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Ning Y, Guo J, Pan D, Wu S, Song L, Wang C, Guo J, Gao X, Zhang J, Guo L, Gu Y. The Effects of Carotid Revascularization on 1-Year Cognitive Performance in Patients With Carotid Artery Stenosis. J Endovasc Ther 2024:15266028241252007. [PMID: 38733298 DOI: 10.1177/15266028241252007] [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: 05/13/2024]
Abstract
PURPOSE The impact of carotid revascularization on cognitive function for patients with severe carotid artery stenosis remains uncertain. This study is aimed to investigate the 1-year neurocognitive outcomes of patients who accept carotid revascularization and identify the risk factors associated with postoperative cognitive decline. METHODS From April 2019 to April 2021, patients with ≥70% carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Logistic regression analysis was built to identify potential risk factors for postoperative long-term cognitive decline. RESULTS A total of 89 patients who met the criteria were enrolled and completed 1-year follow-up. At 3, 6, and 12 months after carotid revascularization, the total MoCA score, attention, language fluency, and delayed recall score were significantly improved compared with the baseline scores (p<0.05). At 12 months, there was also a significant improvement in cube copying compared with baseline (p=0.034). Logistic regression analysis showed that the advancing age, left side, and symptomatic carotid artery stenosis were independent risk factors for cognitive deterioration at 12 months after surgery. CONCLUSIONS Overall, carotid revascularization has a beneficial effect on cognition function in patients with severe carotid artery stenosis, while advancing age, left side, and symptomatic carotid artery stenosis were significantly related to a decreased cognitive score after carotid revascularization. CLINICAL IMPACT This study focused on the changes in cognitive function within 1 year after carotid revascularization in patients with severe carotid stenosis. Of course, carotid revascularization can improve the cognition function in these patients. On the other hand, we found the advancing age, left side and symptomatic carotid artery stenosis were significantly associated with decreased cognitive scores at 1 year after carotid revascularization, which suggests that clinicians may need to be aware of patients with these characteristics.
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Affiliation(s)
- Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Dikang Pan
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Sensen Wu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lipo Song
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Xixiang Gao
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
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Jelaska J, Vučković M, Gugić Ordulj I, Kolak E, Šolić Šegvić L, Đapić Kolak Z, Keser I, Radić J. Unlocking Cognitive Potential: Association of Sarcopenia and Mediterranean Diet on Cognitive Function in Community-Dwelling Elderly of the Dalmatian Region. Nutrients 2024; 16:991. [PMID: 38613024 PMCID: PMC11013823 DOI: 10.3390/nu16070991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
The aim of this study was to determine the association between muscle strength, adherence to the Mediterranean diet (MeDi) and cognitive function in community-dwelling elderly. General data, data of body composition and anthropometric parameters, clinical and laboratory findings, cognitive test questionnaires (Mini-Mental State Examination-MMSE, Trail Making Test-TMT, Symbol Digit Modalities Test-SDMT), and nutritional assessments (Mini Nutritional Assessment-MNA, Mediterranean Diet Serving Score-MDSS) were obtained for each study participant. Handgrip strength (HS) was used as one of the key parameters for defining probable sarcopenia, among the Short Physical Performance Battery test (SPPB) (for defining physical activity) and the strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire (SARC-F). Our cross-sectional study involved 114 participants aged ≥ 60 years, and two-thirds of the participants were female (76.3% vs. 23.7%). Probable sarcopenia was found in 34.7% of them. Using bivariate regression analysis, cognitive deficit among the sarcopenic population was associated with the following groups of collected data: (a) sociodemographic-associated factors-advanced age (OR: 1.07; p = 0.004), single marital status (OR: 3.25; p = 0.03), and low level of education (OR: 0.22; p < 0.003); (b) behavioral-associated factors-duration of institutionalization (OR: 1.05; p = 0.007), performance of heavy physical work (OR: 6.26; p = 0.001), low physical activity (OR: 0.08; p = 0.002), and risk of malnutrition (OR: 3.87; p = 0.005); (c) disease-related factors-loss of appetite (OR: 2.24; p = 0.04), information processing speed (OR: 0.88; p < 0.001), blood pressure systolic/diastolic variables (OR: 0.96/0.96; p = 0.002/0.02), medications (OR: 1.19; p = 0.005), predictive sarcopenia score ≥ 4 (OR: 3.1; p = 0.003), and low muscle strength (OR: 0.92; p = 0.002). Cognitive preservation among the sarcopenic population was associated with married status (OR: 0.23; p = 0.20), a high level of education (OR: 0.18; p = 0.002), smoking (OR: 0.33; p = 0.02), high physical activity (OR: 0.07; p < 0.001), and dietary habits using poultry (OR: 0.12; p = 0.004). The results suggest a significant association between sarcopenia and cognitive function in community-dwelling elderly, highlighting the need for regular nutritional interventions in this special population.
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Affiliation(s)
- Julija Jelaska
- Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (J.J.); (I.G.O.)
| | - Marijana Vučković
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia; (M.V.); (L.Š.Š.)
| | - Ivana Gugić Ordulj
- Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (J.J.); (I.G.O.)
| | - Ela Kolak
- Nutrition and Dietetics Department, University Hospital of Split, 21000 Split, Croatia;
| | - Lucija Šolić Šegvić
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia; (M.V.); (L.Š.Š.)
| | | | - Irena Keser
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia;
| | - Josipa Radić
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia; (M.V.); (L.Š.Š.)
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
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Shang Y, Guo Y, Wei C, Zhou B, Xie H. A comparison of the diagnostic accuracy of the Mini-Cog and AD8 in identifying cognitive impairment in a geriatric health screening population in China. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:69-76. [PMID: 34672895 DOI: 10.1080/23279095.2021.1991930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study aimed to evaluate and compare the discriminative abilities of the Mini-Cog and AD8 tests in detecting cognitive impairment in a Chinese health screening population. 160 geriatric participants were enrolled at an academic medical center . The Mini-Cog, AD8, and Mini-Mental State Examination (MMSE) were used to assess the possibility of cognitive impairment. Logistic regression and receiver operator characteristic curve analyses were performed to evaluate the discriminative abilities of the tests. The prevalence of cognitive impairment was 41.25%. Logistic regression modeling showed that the Mini-Cog (odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.25-0.46) and MMSE (OR = 0.58, 95%CI: 0.49-0.69) predicted cognitive impairment with 79.4% and 80.6% correct classification, respectively. While the AD8 (OR = 1.56, 95% CI: 1.32-1.85) predicted cognitive impairment with 72.5% correct classification. The areas under the receiver operating characteristic curves of the Mini-Cog, AD8 and MMSE for detecting cognitive impairment were 0.79 (95% CI: 0.72-0.85), 0.66 (95% CI: 0.58-0.73) and 0.80 (95% CI: 0.73-0.86). Both sensitivity and specificity of the Mini-Cog were superior to those of the AD8 (sensitivity 78.79% vs. 56.06%; specificity 79.79% vs. 75.53%). Cognitive screening is crucial to maintain the quality of life of older adults. Compared with the AD8, the Mini-Cog test is a more effective tool for screening cognitive impairment in older adults.
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Affiliation(s)
- Yanchang Shang
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yane Guo
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Chao Wei
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bo Zhou
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hengge Xie
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Nakagawa T. Advances in cross-national comparisons of cognitive ageing. THE LANCET. HEALTHY LONGEVITY 2023; 4:e526-e527. [PMID: 37804840 DOI: 10.1016/s2666-7568(23)00192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Takeshi Nakagawa
- Research Institute, National Center for Geriatrics and Gerontology, Aichi, 474-8511, Japan.
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Scheffels JF, Ballasch I, Scheichel N, Voracek M, Kalbe E, Kessler J. The Influence of Age, Gender and Education on Neuropsychological Test Scores: Updated Clinical Norms for Five Widely Used Cognitive Assessments. J Clin Med 2023; 12:5170. [PMID: 37629212 PMCID: PMC10455991 DOI: 10.3390/jcm12165170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Sociodemographic effects (i.e., age, gender, education) have been shown to influence neuropsychological test scores. The current retrospective, quasi-epidemiological work provides age-, gender- and education-corrected clinical norms for five common cognitive assessments. METHODS In total, test scores of 4968 patients from the University Hospital of Cologne (Department of Neurology), recruited between 2009 and 2020, were analyzed retrospectively. Conducted tests were the Mini-Mental State Examination (MMSE), F-A-S Test (FAS), Rey-Osterrieth Complex Figure Test (ROCFT) and Trail Making Test, Part A and B (TMT-A/-B). Using multiple linear regression analyses, test scores were analyzed for sociodemographic influences (age, gender, education). Based on these analyses, norms were generated by first separating patients into different age groups stratified by educational level and (if necessary) gender. Subsequently, percentile ranks and z-scores for a subsample including only individuals without dementia were calculated. RESULTS Lower age and higher educational level predicted better test scores (MMSE, FAS, ROCFT) and completion times (TMT-A/-B). Additionally, produced words on the FAS and remembered drawings from the ROCFT were influenced by gender, with females having better FAS but lower ROCFT (delayed recall) scores than males. Considering these effects, clinical norms were provided for the five cognitive assessments. CONCLUSIONS We found influences of age, gender and education on test scores, although they are frequently not or only partially considered for test score interpretation. With the provided norms, neuropsychologists can make more profound evaluations of cognitive performance. A user-friendly Microsoft Excel file is offered to assist this process.
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Affiliation(s)
| | - Isabell Ballasch
- Department of Medical Psychology, Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Nadine Scheichel
- Department of Medical Psychology, Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Martin Voracek
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Josef Kessler
- Department of Medical Psychology, Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
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Cadar D, Brocklebank L, Yan L, Zhao Y, Steptoe A. Socioeconomic and Contextual Differentials in Memory Decline: A Cross-Country Investigation Between England and China. J Gerontol B Psychol Sci Soc Sci 2023; 78:544-555. [PMID: 36625075 PMCID: PMC9985334 DOI: 10.1093/geronb/gbac163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Although cognitive functioning is strongly associated with biological changes in the brain during the aging process, very little is known about the role of sociocultural differentials between the western and eastern parts of the world. We examined the associations between individual socioeconomic markers (e.g., education, household wealth) and contextual levels characteristics (e.g., urbanicity) with memory performance and memory decline over up to 8 years of follow-up in England and China. METHODS The analytical samples included participants aged 50+ from the English Longitudinal Study of Aging (n = 6,687) and the China Health and Retirement Longitudinal Study (n = 10,252). Mixed linear models were employed to examine the association between baseline individual socioeconomic markers (education, wealth) and contextual-level characteristics (urbanicity) on the change in memory over time. RESULTS Our analyses showed that higher education and wealth were associated with better baseline memory in both England and China. Still, the impact of contextual-level characteristics such as urbanicity differed between the 2 countries. For English individuals, living in a rural area showed an advantage in memory, while the opposite pattern was observed in China. Memory decline appeared to be socioeconomically patterned by higher education, wealth, and urbanicity in China but not in England. DISCUSSION Our findings highlight substantial socioeconomic and contextual inequity in memory performance in both England and China, as well as in the rate of memory decline primarily in China. Public health strategies for preventing memory decline should target the socioeconomic gaps at the individual and contextual levels to protect those particularly disadvantaged.
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Affiliation(s)
- Dorina Cadar
- Centre for Dementia Studies, Department of Neuroscience, Brighton and Sussex Medical School, Sussex, UK
- Department of Primary Care, Brighton and Sussex Medical School, Sussex, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Laura Brocklebank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Li Yan
- National School of Development, Peking University, Beijing, China
| | - Yaohui Zhao
- National School of Development, Peking University, Beijing, China
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
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Haberstumpf S, Leinweber J, Lauer M, Polak T, Deckert J, Herrmann MJ. Factors associated with dropout in the longitudinal Vogel study of cognitive decline. Eur J Neurosci 2022; 56:5587-5600. [PMID: 34490950 DOI: 10.1111/ejn.15446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
Dementia, including Alzheimer's disease, is a growing problem worldwide. Prevention or early detection of the disease or a prodromal cognitive decline is necessary. By means of our long-term follow-up 'Vogel study', we aim to predict the pathological cognitive decline of a German cohort (mean age was 73.9 ± 1.55 years at first visit) with three measurement time points within 6 years per participant. Especially in samples of the elderly and subjects with chronic or co-morbid diseases, dropouts are one of the biggest problems of long-term studies. In contrast to the large number of research articles conducted on the course of dementia, little research has been done on the completion of treatment. To ensure unbiased and reliable predictors of cognitive decline from study completers, our objective was to determine predictors of dropout. We conducted multivariate analyses of covariance and multinomial logistic regression analyses to compare and predict the subject's dropout behaviour at the second visit 3 years after baseline (full participation, partial participation and no participation/dropout) with neuropsychiatric, cognitive, blood and lifestyle variables. Lower performance in declarative memory, attention and visual-spatial processing predicted dropout rather than full participation. Lower performance in visual-spatial processing predicted partial participation as opposed to full participation. Furthermore, lower performance in mini-mental status examination predicted whether subjects dropped out or participated partially instead of full participation. Baseline cognitive parameters are associated with dropouts at follow-up with a loss of impaired participants. We expect a bias into a healthier sample over time.
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Affiliation(s)
- Sophia Haberstumpf
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Jonas Leinweber
- Department of Psychotherapy, Alexianer Psychiatric Hospital Köln-Porz, Köln, Germany
| | - Martin Lauer
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Polak
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Jürgen Deckert
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Center for Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
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Handels RL, Green C, Gustavsson A, Herring WL, Winblad B, Wimo A, Sköldunger A, Karlsson A, Anderson R, Belger M, Brück C, Espinosa R, Hlávka JP, Jutkowitz E, Lin P, Mendez ML, Mar J, Shewmaker P, Spackman E, Tafazzoli A, Tysinger B, Jönsson L. Cost‐effectiveness models for Alzheimer's disease and related dementias: IPECAD modeling workshop cross‐comparison challenge. Alzheimers Dement 2022; 19:1800-1820. [PMID: 36284403 PMCID: PMC10126209 DOI: 10.1002/alz.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/14/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The credibility of model-based economic evaluations of Alzheimer's disease (AD) interventions is central to appropriate decision-making in a policy context. We report on the International PharmacoEconomic Collaboration on Alzheimer's Disease (IPECAD) Modeling Workshop Challenge. METHODS Two common benchmark scenarios, for the hypothetical treatment of AD mild cognitive impairment (MCI) and mild dementia, were developed jointly by 29 participants. Model outcomes were summarized, and cross-comparisons were discussed during a structured workshop. RESULTS A broad concordance was established among participants. Mean 10-year restricted survival and time in MCI in the control group ranged across 10 MCI models from 6.7 to 9.5 years and 3.4 to 5.6 years, respectively; and across 4 mild dementia models from 5.4 to 7.9 years (survival) and 1.5 to 4.2 years (mild dementia). DISCUSSION The model comparison increased our understanding of methods, data used, and disease progression. We established a collaboration framework to assess cost-effectiveness outcomes, an important step toward transparent and credible AD models.
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Affiliation(s)
- Ron L.H. Handels
- Maastricht University Department of Psychiatry and Neuropsychology Alzheimer Centre Limburg School for Mental Health and Neurosciences Maastricht The Netherlands
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Colin Green
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Health Economics Group University of Exeter College of Medicine and Health University of Exeter Exeter UK
| | - Anders Gustavsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Quantify Research Hantverkargatan 8 Stockholm Sweden
| | | | - Bengt Winblad
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Anders Wimo
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Anders Sköldunger
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Andreas Karlsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Solna Sweden
| | - Robert Anderson
- Care Policy Evaluation Centre London School of Economics London UK
| | | | - Chiara Brück
- Erasmus MC University Medical Center Department of Public Health Rotterdam The Netherlands
| | | | - Jakub P. Hlávka
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics Los Angeles California USA
| | - Eric Jutkowitz
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
- Providence Veterans Affairs (VA) Medical Center Center of Innovation in Long Term Services and Supports Providence Rhode Island USA
| | - Pei‐Jung Lin
- Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston Massachusetts USA
| | - Mauricio Lopez Mendez
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
| | - Javier Mar
- Osakidetza Basque Health Service Debagoiena Integrated Health Organisation Research Unit Arrasate‐Mondragón Spain
- Biodonostia Health Research Institute Donostia‐San Sebastián Spain
| | - Peter Shewmaker
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
| | - Eldon Spackman
- University of Calgary Department of Community Health Sciences Calgary Canada
- O'Brien Institute of Public Health Alberta Canada
| | | | - Bryan Tysinger
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics Los Angeles California USA
| | - Linus Jönsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- H. Lundbeck A/S Valby Denmark
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Tan NC, Lim JE, Allen JC, Wong WT, Quah JHM, Muthulakshmi P, Teh TA, Lim SH, Malhotra R. Age-Related Performance in Using a Fully Immersive and Automated Virtual Reality System to Assess Cognitive Function. Front Psychol 2022; 13:847590. [PMID: 35360611 PMCID: PMC8963351 DOI: 10.3389/fpsyg.2022.847590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Cognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. The rate of regression varies among the six cognitive domains (perceptual motor, executive function, complex attention, learning and memory, social cognition and language). Current modality of cognitive assessment using neuropsychological paper-and-pencil screening tools for cognitive impairment such as the Montreal Cognitive Assessment (MoCA) has limitations and is influenced by age. Virtual reality (VR) is considered as a potential alternative tool to assess cognition. A novel, fully immersive automated VR system (Cognitive Assessment using Virtual Reality, CAVIRE) has been developed to assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system. Aims This is a feasibility study to evaluate the VR performance of cognitively healthy adults aged between 35 and 74 years old, based on the performance score and completion time using the CAVIRE system. Methods Conducted in a public primary care clinic in Singapore, 25 multi-ethnic Asian adults were recruited in each of the four age groups in years: (1) 35–44; (2) 45–54; (3) 55–64, and (4) 65–74. The eligibility criteria included a MoCA score of 26 or higher to reflect normal cognition and understanding English instructions. They completed common daily activities ranging from brushing teething to shopping, across 13 VR segments. Their performances scores and completion time were automatically computed by the CAVIRE system. These VR performance indices were compared across the four age groups using one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test (p < 0.05). Results One participant dropped out from Group 1. The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups 1 and 2 attained higher VR performance scores and shorter completion time, compared to those in Groups 3 and 4, in all six cognitive domains (all p < 0.05). Conclusion The CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices.
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Affiliation(s)
- Ngiap Chuan Tan
- Duke-NUS Medical School, Singapore, Singapore
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Ngiap Chuan Tan,
| | - Jie En Lim
- SingHealth Polyclinics, Singapore, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Wei Teen Wong
- Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Polyclinics-Outram, SingHealth Polyclinics, Singapore, Singapore
| | - Joanne Hui Min Quah
- Duke-NUS Medical School, Singapore, Singapore
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | | | - Tuan Ann Teh
- Technology Development Centre, Institute of Technical Education College West, Singapore, Singapore
| | - Soon Huat Lim
- Technology Development Centre, Institute of Technical Education College West, Singapore, Singapore
| | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Graham EK, Willroth EC, Weston SJ, Muniz-Terrera G, Clouston SA, Hofer SM, Mroczek DK, Piccinin AM. Coordinated data analysis: Knowledge accumulation in lifespan developmental psychology. Psychol Aging 2022; 37:125-135. [PMID: 35113619 PMCID: PMC8814465 DOI: 10.1037/pag0000612] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Coordinated analysis is a powerful form of integrative analysis, and is well suited in its capacity to promote cumulative scientific knowledge, particularly in subfields of psychology that focus on the processes of lifespan development and aging. Coordinated analysis uses raw data from individual studies to create similar hypothesis tests for a given research question across multiple datasets, thereby making it less vulnerable to common criticisms of meta-analysis such as file drawer effects or publication bias. Coordinated analysis can sometimes use random effects meta-analysis to summarize results, which does not assume a single true effect size for a given statistical test. By fitting parallel models in separate datasets, coordinated analysis preserves the heterogeneity among studies, and provides a window into the generalizability and external validity of a set of results. The current article achieves three goals: First, it describes the phases of a coordinated analysis so that interested researchers can more easily adopt these methods in their labs. Second, it discusses the importance of coordinated analysis within the context of the credibility revolution in psychology. Third, it encourages the use of existing data networks and repositories for conducting coordinated analysis, in order to enhance accessibility and inclusivity. Subfields of research that require time- or resource- intensive data collection, such as longitudinal aging research, would benefit by adopting these methods. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Graciela Muniz-Terrera
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, Scotland, UK,University of Edinburgh, Centre for Dementia Prevention, Edinburgh, Scotland, UK
| | - Sean A.P. Clouston
- Department of Family, Population, and Preventive Medicine; Program in Public Health, University of Stony Brook
| | - Scott M. Hofer
- University of Victoria, Department of Psychology, Victoria, BC, Canada
| | - Daniel K. Mroczek
- Department of Medical Social Sciences, Northwestern University,Department of Psychology, Northwestern University
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11
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Alantie S, Tyrkkö J, Makkonen T, Renvall K. Is Old Age Just a Number in Language Skills? Language Performance and Its Relation to Age, Education, Gender, Cognitive Screening, and Dentition in Very Old Finnish Speakers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:274-291. [PMID: 34929110 DOI: 10.1044/2021_jslhr-21-00178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study reports on how very old (VO) Finnish people without dementia perform in the Western Aphasia Battery (WAB) and two verbal fluency tasks and which demographic factors predict the performance. METHOD The study included fifty 80- to 100-year-old community-dwelling Finnish speakers with no dementing illnesses or speech-language disabilities, who completed the WAB and two verbal fluency tasks. Multifactorial statistical analyses with recursive partitioning were carried out to determine the significant predictors out of five predictor variables (age, gender, education, dentition, and Mini-Mental State Examination [MMSE]) for four response variables (WAB Aphasia Quotient [AQ], Language Quotient [LQ], semantic, and phonemic word fluencies). RESULTS Overall, individual variation was notable in VO speakers. All predictor variables were statistically significantly associated with one or more of the language skills. Age was the most significant predictor; the critical age of 85-86 years was associated with a decline in WAB-AQ and semantic fluency. Poor dentition and the MMSE score both predicted a decline in WAB-LQ and phonemic fluency. A high level of education was positively associated with the skills of the best-performing individuals in WAB-AQ, WAB-LQ, and semantic fluency. CONCLUSIONS VO age is a significant factor contributing to language performance. However, a younger age, a good cognitive performance, intact teeth, and a higher educational level also seem to have a preservative power as regards language skills. Gender differences should be interpreted with caution. The results of this study provide culture- and language-specific normative data, which aids in differentiating typical aging from the signs of acute or degenerative neuropathology to ensure appropriate medical and therapeutic interventions.
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Affiliation(s)
- Sonja Alantie
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
- Speech-Language Pathology, Tampere University Hospital, Finland
| | - Jukka Tyrkkö
- Department of Languages, Linnaeus University, Växjö, Sweden
| | - Tanja Makkonen
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
- Speech-Language Pathology, Tampere University Hospital, Finland
| | - Kati Renvall
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
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12
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Zammit AR, Piccinin AM, Duggan EC, Koval A, Clouston S, Robitaille A, Brown CL, Handschuh P, Wu C, Jarry V, Finkel D, Graham RB, Muniz-Terrera G, Praetorius Björk M, Bennett D, Deeg DJ, Johansson B, Katz MJ, Kaye J, Lipton RB, Martin M, Pederson NL, Spiro A, Zimprich D, Hofer SM. A Coordinated Multi-study Analysis of the Longitudinal Association Between Handgrip Strength and Cognitive Function in Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:229-241. [PMID: 31187137 DOI: 10.1093/geronb/gbz072] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Handgrip strength, an indicator of overall muscle strength, has been found to be associated with slower rate of cognitive decline and decreased risk for cognitive impairment and dementia. However, evaluating the replicability of associations between aging-related changes in physical and cognitive functioning is challenging due to differences in study designs and analytical models. A multiple-study coordinated analysis approach was used to generate new longitudinal results based on comparable construct-level measurements and identical statistical models and to facilitate replication and research synthesis. METHODS We performed coordinated analysis on 9 cohort studies affiliated with the Integrative Analysis of Longitudinal Studies of Aging and Dementia (IALSA) research network. Bivariate linear mixed models were used to examine associations among individual differences in baseline level, rate of change, and occasion-specific variation across grip strength and indicators of cognitive function, including mental status, processing speed, attention and working memory, perceptual reasoning, verbal ability, and learning and memory. Results were summarized using meta-analysis. RESULTS After adjustment for covariates, we found an overall moderate association between change in grip strength and change in each cognitive domain for both males and females: Average correlation coefficient was 0.55 (95% CI = 0.44-0.56). We also found a high level of heterogeneity in this association across studies. DISCUSSION Meta-analytic results from nine longitudinal studies showed consistently positive associations between linear rates of change in grip strength and changes in cognitive functioning. Future work will benefit from the examination of individual patterns of change to understand the heterogeneity in rates of aging and health-related changes across physical and cognitive biomarkers.
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Affiliation(s)
- Andrea R Zammit
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Emily C Duggan
- Department of Psychology, University of Victoria, Canada
| | - Andriy Koval
- Department of Psychology, University of Victoria, Canada
| | - Sean Clouston
- Department of Family, Population and Preventive Medicine, Stony Brook University, New York
| | - Annie Robitaille
- Department of Psychology, Université du Québec à Montréal, Canada
| | | | - Philipp Handschuh
- Department of Developmental Psychology, Institute of Psychology and Education, Ulm University, Germany
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, China.,Department of Epidemiology and Community Health, School of Health Sciences and Practice, New York Medical College, Valhalla.,School of Biological and Population Health Sciences, Oregon State University, Corvallis
| | - Valérie Jarry
- Research Center on Aging, Integrated Academic Health Center and Social Services in the Eastern Townships, Sherbrooke, Canada.,Faculty of Medicine and Health Sciences, University of Sherbrooke, Canada
| | - Deborah Finkel
- Department of Psychology, Indiana University Southeast, New Albany
| | | | | | - Marcus Praetorius Björk
- Department of Psychology, University of Gothenburg, Sweden.,Centre for Ageing and Health, AgeCap, University of Gothenburg, Sweden
| | - David Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Dorly J Deeg
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Boo Johansson
- Department of Psychology, University of Gothenburg, Sweden.,Centre for Ageing and Health, AgeCap, University of Gothenburg, Sweden
| | - Mindy J Katz
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland
| | - Richard B Lipton
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Mike Martin
- Department of Psychology, University of Zurich, Switzerland
| | - Nancy L Pederson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Avron Spiro
- Department of Psychiatry, Boston University School of Medicine, Massachusetts.,Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Department of Veterans Affairs Boston Healthcare System, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Daniel Zimprich
- Department of Developmental Psychology, Institute of Psychology and Education, Ulm University, Germany
| | - Scott M Hofer
- Department of Psychology, University of Victoria, Canada.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
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13
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Cheng Y, Wang YZ, Zhang Y, Wang Y, Xie F, Zhang Y, Wu YH, Guo J, Fei X. Comparative analysis of rowland universal dementia assessment scale and mini-mental state examination in cognitive assessment of traumatic brain injury patients. NeuroRehabilitation 2021; 49:39-46. [PMID: 34057101 DOI: 10.3233/nre-210044] [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: 11/15/2022]
Abstract
BACKGROUND Rowland Universal Dementia Assessment Scale (RUDAS) has demonstrated usefulness in cognitive assessment. Studies supporting the use of RUDAS as an evaluation tool in traumatic brain injury (TBI) patients remain limited. This study examined whether the Chinese version of RUDAS can be effectively applied to the cognitive assessment of TBI patients in China. OBJECTIVE To compare the performance of Mini-Mental State Examination (MMSE) and the Chinese version of RUDAS in the cognitive assessment of Chinese patients with TBI so as to provide reference for clinical use. METHODS 86 inpatients with TBI in a hospital were selected from July 2019 to July 2020 and were enrolled as the TBI group, while another 40 healthy individuals matched with age, sex and education level were selected as the control group. All subjects were assessed by trained rehabilitation physicians with MMSE and RUDAS. RESULTS (1) Compared with the control group, the scores of MMSE and RUDAS in the TBI group decreased significantly; (2) The results of MMSE and RUDAS in the TBI group were positively correlated (r = 0.611, P < 0.001); (3) Linear correlation suggested that age was negatively correlated with MMSE (r = -0.344, P = 0.001) and RUDAS (r = -0.407, P < 0.001), while education years were positively correlated with MMSE (r = 0.367, P = 0.001) and RUDAS (r = 0.375, P < 0.001). However, according to the multiple linear regression, the results of RUDAS were not affected by the years of education; (4) Receiver operating curve analysis showed that there was no significant difference in the areas under the curve between MMSE and RUDAS. The best cut-off values of MMSE and RUDAS were 27.5 and 24.5, respectively. CONCLUSIONS MMSE and RUDAS have similar diagnostic efficacy in evaluating cognitive impairment of patients with TBI. Since the Chinese version of RUDAS is not affected by the education level, it is more suitable for TBI patients in China.
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Affiliation(s)
- Yun Cheng
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yong-Zheng Wang
- Department of Rehabilitation Medicine, People's Hospital of Deyang City, Sichuan, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ya Wang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fan Xie
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jing Guo
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao Fei
- Department of Rehabilitation Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China
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14
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Zahodne LB. Psychosocial Protective Factors in Cognitive Aging: A Targeted Review. Arch Clin Neuropsychol 2021; 36:1266-1273. [PMID: 34244708 DOI: 10.1093/arclin/acab051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The lack of disease-modifying pharmacological agents for dementia highlights the critical importance of prevention, but known modifiable factors (e.g., education, physical health and health behaviors, depression, and social isolation) do not fully represent potential intervention targets. Positive psychosocial factors predict cognitive aging outcomes above and beyond known risk factors and may also correspond to upstream determinants that open up new avenues for prevention and intervention, as well as for reducing racial/ethnic inequalities in dementia. In this brief report, I summarize contemporary evidence for three positive psychosocial factors that appear to be particularly relevant to cognitive aging: perceived control, religious involvement, and social relations. METHODS Targeted review and synthesis of published studies. RESULTS Each of the multidimensional constructs appears to contain "active ingredients" that could help to optimize cognitive aging through disparate mechanisms. Although historically marginalized racial/ethnic groups face disproportionate barriers to accessing certain psychosocial protective factors (e.g., perceived control), these same groups also exhibit naturally occurring sources of psychosocial resilience (e.g., religious involvement) that allow them to achieve better late-life cognitive health than would be otherwise expected. With regard to social relations, converging evidence from disparate studies shows that fostering late-life friendships in particular may have high potential for building cognitive reserve and promoting healthy cognitive aging. CONCLUSIONS Positive psychosocial factors represent culturally relevant resources that, through careful research, could ultimately be harnessed to promote better cognitive aging for a growing and increasingly diverse population of older adults.
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Affiliation(s)
- Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
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15
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Mogle J, Hill NL, Turner JR. Individual Differences and Features of Self-reported Memory Lapses as Risk Factors for Alzheimer Disease Among Adults Aged 50 Years and Older: Protocol for a Coordinated Analysis Across Two Longitudinal Data Sets. JMIR Res Protoc 2021; 10:e25233. [PMID: 33988514 PMCID: PMC8164128 DOI: 10.2196/25233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Increasing evidence has promoted the clinical utility of self-reported memory problems for detecting early impairment associated with Alzheimer disease (AD). However, previous studies investigating memory problems often conflated the types of problems (ie, retrospective and prospective) with their features (ie, frequency and consequences). This bias limits the specificity of traditional measures of memory problems and minimizes their ability to detect differential trajectories associated with cognitive decline. In this study, we use a novel measure of self-reported memory problems that uses daily reports of memory lapses to disentangle types from features for analyzing the impact of each dimension in two longitudinal data sets. Furthermore, this study explores the individual difference factors of age and gender as potential moderators of the relationships between self-reported memory lapses and objective cognitive decline. OBJECTIVE The aim of this study is to describe the protocol for a secondary data analysis project that explores the relationship between experiences of daily memory lapses and their associations with cognitive decline in middle-aged and older adults. METHODS This study uses multilevel, coordinated analyses across two measurement burst data sets to examine the links between features and consequences of memory lapses (retrospective and prospective) and their association with objective cognitive decline. This study's sample (N=392; aged 50-85 years; n=254, 64.8% women) is drawn from two ongoing, nationally funded research studies: The Effects of Stress on Cognitive Aging, Physiology, and Emotion study and the Einstein Aging Study. Both studies assess the daily experience of memory lapses, including the type as well as the emotional and functional outcomes, and objective measures of cognition, such as processing speed and episodic memory. We will use multilevel modeling to test our conceptual model demonstrating that differences in frequency and types of memory lapses show differential trends in their relationships with cognitive decline and that these relationships vary by the age and gender of participants. RESULTS This project was funded in August 2019. The approval for secondary data analysis was given by the institutional review board in February 2020. Data analysis for this project has not yet started. CONCLUSIONS The early and accurate identification of individuals most at risk for cognitive decline is of paramount importance. Previous research exploring self-reported memory problems and AD is promising; however, limitations in measurement may explain previous reports of inconsistences. This study addresses these concerns by examining daily reports of memory lapses, how these vary by age and gender, and their relationship with objective cognitive performance. Overall, this study aims to identify the key features of daily memory lapses and the differential trajectories that best predict cognitive decline to help inform future AD risk screening tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25233.
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Affiliation(s)
- Jacqueline Mogle
- Edna Bennett Pierce Prevention Research Center, College of Health and Human Development, Pennsylvania State University, University Park, PA, United States
| | - Nikki L Hill
- College of Nursing, Pennsylvania State University, University Park, PA, United States
| | - Jennifer R Turner
- Edna Bennett Pierce Prevention Research Center, College of Health and Human Development, Pennsylvania State University, University Park, PA, United States
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16
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Jiang X, Cai Y, Zhao Y, Gao X, Peng D, Zhang H, Deng W, Fu W, Qin N, Chang R, Manor B, Zhou J. The Complexity of Blood Pressure Fluctuation Mediated the Effects of Hypertension on Walking Speed in Older Adults. Front Aging Neurosci 2021; 13:640942. [PMID: 33994993 PMCID: PMC8118160 DOI: 10.3389/fnagi.2021.640942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Older adults with hypertension often had diminished walking performance. The underlying mechanism through which hypertension affects walking performance, however, has not been fully understood. We here measured the complexity of the continuous systolic (SBP) and diastolic (DBP) blood pressure fluctuation, grade of white matter lesions (WMLs), and cognitive function and used structural equation modeling (SEM) to examine the interrelationships between hypertension, BP complexity, WMLs, cognitive function, and walking speed in single- and dual-task conditions. Methods: A total of 152 older adults with age > 60 years (90 hypertensive and 62 normotensive participants) completed one MRI scan of brain structure, a finger BP assessment of at least 10 min, Mini-Mental State Examination (MMSE) to assess cognitive function, and 10-meter walking tests in single (i.e., normal walking) and dual tasks (i.e., walking while performing a serial subtraction of three from a random three-digit number). The grade of WMLs was assessed using the total score of Fazekas scale; the complexity of SBP and DBP was measured using multiscale entropy (MSE), and the walking performance was assessed by walking speed in single- and dual-task conditions. Results: As compared to normotensives, hypertensive older adults had significantly slower walking speed, lower complexity of SBP and DBP, greater grade of WMLs, and poorer cognitive function (p < 0.03). Those with lower BP complexity (β > 0.31, p < 0.003), greater WML grade (β < −0.39, p < 0.0002), and/or poorer cognitive function (β < −0.39, p < 0.0001) had slower walking speed in single- and/or dual-task conditions. The SEM model demonstrated significant total effects of hypertension on walking speed, and such effects were mediated by BP complexity only, or BP complexity, WML grade, and cognitive function together. Conclusion: This study demonstrates the cross-sectional association between the complexity of continuous beat-to-beat BP fluctuation, WML grade, cognitive function, and walking speed in hypertensive and normotensive older adults, revealing a potential mechanism that hypertension may affect walking performance in older adults through diminished BP complexity, increased WML grade, and decreased cognitive function, and BP complexity is an important factor for such effects. Future longitudinal studies are warranted to confirm the findings in this study.
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Affiliation(s)
- Xin Jiang
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yue Zhao
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NJ, United States
| | - Xia Gao
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Dan Peng
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Hui Zhang
- The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Department of Neurology, Shenzhen People's Hospital, Shenzhen, China
| | - Wuhong Deng
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Wen Fu
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Na Qin
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Ruizhen Chang
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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17
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Williams BD, Pendleton N, Chandola T. Does the association between cognition and education differ between older adults with gradual or rapid trajectories of cognitive decline? NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2021; 29:1-21. [PMID: 33683174 DOI: 10.1080/13825585.2021.1889958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Education is associated with improved baseline cognitive performance in older adults, but the association with maintenance of cognitive function is less clear. Education may be associated with different types of active cognitive reserve in those following different cognitive trajectories. We used data on n = 5642 adults aged >60 from the English Longitudinal Study of Aging (ELSA) over 5 waves (8 years). We used growth mixture models to test if the association between educational attainment and rate of change in verbal fluency or immediate recall varied by latent class trajectory. For recall, 91.5% (n = 5164) of participants were in a gradual decline class and 8.5% (n = 478) in a rapid decline class. For fluency, 90.0% (n = 4907) were in a gradual decline class and 10.0% (n = 561) were in a rapid decline class. Educational attainment was associated with improved baseline performance for both verbal fluency and recall. In the rapidly declining classes, educational attainment was not associated with rate of change for either outcome. In the verbal fluency gradual decline class, education was associated with higher (an additional 0.05-0.38 words per 2 years) or degree level education (an additional 0.04-0.42 words per 2 years) when compared to those with no formal qualifications. We identified no evidence of a protective effect of education against rapid cognitive decline. There was some evidence of active cognitive reserve for verbal fluency but not recall, which may reflect a small degree of domain-specific protection against age-related cognitive decline.
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Affiliation(s)
| | - Neil Pendleton
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Tarani Chandola
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
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18
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The Relationship of Race, Psychosocial Stress and Resiliency Indicators to Neurocognitive Impairment among Older Americans Enrolled in the Health and Retirement Survey: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031358. [PMID: 33540911 PMCID: PMC7908633 DOI: 10.3390/ijerph18031358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022]
Abstract
Background: Race/ethnicity, toxic stress (TS), resilience-promoting factors (RPFs), and their interactions were investigated in relationship to neurocognitive impairment (NI) in a nationally representative sample of adult Americans ≥50 years enrolled in the Health and Retirement Study (HRS) between 2012 and 2014. Methods: NI was defined as physician diagnosis of Alzheimer’s disease/dementia or HRS total cognition score ≤ 10. Race/ethnicity (i.e., African American, White, or Other), TS (i.e., everyday discrimination and chronic stressors), and mastery (as indicator of RPF) were self-reported. Multivariable logistic regression models estimated race-, TS-, RPF-associated odds ratios (ORs), and 95% confidence intervals (CI) for NI adjusting for socio-demographic confounders. Results: 6317 respondents interviewed between the years 2012 and 2014, age range 55–104 years old, 83% White, 13% Black and 4% Other race were included in the study. Chronic stress (OR = 1.88, 95% CI: 1.42–2.48), discrimination (OR = 3.31, 95% CI: 2.12–5.19) and low mastery (OR = 1.85, 95% CI: 1.38–2.48) were each associated with higher NI risk while low mastery was associated with higher NI risk in discrimination and race/ethnicity dependent manner. Specifically, low mastery-associated risk for NI was evident among adults that denied experiencing discrimination (OR = 2.01, 95% CI: 1.51–2.68), but absent among those that experienced discrimination (OR = 0.72, 95% CI: 0.32–1.62). Further, AA race was associated with NI risk but only among adults with high mastery (OR = 2.00, 95% CI: 1.20–3.35). Conclusions: Discrimination, chronic stress, and low mastery were associated with worse cognition. Persisting cognitive disadvantage for AA vs. White/Other race only among high mastery adults suggests that adverse social experiences may counteract mastery-associated cognitive benefits among AA population. TS reduction through policies that promote equal treatment by race/ethnicity in social life, health, justice, and economic systems may promote successful cognitive aging.
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19
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Stieger M, Lachman ME. Increases in Cognitive Activity Reduce Aging-Related Declines in Executive Functioning. Front Psychiatry 2021; 12:708974. [PMID: 34393863 PMCID: PMC8358146 DOI: 10.3389/fpsyt.2021.708974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022] Open
Abstract
Declines in cognitive functioning are commonly experienced with aging, yet there is wide variation in the nature and extent of these changes. Previous research has shown associations between the frequency of engaging in stimulating cognitive activities and performance on cognitive tests. However, it is not known whether it is important to increase the amount of cognitive activity as one gets older in order to curtail cognitive declines. We examined cognitive activities and cognition in a national sample of 2,130 community-dwelling middle-aged and older adults from the Midlife in the United States longitudinal study. Participants completed cognitive assessments of episodic memory (EM) and executive functioning (EF) on two occasions, ~9 years apart. At the first assessment, participants ranged in age between 33 and 83 years (M = 55.76, SD = 11.09), with 56.1% women. Multilevel models were tested to examine educational level and change in cognitive activity as predictors of change in EM and EF, controlling for initial level of cognitive activity and key correlates of cognitive decline. Results indicated that increases in cognitive activity were important over and above earlier levels of cognitive activity for reducing declines in EF. Further analysis also showed differential results by educational level. Increased cognitive activity was not associated with changes in EF among individuals with a college degree. In contrast, individuals without a college degree who increased their cognitive activity showed significantly less decline in EF compared to those without a college degree who decreased or maintained their cognitive activity across the 9 years. Thus, the results suggest that increased engagement in cognitive activity makes more of a difference for EF declines among those without a college degree. The results have particular relevance given that aging-related changes in domains such as work status, health, or social relationships can lead to reductions in stimulating cognitive activities. The findings emphasize the importance of increasing cognitive activities especially among those with lower educational attainment.
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Affiliation(s)
- Mirjam Stieger
- Lifespan Developmental Psychology Laboratory, Department of Psychology, Brandeis University, Waltham, MA, United States
| | - Margie E Lachman
- Lifespan Developmental Psychology Laboratory, Department of Psychology, Brandeis University, Waltham, MA, United States
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Knight JE, Bennett DA, Piccinin AM. Variability and Coupling of Olfactory Identification and Episodic Memory in Older Adults. J Gerontol B Psychol Sci Soc Sci 2020; 75:577-584. [PMID: 29762752 DOI: 10.1093/geronb/gby058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To determine whether assessment-to-assessment fluctuations in episodic memory (EM) reflect fluctuations in olfaction over time. METHODS Within-person coupled variation in EM and the Brief Smell Identification Test (BSIT) was examined in 565 participants aged 58-106 with autopsy data from the Rush Memory and Aging Project. A growth model for up to 15 years of EM data, with BSIT as time-varying covariate, was estimated accounting for main effects of sex, education, ε4 allele, and Alzheimer's disease (AD) pathology, BSIT and time-varying BSIT, as well as the interaction between AD pathology and time-varying BSIT. RESULTS Individuals with higher BSIT scores (b = .01, standard error [SE] = .004, p = .009) had slower declines in EM. High AD pathology (b = -.06, SE = .02, p = .001) was associated with more rapid declines in EM. The association between time-specific fluctuations in EM and BSIT differed by level of AD pathology (b = .08, SE = .034, p = .028), with a higher EM-BSIT association at higher levels of pathology. DISCUSSION BSIT and EM fluctuate together over measurement occasions, particularly for individuals with AD pathology. Repeated intraindividual measurements provide information that could lead to early detection and inexpensive monitoring of accumulating AD pathology.
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Affiliation(s)
- Jamie E Knight
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - David A Bennett
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Chicago, Illinois
| | - Andrea M Piccinin
- Department of Psychology, University of Victoria, Victoria, BC, Canada
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21
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Yoneda T, Lewis NA, Knight JE, Rush J, Vendittelli R, Kleineidam L, Hyun J, Piccinin AM, Hofer SM, Hoogendijk EO, Derby CA, Scherer M, Riedel-Heller S, Wagner M, van den Hout A, Wang W, Bennett DA, Muniz-Terrera G. The Importance of Engaging in Physical Activity in Older Adulthood for Transitions Between Cognitive Status Categories and Death: A Coordinated Analysis of 14 Longitudinal Studies. J Gerontol A Biol Sci Med Sci 2020; 76:1661-1667. [PMID: 33099603 DOI: 10.1093/gerona/glaa268] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories. METHOD Applying a coordinated analysis approach, this project independently analyzed 14 longitudinal studies (NTotal = 52 039; mean baseline age across studies = 69.9-81.73) from North America and Europe using multistate survival models to estimate the impact of engaging in PA on cognitive status transitions (nonimpaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs. RESULTS Controlling for baseline age, sex, education, and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from nonimpaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (eg, decreased risk of transitioning from mild-to-severe cognitive impairment; increased likelihood of transitioning backward from severe-to-mild cognitive impairment), though between-study heterogeneity suggests a less robust association. CONCLUSIONS These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.
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Affiliation(s)
- Tomiko Yoneda
- Department of Psychology, University of Victoria, British Columbia, Canada
| | - Nathan A Lewis
- Department of Psychology, University of Victoria, British Columbia, Canada
| | - Jamie E Knight
- Department of Psychology, University of Victoria, British Columbia, Canada
| | - Jonathan Rush
- Center for Healthy Aging, Pennsylvania State University, State College
| | | | - Luca Kleineidam
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Germany.,German Center for Neurodegenerative Diseases/Clinical Research, Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Zentrum für klinische Forschung/AG Neuropsychologie, Bonn, Germany
| | - Jinshil Hyun
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea M Piccinin
- Department of Psychology, University of Victoria, British Columbia, Canada
| | - Scott M Hofer
- Department of Psychology, University of Victoria, British Columbia, Canada.,Institute on Aging and Lifelong Health, University of Victoria, British Columbia, Canada
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, The Netherlands
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - Michael Wagner
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Germany.,German Center for Neurodegenerative Diseases/Clinical Research, Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Zentrum für klinische Forschung/AG Neuropsychologie, Bonn, Germany
| | | | - Wenyu Wang
- Department of Statistical Science, University College London
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Graciela Muniz-Terrera
- Department of Psychology, University of Victoria, British Columbia, Canada.,Centre for Dementia Prevention, The University of Edinburgh
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22
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Liu S, Lu Y, Cai X, Cong R, Li J, Jiang H, Li M. Glycemic Control is Related to Cognitive Dysfunction in Elderly People with Type 2 Diabetes Mellitus in a Rural Chinese Population. Curr Alzheimer Res 2020; 16:950-962. [PMID: 31642779 DOI: 10.2174/1567205016666191023110712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is an increasing interest on Cognitive Impairment (CI) in patients with type 2 diabetes mellitus (T2DM), but evidence is conflicting regarding the association between CI and glycemic control. OBJECTIVE The present study aimed to estimate the prevalence of CI in patients with T2DM from northern rural China in order to determine whether cognitive dysfunction is related to glycemic control. METHODS First, we conducted a study with a cross-sectional design. We performed cluster random sampling of 1848 residents who were aged 60 years or older and lived in the countryside in China. All eligible participants with and without T2DM were interviewed and screened for cognitive function status. Diagnoses for dementia and Cognitive Impairment No Dementia (CIND) were based on the standard criteria. Second, on the basis of the results of the cross-sectional survey, we conducted a case-control study. In the T2DM group, we identified cases of T2DM with Cognitive Impairment (T2DM-CI), as well as cases of T2DM with normal cognition (T2DM-NC) to be used as controls. The effects of specific diabetes-related variables were examined. After matching for sex, age, and education level in the T2DM-CI and T2DM-NC groups, multivariate logistic regression analyses were performed to evaluate risk factors for T2DM-CI. RESULTS In the cross-sectional study, the prevalence of T2DM with CIND and dementia were 28.3% (95% CI: 23.5-33.2) and 9.5% (95% CI: 6.3-12.6), respectively. Compared with subjects without DM, the prevalence of CI in T2DM patients was more frequent than the prevalence of CI in the general population in almost every age group. In the case-control study, the multivariate logistic regression analyses showed that variables, including duration from diabetes onset, glycosylated hemoglobin A1c level (HbA1c), and severe hypoglycemia history, were significantly associated with an increased risk of CI in patients with T2DM (odds ratios [ORs] [95%CIs]: 1.67 [1.03-2.70], 1.40 [1.15-1.72], and 2.72 [1.02- 7.21], respectively [P <0.05]). CONCLUSION The present study demonstrates a high prevalence of CI in patients with T2DM among the elderly population of rural China. Glycemic control, including HbA1c and exposure to severe hypoglycemia, affected cognitive function in patients with T2DM.
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Affiliation(s)
- Shuling Liu
- School of Nursing, Peking University, Beijing, China.,Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing, China
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Rizhao Cong
- School of Nursing, Peking University, Beijing, China.,Inner Mongolia Vocational and Technical School, Hohhot, China
| | - Jun Li
- School of Nursing, Peking University, Beijing, China
| | - Hua Jiang
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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23
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Clouston SAP, Smith DM, Mukherjee S, Zhang Y, Hou W, Link BG, Richards M. Education and Cognitive Decline: An Integrative Analysis of Global Longitudinal Studies of Cognitive Aging. J Gerontol B Psychol Sci Soc Sci 2020; 75:e151-e160. [PMID: 31059564 PMCID: PMC7424268 DOI: 10.1093/geronb/gbz053] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the association between education and incidence of accelerated cognitive decline. METHODS Secondary analyses of data from the Health and Retirement Study (HRS), a nationally representative prospective cohort study of U.S. residents were conducted (N = 28,417). Cox proportional hazards survival models were layered on longitudinal mixed-effects modeling to jointly examine healthy cognitive aging and incidence of accelerated cognitive decline consistent with patterns seen in preclinical Alzheimer's disease and related dementias (ADRD). Replication analyses were completed on a database including 62,485 additional respondents from HRS sister studies. Life expectancy ratios (LER) and 95% confidence intervals (CIs) were reported. RESULTS This study replicated research showing that education was positively associated with cognition at baseline. Model fit improved using the survival method compared to random-slopes models alone. Analyses of HRS data revealed that higher education was associated with delayed onset of accelerated cognitive decline (LER = 1.031 95% CI = [1.013-1.015], p < 1E-06). Replication analyses using data from 14 countries identified similar results. CONCLUSIONS These results are consistent with cognitive reserve theory, suggesting that education reduces risk of ADRD-pattern cognitive decline. Follow-up work should seek to differentiate specific dementia types involved and consider potential mechanisms.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Dylan M Smith
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Soumyadeep Mukherjee
- Community and Public Health Promotion, Health and Physical Education Department, Rhode Island College, Providence, Rhode Island
| | - Yun Zhang
- Program in Public Health, Stony Brook University, New York
| | - Wei Hou
- Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Bruce G Link
- Department of Sociology and School of Public Policy, University of California – Riverside, Riverside, California
| | - Marcus Richards
- Unit for Lifelong Health and Ageing at University College London, London, UK
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Abstract
Ceiling and floor effects are often observed in social and behavioral science. The current study examines ceiling/floor effects in the context of the t-test and ANOVA, two frequently used statistical methods in experimental studies. Our literature review indicated that most researchers treated ceiling or floor data as if these data were true values, and that some researchers used statistical methods such as discarding ceiling or floor data in conducting the t-test and ANOVA. The current study evaluates the performance of these conventional methods for t-test and ANOVA with ceiling or floor data. Our evaluation also includes censored regression with regard to its capacity for handling ceiling/floor data. Furthermore, we propose an easy-to-use method that handles ceiling or floor data in t-tests and ANOVA by using properties of truncated normal distributions. Simulation studies were conducted to compare the performance of the methods in handling ceiling or floor data for t-test and ANOVA. Overall, the proposed method showed greater accuracy in effect size estimation and better-controlled Type I error rates over other evaluated methods. We developed an easy-to-use software package and web applications to help researchers implement the proposed method. Recommendations and future directions are discussed.
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25
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Zhang W, Tang F, Chen Y, Silverstein M, Liu S, Dong X. Education, Activity Engagement, and Cognitive Function in US Chinese Older Adults. J Am Geriatr Soc 2020; 67:S525-S531. [PMID: 31403195 DOI: 10.1111/jgs.15560] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether and how early-life experiences such as years of schooling affect late-life cognitive function through a pathway of activity engagement. DESIGN Prospective. SETTING We used data from 2 waves of the Population Study of Chinese Elderly in Chicago (PINE). PARTICIPANTS PINE is the largest population-based epidemiological study of Chinese-American adults aged 60 and older in the greater Chicago area. Wave 1 data were collected for 2 years, from July 2011 to June 2013, and Wave 2 data were collected from 2013 to 2015; total sample size was 2,713. MEASUREMENTS Education was measured in years of schooling. Activity engagement was assessed using 15 items grouped into two clusters: cognitive activity and social activity. Cognitive function was evaluated using five instruments to assess general mental status (Chinese Mini-Mental State Examination (C-MMSE)), episodic memory, perceptual speed, working memory, global cognition score. RESULTS Adjusting for sociodemographic and health-related control variables, education measured at Wave 1 was associated with better global cognition (b = 0.025, p < .001), C-MMSE (b = .037, p < .001), episodic memory (b = .026, p < .001), Symbol Digit Modalities Test perceptual speed (b = .036, p < .001), and Digit Span Backward working memory (b = .047, p < .001) at Wave 2. Activity engagement, cognitive activity in particular, significantly mediates the effect of education on all cognitive tests, with the size of the mediating effect ranging from 16% to approximately 24%. CONCLUSION Amount of schooling early in life is significantly related to late-life cognitive function in virtually all domains, and cognitive activity is one of many links between the two. J Am Geriatr Soc 67:S525-S531, 2019.
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Affiliation(s)
- Wei Zhang
- Department of Sociology, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yiwei Chen
- Psychology Department, Bowling Green State University, Bowling Green, Ohio
| | - Merril Silverstein
- Department of Sociology, Aging Studies Institute, Syracuse University, Syracuse, New York
| | - Sizhe Liu
- Department of Sociology, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - XinQi Dong
- Health Care Policy and Aging Research, Institute for Health, The State University of New Jersey, Rutgers University, New Brunswick, NJ
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Itaguchi Y, Yamada C, Fukuzawa K. Writing in the air: Facilitative effects of finger writing in older adults. PLoS One 2019; 14:e0226832. [PMID: 31881067 PMCID: PMC6934278 DOI: 10.1371/journal.pone.0226832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
Kūsho, which refers to a behavior in which one moves the index finger as a substitute for a pen in the air or on a surface, mostly used when trying to recall the shape of a written character or the spelling of a word, has been known to facilitate cognitive task performance among kanji writing-system users. This study investigates whether the facilitative effect of kūsho, the existence of which has been exclusively confirmed in younger adults, is present in old age. Moreover, to further understand the interaction between finger movement and cognitive processing, we analyzed the correlation between the kūsho effect and factors such as age, mini-mental state examination (MMSE) score, and number of years of education. The kūsho effect was assessed by a task where participants mentally assembled a set of kanji subparts to form an actual character. The results showed a significant facilitative effect of kūsho and a strong negative correlation between kūsho effect and education. This study confirms the benefits of finger movement for solving cognitive tasks involving visual processing of written language among older adults and suggests the kūsho effect may be mediated by education.
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Affiliation(s)
- Yoshihiro Itaguchi
- Department of Computer Science, Shizuoka University, Hamamatsu, Japan
- * E-mail:
| | - Chiharu Yamada
- Department of Psychology, Waseda University, Tokyo, Japan
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27
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Fernández-Calvo B, Contador I, Chelune G, Lora D, Llamas S, Tapias E, Bermejo-Pareja F. Reliable change indices for the 37-item version of the MMSE in Spanish older adults. Clin Neuropsychol 2019; 34:13-28. [PMID: 31757190 DOI: 10.1080/13854046.2019.1692077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to establish reliable change and regression-based change score norms on the 37-item version of MMSE in older Spanish adults at the three-year follow-up. METHOD All subjects of this research were selected from the Neurological Disorders in Central Spain (NEDICES), a prospective population-based cohort study of older adults (65 years and over). Of the 4208 individuals free from neurological disorders in this cohort, 2073 participants completed the MMSE-37 at baseline and at the three-year follow-up. Reliable Change Indices were computed for the 80, 90% and 95 confidence intervals (CIs). Multiple regression analyses were used to derive equations for predicting MMSE-37 post-test scores taking into account baseline scores, time to follow-up and sociodemographic factors. RESULTS The MMSE-37 obtained a marginal test-retest reliability (.70). The results showed significant effects of education, age, and sex on the MMSE-37 change scores. After correcting for regression to the mean, at least a 6-point change on MMSE-37 (three-years follow-up) is required to be classified as reliable (90% CI). CONCLUSIONS These findings demonstrate that the MMSE-37 is a reliable test-retest measure whose change scores are significantly influenced by sociodemographic factors. Importantly, small changes on this measure require a cautious interpretation.
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Affiliation(s)
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science. Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - Gordon Chelune
- Center for Alzheimer's Care, Imaging, and Research, University of Utah, Salt Lake City, UT, USA
| | - David Lora
- Research Institute of Hospital "12 de Octubre" (i + 12), Madrid, Spain
| | - Sara Llamas
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
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Zahodne LB, Sharifian N, Manly JJ, Sumner JA, Crowe M, Wadley VG, Howard VJ, Murchland AR, Brenowitz WD, Weuve J. Life course biopsychosocial effects of retrospective childhood social support and later-life cognition. Psychol Aging 2019; 34:867-883. [PMID: 31566397 PMCID: PMC6829036 DOI: 10.1037/pag0000395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Social support during childhood lays the foundation for social relationships throughout the life course and has been shown to predict a wide range of mental and physical health outcomes. Social support measured in late life is prospectively associated with better cognitive aging, but few studies have evaluated social support received earlier in the life course. We quantified the effects of childhood social support, reported retrospectively, on later-life cognitive trajectories and investigated biopsychosocial mechanisms underlying these associations. Latent growth curve models estimated 10-year cognitive trajectories in 8,538 participants (baseline ages 45-93; Mage = 63) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) project. Independent of sociodemographics, childhood socioeconomic status, and household size, greater retrospective childhood social support was associated with better initial episodic memory, but not verbal fluency or cognitive change, in later adulthood. Associations with initial memory level were mediated by sociodemographic and psychosocial variables; specifically, those who reported greater childhood social support reported higher educational attainment and had better physical and emotional health in adulthood, which were each associated with better memory. These results provide support for broad and enduring effects of childhood social support on mental, physical, and cognitive health decades later. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Díaz-Venegas C, Samper-Ternent R, Michaels-Obregón A, Wong R. The effect of educational attainment on cognition of older adults: results from the Mexican Health and Aging Study 2001 and 2012. Aging Ment Health 2019; 23:1586-1594. [PMID: 30449138 PMCID: PMC6525654 DOI: 10.1080/13607863.2018.1501663] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This paper seeks to document changes in the effect of educational attainment on cognitive function of older adults in Mexico, and measure gender differences using data from two time periods. Methods: The data come from the Mexican Health and Aging Study (MHAS), taking the cross-sections of adults aged 60 years or older interviewed in 2001 and 2012. We perform an OLS regression using standardized z-scores for five individual cognitive domains and for total cognition. Results: Total cognitive scores and educational attainment were higher for men than women in both years. When cognitive components were analyzed separately, women had higher verbal memory and verbal recall scores than men. The gender gap in overall cognition score was smaller in 2012 compared to 2001, while the gender gap in educational attainment was larger in 2012 than in 2001. Even though men had higher educational attainment than women, the effect of educational attainment on cognition was higher for women. Similarly, the difference between total scores for each task for men compared to women decreased between 2012 and 2001, except for verbal learning and verbal recall where the gender difference widened. Conclusions: If younger cohorts of women continue to progressively achieve higher levels of education, the gender gap in old-age cognition should close. Additional work should determine the mechanisms through which added formal education seems to translate into higher cognitive gains for women compared to men.
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Affiliation(s)
- Carlos Díaz-Venegas
- Research Scientist, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, Rostock, Germany, 18057, Phone: (+49) 381 2081-166, Fax: (+49) 381 2081-280,
| | - Rafael Samper-Ternent
- Assistant Professor, Internal Medicine/Geriatrics - Sealy Center on Aging, The University of Texas Medical Branch,
| | - Alejandra Michaels-Obregón
- Research Coordinator, Sealy Center on Aging, WHO/PAHO Collaborating Center on Aging and Health, The University of Texas Medical Branch,
| | - Rebeca Wong
- P&S Kempner Distinguished Professor in Health Disparities, Department of Preventive Medicine and Community Health, Director, WHO/PAHO Collaborating Center on Aging and Health, The University of Texas Medical Branch,
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Baumard J, Lesourd M, Remigereau C, Lucas C, Jarry C, Osiurak F, Le Gall D. Imitation of meaningless gestures in normal aging. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:729-747. [PMID: 31595839 DOI: 10.1080/13825585.2019.1674773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
While imitation of meaningless gestures is a gold standard in the assessment of apraxia in patients with either stroke or neurodegenerative diseases, little is known about potential age-related effects on this measure. A significant body of literature has indicated that different mechanisms (i.e., executive functioning, visuospatial skills, sensory integration, body knowledge, categorical apprehension) may underlie the performance depending on imitation conditions (i.e., finger/hand, uni-/bimanual, symmetric/asymmetric, crossed/uncrossed configurations). However, neither the effects of these conditions on performance, nor the contribution of the abovementioned mechanisms to imitation have been explored in normal aging. The aim of the present study was to fill this gap. To do so, healthy adults (n = 103) aged 50 to 89 were asked to imitate 45 meaningless gestures. The authors controlled for general cognitive function, motor function, visual-spatial skills, executive function, sensory integration, body knowledge, and mechanical problem-solving skills. The results showed that asymmetry, body-midline crossing and, to a lesser extent, bimanual activity added an additional layer of difficulty to imitation tasks. After controlling for motor speed and cognitive function, age had an effect on imitation skills after 70 years old. This may reflect a decline in body knowledge, sensory integration, and executive functions. In contrast, the visuospatial and mechanical problem-solving hypotheses were ruled out. An additional motor simulation hypothesis is proposed. These findings may prove useful for clinicians working in memory clinics by providing insights on how to interpret imitation deficits. Lower performance after 70 years old should not be considered abnormal in a systematic manner.
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Affiliation(s)
| | - Mathieu Lesourd
- CNRS, LNC, Laboratoire de Neurosciences Cognitives, Aix Marseille University , Marseille, France.,CNRS, Fédération 3C, Aix Marseille University , Marseille, France
| | | | - Charlène Lucas
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), Université d'Angers , France
| | - Christophe Jarry
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), Université d'Angers , France
| | - François Osiurak
- Laboratoire d'Etude des Mécanismes Cognitifs (EA 3082), Université de Lyon , France.,Institut Universitaire de France , Paris, France
| | - Didier Le Gall
- Laboratoire de Psychologie des Pays de la Loire (EA 4638), Université d'Angers , France.,Unité de Neuropsychologie, Département de Neurologie, Centre Hospitalier Universitaire d'Angers , France
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Karim Y, Siddique AE, Hossen F, Rahman M, Mondal V, Banna HU, Hasibuzzaman MM, Hosen Z, Islam MS, Sarker MK, Nikkon F, Saud ZA, Xin L, Himeno S, Hossain K. Dose-dependent relationships between chronic arsenic exposure and cognitive impairment and serum brain-derived neurotrophic factor. ENVIRONMENT INTERNATIONAL 2019; 131:105029. [PMID: 31352261 DOI: 10.1016/j.envint.2019.105029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Arsenic poisoning is a public health problem worldwide. A few studies have reported the effects of arsenic exposure on adult cognitive function, but with limitations in the subject selection and exposure markers. Moreover, information regarding the association between arsenic exposure and biomarker of cognitive impairment is scarce. OBJECTIVES We examined the associations between arsenic exposure and adult cognitive impairment using the Mini-Mental State Examination (MMSE) and the serum levels of brain-derived neurotrophic factor (BDNF), a potential biomarker of cognitive health status. METHODS We designed a cross-sectional study that recruited 693 adult (18-60 years old) subjects from the areas of low- and high‑arsenic exposure in rural Bangladesh. The subjects' arsenic exposure levels (drinking water, hair, and nail arsenic concentrations) were measured by inductively coupled plasma-mass spectroscopy. The Bangla version of the MMSE was used as a cognitive assessment tool. Serum BDNF (sBDNF) levels were assessed by immunoassay. RESULTS In this study, we found that average MMSE score and sBDNF level of the subjects in arsenic-endemic areas were significantly (p < 0.001 for both) lower than those of the subjects in non-endemic area. Our analyses revealed that both MMSE scores and sBDNF levels were decreased with the increasing concentrations of arsenic in drinking water, hair, and nails in a dose-dependent fashion. In regression analyses, significant associations of arsenic exposure metrics with MMSE scores and sBDNF levels were observed even after adjustment for several variables. Intriguingly, MMSE scores showed a significantly positive correlation with sBDNF levels. CONCLUSION Our findings demonstrate that chronic exposure to arsenic dose-dependently decreases cognitive function in adults, with a concomitant reduction of sBDNF levels. A decreased BDNF level may be part of the biochemical basis of chronic arsenic exposure-related cognitive impairment.
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Affiliation(s)
- Yeasir Karim
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Abu Eabrahim Siddique
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Faruk Hossen
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Mizanur Rahman
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Victor Mondal
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Hasan Ul Banna
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M M Hasibuzzaman
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Zubaer Hosen
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia 7003, Bangladesh
| | - Md Shofikul Islam
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia 7003, Bangladesh
| | | | - Farjana Nikkon
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Zahangir Alam Saud
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Lian Xin
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8514, Japan
| | - Seiichiro Himeno
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8514, Japan
| | - Khaled Hossain
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh.
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Lipnicki DM, Makkar SR, Crawford JD, Thalamuthu A, Kochan NA, Lima-Costa MF, Castro-Costa E, Ferri CP, Brayne C, Stephan B, Llibre-Rodriguez JJ, Llibre-Guerra JJ, Valhuerdi-Cepero AJ, Lipton RB, Katz MJ, Derby CA, Ritchie K, Ancelin ML, Carrière I, Scarmeas N, Yannakoulia M, Hadjigeorgiou GM, Lam L, Chan WC, Fung A, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Suh SW, Riedel-Heller SG, Roehr S, Pabst A, van Boxtel M, Köhler S, Deckers K, Ganguli M, Jacobsen EP, Hughes TF, Anstey KJ, Cherbuin N, Haan MN, Aiello AE, Dang K, Kumagai S, Chen T, Narazaki K, Ng TP, Gao Q, Nyunt MSZ, Scazufca M, Brodaty H, Numbers K, Trollor JN, Meguro K, Yamaguchi S, Ishii H, Lobo A, Lopez-Anton R, Santabárbara J, Leung Y, Lo JW, Popovic G, Sachdev PS. Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study. PLoS Med 2019; 16:e1002853. [PMID: 31335910 PMCID: PMC6650056 DOI: 10.1371/journal.pmed.1002853] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. METHODS AND FINDINGS We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. CONCLUSIONS These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.
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Affiliation(s)
- Darren M. Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Steve R. Makkar
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - John D. Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, Cambridge, United Kingdom
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Jorge J. Llibre-Guerra
- Institute of Neurology and Neurosurgery, Havana, Cuba
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Richard B. Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
| | - Mindy J. Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
| | - Carol A. Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
| | - Karen Ritchie
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier, France
- Université de Montpellier, Montpellier, France
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Marie-Laure Ancelin
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Isabelle Carrière
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, New York, United States of America
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Georgios M. Hadjigeorgiou
- University of Thessaly, Larissa, Greece
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Linda Lam
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-chi Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Ada Fung
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | | | | | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Korea
- Department of Brain and Cognitive Science, College of Natural Sciences, Seoul National University, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mary Ganguli
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Erin P. Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Tiffany F. Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio, United States of America
| | - Kaarin J. Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mary N. Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Allison E. Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kristina Dang
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Shuzo Kumagai
- Center for Health Science and Counseling, Kyushu University, Kasuga, Japan
| | - Tao Chen
- Center for Health Science and Counseling, Kyushu University, Kasuga, Japan
| | - Kenji Narazaki
- Faculty of Socio-Environmental Studies, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marcia Scazufca
- Instituto de Psiquiatria e LIM-23, Hospital da Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Katya Numbers
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian N. Trollor
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenichi Meguro
- Geriatric Behavioral Neurology, Tohoku University, Sendai, Japan
| | | | - Hiroshi Ishii
- Geriatric Behavioral Neurology, Tohoku University, Sendai, Japan
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain
| | - Raul Lopez-Anton
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Santabárbara
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - Yvonne Leung
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica W. Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Gordana Popovic
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- School of Mathematics and Statistics, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Uhlmann EL, Ebersole CR, Chartier CR, Errington TM, Kidwell MC, Lai CK, McCarthy RJ, Riegelman A, Silberzahn R, Nosek BA. Scientific Utopia III: Crowdsourcing Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 14:711-733. [PMID: 31260639 DOI: 10.1177/1745691619850561] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most scientific research is conducted by small teams of investigators who together formulate hypotheses, collect data, conduct analyses, and report novel findings. These teams operate independently as vertically integrated silos. Here we argue that scientific research that is horizontally distributed can provide substantial complementary value, aiming to maximize available resources, promote inclusiveness and transparency, and increase rigor and reliability. This alternative approach enables researchers to tackle ambitious projects that would not be possible under the standard model. Crowdsourced scientific initiatives vary in the degree of communication between project members from largely independent work curated by a coordination team to crowd collaboration on shared activities. The potential benefits and challenges of large-scale collaboration span the entire research process: ideation, study design, data collection, data analysis, reporting, and peer review. Complementing traditional small science with crowdsourced approaches can accelerate the progress of science and improve the quality of scientific research.
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Affiliation(s)
| | | | | | | | | | - Calvin K Lai
- 6 Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Randy J McCarthy
- 7 Center for the Study of Family Violence and Sexual Assault, Northern Illinois University
| | | | | | - Brian A Nosek
- 2 Department of Psychology, University of Virginia.,4 Center for Open Science, Charlottesville, Virginia
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APOE Variant (rs405509) might Modulate the Effect of Sex and Educational Level on Cognitive Impairment Risk in a Taiwanese Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101732. [PMID: 31100889 PMCID: PMC6571898 DOI: 10.3390/ijerph16101732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 01/10/2023]
Abstract
Education, sex, and the APOE-rs405509 variant are associated with Alzheimer’s disease and cognitive performance. We investigated if the rs405509 TT, TG, and GG genotypes modulate the effect of sex and education on cognitive impairment in Taiwanese adults. Data on cognitive health (defined by Mini-Mental State Examination (MMSE) scores) and rs405509 were from Taiwan Biobank. Participants included 2105 men and 2027 women with a mean age of 64 years. Education below university level was significantly associated with lower MMSE scores. The odds ratios (ORs) were 1.82; 95% confidence interval (CI) 1.38–2.41 for senior high school, 3.39; 95% CI 2.50–4.59 for junior high school, and 11.94; 95% CI 9.91–15.50 for elementary school and below (p-trend < 0.05). The association between MMSE score and sex was significant only in the lowest educational group (elementary and below), with lower odds of having a low MMSE score in men compared to women (OR = 0.51; 95% CI 0.34–0.77). After stratification by rs405509 genotypes, this association was significant only among TT genotype carriers (OR = 0.481; CI = 0.253–0.915). In conclusion, a significant association between MMSE score and sex was observed in the lowest educational group, especially among carriers of rs405509 TT genotypes.
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Lavrencic LM, Richardson C, Harrison SL, Muniz-Terrera G, Keage HAD, Brittain K, Kirkwood TBL, Jagger C, Robinson L, Stephan BCM. Is There a Link Between Cognitive Reserve and Cognitive Function in the Oldest-Old? J Gerontol A Biol Sci Med Sci 2019; 73:499-505. [PMID: 28977420 DOI: 10.1093/gerona/glx140] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/17/2017] [Indexed: 12/22/2022] Open
Abstract
Background The oldest-old (aged ≥85 years) are the fastest growing age group, with the highest risk of cognitive impairment and dementia. This study investigated whether cognitive reserve applies to the oldest-old. This has implications for cognitive interventions in this age group. Methods Baseline and 5-year follow-up data from the Newcastle 85+ Study were used (N = 845, mean age = 85.5, 38% male). A Cognitive Reserve Index (CRI) was created, including: education, social class, marital status, engagement in mental activities, social participation, and physical activity. Global (Mini-Mental State Examination) and domain specific (Cognitive Drug Research Battery subtests assessing memory, attention, and speed) cognitive functions were assessed. Dementia diagnosis was determined by health records. Logistic regression analysis examined the association between CRI scores and incident dementia. Mixed effects models investigated baseline and longitudinal associations between the CRI scores and cognitive function. Analyses controlled for sex, age, depression, and cardiovascular disease history. Results Higher reserve associated with better cognitive performance on all baseline measures, but not 5-year rate of change. The CRI associated with prevalent, but not incident dementia. Conclusions In the oldest-old, higher reserve associated with better baseline global and domain-specific cognitive function and reduced risk of prevalent dementia; but not cognitive decline or incident dementia. Increasing reserve could promote cognitive function in the oldest-old. The results suggest there would be little impact on trajectories, but replication is needed. Development of preventative strategies would benefit from identifying the role of each factor in building reserve and why rate of change is not affected.
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Affiliation(s)
- Louise M Lavrencic
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Connor Richardson
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Adelaide, South Australia
| | | | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Thomas B L Kirkwood
- Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK.,University of Copenhagen Center for Healthy Aging, Copenhagen, Denmark
| | - Carol Jagger
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom C M Stephan
- Newcastle University Institute for Ageing and Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Foverskov E, Glymour MM, Mortensen EL, Holm A, Lange T, Lund R. Education and Cognitive Aging: Accounting for Selection and Confounding in Linkage of Data From the Danish Registry and Survey of Health, Ageing and Retirement in Europe. Am J Epidemiol 2018; 187:2423-2430. [PMID: 30099480 DOI: 10.1093/aje/kwy162] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Earlier studies report inconsistent associations between education and cognitive aging. We assessed the association, accounting for selective dropout due to death or dementia, and, in a subsample, accounting for confounding by early-life intelligence. Data from the Danish component of the Survey of Health, Ageing and Retirement in Europe (n = 3,400) were linked to registry data (education records, dementia diagnoses, and mortality) and the Danish Conscription Database (youth intelligence measurements for 854 men). Word recall and verbal fluency were assessed up to 4 times over 10 years (2004-2013) and combined by averaging the z scores. We fitted a joint model linking a time-to-event model for dementia or death to a linear mixed-effects model for cognitive change. Rate of cognitive decline was slower among people with high education compared with low education (β = 0.112, 95% confidence interval (CI): 0.056, 0.170). Adjusting for youth intelligence did not attenuate the association between education and cognitive decline (crude β = 0.136, 95% CI: 0.028, 0.244 vs. adjusted β = 0.145, 95% CI: 0.022, 0.269). The results suggest that higher education may slow cognitive decline in later life. In this sample, results changed little when accounting for selective attrition and confounding by intelligence.
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Affiliation(s)
- Else Foverskov
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anders Holm
- Department of Sociology, University of Western Ontario, London, Canada
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Blood acetylcholinesterase level is a potential biomarker for the early detection of cerebral amyloid deposition in cognitively normal individuals. Neurobiol Aging 2018; 73:21-29. [PMID: 30316049 DOI: 10.1016/j.neurobiolaging.2018.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 01/05/2023]
Abstract
Cerebral β-amyloid (cAβ) deposition and cholinergic dysfunction have been considered as major pathological and functional hallmarks of Alzheimer's disease (AD). Acetylcholinesterase (AChE) is one of the major cholinergic enzymes, and there is no report to show the relationship between cAβ accumulation and peripheral AChE alteration in early stage of AD pathogenesis. Recent studies demonstrate that cAβ starts to deposit 15-20 years ahead of symptomatic appearance and this preclinical AD is important for early diagnosis of disease. In this study, we investigated the link between cAβ deposition and the peripheral AChE in cognitively normal (CN) individuals. A total of 407 individuals who underwent Pittsburgh compound B (PiB)-positron emission tomography participated in our study. Lower levels of plasma AChE and its enzymatic activity were detected in CN individuals with cAβ deposition than in those without cAβ. Plasma AChE levels and enzymatic activity were negatively correlated with the degree of cAβ deposition. Our results suggest that blood AChE can be used as a potential blood biomarker for the prediction of cAβ deposition in CN individuals.
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Longitudinal effects of aging on 18F-FDG distribution in cognitively normal elderly individuals. Sci Rep 2018; 8:11557. [PMID: 30068919 PMCID: PMC6070529 DOI: 10.1038/s41598-018-29937-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/18/2018] [Indexed: 11/25/2022] Open
Abstract
Previous studies of aging effects on fluorine-18-labeled fluorodeoxyglucose (18F-FDG) distribution have employed cross-sectional designs. We examined aging effects on 18F-FDG distribution using both cross-sectional and longitudinal assessments. We obtained two 18F-FDG positron emission tomography scans at two different time points from 107 cognitively normal elderly participants. The participants’ mean ages at baseline and second scans were 67.9 and 75.7, respectively. The follow-up period ranged from 4 to 11 years with a mean of 7.8 years. The voxel-wise analysis revealed significant clusters in which 18F-FDG uptake was decreased between baseline and second scans (p < 0.05, family-wise error corrected) in the anterior cingulate cortex (ACC), posterior cingulate cortex/precuneus (PCC/PC), and lateral parietal cortex (LPC). The cross-sectional analysis of 18F-FDG uptake and age showed significant correlations in the ACC (p = 0.016) but not the PCC/PC (p = 0.240) at baseline, and in the ACC (p = 0.004) and PCC/PC (p = 0.002) at the second scan. The results of longitudinal assessments suggested that 18F-FDG uptake in the ACC, PCC/PC, and LPC decreased with advancing age in cognitively normal elderly individuals, and those of the cross-sectional assessments suggested that the trajectories of age-associated 18F-FDG decreases differed between the ACC and PCC/PC.
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Cognitive Aging in Black and White Americans: Cognition, Cognitive Decline, and Incidence of Alzheimer Disease Dementia. Epidemiology 2018; 29:151-159. [PMID: 28863046 DOI: 10.1097/ede.0000000000000747] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND US-based studies have reported that older blacks perform worse than older whites on cognitive tests and have higher risk of Alzheimer disease dementia (AD). It is unclear whether these findings reflect differences in cognitive decline. METHODS The Chicago Health and Aging Project followed individuals, 65+ years old (64% black, 36% white), for up to 18 years. Participants underwent triennial cognitive assessments; stratified randomized samples underwent assessments for AD. We compared black and white participants' cognitive performance, cognitive decline rate (N = 7,735), and AD incidence (N = 2,144), adjusting for age and sex. RESULTS Black participants performed worse than white participants on the cognitive tests; 441 participants developed AD. Black participants' incident AD risk was twice that of whites (RR = 1.9; 95% CI, 1.4, 2.7), with 58 excess cases/1,000 occurring among blacks (95% CI, 28, 88). Among noncarriers of APOE ε4, blacks had 2.3 times the AD risk (95% CI, 1.5, 3.6), but among carriers, race was not associated with risk (RR = 1.1; 95% CI, 0.6, 2.0; Pinteraction = 0.05). However, cognitive decline was not faster among blacks: the black-white difference in 5-year change in global cognitive score was 0.007 standard unit (95% CI, -0.034, 0.047). Years of education accounted for a sizable portion of racial disparities in cognitive level and AD risk, in analyses using a counterfactual approach. CONCLUSIONS The higher risk of AD among blacks may stem from lower level of cognitive test performance persisting throughout the observation period rather than faster rate of late-life cognitive decline. Disparities in educational attainment may contribute to these performance disparities. See video abstract at, http://links.lww.com/EDE/B299.
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A new device-aided cognitive function test, User eXperience-Trail Making Test (UX-TMT), sensitively detects neuropsychological performance in patients with dementia and Parkinson's disease. BMC Psychiatry 2018; 18:220. [PMID: 29976167 PMCID: PMC6034323 DOI: 10.1186/s12888-018-1795-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/18/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A newer generation neuropsychological tests can take advantage of touch screen and mobile technology. We have developed a new Android application termed "User eXperience-Trail Making Test (UX-TMT)" for neurocognitive assessment and training. This study investigated the utility, including the reliability and the validity, of the UX-TMT as a screening test for cognitive decline in adults. METHODS A total of 84 individuals aged 27-86 years were divided into three groups; healthy controls ([HC] n = 29), people with Parkinson's disease (PD; n = 28), and people with mild cognitive impairment (MCI) and dementia (MCI&D; n = 27). We examined the distributions of the scores and the time required, and the effects of age and group on these distributions. We analyzed internal consistency and convergent validity in all samples and applied receiver operator characteristic (ROC) analysis to determine a cutoff score that could differentiate the MCI & D group from the HC group. RESULTS 97.6% of the participants completed all of the tasks, and the average total test time required for UX-TMT was 428.8 (± 109.1) s in the HC, 542.0 (± 168.7) s in the PD, and 777.5 (± 256.1) s in the MCI&D groups, respectively. The MCI&D group showed significantly lower UX-TMT scores and longer total time in completing the task than the HC group. In an ROC analysis, a score of 21 showed high sensitivity (.83) and specificity (.92), and the UX-TMT score plus age improved sensitivity to .96. Additionally, the UX-TMT scores showed significant correlation with the Mini-Mental State Examination (Japanese version) scores (r = .77, p = .001), and Cronbach's alpha (.71-.83) indicated acceptable internal consistency. CONCLUSION The UX-TMT demonstrated high reliability and validity to detect cognitive decline in Japanese adults, highlighting its utility as a screening tool for epidemiological and clinical research.
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Lee Y. Adult children's educational attainment and the cognitive trajectories of older parents in South Korea. Soc Sci Med 2018; 209:76-85. [DOI: 10.1016/j.socscimed.2018.05.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 04/02/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
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Muniz-Terrera G, Massa F, Benaglia T, Johansson B, Piccinin A, Robitaille A. Visuospatial Reasoning Trajectories and Death in a Study of the Oldest Old: A Formal Evaluation of Their Association. J Aging Health 2018. [PMID: 29537357 DOI: 10.1177/0898264317753878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To model trajectories of visuospatial reasoning measured using Kohs Block Design test under realistic missing data assumptions and evaluate their association with hazard of death. METHODS A joint longitudinal-survival model was used to estimate trajectories of visuospatial reasoning under a missing not at random assumption of participants from the Origins of Variance in the Old-Old: Octogenarian Twins study. Sensitivity analyses to missing data assumptions were conducted. RESULTS Visuospatial reasoning declined at constant rate. Baseline age, dementia status, education, and history of stroke were associated with visuospatial reasoning performance, but only dementia was associated with its rate of decline. Importantly, our results demonstrated an association between poorer visuospatial reasoning and increased hazard of death. Baseline age and sex were associated with risk of death. DISCUSSION We confirmed an association between visuospatial reasoning and death under plausible missing data assumptions.
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Stephan BCM, Muniz‐Terrera G, Granic A, Collerton J, Davies K, Saxby BK, Wesnes KA, Kirkwood TB, Jagger C. Longitudinal changes in global and domain specific cognitive function in the very-old: findings from the Newcastle 85+ Study. Int J Geriatr Psychiatry 2018; 33. [PMID: 28639724 PMCID: PMC5811803 DOI: 10.1002/gps.4743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Ageing is associated with changes in cognition in some, but not all domains. In young-old adults, defined as persons aged 65-84 years, baseline cognitive function has been shown to impact on cognitive trajectories. Whether similar patterns occur in the very-old, defined as persons aged 85 years and over, is not known. METHODS Longitudinal changes (5 years' follow-up) in global and domain specific cognitive function including memory, attention and speed were investigated in participants from the Newcastle 85+ Study (n = 845). At baseline, participants were grouped using Mini-Mental State Examination cut-off scores and dementia status into the following: not impaired, mildly impaired or severely impaired/dementia groups. RESULTS Only a limited number of cognitive measures showed significant decline in performance over time. Where observed, change generally occurred only in the severely impaired group. In the severely impaired group, small differences in baseline age were associated with poorer performance over time on most measures. Education was not protective against cognitive decline in any group. CONCLUSIONS There are individuals who maintain a high level of cognitive function or only show mild impairments even into their ninth decade of life. This group of successful cognitive agers may provide insight for identifying predictors of cognitive integrity in later life. In individuals with severe impairment, cognitive performance shows significant decline over time, especially in measures of attention and speed. Further work to identify those individuals at highest risk of cognitive decline is necessary to implement early support and intervention strategies in this rapidly expanding age group. © 2017 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
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Affiliation(s)
- Blossom C. M. Stephan
- Institute of Health and SocietyNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Graciela Muniz‐Terrera
- Centre for Dementia PreventionUniversity of Edinburgh, Royal Edinburgh HospitalEdinburghUK
| | - Antoneta Granic
- AGE Research Group, Institute of NeuroscienceNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK,NIHR Newcastle Biomedical Research Centre, and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Joanna Collerton
- Institute of Health and SocietyNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Karen Davies
- AGE Research Group, Institute of NeuroscienceNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK,NIHR Newcastle Biomedical Research Centre, and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Brian K. Saxby
- Institute for AgeingNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Keith A. Wesnes
- Department of PsychologyNorthumbria UniversityNewcastle upon TyneUK,Wesnes Cognition LimitedStreatley‐on‐ThamesUK
| | - Thomas B.L. Kirkwood
- Institute for Cell and Molecular Biosciences and Institute for AgeingNewcastle UniversityNewcastle upon TyneUK
| | - Carol Jagger
- Institute of Health and SocietyNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
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Rong H, Xi Y, An Y, Tao L, Zhang X, Yu H, Wang Y, Qin Z, Xiao R. The Correlation between Early Stages of Life Exposed to Chinese Famine and Cognitive Decline in Adulthood: Nutrition of Adulthood Plays an Important Role in the Link? Front Aging Neurosci 2018; 9:444. [PMID: 29375368 PMCID: PMC5767719 DOI: 10.3389/fnagi.2017.00444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/26/2017] [Indexed: 12/22/2022] Open
Abstract
Objective: The aim of this study was to investigate whether people exposed to the Chinese Famine in fetal period or in multiple stages of childhood are associated with cognitive decline in adulthood. Furthermore, the nutritional environment of adulthood was explored as an important factor in this correlation. Methods: 1162 adults born between 1952 and 1964 were recruited. They were divided into five groups which were non-exposed group, fetal-exposed group, early childhood-exposed group, mid childhood-exposed group and late childhood-exposed group. Cognitive function was measured by using a comprehensive neuropsychological battery test, including Montreal cognitive assessment-Beijing version, mini-mental state examination, auditory verbal learning test, digit span forward, digit span backward, trail making test, and digit symbol test. Semi-quantified food frequency questionnaire (FFQ) was used to assess the dietary nutrition in their adulthood. The dietary nutrient consumption pattern was identified by Two-step and K-means cluster analysis. Results: The significant differences in cognitive function were manifested in different groups. Compared with non-exposed group, subjects in fetal-exposed group had a higher risk of mild cognitive impairment (MCI) (OR 1.51 95% CI 1.02–2.23, P = 0.039) and global cognitive decline (OR 1.68 59% CI 1.02–2.77, P = 0.044). The similar result was also observed in subjects of early childhood-exposed group. Otherwise, subjects who were classified in high nutrient consumption pattern had higher risk of cognitive decline. Moreover, the higher consumption of several nutrients such as fat, carbohydrate and manganese were associated with worse performance on digit span forward, digit span backward, trail making test A, trail making test B and digit symbol. Conclusion: Early stages of life exposed to the Chinese Famine were associated with higher risk of cognitive decline in adulthood. The stronger associations were manifested in the people with high nutrient consumption pattern. The consumption of fat, carbohydrate and manganese were associated with multiple domains cognitive decline.
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Affiliation(s)
- Hongguo Rong
- School of Public Health, Capital Medical University, Beijing, China
| | - Yuandi Xi
- School of Public Health, Capital Medical University, Beijing, China
| | - Yu An
- School of Public Health, Capital Medical University, Beijing, China
| | - Lingwei Tao
- School of Public Health, Capital Medical University, Beijing, China
| | - Xiaona Zhang
- School of Public Health, Capital Medical University, Beijing, China
| | - Huiyan Yu
- School of Public Health, Capital Medical University, Beijing, China
| | - Ying Wang
- School of Public Health, Capital Medical University, Beijing, China
| | | | - Rong Xiao
- School of Public Health, Capital Medical University, Beijing, China
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Sociodemographic Characteristics, Cognitive Function, and Health-related Quality of Life of Patients Referred to Memory Assessment Services in England. Alzheimer Dis Assoc Disord 2017; 31:159-167. [PMID: 27819844 DOI: 10.1097/wad.0000000000000166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
National policy in England is to encourage referral of people with suspected dementia to Memory Assessment Services (MAS). However, little is known about the characteristics of new referrals, which limits our capacity to evaluate these services. The objectives were to: describe the characteristics (age, sex, ethnicity, socioeconomic deprivation, and comorbidity) of referred patients, and examine the relationships between these characteristics and cognitive function (tertiles of Mini-Mental State Examination score) and health-related quality of life (HRQL) (DEMQOL, DEMQOL-Proxy). We used multivariable regression methods to analyze data from 1420 patients from 73 MAS, and their lay carers (n=1020). The mean age of patients was 78 years; 42% had cognitive function equivalent to Mini-Mental State Examination <24. Characteristics associated with lower function were: older age, being female, deprivation, and nonwhite ethnicity. Deprivation and nonwhite ethnicity were also associated with lower self-reported HRQL, as was having multiple comorbidities; older age was associated with better self-reported HRQL. Lower proxy-reported HRQL was associated with being female, deprivation and comorbidities, but not age and ethnicity. A large proportion of study participants had moderate or high cognitive function scores, suggesting that these patients were referred early to MAS. Research is needed to identify why apparent sociodemographic inequalities in use of MAS exist.
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Davis D, Bendayan R, Muniz Terrera G, Hardy R, Richards M, Kuh D. Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort. Neuroepidemiology 2017; 49:121-128. [PMID: 29145205 DOI: 10.1159/000481136] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cognitive capabilities change in later life, although their onset and rate of decline, and how they are shaped by lifetime socioeconomic position, childhood cognition and adult health status are all unclear. METHODS From the Medical Research Council National Survey of Health and Development, we analysed 3,192 participants undergoing one or more cognitive assessments at ages 43, 53, 60-64 and 69. Linear mixed models described cognitive trajectories, adjusting for factors across the life course. RESULTS For both search speed and verbal memory, better performance at age 43 (the intercept) was associated with higher paternal and own education, childhood cognition, and adult occupational class. For search speed, the trajectory was best described as a quadratic function (decline of 45.6 letters/5-years + 4.6 letters). Verbal memory showed a linear decline of 0.20 words/5-years between ages 43 and 60 and a steeper linear decline of 0.95 words/5-years between ages 60 and 69. Decline in verbal memory in the latter period was steeper in those with higher educational achievements at age 26 (additional 0.28 words/5-years for highest attainment). CONCLUSIONS Decline in verbal memory and search speed across midlife is evident, though with different non-linear trajectories. By implication, pathways to cognitive impairment and dementia in older age may have their origins in this period.
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Affiliation(s)
- Daniel Davis
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Rebecca Bendayan
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | | | - Rebecca Hardy
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Marcus Richards
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Diana Kuh
- MRC Unit of Lifelong Health and Ageing at UCL, London, United Kingdom
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Social network type and informal care use in later life: a comparison of three Dutch birth cohorts aged 75–84. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17001246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTRecent societal changes have increased the salience of non-kin relationships. It can be questioned whether network types that are more strongly non-kin-based give more informal care nowadays. We study how informal care use differs according to network type for three birth cohorts. Data from the Longitudinal Aging Study Amsterdam (LASA) on older adults aged 75–84 years, interviewed in 1992, 2002 and 2012, respectively (total sample size N = 2,151, analytical sample having functional limitations N = 926). We found four network types: restricted, family-focused with a partner, family-focused without a partner and wider community-focused diverse networks. Wider community-focused diverse networks are more common in the late birth cohort, whereas restricted networks and family-focused networks without a partner are less common. Logistic regression analyses reveal that those in a family-focused network with a partner use informal care more often than those in the other three network types, and insignificant interaction terms show that this does not differ by birth cohort. Irrespective of their network type, those in the late birth cohort use informal care less often. However, after controlling for need, predisposing and context factors, this cohort-difference is no longer significant. We conclude that despite large-scale societal changes, wider community-focused diverse networks do not provide more informal care than before and that among the functionally impaired, the odds of receiving informal care does not decline across birth cohorts.
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Park JC, Han SH, Byun MS, Yi D, Lee JH, Park K, Lee DY, Mook-Jung I. Low Serum Phosphorus Correlates with Cerebral Aβ Deposition in Cognitively Impaired Subjects: Results from the KBASE Study. Front Aging Neurosci 2017; 9:362. [PMID: 29163142 PMCID: PMC5681522 DOI: 10.3389/fnagi.2017.00362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/23/2017] [Indexed: 11/29/2022] Open
Abstract
Alzheimer's disease (AD), characterized by progressive cognitive decline, is the most prevalent neurodegenerative disease in the elderly. Cerebral β-amyloid (Aβ) deposition is the major pathological hallmark of AD. Recent studies also have shown that the serum level of phosphorus correlates to the risk of incident dementia. To date, the linkage between cerebral Aβ deposition and the serum phosphorus level remains unknown. In this study, we analyzed the levels of serum phosphorus in 109 mild cognitive impairment (MCI) and 73 AD dementia (ADD) subjects. All subjects underwent Pittsburgh compound B positron emission tomography (PiB-PET) imaging to measure cerebral Aβ deposition. The results with Aβ deposition was compared with the serum levels of phosphorus. The subjects with cerebral Aβ deposition showed lower levels of serum phosphorus than those without Aβ deposition. Furthermore, multiple regression analyses showed that a low level of serum phosphorus correlated with cerebral Aβ deposition, even when age, sex, apolipoprotein E ε4 genotype, and MMSE z-score were controlled for. Serum levels of other ions, including calcium, iron, zinc, and copper, showed no such correlation. In conclusion, our results suggest that the serum level of phosphorus may be used as an easily accessible blood biomarker for cerebral Aβ deposition in a cognitively impaired population.
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Affiliation(s)
- Jong-Chan Park
- Department of Biochemistry and Biomedical Sciences, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sun-Ho Han
- Department of Biochemistry and Biomedical Sciences, College of Medicine, Seoul National University, Seoul, South Korea.,Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Min S Byun
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, South Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, South Korea
| | - Jun Ho Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Kyua Park
- Department of Biology, College of Arts & Sciences, University of Pennsylvania, Pennsylvania, PA, United States
| | - Dong Young Lee
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Inhee Mook-Jung
- Department of Biochemistry and Biomedical Sciences, College of Medicine, Seoul National University, Seoul, South Korea.,Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
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Marden JR, Tchetgen Tchetgen EJ, Kawachi I, Glymour MM. Contribution of Socioeconomic Status at 3 Life-Course Periods to Late-Life Memory Function and Decline: Early and Late Predictors of Dementia Risk. Am J Epidemiol 2017; 186:805-814. [PMID: 28541410 PMCID: PMC5859987 DOI: 10.1093/aje/kwx155] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/17/2016] [Accepted: 11/21/2016] [Indexed: 11/14/2022] Open
Abstract
Both early life and adult socioeconomic status (SES) predict late-life level of memory; however, evidence is mixed on the relationship between SES and rate of memory decline. Further, the relative importance of different life-course periods for rate of late-life memory decline has not been evaluated. We examined associations between life-course SES and late-life memory function and decline. Health and Retirement Study participants (n = 10,781) were interviewed biennially from 1998-2012 (United States). SES measurements for childhood (composite score including parents' educational attainment), early adulthood (high-school or college completion), and older adulthood (income, mean age 66 years) were all dichotomized. Word-list memory was modeled via inverse-probability weighted longitudinal models accounting for differential attrition, survival, and time-varying confounding, with nonrespondents retained via proxy assessments. Compared to low SES at all 3 points (referent), stable, high SES predicted the best memory function and slowest decline. High-school completion had the largest estimated effect on memory (β = 0.19; 95% confidence interval: 0.15, 0.22), but high late-life income had the largest estimated benefit for slowing declines (for 10-year memory change, β = 0.35; 95% confidence interval: 0.24, 0.46). Both early and late-life interventions are potentially relevant for reducing dementia risk by improving memory function or slowing decline.
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Affiliation(s)
- Jessica R. Marden
- Correspondence to Dr. Jessica R. Marden, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115 (e-mail: )
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Suanet B, Antonucci TC. Cohort Differences in Received Social Support in Later Life: The Role of Network Type. J Gerontol B Psychol Sci Soc Sci 2017; 72:706-715. [PMID: 27334639 DOI: 10.1093/geronb/gbw075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 06/09/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The objective is to assess cohort differences in received emotional and instrumental support in relation to network types. The main guiding hypothesis is that due to increased salience of non-kin with recent social change, those in friend-focused and diverse network types receive more support in later birth cohorts than earlier birth cohorts. Method Data from the Longitudinal Aging Study Amsterdam are employed. We investigate cohort differences in total received emotional and instrumental support in a series of linear regression models comparing birth cohorts aged 55-64, 65-74, 75-84, and 85-94 across three time periods (1992, 2002, and 2012). Results Four network types (friend, family, restricted, and diverse) are identified. Friend-focused networks are more common in later birth cohorts, restrictive networks less common. Those in friend-focused networks in later cohorts report receiving more emotional and instrumental support. No differences in received support are evident upon diverse networks. Discussion The increased salience of non-kin is reflected in an increase in received emotional and instrumental support in friend-focused networks in later birth cohorts. The preponderance of non-kin in networks should not be perceived as a deficit model for social relationships as restrictive networks are declining across birth cohorts.
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Affiliation(s)
- Bianca Suanet
- Department of Sociology, Faculty of Social Sciences, VU University Amsterdam, The Netherlands
| | - Toni C Antonucci
- Institute for Social Research, The University of Michigan, Ann Arbor
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