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Power MC, Lynch KM, Bennett EE, Ying Q, Park ES, Xu X, Smith RL, Stewart JD, Yanosky JD, Liao D, van Donkelaar A, Kaufman JD, Sheppard L, Szpiro AA, Whitsel EA. A comparison of PM 2.5 exposure estimates from different estimation methods and their associations with cognitive testing and brain MRI outcomes. ENVIRONMENTAL RESEARCH 2024; 256:119178. [PMID: 38768885 PMCID: PMC11186721 DOI: 10.1016/j.envres.2024.119178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Reported associations between particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) and cognitive outcomes remain mixed. Differences in exposure estimation method may contribute to this heterogeneity. OBJECTIVES To assess agreement between PM2.5 exposure concentrations across 11 exposure estimation methods and to compare resulting associations between PM2.5 and cognitive or MRI outcomes. METHODS We used Visit 5 (2011-2013) cognitive testing and brain MRI data from the Atherosclerosis Risk in Communities (ARIC) Study. We derived address-linked average 2000-2007 PM2.5 exposure concentrations in areas immediately surrounding the four ARIC recruitment sites (Forsyth County, NC; Jackson, MS; suburbs of Minneapolis, MN; Washington County, MD) using 11 estimation methods. We assessed agreement between method-specific PM2.5 concentrations using descriptive statistics and plots, overall and by site. We used adjusted linear regression to estimate associations of method-specific PM2.5 exposure estimates with cognitive scores (n = 4678) and MRI outcomes (n = 1518) stratified by study site and combined site-specific estimates using meta-analyses to derive overall estimates. We explored the potential impact of unmeasured confounding by spatially patterned factors. RESULTS Exposure estimates from most methods had high agreement across sites, but low agreement within sites. Within-site exposure variation was limited for some methods. Consistently null findings for the PM2.5-cognitive outcome associations regardless of method precluded empirical conclusions about the potential impact of method on study findings in contexts where positive associations are observed. Not accounting for study site led to consistent, adverse associations, regardless of exposure estimation method, suggesting the potential for substantial bias due to residual confounding by spatially patterned factors. DISCUSSION PM2.5 estimation methods agreed across sites but not within sites. Choice of estimation method may impact findings when participants are concentrated in small geographic areas. Understanding unmeasured confounding by factors that are spatially patterned may be particularly important in studies of air pollution and cognitive or brain health.
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Affiliation(s)
- Melinda C Power
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA.
| | - Katie M Lynch
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA
| | - Erin E Bennett
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, Washington, DC, 20052, USA
| | - Qi Ying
- Zachry Department of Civil & Environmental Engineering, Texas A&M University, 201 Dwight Look, College Station, TX, 77840, USA
| | - Eun Sug Park
- Texas A&M Transportation Institute, Texas A&M University System, 3135 TAMU, College Station, TX, 77843, USA
| | - Xiaohui Xu
- Department of Epidemiology & Biostatistics, Texas A&M Health Science Center School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Richard L Smith
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, 318 E Cameron Ave, Chapel Hill, NC, 27599, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Daur Dr, Chapel Hill, NC, 27516, USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Daur Dr, Chapel Hill, NC, 27516, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 700 HMC Cres Rd, Hershey, PA, 17033, USA
| | - Duanping Liao
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 700 HMC Cres Rd, Hershey, PA, 17033, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental, and Chemical Engineering McKelvey School of Engineering, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Joel D Kaufman
- Department of Medicine, School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA; Department of Biostatistics, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Daur Dr, Chapel Hill, NC, 27516, USA; Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 321 S Columbia St, Chapel Hill, NC, 27599, USA
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Duodu PA, Dey NEY, Okyere J, Simkhada B, Barker C, Gillibrand W, Simkhada P. Gendered differences in the prevalence and associated factors of dementia in Ghana: a cross-sectional survey. BMC Psychiatry 2024; 24:397. [PMID: 38802813 PMCID: PMC11131303 DOI: 10.1186/s12888-024-05856-3] [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: 12/08/2023] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Dementia as a global phenomenon has received significant attention in research due to the adverse effects it has on the daily functioning of its victims. Despite studies conducted in relation to the prevalence and associated factors of dementia in Ghana, not much attention has been paid to the influence of gender. The study, therefore, focused on estimating gender differences in the prevalence and associated factors of dementia in the Ashanti Region of Ghana. METHODS This study adopted a cross-sectional design with surveys to recruit 800 participants who were 45 years or older. The data was obtained using the standardized Rowland Universal Dementia Assessment Scale (RUDAS) together with information on the various associated factors. A series of logistic models comprising of the total sample model, male sample model, and female sample model were estimated to analyse the data. All data analyses were completed in Stata version 14. RESULTS The overall prevalence of dementia was 23.38% [95% CI:20.44, 26.31]. More females 24.56% [95% CI:20.81, 28.31] compared to males 21.31% [95% CI:16.57, 26.04] were at risk of dementia. Younger age, attaining formal education, and belonging to richer households were negatively associated with the risk of dementia. In the total sample model, younger age and attaining formal education were negatively associated with dementia risk. In the male-female stratified models, education and household wealth index were negatively associated with dementia risk in the male sample while age and education were negatively related to dementia risk in the female sample. CONCLUSION The study concludes that there are gendered differences in the prevalence and factors associated with the risk of dementia in Ghana. As such, interventions and programmes to identify dementia cases must be gender sensitive. Specifically, when addressing dementia risk in males, interventions should be directed towards those with lower wealth status. Likewise, when developing programmes to mitigate dementia risk in women, particular attention should be given to women in the oldest age category.
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Grants
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
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Affiliation(s)
- Precious Adade Duodu
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | | | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Bibha Simkhada
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | - Caroline Barker
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | - Warren Gillibrand
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
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Geng C, Meng K, Tang Y. Identifying the mediating role of inflammation on the relationship between socioeconomic status and Alzheimer's disease: a Mendelian randomization analysis and mediation analysis. J Neurol 2024; 271:2484-2493. [PMID: 38253907 DOI: 10.1007/s00415-023-12176-1] [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: 11/29/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Observational studies have demonstrated a significant association between socio-economic status (SES) and Alzheimer's disease (AD). Nonetheless, the precise biological mechanisms underlying this association remain unclear. Therefore, we adopted a Mendelian Randomization (MR) approach to investigate the causal relationship between SES and genetic susceptibility to AD, as well as to explore the potential mediation effects of inflammation. METHODS Large-scale cohorts based on publicly available genome-wide association study (GWAS) datasets from European populations were employed for conducting the MR study. The primary criterion utilized was the inverse-variance weighting (IVW) model. Heterogeneity and horizontal pleiotropy were assessed. In addition, multivariate MR (MVMR) was utilized to correct the confounders. Moreover, a two-step MR approach was used to evaluate the potential mediating effects of factors on the causal effects between SES and AD. RESULTS As indicated by the results of the IVW model, educational years (OR = 0.708, 95% CI 0.610-0.821, P < 0.001) and household income (OR = 0.746, 95% CI 0.566-0.982, P = 0.037) was associated with a decreased genetic susceptibility risk for AD. The univariable results showed that the causal effect of educational years on the lower risk of AD remained significant (OR = 0.643, 95% CI 0.467-0.886, P = 0.006). In addition, our findings indicated that C-reactive protein (CRP) played a role in the causal effect of educational years on AD. The proportions of mediation were - 50.08% (95% CI - 92.78; - 7.38%). DISCUSSION These findings provided evidence supporting the causal effect of educational attainment lower AD risk, with inflammation playing a mediating role. These findings may inform prevention strategies and interventions directed toward AD. Future studies should explore other plausible biological mechanisms.
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Affiliation(s)
- Chaofan Geng
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Ke Meng
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Yi Tang
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
- Neurodegenerative Laboratory of Ministry of Education of the People's Republic of China, Beijing, China.
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Bridson L, Robinson E, Putra IGNE. Financial-related discrimination and socioeconomic inequalities in psychological well-being related measures: a longitudinal study. BMC Public Health 2024; 24:1008. [PMID: 38605335 PMCID: PMC11010292 DOI: 10.1186/s12889-024-18417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND This study examined the prospective association between financial-related discrimination and psychological well-being related measures and assessed the role of financial-related discrimination in explaining socioeconomic inequalities in psychological well-being related measures. METHODS Data of UK older adults (≥ 50 years) from the English Longitudinal Study of Ageing were used (baseline: Wave 5, 2010/2011; n = 8,988). The baseline total non-pension wealth (in tertiles: poorest, middle, richest) was used as a socioeconomic status (SES) measure. Financial-related discrimination at baseline was defined as participants who reported they had been discriminated against due to their financial status. Five psychological well-being related measures (depressive symptoms, enjoyment of life, eudemonic well-being, life satisfaction and loneliness) were examined prospectively across different follow-up periods (Waves 6, 2012/2013, 2-year follow-up; and 7, 2014/2015, 4-year follow-up). Regression models assessed associations between wealth, financial-related discrimination, and follow-up psychological measures, controlling for sociodemographic covariates and baseline psychological measures (for longitudinal associations). Mediation analysis informed how much (%) the association between wealth and psychological well-being related measures was explained by financial-related discrimination. RESULTS Participants from the poorest, but not middle, (vs. richest) wealth groups were more likely to experience financial-related discrimination (OR = 1.97; 95%CI = 1.49, 2.59). The poorest (vs. richest) wealth was also longitudinally associated with increased depressive symptoms and decreased enjoyment of life, eudemonic well-being and life satisfaction in both 2-year and 4-year follow-ups, and increased loneliness at 4-year follow-up. Experiencing financial-related discrimination was longitudinally associated with greater depressive symptoms and loneliness, and lower enjoyment of life across follow-up periods. Findings from mediation analysis indicated that financial-related discrimination explained 3-8% of the longitudinal associations between wealth (poorest vs. richest) and psychological well-being related measures. CONCLUSIONS Financial-related discrimination is associated with worse psychological well-being and explains a small proportion of socioeconomic inequalities in psychological well-being.
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Affiliation(s)
- Lucy Bridson
- Department of Psychology, Institute of Population Health, University of Liverpool, Bedford Street South, L69 7ZA, Liverpool, UK
| | - Eric Robinson
- Department of Psychology, Institute of Population Health, University of Liverpool, Bedford Street South, L69 7ZA, Liverpool, UK
| | - I Gusti Ngurah Edi Putra
- Department of Psychology, Institute of Population Health, University of Liverpool, Bedford Street South, L69 7ZA, Liverpool, UK.
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Ou YN, Zhang YB, Li YZ, Huang SY, Zhang W, Deng YT, Wu BS, Tan L, Dong Q, Pan A, Chen RJ, Feng JF, Smith AD, Cheng W, Yu JT. Socioeconomic status, lifestyle and risk of incident dementia: a prospective cohort study of 276730 participants. GeroScience 2024; 46:2265-2279. [PMID: 37926784 PMCID: PMC10828350 DOI: 10.1007/s11357-023-00994-0] [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: 05/11/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023] Open
Abstract
Healthy lifestyle might alleviate the socioeconomic inequities in health, but the extent of the joint and interactive effects of these two factors on dementia are unclear. This study aimed to detect the joint and interactive associations of socioeconomic status (SES) and lifestyle factors with incident dementia risk, and the underlying brain imaging alterations. Cox proportional hazards analysis was performed to test the joint and interactive associations. Partial correlation analysis was performed to reflect the brain imaging alterations. A total of 276,730 participants with a mean age of 55.9 (±8.0) years old from UK biobank were included. Over 8.5 (±2.6) years of follow-up, 3013 participants were diagnosed with dementia. Participants with high SES and most healthy lifestyle had a significantly lower risk of incident dementia (HR=0.19, 95% CI=0.14 to 0.26, P<2×10-16), Alzheimer's disease (AD, HR=0.19, 95% CI=0.13 to 0.29, P=8.94×10-15), and vascular dementia (HR=0.24, 95% CI=0.12 to 0.48, P=7.57×10-05) compared with participants with low SES and an unhealthy lifestyle. Significant interactions were found between SES and lifestyle on dementia (P=0.002) and AD (P=0.001) risks; the association between lifestyle and dementia was stronger among those of high SES. The combination of high SES and healthy lifestyle was positively associated with higher volumes in brain regions vulnerable to dementia-related atrophy. These findings suggest that SES and lifestyle significantly interact and influence dementia with its related brain structure phenotypes.
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Affiliation(s)
- Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Yan-Bo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Yu-Zhu Li
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Shu-Yi Huang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Wei Zhang
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Yue-Ting Deng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Bang-Sheng Wu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China.
| | - Qiang Dong
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Ren-Jie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200040, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - A David Smith
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, UK
| | - Wei Cheng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
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van der Heide FC, Valeri L, Dugravot A, Danilevicz I, Landre B, Kivimaki M, Sabia S, Singh-Manoux A. Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies. EClinicalMedicine 2024; 70:102539. [PMID: 38516105 PMCID: PMC10955651 DOI: 10.1016/j.eclinm.2024.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background The contribution of modifiable risk factors to social inequalities in dementia, observed in longitudinal studies, remains unclear. We aimed to quantify the role of cardiovascular health factors, assessed using Life's Essential 8 (LE8) score, in mediating social inequalities in incidence of dementia and, for comparison, in incidence of stroke, coronary heart disease, and mortality. Methods In this prospective, population-based cohort study, we collected data from the UK Whitehall II Study and UK Biobank databases. Participants were included if data were available on SEP, outcomes and LE8 (smoking, physical activity, diet, body mass index, blood pressure, fasting blood glucose, lipid levels, sleep duration). The primary outcome was incident dementia and secondary outcomes were stroke, coronary heart disease, and mortality. Outcomes were derived from electronic healthcare records. Socioeconomic position (SEP) was measured by occupation in Whitehall II and education in UK Biobank. Counterfactual mediation analysis was used to quantify the extent to which LE8 score explained the associations of SEP with all outcomes. Analyses involved Cox regression, accelerated failure time models, and linear regression; and were adjusted for age, sex, and ethnicity. Findings Between 10.09.1985 and 29.03.1988, a total of 9688 participants (mean age ± SD 44.9 ± 6.0; 67% men) from the Whitehall II study, and between 19.12.2006 and 01.10.2010, 278,215 participants (mean age ± SD 56.0 ± 8.1; 47% men) from the UK Biobank were included. There were 606 and 4649 incident dementia cases over a median (interquartile range) follow-up of 31.7 (31.1-32.7) and 13.5 (12.7-14.1) years respectively in Whitehall II and UK Biobank. In Whitehall II, the hazard ratio was 1.85 [95% CI 1.42, 2.32] for the total effect of SEP on dementia and 1.20 [1.12, 1.28] for the indirect effect via the LE8, the proportion mediated being 36%. In UK Biobank, the total effect of SEP on dementia was 1.65 [1.54, 1.78]; the indirect effect was 1.11 [1.09, 1.12], and the proportion mediated was 24%. The proportions mediated for stroke, coronary heart disease, and mortality were higher, ranging between 34% and 63% in Whitehall II and between 36% and 50% in UK Biobank. Interpretation In two well-characterised cohort studies, up to one third of the social inequalities in incidence of dementia was attributable to cardiovascular health factors. Promotion of cardiovascular health in midlife may contribute to reducing social inequalities in risk of dementia, in addition to cardiovascular diseases and all-cause mortality. This study used adult measures of SEP, further research is warranted using lifecourse measures of SEP. Funding NIH (RF1AG062553).
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Affiliation(s)
- Frank C.T. van der Heide
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Ian Danilevicz
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landre
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimaki
- Faculty of Brain Sciences, University College London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Faculty of Brain Sciences, University College London, UK
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Faculty of Brain Sciences, University College London, UK
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7
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Rosenau C, Köhler S, Soons LM, Anstey KJ, Brayne C, Brodaty H, Engedal K, Farina FR, Ganguli M, Livingston G, Lyketsos CG, Mangialasche F, Middleton LE, Rikkert MGMO, Peters R, Sachdev PS, Scarmeas N, Salbæk G, van Boxtel MPJ, Deckers K. Umbrella review and Delphi study on modifiable factors for dementia risk reduction. Alzheimers Dement 2024; 20:2223-2239. [PMID: 38159267 PMCID: PMC10984497 DOI: 10.1002/alz.13577] [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: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. HIGHLIGHTS: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.
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Affiliation(s)
- Colin Rosenau
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Lion M. Soons
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kaarin J. Anstey
- School of PsychologyUniversity of New South WalesKensingtonNew South WalesAustralia
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
| | - Carol Brayne
- Cambridge Public HealthUniversity of CambridgeCambridgeUK
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Knut Engedal
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
| | - Francesca R. Farina
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Mary Ganguli
- Departments of PsychiatryNeurologyand EpidemiologySchool of Medicine and School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Constantine G. Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer's DiseaseJohns Hopkins BayviewJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Francesca Mangialasche
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingMedical Unit AgingKarolinska University HospitalStockholmSweden
| | - Laura E. Middleton
- Department of Kinesiology and Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐UW Research Institute for AgingWaterlooOntarioCanada
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineRadboud University Medical CenterNijmegenthe Netherlands
- Radboudumc Alzheimer CenterDonders Center of Medical NeurosciencesNijmegenthe Netherlands
| | - Ruth Peters
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
- The George Institute for Global HealthNewtownNew South WalesAustralia
- School of Biomedical SciencesUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nikolaos Scarmeas
- 1st Department of NeurologyAiginition HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | - Geir Salbæk
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Martin P. J. van Boxtel
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kay Deckers
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
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Bernini S, Conti S, Perdixi E, Jesuthasan N, Costa A, Severgnini M, Ramusino MC, Prinelli F. Investigating the individual and joint effects of socioeconomic status and lifestyle factors on mild cognitive impairment in older Italians living independently in the community: results from the NutBrain study. J Nutr Health Aging 2024; 28:100040. [PMID: 38280834 DOI: 10.1016/j.jnha.2024.100040] [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: 11/21/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Despite extensive research, a clear understanding of the role of the interaction between lifestyle and socioeconomic status (SES) on cognitive health is still lacking. We investigated the joint association of socioeconomic factors in early to midlife and lifestyle in later life and Mild Cognitive Impairment (MCI). DESIGN Observational cross-sectional study. SETTING NutBrain study in northern Italy. PARTICIPANTS 773 community-dwelling adults aged 65 years and older (73.2 ± 6.0 SD, 58.6% females) participating in the NutBrain study (2019-2023). MEASUREMENTS Three SES indicators (home ownership, educational level, occupation) and five lifestyle factors (adherence to Mediterranean diet, physical activity, smoking habits, social network, leisure activities) were selected. Each factor was scored and summed to calculate SES and healthy lifestyle scores; their joint effect was also examined. The association with MCI was assessed by logistic regression controlling for potential confounders. Sex-stratified analysis was performed. RESULTS In total, 24% of the subjects had MCI. The multivariable logistic model showed that a high SES and a high lifestyle score were associated with 81.8% (OR0.182; 95%CI 0.095-0.351), and 44.1% (OR0.559; 95%CI 0.323-0.968) lower odds of having MCI, respectively. When examining the joint effect of SES and lifestyle factors, the cognitive benefits of a healthy lifestyle were most pronounced in participants with low SES. A healthier lifestyle score was found to be significantly associated with lower odds of MCI, only in females. CONCLUSIONS According to our findings, SES was positively associated with preserved cognitive function, highlighting the importance of active lifestyles in reducing socioeconomic health inequalities, particularly among those with a relatively low SES. TRIAL REGISTRATION Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).
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Affiliation(s)
- Sara Bernini
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Silvia Conti
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Elena Perdixi
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Department of Neurology, IRCCS Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - Nithiya Jesuthasan
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Alfredo Costa
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Unit of Behavioral Neurology IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Marco Severgnini
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Matteo Cotta Ramusino
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Unit of Behavioral Neurology IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Federica Prinelli
- Neuropsychology Lab/Center for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy.
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9
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Sahota CM, Cable N, Cadar D. Life-Course Socioeconomic Position and Mild Cognitive Impairment in Midlife: Evidence from the 1958 British Birth Cohort. J Epidemiol Glob Health 2024; 14:102-110. [PMID: 38191951 PMCID: PMC11043258 DOI: 10.1007/s44197-023-00173-6] [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: 06/05/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Dementia has been the leading cause of death in the UK since 2015. Increasing evidence supports an association between socioeconomic position (SEP) and dementia onset in later life. However, limited studies have examined how life-course SEP influences the development of mild cognitive impairment (MCI), an intermediate state potentially preceding dementia. Therefore, the present study aims to examine the relationship between life-course SEP and MCI amongst adults aged 50 years in Great Britain. METHODS We employed data from the National Child Development Study (NCDS), also known as the 1958 British Birth Cohort, to determine the associations between SEP and MCI in 6590 participants. We categorised life-course measures of SEP as stable high/low or moving upward/downward over the life course. We assessed MCI at age 50 using one standard deviation below the averaged combined scores from all cognitive tests available. We then used binary logistic regression to estimate the longitudinal associations between life-course SEP and MCI. RESULTS Relative to those of a high SEP across the life course, participants who moved upward, downward, or remained at a low SEP were significantly associated with 25% (95% CI 1.02-1.54, p = 0.035), 70% (95% CI 1.27-2.27, p < 0.001), and 85% (95% CI 1.50-2.29, p < 0.001), respectively, higher odds of MCI, independent of all selected covariates. CONCLUSIONS Lower life-course SEP was associated with significantly higher odds of MCI onset in middle life within the NCDS cohort. Public health policies targeting cognitive impairment should encompass a life-course approach to reduce socioeconomic inequalities.
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Affiliation(s)
| | - Noriko Cable
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Dorina Cadar
- Department of Behavioural Science and Health, University College London, London, UK.
- Department of Neuroscience, Brighton and Sussex Medical School, Trafford Centre, Sussex, BN1 9RH, UK.
- Department of Primary Care, Brighton and Sussex Medical School, Sussex, UK.
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10
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Rahmani A, Najand B, Sonnega A, Akhlaghipour G, Mendez MF, Assari S. Intersectional Effects of Race and Educational Attainment on Memory Function of Middle-Aged and Older Adults With Alzheimer's Disease. J Racial Ethn Health Disparities 2024; 11:81-91. [PMID: 36576695 DOI: 10.1007/s40615-022-01499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND High educational attainment may protect individuals, particularly middle-aged and older adults, against a wide range of health risks, including memory decline with age; however, this protection is less clear in patients with Alzheimer's disease (AD). In addition, this effect may differ across racial groups. According to the Marginalized-Related Diminished Return (MDR) theory, for example, the protective effect of high educational attainment on mental and physical health shows a weaker protective effect for racial minority groups, particularly Black people compared to White individuals. OBJECTIVES This longitudinal study used data of middle-aged and older adults with AD with two aims: first, to test the association between educational attainment and memory, and second, to explore racial differences in this association in the USA. METHODS Data came from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. The total sample was 1673 American middle-aged and older adults. The independent variable was educational attainment measured as years of education. The main outcome was memory operationalized as Rey Auditory Verbal Learning Test (RAVLT) Verbal Forgetting percentage (VF%). Age, gender, and follow-up duration were covariates. Race was the effect modifier. Linear regression model was utilized to analyze the data. RESULTS Of all participants, 68 (4.1%) were Black, and the remaining were White, with a mean age of 75 years old. In the pooled sample, educational attainment did not show a significant association with memory, independent of confounders. Educational attainment showed a significant interaction with race on memory, with higher educational attainment having a different effect on memory in White patients compared to Black patients. CONCLUSION The effect of higher educational attainment on memory differs for Black patients with AD compared to White patients. To prevent cognitive disparities by race, we need to go beyond racial inequality in access to resources (e.g., education) and minimize diminished returns of educational attainment for racial minorities. To tackle health inequalities, social policies should not be limited to equalizing socioeconomic status but also help minority groups leverage their available resources, such as educational attainment, and secure tangible outcomes.
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Affiliation(s)
- Arash Rahmani
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA
| | - Babak Najand
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA
| | - Amanda Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Golnoush Akhlaghipour
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA
| | - Mario F Mendez
- Department of Neurology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Shervin Assari
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA.
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
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11
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Arias F, Dufour AB, Jones RN, Alegria M, Fong TG, Inouye SK. Social determinants of health and incident postoperative delirium: Exploring key relationships in the SAGES study. J Am Geriatr Soc 2024; 72:369-381. [PMID: 37933703 PMCID: PMC10922227 DOI: 10.1111/jgs.18662] [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: 06/23/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Examining the associations of social determinants of health (SDOH) with postoperative delirium in older adults will broaden our understanding of this potentially devastating condition. We explored the association between SDOH factors and incident postoperative delirium. METHODS A retrospective study of a prospective cohort of patients enrolled from June 18, 2010, to August 8, 2013, across two academic medical centers in Boston, Massachusetts. Overall, 560 older adults age ≥70 years undergoing major elective non-cardiac surgery were included in this analysis. Exposure variables included income, lack of private insurance, and neighborhood disadvantage. Our main outcome was incident postoperative delirium, measured using the Confusion Assessment Method long form. RESULTS Older age (odds ratio, OR: 1.01, 95% confidence interval, CI: 1.00, 1.02), income <20,000 a year (OR: 1.12, 95% CI: 1.00, 1.26), lack of private insurance (OR: 1.19, 95% CI: 1.04, 1.38), higher depressive symptomatology (OR: 1.02, 95% CI: 1.01, 1.04), and the Area Deprivation Index (OR: 1.02, 95% CI: 1.01, 1.04) were significantly associated with increased risk of postoperative delirium in bivariable analyses. In a multivariable model, explaining 27% of the variance in postoperative delirium, significant independent variables were older age (OR 1.01, 95% CI 1.00, 1.02), lack of private insurance (OR 1.18, 95% CI 1.02, 1.36), and depressive symptoms (OR 1.02, 95% CI 1.00, 1.03). Household income was no longer a significant independent predictor of delirium in the multivariable model (OR:1.02, 95% CI: 0.90, 1.15). The type of medical insurance significantly mediated the association between household income and incident delirium. CONCLUSIONS Lack of private insurance, a social determinant of health reflecting socioeconomic status, emerged as a novel and important independent risk factor for delirium. Future efforts should consider targeting SDOH factors to prevent postoperative delirium in older adults.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32608, USA
| | - Alyssa B. Dufour
- Harvard Medical School, Boston, MA 02131, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI 02912, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA 02131, USA
- Department of Medicine and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02131, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
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Paauw D, Heger I, Bjerre JF, Ringgaard MF, Stensgård V, Horstkötter D, Köhler S, Deckers K. Increasing awareness for dementia risk reduction through a public awareness campaign in Denmark: A pre-post study. Prev Med 2024; 179:107848. [PMID: 38215992 DOI: 10.1016/j.ypmed.2024.107848] [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: 08/29/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE It is estimated that about 40% of all dementia cases are potentially attributable to modifiable risk factors, but awareness of this is relatively lacking. METHODS An 18-months nation-wide public awareness campaign on dementia risk reduction was rolled out in Denmark that combined a mass-media approach with an online risk assessment tool and knowledge bank targeting all inhabitants aged between 40 and 75 years. Campaign effects (increase in awareness and knowledge of modifiable dementia risk and protective factors) were assessed via online surveys in two independent random samples before (n = 1003) and after the campaign (n = 1076). RESULTS After adjusting for differences in educational level between the two samples, there was no significant difference in awareness of dementia risk reduction between the pre-campaign (66.5% aware) and post-campaign (63.4% aware) sample (probit z = -0.08, p = 0.151). The number of correctly identified risk/protective factors was significantly higher in the post-campaign sample. After adjusting for potential confounding factors, self-reported exposure to the campaign was associated with more awareness, better recognition of risk/protective factors, more motivation for and actual implementation of lifestyle changes. CONCLUSIONS This mass-media campaign did not increase overall awareness that dementia risk is partly modifiable. However, exposure to the campaign was associated with more awareness and willingness to take action to improve brain health. Future campaigns should tailor messages to specific subgroups to broaden the reach (e.g., males), co-create materials with the target group, and give special attention to the contribution of metabolic/cardiovascular risk factors to dementia risk.
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Affiliation(s)
- Dominique Paauw
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Irene Heger
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Dorothee Horstkötter
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands; Department of Health Ethics and Society, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Kay Deckers
- Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
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13
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Yin Y, Tam HL, Quint J, Chen M, Ding R, Zhang X. Epidemiology of Dementia in China in 2010-2020: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:334. [PMID: 38338219 PMCID: PMC10855047 DOI: 10.3390/healthcare12030334] [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: 12/12/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Dementia has become one of the leading causes of death across the world. AIMS The aim of this study was to investigate the incidence, prevalence, and mortality of dementia in China between 2010 and 2020, and to investigate any geographical, age, and sex differences in the prevalence and incidence of dementia. METHODS Five databases were searched. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the included studies. A random-effects meta-analysis was performed to estimate the pooled prevalence of dementia. Subgroup analysis was based on the type of dementia. The incidence and mortality of dementia were synthesized qualitatively. RESULTS A total of 19 studies were included. The meta-analysis showed that the prevalence of dementia was 6% (95%CI 5%, 8%), the prevalence of Alzheimer's disease (AD) was 5% (95%CI 4%, 6%), and the prevalence of vascular dementia (VaD) was 1% (95%CI 0%, 2%). The subgroup analysis showed that the prevalence rates of dementia in rural (6%, 95%CI 4%, 8%) and urban areas were similar (6%, 95%CI 4%, 8%). Deaths due to dementia increased over time. CONCLUSION The prevalence, incidence, and mortality of dementia increased with age and over time. Applying consistent criteria to the diagnosis of cognitive impairment and dementia is necessary to help with disease monitoring. Promoting dementia knowledge and awareness at the community level is necessary.
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Affiliation(s)
- Yueheng Yin
- School of Nursing, Nanjing Medical University, Nanjing 210029, China;
| | - Hon Lon Tam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Jennifer Quint
- School of Public Health, National Heart and Lung Institute, Imperial College London, London W12 7RQ, UK; (J.Q.); (R.D.)
| | - Mengyun Chen
- School of Nursing, Lanzhou University, Lanzhou 730000, China;
| | - Rong Ding
- School of Public Health, National Heart and Lung Institute, Imperial College London, London W12 7RQ, UK; (J.Q.); (R.D.)
| | - Xiubin Zhang
- School of Public Health, National Heart and Lung Institute, Imperial College London, London W12 7RQ, UK; (J.Q.); (R.D.)
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14
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Bermejo-Pareja F, del Ser T. Controversial Past, Splendid Present, Unpredictable Future: A Brief Review of Alzheimer Disease History. J Clin Med 2024; 13:536. [PMID: 38256670 PMCID: PMC10816332 DOI: 10.3390/jcm13020536] [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: 10/12/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Background: The concept of Alzheimer disease (AD)-since its histological discovery by Alzheimer to the present day-has undergone substantial modifications. Methods: We conducted a classical narrative review of this field with a bibliography selection (giving preference to Medline best match). Results: The following subjects are reviewed and discussed: Alzheimer's discovery, Kraepelin's creation of a new disease that was a rare condition until the 1970's, the growing interest and investment in AD as a major killer in a society with a large elderly population in the second half of the 20th century, the consolidation of the AD clinicopathological model, and the modern AD nosology based on the dominant amyloid hypothesis among many others. In the 21st century, the development of AD biomarkers has supported a novel biological definition of AD, although the proposed therapies have failed to cure this disease. The incidence of dementia/AD has shown a decrease in affluent countries (possibly due to control of risk factors), and mixed dementia has been established as the most frequent etiology in the oldest old. Conclusions: The current concept of AD lacks unanimity. Many hypotheses attempt to explain its complex physiopathology entwined with aging, and the dominant amyloid cascade has yielded poor therapeutic results. The reduction in the incidence of dementia/AD appears promising but it should be confirmed in the future. A reevaluation of the AD concept is also necessary.
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Affiliation(s)
- Félix Bermejo-Pareja
- CIBERNED, Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | - Teodoro del Ser
- Alzheimer’s Centre Reina Sofia—CIEN Foundation, Institute of Health Carlos III, 28031 Madrid, Spain;
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Vandenbroucke JP, Sørensen HT, Rehkopf DH, Gradus JL, Mackenbach JP, Glymour MM, Galea S, Henderson VW. Report on the Joint Workshop on the Relations between Health Inequalities, Ageing and Multimorbidity, Iceland, May 3-4, 2023. Clin Epidemiol 2024; 16:9-22. [PMID: 38259327 PMCID: PMC10801289 DOI: 10.2147/clep.s443152] [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: 11/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
This paper is a summary of key presentations from a workshop in Iceland on May 3-4, 2023 arranged by Aarhus University and with participation of the below-mentioned scientists. Below you will find the key messages from the presentations made by: Professor Jan Vandenbroucke, Department of Clinical Epidemiology, Aarhus University, Emeritus Professor, Leiden University; Honorary Professor, London School of Hygiene & Tropical Medicine, UKProfessor, Chair Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, DenmarkProfessor David H. Rehkopf, Director, the Stanford Center for Population Health Sciences, Stanford University, CA., USProfessor Jaimie Gradus, Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Johan Mackenbach, Emeritus Professor, Department of Public Health, Erasmus University Rotterdam, HollandProfessor, Chair M Maria Glymour, Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts, USProfessor, Dean Sandro Galea, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Victor W. Henderson, Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, US; Department of Clinical Epidemiology, Aarhus University, Aarhus, DK.
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Affiliation(s)
- Jan P Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Leiden University, Leiden, Netherlands
- London School of Hygiene & Tropical Medicine, London, UK
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Aarhus University Hospital, Aarhus, Denmark
| | - David H Rehkopf
- Stanford Center for Population Health Sciences, Stanford University, CA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Rotterdam, Rotterdam, Holland
| | - M Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Victor W Henderson
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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16
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Li T, Tian J, Wu M, Tian Y, Li Z. Electroacupuncture stimulation improves cognitive ability and regulates metabolic disorders in Alzheimer's disease model mice: new insights from brown adipose tissue thermogenesis. Front Endocrinol (Lausanne) 2024; 14:1330565. [PMID: 38283741 PMCID: PMC10811084 DOI: 10.3389/fendo.2023.1330565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Background Metabolic defects play a crucial role in Alzheimer's disease (AD) development. Brown adipose tissue (BAT) has been identified as a novel potential therapeutic target for AD due to its unique role in energy metabolism. Electroacupuncture (EA) shows promise in improving cognitive ability and brain glucose metabolism in AD, but its effects on peripheral and central metabolism are unclear. Methods In this study, SAMP8 mice (AD model) received EA stimulation at specific acupoints. Cognitive abilities were evaluated using the Morris water maze test, while neuronal morphology and tau pathology were assessed through Nissl staining and immunofluorescence staining, respectively. Metabolic variations and BAT thermogenesis were measured using ELISA, HE staining, Western blotting, and infrared thermal imaging. Results Compared to SAMR1 mice, SAMP8 mice showed impaired cognitive ability, neuronal damage, disrupted thermoregulation, and metabolic disorders with low BAT activity. Both the EA and DD groups improved cognitive ability and decreased tau phosphorylation (p<0.01 or p<0.05). However, only the EA group had a significant effect on metabolic disorders and BAT thermogenesis (p<0.01 or p<0.05), while the DD group did not. Conclusion These findings indicate that EA not only improves the cognitive ability of SAMP8 mice, but also effectively regulates peripheral and central metabolic disorders, with this effect being significantly related to the activation of BAT thermogenesis.
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Affiliation(s)
- Ting Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Junjian Tian
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Meng Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanshuo Tian
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhigang Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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17
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Klee M, Aho VTE, May P, Heintz-Buschart A, Landoulsi Z, Jónsdóttir SR, Pauly C, Pavelka L, Delacour L, Kaysen A, Krüger R, Wilmes P, Leist AK. Education as Risk Factor of Mild Cognitive Impairment: The Link to the Gut Microbiome. J Prev Alzheimers Dis 2024; 11:759-768. [PMID: 38706292 PMCID: PMC11060993 DOI: 10.14283/jpad.2024.19] [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: 07/04/2023] [Accepted: 12/03/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND With differences apparent in the gut microbiome in mild cognitive impairment (MCI) and dementia, and risk factors of dementia linked to alterations of the gut microbiome, the question remains if gut microbiome characteristics may mediate associations of education with MCI. OBJECTIVES We sought to examine potential mediation of the association of education and MCI by gut microbiome diversity or composition. DESIGN Cross-sectional study. SETTING Luxembourg, the Greater Region (surrounding areas in Belgium, France, Germany). PARTICIPANTS Control participants of the Luxembourg Parkinson's Study. MEASUREMENTS Gut microbiome composition, ascertained with 16S rRNA gene amplicon sequencing. Differential abundance, assessed across education groups (0-10, 11-16, 16+ years of education). Alpha diversity (Chao1, Shannon and inverse Simpson indices). Mediation analysis with effect decomposition was conducted with education as exposure, MCI as outcome and gut microbiome metrics as mediators. RESULTS After exclusion of participants below 50, or with missing data, n=258 participants (n=58 MCI) were included (M [SD] Age=64.6 [8.3] years). Higher education (16+ years) was associated with MCI (Odds ratio natural direct effect=0.35 [95% CI 0.15-0.81]. Streptococcus and Lachnospiraceae-UCG-001 genera were more abundant in higher education. CONCLUSIONS Education is associated with gut microbiome composition and MCI risk without clear evidence for mediation. However, our results suggest signatures of the gut microbiome that have been identified previously in AD and MCI to be reflected in lower education and suggest education as important covariate in microbiome studies.
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Affiliation(s)
- M Klee
- Matthias Klee, University of Luxembourg, Institute for Research on Socio-Economic Inequality, Department of Social Sciences, 11, Porte des Sciences, L-4366, Esch-sur-Alzett, Luxembourg, Mail: , Phone: +352 46 66 44 5161
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Bransby L, Rosenich E, Maruff P, Lim YY. How Modifiable Are Modifiable Dementia Risk Factors? A Framework for Considering the Modifiability of Dementia Risk Factors. J Prev Alzheimers Dis 2024; 11:22-37. [PMID: 38230714 PMCID: PMC10995020 DOI: 10.14283/jpad.2023.119] [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: 06/13/2023] [Accepted: 08/06/2023] [Indexed: 01/18/2024]
Abstract
Many risk factors for dementia, identified from observational studies, are potentially modifiable. This raises the possibility that targeting key modifiable dementia risk factors may reduce the prevalence of dementia, which has led to the development of dementia risk reduction and prevention strategies, such as intervention trials or dementia prevention guidelines. However, what has rarely been considered in the studies that inform these strategies is the extent to which modifiable dementia risk factors can (1) be identified by individuals, and (2) be readily modified by individuals. Characteristics of modifiable dementia risk factors such as readiness of identification and targeting, as well as when they should be targeted, can influence the design, or success of strategies for reducing dementia risk. This review aims to develop a framework for classifying the degree of modifiability of dementia risk factors for research studies. The extent to which these modifiable dementia risk factors could be modified by an individual seeking to reduce their dementia risk is determined, as well as the resources that might be needed for both risk factor identification and modification, and whether modification may be optimal in early-life (aged <45 years), midlife (aged 45-65 years) or late-life (aged >65 years). Finally, barriers that could influence the ability of an individual to engage in risk factor modification and, ultimately, dementia risk reduction are discussed.
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Affiliation(s)
- L Bransby
- Lisa Bransby, Turner Institute for Brain and Mental Health, 18 Innovation Walk, Clayton, VIC 3800, Australia;
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Van Asbroeck S, Köhler S, Wimmers SC, Muris JW, van Boxtel MP, Deckers K. Multidomain Dementia Risk Reduction in Primary Care is Feasible: A Proof-of-concept study. J Alzheimers Dis 2024; 99:1455-1471. [PMID: 38759017 PMCID: PMC11191460 DOI: 10.3233/jad-240229] [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] [Accepted: 04/19/2024] [Indexed: 05/19/2024]
Abstract
Background Dementia risk reduction is a public health priority, but interventions that can be easily implemented in routine care are scarce. Objective To evaluate the feasibility of integrating dementia risk reduction in regular consultations in primary care and the added value of a dedicated smartphone app ('MyBraincoach'). Methods 188 participants (40-60 years), with modifiable dementia risk factors were included from ten Dutch general practices in a cluster-randomized trial (NL9773, 06/10/2021). Practices were randomly allocated (1 : 1) to provide a risk-reduction consultation only or to additionally provide the app. During the consultation, participants learned about dementia risk reduction and how to improve their risk profile. The app group received daily microteaching-notifications about their personally relevant risk factors. Feasibility was evaluated after 3 months using questionnaires assessing knowledge on dementia risk reduction and health behavior change. The primary outcome was change in the validated "LIfestyle for BRAin health" (LIBRA) score. In-depth interviews were conducted with participants and primary care providers (PCPs). Results The interventions were positively perceived, with 72.0% finding the consultation informative and 69.2% considering the app useful. Drop-out was low (6.9%). LIBRA improved similarly in both groups, as did Mediterranean diet adherence and body mass index. Knowledge of dementia risk reduction increased, but more in the app group. Interviews provided insight in participants' and PCPs' needs and wishes. Conclusions Integrating dementia risk reduction in primary care, supported by a smartphone app, is a viable approach towards dementia risk reduction. Larger trials are needed to establish (cost-)effectiveness.
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Affiliation(s)
- Stephanie Van Asbroeck
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Sophie C.P.M. Wimmers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Jean W.M. Muris
- Department of Family Medicine, Careand Public Health Research Institute (CAPHRI), MaastrichtUniversity, Maastricht, the Netherlands
| | - Martin P.J. van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, the Netherlands
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20
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Brown SC, Aitken WW, Lombard J, Parrish A, Dewald JR, Ma R, Messinger S, Liu S, Nardi MI, Rundek T, Szapocznik J. Longitudinal Impacts of Precision Greenness on Alzheimer's Disease. J Prev Alzheimers Dis 2024; 11:710-720. [PMID: 38706287 PMCID: PMC11061009 DOI: 10.14283/jpad.2024.38] [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: 06/16/2023] [Accepted: 11/13/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND The potential for greenness as a novel protective factor for Alzheimer's disease (AD) requires further exploration. OBJECTIVES This study assesses prospectively and longitudinally the association between precision greenness - greenness measured at the micro-environmental level, defined as the Census block - and AD incidence. DESIGN Older adults living in consistently high greenness Census blocks across 2011 and 2016 were compared to those living in consistently low greenness blocks on AD incidence during 2012-2016. SETTING Miami-Dade County, Florida, USA. PARTICIPANTS 230,738 U.S. Medicare beneficiaries. MEASUREMENTS U.S. Centers for Medicare and Medicaid Services Chronic Condition Algorithm for AD based on ICD-9 codes, Normalized Difference Vegetation Index, age, sex, race/ethnicity, neighborhood income, and walkability. RESULTS Older adults living in the consistently high greenness tertile, compared to those in the consistently low greenness tertile, had 16% lower odds of AD incidence (OR=0.84, 95% CI: 0.76-0.94, p=0.0014), adjusting for age, sex, race/ethnicity, and neighborhood income. Age, neighborhood income and walkability moderated greenness' relationship to odds of AD incidence, such that younger ages (65-74), lower-income, and non-car dependent neighborhoods may benefit most from high greenness. CONCLUSIONS High greenness, compared to low greenness, is associated with lower 5-year AD incidence. Residents who are younger and/or who reside in lower-income, walkable neighborhoods may benefit the most from high greenness. These findings suggest that consistently high greenness at the Census block-level, may be associated with reduced odds of AD incidence at a population level.
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Affiliation(s)
- S C Brown
- William W. Aitken, M.D., on behalf of the University of Miami Built Environment, Behavior, and Health Research Group, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite #1065, Miami, FL 33136, USA. Tel.: +1 305-519-5136.
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21
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Bhuiyan NZ, Hasan MK, Mahmud Z, Hossain MS, Rahman A. Prevention of Alzheimer's disease through diet: An exploratory review. Metabol Open 2023; 20:100257. [PMID: 37781687 PMCID: PMC10539673 DOI: 10.1016/j.metop.2023.100257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction This exploratory review article describes about the genetic factors behind Alzheimer's disease (AD), their association with foods, and their relationships with cognitive impairment. It explores the dietary patterns and economic challenges in AD prevention. Methods Scopus, PubMed and Google Scholar were searched for articles that examined the relationships between Diets, Alzheimer's Disease (AD), and Socioeconomic conditions in preventative Alzheimer's disease studies. Graphs and Network analysis data were taken from Scopus under the MeSH search method, including words, Alzheimer's, APoE4, Tau protein, APP, Amyloid precursor protein, Beta-Amyloid, Aβ, Mediterranean Diet, MD, DASH diet, MIND diet, SES, Socioeconomic, Developed country, Underdeveloped country, Preventions. The network analysis was done through VOS viewer. Results Mediterranean diet (MD) accurately lowers AD (Alzheimer's Disease) risk to 53% and 35% for people who follow it moderately. MIND scores had a statistically significant reduction in AD rate compared to those in the lowest tertial (53% and 35% reduction, respectively). Subjects with the highest adherence to the MD and DASH had a 54% and 39% lower risk of developing AD, respectively, compared to those in the lowest tertial. Omega-6, PUFA, found in nuts and fish, can play most roles in the clearance of Aβ. Vitamin D inhibits induced fibrillar Aβ apoptosis. However, the high cost of these diet components rise doubt about the effectiveness of AD prevention through healthy diets. Conclusion The finding of this study revealed an association between diet and the effects of the chemical components of foods on AD biomarkers. More research is required to see if nutrition is a risk or a protective factor for Alzheimer's disease to encourage research to be translated into therapeutic practice and to clarify nutritional advice.
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Affiliation(s)
- Nusrat Zahan Bhuiyan
- Department of Biochemistry and Molecular Biology, National University Bangladesh, Gazipur, 1704, Bangladesh
| | - Md. Kamrul Hasan
- Department of Biochemistry and Molecular Biology, National University Bangladesh, Gazipur, 1704, Bangladesh
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Zimam Mahmud
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md. Sabbir Hossain
- Department of Biochemistry and Molecular Biology, National University Bangladesh, Gazipur, 1704, Bangladesh
| | - Atiqur Rahman
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh
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Heger I, van Boxtel M, Deckers K, Bosma H, Verhey F, Köhler S. Socioeconomic position, modifiable dementia risk and cognitive decline: results of 12-year Maastricht Aging Study. Int Psychogeriatr 2023:1-13. [PMID: 37905417 DOI: 10.1017/s1041610223000819] [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: 11/02/2023]
Abstract
OBJECTIVES This study investigated whether the association between modifiable dementia risk and rate of cognitive decline differs across socioeconomic status (SES) strata. DESIGN, SETTING AND PARTICIPANTS Data were used from Maastricht Aging Study, a prospective cohort study with a 12-year follow-up. The baseline sample consisted of 1023 adults over 40 years old. MEASUREMENTS The "LIfestyle for BRAin health" (LIBRA) index was used to assess modifiable dementia risk. Cognitive performance was assessed at baseline, 6 and 12 years, and measured in the domains of information processing speed, executive functioning and verbal memory function. An SES score was calculated from equivalent income and educational level (tertiles). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline. RESULTS Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, P = 0.029; vs. high SES: X2 = 9.49, P = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, P < 0.001; vs. high SES: X2 = 16.68, P < 0.001) over 6 years compared to their middle- and high-SES counterparts. Higher (unhealthier) LIBRA scores were associated with more decline in information processing speed (X2 = 12.66, P = 0.002) over 12 years and verbal memory (X2 = 4.63, P = 0.032) over 6 years. No consistent effect modification by SES on the association between LIBRA and cognition was found. CONCLUSIONS Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavorable modifiable risk score suggesting more potential for lifestyle-based interventions.
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Affiliation(s)
- Irene Heger
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Ajnakina O, Shamsutdinova D, Stahl D, Steptoe A. Polygenic Propensity for Longevity, APOE-ε4 Status, Dementia Diagnosis, and Risk for Cause-Specific Mortality: A Large Population-Based Longitudinal Study of Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:1973-1982. [PMID: 37434484 PMCID: PMC10613005 DOI: 10.1093/gerona/glad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Indexed: 07/13/2023] Open
Abstract
To deepen the understanding of genetic mechanisms influencing mortality risk, we investigated the impact of genetic predisposition to longevity and APOE-ε4, on all-cause mortality and specific causes of mortality. We further investigated the mediating effects of dementia on these relationships. Using data on 7 131 adults aged ≥50 years (mean = 64.7 years, standard deviation [SD] = 9.5) from the English Longitudinal Study of Aging, genetic predisposition to longevity was calculated using the polygenic score approach (PGSlongevity). APOE-ε4 status was defined according to the absence or presence of ε4 alleles. The causes of death were ascertained from the National Health Service central register, which was classified into cardiovascular diseases, cancers, respiratory illness, and all other causes of mortality. Of the entire sample, 1 234 (17.3%) died during an average 10-year follow-up. One-SD increase in PGSlongevity was associated with a reduced risk for all-cause mortality (hazard ratio [HR] = 0.93, 95% confidence interval [CI]: 0.88-0.98, p = .010) and mortalities due to other causes (HR = 0.81, 95% CI: 0.71-0.93, p = .002) in the following 10 years. In gender-stratified analyses, APOE-ε4 status was associated with a reduced risk for all-cause mortality and mortalities related to cancers in women. Mediation analyses estimated that the percent excess risk of APOE-ε4 on other causes of mortality risk explained by the dementia diagnosis was 24%, which increased to 34% when the sample was restricted to adults who were aged ≤75 years old. To reduce the mortality rate in adults who are aged ≥50 years old, it is essential to prevent dementia onset in the general population.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Diana Shamsutdinova
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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24
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Rebok GW, Gellert A, Coe NB, Clay OJ, Wallace G, Parisi JM, Aiken-Morgan AT, Crowe M, Ball K, Thorpe RJ, Marsiske M, Zahodne LB, Felix C, Willis SL. Effects of Cognitive Training on Alzheimer's Disease and Related Dementias: The Moderating Role of Social Determinants of Health. J Aging Health 2023; 35:40S-50S. [PMID: 37994850 DOI: 10.1177/08982643231203755] [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] [Indexed: 11/24/2023]
Abstract
Objective: We examined whether social determinants of health (SDoH) are associated with Alzheimer's disease and related dementias (ADRD) risk and the effects of cognitive training over a 20-year follow-up period. Methods: Data were obtained from 1605 participants in ACTIVE. SDoH measures were created using baseline data at the individual and neighborhood level. Incident ADRD was defined using administrative claims data (1999-2019). Cause-specific hazard models estimated associations between SDoH and claims-based diagnosed ADRD. Results: Higher scores on neighborhood and built environment were associated with lower ADRD risk. Trained participants obtained a greater degree of protection from ADRD when they had higher scores for SDoH domains associated with health care and education access. However, there were fewer significant SDoH moderation effects on cognitive training than expected. Discussion: Future work should continue to explore culturally tailored cognitive training interventions to reduce ADRD risk associated with SDoH that disproportionately affects racially diverse aging populations.
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Affiliation(s)
- George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Norma B Coe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gail Wallace
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
| | | | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karlene Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roland J Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Dark HE, Huang A, Cordon J, Deal JA, Palta P, Windham BG, Barnes LL, Kucharska-Newton A, Mosley T, Gottesman RF, Sims M, Griswold M, Rentería MA, Manly JJ, Walker KA. The association of perceived discrimination with dementia risk in Black older adults. Alzheimers Dement 2023; 19:4346-4356. [PMID: 37218405 PMCID: PMC10734390 DOI: 10.1002/alz.13135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Non-Hispanic Black, compared to non-Hispanic White, older adults are at increased risk for dementia. This may be due partly to greater exposure to psychosocial stressors, such as discrimination; however, few studies have examined this association. METHODS We examined the association of perceived discrimination (e.g., everyday, lifetime, and discrimination burden) with dementia risk in 1583 Black adults co-enrolled in the Atherosclerosis Risk in Communities (ARIC) Study and the Jackson Heart Study (JHS). Perceived discrimination (defined continuously and using tertiles) was assessed at JHS Exam 1 (2000-2004; mean age ± SD:66.2 ± 5.5) and related to dementia risk through ARIC visit 6 (2017) using covariate-adjusted Cox proportional hazards models. RESULTS Associations of perceived everyday, lifetime, and burden of discrimination with dementia risk were not supported in age-adjusted models or demographic- and cardiovascular health-adjusted models. Results were similar across sex, income, and education. DISCUSSION In this sample, associations between perceived discrimination and dementia risk were not supported. HIGHLIGHTS In Black older adults perceived discrimination not associated with dementia risk. Younger age and greater education linked to greater perceived discrimination. Older age and less education among factors associated with dementia risk. Factors increasing exposure to discrimination (education) are also neuroprotective.
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Affiliation(s)
- Heather E. Dark
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Alison Huang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Jenifer Cordon
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Jennifer A. Deal
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, 10032, USA
| | - B. Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Lisa L. Barnes
- Department of Neurological Sciences at Rush University Medical Center, Chicago, IL, 60612, USA
- Rush Alzheimer’s Disease Center at Rush University Medical Center, Chicago, IL, 60612, USA
| | - Anna Kucharska-Newton
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Program, NIH, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Michael Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Miguel Arce Rentería
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Jennifer J. Manly
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
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Dukelow T, Vassilev P, Lawrence EG, Jacobson L, Koychev I, Muhammed K, Kennelly SP. Barriers to brain health behaviours: results from the Five Lives Brain Health Ireland Survey. Front Psychol 2023; 14:1101514. [PMID: 37691817 PMCID: PMC10483831 DOI: 10.3389/fpsyg.2023.1101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/17/2023] [Indexed: 09/12/2023] Open
Abstract
Modifiable risk factors for dementia remain prevalent in Ireland. A detailed examination of barriers to risk reduction behaviours in an Irish context has heretofore been lacking. Many existing studies examining barriers to brain health behaviours fail to examine how they might vary across different modifiable risk factors. This study undertook a detailed assessment of barriers to individual risk reduction behaviours. As existing research suggests that barriers may vary across sociodemographic factors, we sought to investigate the distribution of barriers across age, gender, educational status, and household income. The Five Lives Brain Health Ireland Survey is a cross-sectional survey that was distributed online amongst a non-patient population. The survey captured the following: (1) Sociodemographic factors; (2) Barriers to brain health behaviours; (3) Exposure to, and knowledge of, modifiable risk factors for dementia, namely diet, social interaction, exercise, hypertension, sleep, current low mood/depression, current smoking, alcohol consumption, cognitive stimulation, hearing impairment, diabetes, air pollution, and head injury; (4) Participants' perceptions regarding potential for dementia prevention, and risk reduction. Lack of motivation was the most prevalent barrier to consuming a healthy diet (64%, n = 213), physical activity (77.7%, n = 167), smoking cessation (68%, n = 85), and moderation of alcohol intake (56.3%, n = 67). Practical factors were the most prevalent barriers to addressing low mood (56.5%, n = 87), air pollution (30.1%, n = 58), hearing impairment (63.8%, n = 44), diabetes (11.1%, n = 5), and head injury (80%, n = 8). Emotional factors were the most prevalent barriers to engaging in mentally stimulating activity (56.9%, n = 66), social activity (54.9%, n = 302), and good sleep (70.1%, n = 129). Lack of knowledge was the most prevalent barrier to hypertension control (14.4%, n = 29). Distribution of barriers varied across age, gender, educational status, and household income. This study investigated barriers to lifestyle change to improve brain health in an Irish sample of adults aged 50 and above. Detailed subtyping of barriers, as well as examination of differences according to age, gender, education, and income were undertaken. The heterogeneity of barriers to brain health behaviours revealed in this study highlights the necessity to tailor public health interventions to their target population, taking into account the gender, age, educational status, and income of recipients.
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Affiliation(s)
- Tim Dukelow
- Cork University Hospital (CUH), Cork, Ireland
| | | | - Erin Grace Lawrence
- Five Lives SAS, Tours, France
- Unit of Psychological Medicine, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | | | - Ivan Koychev
- Five Lives SAS, Tours, France
- Department of Psychiatry, University of Oxford, Oxford, England, United Kingdom
| | - Kinan Muhammed
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, England, United Kingdom
| | - Sean P. Kennelly
- Department of Age Related Health Care, Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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Nong W, Mo G, Luo C. Exploring the bidirectional causal link between household income status and genetic susceptibility to neurological diseases: findings from a Mendelian randomization study. Front Public Health 2023; 11:1202747. [PMID: 37564429 PMCID: PMC10411908 DOI: 10.3389/fpubh.2023.1202747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023] Open
Abstract
Objectives Observational studies have revealed that socioeconomic status is associated with neurological disorders and aging. However, the potential causal effect between the two remains unclear. We therefore aimed to investigate the causal relationship between household income status and genetic susceptibility to neurological diseases using a bidirectional Mendelian randomization (MR) study. Methods An MR study was conducted on a large-sample cohort of the European population pulled from a publicly available genome-wide association study dataset, using a random-effects inverse-variance weighting model as the main standard. MR-Egger regression, weighted median, and maximum likelihood estimation were also performed concurrently as supplements. A sensitivity analysis, consisting of a heterogeneity test and horizontal pleiotropy test, was performed using Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to ensure the reliability of the conclusion. Results The results suggested that higher household income tended to lower the risk of genetic susceptibility to Alzheimer's disease (odds ratio [OR]: 0.740, 95% confidence interval [CI] = 0.559-0.980, p-value = 0.036) and ischemic stroke (OR: 0.801, 95% CI = 0.662-0.968, p-value = 0.022). By contrast, higher household income tended to increase the risk of genetic susceptibility to Parkinson's disease (OR: 2.605, 95% CI = 1.413-4.802, p-value = 0.002). No associations were evident for intracranial hemorrhage (OR: 1.002, 95% CI = 0.607-1.653, p-value = 0.993), cerebral aneurysm (OR: 0.597, 95% CI = 0.243-1.465, p-value = 0.260), subarachnoid hemorrhage (OR: 1.474, 95% CI = 0.699-3.110, p-value = 0.308), or epilepsy (OR: 1.029, 95% CI = 0.662-1.600, p-value = 0.899). The reverse MR study suggested no reverse causal relationship between neurological disorders and household income status. A sensitivity analysis verified the reliability of the results. Conclusion Our results revealed that the populations with a superior household income exhibit an increased predisposition of genetic susceptibility to Parkinson's Disease, while demonstrating a potential decreased genetic susceptibility to ischemic stroke and Alzheimer's disease.
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Affiliation(s)
| | | | - Chun Luo
- Department of Neurology, Affiliated Minzu Hospital of Guangxi Medical University, Nanning, China
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Mohanannair Geethadevi G, Quinn TJ, George J, Anstey KJ, Bell JS, Sarwar MR, Cross AJ. Multi-domain prognostic models used in middle-aged adults without known cognitive impairment for predicting subsequent dementia. Cochrane Database Syst Rev 2023; 6:CD014885. [PMID: 37265424 PMCID: PMC10239281 DOI: 10.1002/14651858.cd014885.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Dementia, a global health priority, has no current cure. Around 50 million people worldwide currently live with dementia, and this number is expected to treble by 2050. Some health conditions and lifestyle behaviours can increase or decrease the risk of dementia and are known as 'predictors'. Prognostic models combine such predictors to measure the risk of future dementia. Models that can accurately predict future dementia would help clinicians select high-risk adults in middle age and implement targeted risk reduction. OBJECTIVES Our primary objective was to identify multi-domain prognostic models used in middle-aged adults (aged 45 to 65 years) for predicting dementia or cognitive impairment. Eligible multi-domain prognostic models involved two or more of the modifiable dementia predictors identified in a 2020 Lancet Commission report and a 2019 World Health Organization (WHO) report (less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol intake, obesity, smoking, depression, social isolation, physical inactivity, diabetes mellitus, air pollution, poor diet, and cognitive inactivity). Our secondary objectives were to summarise the prognostic models, to appraise their predictive accuracy (discrimination and calibration) as reported in the development and validation studies, and to identify the implications of using dementia prognostic models for the management of people at a higher risk for future dementia. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ISI Web of Science Core Collection from inception until 6 June 2022. We performed forwards and backwards citation tracking of included studies using the Web of Science platform. SELECTION CRITERIA: We included development and validation studies of multi-domain prognostic models. The minimum eligible follow-up was five years. Our primary outcome was an incident clinical diagnosis of dementia based on validated diagnostic criteria, and our secondary outcome was dementia or cognitive impairment determined by any other method. DATA COLLECTION AND ANALYSIS Two review authors independently screened the references, extracted data using a template based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and assessed risk of bias and applicability of included studies using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We synthesised the C-statistics of models that had been externally validated in at least three comparable studies. MAIN RESULTS: We identified 20 eligible studies; eight were development studies and 12 were validation studies. There were 14 unique prognostic models: seven models with validation studies and seven models with development-only studies. The models included a median of nine predictors (range 6 to 34); the median number of modifiable predictors was five (range 2 to 11). The most common modifiable predictors in externally validated models were diabetes, hypertension, smoking, physical activity, and obesity. In development-only models, the most common modifiable predictors were obesity, diabetes, hypertension, and smoking. No models included hearing loss or air pollution as predictors. Nineteen studies had a high risk of bias according to the PROBAST assessment, mainly because of inappropriate analysis methods, particularly lack of reported calibration measures. Applicability concerns were low for 12 studies, as their population, predictors, and outcomes were consistent with those of interest for this review. Applicability concerns were high for nine studies, as they lacked baseline cognitive screening or excluded an age group within the range of 45 to 65 years. Only one model, Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE), had been externally validated in multiple studies, allowing for meta-analysis. The CAIDE model included eight predictors (four modifiable predictors): age, education, sex, systolic blood pressure, body mass index (BMI), total cholesterol, physical activity and APOEƐ4 status. Overall, our confidence in the prediction accuracy of CAIDE was very low; our main reasons for downgrading the certainty of the evidence were high risk of bias across all the studies, high concern of applicability, non-overlapping confidence intervals (CIs), and a high degree of heterogeneity. The summary C-statistic was 0.71 (95% CI 0.66 to 0.76; 3 studies; very low-certainty evidence) for the incident clinical diagnosis of dementia, and 0.67 (95% CI 0.61 to 0.73; 3 studies; very low-certainty evidence) for dementia or cognitive impairment based on cognitive scores. Meta-analysis of calibration measures was not possible, as few studies provided these data. AUTHORS' CONCLUSIONS We identified 14 unique multi-domain prognostic models used in middle-aged adults for predicting subsequent dementia. Diabetes, hypertension, obesity, and smoking were the most common modifiable risk factors used as predictors in the models. We performed meta-analyses of C-statistics for one model (CAIDE), but the summary values were unreliable. Owing to lack of data, we were unable to meta-analyse the calibration measures of CAIDE. This review highlights the need for further robust external validations of multi-domain prognostic models for predicting future risk of dementia in middle-aged adults.
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Affiliation(s)
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Kaarin J Anstey
- School of Psychology, The University of New South Wales, Sydney, Australia
- Ageing Futures Institute, The University of New South Wales, Sydney, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Muhammad Rehan Sarwar
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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Siette J, Dodds L, Deckers K, Köhler S, Armitage CJ. Cross-sectional survey of attitudes and beliefs towards dementia risk reduction among Australian older adults. BMC Public Health 2023; 23:1021. [PMID: 37254125 DOI: 10.1186/s12889-023-15843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Little is known about what drives older adults' motivation to change their behaviour and whether that is associated with their personal dementia risk profile. Our aims were to (i) understand what sociodemographic factors are associated with older Australians' motivation to change behaviour to reduce their dementia risk, and (ii) explore the relationship between socio-demographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk scores in older adults. METHODS A cross-sectional online postal or telephone survey was administered to community-dwelling older adults in New South Wales, Australia between January and March 2021. Measures included socioeconomic status, locality, and health status, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale and the lifestyle-based dementia risk score (LIBRA index). Multiple linear regression analyses were used to explore the associations for (i) sociodemographic factors and motivation to reduce dementia risk (MCLHB-DRR scales) and (ii) sociodemographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk (LIBRA index). RESULTS A total of 857 older adults (mean age 73.3 years, SD = 6.0, range 65-94; 70% women; 34.6% less than grade 6 education) completed the survey. Respondents reported high levels of motivation to adopt behaviour changes, agreeing on the importance of good health. Individuals who were younger were more likely to have greater motivation to modify lifestyle to reduce dementia risk and had higher perceived benefits to gain by adopting a healthy lifestyle. Dementia risk scores were moderately low (mean LIBRA index =- 2.8 [SD = 2.0], range - 5.9-3.8), indicating relatively moderate-to-good brain health. Men with low socioeconomic status and higher perceived barriers to lifestyle change had higher dementia risk scores. CONCLUSIONS Public health campaigns need to overcome motivational barriers to support reductions in dementia risk. A multifaceted and inclusive approach targeting both sociodemographic differences and impediments to brain healthy lifestyles is required to achieve genuine change. TRIAL REGISTRATION ACTRN12621000165886, Date of registration: 17/02/2021.
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Affiliation(s)
- Joyce Siette
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, 2145, Australia.
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - Laura Dodds
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, 2145, Australia
| | - Kay Deckers
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK
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Eithz N, Sørensen J, Sopina L. Healthcare Costs in the Year Before and After Alzheimer's Disease Diagnosis: A Danish Register-Based Matched Cohort Study. J Alzheimers Dis 2023; 93:421-433. [PMID: 37066907 DOI: 10.3233/jad-220821] [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: 04/18/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) carries a significant economic burden, with costs peaking around the time of diagnosis. However, the cost of diagnosis, including the time leading up to it, has not been studied thoroughly. Furthermore, regionalized healthcare structure could result in differences in the pre-diagnostic costs for people with suspected AD. OBJECTIVE This study set out to estimate the excess healthcare costs before and after AD diagnosis compared to a matched non-AD population and to investigate regional variation in AD healthcare costs in Denmark. METHODS We used a register-based cohort of 25,523 matched pairs of new cases of AD and non-AD controls. The healthcare costs included costs on medication, and inpatient-, outpatient-, and primary care visits. Generalized estimating equations were employed to estimate the excess healthcare cost attributable to diagnosing AD, and the variation in costs across regions. RESULTS Mean excess costs attributable to AD were € 3,284 and € 6,173 in the year before and after diagnosis, respectively. Regional differences in healthcare costs were identified in both the AD and control groups and were more pronounced in patients with AD (PwAD). The variation over time in regional inequality between PwAD and their controls was identified. CONCLUSION PwAD incur higher healthcare costs across all cost categories in the year before and after diagnosis. Regional differences in healthcare utilization by PwAD may reveal potential variation in access to healthcare. These findings suggest that a more standardized and targeted diagnostic process may help reduce costs and variation in access to healthcare.
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Affiliation(s)
- Nanna Eithz
- Danish Centre for Health Economics, IST, SDU, Denmark
| | - Jan Sørensen
- Danish Centre for Health Economics, IST, SDU, Denmark
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Liza Sopina
- Danish Centre for Health Economics, IST, SDU, Denmark
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Soh Y, Whitmer RA, Mayeda ER, Glymour MM, Peterson RL, Eng CW, Quesenberry CP, Manly JJ, Gilsanz P. State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults. JAMA Neurol 2023; 80:352-359. [PMID: 36780143 PMCID: PMC9926357 DOI: 10.1001/jamaneurol.2022.5337] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/11/2022] [Indexed: 02/14/2023]
Abstract
Importance Higher educational attainment is associated with reduced dementia risk, but the role of educational quality is understudied, presenting a major evidence gap, especially as it may contribute to racial inequities. Objective To evaluate the association between state-level educational quality during childhood and dementia risk. Design, Setting, and Participants This cohort study analyzed longitudinal data collected from January 1, 1997, through December 31, 2019 (23-year follow-up period). The sample comprised members of Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system, who completed an optional survey during 1964-1972. Eligible individuals were US born; non-Hispanic Black or non-Hispanic White; aged 65 years or older as of January 1, 1996; were still alive; and did not have a dementia diagnosis or lapse in KPNC membership greater than 90 days between January 1 and December 31, 1996. Exposures Historical state-level administrative indicators of school quality (school term length, student-teacher ratio, and attendance rates) linked to participants using birth state and birth year (with a 6-year lag) and divided into tertiles using the pooled sample. Main Outcomes and Measures Dementia diagnoses from electronic health records between 1997 and 2019 were analyzed between March 1 and August 31, 2022. The associations of educational quality with incident dementia were estimated using Cox proportional hazards regression models. Results Among 21 450 KPNC members who participated in the optional survey, individuals born before availability of educational quality records (n = 87) and missing educational attainment (n = 585) were excluded. The final analytic sample was 20 778 individuals (56.5% women, 43.5% men; mean [SD] age, 74.7 [6.5] years; 18.8% Black; 81.2% White; 41.0% with less than high school education). Among Black individuals, 76.2% to 86.1% (vs 20.8%-23.3% of White individuals) attended schools in states in the lowest educational quality tertiles. Highest (vs lowest) educational quality tertiles were associated with lower dementia risk (student-teacher ratio: hazard ratio [HR], 0.88 [95% CI, 0.83-0.94]; attendance rates: HR, 0.80 [95% CI, 0.73-0.88]; term length: HR, 0.79 [95% CI, 0.73-0.86]). Effect estimates did not differ by race and were not attenuated by adjustment for educational attainment. Conclusions and Relevance In this cohort study, lower state-average educational quality was more common among Black individuals and associated with higher dementia risk. Differential investment in high-quality education due to structural racism may contribute to dementia disparities.
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Affiliation(s)
- Yenee Soh
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California, Davis
- Department of Neurology, School of Medicine, University of California, Davis
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Rachel L. Peterson
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - Chloe W. Eng
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | | | - Jennifer J. Manly
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Yu S, Qian L, Ma J. The influence of gender and wealth inequality on Alzheimer's disease among the elderly: A global study. Heliyon 2023; 9:e14677. [PMID: 37009238 PMCID: PMC10060615 DOI: 10.1016/j.heliyon.2023.e14677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2023] Open
Abstract
This study was designed to explore the relationship between Alzheimer's disease (AD) rates and socioeconomic conditions in 120 countries. We used mixed effect models to investigate the relationship between the rates of AD and socioeconomic data. This study is among the first studies to put forward statistical evidence of a significant association between AD and other dementias among the elderly and socioeconomic inequality. These findings could help to inform the policies to be designed to improve the quality of interventions for AD.
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Affiliation(s)
- Shoukai Yu
- Corresponding author. Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | | | - Jun Ma
- Hongqiao International Institute of Medicine, Tongren Hospital.
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The role of social deprivation and depression in dementia risk: findings from the longitudinal survey of health, ageing and retirement in Europe. Epidemiol Psychiatr Sci 2023; 32:e10. [PMID: 36786038 PMCID: PMC9971857 DOI: 10.1017/s2045796023000033] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
AIMS Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association. METHODS We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome. RESULTS High (v. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31-2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23-2.25]), baseline (HR = 1.48 [95% CI 1.04-2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12-4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results. CONCLUSIONS Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.
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Dukelow T, Lawrence EG, Jacobson L, Vassilev P, Koychev I, Muhammed K, Kennelly SP. Modifiable risk factors for dementia, and awareness of brain health behaviors: Results from the Five Lives Brain Health Ireland Survey (FLBHIS). Front Psychol 2023; 13:1070259. [PMID: 36710802 PMCID: PMC9879702 DOI: 10.3389/fpsyg.2022.1070259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Up to 40% of dementias globally are attributable to modifiable risk factors. Many existing studies examining attitudes to brain health are limited by a failure to consider a range of pertinent risk factors and associated barriers to protective behaviors. In Ireland, self-reported knowledge of dementia is poor compared to other conditions. In this context, the current study aimed to explore exposure to and awareness of specific modifiable risk factors for dementia. We also aimed to investigate whether exposure to these risk factors is associated with demographic and socioeconomic factors. A cross-sectional survey was administered to 555 voluntary participants in February 2022. The survey captured the following information: (1) Sociodemographic factors; (2) Exposure to, as well as knowledge of modifiable risk factors for dementia, namely diet, social interaction, exercise, hypertension, sleep, depression, smoking, alcohol consumption, cognitive stimulation, hearing impairment, diabetes, air pollution, and head injury. The study population comprised 551 participants (50.3% male; 49.6% female). Mean age was 59.7 years. Modifiable risk factors for dementia were prevalent. Relative to females, male gender was significantly associated with multiple risk factors. Whilst 65.6% of participants believed that lifestyle improvements can decrease a person's risk of developing dementia, only 31.4% believed that dementia could be prevented. Head injury (90.9%, n = 500), low mental stimulation (85.3%, n = 469), and alcohol consumption (77.8%, n = 428) were the three most commonly recognized risk factors. Awareness was significantly greater in both university groups (undergraduate and postgraduate) for multiple risk factors. Our findings demonstrate that the distribution of exposure to modifiable risk factors for dementia is unequal across gender and age groups, and that awareness levels vary across risk factors. These findings highlight that focus surrounding dementia prevention should shift toward individual risk profiling and should be tailored toward an individual's specific needs.
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Affiliation(s)
- Tim Dukelow
- Cork University Hospital (CUH), Cork, Ireland,*Correspondence: Tim Dukelow,
| | - Erin Grace Lawrence
- Unit of Psychological Medicine, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom,Five Lives SAS, Tours, France
| | | | | | - Ivan Koychev
- Five Lives SAS, Tours, France,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kinan Muhammed
- Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Sean P. Kennelly
- Tallaght University Hospital, Dublin, Ireland,Trinity College Dublin, Dublin, Ireland
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Sex/gender and socioeconomic differences in modifiable risk factors for dementia. Sci Rep 2023; 13:80. [PMID: 36596822 PMCID: PMC9810648 DOI: 10.1038/s41598-022-27368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Both sex/gender and socioeconomic differences have been reported in the prevalence of modifiable risk factors for dementia. However, it remains unclear whether the associations between modifiable risk factors for dementia and incident dementia differ by sex/gender or socioeconomic status. This study aimed to investigate sex/gender and socioeconomic differences in the associations of modifiable risk factors with incident dementia using a life-course perspective. We used data from the English Longitudinal Study of Ageing (2008/2009 to 2018/2019). A total of 8,941 individuals were included [mean (standard deviation) age, 66.1 ± 9.8 years; 4,935 (55.2%) were women]. No overall sex/gender difference in dementia risk was found. Dementia risk was higher among those who experienced childhood deprivation [hazard ratio (HR) = 1.51 (1.17; 1.96)], lower occupational attainment [HR low versus high = 1.60 (1.23; 2.09) and HR medium versus high = 1.53 (1.15; 2.06)], and low wealth [HR low versus high = 1.63 (1.26; 2.12)]. Though different associations were found among the subgroups, there might be a sex/gender difference in dementia risk only for low cognitive activity, suggesting a higher risk for women [HR = 2.61 (1.89; 3.60)] compared to men [HR = 1.73 (1.20; 2.49)]. No consistent socioeconomic differences in modifiable dementia risk were found. A population-based approach that tackles inequalities in dementia risk profiles directly may be more effective than individual approaches in dementia prevention.
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Köhler S, Soons LM, Tange H, Deckers K, van Boxtel MP. Sleep Quality and Cognitive Decline Across the Adult Age Range: Findings from the Maastricht Aging Study (MAAS). J Alzheimers Dis 2023; 96:1041-1049. [PMID: 38007668 PMCID: PMC10741338 DOI: 10.3233/jad-230213] [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] [Accepted: 09/11/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Sleep disturbances have been linked with cognitive decline and a higher risk of dementia. However, there is a lack of studies with sufficient follow-up duration, a detailed neuropsychological assessment and adequate control of main confounders. OBJECTIVE To investigate the relation between self-reported sleep quality and cognitive decline over 12 years in cognitively healthy individuals from the general population. METHODS We used data from the Maastricht Aging Study (MAAS), a Dutch population-based prospective cohort study of 1,823 community-dwelling adults aged 24 to 82 years at baseline. Cognitive performance was measured at baseline, 6 and 12 years on verbal memory, executive functions, and information processing speed. Sleep quality was assessed at baseline using the sleep subscale score of the 90-item Symptom Checklist (SCL-90). Additional modifiable dementia risk factors were summarized in the LIfestyle for BRAin health (LIBRA) risk score. Weighted linear mixed models tested the association between continuous scores and tertiles of subjective sleep quality and change in cognitive performances over time. Models were adjusted for age, gender, educational level, LIBRA, and use of hypnotic (sleep) medication. RESULTS Worse sleep quality was associated with faster decline in processing speed. At older age (≥65 years), it was also associated with faster decline in verbal memory. Association were independent of other modifiable dementia risk factors and use of hypnotic medication. Directionally similar but non-significant associations were found between worse sleep quality and executive functions. CONCLUSIONS In this population-based study across the adult age range, poor self-reported sleep was associated with accelerated cognitive decline.
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Affiliation(s)
- Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lion M. Soons
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Huibert Tange
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Martin P.J. van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Alzheimer Center Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands
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Bruinsma J, Heger I, Loukas VS, Kassiotis T, Karanasiou G, Fotiadis DI, Hanke S, Crutzen R. Public Perspectives on Lifestyle-Related Behavior Change for Dementia Risk Reduction: An Exploratory Qualitative Study in The Netherlands. J Alzheimers Dis 2023; 95:1635-1642. [PMID: 37718799 PMCID: PMC10578282 DOI: 10.3233/jad-230217] [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] [Accepted: 07/31/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND There is accumulating evidence that addressing modifiable risk and protective factors has an impact on dementia rates. Insight into the public's perspectives on dementia risk reduction is needed to inform future individual-level interventions and public health approaches. OBJECTIVE This study explores the publics' openness towards dementia risk reduction and willingness towards changing lifestyle behavior to reduce the future risk for dementia. METHODS Using a screening questionnaire, participants were purposively selected based on lifestyle behaviors that are associated with dementia risk. One-on-one interviews were used to explore their openness towards dementia risk reduction and willingness towards behavior change. Independently, two researchers performed an inductive content analysis. RESULTS Interviews were conducted with 23 participants aged from 40 to 79 years. Main themes that were identified from the data were: 1) abstractness of dementia risk reduction, 2) ambivalence towards changing behavior, 3) negative self-image and low behavioral control, and 4) all-or-nothing thinking about lifestyle change. CONCLUSIONS The concept of dementia risk reduction seems difficult to translate to the personal context, particularly if individuals perceive that dementia would occur decades in the future. This is problematic because a large proportion of the public needs a healthier lifestyle to reduce the incidence of dementia. Translating healthy intentions into behavior is complex and involves overcoming a variety of barriers that complicate dementia risk reduction initiatives. Support is needed for individuals who experience additional obstacles that obstruct commencing to a healthier lifestyle (e.g., negative self-image, engaging in multiple unhealthy behaviors, unrealistic perceptions about lifestyle change).
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Affiliation(s)
- Jeroen Bruinsma
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
| | - Irene Heger
- Department of Psychiatry and Neuropsychology of the School for Mental Health and Neuroscience at Maastricht University, Maastricht, The Netherlands
| | - Vasileios S. Loukas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology - Hellas, FORTH-BRI, Ioannina, Greece
| | - Thomas Kassiotis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology – Hellas, FORTH-ICS-CBML, Heraklion, Crete, Greece
| | - Georgia Karanasiou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology - Hellas, FORTH-BRI, Ioannina, Greece
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology - Hellas, FORTH-BRI, Ioannina, Greece
| | - Sten Hanke
- Institute of eHealth at University of Applied Science at FH Joanneum, Graz, Austria
| | - Rik Crutzen
- Department of Health Promotion of the Care and Public Health Research Institute at Maastricht University, Maastricht, The Netherlands
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Heger I, Deckers K, de Vugt M, Verhey F, Oenema A, van Boxtel M, Köhler S. Using mHealth for Primary Prevention of Dementia: A Proof-of-Concept Study on Usage Patterns, Appreciation, and Beliefs and Attitudes Regarding Prevention. J Alzheimers Dis 2023; 94:935-948. [PMID: 37355903 PMCID: PMC10473134 DOI: 10.3233/jad-230225] [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] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Health- and lifestyle factors account for a substantial part of all dementia cases, which opens the opportunity for primary prevention. However, the required behavioral change is complex and involves targeting multiple risk factors. mHealth interventions can potentially contribute to improving motivation in a low-cost and scalable way. OBJECTIVE To explore usage patterns, appreciation, and beliefs and attitudes regarding dementia risk reduction during the use of the MyBraincoach mobile app. METHODS Participants were community-dwelling middle-aged adults from the Netherlands and used either the standard (education) or extended (education+motivational triggers) app version for three months. Two panel studies were combined in this paper. Chi-square tests, t-tests and linear mixed models were used, adjusted for age, sex, and education. RESULTS Of all participants (n = 299, 50.2% male), 167 (55.9%) had installed the app. The most reported reason for non-use was technical problems (47%). Those who used the app were at baseline already more positive about dementia risk reduction than those who did not use the app. Of all users who completed the evaluation (n = 102), 78.4% (n = 80) stated that the app provided a positive approach towards brain health and 80.4% (n = 82) felt better informed. Younger (<60y) and lower educated participants evaluated the app most positively. CONCLUSION Usage of the app was low, but users showed more positive beliefs and attitudes regarding dementia risk reduction. Most users evaluated the app positively and stated to have gained knowledge on the topic. Improving the use of the app must keep high priority in future studies.
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Affiliation(s)
- Irene Heger
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anke Oenema
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute Maastricht, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Knobel P, Litke R, Mobbs CV. Biological age and environmental risk factors for dementia and stroke: Molecular mechanisms. Front Aging Neurosci 2022; 14:1042488. [PMID: 36620763 PMCID: PMC9813958 DOI: 10.3389/fnagi.2022.1042488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Since the development of antibiotics and vaccination, as well as major improvements in public hygiene, the main risk factors for morbidity and mortality are age and chronic exposure to environmental factors, both of which can interact with genetic predispositions. As the average age of the population increases, the prevalence and costs of chronic diseases, especially neurological conditions, are rapidly increasing. The deleterious effects of age and environmental risk factors, develop chronically over relatively long periods of time, in contrast to the relatively rapid deleterious effects of infectious diseases or accidents. Of particular interest is the hypothesis that the deleterious effects of environmental factors may be mediated by acceleration of biological age. This hypothesis is supported by evidence that dietary restriction, which universally delays age-related diseases, also ameliorates deleterious effects of environmental factors. Conversely, both age and environmental risk factors are associated with the accumulation of somatic mutations in mitotic cells and epigenetic modifications that are a measure of "biological age", a better predictor of age-related morbidity and mortality than chronological age. Here we review evidence that environmental risk factors such as smoking and air pollution may also drive neurological conditions, including Alzheimer's Disease, by the acceleration of biological age, mediated by cumulative and persistent epigenetic effects as well as somatic mutations. Elucidation of such mechanisms could plausibly allow the development of interventions which delay deleterious effects of both aging and environmental risk factors.
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Affiliation(s)
- Pablo Knobel
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rachel Litke
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Charles V. Mobbs
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Charles V. Mobbs,
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Love T, Wiese LAK, Duncan V, Bertrand H. Does self-directed learning address gaps in nursing student knowledge of Alzheimer's disease? EDUCATIONAL GERONTOLOGY 2022; 49:673-686. [PMID: 37674775 PMCID: PMC10479950 DOI: 10.1080/03601277.2022.2148445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
In the past two decades, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from age-related Alzheimer's disease (AD) have increased. Future nurses will be caring for the rapidly escalating number of older adults facing increased AD risk, yet nursing students' knowledge has been shown to be limited regarding the age-related disease of Alzheimer's (and the most common dementia type) (Aljezawi et al., 2022; Mattos et al., 2015). In this pilot study, a quasi-experimental approach was used to examine undergraduate baccalaureate nursing students' basic knowledge about AD among two cohorts (N = 146). Testing occurred following an assigned self-directed learning activity as a means of providing the most current information regarding dementia. Pearson correlation and t-tests were applied in comparing student results in pre- and posttest surveys and investigating possible correlations between sociodemographic variables. Students in the 2020 group scored lower on ten of the thirty test items than the earlier 2018 cohort, suggesting that the method of self-directed learning, despite offering the most recent information, may be inadequate. To prepare nursing students to care for the increasing numbers of older adults at risk for Alzheimer's disease, curricula that are inclusive of the most recent advances in science surrounding dementia-related illnesses, and supplemented by faculty lectures, is recommended. This requires faculty themselves to be knowledgeable of the most recent advances in dementia risk, prevention, detection and management.
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Affiliation(s)
- Tamara Love
- C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Lisa Ann Kirk Wiese
- C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Vanessa Duncan
- Nursing, Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Herlie Bertrand
- School of Nursing, Florida Atlantic University, Boca Raton,FL,USA
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Röhr S, Pabst A, Baber R, Engel C, Glaesmer H, Hinz A, Schroeter ML, Witte AV, Zeynalova S, Villringer A, Löffler M, Riedel-Heller SG. Socioeconomic Inequalities in Cognitive Functioning Only to a Small Extent Attributable to Modifiable Health and Lifestyle Factors in Individuals Without Dementia. J Alzheimers Dis 2022; 90:1523-1534. [PMID: 36278347 DOI: 10.3233/jad-220474] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are socioeconomic inequalities in dementia risk. Underlying pathways are not well known. OBJECTIVE To investigate whether modifiable health and lifestyle factors for brain health mediate the association of socioeconomic status (SES) and cognitive functioning in a population without dementia. METHODS The "LIfestyle for BRAin health" (LIBRA) score was computed for 6,203 baseline participants of the LIFE-Adult-Study. LIBRA predicts dementia in midlife and early late life, based on 12 modifiable factors. Associations of SES (education, net equivalence income, and occupational status) and LIBRA with cognitive functioning (composite score) were investigated using adjusted linear regression models. Bootstrapped structural equation modelling (SEM) was used to investigate whether LIBRA mediated the association of SES and cognitive functioning. RESULTS Participants were M = 57.4 (SD = 10.6, range: 40-79) years old; 50.3% were female. Both, SES (Wald: F(2)=52.5, p < 0.001) and LIBRA (Wald: F(1)=5.9, p < 0.05) were independently associated with cognitive functioning; there was no interaction (Wald: F(2)=2.9, p = 0.060). Lower SES and higher LIBRA scores indicated lower cognitive functioning. LIBRA partially mediated the association of SES and cognitive functioning (IE: =0.02, 95% CI [0.02, 0.03], p < 0.001). The proportion mediated was 12.7%. CONCLUSION Differences in cognitive functioning due to SES can be partially attributed to differences in modifiable health and lifestyle factors; but to a small extent. This suggests that lifestyle interventions could attenuate socioeconomic inequalities in cognitive functioning. However, directly intervening on the social determinants of health may yield greater benefits for dementia risk reduction.
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Affiliation(s)
- Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany.,Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland.,School of Psychology, Massey University, Manawatū Campus, Palmerston North, New Zealand
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Ronny Baber
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany.,LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - A Veronica Witte
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Samira Zeynalova
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Markus Löffler
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
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Contribution of smoking towards the association between socioeconomic position and dementia: 32-year follow-up of the Whitehall II prospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 23:100516. [PMID: 36189426 PMCID: PMC9523395 DOI: 10.1016/j.lanepe.2022.100516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background There is consistent evidence of social inequalities in dementia but the mechanisms underlying this association remain unclear. We examined the role of smoking in midlife in socioeconomic differences in dementia at older ages. Methods Analyses were based on 9951 (67% men) participants, median age 44.3 [IQR=39.6, 50.3] years at baseline in 1985-1988, from the Whitehall II cohort study. Socioeconomic position (SEP) and smoking (smoking status (current, ex-, never-smoker), pack years of smoking, and smoking history score (combining status and pack-years)) were measured at baseline. Counterfactual mediation analysis was used to examine the contribution of smoking to the association between SEP and dementia. Findings During a median follow-up of 31.6 (IQR 31.1, 32.6) years, 628 participants were diagnosed with dementia and 2110 died. Analyses adjusted for age, sex, ethnicity, education, and SEP showed smokers (hazard ratio [HR] 1.36 [95% CI 1.10-1.68]) but not ex-smokers (HR 0.95 [95% CI 0.79-1.14]) to have a higher risk of dementia compared to never-smokers; similar results for smoking were obtained for pack-years of smoking and smoking history score. Mediation analysis showed low SEP to be associated with higher risk of dementia (HRs between 1.97 and 2.02, depending on the measure of smoking in the model); estimate for the mediation effect was 16% for smoking status (Indirect Effect HR 1.09 [95% CI 1.03-1.15]), 7% for pack-years of smoking (Indirect Effect HR 1.03 [95% CI 1.01-1.06]) and 11% for smoking history score (Indirect Effect HR 1.06 [95% CI 1.02-1.10]). Interpretation Our findings suggest that part of the social inequalities in dementia is mediated by smoking. Funding NIH.
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Siette J, Dodds L, Dawes P, Richards D, Savage G, Strutt P, Ijaz K, Johnco C, Wuthrich V, Heger I, Deckers K, Köhler S, Armitage CJ. Protocol for a pre-post, mixed-methods feasibility study of the Brain Bootcamp behaviour change intervention to promote healthy brain ageing in older adults. PLoS One 2022; 17:e0272517. [PMID: 36445869 PMCID: PMC9707764 DOI: 10.1371/journal.pone.0272517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Behaviour change interventions represent key means for supporting healthy ageing and reducing dementia risk yet brief, scalable behaviour change interventions targeting dementia risk reduction in older adults is currently lacking. Here we describe the aims and design of the three-month Brain Bootcamp initiative that seeks to target multiple dementia risk and protective factors (healthy eating, physical, social and cognitive inactivity), through the use of multiple behaviour change techniques, including goal-setting for behaviour, information about health consequences and physical prompts to change behaviours that reduce dementia risk among older adults. Our secondary aim is to understand participants' views of dementia prevention and explore the acceptability and integration of this campaign into daily life. METHODS Brain Bootcamp is a pre-post feasibility trial conducted in Sydney, Australia beginning in January 2021 until late August. Participants aged ≥65 years living independently in the community (n = 252), recruited through social media and flyers, will provide information about their demographics, medical history, alcohol consumption, smoking habits, mental health, physical activity, cognitive activity, and diet to generate a dementia risk profile at baseline and assess change therein at three-month follow-up. During the intervention, participants will receive a resource pack containing their individual risk profile, educational booklet on dementia risk factors and four physical items designed to prompt physical, social and mental activity, and better nutrition. Outcome measures include change in dementia risk scores, dementia awareness and motivation. A qualitative process evaluation will interview a sample of participants on the acceptability and feasibility of the intervention. DISCUSSION This will be the first short-term multi-domain intervention targeting dementia risk reduction in older adults. Findings will generate a new evidence base on how to best support efforts targeting lifestyle changes and to identify ways to optimise acceptability and effectiveness towards brain health for older adults. TRIAL REGISTRATION NUMBER ACTRN 381046 (registered 17/02/2021); Pre-results.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Piers Dawes
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Deborah Richards
- Department of Computing, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Greg Savage
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Paul Strutt
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
- Department of Cognitive Science, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Viviana Wuthrich
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Irene Heger
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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Tan V, Chen C, Merchant RA. Association of social determinants of health with frailty, cognitive impairment, and self-rated health among older adults. PLoS One 2022; 17:e0277290. [PMID: 36367863 PMCID: PMC9651553 DOI: 10.1371/journal.pone.0277290] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Recently, the role of social determinants of health on frailty and dementia has received increased attention. The aim of the present study is to explore the association of social determinants on cognitive impairment, frailty, and self-rated health. As health is influenced by many factors, we also examine other health determinants including lifestyle, health seeking behaviour, socio-demographics, and multimorbidity in the analysis. Research design and methods Cross-sectional analysis of the Healthy Older People Everyday (HOPE) study in Singapore was carried out on 998 older adults above the age of 65. We used forward stepwise multivariable logistic and linear regression analyses to assess the association of five health determinants (social determinants, lifestyle, health seeking behaviour, socio-demographics and multimorbidity) on frailty, cognitive impairment, and self-rated health. Results Mean age of participants was 71.1 ± 0.2 years; 154 (15.4%) were cognitively impaired; 430 (43.1%) were pre-frail or frail; mean self-rated health was 80.4 ± 15.6. Social determinants contributed between 29% to 57% of the overall variation found in the full model with all five health determinants adjusted for. Participants with higher education had significantly lower odds of cognitive impairment and frailty. Leisure physical activity was significantly associated with lower odds of frailty and cognitive impairment, and better self-rated health. Discussion and implications Understanding the dynamics of different health determinants is crucial to protect the vulnerable in an ageing population. Our study highlights the need for a multidimensional, multidisciplinary and multisectoral approach in the prevention of frailty, cognitive impairment, and associated disability.
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Affiliation(s)
- Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Avila-Rieger J, Turney IC, Vonk JMJ, Esie P, Seblova D, Weir VR, Belsky DW, Manly JJ. Socioeconomic Status, Biological Aging, and Memory in a Diverse National Sample of Older US Men and Women. Neurology 2022; 99:e2114-e2124. [PMID: 36038275 PMCID: PMC9651454 DOI: 10.1212/wnl.0000000000201032] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure to socioeconomic disadvantage is associated with early-onset cognitive aging. Biological aging, the progressive loss of system integrity that occurs as we age, is proposed as a modifiable process mediating this health inequality. We examined whether socioeconomic disparities in cognitive aging in mid-to late-life adults is explained by accelerated biological aging similarly across race, ethnicity, and sex/gender. METHODS Data were from a prospective cohort study of the US Health and Retirement Study DNA methylation substudy. Socioeconomic status (SES) was measured from years of education and household wealth at baseline. The extent and pace of biological aging were quantified using 3 DNA methylation measures: PhenoAge, GrimAge, and DunedinPoAm. Cognitive aging was measured from repeated longitudinal assessments of immediate and delayed word recall. Latent growth curve modeling estimated participants' level of memory performance and rate of decline over 2-11 follow-up assessments spanning 2-20 years. Multiple-group models were estimated to assess whether the relationship between SES and memory trajectories was mediated by biological aging across racial-ethnic by sex/gender subgroups. RESULTS Data from a total of 3,997 adults aged 50-100 years were analyzed. Participants with lower SES had a lower memory performance, had a faster decline, and exhibited accelerated biological aging (SES effect size associations [β] ranged from 0.08 to 0.41). Accelerated biological aging was associated with decreased memory performance and faster memory decline (effect size range 0.03-0.23). SES-biological aging associations were the strongest for White men and women and weakest for Latinx women. The relationship between biological aging measures and memory was weaker for Black participants compared with that for White and Latinx people. In mediation analysis, biological aging accounted for 4%-27% of the SES-memory gradient in White participants. There was little evidence of mediation in Black or Latinx participants. DISCUSSION Among a national sample of mid-to late-life adults, DNA methylation measures of biological aging were variably associated with memory trajectories and SES across White, Black, and Latinx mid-to late-life adults. These results challenge the assumption that DNA methylation biomarkers of aging that were developed in primarily White people can equivalently quantify aging processes affecting cognition in Black and Latinx mid-to late-life adults.
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Affiliation(s)
- Justina Avila-Rieger
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Indira C Turney
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jet M J Vonk
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Precious Esie
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Dominika Seblova
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Vanessa R Weir
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Daniel W Belsky
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jennifer J Manly
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY.
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Kjelvik G, Rokstad AMM, Stuebs J, Thingstad P, Deckers K, Köhler S, Selbæk G. Public knowledge about dementia risk reduction in Norway. BMC Public Health 2022; 22:2046. [DOI: 10.1186/s12889-022-14433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Several modifiable lifestyle risk factors for dementia have been identified, but it is unclear how much the Norwegian public knows about the relationship between lifestyle and brain health. Therefore, this study aimed to investigate knowledge about modifiable dementia risk and protective factors and beliefs and attitudes towards dementia and dementia risk reduction in a randomly selected subsample of the Norwegian population.
Methods
The total sample (n = 1435) included individuals aged 40–70 years from four counties (Oslo, Innlandet, Nordland and Trøndelag) in Norway. Two online questionnaires were used to measure (1) awareness about dementia risk reduction and (2) an individual`s motivation to change behaviour for dementia risk reduction (MOCHAD-10).
Results
Of the participants, 70% were aware of the potential of dementia risk reduction in general. Physical inactivity (86%), cognitive inactivity (84%) and social isolation (80%) were the most frequently recognised dementia risk factors. On the other hand, diabetes (26%), coronary heart disease (19%), hearing loss (18%) and chronic kidney disease (7%) were less often recognised as dementia risk factors. Comparing men and women, the only significant difference was that women were more likely to report parents with dementia as a risk factor compared to men. Gender, age and educational differences were seen in beliefs and attitudes towards dementia prevention:women reported more negative feelings and attitudes towards dementia than men;those aged 40–49 years – more likely than older age groups – reported that ‘knowing family members with dementia’ or ‘having risk factors’ made them believe they had to change their lifestyle and behaviour.
Conclusions
The results indicate that 70% of the Norwegian public are aware of the potential for dementia risk reduction in general. However, there are major gaps in existing knowledge, particularly for cardiovascular risk factors such as hypertension, coronary heart disease, hypercholesterolemia and metabolic factors (diabetes, obesity). These findings underline the importance of further informing the Norwegian public about lifestyle-related risk and protective factors of dementia. Differences in beliefs and attitudes towards dementia risk prevention by age, gender and education require tailored public risk reduction interventions.
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Avila-Rieger J, Turney IC, Vonk JMJ, Esie P, Seblova D, Weir VR, Belsky DW, Manly JJ. Socioeconomic Status, Biological Aging, and Memory in a Diverse National Sample of Older US Men and Women. Neurology 2022; 99:e2114-e2124. [PMID: 36038275 PMCID: PMC9651454 DOI: 10.1212/wnl.0000000000201032 10.1212/wnl.0000000000201032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/13/2022] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure to socioeconomic disadvantage is associated with early-onset cognitive aging. Biological aging, the progressive loss of system integrity that occurs as we age, is proposed as a modifiable process mediating this health inequality. We examined whether socioeconomic disparities in cognitive aging in mid-to late-life adults is explained by accelerated biological aging similarly across race, ethnicity, and sex/gender. METHODS Data were from a prospective cohort study of the US Health and Retirement Study DNA methylation substudy. Socioeconomic status (SES) was measured from years of education and household wealth at baseline. The extent and pace of biological aging were quantified using 3 DNA methylation measures: PhenoAge, GrimAge, and DunedinPoAm. Cognitive aging was measured from repeated longitudinal assessments of immediate and delayed word recall. Latent growth curve modeling estimated participants' level of memory performance and rate of decline over 2-11 follow-up assessments spanning 2-20 years. Multiple-group models were estimated to assess whether the relationship between SES and memory trajectories was mediated by biological aging across racial-ethnic by sex/gender subgroups. RESULTS Data from a total of 3,997 adults aged 50-100 years were analyzed. Participants with lower SES had a lower memory performance, had a faster decline, and exhibited accelerated biological aging (SES effect size associations [β] ranged from 0.08 to 0.41). Accelerated biological aging was associated with decreased memory performance and faster memory decline (effect size range 0.03-0.23). SES-biological aging associations were the strongest for White men and women and weakest for Latinx women. The relationship between biological aging measures and memory was weaker for Black participants compared with that for White and Latinx people. In mediation analysis, biological aging accounted for 4%-27% of the SES-memory gradient in White participants. There was little evidence of mediation in Black or Latinx participants. DISCUSSION Among a national sample of mid-to late-life adults, DNA methylation measures of biological aging were variably associated with memory trajectories and SES across White, Black, and Latinx mid-to late-life adults. These results challenge the assumption that DNA methylation biomarkers of aging that were developed in primarily White people can equivalently quantify aging processes affecting cognition in Black and Latinx mid-to late-life adults.
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Affiliation(s)
- Justina Avila-Rieger
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Indira C Turney
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jet M J Vonk
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Precious Esie
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Dominika Seblova
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Vanessa R Weir
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Daniel W Belsky
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY
| | - Jennifer J Manly
- From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Gertrude H. Sergievsky Center (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Department of Neurology (J.A.-R., I.C.T., J.M.J.V., D.S., V.R.W., J.J.M.), College of Physicians and Surgeons, Columbia University, New York; Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Epidemiology (P.E., D.W.B.), Columbia University Mailman School of Public Health, New York; and Butler Columbia Aging Center (D.W.B.), Columbia University Mailman School of Public Health, New York, NY.
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Chino B, Zegarra-Valdivia J, de Frutos-Lucas J, Paredes-Manrique C, Custodio N. Impact of Sociodemographic Features and Lifestyle on Cognitive Performance of Peruvian Adults. J Alzheimers Dis 2022; 90:599-608. [DOI: 10.3233/jad-220428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cognitive impairment and dementia may result from a combination of modifiable and nonmodifiable risk and protective factors, such as the environment, educational attainment, time devoted to cognitively stimulating activities, and physical activity. Objective: This study aimed to investigate the mediating role of sociodemographic characteristics and lifestyle factors in the years of education and cognitive performance in Peruvian adults. Methods: This cross-sectional study included 1,478 subjects assessed by Addenbrooke’s Cognitive Examination Revised (ACE-R). Using mediation models, we evaluated the mediation role of parents’ educational level, reading time (RT), and physical activity time (PAT) in the years of education (IYE) and cognitive performance. Results: People who reported having lived in an urban area during their childhood are estimated to have, on average, 2.085 years more formal education than those who lived in rural areas. In addition, 49% of cognitive performance scores are explained by the mediation effect of reading and physical activity time in the IYE. This implies that higher levels of education, mediated by RT and PAT per week, are 1.596 units associated with higher scores on the ACE-R. Conclusion: Despite the fact that nonmodifiable factors (i.e., childhood residence area, parents’ educational level) seem to exert an effect on older adults’ cognition, their influence is mediated by other factors that are indeed modifiable (i.e., reading time, physical activity engagement). In this sense, lifestyle changes could help prevent or decrease the risk of cognitive impairment and reduce the disease’s impact on vulnerable environments in Latin American and Caribbean countries.
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Affiliation(s)
- Brenda Chino
- Center of Cognitive and Computational Neuroscience-UCM, Spain
- Institute of Neuroscience INc, Universidad Autónoma de Barcelona, Spain
- Universidad Nacional de San Agustín deArequipa, Perú
| | - Jonathan Zegarra-Valdivia
- Universidad Señor deSipán, Chiclayo, Perú
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Achucarro Basque Center for Neuroscience, Leioa, Spain
| | - Jaisalmer de Frutos-Lucas
- Center of Cognitive and Computational Neuroscience-UCM, Spain
- Centre for Precision Health, Edith CowanUniversity, Joondalup, Western Australia, Australia
- Departamento de Psicología, Facultad deCiencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, Spain
| | | | - Nilton Custodio
- Instituto Peruano de Neurociencias, Lima, Perú
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
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Social determinants and lifestyle factors for brain health: implications for risk reduction of cognitive decline and dementia. Sci Rep 2022; 12:12965. [PMID: 35902604 PMCID: PMC9334303 DOI: 10.1038/s41598-022-16771-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/15/2022] [Indexed: 11/08/2022] Open
Abstract
Substantial evidence indicates a huge potential for risk reduction of cognitive decline and dementia based on modifiable health and lifestyle factors. To maximize the chances for risk reduction, it is useful to investigate associations of social determinants and lifestyle for brain health. We computed the "LIfestyle for BRAin health" (LIBRA) score for baseline participants of the Leipzig Research Centre for Civilization Diseases (LIFE) Adult Study, a population-based urban cohort in Germany. LIBRA predicts dementia in midlife and early late life populations, comprising 12 modifiable risk factors (heart disease, kidney disease, diabetes, obesity, hypertension, hypercholesterolemia, alcohol consumption, smoking, physical inactivity, diet, depression, cognitive inactivity). Associations of social determinants (living situation, marital status, social isolation, education, net equivalence income, occupational status, socioeconomic status/SES, employment) with LIBRA were inspected using age- and sex-adjusted multivariable linear regression analysis. Z-standardization and sampling weights were applied. Participants (n = 6203) were M = 57.4 (SD = 10.6, range 40-79) years old and without dementia, 53.0% were women. Except for marital status, all considered social determinants were significantly associated with LIBRA. Beta coefficients for the association with higher LIBRA scores were most pronounced for low SES (β = 0.80, 95% CI [0.72-0.88]; p < 0.001) and middle SES (β = 0.55, 95% CI [0.47-0.62]; p < 0.001). Social determinants, particularly socioeconomic factors, are associated with lifestyle for brain health, and should thus be addressed in risk reduction strategies for cognitive decline and dementia. A social-ecological public health perspective on risk reduction might be more effective and equitable than focusing on individual lifestyle behaviors alone.
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Socioeconomic disparities and dementia in China. Psychiatry Res 2022; 313:114611. [PMID: 35561537 DOI: 10.1016/j.psychres.2022.114611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aimed to investigate the associations between individual-level SES, area-level SES, and their interaction with dementia in China. METHODS This study used data from the Second China National Sample Survey on Disability and restricted our finalized analysis to 688,507 participants aged 50 years or older. Dementia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Multilevel logistic regression models were fitted to examine the associations between individual-level SES, area-level SES, and their interaction with dementia. RESULTS Participants with higher individual SES were less likely to develop dementia; the risk of dementia decreased by 18% for each standard deviation increase in individual SES (OR=0.82, 95% CI=0.77, 0.88). Advantaged areas were associated with an increased risk of dementia in Chinese adults by 1.52 (95% CI=1.43, 1.62). Analysis of the combination between individual-level SES and area-level SES revealed that as the level of area SES increased, the risk of dementia in lower SES people was significantly higher than in higher SES people (OR=1.09, 95% CI=1.04,1.14). DISCUSSION This study found that people with lower SES living in high-SES areas had a higher risk of dementia than people with lower SES living in low-SES areas. Significant socioeconomic differences in the risk of dementia exist in China, and more attention should be given to low-SES populations living in high-SES areas.
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