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Leung Y, Barzilai N, Batko-Szwaczka A, Beker N, Boerner K, Brayne C, Brodaty H, Cheung KSL, Corrada MM, Crawford JD, Galbussera AA, Gondo Y, Holstege H, Hulsman M, Ishioka YL, Jopp D, Kawas CH, Kaye J, Kochan NA, Lau BHP, Lipnicki DM, Lo JW, Lucca U, Makkar SR, Marcon G, Martin P, Meguro K, Milman S, Poon LW, Recchia A, Ribeiro O, Riva E, Rott C, Sikkes SA, Skoog I, Stephan B, Szewieczek J, Teixeira L, Tettamanti M, Wilczyński K, Sachdev P. Cognition, function, and prevalent dementia in centenarians and near-centenarians: An individual participant data (IPD) meta-analysis of 18 studies. Alzheimers Dement 2023; 19:2265-2275. [PMID: 36453627 DOI: 10.1002/alz.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION There are limited data on prevalence of dementia in centenarians and near-centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100. METHODS Participant-level data were obtained from 18 community-based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization protocol was applied to cognitive and functional impairments, and a meta-analysis was performed. RESULTS The mean age was 98.3 years (SD = 2.67); 79% were women. After adjusting for age, sex, and education, dementia prevalence was 53.2% in women and 45.5% in men, with risk continuing to increase with age. Education (OR 0.95;0.92-0.98) was protective, as was hypertension (odds ratio [OR] 0.51;0.35-0.74) in five studies. Dementia was not associated with diabetes, vision and hearing impairments, smoking, and body mass index (BMI). DISCUSSION Among the exceptional old, dementia prevalence remains higher in the older participants. Education was protective against dementia, but other factors for dementia-free survival in C/NC remain to be understood.
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Affiliation(s)
- Yvonne Leung
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Nir Barzilai
- Albert Einstein College of Medicine, New York, USA
| | - Agnieszka Batko-Szwaczka
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Nina Beker
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School, University of Massachusetts Boston, Boston, USA
| | - Carol Brayne
- University of Cambridge, Cambridge, United Kingdom
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | | | | | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Alessia A Galbussera
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milano, Italy
| | - Yasuyuki Gondo
- Osaka University Graduate School of Human Sciences School of Human Sciences: Osaka, Osaka, Japan
| | - Henne Holstege
- Genomics of Neurodegenerative Diseases and Aging, Human Genetics, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Marc Hulsman
- Genomics of Neurodegenerative Diseases and Aging, Human Genetics, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | | | | | | | - Jeff Kaye
- NIA - sLayton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, USA
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Bobo Hi-Po Lau
- Hong Kong Shue Yan University (HKSYU), Hong Kong SAR, Hong Kong
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milano, Italy
| | - Steve R Makkar
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
| | - Gabriella Marcon
- University of Trieste, Trieste, Italy
- University of Udine, Udine, Italy
| | | | - Kenichi Meguro
- Geriatric Behavioral Neurology, Tohoku University, Sendai, Japan
| | | | | | - Angela Recchia
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milano, Italy
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS), University of Aveiro and ICBAS-University of Porto, Porto, Portugal
| | - Emma Riva
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milano, Italy
| | - Christoph Rott
- Institute of Gerontology, Heidelberg University, Heidelberg, Germany
| | - Sietske Am Sikkes
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Section Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Blossom Stephan
- Institute for Ageing and Institute for Health & Society, Newcastle University, Newcastle, UK
| | - Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Laetitia Teixeira
- Center for Health Technology and Services Research (CINTESIS), University of Aveiro and ICBAS-University of Porto, Porto, Portugal
| | - Mauro Tettamanti
- Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Krzysztof Wilczyński
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia
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Petrosyan D, Corrada MM, Kawas CH, Demoz A, Ganzon C, Popovich O, Gaied R, Mungas D, Gilsanz P, Vieira KE, Whitmer RA, DeCarli C. Assessing cognitive impairment in an ethnically diverse cohort of oldest-old: the life after 90 study. Aging Clin Exp Res 2023; 35:979-986. [PMID: 36870029 PMCID: PMC10149459 DOI: 10.1007/s40520-023-02368-0] [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: 12/28/2022] [Accepted: 02/09/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Though dementia rates vary by racial or ethnic groups, it is unknown if these disparities remain among those aged 90 or older. AIMS To test this hypothesis, we used baseline clinical evaluation of 541 ethnically and racially diverse individuals participating in the LifeAfter90 Study to assess how associations between core demographic characteristics and measures of physical and cognitive performance differ across the racial/ethnic groups. METHODS Participants in this study were long-term non-demented members of Kaiser Permanente Northern California. They were clinically evaluated and diagnosed with normal or impaired cognition (mild cognitive impairment and dementia) through an in-person comprehensive clinical assessment consisting of a detailed medical history, physical and neurological examination, functional, and cognitive tests. RESULTS The average age at enrollment was 93.0 ± 2.6 years, 62.4% female and 34.2% non-Hispanic White. At initial evaluation 301 participants had normal cognition and 165 had mild cognitive impairment (MCI) and despite screening, 69 participants were determined to have dementia. Age, education, 3MS, FAQ and CDR scores were significantly associated with cognitive impairment (normal versus MCI and dementia), but not gender. There was a significant univariate association between race/ethnicity and cognitive impairment (p < 0.02) being highest among Black (57.4%) and lowest among Asian (32.7%) individuals. After adjustment for age, gender, and education, however, prevalence of cognitive impairment was not influenced by race or ethnicity. CONCLUSION Our results confirm the ability to reliably assess clinical diagnosis in a diverse sample of very old individuals.
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Affiliation(s)
- Diana Petrosyan
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA
| | - Maria M Corrada
- School of Medicine, Department of Neurology, University of California at Irvine, Irvine, CA, 92617, USA
- School of Medicine, Department of Epidemiology, University of California at Irvine, Irvine, CA, 92617, USA
| | - Claudia H Kawas
- School of Medicine, Department of Neurology, University of California at Irvine, Irvine, CA, 92617, USA
- School of Biological Sciences, Department of Neurobiology and Behavior, University of California at Irvine, Irvine, CA, 92617, USA
| | - Asmeret Demoz
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA
| | - Czarina Ganzon
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA
| | - Oksana Popovich
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA
| | - Reham Gaied
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA
| | - Dan Mungas
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, CA, 94612, USA
| | | | - Rachel A Whitmer
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA
- School of Medicine, Department of Public Health Sciences, University of California at Davis, Davis, CA, 95616, USA
| | - Charles DeCarli
- School of Medicine, Department of Neurology, University of California at Davis, 4860 Y Street, Suite 3700, Sacramento, CA, 95817, USA.
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Abstract
Parkinson disease (PD) is the second most common age-related neurodegenerative condition diagnosed in North America. We recently demonstrated, using multiple epidemiological data sources, that the prevalence of PD diagnoses was greater than previously reported and currently used for clinical, research, and policy decision-making. Prior PD incidence estimates have varied, for unclear reasons. There is a need for improved estimates of PD incidence, not only for care delivery planning and future policy but also for increasing our understanding of disease risk. The objective of this study was thus to investigate the incidence of Parkinson disease across five epidemiological cohorts in North America in a common year, 2012. The cohorts contained data on 6.7 million person-years of adults ages 45 and older, and 9.3 million person-years of adults ages 65 and older. Our estimates of age-sex-adjusted incidence of PD ranged from 108 to 212 per 100,000 among persons ages 65 and older, and from 47 to 77 per 100,00 among persons ages 45 and older. PD incidence increased with age and was higher among males. We also found persistent spatial clustering of incident PD diagnoses in the U.S. PD incidence estimates varied across our data sources, in part due to case ascertainment and diagnosis methods, but also possibly due to the influence of population factors (prevalence of genetic risk factors or protective markers) and geographic location (exposure to environmental toxins). Understanding the source of these variations will be important for health care policy, research, and care planning.
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Quick M, Rutter E, Tyas SL, Maxwell C, Law J, Oremus M. Urban-rural variation in the association between social support availability and cognitive function in middle-aged and older adults: Results from the baseline Tracking Cohort of the Canadian Longitudinal Study on Aging. Health Place 2022; 77:102894. [PMID: 35986980 DOI: 10.1016/j.healthplace.2022.102894] [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] [Received: 11/17/2021] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate if and how the associations between social support availability (SSA) and cognitive function varied across urban, rural, and geographical regions in Canada. Data from a population-level sample of community-dwelling adults aged 45-85 years were obtained from the baseline Tracking Cohort of the Canadian Longitudinal Study on Aging. The associations between SSA and two domains of cognitive function, memory and executive function, were analyzed using multilevel regression models. SSA was positively and significantly associated with both executive function and memory. We found SSA had stronger positive associations with executive function among participants living in rural areas compared to urban areas in all geographical regions; however, geographical variation in the associations between SSA and memory were not supported by model results. Understanding how the associations between cognitive function and modifiable risk factors, including SSA, vary across geographical contexts is important for developing policies and programs to support healthy aging.
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Affiliation(s)
- Matthew Quick
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - Emily Rutter
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Colleen Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Jane Law
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
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Cheung JCW, Tam EWC, Mak AHY, Chan TTC, Zheng YP. A Night-Time Monitoring System (eNightLog) to Prevent Elderly Wandering in Hostels: A Three-Month Field Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042103. [PMID: 35206290 PMCID: PMC8872318 DOI: 10.3390/ijerph19042103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/02/2022]
Abstract
Older people are increasingly dependent on others to support their daily activities due to geriatric symptoms such as dementia. Some of them stay in long-term care facilities. Elderly people with night wandering behaviour may lose their way, leading to a significant risk of injuries. The eNightLog system was developed to monitor the night-time bedside activities of older people in order to help them cope with this issue. It comprises a 3D time-of-flight near-infrared sensor and an ultra-wideband sensor for detecting human presence and to determine postures without a video camera. A threshold-based algorithm was developed to classify different activities, such as leaving the bed. The system is able to send alarm messages to caregivers if an elderly user performs undesirable activities. In this study, 17 sets of eNightLog systems were installed in an elderly hostel with 17 beds in 9 bedrooms. During the three-month field test, 26 older people with different periods of stay were included in the study. The accuracy, sensitivity and specificity of detecting non-assisted bed-leaving events was 99.8%, 100%, and 99.6%, respectively. There were only three false alarms out of 2762 bed-exiting events. Our results demonstrated that the eNightLog system is sufficiently accurate to be applied in the hostel environment. Machine learning with instance segmentation and online learning will enable the system to be used for widely different environments and people, with improvements to be made in future studies.
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Affiliation(s)
- James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
- Correspondence: ; Tel.: +852-2766-7673
| | - Eric Wing-Cheung Tam
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
| | - Alex Hing-Yin Mak
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
| | - Tim Tin-Chun Chan
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
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Sutovsky S, Petrovic R, Fischerova M, Haverlikova V, Ukropcova B, Ukropec J, Turcani P. Allelic Distribution of Genes for Apolipoprotein E and MTHFR in Patients with Alzheimer's Disease and Their Epistatic Interaction. J Alzheimers Dis 2021; 77:1095-1105. [PMID: 32804129 PMCID: PMC7683064 DOI: 10.3233/jad-200321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Genetic risk factors play an important role in the pathogenesis of Alzheimer’s disease (AD). However, the gene-gene interaction (epistasis) between specific allelic variants is only partially understood. Objective: In our study, we examined the presence of the ɛ4 allele of apolipoprotein E (APOE) and the presence of C677T and A1298C (rs1801133 and rs1801131) polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with AD and controls. We also evaluated the epistatic interaction between MTHFR and the APOE variants. Methods: A total of 564 patients with AD and 534 cognitively unimpaired age-matched controls were involved in the study. Results: The presence of the ɛ4 allele of APOE increases the risk of developing AD in a dose-dependent manner (OR 32.7: homozygotes, 15.6: homozygotes + heterozygotes, 14.3: heterozygotes). The combination of genotypes also increases the risk of developing AD in a dose-dependent manner: OR 18.3 (APOE 4/X and 4/4 + CT rs1801133), OR 19.4 (APOE 4/X and 4/4 + CT rs1801133 + AC rs1801131), OR 22.4 (APOE 4/X and 4/4 + TT rs1801133), and OR 21.2 (APOE 4/X and 4/4 + CC rs1801131). Homozygotes for variant alleles of MTHFR as well as patients with AD had significantly higher levels of homocysteine than homozygotes for standard alleles or controls. Conclusion: Homozygotes for APOE4 and carriers of APOE4 with TT genotype of rs1801133 were found to be at the highest risk of developing AD. These findings suggest that the epistatic interaction of specific gene variants can have a significant effect on the development of AD.
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Affiliation(s)
- Stanislav Sutovsky
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Robert Petrovic
- Department of Genetics and Clinical Genetics, Institute of Medical Biology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Maria Fischerova
- Department of Genetics and Clinical Genetics, Institute of Medical Biology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Viera Haverlikova
- Department of Didactics in Mathematics, Physics and Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
| | - Barbara Ukropcova
- Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Jozef Ukropec
- Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
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Zhang S, Qiu Q, Qian S, Lin X, Yan F, Sun L, Xiao S, Wang J, Fang Y, Li X. Determining Appropriate Screening Tools and Cutoffs for Cognitive Impairment in the Chinese Elderly. Front Psychiatry 2021; 12:773281. [PMID: 34925100 PMCID: PMC8674928 DOI: 10.3389/fpsyt.2021.773281] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are the most commonly used tools for cognitive impairment screening. The present study aimed to investigate the ability of the MOCA and MMSE to differentiate between cognitively normal elderly individuals, MCI patients and dementia patients at different ages and education levels and to establish the optimal cutoff scores of the MoCA and MMSE for MCI and dementia in the Chinese elderly. Methods: A total of 2,954 Chinese elderly individuals, including 1,746 normal controls, 599 MCI patients and 249 dementia patients, were consecutively recruited in the study. The optimal cutoffs for MoCA and MMSE were determined using receiver operating characteristic (ROC) analysis among the different age and education levels in the three groups. Furthermore, comparison of ROC curves were made to evaluate the performances of the two tests. Results: The area under the curve(AUC) of the MoCA (0.82) for detecting MCI was significantly higher than that of the MMSE (0.75) (P < 0.001). When the sample was divided according to age and education level, the AUC of the MoCA (0.84) was higher than those of the MMSE (0.71) for MCI (P < 0.001) in the younger and more highly-educated groups. The optimal cutoff scores of the MoCA for the groups aged ≤ 75 years old and education ≤ 6 years, aged > 75 years old and education ≤ 6 years, aged ≤ 75 years old and education > 6 years, aged > 75 years old and education > 6 years in screening for MCI were identified as 19.5, 15.5, 24.5 and 24.5, respectively, and the optimal cutoff scores for dementia were 18.5, 10.5, 18.5 and 20.5, respectively. For MMSE in the above four groups, the cutoff scores to detect MCI were 26.5, 22.5, 28.5 and 26.5, respectively, and the optimal cutoff scores for dementia were 23.5, 19.5, 23.5 and 23.5, respectively. Conclusion: Compared to MMSE, the MoCA is more suitable for discriminating MCI in younger and more highly educated elderly Chinese individuals. However, the MMSE has advantage over MoCA in screening MCI in individuals with lower education levels and the older groups of Chinese elderly.
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Affiliation(s)
- Shaowei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Qiu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shixing Qian
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Yan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Sun
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shifu Xiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghua Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Specificities of acute phase stroke management in the elderly. Rev Neurol (Paris) 2020; 176:684-691. [PMID: 32980154 DOI: 10.1016/j.neurol.2020.07.006] [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: 10/25/2019] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022]
Abstract
Health professionals are currently facing the challenge of managing an increasing number of old patients presenting with acute stroke, due to rapid aging of the population. Compared to their younger counterparts, elderly patients differ in many ways in the setting of acute stroke. Apart from a striking high stroke incidence, which increases exponentially as age increases, cardioembolism also becomes, as patients age, the main cause of ischemic stroke. Delirium, which can challenge the diagnosis, is frequent at the acute phase of stroke, and may be related to an underlying dementia, which is almost exclusively observed in the elderly during stroke. At all levels, management of elderly stroke patients is suboptimal, especially when they are cognitively impaired, with insufficiencies including admission to stroke units, applying standards of care and investigation, reperfusion therapy for ischemic stroke, and finally transfer to rehabilitation centers. A paradigm shift must take place to limit age-related discrimination for acute-phase management of stroke.
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Wang Y, Jia R, Liang J, Li J, Qian S, Li J, Xu Y. Dementia in China (2015–2050) estimated using the 1% population sampling survey in 2015. Geriatr Gerontol Int 2019; 19:1096-1100. [DOI: 10.1111/ggi.13778] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Ying‐Quan Wang
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public HealthSoochow University Suzhou China
| | - Rui‐Xia Jia
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public HealthSoochow University Suzhou China
| | - Jing‐Hong Liang
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public HealthSoochow University Suzhou China
| | - Jing Li
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public HealthSoochow University Suzhou China
| | - Sheng Qian
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public HealthSoochow University Suzhou China
| | - Jia‐Yu Li
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public HealthSoochow University Suzhou China
| | - Yong Xu
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public HealthSoochow University Suzhou China
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Hall A, Pekkala T, Polvikoski T, van Gils M, Kivipelto M, Lötjönen J, Mattila J, Kero M, Myllykangas L, Mäkelä M, Oinas M, Paetau A, Soininen H, Tanskanen M, Solomon A. Prediction models for dementia and neuropathology in the oldest old: the Vantaa 85+ cohort study. ALZHEIMERS RESEARCH & THERAPY 2019; 11:11. [PMID: 30670070 PMCID: PMC6343349 DOI: 10.1186/s13195-018-0450-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
Background We developed multifactorial models for predicting incident dementia and brain pathology in the oldest old using the Vantaa 85+ cohort. Methods We included participants without dementia at baseline and at least 2 years of follow-up (N = 245) for dementia prediction or with autopsy data (N = 163) for pathology. A supervised machine learning method was used for model development, considering sociodemographic, cognitive, clinical, vascular, and lifestyle factors, as well as APOE genotype. Neuropathological assessments included β-amyloid, neurofibrillary tangles and neuritic plaques, cerebral amyloid angiopathy (CAA), macro- and microscopic infarcts, α-synuclein pathology, hippocampal sclerosis, and TDP-43. Results Prediction model performance was evaluated using AUC for 10 × 10-fold cross-validation. Overall AUCs were 0.73 for dementia, 0.64–0.68 for Alzheimer’s disease (AD)- or amyloid-related pathologies, 0.72 for macroinfarcts, and 0.61 for microinfarcts. Predictors for dementia were different from those in previous reports of younger populations; for example, age, sex, and vascular and lifestyle factors were not predictive. Predictors for dementia versus pathology were also different, because cognition and education predicted dementia but not AD- or amyloid-related pathologies. APOE genotype was most consistently present across all models. APOE alleles had a different impact: ε4 did not predict dementia, but it did predict all AD- or amyloid-related pathologies; ε2 predicted dementia, but it was protective against amyloid and neuropathological AD; and ε3ε3 was protective against dementia, neurofibrillary tangles, and CAA. Very few other factors were predictive of pathology. Conclusions Differences between predictors for dementia in younger old versus oldest old populations, as well as for dementia versus pathology, should be considered more carefully in future studies. Electronic supplementary material The online version of this article (10.1186/s13195-018-0450-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anette Hall
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Timo Pekkala
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Tuomo Polvikoski
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Miia Kivipelto
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | | | - Mia Kero
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Liisa Myllykangas
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Mira Mäkelä
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Minna Oinas
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anders Paetau
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Maarit Tanskanen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Alina Solomon
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland. .,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.
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11
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Halaschek-Wiener J, Tindale LC, Collins JA, Leach S, McManus B, Madden K, Meneilly G, Le ND, Connors JM, Brooks-Wilson AR. The Super-Seniors Study: Phenotypic characterization of a healthy 85+ population. PLoS One 2018; 13:e0197578. [PMID: 29795606 PMCID: PMC5967696 DOI: 10.1371/journal.pone.0197578] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/06/2018] [Indexed: 11/18/2022] Open
Abstract
Background To understand why some people live to advanced age in good health and others do not, it is important to study not only disease, but also long-term good health. The Super-Seniors Study aims to identify factors associated with healthy aging. Methods 480 healthy oldest-old ‘Super-Seniors’ aged 85 to 105 years and never diagnosed with cancer, cardiovascular disease, diabetes, dementia, or major pulmonary disease, were compared to 545 mid-life controls aged 41–54, who represent a group that is unselected for survival from late-life diseases. Health and lifestyle information, personal and family medical history, and blood samples were collected from all participants. Super-Seniors also underwent four geriatric tests. Results Super-Seniors showed high cognitive (Mini-Mental State Exam mean = 28.3) and functional capacity (Instrumental Activities of Daily Living Scale mean = 21.4), as well as high physical function (Timed Up and Go mean = 12.3 seconds) and low levels of depression (Geriatric Depression Scale mean = 1.5). Super-Seniors were less likely to be current smokers than controls, but the frequency of drinking alcohol was the same in both groups. Super-Seniors were more likely to have 4 or more offspring; controls were more likely to have no children. Female Super-Seniors had a mean age of last fertility 1.9 years older than controls, and were 2.3 times more likely to have had a child at ≥ 40 years. The parents of Super-Seniors had mean ages of deaths of 79.3 years for mothers, and 74.5 years for fathers, each exceeding the life expectancy for their era by a decade. Conclusions Super-Seniors are cognitively and physically high functioning individuals who have evaded major age-related chronic diseases into old age, representing the approximately top 1% for healthspan. The familiality of long lifespan of the parents of Super-Seniors supports the hypothesis that heritable factors contribute to this desirable phenotype.
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Affiliation(s)
- Julius Halaschek-Wiener
- Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Lauren C. Tindale
- Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jennifer A. Collins
- Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Stephen Leach
- Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Bruce McManus
- PROOF Centre of Excellence, University of British Columbia, Providence Health Care, Vancouver, British Columbia, Canada
| | - Kenneth Madden
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon Meneilly
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nhu D. Le
- Cancer Control Research, BCCA, Vancouver, British Columbia, Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer, BCCA, Vancouver, British Columbia, Canada
| | - Angela R. Brooks-Wilson
- Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
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12
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Lim EY, Yang DW, Kim JS, Cho AH. Safety and Efficacy of Anti-dementia Agents in the Extremely Elderly Patients with Dementia. J Korean Med Sci 2018; 33:e133. [PMID: 29736156 PMCID: PMC5934516 DOI: 10.3346/jkms.2018.33.e133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are debates on representation and generalizability of previous randomized controlled trials about anti-dementia agents in the oldest old population. In this context, we aimed to investigate the efficacy and safety of anti-dementia agents in the very elderly patients with dementia. METHODS We conducted a retrospective study of patients with dementia 1) who were 85 years or older, 2) got started anti-dementia agents, and 3) went through follow-up evaluation about one year thereafter. As a control, patients with dementia who were less than 85 years old with similar inclusion criteria were randomly selected during the same period. The adverse drug effects and discontinuation rates were investigated with self-reported complaint after starting or increasing anti-dementia drugs. For efficacy outcome, we also analyzed the change in neuropsychological results during follow-up period. RESULTS A total of 77 dementia patients who were at least 85 years were enrolled. As a control group, 78 patients with dementia who were younger than 85 was analyzed. The adverse drug effects were observed in 26 (33.3%) patients in the younger old and in 26 (33.8%) in the oldest old (P = 0.095). Twenty-one patients (26.9%) in the younger old group and 13 patients (16.9%) in the oldest old group discontinued their medication (P = 0.131). There were no differences between the two groups about changes of Mini-Mental State Examination and Instrumental Activity of Daily Living scores over time. CONCLUSION The use of anti-dementia agents in the oldest old dementia patients may be safe and effective as the younger old dementia patients.
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Affiliation(s)
- Eun-Ye Lim
- Department of Neurology, The Catholic University of Korea, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Won Yang
- Department of Neurology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Seok Kim
- Department of Neurology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - A-Hyun Cho
- Department of Neurology, The Catholic University of Korea, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Abstract
Introduction: Population aging increases the number of people with dementia. Dementia is a set of symptoms that include memory difficulties, learning difficulties, speech and language difficulties, disorientation in time and space, difficulties in understanding and behavioral changes. Dementia is not part of natural aging and needs to be understood as such and have to be recognized at time to provide adequate support for people with dementia. Aim: To present the importance of communication: To present communication difficulties which are the result of dementia; To present adaptations in the way of communicating with people with dementia. Material and methods: The article has a descriptive character, and represents a review of the literature dealing with this topic. Results: Difficulties in area of language are a common symptom in people with dementia. Those communication difficulties are a consequence of nerve cell failure, and person with dementia should not be blamed of the symptoms that arise. People with dementia show lower results in the area of understanding and verbal expression, repetition, reading and writing. Syntax and phonology remain relatively intact in early stages, but semantic abilities are impaired. Conclusion: Communication for people with dementia and with people with dementia for all persons involved in care (including family members, medical staff and therapists, and members of the community) can be very challenging. It is often necessary to adapt the way of communication to avoid stress and negative feelings in a person with dementia. As the disease causing dementia progresses, communication problems are increasing as well. Many times caregivers and therapists are in situations where their communicative behavior (verbal, but also nonverbal) needs to show support, compassion, care, and desire to help.
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Affiliation(s)
- Silva Banovic
- Faculty of Education and Rehabilitation, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Lejla Junuzovic Zunic
- Faculty of Education and Rehabilitation, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Osman Sinanovic
- Faculty of Medicine and Faculty of Education and Rehabilitation, University of Tuzla, Tuzla, Bosnia and Herzegovina
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14
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The Prevalence and Incidence of Dementia Due to Alzheimer's Disease: a Systematic Review and Meta-Analysis. Can J Neurol Sci 2017; 43 Suppl 1:S51-82. [PMID: 27307128 DOI: 10.1017/cjn.2016.36] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Updated information on the epidemiology of dementia due to Alzheimer's disease (AD) is needed to ensure that adequate resources are available to meet current and future healthcare needs. We conducted a systematic review and meta-analysis of the incidence and prevalence of AD. METHODS The MEDLINE and EMBASE databases were searched from 1985 to 2012, as well as the reference lists of selected articles. Included articles had to provide an original population-based estimate for the incidence and/or prevalence of AD. Two individuals independently performed abstract and full-text reviews, data extraction and quality assessments. Random-effects models were employed to generate pooled estimates stratified by age, sex, diagnostic criteria, location (i.e., continent) and time (i.e., when the study was done). RESULTS Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 119 studies met the inclusion criteria. In community settings, the overall point prevalence of dementia due to AD among individuals 60+ was 40.2 per 1000 persons (CI95%: 29.1-55.6), and pooled annual period prevalence was 30.4 per 1000 persons (CI95%: 15.6-59.1). In community settings, the overall pooled annual incidence proportion of dementia due to AD among individuals 60+ was 34.1 per 1000 persons (CI95%: 16.4-70.9), and the incidence rate was 15.8 per 1000 person-years (CI95%: 12.9-19.4). Estimates varied significantly with age, diagnostic criteria used and location (i.e., continent). CONCLUSIONS The burden of AD dementia is substantial. Significant gaps in our understanding of its epidemiology were identified, even in a high-income country such as Canada. Future studies should assess the impact of using such newer clinical diagnostic criteria for AD dementia such as those of the National Institute on Aging-Alzheimer's Association and/or incorporate validated biomarkers to confirm the presence of Alzheimer pathology to produce more precise estimates of the global burden of AD.
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15
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Rieben C, Segna D, da Costa BR, Collet TH, Chaker L, Aubert CE, Baumgartner C, Almeida OP, Hogervorst E, Trompet S, Masaki K, Mooijaart SP, Gussekloo J, Peeters RP, Bauer DC, Aujesky D, Rodondi N. Subclinical Thyroid Dysfunction and the Risk of Cognitive Decline: a Meta-Analysis of Prospective Cohort Studies. J Clin Endocrinol Metab 2016; 101:4945-4954. [PMID: 27689250 PMCID: PMC6287525 DOI: 10.1210/jc.2016-2129] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Although both overt hyper- and hypothyroidism are known to lead to cognitive impairment, data on the association between subclinical thyroid dysfunction and cognitive function are conflicting. OBJECTIVE This study sought to determine the risk of dementia and cognitive decline associated with subclinical thyroid dysfunction among prospective cohorts. DATA SOURCES We searched in MEDLINE and EMBASE from inception until November 2014. STUDY SELECTION Two physicians identified prospective cohorts that assessed thyroid function and cognitive outcomes (dementia; Mini-Mental State Examination [MMSE]). DATA EXTRACTION Data were extracted by one reviewer following standardized protocols and verified by a second reviewer. The primary outcome was dementia and decline in cognitive function was the secondary outcome. DATA SYNTHESIS Eleven prospective cohorts followed 16,805 participants during a median followup of 44.4 months. Five studies analyzed the risk of dementia in subclinical hyperthyroidism (SHyper) (n = 6410), six in subclinical hypothyroidism (SHypo) (n = 7401). Five studies analyzed MMSE decline in SHyper (n = 7895), seven in SHypo (n = 8960). In random-effects models, the pooled adjusted risk ratio for dementia in SHyper was 1.67 (95% confidence interval, 1.04; 2.69) and 1.14 (95% confidence interval, 0.84; 1.55) in SHypo vs euthyroidism, both without evidence of significant heterogeneity (I2 = 0.0%). The pooled mean MMSE decline from baseline to followup (mean 32 mo) did not significantly differ between SHyper or SHypo vs euthyroidism. CONCLUSIONS SHyper might be associated with an elevated risk for dementia, whereas SHypo is not, and both conditions are not associated with faster decline in MMSE over time. Available data are limited, and additional large, high-quality studies are needed.
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Affiliation(s)
- Carole Rieben
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Daniel Segna
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Bruno R da Costa
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Tinh-Hai Collet
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Layal Chaker
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Carole E Aubert
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Christine Baumgartner
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Osvaldo P Almeida
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Eef Hogervorst
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Stella Trompet
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Kamal Masaki
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Simon P Mooijaart
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Jacobijn Gussekloo
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Robin P Peeters
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Douglas C Bauer
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Drahomir Aujesky
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Nicolas Rodondi
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
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16
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Ihle A, Jopp DS, Oris M, Fagot D, Kliegel M. Investigating Discontinuity of Age Relations in Cognitive Functioning, General Health Status, Activity Participation, and Life Satisfaction between Young-Old and Old-Old Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1092. [PMID: 27827960 PMCID: PMC5129302 DOI: 10.3390/ijerph13111092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/27/2016] [Accepted: 11/03/2016] [Indexed: 11/24/2022]
Abstract
Health research suggests that findings on young-old adults cannot be generalized to old-old adults and thus that old-old age seems not a simple continuation of young-old age due to qualitative changes that result in a discontinuity in old age. Specifically, it would be of conceptual and methodological importance to inform research regarding estimates around which chronological age the beginning of old-old age could be placed at a population level, and whether this is universal or domain-specific. To derive such criteria, we investigated potential discontinuity of age relations between young-old and old-old age in a large population-based sample considering measures in different domains (processing speed, verbal abilities, general health status, activity participation, and life satisfaction). For processing speed, verbal abilities, general health status, and life satisfaction we observed some very small indication that there might be a discontinuity of age relations at the end of individuals' eighties, and for activity participation already at the beginning of individuals' eighties. In conclusion, models conceptualizing aging as a gradual development might not suffice to adequately represent the differences between the stages of young-old and old-old age due to some very small indication that there might be discontinuity in late adulthood.
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Affiliation(s)
- Andreas Ihle
- Department of Psychology, University of Geneva, Boulevard du Pont d'Arve 40, Geneva CH-1211, Switzerland.
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, route des Acacias 54, Carouge CH-1227, Switzerland.
| | - Daniela S Jopp
- Department of Psychology, University of Lausanne, Geopolis Buildin, Lausanne CH-1015, Switzerland.
| | - Michel Oris
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, route des Acacias 54, Carouge CH-1227, Switzerland.
| | - Delphine Fagot
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, route des Acacias 54, Carouge CH-1227, Switzerland.
| | - Matthias Kliegel
- Department of Psychology, University of Geneva, Boulevard du Pont d'Arve 40, Geneva CH-1211, Switzerland.
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, route des Acacias 54, Carouge CH-1227, Switzerland.
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17
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Tsolaki M, Fountoulakis C, Pavlopoulos I, Chatzi E, Kazis A. Prevalence and incidence of Alzheimers disease and other dementing disorders in Pylea, Greece. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759901400308] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the prevalence and incidence of dementing disorders in the city of Pylea, Greece, using a door-to-door three-phase approach, and explored the relationship between age and gender. From the initial cohort of 704-subjects, 112-subjects (15.9 percent) were excluded because they had moved out of town or could not be traced, 102-subjects (14.4 percent) died before the time of actual contact, and 110-subjects (15.6 percent) refused to be contacted. We were able to visit and examine 380-subjects (54 percent); each of them were administered the MMSE by one of three nurses and the CAMCOG by one of three physicians. We selected January 1, 1993, as the study prevalence day. Using specified diagnostic criteria, NINCDS-ADRDA and DSMIIIR, the study neurologists extensively investigated 118 from 380-subjects, who screened positive on MMSE (MMSE < 23) and CAMCOG (< 65). We found 35-subjects affected by dementia, 20 had Alzheimer's disease (AD), 11 had vascular or mixed dementia and four had secondary dementia (one Parkinson's disease, one Vitamin B12 deficiency, and two had Tumors). The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples was 57/1,000 persons aged > 70, made up of dementia of Alzheimer type (39.9/1,000), vascular dementia (13.9/1,000) and other forms (3.5/1,000). The prevalence of both dementia and AD increased steeply with advancing age and was consistently higher in women. The incidence of dementia increases with age, even in the oldest age groups and women have a higher risk of developing dementia than men. AD was the most common type of dementia. Our prevalence and incidence figures for dementia and AD are almost similar to those previously reported in Europe, the United States and Canada.
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Affiliation(s)
| | | | | | | | - A. Kazis
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Macedonia, Greece
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18
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Kondo D, Ota K, Kasanuki K, Fujishiro H, Chiba Y, Murayama N, Sato K, Hirayasu Y, Arai H, Iseki E. Characteristics of mild cognitive impairment tending to convert into Alzheimer's disease or dementia with Lewy bodies: A follow-up study in a memory clinic. J Neurol Sci 2016; 369:102-108. [PMID: 27653873 DOI: 10.1016/j.jns.2016.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
AIM To determine characteristics of MCI that can predict whether patients will go on to develop AD or DLB. METHODS Ninety-three patients diagnosed with MCI underwent neuropsychological and neuroimaging examinations, and were followed-up for a mean of 44.9±19.3months. They were divided into four MCI subtypes (amnestic/non-amnestic MCI, single/multiple domain) according to neuropsychological findings, and into three other MCI categories (AD-type PET, DLB-type PET, and unknown-type PET) based on (18)F-fluorodeoxyglucose PET findings. Patients who were eventually diagnosed with AD, DLB, other dementia, or remained MCI were analyzed in relation to the groups to which they had initially been allocated at the MCI stage. RESULTS Clinical diagnosis after follow-up determined AD in 21 patients (22.6%), DLB in 12 patients (12.9%), other dementia in 2 patients (2.2%), and non-converter in 58 patients (62.3%). Amnestic single-domain MCI and AD-type PET tended to convert into AD. Amnestic multiple-domain MCI and DLB-type PET tended to convert into DLB. A few patients with AD-type PET later developed DLB, and some with DLB-type PET later developed AD. CONCLUSIONS Predicting which type of dementia a person with MCI will later develop might be possible based on early assessment with clinical symptoms in conjunction with neuropsychological and (18)F-fluorodeoxyglucose PET findings.
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Affiliation(s)
- Daizo Kondo
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan; Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Kazumi Ota
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan
| | - Koji Kasanuki
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan; Department of Psychiatry, Juntendo University School of Medicine, Japan
| | - Hiroshige Fujishiro
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan
| | - Yuhei Chiba
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan; Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Norio Murayama
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan
| | - Kiyoshi Sato
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, Japan
| | - Heii Arai
- Department of Psychiatry, Juntendo University School of Medicine, Japan
| | - Eizo Iseki
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Japan; Department of Psychiatry, Juntendo University School of Medicine, Japan.
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19
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The Prevalence and Incidence of Dementia: a Systematic Review and Meta-analysis. Can J Neurol Sci 2016; 43 Suppl 1:S3-S50. [DOI: 10.1017/cjn.2016.18] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionDementia is a common neurological condition affecting many older individuals that leads to a loss of independence, diminished quality of life, premature mortality, caregiver burden and high levels of healthcare utilization and cost. This is an updated systematic review and meta-analysis of the worldwide prevalence and incidence of dementia.MethodsThe MEDLINE and EMBASE databases were searched for relevant studies published between 2000 (1985 for Canadian papers) and July of 2012. Papers selected for full-text review were included in the systematic review if they provided an original population-based estimate for the incidence and/or prevalence of dementia. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. Random-effects models and/or meta-regression were used to generate pooled estimates by age, sex, setting (i.e., community, institution, both), diagnostic criteria utilized, location (i.e., continent) and year of data collection.ResultsOf 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 160 studies met the inclusion criteria. Among individuals 60 and over residing in the community, the pooled point and annual period prevalence estimates of dementia were 48.62 (CI95%: 41.98-56.32) and 69.07 (CI95%: 52.36-91.11) per 1000 persons, respectively. The respective pooled incidence rate (same age and setting) was 17.18 (CI95%: 13.90-21.23) per 1000 person-years, while the annual incidence proportion was 52.85 (CI95%: 33.08-84.42) per 1,000 persons. Increasing participant age was associated with a higher dementia prevalence and incidence. Annual period prevalence was higher in North America than in South America, Europe and Asia (in order of decreasing period prevalence) and higher in institutional compared to community and combined settings. Sex, diagnostic criteria (except for incidence proportion) and year of data collection were not associated with statistically significant different estimates of prevalence or incidence, though estimates were consistently higher for females than males.ConclusionsDementia is a common neurological condition in older individuals. Significant gaps in knowledge about its epidemiology were identified, particularly with regard to the incidence of dementia in low- and middle-income countries. Accurate estimates of prevalence and incidence of dementia are needed to plan for the health and social services that will be required to deal with an aging population.
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20
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Brodaty H, Woolf C, Andersen S, Barzilai N, Brayne C, Cheung KSL, Corrada MM, Crawford JD, Daly C, Gondo Y, Hagberg B, Hirose N, Holstege H, Kawas C, Kaye J, Kochan NA, Lau BHP, Lucca U, Marcon G, Martin P, Poon LW, Richmond R, Robine JM, Skoog I, Slavin MJ, Szewieczek J, Tettamanti M, Viña J, Perls T, Sachdev PS. ICC-dementia (International Centenarian Consortium - dementia): an international consortium to determine the prevalence and incidence of dementia in centenarians across diverse ethnoracial and sociocultural groups. BMC Neurol 2016; 16:52. [PMID: 27098177 PMCID: PMC4839126 DOI: 10.1186/s12883-016-0569-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/07/2016] [Indexed: 12/29/2022] Open
Abstract
Background Considerable variability exists in international prevalence and incidence estimates of dementia. The accuracy of estimates of dementia in the oldest-old and the controversial question of whether dementia incidence and prevalence decline at very old age will be crucial for better understanding the dynamics between survival to extreme old age and the occurrence and risk for various types of dementia and comorbidities. International Centenarian Consortium – Dementia (ICC-Dementia) seeks to harmonise centenarian and near-centenarian studies internationally to describe the cognitive and functional profiles of exceptionally old individuals, and ascertain the trajectories of decline and thereby the age-standardised prevalence and incidence of dementia in this population. The primary goal of the ICC-Dementia is to establish a large and thorough heterogeneous sample that has the power to answer epidemiological questions that small, separate studies cannot. A secondary aim is to examine cohort-specific effects and differential survivorship into very old age. We hope to lay the foundation for further investigation into risk and protective factors for dementia and healthy exceptional brain ageing in centenarians across diverse ethnoracial and sociocultural groups. Methods Studies focusing on individuals aged ≥95 years (approximately the oldest 1 percentile for men, oldest 5th percentile for women), with a minimum sample of 80 individuals, including assessment of cognition and functional status, are invited to participate. There are currently seventeen member or potential member studies from Asia, Europe, the Americas, and Oceania. Initial attempts at harmonising key variables are in progress. Discussion General challenges facing large, international consortia like ICC-Dementia include timely and effective communication among member studies, ethical and practical issues relating to human subject studies and data sharing, and the challenges related to data harmonisation. A specific challenge for ICC-Dementia relates to the concept and definition of’abnormal’ in this exceptional group of individuals who are rarely free of physical, sensory and/or cognitive impairments.
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Affiliation(s)
- Henry Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Claudia Woolf
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Psychogeriatric Mental Health and Dementia Service, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Stacy Andersen
- New England Centenarian Study, Geriatrics Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, USA.,Department of Genetics, Albert Einstein College of Medicine, Bronx, USA
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Cambridge, UK
| | - Karen Siu-Lan Cheung
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, SAR, China.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Maria M Corrada
- Department of Neurology, University of California Irvine, Irvine, USA.,Department of Epidemiology, University of California Irvine, Irvine, USA
| | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Catriona Daly
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Yasuyuki Gondo
- Graduate School of Human Sciences, Clinical Thanatology and Geriatric Behavioral Science, Osaka University, Suita, Japan
| | - Bo Hagberg
- Gerontology Research Centre, Lund, Sweden
| | - Nobuyoshi Hirose
- Centre for Supercentenarian Research, Keio University School of Medicine, Tokyo, Japan
| | - Henne Holstege
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, The Netherlands.,Alzheimer Centre, Department of Neurology, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Claudia Kawas
- Department of Neurology, University of California Irvine, Irvine, USA.,Department of Neurobiology and Behavior, University of California Irvine, Irvine, USA
| | - Jeffrey Kaye
- Department of Neurology and Biomedical Engineering, Oregon Health and Science University, Portland, USA
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia
| | - Bobo Hi-Po Lau
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gabriella Marcon
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.,AAS 1 Triestina, Trieste, Italy
| | - Peter Martin
- Department of Human Development and Family Studies, Iowa State University, Ames, USA
| | - Leonard W Poon
- Institute of Gerontology, University of Georgia, Athens, Georgia, USA
| | - Robyn Richmond
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Jean-Marie Robine
- National Institute on Health and Medical Research, INSERM, Paris, France
| | - Ingmar Skoog
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Melissa J Slavin
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - José Viña
- Department of Physiology, University of Valencia and INCLIVA, Valencia, Spain
| | - Thomas Perls
- New England Centenarian Study, Geriatrics Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia. .,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia.
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21
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Silagi ML, Bertolucci PHF, Ortiz KZ. Naming ability in patients with mild to moderate Alzheimer's disease: what changes occur with the evolution of the disease? Clinics (Sao Paulo) 2015; 70:423-8. [PMID: 26106961 PMCID: PMC4462568 DOI: 10.6061/clinics/2015(06)07] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/19/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Naming deficit is a linguistic symptom that appears in the initial phase of Alzheimer's disease, but the types of naming errors and the ways in which this deficit changes over the course of the disease are unclear. We analyzed the performance of patients with Alzheimer's disease on naming tasks during the mild and moderate phases and verified how this linguistic skill deteriorates over the course of the disease. METHODS A reduced version of the Boston Naming Test was administered to 30 patients with mild Alzheimer's disease, 30 patients with moderate Alzheimer's disease and 30 healthy controls. Errors were classified as verbal semantic paraphasia, verbal phonemic paraphasia, no response (pure anomia), circumlocution, unrelated verbal paraphasia, visual errors or intrusion errors. RESULTS The patients with moderate Alzheimer's disease had significantly fewer correct answers than did both the control group and the group with mild Alzheimer's disease. With regard to the pattern of errors, verbal semantic paraphasia errors were the most frequent errors in all three groups. Additionally, as the disease severity increased, there was an increase in the number of no-response errors (pure anomia). The group with moderate Alzheimer's disease demonstrated a greater incidence of visual errors and unrelated verbal paraphasias compared with the other two groups and presented a more variable pattern of errors. CONCLUSIONS Performance on nominative tasks worsened as the disease progressed in terms of both the quantity and the type of errors encountered. This result reflects impairment at different levels of linguistic processing.
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Affiliation(s)
- Marcela Lima Silagi
- Universidade Federal de São Paulo, Department of Speech Therapy, São Paulo/, SP, Brazil
| | | | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Department of Speech Therapy, São Paulo/, SP, Brazil
- Karin Zazo OrtizCorresponding author: E-mail:
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22
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Rogus-Pulia N, Malandraki GA, Johnson S, Robbins J. Understanding Dysphagia in Dementia: The Present and the Future. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0078-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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23
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Zhao W, Wang J, Varghese M, Ho L, Mazzola P, Haroutunian V, Katsel PL, Gibson GE, Levine S, Dubner L, Pasinetti GM. Impaired mitochondrial energy metabolism as a novel risk factor for selective onset and progression of dementia in oldest-old subjects. Neuropsychiatr Dis Treat 2015; 11:565-74. [PMID: 25784811 PMCID: PMC4356684 DOI: 10.2147/ndt.s74898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Recent evidence shows that Alzheimer disease (AD) dementia in the oldest-old subjects was associated with significantly less amyloid plaque and fibrillary tangle neuropathology than in the young-old population. In this study, using quantitative (q) PCR studies, we validated genome-wide microarray RNA studies previously conducted by our research group. We found selective downregulation of mitochondrial energy metabolism genes in the brains of oldest-old, but not young-old, AD dementia cases, despite a significant lack of classic AD neuropathology features. We report a significant decrease of genes associated with mitochondrial pyruvate metabolism, the tricarboxylic acid cycle (TCA), and glycolytic pathways. Moreover, significantly higher levels of nitrotyrosylated (3-NT)-proteins and 4-hydroxy-2-nonenal (HNE) adducts, which are indexes of cellular protein oxidation and lipid peroxidation, respectively, were detected in the brains of oldest-old subjects at high risk of developing AD, possibly suggesting compensatory mechanisms. These findings support the hypothesis that although oldest-old AD subjects, characterized by significantly lower AD neuropathology than young-old AD subjects, have brain mitochondrial metabolism impairment, which we hypothesize may selectively contribute to the development of dementia. Outcomes from this study provide novel insights into the molecular mechanisms underlying clinical dementia in young-old and oldest-old AD subjects and provide novel strategies for AD prevention and treatment in oldest-old dementia cases.
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Affiliation(s)
- Wei Zhao
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Geriatric Research Education Clinical Center - James J Peter VA Medical Center, Bronx, NY, USA
| | - Jun Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Geriatric Research Education Clinical Center - James J Peter VA Medical Center, Bronx, NY, USA
| | - Merina Varghese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lap Ho
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Geriatric Research Education Clinical Center - James J Peter VA Medical Center, Bronx, NY, USA
| | - Paolo Mazzola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Vahram Haroutunian
- Geriatric Research Education Clinical Center - James J Peter VA Medical Center, Bronx, NY, USA ; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pavel L Katsel
- Geriatric Research Education Clinical Center - James J Peter VA Medical Center, Bronx, NY, USA ; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gary E Gibson
- Department of Neurology and Neuroscience, Weill Cornell Medical College, Burke Medical Research Institute, New York, NY, USA
| | - Samara Levine
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Dubner
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giulio Maria Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Geriatric Research Education Clinical Center - James J Peter VA Medical Center, Bronx, NY, USA ; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Department of Geriatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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24
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Sachs-Ericsson N, Blazer DG. The new DSM-5 diagnosis of mild neurocognitive disorder and its relation to research in mild cognitive impairment. Aging Ment Health 2015; 19:2-12. [PMID: 24914889 DOI: 10.1080/13607863.2014.920303] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The Diagnostic Statistical Manual-5 (DSM-5) has included a category named the neurocognitive disorder which was formally known in DSM-IV as 'dementia, delirium, amnestic, and other cognitive disorders'. The DSM-5 distinguishes between 'mild' and 'major' neurocognitive disorders. Major neurocognitive disorder replaces the DSM-IV's term 'dementia or other debilitating conditions'. A pivotal addition is 'mild neurocognitive disorder (mNCD)' defined by a noticeable decrement in cognitive functioning that goes beyond normal changes seen in aging. It is a disorder that may progress to dementia - importantly, it may not. Presently, our understanding of mNCD is derived from research on mild cognitive impairment (MCI). Whereas there is currently no clear treatment for mNCD, many experimental therapies now and into the future will focus upon secondary prevention, namely decreasing the risk of progression to major NCD. In this article, we will focus on mNCD by reviewing the relevant literature on MCI. We will review the research on the incidence and prevalence of MCI, conversion rates from MCI to dementia, risk factors for conversion of MCI to dementia, comorbidity of MCI with other neuropsychiatric disorders (NPS), and the development of treatment strategies for neuropsychiatric disorders in MCI. The presence of NPS is common among individuals with MCI and is an important risk for progression to dementia. However, there has been little research on effective treatments for NPS in MCI. Clinicians and investigators must determine if the treatment of the NPS in mNCD will improve quality of life and help reduce the progression of the cognitive impairment.
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25
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Wang S, Luo X, Barnes D, Sano M, Yaffe K. Physical activity and risk of cognitive impairment among oldest-old women. Am J Geriatr Psychiatry 2014; 22:1149-57. [PMID: 23831179 PMCID: PMC3864545 DOI: 10.1016/j.jagp.2013.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 02/14/2013] [Accepted: 03/04/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Physical activity may reduce the risk of cognitive decline in the elderly, but its effects among the oldest-old (i.e., those aged 85 years and older) are not well known. Our study assessed the association between very late-life physical activity and 5-year risk of mild cognitive impairment (MCI) or dementia and neuropsychological test performance among oldest-old women. METHODS This prospective study was conducted at three sites. Participants included 1,249 women (mean [standard deviation] age: 83.3 [2.8] years). Baseline physical activity was measured by self-reported blocks walked per week and analyzed according to tertile. Five years later, surviving participants who were 85 years and older (oldest-old) completed neuropsychological testing and underwent adjudication of clinical cognitive status (normal, MCI, or dementia). All analyses were adjusted for baseline age, education, cognition, depression, body mass index, hypertension, smoking, and coronary artery disease. RESULTS Compared with women in the lowest tertile, women in the highest tertile were less likely to develop dementia (13.0% versus 23.2%; multivariate adjusted odds ratio: 0.54 [95% confidence interval: 0.36-0.82]). However, risk of MCI was not associated with physical activity. Physical activity was also associated with higher performance 5 years later on tests of global cognition, category fluency, and executive function but not phonemic fluency, memory, or attention. CONCLUSIONS Higher level of very late-life physical activity was associated with a lower risk of subsequent dementia in oldest-old women. These findings support future studies for late-life physical activity interventions for the prevention of dementia among oldest-old women.
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Affiliation(s)
- Sophia Wang
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA; San Francisco VA Medical Center, San Francisco, CA.
| | - Xiaodong Luo
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY; Veterans Affairs Medical Center, Bronx, NY
| | - Deborah Barnes
- San Francisco VA Medical Center, San Francisco, CA; Departments of Psychiatry and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Mary Sano
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY; Veterans Affairs Medical Center, Bronx, NY
| | - Kristine Yaffe
- San Francisco VA Medical Center, San Francisco, CA; Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
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26
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Lucca U, Tettamanti M, Logroscino G, Tiraboschi P, Landi C, Sacco L, Garrì M, Ammesso S, Bertinotti C, Biotti A, Gargantini E, Piedicorcia A, Nobili A, Pasina L, Franchi C, Djade CD, Riva E, Recchia A. Prevalence of dementia in the oldest old: The Monzino 80‐plus population based study. Alzheimers Dement 2014; 11:258-70.e3. [DOI: 10.1016/j.jalz.2014.05.1750] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/15/2014] [Accepted: 05/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ugo Lucca
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Mauro Tettamanti
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | | | - Pietro Tiraboschi
- Division of Neuropathology Fondazione IRCCS Istituto Neurologico “Carlo Besta” Milan Italy
| | - Cristina Landi
- Division of Neurological Rehabilitation European Foundation of Biomedical Research (FERB) Milan Italy
| | - Leonardo Sacco
- Division of Neurology Neurocentre of Southern Switzerland Lugano Switzerland
| | - Mariateresa Garrì
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Sonia Ammesso
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Chiara Bertinotti
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Anna Biotti
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Elena Gargantini
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Alessandro Piedicorcia
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Alessandro Nobili
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Luca Pasina
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Carlotta Franchi
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Codjo Djignefa Djade
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Emma Riva
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Angela Recchia
- Department of Neuroscience Laboratory of Geriatric Neuropsychiatry, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
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27
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Szigeti K, Kellermayer B, Lentini JM, Trummer B, Lal D, Doody RS, Yan L, Liu S, Ma C. Ordered subset analysis of copy number variation association with age at onset of Alzheimer's disease. J Alzheimers Dis 2014; 41:1063-71. [PMID: 24787912 PMCID: PMC4866488 DOI: 10.3233/jad-132693] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Genetic heterogeneity is a common problem for genome-wide association studies of complex human diseases. Ordered-subset analysis (OSA) reduces genetic heterogeneity and optimizes the use of phenotypic information, thus improving power under some disease models. We hypothesized that in a genetically heterogeneous disorder such as Alzheimer's disease (AD), utilizing OSA by age at onset (AAO) of AD may increase the power to detect relevant loci. Using this approach, 8 loci were detected, including the chr15 : 30,44 region harboring CHRFAM7A. The association was replicated in the NIA-LOAD Familial Study dataset. CHRFAM7A is a dominant negative regulator of CHRNA7 function, the receptor that facilitates amyloid-β1-42 internalization through endocytosis and has been implicated in AD. OSA, using AAO as a quantitative trait, optimized power and detected replicable signals suggesting that AD is genetically heterogeneous between AAO subsets.
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Affiliation(s)
- Kinga Szigeti
- Department of Neurology, University at Buffalo, SUNY, Buffalo, NY, USA,Correspondence to: Kinga Szigeti, MD, PhD, University of Buffalo SUNY, 100 High Street, Buffalo, NY 14203, USA. Tel.: +1 716 859 3484; Fax: +1 716 859 7833;
| | | | - Jenna M. Lentini
- Department of Neurology, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Brian Trummer
- Department of Neurology, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Deepika Lal
- Department of Neurology, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Rachelle S. Doody
- Alzheimer’s Disease and Memory Disorders Center, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Li Yan
- Department of Bioinformatics, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Song Liu
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Changxing Ma
- Department of Bioinformatics, University at Buffalo, SUNY, Buffalo, NY, USA
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Omoumi A, Fok A, Greenwood T, Sadovnick AD, Feldman HH, Hsiung GYR. Evaluation of late-onset Alzheimer disease genetic susceptibility risks in a Canadian population. Neurobiol Aging 2013; 35:936.e5-12. [PMID: 24176626 DOI: 10.1016/j.neurobiolaging.2013.09.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Abstract
We performed case-control studies using 2 Canadian cohorts to examine the role of 10 promising Alzheimer's disease (AD) loci identified in recent genomewide association studies. Patients age 65 years and older diagnosed with AD at baseline (prevalent cases) or who developed AD during follow-up assessments (incident cases) were compared with control subjects with no cognitive impairment. Our prevalent case study comparing prevalent AD cases (n = 428) with participants with no cognitive impairment (n = 524) revealed a significant association of rs6656401 and rs3818361 (CR1), rs2075650 (TOMM40), rs7561528 (BIN1), and rs3865444 (CD33) with late-onset AD that were robust to adjustment with age and apolipoprotein E ε4 genotype. The incident case study comparing patients who developed AD during longitudinal observation (n = 152) with participants with no cognitive impairment found that rs2075650 (TOMM40) and rs3865444 (CD33) influence the risk of developing AD in this population. In addition, pooled analysis of our AD patients confirmed that CR1, TOMM40, BIN1, and CD33 contribute to late-onset AD susceptibility, in addition to apolipoprotein E.
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Affiliation(s)
- Ardeshir Omoumi
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alice Fok
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Talitha Greenwood
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - A Dessa Sadovnick
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Howard H Feldman
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ging-Yuek R Hsiung
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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29
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Gardner RC, Valcour V, Yaffe K. Dementia in the oldest old: a multi-factorial and growing public health issue. ALZHEIMERS RESEARCH & THERAPY 2013; 5:27. [PMID: 23809176 PMCID: PMC3706944 DOI: 10.1186/alzrt181] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The population of oldest old, or people aged 85 and older, is growing rapidly. A better understanding of dementia in this population is thus of increasing national and global importance. In this review, we describe the major epidemiological studies, prevalence, clinical presentation, neuropathological and imaging features, risk factors, and treatment of dementia in the oldest old. Prevalence estimates for dementia among those aged 85+ ranges from 18 to 38%. The most common clinical syndromes are Alzheimer's dementia, vascular dementia, and mixed dementia from multiple etiologies. The rate of progression appears to be slower than in the younger old. Single neuropathological entities such as Alzheimer's dementia and Lewy body pathology appear to have declining relevance to cognitive decline, while mixed pathology with Alzheimer's disease, vascular disease (especially cortical microinfarcts), and hippocampal sclerosis appear to have increasing relevance. Neuroimaging data are sparse. Risk factors for dementia in the oldest old include a low level of education, poor mid-life general health, low level of physical activity, depression, and delirium, whereas apolipoprotein E genotype, late-life hypertension, hyperlipidemia, and elevated peripheral inflammatory markers appear to have less relevance. Treatment approaches require further study, but the oldest old may be more prone to negative side effects compared with younger patients and targeted therapies may be less efficacious since single pathologies are less frequent. We also highlight the limitations and challenges of research in this area, including the difficulty of defining functional decline, a necessary component for a dementia diagnosis, the lack of normative neuropsychological data, and other shortcomings inherent in existing diagnostic criteria. In summary, our understanding of dementia in the oldest old has advanced dramatically in recent years, but more research is needed, particularly among varied racial, ethnic, and socioeconomic groups, and with respect to biomarkers such as neuroimaging, modifiable risk factors, and therapy.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA
| | - Victor Valcour
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA ; Division of Geriatric Medicine, Department of Medicine, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, Epidemiology and Biostatistics, School of Medicine, University of California, 4150 Clement Street - Box 181, San Francisco, CA 94121, USA ; Veterans Affairs Medical Center, 4150 Clement Street - Box 181, San Francisco, CA 94121, USA
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30
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Cosentino S, Schupf N, Christensen K, Andersen SL, Newman A, Mayeux R. Reduced prevalence of cognitive impairment in families with exceptional longevity. JAMA Neurol 2013; 70:867-74. [PMID: 23649824 PMCID: PMC4151346 DOI: 10.1001/jamaneurol.2013.1959] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Family studies of centenarians and long-lived persons have found substantial familial aggregation of survival to extreme ages; however, the extent to which such familial longevity is characterized by cognitively intact survival is not established. OBJECTIVE To determine whether families with exceptional longevity are protected against cognitive impairment consistent with Alzheimer disease. DESIGN Cross-sectional analysis. SETTING Multisite study in New York, Massachusetts, Pennsylvania, and Denmark. PARTICIPANTS A total of 1870 individuals (1510 family members and 360 spouse controls) recruited through the Long Life Family Study. MAIN OUTCOME AND MEASURE Prevalence of cognitive impairment based on a diagnostic algorithm validated using the National Alzheimer's Coordinating Center data set. RESULTS The cognitive algorithm classified 546 individuals (38.5%) as having cognitive impairment consistent with Alzheimer disease. Long Life Family Study probands had a slightly but not statistically significant reduced risk of cognitive impairment compared with spouse controls (121 of 232 for probands vs 45 of 103 for spouse controls; odds ratio = 0.7; 95% CI, 0.4-1.4), whereas Long Life Family Study sons and daughters had a clearly reduced risk of cognitive impairment (11 of 213 for sons and daughters vs 28 of 216 for spouse controls; odds ratio = 0.4; 95% CI, 0.2-0.9). Restriction to nieces and nephews in the offspring generation attenuated this effect (37 of 328 for nieces and nephews vs 28 of 216 for spouse controls; odds ratio = 0.8; 95% CI, 0.4-1.4). CONCLUSIONS AND RELEVANCE Rates of cognitive impairment characteristic of Alzheimer disease were relatively high. In the proband generation, rates were comparable across family members and spouse controls, whereas sons and daughters of probands had significantly lower rates than spouse controls. Results suggest a delayed onset of cognitive impairment in families with exceptional longevity, but assessment of age-specific incidence rates is required to confirm this hypothesis.
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Affiliation(s)
- Stephanie Cosentino
- Gertrude H. Sergievsky Center, Columbia University, New York, NY
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Nicole Schupf
- Gertrude H. Sergievsky Center, Columbia University, New York, NY
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Kaare Christensen
- The Danish Aging Research Center, University of Southern Denmark and the Department of Clinical Genetics, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Stacy L. Andersen
- Geriatrics Section, School of Medicine, Boston University and Boston Medical Center, Boston, MA
| | - Anne Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Richard Mayeux
- Gertrude H. Sergievsky Center, Columbia University, New York, NY
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Szigeti K, Lal D, Li Y, Doody RS, Wilhelmsen K, Yan L, Liu S, Ma C. Genome-wide scan for copy number variation association with age at onset of Alzheimer's disease. J Alzheimers Dis 2013. [PMID: 23202439 DOI: 10.3233/jad-2012-121285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease with high prevalence, which imposes a substantial public health problem. The heritability of AD is estimated at 60-80% forecasting the potential use of genetic biomarkers for risk stratification in the future. Several large scale genome-wide association studies using high frequency variants identified 10 loci accountable for only a fraction of the estimated heritability. To find the missing heritability, systematic assessment of various mutational mechanisms needs to be performed. This copy number variation (CNV) genome-wide association study with age at onset (AAO) of AD identified 5 CNV regions that may contribute to the heritability of AAO of AD. Two CNV events are intragenic causing a deletion in CPNE4. In addition, to further study the mutational load at the 10 known susceptibility loci, CNVs overlapping with these loci were also catalogued. We identified rare small events overlapping CR1 and BIN1 in AD and normal controls with opposite CNV dosage. The CR1 events are consistent with previous reports. Larger scale studies with deeper genotyping specifically addressing CNV are needed to evaluate the significance of these findings.
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Affiliation(s)
- Kinga Szigeti
- Department of Neurology, University at Buffalo SUNY, Buffalo, NY 14203, USA.
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Slavin MJ, Brodaty H, Sachdev PS. Challenges of diagnosing dementia in the oldest old population. J Gerontol A Biol Sci Med Sci 2013; 68:1103-11. [PMID: 23685769 DOI: 10.1093/gerona/glt051] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
People aged 90 and older are the fastest growing age group in most parts of the world. Since the prevalence of dementia has been shown to increase exponentially after the age of 65, there is an acceptance that the oldest old population has a high burden of dementia; however, there is a lack of consensus on how best to diagnose dementia in this population. This review summarizes the various approaches to diagnosing dementia and the prevalence and incidence rates of dementia that have been reported. We also summarize the literature on cognitive and functional performance and biomarkers for dementia and discuss the limitations to interpretation of these data. Finally, we make recommendations for both researchers and clinicians who intend to diagnose dementia in the oldest old population.
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Affiliation(s)
- Melissa J Slavin
- Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, NSW 2052, Australia.
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Li Y, Shaw CA, Sheffer I, Sule N, Powell SZ, Dawson B, Zaidi SNY, Bucasas KL, Lupski JR, Wilhelmsen KC, Doody R, Szigeti K. Integrated copy number and gene expression analysis detects a CREB1 association with Alzheimer's disease. Transl Psychiatry 2012; 2:e192. [PMID: 23168992 PMCID: PMC3565761 DOI: 10.1038/tp.2012.119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Genetic variation, both single-nucleotide variations and copy number variations (CNV), contribute to changes in gene expression. In some cases these variations are meaningfully correlated with disease states. We hypothesized that in a genetically heterogeneous disorder such as sporadic Alzheimer's disease (AD), utilizing gene expression as a quantitative trait and CNVs as a genetic marker map within the same individuals in the context of case-control status may increase the power to detect relevant loci. Using this approach an 8-kb deletion was identified that contains a PAX6-binding site on chr2q33.3 upstream of CREB1 encoding the cAMP responsive element-binding protein1 transcription factor. The association of the CNV to AD was confirmed by a case-control association study consisting of the Texas Alzheimer Research and Care Consortium and NIA-LOAD Family Study data sets.
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Affiliation(s)
- Y Li
- Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| | - C A Shaw
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA,Department of Molecular and Human Genetics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, USA. E-mail:
| | - I Sheffer
- Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| | - N Sule
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - S Z Powell
- Department of Neuropathology, The Methodist Hospital, Houston, TX, USA
| | - B Dawson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA,Howard Hughes Medical Institute, Houston, TX, USA
| | - S N Y Zaidi
- Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| | - K L Bucasas
- Departmentof Immunology, Baylor College of Medicine, Houston, TX, USA
| | - J R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - K C Wilhelmsen
- Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Doody
- Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| | - K Szigeti
- Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA,Department of Neurology, University at Buffalo, SUNY, Buffalo, NY, USA,Department of Neurology, University of Buffalo, SUNY, 100 High Street, Buffalo, NY 14203, USA. E-mail:
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Hülür G, Infurna FJ, Ram N, Gerstorf D. Cohorts based on decade of death: no evidence for secular trends favoring later cohorts in cognitive aging and terminal decline in the AHEAD study. Psychol Aging 2012; 28:115-27. [PMID: 23046001 DOI: 10.1037/a0029965] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies of birth-year cohorts examined over the same age range often report secular trends favoring later-born cohorts, who are cognitively fitter and show less steep cognitive declines than earlier-born cohorts. However, there is initial evidence that those advantages of later-born cohorts do not carry into the last years of life, suggesting that pervasive mortality-related processes minimize differences that were apparent earlier in life. Elaborating this work from an alternative perspective on cohort differences, we compared rates of cognitive aging and terminal decline in episodic memory between cohorts based on the year participants had died, earlier (between 1993 and 1999) or later in historical time (between 2000 and 2010). Specifically, we compared trajectories of cognitive decline in 2 death-year cohorts of participants in the Asset and Health Dynamics Among the Oldest Old study that were matched on age at death and education and controlled for a variety of additional covariates. Results revealed little evidence of secular trends favoring later cohorts. To the contrary, the cohort that died in the 2000s showed a less favorable trajectory of age-related memory decline than the cohort that died in the 1990s. In examinations of change in relation to time to death, the cohort dying in the 2000s experienced even steeper terminal declines than the cohort dying in the 1990s. We suggest that secular increases in "manufacturing" survival may exacerbate age- and mortality-related cognitive declines among the oldest old.
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Affiliation(s)
- Gizem Hülür
- Institute of Psychology, Humboldt University, Berlin, Germany.
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Russ TC, Batty GD, Hearnshaw GF, Fenton C, Starr JM. Geographical variation in dementia: systematic review with meta-analysis. Int J Epidemiol 2012; 41:1012-32. [PMID: 22798662 PMCID: PMC3429875 DOI: 10.1093/ije/dys103] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Geographical variation in dementia prevalence and incidence may indicate important socio-environmental contributions to dementia aetiology. However, previous comparisons have been hampered by combining studies with different methodologies. This review systematically collates and synthesizes studies examining geographical variation in the prevalence and incidence of dementia based on comparisons of studies using identical methodologies. METHODS Papers were identified by a comprehensive electronic search of relevant databases, scrutinising the reference sections of identified publications, contacting experts in the field and re-examining papers already known to us. Identified articles were independently reviewed against inclusion/exclusion criteria and considered according to geographical scale. Rural/urban comparisons were meta-analysed. RESULTS Twelve thousand five hundred and eighty records were reviewed and 51 articles were included. Dementia prevalence and incidence varies at a number of scales from the national down to small areas, including some evidence of an effect of rural living [prevalence odds ratio (OR) = 1.11, 90% confidence interval (CI) 0.79-1.57; incidence OR = 1.20, 90% CI 0.84-1.71]. However, this association of rurality was stronger for Alzheimer disease, particularly when early life rural living was captured (prevalence OR = 2.22, 90% CI 1.19-4.16; incidence OR = 1.64, 90% CI 1.08-2.50). CONCLUSIONS There is evidence of geographical variation in rates of dementia in affluent countries at a variety of geographical scales. Rural living is associated with an increased risk of Alzheimer disease, and there is a suggestion that early life rural living further increases this risk. However, the fact that few studies have been conducted in resource-poor countries limits conclusions.
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Affiliation(s)
- Tom C Russ
- Scottish Dementia Clinical Research Network, NHS Scotland, UK.
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Caracciolo B, Gatz M, Xu W, Pedersen NL, Fratiglioni L. Differential distribution of subjective and objective cognitive impairment in the population: a nation-wide twin-study. J Alzheimers Dis 2012; 29:393-403. [PMID: 22233768 DOI: 10.3233/jad-2011-111904] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report the prevalence of subjective cognitive impairment (SCI) and cognitive impairment no dementia (CIND), their socio-demographic profile, and the contribution of genetic background and shared familial environment to SCI and CIND. Subjects were 11,926 dementia-free twin individuals aged ≥65 from the Swedish Twin Registry. SCI was defined as subjective complaint of cognitive change without objective cognitive impairment and CIND was defined according to current criteria. Overall prevalence rates of SCI and CIND were 39% (95% CI 38-39%) and 25% (95% CI 24-25%). In multivariate GEE models, both SCI and CIND were older compared with people without any cognitive impairment. CIND were also less educated, more likely to be unmarried and to have lower socioeconomic status (SES). SCI individuals differed from persons with CIND as they were older, more educated, more likely to be married, and to have higher SES. Co-twin control analysis, which corrects for common genetic and shared environmental background, confirmed the association of low education with CIND. Probandwise concordance for SCI and CIND was 63% and 52% in monozygotic twins, 63% and 50% in dizygotic same-sex twins, and 42% and 29% in dizygotic unlike-sex twins. Tetrachoric correlations showed no significant differences between monozygotic and dizygotic same-sex twins. We conclude that subjective and objective cognitive impairment are both highly prevalent among nondemented elderly yet have distinct sociodemographic profiles. Shared environmental influences rather than genetic background play a role in the occurrence of SCI and CIND.
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Affiliation(s)
- Barbara Caracciolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
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Lucca U, Garrì M, Recchia A, Logroscino G, Tiraboschi P, Franceschi M, Bertinotti C, Biotti A, Gargantini E, Maragna M, Nobili A, Pasina L, Franchi C, Riva E, Tettamanti M. A Population-based study of dementia in the oldest old: the Monzino 80-plus study. BMC Neurol 2011; 11:54. [PMID: 21612585 PMCID: PMC3120664 DOI: 10.1186/1471-2377-11-54] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 05/25/2011] [Indexed: 11/10/2022] Open
Abstract
Background Despite being the fastest growing and the most cognitively impaired age group, the oldest olds are under-represented in clinical research. The purpose of this study was to describe the design, methods, and baseline characteristics of the survey population and investigate possible differences in demographic, cognitive, functional, and behavioral characteristics between oldest old with and without any performance on cognitive tests and between oldest old alive and those deceased prior to the interview. Methods The Monzino 80-plus Study is a prospective door-to-door population-based survey among 80 years or older residents in the municipalities in the province of Varese, Italy. Dementia cases were identified with a one-phase design. Trained psychologists interviewed both the subject and a proxy informant. The interview included a comprehensive standardized questionnaire together with an array of rating scales and a multidomain cognitive battery to assess cognitive and functional ability, behavioral disturbances and mood. Results Information was available for 2,139 of the 2,428 registered individuals aged 80 years or older. Main baseline characteristics of the population are reported and discussed. In comparison with those living, elderly persons who had died before the first visit were older, had twice the rate of institutionalization, poorer cognitive performance and competence, and significantly greater instrumental and basic functional disability. The percentage of elderly persons, alive at baseline, without Mini-Mental State Examination rose rather evenly with age. Moreover, they had significantly worse cognitive competence and functional ability, and reported higher prevalences of depressive symptoms and problem behaviors than those with Mini-Mental State Examination. Conclusions Prospective investigation of a large population of oldest old can contribute significantly to understanding the relations between age, cognitive decline, and dementia occurrence. Use of informant-based instruments in surveys in the oldest old is crucial in assessing everyday functioning and changes, especially in participants with no cognitive test performance available. Failure to include information on deceased elderly would underestimate, increasingly with age, the prevalence of cognitive and functional disability in the elderly population.
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Affiliation(s)
- Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
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Bugiani O. Alzheimer’s disease: ageing-related or age-related? New hypotheses from an old debate. Neurol Sci 2011; 32:1241-7. [DOI: 10.1007/s10072-011-0614-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/28/2011] [Indexed: 11/28/2022]
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Mayeux R, Reitz C, Brickman AM, Haan MN, Manly JJ, Glymour MM, Weiss CC, Yaffe K, Middleton L, Hendrie HC, Warren LH, Hayden KM, Welsh-Bohmer KA, Breitner JCS, Morris JC. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment-Part 1. Alzheimers Dement 2011; 7:15-34. [PMID: 21255741 DOI: 10.1016/j.jalz.2010.11.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this article, the challenges faced by several noted population studies for Alzheimer dementia in operationalizing current clinical diagnostic criteria for Alzheimer's disease (AD) have been reviewed. Differences in case ascertainment, methodological biases, cultural and educational influences on test performance, inclusion of special populations such as underrepresented minorities and the oldest old, and detection of the earliest symptomatic stages of underlying AD have been considered. Classification of Alzheimer dementia may be improved by the incorporation of biomarkers for AD if the sensitivity, specificity, and predictive value of the biomarkers are established and if they are appropriate for epidemiological studies, as may occur should a plasma biomarker be developed. Biomarkers for AD could also facilitate studies of the interactions of various forms of neurodegenerative disorders with cerebrovascular disease, resulting in "mixed dementia".
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Affiliation(s)
- Richard Mayeux
- Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA.
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Abstract
The incidence of dementia increases steeply with age in older people, although from the tenth decade the slope may be smoother, perhaps reflecting different pathological processes in the oldest old. The prevalence depends upon interaction of age with other factors (e.g., comorbidities, genetic or environmental factors) that in turn are subject to change. If onset of dementia could be postponed by modulating its risk factors, this could significantly affect its incidence. Analysis of risk and protection factors should take into account the critical period during which these factors play a role. For example, the impact of education and diabetes mellitus occurs in early- and midlife, respectively, while maintaining optimal physical and mental activity and controlling vascular factors later in life may slow the rate of cognitive decline. Modifying factors need to be evaluated for different clinical groups, taking into account genetic background, age, and duration at exposure. The aim of the present article is to try to take stock of epidemiological data concerning factors affecting the prevalence of dementia and predict future developments, as well as to look for possible interventions that could affect outcome.
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Affiliation(s)
- T A Treves
- Memory Disorders Clinic, Rabin Medical Center, Petach Tikva, Israel
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Jellinger KA, Attems J. Is there pure vascular dementia in old age? J Neurol Sci 2010; 299:150-4. [PMID: 20869729 DOI: 10.1016/j.jns.2010.08.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 02/23/2010] [Accepted: 08/24/2010] [Indexed: 11/24/2022]
Abstract
Vascular dementia (VaD) has been suggested to be the most common form of dementia in old age, but clinico-pathologic studies showed big differences in its epidemiology. A retrospective hospital-based study of the frequency and pathology of "pure" VaD (due to cerebrovascular disease without other pathologies) was performed in 1110 consecutive autopsy cases of demented elderly in Vienna, Austria. It assessed clinical, general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7th to 10th decades) were evaluated. "Pure" VaD was observed in 10.8% of the total cohort, decreasing from age 60 to 90+. 85-95% had histories of diabetes, morphologic signs of hypertension, 65% myocardial infarction/cardiac decompensation, and 75% a history of stroke(s). Neuritic AD-pathology was low (mean Braak stages 1.2-1.6). Morphologic subtypes (multi-infarct (MID), subcortical arteriosclerotic (SAE)-the most frequent, and strategic infarct dementia (SID)) showed no age-related differences. By contrast, AD (without vascular or Lewy pathologies), mixed dementia (AD+cerebrovascular encephalopathy), and AD with minor cerebrovascular lesions increased with age. AD+Lewy pathology and other dementias decreased significantly over age 90. This retrograde study using strict morphologic diagnostic criteria confirmed the existence of "pure" VaD in old age, with a tendency to decline at age 90+, while AD and AD+cerebrovascular pathologies showed considerable age-related increase. Another autopsy study distinguishing two age groups of demented showed a significant increase of both AD and cerebral amyloid angiopathy (CAA), but decrease of VaD over age 85, while in a small subgroup of old subjects CAA without considerable AD-pathology may be an independent risk factor for cognitive decline.
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Jellinger KA, Attems J. Prevalence of dementia disorders in the oldest-old: an autopsy study. Acta Neuropathol 2010; 119:421-33. [PMID: 20204386 DOI: 10.1007/s00401-010-0654-5] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 02/03/2010] [Accepted: 02/06/2010] [Indexed: 02/06/2023]
Abstract
The prevalence of Alzheimer disease (AD) and vascular dementia (VD) increases with advancing age, but less so after age 90 years. A retrospective hospital-based study of the relative prevalence of different disorders was performed in 1,110 consecutive autopsy cases of demented elderly in Vienna, Austria (66% females, MMSE <20; mean age 83.3 +/- 5.4 SD years). It assessed clinical, general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7-10th decade) were evaluated. In the total cohort AD pathology was seen in 82.9% ("pure" AD 42.9%; AD + other pathologies 39.9%), VD in 10.8% (mixed dementia, MIX, i.e. AD + vascular encephalopathy in 5.5%); other disorders in 5.7%, and negative pathology in 0.8%. The relative prevalence of AD increased from age 60 to 89 years and decreased slightly after age 90+, while "pure" VD diagnosed in the presence of vascular encephalopathy of different types with low neuritic AD pathology (Braak stages <3; mean 1.2-1.6) decreased progressively from age 60 to 90+; 85-95% of these patients had histories of diabetes, morphologic signs of hypertension, 65% myocardial infarction/cardiac decompensation, and 75% a history of stroke(s). Morphologic subtypes, subcortical arteriosclerotic (the most frequent), multi-infarct encephalopathy, and strategic infarct dementia showed no age-related differences. The relative prevalence of AD + Lewy pathology remained fairly constant with increasing age. Mixed dementia and AD with minor cerebrovascular lesions increased significantly with age, while other dementias decreased. This retrospective study using strict morphologic criteria confirmed increased prevalence of AD with age, but mild decline at age 90+, and progressive decline of VD, while AD + vascular pathologies including MIX showed considerable age-related increase, confirming that mixed pathologies account for most dementia cases in very old persons. A prospective clinicopathologic study in oldest-old subjects showed a significant increase in both AD and cerebral amyloid angiopathy (CAA), but decrease in VD over age 85, while in a small group of old subjects CAA without considerable AD pathology may be an independent risk factor for cognitive decline.
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Luck T, Riedel-Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H. Risk factors for incident mild cognitive impairment--results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Acta Psychiatr Scand 2010; 121:260-72. [PMID: 19824992 DOI: 10.1111/j.1600-0447.2009.01481.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide age- and gender-specific incidence rates of MCI among elderly general practitioner (GP) patients (75+ years) and to identify risk factors for incident MCI. METHOD Data were derived from the longitudinal German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Incidence was calculated according to the 'person-years-at-risk' method. Risk factors were analysed using multivariate logistic regression models. RESULTS During the 3-year follow-up period, 350 (15.0%) of the 2331 patients whose data were included in the calculation of incidence developed MCI [person-years (PY) = 6198.20]. The overall incidence of MCI was 56.5 (95% confidence interval = 50.7-62.7) per 1000 PY. Older age, vascular diseases, the apoE epsilon4 allele and subjective memory complaints were identified as significant risk factors for future MCI. CONCLUSION Mild cognitive impairment is frequent in older GP patients. Subjective memory complaints predict incident MCI. Especially vascular risk factors provide the opportunity of preventive approaches.
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Affiliation(s)
- T Luck
- Public Health Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany.
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Abstract
OBJECTIVE To review the recent literature on cognitive screening with a focus on brief screening methods in primary care as well as geriatric services. DESIGN The Medline search engine was utilized using the keyword search terms 'cognitive screening', 'cognitive assessment', and 'dementia screening' limiting articles to those published in English since 1998. RESULTS 679 abstracts were retrieved. Articles focusing on attitudes toward cognitive screening, current screening practices, promising new instruments and more recent updates contributing significant information on established instruments were retrieved and incorporated into this review. Reference lists were reviewed for relevant contributing articles. Instruments recommended from previous reviews of cognitive screening and those identified in surveys as most frequently used in primary care and geriatric settings were emphasized in this review. CONCLUSIONS Dementia remains under-diagnosed in the elderly population. Despite significant limitations, the Mini Mental State Exam remains the most frequently used cognitive screening instrument. Its best value in the community and primary care appears to be for the purpose of ruling out a diagnosis of dementia. Instruments such as the Mini-Cog, Memory Impairment Screen (MIS), and the General Practitioner Assessment of Cognition (GPCOG) have consistently been recognized for utility in primary care. The clock drawing test (CDT) and newer instruments such as the Montreal Cognitive Assessment (MoCA) and the Rowland Universal Dementia Assessment Scale (RUDAS) are gaining credibility due to improvements in sensitivity, addressing frontal/executive functioning, and decreasing susceptibility to cultural and educational biases.
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Affiliation(s)
- Zahinoor Ismail
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Geriatric Mental Health Program, Centre for Addiction and Mental Health, Canada.
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Schneider BA, Pichora-Fuller K, Daneman M. Effects of Senescent Changes in Audition and Cognition on Spoken Language Comprehension. THE AGING AUDITORY SYSTEM 2010. [DOI: 10.1007/978-1-4419-0993-0_7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Puangthong U, Hsiung GYR. Critical appraisal of the long-term impact of memantine in treatment of moderate to severe Alzheimer's disease. Neuropsychiatr Dis Treat 2009; 5:553-61. [PMID: 19898670 PMCID: PMC2773287 DOI: 10.2147/ndt.s5021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Indexed: 11/23/2022] Open
Abstract
Alzheimer's disease is the most common cause of dementia in older adults. The clinical features include progressive memory decline as well as cognitive deficits with executive dysfunction, language, visual perceptual difficulties, apraxia and agnosia. During the moderate to severe stage of the disease, there is a major decline in memory and function, while neuropsychiatric disturbances often emerge and patients become difficult to manage. These distressing symptoms increase caregiver burden and add to the direct costs of care of the patients. Any improvements in patient function and behavioral symptoms can reduce caregiver burden. Memantine has been available for a number of years in Europe and in North America. In this article, we examine the pharmacological rationale for its use, and the current clinical evidence for its efficacy and long-term effectiveness in the management of cognitive and behavioral symptoms in moderate to severe stages of Alzheimer's disease.
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Affiliation(s)
- Umamon Puangthong
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ging-Yuek Robin Hsiung
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Katsel P, Tan W, Haroutunian V. Gain in brain immunity in the oldest-old differentiates cognitively normal from demented individuals. PLoS One 2009; 4:e7642. [PMID: 19865478 PMCID: PMC2764344 DOI: 10.1371/journal.pone.0007642] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 10/04/2009] [Indexed: 11/18/2022] Open
Abstract
Background Recent findings suggest that Alzheimer's disease (AD) neuropathological features (neuritic plaques and NFTs) are not strongly associated with dementia in extreme old (over 90 years of age) and compel a search for neurobiological indices of dementia in this rapidly growing segment of the elderly population. We sought to characterize transcriptional and protein profiles of dementia in the oldest-old. Methods and Findings Gene and protein expression changes relative to non-demented age-matched controls were assessed by two microarray platforms, qPCR and Western blot in different regions of the brains of oldest-old and younger old persons who died at mild or severe stages of dementia. Our results indicate that: i) consistent with recent neuropathological findings, gene expression changes associated with cognitive impairment in oldest-old persons are distinct from those in cognitively impaired youngest-old persons; ii) transcripts affected in young-old subjects with dementia participate in biological pathways related to synaptic function and neurotransmission while transcripts affected in oldest-old subjects with dementia are associated with immune/inflammatory function; iii) upregulation of immune response genes in cognitively intact oldest-old subjects and their subsequent downregulation in dementia suggests a potential protective role of the brain immune-associated system against dementia in the oldest-old; iv) consistent with gene expression profiles, protein expression of several selected genes associated with the inflammatory/immune system in inferior temporal cortex is significantly increased in cognitively intact oldest-old persons relative to cognitively intact young-old persons, but impaired in cognitively compromised oldest-old persons relative to cognitively intact oldest-old controls. Conclusions These results suggest that disruption of the robust immune homeostasis that is characteristic of oldest-old individuals who avoided dementia may be directly associated with dementia in the oldest-old and contrast with the synaptic and neurotransmitter system failures that typify dementia in younger old persons.
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Affiliation(s)
- Pavel Katsel
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
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Physicians appeals on the dangers of mobile communication--what is the evidence? Assessment of public health data. Int J Hyg Environ Health 2009; 212:576-87. [PMID: 19736044 DOI: 10.1016/j.ijheh.2009.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/13/2009] [Accepted: 07/19/2009] [Indexed: 12/22/2022]
Abstract
In October 2002 German physicians appealed to persons in the field of health care, politicians and the public with "great concern" ("Freiburger Appell", "Appeal of Freiburg") claiming "soaring incidences of symptoms and diseases in the general population" to be causally related to the "commence of radio (wave) burden", i.e. due to mobile radio technology. This first example was followed by several further appeals published nationally and Europe-wide up until today. The aim of the present paper is an evaluation of the scientific literature and databases to check incidence and prevalence of symptoms and diseases stated in the appeals to have "dramatically increased" or to have appeared in "greater frequency" in adults. If the allegations were true a clear time-trend should show up since the start of widely-used mobile communication technology. The following health conditions were considered: Alzheimer's disease, dementia, sleep disturbances, tinnitus, cerebrovascular disease, ischemic heart-diseases, headache, migraine. Data on the incidence of these conditions were assessed from 1993 through at least 2005. For this, a systematic search by keywords was performed in the online-database of the National Library of Medicine (pubmed) and other national and international (European and US) databases. For none of the considered symptoms or diseases a "dramatic increase" was found to have occurred since 1993. Because of the different diagnoses and terms used in the studies, direct comparability is somewhat difficult. Indeed, with the data available no time related increases and surely no "dramatic increase" can be identified, even if the limited comparability is considered. This analysis strongly suggests that the allegations of the quoted appeals are not supported by public health data.
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