The recent decline in prevalence of dementia in developed countries: implications for prevention in the Republic of Korea

Comparative Analysis on the Policy Approaches in the National Dementia Plans of G7 Countries and Korea and Their Implementation

BACKGROUND

The World Health Organization (WHO) proposed a global action plan for dementia and aimed to have 75% of their member states formulating National Dementia Plans (NDPs) by 2025. The Organization for Economic Cooperation and Development (OECD) proposed the ten key objectives of dementia policy in 2015. Among previous studies on NDPs, few studies have investigated measures for proper implementation of NDPs. This study aimed to compare the implementation basis and specific action plans of NDPs between the G7 countries and South Korea.

METHODS

We investigated the measures for proper implementation of the NDPs of G7 countries and South Korea. To compare the specific policy approaches, the seven action areas of the WHO action plan and the ten key objectives of dementia policy proposed by the OECD were integrated into 11 targets (prevention, diagnosis, awareness, caregiver support, appropriate environments, long-term care, health service, end-of-life care, care coordination, research and technology, information systems).

RESULTS

Although most NDPs included specific action plans of the 11 targets, caregiver support, safe environments, healthcare services, and end-of-life care were lacking in some NDPs. For implementation, some countries reinforced the policy priority of their NDPs by timely updates, evaluation, legislations, or head-of-state leadership. However, only three countries had a legislative basis, and three countries included outcome measures in their latest NDP.

CONCLUSION

Effective measures for feasible implementation are needed. The WHO should promote not only the establishment of NDPs, but also their proper implementation.

Satisfaction With Life and Risk of Dementia: Findings From the Korean Longitudinal Study of Aging

OBJECTIVES

Life satisfaction is increasingly viewed as an asset associated with better general health, but its association with cognitive health and risk of dementia is less examined. We tested the hypothesis that higher life satisfaction would be associated with lower risk of dementia.

METHODS

Participants were a nationally representative sample of adults (n = 8,021; age range: 45-93 years) from the Korean Longitudinal Study of Aging assessed every 2 years for up to 12 years. Multilevel modeling analysis examined whether life satisfaction is associated with cognitive functioning and decline. The primary analysis used Cox regression to examine the association between baseline life satisfaction and risk of incident dementia.

RESULTS

Between-person differences and within-person changes in life satisfaction were associated with cognitive functioning, but life satisfaction was unrelated to the rate of cognitive decline. Higher life satisfaction was also associated with lower risk of dementia, even after accounting for demographic factors, depressive symptoms, cardiovascular and functional risk factors, health behaviors, and social contact.

DISCUSSION

Satisfaction with life may function as a positive psychological resource for maintaining cognitive functioning and protecting against the risk of dementia.

Cognitive Tele-Enhancement in Healthy Older Adults and Subjects With Subjective Memory Complaints: A Review

Background: In recent years, emphasis has been placed on cognitive enhancement to stimulate cognitive abilities and prevent functional decline. Considering that traditional face-to-face interventions can be very expensive and are not accessible to all individuals, the need to transfer care from the clinic to the patient's home is evident. In this regard, cognitive tele-enhancement interventions have received increased attention. Aim: The aim of this review was to provide an overview of protocols that apply remotely controlled cognitive training with individualized feedback on performance by the therapist in healthy older adults or participants with subjective memory complaints. Methods: Out of 35 articles assessed for eligibility, eight studies were identified. Of the selected studies, five included cognitively healthy older adults, while three included participants with subjective memory complaints. Results: Most of the reviewed studies showed beneficial effects of cognitive tele-enhancement interventions, reporting improvements in memory, sustained attention, working memory, executive functions, and language abilities. Moreover, reductions in anxiety and depression symptomatology levels, as well as in subjective memory difficulties, were described in some of the studies. Conclusions: Cognitive tele-enhancement treatment could be a good alternative to face-to-face intervention. This literature review highlights the importance of applying preventive cognitive interventions to subjects with initial subjective memory complaints. Remote modalities seem to facilitate the application of such interventions.

Decline in the Incidence of All-Cause and Alzheimer's Disease Dementia: a 12-Year-Later Rural Cohort Study in Korea

BACKGROUND

There has been no study on the time trends of dementia incidence in Korea. We report the 5-year incidence and its correlates of all-cause and Alzheimer's disease (AD) dementia, and compared our results with those of a 12-year-prior cohort study conducted in the same area.

METHODS

A total of 751 community-dwelling older adults were followed up for a mean duration of 5.4 years. The age-, gender-, and educational attainment-specific incidence of all-cause and AD dementia were reported as cases per 1,000 person-years. We performed univariate and multivariate cox proportional hazard regression analyses to determine whether baseline sociodemographic, lifestyle, and clinical variables were associated with the risk of all-cause and AD dementia. A 12-year-prior cohort study was used for descriptive comparison to indicate the time trends of dementia incidence.

RESULTS

The incidence rates were 16.2 and 13.0 cases per 1,000 person-years for all-cause and AD dementia, respectively. The baseline diagnosis of mild cognitive impairment increased the 5-year incidence of all-cause dementia by more than 4-fold. Old age and low baseline global cognitive function were noted as risk factors for both all-cause and AD dementia.

CONCLUSION

Upon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea.

Anti-herpetic Medications and Reduced Risk of Dementia in Patients with Herpes Simplex Virus Infections-a Nationwide, Population-Based Cohort Study in Taiwan

This retrospective cohort study is to investigate the association between herpes simplex virus (HSV) infections and dementia, and the effects of anti-herpetic medications on the risk involved, using Taiwan's National Health Insurance Research Database (NHIRD). We enrolled a total of 33,448 subjects, and identified 8362 with newly diagnosed HSV infections and 25,086 randomly selected sex- and age-matched controls without HSV infections in a ratio of 1:3, selected from January 1, to December 31, 2000. A multivariable Cox proportional hazards regression model was used to evaluate the risk of developing dementia in the HSV cohort. This analysis revealed an adjusted hazard ratio of 2.564 (95% CI: 2.351-2.795, P < 0.001) for the development of dementia in the HSV-infected cohort relative to the non-HSV cohort. Thus, patients with HSV infections may have a 2.56-fold increased risk of developing dementia. A risk reduction of dementia development in patients affected by HSV infections was found upon treatment with anti-herpetic medications (adjusted HR = 0.092 [95% CI 0.079-0.108], P < 0.001). The usage of anti-herpetic medications in the treatment of HSV infections was associated with a decreased risk of dementia. These findings could be a signal to clinicians caring for patients with HSV infections. Further research is, therefore, necessary to explore the underlying mechanism(s) of these associations.

Effects of smartphone-based memory training for older adults with subjective memory complaints: a randomized controlled trial

OBJECTIVES

We explored whether newly developed application (Smartphone-based brain Anti-aging and memory Reinforcement Training, SMART) improved memory performance in older adults with subjective memory complaints (SMC).

METHOD

A total of 53 adults (range: 50-68 years; 52.8% female) were randomized into either one of two intervention groups [SMART (n = 18) vs. Fit Brains® (n = 19)] or a wait-list group (n = 16). Participants in the intervention groups underwent 15-20 minutes of training per day, five days per week for 8 weeks. We used objective cognitive measures to evaluate changes with respect to four domains: attention, memory, working memory (WM), and response inhibition. In addition, we included self-report questionnaires to assess levels of SMC, depression, and anxiety.

RESULTS

Total WM quotient [t(17) = 6.27, p < .001] as well as auditory-verbal WM score [t(17) = 4.45, p < .001] increased significantly in the SMART group but not in the control groups. Self-reports of memory contentment, however, increased in the Fit Brains® group only [t(18) = 2.12, p < .05).

CONCLUSION

Use of an 8-week smartphone-based memory training program may improve WM function in older adults. However, objective improvement in performance does not necessarily lead to decreased SMC.

Trends in Dementia Incidence in a Birth Cohort Analysis of the Einstein Aging Study

Importance

Trends in dementia incidence rates have important implications for planning and prevention. To better understand incidence trends over time requires separation of age and cohort effects, and few prior studies have used this approach.

Objectives

To examine trends in dementia incidence and concomitant trends in cardiovascular comorbidities among individuals aged 70 years or older who were enrolled in the Einstein Aging Study between 1993 and 2015.

Design, Setting, and Participants

In this birth cohort analysis of all-cause dementia incidence in persons enrolled in the Einstein Aging Study from October 20, 1993, through November 17, 2015, a systematically recruited, population-based sample of 1348 participants from Bronx County, New York, who were 70 years or older without dementia at enrollment and at least one annual follow-up was studied. Poisson regression was used to model dementia incidence as a function of age, sex, educational level, race, and birth cohort, with profile likelihood used to identify the timing of significant increases or decreases in incidence.

Exposures

Birth year and age.

Main Outcomes and Measures

Incident dementia defined by consensus case conference based on annual, standardized neuropsychological and neurologic examination findings, using criteria from the DSM-IV.

Results

Among 1348 individuals (mean [SD] baseline age, 78.5 [5.4] years; 830 [61.6%] female; 915 [67.9%] non-Hispanic white), 150 incident dementia cases developed during 5932 person-years (mean [SD] follow-up, 4.4 [3.4] years). Dementia incidence decreased in successive birth cohorts. Incidence per 100 person-years was 5.09 in birth cohorts before 1920, 3.11 in the 1920 through 1924 birth cohorts, 1.73 in the 1925 through 1929 birth cohorts, and 0.23 in cohorts born after 1929. Change point analyses identified a significant decrease in dementia incidence among those born after July 1929 (95% CI, June 1929 to January 1930). The relative rate for birth cohorts before July 1929 vs after was 0.13 (95% CI, 0.04-0.41). Prevalence of stroke and myocardial infarction decreased across successive birth cohorts, whereas diabetes prevalence increased. Adjustment for these cardiovascular comorbidities did not explain the decreased dementia incidence rates for more recent birth cohorts.

Conclusions and Relevance

Analyses confirm decreasing dementia incidence in this population-based sample. Whether decreasing incidence will contribute to reduced burden of dementia given the aging of the population is not known.

Dementia Population Risk Tool (DemPoRT): study protocol for a predictive algorithm assessing dementia risk in the community

INTRODUCTION

The burden of disease from dementia is a growing global concern as incidence increases dramatically with age, and average life expectancy has been increasing around the world. Planning for an ageing population requires reliable projections of dementia prevalence; however, existing population projections are simple and have poor predictive accuracy. The Dementia Population Risk Tool (DemPoRT) will predict incidence of dementia in the population setting using multivariable modelling techniques and will be used to project dementia prevalence.

METHODS AND ANALYSIS

The derivation cohort will consist of elderly Ontario respondents of the Canadian Community Health Survey (CCHS) (2001, 2003, 2005 and 2007; 18 764 males and 25 288 females). Prespecified predictors include sociodemographic, general health, behavioural, functional and health condition variables. Incident dementia will be identified through individual linkage of survey respondents to population-level administrative healthcare databases (1797 and 3281 events, and 117 795 and 166 573 person-years of follow-up, for males and females, respectively, until 31 March 2014). Using time of first dementia capture as the primary outcome and death as a competing risk, sex-specific proportional hazards regression models will be estimated. The 2008/2009 CCHS survey will be used for validation (approximately 4600 males and 6300 females). Overall calibration and discrimination will be assessed as well as calibration within predefined subgroups of importance to clinicians and policy makers.

ETHICS AND DISSEMINATION

Research ethics approval has been granted by the Ottawa Health Science Network Research Ethics Board. DemPoRT results will be submitted for publication in peer-review journals and presented at scientific meetings. The algorithm will be assessable online for both population and individual uses.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT03155815, pre-results.

2-Arylbenzofurans from Artocarpus lakoocha and methyl ether analogs with potent cholinesterase inhibitory activity

In vitro screening for acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitory activities of the Artocarpus lakoocha root-bark extracts revealed interesting results. Bioassay-guided fractionation resulted in the isolation of two new (1 and 2) and six known 2-arylbenzofurans 3-8, along with one stilbenoid 9 and one flavonoid 10. The structures of the isolated compounds were elucidated by UV, IR, 1D- and 2D-NMR and MS spectroscopic data analysis. Compounds 4, 6 and 7 exhibited more potent AChE inhibitory activity (IC₅₀ = 0.87-1.10 μM) than the reference drug, galantamine. Compounds 4, 8 and 9 displayed greater BChE inhibition than the standard drug. The preferential inhibition of BChE over AChE indicated that 4 also showed a promising dual AChE and BChE inhibitor. The synthetic mono-methylated analogs 4a-c and 6a-b were found to be good BChE inhibitors with IC₅₀ values ranging between 0.31 and 1.11 μM. Based on the docking studies, compounds 4 and 6 are well-fitted in the catalytic triad of AChE. Compounds 4 and 6 showed different binding orientations on BChE, and the most potent BChE inhibitor 4 occupied dual binding to both CAS and PAS more efficiently.

Simultaneous temporal trends in dementia incidence and prevalence, 2005-2013: a population-based retrospective cohort study in Saskatchewan, Canada

BACKGROUND

Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006 to 2012/2013 to: (1) examine simultaneous temporal trends in annual age- and sex-specific dementia incidence and prevalence among individuals aged 45 and older, and (2) stratify the changes in incidence over time by database of identification.

METHODS

Using a population-based retrospective cohort study design, data were extracted from seven provincial administrative health databases linked by a unique anonymized identification number. Individuals 45 years and older at first identification of dementia between April 1, 2005 and March 31, 2013 were included, based on case definition criteria met within any one of four administrative health databases (hospital, physician, prescription drug, and long-term care).

RESULTS

Between 2005/2006 and 2012/2013, the 12-month age-standardized incidence rate of dementia declined significantly by 11.07% and the 12-month age-standardized prevalence increased significantly by 30.54%. The number of incident cases decreased from 3,389 to 3,270 and the number of prevalent cases increased from 8,795 to 13,012. Incidence rate reductions were observed in every database of identification.

CONCLUSIONS

We observed a simultaneous trend of decreasing incidence and increasing prevalence of dementia over a relatively short 8-year time period from 2005/2006 to 2012/2013. These trends indicate that the average survival time of dementia is lengthening. Continued observation of these time trends is warranted given the short study period.

Biomarkers in Alzheimer's Disease

Alzheimer's disease (AD) so far did not have promising treatment. The accurate and early diagnosis is still the important issue. For these purpose, biomarkers related to diagnosis, clinical course, and other aims have been proposed and reported. Meanwhile, along with the ongoing researches for AD, biomarkers with their own aims are also on the way.

Prevalence and Incidence of Osteoporosis and Osteoporotic Vertebral Fracture in Korea: Nationwide Epidemiological Study Focusing on Differences in Socioeconomic Status

STUDY DESIGN

A cross-national study.

OBJECTIVE

To determine the prevalence and incidence of osteoporosis (OP) and osteoporotic vertebral fracture (OVF) in Korea and to investigate if socioeconomic status has an effect.

SUMMARY OF BACKGROUND DATA

As life expectancy increases, OP and related fragility fractures are also increasing. This presents a serious challenge, not only for health authorities but also for individuals, their families, and society overall. Determining the prevalence and incidence of OP and related fragility fractures is the first step in developing strategies to reduce their increasing disease burdens. Concurrently, we need to confirm whether people with low socioeconomic status are more susceptible to these diseases.

METHODS

Using the Health Insurance Review and Assessment Service (HIRA) database from 2008 to 2012, we estimated the annual prevalence and incidence of OP and OVF and investigated the differences according to socioeconomic status by National Health Insurance (NHI) beneficiaries and Medical Aid (MA) recipients.

RESULTS

In 2012, the standardized prevalence of OP in the NHI and MA groups was 3968 and 6927 per 100,000, respectively (odds ratio, 3.83). The standardized incidence of OP in the MA group was significantly higher than in the NHI group in 2011 and 2012 (odds ratios, 2.34 and 2.19, respectively). In addition, the standardized incidence of OVF in the MA group in 2011 and 2012 was 408 and 389 per 100,000, respectively, and the incidence in the MA group was significantly higher than in the NHI group (odds ratios, 4.13 and 4.12, respectively; P < 0.001).

CONCLUSION

We confirmed that the prevalence and incidence of OP and OVF in the MA group were higher than those in the NHI group. It showed that low income might be a significant factor related to OP and OVF.

LEVEL OF EVIDENCE

3.