Cancer risks among iron and steel workers in Anshan, China, Part II: Case-control studies of lung and stomach cancer

Nested case-control interview studies of lung cancer (610 incident cases), stomach cancer (292 incident cases), and 959 controls were conducted to follow up leads from a proportional mortality analysis of deaths among male workers in a large integrated iron-steel complex in Anshan, China. For lung cancer, after adjusting for the significant non-occupational risk factors (smoking, other pulmonary disease, family history of lung cancer, and low consumption of fruit or tea), risks were significantly elevated for those employed for 15 or more years in smelting and rolling (OR = 1.5, CI = 1.1-2.2), in the fire-resistant brick factory (OR = 2.9, CI = 1.4-5.9), in general loading (OR = 2.5, CI = 1.0-6.1), and as coke oven workers (OR = 3.4; CI = 1.4-8.5). For stomach cancer, after adjusting for consumption of pickled vegetables, prior gastric diseases, family history of stomach cancer, low intake of fruits and vegetables, and education, risks were significantly elevated for those employed for 15 or more years in ore sintering and transportation (OR = 2.1, CI = 1.0-4.4), in the fire-resistant brick factory (OR = 2.5, CI = 1.1-5.8), in general loading (OR = 3.2, CI = 1.2-8.9), as boilerworkers and cooks (OR = 2.6, CI = 1.2-5.6), and as coke oven workers (OR = 5.4, CI = 1.8-16.0). For both lung and stomach cancers, significant dose-response gradients were observed for exposure to total dust and benzo(a)pyrene, but not for specific chemical components of dust. Overall, long-term steel workers with exposure to workplace pollutants had a 40% increased risk of both lung and stomach cancers. These case-control studies confirm many of the occupational findings reported in the proportionate mortality analysis, and suggest avenues for further work to evaluate the carcinogenicity of individual components of dust.

Cancer risks among iron and steel workers in Anshan, China, Part I: Proportional mortality ratio analysis

A standardized proportional mortality ratio (SPMR) study of 8,887 deaths during 1980-1989 among male workers in a large integrated iron-steel complex in Anshan, China, was conducted to provide clues to occupational risk factors. Accidents and cancer accounted for a higher proportion of deaths among the iron-steel workers than among the general male population (SPMR = 1.21; 95% CI = 1.12-1.31 and 1.14; 95% CI = 1.10-1.18, respectively). Among all workers, SPMRs were significantly elevated for stomach, lung, and colorectal cancers (SPMR = 1.37, 1.37, 1.38, respectively), but not other cancers. Risks of stomach cancer appeared to be highest among workers employed in jobs with exposure to iron and coal dust, whereas significant increases in colorectal cancer were seen for loading and other dusty jobs and for administrative and sedentary jobs without dust exposure. Risks of lung cancer appeared increased for a variety of jobs throughout the complex, especially those with probable high levels of exposure to polycyclic hydrocarbons and asbestos. Risk of esophageal cancer was significantly elevated for fire-resistant brick makers, and risk of nonmalignant respiratory disease was significantly elevated for those employed as furnace workers, foundry workers, and fire-resistant brick makers.

Lifestyle, environmental pollution and lung cancer in cities of Liaoning in northeastern China

Several studies were conducted in cities of Liaoning Province, one of the areas of China with heavy concentrations of industry, to investigate the effects of life-style factors and environmental pollutants on lung cancer causation. A case-control study involving 1249 lung cancer patients and 1345 population-based controls was conducted in 1985-1988 in Shenyang, the capital of Liaoning. Cigarette smoking was found to be the principal cause of lung cancer in this population, accounting for 55% of the disease in males and 37% in females. There was also a significant increase in lung cancer risk associated with an overall index of indoor air pollution due to coal-burning emission. The population attributable risk (PAR) for indoor air pollution was 13% for males and 17% for females. Risks were significantly increased for workers in the non-ferrous smelter (odds ratio (OR) = 2.6, 95% CI, 1.3-5.1), chemical and drug manufacturing (OR = 3.0, 95% CI, 1.0-8.0), and the glass and pottery industry (OR = 1.6, 95% CI, 1.0-2.5). Studies in the Anshan Iron-Steel Complex showed a significant excess of lung cancer for workers exposed to a variety of dusts. A standardized proportional mortality ratio (SPMR) study of 8887 deaths during 1980-1989 among male workers of the complex indicated a 37% excess risk of lung cancer compared to residents of the city. A nested case-control study was then conducted in that complex. A total of 610 cases of lung cancer diagnosed during 1987-1993 and 959 randomly selected controls from 196 993 active and retired employees of the complex were interviewed. Historical monitoring records for dust and benzo(a)pyrene (B(a)P) were collected from 1956-1992 to calculate cumulative exposure for each person. Results suggested that risks were increased for all occupations in which there was exposure to dusts, with the highest risks seen among coke oven workers (OR = 3.5, 95% CI, 2.0-6.4) and fire-resistant brick makers (OR = 2.9, 95% CI, 1.9-4.4). Significant dose-response patterns between cumulative total dust, cumulative total B(a)P and lung cancer risk were observed. The findings suggest that smoking and environmental pollution combine to account for elevated rates of lung cancer in cities of northeastern China.

The Relationship Between Hearing and Mild Behavioral Impairment and the Influence of Sex: A Study of Older Adults Without Dementia from the COMPASS-ND Study

Background

Hearing loss and mild behavioral impairment (MBI), both non-cognitive markers of dementia, can be early warning signs of incident cognitive decline.

Objective

We investigated the relationship between these markers and reported the influence of sex, using non-dementia participants (n = 219; 107 females) from the Canadian Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND).

Methods

Hearing was assessed with the 10-item Hearing Handicap for the Elderly-Screening (HHIE-S) questionnaire, a speech-in-noise test, screening audiometry, and hearing aid use. MBI symptoms were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Multivariable linear regressions examined the association between hearing and MBI symptom severity and multiple logistic regressions examined the association between hearing and MBI domains.

Results

HHIE-S score was significantly associated with greater global MBI symptom burden, and symptoms in the apathy and affective dysregulation domains. Objective measures of audiometric hearing loss and speech-in-noise testing as well as hearing aid use were not associated with global MBI symptom severity or the presence of MBI domain-specific symptoms. Males were older, had more audiometric and speech-in-noise hearing loss, higher rates of hearing-aid use, and showed more MBI symptoms than females, especially apathy.

Conclusion

The HHIE-S, a subjective self-report measure that captures emotional and social aspects of hearing disability, was associated with informant-reported global MBI symptom burden, and more specifically the domains of affective dysregulation and apathy. These domains can be potential drivers of depression and social isolation. Hearing and behavior change can be assessed with non-invasive measures, adding value to a comprehensive dementia risk assessment.

Dual-task gait and mild behavioral impairment: The Interface between non-cognitive dementia markers

BACKGROUND

Mild behavioral impairment (MBI) and dual-task gait cost (DTGC) are two non-cognitive markers of dementia that capture behavioral and motor symptoms. We investigated the relationship between MBI and DTGC in a sample of non-demented older adults.

METHODS

This was a cross-sectional observational study of 193 participants (10 cognitively normal, 48 subjective cognitive decline (SCD), 135 mild cognitive impairment (MCI); 52.8% female) from 13 Canadian sites from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study. The Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to define MBI severity using a published algorithm. DTGC, the percentage difference between dual-task and preferred walking speeds, was assessed under three cognitive tasks: animal naming, counting backwards, and serial seven subtractions. Associations were tested in the entire cohort and in the MCI subgroup using multivariable linear regression adjusted for age, sex, education, and diagnosis. The role of global cognition, executive function, verbal and working memory in the association were investigated using tests of mediation and moderation.

RESULTS

MBI symptoms were present in 46.6% of participants (mean age = 72.4 years). Greater overall MBI burden was associated with lower gait speed across all conditions. Furthermore, a one-point increase in global MBI symptom severity was associated with a 0.8% increase in DTGC in the animal fluency condition, a 0.9% increase in the counting backwards condition and a 1.1% increase in the serial sevens condition. These associations were strongest in the subgroup of MCI participants. Executive function but not global cognition or verbal and working memory mediated the association between MBI and DTGC in all three conditions.

CONCLUSIONS

MBI is associated with gait speed and DTGC in this group of non-demented individuals, independent of the presence or absence of MCI. These findings provide evidence of the relationship between these non-cognitive dementia markers of behavior and gait beyond cognitive impairment.

Persistence of neuropsychiatric symptoms and dementia prognostication: A comparison of three operational case definitions of mild behavioral impairment

INTRODUCTION

We compared three operational case definitions of mild behavioral impairment (MBI) in the context of MBI prevalence estimates and dementia risk modeling.

METHODS

Participants were dementia-free older adults (n = 13701) from the National Alzheimer's Coordinating Center. Operational case definitions of MBI were generated based on neuropsychiatric symptoms at one (OV), two-consecutive (TCV), or more than two-thirds (TTV) of dementia-free study visits. Definitions were compared in prevalence and in Cox regressions using MBI to predict incident dementia.

RESULTS

OV MBI was the most prevalent (54.4%), followed by TCV (32.3%) and TTV (26.7%) MBI. However, OV MBI had the lowest rate of incident dementia (hazard ratio [HR] = 2.54, 95% confidence interval [CI]: 2.33-2.78) and generated poorer model metrics than TCV MBI (HR = 4.06, 95% CI: 3.74-4.40) and TTV MBI (HR = 5.77, 95% CI: 5.32-6.26).

DISCUSSION

Case ascertainment with longer timeframe MBI operational case definitions may more accurately define groups at risk of dementia in datasets lacking tools designed to detect MBI.Highlights: Mild behavioral impairment (MBI) can identify older adults at risk of dementia.Neuropsychiatric symptom (NPS) assessment tools can be proxy measures for MBI.Hazard for dementia was highest for MBI defined by NPS presence at more than two-thirds of visits.

[Clinical analysis of eosinophilic gastroenteritis in 71 children]

Objective: To summarize the clinical data including manifestations, diagnosis, treatment and prognosis of eosinophilic gastroenteritis (EGE) in children. Methods: A retrospective analysis was performed in 71 patients with pathologically proven EGE at Beijing Children's Hospital Affiliated to Capital Medical University from January 2008 to January 2017. Their clinical manifestations, laboratory and imaging examinations, endoscopic findings, histopathological examinations, and treatment were collected and analyzed. Results: Among 71 EGE cases, 47 (66%) cases were male and 24 (34%) cases were female, and the median age was 9.2 (0.2-16.5) years old. The main clinical manifestations included abdominal pain (76%, 54/71), vomiting (68%, 48/71), anorexia (54%, 38/71), weight loss (38%, 27/71), and diarrhea (37%, 26/71). There were 27 cases (38%) with a history of allergic diseases or family history. The median absolute value of eosinophil in peripheral blood of the 71 patients was 0.4 (0-36.8)×10(9)/L, and 27 cases (38%) showed an increase in eosinophil counts. Serum IgE was measured in 52 patients (104.3 (3.4- 3 000.0)×10(3) U/L), and 30 patients (58%) showed an increase in serum IgE. A large number of eosinophils ((41.0±8.5)/HP) were found in 3 patients' ascites. The endoscopic examination of upper gastrointestinal tract revealed hyperemic edema in 62 cases (87%), plaque in 44 cases (62%), erosion in 17 cases (24%) and ulceration in 16 cases (23%). Histopathologically, in 8 cases (11%) the disease involved both stomach and duodeneum, in 21 cases (30%) involved stomach only, and in 37 cases (52%) involved duodeneum only. In addition, in 6 cases (8%) the disease involved esophagus and in 10 cases (14%) involved colorectum. Microscopically, eosinophil counts averaged 67/HP, 33/HP, 40/HP and 38/HP in esophageal, gastric, duodenal and colorectal mucosa respectively. A total of 34 cases were treated with glucocorticoid, and all these patients had alleviation of symptoms, which occurred within 14.9 days on average, but EGE recurred in 11 cases (32%). Conclusions: The clinical symptoms and endoscopic findings of EGE are diverse and nonspecific. Histopathological examination of gastrointestinal mucosa is particularly important for the diagnosis. Glucocorticoid treatment is effective, but the patients with EGE are prone to relapse.

Longitudinal Associations Between Mild Behavioral Impairment, Sleep Disturbance, and Progression to Dementia

Background

Clinical guidelines recommend incorporating non-cognitive markers like mild behavioral impairment (MBI) and sleep disturbance (SD) into dementia screening to improve detection.

Objective

We investigated the longitudinal associations between MBI, SD, and incident dementia.

Methods

Participant data were from the National Alzheimer's Coordinating Center in the United States. MBI was derived from the Neuropsychiatric Inventory Questionnaire (NPI-Q) using a published algorithm. SD was determined using the NPI-Q nighttime behaviors item. Cox proportional hazard regressions with time-dependant variables for MBI, SD, and cognitive diagnosis were used to model associations between baseline 1) MBI and incident SD (n = 11,277); 2) SD and incident MBI (n = 10,535); 3) MBI with concurrent SD and incident dementia (n = 13,544); and 4) MBI without concurrent SD and incident dementia (n = 11,921). Models were adjusted for first-visit age, sex, education, cognitive diagnosis, race, and for multiple comparisons using the Benjamini-Hochberg method.

Results

The rate of developing SD was 3.1-fold higher in older adults with MBI at baseline compared to those without MBI (95% CI: 2.8-3.3). The rate of developing MBI was 1.5-fold higher in older adults with baseline SD than those without SD (95% CI: 1.3-1.8). The rate of developing dementia was 2.2-fold greater in older adults with both MBI and SD, as opposed to SD alone (95% CI:1.9-2.6).

Conclusions

There is a bidirectional relationship between MBI and SD. Older adults with SD develop dementia at higher rates when co-occurring with MBI. Future studies should explore the mechanisms underlying these relationships, and dementia screening may be improved by assessing for both MBI and SD.

Sex Moderates the Association between Frailty and Mild Behavioral Impairment

BACKGROUND

Frailty has been associated with cognitive markers of dementia but its relationship with behavioral markers of dementia are poorly understood.

OBJECTIVES

To investigate the association between frailty and mild behavioral impairment (MBI), and whether this association is moderated by sex.

DESIGN

Cross-sectional observational study.

PARTICIPANTS/SETTING

219 non-dementia participants (cognitively normal and mild cognitive impairment) from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study.

MEASUREMENTS

Frailty was measured using the frailty index (FI) with higher scores indicating more health deficits/greater frailty. MBI symptoms were derived from Neuropsychiatric Inventory Questionnaire scores using a published algorithm with a cut-off of >0 indicating MBI symptom presence and higher scores indicating greater severity. Multivariable logistic and linear regressions adjusted for age, sex, education, and cognitive diagnosis were used to test the association between FI and MBI symptom presence and severity, respectively, with MBI as the outcome variable. An FI-by-sex interaction term was included to test for sex-dependent effects.

RESULTS

The FI mean and SD across the entire cohort was 0.14 ± 0.06 (median = 0.14, IQR = 0.09-0.17, range = 0.02-0.38). Higher FI scores were associated with the presence of MBI symptoms both globally and in the domains of decreased motivation, affective dysregulation, and psychosis. Higher FI scores were also associated with more severe MBI symptoms in a sex-dependent manner: both sexes reported similarly low MBI symptom severity at low (-1 SD) levels of FI but males reported 1.9x higher MBI symptom severity relative to females at high (+1 SD) levels of FI.

CONCLUSIONS

The FI is associated with both the presence and severity of MBI, especially for males. This suggests that screening for early dementia risk should incorporate assessments of MBI for patients with frailty, and assessments of frailty for patients with MBI.

The mind and motion: exploring the interplay between physical activity and Mild Behavioral Impairment in dementia-free older adults

Physical inactivity in mid-life is a modifiable risk factor for dementia. Mild behavioral impairment (MBI) is a marker of potential neurodegenerative disease. We investigated the association between physical activity and MBI. Baseline data from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT) were used. Four categories of weekly physical activity (cardiovascular, mind-body, strength training, and physical labour) were derived from the Community Healthy Activities Model Program for Seniors questionnaire. MBI was measured using the MBI-Checklist. Multivariable negative binomial regressions modelled the association between the standardized physical activity duration and MBI severity, adjusted for age, sex, education, marital status, ethno cultural origin, occupation, hypertension, dyslipidemia, mobility, and body mass index. Every 1 SD increase in cardiovascular activity was associated with 8.42% lower MBI severity. In contrast, every 1 SD increase in physical labor duration was associated with 5.64% greater MBI severity. These associations were neither moderated by the frequency engaging in each physical activity nor by sex. Cardiovascular physical activity in older persons may reduce levels of non-cognitive dementia markers like MBI, comparable to effects seen in cognition, potentially modulating dementia risk.

[Clinical analysis of intestinal lymphangiectasia in 47 children]

Objective: To analyze the clinical manifestations, diagnosis, treatment and prognosis of intestinal lymphangiectasia (IL) in children in order to improve the skills of diagnosis and treatment of IL. Method: Clinical manifestations, laboratory findings, gastroscopic findings, histopathological examinations and lymphatic radionuclide imaging assessments were analyzed retrospectively among 47 IL patients who were hospitalized in the Gastroenterology Department of Beijing Children's Hospital Affiliated to Capital Medical University from June 2007 to December 2015. All patients were followed up by telephone. According to the various causes, the patients were divided into the primary intestinal lymphangiectasia (PIL) group and secondary IL group, and their clinical manifestations were compared by t test, Rank sum test or Chi-square test. Result: In 47 IL patients, there were 38 children (81%) younger than 3 years old. There were 43 PIL patients (91%) and 4 secondary IL patients (9%). Between PIL and secondary IL, there were statistical differences in serum albumin (t=-3.950, P<0.005) , globulin(t=-2.850, P=0.007), age of onset(U=27.000, P=0.024), age at diagnosis(U=29.000, P=0.030) and course of disease(U=26.500, P=0.023), whereas there were no statistical differences in lymphocyte count, IgG, lymphatic radionuclide imaging, histopathology and gender(all P>0.05). Edema (44 cases, 94%), diarrhea (42 cases, 89%), accompanied with infection (35 cases, 74%) and ascites (30 cases, 64%) were the main clinical manifestations. In 47 IL patients, 45 patients were done gastroscopy and histopathological examinations, and there were 31 patients' histopathological examinations(69%) were positive. Forty patients were done lymphatic radionuclide imaging, and there was evidence of protein losing from gut via lymphatic radionuclide imaging in 39 patients(98%). Among 47 patients, 35 patients (74%) were followed up, 32 patients had good prognosis, 2 patient failed to show evidence of improvement, 1 patient died and no patient experienced a relapse till the end of the follow-up. In 35 patients, 28 patients were treated with medium chain triglycerides (MCT) dietary therapy, 26 patients showed improvement in symptoms, and 2 patients had no improvement. Among 35 patients with follow-up, there were 6 patients received surgical treatment, and their symptoms were improved. Conclusion: PIL are the majority of IL in children younger than 3 years old. The main clinical manifestations are edema, diarrhea, accompanied with infection and ascites. For the patients without the evidence of lymphangiectasia from duodenum histopathological examination, further consideration of lymphatic radionuclide imaging, clinical manifestations, and laboratory studies are needed to make a final diagnosis. MCT dietary therapy is the cornerstone of IL medical management.

Linking cognitive and behavioral reserve: Evidence from the CAN-PROTECT study

INTRODUCTION

Changes to the brain due to Alzheimer's disease and other age-related neuropathologies may present with cognitive and behavioral symptoms, even during preclinical and prodromal stages. While cognitive reserve is known to mitigate cognitive decline in the preclinical stages of Alzheimer's disease, links between cognitive reserve and behavioral symptoms remain unclear. This study investigates the relationship between cognitive reserve and mild behavioral impairment (MBI), a neurodegenerative behavioral prodrome.

METHODS

We analyzed cross-sectional data from 1204 participants in the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN-PROTECT) study. A cognitive reserve score (CRS) was generated based on education, occupation, and personal cognitive reserve proxies. MBI presence (MBI+) and MBI global and domain symptom severity were evaluated using the self-reported MBI Checklist. Initial analyses examined the convergent validity of the CRS through associations with objective neuropsychological test performance and self-reported cognitive symptoms (Everyday Cognition [ECog-II] scale). Models were also fitted to assess MBI status and severity as functions of the CRS.

RESULTS

Higher CRS was associated with better neuropsychological test scores, lower odds of subjective cognitive decline (OR = 0.86, 95% CI: [0.76, 0.98], p = .03), and lower ECog-II total score. Likewise, higher CRS was associated with lower odds of MBI+ (OR = 0.81, 95% CI: [0.71, 0.93], p = .003), and lower MBI symptom severity globally, and in impulse dyscontrol and social inappropriateness domains.

DISCUSSION

We provide preliminary evidence that engagement in activities known to preserve cognitive function in aging and disease may also preserve behavioral function. Future research should disentangle possible pathways through which cognitive reserve may preserve both cognition and behavior, explore common etiologies for these symptoms, and observe outcomes longitudinally to better understand these relationships.

Highlights

Education, occupation, and personal activities are cognitive reserve proxies.Cognitive reserve is linked to lower subjective cognitive decline in older persons.Cognitive reserve is linked to lower mild behavioral impairment odds and severity.

The effect of study partner characteristics on the reporting of neuropsychiatric symptoms across the neurocognitive spectrum

OBJECTIVES

We explored the influence of study partner (SP) characteristics on SP-reported neuropsychiatric symptoms (NPS) presence across the neurocognitive spectrum and on the prognostic utility of mild behavioral impairment (MBI).

DESIGN, SETTING, AND PARTICIPANTS

We performed cross-sectional (n = 26,748) and longitudinal (n = 12,794) analyses using participant-SP dyad data from the National Alzheimer's Coordinating Center. Participants were cognitively normal (CN; n = 11,951) or had mild cognitive impairment (MCI; n = 5686) or dementia (n = 9111).

MEASUREMENTS

SPs rated NPS using the Neuropsychiatric Inventory Questionnaire. We used multivariable logistic regression to model the association between SP characteristics (age, sex, and relationship to participant [spouse, child, and other]) and NPS status (outcome). Cox regressions assessed SP characteristics as moderators of MBI associations with incident dementia or as predictors of incident dementia in MBI + participants only.

RESULTS

Among CN persons, younger, female, and spouse SPs reported NPS more frequently. In MCI, younger SPs and those who were spouses or children of participants reported higher NPS odds. For dementia participants, NPS odds were higher in female and spouse SPs. MBI associations with incident dementia were slightly weaker when SPs were older but did not depend on SP sex or relationship to participant. Among MBI + participants with spouse or child SPs, hazard for dementia was higher when compared to MBI + participants with other SPs.

CONCLUSIONS

SP age, sex, and relationship to participant influence NPS reporting across the neurocognitive spectrum, with potential implications for MBI prognosis. Considering SP characteristics may enhance the accuracy of NPS assessments, which may facilitate therapy planning and prognosis.

Neuroanatomical correlates of distracted straight driving performance: a driving simulator MRI study across the lifespan

Background

Driving is the preferred mode of transportation for adults across the healthy age span. However, motor vehicle crashes are among the leading causes of injury and death, especially for older adults, and under distracted driving conditions. Understanding the neuroanatomical basis of driving may inform interventions that minimize crashes. This exploratory study examined the neuroanatomical correlates of undistracted and distracted simulated straight driving.

Methods

One-hundred-and-thirty-eight participants (40.6% female) aged 17-85 years old (mean and SD = 58.1 ± 19.9 years) performed a simulated driving task involving straight driving and turns at intersections in a city environment using a steering wheel and foot pedals. During some straight driving segments, participants responded to auditory questions to simulate distracted driving. Anatomical T1-weighted MRI was used to quantify grey matter volume and cortical thickness for five brain regions: the middle frontal gyrus (MFG), precentral gyrus (PG), superior temporal cortex (STC), posterior parietal cortex (PPC), and cerebellum. Partial correlations controlling for age and sex were used to explore relationships between neuroanatomical measures and straight driving behavior, including speed, acceleration, lane position, heading angle, and time speeding or off-center. Effects of interest were noted at an unadjusted p-value threshold of 0.05.

Results

Distracted driving was associated with changes in most measures of straight driving performance. Greater volume and cortical thickness in the PPC and cerebellum were associated with reduced variability in lane position and heading angle during distracted straight driving. Cortical thickness of the MFG, PG, PPC, and STC were associated with speed and acceleration, often in an age-dependent manner.

Conclusion

Posterior regions were correlated with lane maintenance whereas anterior and posterior regions were correlated with speed and acceleration, especially during distracted driving. The regions involved and their role in straight driving may change with age, particularly during distracted driving as observed in older adults. Further studies should investigate the relationship between distracted driving and the aging brain to inform driving interventions.

Clinical Manifestations

BACKGROUND

Changes in sleep are common in older persons and have been linked to higher dementia risk. The link between sleep complaints and early risk markers of Alzheimer's disease (AD), namely subjective changes in cognition and mild behavioral impairment (MBI), have not been fully explored. This study investigated associations between sleep complaints with cognitive and behavioral AD risk markers and quality of life (QoL) among cognitively unimpaired older persons. We hypothesized that older persons reporting sleep changes would also report more severe cognitive and behavioral changes, and poorer QoL.

METHOD

Participants (n = 1395) were from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT) study. Sleep complaints were self-reported presence or absence of sleep disruption (symptoms of insomnia or sleep-related movement disorders), daytime sleepiness, sleep-disordered breathing, or prolonged sleep duration. Outcomes included the Everyday Cognition (ECog-II) scale, Mild Behavioral Impairment Checklist (MBI-C), and Quality of Life and Function (QFS-5) scale. Age, sex, years of education, marital status, and ethnocultural origin were balanced across exposure groups using inverse probability of treatment weighting. Negative binomial and bootstrapped linear regressions were used, as appropriate, to model sleep complaint (exposure) associations with ECog-II and MBI-C total scores, and QFS-5 mean scores (outcomes).

RESULT

Participant characteristics are summarized in Table 1. Table 2 shows that all sleep complaints were associated with poorer everyday cognition, more severe MBI symptoms, and poorer QoL. However, excessive daytime sleepiness was generally the most strongly associated with the three outcomes with them having 1.50 (95%CI [1.40, 1.60]) and 2.29 (95%CI [2.10, 2.50]) times higher ECog-II and MBI-C score compared to participants without daytime sleepiness, and a 0.71 SD (95%CI [0.59, 0.82]) lower QFS-5 mean score.

CONCLUSION

Sleep complaints, even among cognitively unimpaired older persons, are linked to cognitive and behavioral risk markers of AD, as well as poorer QoL. These findings provide further evidence that sleep complaints represent modifiable risk factors or may reflect a prodrome for AD, and may contribute to overall disease burden.

Updates and future perspectives on neuropsychiatric symptoms in Alzheimer's disease

Neuropsychiatric symptoms (NPS) are common throughout the Alzheimer's disease (AD) continuum and profoundly affect patients, caregivers, and health-care systems. This review synthesizes key research presented in the 2022 and 2023 Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment Neuropsychiatric Syndromes-Professional Interest Area (NPS-PIA) Year-In-Reviews, emphasizing six critical areas: (1) diversity and disparities, (2) diagnostic frameworks, (3) neurobiology of NPS, (4) NPS as a disease marker, (5) the impact of COVID-19, and (6) interventions. NPS accelerates AD progression, increases functional decline, diminishes quality of life, and heightens caregiver burden and institutionalization rates. Current treatments primarily rely on psychotropics, which offer limited efficacy and raise safety concerns. This review aims to inform clinicians and researchers about recent NPS advancements while identifying gaps for future studies to improve outcomes for individuals with AD. HIGHLIGHTS: Research in Alzheimer's disease-related neuropsychiatric symptoms has rapidly increased, indicating heightened interest. Key areas include: diversity, diagnostics, markers, COVID-19 impact, and treatments. A road map for future studies, based on the key areas of research, is provided. This road map includes considerations to improve study applicability and validity.

Clinical Manifestations

BACKGROUND

The utility of neuropsychiatric symptoms (NPS) for early detection of AD and/or other neuropathologies is not fully understood, with concerns regarding specificity. Mild behavioral impairment (MBI) is a syndrome identifying persons at risk for incident cognitive decline and dementia by leveraging risk associated with later-life emergent and persistent NPS. Here, in dementia-free individuals at baseline, we examined whether AD, Lewy body (LB), and/or transactive response DNA-binding protein 43 (TDP-43) pathology at autopsy were associated with the presence of MBI five years before death.

METHOD

National Alzheimer's Coordinating Center participants (n = 1016) were included. Using the Neuropsychiatric Inventory-Questionnaire, three NPS statuses were derived: MBI, NPSnoMBI, or noNPS. Proteinopathy presence/absence was determined using published guidelines. Adjusted multinomial logistic regressions modeled pathology-NPS status associations. Adjusted Cox proportional hazards regressions modeled hazard for AD-dementia at each NPS status level, including interaction terms with cognitive status and each co-pathology.

RESULT

Participant characteristics are presented in Table 1. AD+ individuals were 88.4% more likely to be MBI+ in the five years before death than AD- (odds ratio (OR):1.88, 95% confidence interval (CI):1.29-2.75, p<0.01); NPSnoMBI did not differ from noNPS (OR:1.22, CI:0.90-1.66, p = 0.20). No significant associations were seen for either co-pathology, even in an AD-only stratum. Among MBI progressors to dementia (n = 137), 43.8% were solely AD+ and 32.8% were mixed AD+/LB+. MBI individuals had a 2.03-fold greater progression rate to AD-dementia than noNPS (CI: 1.60-2.57, p<0.01). NPSnoMBI did not differ from noNPS (OR:1.22, CI:0.90-1.66, p = 0.20). Progression rates to AD-dementia among MBI+ who had limbic LBs at autopsy were significantly greater than those without (HR:2.56, CI:1.09-6.06, p<0.05). No significant interaction was noted for TDP-43. Progression rates to dementia were higher in MCI, but the effect of MBI on progression was greater for NC (HR:3.05, CI:1.37-6.80, p<0.01) vs. MCI (HR:1.93, CI:1.51-2.47, p<0.01).

CONCLUSION

These findings suggest that those with autopsy-confirmed AD-but not other common proteinopathies-are more likely to be preceded by MBI than by NPSnoMBI or noNPS in the five years before death. Among those with MBI, the presence of LB might serve as an important co-pathology in the development of AD dementia. By extension to postmortem diagnosis, these results reinforce the utility of MBI in AD-related dementia prognostication.

Comments on ;Electromagnetic field distribution and developed losses inside a finite cylinder and sphere under MRI conditions' by G. Sergiadis et al

In the above-named work by G. Sergiadis et al. (see ibid., vol.7, p.381-5, 1988), an exact solution to the electromagnetic field distribution inside a conductive cylinder of finite length was proposed for estimation of the thermal losses in biological tissues under MRI conditions. The commenters claim to show that such a solution is untrue for a finite-length cylinder, and that the related numerical treatments in the work of Sergiadis et al. are for an infinite cylinder, not a finite cylinder.

Clinical Manifestations

BACKGROUND

Menopause has been associated with greater dementia risk. We investigated the relationship between the presence of specific symptoms experienced during menopause (i.e., perimenopausal symptoms) and later-life emergence of cognitive and behavioral symptoms that are linked to elevated dementia risk.

METHOD

Participant data were from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT) study. The sample for this analysis comprised 896 post-menopausal participants, who recalled the presence or absence of 11 perimenopausal symptoms. Symptoms were categorized as vasomotor, weight changes, vaginal dryness, irregular periods, sleep problems, mood changes, brain fog, and other unnamed symptoms. Currently experienced subjective cognitive symptoms were measured with the Everyday Cognition (ECog-II) scale. Emergent and persistent neuropsychiatric symptoms were measured with the Mild Behavioral Impairment Checklist (MBI-C). Higher scores reflected greater severity on both measures. A negative binomial regression examined the association between perimenopausal symptoms and cognitive function. A zero-inflated negative binomial regression examined the association between perimenopausal symptoms and MBI symptoms. All models adjusted for age of menopausal onset, menopausal hormone therapy (MHT), menopause type (i.e., spontaneous, or due to medical reasons), age, and years of education.

RESULT

Symptoms of brain fog, weight changes, and mood changes were associated with poorer current ECog-II score (b = 74.8, 95%CI [47.2, 108.0], p<.001; b = 24.4, 95%CI [8.9, 42.2], p = .001; b = 36.2, 95%CI [17.3, 58.3], p<.001, respectively). Comparatively, use of estrogen and non-estrogen-based MHT during menopause was not significantly associated with current ECog-II scores (b = -11.0,95%CI[-25.3, 6.5], p = .2; b = 16.9, 95%CI[-10.9, 56.1], p = .3, respectively). Weight and mood symptoms of perimenopause were significantly associated with poorer current MBI-C score (b = 24.4,95%CI[2.4,51.1], p = .03; b = 68.4%,95%CI[36.3,108.1], p<.001, respectively). MBI-C scores differed based on type of MHT used. Estrogen-based MHT was associated with a statistically significant 26.9% lower MBI-C score (95%CI[-43.3, -5.7], p = .02), while score did not differ significantly with non-estrogen-based MHT (b = -19.1,95%CI[-44.6, 18.1], p = .3).

CONCLUSION

The experience of brain fog, weight changes, and mood changes during perimenopause may predict greater risk for cognitive and behavioral changes later on. Use of estrogen-based MHT may mitigate the relationship between perimenopause symptoms and MBI symptoms. However, longitudinal data are required to explore mechanisms.

Temporal associations between treated and untreated hearing loss and mild behavioral impairment in older adults without dementia

INTRODUCTION

Hearing loss (HL) and mild behavioral impairment (MBI) are non-cognitive markers of dementia. This study investigated the relationship between hearing and MBI and explored the influence of hearing aid use on the treatment of hearing loss, both cross-sectionally and longitudinally.

METHODS

Data were analyzed from National Alzheimer's Coordinating Center participants, age ≥50, dementia-free at baseline, collected between 2005 and 2022. Three self-report questions were used to generate a three-level categorical hearing variable: No-HL, Untreated-HL, and Treated-HL. MBI status was derived from the informant-rated Neuropsychiatric Inventory Questionnaire (NPI-Q) using a published algorithm. At baseline (n = 7080), logistic regression was used to examine the association between hearing status (predictor) and the presence of global and domain-specific MBI (outcome), adjusting for age, sex, cognitive diagnosis, and apolipoprotein E4 (APOE4). Cox proportional hazard models with time-dependent covariates were used to examine the effect of (1) hearing status as exposure on the rate of incident MBI (n = 5889); and (2) MBI as exposure on the rate of incident HL in those with no HL at baseline (n = 6252).

RESULTS

Cross-sectionally, participants with Untreated-HL were more likely to exhibit global MBI (adjusted odds ratio (aOR) = 1.66, 95% CI: 1.24-2.21) and individual MBI domains of social inappropriateness (aOR = 1.95, 95% CI: 1.06-3.39), affective dysregulation (aOR = 1.71, 95% CI: 1.21-2.38), and impulse dyscontrol (aOR = 1.71, 95% CI: 1.21-2.38), compared to those with No-HL. Participants with Treated-HL (i.e., hearing aid use) did not differ from No-HL for odds of global or most MBI domains, except for impulse dyscontrol (aOR = 1.38, 95% CI: 1.05-1.81). Longitudinally, we found relationships between Treated-HL and incident MBI (adjusted hazard ratio (aHR) = 1.29, 95% CI: 1.01-1.63) and between MBI and incident Untreated-HL (aHR = 1.51, 95% CI: 1.19-1.94).

DISCUSSION

Our cross-sectional results support that hearing aid use is associated with lower odds of concurrent global MBI in dementia-free participants. Longitudinally, relationships were found between MBI and HL. The severity of HL was not assessed, however, and may require further exploration.

Highlights

Hearing Loss (HL) and mild behavioral impairment (MBI) are markers of dementiaCross-sectionally: Untreated-HL was associated with global MBI burden, butHL treated with hearing aids was notWe found associations between MBI and incident Untreated-HL.

[Clinical features and risk factors for early relapse of pediatric ulcerative colitis]

Objective: To investigate the clinical features of pediatric ulcerative colitis (UC) and analyze the risk factors of disease relapse. Methods: The clinical data of 79 children with UC diagnosed in Beijing Children's Hospital, Capital Medical University from January 2016 to February 2021 were retrospectively analyzed. They were divided into early relapse group and non-early relapse group according to the clinical relapse within 12 months after diagnosis. T-test, rank sum test, χ² test or Fisher's exact test were used to compare the variables between the 2 groups, including the clinical features, laboratory examination results and treatments. The Logistic regression was used to analyze the risk factors of early relapse. The cumulative relapse rate during follow-up was calculated by Kaplan-Meier method. Results: Among the 79 UC children, 46 were males and 33 were females, and the age of onset was 10.6 (6.4, 12.7) years. The children were mainly characterized by extensive disease (E3) and pancolitis (E4) (51/79, 65%), moderate to severe activity (48/79, 61%) and moderate to severe inflammation of colonic mucosa (71/79, 90%). Thirty-eight (48%) patients had atypical phenotype and 17 (22%) had extraintestinal manifestations. The follow-up period was 43.9 (22.8, 61.3) months, and of the 41 patients rechecked with colonoscopy, 7 (17%) had disease progression. According to Kaplan-Meier analysis, the cumulative relapse rate of the 79 cases at 3 months, 6 months, 1 year and 2 years after diagnosis were 27% (21/79), 47% (37/79), 57% (45/79) and 73% (53/73), respectively. There were 45 children (57%) in early relapse group and 34 (43%) in non-early relapse group. In early relapse group, hemoglobin and mucosal healing rate were both significantly lower (105 (87, 122) vs. 120 (104, 131) g/L, 28% (7/25) vs. 7/9, Z=-2.38, χ²=4.87, both P<0.05). The rate of steroid-dependent, E3 and step-up therapy during the induction period were all significantly higher than those in non-early relapse group (11/19 vs. 1/12, 24% (11/45) vs. 6% (2/34), 29% (13/45) vs. 6% (2/34), χ²=5.67, 4.85, 6.66, all P<0.05). Multivariate Logistic regression analysis showed that extraintestinal manifestations (OR=4.33, 95%CI 1.05-17.83), E3 (OR=8.27, 95%CI 1.47-46.46) and step-up therapy during the induction period (OR=5.58, 95%CI 1.01-30.77) were independent risk factors for early relapse. Conclusions: Pediatric UC is usually extensive and severe, with atypical phenotype, a high rate of relapse and a risk of disease progression. Extraintestinal manifestations, E3 and step-up therapy during the induction period are independent risk factors for early relapse.

Early life factors and dementia risk: A study of adverse childhood experiences and later-life cognition and behaviour

OBJECTIVES

Adverse childhood experiences (ACE) are associated with brain alterations and cognitive decline. In later life, cognitive impairment and mild behavioural impairment (MBI) are associated with greater dementia risk. We investigated whether more severe ACE are cross-sectionally associated with worse later-life cognitive and behavioural symptoms.

STUDY DESIGN

Cross-sectional study.

METHODS

Data are from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT). Measures included the Childhood Trauma Screener (CTS-5), neuropsychological testing, Everyday Cognition (ECog)-II scale, and MBI Checklist (MBI-C). Linear regressions modelled associations between ACE severity and neuropsychological test scores. Multivariable negative binomial regressions (zero-inflated, if appropriate) modelled associations between ACE severity and ECog-II and MBI-C scores. All models controlled for age, sex, education, and ethnocultural origin. Clinical diagnoses of depression and/or anxiety were explored as covariates or mediators.

RESULTS

In adjusted analyses, higher ACE scores were associated with worse performance on Trail-Making B (standardized b = 0.10, q = 0.003), Switching Stroop (b = -0.08, q = 0.027), Paired Associates Learning (b = -0.08, q = 0.049), and Digit Span (b = -0.08, q = 0.029). Higher ACE scores were also associated with higher ECog-II (b = 1.08, q = 0.029) and MBI-C (b = 1.20, q < 0.001) scores; these associations were neither mediated by affective symptoms (ECog p = 0.16; MBI p = 0.13) nor moderated by sex (ECog p = 0.09; MBI p = 0.46).

CONCLUSION

Older adults with a history of more severe ACE show greater cognitive and behavioural risk markers for dementia that cannot be explained by previous psychiatric history. Further research into ACE as an early modifiable risk factor for dementia is warranted.

Clinical Manifestations

BACKGROUND

Mild behavioral impairment (MBI) is a syndrome that leverages neuropsychiatric symptoms that emerge in later-life, and which persist, to identify individuals at high-risk for incident dementia. Attendant with MBI are changes in quality of life (QoL), which can present concurrent with the onset of cognitive decline or even before. Obtaining information from participants and study partners can provide a broader overview of health and QoL. We investigated the relationship between MBI and QoL in dementia-free older adults, incorporating both self- and study partner reports.

METHODS

Data (n = 608) are from the CAN-PROTECT study. MBI status (±) was determined with a MBI Checklist cut-off score ≥8 based on self- or study-partner report, resulting in a four-level categorical variable of MBI positivity/negativity (S-/SP-[concordant MBI-], S+/SP-[discordant MBI S+], S-/SP+[discordant MBI SP+], S+/SP+[concordant MBI+]). QoL was assessed using the self- and study-partner-reported EQ-5D (higher scores reflecting poorer QoL). Linear regression modelled associations between MBI status (exposure) and EQ-5D total score (outcome), adjusted for age, cognition, sex, education, ethnocultural origin, marital status, employment status, high blood pressure, diabetes, and heart disease. A sensitivity analysis removed EQ-5D affective symptoms.

RESULTS

Participants (mean age = 64.8±7.1, 77.0% female) had mean self-reported scores of 4.6±6.7 for MBI and 6.7±1.8 for EQ-5D. Study partners reported mean scores of 3.7±5.8 for MBI and 1.4±0.4 for EQ-5D. Distribution of MBI status was 71.9% for concordant MBI-, 13.3% for discordant S+, 8.3% for discordant SP+ and 6.6% for concordant MBI+. QoL was poorer in the concordant MBI+ group for self-reported (b = 2.48, 95% confidence interval [95%CI]: 1.96-3.00, p<.001) (Table 1) and study-partner reported EQ-5D (b = 2.63, 95%CI: 2.00-3.27, p<.001) (Table 2), compared to concordant MBI- group. There was a significant association with discordant MBI S+ (p<.001) but not discordant MBI SP+ (p<.81) with self-reported EQ-5D. Both discordant groups were significant with study-partner reported EQ-5D.

CONCLUSION

In a mostly cognitively unimpaired community dwelling sample, MBI associations with self- and study-partner-reported QoL were strongest when MBI symptoms were endorsed by both participants and their study partners. These findings underscore the importance of including study partners brain aging research across the cognitive continuum.