Associations of cumulative depressive symptoms with subsequent cognitive decline and adverse health events: Two prospective cohort studies

Urinary selenium, cranial MRI, and cognitive function in American Indians: The Strong Heart Study

INTRODUCTION

Selenium (Se), a trace element found in soil and groundwater, is necessary for many biological functions, including cerebrovascular health, through selenoprotein formation. However, high concentrations may be harmful. American Indians face elevated cerebrovascular disease rates, which may be associated with other trace elements, such as Se. This cohort study evaluates associations of Se levels with brain health in older American Indians.

METHODS

The Strong Heart Study is a longitudinal cohort of American Indians, with comprehensive medical assessments, including trace element exposure assessment. Urinary Se measurements, brain MRIs, and neuropsychological testing were available for 728 participants aged 65-95 at the time of brain MRI. We evaluated associations of urinary Se (divided by urinary creatinine to account for urine dilution) with MRI and neuropsychological tests and adjusted for potential confounders using linear regression models.

RESULTS

Increased urinary Se was significantly associated with abnormal sulcal atrophy, ventricular widening, and increased white matter hyperintensity volume but not independent of sociodemographic factors and common vascular co-morbidities. Increased urinary Se was also significantly and independently associated with decreased performance in verbal fluency and processing speed, independent of sociodemographics, vascular co-morbidities, depression, and traumatic brain injury.

DISCUSSION

These findings suggest urinary Se levels, particularly those above 50-60 μg Se/g creatinine, are associated with adverse structural brain findings on imaging and diminished cognitive health in older American Indians. This epidemiologic evidence may be useful for public health professionals in evaluating environmental risk, especially within the context of vulnerable populations and high Se intake.

Association between the cumulative estimated glucose disposal rate and incident cardiovascular disease in individuals over the age of 50 years and without diabetes: data from two large cohorts in China and the United States

BACKGROUND

The estimated glucose disposal rate (eGDR) has been linked to incident cardiovascular disease (CVD) in individuals without diabetes. However, few studies have accounted for long-term cumulative eGDR exposure.

OBJECTIVE

The aim of this study was to explore whether long-term cumulative eGDR was independently associated with incident CVD in individuals over the age of 50 years and without diabetes.

METHODS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The cumulative eGDR was calculated as the summation of the average eGDR for each pair of consecutive examinations multiplied by the time between these two consecutive visits, in years. The outcome was incident CVD. Cox proportional hazards regression models and restricted cubic spline (RCS) regression models were used to evaluate the association between cumulative eGDR and incident CVD.

RESULTS

A total of 2430 participants from CHARLS and 2008 participants from HRS were included in the analysis. The median age of the participants in CHARLS at baseline was 59 years [IQR: 55-65 years], and 1205 (49.59%) were men. The median age of the participants in HRS at baseline was 64 years [IQR: 57-70 years], and 705 (35.11%) were men. The RCS regression model showed a negative and linear association between the cumulative eGDR and incidence of CVD (CHARLS: P < 0.001, P for nonlinearity = 0.248; HRS: P = 0.013, P for nonlinearity = 0.121). After multivariate adjustment, the higher levels of cumulative eGDR were independently associated with a lower risk of CVD (per SD, CHARLS: HR: 0.802, 95% CI: 0.716-0.898, HRS: HR: 0.791, 95% CI: 0.665-0.940, pooled analysis: HR: 0.799, 95% CI: 0.726-0.878).

CONCLUSIONS

A lower level of cumulative eGDR was associated with an increased risk of incident CVD in individuals over the age of 50 years and without diabetes. Continuous monitoring of cumulative eGDR exposure over time, based on consideration of traditional risk factors, may prove beneficial for the early identification and intervention of individuals at high risk of CVD. In regions with limited healthcare resources, among individuals with limited ability to access, process, and understand health information and services, cumulative eGDR may offer improved clinical applicability.

Association of cumulative health status with subsequent mortality in patients with acute heart failure

AIMS

We aim to examine the association between long-term cumulative health status and subsequent mortality among patients with acute heart failure (HF).

METHODS AND RESULTS

Based on a national prospective cohort study of patients hospitalized for HF, we measured health status by Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 at four time points, i.e. admission and 1, 6 and 12 months after discharge. Cumulative health status was interpreted by cumulative KCCQ-12 score and cumulative times of good health status. Outcomes included subsequent all-cause and cardiovascular mortality. Multivariable Cox proportional hazard models were performed to examine the association between cumulative health status and subsequent mortality. Totally, 2328 patients {36.7% women with median age 66 [interquartile range (IQR): 56-75] years} were included, and the median follow-up was 4.34 (IQR: 3.93-4.96) years. Compared with quartile 4, the lowest quartile 1 had the highest hazard ratio (HR) for all-cause mortality [2.96; 95% confidence interval (CI): 2.26-3.87], followed by quartile 2 (1.79; 95% CI: 1.37-2.34) and quartile 3 (1.62; 95% CI: 1.23-2.12). Patients with zero times of good health status had the highest risk of all-cause mortality (HR: 2.41, 95% CI: 1.69-3.46) compared with patients with four times of good health status. Similar associations persisted for cardiovascular mortality.

CONCLUSION

A greater burden of cumulative health status indicated worse survival among patients hospitalized for HF. Repeated KCCQ measurements could be helpful to monitor long-term health status and identify patients vulnerable to death.

Association between loneliness and incident atrial fibrillation across different genetic predisposition: findings from the UK Biobank

BACKGROUND

Loneliness has garnered significant attention globally, with extensive exploration of its association with cardiovascular disease. However, a notable research gap persists concerning loneliness and its potential link to atrial fibrillation (AF).

METHODS

This prospective cohort study utilized data from the UK Biobank (UKB), encompassing 441,056 participants. Loneliness was assessed through self-reported questionnaires gauging feelings of isolation and willingness to confide. AF diagnoses were ascertained using hospitalization records and cause-of-death registry data. The association between loneliness and AF risk was analyzed through multivariable Cox proportional hazard models.

RESULTS

Over a median follow-up period of 13.9 years, 25,386 AF cases were identified. In comparison to individuals without reported loneliness, those in the loneliness group exhibited a significantly higher risk of AF (loneliness vs. non-loneliness: hazard ratio [HR]: 1.11, 95% confidence interval [CI] 1.07-1.16). Subgroup analysis revealed that the association between loneliness and increased AF risk was significant solely in individuals without heart valve disease (HR: 1.12, 95% CI 1.07-1.16). Additionally, significant associations between loneliness and heightened AF risk were noted across strata of genetic susceptibility to AF, with no observable impact on these associations by genetic susceptibility (P for interaction = 0.070).

CONCLUSIONS

This study establishes a robust association between loneliness and an elevated long-term risk of AF. Notably, this association is particularly pronounced in individuals without valvular disease and does not appear to be influenced by genetic predisposition to AF.

Associations of cumulative depressive symptoms within 1-year of discharge with subsequent mortality among patients hospitalized for acute heart failure: Findings from The China PEACE Prospective Heart Failure Study

BACKGROUND

To examine the associations between cumulative depressive symptoms and subsequent mortality among patients hospitalized for acute hear failure (AHF).

METHODS

By using data from a prospective cohort study of patients with HF, depressive symptoms were measured by using Patient Health Questionnaire-2 (PHQ-2) at admission, 1-and 12-month after discharge. Cumulative depressive symptoms were interpreted by cumulative PHQ-2 score and cumulative times of depressive symptoms. Outcomes included subsequent 3-year all-cause and cardiovascular mortality.

RESULTS

We included 2347 patients with the median follow-up of 4.4 (interquartile range [IQR]: 4.0-5.0) years. Tertile 3 of cumulative PHQ-2 score had the highest risk of all-cause (hazard ratio [HR]: 1.47, 95 % confidence interval [CI]: 1.21-1.78) and cardiovascular mortality (HR: 1.51, 95 % CI: 1.21-1.89) compared with Tertile 1; patients with≥2 times of depressive symptoms had the highest risk of all-cause (HR: 1.62, 95 % CI: 1.31-2.00) and cardiovascular mortality (HR: 1.60, 95 % CI: 1.25-2.05) compared with patients without any depressive symptom. Cumulative PHQ-2 score provided the highest level of incremental prognostic ability in predicting the risk of all-cause (C-statistics: 0.64, 95 % CI: 0.62-0.66) and cardiovascular mortality (C-statistics: 0.65, 95 % CI: 0.62-0.67) on the basis of Get With The Guidelines-Heart Failure score.

CONCLUSION

Cumulative depressive symptoms were associated with the increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with HF. Repeated depressive symptom measurements could be helpful to monitor long-term depressive symptoms, identify targeted patients and perform psychological interventions and social support to improve clinical outcomes among patients with AHF.

Comparison of the 10-, 14- and 20-Item CES-D Scores as Predictors of Cognitive Decline

The association between depressive symptomatology and cognitive decline has been examined using the Centre for Epidemiologic Studies-Depression Scale (CES-D); however, concerns have been raised about this self-report measure. Here, we examined how the CES-D total score from the 14- and 10-item versions compared to the 20-item version in predicting progression to cognitive decline from a cognitively unimpaired baseline. Data from 1054 participants were analysed using ordinal logistic regression, alongside moderator and receiver-operating characteristics curve analyses. All baseline total scores significantly predicted progression to cognitive decline. The 14-item version was better than the 20-item version in predicting consensus diagnosis, as shown by their AICs, while also showing the highest accuracy when discriminating between participants by diagnosis at last visit. We did not find sex to moderate the relationship between CES-D score and cognitive decline. Current findings suggest the 10- and 14-item versions of the CES-D are comparable to the 20-item version, and that the 14-item version may be better at predicting longitudinal consensus diagnosis compared to the 20-item version.

[An Investigation of the Cumulative Effects of Depressive Symptoms on the Cognitive Function in Community-Dwelling Older Adults: Analysis of the Korean Longitudinal Study of Aging]

PURPOSE

This study investigated the cumulative effects of depressive symptoms on cognitive function over time in community-dwelling older adults.

METHODS

Data were investigated from 2,533 community-dwelling older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) from the 5th (2014) to the 8th wave (2020). The association between cumulative depressive symptoms and cognitive function was identified through multiple regression analysis.

RESULTS

When the multiple regression analysis was conducted from each wave, the current depressive symptoms scores and cognitive function scores were negatively associated, regardless of the waves (B5th = -0.26, B6th = -0.26, B7th = -0.26, and B8th = -0.27; all p < .001). Further, when all the previous depressive symptoms scores were added as explanatory variables in the 8th wave, the current one (B8th = -0.09, p < .001) and the previous ones (B5th = -0.11, B6th = -0.09, and B7th = -0.13; all p < .001) were also negatively associated with the cognitive function score. The delta R², which indicates the difference between the model's R² with and without the depressive symptoms scores, was greater in the model with all the previous and current depressive symptoms scores (6.4%) than in the model with only the current depressive symptoms score (3.6%).

CONCLUSION

Depressive symptoms in older adults have a long-term impact. This results in an accumulated adverse effect on the cognitive function. Therefore, to prevent cognitive decline in older adults, we suggest detecting their depressive symptoms early and providing continuous intervention to reduce exposure to long-term depressive symptoms.

Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs)

Background

The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores.

Methods

We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment.

Findings

IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment.

Interpretation

We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes.

Funding

National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).