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Zhao X, Xu X, Yan Y, Lipnicki DM, Pang T, Crawford JD, Chen C, Cheng CY, Venketasubramanian N, Chong E, Blay SL, Lima-Costa MF, Castro-Costa E, Lipton RB, Katz MJ, Ritchie K, Scarmeas N, Yannakoulia M, Kosmidis MH, Gureje O, Ojagbemi A, Bello T, Hendrie HC, Gao S, Guerra RO, Auais M, Gomez JF, Rolandi E, Davin A, Rossi M, Riedel-Heller SG, Löbner M, Roehr S, Ganguli M, Jacobsen EP, Chang CCH, Aiello AE, Ho R, Sanchez-Juan P, Valentí-Soler M, Ser TD, Lobo A, De-la-Cámara C, Lobo E, Sachdev PS, Xu X. Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 51:101198. [PMID: 39308753 PMCID: PMC11416683 DOI: 10.1016/j.lanwpc.2024.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/09/2024] [Accepted: 08/25/2024] [Indexed: 09/25/2024]
Abstract
Background Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical. Methods Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies. Findings Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = -0.207, 95% CI = (-0.255, -0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = -0.040, 95% CI = (-0.047, -0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies. Interpretation Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness. Funding Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.
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Lo JW, Crawford JD, Lipnicki DM, Lipton RB, Katz MJ, Preux PM, Guerchet M, d’Orsi E, Quialheiro A, Rech CR, Ritchie K, Skoog I, Najar J, Sterner TR, Rolandi E, Davin A, Rossi M, Riedel-Heller SG, Pabst A, Röhr S, Ganguli M, Jacobsen E, Snitz BE, Anstey KJ, Aiello AE, Brodaty H, Kochan NA, Chen YC, Chen JH, Sanchez-Juan P, del Ser T, Valentí M, Lobo A, De-la-Cámara C, Lobo E, Sachdev PS. Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts. JAMA Netw Open 2024; 7:e2437133. [PMID: 39356504 PMCID: PMC11447567 DOI: 10.1001/jamanetworkopen.2024.37133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/25/2024] [Indexed: 10/03/2024] Open
Abstract
Importance Poststroke cognitive impairment is common, but the cognitive trajectory following a first stroke, relative to prestroke cognitive function, remains unclear. Objective To map the trajectory of cognitive function before any stroke and after stroke in global cognition and in 4 cognitive domains, as well as to compare the cognitive trajectory prestroke in stroke survivors with the trajectory of individuals without incident stroke over follow-up. Design, Setting, and Participants The study used harmonized and pooled data from 14 population-based cohort studies included in the Cohort Studies of Memory in an International Consortium collaboration. These studies were conducted from 1993 to 2019 across 11 countries among community-dwelling older adults without a history of stroke or dementia. For this study, linear mixed-effects models were used to estimate trajectories of cognitive function poststroke relative to a stroke-free cognitive trajectory. The full model adjusted for demographic and vascular risk factors. Data were analyzed from July 2022 to March 2024. Exposure Incident stroke. Main outcomes and measures The primary outcome was global cognition, defined as the standardized average of 4 cognitive domains (language, memory, processing speed, and executive function). Cognitive domain scores were formed by selecting the most commonly administered test within each domain and standardizing the scores. Results The study included 20 860 participants (12 261 [58.8%] female) with a mean (SD) age of 72.9 (8.0) years and follow-up of 7.51 (4.2) years. Incident stroke was associated with a substantial acute decline in global cognition (-0.25 SD; 95% CI, -0.33 to -0.17 SD), the Mini-Mental State Examination, and all cognitive domains (ranging from -0.17 SD to -0.22 SD), as well as accelerated decline in global cognition (-0.038 SD per year; 95% CI, -0.057 to -0.019 SD per year) and all domains except memory (ranging from -0.020 to -0.055 SD per year), relative to a stroke-free cognitive trajectory. There was no significant difference in prestroke slope in stroke survivors compared with the rate of decline in individuals without stroke in all cognitive measures. The mean rate of decline without a previous stroke was -0.049 SD per year (95% CI, -0.051 to -0.047 SD) in global cognition. Conclusions and relevance In this cohort study using pooled data from 14 cohorts, incident stroke was associated with acute and accelerated long-term cognitive decline in older stroke survivors.
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Lennon MJ, Lipnicki DM, Lam BCP, Crawford JD, Schutte AE, Peters R, Rydberg-Sterner T, Najar J, Skoog I, Riedel-Heller SG, Röhr S, Pabst A, Lobo A, De-la-Cámara C, Lobo E, Lipton RB, Katz MJ, Derby CA, Kim KW, Han JW, Oh DJ, Rolandi E, Davin A, Rossi M, Scarmeas N, Yannakoulia M, Dardiotis T, Hendrie HC, Gao S, Carriere I, Ritchie K, Anstey KJ, Cherbuin N, Xiao S, Yue L, Li W, Guerchet M, Preux PM, Aboyans V, Haan MN, Aiello A, Scazufca M, Sachdev PS. Blood Pressure, Antihypertensive Use, and Late-Life Alzheimer and Non-Alzheimer Dementia Risk: An Individual Participant Data Meta-Analysis. Neurology 2024; 103:e209715. [PMID: 39141884 PMCID: PMC11329294 DOI: 10.1212/wnl.0000000000209715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Previous randomized controlled trials and longitudinal studies have indicated that ongoing antihypertensive use in late life reduces all-cause dementia risk, but the specific impact on Alzheimer dementia (AD) and non-AD risk remains unclear. This study investigates whether previous hypertension or antihypertensive use modifies AD or non-AD risk in late life and the ideal blood pressure (BP) for risk reduction in a diverse consortium of cohort studies. METHODS This individual participant data meta-analysis included community-based longitudinal studies of aging from a preexisting consortium. The main outcomes were risk of developing AD and non-AD. The main exposures were hypertension history/antihypertensive use and baseline systolic BP/diastolic BP. Mixed-effects Cox proportional hazards models were used to assess risk and natural splines were applied to model the relationship between BP and the dementia outcomes. The main model controlled for age, age2, sex, education, ethnoracial group, and study cohort. Supplementary analyses included a fully adjusted model, an analysis restricting to those with >5 years of follow-up and models that examined the moderating effect of age, sex, and ethnoracial group. RESULTS There were 31,250 participants from 14 nations in the analysis (41% male) with a mean baseline age of 72 (SD 7.5, range 60-110) years. Participants with untreated hypertension had a 36% (hazard ratio [HR] 1.36, 95% CI 1.01-1.83, p = 0.0406) and 42% (HR 1.42, 95% CI 1.08-1.87, p = 0.0135) increased risk of AD compared with "healthy controls" and those with treated hypertension, respectively. Compared with "healthy controls" both those with treated (HR 1.29, 95% CI 1.03-1.60, p = 0.0267) and untreated hypertension (HR 1.69, 95% CI 1.19-2.40, p = 0.0032) had greater non-AD risk, but there was no difference between the treated and untreated groups. Baseline diastolic BP had a significant U-shaped relationship (p = 0.0227) with non-AD risk in an analysis restricted to those with 5-year follow-up, but otherwise there was no significant relationship between baseline BP and either AD or non-AD risk. DISCUSSION Antihypertensive use was associated with decreased AD but not non-AD risk throughout late life. This suggests that treating hypertension throughout late life continues to be crucial in AD risk mitigation. A single measure of BP was not associated with AD risk, but DBP may have a U-shaped relationship with non-AD risk over longer periods in late life.
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Matison AP, Flood VM, Lam BCP, Lipnicki DM, Tucker KL, Preux PM, Guerchet M, d'Orsi E, Quialheiro A, Rech CR, Skoog I, Najar J, Rydberg Sterner T, Scarmeas N, Kosmidis MH, Yannakoulia M, Gureje O, Ojagbemi A, Bello T, Shahar S, Fakhruddin NNINM, Rivan NFM, Anstey KJ, Cherbuin N, Mortby ME, Ho R, Brodaty H, Sachdev PS, Reppermund S, Mather KA. Associations between fruit and vegetable intakes and incident depression in middle-aged and older adults from 10 diverse international longitudinal cohorts. J Affect Disord 2024; 359:373-381. [PMID: 38788860 DOI: 10.1016/j.jad.2024.05.096] [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: 02/04/2024] [Revised: 04/26/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Emerging observational evidence supports a role for higher fruit and vegetable intake in protecting against the development of depression. However, there is a scarcity of research in older adults or in low- to middle-income countries (LMICs). METHODS Participants were 7801 community-based adults (mean age 68.6 ± 8.0 years, 55.8 % female) without depression, from 10 diverse cohorts, including four cohorts from LMICs. Fruit and vegetable intake was self-reported via comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated measures, and depression defined applying validated cut-offs. The associations between baseline fruit and vegetable intakes and incident depression over a follow-up period of three to nine years were examined using Cox regression. Analyses were performed by cohort with results meta-analysed. RESULTS There were 1630 cases of incident depression (21 % of participants) over 40,258 person-years of follow-up. Higher intake of fruit was associated with a lower risk of incident depression (HR 0.87, 95%CI [0.77, 0.99], I2 = 4 %). No association was found between vegetable intake and incident depression (HR 0.93, 95%CI [0.84, 1.04], I2 = 0 %). LIMITATIONS Diverse measures used across the different cohorts and the modest sample size of our study compared with prior studies may have prevented an association being detected for vegetable intake. CONCLUSIONS Our study supports a role for fruit, but not vegetable intake in protecting against depression. Research investigating different types of fruits and vegetables using standardised measures in larger cohorts of older adults from low- and middle-income countries is warranted.
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Van Asbroeck S, Köhler S, van Boxtel MPJ, Lipnicki DM, Crawford JD, Castro‐Costa E, Lima‐Costa MF, Blay SL, Shifu X, Wang T, Yue L, Lipton RB, Katz MJ, Derby CA, Guerchet M, Preux P, Mbelesso P, Norton J, Ritchie K, Skoog I, Najar J, Sterner TR, Scarmeas N, Yannakoulia M, Dardiotis T, Rolandi E, Davin A, Rossi M, Gureje O, Ojagbemi A, Bello T, Kim KW, Han JW, Oh DJ, Trompet S, Gussekloo J, Riedel‐Heller SG, Röhr S, Pabst A, Shahar S, Rivan NFM, Singh DKA, Jacobsen E, Ganguli M, Hughes T, Haan M, Aiello AE, Ding D, Zhao Q, Xiao Z, Narazaki K, Chen T, Chen S, Ng TP, Gwee X, Gao Q, Brodaty H, Trollor J, Kochan N, Lobo A, Santabárbara J, Gracia‐Garcia P, Sachdev PS, Deckers K. Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis. Alzheimers Dement 2024; 20:3972-3986. [PMID: 38676366 PMCID: PMC11180928 DOI: 10.1002/alz.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. RESULTS A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. HIGHLIGHTS A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.
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Grants
- AG03949 NIH HHS
- Netherlands Programme for Research on Aging (NESTOR)
- The Alzheimer's Association Zenith Award
- 2009BAI77B03 China Ministry of Science and Technology
- CRC2017ZD02 Clinical Research Center, Shanghai Mental Health Center
- 03/0815 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- R01 AG057531 NIA NIH HHS
- Greek National Resources
- DCP-2017-002/1 Universiti Kebangsaan Malaysia Grand Challenge
- 20H04030 JSPS KAKENHI
- Stiftelsen Professor Bror Gadelius' Minnesfond
- 01/0255 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- The Alzheimer's Association Stephanie B Overstreet Scholars
- AgeCap-Center for Aging and Health
- The Bank of Sweden Tercentenary Foundation
- European Social Fund
- HJSV2023023 Stiftelsens Hjalmar Svenssons forskningsfond
- 06/0617 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- Fondo de Investigación Sanitaria
- R37AG02365 NIH/NIA
- Instituto de Salud Carlos III
- Epilife
- 16/00896 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- B15_23R Gobierno de Aragón
- B15_17R Gobierno de Aragón
- G03/128 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- AG03949 NIH/NIA
- LRGS/BU/2012/UKM-UKM/K/01 Long-term Research Grant Scheme (LGRS) Ministry of Higher Education, Malaysia
- Limoges University Hospital Appel à Projet des Equipes Émergentes et Labellisées scheme (APREL)
- 189 10276/8/9/2011 Alzheimer's Association
- NMRC/1108/2007 National Medical Research Council
- 97/1321E Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- AG03949 NIA NIH HHS
- Swedish Brain Power
- FORTE
- 2012-Project Public Health Institute [Inserm]-PREUXPierre-Marie AXA Research Fund
- National Strategic Reference Framework (NSFR) - EU Program Excellence Grant (ARISTEIA)
- PI16/00896 Fondo Europeo de Desarrollo Regional (FEDER) of the European Union "Una manera de hacer Europa"
- Shanghai Brain Health Foundation
- JP17K09146 JSPS KAKENHI
- NMRC/CIRG/1409/2014 National Medical Research Council
- AF-967865 Alzheimersfonden
- R37AG02365 NIH HHS
- HJSV2022059 Stiftelsens Hjalmar Svenssons forskningsfond
- 98/0103 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- RF1AG057531 NIH HHS
- Riksbankens Jubileumsfond
- Handlanden Hjalmar Svenssons Forskningsfond
- Stiftelsen för Gamla Tjänarinnor
- P01 AG003949 NIA NIH HHS
- IIRG-09-133014 Alzheimer's Association
- LRGS/1/2019/UM-UKM/1/4 Long-term Research Grant Scheme (LGRS) Ministry of Higher Education, Malaysia
- Wellcome Trust
- Swedish Research Council
- Leonard and Sylvia Marx Foundation
- Maastricht University Medical Center
- 733050511 Netherlands Organisation for Health Research and Development (ZonMw)
- BMRC/08/1/21/19/567 Agency for Science Technology and Research (A*STAR) Biomedical Research Council
- Associazione Alzheimer Milano
- 2017-0557 Fondazione CARIPLO, FrailBioTrack Project
- DCP-2017-002/2 Universiti Kebangsaan Malaysia Grand Challenge
- PI/19/01874 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- 72660 ALF-agreement
- 12/02254 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- Ministry for Health and Social Solidarity (Greece)
- 94/1562 Spanish Ministry of Economy and Competitiveness, Madrid, Spain
- 01KS9504 Interdisciplinary Centre for Clinical Research University of Leipzig (Interdisziplinäres Zentrum für Klinische Forschung/IZKF)
- Czap Foundation
- ANR-09-MNPS-009-01 French National Research Agency
- Stiftelsen Söderström-Königska Sjukhemmet
- National Institute on Aging
- National Institutes of Health
- Wellcome Trust
- Gobierno de Aragón
- Alzheimer's Association
- National Medical Research Council
- French National Research Agency
- AXA Research Fund
- Riksbankens Jubileumsfond
- FORTE
- Swedish Brain Power
- Swedish Research Council
- Stiftelsen för Gamla Tjänarinnor
- Instituto de Salud Carlos III
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Lipnicki DM, Weinstein G. Editorial: Health conditions outside the brain and the risk of brain aging and dementia. FRONTIERS IN DEMENTIA 2024; 3:1372536. [PMID: 39081606 PMCID: PMC11285557 DOI: 10.3389/frdem.2024.1372536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 08/02/2024]
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Kalam S, Numbers K, Lipnicki DM, Lam BCP, Brodaty H, Reppermund S. The combination of olfactory dysfunction and depression increases the risk of incident dementia in older adults. Int Psychogeriatr 2024; 36:130-141. [PMID: 37264675 DOI: 10.1017/s1041610223000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Olfactory dysfunction and depression are common in later life, and both have been presented as risk factors for dementia. Our purpose was to investigate the associations between these two risk factors and determine if they had an additive effect on dementia risk. DESIGN Olfactory function was assessed using the Brief Smell Identification Test (BSIT), and depression was classified using a combination of the 15-item Geriatric Depression Scale (GDS) score and current antidepressant use. Cross-sectional associations between depression and olfactory function were examined using correlations. Cox regression analyses were conducted to examine the longitudinal relationship between olfaction and depression and incident dementia across 12-years of follow-up. PARTICIPANTS Participants were 780 older adults (aged 70-90 years; 56.5% female) from the Sydney Memory and Ageing Study (MAS) without a diagnosis of dementia at baseline. RESULTS Partial correlation revealed a nonsignificant association between baseline depression and olfactory function after accounting for covariates (r = -.051, p = .173). Cox regression showed that depression at baseline (hazard ratio = 1.706, 95% CI 1.185-2.456, p = .004) and lower BSIT scores (HR = .845, 95%CI .789-.905, p < .001) were independently associated with a higher risk of incident dementia across 12 years. Entering both predictors together improved the overall predictive power of the model. CONCLUSIONS Lower olfactory identification scores and depressive symptoms predict incident dementia over 12 years. The use of BSIT scores and depression in conjunction provides a greater ability to predict dementia than either used alone. Assessment of olfactory function and depression screening may provide clinical utility in the early detection of dementia.
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Lin K, Wen W, Lipnicki DM, Mewton L, Chen R, Du J, Wang D, Skoog I, Sterner TR, Najar J, Kim KW, Han JW, Kim JS, Ng TP, Ho R, Chua DQL, Anstey KJ, Cherbuin N, Mortby ME, Brodaty H, Kochan N, Sachdev PS, Jiang J. Risk factors and cognitive correlates of white matter hyperintensities in ethnically diverse populations without dementia: The COSMIC consortium. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12567. [PMID: 38487075 PMCID: PMC10937819 DOI: 10.1002/dad2.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION White matter hyperintensities (WMHs) are an important imaging marker for cerebral small vessel diseases, but their risk factors and cognitive associations have not been well documented in populations of different ethnicities and/or from different geographical regions. METHODS We investigated how WMHs were associated with vascular risk factors and cognition in both Whites and Asians, using data from five population-based cohorts of non-demented older individuals from Australia, Singapore, South Korea, and Sweden (N = 1946). WMH volumes (whole brain, periventricular, and deep) were quantified with UBO Detector and harmonized using the ComBat model. We also harmonized various vascular risk factors and scores for global cognition and individual cognitive domains. RESULTS Factors associated with larger whole brain WMH volumes included diabetes, hypertension, stroke, current smoking, body mass index, higher alcohol intake, and insufficient physical activity. Hypertension and stroke had stronger associations with WMH volumes in Whites than in Asians. No associations between WMH volumes and cognitive performance were found after correction for multiple testing. CONCLUSION The current study highlights ethnic differences in the contributions of vascular risk factors to WMHs.
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Mahalingam G, Samtani S, Lam BCP, Lipnicki DM, Lima-Costa MF, Blay SL, Castro-Costa E, Shifu X, Guerchet M, Preux PM, Gbessemehlan A, Skoog I, Najar J, Sterner TR, Scarmeas N, Yannakoulia M, Riedel-Heller S, Dardiotis T, Röhr S, Kim KW, Pabst A, Shahar S, Numbers K, Ganguli M, Hughes TF, Chang CCH, Crowe M, Ng TP, Gwee X, Chua DQL, Rymaszewska J, Wolf-Ostermann K, Welmer AK, Stafford J, Mélis R, Vernooij-Dassen M, Jeon YH, Sachdev PS, Brodaty H. Social connections and risk of incident mild cognitive impairment, dementia, and mortality in 13 longitudinal cohort studies of ageing. Alzheimers Dement 2023; 19:5114-5128. [PMID: 37102417 PMCID: PMC10603208 DOI: 10.1002/alz.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Previous meta-analyses have linked social connections and mild cognitive impairment, dementia, and mortality. However, these used aggregate data from North America and Europe and examined a limited number of social connection markers. METHODS We used individual participant data (N = 39271, Mage = 70.67 (40-102), 58.86% female, Meducation = 8.43 years, Mfollow-up = 3.22 years) from 13 longitudinal ageing studies. A two-stage meta-analysis of Cox regression models examined the association between social connection markers with our primary outcomes. RESULTS We found associations between good social connections structure and quality and lower risk of incident mild cognitive impairment (MCI); between social structure and function and lower risk of incident dementia and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality. DISCUSSION Different aspects of social connections - structure, function, and quality - are associated with benefits for healthy aging internationally. HIGHLIGHTS Social connection structure (being married/in a relationship, weekly community group engagement, weekly family/friend interactions) and quality (never lonely) were associated with lower risk of incident MCI. Social connection structure (monthly/weekly friend/family interactions) and function (having a confidante) were associated with lower risk of incident dementia. Social connection structure (living with others, yearly/monthly/weekly community group engagement) and function (having a confidante) were associated with lower risk of mortality. Evidence from 13 longitudinal cohort studies of ageing indicates that social connections are important targets for reducing risk of incident MCI, incident dementia, and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality.
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Lennon MJ, Lam BCP, Lipnicki DM, Crawford JD, Peters R, Schutte AE, Brodaty H, Thalamuthu A, Rydberg-Sterner T, Najar J, Skoog I, Riedel-Heller SG, Röhr S, Pabst A, Lobo A, De-la-Cámara C, Lobo E, Bello T, Gureje O, Ojagbemi A, Lipton RB, Katz MJ, Derby CA, Kim KW, Han JW, Oh DJ, Rolandi E, Davin A, Rossi M, Scarmeas N, Yannakoulia M, Dardiotis T, Hendrie HC, Gao S, Carrière I, Ritchie K, Anstey KJ, Cherbuin N, Xiao S, Yue L, Li W, Guerchet MM, Preux PM, Aboyans V, Haan MN, Aiello AE, Ng TP, Nyunt MSZ, Gao Q, Scazufca M, Sachdev PSS. Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis. JAMA Netw Open 2023; 6:e2333353. [PMID: 37698858 PMCID: PMC10498335 DOI: 10.1001/jamanetworkopen.2023.33353] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023] Open
Abstract
Importance The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. Objectives To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group. Data Source and Study Selection Longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece). Data Extraction and Synthesis Participants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines. Main Outcomes and Measures The key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group. Results The analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P = .001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P = .02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P = .07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses. Conclusions and Relevance This individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.
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Gracia‐García P, Bueno‐Notivol J, Lipnicki DM, de la Cámara C, Lobo A, Santabárbara J. Clinically significant anxiety as a risk factor for Alzheimer's disease: Results from a 10-year follow-up community study. Int J Methods Psychiatr Res 2023; 32:e1934. [PMID: 36597404 PMCID: PMC10485344 DOI: 10.1002/mpr.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE There is growing evidence for an association between anxiety and an increased risk of dementia, but it is not clear whether anxiety is a risk factor or a prodromic symptom. In this study, we investigated if clinically significant anxiety increases the risk of developing Alzheimer's disease (AD) up to 10 years later. METHODS We used data from the longitudinal Zaragoza Dementia and Depression (ZARADEMP) Project. Excluding subjects with dementia at baseline left us with 3044 individuals aged >65 years. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) package was used to identify cases and subcases of anxiety. AD was diagnosed by a panel of research psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Multivariate survival analysis with a competing risk regression model was performed. RESULTS We observed a significant association between clinically significant anxiety at baseline and AD risk within a 10-year follow-up (SHR 2.82 [95% CI 1.21-6.58]), after controlling for confounders including depression. In contrast, isolated symptoms of anxiety were not significantly associated with an increased incidence of AD. CONCLUSION Our results support the hypothesis that clinically significant anxiety is an independent risk factor for AD and not just a prodromic symptom. Future studies should clarify if treating anxiety reduces the incidence of AD.
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Lin K, Wen W, Lipnicki DM, Mewton L, Chen R, Du J, Wang D, Skoog I, Sterner TR, Najar J, Kim KW, Han JW, Kim JS, Ng TP, Ho R, Chua DQL, Anstey KJ, Cherbuin N, Mortby ME, Brodaty H, Kochan N, Sachdev PS, Jiang J. Risk factors and cognitive correlates of white matter hyperintensities in ethnically diverse populations without dementia: the COSMIC consortium. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.30.23294876. [PMID: 37693599 PMCID: PMC10491386 DOI: 10.1101/2023.08.30.23294876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
INTRODUCTION White matter hyperintensities (WMH) are an important imaging marker for cerebral small vessel diseases, but their risk factors and cognitive associations have not been well-documented in populations of different ethnicities and/or from different geographical regions. METHOD Magnetic resonance imaging data of five population-based cohorts of non-demented older individuals from Australia, Singapore, South Korea, and Sweden (N = 1,946) were examined for WMH and their associations with vascular risk factors and cognition. RESULT Factors associated with larger whole brain WMH volumes included diabetes, hypertension, stroke, current smoking, body mass index, higher alcohol intake and insufficient physical activity. Participants with moderate or higher physical activity had less WMH than those who never exercised, but the former two groups did not differ. Hypertension and stroke had stronger associations with WMH volumes in the White, compared to Asian subsample. DISCUSSION The current study highlighted the ethnic differences in the contributions of vascular risk factors to WMH.
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Gong J, Harris K, Lipnicki DM, Castro‐Costa E, Lima‐Costa MF, Diniz BS, Xiao S, Lipton RB, Katz MJ, Wang C, Preux P, Guerchet M, Gbessemehlan A, Ritchie K, Ancelin M, Skoog I, Najar J, Sterner TR, Scarmeas N, Yannakoulia M, Kosmidis MH, Guaita A, Rolandi E, Davin A, Gureje O, Trompet S, Gussekloo J, Riedel‐Heller S, Pabst A, Röhr S, Shahar S, Singh DKA, Rivan NFM, van Boxtel M, Köhler S, Ganguli M, Chang C, Jacobsen E, Haan M, Ding D, Zhao Q, Xiao Z, Narazaki K, Chen T, Chen S, Ng TP, Gwee X, Numbers K, Mather KA, Scazufca M, Lobo A, De‐la‐Cámara C, Lobo E, Sachdev PS, Brodaty H, Hackett ML, Peters SAE, Woodward M. Sex differences in dementia risk and risk factors: Individual-participant data analysis using 21 cohorts across six continents from the COSMIC consortium. Alzheimers Dement 2023; 19:3365-3378. [PMID: 36790027 PMCID: PMC10955774 DOI: 10.1002/alz.12962] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Sex differences in dementia risk, and risk factor (RF) associations with dementia, remain uncertain across diverse ethno-regional groups. METHODS A total of 29,850 participants (58% women) from 21 cohorts across six continents were included in an individual participant data meta-analysis. Sex-specific hazard ratios (HRs), and women-to-men ratio of hazard ratios (RHRs) for associations between RFs and all-cause dementia were derived from mixed-effect Cox models. RESULTS Incident dementia occurred in 2089 (66% women) participants over 4.6 years (median). Women had higher dementia risk (HR, 1.12 [1.02, 1.23]) than men, particularly in low- and lower-middle-income economies. Associations between longer education and former alcohol use with dementia risk (RHR, 1.01 [1.00, 1.03] per year, and 0.55 [0.38, 0.79], respectively) were stronger for men than women; otherwise, there were no discernible sex differences in other RFs. DISCUSSION Dementia risk was higher in women than men, with possible variations by country-level income settings, but most RFs appear to work similarly in women and men.
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Oh DJ, Bae JB, Lipnicki DM, Han JW, Sachdev PS, Kim TH, Kwak KP, Kim BJ, Kim SG, Kim JL, Moon SW, Park JH, Ryu SH, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Skoog I, Najar J, Sterner TR, Guaita A, Vaccaro R, Rolandi E, Scarmeas N, Yannakoulia M, Kosmidis MH, Riedel-Heller SG, Roehr S, Dominguez J, Guzman MFD, Fowler KC, Lobo A, Saz P, Lopez-Anton R, Anstey KJ, Cherbuin N, Mortby ME, Brodaty H, Trollor J, Kochan N, Kim KW. Parental history of dementia and the risk of dementia: A cross-sectional analysis of a global collaborative study. Psychiatry Clin Neurosci 2023; 77:449-456. [PMID: 37165609 PMCID: PMC10524874 DOI: 10.1111/pcn.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/06/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Parental history of dementia appears to increase the risk of dementia, but there have been inconsistent results. We aimed to investigate whether the association between parental history of dementia and the risk of dementia are different by dementia subtypes and sex of parent and offspring. METHODS For this cross-sectional study, we harmonized and pooled data for 17,194 older adults from nine population-based cohorts of eight countries. These studies conducted face-to-face diagnostic interviews, physical and neurological examinations, and neuropsychological assessments to diagnose dementia. We investigated the associations of maternal and paternal history of dementia with the risk of dementia and its subtypes in offspring. RESULTS The mean age of the participants was 72.8 ± 7.9 years and 59.2% were female. Parental history of dementia was associated with higher risk of dementia (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.15-1.86) and Alzheimer's disease (AD) (OR = 1.72, 95% CI = 1.31-2.26), but not with the risk of non-AD. This was largely driven by maternal history of dementia, which was associated with the risk of dementia (OR = 1.51, 95% CI = 1.15-1.97) and AD (OR = 1.80, 95% CI = 1.33-2.43) whereas paternal history of dementia was not. These results remained significant when males and females were analyzed separately (OR = 2.14, 95% CI = 1.28-3.55 in males; OR = 1.68, 95% CI = 1.16-2.44 for females). CONCLUSIONS Maternal history of dementia was associated with the risk of dementia and AD in both males and females. Maternal history of dementia may be a useful marker for identifying individuals at higher risk of AD and stratifying the risk for AD in clinical trials.
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Leung Y, Barzilai N, Batko-Szwaczka A, Beker N, Boerner K, Brayne C, Brodaty H, Cheung KSL, Corrada MM, Crawford JD, Galbussera AA, Gondo Y, Holstege H, Hulsman M, Ishioka YL, Jopp D, Kawas CH, Kaye J, Kochan NA, Lau BHP, Lipnicki DM, Lo JW, Lucca U, Makkar SR, Marcon G, Martin P, Meguro K, Milman S, Poon LW, Recchia A, Ribeiro O, Riva E, Rott C, Sikkes SA, Skoog I, Stephan B, Szewieczek J, Teixeira L, Tettamanti M, Wilczyński K, Sachdev P. Cognition, function, and prevalent dementia in centenarians and near-centenarians: An individual participant data (IPD) meta-analysis of 18 studies. Alzheimers Dement 2023; 19:2265-2275. [PMID: 36453627 DOI: 10.1002/alz.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION There are limited data on prevalence of dementia in centenarians and near-centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100. METHODS Participant-level data were obtained from 18 community-based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization protocol was applied to cognitive and functional impairments, and a meta-analysis was performed. RESULTS The mean age was 98.3 years (SD = 2.67); 79% were women. After adjusting for age, sex, and education, dementia prevalence was 53.2% in women and 45.5% in men, with risk continuing to increase with age. Education (OR 0.95;0.92-0.98) was protective, as was hypertension (odds ratio [OR] 0.51;0.35-0.74) in five studies. Dementia was not associated with diabetes, vision and hearing impairments, smoking, and body mass index (BMI). DISCUSSION Among the exceptional old, dementia prevalence remains higher in the older participants. Education was protective against dementia, but other factors for dementia-free survival in C/NC remain to be understood.
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Lo JW, Crawford JD, Desmond DW, Bae HJ, Lim JS, Godefroy O, Roussel M, Köhler S, Staals J, Verhey F, Chen C, Xu X, Chong E, Kandiah N, Bordet R, Dondaine T, Mendyk AM, Brodaty H, Traykov L, Mehrabian S, Petrova N, Lipnicki DM, Pan Lam BC, Sachdev PS. Short-term Trajectories of Poststroke Cognitive Function: A STROKOG Collaboration Study. Neurology 2023:WNL.0000000000207281. [PMID: 37072222 DOI: 10.1212/wnl.0000000000207281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Past studies on post-stroke cognitive function have focused on the average performance or change over time, but few have investigated patterns of cognitive trajectories after stroke. This project used latent class growth analysis (LCGA) to identify clusters of patients with similar patterns of cognition scores over the first-year post-stroke and the extent to which long-term cognitive outcome is predicted by the clusters ("trajectory groups"). METHODS Data were sought from the Stroke and Cognition consortium (STROKOG). LCGA was used to identify clusters of trajectories based on standardized global cognition scores at baseline (T1) and at the 1-year follow-up (T2). One-step IPD meta-analysis was used to examine risk factors for trajectory groups and association of trajectory groups with cognition at the long-term follow-up (T3). RESULTS Nine hospital-based stroke cohorts with 1149 patients (63% male; mean age 66.4 years (SD=11.0)) were included. The median time assessed at T1 was 3.6 months post-stroke, 1.0 year at T2 and 3.2 years at T3. LCGA identified 3 trajectory groups, which were characterized by different mean levels of cognition scores at T1 (low-, -3.27SD (0.94), 17%; medium-, -1.23SD (0.68), 48%; and high-performance, 0.71SD (0.77), 35%). There was significant improvement in cognition for the high-performance group (0.22 SD/year, 95% CI 0.07, 0.36), but changes for the low and medium performance groups were not significant (-0.10 SD/year, 95% CI -0.33, 0.13; 0.11 SD/year, 95% CI -0.08, 0.24 respectively). Factors associated with the low- (versus high-) performance group include age (relative risk ratio [RRR] 1.18, 95% CI 1.14, 1.23), years of education (RRR 0.61, 95% CI 0.56, 0.67), diabetes (RRR 3.78, 95% CI 2.08, 6.88), large artery versus small vessel strokes (RRR 2.77, 95% CI 1.32, 5.83), and moderate/severe strokes (RRR 3.17, 95% 1.42, 7.08). Trajectory groups were predictive of global cognition at T3, but its predictive power was comparable to scores at T1. CONCLUSION The trajectory of cognitive function over the first-year post-stroke is heterogenous. Baseline cognitive function ∼3.6 months post-stroke is a good predictor of long-term cognitive outcome. Older age, lower levels of education, diabetes, large artery strokes, and greater stroke severity are risk factors for lower cognitive performance over the first year.
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Ozamiz-Etxebarria N, Legorburu Fernnadez I, Lipnicki DM, Idoiaga Mondragon N, Santabárbara J. Prevalence of Burnout among Teachers during the COVID-19 Pandemic: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4866. [PMID: 36981775 PMCID: PMC10049404 DOI: 10.3390/ijerph20064866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Since the start of the COVID-19 pandemic, many studies have found that there has been a lot of teacher overload. One of the additional burdens has been that they have had to teach online. In addition, when they returned to face-to-face classes, they had to follow all the hygiene rules so that the COVID-19 virus would not spread. It is therefore not surprising that, during this pandemic period, high levels of psychological symptoms have been reported among teachers. Among this symptomatology, burnout has been very frequent among teachers. Therefore, the aim of this study is to conduct a meta-analysis to determine the overall prevalence of burnout among teachers during the COVID-19 pandemic. For this purpose, a search was conducted for cross-sectional studies listed in PubMed from 1 December 2019 to 14 February 2022 that reported on the prevalence of burnout among teachers. A total of nine studies from eight different countries in Africa, Asia, Europe, and North and South America, were included in this study. The pooled prevalence of burnout among teachers was 52% (95% CI 33-71%), which is higher than burnout rates reported for health professionals. There was significant heterogeneity between studies (I2 = 99%, p-value < 0.001), and the prevalence of burnout was higher in women and school teachers (compared to university educators), and lower in American studies. This meta-analysis concludes that teachers worldwide experienced a high rate of burnout during the COVID-19 pandemic. This has implications not only for the teachers themselves, but also for the quality of the education they were able to provide. This education has an influence on the student population. The possible long-term effects are yet to be determined.
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Mewton L, Visontay R, Hoy N, Lipnicki DM, Sunderland M, Lipton RB, Guerchet M, Ritchie K, Najar J, Scarmeas N, Kim K, Riedel Heller S, van Boxtel M, Jacobsen E, Brodaty H, Anstey KJ, Haan M, Scazufca M, Lobo E, Sachdev PS. The relationship between alcohol use and dementia in adults aged more than 60 years: a combined analysis of prospective, individual-participant data from 15 international studies. Addiction 2023; 118:412-424. [PMID: 35993434 PMCID: PMC9898084 DOI: 10.1111/add.16035] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/04/2022] [Indexed: 02/06/2023]
Abstract
AIM To synthesize international findings on the alcohol-dementia relationship, including representation from low- and middle-income countries. METHODS Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in six continents. Cox regression investigated the dementia risk associated with alcohol use in older adults aged over 60 years. Additional analyses assessed the alcohol-dementia relationship in the sample stratified by sex and by continent. Participants included 24 478 community dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. The main outcome measure was all-cause dementia as determined by clinical interview. RESULTS At baseline, the mean age across studies was 71.8 (standard deviation = 7.5, range = 60-102 years), 14 260 (58.3%) were female and 13 269 (54.2%) were current drinkers. During 151 636 person-years of follow-up, there were 2124 incident cases of dementia (14.0 per 1000 person-years). When compared with abstainers, the risk for dementia was lower in occasional [hazard ratio (HR) = 0.78; 95% confidence interval (CI) = 0.68-0.89], light-moderate (HR = 0.78; 95% CI = 0.70-0.87) and moderate-heavy drinkers (HR = 0.62; 95% CI = 0.51-0.77). There was no evidence of differences between life-time abstainers and former drinkers in terms of dementia risk (HR = 0.98; 95% CI = 0.81-1.18). In dose-response analyses, moderate drinking up to 40 g/day was associated with a lower risk of dementia when compared with lif-time abstaining. Among current drinkers, there was no consistent evidence for differences in terms of dementia risk. Results were similar when the sample was stratified by sex. When analysed at the continent level, there was considerable heterogeneity in the alcohol-dementia relationship. CONCLUSIONS Abstinence from alcohol appears to be associated with an increased risk for all-cause dementia. Among current drinkers, there appears to be no consistent evidence to suggest that the amount of alcohol consumed in later life is associated with dementia risk.
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Lipnicki DM, Lam BCP, Mewton L, Crawford JD, Sachdev PS. Harmonizing Ethno-Regionally Diverse Datasets to Advance the Global Epidemiology of Dementia. Clin Geriatr Med 2023; 39:177-190. [PMID: 36404030 PMCID: PMC9767705 DOI: 10.1016/j.cger.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Understanding dementia and cognitive impairment is a global effort needing data from multiple sources across diverse ethno-regional groups. Methodological heterogeneity means that these data often require harmonization to make them comparable before analysis. We discuss the benefits and challenges of harmonization, both retrospective and prospective, broadly and with a focus on data types that require particular sorts of approaches, including neuropsychological test scores and neuroimaging data. Throughout our discussion, we illustrate general principles and give examples of specific approaches in the context of contemporary research in dementia and cognitive impairment from around the world.
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Wu W, Ding D, Zhao Q, Xiao Z, Luo J, Ganguli M, Hughes TF, Jacobsen E, Haan MN, van Dang K, Lima-Costa MF, Blay SL, de Castro-Costa E, Ng TP, Gwee X, Gao Q, Gureje O, Ojagbemi A, Bello T, Shahar S, Ludin AFM, Rivan NFM, Scarmeas N, Anastasiou CA, Yannakoulia M, Brodaty H, Crawford JD, Lipton RB, Derby CA, Katz MJ, Lipnicki DM, Sachdev PS. Dose-response relationship between late-life physical activity and incident dementia: A pooled analysis of 10 cohort studies of memory in an international consortium. Alzheimers Dement 2023; 19:107-122. [PMID: 35290713 PMCID: PMC9652610 DOI: 10.1002/alz.12628] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Though consistent evidence suggests that physical activity may delay dementia onset, the duration and amount of activity required remains unclear. METHODS We harmonized longitudinal data of 11,988 participants from 10 cohorts in eight countries to examine the dose-response relationship between late-life physical activity and incident dementia among older adults. RESULTS Using no physical activity as a reference, dementia risk decreased with duration of physical activity up to 3.1 to 6.0 hours/week (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.67 to 1.15 for 0.1 to 3.0 hours/week; HR 0.68, 95% CI 0.52 to 0.89 for 3.1 to 6.0 hours/week), but plateaued with higher duration. For the amount of physical activity, a similar pattern of dose-response curve was observed, with an inflection point of 9.1 to 18.0 metabolic equivalent value (MET)-hours/week (HR 0.92, 95% CI 0.70 to 1.22 for 0.1 to 9.0 MET-hours/week; HR 0.70, 95% CI 0.53 to 0.93 for 9.1 to 18.0 MET-hours/week). DISCUSSION This cross-national analysis suggests that performing 3.1 to 6.0 hours of physical activity and expending 9.1 to 18.0/MET-hours of energy per week may reduce dementia risk.
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Samtani S, Mahalingam G, Lam BCP, Lipnicki DM, Lima-Costa MF, Blay SL, Castro-Costa E, Shifu X, Guerchet M, Preux PM, Gbessemehlan A, Skoog I, Najar J, Rydberg Sterner T, Scarmeas N, Kim KW, Riedel-Heller S, Röhr S, Pabst A, Shahar S, Numbers K, Ganguli M, Jacobsen E, Hughes TF, Crowe M, Ng TP, Maddock J, Marseglia A, Mélis R, Szcześniak D, Wiegelmann H, Vernooij-Dassen M, Jeon YH, Sachdev PS, Brodaty H. Associations between social connections and cognition: a global collaborative individual participant data meta-analysis. THE LANCET. HEALTHY LONGEVITY 2022; 3:e740-e753. [PMID: 36273484 PMCID: PMC9750173 DOI: 10.1016/s2666-7568(22)00199-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Poor social connections (eg, small networks, infrequent interactions, and loneliness) are modifiable risk factors for cognitive decline. Existing meta-analyses are limited by reporting aggregate responses, a focus on global cognition, and combining social measures into single constructs. We aimed to investigate the association between social connection markers and the rate of annual change in cognition (ie, global and domain-specific), as well as sex differences, using an individual participant data meta-analysis. METHODS We harmonised data from 13 longitudinal cohort studies of ageing in North America, South America, Europe, Africa, Asia, and Australia. Studies were eligible for inclusion if they had baseline data for social connection markers and at least two waves of cognitive scores. Follow-up periods ranged from 0 years to 15 years across cohorts. We included participants with cognitive data for at least two waves and social connection data for at least one wave. We then identified and excluded people with dementia at baseline. Primary outcomes were annual rates of change in global cognition and cognitive domain scores over time until final follow-up within each cohort study analysed by use of an individual participant data meta-analysis. Linear mixed models within cohorts used baseline social connection markers as predictors of the primary outcomes. Effects were pooled in two stages using random-effects meta-analyses. We assessed the primary outcomes in the main (partially adjusted) and fully adjusted models. Partially adjusted models controlled for age, sex, and education; fully adjusted models additionally controlled for diabetes, hypertension, smoking, cardiovascular risk, and depression. FINDINGS Of the 40 006 participants in the 13 cohort studies, we excluded 1392 people with dementia at baseline. 38 614 individual participants were included in our analyses. For the main models, being in a relationship or married predicted slower global cognitive decline (b=0·010, 95% CI 0·000-0·019) than did being single or never married; living with others predicted slower global cognitive (b=0·007, 0·002-0·012), memory (b=0·017, 0·006-0·028), and language (b=0·008, 0·000-0·015) decline than did living alone; and weekly interactions with family and friends (b=0·016, 0·006-0·026) and weekly community group engagement (b=0·030, 0·007-0·052) predicted slower memory decline than did no interactions and no engagement. Never feeling lonely predicted slower global cognitive (b=0·047, 95% CI 0·018-0·075) and executive function (b=0·047, 0·017-0·077) decline than did often feeling lonely. Degree of social support, having a confidante, and relationship satisfaction did not predict cognitive decline across global cognition or cognitive domains. Heterogeneity was low (I2=0·00-15·11%) for all but two of the significant findings (association between slower memory decline and living with others [I2=58·33%] and community group engagement, I2=37·54-72·19%), suggesting robust results across studies. INTERPRETATION Good social connections (ie, living with others, weekly community group engagement, interacting weekly with family and friends, and never feeling lonely) are associated with slower cognitive decline. FUNDING EU Joint Programme-Neurodegenerative Disease Research grant, funded by the National Health and Medical Research Council Australia, and the US National Institute on Aging of the US National Institutes of Health.
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Hyun J, Hall CB, Katz MJ, Derby CA, Lipnicki DM, Crawford JD, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Bae JB, Röhr S, Riedel-Heller S, Ganguli M, Jacobsen E, Hughes TF, Brodaty H, Kochan NA, Trollor J, Lobo A, Santabarbara J, Lopez-Anton R, Sachdev PS, Lipton RB. Education, Occupational Complexity, and Incident Dementia: A COSMIC Collaborative Cohort Study. J Alzheimers Dis 2022; 85:179-196. [PMID: 34776437 PMCID: PMC8748312 DOI: 10.3233/jad-210627] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Education and occupational complexity are main sources of mental engagement during early life and adulthood respectively, but research findings are not conclusive regarding protective effects of these factors against late-life dementia. OBJECTIVE This project aimed to examine the unique contributions of education and occupational complexity to incident dementia, and to assess the mediating effects of occupational complexity on the association between education and dementia across diverse cohorts. METHOD We used data from 10,195 participants (median baseline age = 74.1, range = 58∼103), representing 9 international datasets from 6 countries over 4 continents. Using a coordinated analysis approach, the accelerated failure time model was applied to each dataset, followed by meta-analysis. In addition, causal mediation analyses were performed. RESULT The meta-analytic results indicated that both education and occupational complexity were independently associated with increased dementia-free survival time, with 28%of the effect of education mediated by occupational complexity. There was evidence of threshold effects for education, with increased dementia-free survival time associated with 'high school completion' or 'above high school' compared to 'middle school completion or below'. CONCLUSION Using datasets from a wide range of geographical regions, we found that both early life education and adulthood occupational complexity were independently predictive of dementia. Education and occupational experiences occur during early life and adulthood respectively, and dementia prevention efforts could thus be made at different stages of the life course.
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Sexton CE, Anstey KJ, Baldacci F, Barnum CJ, Barron AM, Blennow K, Brodaty H, Burnham S, Elahi FM, Götz J, Jeon YH, Koronyo-Hamaoui M, Landau SM, Lautenschlager NT, Laws SM, Lipnicki DM, Lu H, Masters CL, Moyle W, Nakamura A, Pasinetti GM, Rao N, Rowe C, Sachdev PS, Schofield PR, Sigurdsson EM, Smith K, Srikanth V, Szoeke C, Tansey MG, Whitmer R, Wilcock D, Wong TY, Bain LJ, Carrillo MC. Alzheimer's disease research progress in Australia: The Alzheimer's Association International Conference Satellite Symposium in Sydney. Alzheimers Dement 2022; 18:178-190. [PMID: 34058063 PMCID: PMC9396711 DOI: 10.1002/alz.12380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/03/2023]
Abstract
The Alzheimer's Association International Conference held its sixth Satellite Symposium in Sydney, Australia in 2019, highlighting the leadership of Australian researchers in advancing the understanding of and treatment developments for Alzheimer's disease (AD) and other dementias. This leadership includes the Australian Imaging, Biomarker, and Lifestyle Flagship Study of Ageing (AIBL), which has fueled the identification and development of many biomarkers and novel therapeutics. Two multimodal lifestyle intervention studies have been launched in Australia; and Australian researchers have played leadership roles in other global studies in diverse populations. Australian researchers have also played an instrumental role in efforts to understand mechanisms underlying vascular contributions to cognitive impairment and dementia; and through the Women's Healthy Aging Project have elucidated hormonal and other factors that contribute to the increased risk of AD in women. Alleviating the behavioral and psychological symptoms of dementia has also been a strong research and clinical focus in Australia.
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Lennon MJ, Lam BCP, Lipnicki DM, Crawford JD, Sachdev PS. Does blood pressure variability predict cognitive decline better than hypertension itself? A harmonised analysis of 10 studies. Alzheimers Dement 2021. [DOI: 10.1002/alz.049424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Samtani S, Stevens A, Lipnicki DM, Sachdev PS, Brodaty H. Social health and reserve in the dementia patient journey (SHARED): The role of social interactions in the clinical phase of dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.053227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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