Sociodemographic Factors Associated With Incidence of Dementia Among Senior Citizens of a Small Town in Japan

Dementia and Risk Factors: Results from a Prospective, Population-Based Cohort Study

The incidence rate of dementia varies between studies. The influence of some sociodemographic factors is reasonably established, but less is known about the role of comorbidities, which are common in the elderly. The objectives of this study was to estimate the incidence of dementia in a population of Italian elders and evaluate the role of walking speed, comorbidity and ApoE-ɛ4 as well as various sociodemographic factors on the new onset of dementia. The InveCe.Ab study is a population-based longitudinal study in people born between 1935 and 1939 and resident in Abbiategrasso, Milan, Italy. After excluding subjects with a diagnosis of dementia and those without a definite diagnosis, 1103 individuals with a median follow-up time of 4.1 years were included in the analyses. The cumulative four-year incidence of dementia was 5.3%. Demographic factors such as old age, male, less educated, ApoE-ɛ4 carrier status and slower gait were risk factors for dementia onset in a cognitively healthy sub-cohort. Comorbidity did not influence the onset of dementia; instead, slow walking speed appears to be a strong predictor of dementia onset.

Gender Differences in the Link Between Marital Status and the Risk of Cognitive Impairment: Results From the Korean Longitudinal Study of Aging

In the context of South Korea, characterized by increasing population aging and a changing family structure, this study examined differences in the risk of cognitive impairment by marital status and investigated whether this association differs by gender. The data were derived from the 2006-2018 Korean Longitudinal Study of Aging. The sample comprised 7,568 respondents aged 45 years or older, who contributed 30,414 person-year observations. Event history analysis was used to predict the odds of cognitive impairment by marital status and gender. Relative to their married counterparts, never-married and divorced people were the most disadvantaged in terms of cognitive health. In addition, the association between marital status and cognitive impairment was much stronger for men than for women. Further, gender-stratified analyses showed that, compared with married men, never-married men had a higher risk of cognitive impairment, but there were no significant effects of marital status for women.

Sex Difference in the Relation Between Marital Status and Dementia Risk in Two Population-Based Cohorts

BACKGROUND

The modifying effect of sex on the relation between marital status and dementia has yet to be determined.

OBJECTIVE

To examine if sex modifies the association between marital status and incident dementia.

METHODS

Population-based samples from the Mayo Clinic Study of Aging (MCSA, N = 3,471) and the Gothenburg H70 Birth Cohort Study (H70-study, N = 913) were used. A multiplicative interaction term was used to analyze the modifying effect of sex on the relation between marital status (married versus not married) and incident dementia using Cox regression models. Further, risk of dementia by marital status was also evaluated in models separated by sex.

RESULTS

In the MCSA, there was an interaction between marital status and sex in relation to dementia (p = 0.015). In contrast, in the H70-study, no significant interaction was observed (p = 0.28). Nevertheless, in both studies, not married men had increased risk of dementia compared to married men in models adjusted for age, education, and number of children (H70-study: 1.99; 1.06-3.76, MCSA: 1.43; 1.08-1.89). Associations remained similar after additional adjustment for depression, BMI, hypertension, dyslipidemia, and diabetes mellitus (H70-study: 2.00; 1.05-3.82, MCSA: 1.32; 0.99-1.76). Further, no significant association was observed between marital status and dementia in women (H70-study: 1.24; 0.82-1.89, MCSA: 0.82; 0.64-1.04).

CONCLUSION

Sex had a modifying effect on the association between marital status and incident dementia. In analyses separated by sex, not married men had an increased risk of dementia compared to married men, while no significant association was observed between marital status and risk of dementia in women.

At-a-glance - Living arrangements and health status of seniors in the 2018 Canadian Community Health Survey

Currently, 1 in 3 Canadian seniors meet the criteria for successful aging, which include low probability of disease and disability, high cognitive and physical ability and active engagement in life. The sociodemographic characteristic of living alone can identify high-risk seniors, due to its association with lower social support and interactions, thus increasing susceptibility to negative health outcomes in older age. However, limited data exists on the living arrangements of Canadian seniors. In this analysis, we present sociodemographic characteristics and measures of health and social well-being of seniors by living arrangement. This information should be used to identify and support vulnerable seniors and increase the prevalence of healthy aging among Canadians.

Living alone and risk of dementia: A systematic review and meta-analysis

AIMS

To systematically review longitudinal studies on living alone and incident dementia, to pool the results in a meta-analysis and calculate the population risk.

METHODS

Embase, Medline and PsycInfo were searched from inception to August 2019 for longitudinal cohort studies of people living alone and risk of dementia. Relative risks (RR) were extracted and effect sizes pooled, with a sensitivity analysis for risk of bias (QUIPS quality rating tool). Population Attributable Fraction (PAF) was calculated, with prevalence of living alone calculated from UK Census data.

RESULTS

Twelve studies were identified for inclusion, nine of which had low risk of bias. The pooled effect size indicated an elevated risk of incident dementia when living alone (all studies RR = 1.30; 95 % CI: 1.15-1.46; low risk of bias studies (RR = 1.31; 95 % CI: 1.13-1.51). The PAF for living alone was 8.9 %.

CONCLUSIONS

Social isolation is a more important risk factor for dementia than previously identified, with living alone associated with greater population risk than physical inactivity, hypertension, diabetes and obesity.

Contributions of Modifiable Risk Factors to Dementia Incidence: A Bayesian Network Analysis

OBJECTIVE

To determine and compare the contributions of modifiable risk factors (RFs) with the prevention of dementia in older adults.

DESIGN

A systematic review and Bayesian network meta-analysis (NMA). The observational group was set as a reference to collect all existing RFs and compare them with each other.

SETTING AND PARTICIPANTS

An exhaustive and comprehensive literature search strategy was used to identify relevant prospective cohort studies from several online databases from their inception to May 1, 2019. Participants without dementia were adults aged greater than 50 years.

MEASURES

The required data were extracted from the eligible studies to facilitate the Bayesian NMA.

RESULTS

Forty-three cohort studies with 277,294 participants were included in this NMA. Using the observation group as the reference, all defined RFs, except for antioxidants, were associated with lower risks of all-cause dementia [no sleep disturbances (odds ratio, OR 0.43, 95% credible interval, CrI 0.24-0.62), a high level of education (OR 0.50, 95% CrI 0.34-0.66), no history of diabetes (OR 0.57, 95% CrI 0.36-0.78), nonobese patients (OR 0.61, 95% CrI 0.39-0.83), no smoking history (OR 0.62, 95% CrI 0.45-0.79), living with family members (OR 0.67, 95% CrI 0.45-0.89), participation in physical exercise (OR 0.73, 95% CrI 0.46-0.94), abstinence from drinking (OR 0.78, 95% CrI 0.56-0.99), and no history of hypertension (OR 0.80, 95% CrI 0.65-0.96)].

CONCLUSIONS/RELEVANCE

The findings provide reliable support for the hypothesis that modifiable somatic and lifestyle factors are strong predictors of all-cause dementia.

Marriage and risk of dementia: systematic review and meta-analysis of observational studies

BACKGROUND

Being married is associated with healthier lifestyle behaviours and lower mortality and may reduce risk for dementia due to life-course factors. We conducted a systematic review and meta-analysis of studies of the association between marital status and the risk of developing dementia.

METHODS

We searched medical databases and contacted experts in the field for relevant studies reporting the relationship, adjusted for age and sex, between marital status and dementia. We rated methodological quality and conducted random-effects meta-analyses to summarise relative risks of being widowed, divorced or lifelong single, compared with being married. Secondary stratified analyses with meta-regression examined the impact of clinical and social context and study methodology on findings.

RESULTS

We included 15 studies with 812 047 participants. Compared with those who are married, lifelong single (relative risk=1.42 (95% CI 1.07 to 1.90)) and widowed (1.20 (1.02 to 1.41)) people have elevated risk of dementia. We did not find an association in divorced people.Further analyses showed that less education partially confounds the risk in widowhood and worse physical health the elevated risk in lifelong single people. Compared with studies that used clinical registers for ascertaining dementia diagnoses, those which clinically examined all participants found higher risk for being unmarried.

CONCLUSIONS

Being married is associated with reduced risk of dementia than widowed and lifelong single people, who are also underdiagnosed in routine clinical practice. Dementia prevention in unmarried people should focus on education and physical health and should consider the possible effect of social engagement as a modifiable risk factor.

The use of psychotropic drugs for behavioral and psychological symptoms of dementia among residents in long-term care facilities in Japan

OBJECTIVE

To examine whether the use of psychotropic drugs (PDs) was related to behavioral and psychological symptoms of dementia (BPSD) focusing on the prevalence, numbers of symptoms, severity, and care burden among the elderly with BPSD living in long-term care facilities in Japan.

METHOD

We conducted a cross-sectional survey among older people with dementia or similar symptoms (n = 312) using a questionnaire for care staff in 10 selected long-term care facilities. A brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD.

RESULTS

PDs were used in 45% among all participants and 47.5% among those exhibiting at least one BPSD. We found that use of PDs was associated with greater numbers, severity, and care burden of BPSD. Also, there was significantly more use of PDs among people who had specific BPSD symptoms, such as delusions, anxiety, and disinhibition, compared with those who did not.

CONCLUSION

The use of PDs among residents in long-term care facilities with dementia or similar symptoms was relatively low compared with previous reports from other countries. Nonetheless, the greater numbers, severity, and care burden of BPSD were associated with the use of PDs.

The Prevalence and Incidence of Dementia: a Systematic Review and Meta-analysis

Introduction

Dementia 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.

Methods

The 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.

Results

Of 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.

Conclusions

Dementia 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.

New approach for the early detection of dementia by recording in-house activities

People with dementia often have low physical activity and some sleep problems. This study focused on daily life activities and sleeping conditions, and examined the use of these parameters for detecting dementia. Five passive infrared (IR) sensors were installed in each of 14 subject's houses. Each patient lived alone. The subjects' in-house movements were recorded by the passive IR sensor for approximately 3 months (average, 78 days). Based on these records, the following parameters of life activities were assessed: (1) the number of outings, (2) total sleep time, (3) number of sleep interruptions, and (4) sleep rhythm. Subjects with impaired cognition (Mini Mental State Examination [MMSE] < 24) had a significantly lesser number of outings (p = 0.001) and a tendency toward a shorter sleep time (p = 0.054) in comparison with control subjects (MMSE >or= 24). These results suggest that the monitoring of life activities by using passive infrared sensors could be an efficient method for detecting dementia.