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Zhou R, Chen F, Zhang L, Sun Y, Hu R, Yan J, Jiang H. Association between adding salt in food and dementia in European descent: A mendelian randomization study. Brain Behav 2024; 14:e3516. [PMID: 38702903 PMCID: PMC11069030 DOI: 10.1002/brb3.3516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND High salt intake has been proposed as a risk factor for dementia. However, causal relationship between salt intake and dementia remains uncertain. PURPOSE The aim of this study was to employ a mendelian randomization (MR) design to investigate the causal impact of salt intake on the risk of dementia. METHODS Genome-wide association study (GWAS) data of exposures and outcomes (any dementia, cognitive performance, different types of dementia, Alzheimer's disease [AD], and Parkinson's disease) were obtained from the IEU database. MR estimates were generated though inverse-variance weighted model. MR-Egger, weighted median, and MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO) method also used in our study. Sensitivity analyses included Cochran's Q test, MR-Egger intercept, MR-PRESSO global test and outlier test, leave-one-out analysis, and funnel plot assessment. RESULTS Our MR analysis provided evidence of a causal association between high salt added to food and dementia (odds ratio [OR] = 1.73, 95% confidence interval [CI]: 1.21-2.49, and p = .003), dementia in AD (OR = 2.10, 95% CI: 1.15-3.83, and p = .015), and undefined dementia (OR = 2.61, 95% CI: 1.26-5.39, and p = .009). Higher salt added was also associated with increased risk of AD (OR = 1.80, 95% CI: 1.12-2.87, and p = .014) and lower cognitive performance (β = -.133, 95% CI: -.229 to -.038, and p = .006). CONCLUSION This study provides evidence suggesting that high salt intake is causally associated with an increased risk of developing dementia, including AD and undefined dementia, highlighting the potential importance of reducing salt consumption as a preventive measure.
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Affiliation(s)
- Ren Zhou
- Department of AnesthesiologyThe Ninth People's Hospital of ShanghaiJiao Tong University School of MedicineShanghaiP. R. China
| | - Fei Chen
- Department of AnesthesiologyThe Ninth People's Hospital of ShanghaiJiao Tong University School of MedicineShanghaiP. R. China
| | - Lei Zhang
- Department of AnesthesiologyThe Ninth People's Hospital of ShanghaiJiao Tong University School of MedicineShanghaiP. R. China
| | - Yu Sun
- Department of AnesthesiologyThe Ninth People's Hospital of ShanghaiJiao Tong University School of MedicineShanghaiP. R. China
| | - Rong Hu
- Department of AnesthesiologyThe Ninth People's Hospital of ShanghaiJiao Tong University School of MedicineShanghaiP. R. China
| | - Jia Yan
- Department of AnesthesiologyThe Ninth People's Hospital of ShanghaiJiao Tong University School of MedicineShanghaiP. R. China
| | - Hong Jiang
- Department of AnesthesiologyThe Ninth People's Hospital of ShanghaiJiao Tong University School of MedicineShanghaiP. R. China
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Key MN, Shaw AR, Erickson KI, Burns JM, Vidoni ED. A retrospective analysis of serious adverse events and deaths in U.S.-based lifestyle clinical trials for cognitive health. Contemp Clin Trials Commun 2024; 38:101277. [PMID: 38404652 PMCID: PMC10884817 DOI: 10.1016/j.conctc.2024.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/03/2024] [Accepted: 02/14/2024] [Indexed: 02/27/2024] Open
Abstract
Objective This retrospective analysis examined serious adverse events (SAEs) and deaths in U.S. lifestyle clinical trials aimed at enhancing cognitive health in older adults. Methods Data was gathered from trials completed between January 1, 2000, and July 19, 2023, via ClinicalTrials.gov's API. Results Among these trials, 76% did not report results. The remaining studies fell into four intervention categories: Cognitive/Behavioral, Exercise/Movement, Diet/Supplement, and Multi-modal. When considering all trial types collectively, the findings suggest that lifestyle clinical trials are generally safe. There was no significant increase in the relative risk of experiencing an SAE in the intervention group compared to the control group. However, in terms of relative risk of death, an increase of 28% was observed in the intervention compared to the control, which was statistically significant (X2 (1, N = 36), p < 0.00688). Nevertheless, this increase did not surpass age-adjusted U.S. mortality rates. Assessing the data by intervention type, Diet/Supplement, and Multi-modal trials displayed an elevated relative risk of SAEs in the intervention. Diet/Supplement trials had a 16% increase (X2 (1, N = 2), p < 0.0263), and Multi-modal trials had a 365% increase (X2 (1, N = 5), p < 0.000213). Diet/Supplement trials also showed a 67% increased risk of death (X2 (1, N = 2), p < 0.000197). Conclusions These findings should be cautiously considered due to the low rate of reporting, but underscore the significance of reporting clinical trial results, enhancing transparency, and facilitating more accurate safety assessments in cognitive aging and lifestyle interventions for older adults.
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Affiliation(s)
- Mickeal N Key
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS, USA
| | - Ashley R Shaw
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS, USA
| | - Kirk I Erickson
- AdventHealth Research Institute, Neuroscience, Orlando, FL, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS, USA
| | - Eric D Vidoni
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Fairway, KS, USA
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Victor CR, Gamble LD, Pentecost C, Quinn C, Charlwood C, Matthews FE, Clare L. Living well with dementia: An exploratory matched analysis of minority ethnic and white people with dementia and carers participating in the IDEAL programme. Int J Geriatr Psychiatry 2024; 39:e6048. [PMID: 38180319 PMCID: PMC10952883 DOI: 10.1002/gps.6048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES The increasing heterogeneity of the population of older people is reflected in an increasing number of people with dementia and carers drawn from minority ethnic groups. Data from the IDEAL study are used to compare indices of 'living well' among people with dementia and carers from ethnic minority groups with matched white peers. METHODS We used an exploratory cross-sectional case-control design to compare 'living well' for people with dementia and carers from minority ethnic and white groups. Measures for both groups were quality of life, life satisfaction, wellbeing, loneliness, and social isolation and, for carers, stress, relationship quality, role captivity and caring competence. RESULTS The sample of people with dementia consisted of 20 minority ethnic and 60 white participants and for carers 15 and 45 respectively. People with dementia from minority ethnic groups had poorer quality of life (-4.74, 95% CI: -7.98 to -1.50) and higher loneliness (1.72, 95% CI: 0.78-2.66) whilst minority ethnic carers had higher stress (8.17, 95% CI: 1.72-14.63) and role captivity (2.00, 95% CI: 0.43-3.57) and lower relationship quality (-9.86, 95% CI: -14.24 to -5.48) than their white peers. CONCLUSION Our exploratory study suggests that people with dementia from minority ethnic groups experience lower quality of life and carers experience higher stress and role captivity and lower relationship quality than their white peers. Confirmatory research with larger samples is required to facilitate analysis of the experiences of specific minority ethnic groups and examine the factors contributing to these disadvantages.
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Affiliation(s)
- Christina R. Victor
- Department of Health SciencesCollege of Health, Medicine and Life SciencesBrunel University LondonLondonUK
| | - Laura D. Gamble
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Catherine Quinn
- Centre for Applied Dementia StudiesFaculty of Health StudiesUniversity of BradfordBradfordUK
| | | | - Fiona E. Matthews
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Linda Clare
- University of Exeter Medical SchoolUniversity of Exeter, and NIHR Applied Research Collaboration South‐West PeninsulaExeterUK
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Taylor B, Barboi C, Boustani M. Passive digital markers for Alzheimer's disease and other related dementias: A systematic evidence review. J Am Geriatr Soc 2023; 71:2966-2974. [PMID: 37249252 DOI: 10.1111/jgs.18426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The timely detection of Alzheimer's disease and other related dementias (ADRD) is suboptimal. Digital data already stored in electronic health records (EHR) offer opportunities for enhancing the timely detection of ADRD by facilitating the development of passive digital markers (PDMs). We conducted a systematic evidence review to identify studies that describe the development, performance, and validity of EHR-based PDMs for ADRD. METHODS We searched the literature published from January 2000 to August 2022 and reviewed cross-sectional, retrospective, or prospective observational studies with a patient population of 18 years or older, published in English that collected and interpreted original data, included EHR as a source of digital data, and had the primary purpose of supporting ADRD care. We extracted relevant data from the included studies with guidance from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and used the US Preventive Services Task Force criteria to appraise each study. RESULTS We included and appraised 19 studies. Four studies were considered to have a fair quality, and none was considered to have a good quality. The functionality of the PDMs varied from detecting mild cognitive impairment, Alzheimer's disease or ADRD, to forecasting stages of ADRD. Only seven studies used a valid reference diagnostic method. Nine PDMs used only structured EHR data, and five studies provided complete information on the race and ethnicity of its population. The number of features included in the PDMs ranges from 10 to 853, and the PMDs used a variety of statistical and machine learning algorithms with various time-at-risk windows. The area under the curve (AUC) for the PDMs varied from 0.67 to 0.97. CONCLUSION Although we noted heterogeneity in the PDMs development and performance, there is evidence that these PDMs have the potential to detect ADRD at earlier stages.
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Affiliation(s)
- Britain Taylor
- Department of Intelligent Systems Engineering, School of Informatics, Computing, and Engineering. Indiana University, Bloomington, Indiana, USA
| | - Cristina Barboi
- Department of Epidemiology, School of Public Health. Indiana University, Indianapolis, Indiana, USA
| | - Malaz Boustani
- Center for Health Innovation and Implementation Science, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
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de Leon J, Bondoc I, Mamuyac E, Posecion L, Europa E, Kintanar LC, Roco N, Lamoca M, Escueta DP, Park VMT. The development of the Cognitive Assessment for Tagalog Speakers (CATS): A culturally and linguistically tailored test battery for Filipino Americans. Alzheimers Dement (N Y) 2023; 9:e12418. [PMID: 37662963 PMCID: PMC10474327 DOI: 10.1002/trc2.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Filipino Americans are one of the largest Asian American and Pacific Islander (AAPI) populations in the United States (US). Previous studies suggest that Filipino Americans have one of the highest incidence rates of Alzheimer's disease and related dementias (ADRD) among AAPI subgroups. Despite the expected increase in Filipino Americans with ADRD, no studies to-date have validated neuropsychological measures in the United States for speakers of Tagalog, a major language spoken by Filipino Americans. A significant barrier to dementia care and diagnosis is the lack of linguistically and socioculturally appropriate cognitive tasks for Tagalog speakers. To address this need, we developed and piloted the Cognitive Assessment for Tagalog Speakers (CATS), the first neuropsychological battery for the detection of ADRD in Filipino American Tagalog speakers. METHODS Based on evidence-based neuropsychological batteries, we adapted and constructed de novo tasks to measure performance across 4 main cognitive domains: visual/verbal memory, visuospatial functioning, speech and language, and frontal/executive functioning. Tasks were developed with a team of bilingual English/Tagalog, bicultural Filipino American/Canadian experts, including a neurologist, speech-language pathologist, linguist, and neuropsychologist. We recruited Tagalog-speaking participants of age 50+ through social media advertisements and recruitment registries for this cross-sectional study. We present the CATS design and protocol. RESULTS To-date, the CATS battery has been administered to 26 healthy control participants (age 64.5 ± 7.8 years, 18F/8 M) at an academic institution in Northern California, United States. The development and administration of the CATS battery demonstrated its feasibility but also highlighted the need to consider the effects of bilingualism, language typology, and cultural factors in result interpretation. DISCUSSION The CATS battery provides a mechanism for cognitive assessment of Filipino Americans, a population that has been underrepresented in ADRD research. As we move toward the treatment and cure of ADRD, linguistically and socioculturally appropriate cognitive tests become even more important for equitable care.
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Affiliation(s)
- Jessica de Leon
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ivan Bondoc
- Department of LinguisticsUniversity of TorontoTorontoOntarioCanada
| | - Eugenie Mamuyac
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lainie Posecion
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Eduardo Europa
- Department of Communicative Disorders and SciencesSan Jose State UniversitySan JoseCaliforniaUSA
| | | | - Niecholle Roco
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mikkael Lamoca
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Danielle P. Escueta
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Van M. Ta Park
- Department of Community Health SystemsSchool of NursingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Asian American Research Center on Health (ARCH)University of California San FranciscoSan FranciscoCaliforniaUSA
- Multiethnic Health Equity Research Center (MERC)University of California San FranciscoSan FranciscoCaliforniaUSA
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Walsh S, Govia I, Peters R, Richard E, Stephan BCM, Wilson NA, Wallace L, Anstey KJ, Brayne C. What would a population-level approach to dementia risk reduction look like, and how would it work? Alzheimers Dement 2023; 19:3203-3209. [PMID: 36791256 DOI: 10.1002/alz.12985] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
Dementia is a leading global public health challenge. Prevention approaches have traditionally focused on individual-level strategies. However, such approaches have limited potential, particularly for resource-constrained populations in which exposure to risk factors is greatest, and exposure to protective factors is lowest. A population-level approach to dementia risk reduction is therefore essential to meet the scale of the challenge and to tackle global inequalities in risk and incidence of disease. Such approaches can be highly cost effective. In this viewpoint article, we describe what such an approach should look like, barriers and facilitators to success, and how we should go about achieving it. We include 10 strategic goals to achieve population-level dementia risk reduction and protection enhancement, targeted at researchers, professionals, funders, science communicators, governments, businesses, and policy makers. If we are to significantly reduce the prevalence of dementia there must be increased emphasis on population-level approaches. HIGHLIGHTS: Dementia risk reduction is a global public health priority Population-level approaches change societal conditions to make them less conducive to dementia's modifiable risk factors, and increase exposure to protective factors. Urgent development of population-level approaches is required to reduce the prevalence of, and inequalities in, dementia Action is required from researchers, governments and business, funders, public health professionals, and science communicators.
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Affiliation(s)
- Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Ruth Peters
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Blossom C M Stephan
- Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Nottingham, UK
| | - Nikki-Anne Wilson
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Lindsay Wallace
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Aggarwal R, Sidnam-Mauch E, Neffa-Creech D, Plant A, Williams E, Shami E, Menon U, George S, Langbaum JB. Development of a Mobile-First Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies. J Prev Alzheimers Dis 2023; 10:857-864. [PMID: 37874108 PMCID: PMC10884078 DOI: 10.14283/jpad.2023.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Web-based participant recruitment registries can be useful tools for accelerating enrollment into studies, but existing Alzheimer's disease (AD)-focused recruitment registries have had limited success enrolling individuals from underrepresented racial and ethnic groups. Designing these registries to meet the needs of individuals from these communities, including designing mobile-first, may facilitate improvement in the enrollment of underrepresented groups. OBJECTIVES Evaluate the usability of a prototype mobile-first participant recruitment registry for AD prevention studies; assess users' perceptions of and willingness to sign up for the registry. DESIGN AND SETTING Quantitative usability testing and an online survey; online setting. PARTICIPANTS We recruited 1,358 adults ages 45-75 who self-reported not having a diagnosis of mild cognitive impairment, AD, or other forms of dementia (Study 1: n=589, Study 2: n=769). Black/African American and Hispanic/Latino participants were specifically recruited, including those with lower health literacy. METHODS AND MEASUREMENTS Study 1 measures the prototype's usability through observed task success rates, task completion times, and responses to the System Usability Scale. Study 2 uses an online survey to collect data on perceptions of and willingness to sign up for the mobile-first registry. RESULTS Study 1 findings show the prototype mobile-first recruitment registry website demonstrates high usability and is equally usable for Black / African American, Hispanic/Latino, and White user groups. Survey results from Study 2 indicate that users from underrepresented communities understand the registry's purpose and content and express willingness to sign up for the registry on a mobile device. CONCLUSIONS Designing mobile-first participant recruitment registries based on feedback from underrepresented communities may result in more sign-ups by individuals from minoritized communities.
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Affiliation(s)
- R Aggarwal
- Jessica Langbaum, Banner Alzheimer's Institute, 901 E. Willetta Street, Phoenix, AZ 85006,
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