotein cholesterol on cognition have been reported; therefore, we aimed to study the contribution of serum cholesterol in cognitive decline in older people with or without dementia. METHODS Cognitive function was assessed by the Cognitive Abilities Screening Instrument (CASI). We investigated associations between serum cholesterol with cognitive decline using multiple regressions controlling for the effects of demographics, vascular risk factors, and treatments. RESULTS Most associations between cholesterol and CASI scores could be explained by non-linear and inverted U-shaped relationships (R2 = 0.003-0.006, p < 0.016, Šidákcorrection). The relationships were most evident between changes in cholesterol and CASI scores in older people at the preclinical or prodromal stages of dementia (R2 = 0.02-0.064, p values < 0.016). There were no differences in level of changes in CASI scores between individuals in 1st decile and 10th decile groups of changes in cholesterol (p = 0.266-0.972). However, individuals in the 1st decile of triglyceride changes and with stable and normal cognitive functions showed significant improvement in CASI scores compared to those in the 10th decile (t(202) = 2.275, p values < 0.05). CONCLUSION These findings could implicate that rigorously lowering cholesterol may not be suitable for the prevention of cognitive decline among older people, especially among individuals in preclinical or prodromal stages of dementia.
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Affiliation(s)
- Hsin-Te Chang
- Department of Psychology, College of Science, Chung Yuan Christian University, Taoyuan, Taiwan
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua City, Changhua, Taiwan
| | - Po-Chi Chan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua City, Changhua, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua City, Changhua, Taiwan.
- Department of Applied Mathematics, College of Science, Tunghai University, Taichung, Taiwan.
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Imboden M. Maintaining Brain Health: An Imperative for Successful Aging and Business Performance. Am J Health Promot 2024; 38:576-580. [PMID: 38553419 DOI: 10.1177/08901171241232042a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Mary Imboden
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Saint Joseph Health, Portland, Oregon, USA
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Imboden M. Maintaining Brain Health: An Imperative for Successful Aging and Business Performance. Am J Health Promot 2024; 38:576-589. [PMID: 38553416 DOI: 10.1177/08901171241232042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Mary Imboden
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Saint Joseph Health, Portland, Oregon, USA
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Jones A, Ali MU, Kenny M, Mayhew A, Mokashi V, He H, Lin S, Yavari E, Paik K, Subramanian D, Dydynsky R, Aryal K, Correia RH, Dash D, Manis DR, O'Connell M, Liu-Ambrose T, Taler V, McMillan JM, Hogan DB, Kirkland S, Costa AP, Wolfson C, Raina P, Griffith L. Potentially Modifiable Risk Factors for Dementia and Mild Cognitive Impairment: An Umbrella Review and Meta-Analysis. Dement Geriatr Cogn Disord 2024; 53:91-106. [PMID: 38346414 DOI: 10.1159/000536643] [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: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION The prevalence of mild and major neurocognitive disorders (NCDs), also referred to as mild cognitive impairment and dementia, is rising globally. The prevention of NCDs is a major global public health interest. We sought to synthesize the literature on potentially modifiable risk factors for NCDs. METHODS We conducted an umbrella review using a systematic search across multiple databases to identify relevant systematic reviews and meta-analyses. Eligible reviews examined potentially modifiable risk factors for mild or major NCDs. We used a random-effects multi-level meta-analytic approach to synthesize risk ratios for each risk factor while accounting for overlap in the reviews. We further examined risk factors for major NCD due to two common etiologies: Alzheimer's disease and vascular dementia. RESULTS A total of 45 reviews with 212 meta-analyses were synthesized. We identified fourteen broadly defined modifiable risk factors that were significantly associated with these disorders: alcohol consumption, body weight, depression, diabetes mellitus, diet, hypertension, less education, physical inactivity, sensory loss, sleep disturbance, smoking, social isolation, traumatic brain injury, and vitamin D deficiency. All 14 factors were associated with the risk of major NCD, and five were associated with mild NCD. We found considerably less research for vascular dementia and mild NCD. CONCLUSION Our review quantifies the risk associated with 14 potentially modifiable risk factors for mild and major NCDs, including several factors infrequently included in dementia action plans. Prevention strategies should consider approaches that reduce the incidence and severity of these risk factors through health promotion, identification, and early management.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Muhammad Usman Ali
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meghan Kenny
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
- Labarge Centre for Mobility in Aging, Hamilton, Ontario, Canada
| | - Vishal Mokashi
- School of Life Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Henry He
- Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Sabrina Lin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ehsan Yavari
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen Paik
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Robert Dydynsky
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Komal Aryal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca H Correia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Megan O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jacqueline M McMillan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Kirkland
- Department of Community Health and Epidemiology and Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health and Department of Medicine, McGill University, QC, Montreal, Canada
- Research Institute of the McGill University Health Centre, QC, Montreal, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
- Labarge Centre for Mobility in Aging, Hamilton, Ontario, Canada
| | - Lauren Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
- Labarge Centre for Mobility in Aging, Hamilton, Ontario, Canada
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Al-Akl NS, Khalifa O, Ponirakis G, Parray A, Ramadan M, Khan S, Chandran M, Ayadathil R, Elsotouhy A, Own A, Al Hamad H, Decock J, Alajez NM, Albagha O, Malik RA, El-Agnaf OMA, Arredouani A. Untargeted Metabolomic Profiling Reveals Differentially Expressed Serum Metabolites and Pathways in Type 2 Diabetes Patients with and without Cognitive Decline: A Cross-Sectional Study. Int J Mol Sci 2024; 25:2247. [PMID: 38396924 PMCID: PMC10889568 DOI: 10.3390/ijms25042247] [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: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Diabetes is recognized as a risk factor for cognitive decline, but the underlying mechanisms remain elusive. We aimed to identify the metabolic pathways altered in diabetes-associated cognitive decline (DACD) using untargeted metabolomics. We conducted liquid chromatography-mass spectrometry-based untargeted metabolomics to profile serum metabolite levels in 100 patients with type 2 diabetes (T2D) (54 without and 46 with DACD). Multivariate statistical tools were used to identify the differentially expressed metabolites (DEMs), and enrichment and pathways analyses were used to identify the signaling pathways associated with the DEMs. The receiver operating characteristic (ROC) analysis was employed to assess the diagnostic accuracy of a set of metabolites. We identified twenty DEMs, seven up- and thirteen downregulated in the DACD vs. DM group. Chemometric analysis revealed distinct clustering between the two groups. Metabolite set enrichment analysis found significant enrichment in various metabolite sets, including galactose metabolism, arginine and unsaturated fatty acid biosynthesis, citrate cycle, fructose and mannose, alanine, aspartate, and glutamate metabolism. Pathway analysis identified six significantly altered pathways, including arginine and unsaturated fatty acid biosynthesis, and the metabolism of the citrate cycle, alanine, aspartate, glutamate, a-linolenic acid, and glycerophospholipids. Classifier models with AUC-ROC > 90% were developed using individual metabolites or a combination of individual metabolites and metabolite ratios. Our study provides evidence of perturbations in multiple metabolic pathways in patients with DACD. The distinct DEMs identified in this study hold promise as diagnostic biomarkers for DACD patients.
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Affiliation(s)
- Neyla S. Al-Akl
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Olfa Khalifa
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation (QF), Doha P.O. Box 24144, Qatar
| | - Aijaz Parray
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Marwan Ramadan
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Shafi Khan
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Mani Chandran
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Raheem Ayadathil
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Ahmed Elsotouhy
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
- Department of Clinical Radiology, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha P.O. Box 24144, Qatar
| | - Ahmed Own
- The Neuroscience Institute, Academic Health System, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
- Neuroradiology Department, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Hanadi Al Hamad
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar
| | - Julie Decock
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Cancer Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Nehad M. Alajez
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Cancer Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Omar Albagha
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation (QF), Doha P.O. Box 24144, Qatar
| | - Omar M. A. El-Agnaf
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
| | - Abdelilah Arredouani
- Diabetes Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
- College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha P.O. Box 34110, Qatar
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Kuate Defo A, Bakula V, Pisaturo A, Labos C, Wing SS, Daskalopoulou SS. Diabetes, antidiabetic medications and risk of dementia: A systematic umbrella review and meta-analysis. Diabetes Obes Metab 2024; 26:441-462. [PMID: 37869901 DOI: 10.1111/dom.15331] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
AIMS The objective of this umbrella review and meta-analysis was to evaluate the effect of diabetes on risk of dementia, as well as the mitigating effect of antidiabetic treatments. MATERIALS AND METHODS We conducted a systematic umbrella review on diabetes and its treatment, and a meta-analysis focusing on treatment. We searched MEDLINE/PubMed, Embase, PsycINFO, CINAHL and the Cochrane Library for systematic reviews and meta-analyses assessing the risk of cognitive decline/dementia in individuals with diabetes until 2 July 2023. We conducted random-effects meta-analyses to obtain risk ratios and 95% confidence intervals estimating the association of metformin, thiazolidinediones, pioglitazone, dipeptidyl peptidase-4 inhibitors, α-glucosidase inhibitors, meglitinides, insulin, sulphonylureas, glucagon-like peptide-1 receptor agonists (GLP1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) with risk of dementia from cohort/case-control studies. The subgroups analysed included country and world region. Risk of bias was assessed with the AMSTAR tool and Newcastle-Ottawa Scale. RESULTS We included 100 reviews and 27 cohort/case-control studies (N = 3 046 661). Metformin, thiazolidinediones, pioglitazone, GLP1RAs and SGLT2is were associated with significant reduction in risk of dementia. When studies examining metformin were divided by country, the only significant effect was for the United States. Moreover, the effect of metformin was significant in Western but not Eastern populations. No significant effect was observed for dipeptidyl peptidase-4 inhibitors, α-glucosidase inhibitors, or insulin, while meglitinides and sulphonylureas were associated with increased risk. CONCLUSIONS Metformin, thiazolidinediones, pioglitazone, GLP1RAs and SGLT2is were associated with reduced risk of dementia. More longitudinal studies aimed at determining their relative benefit in different populations should be conducted.
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Affiliation(s)
- Alvin Kuate Defo
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Veselko Bakula
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Christopher Labos
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Simon S Wing
- Division of Endocrinology & Metabolism, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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9
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Baer SB, Dorn AD, Osborne DM. Sex differences in response to obesity and caloric restriction on cognition and hippocampal measures of autophagic-lysosomal transcripts and signaling pathways. BMC Neurosci 2024; 25:1. [PMID: 38166559 PMCID: PMC10759648 DOI: 10.1186/s12868-023-00840-1] [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: 04/20/2023] [Accepted: 12/18/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Obesity rates in the U.S. continue to increase, with nearly 50% of the population being either obese or morbidly obese. Obesity, along with female sex, are leading risk factors for sporadic Alzheimer's Disease (AD) necessitating the need to better understand how these variables impact cellular function independent of age or genetic mutations. Animal and clinical studies both indicate that autophagy-lysosomal pathway (ALP) dysfunction is among the earliest known cellular systems to become perturbed in AD, preceding cognitive decline, yet little is known about how obesity and sex affects these cellular functions in the hippocampus, a brain region uniquely susceptible to the negative effects of obesity. We hypothesized that obesity would negatively affect key markers of ALP in the hippocampus, effects would vary based on sex, and that caloric restriction would counteract obesity effects. METHODS Female and male mice were placed on an obesogenic diet for 10 months, at which point half were switched to caloric restriction for three months, followed by cognitive testing in the Morris watermaze. Hippocampus was analyzed by western blot and qPCR. RESULTS Cognitive function in female mice responded differently to caloric restriction based on whether they were on a normal or obesogenic diet; male cognition was only mildly affected by caloric restriction and not obesity. Significant male-specific changes occurred in cellular markers of autophagy, including obesity increasing pAkt, Slc38a9, and Atg12, while caloric restriction reduced pRPS6 and increased Atg7. In contrast females experienced changes due to diet/caloric restriction predominately in lysosomal markers including increased TFE3, FLCN, FNIP2, and pAMPK. CONCLUSIONS Results support that hippocampal ALP is a target of obesity and that sex shapes molecular responses, while providing insight into how dietary manipulations affect learning and memory based on sex.
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Affiliation(s)
- Sadie B Baer
- R.S. Dow Neurobiology, Legacy Research Institute, Portland, OR, USA
| | - Adrianah D Dorn
- R.S. Dow Neurobiology, Legacy Research Institute, Portland, OR, USA
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10
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Li W, Sun L, Yue L, Xiao S. Associations between afternoon napping, left amygdala volume and cognitive performance in elderly with normal cognitive function. Sleep Med 2024; 113:232-237. [PMID: 38064794 DOI: 10.1016/j.sleep.2023.11.032] [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: 09/15/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The relationship between afternoon napping and cognitive function in the elderly is very complex and the mechanism is unknown. METHODS In the current study, 194 community elders with normal cognitive functions were included. All subjects completed baseline clinical assessment, baseline neuropsychological test as well as baseline structural MRI. Based on their napping status, these 194 participants were divided into the napping group (n = 88) and the non-napping group (n = 106). We then compared the differences in cognitive performance and structural magnetic resonance between the two groups. RESULTS In the intergroup analysis, we found that the nappers showed poorer cognitive performance on both overall cognitive function and domain specific cognitive function; while on the whole sample, we found a significant negative association (F = 20.27, p<0.001) between afternoon napping and left amygdala volume. However, we did not find any effect of night sleep length or napping frequency on cognitive performance or left amygdala volume. CONCLUSIONS In community elders with normal cognitive functions, afternoon napping is associated with cognitive performance, and left amygdala may play an important role in this process.
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Affiliation(s)
- Wei Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Lin Sun
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Yue
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Shifu Xiao
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
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11
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Ding H, Liu C, Li Y, Ang TFA, Devine S, Liu Y, Au R, Doraiswamy PM. Sex-specific blood biomarkers linked to memory changes in middle-aged adults: The Framingham Heart Study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12569. [PMID: 38545543 PMCID: PMC10966919 DOI: 10.1002/dad2.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 06/06/2024]
Abstract
The relationship between sex-specific blood biomarkers and memory changes in middle-aged adults remains unclear. We aimed to investigate this relationship using the data from the Framingham Heart Study (FHS). We conducted association analysis, partial correlation analysis, and causal dose-response curves using blood biomarkers and other data from 793 middle-aged participants (≤ 60 years) from the FHS Offspring Cohort. The results revealed associations of adiponectin and fasting blood glucose with midlife memory change, along with a U-shaped relationship of high-density lipoprotein cholesterol with memory change. No significant associations were found for the other blood biomarkers (e.g., amyloid beta protein 42) with memory change. To our knowledge, this is the first sex-specific network analysis of blood biomarkers related to midlife memory change in a prospective cohort study. Our findings highlight the importance of targeting cardiometabolic risks and the need to validate midlife-specific biomarkers that can accelerate the development of primary preventive strategies.
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Affiliation(s)
- Huitong Ding
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Chunyu Liu
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Yi Li
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Ting Fang Alvin Ang
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Sherral Devine
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Yulin Liu
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Rhoda Au
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - P. Murali Doraiswamy
- Neurocognitive Disorders ProgramDepartments of Psychiatry and Medicineand the Duke Institute for Brain SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
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12
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Gafni T, Weinstein G, Leonard D, Barlow CE, DeFina LF, Pettee Gabriel K, Berry JD, Shuval K. Independent and joint associations of cardiorespiratory fitness and BMI with dementia risk: the Cooper Center Longitudinal Study. BMJ Open 2023; 13:e075571. [PMID: 38086580 PMCID: PMC10729062 DOI: 10.1136/bmjopen-2023-075571] [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: 05/12/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to examine the association of midlife fitness and body mass index (BMI) with incident dementia later in life. DESIGN AND PARTICIPANTS A cohort study of 6428 individuals (mean age 50.9±7.6 years) from the Cooper Center Longitudinal Study. MEASURES Cardiorespiratory fitness and BMI were assessed twice (1970-1999) during visits to the Cooper Clinic, a preventive medicine clinic in Dallas, Texas. These measures were examined as continuous and categorical variables. As continuous variables, fitness and BMI were examined at baseline (averaged of two examinations) and as absolute change between exams (mean time 2.1±1.8 years). Variables were categorised: unfit versus fit and normal versus overweight/obese. Medicare claims data were used to obtain all-cause dementia incidence (1999-2009). Mean follow-up between midlife examinations and Medicare surveillance was 15.7 ((SD=6.2) years. Multivariable models were used to assess the associations between fitness, BMI and dementia. RESULTS During 40 773 person years of Medicare surveillance, 632 cases of dementia were identified. After controlling for BMI and covariates, each 1-metabolic equivalent increment in fitness was associated with 5% lower (HR 0.95; 95% CI 0.90 to 0.99) dementia risk. In comparison, after controlling for fitness and covariates, each 1 kg/m2 increment in BMI was associated with a 3.0% (HR 1.03; 95% CI 1.00 to 1.07) higher risk for dementia, yet without significance (p=0.051). Similar findings were observed when the exposures were categorised. Changes in fitness and BMI between examinations were not related to dementia. Jointly, participants who were unfit and overweight/obese had the highest (HR 2.28 95% CI 1.57 to 3.32) dementia risk compared with their fit and normal weight counterparts. CONCLUSION Lower midlife fitness is a risk marker for dementia irrespective of weight status. Being unfit coupled with overweight/obese status might increase one's risk for dementia even further.
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Affiliation(s)
- Tal Gafni
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - Galit Weinstein
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - David Leonard
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Carolyn E Barlow
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Laura F DeFina
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabam, USA
| | | | - Kerem Shuval
- Department of Research, The Cooper Institute, Dallas, Texas, USA
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13
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Sutin AR, Stephan Y, Luchetti M, Terracciano A. Purpose in life and markers of immunity and inflammation: Testing pathways of episodic memory. J Psychosom Res 2023; 174:111487. [PMID: 37696089 PMCID: PMC10591954 DOI: 10.1016/j.jpsychores.2023.111487] [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: 03/07/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE This prospective cohort study examines whether purpose in life is associated with markers of immunity and inflammation and tests these markers as mediators between purpose and episodic memory. METHODS Participants from the Venous Blood Study of the Health and Retirement Study reported on their purpose in life, had their blood assayed for markers of immunity and inflammation, and were administered an episodic memory task (N = 8999). Regression analyses tested the association between purpose and each marker. Prospective mediation analyses (N = 6092) tested whether these markers measured in 2016 were mediators between purpose measured in 2012/2014 and episodic memory measured in 2018. RESULTS Higher purpose in life was associated with lower neutrophil counts (β = -0.08, p < .001), lower ratio of neutrophils/lymphocytes (β = -0.05, p < .001), and lower systemic immune inflammation index (β = -0.04, p < .001); purpose was unrelated to monocyte, platelet, and lymphocyte counts or the ratio of platelets/lymphocytes (all ns). Purpose was associated negatively with c-reactive protein (β = -0.07, p < .001), Interleukin-6 (β = -0.08, p < .001), Interleukin-10 (β = -0.07, p < .001), Interleukin-1ra (β = -0.08, p < .001), and soluble Tumor Necrosis Factor Receptor 1 (sTNFR1; β = -0.10, p < .001); purpose was unrelated to Transforming Growth Factor beta 1. These associations were largely not moderated by age, sex, race, ethnicity, and education. Lower neutrophils, Interleukin-6, and sTNFR1 were associated prospectively with better episodic memory and mediated the association between purpose and episodic memory. CONCLUSION Purpose in life is associated with markers of immunity and inflammation, some of which are one mechanism in the pathway between purpose and healthier episodic memory.
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14
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Kuneš J, Hojná S, Mráziková L, Montezano A, Touyz RM, Maletínská L. Obesity, Cardiovascular and Neurodegenerative Diseases: Potential Common Mechanisms. Physiol Res 2023; 72:S73-S90. [PMID: 37565414 PMCID: PMC10660578 DOI: 10.33549/physiolres.935109] [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: 04/04/2023] [Accepted: 05/12/2023] [Indexed: 12/01/2023] Open
Abstract
The worldwide increase in the incidence of obesity and cardiovascular and neurodegenerative diseases, e.g. Alzheimer's disease, is related to many factors, including an unhealthy lifestyle and aging populations. However, the interconnection between these diseases is not entirely clear, and it is unknown whether common mechanisms underlie these conditions. Moreover, there are currently no fully effective therapies for obesity and neurodegeneration. While there has been extensive research in preclinical models addressing these issues, the experimental findings have not been translated to the clinic. Another challenge relates to the time of onset of individual diseases, which may not be easily identified, since there are no specific indicators or biomarkers that define disease onset. Hence knowing when to commence preventive treatment is unclear. This is especially pertinent in neurodegenerative diseases, where the onset of the disease may be subtle and occur decades before the signs and symptoms manifest. In metabolic and cardiovascular disorders, the risk may occur in-utero, in line with the concept of fetal programming. This review provides a brief overview of the link between obesity, cardiovascular and neurodegenerative diseases and discusses potential common mechanisms including the role of the gut microbiome.
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Affiliation(s)
- J Kuneš
- Institute of Physiology AS CR, Prague, Czech Republic. . Research Institute of McGill University Health Centre (RI-MUHC), Québac, Canada,
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15
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Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, Bailes JE, Hayden KA, Koerte IK, Manley GT, McNamee M, Patricios JS, Tator CH, Cantu RC, Dvorak J. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. Br J Sports Med 2023; 57:810-821. [PMID: 37316187 DOI: 10.1136/bjsports-2023-106890] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes. DESIGN Systematic review. DATA SOURCES Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022. ELIGIBILITY CRITERIA Studies measuring future risk (cohort studies) or approximating that risk (case-control studies). RESULTS Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias. CONCLUSION Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors. PROSPERO REGISTRATION NUMBER CRD42022159486.
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Affiliation(s)
- Grant L Iverson
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Rudolph J Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Geoff M Schneider
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
- University Orthopedic Centre, Concussion Care Clinic, State College, Pennsylvania, USA
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles H Tator
- Department of Surgery and Division of Neurosurgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert C Cantu
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Jiri Dvorak
- Schulthess Clinic Zurich, Zurich, Switzerland
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16
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Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, Davis GA, Echemendia RJ, Makdissi M, McNamee M, Broglio S, Emery CA, Feddermann-Demont N, Fuller GW, Giza CC, Guskiewicz KM, Hainline B, Iverson GL, Kutcher JS, Leddy JJ, Maddocks D, Manley G, McCrea M, Purcell LK, Putukian M, Sato H, Tuominen MP, Turner M, Yeates KO, Herring SA, Meeuwisse W. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med 2023; 57:695-711. [PMID: 37316210 DOI: 10.1136/bjsports-2023-106898] [Citation(s) in RCA: 187] [Impact Index Per Article: 187.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.
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Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jiri Dvorak
- Spine Unit, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, Staffordshire, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Harvard Medical School, Boston, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation, Boston, Massachusetts, USA
| | - Robert C Cantu
- CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Medicine, Swansea University, Swansea, UK
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nina Feddermann-Demont
- University Hospital Zurich, Zurich, Switzerland
- Sports Neuroscience, University of Zurich, Zurich, Switzerland
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | | | - John J Leddy
- UBMD Orthopaedics and Sports Medicne, SUNY Buffalo, Buffalo, New York, USA
| | - David Maddocks
- Melbourne Neuropsychology Services & Perry Maddocks Trollope Lawyers, Melbourne, Victoria, Australia
| | - Geoff Manley
- Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Haruhiko Sato
- Neurosurgery, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | | | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | | | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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17
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Jiang X, Cui L, Huang L, Guo Y, Huang G, Guo Q. The Relationship between Beverages Consumption and Cognitive Impairment in Middle-Aged and Elderly Chinese Population. Nutrients 2023; 15:nu15102309. [PMID: 37242194 DOI: 10.3390/nu15102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/23/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Some evidence shows that beverage consumption has an impact on cognitive performance. This is a follow-up study of dietary habits and cognitive function in the Chinese middle-aged and elderly population. The objective of this study was to explore the relationship between beverage consumption and cognitive impairment. The source and grouping of the participants can be seen in the previous article, "Study of Diet Habits and Cognitive Function in the Chinese Middle-Aged and Elderly Population: The Association between Folic Acid, B Vitamins, Vitamin D, Coenzyme Q10 Supplementation and Cognitive Ability". Among 892 participants, one-third (296) completed both Amyloid beta(Aβ)-PET and plasma biomarkers. The results showed that the consumption of beverages (green tea, coffee, pure milk) was a protective factor for cognitive impairment, daily water consumption <1500 mL (especially <500 mL) was a risk factor for cognitive impairment, and the above correlated with baseline cognitive status. The relationship of green tea, coffee, and pure milk consumption with cognitive impairment was related to gender. We also found that among the participants with Aβ deposition, the consumption of pure milk and green tea was associated with low levels of p-Tau-181. In conclusion, the relationship between beverage consumption and cognitive impairment in Chinese middle-aged and elderly adults may be related to baseline cognitive status, gender, and Aβ deposition.
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Affiliation(s)
- Xinting Jiang
- Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
- Department of VIP Clinical, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Liang Cui
- Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Lin Huang
- Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Yihan Guo
- Faculty of Medicine, The University of Queensland, Brisbane 4072, Australia
| | - Gaozhong Huang
- Department of VIP Clinical, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
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Bai L, Zhou Y, Zhang J, Ma J. The Role of a Ketogenic Diet in the Treatment of Dementia in Type 2 Diabetes Mellitus. Nutrients 2023; 15:nu15081971. [PMID: 37111190 PMCID: PMC10142932 DOI: 10.3390/nu15081971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) shares a common molecular mechanism and underlying pathology with dementia, and studies indicate that dementia is widespread in people with T2DM. Currently, T2DM-induced cognitive impairment is characterized by altered insulin and cerebral glucose metabolism, leading to a shorter life span. Increasing evidence indicates that nutritional and metabolic treatments can possibly alleviate these issues, as there is a lack of efficient preventative and treatment methods. The ketogenic diet (KD) is a very high-fat, low-carbohydrate diet that induces ketosis in the body by producing a fasting-like effect, and neurons in the aged brain are protected from damage by ketone bodies. Moreover, the creation of ketone bodies may improve brain neuronal function, decrease inflammatory expression and reactive oxygen species (ROS) production, and restore neuronal metabolism. As a result, the KD has drawn attention as a potential treatment for neurological diseases, such as T2DM-induced dementia. This review aims to examine the role of the KD in the prevention of dementia risk in T2DM patients and to outline specific aspects of the neuroprotective effects of the KD, providing a rationale for the implementation of dietary interventions as a therapeutic strategy for T2DM-induced dementia in the future.
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Affiliation(s)
- Lin Bai
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, China
- Key Laboratory of Transplant Engineering and Immunology, NHFPC, West China Hospital of Sichuan University, Chengdu 610041, China
- Core Facility of West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yue Zhou
- Department of Pharmacy, Xindu District People's Hospital of Chengdu, Chengdu 610500, China
| | - Jie Zhang
- Key Laboratory of Transplant Engineering and Immunology, NHFPC, West China Hospital of Sichuan University, Chengdu 610041, China
- Core Facility of West China Hospital of Sichuan University, Chengdu 610041, China
| | - Junpeng Ma
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, China
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19
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Sebastian MJ, Khan SKA, Pappachan JM, Jeeyavudeen MS. Diabetes and cognitive function: An evidence-based current perspective. World J Diabetes 2023; 14:92-109. [PMID: 36926658 PMCID: PMC10011899 DOI: 10.4239/wjd.v14.i2.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 02/14/2023] Open
Abstract
Several epidemiological studies have clearly identified diabetes mellitus (DM) as a major risk factor for cognitive dysfunction, and it is going to be a major public health issue in the coming years because of the alarming rise in diabetes prevalence across the world. Brain and neural tissues predominantly depend on glucose as energy substrate and hence, any alterations in carbohydrate meta-bolism can directly impact on cerebral functional output including cognition, executive capacity, and memory. DM affects neuronal function and mental capacity in several ways, some of which include hypoperfusion of the brain tissues from cerebrovascular disease, diabetes-related alterations of glucose transporters causing abnormalities in neuronal glucose uptake and metabolism, local hyper- and hypometabolism of brain areas from insulin resistance, and recurrent hypoglycemic episodes inherent to pharmacotherapy of diabetes resulting in neuronal damage. Cognitive decline can further worsen diabetes care as DM is a disease largely self-managed by patients. Therefore, it is crucial to understand the pathobiology of cognitive dysfunction in relation to DM and its management for optimal long-term care plan for patients. A thorough appraisal of normal metabolic characteristics of the brain, how alterations in neural metabolism affects cognition, the diagnostic algorithm for patients with diabetes and dementia, and the management and prognosis of patients when they have this dangerous combination of illnesses is imperative in this context. This evidence-based narrative with the back-up of latest clinical trial reviews elaborates the current understanding on diabetes and cognitive function to empower physicians to manage their patients in day-to-day clinical practice.
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Affiliation(s)
| | - Shahanas KA Khan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Mohammad Sadiq Jeeyavudeen
- Department of Endocrinology and Metabolism, University Hospitals of Edinburgh, Edinburgh EH16 4SA, United Kingdom
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20
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Brain J, Greene L, Tang EYH, Louise J, Salter A, Beach S, Turnbull D, Siervo M, Stephan BCM, Tully PJ. Cardiovascular disease, associated risk factors, and risk of dementia: An umbrella review of meta-analyses. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1095236. [PMID: 38455934 PMCID: PMC10910908 DOI: 10.3389/fepid.2023.1095236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 03/09/2024]
Abstract
Introduction Cardiovascular diseases (CVDs) have been associated with an increased risk of dementia; yet the evidence is mixed. This review critically appraises and synthesises current evidence exploring associations between dementia risk and CVD and their risk factors, including coronary heart disease, heart failure, atrial fibrillation, hypertension, hyperlipidaemia, and arterial stiffness. Methods MEDLINE, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews with meta-analyses investigating the association between at least one of the CVDs of interest and dementia risk. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews was used to assess methodological quality. Results Twenty-five meta-analyses published between 2007 and 2021 were included. Studies largely consisted of cohorts from North America and Europe. Findings were variable, with coronary heart disease, heart failure, and atrial fibrillation consistently associated with increased risk for all-cause dementia, but results were inconsistent for Alzheimer's disease. Hypertension was more frequently associated with dementia during mid-life compared to late life. Findings concerning cholesterol were complex, and while results were inconsistent for low-density lipoprotein cholesterol and total cholesterol, there appeared to be no associations between triglycerides and high-density lipoprotein cholesterol. All meta-analyses investigating hypercholesterolaemia showed significant increases in dementia risk. There was a paucity of research on the association between arterial stiffness and dementia risk. Conclusion Targeted CVD dementia prevention strategies could reduce dementia prevalence. Future research should determine the underpinning mechanisms linking heart and brain health to determine the most effective strategies for dementia risk reduction in CVD populations.
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Affiliation(s)
- Jacob Brain
- Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Jubilee Campus, Nottingham, United Kingdom
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Leanne Greene
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Eugene Y. H. Tang
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jennie Louise
- Discipline of Obstetrics & Gynaecology, the Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Amy Salter
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Sarah Beach
- University of Nottingham Libraries, University of Nottingham, King’s Meadow Campus, Nottingham, United Kingdom
| | - Deborah Turnbull
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Mario Siervo
- School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Blossom C. M. Stephan
- Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Jubilee Campus, Nottingham, United Kingdom
| | - Phillip J. Tully
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia
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21
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Maki PM, Jaff NG. Brain fog in menopause: a health-care professional's guide for decision-making and counseling on cognition. Climacteric 2022; 25:570-578. [PMID: 36178170 DOI: 10.1080/13697137.2022.2122792] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Midlife women commonly experience changes in their cognitive function as they transition through menopause and express concern about whether these changes represent the initial stages of a more serious cognitive disorder. Health-care practitioners play an important role in counseling women on cognitive changes at midlife and normalizing women's experience. The aim of this commissioned International Menopause Society White Paper on cognition is to provide practitioners with an overview of data informing the clinical care of menopausal women and a framework for clinical counseling and decision-making. Among the topics presented are the specific cognitive changes occurring in menopause, the duration of such changes and their severity. The role of estrogen and menopause symptoms is reviewed. We present talking points for clinical counseling on the effects of hormone therapy on cognition and dementia risk in women, including discussion of absolute risk. Lastly, a brief review of modifiable risk factors for age-related cognitive decline and dementia is presented, with guidance for counseling patients on optimizing their brain health at midlife and beyond.
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Affiliation(s)
- P M Maki
- Department of Psychiatry, Psychology and OB/GYN, University of Illinois College of Medicine, Chicago, IL, USA
| | - N G Jaff
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
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22
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Haberstumpf S, Leinweber J, Lauer M, Polak T, Deckert J, Herrmann MJ. Factors associated with dropout in the longitudinal Vogel study of cognitive decline. Eur J Neurosci 2022; 56:5587-5600. [PMID: 34490950 DOI: 10.1111/ejn.15446] [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: 06/01/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
Dementia, including Alzheimer's disease, is a growing problem worldwide. Prevention or early detection of the disease or a prodromal cognitive decline is necessary. By means of our long-term follow-up 'Vogel study', we aim to predict the pathological cognitive decline of a German cohort (mean age was 73.9 ± 1.55 years at first visit) with three measurement time points within 6 years per participant. Especially in samples of the elderly and subjects with chronic or co-morbid diseases, dropouts are one of the biggest problems of long-term studies. In contrast to the large number of research articles conducted on the course of dementia, little research has been done on the completion of treatment. To ensure unbiased and reliable predictors of cognitive decline from study completers, our objective was to determine predictors of dropout. We conducted multivariate analyses of covariance and multinomial logistic regression analyses to compare and predict the subject's dropout behaviour at the second visit 3 years after baseline (full participation, partial participation and no participation/dropout) with neuropsychiatric, cognitive, blood and lifestyle variables. Lower performance in declarative memory, attention and visual-spatial processing predicted dropout rather than full participation. Lower performance in visual-spatial processing predicted partial participation as opposed to full participation. Furthermore, lower performance in mini-mental status examination predicted whether subjects dropped out or participated partially instead of full participation. Baseline cognitive parameters are associated with dropouts at follow-up with a loss of impaired participants. We expect a bias into a healthier sample over time.
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Affiliation(s)
- Sophia Haberstumpf
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Jonas Leinweber
- Department of Psychotherapy, Alexianer Psychiatric Hospital Köln-Porz, Köln, Germany
| | - Martin Lauer
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Polak
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Jürgen Deckert
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
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23
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Vitorino LM, Granero Lucchetti AL, Lucchetti G. The role of spirituality and religiosity on the cognitive decline of community-dwelling older adults: a 4-year longitudinal study. Aging Ment Health 2022:1-8. [PMID: 36318500 DOI: 10.1080/13607863.2022.2141195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVES This study aims to assess whether having religious beliefs, attending religious services and using spiritual-religious coping (SRC) are longitudinally associated with cognitive decline in community-dwelling older adults. METHODS A 4-year longitudinal study of 261 Brazilian older adults was conducted. Hierarchical adjusted linear regression models and logistic regression models were performed to evaluate the longitudinal effects of religious beliefs, church attendance and positive and negative SRC on cognitive decline. RESULTS The findings revealed that spiritual and religious beliefs at baseline could affect cognitive function in two different ways. When older adults use religiosity and spirituality (RS) in a functional positive manner, it results in better cognitive outcomes and a slower rate of decline. However, when used in a negative manner, it results in worse cognitive outcomes. CONCLUSION These results could help health care professionals address SRC among older adults, particularly those at a higher risk of cognitive decline. Considering that RS is very important for older adults, health care professionals should be aware of the beliefs of their patients and address RS in clinical practice.
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Affiliation(s)
- Luciano Magalhães Vitorino
- School of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.,Faculty of Medicine of Itajubá (FMIT), Itajubá, MG, Brazil
| | | | - Giancarlo Lucchetti
- School of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
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24
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Parikh NS, Kamel H, Zhang C, Kumar S, Rosenblatt R, Spincemaille P, Gupta A, Cohen DE, de Leon MJ, Gottesman RF, Iadecola C. Association between liver fibrosis and incident dementia in the UK Biobank study. Eur J Neurol 2022; 29:2622-2630. [PMID: 35666174 PMCID: PMC9986963 DOI: 10.1111/ene.15437] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE There is growing recognition that chronic liver conditions influence brain health. The impact of liver fibrosis on dementia risk was unclear. We evaluated the association between liver fibrosis and incident dementia in a cohort study. METHODS We performed a cohort analysis using data from the UK Biobank study, which prospectively enrolled adults starting in 2007, and continues to follow them. People with a Fibrosis-4 (FIB-4) liver fibrosis score >2.67 were categorized as at high risk of advanced fibrosis. The primary outcome was incident dementia, ascertained using a validated approach. We excluded participants with prevalent dementia at baseline. We used Cox proportional hazards models to evaluate the association between liver fibrosis and dementia while adjusting for potential confounders. RESULTS Among 455,226 participants included in this analysis, the mean age was 56.5 years and 54% were women. Approximately 2.17% (95% confidence interval [CI] 2.13%-2.22%) had liver fibrosis. The rate of dementia per 1000 person-years was 1.76 (95% CI 1.50-2.07) in participants with liver fibrosis and 0.52 (95% CI 0.50-0.54) in those without. After adjusting for demographics, socioeconomic deprivation, educational attainment, metabolic syndrome, hypertension, diabetes, dyslipidemia, and tobacco and alcohol use, liver fibrosis was associated with an increased risk of dementia (hazard ratio 1.52, 95% CI 1.22-1.90). Results were robust to sensitivity analyses. Effect modification by sex, metabolic syndrome, and apolipoprotein E4 carrier status was not observed. CONCLUSION Liver fibrosis in middle age was associated with an increased risk of incident dementia, independent of shared risk factors. Liver fibrosis may be an underrecognized risk factor for dementia.
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Affiliation(s)
- Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Sonal Kumar
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - David E Cohen
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mony J de Leon
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
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25
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Abstract
The traditional complications of diabetes mellitus are well known and continue to pose a considerable burden on millions of people living with diabetes mellitus. However, advances in the management of diabetes mellitus and, consequently, longer life expectancies, have resulted in the emergence of evidence of the existence of a different set of lesser-acknowledged diabetes mellitus complications. With declining mortality from vascular disease, which once accounted for more than 50% of deaths amongst people with diabetes mellitus, cancer and dementia now comprise the leading causes of death in people with diabetes mellitus in some countries or regions. Additionally, studies have demonstrated notable links between diabetes mellitus and a broad range of comorbidities, including cognitive decline, functional disability, affective disorders, obstructive sleep apnoea and liver disease, and have refined our understanding of the association between diabetes mellitus and infection. However, no published review currently synthesizes this evidence to provide an in-depth discussion of the burden and risks of these emerging complications. This Review summarizes information from systematic reviews and major cohort studies regarding emerging complications of type 1 and type 2 diabetes mellitus to identify and quantify associations, highlight gaps and discrepancies in the evidence, and consider implications for the future management of diabetes mellitus.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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26
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Pal L, Morgan K, Santoro NF, Manson JE, Taylor HS, Miller VM, Brinton EA, Lobo R, Neal-Perry G, Cedars MI, Harman SM, James TT, Gleason CE. Cardiometabolic measures and cognition in early menopause - Analysis of baseline data from a randomized controlled trial. Maturitas 2022; 162:58-65. [PMID: 35617770 PMCID: PMC10089771 DOI: 10.1016/j.maturitas.2022.04.004] [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: 11/22/2021] [Revised: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The relationships between cardiometabolic indices and cognition were examined in recently menopausal women. METHODS Cross-sectional analysis of baseline data from the KEEPS (Kronos Early Estrogen Prevention Study)-Cognitive ancillary study (n = 621). Cognitive performance was assessed by the Modified Mini Mental Status (3MS) score (primary outcome). Physical cardiometabolic indices included body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and blood pressure (BP). Biochemical cardiometabolic indices included serum levels of high sensitivity C-reactive protein (hs-CRP), total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), non-HDL (non-HDL-C), triglycerides (TG), fasting serum glucose (FSG), and insulin resistance (HOMA-IR). Socio-demographic variables included age, race/ethnicity, education, and lifestyle (physical activity, smoking). Central adiposity was defined as WC > 88 cm (>35 in) and WHR > 0.8. Separate stepwise multivariable analyses (GLM, ordinal logistic regression and logistic regression) assessed relationships between 3MS scores (as continuous, in tertiles and dichotomized at 90 respectively) with the measures of central adiposity (predictor variables); socio-demographic variables (age, time since menopause, race, educational status and lifestyle) and cardiometabolic variables (BP, lipids, FSG, HOMA-IR and hs-CRP) were examined as covariates. The final multivariable models included time since menopause, race, ethnicity, educational status, strenuous exercise, BMI ≥30 kg/m2, non-HDL-C and hs-CRP as covariates. Due to the high collinearity between the two indices of central adiposity, within each analytic strategy, separate models examined the respective associations of WC > 88 cm and WHR > 0.8 with 3MS score. RESULTS On adjusted analyses, indices of central adiposity were independent predictors of significantly lower 3MS scores (p < 0.05). Consistency in this relationship was observed across the three different multivariable regression analytic approaches (GLM, ordinal and logistic regression). CONCLUSIONS Among recently menopausal women, WC > 88 cm and WHR > 0.8 were associated with significantly lower cognitive function, as reflected by lower 3MS scores. The mechanisms that might explain the observed negative implications of central adiposity for cognitive function warrant further study.
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Affiliation(s)
- Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States.
| | - Kelly Morgan
- SSM Health Dean Medical Group, Madison, WI, United States
| | - Nanette F Santoro
- Department of Obstetrics, Gynecology, University of Colorado, Denver, United States
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, United States
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, United States
| | | | - Rogerio Lobo
- Department of Obstetrics and Gynecology, Columbia University, United States
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, United States
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, United States
| | - S Mitchell Harman
- Kronos Longevity Research Institute and the Phoenix Veterans Administration Health Care System, Phoenix, AZ, United States
| | - Taryn T James
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison Geriatric Research Education and Clinical Center (GRECC), United States
| | - Carey E Gleason
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison Geriatric Research Education and Clinical Center (GRECC), United States
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27
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Lambrou NH, Gleason CE, Obedin-Maliver J, Lunn MR, Flentje A, Lubensky ME, Flatt JD. Subjective Cognitive Decline Associated with Discrimination in Medical Settings among Transgender and Nonbinary Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159168. [PMID: 35954522 PMCID: PMC9368374 DOI: 10.3390/ijerph19159168] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022]
Abstract
Background: Transgender and nonbinary (TNB) individuals report greater subjective cognitive decline (SCD) compared to non-TNB people. SCD involves self-reported problems with memory and thinking and is a potential risk for Alzheimer’s disease and related dementias (ADRD). We explored psychosocial factors, such as discrimination in medical settings, associated with SCD in a sample of TNB older adults. Methods: We utilized cross-sectional data on aging health, SCD (memory complaints and worsening memory in the past year), and discrimination in medical settings from The PRIDE Study for LGBTQ+ adults aged 50+ including TNB adults (n = 115). Associations were tested using multivariate logistic regression. Results: Nearly 16% of TNB participants rated their memory as poor/fair, and 17% reported that their memory was worse than a year ago. TNB older adults with SCD were more likely to report experiencing discrimination in medical settings. After adjustment, those reporting discrimination in medical settings had 4.5 times higher odds of reporting worsening memory than those who did not (OR: 4.5; 95%-CI: 1.5–13.2; p = 0.006), and 7.5 times more likely to report poor/fair memory (OR: 7.49; 95%-CI: 1.7–32.8; p = 0.008); Conclusions: TNB older adults reported high frequencies of SCD and discrimination in medical settings. Further research exploring affirmative cognitive screening and healthcare services is needed.
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Affiliation(s)
- Nickolas H. Lambrou
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (N.H.L.); (C.E.G.)
| | - Carey E. Gleason
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (N.H.L.); (C.E.G.)
- Geriatric Research Education and Clinical Center, Wm S Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA 94304, USA; (J.O.-M.); (M.R.L.)
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA 94304, USA; (J.O.-M.); (M.R.L.)
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA 94143, USA; (A.F.); (M.E.L.)
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA 94102, USA
| | - Micah E. Lubensky
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA 94143, USA; (A.F.); (M.E.L.)
| | - Jason D. Flatt
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA 94143, USA
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
- Correspondence: ; Tel.: +1-702-895-5586
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28
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Völter C, Götze L, Bajewski M, Dazert S, Thomas JP. Cognition and Cognitive Reserve in Cochlear Implant Recipients. Front Aging Neurosci 2022; 14:838214. [PMID: 35391751 PMCID: PMC8980358 DOI: 10.3389/fnagi.2022.838214] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
At present, dementia is a hot topic. Hearing loss is considered to be a modifiable risk factor for cognitive decline. The underlying mechanism remains unclear and might be mediated by socioeconomic and psychosocial factors. Cochlear implantation has been shown not only to restore auditory abilities, but also to decrease mental distress and to improve cognitive functions in people with severe hearing impairment. However, the promising results need to be confirmed. In a prospective single-center study, we tested the neurocognitive abilities of a large group of 71 subjects with bilateral severe hearing impairment with a mean age of 66.03 (SD = 9.15) preoperatively and 6, 12, and 24 months after cochlear implantation using a comprehensive non-auditory computer-based test battery, and we also assessed the cognitive reserve (CR) [Cognitive Reserve Index (CRI)], health-related quality of life (QoL) (Nijmegen Cochlear Implant Questionnaire), and depression (Geriatric Depression Scale-15). Cognitive functions significantly increased after 6 months in attention (p = 0.00004), working memory (operation span task; p = 0.002), and inhibition (p = 0.0002); and after 12 months in recall (p = 0.003) and verbal fluency (p = 0.0048), and remained stable up to 24 months (p ≥ 0.06). The CR positively correlated with cognitive functions pre- and post-operatively (both p < 0.005), but postoperative improvement in cognition was better in subjects with poor CR (p = 0.003). Depression had only a slight influence on one subtest. No correlation was found among cognitive skills, quality of life, and speech perception (each p ≥ 0.05). Cochlear implantation creates an enriched environment stimulating the plasticity of the brain with a global positive impact on neurocognitive functions, especially in subjects with poor preoperative cognitive performance and low cognitive reserve.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
- *Correspondence: Christiane Völter,
| | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Marcel Bajewski
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St.-Johannes-Hospital, Dortmund, Germany
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Brocchi A, Rebelos E, Dardano A, Mantuano M, Daniele G. Effects of Intermittent Fasting on Brain Metabolism. Nutrients 2022; 14:nu14061275. [PMID: 35334932 PMCID: PMC8954770 DOI: 10.3390/nu14061275] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] Open
Abstract
We are facing an obesity epidemic, and obesity itself and its close companion, type 2 diabetes, are independent risk factors for neurodegeneration. While most medical treatments fail to induce a clinically meaningful improvement in neurodegenerative disorders, lifestyle interventions have emerged in the spotlight. A recently rediscovered approach is intermittent fasting (IF), which, compared to the classic caloric restriction regimens, limits only the time of eating, rather than the number of calories allowed per day. There is already a large amount of evidence from preclinical and clinical studies showing the beneficial effects of IF. In this review, we specifically focus on the effects of IF on brain metabolism. Key molecular players modified during IF and involved in its beneficial central effects (ketone bodies, BDNF, GABA, GH/IGF-1, FGF2, sirtuin-3, mTOR, and gut microbiota) are identified and discussed. Studies suggest that IF induces several molecular and cellular adaptations in neurons, which, overall, enhance cellular stress resistance, synaptic plasticity, and neurogenesis. Still, the absence of guidelines regarding the application of IF to patients hampers its broad utilization in clinical practice, and further studies are needed to improve our knowledge on the different IF protocols and long-term effects of IF on brain metabolism before it can be widely prescribed.
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Affiliation(s)
- Alex Brocchi
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy; (A.B.); (A.D.); (M.M.)
| | - Eleni Rebelos
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy;
| | - Angela Dardano
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy; (A.B.); (A.D.); (M.M.)
| | - Michele Mantuano
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy; (A.B.); (A.D.); (M.M.)
| | - Giuseppe Daniele
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy; (A.B.); (A.D.); (M.M.)
- Correspondence: ; Tel.: +39-3404618257
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Ylilauri MPT, Hantunen S, Lönnroos E, Salonen JT, Tuomainen TP, Virtanen JK. Associations of dairy, meat, and fish intakes with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD). Eur J Nutr 2022; 61:2531-2542. [PMID: 35217900 PMCID: PMC9279192 DOI: 10.1007/s00394-022-02834-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
Purpose To investigate if dairy, meat, and fish intakes associate with dementia and cognitive performance. Methods We included 2497 dementia-free men from Eastern Finland, aged 42–60 years in 1984–1989 at the baseline examinations. Data on cognitive tests [Mini Mental State Exam (MMSE), trail making test (TMT), verbal fluency test (VFL), selective reminding test (SRT), and Russell’s adaptation of the visual reproduction test (VRT)] at the 4-year re-examinations were available for 482 men and on the ApoE phenotype for 1259 men. Data on dementia events were obtained by linkage to national health registers. Diet was assessed with baseline 4-day food records. Cox regression and analysis of covariance were used for analyses. Results During a mean 22-year follow-up, 337 men had a dementia diagnosis. Among the foods, only cheese intake associated with dementia risk (hazard ratio in the highest vs. the lowest quartile = 0.72, 95% confidence interval = 0.52–0.99, P-trend = 0.05). In the cognitive tests, higher non-fermented dairy and milk intakes associated with worse verbal fluency (VFT). Higher processed red meat intake associated with worse verbal (SRT) and visual memory (VRT), whereas higher unprocessed red meat intake associated with better general cognitive functioning (MMSE) and processing speed and executive functioning (TMT). Higher fish intake associated with better verbal memory (SRT). Among APOE-ε4 carriers, especially non-fermented dairy intake associated with higher risk of dementia outcomes, and higher fish intake indicated better cognitive performance. Conclusion Although higher intake of some food groups associated with cognitive performance, we found little evidence for associations with dementia risk. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-022-02834-x.
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Affiliation(s)
- Maija P T Ylilauri
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Jukka T Salonen
- MAS-Metabolic Analytical Services Oy, Helsinki, Finland.,Department of Public Health, The Faculty of Medicine, The University of Helsinki, Helsinki, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
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Cerin E, Barnett A, Shaw JE, Martino E, Knibbs LD, Tham R, Wheeler AJ, Anstey KJ. Urban Neighbourhood Environments, Cardiometabolic Health and Cognitive Function: A National Cross-Sectional Study of Middle-Aged and Older Adults in Australia. TOXICS 2022; 10:23. [PMID: 35051065 PMCID: PMC8779212 DOI: 10.3390/toxics10010023] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
Population ageing and urbanisation are global phenomena that call for an understanding of the impacts of features of the urban environment on older adults' cognitive function. Because neighbourhood characteristics that can potentially have opposite effects on cognitive function are interdependent, they need to be considered in conjunction. Using data from an Australian national sample of 4141 adult urban dwellers, we examined the extent to which the associations of interrelated built and natural environment features and ambient air pollution with cognitive function are explained by cardiometabolic risk factors relevant to cognitive health. All examined environmental features were directly and/or indirectly related to cognitive function via other environmental features and/or cardiometabolic risk factors. Findings suggest that dense, interconnected urban environments with access to parks, blue spaces and low levels of air pollution may benefit cognitive health through cardiometabolic risk factors and other mechanisms not captured in this study. This study also highlights the need for a particularly fine-grained characterisation of the built environment in research on cognitive function, which would enable the differentiation of the positive effects of destination-rich neighbourhoods on cognition via participation in cognition-enhancing activities from the negative effects of air pollutants typically present in dense, destination-rich urban areas.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (A.B.); (R.T.); (A.J.W.)
- School of Public Health, The University of Hong Kong, Hong Kong, China
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
- Department of Community Medicine, UiT the Artic University of Norway, 9019 Tromsø, Norway
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (A.B.); (R.T.); (A.J.W.)
| | - Jonathan E. Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Life Sciences, La Trobe University, Melbourne, VIC 3086, Australia
| | - Erika Martino
- School of Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia;
| | - Luke D. Knibbs
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia;
| | - Rachel Tham
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (A.B.); (R.T.); (A.J.W.)
| | - Amanda J. Wheeler
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia; (A.B.); (R.T.); (A.J.W.)
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Kaarin J. Anstey
- School of Psychology, University of New South Wales, Randwick, NSW 2052, Australia;
- Neuroscience Research Australia (NeuRA), Sydney, NSW 2031, Australia
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Vrijsen J, Abu-Hanna A, de Rooij SE, Smidt N. Association between dementia parental family history and mid-life modifiable risk factors for dementia: a cross-sectional study using propensity score matching within the Lifelines cohort. BMJ Open 2021; 11:e049918. [PMID: 34930728 PMCID: PMC8689157 DOI: 10.1136/bmjopen-2021-049918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Individuals with a parental family history (PFH) of dementia have an increased risk to develop dementia, regardless of genetic risks. The aim of this study is to investigate the association between a PFH of dementia and currently known modifiable risk factors for dementia among middle-aged individuals using propensity score matching (PSM). DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A subsample of Lifelines (35-65 years), a prospective population-based cohort study in the Netherlands was used. OUTCOME MEASURES Fourteen modifiable risk factors for dementia and the overall Lifestyle for Brain Health (LIBRA) score, indicating someone's potential for dementia risk reduction (DRR). RESULTS The study population included 89 869 participants of which 10 940 (12.2%) had a PFH of dementia (mean (SD) age=52.95 (7.2)) and 36 389 (40.5%) without a PFH of dementia (mean (SD) age=43.19 (5.5)). Of 42 540 participants (47.3%), PFH of dementia was imputed. After PSM, potential confounding variables were balanced between individuals with and without PFH of dementia. Individuals with a PFH of dementia had more often hypertension (OR=1.19; 95% CI 1.14 to 1.24), high cholesterol (OR=1.24; 95% CI 1.18 to 1.30), diabetes (OR=1.26; 95% CI 1.11 to 1.42), cardiovascular diseases (OR=1.49; 95% CI 1.18 to 1.88), depression (OR=1.23; 95% CI 1.08 to 1.41), obesity (OR=1.14; 95% CI 1.08 to 1.20) and overweight (OR=1.10; 95% CI 1.05 to 1.17), and were more often current smokers (OR=1.20; 95% CI 1.14 to 1.27) and ex-smokers (OR=1.21; 95% CI 1.16 to 1.27). However, they were less often low/moderate alcohol consumers (OR=0.87; 95% CI 0.83 to 0.91), excessive alcohol consumers (OR=0.93; 95% CI 0.89 to 0.98), socially inactive (OR=0.84; 95% CI 0.78 to 0.90) and physically inactive (OR=0.93; 95% CI 0.91 to 0.97). Having a PFH of dementia resulted in a higher LIBRA score (RC=0.15; 95% CI 0.11 to 0.19). CONCLUSION We found that having a PFH of dementia was associated with several modifiable risk factors. This suggests that middle-aged individuals with a PFH of dementia are a group at risk and could benefit from DRR. Further research should explore their knowledge, beliefs and attitudes towards DRR, and whether they are willing to assess their risk and change their lifestyle to reduce dementia risk.
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Affiliation(s)
- Joyce Vrijsen
- Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ameen Abu-Hanna
- Medical Informatics, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Frye BM, Craft S, Latimer CS, Keene CD, Montine TJ, Register TC, Orr ME, Kavanagh K, Macauley SL, Shively CA. Aging-related Alzheimer's disease-like neuropathology and functional decline in captive vervet monkeys (Chlorocebus aethiops sabaeus). Am J Primatol 2021; 83:e23260. [PMID: 33818801 PMCID: PMC8626867 DOI: 10.1002/ajp.23260] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/05/2021] [Accepted: 03/21/2021] [Indexed: 12/17/2022]
Abstract
Age-related neurodegeneration characteristic of late-onset Alzheimer's disease (LOAD) begins in middle age, well before symptoms. Translational models to identify modifiable risk factors are needed to understand etiology and identify therapeutic targets. Here, we outline the evidence supporting the vervet monkey (Chlorocebus aethiops sabaeus) as a model of aging-related AD-like neuropathology and associated phenotypes including cognitive function, physical function, glucose handling, intestinal physiology, and CSF, blood, and neuroimaging biomarkers. This review provides the most comprehensive multisystem description of aging in vervets to date. This review synthesizes a large body of evidence that suggests that aging vervets exhibit a coordinated suite of traits consistent with early AD and provide a powerful, naturally occurring model for LOAD. Notably, relationships are identified between AD-like neuropathology and modifiable risk factors. Gaps in knowledge and key limitations are provided to shape future studies to illuminate mechanisms underlying divergent neurocognitive aging trajectories and to develop interventions that increase resilience to aging-associated chronic disease, particularly, LOAD.
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Affiliation(s)
- Brett M. Frye
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
| | - Suzanne Craft
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
- J. Paul Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine
| | - Caitlin S. Latimer
- Department of Laboratory Medicine and Pathology, University of Washington-Seattle
| | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington-Seattle
| | | | - Thomas C. Register
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
- J. Paul Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine
| | - Miranda E. Orr
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
| | - Kylie Kavanagh
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
| | - Shannon L. Macauley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
| | - Carol A. Shively
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
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Masoli JAH, Delgado J. Blood pressure, frailty and dementia. Exp Gerontol 2021; 155:111557. [PMID: 34537278 DOI: 10.1016/j.exger.2021.111557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
High blood pressure (BP) affects 75% of people aged over 70. Ageing alters BP homeostasis, resulting in postural hypotension and increased BP variability. Co-morbidity and frailty add complexity to understanding BP changes in later life. Longitudinal BP declines are likely driven by accumulating co-morbidity and are accelerated in both frailty and dementia. This narrative review summarises what is known about the association between BP and frailty, the clinical management of BP in frailty and the association between BP, cognitive decline and dementia.
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Affiliation(s)
- Jane A H Masoli
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, Exeter, UK; Healthcare for Older People Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - João Delgado
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, Exeter, UK
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Huang LY, Hu HY, Wang ZT, Ma YH, Dong Q, Tan L, Yu JT. Association of Occupational Factors and Dementia or Cognitive Impairment: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 78:217-227. [PMID: 32986670 DOI: 10.3233/jad-200605] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several existing studies have reported that occupational factors might play an important part in cognitive function with aging. OBJECTIVE We aim to explore the associations between modifiable occupational factors and risk of dementia or mild cognitive impairment (MCI). METHODS Adopting random-effect models, this study conducted primary analyses for all occupational factors and subgroup analyses for the effect of occupation type based on prospective cohort and case-control studies searched from PubMed and EMBASE databases up to March 2020. RESULTS Among the 38,111 identified literatures, 9 studies on occupation type, 4 studies on work complexity, and 30 studies on occupational exposure were included. In terms of occupation type, mental work conferred a 44% reduced risk (95% CI = 0.34-0.94, I² = 85.00%, p < 0.01) for MCI. In terms of work complexity, higher work complexity conferred a 5% reduced risk (95% CI = 0.91-1.00, I² = 57.00%, p < 0.01) for dementia. In terms of occupational exposure, high strain and passive job in the longest-held job conferred a 1.21- and 1.15-fold excess risk (95% CI = 1.05-1.39 I² = 62.00%, p < 0.05; 95% CI = 1.05-1.26 I² = 31.00%, p = 0.23; respectively) of cognitive decline. Besides, magnetic field exposure conferred a 1.26-fold excess risk (95% CI = 1.01-1.57, I² = 69.00%, p < 0.01) for dementia. CONCLUSION Novel prevention strategies based on occupational factors may hold promise against dementia and MCI.
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Affiliation(s)
- Liang-Yu Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - He-Ying Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Więckowska-Gacek A, Mietelska-Porowska A, Wydrych M, Wojda U. Western diet as a trigger of Alzheimer's disease: From metabolic syndrome and systemic inflammation to neuroinflammation and neurodegeneration. Ageing Res Rev 2021; 70:101397. [PMID: 34214643 DOI: 10.1016/j.arr.2021.101397] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/10/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
An excess of saturated fatty acids and simple sugars in the diet is a known environmental risk factor of Alzheimer's disease (AD) but the holistic view of the interacting processes through which such diet may contribute to AD pathogenesis is missing. We addressed this need through extensive analysis of published studies investigating the effects of western diet (WD) on AD development in humans and laboratory animals. We reviewed WD-induced systemic alterations comprising metabolic changes, induction of obesity and adipose tissue inflammation, gut microbiota dysbiosis and acceleration of systemic low-grade inflammation. Next we provide an overview of the evidence demonstrating that WD-associated systemic alterations drive impairment of the blood-brain barrier (BBB) and development of neuroinflammation paralleled by accumulation of toxic amyloid. Later these changes are followed by dysfunction of synaptic transmission, neurodegeneration and finally memory and cognitive impairment. We conclude that WD can trigger AD by acceleration of inflammaging, and that BBB impairment induced by metabolic and systemic inflammation play the central role in this process. Moreover, the concurrence of neuroinflammation and Aβ dyshomeostasis, which by reciprocal interactions drive the vicious cycle of neurodegeneration, contradicts Aβ as the primary trigger of AD. Given that in 2019 the World Health Organization recommended focusing on modifiable risk factors in AD prevention, this overview of the sequential, complex pathomechanisms initiated by WD, which can lead from peripheral disturbances to neurodegeneration, can support future prevention strategies.
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Blümel JE, Arteaga E, Vallejo MS, Ojeda E, Meza P, Martino M, Rodríguez-Vidal D, Ñañez M, Tserotas K, Rojas J, Rodrígues MA, Espinoza MT, Salinas C, Párraga-Párraga J, Chedraui P. Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study. Climacteric 2021; 25:195-202. [PMID: 34323137 DOI: 10.1080/13697137.2021.1951203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women. OBJECTIVE This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI). METHOD The case-control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA). RESULTS Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m2, respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20-0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10-0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20-2.38), parity (having >2 children; OR 1.69; 95% CI 1.21-2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09-2.24), hypertension (OR 1.41; 95% CI 1.01-1.96), being sexually active (OR 0.56; 95% CI 0.40-0.79), education >12 years (OR 0.46; 95% CI 0.32-0.65) and MHT use (OR 0.31; 95% CI 0.21-0.46). CONCLUSION Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.
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Affiliation(s)
- J E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - E Arteaga
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - M S Vallejo
- Clínica Quilín, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - E Ojeda
- Departamento de Obstetricia y Ginecología, Universidad Andina, Cusco, Perú
| | - P Meza
- Departamento de Medicina Familiar, Universidad San Martin de Porres, Lima, Perú
| | - M Martino
- Departamento de Obstetricia y Ginecología, Universidad Nacional de Rosario, Rosario, Argentina
| | - D Rodríguez-Vidal
- Departamento de Obstetricia y Ginecología, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - M Ñañez
- Cátedra de Ginecología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - K Tserotas
- Complejo Hospitalario Dr. Arnulfo Arias Madrid, Caja del Seguro Social, Panamá, Panamá
| | - J Rojas
- Departamento de Ginecología Obstetricia, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - M A Rodrígues
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M T Espinoza
- Unidad de Climaterio, Clínica Los Ángeles, Cochabamba, Bolivia
| | - C Salinas
- Servicio de Obstetricia y Ginecología, Hospital Ángeles Puebla, Puebla, México
| | - J Párraga-Párraga
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - P Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Facultad de Ciencias de la Salud, Universidad Católica 'Nuestra Señora de la Asunción', Asunción, Paraguay
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38
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İnce N, Öztürk M, Meseri R, Besler HT. Is Obesity Associated with Lower Mini Mental Test Scores among Elderly? A Cross Sectional Study. J Am Coll Nutr 2021; 41:600-607. [PMID: 34283003 DOI: 10.1080/07315724.2021.1946869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Obesity leads to many chronic diseases and its association with cognitive impairment is controversial. The objective was to investigate the association between obesity, anthropometric measurements and cognitive functions of elderly. METHODS Planned cross-sectionally, community-dwelling Cypriots (aged ≥ 50 years) without any neurological disorders, were included. Cognitive impairment evaluated by Mini Mental State Examination (MMSE) was the dependent variable. Socio-demographic variables, anthropometric measurements and obesity were the independent variables. The data was collected via face-to-face interview. Logistic regression models were constituted to determine the association of anthropometric measurements, obesity and dementia. RESULTS The mean age of participants (n = 541) was 60.0 ± 8.7 for women (n = 377) and 61.5 ± 6.0 years for men (n = 164). According to MMSE, 26.0% of women and 11.0% of men had mild-dementia, and the rest scored normal. After adjusted for age and sex, each unit increase in BMI (OR: 1.045, 95%CI: 1.008-1.091), Waist to height ratio (WHtR; OR: 1.030, 95%CI: 1.006-1.055) and Mid upper arm circumference (MUAC; OR: 1.077, 95%CI: 1.016-1.141) increases the risk of mild-dementia. When education, employment and smoking were included in the models, significance of anthropometric measurements was diminished and only sex and education were remained significant for all. CONCLUSION After controlled for age and sex, increment in anthropometric measurements increased the risk of dementia but when education was taken into consideration, this significant association was diminished showing that sex and education is more predominant in a heterogeneous group in means of education. Thus, for heterogeneous groups it might be better to revise MMSE. To determine the association between obesity and dementia cohort studies with longer follow-up duration with larger samples are needed.
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Affiliation(s)
- Nezire İnce
- Nutrition and Dietetic Department, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Cyprus
| | - Müjgan Öztürk
- Nutrition and Dietetic Department, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Cyprus
| | - Reci Meseri
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Halit Tanju Besler
- Nutrition and Dietetic Department, Faculty of Health Sciences, Istinye University, Istanbul, Turkey
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Vrijsen J, Maeckelberghe ELM, Broekstra R, de Vries JJ, Abu-Hanna A, De Deyn PP, Voshaar RCO, Reesink FE, Buskens E, de Rooij SE, Smidt N. Knowledge, health beliefs and attitudes towards dementia and dementia risk reduction among descendants of people with dementia: a qualitative study using focus group discussions. BMC Public Health 2021; 21:1344. [PMID: 34233658 PMCID: PMC8265097 DOI: 10.1186/s12889-021-11415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Individuals with a parental family history of dementia have an increased risk of developing dementia because they share their genes as well as their psychosocial behaviour. Due to this increased risk and their experience with dementia, they may be particularly eager to receive information regarding dementia risk reduction (DRR). This study evaluated the knowledge, beliefs and attitudes towards dementia and DRR among descendants of people with dementia. Method Using a semi-structured topic guide, three focus group discussions were conducted consisting of 12 female (80%) and 3 male (20%) descendants of people with dementia with a mean (± SD) age of 48.8 (± 12) years. Focus group discussions were audio recorded and transcribed. Each transcript was analysed thoroughly, and where appropriate, a code was generated and assigned by two researchers independently. Then, similar codes were grouped together and categorized into themes. Results The items in the topic guide could only be addressed after participants had been given the opportunity to share their experiences of having a parent with dementia. Participants were unaware or uncertain about the possibility of reducing the risk of developing dementia and therefore hesitant to assess their dementia risk without treatment options in sight. Moreover, participants indicated that their general practitioner only gave some information on heritability, not on DRR. Although participants identified a large number of modifiable risk factors as a group during the group discussions, they were eager to receive more information on dementia and DRR. In the end, participants adopted a more positive attitude towards a DRR programme and provided suggestions for the development of future DRR programmes. Conclusions Although the research aim was to evaluate the knowledge, beliefs and attitudes towards dementia and DRR, sharing experiences of having a parent with dementia seemed a prerequisite for considering participants’ own risk of developing dementia and participating in a DRR programme. Knowledge of dementia and DRR was limited. Due to unawareness of the possibility of reducing dementia risk, participants were hesitant about assessing their dementia risk. Group discussions positively changed the perception of dementia risk assessment and participants’ willingness to participate in a DRR programme. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11415-2.
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Affiliation(s)
- J Vrijsen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, FA40, PO Box 30 001, 9700, RB, Groningen, the Netherlands.
| | - E L M Maeckelberghe
- Wenckebach Institute for Training and Education, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - R Broekstra
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, FA40, PO Box 30 001, 9700, RB, Groningen, the Netherlands.,Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - J J de Vries
- Department of Neurology and Alzheimer Centre Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Abu-Hanna
- Department of Medical Informatics, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - P P De Deyn
- Department of Neurology and Alzheimer Centre Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - R C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - F E Reesink
- Department of Neurology and Alzheimer Centre Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - E Buskens
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, FA40, PO Box 30 001, 9700, RB, Groningen, the Netherlands
| | - S E de Rooij
- Department of Internal Medicine & Geriatrics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - N Smidt
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, FA40, PO Box 30 001, 9700, RB, Groningen, the Netherlands
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40
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Smoking and Neuropsychiatric Disease-Associations and Underlying Mechanisms. Int J Mol Sci 2021; 22:ijms22147272. [PMID: 34298890 PMCID: PMC8304236 DOI: 10.3390/ijms22147272] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 01/02/2023] Open
Abstract
Despite extensive efforts to combat cigarette smoking/tobacco use, it still remains a leading cause of global morbidity and mortality, killing more than eight million people each year. While tobacco smoking is a major risk factor for non-communicable diseases related to the four main groups—cardiovascular disease, cancer, chronic lung disease, and diabetes—its impact on neuropsychiatric risk is rather elusive. The aim of this review article is to emphasize the importance of smoking as a potential risk factor for neuropsychiatric disease and to identify central pathophysiological mechanisms that may contribute to this relationship. There is strong evidence from epidemiological and experimental studies indicating that smoking may increase the risk of various neuropsychiatric diseases, such as dementia/cognitive decline, schizophrenia/psychosis, depression, anxiety disorder, and suicidal behavior induced by structural and functional alterations of the central nervous system, mainly centered on inflammatory and oxidative stress pathways. From a public health perspective, preventive measures and policies designed to counteract the global epidemic of smoking should necessarily include warnings and actions that address the risk of neuropsychiatric disease.
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Wang C, Fu W, Cao S, Jiang H, Guo Y, Xv H, Liu J, Gan Y, Lu Z. Weight Loss and the Risk of Dementia: A Meta-analysis of Cohort Studies. Curr Alzheimer Res 2021; 18:125-135. [PMID: 33855945 DOI: 10.2174/1567205018666210414112723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Weight loss is a common phenomenon among the elderly and is identified as an important indicator of health status. Many epidemiology studies have investigated the association between weight loss and dementia, but the results were inconsistent. OBJECTIVE To examine and determine the association between weight loss and the risk of dementia. METHODS Eligible cohort studies involving weight loss and dementia were searched from PubMed, Embase, and Ovid databases through October 2018. Pooled relative risks (RRs) with its 95% confidence intervals (CIs) were used to estimate the effects of weight loss on the risk of dementia. Subgroup and sensitivity analyses were performed to explore the potential sources of heterogeneity. The Begg's test and Egger's test were used to assess the publication bias. RESULTS A total of 20 cohort studies with 38,141 participants were included in this meta-analysis. Weight loss was significantly associated with the risk of dementia (RR=1.26, 95% CI=1.15-1.38). BMI decline ≥0.8 units (RR=1.31, 95% CI=1.10-1.56) and ≥4% (RR=1.19, 95% CI=1.03-1.38) could increase the risk of dementia. The risk of all-cause dementia for people with weight loss increased by 31% (RR=1.31, 95% CI=1.15-1.49), and 25% higher for incident Alzheimer's disease (RR=1.25, 95% CI=1.07-1.46). Weight loss in participants with normal weight had a similar dementia risk (RR=1.21, 95% CI=1.06-1.38) with the overweight individuals (RR=1.22, 95% CI=1.11-1.34). CONCLUSION Weight loss may be associated with an increased risk of dementia, especially for Alzheimer's disease. Maintaining weight stability may help prevent dementia.
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Affiliation(s)
- Chao Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenning Fu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Yingying Guo
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongbin Xv
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianxin Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Tyagi A, Pugazhenthi S. Targeting Insulin Resistance to Treat Cognitive Dysfunction. Mol Neurobiol 2021; 58:2672-2691. [PMID: 33483903 DOI: 10.1007/s12035-021-02283-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
Dementia is a devastating disease associated with aging. Alzheimer's disease is the most common form of dementia, followed by vascular dementia. In addition to clinically diagnosed dementia, cognitive dysfunction has been reported in diabetic patients. Recent studies are now beginning to recognize type 2 diabetes mellitus, characterized by chronic hyperglycemia and insulin resistance, as a risk factor for Alzheimer's disease and other cognitive disorders. While studies on insulin action have remained traditionally in the domain of peripheral tissues, the detrimental effects of insulin resistance in the central nervous system on cognitive dysfunction are increasingly being reported by recent clinical and preclinical studies. The findings from these studies suggest that antidiabetic drugs have the potential to be used to treat dementia. In this review, we discuss the physiological functions of insulin in the brain, studies on the evaluation of cognitive function under conditions of insulin resistance, and reports on the beneficial actions of antidiabetic drugs in the brain. This review covers clinical studies as well as investigations in animal models and will further highlight the emerging link between insulin resistance and neurodegenerative disorders.
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Affiliation(s)
- Anit Tyagi
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.,Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.,University of Denver, Denver, CO, USA
| | - Subbiah Pugazhenthi
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA. .,Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.
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Theodore LE, Kellow NJ, McNeil EA, Close EO, Coad EG, Cardoso BR. Nut Consumption for Cognitive Performance: A Systematic Review. Adv Nutr 2020; 12:777-792. [PMID: 33330927 PMCID: PMC8166568 DOI: 10.1093/advances/nmaa153] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 01/24/2023] Open
Abstract
Diet is considered an important modifiable lifestyle factor capable of attenuating early cognitive changes in healthy older people. The inclusion of nuts in the diet has been investigated as a dietary strategy for maintenance of brain health across the lifespan. This review aimed to present up-to-date evidence regarding the association between nut intake and cognitive performance. Four databases (Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Embase) were systematically searched from inception to April 2020. Eligible articles were interventional or observational studies in humans aged ≥18 y that measured the effects (or association) of nuts (almond, hazelnut, macadamia, pistachio, walnut, pecan, pine nut, Brazil nut, cashew, peanut) on cognitive outcomes. Out of the 2374 articles identified in the searches, 22 involving 43,793 participants met the criteria and were ultimately included in this review. Memory (immediate and delayed), attention, processing speed, executive function, and visual-spatial ability, as well as risk of mild cognitive impairment, were the outcomes investigated. Lack of consistency across the studies regarding study design, types of nut used, and cognitive outcomes measured resulted in inconsistent evidence that the regular consumption of mixed nuts has a protective effect on cognition in adults of different ages. Nonetheless, we observed that studies targeting populations with a higher risk of cognitive decline tended to find a more favorable outcome. Furthermore, homogeneous findings were observed in the studies that specifically addressed the association between walnut consumption and cognitive performance: out of the 6 studies, including 2 randomized controlled trials, only 1 did not find a positive association.
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Affiliation(s)
- Lauren E Theodore
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Nicole J Kellow
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Emily A McNeil
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Evangeline O Close
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Eliza G Coad
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
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Colovati MES, Novais IP, Zampol M, Mendes GD, Cernach MCS, Zanesco A. Interaction between physical exercise and APOE gene polymorphism on cognitive function in older people. ACTA ACUST UNITED AC 2020; 54:e10098. [PMID: 33331535 PMCID: PMC7727114 DOI: 10.1590/1414-431x202010098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/18/2020] [Indexed: 12/27/2022]
Abstract
We aimed to present an overview of the literature regarding the interaction between physical exercise and APOE gene polymorphism on cognitive function, particularly in patients with Alzheimer's disease (AD). Firstly, this review focused on the effect of the physical exercise on cognitive function, regardless of APOE gene polymorphism. Some studies have shown that a high level of cardiorespiratory fitness is associated with less neuronal damage with an improvement in memory score tests whereas other studies failed to detect any association between physical exercise and cognitive improvement either in healthy individuals or patients with AD. Taken together, standardized protocols and more longitudinal studies are required to provide a better insight into the effects of physical exercise on cognitive function. Although there is no agreement in the literature regarding the effects of physical exercise on cognitive function, it is well established that it improves social interaction and the feeling of well-being, thereby positively contributing to the quality of life of the elderly. Regarding the influence of physical exercise on cognitive function in APOE ε4 allele carriers, the data trend shows that the carriers of allele ε4 for APOE gene were more responsive to the beneficial effects of physical exercise on cognitive function compared with non-carriers. Nevertheless, studies with larger sample sizes will provide more accuracy about this relationship.
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Affiliation(s)
- M E S Colovati
- Laboratório de Fisiopatologia do Envelhecimento, Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos, Santos, SP, Brasil
| | - I P Novais
- Departamento de Saúde I, Programa de Pós-Graduação em Educação Física UESB/UESC, Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brasil
| | - M Zampol
- Laboratório de Fisiopatologia do Envelhecimento, Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos, Santos, SP, Brasil
| | - G D Mendes
- Laboratório de Fisiopatologia do Envelhecimento, Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos, Santos, SP, Brasil
| | - M C S Cernach
- Laboratório de Fisiopatologia do Envelhecimento, Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos, Santos, SP, Brasil
| | - A Zanesco
- Laboratório de Fisiopatologia do Envelhecimento, Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos, Santos, SP, Brasil
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45
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Werner P, AboJabel H. Perceptions About and Engagement in Behaviors to Reduce the Risk of Dementia Among Adult Persons in Israel. J Alzheimers Dis 2020; 78:1011-1017. [PMID: 33074232 DOI: 10.3233/jad-200780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BackgroundEngagement in behaviors aimed at reducing the risk of developing dementia is a leading recommendation in most National Dementia Strategy programs. OBJECTIVE In an effort to advance knowledge regarding the implementation of this recommendation, the current study examined the perceptions and engagement of the adult population in Israel regarding behaviors aimed at reducing the risk of developing dementia, and its correlates. METHODS A cross-sectional survey was conducted among 502 Israeli adults aged 40 and over. Approximately half of the participants (51.2%) were female, and the majority (80.1%) were Jewish. RESULTS Overall, while the percentage of participants reporting that the examined activities were important for brain health was moderate, percentages reporting engaging in these behaviors were low. The most important correlate of engagement in health behaviors was participants' perceptions about the importance of these behaviors for their brain health. Increased age, being Jewish, and enhanced perceived susceptibility to develop dementia were also significantly associated with increased engagement in behaviors to reduce the risk of dementia. CONCLUSION The results of this study emphasize the need to develop intervention programs aimed at promoting engagement in behaviors to reduce the risk of dementia development. These programs will benefit from assessing participants' perceived importance of these behaviors, and from identifying the needs of unique groups, such as older persons and those pertaining to ethno-cultural groups.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Israel
| | - Hanan AboJabel
- Department of Community Mental Health, University of Haifa, Israel
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Reiss AB, Glass AD, Wisniewski T, Wolozin B, Gomolin IH, Pinkhasov A, De Leon J, Stecker MM. Alzheimer's disease: many failed trials, so where do we go from here? J Investig Med 2020; 68:1135-1140. [PMID: 32699179 DOI: 10.1136/jim-2020-001297] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/21/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative brain disorder associated with relentlessly progressive cognitive impairment and memory loss. AD pathology proceeds for decades before cognitive deficits become clinically apparent, opening a window for preventative therapy. Imbalance of clearance and buildup of amyloid β and phosphorylated tau proteins in the central nervous system is believed to contribute to AD pathogenesis. However, multiple clinical trials of treatments aimed at averting accumulation of these proteins have yielded little success, and there is still no disease-modifying intervention. Here, we discuss current knowledge of AD pathology and treatment with an emphasis on emerging biomarkers and treatment strategies.
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Affiliation(s)
- Allison Bethanne Reiss
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Amy D Glass
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Thomas Wisniewski
- Departments of Neurology, Pathology and Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Benjamin Wolozin
- Departments of Pharmacology and Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Irving H Gomolin
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Winthrop Hospital, Mineola, New York, USA
| | - Joshua De Leon
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Mark M Stecker
- Neurology, UCSF San Francisco/Fresno, Fresno, California, USA
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