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Lanctôt KL, Hviid Hahn-Pedersen J, Eichinger CS, Freeman C, Clark A, Tarazona LRS, Cummings J. Burden of Illness in People with Alzheimer's Disease: A Systematic Review of Epidemiology, Comorbidities and Mortality. J Prev Alzheimers Dis 2024; 11:97-107. [PMID: 38230722 PMCID: PMC10225771 DOI: 10.14283/jpad.2023.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide, and an updated quantification of its impact on morbidity, disability, and mortality is warranted. We conducted a systematic literature review, focusing on the past decade, to characterize AD and assess its impact on affected individuals. METHODS Searches of Embase, MEDLINE, and the Cochrane Library were conducted on August 7, 2020 and updated on November 10, 2021. Observational studies from any country reporting incidence, prevalence, comorbidities, and/or outcomes related to disability and mortality/life expectancy, in people with mild cognitive impairment (MCI) due to AD, or mild, moderate, or severe AD dementia, were considered relevant. RESULTS Data were extracted from 88 studies (46 incidence/prevalence; 44 comorbidities; 25 mortality-/disability-related outcomes), mostly from Europe, the USA, and Asia. AD dementia diagnosis was confirmed using biomarkers in only 6 studies. Estimated 5-year mortality in AD was 35%, and comorbidity prevalence estimates varied widely (hypertension: 30.2-73.9%; diabetes: 6.0-24.3%; stroke: 2.7-13.7%). Overall, people with AD dementia were more likely to have cardiovascular disease or diabetes than controls, and 5-year mortality in people with AD dementia was double that in the age- and year-matched general population (115.0 vs 60.6 per 1,000 person-years). CONCLUSIONS AD is associated with excess morbidity and mortality. Future longitudinal studies of population aging, incorporating biomarker assessment to confirm AD diagnoses, are needed to better characterize the course of MCI due to AD and AD dementia.
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Affiliation(s)
- K L Lanctôt
- Krista L. Lanctôt, Hurvitz Brain Sciences Program, Sunnybrook Research Institute; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, Email address: Telephone: +1 416 480-6100; Ext: 2241
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Fernández Fernández R, Martín JI, Antón MAM. Depression as a Risk Factor for Dementia: A Meta-Analysis. J Neuropsychiatry Clin Neurosci 2023; 36:101-109. [PMID: 38111332 DOI: 10.1176/appi.neuropsych.20230043] [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: 12/20/2023]
Abstract
Dementia is a syndrome characterized by the deterioration of cognitive function beyond what is expected. The increased risk of developing this syndrome resulting from established modifiable risk factors, such as depressive episodes, is currently a subject of interest. The aim of this study was to review the scientific evidence that addresses the relationship between depression and dementia. A bibliographic search of the PubMed and PsycInfo databases for articles published over the past 20 years was conducted with the following medical subject heading terms: depression or depressive, dementia, and incidence or cohort studies. After articles meeting the inclusion criteria were selected, relevant moderating variables were grouped as sample characteristics, methodological characteristics, extrinsic characteristics, and outcome variables. The 26 selected studies resulted in a sample comprising 1,760,262 individuals. Statistical analysis revealed a pooled relative risk for the development of dementia of 1.82 (95% CI=1.62-2.06). The primary variables evaluated were the diagnostic methods for depression and dementia and the presence of depression. Other variables, such as mean age, methodological quality of each study, follow-up time, and publication year, were also evaluated. Age was statistically but not clinically significant. No relevant publication bias or alterations in the results were found when accounting for the quality of the studies. It is recommended that new moderating variables be evaluated or that existing variables be reformulated in future studies.
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Affiliation(s)
- Roberto Fernández Fernández
- Department of Psychiatry, Infanta Cristina University Hospital, Madrid (Fernández Fernández); Department of Methodology of Behavioral Sciences, National University of Distance Education (UNED), Madrid (all authors)
| | - Javier Ibias Martín
- Department of Psychiatry, Infanta Cristina University Hospital, Madrid (Fernández Fernández); Department of Methodology of Behavioral Sciences, National University of Distance Education (UNED), Madrid (all authors)
| | - María Araceli Maciá Antón
- Department of Psychiatry, Infanta Cristina University Hospital, Madrid (Fernández Fernández); Department of Methodology of Behavioral Sciences, National University of Distance Education (UNED), Madrid (all authors)
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Guo Y, Pai M, Xue B, Lu W. Bidirectional association between depressive symptoms and mild cognitive impairment over 20 years: Evidence from the Health and Retirement Study in the United States. J Affect Disord 2023; 338:449-458. [PMID: 37356735 DOI: 10.1016/j.jad.2023.06.046] [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: 01/07/2023] [Revised: 05/20/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Research examining the association between depressive symptoms and mild cognitive impairment (MCI) has yielded conflicting results. This study aimed to examine the bidirectional association between depressive symptoms and MCI, and the extent to which this bidirectional association is moderated by gender and education. METHODS Data come from the US Health and Retirement Study over a 20-year period (older adults aged ≥50 years). Competing-risks regression is employed to examine the association between baseline high-risk depressive symptoms and subsequent MCI (N = 9317), and baseline MCI and subsequent high-risk depressive symptoms (N = 9428). Interactions of baseline exposures with gender and education are tested. RESULTS After full adjustment, baseline high-risk depressive symptoms were significantly associated with subsequent MCI (SHR = 1.20, 95%CI 1.08-1.34). Participants with baseline MCI are more likely to develop subsequent high-risk depressive symptoms than those without baseline MCI (SHR = 1.16, 95%CI 1.01-1.33). Although gender and education are risk factors for subsequent depression and MCI, neither moderates the bidirectional association. LIMITATIONS Items used to construct the composite cognitive measure are limited; selection bias due to missing data; and residual confounding. CONCLUSIONS Our study found a bidirectional association between depressive symptoms and MCI. High-risk depressive symptoms are related to a higher risk of subsequent MCI; and MCI predicts subsequent high-risk depression. Though neither gender nor education moderated the bidirectional association, public health interventions crafted to reduce the risk of depression and MCI should pivot attention to older women and those with less formal education.
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Affiliation(s)
- Yunyun Guo
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom; Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Manacy Pai
- Department of Sociology, Kent State University, Kent, OH, United States of America
| | - Baowen Xue
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Wentian Lu
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
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Yang HW, Wu YH, Lin MC, Liao SF, Fan CC, Wu CS, Wang SH. Association between neighborhood availability of physical activity facilities and cognitive performance in older adults. Prev Med 2023; 175:107669. [PMID: 37595898 DOI: 10.1016/j.ypmed.2023.107669] [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] [Received: 05/09/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/20/2023]
Abstract
The existing evidence on the contextual influence of the availability of local facilities for physical activity on the cognitive health of elderly residents is sparse. This study examined the association between neighborhood physical activity facilities and cognitive health in older individuals. A cohort study of community-dwelling older adults was performed using baseline data and follow-up data from the Taiwan Biobank. Cognitive health was measured in 32,396 individuals aged 60-70 years using the Mini-Mental State Examination (MMSE) with follow-up information on 8025 participants. The district was used as the proxy for local neighborhood. To determine neighborhood physical activity facilities, school campuses, parks, activity centers, gyms, swimming pools, and stadiums were included. Multilevel linear regression models were applied to examine the associations of neighborhood physical activity facilities with baseline MMSE and MMSE decline during follow-up, with adjustment for individual factors and neighborhood socioeconomic characteristics. Multilevel analyses revealed that there was a neighborhood-level effect on cognitive health among older adults. After adjusting for compositional and neighborhood socioeconomic characteristics, baseline MMSE was higher in individuals living in the middle- (beta = 0.12, p-value = 0.140) and high-density facility (beta = 0.22, p-value = 0.025) groups than in the low-density group (p-value for trend-test = 0.031). MMSE decline during follow-up was slower in the middle- (beta = 0.15, p-value = 0.114) and high-density facility (beta = 0.27, p-value = 0.052) groups than in the low-density group (p-value for trend-test = 0.032). Greater neighborhood availability of physical activity facilities was associated with better cognitive health among older residents. These findings have implications for designing communities and developing strategies to support cognitive health of an aging population.
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Affiliation(s)
- Hui-Wen Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Yun-Hsuan Wu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Mei-Chen Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shu-Fen Liao
- Department of Medical Research, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Fan
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin branch, Douliu, Taiwan
| | - Shi-Heng Wang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
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Li X, Xia J, Li Y, Xu K, Chen K, Zhang J, Li H, Zhang Z. Risk scores of incident mild cognitive impairment in a Beijing community-based older cohort. Front Aging Neurosci 2022; 14:976126. [PMID: 36262884 PMCID: PMC9574183 DOI: 10.3389/fnagi.2022.976126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: It is very important to identify individuals who are at greatest risk for mild cognitive impairment (MCI) to potentially mitigate or minimize risk factors early in its course. We created a practical MCI risk scoring system and provided individualized estimates of MCI risk. Methods: Using data from 9,000 older adults recruited for the Beijing Ageing Brain Rejuvenation Initiative, we investigated the association of the baseline demographic, medical history, lifestyle and cognitive data with MCI status based on logistic modeling and established risk score (RS) models 1 and 2 for MCI. We evaluated model performance by computing the area under the receiver operating characteristic (ROC) curve (AUC). Finally, RS model 3 was further confirmed and improved based on longitudinal outcome data from the progression of MCI in a sub-cohort who had an average 3-year follow-up. Results: A total of 1,174 subjects (19.8%) were diagnosed with MCI at baseline, and 72 (7.8%) of 849 developed MCI in the follow-up. The AUC values of RS models 1 and 2 were between 0.64 and 0.70 based on baseline age, education, cerebrovascular disease, intelligence and physical activities. Adding baseline memory and language performance, the AUC of RS model 3 more accurately predicted MCI conversion (AUC = 0.785). Conclusion: A combination of risk factors is predictive of the likelihood of MCI. Identifying the RSs may be useful to clinicians as they evaluate their patients and to researchers as they design trials to study possible early non-pharmaceutical interventions to reduce the risk of MCI and dementia.
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Affiliation(s)
- Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
| | - Jianan Xia
- BABRI Centre, Beijing Normal University, Beijing, China
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Yumeng Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
| | - Kai Xu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
| | - Kewei Chen
- BABRI Centre, Beijing Normal University, Beijing, China
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Junying Zhang
- BABRI Centre, Beijing Normal University, Beijing, China
- Institute of Basic Research in Clinical Medicine, China Academy of Traditional Chinese Medicine, Beijing, China
| | - He Li
- BABRI Centre, Beijing Normal University, Beijing, China
- Institute of Basic Research in Clinical Medicine, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
- *Correspondence: Zhanjun Zhang
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A Pilot Study of Interactive-Video Games in People with Mild Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063536. [PMID: 35329218 PMCID: PMC8954200 DOI: 10.3390/ijerph19063536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
Early preventive strategies for improving cognitive function are crucial for people with mild cognitive impairment (MCI). Cognitive training exercises may improve cognitive functioning. However, there was limited evidence from training programs that combined cognitive-specific and physical activities, particularly in using interactive video games as interventions. This study aimed to evaluate the feasibility and effects of the interactive-video games on cognitive function, physical function, mood status and quality of life in community-dwelling people with MCI. A quasi-experimental study was undertaken. Participants in the intervention group received 60 min group-based training program once per week for 12 weeks. A generalised estimating equation (GEE) was used to examine the main effect, interactions and changes in outcomes over time. Sixteen participants completed the trial with eight in the intervention group and eight in the comparison group. The tolerable acceptance rate, perfect attendance rate, high satisfaction with the training content, and no injuries or falls demonstrated the feasibility of this program. The scores of cognitive function increased in both groups and the interaction between time and groups were significant over 12 weeks of training (p < 0.05). As the result, we determined that interactive-video games can be a safe, feasible, enjoyable intervention and user-friendly among people with MCI in community settings.
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Chow YY, Verdonschot M, McEvoy CT, Peeters G. Associations between depression and cognition, mild cognitive impairment and dementia in persons with diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2022; 185:109227. [PMID: 35122905 DOI: 10.1016/j.diabres.2022.109227] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022]
Abstract
AIMS This systematic review aimed to examine whether persons with diabetes and depression had poorer cognition and higher dementia risk than persons with diabetes only. Moreover, the impact of timing, frequency of depressive episodes throughout life, and antidepressant treatment were examined. METHODS PubMed, Embase and PsycINFO were searched to obtain observational studies between August 2015 and June 2021 that examined the association between depression and cognition, mild cognitive impairment or dementia in people with diabetes. Studies published before August 2015 were retrieved from a previous systematic review. Findings were pooled using meta-analyses. RESULTS 10 out of 19 included articles were appropriate for the meta-analyses. Persons with diabetes and depression experienced greater declines in executive function (SMD = -0.39 (-0.69, -0.08)), language (SMD = -0.80 (-1.52, -0.09)), memory (SMD = -0.63 (-1.12, -0.14)) and overall cognition (SMD = -0.77 (-1.33, -0.20)), and greater dementia risk (HR = 1.82 (1.79, 1.85)) than persons with diabetes only. No significant differences were observed for complex attention. No studies examined the role of timing and frequency of depressive episodes and antidepressant treatment. CONCLUSION In persons with diabetes, depression is associated with worse cognition and higher dementia risk. The potential mitigating effect of antidepressant treatment remains unclear.
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Affiliation(s)
- Yeng Yan Chow
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands.
| | - Milou Verdonschot
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands.
| | - Claire T McEvoy
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Llyod Building, Dublin 2, Ireland; Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6 BJ Northern Ireland, United Kingdom.
| | - Geeske Peeters
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands; Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Llyod Building, Dublin 2, Ireland.
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Ozen LJ, Dubois S, English MM, Gibbons C, Maxwell H, Lowey J, Sawula E, Bédard M. The efficacy of mindfulness-based cognitive therapy to improve depression symptoms and quality of life in individuals with memory difficulties and caregivers: A short report. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12252. [PMID: 35128035 PMCID: PMC8804601 DOI: 10.1002/trc2.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Depression symptoms are common for older adults with memory difficulties and their caregivers. Mindfulness-based cognitive therapy (MBCT) reduces the risk of relapse in recurrent depression and improves depression symptoms. We explored recruitment and retention success and preliminary effect sizes of MBCT on depression and anxiety symptoms, as well as mindfulness facets, in individuals with memory difficulties and their caregivers. METHODS A difficulty with memory group (DG) and caregiver group (CG) were randomized into either the MBCT intervention or waitlist control. After serving as controls, participants received the intervention. Mean pre-post changes by group were compared and effect sizes computed. Correlations between mindfulness facets and depression symptoms are also presented. RESULTS Only 47% of the initial participants completed the study. The intervention did not have an effect on the outcome variables examined. However, improvements in non-judgmental scores were associated with reductions in the number of depression symptoms reported by DG participants (r = -0.90, 95% confidence interval [CI]: -0.98, -0.52) and CG participants (r = -0.76, 95% CI: -0.95, -0.19). Furthermore, improvements in awareness scores (r = -0.69, 95% CI: -0.93, -0.05) and level of burden (r = 0.87, 95% CI: 0.49, 0.97) also significantly correlated with reduced depression symptoms in the CG group. CONCLUSIONS By determining preliminary MBCT effect sizes in individuals with memory difficulties and their caregivers, research with larger, controlled samples is now justified to determine the true effects of MBCT in these populations.
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Affiliation(s)
- Lana J. Ozen
- Centre for Applied Health ResearchSt. Joseph's Care GroupThunder BayOntarioCanada
| | - Sacha Dubois
- Centre for Applied Health ResearchSt. Joseph's Care GroupThunder BayOntarioCanada
- Northern Ontario School of MedicineLakehead UniversityThunder BayOntarioCanada
| | - Megan M. English
- Medicine Program‐NeurologyEastern Health, Health Sciences CentreThunder BayOntarioCanada
| | - Carrie Gibbons
- Centre for Applied Health ResearchSt. Joseph's Care GroupThunder BayOntarioCanada
| | - Hillary Maxwell
- Centre for Applied Health ResearchSt. Joseph's Care GroupThunder BayOntarioCanada
- Department of Health SciencesLakehead UniversityThunder BayOntarioCanada
| | - Jessica Lowey
- Centre for Applied Health ResearchSt. Joseph's Care GroupThunder BayOntarioCanada
| | - Erica Sawula
- Thunder Bay District Health UnitThunder BayOntarioCanada
| | - Michel Bédard
- Centre for Applied Health ResearchSt. Joseph's Care GroupThunder BayOntarioCanada
- Northern Ontario School of MedicineLakehead UniversityThunder BayOntarioCanada
- Department of Health SciencesLakehead UniversityThunder BayOntarioCanada
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Wang Q, Zhu H, Dai R, Zhang T. Associations Between Total Sleep Duration and Cognitive Function Among Middle-Aged and Older Chinese Adults: Does Midday Napping Have an Effect on It? Int J Gen Med 2022; 15:1381-1391. [PMID: 35173475 PMCID: PMC8843353 DOI: 10.2147/ijgm.s343286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Aim The effect of sleep duration on cognitive function has been reported. However, the studies about the combined effects of total sleep duration and midday napping on cognition in elders were limited and inconclusive. We aimed to investigate the associations between total sleep duration, midday napping and cognitive function among middle-aged and older Chinese adults. Methods Based on the 3rd wave of the China Health and Retirement Longitudinal Study (CHARLS) in 2015, a total of 9218 participants aged ≥45 years with completed cognition measurements were included. Cognitive functions were assessed by a combined global cognition score of episodic memory and mental status. Information about sleep-related variables, demographic characteristics, and health status were collected by validated questionnaires. Multivariate linear regression models were performed to evaluate the associations between total sleep duration, midday napping, and cognitive function. Stratified analyses were used to explore the potential effect modifier. Results Overall, the global cognition score was 10.38 ± 4.30 among the participants (mean age: 61.5 ± 8.7 years). For sleep duration, both short sleep and long sleep duration were significantly associated with the increased risk of cognitive impairment after controlling for demographics and other confounders. Compared with sleeping for 7h per day, the adjusted β-coefficient and 95% CI of the risk of cognitive impairment was −0.967 (95% CIs: −1.191, −0.742) for ≤5h, −0.257 (−0.498, −0.016) for 6h, −0.424 (−0.650, −0.198) for 8h and −0.664 (−0.876, −0.452) for ≥9h. The combined effect analysis indicated that subjects with extended or without naps had a significantly higher risk of cognitive impairment in the ≤5h sleep time group (ref: 7h) and in extended nappers or without naps group (ref: short nappers). Subjects with extended naps or without naps might increase the risk of cognitive impairment, especially those having ≤5h total sleep time. Stratified analysis showed that participants aged ≥60 years without social activity increased the risk of cognitive decline. Conclusion An inverted U-shaped association was observed between total sleep duration and cognitive function in Chinese elders, especially in those aged ≥60 years or without social activity. Short midday naps could mitigate the deleterious effects of poor sleep quality and shorter sleep duration on cognitive function. The findings could help us identify the vulnerable population and decrease the burden of cognitive impairment.
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Affiliation(s)
- Qian Wang
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Huanhuan Zhu
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Ruiming Dai
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Tiantian Zhang
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
- Correspondence: Tiantian Zhang, School of Public Health, Fudan University, 130 Dong’an Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Email
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Age-related hearing loss and mild cognitive impairment: a meta-analysis and systematic review of population-based studies. The Journal of Laryngology & Otology 2021; 136:103-118. [PMID: 34895373 DOI: 10.1017/s0022215121004114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Khajehpiri B, Moghaddam HA, Forouzanfar M, Lashgari R, Ramos-Cejudo J, Osorio RS, Ardekani BA. Survival Analysis in Cognitively Normal Subjects and in Patients with Mild Cognitive Impairment Using a Proportional Hazards Model with Extreme Gradient Boosting Regression. J Alzheimers Dis 2021; 85:837-850. [PMID: 34864679 DOI: 10.3233/jad-215266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evaluating the risk of Alzheimer's disease (AD) in cognitively normal (CN) and patients with mild cognitive impairment (MCI) is extremely important. While MCI-to-AD progression risk has been studied extensively, few studies estimate CN-to-MCI conversion risk. The Cox proportional hazards (PH), a widely used survival analysis model, assumes a linear predictor-risk relationship. Generalizing the PH model to more complex predictor-risk relationships may increase risk estimation accuracy. OBJECTIVE The aim of this study was to develop a PH model using an Xgboost regressor, based on demographic, genetic, neuropsychiatric, and neuroimaging predictors to estimate risk of AD in patients with MCI, and the risk of MCI in CN subjects. METHODS We replaced the Cox PH linear model with an Xgboost regressor to capture complex interactions between predictors, and non-linear predictor-risk associations. We endeavored to limit model inputs to noninvasive and more widely available predictors in order to facilitate future applicability in a wider setting. RESULTS In MCI-to-AD (n = 882), the Xgboost model achieved a concordance index (C-index) of 84.5%. When the model was used for MCI risk prediction in CN (n = 100) individuals, the C-index was 73.3%. In both applications, the C-index was statistically significantly higher in the Xgboost in comparison to the Cox PH model. CONCLUSION Using non-linear regressors such as Xgboost improves AD dementia risk assessment in CN and MCI. It is possible to achieve reasonable risk stratification using predictors that are relatively low-cost in terms of time, invasiveness, and availability. Future strategies for improving AD dementia risk estimation are discussed.
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Affiliation(s)
- Boshra Khajehpiri
- Machine Vision and Medical Image Processing(MVMIP) Laboratory, Faculty of Electrical and Computer Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Hamid Abrishami Moghaddam
- Machine Vision and Medical Image Processing(MVMIP) Laboratory, Faculty of Electrical and Computer Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Mohamad Forouzanfar
- Machine Vision and Medical Image Processing(MVMIP) Laboratory, Faculty of Electrical and Computer Engineering, K. N. Toosi University of Technology, Tehran, Iran.,Department of Systems Engineering, École deTechnologie Supérieure, Université duQuébec, Montreal, Quebec, Canada
| | - Reza Lashgari
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Jaime Ramos-Cejudo
- Department of Psychiatry, New York University(NYU) Grossman School of Medicine, New York, NY, USA
| | - Ricardo S Osorio
- TheNathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.,Department of Psychiatry, New York University(NYU) Grossman School of Medicine, New York, NY, USA
| | - Babak A Ardekani
- TheNathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Brewster KK, Hu MC, Zilcha-Mano S, Stein A, Brown PJ, Wall MM, Roose SP, Golub JS, Rutherford BR. Age-Related Hearing Loss, Late-Life Depression, and Risk for Incident Dementia in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:827-834. [PMID: 32959064 PMCID: PMC8427720 DOI: 10.1093/gerona/glaa242] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hearing loss (HL), late-life depression, and dementia are 3 prevalent and disabling conditions in older adults, but the interrelationships between these disorders remain poorly understood. METHODS N = 8529 participants ≥60 years who were free of cognitive impairment at baseline were analyzed from National Alzheimer's Coordinating Center Uniform Data Set. Participants had either No HL, Untreated HL, or Treated HL. Primary outcomes included depression (15-item Geriatric Depression Scale ≥5) and conversion to dementia. A longitudinal logistic model was fit to examine the association between HL and changes in depressive symptoms across time. Two Cox proportional hazards models were used to examine HL and the development of dementia: Model A included only baseline variables and Model B included time-varying depression to evaluate for the direct effect of changes in depression on dementia over time. RESULTS Treated HL (vs no HL) had increased risk for depression (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04-1.54, p = .02) and conversion to dementia (hazard ratio [HR] = 1.29, 95% CI = 1.03-1.62, p = .03). Baseline depression was a strong independent predictor of conversion to dementia (HR = 2.32, 95% CI = 1.77-3.05, p < .0001). Development/persistence of depression over time was also associated with dementia (HR = 1.89, 95% CI = 1.47-2.42, p < .0001), but only accounted for 6% of the direct hearing-dementia relationship (Model A logHR = 0.26 [SE = 0.12] to Model B logHR = 0.24 [SE = 0.12]) suggesting no significant mediation effect of depression. CONCLUSIONS Both HL and depression are independent risk factors for eventual conversion to dementia. Further understanding the mechanisms linking these later-life disorders may identify targets for early interventions to alter the clinical trajectories of at-risk individuals.
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Affiliation(s)
- Katharine K Brewster
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Mei-Chen Hu
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Sigal Zilcha-Mano
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York.,Department of Psychiatry, University of Haifa, Israel
| | - Alexandra Stein
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Patrick J Brown
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Melanie M Wall
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Steven P Roose
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
| | - Justin S Golub
- Columbia University Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York
| | - Bret R Rutherford
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
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13
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McClintock SM, Minto L, Denney DA, Bailey KC, Cullum CM, Dotson VM. Clinical Neuropsychological Evaluation in Older Adults With Major Depressive Disorder. Curr Psychiatry Rep 2021; 23:55. [PMID: 34255167 PMCID: PMC8764751 DOI: 10.1007/s11920-021-01267-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Older adults with major depressive disorder are particularly vulnerable to MDD-associated adverse cognitive effects including slowed processing speed, decreased attention, and executive dysfunction. The purpose of this review is to describe the approach to a clinical neuropsychological evaluation in older adults with MDD. Specifically, this review compares and contrasts neurocognitive screening and clinical neuropsychological evaluation procedures and details the multiple components of the clinical neuropsychological evaluation. RECENT FINDINGS Research has shown that neurocognitive screening serves a useful purpose to provide an acute and rapid assessment of global cognitive function; however, it has limited sensitivity and specificity. The clinical neuropsychological evaluation process is multifaceted and encompasses a review of available medical records, neurobehavioral status and diagnostic interview, comprehensive cognitive and clinical assessment, examination of inclusion and diversity factors as well as symptom and performance validity, and therapeutic feedback. As such, the evaluation provides invaluable information on multiple cognitive functions, establishes brain and behavior relationships, clarifies neuropsychiatric diagnoses, and can inform the etiology of cognitive impairment. Clinical neuropsychological evaluation plays a unique and critical role in integrated healthcare for older adults with MDD. Indeed, the evaluation can serve as a nexus to synthesize information across healthcare providers in order to maximize measurement-based care that can optimize personalized medicine and overall health outcomes.
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Affiliation(s)
- Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA.
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Lex Minto
- Georgia State University, Atlanta, GA, USA
| | - David A Denney
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA
| | - K Chase Bailey
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA
| | - C Munro Cullum
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
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14
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Brender R, Mulsant BH, Blumberger DM. An update on antidepressant pharmacotherapy in late-life depression. Expert Opin Pharmacother 2021; 22:1909-1917. [PMID: 33910422 DOI: 10.1080/14656566.2021.1921736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Clinically important depressive symptoms that occur in adults over age 60 are often termed late-life depression (LLD). LLD poses challenges for treating clinicians in both detection and treatment. Antidepressants are the most common first-line treatment approach. Older adults are at an increased risk of adverse effects because of polypharmacy.Areas covered: This article summarizes the challenges and approaches when using pharmacotherapy in LLD with a focus on newer data that have become available during the last five years. While no new antidepressants have become available during this period, a review of the literature summarizes advances in the knowledge of the adverse effects associated with various antidepressants and on the potential contribution of pharmacogenetic tools when prescribing antidepressants to older patients.Expert opinion: During the past 5 years, most of the literature relevant to the pharmacotherapy of MDD in older patients has focused on adverse effects. In particular, the effects of antidepressants on cognition and bone are emerging as important areas for clinical attention and further investigation. There is also an emerging literature on the potential role of pharmacogenetic testing in patients with MDD, though recommendations for use in older adults await larger studies that demonstrate its efficacy and cost-effectiveness.
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Affiliation(s)
- Ram Brender
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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15
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Increase in Number of Depression Symptoms Over Time is Related to Worse Cognitive Outcomes in Older Adults With Type 2 Diabetes. Am J Geriatr Psychiatry 2021; 29:1-11. [PMID: 33127316 PMCID: PMC7771631 DOI: 10.1016/j.jagp.2020.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Older adults with type 2 diabetes (T2D) are at increased risk for depression, cognitive decline, and dementia compared to those without T2D. Little is known about the association of simultaneous changes in depression symptoms and cognitive decline over time. METHODS Subjects (n=1021; mean age 71.6 [SD=4.6]; 41.2% female) were initially cognitively normal participants of the Israel Diabetes and Cognitive Decline study who underwent evaluations of depression and cognition approximately every 18 months. Cognitive tests were summarized into four cognitive domains: episodic memory, attention/working memory, executive functions, and semantic categorization. The average of the z-scores of the four domains defined global cognition. Depression symptoms were assessed using the Geriatric Depression Scale, 15-item version. We fit a random coefficients model of changes in depression and in cognitive functions, adjusting for baseline sociodemographic and cardiovascular variables. RESULTS Higher number of depression symptoms at baseline was significantly associated with lower baseline cognitive scores in global cognition (estimate = -0.1175, SE = 0.021, DF = 1,014, t = -5.59; p < 0.001), executive functions (estimate = -0.186, SE = 0.036, DF = 1,013, t = -5.15; p = <0.001), semantic categorization (estimate = -0.155, SE = 0.029, DF = 1,008, t = -5.3; p < 0.001), and episodic memory (estimate = -0.08165, SE = 0.027, DF = 1,035, t = -2.92; p = 0.0036), but not with rate of decline in any cognitive domain. During follow-up, a larger increase in number of depression symptoms, was associated with worse cognitive outcomes in global cognition (estimate = -0.1053, SE = 0.027, DF = 1,612, t = -3.77; p = 0.0002), semantic categorization (estimate = -0.123, SE = 0.036, DF = 1,583, t = -3.36; p = 0.0008), and in episodic memory (estimate = -0.165, SE = 0.055, DF = 1,622, t = -3.02; p = 0.003), but the size of this effect was constant over time. CONCLUSION In elderly with T2D, increase in depression symptoms over time is associated with parallel cognitive decline, indicating that the natural course of the two conditions progresses concurrently and suggesting common underlying mechanisms".
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16
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Kamalabadi YM, Sedigh SS, Abbaslou M. The relationship between DMFT index and cognitive impairment: A descriptive cross-sectional study. J Family Med Prim Care 2020; 9:4317-4322. [PMID: 33110852 PMCID: PMC7586545 DOI: 10.4103/jfmpc.jfmpc_90_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/12/2020] [Accepted: 04/18/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Cognitive disorders are characterized by major impairments in functions such as memory, judgment, language and attention. One of the tests used to assess these disorders is called the Montreal Cognitive Assessment Test, which is one of the most recent tests known in this field. DMFT index is the most important dental index for evaluation of decayed, missing and filled teeth. Since alteration or damage to the sensory function of teeth can cause changes in chewing function and different levels of cognitive disorders. The objective of this study was to determine the relationship of DMFT index with cognitive disorders in people aged 25-55 in Rafsanjan in 2019. Materials and Methods This cross-sectional study was performed on 350 patients chosen by simple random sampling within age range of 25-55 years, referred to Rafsanjan Dental School in 2019. Patients' demographic information was recorded and each was given a consent form and also Montreal Cognitive Assessment Test. Dental examination regarding decayed, missing and filled teeth was then carried out by a dentist and The DMFT index was recorded. Data were then analyzed by SPSS version 21; P value less than 0.05 was considered as significant level. Results Data showed that the MOCA index had a negative significant relationship with DMFT (P = 0.001) and age (P = 0.001) and had a significant positive relationship with education (P = 0.001), but it had no significant relationship with gender (P = 0.853), time of last dental appointment (P = 0.231) and place of residence (P = 0.428). The effect of age (P = 0.67) and gender (P = 0.525) on the relationship of DMFT and MOCA was not significant. But the effect of education (P = 0.001), place of residence (P = 0.0003) and time of last dental appointment (P = 0.002) on it was significant. Conclusion The results of this study showed that the relationship between DMFT index and cognitive disorders was significant and the higher the score of this index, the more severe cognitive disorders.
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Affiliation(s)
| | - Somaye Salari Sedigh
- Department of Periodontology, School of Dentistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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17
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Lau H, Shahar S, Mohamad M, Rajab NF, Yahya HM, Din NC, Hamid HA. The effects of six months Persicaria minor extract supplement among older adults with mild cognitive impairment: a double-blinded, randomized, and placebo-controlled trial. BMC Complement Med Ther 2020; 20:315. [PMID: 33076878 PMCID: PMC7574246 DOI: 10.1186/s12906-020-03092-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/20/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Persicaria minor extract exhibits antioxidant and anti-inflammatory properties and has potential effects on cognitive function and mood. However, the effects of P.minor on brain activation and biomarkers have not been studied among older adults. This multicentre, randomized, double-blinded, placebo-controlled study aimed to investigate the effect of 6 months P.minor extract supplement (Biokesum®) on cognition, mood, biomarkers, and brain activation among older adults with Mild Cognitive Impairment (MCI). METHOD A total of 36 Malaysian community-dwelling older adults with MCI (60-75-year-old) were randomized into Biokesum® (n = 18) and placebo group (n = 18). Each subject consumed one capsule of Biokesum® (250 mg/capsule) or placebo (maltodextrin, 280 mg/capsule) twice daily for 6 months. Cognitive function and mood were assessed at baseline, 3rd, and 6th-month using neuropsychological tests (MMSE, Digit Span, RAVLT, Digit Symbol, and Visual Reproduction) and Profile of Mood State (POMS) questionnaire. Blood lipid profile, fasting blood glucose, and biomarkers (MDA, LPO, COX-2, iNOS, and BDNF) were measured at baseline and 6th month. By the end of the intervention, there were 30 compliers (Biokesum®: N = 15; Placebo: N = 15) and 6 dropouts. For brain activation assessment, 15 subsamples (Biokesum®: N = 8; Placebo: N = 7) completed N-back and Stroop tasks during fMRI scanning at baseline and 6th month. The dorsolateral prefrontal cortex (Brodmann's area 9 and 46) was identified as a region of interest (ROI) for brain activation analysis using SPM software. RESULTS Two-way mixed ANOVA analysis showed significant improvements in Visual Reproduction II (p = 0.012, partial η2 = 0.470), tension (p = 0.042, partial η2 = 0.147), anger (p = 0.010, partial η2 = 0.207), confusion (p = 0.041, partial η2 = 0.148), total negative subscales (p = 0.043, partial η2 = 0.145), BDNF (p = 0.020, partial η2 = 0.179) and triglyceride (p = 0.029, partial η2 = 0.237) following 6 months of Biokesum® supplementation. Preliminary finding also demonstrated significant improvement at 0-back task-induced right DLPFC activation (p = 0.028, partial η2 = 0.652) among subsamples in Biokesum® group. No adverse events were reported at the end of the study. CONCLUSION Six months Biokesum® supplementation potentially improved visual memory, negative mood, BDNF, and triglyceride levels among older adults with MCI. Significant findings on brain activation at the right DPLFC must be considered as preliminary. TRIAL REGISTRATION Retrospectively registered on 30th August 2019 [ ISRC TN12417552 ].
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Affiliation(s)
- Huijin Lau
- Center for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Center for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Mazlyfarina Mohamad
- Centre for Diagnostic and Applied Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Nor Fadilah Rajab
- Center for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Hanis Mastura Yahya
- Center for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Normah Che Din
- Center for Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Hamzaini Abdul Hamid
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Batu 9 Cheras, Kuala Lumpur, Malaysia
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18
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Yeung A, Kiss A, Gallagher D. Intensive control of hypertension and risk of Alzheimer's dementia in older adults with depression. Int J Geriatr Psychiatry 2020; 35:888-896. [PMID: 32281159 PMCID: PMC7375011 DOI: 10.1002/gps.5309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Intensive control of hypertension has been reported to decrease risk of cognitive decline. However, the effect of this in older adults with hypertension and comorbid depression is not well understood. We aim to identify whether intensive control of systolic blood pressure (BP) is associated with reduced risk of Alzheimer's dementia (AD) in a clinical population. METHODS Using data from the National Alzheimer's Coordinating Center, we conducted survival analyses in older adults with normal cognition at baseline and treated hypertension. We also examined those with comorbid depression, to determine if intensive control of systolic BP (≤120 mmHg) was associated with reduced risk of AD. RESULTS In all older adults with treated hypertension (n = 4505), 298 (6.6%) developed AD during a median follow-up duration of 4.2 years. In the comorbid depression subgroup (n = 1327), 152 (11.5%) developed AD. Intensive control of systolic BP was not significantly associated with reduced risk of AD in the overall sample (HR 1.13, 95%, 0.79-1.64). However, in the comorbid depression subgroup, intensive control of systolic BP (≤120 mmHg) was associated with increased risk of AD (HR 1.49, 95%, 1.03-2.15) compared to standard control (121-139 mmHg). CONCLUSIONS In a clinical population of older adults with hypertension and comorbid depression, we found that an intensive systolic BP target of ≤120 mmHg was associated with increased risk of AD. While these findings are preliminary, they suggest that a more cautious approach to hypertension treatment may be warranted in this vulnerable subgroup.
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Affiliation(s)
- Anthony Yeung
- Department of Psychiatry, University of Toronto, Ontario
| | - Alex Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute
| | - Damien Gallagher
- Department of Psychiatry, University of Toronto, Ontario
- Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
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19
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Li JM, Zhao Y, Sun Y, Kong LD. Potential effect of herbal antidepressants on cognitive deficit: Pharmacological activity and possible molecular mechanism. JOURNAL OF ETHNOPHARMACOLOGY 2020; 257:112830. [PMID: 32259666 DOI: 10.1016/j.jep.2020.112830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cognitive symptom is a "core" symptom of major depressive disorder (MDD) patients with clear deficit in memory, social and occupational function, and may persist during the remitting phase. Therefore, the remission of cognitive symptom has been considered as one of the main objectives in the treatment of MDD. Herbal antidepressants have been used to treat MDD, and there has been great advances in the understanding of the ability of these herbs to improve cognitive deficit linked to brain injury and various diseases including depression, Alzheimer disease, diabetes and age-related disorders. This systematic review summarizes the evidence from preclinical studies and clinical trials of herbal antidepressants with positive effects on cognitive deficit. The potential mechanisms by which herbal antidepressants prevent cognitive deficit are also reviewed. This review will facilitate further research and applications. MATERIALS AND METHODS We conducted an open-ended, English restricted search of MEDLINE (PubMed), Web of Science and Scopus for all available articles published or online before 31 December 2019, using terms pertaining to medical herb/phytomedicine/phytochemical/Chinese medicine and depression/major depressive disorder/antidepressant and/or cognitive impairment/cognitive deficit/cognitive dysfunction. RESULTS 7 prescriptions, more than 30 individual herbs and 50 phytochemicals from China, Japan, Korea and India with positive effects on the depressive state and cognitive deficit are reviewed herein. The evidence from preclinical studies and clinical trials proves that these herbal antidepressants exhibit positive effects on one or more aspects of cognitive defect including spatial, episodic, aversive, and short- and long-term memory. The action mode of the improvement of cognitive deficit by these herbal antidepressants is mediated mainly through two pathways. One pathway is to promote hippocampal neurogenesis through activating brain derived neurotrophic factor-tropomyosin-related kinase B signaling. The other pathway is to prevent neuronal apoptosis through the inhibition of neuro-inflammation and neuro-oxidation. CONCLUSION These herbal antidepressants, having potential therapy for cognitive deficit, may prevent pathological processes of neurodegenerative diseases. Furthermore, these herbal medicines should provide a treasure trove, which will accelerate the development of new antidepressants that can effectively improve cognitive symptom in MDD. Studies on their molecular mechanisms may provide more potential targets and therapeutic approaches for new drug discovery.
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Affiliation(s)
- Jian-Mei Li
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, PR China
| | - Yue Zhao
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, PR China
| | - Yang Sun
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, PR China
| | - Ling-Dong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210023, PR China.
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