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Eyre HA, Stirland LE, Jeste DV, Reynolds CF, Berk M, Ibanez A, Dawson WD, Lawlor B, Leroi I, Yaffe K, Gatchel JR, Karp JF, Newhouse P, Rosand J, Letourneau N, Bayen E, Farina F, Booi L, Devanand DP, Mintzer J, Madigan S, Jayapurwala I, Wong STC, Falcoa VP, Cummings JL, Reichman W, Lock SL, Bennett M, Ahuja R, Steffens DC, Elkind MSV, Lavretsky H. Life-Course Brain Health as a Determinant of Late-Life Mental Health: American Association for Geriatric Psychiatry Expert Panel Recommendations. Am J Geriatr Psychiatry 2023; 31:1017-1031. [PMID: 37798224 PMCID: PMC10655836 DOI: 10.1016/j.jagp.2023.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities. Furthermore, our statement underscores the significance of prevention, early detection, and intervention in identifying cognitive decline, mood changes, and related mental illness. Action should also be taken to understand and address the needs of communities that traditionally have unequal access to preventive health information and services. By implementing culturally relevant and tailored evidence-based practices and advancing research in geriatric psychiatry, behavioral neurology, and geroscience, we can enhance the quality of life for older adults facing the unique challenges of aging. This position statement emphasizes the intrinsic link between brain health and mental health in aging, urging healthcare professionals, policymakers, and a broader society to prioritize comprehensive strategies that safeguard and promote brain health from birth through later years across all communities. The AAGP Expert Panel has the goal of launching further activities in the coming months and years.
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Affiliation(s)
- Harris A Eyre
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University (HAE), Houston, TX; Meadows Mental Health Policy Institute (HAE), Dallas, TX; Euro-Mediterranean Economists Association (HAE), Barcelona, Spain; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine (HAE), Houston, TX; Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center (HAE), Houston, TX; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Trinity College Dublin (HAE), Dublin, Ireland; FondaMental Fondation (HAE), Paris, France; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez (HAE, AI), Santiago de Chile, Chile; Houston Methodist Behavioral Health, Houston Methodist Academic Institute (HAE), Houston, TX.
| | - Lucy E Stirland
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh (LES), Edinburgh, UK
| | - Dilip V Jeste
- Global Research Network on Social Determinants of Mental Health and Exposomics (DVJ), La Jolla, CA
| | - Charles F Reynolds
- Department of Psychiatry, The University of Pittsburgh (CFR), Pittsburgh, PA
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne (MB), Parkville, Victoria, Australia; The Florey Institute for Neuroscience and Mental Health, University of Melbourne (MB), Parkville, Victoria, Australia; ORYGEN Youth Health, University of Melbourne (MB), Parkville, Victoria, Australia
| | - Agustin Ibanez
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez (HAE, AI), Santiago de Chile, Chile; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET) (AI), Buenos Aires, Argentina
| | - Walter D Dawson
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Oregon Alzheimer's Disease Research Center, School of Medicine, Oregon Health & Science University (WDD), Portland, OR; Institute on Aging, College of Urban & Public Affairs, Portland State University (WDD), Portland, OR
| | - Brian Lawlor
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA
| | - Iracema Leroi
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco (KY), San Francisco, CA; Department of Psychiatry and Neurology, University of California, San Francisco (KY), San Francisco, CA
| | - Jennifer R Gatchel
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School (JRG), Belmont, MA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School (JRG), Boston, MA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona (JFK), Tucson, AZ
| | - Paul Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center (PN), Nashville, TN; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs-Tennessee Valley Health Care System (PN), Nashville, TN
| | - Jonathan Rosand
- McCance Center for Brain Health, Department of Neurology, Mass General Brigham (JR), Boston, MA; Broad Institute of MIT and Harvard (JR), Cambridge, MA
| | - Nicole Letourneau
- Alberta Children's Hospital Research Institute, University of Calgary (NL), Calgary, Alberta, Canada
| | - Eleonore Bayen
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Department of Physical and Rehabilitation Medicine, Sorbonne Université - Pitié-Salpêtrière Hospital (EB), Paris, France
| | - Francesca Farina
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University (FF), Chicago, IL
| | - Laura Booi
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Centre for Dementia Research, School of Health, Leeds Beckett University (LB), Leeds, UK
| | - Devangere P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University (DPD), New York, NY
| | - Jacobo Mintzer
- Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina (JM), Charleston, SC
| | - Sheri Madigan
- University of Calgary (SM), Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute (SM), Calgary, Alberta, Canada
| | | | - Stephen T C Wong
- T.T. and W.F. Chao Center for BRAIN Houston Methodist Hospital (STCW), Houston, TX; Houston Methodist Cancer Center, Houston Methodist Hospital (STCW), Houston, TX; Department of Radiology, Weill Cornell Medicine (STCW), New York, NY; Department of Neurosciences, Weill Cornell Medicine (STCW), New York, NY; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine (STCW), New York, NY
| | - Veronica Podence Falcoa
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Hospital Beatriz Angelo (VPF), Lisbon, Portugal
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, University of Nevada (JLC), Las Vegas, NV
| | - William Reichman
- Department of Psychiatry, Faculty of Medicine, University of Toronto (WR), Toronto, Ontario, Canada
| | - Sarah Lenz Lock
- Global Council on Brain Health, Policy and Brain Health, AARP (SLL), Washington, DC
| | - Marc Bennett
- School of Psychology, University College Dublin (MB), Belfield, Dublin, Ireland; MRC-Cognition and Brain Sciences Unit, University of Cambridge (MB), England, UK
| | - Rajiv Ahuja
- Center for the Future of Aging, The Milken Institute (RA), Washington, DC
| | - David C Steffens
- Department of Psychiatry, University of Connecticut School of Medicine (DCS), Farmington, CT
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University (MSVE), New York City, NY; American Heart Association/American Stroke Association (MSVE), Dallas, TX
| | - Helen Lavretsky
- David Geffen School of Medicine, University of California, Los Angeles (UCLA) (HL), Los Angeles, CA; Semel Institute for Neuroscience and Human Behavior, UCLA (HL), Los Angeles, CA
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Andreacchi AT, Brini A, Van den Heuvel E, Muniz-Terrera G, Mayhew A, St John P, Stirland LE, Griffith LE. An Exploration of Methods to Resolve Inconsistent Self-Reporting of Chronic Conditions and Impact on Multimorbidity in the Canadian Longitudinal Study on Aging. J Aging Health 2023:8982643231215476. [PMID: 38016065 DOI: 10.1177/08982643231215476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To quantify inconsistent self-reporting of chronic conditions between the baseline (2011-2015) and first follow-up surveys (2015-2018) in the Canadian Longitudinal Study on Aging (CLSA), and to explore methods to resolve inconsistent responses and impact on multimorbidity. METHODS Community-dwelling adults aged 45-85 years in the baseline and first follow-up surveys were included (n = 45,184). At each survey, participants self-reported whether they ever had a physician diagnosis of 35 chronic conditions. Identifiable inconsistent responses were enumerated. RESULTS 32-40% of participants had at least one inconsistent response across all conditions. Illness-related information (e.g., taking medication) resolved most inconsistent responses (>93%) while computer-assisted software asking participants to confirm their inconsistent disease status resolved ≤53%. Using these adjudication methods, multimorbidity prevalence at follow-up increased by ≤1.6% compared to the prevalence without resolving inconsistent responses. DISCUSSION Inconsistent self-reporting of chronic conditions is common but may not substantially affect multimorbidity prevalence. Future research should validate methods to resolve inconsistencies.
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Affiliation(s)
- Alessandra T Andreacchi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alberto Brini
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Edwin Van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Alexandra Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Philip St John
- Section of Geriatric Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lucy E Stirland
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
- Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
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Stirland LE, Ayele BA, Correa-Lopera C, Sturm VE. Authenticity and brain health: a values-based perspective and cultural education approach. Front Neurol 2023; 14:1206142. [PMID: 37592945 PMCID: PMC10432154 DOI: 10.3389/fneur.2023.1206142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023] Open
Abstract
This perspective paper discusses the concept of authenticity in relation to brain health and neurodegenerative diseases. We define authenticity as being true to oneself and consider it a social value of relevance to neuroscientists, clinicians, and caregivers. From a biological perspective, behaviors that can be interpreted as expressions of authenticity are produced by distributed brain networks. By understanding it as a dynamic process, we argue that harnessing authenticity across the lifespan can be protective by promoting resilience. We discuss the idea of authentic aging, which appreciates the complexity of human life within the world and can enhance positive views of later life. Authenticity is additionally applicable to caring for people with neurodegenerative diseases, both when understanding the behavior of people with dementia and the response of caregivers. Tailoring care to an individual's personality and strengths may improve their brain health. Finally, we describe an interdisciplinary learning event, themed around masks, designed to engage participants in identifying authenticity in their own work. For scientists, care professionals, and caregivers, reflecting upon authenticity can aid understanding of the person with dementia and therefore improve care.
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Affiliation(s)
- Lucy E. Stirland
- Global Brain Health Institute, University of California, San Francisco, CA, United States
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Biniyam A. Ayele
- Global Brain Health Institute, University of California, San Francisco, CA, United States
- Department of Neurology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Virginia E. Sturm
- Global Brain Health Institute, University of California, San Francisco, CA, United States
- Memory and Aging Center, University of California, San Francisco, CA, United States
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Mullin DS, Stirland LE, Buchanan E, Convery CA, Cox SR, Deary IJ, Giuntoli C, Greer H, Page D, Robertson E, Shenkin SD, Szalek A, Taylor A, Weatherdon G, Wilkinson T, Russ TC. Identifying dementia using medical data linkage in a longitudinal cohort study: Lothian Birth Cohort 1936. BMC Psychiatry 2023; 23:303. [PMID: 37127606 PMCID: PMC10152609 DOI: 10.1186/s12888-023-04797-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The Lothian Birth Cohort 1936 (LBC1936) is a longitudinal study of ageing with well-characterised assessments, but until now, it has relied on self-report or proxies for dementia such as cognitive tests. Our aims were twofold: a) to describe a framework for identifying dementia in a cohort study. b) to report the age-specific incidence and prevalence of all-cause dementia and dementia subtypes in 865 individuals in the LBC1936. METHODS Electronic Health Records (EHR) of all participants were reviewed, and relevant information was extracted to form case vignettes for everyone with any record of cognitive dysfunction. The EHR data sources include hospital and clinic letters, general practitioner and hospital referrals, prescribed medications, imaging and laboratory results. Death certificate data were obtained separately. Clinician assessments were performed when there was concern about a participant's cognition. A diagnosis of probable dementia, possible dementia, or no dementia was agreed upon by a consensus diagnostic review board, comprised of a multidisciplinary team of clinical dementia experts who reviewed case vignettes and clinician assessment letters. For those with probable dementia, a subtype was also determined, where possible. We compared the agreement between our newly ascertained dementia diagnoses with the existing self-reported dementia diagnoses. RESULTS Self-reported dementia diagnoses were positive in only 17.8% of ascertained dementia diagnoses. The EHR review identified 163/865 (18.8%) individuals as having cognitive dysfunction. At the consensus diagnostic review board, 118/163 were diagnosed with probable all-cause dementia, a prevalence of 13.6%. Age-specific dementia prevalence increased with age from 0.8% (65-74.9 years) to 9.93% (85-89.9 years). Prevalence rates for women were higher in nearly all age groups. The most common subtype was dementia due to Alzheimer disease (49.2%), followed by mixed Alzheimer and cerebrovascular disease (17.0%), dementia of unknown or unspecified cause (16.1%), and dementia due to vascular disease (8.5%). CONCLUSIONS We present a robust systematic framework and guide for other cohort teams wanting to ascertain dementia diagnoses. The newly ascertained dementia diagnosis provides vital data for further analyses of LBC1936 to allow exploration of lifecourse predictors of dementia.
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Affiliation(s)
- Donncha S Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK.
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, EH10 5HF, UK.
| | - Lucy E Stirland
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Global Brain Health Institute, University of California San Francisco, San Francisco, UK
| | - Emily Buchanan
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Catherine-Anne Convery
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Simon R Cox
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Cinzia Giuntoli
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Holly Greer
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Danielle Page
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Robertson
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | | | - Anna Szalek
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Adele Taylor
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Georgina Weatherdon
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
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Mullin DS, Stirland LE, Russ TC, Luciano M, Muniz-Terrera G. Socioeconomic status as a risk factor for motoric cognitive risk syndrome in a community-dwelling population: A longitudinal observational study. Eur J Neurol 2023; 30:1191-1199. [PMID: 36755198 DOI: 10.1111/ene.15731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Motoric cognitive risk (MCR) is a syndrome characterised by measured slow gait speed and self-reported cognitive complaints. MCR is a high-risk state for adverse health outcomes in older adults, particularly cognitive impairment and dementia. Previous studies have identified risk factors for MCR, but the effect of socioeconomic status has, to date, been insufficiently examined. This study explored the association between MCR and socioeconomic status, as determined by occupational social class and years of education. METHODS Some 692 community-based adults of the Lothian Birth Cohort 1936 (LBC1936), aged 70 years at baseline, were followed up after 6 years and classified into non-MCR and MCR groups. We applied logistic regression analyses adjusting for demographic, lifestyle, and health covariates to investigate the association between MCR and years of education and occupational social class, categorised into manual versus non-manual occupations. RESULTS MCR prevalence at age 76 years was 5.6% (95% CI 4.0-7.6). After multivariate adjustment, participants of lower socioeconomic status (manual occupation) had a greater than three-fold increased likelihood of MCR (adjusted odds ratio 3.55, 95% CI 1.46-8.74; p = 0.005) compared with those of higher socioeconomic status (non-manual occupation). CONCLUSIONS Working in a manual job earlier in life triples the risk of MCR later in life, regardless of education. Unravelling this association will likely reveal important pathophysiological mechanisms underlying MCR and may unearth modifiable risk factors which could be targeted to reduce the incidence of MCR and, ultimately, dementia. Policy and healthcare practice addressing dementia risks such as MCR in their social context and early in the lifecourse could be effective strategies for reducing health inequalities in older age.
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Affiliation(s)
- Donncha S Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Lucy E Stirland
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Michelle Luciano
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Department of Social Medicine, Ohio University, Athens, Ohio, USA
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Mullin DS, Stirland LE, Welstead M, Russ TC, Luciano M, Muniz‐Terrera G. Prevalence and predictors of Motoric Cognitive Risk syndrome in a community-dwelling older Scottish population: A longitudinal observational study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5824. [PMID: 36200618 PMCID: PMC9828770 DOI: 10.1002/gps.5824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Motoric Cognitive Risk (MCR) is a gait-based predementia syndrome that is easy to measure and prognostic of dementia and falls. We aimed to examine the prevalence and risk factors for MCR, and assess its overlap with Mild Cognitive Impairment, Prefrailty, and Frailty, in a cohort of older Scottish adults without dementia. METHODS In this longitudinal prospective study, we classified 690 participants (mean [SD] age 76.3 [0.8] years; wave 3) of the Lothian Birth Cohort 1936 (LBC1936) into non-MCR or MCR groups. We examined their baseline (age 69.5 [0.8] years; wave 1) risk factors for MCR at waves 3, 4, and 5 (6, 9, and 12 years later respectively). RESULTS MCR prevalence rate ranged from 5.3% to 5.7% across the three waves. The presence of MCR was associated with older baseline age (6 and 9 years later), lower occupational socioeconomic status (6 years later), and worse scores in a range of tests of executive function (6, 9 and 12 years later). Approximately 46% of the MCR group also had Mild Cognitive Impairment, and almost everyone in the MCR group had either Prefrailty or Frailty. CONCLUSIONS The prevalence of MCR in this Scottish cohort is lower than the pooled global average, possibly reflecting the general good health of the LBC cohort. However, it is higher than the prevalence in two neighbouring countries' cohorts, which may reflect the younger average ages of those cohorts. Future LBC1936 research should assess the risk factors associated with MCR to validate previous findings and analyse novel predictive factors, particularly socioeconomic status.
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Affiliation(s)
- Donncha S. Mullin
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
| | - Lucy E. Stirland
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
| | - Miles Welstead
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Michelle Luciano
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Department of Social MedicineOhio UniversityAthensOhioUSA
- BrainLatUniversidad Adolfo IbanezPenalolenChile
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Stirland LE, Gregory S, Russ TC, Ritchie CW, Muniz-Terrera G. Associations between midlife chronic conditions and medication use with anxiety and depression: A cross-sectional analysis of the PREVENT Dementia study. J Comorb 2020; 10:2235042X20920443. [PMID: 32426293 PMCID: PMC7218309 DOI: 10.1177/2235042x20920443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/24/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
Background Multimorbidity including physical and mental illness is increasing in prevalence. We aimed to investigate the associations between physical conditions and medication use with anxiety and depression in midlife. Methods We conducted an observational cross-sectional study of volunteers in the PREVENT Dementia study. Using logistic and linear regression, we investigated the association between increasing numbers of self-reported chronic physical conditions and medications with self-reported depression and anxiety disorder, and scores on the Center for Epidemiologic Studies Depression (CES-D) scale and Spielberger State-Trait Anxiety Inventory (STAI) state subtest. Results Of the 210 participants, 148 (71%) were women and 188 (90%) Caucasian. The mean age was 52 (standard deviation (SD) = 5.5) years. The mean number of physical conditions was 2.2 (SD = 1.9) and medications 1.7 (SD = 2.2). Each additional physical condition was associated with increased odds of self-reported depression (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.11-1.80; p = 0.004, adjusted for age and gender) and anxiety disorder (OR 1.70, 95% CI 1.30-2.37; p < 0.001). Increasing medication use was associated with self-reported depression (adjusted OR per additional medication 1.35, 95% CI 1.08-1.71; p = 0.008) but not anxiety disorder. For each additional condition, CES-D scores increased by 0.72 (95% CI 0.11-1.33; p = 0.020) and for each extra medication, by 0.88 (95% CI 0.32-1.44; p = 0.002). There was no significant association between increasing conditions and medications with STAI scores. In models accounting for antidepressant use, all associations were attenuated. Conclusions Having more physical conditions is associated with anxiety and depression in midlife, and taking more medications is associated with depression but not anxiety.
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Affiliation(s)
- Lucy E Stirland
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Psychiatry of Old Age, NHS Lothian, Edinburgh, UK
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Stirland LE, González-Saavedra L, Mullin DS, Ritchie CW, Muniz-Terrera G, Russ TC. Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice. BMJ 2020; 368:m160. [PMID: 32071114 PMCID: PMC7190061 DOI: 10.1136/bmj.m160] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify and summarise existing indices for measuring multimorbidity beyond disease counts, to establish which indices include mental health comorbidities or outcomes, and to develop recommendations based on applicability, performance, and usage. DESIGN Systematic review. DATA SOURCES Seven medical research databases (Medline, Web of Science Core Collection, Cochrane Library, Embase, PsycINFO, Scopus, and CINAHL Plus) from inception to October 2018 and bibliographies and citations of relevant papers. Searches were limited to English language publications. ELIGIBILITY CRITERIA FOR STUDY SELECTION Original articles describing a new multimorbidity index including more information than disease counts and not focusing on comorbidity associated with one specific disease. Studies were of adults based in the community or at population level. RESULTS Among 7128 search results, 5560 unique titles were identified. After screening against eligibility criteria the review finally included 35 papers. As index components, 25 indices used conditions (weighted or in combination with other parameters), five used diagnostic categories, four used drug use, and one used physiological measures. Predicted outcomes included mortality (18 indices), healthcare use or costs (13), hospital admission (13), and health related quality of life (7). 29 indices considered some aspect of mental health, with most including it as a comorbidity. 12 indices are recommended for use. CONCLUSIONS 35 multimorbidity indices are available, with differing components and outcomes. Researchers and clinicians should examine existing indices for suitability before creating new ones. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017074211.
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Affiliation(s)
- Lucy E Stirland
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Donncha S Mullin
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
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Stirland L, Stirland LE, Russ TC, Ritchie CW, Terrera GM. ASSOCIATIONS BETWEEN CHRONIC PHYSICAL CONDITIONS, MEDICATIONS AND MENTAL HEALTH IN AN AGING COHORT. Innov Aging 2019. [PMCID: PMC6841148 DOI: 10.1093/geroni/igz038.2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Older people increasingly live with multiple chronic conditions and medications. We explored their interactions with mental health in the PREVENT Dementia study participants. Using logistic and linear regression, we investigated the association between increasing self-reported chronic physical conditions and current medications with self-reported depression and anxiety disorder, and scores on the Center for Epidemiologic Studies Depression (CES-D) scale and Spielberger State-Trait Anxiety Inventory (STAI) state subtest. Among 210 participants, each additional condition was associated with increased odds of depression (adjusted OR, 95% CI: 1.41, 1.11-1.80; P=0.005) and anxiety (1.71, 1.35-2.21; P<0.001). Each additional medication was associated with depression (1.36, 1.07-1.73; P=0.010) but not anxiety. For each additional condition, CES-D scores increased by 0.62 (0.04-1.20, P=0.035) and for each medication, by 0.66 (0.12-1.21, P=0.017). There was no significant association between conditions or medications and STAI scores. These findings provide crucial information on the future brain health of these individuals.
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Affiliation(s)
- Lucy Stirland
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom
| | - Lucy E Stirland
- Centre forClinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, Edinburgh, Scotland, United Kingdom
| | - Craig W Ritchie
- Centre for Dementia Prevention, Edinburgh, Scotland, United Kingdom
| | - Graciela Muniz Terrera
- Centre for Clinical Brain Sciences ,University of Edinburgh, Edinburgh, Scotland, United Kingdom
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Stirland LE, Russ TC, Ritchie CW, Muniz-Terrera G. Associations Between Multimorbidity and Cerebrospinal Fluid Amyloid: A Cross-Sectional Analysis of the European Prevention of Alzheimer's Dementia (EPAD) V500.0 Cohort. J Alzheimers Dis 2019; 71:703-711. [PMID: 31424394 DOI: 10.3233/jad-190222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multimorbidity (the co-occurrence of multiple chronic conditions) is increasingly common, especially among people with dementia. Few neuroimaging studies have explored amyloid biomarkers in people with multimorbidity. OBJECTIVE We aimed to conduct the first study of the association between multimorbidity and cerebrospinal fluid amyloid-β42 (CSF Aβ). METHOD The European Prevention of Alzheimer's Dementia (EPAD) Longitudinal Cohort Study V500.0 dataset includes volunteers aged ≥50 years from 12 sites. Participants undergo detailed phenotyping, including CSF measures and a self-reported medical history. Using logistic and linear regression analyses, we explored the association between multimorbidity and continuous chronic condition count with CSF Aβ positivity (Aβ42 <1000pg/ml) and continuous CSF Aβ concentration. All models were adjusted for age, sex, APOE status, education, and family history of dementia. RESULTS Among 447 eligible participants without dementia, the mean (SD) age was 66.6 (6.6) years, 234 (52.3%) were women, and 157 (35.1%) were amyloid positive. With chronic conditions regarded as pseudo-continuous, each additional condition carried a decreased likelihood of amyloid positivity (OR = 0.82, 95% CI: 0.68-0.97; p = 0.026). With CSF Aβ as a continuous variable, each additional condition was associated with an increase of 54.2 pg/ml (95% CI: 9.9-98.5, p = 0.017). Having ≥2 conditions was inversely associated with amyloid positivity (OR 0.59, 95% CI: 0.37-0.95, p = 0.030) compared to one or none. CONCLUSION Our findings suggest that the established association between multimorbidity and dementia may be due to a pathway other than amyloid. However, this cross-sectional study does not allow us to make causal inferences. Longitudinal work is required to confirm the inverse association found.
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Affiliation(s)
- Lucy E Stirland
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK
| | - Tom C Russ
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,NHS Lothian, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK
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Stirland LE, Russ TC, Ritchie CW, Terrera GM. O4-13-06: ASSOCIATIONS BETWEEN MULTIMORBIDITY AND CSF AMYLOID: CROSS-SECTIONAL ANALYSIS OF THE EUROPEAN PREVENTION OF ALZHEIMER'S DEMENTIA (EPAD) COHORT. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research Centre; University of Edinburgh; Edinburgh United Kingdom
- Centre for Dementia Prevention; University of Edinburgh; Edinburgh United Kingdom
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Stirland LE, O'Shea CI, Russ TC. [P3–546]: PASSIVE SMOKING AS A RISK FACTOR FOR DEMENTIA AND COGNITIVE IMPAIRMENT: SYSTEMATIC REVIEW OF LONGITUDINAL AND CROSS‐SECTIONAL STUDIES. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Tom C. Russ
- University of EdinburghEdinburghUnited Kingdom
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