1
|
Yang W, Wang J, Dove A, Dunk MM, Qi X, Bennett DA, Xu W. Association of cognitive reserve with the risk of dementia in the UK Biobank: role of polygenic factors. Br J Psychiatry 2024; 224:213-220. [PMID: 38328972 DOI: 10.1192/bjp.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND It remains unclear whether cognitive reserve can attenuate dementia risk among people with different genetic predispositions. AIMS We aimed to examine the association between cognitive reserve and dementia, and further to explore whether and to what extent cognitive reserve may modify the risk effect of genetic factors on dementia. METHOD Within the UK Biobank, 210 631 dementia-free participants aged ≥60 years were followed to detect incident dementia. Dementia was ascertained through medical and death records. A composite cognitive reserve indicator encompassing education, occupation and multiple cognitively loaded activities was created using latent class analysis, categorised as low, moderate and high level. Polygenic risk scores for Alzheimer's disease were constructed to evaluate genetic risk for dementia, categorised by tertiles (high, moderate and low). Data were analysed using Cox models and Laplace regression. RESULTS In multi-adjusted Cox models, the hazard ratio (HR) of dementia was 0.66 (95% confidence interval (CI) 0.61-0.70) for high cognitive reserve compared with low cognitive reserve. In Laplace regression, participants with high cognitive reserve developed dementia 1.62 (95% CI 1.35-1.88) years later than those with low cognitive reserve. In stratified analysis by genetic risk, high cognitive reserve was related to more than 30% lower dementia risk compared with low cognitive reserve in each stratum. There was an additive interaction between low cognitive reserve and high genetic risk on dementia (attributable proportion 0.24, 95% CI 0.17-0.31). CONCLUSIONS High cognitive reserve is associated with reduced risk of dementia and may delay dementia onset. Genetic risk for dementia may be mitigated by high cognitive reserve. Our findings underscore the importance of enhancing cognitive reserve in dementia prevention.
Collapse
Affiliation(s)
- Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jiao Wang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Michelle M Dunk
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; and Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, USA
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; and Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
| |
Collapse
|
2
|
Steffener J, Nicholls J, Farghal S, Franklin D. The Beneficial, Formative Role of Lifetime Exposures across Cognitive Domains in Barbados Using Data from the SABE Study. Can J Aging 2024:1-11. [PMID: 38801134 DOI: 10.1017/s0714980824000242] [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: 05/29/2024] Open
Abstract
This study tested the hypothesis that within older Barbadian adults, sex, education, and occupation type lessen age-related cognitive decline. The analyses used a cross-sectional data set from 1325 people collected in the 2006 SABE Study (Health, Well-being, and Aging). Cognition was assessed as scores in each subdomain of the Mini-Mental State Exam. The loss of a single point in each subdomain was predicted by sex, years of education, job type, and their interactions with age. Results demonstrated that age and protective factors affect each cognitive domain differently. High education combined with mentally complex employment helped maintain cognitive performance in later life. Beneficial lifetime exposures are additive, providing combined benefits. Findings provide insight into public policy aiming to minimize the number of adults with cognitive decline and dementia in Barbados and the Caribbean.
Collapse
Affiliation(s)
- Jason Steffener
- Interdisciplinary School of Health Science, University of Ottawa, Ottawa, ON, Canada
| | | | - Shireen Farghal
- Interdisciplinary School of Health Science, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Franklin
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
3
|
Melcher EM, Vilen L, Pfaff A, Lim S, DeWitt A, Powell WR, Bendlin BB, Kind AJH. Deriving life-course residential histories in brain bank cohorts: A feasibility study. Alzheimers Dement 2024; 20:3219-3227. [PMID: 38497250 PMCID: PMC11095419 DOI: 10.1002/alz.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The exposome is theorized to interact with biological mechanisms to influence risk for Alzheimer's disease but is not well-integrated into existing Alzheimer's Disease Research Center (ADRC) brain bank data collection. METHODS We apply public data tracing, an iterative, dual abstraction and validation process rooted in rigorous historic archival methods, to develop life-course residential histories for 1254 ADRC decedents. RESULTS The median percentage of the life course with an address is 78.1% (IQR 24.9); 56.5% of the sample has an address for at least 75% of their life course. Archivists had 89.7% agreement at the address level. This method matched current residential survey methodology 97.4% on average. DISCUSSION This novel method demonstrates feasibility, reproducibility, and rigor for historic data collection. To our knowledge, this is the first study to show that public data tracing methods for brain bank decedent residential history development can be used to better integrate the social exposome with biobank specimens. HIGHLIGHTS Public data tracing compares favorably to survey-based residential history. Public data tracing is feasible and reproducible between archivists. Archivists achieved 89.7% agreement at the address level. This method identifies residences for nearly 80% of life-years, on average. This novel method enables brain banks to add social characterizations.
Collapse
Affiliation(s)
- Eleanna M. Melcher
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthWarf Office BldgMadisonUSA
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Leigha Vilen
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Aly Pfaff
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Sarah Lim
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Amanda DeWitt
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - W. Ryan Powell
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
- Department of Medicine Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158Medical Foundation Centennial BuildingMadisonUSA
| | - Barbara B. Bendlin
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
- Department of Medicine Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158Medical Foundation Centennial BuildingMadisonUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonUSA
| | - Amy J. H. Kind
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
- Department of Medicine Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158Medical Foundation Centennial BuildingMadisonUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonUSA
| |
Collapse
|
4
|
Stephan Y, Sutin AR, Mõttus R, Luchetti M, Aschwanden D, Terracciano A. Personality nuances and risk of dementia: Evidence from two longitudinal studies. J Psychiatr Res 2024; 175:1-8. [PMID: 38696946 DOI: 10.1016/j.jpsychires.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
Personality traits are broad constructs composed of nuances, operationalized by personality items, that can provide a more granular understanding of personality associations with health outcomes. This study examined the associations between personality nuances and incident dementia and evaluated whether nuances associations replicate across two samples. Health and Retirement Study (HRS, N = 11,400) participants were assessed in 2006/2008, and the English Longitudinal Study of Ageing (ELSA, N = 7453) participants were assessed in 2010/2011 on personality and covariates. Dementia incidence was tracked for 14 years in the HRS and 8 years in ELSA. In both HRS and ELSA, higher neuroticism domain and nuances (particularly nervous and worry) were related to a higher risk of incident dementia, whereas higher conscientiousness domain and nuances (particularly responsibility and organization) were associated with a lower risk of dementia. To a lesser extent, higher extraversion (active), openness (broad-minded, curious, and imaginative), and agreeableness (helpful, warm, caring, and sympathetic) nuances were associated with a lower risk of dementia, with replicable effects across the two samples. A poly-nuance score, aggregating the effects of personality items, was associated with an increased risk of incident dementia in the HRS and ELSA, with effect sizes slightly stronger than those of the personality domains. Clinical, behavioral, psychological, and genetic covariates partially accounted for these associations. The present study provides novel and replicable evidence for specific personality characteristics associated with the risk of incident dementia.
Collapse
Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - René Mõttus
- Department of Psychology, University of Edinburg, UK; Institute of Psychology, University of Tartu, Estonia
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - Damaris Aschwanden
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland; Department of Geriatrics, College of Medicine, Florida State University, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA
| |
Collapse
|
5
|
While A. The challenge of longevity. Br J Community Nurs 2024; 29:104-105. [PMID: 38421890 DOI: 10.12968/bjcn.2024.29.3.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London and Fellow of the Queen's Nursing Institute
| |
Collapse
|
6
|
Ayton A, Hicks AJ, Spitz G, Ponsford J. The utility of the Cognitive Reserve Index questionnaire in chronic traumatic brain injury. Clin Neuropsychol 2024; 38:182-201. [PMID: 37035985 DOI: 10.1080/13854046.2023.2196441] [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: 09/04/2022] [Accepted: 03/23/2023] [Indexed: 04/11/2023]
Abstract
Objective: This study examined the relationship between cognitive reserve measured with the Cognitive Reserve Index questionnaire (CRIq) and cognitive and functional outcomes in a chronic traumatic brain injury (TBI) cohort compared to a non-TBI cohort. The utility of the CRIq was compared to common proxies of cognitive reserve (premorbid IQ and years of education) in TBI and non-TBI cohorts. Method: Participants were 105 individuals with moderate-severe TBI (10-33 years post injury) and 91 participants without TBI. Cognitive outcome was examined across four cognitive factors; verbal memory, visual ability and memory, executive attention, and episodic memory. Functional outcome was measured using the Glasgow Outcome Scale Extended. The CRIq total score and three subscale scores (education, work, leisure) were examined. Results: In the TBI cohort, associations were identified between two CRIq subscales and cognitive factors (CRIq education and verbal memory; CRIq work and executive attention). There were no associations between CRIq leisure and cognitive outcomes, or between CRIq and functional outcome. Model selection statistics suggested premorbid IQ and years of education provided a better fit than the CRIq for the relationship between cognitive reserve with two cognitive factors and functional outcome, with neither model providing an improved fit for the remaining two cognitive factors. This finding was broadly consistent in the non-TBI cohort. Conclusion: Cognitive reserve contributes significantly to long-term clinical outcomes following moderate-severe TBI. The relationship between cognitive reserve and long-term cognitive and functional outcomes following TBI is best characterised with traditional proxies of cognitive reserve, mainly premorbid IQ, rather than the CRIq.
Collapse
Affiliation(s)
- Amber Ayton
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Tsiaras Y, Kiosseoglou G, Dardiotis E, Yannakoulia M, Hadjigeorgiou GM, Sakka P, Ntanasi E, Scarmeas N, Kosmidis MH. Predictive ability of the clock drawing test to detect mild cognitive impairment and dementia over time: Results from the HELIAD study. Clin Neuropsychol 2023; 37:1651-1668. [PMID: 36645823 DOI: 10.1080/13854046.2023.2167736] [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: 05/31/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Objective: We investigated the diagnostic accuracy of the Clock Drawing Test (CDT) in discriminating Mild Cognitive Impairment (MCI) and dementia from normal cognition. Additionally, its clinical utility in predicting the transition from normal cognition to MCI and dementia over the course of several years was explored. Method: In total, 1037 older adults (633 women) who completed the CDT in a baseline assessment were drawn from the population-based HELIAD cohort. Among these, 848 participants were identified as cognitively normal, 142 as having MCI and 47 with dementia during the baseline assessment. Of these individuals, 565 attended the follow-up assessment (mean interval: 3.21 years). ROC curve and binary logistic regression analyses were performed. Results: The CDT exhibited good diagnostic accuracy for the discrimination between dementia and normal cognition (AUC = .879, SN = .813, SP = .778, LR+ = 3.66, LR- = .240, < .001, d = 1.655) and acceptable diagnostic accuracy for the discrimination between dementia and MCI (AUC=.761, SN= .750, SP= .689, LR+ = 2.41, LR- = .362, p < .001, d = 1.003). We found limited diagnostic accuracy, however, for the discrimination between MCI and normal cognition (AUC = .686, SN = .764, SP = .502, LR+ = 1.53, LR- = .470, p < .001, d = .685). Moreover, the CDT significantly predicted the transition from normal cognition to dementia [Exp(B)= 1.257, p = .022], as well as the transition from MCI to normal cognition [Exp(B) = 1.334, p = .023] during the longitudinal investigation. Conclusions: The CDT is a neuropsychological test with acceptable diagnostic accuracy for the discrimination of dementia from MCI and normal cognition. Furthermore, it has an important predictive value for the transition from normal cognition to dementia and from MCI to normal cognition.
Collapse
Affiliation(s)
- Yiannis Tsiaras
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Psychiatric Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Grigoris Kiosseoglou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, University of Thessaly, Volos, Greece
| | - Mary Yannakoulia
- Department of Nutrition and-Dietetics, Harokopio University, Kallithea, Greece
| | | | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Eva Ntanasi
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Τhe Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, ΝΥ, USA
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
8
|
Quan M, Wang X, Gong M, Wang Q, Li Y, Jia J. Post-COVID cognitive dysfunction: current status and research recommendations for high risk population. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100836. [PMID: 37457901 PMCID: PMC10344681 DOI: 10.1016/j.lanwpc.2023.100836] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/13/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Post-COVID cognitive dysfunction (PCCD) is a condition in which patients with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, usually three months from the onset, exhibit subsequent cognitive impairment in various cognitive domains, and cannot be explained by an alternative diagnosis. While our knowledge of the risk factors and management strategy of PCCD is still incomplete, it is necessary to integrate current epidemiology, diagnosis and treatment evidence, and form consensus criteria to better understand this disease to improve disease management. Identifying the risk factors and vulnerable population of PCCD and providing reliable strategies for effective prevention and management is urgently needed. In this paper, we reviewed epidemiology, diagnostic markers, risk factors and available treatments on the disease, formed research recommendation framework for vulnerable population, under the background of post-COVID period.
Collapse
Affiliation(s)
- Meina Quan
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Xuechu Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Min Gong
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Qi Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Yan Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Jianping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
- Beijing Key Laboratory of Geriatric Cognitive Disorders, China
- Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, China
- Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
| |
Collapse
|
9
|
Mohanannair Geethadevi G, Quinn TJ, George J, Anstey KJ, Bell JS, Sarwar MR, Cross AJ. Multi-domain prognostic models used in middle-aged adults without known cognitive impairment for predicting subsequent dementia. Cochrane Database Syst Rev 2023; 6:CD014885. [PMID: 37265424 PMCID: PMC10239281 DOI: 10.1002/14651858.cd014885.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Dementia, a global health priority, has no current cure. Around 50 million people worldwide currently live with dementia, and this number is expected to treble by 2050. Some health conditions and lifestyle behaviours can increase or decrease the risk of dementia and are known as 'predictors'. Prognostic models combine such predictors to measure the risk of future dementia. Models that can accurately predict future dementia would help clinicians select high-risk adults in middle age and implement targeted risk reduction. OBJECTIVES Our primary objective was to identify multi-domain prognostic models used in middle-aged adults (aged 45 to 65 years) for predicting dementia or cognitive impairment. Eligible multi-domain prognostic models involved two or more of the modifiable dementia predictors identified in a 2020 Lancet Commission report and a 2019 World Health Organization (WHO) report (less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol intake, obesity, smoking, depression, social isolation, physical inactivity, diabetes mellitus, air pollution, poor diet, and cognitive inactivity). Our secondary objectives were to summarise the prognostic models, to appraise their predictive accuracy (discrimination and calibration) as reported in the development and validation studies, and to identify the implications of using dementia prognostic models for the management of people at a higher risk for future dementia. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ISI Web of Science Core Collection from inception until 6 June 2022. We performed forwards and backwards citation tracking of included studies using the Web of Science platform. SELECTION CRITERIA: We included development and validation studies of multi-domain prognostic models. The minimum eligible follow-up was five years. Our primary outcome was an incident clinical diagnosis of dementia based on validated diagnostic criteria, and our secondary outcome was dementia or cognitive impairment determined by any other method. DATA COLLECTION AND ANALYSIS Two review authors independently screened the references, extracted data using a template based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS), and assessed risk of bias and applicability of included studies using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We synthesised the C-statistics of models that had been externally validated in at least three comparable studies. MAIN RESULTS: We identified 20 eligible studies; eight were development studies and 12 were validation studies. There were 14 unique prognostic models: seven models with validation studies and seven models with development-only studies. The models included a median of nine predictors (range 6 to 34); the median number of modifiable predictors was five (range 2 to 11). The most common modifiable predictors in externally validated models were diabetes, hypertension, smoking, physical activity, and obesity. In development-only models, the most common modifiable predictors were obesity, diabetes, hypertension, and smoking. No models included hearing loss or air pollution as predictors. Nineteen studies had a high risk of bias according to the PROBAST assessment, mainly because of inappropriate analysis methods, particularly lack of reported calibration measures. Applicability concerns were low for 12 studies, as their population, predictors, and outcomes were consistent with those of interest for this review. Applicability concerns were high for nine studies, as they lacked baseline cognitive screening or excluded an age group within the range of 45 to 65 years. Only one model, Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE), had been externally validated in multiple studies, allowing for meta-analysis. The CAIDE model included eight predictors (four modifiable predictors): age, education, sex, systolic blood pressure, body mass index (BMI), total cholesterol, physical activity and APOEƐ4 status. Overall, our confidence in the prediction accuracy of CAIDE was very low; our main reasons for downgrading the certainty of the evidence were high risk of bias across all the studies, high concern of applicability, non-overlapping confidence intervals (CIs), and a high degree of heterogeneity. The summary C-statistic was 0.71 (95% CI 0.66 to 0.76; 3 studies; very low-certainty evidence) for the incident clinical diagnosis of dementia, and 0.67 (95% CI 0.61 to 0.73; 3 studies; very low-certainty evidence) for dementia or cognitive impairment based on cognitive scores. Meta-analysis of calibration measures was not possible, as few studies provided these data. AUTHORS' CONCLUSIONS We identified 14 unique multi-domain prognostic models used in middle-aged adults for predicting subsequent dementia. Diabetes, hypertension, obesity, and smoking were the most common modifiable risk factors used as predictors in the models. We performed meta-analyses of C-statistics for one model (CAIDE), but the summary values were unreliable. Owing to lack of data, we were unable to meta-analyse the calibration measures of CAIDE. This review highlights the need for further robust external validations of multi-domain prognostic models for predicting future risk of dementia in middle-aged adults.
Collapse
Affiliation(s)
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Kaarin J Anstey
- School of Psychology, The University of New South Wales, Sydney, Australia
- Ageing Futures Institute, The University of New South Wales, Sydney, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Muhammad Rehan Sarwar
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
10
|
Wei W, Wang K, Shi J, Li Z. Instruments to Assess Cognitive Reserve Among Older Adults: a Systematic Review of Measurement Properties. Neuropsychol Rev 2023:10.1007/s11065-023-09594-3. [PMID: 37115436 DOI: 10.1007/s11065-023-09594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
Cognitive reserve explains the differences in the susceptibility to cognitive impairment related to brain aging, pathology, or insult. Given that cognitive reserve has important implications for the cognitive health of typically and pathologically aging older adults, research needs to identify valid and reliable instruments for measuring cognitive reserve. However, the measurement properties of current cognitive reserve instruments used in older adults have not been evaluated according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). This systematic review aimed to critically appraise, compare, and summarize the quality of the measurement properties of all existing cognitive reserve instruments for older adults. A systematic literature search was performed to identify relevant studies published up to December 2021, which was conducted by three of four researchers using 13 electronic databases and snowballing method. The COSMIN was used to assess the methodological quality of the studies and the quality of measurement properties. Out of the 11,338 retrieved studies, only seven studies that concerned five instruments were eventually included. The methodological quality of one-fourth of the included studies was doubtful and three-seventh was very good, while only four measurement properties from two instruments were supported by high-quality evidence. Overall, current studies and evidence for selecting cognitive reserve instruments suitable for older adults were insufficient. All included instruments have the potential to be recommended, while none of the identified cognitive reserve instruments for older adults appears to be generally superior to the others. Therefore, further studies are recommended to validate the measurement properties of existing cognitive reserve instruments for older adults, especially the content validity as guided by COSMIN.Systematic Review Registration numbers: CRD42022309399 (PROSPERO).
Collapse
Affiliation(s)
- Wanrui Wei
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China
| | - Kairong Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China
| | - Jiyuan Shi
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China.
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Devos H, Gustafson KM, Liao K, Ahmadnezhad P, Kuhlmann E, Estes BJ, Martin LE, Mahnken JD, Brooks WM, Burns JM. Effect of Cognitive Reserve on Physiological Measures of Cognitive Workload in Older Adults with Cognitive Impairments. J Alzheimers Dis 2023; 92:141-151. [PMID: 36710677 PMCID: PMC10023364 DOI: 10.3233/jad-220890] [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: 01/25/2023]
Abstract
BACKGROUND Cognitive reserve may protect against cognitive decline. OBJECTIVE This cross-sectional study investigated the association between cognitive reserve and physiological measures of cognitive workload in older adults with cognitive impairment. METHODS 29 older adults with cognitive impairment (age: 75±6, 11 (38%) women, MoCA: 20±7) and 19 with normal cognition (age: 74±6; 11 (58%) women; MoCA: 28±2) completed a working memory test of increasing task demand (0-, 1-, 2-back). Cognitive workload was indexed using amplitude and latency of the P3 event-related potential (ERP) at electrode sites Fz, Cz, and Pz, and changes in pupillary size, converted to an index of cognitive activity (ICA). The Cognitive Reserve Index questionnaire (CRIq) evaluated Education, Work Activity, and Leisure Time as a proxy of cognitive reserve. Linear mixed models evaluated the main effects of cognitive status, CRIq, and the interaction effect of CRIq by cognitive status on ERP and ICA. RESULTS The interaction effect of CRIq total score by cognitive status on P3 ERP and ICA was not significant. However, higher CRIq total scores were associated with lower ICA (p = 0.03). The interaction effects of CRIq subscores showed that Work Activity affected P3 amplitude (p = 0.03) and ICA (p = 0.03) differently between older adults with and without cognitive impairments. Similarly, Education affected ICA (p = 0.02) differently between the two groups. No associations were observed between CRIq and P3 latency. CONCLUSION Specific components of cognitive reserve affect cognitive workload and neural efficiency differently in older adults with and without cognitive impairments.
Collapse
Affiliation(s)
- Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.,University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kathleen M Gustafson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ke Liao
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Pedram Ahmadnezhad
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Emily Kuhlmann
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley J Estes
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Laura E Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - William M Brooks
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
13
|
Vernooij-Dassen M, Verspoor E, Samtani S, Sachdev PS, Ikram MA, Vernooij MW, Hubers C, Chattat R, Lenart-Bugla M, Rymaszewska J, Szczesniak D, Brodaty H, Welmer AK, Maddock J, van der Velpen IF, Wiegelmann H, Marseglia A, Richards M, Melis R, de Vugt M, Moniz-Cook E, Jeon YH, Perry M, Wolf-Ostermann K. Recognition of social health: A conceptual framework in the context of dementia research. Front Psychiatry 2022; 13:1052009. [PMID: 36590639 PMCID: PMC9798783 DOI: 10.3389/fpsyt.2022.1052009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The recognition of dementia as a multifactorial disorder encourages the exploration of new pathways to understand its origins. Social health might play a role in cognitive decline and dementia, but conceptual clarity is lacking and this hinders investigation of associations and mechanisms. The objective is to develop a conceptual framework for social health to advance conceptual clarity in future studies. Process We use the following steps: underpinning for concept advancement, concept advancement by the development of a conceptual model, and exploration of its potential feasibility. An iterative consensus-based process was used within the international multidisciplinary SHARED project. Conceptual framework Underpinning of the concept drew from a synthesis of theoretical, conceptual and epidemiological work, and resulted in a definition of social health as wellbeing that relies on capacities both of the individual and the social environment. Consequently, domains in the conceptual framework are on both the individual (e.g., social participation) and the social environmental levels (e.g., social network). We hypothesize that social health acts as a driver for use of cognitive reserve which can then slow cognitive impairment or maintain cognitive functioning. The feasibility of the conceptual framework is demonstrated in its practical use in identifying and structuring of social health markers within the SHARED project. Discussion The conceptual framework provides guidance for future research and facilitates identification of modifiable risk and protective factors, which may in turn shape new avenues for preventive interventions. We highlight the paradigm of social health in dementia as a priority for dementia research.
Collapse
Affiliation(s)
- Myrra Vernooij-Dassen
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eline Verspoor
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suraj Samtani
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - Perminder S. Sachdev
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Claudia Hubers
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | | | - Dorota Szczesniak
- Department of Psychiatry, Wrocław Medical University, Wrocław, Poland
| | - Henry Brodaty
- Discipline of Psychiatry and Mental Health, Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
- Dementia Centre for Research Collaboration, Sydney, NSW, Australia
| | - Anna-Karin Welmer
- Department of Neurobiology Care Sciences and Society, Aging Research Center & Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Jane Maddock
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, United Kingdom
| | - Isabelle F. van der Velpen
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Henrik Wiegelmann
- Department of Nursing Science Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Anna Marseglia
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, United Kingdom
| | - Rene Melis
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, Faculty of Health, Medicine and Life Sciences, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherland
| | - Esme Moniz-Cook
- Department of Clinical Psychology, University of Hull, Hull, United Kingdom
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marieke Perry
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin Wolf-Ostermann
- Department of Nursing Science Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| |
Collapse
|
14
|
Li Y, Wang X, Guo L, Zhu L, Shi J, Wang W, Lu C. Eight-Year Trajectories of Late-Life Loneliness and Incident Dementia: A Nationally Representative Cohort Study. Am J Geriatr Psychiatry 2022:S1064-7481(22)00575-9. [PMID: 36549995 DOI: 10.1016/j.jagp.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Some older adults with loneliness might have transient loneliness, followed by full remission, while others might have persistent loneliness. Such different courses might differ in predicting the risk of dementia, but most previous studies assessed short-term loneliness at a single time point, ignoring the long-term changes of loneliness. This study aimed to explore the association between 8-year trajectories of late-life loneliness and incident dementia. METHODS Data were from the English Longitudinal Study of Ageing (waves 2-9). This study included 6,722 older adults measured for loneliness greater than or equal to three times from wave 2 (2004-2005) to wave 6 (2012-2013) and free from dementia in wave 6. Loneliness was assessed using the short 1980 version of the University of California, Los Angeles Loneliness Scale. Group-based trajectory modeling was used to explore loneliness trajectories during waves 2-6. Cox proportional hazard models were used to investigate the association of loneliness trajectories with incident dementia during waves 6-9. RESULTS Five distinct loneliness trajectories were identified: long-term low, persistently decreasing, persistently increasing, long-term moderate, and long-term high. Compared with long-term low loneliness, the HRs (95% confidence intervals) for persistently decreasing, persistently increasing, long-term moderate, and long-term high loneliness were 1.29 (0.83-2.00), 1.55 (1.04-2.31), 1.56 (1.03-2.38), and 3.35 (1.89-5.91), respectively. CONCLUSION The elderly show distinct patterns of loneliness over time, which cannot be captured by a single assessment of loneliness. The elderly with long-term loneliness and persistently increasing loneliness might be the high-risk group for dementia. Further studies are needed to determine whether reducing loneliness can prevent dementia.
Collapse
Affiliation(s)
- Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaojie Wang
- Department of Neurology, Shenzhen Shekou People's Hospital, Shenzhen, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Liwan Zhu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
15
|
Almeida-Meza P, Richards M, Cadar D. Moderating Role of Cognitive Reserve Markers Between Childhood Cognition and Cognitive Aging: Evidence From the 1946 British Birth Cohort. Neurology 2022; 99:e1239-e1250. [PMID: 35922143 PMCID: PMC9576292 DOI: 10.1212/wnl.0000000000200928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As the population ages, differences in cognitive abilities become more evident. We investigated key genetic and life course influences on cognitive state at age 69 years, building on previous work using the longitudinal Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). METHODS Multivariable regressions investigated the association between 4 factors: (1) childhood cognition at age 8 years; (2) a Cognitive Reserve Index (CRI) composed of 3 markers: (i) educational attainment by age 26 years, (ii) engagement in leisure activities at age 43 years, and (iii) occupation up to age 53 years; (3) reading ability assessed by the National Adult Reading Test (NART) at age 53 years; and (4) APOE genotype in relation to cognitive state measured at age 69 years with Addenbrooke's Cognitive Examination, third edition (ACE-III). We then investigated the modifying role of the CRI, NART, and APOE in the association between childhood cognition and the ACE-III. RESULTS The analytical sample comprised 1,184 participants. Higher scores in childhood cognition, CRI, and NART were associated with higher scores in the ACE-III. We found that the CRI and NART modified the association between childhood cognition and the ACE-III: for 30 additional points in the CRI or 20 additional points in the NART, the simple slope of childhood cognition decreased by approximately 0.10 points (CRI = 70: marginal effects (MEs) 0.22, 95% CI 0.12-0.32, p < 0.001 vs CRI = 100: MEs 0.12, 95% CI 0.06-0.17, p < 0.001; NART = 15: MEs 0.22, 95% CI 0.09-0.35, p = 0.001, vs NART = 35: MEs 0.11, 95% CI 0.05-0.17, p < 0.001). The association between childhood cognition and the ACE-III was nonsignificant at high levels of the CRI or NART. Furthermore, the e4 allele of the APOE gene was associated with lower scores in the ACE-III (β = -0.71, 95% CI -1.36 to -0.06, p = 0.03) but did not modify the association between childhood cognition and cognitive state in later life. DISCUSSION The CRI and NART are independent measures of cognitive reserve because both modify the association between childhood cognition and cognitive state.
Collapse
Affiliation(s)
- Pamela Almeida-Meza
- From the Department of Behavioural Science and Health (P.A.-M., D.C.), University College London; MRC Unit for Lifelong Health and Ageing, University College London; and Centre for Dementia Studies (D.C.), Department of Neuroscience, Brighton and Sussex Medical School, UK.
| | - Marcus Richards
- From the Department of Behavioural Science and Health (P.A.-M., D.C.), University College London; MRC Unit for Lifelong Health and Ageing, University College London; and Centre for Dementia Studies (D.C.), Department of Neuroscience, Brighton and Sussex Medical School, UK
| | - Dorina Cadar
- From the Department of Behavioural Science and Health (P.A.-M., D.C.), University College London; MRC Unit for Lifelong Health and Ageing, University College London; and Centre for Dementia Studies (D.C.), Department of Neuroscience, Brighton and Sussex Medical School, UK
| |
Collapse
|
16
|
Ford KJ, Kobayashi LC, Leist AK. Childhood Socioeconomic Disadvantage and Pathways to Memory Performance in Mid to Late Adulthood: What Matters Most? J Gerontol B Psychol Sci Soc Sci 2022; 77:1478-1489. [PMID: 35583218 PMCID: PMC9371451 DOI: 10.1093/geronb/gbac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Childhood socioeconomic disadvantage is consistently associated with lower cognitive function in later life. This study aims to distinguish the contribution of specific aspects of childhood socioeconomic disadvantage for memory performance in mid-to-late adulthood, with consideration for direct and indirect effects through education and occupation. METHODS Data were from adults aged 50-80 years who completed the life history module in the 2006/07 wave of the English Longitudinal Study of Ageing (n=4,553). The outcome, memory score, was based on word recall tests (range: 0-20 points). We used the g-formula to estimate direct and indirect effects of a composite variable for childhood socioeconomic disadvantage, and its four individual components: lower-skilled occupation of the primary breadwinner, having few books in the home, overcrowding in the home, and lack of water and heating facilities in the home. RESULTS Few books were the most consequential component of childhood socioeconomic disadvantage for later life memory (total effect: ⎼0.82 points for few books; 95% CI: ⎼1.04, ⎼0.60), with roughly half being a direct effect. The total effect of a breadwinner in lower-skilled occupations was smaller but not significantly different from few books (⎼0.67 points; 95% CI: ⎼0.88, ⎼0.46), while it was significantly smaller with overcrowding (⎼0.31 points; 95% CI: ⎼0.56, ⎼0.06). The latter two total effects were mostly mediated by education and occupation. DISCUSSION A literate environment in the childhood home may have lasting direct effects on memory function in mid-to-later life, while parental occupation and overcrowding appear to influence memory primarily through educational and occupational pathways.
Collapse
Affiliation(s)
- Katherine J Ford
- Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan 48109, USA
| | - Anja K Leist
- Institute for Research on Socio-Economic Inequality (IRSEI), University of Luxembourg, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
| |
Collapse
|
17
|
Cognitive reserve and its correlates in child and adolescent offspring of patients diagnosed with schizophrenia or bipolar disorder. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-01957-0. [PMID: 35175425 DOI: 10.1007/s00787-022-01957-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
AIM To analyze cognitive reserve (CR) in child and adolescent offspring of patients diagnosed with schizophrenia (SZ-off) or bipolar disorder (BD-off) and compare them with a group of community controls (CC-off). We also aimed to investigate whether there was an association between CR and clinical and neuropsychological variables according to group. METHODS The study included 46 SZ-off, 105 BD-off and 102 CC-off. All participants completed assessments regarding CR and clinical, neuropsychological and psychosocial functioning. CR was measured with a proxy based on premorbid intelligence, parental occupational level, educational attainment, developmental milestones and sociability. The clinical assessment included the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime, the Semi-structured Interview for Prodromal Syndromes, and the Global Assessment Functioning scale. The neuropsychological assessment included measures of executive functioning, attention, verbal memory, working memory and processing speed. RESULTS SZ-off showed a lower level of CR compared to BD-off and CC-off, while BD-off showed an intermediate level of CR between SZ-off and CC-off. Moreover, an association between higher CR and less lifetime psychopathology, fewer prodromal psychotic symptoms, higher psychosocial functioning, and a higher working memory score was observed in all groups, but it was stronger in SZ-off. CONCLUSIONS CR seemed to be associated with psychopathology, clinical symptoms, psychosocial functioning, and some cognitive functions. SZ-off appeared to benefit more from a higher CR, therefore it could be considered a protective factor against the development of clinical symptomatology and cognitive impairment.
Collapse
|
18
|
Steeg S, Carr M, Trefan L, Ashcroft D, Kapur N, Nielsen E, McMillan B, Webb R. Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study. BMJ Open 2022; 12:e052613. [PMID: 35165109 PMCID: PMC8844953 DOI: 10.1136/bmjopen-2021-052613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES A substantial reduction in self-harm recorded in primary care occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown. Our objectives were to examine the impact of COVID-19 on clinical management within 3 months of an episode of self-harm. DESIGN Retrospective cohort study. SETTING UK primary care. PARTICIPANTS 4238 patients with an index episode of self-harm recorded in UK primary care during the COVID-19 first-wave period (10 March 2020-10 June 2020) compared with 48 739 patients in a prepandemic comparison period (10 March-10 June, 2010-2019). OUTCOME MEASURES Using data from the UK Clinical Practice Research Datalink, we compared cohorts of patients with an index self-harm episode recorded during the prepandemic period versus the COVID-19 first-wave period. Patients were followed up for 3 months to capture subsequent general practitioner (GP)/practice nurse consultation, referral to mental health services and psychotropic medication prescribing. We examined differences by gender, age group and Index of Multiple Deprivation quintile. RESULTS Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (4.2%) was around two-thirds of that in the prepandemic cohort (6.1%). Similar proportions were prescribed psychotropic medication within 3 months in the prepandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. CONCLUSIONS Despite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to prepandemic levels. We found no evidence of widening of digital exclusion in terms of access to remote consultations. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.
Collapse
Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Matthew Carr
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Laszlo Trefan
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Emma Nielsen
- Self-harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Roger Webb
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| |
Collapse
|
19
|
Kim J, Kim MS. An Overview of Cognitive Reserve in Aging Based on Keyword Network Analysis. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221139374. [DOI: 10.1177/00469580221139374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Many studies have reported that Cognitive reserve is a critical mechanism affecting cognitive statuses, such as dementia. The purposes of this study were to identify the knowledge structure and the research trend on cognitive reserve by conducting keyword analysis on research papers ranging from the earliest to the most recent studies done on the topic and to suggest directions for future research. The Web of Science (WOS) database was used to search for articles on cognitive reserve in aging from 2001 to 2020. NetMiner version 4 (cyram, KOREA), a social network analysis program, was used for keyword network analysis. Data analysis showed keywords that could be categorized as cognitive reserve related keywords (cognitive reserve related concepts, cognitive reserve related factor, cognitive reserve diagnosis and measurement, cognitive reserve outcomes) and cognitive reserve research keywords (research subject/disease, research method, intervention, research field). Through trend analysis, we found that various keywords appeared, indicating that the research has gradually developed conceptually and methodically. Based on these findings, future CR studies require the development of multimodal interface-based tools by applying modern digital technology that can be used to more accurately diagnose and monitor CR; remotely, in real time. In addition, to improve CR, it is suggested that the development of cognitive stimulation interventions utilizing VR which fuses AI based interaction technology with the subjects. Finally, CR could develop further through a cooperation of multidisciplinary professionals such as psychology, medicine and nursing.
Collapse
Affiliation(s)
- Jihyun Kim
- Sahmyook University, Seoul, Republic of Korea
| | - Mi So Kim
- Shinhan University, Gyeonggi-do, Republic of Korea
| |
Collapse
|
20
|
Associations between Brain Reserve Proxies and Clinical Progression in Alzheimer's Disease Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212159. [PMID: 34831913 PMCID: PMC8625916 DOI: 10.3390/ijerph182212159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to investigate whether brain and cognitive reserves were associated with the clinical progression of AD dementia. We included participants with AD dementia from the Alzheimer’s Disease Neuroimaging Initiative, provided they were followed up at least once, and candidate proxies for cognitive (education for early-life reserve and Adult Reading Test for late-life reserve) or brain reserve (intracranial volume [ICV] for early-life reserve and the composite value of [18F] fluorodeoxyglucose positron emission tomography regions of interest (FDG-ROIs) for late-life reserve) were available. The final analysis included 120 participants. Cox proportional hazards model revealed that FDG-ROIs were the only significant predictor of clinical progression. Subgroup analysis revealed a significant association between FDG-ROIs and clinical progression only in the larger ICV group (HR = 0.388, p = 0.028, 95% CI 0.167–0.902). Our preliminary findings suggest that relatively preserved cerebral glucose metabolism might delay further clinical progression in AD dementia, particularly in the greater ICV group. In addition to ICV, cerebral glucose metabolism could play an important role as a late-life brain reserve in the process of neurodegeneration. Distinguishing between early- and late-life reserves, and considering both proxies simultaneously, would provide a wider range of factors associated with the prognosis of AD dementia.
Collapse
|
21
|
Kivimäki M, Walker KA, Pentti J, Nyberg ST, Mars N, Vahtera J, Suominen SB, Lallukka T, Rahkonen O, Pietiläinen O, Koskinen A, Väänänen A, Kalsi JK, Goldberg M, Zins M, Alfredsson L, Westerholm PJM, Knutsson A, Theorell T, Ervasti J, Oksanen T, Sipilä PN, Tabak AG, Ferrie JE, Williams SA, Livingston G, Gottesman RF, Singh-Manoux A, Zetterberg H, Lindbohm JV. Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies. BMJ 2021; 374:n1804. [PMID: 34407988 PMCID: PMC8372196 DOI: 10.1136/bmj.n1804] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association. DESIGN Multicohort study with three sets of analyses. SETTING United Kingdom, Europe, and the United States. PARTICIPANTS Three associations were examined: cognitive stimulation and dementia risk in 107 896 participants from seven population based prospective cohort studies from the IPD-Work consortium (individual participant data meta-analysis in working populations); cognitive stimulation and proteins in a random sample of 2261 participants from one cohort study; and proteins and dementia risk in 13 656 participants from two cohort studies. MAIN OUTCOME MEASURES Cognitive stimulation was measured at baseline using standard questionnaire instruments on active versus passive jobs and at baseline and over time using a job exposure matrix indicator. 4953 proteins in plasma samples were scanned. Follow-up of incident dementia varied between 13.7 to 30.1 years depending on the cohort. People with dementia were identified through linked electronic health records and repeated clinical examinations. RESULTS During 1.8 million person years at risk, 1143 people with dementia were recorded. The risk of dementia was found to be lower for participants with high compared with low cognitive stimulation at work (crude incidence of dementia per 10 000 person years 4.8 in the high stimulation group and 7.3 in the low stimulation group, age and sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 to 0.92, heterogeneity in cohort specific estimates I2=0%, P=0.99). This association was robust to additional adjustment for education, risk factors for dementia in adulthood (smoking, heavy alcohol consumption, physical inactivity, job strain, obesity, hypertension, and prevalent diabetes at baseline), and cardiometabolic diseases (diabetes, coronary heart disease, stroke) before dementia diagnosis (fully adjusted hazard ratio 0.82, 95% confidence interval 0.68 to 0.98). The risk of dementia was also observed during the first 10 years of follow-up (hazard ratio 0.60, 95% confidence interval 0.37 to 0.95) and from year 10 onwards (0.79, 0.66 to 0.95) and replicated using a repeated job exposure matrix indicator of cognitive stimulation (hazard ratio per 1 standard deviation increase 0.77, 95% confidence interval 0.69 to 0.86). In analysis controlling for multiple testing, higher cognitive stimulation at work was associated with lower levels of proteins that inhibit central nervous system axonogenesis and synaptogenesis: slit homologue 2 (SLIT2, fully adjusted β -0.34, P<0.001), carbohydrate sulfotransferase 12 (CHSTC, fully adjusted β -0.33, P<0.001), and peptidyl-glycine α-amidating monooxygenase (AMD, fully adjusted β -0.32, P<0.001). These proteins were associated with increased dementia risk, with the fully adjusted hazard ratio per 1 SD being 1.16 (95% confidence interval 1.05 to 1.28) for SLIT2, 1.13 (1.00 to 1.27) for CHSTC, and 1.04 (0.97 to 1.13) for AMD. CONCLUSIONS The risk of dementia in old age was found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs. The findings that cognitive stimulation is associated with lower levels of plasma proteins that potentially inhibit axonogenesis and synaptogenesis and increase the risk of dementia might provide clues to underlying biological mechanisms.
Collapse
Affiliation(s)
- Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Keenan A Walker
- Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA
| | - Jaana Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Solja T Nyberg
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Nina Mars
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Sakari B Suominen
- Department of Public Health, University of Turku, Turku, Finland
- School of Health Science, University of Skövde, Skövde, Sweden
| | - Tea Lallukka
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jatinderpal K Kalsi
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Marcel Goldberg
- Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Marie Zins
- Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | | | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Töres Theorell
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuula Oksanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Pyry N Sipilä
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Internal Medicine and Oncology and Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Jane E Ferrie
- Department of Epidemiology and Public Health, University College London, London, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease and UK Dementia Research Institute, University College London, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, and Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Joni V Lindbohm
- Department of Epidemiology and Public Health, University College London, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
22
|
Scherrer JF, Morley JE. Lowering dementia risk and slowing progression of disease: the role of cognitive reserve and cognitive training. Br J Psychiatry 2021; 218:252-253. [PMID: 32605685 DOI: 10.1192/bjp.2020.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Almeida-Meza et al found an inverse correlation between cognitive reserve (associated with educational level, complexity of occupations and leisure activities) and dementia incidence. We suggest clarifying studies using their data-set and consider what can be done to modify socioeconomic inequalities that affect cognitive reserve or to slow early dementia.
Collapse
Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
23
|
Almeida-Meza P, Steptoe A, Cadar D. Is Engagement in Intellectual and Social Leisure Activities Protective Against Dementia Risk? Evidence from the English Longitudinal Study of Ageing. J Alzheimers Dis 2021; 80:555-565. [PMID: 33554903 PMCID: PMC8075407 DOI: 10.3233/jad-200952] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Studies have suggested that mentally stimulating activities and socially engaged lifestyles may reduce dementia risk; however, it is unclear which activities are more beneficial. Objective: We investigated intellectual and social leisure activities in relation to dementia incidence and explored the modifying role of sex and marital status in these associations. Methods: The sample was comprised of 8,030 participants aged 50+ from the English Longitudinal Study of Ageing, who joined at wave 1 (2002-2003), or waves 3 (2006-2007), or 4 (2008-2009). The end of the study period was wave 8 (2016-2017). Subdistribution hazard models investigated the role of leisure activities grouped into intellectual and social domains in relation to dementia while accounting for the risk of death. Subsequent analyses were conducted with individual leisure activities. Results: During the study period of up to 15 years, 412 participants developed dementia, and 2,192 died. We found that increased engagement in the intellectual activities’ domain was associated with a decreased dementia incidence (SHR 0.85, 95% CI 0.76–0.96, p = 0.007), independent of the risk of death in married individuals, but not in those who were single, divorced, or widowed. Individual analyses for each leisure activity showed independent associations for reading newspapers in females (SHR 0.65, 95% CI 0.49–0.84, p = 0.001), mobile phone usage in males (SHR 0.61, 95% CI 0.45–0.84, p = 0.002), and having hobbies for married individuals (SHR 0.70, 95% CI 0.51–0.95, p = 0.02). Conclusion: We found that intellectual leisure activities contribute to lower dementia risk in a representative population of English adults, suggesting intervention opportunities.
Collapse
Affiliation(s)
- Pamela Almeida-Meza
- University College London, Department of Behavioral Science and Health, London, UK
| | - Andrew Steptoe
- University College London, Department of Behavioral Science and Health, London, UK
| | - Dorina Cadar
- University College London, Department of Behavioral Science and Health, London, UK
| |
Collapse
|
24
|
Garba AE, Grossberg GT, Enard KR, Jano FJ, Roberts EN, Marx CA, Buchanan PM. Testing the Cognitive Reserve Index Questionnaire in an Alzheimer's Disease Population. J Alzheimers Dis Rep 2020; 4:513-524. [PMID: 33532699 PMCID: PMC7835984 DOI: 10.3233/adr-200244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Alzheimer's disease (AD) is the 6th leading cause of death in the United States and has no cure or progression prevention. The Cognitive Reserve (CR) theory poses that constant brain activity earlier in life later helps to deter pathological changes in the brain, delaying the onset of disease symptoms. Objective To determine the reliability and validity of the Cognitive Reserve Index questionnaire (CRIq) in AD patients. Methods Primary data collection was done using the CRIq to quantify CR in 90 participants. Correlations and multivariable linear regressions were used to assess reliability and validity. Results Reliability was tested in 34 participants. A Pearson correlation coefficient of 0.89 (p < 0.001) indicated a strong positive correlation. Validity was tested in 33 participants. A Pearson correlation coefficient of 0.30 (p = 0.10) indicated an insignificant weak positive correlation. Conclusion The CRIq was found reliable. Gaining a better understanding of how CR tools can be used in various cognitive populations will help with the establishment of a research tool that is universally accepted as a true CR measure.
Collapse
Affiliation(s)
- Asabe E Garba
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | | | - Kimberly R Enard
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Fabian J Jano
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Emma N Roberts
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | | |
Collapse
|