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Schuurmans IK, Hoepel SJW, Cecil CAM, Hillegers MHJ, Ikram MA, Luik AI. The Association of Life Stress with Subsequent Brain and Cognitive Reserve in Middle-Aged Women. J Alzheimers Dis 2023; 93:97-106. [PMID: 36938734 DOI: 10.3233/jad-220923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Cognitive and brain reserve refer to individual differences that allow some people to better withstand brain pathology than others. Although early life stress has been recognized as a risk factor for low reserve in late life, no research yet has studied this across midlife. OBJECTIVE To examine the associations of life stress with brain and cognitive reserve in midlife. METHODS We included 1,232 middle-aged women who participated in the ORACLE Study between 2002-2006). Life stress was calculated as the shared variance of four cumulative stress domains, created from items measured between pregnancy and 10 years after childbirth. Brain reserve was defined as healthy-appearing brain volume measured with MRI; cognitive reserve as better cognitive functioning than expected based on age, education, and brain MRI measures, using structural equation modelling. RESULTS More life stress was associated with lower brain (standardized adjusted difference: -0.18 [95% CI 0.25,-0.12]) and cognitive reserve (-0.19 [-0.28,-0.10]). Although, effect sizes were typically smaller, cumulative stress domains were also associated with brain reserve (life events: -0.10 [-0.16,-0.04]; contextual stress: -0.13 [-0.19,-0.07]; parenting-related stress: -0.13[-0.19,-0.07]; interpersonal stress: -0.10 [-0.16,-0.04]) and cognitive reserve (life events: -0.18 [-0.25,-0.11]; contextual stress: -0.15 [-0.10,-0.02]; parenting-related stress: -0.10 [-0.18,-0.03]; interpersonal stress not significant). CONCLUSION Women who experience more life stress in midlife were found to have lower reserve. Effects were primarily driven by shared variance across cumulative stress domains, suggesting that focusing on single domains may underestimate effects. The effect of life stress on lower reserve may make women with stress more prone to neurodegenerative disease later in life than women without stress.
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Affiliation(s)
- Isabel K Schuurmans
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sanne J W Hoepel
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Charlotte A M Cecil
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Biomedical Data Sciences, Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Zijlmans JL, Riemens MS, Vernooij MW, Ikram MA, Luik AI. Sleep, 24-Hour Activity Rhythms, and Cognitive Reserve: A Population-Based Study. J Alzheimers Dis 2023; 91:663-672. [PMID: 36463444 PMCID: PMC9912716 DOI: 10.3233/jad-220714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND The cognitive reserve hypothesis aims to explain individual differences in susceptibility to the functional impact of dementia-related pathology. Previous research suggested that poor subjective sleep may be associated with a lower cognitive reserve. OBJECTIVE The objective was to investigate if actigraphy-estimated sleep and 24-hour activity rhythms are associated with cognitive reserve. METHODS This cross-sectional study included 1,002 participants from the Rotterdam Study (mean age: 65.0 years, standard deviation (SD): 7.1) who were assessed with actigraphy, five cognitive tests, and brain-MRI between 2009- 2014. Sleep and 24-hour activity rhythms were measured using actigraphy (mean days: 6.7, SD: 0.5). Cognitive reserve was defined as a latent variable that captures variance across cognitive tests, while adjusting for age, sex, education, total brain volume, intracranial volume, and white matter hyperintensity volume. Associations of sleep and 24-hour activity rhythms with cognitive reserve were assessed using structural equation models. RESULTS Longer sleep onset latency (adjusted mean difference: - 0.16, 95% CI: - 0.24; - 0.08) and lower sleep efficiency (0.14, 95% CI: 0.05; 0.22) were associated with lower cognitive reserve. Total sleep time and wake after sleep onset were not significantly associated with cognitive reserve. After mutual adjustment, only the association of longer sleep onset latency remained significant (- 0.12, 95% CI: - 0.20; - 0.04). The 24-hour activity rhythm was not significantly associated with cognitive reserve. CONCLUSION In conclusion, our study suggests that longer sleep onset latency is particularly associated with lower cognitive reserve. Future longitudinal work is needed to assess whether shortening the sleep onset latency could enhance cognitive reserve, in order to limit the susceptibility to the functional impact of dementia-related pathology.
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Affiliation(s)
- Jend L. Zijlmans
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Mariska S. Riemens
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands,
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Annemarie I. Luik
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands,Correspondence to: Annemarie I. Luik, Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Tel.: +31 10 703 21 83; E-mail:
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3
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Zijlmans JL, Vernooij MW, Ikram MA, Luik AI. The role of cognitive and brain reserve in late-life depressive events: The Rotterdam Study. J Affect Disord 2023; 320:211-217. [PMID: 36183828 DOI: 10.1016/j.jad.2022.09.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cognitive and brain reserve aim to explain individual differences in susceptibility to dementia and may also affect the risk of late-life depressive events. We assessed whether higher cognitive and brain reserve are associated with lower risk of a late-life depressive event. METHODS This study included 4509 participants from the population-based Rotterdam Study (mean age: 63.4 ± 10.2 years, 55 % women) between 2005 and 2019. Participants completed cognitive testing and brain-MRI at baseline. Cognitive reserve was defined as the common variance across cognitive tests, while adjusting for demographic factors and brain MRI-markers. Brain reserve was defined as total brain volume divided by intracranial volume. Depressive events (depressive symptoms/depressive syndrome/major depressive disorder) were repeatedly measured (follow-up: 6.6 ± 3.9 years) with validated questionnaires, clinical interviews, and follow-up of medical records. Hazard ratios (HR) with 95 % confidence intervals (CI) were estimated using Cox-regressions. RESULTS Higher cognitive (HR: 0.91/SD, 95%CI: 0.84; 1.00) and brain reserve (HR: 0.88/SD, 95%CI: 0.77; 1.00) were associated with a lower risk of a depressive event after adjustment for baseline depressive symptoms. These associations attenuated when participants with clinically relevant depressive symptoms at baseline were excluded (HR: 0.95/SD, 95%CI: 0.86; 1.05, HR: 0.89/SD, 95%CI: 0.76; 1.03, respectively). LIMITATIONS No data was available on depression in early-life and the number of participants with major depressive disorder was relatively low (n = 105). CONCLUSIONS Higher cognitive and brain reserve may be protective factors for late-life depressive events, particularly in those who have experienced clinical relevant depressive symptoms before. Further research is needed to determine whether cognitive and brain reserve could be used as targets for the prevention of late-life depression.
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Affiliation(s)
- Jendé L Zijlmans
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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Zijlmans JL, Lamballais S, Vernooij MW, Ikram MA, Luik AI. Sociodemographic, Lifestyle, Physical, and Psychosocial Determinants of Cognitive Reserve. J Alzheimers Dis 2021; 85:701-713. [PMID: 34864674 PMCID: PMC8842775 DOI: 10.3233/jad-215122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive reserve aims to explain individual differences in the susceptibility to the functional impact of dementia in the presence of equal amount of neuropathological damage. It is thought to be shaped by a combination of innate individual differences and lifetime exposures. Which determinants are associated with cognitive reserve remains unknown. OBJECTIVE The objective of this study was to investigate the associations of sociodemographic, lifestyle, physical, and psychosocial determinants with cognitive reserve, and potential sex differences. METHODS This cross-sectional study included 4,309 participants from the Rotterdam Study (mean age 63.9±10.7) between 2006-2016. Participants completed five cognitive tests and a brain MRI-scan. Cognitive reserve was defined as a latent variable that captures variance common across five cognitive tests, while adjusting for demographic and MRI-inferred neuropathological factors. The associations of potential determinants and cognitive reserve, adjusted for relevant confounders, were assessed with structural equation models. RESULTS Current smoking (adjusted mean difference: -0.31, 95%confidence interval -0.42; -0.19), diabetes mellitus (-0.25, -0.40; -0.10) and depressive symptoms (-0.07/SD, -0.12; -0.03) were associated with a lower cognitive reserve whereas alcohol use (0.07/SD, 0.03; 0.12) was associated with higher cognitive reserve. Only smoking was associated with cognitive reserve in both men and women. Employment, alcohol use, diabetes, history of cancer, COPD, and depressive symptoms were only associated with cognitive reserve in women. CONCLUSION Our study found that current smoking, diabetes mellitus, and depressive symptoms were associated with a lower cognitive reserve, whereas more alcohol use was associated with a higher cognitive reserve, but with clear differences between men and women.
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Affiliation(s)
- Jendé L Zijlmans
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Sander Lamballais
- Department of Clinical Genetics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.,Department of Radiology and nuclear medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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Villa AR, Guerrero E, Villa AM, Sánchez-Arenas R, Ortiz-Rodríguez MA, Contreras-Sánchez V, Alonso-Catalán M, Guerrero-López B, Vargas-Huicochea I, Fajardo-Dolci GE, Díaz-Olavarrieta C. The Paradoxical Effect of Living Alone on Cognitive Reserve and Mild Cognitive Impairment among Women Aged 60+ in Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010939. [PMID: 34682684 PMCID: PMC8535294 DOI: 10.3390/ijerph182010939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 12/27/2022]
Abstract
An elderly person who lives alone must often be autonomous and self-sufficient in daily living activities. We explored if living alone and marital status were associated with mild cognitive impairment and low cognitive reserve in a sample of Mexican women aged 60+ attending continuing education courses using a cross-sectional design. Objective cognitive functions were assessed using the MMSE and Blessed Dementia Scale. We administered the Cognitive Reserve Questionnaire. Independence skills were assessed with the Katz index and Lawton index. Multivariate logistic regression analysis was used. We recruited 269 participants (x¯ = 69.0 ± 5.8 years). Single, widowed, separated, and divorced women comprised 73% of the participants. A third lived alone and 84% had completed high school. Mild cognitive deficit was observed among 24.5–29.0%; the upper range for cognitive reserve was 61.7%. Living alone versus living with someone was associated with cognitive impairment (OR = 0.51, p = 0.04) and with low to medium cognitive reserve (OR = 0.51, p = 0.02) after adjusting for confounding variables. Living alone was an independent factor associated with a lower probability of displaying mild cognitive impairment and a higher probability of displaying high cognitive reserve. Women living alone in this study had a more robust cognitive framework and had built their own support networks.
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Affiliation(s)
- Antonio R. Villa
- Research Division, Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico; (A.R.V.); (A.M.V.)
| | - Elsa Guerrero
- University Program of Health Research, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico;
| | - Ana M. Villa
- Research Division, Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico; (A.R.V.); (A.M.V.)
| | - Rosalinda Sánchez-Arenas
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Mexico City 06720, Mexico;
| | | | - Vania Contreras-Sánchez
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico; (V.C.-S.); (M.A.-C.); (B.G.-L.); (I.V.-H.)
| | - María Alonso-Catalán
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico; (V.C.-S.); (M.A.-C.); (B.G.-L.); (I.V.-H.)
| | - Benjamín Guerrero-López
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico; (V.C.-S.); (M.A.-C.); (B.G.-L.); (I.V.-H.)
| | - Ingrid Vargas-Huicochea
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico; (V.C.-S.); (M.A.-C.); (B.G.-L.); (I.V.-H.)
| | - Germán E. Fajardo-Dolci
- Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico;
| | - Claudia Díaz-Olavarrieta
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, 3000 Ave. Universidad, Copilco Universidad, Coyoacán, Mexico City 04510, Mexico; (V.C.-S.); (M.A.-C.); (B.G.-L.); (I.V.-H.)
- Correspondence:
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Lamballais S, Zijlmans JL, Vernooij MW, Ikram MK, Luik AI, Ikram MA. The Risk of Dementia in Relation to Cognitive and Brain Reserve. J Alzheimers Dis 2021; 77:607-618. [PMID: 32741820 PMCID: PMC7592692 DOI: 10.3233/jad-200264] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Individual differences in the risk to develop dementia remain poorly understood. These differences may partly be explained through reserve, which is the ability to buffer cognitive decline due to neuropathology and age. Objective: To determine how much early and late–life cognitive reserve (CR) and brain reserve (BR) contribute to the risk of dementia. Methods: 4,112 dementia-free participants (mean age = 66.3 years) from the Rotterdam Study were followed up for on average 6.0 years. Early-life CR and BR were defined as attained education and intracranial volume, respectively. Late-life CR was derived through variance decomposition based on cognition. Late-life BR was set as the total non-lesioned brain volume divided by intracranial volume. Results: Higher early-life CR (hazard ratio = 0.48, 95% CI = [0.21; 1.06]) but not early-life BR associated with a lower risk of incident dementia. Higher late-life CR (hazard ratio = 0.57, 95% CI = [0.48; 0.68]) and late-life BR (hazard ratio = 0.54, 95% CI = [0.43; 0.68]) also showed lower levels of dementia. Combining all proxies into one model attenuated the association between early-life CR and dementia (hazard ratio = 0.56, 95% CI = [0.25; 1.25]) whereas the other associations were unaffected. These findings were stable upon stratification for sex, age, and APOEɛ4. Finally, high levels of late-life CR and BR provided additive protection against dementia. Conclusion: The findings illustrate the importance of late-life over early-life reserve in understanding the risk of dementia, and show the need to study CR and BR conjointly.
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Affiliation(s)
- Sander Lamballais
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Jendé L Zijlmans
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands
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The interaction of cognitive and brain reserve with frailty in the association with mortality: an observational cohort study. THE LANCET HEALTHY LONGEVITY 2021; 2:e194-e201. [DOI: 10.1016/s2666-7568(21)00028-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
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Cognitive Reserve, Alzheimer's Neuropathology, and Risk of Dementia: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2021; 31:233-250. [PMID: 33415533 PMCID: PMC7790730 DOI: 10.1007/s11065-021-09478-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/03/2021] [Indexed: 01/06/2023]
Abstract
Cognitive reserve (CR) may reduce the risk of dementia. We summarized the effect of CR on progression to mild cognitive impairment (MCI) or dementia in studies accounting for Alzheimer's disease (AD)-related structural pathology and biomarkers. Literature search was conducted in Web of Science, PubMed, Embase, and PsycINFO. Relevant articles were longitudinal, in English, and investigating MCI or dementia incidence. Meta-analysis was conducted on nine articles, four measuring CR as cognitive residual of neuropathology and five as composite psychosocial proxies (e.g., education). High CR was related to a 47% reduced relative risk of MCI or dementia (pooled-hazard ratio: 0.53 [0.35, 0.81]), with residual-based CR reducing risk by 62% and proxy-based CR by 48%. CR protects against MCI and dementia progression above and beyond the effect of AD-related structural pathology and biomarkers. The finding that proxy-based measures of CR rivaled residual-based measures in terms of effect on dementia incidence underscores the importance of early- and mid-life factors in preventing dementia later.
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Smith PJ. Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition. Brain Plast 2019; 5:3-38. [PMID: 31970058 PMCID: PMC6971820 DOI: 10.3233/bpl-190083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) represent an increasingly urgent public health concern, with an increasing number of baby boomers now at risk. Due to a lack of efficacious therapies among symptomatic older adults, an increasing emphasis has been placed on preventive measures that can curb or even prevent ADRD development among middle-aged adults. Lifestyle modification using aerobic exercise and dietary modification represents one of the primary treatment modalities used to mitigate ADRD risk, with an increasing number of trials demonstrating that exercise and dietary change, individually and together, improve neurocognitive performance among middle-aged and older adults. Despite several optimistic findings, examination of treatment changes across lifestyle interventions reveals a variable pattern of improvements, with large individual differences across trials. The present review attempts to synthesize available literature linking lifestyle modification to neurocognitive changes, outline putative mechanisms of treatment improvement, and discuss discrepant trial findings. In addition, previous mechanistic assumptions linking lifestyle to neurocognition are discussed, with a focus on potential solutions to improve our understanding of individual neurocognitive differences in response to lifestyle modification. Specific recommendations include integration of contemporary causal inference approaches for analyzing parallel mechanistic pathways and treatment-exposure interactions. Methodological recommendations include trial multiphase optimization strategy (MOST) design approaches that leverage individual differences for improved treatment outcomes.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences (Primary), Duke University Medical Center, NC, USA
- Department of Medicine (Secondary), Duke University Medical Center, NC, USA
- Department of Population Health Sciences (Secondary), Duke University, NC, USA
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Lerner AJ, Pieper AA. Neurotherapeutics of the Aging Brain: Complexity Meets Complexity. Neurotherapeutics 2019; 16:539-542. [PMID: 31290090 PMCID: PMC6694363 DOI: 10.1007/s13311-019-00757-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Alan J. Lerner
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH USA
- Department of Neurology, Case Western Reserve University, 3619 Park east Drive, suite 206, Beachwood, OH 44122 USA
| | - Andrew A. Pieper
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH USA
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH USA
- Geriatric Research and Education and Clinical Center, Louis Stokes Cleveland VAMC, Cleveland, OH 44106 USA
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