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Loughrey DG, Jordan C, Ibanez A, Parra MA, Lawlor BA, Reilly RB. Age-related hearing loss associated with differences in the neural correlates of feature binding in visual working memory. Neurobiol Aging 2023; 132:233-245. [PMID: 37866083 DOI: 10.1016/j.neurobiolaging.2023.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/14/2023] [Revised: 08/09/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
The underlying neural mechanisms underpinning the association between age-related hearing loss (ARHL) and dementia remain unclear. A limitation has been the lack of functional neuroimaging studies in ARHL cohorts to help clarify this relationship. In the present study, we investigated the neural correlates of feature binding in visual working memory with ARHL (controls = 14, mild HL = 21, and moderate or greater HL = 23). Participants completed a visual change detection task assessing feature binding while their neural activity was synchronously recorded via high-density electroencephalography. There was no difference in accuracy scores for ARHL groups compared to controls. There was increased electrophysiological activity in those with ARHL, particularly in components indexing the earlier stages of visual cognitive processing. This activity was more pronounced with more severe ARHL and was associated with maintained feature binding. Source space (sLORETA) analyses indicated greater activity in networks modulated by frontoparietal and temporal regions. Our results demonstrate there may be increased involvement of neurocognitive control networks to maintain lower-order neurocognitive processing disrupted by ARHL.
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Affiliation(s)
- David G Loughrey
- Global Brain Health Institute, Trinity College, The University of Dublin, Ireland; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA; Trinity College Institute of Neuroscience, Trinity College, The University of Dublin, Ireland.
| | - Catherine Jordan
- Global Brain Health Institute, Trinity College, The University of Dublin, Ireland; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Agustin Ibanez
- Global Brain Health Institute, Trinity College, The University of Dublin, Ireland; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA; Cognitive Neuroscience Center, University of San Andrés, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Brian A Lawlor
- Global Brain Health Institute, Trinity College, The University of Dublin, Ireland; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Richard B Reilly
- Trinity College Institute of Neuroscience, Trinity College, The University of Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Ireland; School of Engineering, Trinity College, The University of Dublin, Ireland; School of Medicine, Trinity College, The University of Dublin, Ireland
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De Looze C, Dehsarvi A, Suleyman N, Crosby L, Hernández B, Coen RF, Lawlor BA, Reilly RB. Structural Correlates of Overt Sentence Reading in Mild Cognitive Impairment and Mild-to-Moderate Alzheimer's Disease. Curr Alzheimer Res 2022; 19:606-617. [PMID: 35929622 DOI: 10.2174/1567205019666220805110248] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Overt sentence reading in mild cognitive impairment (MCI) and mild-tomoderate Alzheimer's disease (AD) has been associated with slowness of speech, characterized by a higher number of pauses, shorter speech units and slower speech rate and attributed to reduced working memory/ attention and language capacity. OBJECTIVE This preliminary case-control study investigates whether the temporal organization of speech is associated with the volume of brain regions involved in overt sentence reading and explores the discriminative ability of temporal speech parameters and standard volumetric MRI measures for the classification of MCI and AD. METHODS Individuals with MCI, mild-to-moderate AD, and healthy controls (HC) had a structural MRI scan and read aloud sentences varying in cognitive-linguistic demand (length). The association between speech features and regional brain volumes was examined by linear mixed-effect modeling. Genetic programming was used to explore the discriminative ability of temporal and MRI features. RESULTS Longer sentences, slower speech rate, and a higher number of pauses and shorter interpausal units were associated with reduced volumes of the reading network. Speech-based classifiers performed similarly to the MRI-based classifiers for MCI-HC (67% vs. 68%) and slightly better for AD-HC (80% vs. 64%) and AD-MCI (82% vs. 59%). Adding the speech features to the MRI features slightly improved the performance of MRI-based classification for AD-HC and MCI-HC but not HC-MCI. CONCLUSION The temporal organization of speech in overt sentence reading reflects underlying volume reductions. It may represent a sensitive marker for early assessment of structural changes and cognitive- linguistic deficits associated with healthy aging, MCI, and AD.
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Affiliation(s)
- Céline De Looze
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland.,Department of Gerontology, The Irish Longitudinal Study on Aging, Trinity College Dublin, Dublin, Ireland
| | - Amir Dehsarvi
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Narin Suleyman
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Lisa Crosby
- Mercer's Institute for Successful Aging, St James's Hospital, Dublin, Ireland
| | - Belinda Hernández
- Department of Gerontology, The Irish Longitudinal Study on Aging, Trinity College Dublin, Dublin, Ireland
| | - Robert F Coen
- Mercer's Institute for Successful Aging, St James's Hospital, Dublin, Ireland
| | - Brian A Lawlor
- Mercer's Institute for Successful Aging, St James's Hospital, Dublin, Ireland.,Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland.,Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin, Ireland
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3
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McHugh Power JE, Feeney J, Fowler E, McMichael AJ, Hyland P, Lawlor BA, Cruise S, Potter C, Young I, McGuinness B, Kee F. Exposure to the troubles in Northern Ireland, memory functioning, and social activity engagement: results from NICOLA. Eur J Ageing 2022; 19:1099-1109. [PMID: 36692739 PMCID: PMC9729674 DOI: 10.1007/s10433-022-00683-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 01/26/2023] Open
Abstract
We investigated the potential impact of a cohort traumatic exposure, the Troubles in Northern Ireland, on memory functioning in later life, and the potential moderating effect of social activity engagement. Using data from 6571 participants aged 60 + in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) cohort, we used a structural equation modelling framework to explore associations between traumatic exposure during the Troubles and memory functioning. As expected, social activity engagement was positively associated with memory functioning, β = .102. Traumatic exposure was also positively associated with memory functioning, β = .053. This association was stronger at low levels of social activity engagement; among those with higher levels, there was little association, interaction β = - 0.054. The positive association between traumatic exposure during the Troubles and memory functioning was not moderated by the age at which the exposures occurred (based on analysis of a subsample with available data), interaction β = - 0.015. We conclude that superior memory functioning was associated with higher levels of traumatic exposure during the Troubles, particularly among those with lower levels of social activity engagement, and regardless of the age at which the exposures occurred. Future longitudinal analyses are required to build on these results, which potentially have implications for life-course epidemiology, in relation to critical periods for traumatising experiences.
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Affiliation(s)
- Joanna E McHugh Power
- Department of Psychology, Maynooth University, Education House, Co Kildare, Republic of Ireland ,Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Joanne Feeney
- School of Medicine, Trinity College, Dublin, Republic of Ireland
| | - Elizabeth Fowler
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Alan J. McMichael
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Education House, Co Kildare, Republic of Ireland
| | - Brian A. Lawlor
- School of Medicine, Trinity College, Dublin, Republic of Ireland
| | - Sharon Cruise
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Claire Potter
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Ian Young
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | | | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
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Abstract
OBJECTIVES The relatively recent identification of a subgroup of patients with apparent behavioral variant frontotemporal dementia (bvFTD) that fails to progress with time has led to a reevaluation of our understanding of bvFTD, and a growing body of research that attempts to characterize the mimic or "phenocopy" syndrome. In this article, we review the literature relating to the phenocopy syndrome, focusing in particular on distinguishing characteristics and potential etiologies. METHODS Published articles were identified via a systematic search of PubMed and Embase. Observational and interventional studies, case reports, and case series were sought for inclusion. RESULTS While bvFTD and the phenocopy syndrome are clinically indistinguishable at initial presentation, the presence or absence of characteristic changes on neuroimaging predicts 2 very different illness trajectories. The etiology for the phenocopy presentation remains uncertain. It is likely that the syndrome represents a heterogenous assortment of clinical frontal syndromes encompassing atypical neurodegenerative, psychiatric, psychological, and as yet unknown neuropsychiatric causes. CONCLUSIONS Although the prognosis of the phenocopy syndrome is generally held to be more favorable than that of bvFTD, patients and families are subject to major disruption in their relationships and social and occupational functioning. Early recognition is crucial to facilitate timely interventions aimed at maintaining relationships, roles, and quality of life of those affected.
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Affiliation(s)
- Clodagh Power
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| | - Brian A Lawlor
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
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5
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Loughrey DG, Feeney J, Kee F, Lawlor BA, Woodside JV, Setti A, Power JM. Social factors may mediate the relationship between subjective age-related hearing loss and episodic memory. Aging Ment Health 2021; 25:824-831. [PMID: 32067488 DOI: 10.1080/13607863.2020.1727847] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To investigate whether the relationship between subjective age-related hearing loss (SARHL) and episodic memory functioning is mediated by measures of social functioning.Methods: Using data from 8,163 adults over 50 that participated in the Irish Longitudinal Study of Ageing (three waves, each two years apart), we used a multiple mediation model within a Structural Equation Modelling framework to explore potential social mediators of the relationship between SARHL and episodic memory functioning, controlling for demographic and health covariates.Results: Neither the direct effect of self-reported hearing difficulties on memory functioning (β = -.03), nor the total effect (β = .01), were significant. A small inconsistent indirect effect of self-reported hearing difficulties on episodic memory via weekly social activity engagement (β = -.002) was found.Conclusions: Self-reported hearing difficulties may exert an indirect effect on episodic memory via weekly social activity engagement. The findings may have implications for identification of individuals at risk of memory decline in later life.
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Affiliation(s)
| | | | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Annalisa Setti
- School of Applied Psychology, University College Cork, Cork, Ireland
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De Looze C, Dehsarvi A, Crosby L, Vourdanou A, Coen RF, Lawlor BA, Reilly RB. Cognitive and Structural Correlates of Conversational Speech Timing in Mild Cognitive Impairment and Mild-to-Moderate Alzheimer's Disease: Relevance for Early Detection Approaches. Front Aging Neurosci 2021; 13:637404. [PMID: 33986656 PMCID: PMC8110716 DOI: 10.3389/fnagi.2021.637404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Increasing efforts have focused on the establishment of novel biomarkers for the early detection of Alzheimer’s disease (AD) and prediction of Mild Cognitive Impairment (MCI)-to-AD conversion. Behavioral changes over the course of healthy ageing, at disease onset and during disease progression, have been recently put forward as promising markers for the detection of MCI and AD. The present study examines whether the temporal characteristics of speech in a collaborative referencing task are associated with cognitive function and the volumes of brain regions involved in speech production and known to be reduced in MCI and AD pathology. We then explore the discriminative ability of the temporal speech measures for the classification of MCI and AD. Method: Individuals with MCI, mild-to-moderate AD and healthy controls (HCs) underwent a structural MRI scan and a battery of neuropsychological tests. They also engaged in a collaborative referencing task with a caregiver. The associations between the conversational speech timing features, cognitive function (domain-specific) and regional brain volumes were examined by means of linear mixed-effect modeling. Genetic programming was used to explore the discriminative ability of the conversational speech features. Results: MCI and mild-to-moderate AD are characterized by a general slowness of speech, attributed to slower speech rate and slower turn-taking in conversational settings. The speech characteristics appear to be reflective of episodic, lexico-semantic, executive functioning and visuospatial deficits and underlying volume reductions in frontal, temporal and cerebellar areas. Conclusion: The implementation of conversational speech timing-based technologies in clinical and community settings may provide additional markers for the early detection of cognitive deficits and structural changes associated with MCI and AD.
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Affiliation(s)
- Céline De Looze
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Amir Dehsarvi
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Lisa Crosby
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Aisling Vourdanou
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Robert F Coen
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Brian A Lawlor
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.,Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland.,Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin, Ireland
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7
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de Heus RAA, de Jong DLK, Rijpma A, Lawlor BA, Olde Rikkert MGM, Claassen JAHR. Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer's Disease. J Gerontol A Biol Sci Med Sci 2021; 75:2169-2176. [PMID: 32449919 PMCID: PMC7566323 DOI: 10.1093/gerona/glaa129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background Impaired recovery of blood pressure (BP) after standing has been shown to be related to cognitive function and mortality in people without dementia, but its role in people with Alzheimer’s disease (AD) is unknown. The aim of this study was to investigate the association of the orthostatic BP response with cognitive decline and mortality in AD. Methods In this post hoc analysis of a randomized controlled trial (Nilvad), we measured the beat-to-beat response of BP upon active standing in mild-to-moderate AD. This included the initial drop (nadir within 40 seconds) and recovery after 1 minute, both expressed relative to resting values. We examined the relationship between a small or large initial drop (median split) and unimpaired (≥100%) or impaired recovery (<100%) with 1.5-year change in Alzheimer’s Disease Assessment—cognitive subscale (ADAS-cog) scores and all-cause mortality. Results We included 55 participants (age 73.1 ± 6.2 years). Impaired BP recovery was associated with higher increases in ADAS-cog scores (systolic: β [95% confidence interval] = 5.6 [0.4–10.8], p = .035; diastolic: 7.6 [2.3–13.0], p = .006). During a median follow-up time of 49 months, 20 participants died. Impaired BP recovery was associated with increased mortality (systolic: HR [95% confidence interval] = 2.9 [1.1–7.8], p = .039; diastolic: HR [95% confidence interval] = 5.5 [1.9–16.1], p = .002). The initial BP drop was not associated with any outcome. Results were adjusted for age, sex, and intervention group. Conclusions Failure to fully recover BP after 1 minute of standing is associated with cognitive decline and mortality in AD. As such, BP recovery can be regarded as an easily obtained marker of progression rate of AD.
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Affiliation(s)
- Rianne A A de Heus
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Daan L K de Jong
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Anne Rijpma
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Brian A Lawlor
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland.,Department of Medical Gerontology, Trinity College Institute of Neuroscience, Dublin, Ireland
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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Glynn K, O'Callaghan M, Hannigan O, Bruce I, Gibb M, Coen R, Green E, A Lawlor B, Robinson D. Clinical utility of mild cognitive impairment subtypes and number of impaired cognitive domains at predicting progression to dementia: A 20-year retrospective study. Int J Geriatr Psychiatry 2021; 36:31-37. [PMID: 32748438 DOI: 10.1002/gps.5385] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the utility of mild cognitive impairment (MCI) subtypes and number of impaired cognitive domains on initial assessment at predicting progression to dementia in a sample of memory clinic patients over a 20-year period. METHODS A retrospective analysis was conducted of those presenting to a memory clinic with MCI from 1 January 1999 to 31 December 2018 inclusive. Those with MCI were broken down into one of the four subtypes using recommended cut-off scores on the Cambridge Cognitive Assessment (CAMCOG). Binomial logistic regression analysis was used to determine the utility of MCI subtypes and number of impaired cognitive domains as predictors for dementia. RESULTS Overall 1188 individuals with MCI diagnosis were identified, with 378 (32%) progressing to dementia, with median [range] time to diagnosis of 2 years [1-8.4]. Six hundred and forty-nine (55%) were identified as amnestic MCI and 539 (45%) as non-amnestic MCI. Amnestic MCI was a significant predictor of progression compared to non-amnestic MCI (OR = 1.85, df = 1, P < .001). Number of cognitive domains impaired was also a significant predictor of progression to dementia (OR = 1.07, df = 1, P = .01) but the single-/multi-domain distinction was not (OR = 1.29, df = 1, P = .36). CONCLUSION This study shows that approximately 32% of those diagnosed with MCI in a memory clinic progressed to dementia, with a median time to progression of 2 years. Those with amnestic MCI are almost twice as likely to progress to dementia than non-amnestic MCI and that therefore this is a useful distinction. However, the utility of the single- and multi-domain MCI distinction is called into question by our findings.
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Affiliation(s)
- Kevin Glynn
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | | | - Oisin Hannigan
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Irene Bruce
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Mathew Gibb
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Robert Coen
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
| | - Elaine Green
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Brian A Lawlor
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - David Robinson
- Mercer Institute for Research on Aging, St James's Hospital, Dublin 8, Ireland
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Power C, Duffy R, Mahon J, McCarroll K, Lawlor BA. Bones of Contention: A Comprehensive Literature Review of Non-SSRI Antidepressant Use and Bone Health. J Geriatr Psychiatry Neurol 2020; 33:340-352. [PMID: 31665962 DOI: 10.1177/0891988719882091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Osteoporotic fractures are associated with major morbidity and mortality, particularly among older age groups. In recent decades, selective serotonin reuptake inhibitors (SSRI) antidepressants have been linked to reduced bone mineral density and increased risk of fragility fracture. However, up to one-third of antidepressant prescriptions are for classes other than SSRIs. Older patients, who are particularly vulnerable to osteoporosis and its clinical and psychosocial consequences, may be prescribed non-SSRI antidepressants preferentially because of increasing awareness of the risks SSRIs pose to bone health. However, to date, the skeletal effects of non-SSRI antidepressants have not been comprehensively reviewed. In this article, we collate and review the available data and discuss the findings. Based on the current literature, we tentatively suggest that tricyclic antidepressants may increase the risk of fracture via mechanisms other than a direct effect on bone mineral density. The risk is apparently confined to current users only and is greatest in the earliest stage of treatment, diminishing thereafter. There is, as yet, insufficient data to conclusively determine the effects of other antidepressant classes on bone. Judicious prescribing of antidepressants among higher risk groups necessitates a thorough review of the individual's risk factors for osteoporosis as well as attention to their falls risk. Further longitudinal, rigorously controlled studies are needed to answer some of the remaining questions on the effects of non-SSRI antidepressants on bone and the mechanisms by which they are exerted.
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Affiliation(s)
- Clodagh Power
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| | - Richard Duffy
- Jonathan Swift Clinic, 58024St James's Hospital, Dublin, Ireland
| | - James Mahon
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| | - Kevin McCarroll
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
| | - Brian A Lawlor
- Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland
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10
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McHugh Power J, Tang J, Kenny RA, Lawlor BA, Kee F. Mediating the relationship between loneliness and cognitive function: the role of depressive and anxiety symptoms. Aging Ment Health 2020; 24:1071-1078. [PMID: 30955348 DOI: 10.1080/13607863.2019.1599816] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the relationship between loneliness and cognitive functioning, and whether depressive and anxiety symptoms have intermediate roles therein.Methods: Information about 7,433 participants of the Irish Longitudinal Study on Ageing (a prospective, representative cohort study), aged over 50, was collected at three time-points two years apart, and analysed using Structural Equation Modelling to assess whether depressive and anxiety symptoms mediate the relationship between loneliness and cognitive functioning. Cognitive functioning was measured as a latent factor, with four indicators: measures of immediate and delayed word recall, verbal fluency, and a global measure (the MMSE). Loneliness was measured using the UCLA Loneliness scale, depressive symptoms using the CES-D-ML scale, and anxiety symptoms using the HADS-A scale.Results: Loneliness at time-point 1 predicted cognitive functioning at time-point 3, β = -0.103, p < 0.001, and depressive (β = 0.426, p < 0.001) and anxiety (β = 0.410, p < 0.001) symptoms at time-point 2. Depressive (β = -0.020, p = 0.001) but not anxiety (β = -0.000, p = 0.658) symptoms mediated the relationship between loneliness and cognitive functioning, total effect: β = -0.123, p < 0.001.Conclusion: The relationship between loneliness and cognitive functioning is in part explained by its relationship with depressive symptoms. Statistically, the mediation model helps us understand possible mechanisms through which loneliness impacts cognitive functioning. Results have implications for cognitive functioning interventions for older adults, and imply that loneliness is also a worthwhile target for intervention.
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Affiliation(s)
- Joanna McHugh Power
- School of Business National College of Ireland, Dublin 1, Ireland.,UK CRC Centre of Excellence for Public Health Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland.,Institute of Neuroscience & School of Medicine, Trinity College, Dublin 2, Ireland
| | - Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Rose Ann Kenny
- Institute of Neuroscience & School of Medicine, Trinity College, Dublin 2, Ireland
| | - Brian A Lawlor
- Institute of Neuroscience & School of Medicine, Trinity College, Dublin 2, Ireland
| | - Frank Kee
- UK CRC Centre of Excellence for Public Health Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Abstract
Objectives: Explorations of relationships between loneliness and depression have focused on loneliness as a uni-dimensional construct. We hypothesised that reciprocal relationships may exist between depressive symptomatology and social and emotional subtypes of loneliness.Methods: Using data from 373 adults aged over 50, who participated in an observational cohort study, we employed a cross-lagged approach within a Structural Equation Modelling framework, to investigate reciprocal links between depressive symptomatology, and social and emotional loneliness, across two waves of data collection, two years apart (controlling for age, sex, education, comorbidities, social network index, and perceived stress).Results: Both depressive symptomatology and loneliness decreased slightly between waves. Auto-regressive effects were strong for all three variables of interest. Cross-lagged pathways were evident, such that depressive symptomatology at baseline predicted both emotional (β = 0.26, p < 0.05) and social (β = 0.17, p < 0.05) loneliness at follow-up. Neither emotional (β = 0.07, p > 0.05) nor social (β = 0.05, p > 0.05) loneliness at baseline predicted depressive symptomatology at follow-up.Conclusions: Results challenge existing understanding of the associations between loneliness and depression. Further investigation of emotional and social loneliness in individuals with depressive disorders is warranted. Findings are discussed in relation to mechanisms that may explain the relationships observed, and possible implications.
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Affiliation(s)
- Joanna McHugh Power
- School of Business, National College of Ireland, Dublin, Republic of Ireland.,Institute of Neuroscience, Trinity College Dublin, Dublin, Republic of Ireland.,UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Caoimhe Hannigan
- Institute of Neuroscience, Trinity College Dublin, Dublin, Republic of Ireland
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Republic of Ireland
| | - Sabina Brennan
- Institute of Neuroscience, Trinity College Dublin, Dublin, Republic of Ireland
| | - Frank Kee
- UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Brian A Lawlor
- Institute of Neuroscience, Trinity College Dublin, Dublin, Republic of Ireland
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Loughrey DG, Mihelj E, Lawlor BA. Age-related hearing loss associated with altered response efficiency and variability on a visual sustained attention task. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2019; 28:1-25. [PMID: 31868123 DOI: 10.1080/13825585.2019.1704393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study investigated the association between age-related hearing loss (ARHL) and differences in response efficiency and variability on a sustained attention task. The study population comprised 32 participants in a hearing loss group (HLG) and 34 controls without hearing loss (CG). Mean reaction time (RT) and accuracy were recorded to assess response efficiency. RT variability was decomposed to examine temporal aspects of variability associated with neural arousal and top-down executive control of vigilant attention. The HLG had a significantly longer mean RT, possibly reflecting a strategic approach to maintain accuracy. The HLG also demonstrated altered variability (indicative of greater decline in neural arousal) but maintained executive control that was significantly predictive of poorer response efficiency. Adults with ARHL may rely on higher-order attention networks to compensate for decline in both peripheral sensory function and in subcortical arousal systems which mediate lower-order automatic neurocognitive processes.
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Affiliation(s)
- David G Loughrey
- Global Brain Health Institute, Trinity College Dublin, Ireland/University of California , San Francisco, CA, USA
| | - Ernest Mihelj
- Institute of Human Movement Sciences and Sport, Eidgenössische Technische Hochschule Zürich , Switzerland
| | - Brian A Lawlor
- Global Brain Health Institute, Trinity College Dublin, Ireland/University of California, San Francisco. Mercer's Institute for Successful Ageing, St James Hospital , Dublin, Ireland
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13
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Loughrey DG, Pakhomov SVS, Lawlor BA. Altered verbal fluency processes in older adults with age-related hearing loss. Exp Gerontol 2019; 130:110794. [PMID: 31790801 DOI: 10.1016/j.exger.2019.110794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/27/2019] [Accepted: 11/24/2019] [Indexed: 11/28/2022]
Abstract
Epidemiological studies have linked age-related hearing loss (ARHL) with an increased risk of neurocognitive decline. Difficulties in speech perception with subsequent changes in brain morphometry, including regions important for lexical-semantic memory, are thought to be a possible mechanism for this relationship. This study investigated differences in automatic and executive lexical-semantic processes on verbal fluency tasks in individuals with acquired hearing loss. The primary outcomes were indices of automatic (clustering/word retrieval at start of task) and executive (switching/word retrieval after start of the task) processes from semantic and phonemic fluency tasks. To extract indices of clustering and switching, we used both manual and computerised methods. There were no differences between groups on indices of executive fluency processes or on any indices from the semantic fluency task. The hearing loss group demonstrated weaker automatic processes on the phonemic fluency task. Further research into differences in lexical-semantic processes with ARHL is warranted.
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Affiliation(s)
- David G Loughrey
- Global Brain Health Institute, Trinity College Dublin, Ireland; Global Brain Health Institute, University of California, San Francisco, USA; Trinity College Institute of Neuroscience, Trinity College Dublin.
| | | | - Brian A Lawlor
- Global Brain Health Institute, Trinity College Dublin, Ireland; Global Brain Health Institute, University of California, San Francisco, USA; Mercer's Institute for Successful Ageing, St James Hospital, Dublin, Ireland
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14
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Glynn K, Coen R, Lawlor BA. Is the Quick Mild Cognitive Impairment Screen (QMCI) more accurate at detecting mild cognitive impairment than existing short cognitive screening tests? A systematic review of the current literature. Int J Geriatr Psychiatry 2019; 34:1739-1746. [PMID: 31418473 DOI: 10.1002/gps.5201] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/11/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Differentiating normal cognition, mild cognitive impairment (MCI), and dementia is important, as these conditions differ in terms of their prognosis and treatment. Existing short cognitive screening tests vary widely in their accuracy, sensitivity, and specificity at detecting MCI and dementia. The Quick Mild Cognitive Impairment Screen (QMCI) was developed in 2012 as a fast and accurate "MCI specific" screening test. The aim of the current study was to conduct a literature review to compare the accuracy, sensitivity, and specificity of the QMCI at differentiating normal cognition, MCI, and dementia to existing short cognitive screening tests at their optimal cut-off scores. METHODS A search of the electronic journal databases EBSCO, Psych info, and Science Direct was undertaken using the keywords "Quick Mild Cognitive Impairment Screen," "QMCI," "accuracy," "sensitivity," and "specificity." Results of individual studies were examined, and 2 × 2 tables were drawn up to obtain the overall accuracy, sensitivity, and specificity of each test across the studies included. RESULTS Results from individual studies show that the QMCI has higher accuracy at detecting MCI and dementia than these cognitive screens. Pooled analysis shows that it also has greater sensitivity and specificity at optimal cut-off points for each test. CONCLUSIONS Based in the current review, the QMCI represents a more accurate, sensitive, and specific screening test for MCI and dementia than the SMMSE or the MoCA. This has important implications in screening for cognitive impairment.
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Affiliation(s)
- Kevin Glynn
- Psychiatry of Old Age, Beaumont Hospital, Dublin, Ireland
| | - Robert Coen
- Memory Clinic, MISA Building, St. James's Hospital, Dublin, Ireland
| | - Brian A Lawlor
- Memory Clinic, MISA Building, St. James's Hospital, Dublin, Ireland
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15
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Abstract
Blood pressure variability (BPV) has been shown to have predictive value over blood pressure (BP) levels alone in stroke patients. We assessed whether BPV predicts cognitive and functional decline in Alzheimer disease, using data from a randomized trial (NILVAD [A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer’s Disease]). Patients with mild-to-moderate Alzheimer disease were included if they had ≥3 office BP measurements available to determine visit-to-visit BPV. Day-to-day BPV was assessed using home BP measurements in a subsample. The variation independent of mean was used to calculate BPV. Outcomes were change in Alzheimer’s Disease Assessment Scale–cognitive subscale-12 and Disability Assessment for Dementia after 1 and 1.5 years. A total of 460 patients aged 72.1 (SD=8.1) years, with mean BP of 134.0/75.1 (10.9/6.3) mm Hg were included. After 1 year, patients in the highest quartile of BPV had deteriorated more on Alzheimer’s Disease Assessment Scale–cognitive subscale compared with patients in the lowest quartile (systolic: β, 2.24 [95% CI, 0.11–4.38],
P
=0.040; diastolic: β, 2.54 [95% CI, 0.33–4.75]
P
=0.024). This association was still present after 1.5 years (systolic: β, 2.86 [95% CI, 0.35–5.36],
P
=0.026; diastolic: β, 3.30 [95% CI, 0.67–5.93],
P
=0.014). There was no effect of visit-to-visit BPV on Disability Assessment for Dementia. Day-to-day BPV was available for 46 patients. Significant associations were observed between day-to-day BPV and deterioration on Alzheimer’s Disease Assessment Scale–cognitive subscale (systolic:
P
=0.036) and Disability Assessment for Dementia (systolic:
P
=0.020; diastolic:
P
=0.007) after 1 year, but not after 1.5 years. All associations were adjusted for potential confounders, including intervention group. In conclusion, this post hoc analysis indicates that higher visit-to-visit and day-to-day BPV might be associated with progression of Alzheimer disease. Targeting BPV may be a future target to slow decline in patients with Alzheimer disease.
Clinical Trial Registration
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02017340.
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Affiliation(s)
- Rianne A.A. de Heus
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Marcel G.M. Olde Rikkert
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
| | - Phillip J. Tully
- School of Medicine, The University of Adelaide, Australia (P.J.T.)
| | - Brian A. Lawlor
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland (B.A.L.)
- Department of Medical Gerontology, Trinity College Institute of Neuroscience, Dublin, Ireland (B.A.L.)
| | - Jurgen A.H.R. Claassen
- From the Department of Geriatric Medicine, Radboud umc University Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (R.A.A.d.H., M.G.M.O.R., J.A.H.R.C.)
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Loughrey DG, Parra MA, Lawlor BA. Visual short-term memory binding deficit with age-related hearing loss in cognitively normal older adults. Sci Rep 2019; 9:12600. [PMID: 31467387 PMCID: PMC6715732 DOI: 10.1038/s41598-019-49023-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/19/2019] [Indexed: 01/12/2023] Open
Abstract
Age-related hearing loss (ARHL) has been posited as a possible modifiable risk factor for neurocognitive impairment and dementia. Measures sensitive to early neurocognitive changes associated with ARHL would help to elucidate the mechanisms underpinning this relationship. We hypothesized that ARHL might be associated with decline in visual short-term memory binding (VSTMB), a potential biomarker for preclinical dementia due to Alzheimer’s disease (AD). We examined differences in accuracy between older adults with hearing loss and a control group on the VSTMB task from a single feature (shapes) condition to a feature binding (shapes-colors) condition. Hearing loss was associated with a weaker capacity to process bound features which appeared to be accounted for by a weaker sensitivity for change detection (A’). Our findings give insight into the neural mechanisms underpinning neurocognitive decline with ARHL and its temporal sequence.
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Affiliation(s)
- David G Loughrey
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland/University of California, San Francisco, USA. .,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.,Programa de Psicología, Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Brian A Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland/University of California, San Francisco, USA.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James Hospital, Dublin, Ireland
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17
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De Looze C, Kelly F, Crosby L, Vourdanou A, Coen RF, Walsh C, Lawlor BA, Reilly RB. Changes in Speech Chunking in Reading Aloud is a Marker of Mild Cognitive Impairment and Mild-to-Moderate Alzheimer's Disease. Curr Alzheimer Res 2019; 15:828-847. [PMID: 29623841 DOI: 10.2174/1567205015666180404165017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/01/2018] [Accepted: 03/27/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Speech and Language Impairments, generally attributed to lexico-semantic deficits, have been documented in Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD). This study investigates the temporal organisation of speech (reflective of speech production planning) in reading aloud in relation to cognitive impairment, particularly working memory and attention deficits in MCI and AD. The discriminative ability of temporal features extracted from a newly designed read speech task is also evaluated for the detection of MCI and AD. METHOD Sixteen patients with MCI, eighteen patients with mild-to-moderate AD and thirty-six healthy controls (HC) underwent a battery of neuropsychological tests and read a set of sentences varying in cognitive load, probed by manipulating sentence length and syntactic complexity. RESULTS Our results show that Mild-to-Moderate AD is associated with a general slowness of speech, attributed to a higher number of speech chunks, silent pauses and dysfluences, and slower speech and articulation rates. Speech chunking in the context of high cognitive-linguistic demand appears to be an informative marker of MCI, specifically related to early deficits in working memory and attention. In addition, Linear Discriminant Analysis shows the ROC AUCs (Areas Under the Receiver Operating Characteristic Curves) of identifying MCI vs. HC, MCI vs. AD and AD vs. HC using these speech characteristics are 0.75, 0.90 and 0.94 respectively. CONCLUSION The implementation of connected speech-based technologies in clinical and community settings may provide additional information for the early detection of MCI and AD.
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Affiliation(s)
- Celine De Looze
- Trinity Centre for Bioengineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Finnian Kelly
- Trinity Centre for Bioengineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Lisa Crosby
- Mercer`s Institute For Successful Ageing, St James`s Hospital, Dublin, Ireland
| | - Aisling Vourdanou
- Trinity Centre for Bioengineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Robert F Coen
- Mercer`s Institute For Successful Ageing, St James`s Hospital, Dublin, Ireland
| | - Cathal Walsh
- Mercer`s Institute For Successful Ageing, St James`s Hospital, Dublin, Ireland.,Health Research Institute (HRI) and Mathematics Applications Consortium for Science and Industry (MACSI), University of Limerick, Limerick, Ireland
| | - Brian A Lawlor
- Mercer`s Institute For Successful Ageing, St James`s Hospital, Dublin, Ireland.,Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Bioengineering, School of Engineering, Trinity College Dublin, Dublin, Ireland.,Institute of Neuroscience, School of Medicine, Trinity College Dublin, Dublin, Ireland
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18
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de Jong DLK, de Heus RAA, Rijpma A, Donders R, Olde Rikkert MGM, Günther M, Lawlor BA, van Osch MJP, Claassen JAHR. Effects of Nilvadipine on Cerebral Blood Flow in Patients With Alzheimer Disease. Hypertension 2019; 74:413-420. [PMID: 31203725 DOI: 10.1161/hypertensionaha.119.12892] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cerebrovascular changes, including reduced cerebral blood flow (CBF), occur early in the development of Alzheimer disease and may accelerate disease progression. This randomized, double-blind, placebo-controlled study investigated how 6 months of treatment with the calcium antagonist nilvadipine would affect CBF in patients with mild-to-moderate Alzheimer disease. CBF was measured with magnetic resonance arterial spin labeling in whole-brain gray matter and in a priori defined regions of interest including the hippocampus. Fifty-eight patients were randomly assigned (29 in each group), of whom 22 in both groups had no magnetic resonance exclusion criteria and were medication compliant over 6 months. Mean age was 72.8±6.2 years, mean mini-mental state examination was 20.4±3.4. Nilvadipine treatment lowered systolic blood pressure (Δ=-11.5 [95% CI, -19.7 to -3.2] mm Hg; P<0.01), while whole-brain gray-matter CBF remained stable (Δ=5.4 [95% CI, -6.4 to 17.2] mL/100 g per minute; P=0.36). CBF in the hippocampus increased (left: Δ=24.4 [95% CI, 4.3-44.5] mL/100 g per minute; P=0.02; right: Δ=20.1 [95% CI, -0.6 to 40.8] mL/100 g per minute; P=0.06). There was no significant change in CBF in the posterior cingulate cortex (Δ=5.2 [95% CI, -16.5 to 27.0] mL/100 g per minute; P=0.63) or other regions of interest. In conclusion, nilvadipine reduced blood pressure and increased CBF in the hippocampus, whereas other regions showed stable or small nonsignificant increases in CBF. These findings not only indicate preserved cerebral autoregulation in Alzheimer disease but also point toward beneficial cerebrovascular effects of antihypertensive treatment. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02017340.
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Affiliation(s)
- Daan L K de Jong
- From the Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.)
| | - Rianne A A de Heus
- From the Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.)
| | - Anne Rijpma
- From the Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.)
| | - Rogier Donders
- Department of Health Evidence (R.D.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel G M Olde Rikkert
- From the Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.)
| | - Matthias Günther
- Frauenhofer Institute for Medical Imaging Computing MEVIS, Bremen, Germany (M.G.)
| | - Brian A Lawlor
- Trinity College Institute of Neuroscience, Dublin, Ireland (B.A.L.)
| | - Matthias J P van Osch
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, the Netherlands (M.J.P.v.O.)
| | - Jurgen A H R Claassen
- From the Department of Geriatric Medicine, Donders Institute for Brain Cognition and Behaviour (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands (D.L.K.d.J., R.A.A.d.H., A.R., M.G.M.O.R., J.A.H.R.C.)
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de Heus RAA, Donders R, Santoso AMM, Olde Rikkert MGM, Lawlor BA, Claassen JAHR. Blood Pressure Lowering With Nilvadipine in Patients With Mild-to-Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension. J Am Heart Assoc 2019; 8:e011938. [PMID: 31088188 PMCID: PMC6585342 DOI: 10.1161/jaha.119.011938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/16/2019] [Indexed: 12/23/2022]
Abstract
Background Hypertension is common among patients with Alzheimer disease. Because this group has been excluded from hypertension trials, evidence regarding safety of treatment is lacking. This secondary analysis of a randomized controlled trial assessed whether antihypertensive treatment increases the prevalence of orthostatic hypotension (OH) in patients with Alzheimer disease. Methods and Results Four hundred seventy-seven patients with mild-to-moderate Alzheimer disease were randomized to the calcium-channel blocker nilvadipine 8 mg/day or placebo for 78 weeks. Presence of OH (blood pressure drop ≥20/≥10 mm Hg after 1 minute of standing) and OH-related adverse events (dizziness, syncope, falls, and fractures) was determined at 7 follow-up visits. Mean age of the study population was 72.2±8.2 years and mean Mini-Mental State Examination score was 20.4±3.8. Baseline blood pressure was 137.8±14.0/77.0±8.6 mm Hg. Grade I hypertension was present in 53.4% (n=255). After 13 weeks, blood pressure had fallen by -7.8/-3.9 mm Hg for nilvadipine and by -0.4/-0.8 mm Hg for placebo ( P<0.001). Across the 78-week intervention period, there was no difference between groups in the proportion of patients with OH at a study visit (odds ratio [95% CI]=1.1 [0.8-1.5], P=0.62), nor in the proportion of visits where a patient met criteria for OH, corrected for number of visits (7.7±13.8% versus 7.3±11.6%). OH-related adverse events were not more often reported in the intervention group compared with placebo. Results were similar for those with baseline hypertension. Conclusions This study suggests that initiation of a low dose of antihypertensive treatment does not significantly increase the risk of OH in patients with mild-to-moderate Alzheimer disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02017340.
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Affiliation(s)
- Rianne A. A. de Heus
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Rogier Donders
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Angelina M. M. Santoso
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Brian A. Lawlor
- Mercer's Institute for Research on AgeingSt. James's HospitalDublinIreland
- Department of Medical GerontologyTrinity College Institute of NeuroscienceDublinIreland
| | - Jurgen A. H. R. Claassen
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
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O'Sullivan M, Brennan S, Lawlor BA, Hannigan C, Robertson IH, Pertl MM. Cognitive functioning among cognitively intact dementia caregivers compared to matched self-selected and population controls. Aging Ment Health 2019; 23:566-573. [PMID: 29381387 DOI: 10.1080/13607863.2018.1428937] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF THE STUDY Caregiving for a person with dementia is frequently used to model the impact of chronic stress on health, including cognitive functioning. However, the prevalence of typically healthier, self-selecting non-caregiving control groups could contribute to a picture of poorer caregiver performance and overstate the negative effects of stress. We investigated differences in cognitive performance between dementia caregivers and two groups of non-caregivers recruited using different sampling methods. DESIGN AND METHODS We compared cognitive function and psychological wellbeing among 252 spousal dementia caregivers with demographically matched non-caregiving control groups drawn from (1) a population study and (2) a self-selecting sample. Comparable cognitive measures included immediate and delayed recall, processing speed reaction time and verbal fluency. RESULTS Caregiver and non-caregiver performance was comparable on most cognitive domains. However, caregivers outperformed both control groups on processing speed (p ≤ .05) and reaction time (p ≤ .05), despite having higher levels of stress and depression (ps < .001). Furthermore, caregivers had significantly better free recall than self-selecting controls (p < .001). IMPLICATIONS Our results, overall, do not support the idea that caregiving is associated with stress-induced cognitive deficits. Rather, the trend toward better caregiver performance is consistent with the healthy caregiver hypothesis.
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Affiliation(s)
- Michael O'Sullivan
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Sabina Brennan
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Brian A Lawlor
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Caoimhe Hannigan
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Ian H Robertson
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland
| | - Maria M Pertl
- a Neuro-Enhancement for Independent Lives (NEIL) Programme , School of Psychology , Trinity College Institute of Neuroscience (TCIN) , Trinity College Dublin , Dublin 2 , Ireland.,b Department of Psychology , Royal College of Surgeons in Ireland , Dublin 2 , Ireland
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McHugh Power JE, Hannigan C, Carney S, Feeney J, Kenny RA, Kee F, Lawlor BA. Lonely SARTs: loneliness and sustained attention in the Irish longitudinal study of aging. Aging, Neuropsychology, and Cognition 2019; 27:197-206. [DOI: 10.1080/13825585.2019.1602705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Joanna E. McHugh Power
- UK CRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
- School of Business, National College of Ireland, Dublin 1, Ireland
| | - Caoimhe Hannigan
- School of Business, National College of Ireland, Dublin 1, Ireland
- School of Nursing, School of Medicine, and School of Medical Gerontology, Trinity College, Dublin 2, Ireland
| | - Sile Carney
- School of Nursing, School of Medicine, and School of Medical Gerontology, Trinity College, Dublin 2, Ireland
| | - Joanne Feeney
- School of Nursing, School of Medicine, and School of Medical Gerontology, Trinity College, Dublin 2, Ireland
| | - Rose Ann Kenny
- School of Nursing, School of Medicine, and School of Medical Gerontology, Trinity College, Dublin 2, Ireland
| | - Frank Kee
- UK CRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, UK
| | - Brian A. Lawlor
- School of Nursing, School of Medicine, and School of Medical Gerontology, Trinity College, Dublin 2, Ireland
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22
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McHugh Power JE, Dolezal L, Kee F, Lawlor BA. Conceptualizing loneliness in health research: Philosophical and psychological ways forward. Journal of Theoretical and Philosophical Psychology 2018. [DOI: 10.1037/teo0000099] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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McHugh Power JE, Steptoe A, Kee F, Lawlor BA. Loneliness and social engagement in older adults: A bivariate dual change score analysis. Psychol Aging 2018; 34:152-162. [PMID: 30211594 DOI: 10.1037/pag0000287] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few longitudinal studies have explored the impact of loneliness on social engagement. We investigated whether loneliness would result in decreased social engagement over time among older adults and also whether the converse, that low levels of social engagement would predict increases in loneliness, held. Additionally, we explored potential mechanisms (specifically, memory and depressive symptomatology as mediators) in the bidirectional relationship(s) between loneliness and social engagement. Data from 4,714 adults over 50 years of age, participating in Waves 3, 4, and 5 of the English Longitudinal Study of Ageing (between 2006 and 2011), were analyzed using bivariate dual change scores within structural equation models. Higher levels of loneliness were inversely associated with social engagement over time, and high levels of social engagement were inversely associated with loneliness over time. To address the 2nd aim, we used structural equation modeling to evaluate potential mediators of the bidirectional relationships between loneliness and changes in social engagement. Depressive symptomatology, semantic memory, and episodic memory were found to partially mediate the relationship between loneliness measured at baseline and social engagement 4 years later. In addition, these variables also partially mediated the relationship between social engagement at baseline and loneliness 4 years later. A comparison of the 2 models revealed that the model proposing a pathway from loneliness to social engagement (as mediated by depressive symptoms and memory) provided a better fit to the data. Implications for theories of loneliness are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Joanna E McHugh Power
- United Kingdom CRC Centre of Excellence for Public Health, Queen's University Belfast
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London
| | - Frank Kee
- United Kingdom CRC Centre of Excellence for Public Health, Queen's University Belfast
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24
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Bowe AK, Owens M, Codd MB, Lawlor BA, Glynn RW. Physical activity and mental health in an Irish population. Ir J Med Sci 2018; 188:625-631. [PMID: 30019096 DOI: 10.1007/s11845-018-1863-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/19/2018] [Accepted: 07/07/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Physical activity represents a modifiable behaviour which may be associated with increased likelihood of experiencing positive mental health. AIMS The aim of this study was to examine the association between self-rated physical activity and subjective indicators of both positive and negative mental health in an Irish adult population. METHODS Based on data from a population-based, observational, cross-sectional study, participants were categorised using the International Physical Activity Questionnaire (IPAQ) into those who reported that they did and did not meet recommended physical activity requirements. Self-reported positive and negative mental health indicators were assessed using the Energy and Vitality Index (EVI) and the Mental Health Index-5 (MHI-5) from the SF-36 Health Survey Instrument, respectively. Binary logistic regression was used to identify variables independently associated with self-reported positive and negative mental health. RESULTS A total of 7539 respondents were included in analysis. Overall, 32% reported that they met recommended minimal physical activity requirements. Self-reported positive and negative mental health were reported by 16 and 9% of respondents, respectively. Compared with those who reported meeting-recommended physical activity requirements, those performing no physical activity were three times less likely to report positive mental health (adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.28-0.55) and three times more likely to report negative mental health (OR 3.27, 95% CI 2.38-4.50). CONCLUSION Compared with those who do not, those who report meeting-recommended physical activity requirements are more and less likely to report experiencing positive and negative mental health, respectively. Future policy development around physical activity should take cognisance of the impact of this activity on both physical and mental health outcomes.
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Affiliation(s)
- Andrea K Bowe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
- James Connolly Memorial Hospital, Blanchardstown, Dublin 15, Ireland.
| | - Miriam Owens
- Department of Health, Hawkins House, Dublin 2, Ireland
| | - Mary B Codd
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Brian A Lawlor
- NEIL Research Programme, Trinity College Institute of Neuroscience, College Green, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Ushers, Dublin 8, Ireland
| | - Ronan W Glynn
- Department of Public Health Medicine, Health Service Executive, Dr. Steevens' Hospital, Steeven's Lane, Dublin 8, Ireland
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25
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de Heus RA, de Jong DL, Sanders ML, van Spijker GJ, Oudegeest-Sander MH, Hopman MT, Lawlor BA, Olde Rikkert MG, Claassen JA. Dynamic Regulation of Cerebral Blood Flow in Patients With Alzheimer Disease. Hypertension 2018; 72:139-150. [DOI: 10.1161/hypertensionaha.118.10900] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/09/2018] [Accepted: 04/05/2018] [Indexed: 01/18/2023]
Abstract
Cerebral autoregulation and baroreflex sensitivity are key mechanisms that maintain cerebral blood flow. This study assessed whether these control mechanisms are affected in patients with dementia and mild cognitive impairment due to Alzheimer disease, as this would increase the risks of antihypertensive treatment. We studied 53 patients with dementia (73.1 years [95% confidence interval (CI), 71.4–74.8]), 37 patients with mild cognitive impairment (69.2 years [95% CI, 66.4–72.0]), and 47 controls (69.4 years [95% CI, 68.3–70.5]). Beat-to-beat blood pressure (photoplethysmography), heart rate, and cerebral blood flow velocity (transcranial Doppler) were measured during 5-minute rest (sitting) and 5 minutes of orthostatic challenges, using repeated sit-to-stand maneuvers. Cerebral autoregulation was assessed using transfer function analysis and the autoregulatory index. Baroreflex sensitivity was estimated with transfer function analysis and by calculating the heart rate response to blood pressure changes during the orthostatic challenges. Dementia patients had the lowest cerebral blood flow velocity (
P
=0.004). During rest, neither transfer function analysis nor the autoregulatory index indicated impairments in cerebral autoregulation. During the orthostatic challenges, higher autoregulatory index (
P
=0.011) and lower transfer function gain (
P
=0.017), indicating better cerebral autoregulation, were found in dementia (4.56 arb. unit [95% CI, 4.14–4.97]; 0.59 cm/s per mm Hg [95% CI, 0.51–0.66]) and mild cognitive impairment (4.59 arb. unit [95% CI, 4.04–5.13]; 0.51 cm/s per mm Hg [95% CI, 0.44–0.59]) compared with controls (3.71 arb. unit [95% CI, 3.35–4.07]; 0.67 cm/s per mm Hg [95% CI, 0.59–0.74]). Baroreflex sensitivity measures did not differ between groups. In conclusion, the key mechanisms to control blood pressure and cerebral blood flow are not reduced in 2 stages of Alzheimer disease compared with controls, both in rest and during orthostatic changes that reflect daily life challenges.
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Affiliation(s)
- Rianne A.A. de Heus
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Daan L.K. de Jong
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Marit L. Sanders
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Gerrita J. van Spijker
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Madelijn H. Oudegeest-Sander
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Department of Physiology (M.H.O.-S., M.T.H.), Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Maria T. Hopman
- Department of Physiology (M.H.O.-S., M.T.H.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brian A. Lawlor
- Mercer's Institute for Research on Ageing, St. James's Hospital and Global Brain Health Institute, Trinity College Dublin, Ireland (B.A.L.)
| | - Marcel G.M. Olde Rikkert
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Jurgen A.H.R. Claassen
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
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26
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Vaughan RM, Coen RF, Kenny R, Lawlor BA. Semantic and Phonemic Verbal Fluency Discrepancy in Mild Cognitive Impairment: Potential Predictor of Progression to Alzheimer's Disease. J Am Geriatr Soc 2018; 66:755-759. [DOI: 10.1111/jgs.15294] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Roisin M. Vaughan
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - Robert F. Coen
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
| | - RoseAnne Kenny
- The Irish Longitudinal Study on Ageing; Trinity College; Dublin Ireland
| | - Brian A. Lawlor
- Mercer's Institute for Research on Ageing; St. James's Hospital; Dublin Ireland
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Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2018; 144:115-126. [PMID: 29222544 PMCID: PMC5824986 DOI: 10.1001/jamaoto.2017.2513] [Citation(s) in RCA: 468] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/05/2017] [Indexed: 11/14/2022]
Abstract
Importance Epidemiologic research on the possible link between age-related hearing loss (ARHL) and cognitive decline and dementia has produced inconsistent results. Clarifying this association is of interest because ARHL may be a risk factor for outcomes of clinical dementia. Objectives To examine and estimate the association between ARHL and cognitive function, cognitive impairment, and dementia through a systematic review and meta-analysis. Data Sources and Study Selection A search of PubMed, the Cochrane Library, EMBASE, and SCOPUS from inception to April 15, 2016, with cross-referencing of retrieved studies and personal files for potentially eligible studies was performed. Keywords included hearing, cognition, dementia, and Alzheimer disease. Cohort and cross-sectional studies published in peer-reviewed literature and using objective outcome measures were included. Case-control studies were excluded. Data Extraction and Synthesis One reviewer extracted and another verified data. Both reviewers independently assessed study quality. Estimates were pooled using random-effects meta-analysis. Subgroup and meta-regression analyses of study-level characteristics were performed. Main Outcomes and Measures Hearing loss measured by pure-tone audiometry only and objective assessment measures of cognitive function, cognitive impairment, and dementia. Cognitive function outcomes were converted to correlation coefficients (r value); cognitive impairment and dementia outcomes, to odds ratios (ORs). Results Forty studies from 12 countries met our inclusion criteria. Of these, 36 unique studies with an estimated 20 264 unique participants were included in the meta-analyses. Based on the pooled maximally adjusted effect sizes using random-effects models, a small but significant association was found for ARHL within all domains of cognitive function. Among cross-sectional studies, a significant association was found for cognitive impairment (OR, 2.00; 95% CI, 1.39-2.89) and dementia (OR, 2.42; 95% CI, 1.24-4.72). Among prospective cohort studies, a significant association was found for cognitive impairment (OR, 1.22; 95% CI, 1.09-1.36) and dementia (OR, 1.28; 95% CI, 1.02-1.59) but not for Alzheimer disease (OR, 1.69; 95% CI, 0.72-4.00). In further analyses, study, demographic, audiometric, and analyses factors were associated with cognitive function. Vascular dysfunction and impaired verbal communication may contribute to the association between hearing loss and cognitive decline. Conclusions and Relevance Age-related hearing loss is a possible biomarker and modifiable risk factor for cognitive decline, cognitive impairment, and dementia. Additional research and randomized clinical trials are warranted to examine implications of treatment for cognition and to explore possible causal mechanisms underlying this relationship.
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Affiliation(s)
- David G. Loughrey
- NEIL (Neuro Enhancement for Independent Lives)
Programme, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin,
Ireland
- School of Medicine, Trinity College Dublin, Dublin,
Ireland
| | - Michelle E. Kelly
- NEIL (Neuro Enhancement for Independent Lives)
Programme, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin,
Ireland
- Department of Psychology, National University of
Ireland Maynooth, Kildare, Ireland
| | - George A. Kelley
- Meta-Analytic Research Group, School of Public Health,
Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia
University, Morgantown
| | - Sabina Brennan
- NEIL (Neuro Enhancement for Independent Lives)
Programme, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin,
Ireland
| | - Brian A. Lawlor
- NEIL (Neuro Enhancement for Independent Lives)
Programme, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin,
Ireland
- School of Medicine, Trinity College Dublin, Dublin,
Ireland
- Mercer’s Institute for Successful Ageing, St
James Hospital, Dublin, Ireland
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28
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Kelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, Loughrey DG. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Rev 2017; 6:259. [PMID: 29258596 PMCID: PMC5735742 DOI: 10.1186/s13643-017-0632-2] [Citation(s) in RCA: 387] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Social relationships, which are contingent on access to social networks, promote engagement in social activities and provide access to social support. These social factors have been shown to positively impact health outcomes. In the current systematic review, we offer a comprehensive overview of the impact of social activities, social networks and social support on the cognitive functioning of healthy older adults (50+) and examine the differential effects of aspects of social relationships on various cognitive domains. METHODS We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and collated data from randomised controlled trials (RCTs), genetic and observational studies. Independent variables of interest included subjective measures of social activities, social networks, and social support, and composite measures of social relationships (CMSR). The primary outcome of interest was cognitive function divided into domains of episodic memory, semantic memory, overall memory ability, working memory, verbal fluency, reasoning, attention, processing speed, visuospatial abilities, overall executive functioning and global cognition. RESULTS Thirty-nine studies were included in the review; three RCTs, 34 observational studies, and two genetic studies. Evidence suggests a relationship between (1) social activity and global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention; (2) social networks and global cognition but not episodic memory, attention or processing speed; (3) social support and global cognition and episodic memory but not attention or processing speed; and (4) CMSR and episodic memory and verbal fluency but not global cognition. CONCLUSIONS The results support prior conclusions that there is an association between social relationships and cognitive function but the exact nature of this association remains unclear. Implications of the findings are discussed and suggestions for future research provided. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2012: CRD42012003248 .
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Affiliation(s)
- Michelle E. Kelly
- Department of Psychology, School of Business, National College of Ireland, 2nd Floor, Mayor Street, IFSC, Dublin, 1 Ireland
| | - Hollie Duff
- The NEIL Programme, Institute of Neuroscience, Trinity College Dublin, Dublin, 2 Ireland
| | - Sara Kelly
- The NEIL Programme, Institute of Neuroscience, Trinity College Dublin, Dublin, 2 Ireland
| | - Joanna E. McHugh Power
- Department of Psychology, School of Business, National College of Ireland, 2nd Floor, Mayor Street, IFSC, Dublin, 1 Ireland
| | | | - Brian A. Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - David G. Loughrey
- The NEIL Programme, Institute of Neuroscience, Trinity College Dublin, Dublin, 2 Ireland
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29
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Glynn RW, Shelley E, Lawlor BA. Public knowledge and understanding of dementia-evidence from a national survey in Ireland. Age Ageing 2017; 46:865-869. [PMID: 28531240 DOI: 10.1093/ageing/afx082] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 11/18/2016] [Accepted: 05/04/2017] [Indexed: 11/12/2022] Open
Abstract
Background there is growing consensus around the importance of population level approaches which seek to improve public knowledge and awareness of dementia. Aim to assess knowledge of the relationship between dementia and ageing, and of the risk and protective factors associated with it, among the general public in Ireland. Design cross-sectional survey. Participants selected using quota sampling based on Census data. Methods the final sample of 1,217 respondents provided estimates of dementia knowledge in the Irish population. Logistic regression was used to assess the impact of potential predictor variables on knowledge of dementia. Results a majority (52%) reported that they knew someone living with dementia. Just 39% were confident that they could tell the difference between the early signs of dementia and normal ageing. Less than half (46%) believed that there were things they could do to reduce their risk of developing dementia, and knowledge of risk and protective factors for dementia was very poor. Although significant differences were seen according to area of residence, social class and experience of dementia, even those groups with 'better' understanding demonstrated substantial knowledge deficits regarding risk and protective factors. Conclusions the general public in Ireland are confused about the relationship between dementia and ageing, and knowledge of risk and protective factors for dementia is very poor. While not dissimilar to those reported internationally, the findings present a challenge to those tasked with promoting behaviour change and interventions to delay or prevent the onset of dementia.
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Affiliation(s)
- Ronan W Glynn
- Department of Public Health Medicine, Health Service Executive, Dr Steeven's Hospital, Dublin 8, Ireland
| | - Emer Shelley
- Department of Public Health Medicine, Health Service Executive, Dr Steeven's Hospital, Dublin 8, Ireland
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Ireland
| | - Brian A Lawlor
- NEIL Research Programme, Trinity College Institute of Neuroscience, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
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Loughrey DG, Lavecchia S, Brennan S, Lawlor BA, Kelly ME. The Impact of the Mediterranean Diet on the Cognitive Functioning of Healthy Older Adults: A Systematic Review and Meta-Analysis. Adv Nutr 2017; 8:571-586. [PMID: 28710144 PMCID: PMC5502874 DOI: 10.3945/an.117.015495] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [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] [Indexed: 11/14/2022] Open
Abstract
Evidence from epidemiologic studies suggests a relation between the Mediterranean diet (MeDi) and cognitive function, but results are inconsistent. Prior reviews have not provided pooled data from meta-analysis of longitudinal studies and randomized controlled trials (RCTs), or they included younger adult participants. This systematic review and meta-analysis examines the impact of the MeDi on the cognitive functioning of healthy older adults. Fifteen cohort studies with 41,492 participants and 2 RCTs with 309 and 162 participants in intervention and control groups, respectively, were included. The primary outcome of interest was cognitive function, divided into domains of memory and executive function. Meta-analysis of cohort studies revealed a significant association between MeDi and older adults' episodic memory (n = 25,369, r = 0.01, P = 0.03) and global cognition (n = 41,492, r = 0.05, P ≤ 0.001), but not working memory (n = 1487, r = 0.007, P = 0.93) or semantic memory (n = 1487, r = 0.08, P = 0.28). Meta-analysis of RCTs revealed that compared with controls, the MeDi improved delayed recall (n = 429, P = 0.01), working memory (n = 566, P = 0.03), and global cognition (n = 429, P = 0.047), but not episodic memory (n = 566, P = 0.15), immediate recall (n = 566, P = 0.17), paired associates (n = 429, P = 0.20), attention (n = 566, P = 0.69), processing speed (n = 566, P = 0.35), or verbal fluency (n = 566, P = 0.12). The strongest evidence suggests a beneficial effect of the MeDi on older adults' global cognition. This article discusses the influence of study design and components of the MeDi on cognitive function and considers possible mechanisms.
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Affiliation(s)
- David G Loughrey
- The NEIL Program, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; and
| | - Sara Lavecchia
- The NEIL Program, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; and
| | - Sabina Brennan
- The NEIL Program, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; and
| | - Brian A Lawlor
- The NEIL Program, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; and
| | - Michelle E Kelly
- Department of Psychology, National University of Ireland, Maynooth, Ireland
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31
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McHugh JE, Kenny RA, Lawlor BA, Steptoe A, Kee F. The discrepancy between social isolation and loneliness as a clinically meaningful metric: findings from the Irish and English longitudinal studies of ageing (TILDA and ELSA). Int J Geriatr Psychiatry 2017; 32:664-674. [PMID: 27246181 DOI: 10.1002/gps.4509] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/06/2016] [Accepted: 04/19/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Scant evidence is available on the discordance between loneliness and social isolation among older adults. We aimed to investigate this discordance and any health implications that it may have. METHOD Using nationally representative datasets from ageing cohorts in Ireland (TILDA) and England (ELSA), we created a metric of discordance between loneliness and social isolation, to which we refer as Social Asymmetry. This metric was the categorised difference between standardised scores on a scale of loneliness and a scale of social isolation, giving categories of: Concordantly Lonely and Isolated, Discordant: Robust to Loneliness, or Discordant: Susceptible to Loneliness. We used regression and multilevel modelling to identify potential relationships between Social Asymmetry and cognitive outcomes. RESULTS Social Asymmetry predicted cognitive outcomes cross-sectionally and at a two-year follow-up, such that Discordant: Robust to Loneliness individuals were superior performers, but we failed to find evidence for Social Asymmetry as a predictor of cognitive trajectory over time. CONCLUSIONS We present a new metric and preliminary evidence of a relationship with clinical outcomes. Further research validating this metric in different populations, and evaluating its relationship with other outcomes, is warranted. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- J E McHugh
- Institute of Neuroscience, Trinity College, Dublin 2, Ireland.,Centre for Public Health, Queen's University Belfast, BT12 6BJ, UK
| | - R A Kenny
- Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - B A Lawlor
- Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - A Steptoe
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - F Kee
- Centre for Public Health, Queen's University Belfast, BT12 6BJ, UK
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McHugh Power JE, Hannigan C, Carney S, Lawlor BA. Exploring the meaning of loneliness among socially isolated older adults in rural Ireland: a qualitative investigation. Qualitative Research in Psychology 2017. [DOI: 10.1080/14780887.2017.1329363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Joanna E. McHugh Power
- Trinity College Dublin, Institute of Neuroscience, Dublin, Ireland
- National College of Ireland, Psychology, Dublin, Ireland
| | - Caoimhe Hannigan
- Trinity College Dublin, Institute of Neuroscience, Dublin, Ireland
| | - Síle Carney
- Trinity College Dublin, Institute of Neuroscience, Dublin, Ireland
| | - Brian A. Lawlor
- Trinity College Dublin, Institute of Neuroscience, Dublin, Ireland
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33
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McHugh Power JE, Lawlor BA, Kee F. Social support mediates the relationships between extraversion, neuroticism, and cognitive function in older adults. Public Health 2017; 147:144-152. [PMID: 28404490 DOI: 10.1016/j.puhe.2017.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/06/2016] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We supplement existing findings on a link between social support and cognitive function in later life by considering the role of personality as an antecedent to both, and of social support as a mediator of the link between personality and cognitive function. STUDY DESIGN An observational cohort study. METHODS We evaluated social support using the Lubben Social Network Scale, across 624 adults aged over 60 years, and investigated this measure as a mediator of the relationships between extraversion and neuroticism at baseline 2007-2009, and cognitive function at follow-up, 2 years later. A half-longitudinal mediation design, within a structural equation modelling framework, was used. RESULTS There was a direct effect of extraversion, such that lower levels were related to higher scores of cognitive function. There was no significant direct effect of neuroticism on cognitive function at follow-up. Social support partially mediated the paths between both extraversion and neuroticism and cognitive function at follow-up. Decomposing the mediation effects by using social support subscales (measuring support from friends, relatives and neighbours) showed meaningful indirect effects for both predictors. CONCLUSION Results suggest that social support may offer a target for interventions for cognitively at-risk older adults and add to the existing empirical evidence describing the link between personality and cognitive function.
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Affiliation(s)
- J E McHugh Power
- UK CRC Centre of Excellence for Public Health, Institute of Clinical Sciences Block B, Grosvenor Road, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BJ, UK; Institute of Neuroscience, Lloyd Institute, Trinity College, Dublin 2, Ireland.
| | - B A Lawlor
- Institute of Neuroscience, Lloyd Institute, Trinity College, Dublin 2, Ireland
| | - F Kee
- UK CRC Centre of Excellence for Public Health, Institute of Clinical Sciences Block B, Grosvenor Road, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BJ, UK
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McHugh JE, Lawlor BA. Executive functioning independently predicts self-rated health and improvement in self-rated health over time among community-dwelling older adults. Aging Ment Health 2016; 20:415-22. [PMID: 25774986 DOI: 10.1080/13607863.2015.1018866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Self-rated health, as distinct from objective measures of health, is a clinically informative metric among older adults. The purpose of our study was to examine the cognitive and psychosocial factors associated with self-rated health. METHODS 624 participants over the age of 60 were assessed at baseline, and of these, 510 were contacted for a follow-up two years later. Measures of executive function and self-rated health were assessed at baseline, and self-rated health was assessed at follow-up. We employed multiple linear regression analyses to investigate the relationship between executive functioning and self-rated health, while controlling for demographic, psychosocial and biological variables. RESULTS Controlling for other relevant variables, executive functioning independently and solely predicted self-rated health, both at a cross-sectional level, and also over time. Loneliness was also found to cross-sectionally predict self-rated health, although this relationship was not present at a longitudinal level. CONCLUSION Older adults' self-rated health may be related to their executive functioning and to their loneliness. Self-rated health appeared to improve over time, and the extent of this improvement was also related to executive functioning at baseline. Self-rated health may be a judgement made of one's functioning, especially executive functioning, which changes with age and therefore may be particularly salient in the reflections of older adults.
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Affiliation(s)
- Joanna Edel McHugh
- a TRIL Centre, Trinity College Institute of Neuroscience , Trinity College Dublin , Dublin , Ireland
| | - Brian A Lawlor
- a TRIL Centre, Trinity College Institute of Neuroscience , Trinity College Dublin , Dublin , Ireland
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Schepens MEW, Lutomski JE, Bruce I, Olde Rikkert MGM, Lawlor BA. Reliability and Validity of the International Dementia Alliance Schedule for the Assessment and Staging of Care in Ireland. Am J Geriatr Psychiatry 2016; 24:297-300. [PMID: 26796923 DOI: 10.1016/j.jagp.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/25/2015] [Revised: 08/31/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To independently assess the inter-rater reliability of the International Dementia Alliance (IDEAL) schedule in Ireland and to examine criterion validity for cognitive functioning and caregiver distress. METHODS Two raters independently completed the IDEAL schedule based on an interview with persons diagnosed with dementia and their informal caregivers. The Clinical Dementia Rating (CDR) scale and the Zarit Burden Interview were used as reference standards for criterion validity. Intraclass coefficients (ICCs) and correlations (Spearman's ρ) were derived. RESULTS ICCs for the IDEAL subdomains ranged from 0.77 to 1.00, indicating robust agreement between raters. Strong correlations between the CDR and the IDEAL cognitive functioning domain (ρ = 0.82) and overall summary score (ρ = 0.77) were observed. The Zarit Burden Interview and the IDEAL carer distress subdomain were moderately correlated (ρ = 0.56). CONCLUSION This study confirmed that the IDEAL schedule is a valid and reliable instrument in the Irish population and further supports the international use of the IDEAL schedule.
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Affiliation(s)
- Mirjam E W Schepens
- Department of Geriatric Medicine, Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands; Mercer's Institute of Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Jennifer E Lutomski
- Department of Geriatric Medicine, Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Irene Bruce
- Mercer's Institute of Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen, Netherlands
| | - Brian A Lawlor
- Mercer's Institute of Research on Ageing, St. James's Hospital, Dublin, Ireland
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Pertl MM, Lawlor BA, Robertson IH, Walsh C, Brennan S. Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study. J Geriatr Psychiatry Neurol 2015; 28:260-71. [PMID: 26071444 DOI: 10.1177/0891988715588834] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Caring for a spouse with dementia is a chronic stressor that may compromise caregivers' own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments.
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Affiliation(s)
- Maria M Pertl
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Psychology, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
| | - Brian A Lawlor
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Medicine, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
| | - Ian H Robertson
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Psychology, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
| | - Cathal Walsh
- Department of Statistics, Trinity College Dublin, Dublin, Ireland
| | - Sabina Brennan
- Neuro-Enhancement for Independent Lives (NEIL) Programme, School of Psychology, Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland
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Hayakawa T, McGarrigle CA, Coen RF, Soraghan CJ, Foran T, Lawlor BA, Kenny RA. Orthostatic Blood Pressure Behavior in People with Mild Cognitive Impairment Predicts Conversion to Dementia. J Am Geriatr Soc 2015; 63:1868-73. [DOI: 10.1111/jgs.13596] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoaki Hayakawa
- Mercer's Institute of Successful Ageing; St James's Hospital; Dublin Ireland
| | - Christine A. McGarrigle
- The Irish Longitudinal Study on Ageing; Trinity College Dublin; The University of Dublin; Dublin Ireland
| | - Robert F. Coen
- Mercer's Institute of Successful Ageing; St James's Hospital; Dublin Ireland
| | - Christopher J. Soraghan
- Mercer's Institute of Successful Ageing; St James's Hospital; Dublin Ireland
- Department of Medical Physics and Bioengineering; St James's Hospital; Dublin Ireland
| | - Tim Foran
- Mercer's Institute of Successful Ageing; St James's Hospital; Dublin Ireland
- Department of Medical Physics and Bioengineering; St James's Hospital; Dublin Ireland
| | - Brian A. Lawlor
- Mercer's Institute of Successful Ageing; St James's Hospital; Dublin Ireland
- Trinity College Institute of Neuroscience; Trinity College Dublin; The University of Dublin; Dublin Ireland
| | - Rose Anne Kenny
- Mercer's Institute of Successful Ageing; St James's Hospital; Dublin Ireland
- The Irish Longitudinal Study on Ageing; Trinity College Dublin; The University of Dublin; Dublin Ireland
- Trinity College Institute of Neuroscience; Trinity College Dublin; The University of Dublin; Dublin Ireland
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Hannigan C, Coen RF, Lawlor BA, Robertson IH, Brennan S. The NEIL Memory Research Unit: psychosocial, biological, physiological and lifestyle factors associated with healthy ageing: study protocol. BMC Psychol 2015; 3:20. [PMID: 26131366 PMCID: PMC4486120 DOI: 10.1186/s40359-015-0079-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 06/19/2015] [Indexed: 01/02/2023] Open
Abstract
Background Population ageing is a global phenomenon that has characterised demographic trends during the 20th and 21st century. The rapid growth in the proportion of older adults in the population, and resultant increase in the incidence of age-related cognitive decline, dementia and Alzheimer’s disease, brings significant social, economic and healthcare challenges. Decline in cognitive abilities represents the most profound threat to active and healthy ageing. Current evidence suggests that a significant proportion of cases of age-related cognitive decline and dementia may be preventable through the modification of risk factors including education, depressive symptomology, physical activity, social engagement and participation in cognitively stimulating activities. The NEIL Memory Research Unit cohort study was established to investigate factors related to brain health and the maintenance of cognitive function. Methods A cohort of 1000 normally ageing adults aged 50 years and over are being recruited to participate in comprehensive assessments at baseline, and at follow-up once every 2 years. The assessment protocol comprises a comprehensive neuropsychological battery, some basic physical measures, psychosocial scales, questionnaire measures related to a range of health, lifestyle and behavioural factors, and a measure of resting state activity using electroencephalography (EEG). Discussion The NEIL Memory Research Unit cohort study will address key questions about brain health and cognitive ageing in the population aged 50+, with a particular emphasis on the influence of potentially modifiable factors on cognitive outcomes. Analyses will be conducted with a focus on factors involved in the maintenance of cognitive function among older adults, and therefore will have the potential to contribute significant knowledge related to key questions within the field of cognitive ageing, and to inform the development of public health interventions aimed at preventing cognitive decline and promoting active and healthy ageing.
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Affiliation(s)
- Caoimhe Hannigan
- NEIL (NeuroEnhancement for Independent Lives), Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - Robert F Coen
- Mercers Institute for Research on Ageing, Hospital 4, St James's Hospital, Dublin 8, Ireland
| | - Brian A Lawlor
- NEIL (NeuroEnhancement for Independent Lives), Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland ; Mercers Institute for Research on Ageing, Hospital 4, St James's Hospital, Dublin 8, Ireland
| | - Ian H Robertson
- NEIL (NeuroEnhancement for Independent Lives), Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - Sabina Brennan
- NEIL (NeuroEnhancement for Independent Lives), Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland
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McHugh J, Lee O, Aspell N, Lawlor BA, Brennan S. A shared mealtime approach to improving social and nutritional functioning among older adults living alone: study protocol for a randomized controlled trial. JMIR Res Protoc 2015; 4:e43. [PMID: 25900904 PMCID: PMC4420840 DOI: 10.2196/resprot.4050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/28/2015] [Accepted: 02/03/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults living alone are at increased risk of malnutrition as well as social isolation. Previous research has evaluated psychosocial interventions aimed at improving social support for older adults living alone. One meta-analysis in particular has suggested that multimodal psychosocial interventions are more effective than unimodal interventions. As such, it may be more effective to deliver an intervention which combines nutritional and social support together. Consequently, we designed the RelAte intervention, which focuses on shared mealtimes as a source of combined social and nutritional support for older adults living alone who are at risk of social isolation. OBJECTIVE The objective of the RelAte trial was to evaluate the impact of such an intervention on energy intake, anthropometric measurements, and nutritional social cognitive variables among older adults living alone in the community. METHODS There are 100 participants that will be recruited and randomized to either the treatment (n=50) or the control group. The treatment group will receive a visit from a trained peer volunteer once weekly for a period of 8 weeks. Outcomes of interest include: energy intake, social cognitive factors related to diet, abdominal circumference, body mass index, psychosocial well-being, frailty, nutritional status, and health utilities. Outcomes will be obtained at baseline, immediately postintervention (8 weeks after baseline), 12-week follow-up, and 26-week follow-up by assessors blinded to participants' randomized assignment. RESULTS The Relate trial is currently active. We are currently at data analysis stage. The study started in June 2013 and will run until June 2015. CONCLUSIONS Results from this study will primarily describe the effectiveness of a shared mealtime intervention for older adults living alone in terms of their dietary well-being, physical health, and psychosocial well-being. TRIAL REGISTRATION TRIAL REGISTRATION Clinicaltrials.gov NCT02007551; http://clinicaltrials.gov/ct2/show/NCT00102401 (Archived by WebCite at http://www.webcitation/6WptuVTtz).
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Affiliation(s)
- Joanna McHugh
- NEIL Program, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
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Kehoe EG, Farrell D, Metzler-Baddeley C, Lawlor BA, Kenny RA, Lyons D, McNulty JP, Mullins PG, Coyle D, Bokde AL. Fornix White Matter is Correlated with Resting-State Functional Connectivity of the Thalamus and Hippocampus in Healthy Aging but Not in Mild Cognitive Impairment - A Preliminary Study. Front Aging Neurosci 2015; 7:10. [PMID: 25698967 PMCID: PMC4318417 DOI: 10.3389/fnagi.2015.00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/22/2015] [Indexed: 01/31/2023] Open
Abstract
In this study, we wished to examine the relationship between the structural connectivity of the fornix, a white matter (WM) tract in the limbic system, which is affected in amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease, and the resting-state functional connectivity (FC) of two key related subcortical structures, the thalamus, and hippocampus. Twenty-two older healthy controls (HC) and 18 older adults with aMCI underwent multi-modal MRI scanning. The fornix was reconstructed using constrained-spherical deconvolution-based tractography. The FC between the thalamus and hippocampus was calculated using a region-of-interest approach from which the mean time series were exacted and correlated. Diffusion tensor imaging measures of the WM microstructure of the fornix were correlated against the Fisher Z correlation values from the FC analysis. There was no difference between the groups in the fornix WM measures, nor in the resting-state FC of the thalamus and hippocampus. We did however find that the relationship between functional and structural connectivity differed significantly between the groups. In the HCs, there was a significant positive association between linear diffusion (CL) in the fornix and the FC of the thalamus and hippocampus, however, there was no relationship between these measures in the aMCI group. These preliminary findings suggest that in aMCI, the relationship between the functional and structural connectivity of regions of the limbic system may be significantly altered compared to healthy ageing. The combined use of diffusion weighted imaging and functional MRI may advance our understanding of neural network changes in aMCI, and elucidate subtle changes in the relationship between structural and functional brain networks.
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Affiliation(s)
- Elizabeth G Kehoe
- Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin , Dublin , Ireland
| | - Dervla Farrell
- Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin , Dublin , Ireland
| | - Claudia Metzler-Baddeley
- Cardiff University Brain Research Imaging Centre (CUBRIC), Neuroscience and Mental Health Research Institute (NMHRI), School of Psychology, Cardiff University , Cardiff , UK
| | - Brian A Lawlor
- Department of Psychiatry, Jonathan Swift Clinic, St. James Hospital, Trinity College Institute of Neuroscience, Trinity College Dublin , Dublin , Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Successful Ageing, St. James Hospital, Trinity College Institute of Neuroscience, Trinity College Dublin , Dublin , Ireland
| | | | - Jonathan P McNulty
- School of Medicine and Medical Science, University College Dublin , Dublin , Ireland
| | | | - Damien Coyle
- Intelligent Systems Research Centre, University of Ulster , Derry , UK
| | - Arun L Bokde
- Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin , Dublin , Ireland
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Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of exercise on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev 2014; 16:12-31. [PMID: 24862109 DOI: 10.1016/j.arr.2014.05.002] [Citation(s) in RCA: 262] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 01/08/2023]
Abstract
Data from epidemiological, cross-sectional, and neuroimaging research show a relationship between higher levels of exercise and reduced risk of cognitive decline but evidence from randomised controlled trials (RCTs) is less consistent. This review examines the impact of aerobic exercise, resistance training, and Tai Chi on the cognitive function of older adults without known cognitive impairment. We investigate explanations for inconsistent results across trials and discrepancies between evidence from RCTs and other research data. Twenty-five RCTs were included in the review. Meta-analysis results revealed significant improvements for resistance training compared to stretching/toning on measures of reasoning (p<0.005); and for Tai Chi compared to 'no exercise' controls on measures of attention (p<0.001) and processing speed (p<0.00001). There were no significant differences between exercise and controls on any of the remaining 26 comparisons. Results should be interpreted with caution however as differences in participant profiles, study design, exercise programmes, adherence rates, and outcome measures contribute to both discrepancies within the exercise research literature and inconsistent results across trials.
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Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of cognitive training and mental stimulation on cognitive and everyday functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev 2014; 15:28-43. [PMID: 24607830 DOI: 10.1016/j.arr.2014.02.004] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 02/20/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
This systematic review and meta-analysis investigates the impact of cognitive training and general mental stimulation on the cognitive and everyday functioning of older adults without known cognitive impairment. We examine transfer and maintenance of intervention effects, and the impact of training in group versus individual settings. Thirty-one randomised controlled trials were included, with 1806 participants in cognitive training groups and 386 in general mental stimulation groups. Meta-analysis results revealed that compared to active controls, cognitive training improved performance on measures of executive function (working memory, p=0.04; processing speed, p<0.0001) and composite measures of cognitive function (p=0.001). Compared to no intervention, cognitive training improved performance on measures of memory (face-name recall, p=0.02; immediate recall, p=0.02; paired associates, p=0.001) and subjective cognitive function (p=0.01). The impact of cognitive training on everyday functioning is largely under investigated. More research is required to determine if general mental stimulation can benefit cognitive and everyday functioning. Transfer and maintenance of intervention effects are most commonly reported when training is adaptive, with at least ten intervention sessions and a long-term follow-up. Memory and subjective cognitive performance might be improved by training in group versus individual settings.
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Braam AW, Copeland JRM, Delespaul PAEG, Beekman ATF, Como A, Dewey M, Fichter M, Holwerda TJ, Lawlor BA, Lobo A, Magnússon H, Prince MJ, Reischies F, Wilson KC, Skoog I. Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: results from the EURODEP concerted action. J Affect Disord 2014; 155:266-72. [PMID: 24355647 DOI: 10.1016/j.jad.2013.11.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the epidemiology of late life depression, few insights are available on the co-occurrence of subthreshold depression and comorbid symptoms of anxiety. The current study aims to describe prevalence patterns of comorbid anxiety symptoms across different levels of depression in old age, and to describe the burden of depressive symptoms and functional disability across patterns of comorbidity. METHODS Respondents were older adults in the community, age 65-104 (N=14,200), from seven European countries, with in total nine study centres, collaborating in the EURODEP concerted action. Depression and anxiety were assessed using the Geriatric Mental State examination (GMS-AGECAT package), providing subthreshold level and case-level diagnoses. Presence of anxiety symptoms was defined as at least three distinct symptoms of anxiety. Number of depressive symptoms was assessed with the EURO-D scale. RESULTS The prevalence of anxiety symptoms amounts to 32% for respondents without depression, 67% for those with subthreshold depression, and 87% for those with case-level depression. The number of depressive symptoms is similar for those with subthreshold-level depression with comorbid anxiety, compared to case-level depression without symptoms of anxiety. In turn, at case level, comorbid symptoms of anxiety are associated with higher levels of depressive symptoms and more functional disability. LIMITATIONS GMS-AGECAT is insufficiently equipped with diagnostic procedures to identify specific types of anxiety disorders. CONCLUSIONS Anxiety symptoms in late life depression are highly prevalent, and are likely to contribute to the burden of symptoms of the depression, even at subthreshold level.
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Affiliation(s)
- Arjan W Braam
- VU University Medical Centre, EMGO+ Institute for Health and Care Research; Department of Epidemiology and Biostatistics, Longitudinal Aging Study Amsterdam, Amsterdam, The Netherlands; Altrecht Mental Health Care, Department of Emergency Psychiatry and Department of Specialist Training, Utrecht, The Netherlands.
| | - John R M Copeland
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, UK
| | - Philippe A E G Delespaul
- Department of Psychiatry and Psychology, Maastricht University, and Mondriaan Regional Care System, The Netherlands
| | - Aartjan T F Beekman
- VU University Medical Centre, EMGO+ Institute for Health and Care Research; Department of Epidemiology and Biostatistics, Longitudinal Aging Study Amsterdam, Amsterdam, The Netherlands
| | - Ariel Como
- Child and Adolescent Psychiatry Service, Tirana University School of Medicine, Tirana, Albania
| | - Michael Dewey
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | - Manfred Fichter
- Department of Psychiatry, Ludwig Maximilians Universität, München, Germany
| | - Tjalling J Holwerda
- VU University Medical Centre, EMGO+ Institute for Health and Care Research; Department of Epidemiology and Biostatistics, Longitudinal Aging Study Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam, The Netherlands
| | - Brian A Lawlor
- Department of Psychiatry, Jonathan Swift Clinic, St. James' Hospital, Dublin, Republic of Ireland
| | - Antonio Lobo
- Department of Psychiatry, University of Zaragoza; Instituto de Investigacion Sanitaria de Aragon (IIS) and Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
| | | | - Martin J Prince
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | - Friedel Reischies
- Psychiatrische Klinik und Poliklinik, Charité - Universitätsmedizin Berlin, Germany
| | - Kenneth C Wilson
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, UK
| | - Ingmar Skoog
- Institute of Clinical Neurosciences, Sahlgrenska University Hospital, Göteborg University, Sweden
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Mellqvist Fässberg M, Östling S, Braam AW, Bäckman K, Copeland JRM, Fichter M, Kivelä SL, Lawlor BA, Lobo A, Magnússon H, Prince MJ, Reischies FM, Turrina C, Wilson K, Skoog I, Waern M. Functional disability and death wishes in older Europeans: results from the EURODEP concerted action. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1475-82. [PMID: 24554123 PMCID: PMC4143593 DOI: 10.1007/s00127-014-0840-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/03/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Physical illness has been shown to be a risk factor for suicidal behaviour in older adults. The association between functional disability and suicidal behaviour in older adults is less clear. The aim of this study was to examine the relationship between functional disability and death wishes in late life. METHODS Data from 11 population studies on depression in persons aged 65 and above were pooled, yielding a total of 15,890 respondents. Level of functional disability was trichotomised (no, intermediate, high). A person was considered to have death wishes if the death wish/suicidal ideation item of the EURO-D scale was endorsed. Odds ratios for death wishes associated with functional disability were calculated in a multilevel logistic regression model. RESULTS In total, 5 % of the men and 7 % of the women reported death wishes. Both intermediate (OR 1.89, 95 % CI 1.42; 2.52) and high functional disability (OR 3.22, 95 % CI 2.34; 4.42) were associated with death wishes. No sex differences could be shown. Results remained after adding depressive symptoms to the model. CONCLUSIONS Functional disability was independently associated with death wishes in older adults. Results can help inform clinicians who care for older persons with functional impairment.
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Affiliation(s)
- Madeleine Mellqvist Fässberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Svante Östling
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arjan W. Braam
- Department of Epidemiology and Biostatistics, VU University Medical Centre, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands ,Department of Resident Training, Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Kristoffer Bäckman
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John R. M. Copeland
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Manfred Fichter
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany ,Schoen Klinik Roseneck, Prien, Germany
| | | | - Brian A. Lawlor
- Department of Psychiatry, St. James’ Hospital, Jonathan Swift Clinic, Dublin, Republic of Ireland
| | - Antonio Lobo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón) and CIBERSAM, Universidad de Zaragoza, Hospital Clínico Universitario, Zaragoza, Spain
| | - Halggrimur Magnússon
- Department of Geriatrics, Landspitali, University Hospital of Iceland, Reykjavík, Iceland
| | - Martin J. Prince
- Health Services and Population Research Department, King’s College London, Institute of Psychiatry, London, UK
| | - Friedel M. Reischies
- Arbeitsgruppe Neuropsychologie Und Experimentelle Psychopathologie, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Turrina
- University Psychiatric Unit, Department of Mental Health, Brescia University School of Medicine, Brescia Spedali Civili, Brescia, Italy
| | - Kenneth Wilson
- Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sweeney EB, Lawlor BA. Case series: extrapyramidal symptoms associated with use of aripiprazole in older adults. Int J Geriatr Psychiatry 2013; 28:1208-10. [PMID: 24101361 DOI: 10.1002/gps.3964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/01/2013] [Accepted: 02/06/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Eileen B Sweeney
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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O Regan C, Kearney PM, Cronin H, Savva GM, Lawlor BA, Kenny R. Oscillometric measure of blood pressure detects association between orthostatic hypotension and depression in population based study of older adults. BMC Psychiatry 2013; 13:266. [PMID: 24138959 PMCID: PMC3816594 DOI: 10.1186/1471-244x-13-266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 10/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND White matter hyperintensities may contribute to depression by disrupting neural connections among brain regions that regulate mood. Orthostatic hypotension (OH) may be a risk factor for white matter hyperintensities and accumulating evidence, although limited suggests it may play a role in the development of late-life depression. The aim of this study was to examine the relationship between an oscillometric measure of orthostatic hypotension and depression in population based sample of older adults. METHODS We analysed data on adults aged 60 and over from the first wave of The Irish Longitudinal Study on Ageing (TILDA). Depression was assessed using the Center for Epidemiologic Studies--Depression (CES-D) scale and OH was assessed by a sit-to-stand orthostatic stress test; two seated blood pressure measurements were followed by a single standing blood pressure measurement. Participants self reported whether they felt dizzy, light-headed or unsteady on standing. RESULTS Participants with symptomatic OH (SOH, n=20) had the highest mean CES-D score (mean 8.6, SE 1.6) when compared to participants with asymptomatic OH (AOH) (mean 5.6, SE .48) and participants with no OH (mean 5.2, SE .14) and this difference was significant for both comparisons (p<0.001). Linear regression analysis adjusted for socio-demographic and clinical characteristics showed that SOH was associated with higher CES-D scores (unstandardised B coefficient = 2.24; 95% CI .301 - 4.79; p =0.05) compared to participants without OH. AOH was not associated with higher CES-D scores (unstandardised B coefficient =.162; 95% CI -.681, 1.00; p= 0.70). CONCLUSIONS Symptomatic orthostatic hypotension is associated with depression in older adults and needs to be considered in studies examining the relationship between vascular disease and depression in older adults.
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Affiliation(s)
- Claire O Regan
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Hilary Cronin
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - George M Savva
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Brian A Lawlor
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Roseanne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
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Sweeney EB, Greene E, Lawlor BA. Use of the Geriatric Anxiety Inventory-short form as a screening tool for detection of generalised anxiety in a memory clinic population. Int J Geriatr Psychiatry 2013; 28:767-8. [PMID: 23737045 DOI: 10.1002/gps.3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Eileen B. Sweeney
- Mercer's Institute for Successful Ageing; St. James's Hospital; Dublin; Ireland
| | - Elaine Greene
- Mercer's Institute for Successful Ageing; St. James's Hospital; Dublin; Ireland
| | - Brian A. Lawlor
- Mercer's Institute for Successful Ageing; St. James's Hospital; Dublin; Ireland
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Östling S, Bäckman K, Waern M, Marlow T, Braam AW, Fichter M, Lawlor BA, Lobos A, Reischies FM, Copeland JRM, Skoog I. Paranoid symptoms and hallucinations among the older people in Western Europe. Int J Geriatr Psychiatry 2013; 28:573-9. [PMID: 22911450 DOI: 10.1002/gps.3861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 06/25/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE It is not clear whether the prevalence of psychosis increases with age. We studied the age-specific prevalence of psychotic symptoms in older people in Western Europe. METHODS Older people without dementia (age 65-104 years, N = 8762) from the western part of Europe in the EURODEP concerted action took part in psychiatric examinations. RESULTS In total, 2.4% of the men and 2.9% of the women had psychotic symptoms. Using a multilevel logistic regression model that included gender and age as a continuous variable, we found that a 5-year increase in age increased the prevalence of psychotic symptoms (odds ratio 1.2 95% confidence interval 1.06-1.3, p = 0.001). A second multilevel regression model showed that wishing to be dead, depressed mood, functional disability, not being married and cognitive impairment measured with Mini mental state examination were all associated with psychotic symptoms whereas gender was not. CONCLUSION The prevalence of psychotic symptoms in non-demented older people increases with age, and these symptoms are associated with other psychopathology, social isolation and problems with daily living.
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Affiliation(s)
- Svante Östling
- Institute of Neuroscience and Physiology, Psychiatry Section, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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McHugh JE, Lawlor BA. Social support differentially moderates the impact of neuroticism and extraversion on mental wellbeing among community-dwelling older adults. J Ment Health 2013; 21:448-58. [PMID: 22978500 DOI: 10.3109/09638237.2012.689436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Personality affects psychological wellbeing, and social support networks may mediate this effect. This may be particularly pertinent in later life, when social structures change significantly, and can lead to a decline in psychological wellbeing. AIM To examine, in an older population, whether the relationships between neuroticism and extraversion and mental wellbeing are moderated by available social support networks. METHOD We gathered information from 536 community-dwelling older adults, regarding personality, social support networks, depressive symptomatology, anxiety and perceived stress, as well as controlling for age and gender. RESULTS Neuroticism and extraversion interacted with social support networks to determine psychological wellbeing (depression, stress and anxiety). High scores on the social support networks measure appear to be protective against the deleterious effects of high scores on the neuroticism scale on psychological wellbeing. Meanwhile, individuals high in extraversion appear to require large social support networks in order to maintain psychological wellbeing. CONCLUSION Large familial and friendship social support networks are associated with good psychological wellbeing. To optimise psychological wellbeing in older adults, improving social support networks may be differentially effective for different personality types.
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Affiliation(s)
- J E McHugh
- TRIL (Technology Research for Independent Living) Centre, St James's Hospital, Dublin, Ireland.
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Abstract
Poor sleep quality and orthostatic hypotension are common complaints in an older population, and both are related to factors such as polypharmacy and depression. However, it is not known whether there is a direct association between the two. Our objective is to investigate a potential association between orthostatic blood pressure response and subjective sleep quality in older people. A within-subjects, cross-sectional design embedded in a larger longitudinal study design. Participants were recruited from the community to visit the TRIL clinic at St James's Hospital, where they underwent a structured medical and psychosocial assessment. A total of 505 community dwelling adults aged 60+ (321 females, mean age 72.44) were participated in this study. Orthostatic blood pressure responses were recorded during an active stand using Finometer equipment, and health-related factors such as pain ratings, co-morbidities, polypharmacy, timed up and go, Mini-Mental State Examination score, body mass index, as well as depression, anxiety, age and gender, were also recorded. Self-reported sleep quality was also assessed using the Pittsburgh Sleep Quality Index. The results showed that timed up and go, polypharmacy, depression, anxiety, gender and delayed recovery of blood pressure at orthostasis were associated with subjective poor sleep quality. There is an association between subjective sleep quality and delayed recovery of blood pressure at orthostasis, independent of mental health or polypharmacy effects, in older adults. This link may have implications for the management of sleep disorders in older people.
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Affiliation(s)
- Joanna E McHugh
- TRIL Centre, Trinity College Institute of Neuroscience, St James's Hospital, Dublin, Ireland.
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